Objective scar assessment—A new method using standardized digital imaging and spectral modelling

Introduction

Quantitative assessment of scars is needed in clinical practice and in scientific studies. To date, there have been no entirely objective methods available for these purposes. We introduce a new method developed for scar assessment combining standardized digital imaging (SDI) and spectral modelling (SpM). With this method, the estimated concentration changes (ECCs) of haemoglobin and melanin in the scar can be determined quantitatively.

Patient and methods

: In the current study, 22 skin graft donor site (SGDS) wounds were treated with two alternative dressing materials, Suprathel^® and Mepilex Transfer^®, side by side on the same wound. The SGSD scars were assessed using SDI and SpM. The scars were given subjective ratings by three surgeons using the POSAS and the Vancouver Scar Scale (VSS). The correlations between the ECCs of melanin and haemoglobin and the corresponding subjective ratings were calculated as well as the Intraclass Correlation Coefficient (ICC) of the subjective ratings.

Results

There was a statistically significant correlation between the ECCs of melanin and haemoglobin and the subjective ratings. A single observer could reliably assess pigmentation with the POSAS scale (ICC = 0.75) but not vascularity (ICC = 0.51). The reliability ratings of the VSS were unacceptably low.

Conclusions

The ECC values of haemoglobin and melanin give accurate documentation of the scar status. The results also show that the subjective ratings in this study were unreliable especially when interfering pigmentation and increased vascularity were both present at the same time.     

426例陕西地区泌尿系结石红外光谱成份分析

目的探讨近年来陕西地区泌尿系结石成份构成情况,并根据结石成份构成指导泌尿系结石的治疗和预防。方法采用天津LIIR型结石红外光谱自动分析系统对426例陕西地区泌尿系结石标本进行成份分析。结果多种成份混合结石占72．30％;各成份的检出率为：一水草酸钙71．83％、碳酸磷灰石63．85％、二水草酸钙42．26％、无水尿酸11．03％、尿酸铵3．76％、磷酸铵镁3．29％。结论陕西地区泌尿系结石的主要成分为草酸钙,碳酸磷灰石和尿酸类结石。     

缺氧缺血型狭长窄蒂皮瓣成活过程中基质细胞衍生因子-1、CD34及微血管密度的表达

目的检测基质细胞衍生因子-1（stromal cell—derived factor-1,SDF-1）、CD34、微血管密度（MVD）在缺氧缺血型狭长窄蒂皮瓣组织的不同时间、不同面积的表达,以及SDF-1在狭长窄蒂皮瓣组织血管新生中的作用。方法在5头家猪两侧背部各制作蒂部长宽比为4：2,携带皮瓣面积分别为2cm×2cm（A组）、3cm×3cm（B组）、4cm×4cm（C组）、5cm×5cm（D组）和6cm×6cm（E组）共5组的窄长蒂皮瓣模型。对5组皮瓣进行大体观察、皮瓣成活情况、光镜下检测MVD、免疫组织化学及酶联免疫技术（ELISA）,检测皮瓣远端组织在术后0、3、5、7、14d时,SDF-1和CD34表达。结果（1）同一组狭长窄蒂皮瓣,随着时间推移,SDF-1、CD34及MVD表达也随之增加,SDF-1在第5天达最高值（A组124．80±4．05,B组137．85±3．03,C组166．53±2．98,D组72．80±2．63,E组62．79±2．20）;CD34在第7天达最高值（A组16．76±0．62,B组17．60±0．72,C组18．48±0．55,D组12．70±0．60,E组11．51±0．70）;MVD在第7天达最高值（A组52．45±2．78,B组59．34±3．12,c组61．14±3．35,D组25．25±3．78,E组24．46±7．46）,随后逐渐下降。（2）不同组狭长窄蒂皮瓣,随着皮瓣面积的增大,SDF-1、CD34及MVD的表达也随之增加,当面积达5cm×5cm时,各项指标不再增加,皮瓣远端出现部分坏死。结论SDF-1对狭长窄蒂皮瓣成活中的新生血管起一定的调节作用。     

结直肠癌相关基因磷脂酶Cε1的筛选及初步验证

目的 筛选新的结直肠癌相关基因并初步验证,探讨结直肠癌的发生、发展机制.方法 在以往研究的基础上,采用基因芯片对既往发现的杂合缺失区域( 10q23.31-24.33)进行扫描,筛选结直肠癌相关候选基因,用real-time PCR初步分析候选基因的表达情况.扩大样本量,通过RT-PCR、免疫组化和Western blot的方法对筛选结果进行初步验证,并结合临床资料分析所筛选基因与结直肠癌发生的关系.结果 基因芯片显示10q23.31-24.33区域磷脂酶Cε1(phospholipase C,epsilon-1,PLCE1)、CPEB3、NKX2-3、SEMA4G 4个基因表达下调,real-time PCR与芯片结果基本一致.RT-PCR、免疫组化和Western blot结果显示PLCE1基因在46％结直肠癌组织中表达下调,年龄＜60岁和低分化腺癌与该基因表达下调相关(P＜0.05),其他临床病理因素与该基因表达下调无明显相关性.结论 PLCE1基因表达下调与结直肠癌的发生相关.PLCE1基因可能对结直肠癌的发生起抑制作用.     

应用OPA-K直丝弓矫治器双颌减数治疗安氏Ⅱ~1类错的临床研究

目的：评价OPA-K直丝弓矫治器双颌减数治疗安氏Ⅱ1类错的临床疗效,并探讨其机制和使用方法。方法：临床选择15～23岁安氏Ⅱ1类错患者22例,应用OPA-K直丝弓矫治器进行双颌减数治疗,并对治疗前后X线头影测量值的变化进行分析。结果：矢状方向上,U1-NA和U1-SN分别减小14.26°和10.32°,U1-NA（mm）减小4.16mm,U1-L1增加17.06°,以上差异均具有统计学意义（P〈0.05）,而SNA、SNB、ANB、L1-NB、L1-MP的变化均无显著性（P〉0.05）。垂直方向上,SN-MP和Y轴的变化均无显著性（P〉0.05）。结论：应用OPA-K直丝弓矫治器治疗安氏Ⅱ1类错可取得令人满意的临床效果。     

精液/精子质量与复发性流产关系的病例对照研究

目的:分析精液常规参数与复发性流产间的关系。方法:采用1∶1配对病例对照研究,比较复发性流产患者配偶与健康体检男性间的精液相关参数。结果:相对于对照组,病例组的精液量[(1.95±1.11)mlvs(2.74±1.43)ml]、精子浓度[(48.68±20.07)×106/ml vs(59.26±25.35)×106/ml]、b级精子百分率[(12.07±3.34)%vs(16.18±6.74)%]、果糖含量[(1.73±0.64)g/L vs(2.21±0.75)g/L]、顶体酶活性[(84.34±26.69)U/mg prot vs(94.20±26.35)U/mg prot]、α-葡糖苷酶(α-GLU)[(36.28±15.98)U/ml vs(44.45±12.54)U/ml]和酸性磷酸酶(ACP)[(68.55±35.45)U/ml vs(84.78±51.10)U/ml]的含量较低(P<0.05),头部畸形精子百分率[(47.36±4.59)%vs(46.50±6.32)%]、尾部畸形精子百分率[(7.56±2.27)%vs(7.28±3.10)%]和弹性硬蛋白酶[(885.64±1 272.30)ng/ml vs(661.08±764.64)ng/ml]的含量较高(P<0.05);判别分析结果显示,精液量、b级精子百分率、混合畸形精子百分率、果糖含量、α-GLU含量和ACP含量可用于复发性流产男性精液/精子质量的判断。结论:常规精液/精子质量相关检测对于评价复发性流产精液因素具有一定的意义,但需要综合分析,特异性不够;精液/精子质量相对较差与复发性流产发生相关。     

喉罩通气全麻应用于老年人腹部手术的临床观察

目的 探讨气管捕管和喉罩通气道用于老年全身麻醉对血液动力学的影响.方法 将40例老年全麻腹部手术患者随机分为2组.喉罩组(L组):全麻诱导后置入喉罩;插管组(M组):全麻后喉镜下气管插管维持通气.分别记录诱导前(T0)、簧喉罩或气管导管前(T1).喉罩置人或气插管即刻(T2),之后2min(T3),4min(T4),6...     

血液透析与心力衰竭患者抑郁和焦虑的比较

目的 比较维持性血液透析患者与心力衰竭患者抑郁和焦虑程度.方法 采用Zung抑郁自评量表和焦虑自评量表分别评估21例心力衰竭患者(心力衰竭组)和22例维持性血液透析患者(血液透析组)抑郁和焦虑得分.结果 心力衰竭患者组抑郁和焦虑得分远远高于维持性血液透析患者组(P＜0.01).结论 心力衰竭患者的抑郁和焦虑程度重于维持...     

股骨头缺血性坏死组织差异表达蛋白质的鉴定和功能蛋白质组学初步研究

目的应用组织蛋白质组学方法寻找与成人股骨头缺血性坏死（ONFH）相关的蛋白质。方法于非创伤性ONFH患者股骨头中分别采集坏死骨组织样品与正常骨组织样品各12份,采用四步溶剂法提取骨组织中的总蛋白,应用多维液相色谱与串联质谱联用技术和生物信息学方法对组织蛋白进行分离鉴定和功能蛋白质组学分析。结果坏死组织样本和正常组织样本中鉴定二肽段以上的高可信度蛋白质数量分别为1302个和999个,假阳性率为0．9％。通过与对照组的质谱计数,在坏死骨组织中鉴定了141个高表达蛋白和56个低表达蛋白。基因本体论蛋白功能分析发现34种蛋白质与ONFH密切相关。本实验在股骨头坏死组织中证实ChST2基因（硫酸软骨素蛋白聚糖合成过程中的关键蛋白）和GPCR26基因（介导细胞内钙离子动员的蛋白质）的低表达。结论非创伤性ONFH存在复杂的信号传导通路。硫酸软骨素蛋白聚糖的生物合成和多种离子的转运、动员可能参与ONFH发病机制中的关键过程。研究发现的差异表达蛋白可能成为ONFH早期临床诊断的候选生物学标志物。     

计算机导航内半骨盆肿瘤切除及有限元分析辅助重建

目的 探讨计算机导航骨盆肿瘤精确切除与重建的安全性和有效性,评价有限元力学分析辅助骨盆环结构与力学重建的可行性.方法 2008年12月至2010年6月,采用有限元分析辅助肿瘤切除后的组配式假体设计,并通过计算机导航对12例内半骨盆恶性肿瘤患者行肿瘤切除与重建术.男8例,女4例;年龄25～53岁,平均39.7岁.软骨肉瘤4例,成骨肉瘤2例,Ewing肉瘤2例,恶性纤维组织细胞瘤1例,转移瘤3例(肾癌1例、甲状腺癌1例、乳腺癌1例).Enneking原发恶性肿瘤分期:ⅠA期1例,Ⅰ B期2例,ⅡA期2例,ⅡB期4例.术后评价肿瘤学结果和功能恢复情况.结果 术中未发生神经、血管和脏器损伤.术后X线片显示肿瘤切除范围与术前计划匹配,肿瘤切除彻底,组配式骨盆假体安放位置满意,固定钉位置满足术前有限元力学分析要求.全部病例随访8～26个月,平均18.2个月.肿瘤局部复发并肺转移1例,深部感染1例,深静脉血栓形成1例.无假体脱位及内固定松动、断裂,无肢体短缩.术后6个月时1993年美国骨肿瘤学会功能评分平均70%,6例随访超过20个月的患者功能评分平均68%.结论 计算机导航辅助骨盆肿瘤切除重建是一种安全有效的方法,有限元分析可为骨盆环重建提供精确的力学指导.

Abstract：

Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.