心脏瓣膜病合并感染性心内膜炎的外科治疗

目的探讨心脏瓣膜心内膜炎的临床特点、手术时机选择和围术期处理。方法回顾分析26例心脏瓣膜病合并感染性心内膜炎的临床表现、治疗经过和临床预后。结果术前死于恶性心力衰竭1例,术后随访25例,随访时间3个月～6年,无术后死亡,无再发感染。结论心脏瓣膜病合并感染性心内膜炎外科治疗风险大,死亡率高,正确掌握手术指征、术中彻底清除感染灶和围术期正确处理是治疗的关键。     

Results of the influenza virus surveillance in wild birds in Western part of Mongolia

ObjectiveTo present results of virological study of wild birds inhabiting Western Mongolia.MethodsOver a period of 2003–2008, we isolated 13 influenza A viruses: H1N1, H3N6, H13N8 and H4N6 subtypes. We did not isolate any H5N1 subtype, that still cause epizooty in wild birds and poultry.ResultsWe revealed taxonomic and ecological heterogeneity of the birds involved in maintenance of circulation of influenza viruses in the given territory. Influenza viruses were isolated from birds of 6 orders; among them there are species preferring water and semi-aquatic biotopes, one species preferring dry plain region, and also one species which can inhabit both dry and water biotopes.ConclusionsRepresentatives of all main orders of Western Mongolia avifauna are involved in support of influenza A virus circulation, highly pathogenic H5N1 influenza viruses were registered in Mongolia thus it's necessary to continue permanent influenza virus surveillance in wild birds' populations.     

口内支抗与微型种植体支抗近中移动下颌磨牙效果比较

目的：研究安氏I类错（牙合）患者中,分别采用微型种植体作支抗与口内前牙作支抗近移下颌磨牙进行比较,以评价两种方法的各自特点。方法：将24例成人患者随机分成两组,分别采用两种方法近移下颌磨牙。测量下颌第二磨牙在移动速度和近远中方向、垂直方向的位置变化,以衡量磨牙的位置改变,并通过下颌中切牙的位置变化,评价支抗强弱。结果：种植体作支抗组下颌第二磨牙平均近中移动8.5mm,疗程10.4个月,平均移动速度0.82mm/月,磨牙长轴向近中倾斜2.5°,磨牙垂直向压低0.28mm,下颌中切牙位置无改变。对照组下颌第二磨牙平均近中移动7.8mm,疗程10.2个月,平均移动速度0.76mm/月,磨牙长轴向近中倾斜角度7.5°,磨牙垂直向压低0.06mm,下颌中切牙发生舌向倾斜9.5°。下颌中切牙切端向舌侧移动了3.0mm。结论：两种方法比较,种植体的支抗更强,未见前牙支抗丧失。二者磨牙的移动方式有所区别。     

利用微型种植体支抗压低下颌磨牙的临床研究

目的研究安氏Ⅰ类错患者中,采用微型种植体作支抗,压低下颌磨牙的临床效果及其作用特点。方法选择12例成人患者,将24枚微型种植体植于下颌第一磨牙近、远中的颊侧牙槽骨内,Ni-Ti螺旋弹簧拉长后分别连接于下颌第一磨牙带环颊侧,来压低下颌第一磨牙。测量磨牙的压低量、颊舌向的位置变化、近远中倾斜度以及磨牙移动的速度,并通过治疗前后的X线片对比以观察磨牙牙根有无吸收,牙周膜腔的变化情况。通过测量下颌第二磨牙与下颌中切牙的位置变化来衡量支抗强弱。结果下颌第一磨牙平均压低3.5mm,疗程5.2个月,平均移动速度0.67mm/月;磨牙牙冠近颊尖、远颊尖分别颊向移动1.2mm、1.3mm。磨牙牙根没有吸收,牙周膜腔宽度没有改变。下颌第二磨牙与下颌中切牙的位置没有改变。结论所有下颌磨牙均被压低到了恰当的位置,为对颌牙的修复治疗提供了足够的间隙。同时该方法临床操作简单易行,适于推广。     

308-nm准分子激光联合他克莫司软膏治疗面部白癜风656例疗效评价

目的：评价308nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效。方法：对656例面部白癜风患者照射308nm准分子激光联合外用他克莫司软膏。他克莫司软膏每日2次,308nm准分子激光每周治疗1-2次,共治疗30次。末次治疗后随访1年。结果：1630块白斑中,总有效率为47.12%,病程<2年皮损总有效率为58.10%高于病程≥2年皮损的16.60%,两组差异具有统计学意义(P<0.001)。眼周皮损疗效最佳,总有效率为54.96%,口周皮损疗效最差,总有效率为40.22%,差异有统计学意义（P<0.0001）。结论：308 nm准分子激光联合他克莫司软膏治疗面部白癜风的疗效与病期和皮损部位有关。     

Semi-automatic segmentation of myocardium at risk in T2-weighted cardiovascular magnetic resonance

Background

T2-weighted cardiovascular magnetic resonance (CMR) has been shown to be a promising technique for determination of ischemic myocardium, referred to as myocardium at risk (MaR), after an acute coronary event. Quantification of MaR in T2-weighted CMR has been proposed to be performed by manual delineation or the threshold methods of two standard deviations from remote (2SD), full width half maximum intensity (FWHM) or Otsu. However, manual delineation is subjective and threshold methods have inherent limitations related to threshold definition and lack of a priori information about cardiac anatomy and physiology. Therefore, the aim of this study was to develop an automatic segmentation algorithm for quantification of MaR using anatomical a priori information.

Methods

Forty-seven patients with first-time acute ST-elevation myocardial infarction underwent T2-weighted CMR within 1 week after admission. Endocardial and epicardial borders of the left ventricle, as well as the hyper enhanced MaR regions were manually delineated by experienced observers and used as reference method. A new automatic segmentation algorithm, called Segment MaR, defines the MaR region as the continuous region most probable of being MaR, by estimating the intensities of normal myocardium and MaR with an expectation maximization algorithm and restricting the MaR region by an a priori model of the maximal extent for the user defined culprit artery. The segmentation by Segment MaR was compared against inter observer variability of manual delineation and the threshold methods of 2SD, FWHM and Otsu.

Results

MaR was 32.9 ± 10.9% of left ventricular mass (LVM) when assessed by the reference observer and 31.0 ± 8.8% of LVM assessed by Segment MaR. The bias and correlation was, -1.9 ± 6.4% of LVM, R = 0.81 (p < 0.001) for Segment MaR, -2.3 ± 4.9%, R = 0.91 (p < 0.001) for inter observer variability of manual delineation, -7.7 ± 11.4%, R = 0.38 (p = 0.008) for 2SD, -21.0 ± 9.9%, R = 0.41 (p = 0.004) for FWHM, and 5.3 ± 9.6%, R = 0.47 (p < 0.001) for Otsu.

Conclusions

There is a good agreement between automatic Segment MaR and manually assessed MaR in T2-weighted CMR. Thus, the proposed algorithm seems to be a promising, objective method for standardized MaR quantification in T2-weighted CMR.     

青春期前型外阴纤维瘤临床病理分析

目的:探讨青春期前型外阴纤维瘤(prepubertal-type vulva fibroma,PVF)的临床病理特征。方法:分析2例PVF的临床特点,光镜观察组织病理学形态及免疫组织化学特征并复习相关文献。结果:2例分别为8岁和39岁女性,均以大阴唇肿块就诊。肿块均分布在一侧,4～5 cm大。组织学观察病变位于真皮层边界不清,由稀疏的梭形纤维母细胞样的细胞和大量胶原纤维组成,病变向皮下组织延伸,在邻近的脂肪组织及血管簇、神经周围穿插性生长;梭形细胞形态温和无异型、核分裂象未查见。免疫组织化学标记显示:瘤细胞表达波形蛋白、CD34,不表达SMA、desmin、CD99、S-100蛋白、bcl-2,成人局灶表达ER和PR。结论:PVF是一种好发于青春前期幼女或女童外阴的良性间叶性病变,偶可发生于成年人。其发生可能与激素有关并起源于外阴阴道间质细胞,表现为纤维母细胞分化特征。临床有少量病例如切除不净可局部复发,并见可自发性消退病例。     

宫颈癌组织Raf激酶抑制蛋白和NF—κBp65表达及其临床意义

目的研究宫颈癌组织中Raf激酶抑制蛋白（RKIP）和核因子xBp65（NF-κBp65）的表达,探讨二者表达之间的相关性及其与宫颈癌各临床病理因素之间的关系。方法用免疫组织化学方法检测69例宫颈癌组织、37例宫颈上皮内瘤变组织和18例正常宫颈组织的RKIP和NF-κBp65表达,并分析其与宫颈癌临床病理学特征的关系。结果宫颈癌组织中RKIP的表达低于宫颈上皮内瘤变及正常宫颈组织,而NF-κBp65的表达高于宫颈上皮内瘤变及正常宫颈组织,差异有统计学意义（Hc=45．124、38．107,Z=4．309～5．159,P〈O．01）;RKIP和NF—κBp65在宫颈癌组织中的表达均与临床分期、有无淋巴结转移及肿瘤分化程度有关（χ^2=5．150～11．917,P〈0．05）。宫颈癌组织中RKIP与NF-κBp65的表达呈显著负相关（r=-0．464,P〈O．01）。结论RKIP表达的减少或缺失与宫颈癌的发生、发展密切相关,RKIP表达的减少或缺失可能通过上调NF—κBp65的表达促进宫颈癌的侵袭和转移。