妇产科手术泌尿系损伤防治方法的探讨

目的 探讨妇产科手术泌尿系损伤的特点及防治方法，为临床妇产科手术中防止泌尿系损伤提供参考。方法 对我院妇产科手术中发生的泌尿系损伤的10例临床资料进行回顾性分析。结果 10例患者中输尿管损伤3例，均为术中发现，术中行输尿管端端吻合；膀胱损伤7例，其中5例于术中发现，2例术后形成膀胱阴道瘘，行膀胱修补术，所有病例均痊愈出院。妇产科损伤泌尿系的主要原因有输尿管解剖移位，盆腔粘连严重等。结论 绝大多数妇产科手术中的泌尿生殖系损伤是可以防范的，一旦发生，应及时发现，尽早修补预后良好。     

Accuracy of internal dynamics models in limb movements depends on stability

This study investigated the ability to use an internal model of the environmental dynamics when the dynamics were predictable but unstable. Subjects performed goal-directed movements using a robot manipulandum while counteracting a force field, which created instability by assisting the movement in proportion to hand velocity. Subjects performance was better on the last trial than on the first trial in the force field for all four movement directions tested: out, in, right and left. Subjects adapted to the force field primarily by increasing muscle co-contraction, compared to null field movements, during all phases of movement. This co-contraction generally declined for both the deceleration and stabilization phases during the course of the first 25 movements in each direction, but tended not to decrease significantly thereafter. Catch trials at the end of the learning period suggested that increased viscoelastic impedance due to muscle co-contraction was used to counteract the force field. Only in the case of outward movements were aftereffects observed that were consistent with formation of an accurate internal model of the force field dynamics. Stabilization of the hand for outward movements required less muscle co-contraction than for movements in other directions due to stability conferred by the geometry of the arm. The results suggest that the accuracy of an internal model depends critically on the stability of the coupled dynamics of the limb and the environment.     

A Strain Device Imposing Dynamic and Uniform Equi-Biaxial Strain to Cultured Cells

The objective of this study is to design a new apparatus to allow the control of the magnitude and frequency of dynamic stretch applied uniformly to cells cultured on a silicon elastic membrane. The apparatus is designed to produce equi-biaxial dynamic stretches with area changes ranging from 0% to 55% and frequencies ranging from 0 to 2 Hz. Homogeneous finite strain analysis using triangles of markers was performed to compute the symmetric two-dimensional Lagrangian strain tensor on the membrane. Measurements of strain in both static and dynamic conditions showed that the shear component of the strain tensor (E_rc) was near zero, and that there was no significant difference between radial (E_rr) and circumferential (E_cc) components, indicating the attainment of equi-biaxial strain. Bovine aortic endothelial cells were transiently transfected with a chimeric construct in which the luciferase reporter is driven by TPA-responsive elements (TRE). The transfected cells cultured on the membrane were stretched. The luciferase activity increased significantly only when the cells were stretched by 15% or more in area. Cells in different locations of the membrane showed similar induction of luciferase activities, confirming that strain is uniform and equi-biaxial across the membrane. © 1998 Biomedical Engineering Society. PAC98: 8780+s, 8745-k, 8722-q     

Influence of plyometric training on the mechanical impedance of the human ankle joint

The objective of this work was to study the effects of plyometric training on the mechanical properties of the ankle joint in humans. Changes in the mechanical parameters of this musculo-articular structure were quantified with the aid of a sinusoidal perturbation technique. This technique allowed the expression of the mechanical impedance of the musculo-articular system in terms of stiffness, viscosity and inertia. Measurements were performed under passive conditions and when the subject performed plantar flexion. A 7-week period of training induced a decrease in the slope of the relationship between stiffness and plantar flexion torque, whereas passive stiffness was increased. A slight decrease in viscosity and an invariability in inertia were also found. These results are interpreted in terms of the possible adaptations of the musculo-articular structure and ultrastructure involved in the performance of plantar flexion. Accepted: 11 April 1997     

胎盘生长因子在妊娠期高血压疾病胎盘组织中的定位及定量分析

目的探讨胎盘生长因子(placental growth factor,PLGF)在妊娠期高血压疾病胎盘中定位及定量表达。方法选择妊娠期高血压疾病患者46例,其中子痫前期重度23例,子痫1例;慢性高血压并发子痫前期1例,选择同期正常妊娠妇女20例作为对照组。采用免疫组织化学染色法和免疫印迹(Western blot)方法检测两组患者胎盘PLC蛋白定位及定量表达。结果 (1)免疫组织化学染色发现PLGF蛋白在妊娠期高血压疾病组及正常妊娠组胎盘中分布范围基本一致, 主要分布在绒毛合体滋养细胞和间质细胞的胞浆,部分血管合体膜上也有PLGF阳性染色。(2)Western blot方法检测妊娠期高血压疾病组子痫前期轻、重度胎盘绒毛PLGF蛋白表达低于正常妊娠组(0.3±0.4 vs 0．6±0．4、0．2±0．5 vs 0．6± 0．4),差异有统计学意义(P<0．01);妊娠期高血压患者胎盘中PLGF蛋白的表迭为0．5±0．6,与对照组比较,差异无显著性(P>0．05)。结论胎盘PLGF蛋白表达异常在妊娠期高血压疾病发病中可能具有重要的作用。     

计算机辅助全膝置换中股骨力线定位精度的实验研究

摘要利用光学定位追踪仪确定全膝置换中患者的股骨头中心从而确定其股骨力线，在力线的定位精度分析中，首次采用股骨的三维重建模型进行精度校验。实验结果表明通过追踪固定于股骨末端的刚性定位器即能确定精确的股骨力线，与传统的髓内定位相比，不仅可重复性好，而且大大地提高了术中股骨力线的位置精度，将其位置偏差减小到10以内。     

孕妇妊娠晚期和妊高征患者血小板参数的分析

目的观察正常孕妇妊娠晚期和妊高征患者血小板参数的变化及临床意义。方法采用日本Sysmex KX-21型血液细胞分析仪分别对正常孕妇（118例）、妊高征患者（59例）及对照组（正常婚检妇女59例）的血液标本进行血小板（PLT）计数、平均血小板体积（MPV）、血小板分布宽度（PDW）的测定。结果妊高征组和正常孕妇组的MPV、PDW显著高于对照组（P〈0.01）;妊高征组MPV、PDW明显高于正常孕妇组（P〈0.05）;妊高征组的PLT显著低于对照组（P〈0.01）。结论妊高征患者由于血小板消耗和破坏增加,导致血小板减少,MPV、PDW明显增高,因此,检测血小板参数对预测妊高征的发生有一定的参考意义。     

Force-, power-, and elasticity-velocity relationships in walking,running, and jumping

Summary Ground reaction forces and mechanical power were investigated when the subjects walked normally, while they were racing or running at four speeds, and when they performed the running long jump take-off. In addition, the apparent spring constants of the support leg in eccentric and concentric phases were investigated at the four running speeds, during the running long jump take-off, and in the triple jump. Six club level track and field athletes, four national level long jumpers, and six national level triple jumpers took part in the study. Cinematographic technique and a mathematical model of hopping (Alexander and Vernon 1975) were employed in the analysis. Force and power values were found to vary in the following order (from highest to lowest): long jump take-off, maximal running speed, submaximal running (80, 60, and 40% of maximum speed), racing gait, and normal gait. The data disclosed that the measured parameters had the highest values in the long jump take-off performed by the long jump athletes. Their peak values were: resultant ground reaction force 3270±74 N and mechanical power 160.1±10.5 J×kg^–1×s^–1. For the track and field athletes the values were 2010±80 N and 126.0±12.6 J ×kg^–1×s^–1. The apparent spring constant values of the support leg in the national level jumper group were in eccentric phase 30.54±8.38 N×mm^–1 ×kg^–1 and in concentric phase 0.129±0.012 N×mm^–1×kg^–1. In the track and field athletes the values were 13.97±1.01 N×mm^–1×kg^–1 and 0.093±0.003 N×mm^–1×kg^–1, respectively. In general, the increase in force and mechanical power output was related to the value of the apparent spring constant of the support leg in the eccentric phase. The spring constant in the eccentric phase increased with the velocity of motion in running, the long jump take-off and the triple jump. This suggests that it may be possible to use this parameter as a measure of mechanical performance, as it may reflect the combined elasticity of muscles, tendons, and bones.     

Inability to activate muscles maximally during cocontraction and the effect on joint stiffness

In order to determine the maximum joint stiffness that could be produced by cocontraction of wrist flexor and extensor muscles, experiments were conducted in which healthy human subjects stabilized a wrist manipulandum that was made mechanically unstable by using positive position feedback to create a load with the characteristics of a negative spring. To determine a subject's limit of stability, the negative stiffness of the manipulandum was increased by increments until the subject could no longer reliably stabilize the manipulandum in a 1° target window. Static wrist stiffness was measured by applying a 3° rampand-hold displacement of the manipulandum, which stretched the wrist flexor muscles. As the load stiffness was made more and more negative, subjects responded by increasing the level of cocontraction of flexor and extensor muscles to increase the stiffness of the wrist. The stiffness measured at a subject's limit of stability was taken as the maximum stiffness that the subject could achieve by cocontraction of wrist flexor and extensor muscles. In almost all cases, this value was as large or larger than that measured when the subject was asked to cocontract maximally to stiffen the wrist in the absence of any load. Static wrist stiffness was also measured when subjects reciprocally activated flexor or extensor muscles to hold the manipulandum in the target window against a load generated by a stretched spring. We found a strong linear correlation between wrist stiffness and flexor torque over the range of torques used in this study (20–80% maximal voluntary contraction). The maximum stiffness achieved by cocontraction of wrist flexor and extensor muscles was less than 50% of the maximum value predicted from the joint stiffness measured during matched reciprocal activation of flexor and extensor muscles. EMG recorded from either wrist flexor or extensor muscles during maximal cocontraction confirmed that this reduced stiffness was due to lower levels of activation during cocontraction of flexor and extensor muscles than during reciprocal contraction.     

Hemodynamic Conditions Alter Axial and Circumferential Remodeling of Arteries Engineered <Emphasis Type="Italic">Ex Vivo</Emphasis>

We previously demonstrated that growth and remodeling was stimulated in arteries elongated ex vivo using step increases in axial strain. Viability and vasoactivity were similar to fresh arteries, however there was a substantial decrease in the ultimate circumferential stress. To test the hypothesis that the subphysiological perfusion conditions (i.e., low pressure and flow) previously used caused the reduction, arteries were subjected to the identical elongation protocol (50% increase over 9 days) while being perfused with physiological levels of flow, viscosity and pulsatile pressure. A significant increase in unloaded length was achieved by elongation under both perfusion conditions, although the increase was less under physiological (7 ± 1%) than under subphysiological conditions (19 ± 2%, p < 0.005). When length at physiological stress was estimated using mechanical testing data the values were similar. The ultimate circumferential stress of arteries elongated under physiological conditions was increased (33%), whereas the ultimate axial stress was decreased (50%) as compared with arteries elongated under subphysiological conditions. Elongated arteries under both perfusion conditions showed significant increases in proliferation and collagen mass, and similar viability and appearance to fresh arteries. These data suggest that there is substantial cross-talk between perfusion conditions and axial strain that modulates arterial remodeling and length.