Normalization of the vagina by dilator treatment alone in Complete Androgen Insensitivity Syndrome and Mayer-Rokitansky-Kuster-Hauser Syndrome

BACKGROUND: Various surgical and non-surgical treatment options are available for women with congenital vaginal agenesis. We report results of vaginal dilation therapy delivered by a multi-disciplinary team as first line treatment for vaginal agenesis. METHODS: Twenty-six women were recruited into a prospective observational study: 18 had Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) and 8 had Complete Androgen Insensitivity Syndrome (CAIS). All women underwent a vaginal dilation programme co-ordinated by a clinical nurse specialist with input from a clinical psychologist. Vaginal length was compared to a normal reference range, and psycho-sexual questionnaires were completed before and after therapy. RESULTS: Twenty-one (81%) patients completed the programme. Seventeen of these 21 (81%) were sexually active without any reported difficulties, whereas 4 were on a maintenance regime. In those who completed the programme the mean vaginal length increased from 4.0 to 8.5 cm and 86% achieved a vaginal length within the normal range. Subjective appraisal of vaginal size recorded that the number of women who reported that their vaginal size was 'more or less normal' increased from 1 to 12 following treatment. Questionnaire scores for sexual satisfaction and sexual depression improved in the CAIS group but did not alter significantly in the MRKH group. CONCLUSION: Non-surgical dilation delivered by a multi-disciplinary team is an effective alternative to vaginal surgery and usually normalizes vaginal length.     

大网膜中间型滋养细胞肿瘤

1．病例简介：患者女,31岁。8年前平产分娩一男婴。因右下腹持续性隐痛13d,加剧2d,以慢性盆腔炎急性发作于2004年8月人院。体检：下腹压痛明显,反跳痛阳性。入宁波市妇女儿童医院后给予抗炎、支持治疗,腹痛无明显好转。实验室检查：血癌抗原（CA）125为112．0IU／ml（正常参考值0～35IU／m1）,血β-人绒毛膜促性腺激素（B—HCG）58．2IU／ml（正常参考值0～5IU／m1）,癌胚抗原（CEA）0．20嵋／L（正常参考值0～10μg／L）。B超：子宫中前位,大小约46mm×43mm×50mm,宫区回声均匀,双卵巢、输卵管正常大小。X线胸片未见异常。为明确诊断行开腹探察术。术中所见：大网膜弥漫性明显增厚,与膀胱腹膜反折粘连,并与横结肠融合成团,质地坚硬,表面布满大小不等灰白色结节。肝、胆、胃、肠表面无肿块。子宫前位,正常大小,双侧卵巢及输卵管外观无异常。遂行大网膜病灶切除术。术后患者腹胀、腹痛仍明显。     

虚拟咬合运动初步仿真模拟的研究与实现

我们试验了利用VR技术进行虚拟咬合仿真制作的全部过程。首先,采用光学三维测量仪对上下颌石膏模型进行数字化,通过预处理获取有效的三角网格曲面模型;其次,对咬合运动模型进行合理的简化,分解为一系列的平移运动和旋转运动;通过动态刷新完成开闭口运动、侧移运动的计算机运动仿真,可视化地观察咬合运动;然后利用模型碰撞检测算法动态地计算咬合接触位,并详细地分析了咬合接触时的咬合点位置分布和咬合剖切面上的咬合点接触关系;最后讨论了目前虚拟咬合仿真存在的问题和今后研究的方向。     

DICOM数据的三维重建与协同可视化系统的开发

复杂手术常需多科医生协商制定综合性治疗方案,网络协同三维可视化软件可使方案制定直观而精确。我们采用VTK工具包对DICOM格式CT图像数据进行三维重建并作网格简化,将结果所得多边形网格模型无缝集成到用HOOPS/3DAF所开发的图形系统进行显示,并用HOOPS/Stream工具包转成适合网络传输的HSF无损压缩流文件,再用HOOPS/NET工具包实现基于Client/Server架构的协同三维交互可视化系统。所得三维重建结果清晰,协同三维可视化操作实时度高。本研究实现了一个协同手术仿真开发平台,该架构易于进一步添加模拟手术操作与修复体设计功能。     

经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折

目的:观察经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的临床疗效.方法:C臂X线透视监控下,以骨水泥为充填材料,经单侧或双侧椎弓根穿刺行经皮椎体成形术(PVP)10例12椎、经皮后凸成形术(PKP)5例8椎.结果:随访2～14个月,10例疼痛完全缓解,4例疼痛部分缓解,1例无效.有效率93.3%.术中穿刺针穿透椎体前壁1例,髓泥渗漏3例,均未产生严重后果.结论:PVP治疗骨质疏松性胸腰椎压缩骨折安全、有效,但要把握好确认"疼痛椎"、准确穿刺、注射骨水泥关键技术.     

下颌支截骨术手术入路的应用解剖学研究

目的:进一步探讨咬肌区浅层的组织结构,为临床行下颌截骨术避免损伤咬肌区的重要结构提供解剖学基础.方法:18例头颈部标本,经双侧颈总动脉插管,加压注入红色乳胶或明胶墨汁,解剖观测咬肌区浅层的组织结构.结果:咬肌区浅层由浅入深的组织层次是:皮肤、皮下组织、SMAS、腮腺咬肌筋膜、咬肌、咬肌下间隙和骨膜.咬肌表面横行结构有面神经颧支、面横动脉、面神经上颊支、腮腺导管、面神经下颊支、下颌缘支和颈支,它们距离下颌角分别为(5.8±0.5)cm、(5.2±0.5)cm、(5.1±0.6)cm、(4.3±0.5)cm、(3.3±0.8)cm、(0.9±0.5)cm和(-0.8±0.4)cm;离角前切迹的距离分别为(6.7±0.6)cm、(5.6±0.6)cm、(5.6±0.7)cm、(4.7±0.5)cm、(3.5±0.7)cm、(1.2±1.0)cm和(-1.0±0.2)cm.该区的动脉供应来源于颞浅动脉、面横动脉、颈外动脉、面动脉和咬肌动脉.结论:行下颌支截骨术时,应熟悉下颌支浅层的组织层次及咬肌浅层横行结构的布局,以免造成误伤.     

Identification and phylogenetic analysis of orf virus from goats in Taiwan

An outbreak of contagious ecthyma in goats in central Taiwan was investigated. The disease was diagnosed by physical and histopathologic examinations, and the etiology of the disease was identified as orf virus by electron microscopy and polymerase chain reaction (PCR) and sequence of major envelope protein (B2L) gene. The entire protein-coding region of B2L gene were cloned and sequenced. Phylogenetic analysis of B2L amino acid sequences showed that the orf virus identified in this outbreak was closer to the Indian ORFV-Mukteswar 59/05 isolate. This is the first report on the molecular characterization of orf virus in Taiwan.     

Identification of ribosomal phosphoprotein P0 of Neospora caninum as a potential common vaccine candidate for the control of both neosporosis and toxoplasmosis

The characterization of the cross-reactive antigens of two closely related apicomplexan parasites, Neospora caninum and Toxoplasma gondii, is important to elucidate the common mechanisms of parasite-host interactions. In this context, a gene encoding N. caninum ribosomal phosphoprotein P0 (NcP0) was identified by immunoscreening of a N. caninum tachyzoite cDNA expression library with antisera from mice immunized with T. gondii tachyzoites. The NcP0 was encoded by a gene with open reading frame of 936 bp, which encoded a protein of 311 amino acids. The NcP0 gene existed as a single copy in the genome and was interrupted by a 432 bp intron. The NcP0 showed 94.5% amino acid identity to T. gondii P0 (TgP0). Anti-recombinant NcP0 (rNcP0) sera recognized a native parasite protein with a molecular mass of 34 kDa in Western blot analysis. Immunofluorescence analysis showed that the NcP0 was localized to the surface of N. caninum tachyzoites. A purified anti-rNcP0 IgG antibody inhibited the growth of N. caninum and T. gondii in vitro in a concentration-dependent manner. These results indicate that P0 is a cross-reactive antigen between N. caninum and T. gondii and a potential common vaccine candidate to control both parasites.     

Recombinant Mycobacterium bovis bacillus Calmette-Guerin elicits human immunodeficiency virus type 1 envelope-specific T lymphocytes at mucosal sites

A successful vaccine vector for human immunodeficiency virus type 1 (HIV-1) should induce anti-HIV-1 T-cell immune responses at mucosal sites. We have constructed recombinant Mycobacterium bovis bacillus Calmette-Guérin (rBCG) expressing an HIV-1 group M consensus envelope (Env) either as a surface, intracellular, or secreted protein as an immunogen. rBCG containing HIV-1 env plasmids engineered for secretion induced optimal Env-specific T-cell gamma interferon enzyme-linked immunospot responses in murine spleen, female reproductive tract, and lungs. While rBCG-induced T-cell responses to HIV-1 envelope in spleen were lower than those induced by adenovirus prime/recombinant vaccinia virus (rAd-rVV) boost, rBCG induced comparable responses to rAd-rVV immunization in the female reproductive tract and lungs. T-cell responses induced by rBCG were primarily CD4(+), although rBCG alone did not induce anti-HIV-1 antibody. However, rBCG could prime for a protein boost by HIV-1 envelope protein. Thus, rBCG can serve as a vector for induction of anti-HIV-1 consensus Env cellular responses at mucosal sites.