楔形真皮瓣塑形矫正乳头内陷21例

目的：探讨Ⅱ、Ⅲ型乳头内陷合并近乳晕区包块的手术治疗方法。方法2010年8月至2013年1月对21例Ⅱ、Ⅲ型乳头内陷合并近乳晕区包块患者行包块切除术的同时行楔形真皮瓣乳头内陷矫正术。根据乳腺包块位置与乳头连线方向设计一个以乳晕侧为蒂的去表皮楔形真皮瓣,包块切除后皮瓣卷起内翻旋转固定于乳头基部以支撑乳头,并作荷包缝合塑形乳头颈部防止乳头回缩。结果用该矫正术治疗21例、21个乳头,术后乳头血运良好,外形满意。随诊6个月,感觉、勃起正常,瘢痕不明显。其中2例Ⅲ型乳头内陷术后出现轻度回缩,但比术前明显改善,患者未要求二次修复。结论该术式操作简单有效,同时解决了乳腺包块、乳头内陷,以及乳头内陷引发包块再发的隐患,针对乳头内陷合并乳腺包块人群值得推广。     

The applicability of correction factor for corneal thickness on non-contact tonometer measured intraocular pressure in LASIK treated eyes

Purpose

To determine the applicability of central corneal thickness (CCT) based correction factor for non-contact tonometer (NCT) measured intraocular pressure (IOP) readings.

Method

A prospective, non-randomized study involved 346 eyes of 173 consecutive patients with age ⩾21 years undergoing laser-assisted in situ keratomileusis (LASIK) for myopia and/or myopic astigmatism. The CCT and IOP were measured before and after the LASIK procedure. The IOP pre and post-LASIK was compared after applying the correction factor for CCT. Patients not completing the 3 month postoperative follow-up were excluded.

Results

The median spherical equivalent before undergoing LASIK was −4.25D (inter-quartile range, −3.25D). The mean preoperative CCT was 536.82 ± 33.71 μm which reduced to 477.55 ± 39.3 μm (p < 0.01) post-LASIK. The mean IOP reduced from a preoperative value of 14.6 ± 2.32 mmHg to 10.64 ± 2.45 mmHg postoperatively (p < 0.01). On applying correction for the corneal thickness, the pre and postoperative IOP was 15.14 ± 2.8 mmHg and 15.37 ± 2.65 mmHg (p = 0.06) respectively with a strong positive correlation (r = 0.7, p < 0.01). Three hundred eyes (86.7%) had an absolute difference in IOP of less than 3.0 mmHg post-CCT correction which is within the retest variability of NCT. Only 46 eyes (13.3%) had an absolute difference of more than 3.0 mmHg.

Conclusion

The modified Ehler’s correction algorithm used in this study can be effectively applied in the normal IOP range in a majority of patients.     

口内进路矫治下颌角肥大畸形的临床研究

目的:探讨和总结口内进路矫治下颌肥大畸形的经验。方法:对10例下颌角肥大的畸形患者,根据临床表现和X线片测量结果,在全麻下分别采用口内进路下颌角切除术和下颌角外板劈开去骨术,切除畸形的骨组织,并对骨创缘进行适当修整。结果:患者伤口均Ⅰ期愈合,在术后3个月和6个月复诊时,发现患者面下份过宽的畸形得以纠正,外型的改善医患双方均感满意,本组病例中未出现严重的并发症。结论:根据下颌角肥大畸形特点选择不同术式是达到术后满意效果的关键。     

Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography

Purpose

The objective of this study was to evaluate 2 years post-surgical loss of three-dimensional correction in adolescent idiopathic scoliosis (AIS) patients using multi-planar reconstruction computed tomography (CT).

Methods

Twenty-seven AIS patients treated by segmental pedicle screw (PS) constructs were included in this study. Correction in the axial plane was evaluated using the “relative apical vertebral rotation angle” (rAVR), defined as the difference between the axial rotation angles of the upper instrumented vertebra and the apical vertebra on reconstructed axial CT images. The Cobb angle of the main curve and apical vertebral translation was measured to evaluate the coronal correction. Thoracic kyphosis was also measured for the evaluation of sagittal profile. Measurements were performed before surgery, and 1 week and 2 years after surgery. The relationships between the correction losses and skeletal maturity, and variety of spinal constructs were also evaluated.

Results

The mean preoperative Cobb angle of the major curve was 59.1° ± 11.2° before and 13.0° ± 7.2° immediately after surgery. Two years later, the mean Cobb angle had increased significantly, to 15.5° ± 7.8°, with a mean correction loss of 2.5° ± 1.5° (p < 0.001). The mean preoperative rAVR of 28.5° ± 8.4° was corrected to 15.8° ± 7.8° after surgery. It had increased significantly to 18.5 ± 8.4 by 2 years after surgery, with a mean correction loss of 2.7° ± 1.0° (p < 0.001). The mean correction losses for both the Cobb angle and rAVR were significantly greater in the skeletally immature patients. The significant correlations were recognized between the correction losses and the proportion of multi-axial screws, and the materials of constructs.

Conclusions

Statistically significant loss of correction in the Cobb angle and apical vertebral axial rotation angle (AVR) were recognized 2 years after surgery using PS constructs. The correction losses, especially AVR, were more evident in the skeletally immature patients, and in patients treated with more multi-axial screws and with titanium constructs rather than with stainless constructs.     

一期后前路联合松解矫形治疗胸腰椎陈旧骨折伴后凸畸形

目的:探讨一期后前路联合松解矫形治疗胸腰椎陈旧骨折伴后凸畸形的临床疗效。方法:2005年6月～2010年10月收治21例胸腰椎陈旧骨折伴后凸畸形患者,男13例,女8例,年龄23～61岁,平均37.6岁。均为单节段骨折,角状后凸顶点:T11 1例,T12 7例,L1 8例,L2 5例;后凸Cobb角23°～59°,平均38.6°。均有严重腰背痛症状,术前VAS评分为7.1～10(7.6±2.1)分。9例伴有神经功能障碍,术前Frankel分级:B级2例,C级2例,D级5例;其中4例合并括约肌功能障碍。2例曾行单纯椎板减压手术,10例曾行椎板减压内固定术。术前CT显示关节突骨性融合14例,骨折椎体前方有骨赘及骨桥形成16例。均采用一期后前路联合松解、减压、前路椎体间植骨、内固定术治疗。随访观察患者临床症状及影像学改善情况。结果:手术均顺利完成,手术时间150~310min,平均200min;术中失血量400~1200ml,平均650ml。术中、术后无一例出现严重并发症。患者均获随访,随访时间12～60个月,平均21.3个月,腰背痛症状均明显缓解,VAS评分改善至1.5～2.6(2.1±0.4)分;后凸角明显改善,末次随访时后凸Cobb角为5°～23°(11.1°±5.8°),与术前比较差异有统计学意义(P<0.05),平均矫正率为71.3%。植骨节段均骨性融合,融合时间平均4.3个月。9例有神经功能障碍者术后8例有不同程度恢复,4例括约肌功能障碍者3例改善。结论:一期后前路联合松解、减压、矫形治疗胸腰椎陈旧骨折伴后凸畸形手术安全,能早期重建脊柱稳定性,效果满意。     

重度僵硬性脊柱侧凸矫正技术进展

目的对重度僵硬性脊柱侧凸矫正技术的进展进行综述。方法查阅近年来国内外重度僵硬性脊柱侧凸的相关文献,总结重度僵硬性脊柱侧凸矫正技术的最新进展。结果重度僵硬性脊柱侧凸矫正技术有如下进展:Halo-重力牵引应用增多;尝试了后路矫形术中应用Halo-股骨髁上牵引;全椎弓根螺钉固定矫形技术逐步得到推广;经后路全脊椎切除技术、一期前后路手术及单纯后路矫形手术应用增多。结论各种矫形技术的进展显显著提高了重度僵硬性脊柱侧凸的矫形效果,但目前尚无标准化治疗方案,未来可期待更显著的进展。     

Mathematical model for assessing true irradiance received by luting materials while curing through modern CAD/CAM resin composites

Statement of problemMeasurement of irradiance passing through a dental restoration for properly curing a dual- or light-polymerized luting composite is imprecise due to surface reflection.ObjectiveTo provide a mathematical correction of measured transmitted irradiance for predicting true transmitted light intensity through CAD/CAM restorations.MethodsA total of 432 specimens were fabricated. Seven modern CAD/CAM resin-based composites (RBCs) and one CAD/CAM glass-ceramic (control group) were sectioned and polished into specimens of 0.5–5 mm thickness (in 0.5 mm steps, n = 6). Irradiance of a violet-blue LED light curing unit (LCU) (power modes: Standard, High and Plasma) was measured after passing through each specimen with a spectrometer. Data was compared based on 95% confidence intervals and using univariate ANOVA followed by Tukey HSD (α = 0.05).ResultsThe measured transmitted irradiance passing through the specimens decreased exponentially. Significantly highest values of transmitted irradiance were measured for 0.5 mm thick specimens for all materials (p < 0.05). The decadic absorption coefficient for CAD/CAM-RBCs ranged from 0.292 mm⁻¹ to 0.387 mm⁻¹ while the control group (glass-ceramic) reached a significantly lower value of 0.283 mm⁻¹. The reflection ratio for all materials ranged from 12.6% to 18.5%.SignificanceA correction can be implemented to predict the true transmitted irradiance after passing through a dental restoration as function of initial irradiance, specimen thickness and material specific parameters. For a practitioner, this model may be applied depending on the specific treatment conditions, the individual LCU's radiant emittance and restoration thickness for the tested materials.     

Lentiviral-mediated gene therapy for murine mucopolysaccharidosis type IIIA

Mucopolysaccharidosis type IIIA (MPS IIIA) is a heritable glycosaminoglycan (GAG) storage disorder which is characterised by lysosomal accumulation of heparan sulphate, secondary to a deficiency of sulphamidase (heparan-N-sulphatase, N-sulphoglucosamine sulphohydrolase, EC No. 3.10.1.1.). There is currently no treatment for affected individuals who experience progressive CNS deterioration prior to an early death.As a first step towards developing gene therapy as a treatment for MPS IIIA, an MPS IIIA mouse model was used to examine the efficacy of intravenous lentiviral-mediated gene therapy. Five-week-old mice were injected with virus expressing murine sulphamidase and analysed 6 months after treatment. Transduction by the lentiviral vector was highest in the liver and spleen of treated animals, and sulphamidase activity in these tissues averaged 68% and 186% of normal, respectively.Storage was assessed using histochemical, chemical and mass spectrometric analyses. Storage in most somatic tissues was largely normalised, although chondrocytes were an obvious exception. Histologically, improvement of lysosomal storage within the brain was variable. However, β-hexosaminidase activity, which is abnormally elevated in MPS IIIA, was significantly reduced in every treated tissue, including the brain. Total uronic acid was also significantly reduced in the brains of treated mice. The level of a disaccharide marker (hexosamine-N-sulphate[α-1,4]hexuronic acid; HNS-UA) of heparan sulphate storage was also decreased in the brains of treated mice, albeit non-significantly.These results suggest that lentiviral-mediated somatic gene transfer may affect not only the somatic, but possibly also the CNS pathology, found in MPS IIIA.     

Evaluation of prospective motion correction of high-resolution 3D-T2-FLAIR acquisitions in epilepsy patients

T2-FLAIR is the single most sensitive MRI contrast to detect lesions underlying focal epilepsies but 3D sequences used to obtain isotropic high-resolution images are susceptible to motion artefacts. Prospective motion correction (PMC) – demonstrated to improve 3D-T1 image quality in a pediatric population – was applied to high-resolution 3D-T2-FLAIR scans in adult epilepsy patients to evaluate its clinical benefit. Coronal 3D-T2-FLAIR scans were acquired with a 1 mm isotropic resolution on a 3 T MRI scanner. Two expert neuroradiologists reviewed 40 scans without PMC and 40 with navigator-based PMC. Visual assessment addressed six criteria of image quality (resolution, SNR, WM-GM contrast, intensity homogeneity, lesion conspicuity, diagnostic confidence) on a seven-point Likert scale (from non-diagnostic to outstanding). SNR was also objectively quantified within the white matter. PMC scans had near-identical scores on the criteria of image quality to non-PMC scans, with the notable exception that intensity homogeneity was generally worse. Using PMC, the percentage of scans with bad image quality was substantially lower than without PMC (3.25% vs. 12.5%) on the other five criteria. Quantitative SNR estimates revealed that PMC and non-PMC had no significant difference in SNR (P = 0.07). Application of prospective motion correction to 3D-T2-FLAIR sequences decreased the percentage of low-quality scans, reducing the number of scans that need to be repeated to obtain clinically useful data.     

加校正因子的RP-HPLC法测定不同方法生产的7-氨基头孢烷酸中有关物质

目的建立一种能够准确测定7-氨基头孢烷酸中有关物质的方法,同时进行不同方法生产的产品的含量测定及有关物质检查。方法采用高效液相色谱法。使用C18色谱柱(SB-C18,5μm,4.6mm×250mm);以磷酸盐缓冲液(取5g磷酸氢二钾和5g磷酸二氢钾溶解于1000m L水中,用磷酸调节流动相p H值至6.0)—乙腈(92:8)为流动相;检测波长为254nm;柱温为35℃;进样量20μL。结果 7-氨基头孢烷酸在504~0.02534μg/m L范围内,线性关系良好,相关系数R2为0.9991;去乙酰7-氨基头孢烷酸在10.52~0.0263μg/m L范围内,线性关系良好,相关系数R2为0.9996;去乙酰氧7-氨基头孢烷酸在9.66~0.02415μg/m L范围内,线性关系良好,相关系数R2为0.9998;头孢菌素C在10.5~0.02625μg/m L范围内,线性关系良好,相关系数R2为0.9998。溶液的稳定性及进样精密度、日内精密度、重复性、专属性良好。去乙酰7-氨基头孢烷酸、去乙酰氧7-氨基头孢烷酸和头孢菌素C的校正因子分别为0.80、0.82、1.67。结论此方法可以准确测定7-氨基头孢烷酸中的含量,并采用校正因子法计算有关物质的含量。不同方法生产的7-氨基头孢烷酸的含量及有关物质无明显差异。