新型腰椎经皮椎弓根螺钉植入定位方法及其对放射暴露剂量的影响

 目的 探讨新型腰椎微创定位方法在定位时间、次数及放射暴露剂量方面的优势。方法 2010年5 月至2013年2 月收治腰椎间盘突出症合并腰椎不稳及胸腰椎骨折121例,随机分为两组：68例采用传统定位方法植入经皮椎弓根螺钉,单节段病变41例、双节段病变27例;53例采用自行研制的腰椎微创定位系统,单节段病变34例、双节段病变19例。两组患者性别、年龄、病程、手术节段的差异无统计学意义。结果 传统定位方法组、微创定位方法组术前定位时间分别为（8.26±3.44） min、（3.51±1.82） min,平均定位次数分别为3.57次、1.22次,准确率分别为60.8%及96.2%。两组单节段病变患者植入双枚经皮椎弓根螺钉,术中定位时间分别为（15.12±4.69） min、（5.51±1.32） min,定位次数分别为6.47次、2.45次;双节段病变患者植入三枚经皮椎弓根螺钉,术中定位时间分别为（24.91±7.43） min、（8.84±2.32） min,定位次数分别为11.72次、3.69次。传统定位方法组手术人员颈部、胸部及手腕部检测出的放射暴露剂量分别为（3.09±0.24） Gy、（4.23±0.71） Gy、（5.17±0.62） Gy,微创定位方法组分别为（1.38±0.47） Gy、（2.69±0.33） Gy、（3.21±1.05） Gy。两组定位时间、定位次数及放射暴露剂量的差异有统计学意义。结论 腰椎微创定位系统及定位方法能够简化手术操作,具有定位准确性高、定位时间短、透视次数少、医护人员及患者接受X线射线暴露量低的优点。     

单侧微创与开放经椎间孔腰椎椎体间融合内固定治疗腰椎椎间盘突出症的临床疗效比较

目的：比较微创经椎间孔融合内固定与传统开放经椎间孔融合内固定术治疗腰椎椎间盘突出症的临床疗效。方法2009年10月～2012年10月,对54例腰椎椎间盘突出症手术患者进行回顾性分析,其中男32例,女22例,年龄34～60岁,平均42．7岁;病变节段为L4/L534例,L5/S120例。依据手术方式将其分成微创经椎间孔腰椎椎体间融合（minimally invasive transforaminal lumbar interbody fusion , MiTLIF）组和开放经椎间孔腰椎椎体间融合（open transforaminal lumbar interbody fusion , OTLIF）组,分别为24例和30例。分析手术时间、手术出血量、住院时间、术中术后并发症,影像学观察术后1年椎间融合情况,采用日本骨科学会（ Japanese Orthopaedic Association ,JOA）评分评估临床效果。结果所有患者均获随访,随访时间12～36个月,平均21．4个月,MiTLIF组出血量（40．2±15．6） mL,住院时间（6．2±2．4） d,术后2周JOA评分18．7±1．9,OTLIF组出血量（203．6±52．8） mL,住院时间（10．8±4．2） d,术后2周JOA评分15．1±1．4,2组差异具有统计学意义（P＜0．05）。2组手术时间,术中术后并发症发生率,术后1个月、3个月和1年JOA评分,术后1年椎间融合率差异无统计学意义（P＞0．05）。结论在行单侧椎弓根固定治疗腰椎椎间盘突出症时,MiTLIF组出血量更少短期临床疗效更好。     

腰椎融合辅以邻近节段动态固定治疗腰椎退行性疾病的早期临床疗效观察

目的 评价腰椎融合辅以邻近节段K-Rod动态固定治疗腰椎退行性疾病的临床疗效及对腰椎运动功能的影响,探讨K-Rod动态固定对邻近节段保护的优劣.方法 回顾性分析2010年4月~2011年9月采用椎间融合辅以邻近节段K-Rod 动态固定及单节段椎间植骨融合内固定术的51例患者.A组（K-Rod组）24例患者术前邻近节段存在退变,行单节段融合辅以邻近节段K-Rod动态固定;B组（单节段融合组）27例患者术前邻近节段无不稳或退变,行单节段椎间植骨融合内固定术.对比评价2组腰腿痛视觉模拟量表（visual analogue scale,VAS）评分、Oswestry 功能障碍指数（ Oswestry disability Index,ODI） 、椎间隙高度、腰椎总活动度（range of motion,ROM）及头侧邻近第一节段活动度（ROM1）、头侧邻近第二节段或尾侧第一邻近节段活动度（ROM2）、保护节段及邻近节段退变（adjacent segment degeneration,ASD）发生率.结果随访 24~37个月.2组患者术后VAS评分及ODI均显著改善,且2组间差异无统计学意义.2组间腰椎总ROM术前及末次随访之间均无差异.A组保护节段末次随访时椎间隙高度与术前无差异.2组ROM1及ROM2术前术后相比差异均有显著统计学意义,2组间相比差异无统计学意义.A组末次随访时8例患者出现11（11/138,8%）枚螺钉松动;B组无螺钉松动.结论 腰椎融合辅以邻近节段动态固定具有较好的临床疗效,增加的动态固定保护了术前已存在退变的节段,避免了多节段融合,降低了单节段融合邻椎病的风险,因此适应证选择合适,具有较好的临床应用价值.     

The metrics of MWCNT-induced pulmonary inflammation are dependent on the selected testing regimen

Convincing evidence suggests that high-surface-activity nano-materials, such as MWCNT, exert two modes of action (MoA), in which one appears to be related to surface activity/area and occurs concurrent with deposition, and the other is related to cumulative lung burden. Pulmonary inflammation induced by the latter mode appears to be dependent on cumulative volumetric lung burden and on whether the accumulated particle displacement volume within the pool of alveolar macrophages is above or below the kinetic lung overload threshold. However, the relative importance and effect of each MoA are still controversial. In addition, the test protocol variables, which may predetermine the leading MoA, have not yet received increased attention. This study compares the respective outcome of previously published repeated-exposure inhalation studies with MWCNT (Nanocyl and Baytube) in rats. Modeling procedures were performed to compare post hoc the equivalence of empirical and modeled outcomes, including critical protocol variables. This comparison provided compelling evidence that the accumulated retained particle displacement volume was the most prominent unifying denominator linking the pulmonary retained volumetric particle dose to inflammogenicity and toxicity. However, conventional study designs may not always be appropriate to unequivocally dissociate the surface area/activity-related acute adversity from the cumulative retention volume-related adversity. Thus, in the absence of adequately designed studies, it may become increasingly challenging to differentiate substance-specific deposition-related acute effects from the more chronic retained cumulative dose-related effects. In summary, this analysis of existing data supports the conclusion that both the deposition and retention-related effects need to be judiciously dissociated to better understand the MoA of heightened concern. This exercise supports the conclusion that hypothesis-based computational study design delivers the highest degree of scientifically important information and may further reduce the number of experimental animals in repeated-exposure inhalation studies with low-toxicity, biopersistent, poorly soluble granular particles.     

组织二尖瓣环位移技术评价重度子痫前期病人左心房功能的应用价值

目的应用组织二尖瓣环位移(TMAD)技术评价重度子痫前期(SPE)病人左心房功能,探讨其临床应用价值。方法选取SPE病人46例(SPE组)和正常妊娠(NP)孕妇43名(NP组),分别行常规及全容积超声心动图检查。采用全容积成像技术获取标化左房膨胀指数(LAEI)、左房被动排空分数(LAPEF)和左房主动排空分数(LAAEF);采用TMAD技术获取相应参数:左心房充盈期位移(TMAD-D)、被动射血期位移(TMAD-P)及左心房收缩期位移(TMAD-S)。结果与NP组相比,SPE组TMAD-D、TMAD-P和TMAD-S降低,差异均有统计学意义(P<0.001);与NP组相比,SPE组标化LAEI、LAPEF和LAAEF均降低,差异均有统计学意义(P<0.001);SPE组TMAD-D、TMAD-P和TMAD-S与相应的标化LAEI、LAPEF、LAAEF均呈正相关(r值分别为0.645、0.576、0.572,P<0.001);TMAD-D、TMAD-P和TMAD-S诊断左房功能受损的曲线下面积(AUC)分别为0.868、0.832、0.759;标化LAEI、LAPEF、LAAEF的AUC分别为0.880、0.840、0.835;全容积成像参数的AUC较TMAD相应参数的AUC略增大,但差异均无统计学意义(P>0.05)。结论TMAD技术可简便、快速、准确地评价SPE病人左房时相功能,可作为临床评价左房功能的新方法。     

Influence of Relative Displacement on Surface Roughness in Longitudinal Turning of X37CrMoV5-1 Steel

The shaping process of surface texture is complicated and depends on many factors and phenomena accompanying them. This article presents the author’s test stand for the measurement of relative displacements in a tool–workpiece system during longitudinal turning. The aim of this study was to determine the influence of edge radius on the relative displacement between the tool and workpiece. The cutting process was carried out with inserts with different edge radii for X37CrMoV5-1 steel. As a result of the research, vibration charts of the tool–workpiece system were obtained. In the range of feed 0.03–0.18 mm/rev, the values of the standard deviation of relative displacements in the x-axis were obtained in the range of 0.36–0.78 μm for the insert with an edge radius of r_n = 48.8 μm. As a result of the work, it was determined that for the feed value of 0.12 mm/rev for all inserts, the relative displacements are the smallest. As the final effect, the formula for forecasting the Ra roughness parameter was presented.     

聚合物驱油工程作业人员健康监护早期指标的研究

目的探索聚合物驱油工程作业人员的职业健康监护早期指标,以早期发现聚合物驱油工程作业人员的职业健康损害情况,从而采取有效的干预措施,以降低职业性疾患的发生率。方法对119名实验组和88名对照组人员进行神经行为功能测试,同时测定血清中IgE、IgM、MDA、GSH—Px、SOD水平。结果试验组工人紧张一焦虑、疲惫一惰性、忧郁一沮丧等负面情绪显著增多,运动协调能力、记忆力存在功能障碍;试验组的IgM和IgE检测结果均显著高于对照组（P〈0．05）,血清中MDA含量和SOD活力与对照组的差异有统计学意义（P〈0．05）;试验组有20人IgE含量超过正常值,实验组的GSH-Px检测结果与对照组的差异无统计学意义。结论作业工人神经行为功能测试结果及血清中IgE、MDA含量及SOD活力可作为聚合物驱油工程作业人员健康监护的早期指标。     

后路脊柱全内镜结合类固醇激素鞘内注射手术治疗腰椎间盘突出症

目的探讨腰椎间盘内镜技术(microendoscopic disectomy,MED)结合类固醇激素神经根鞘内注射治疗腰椎间盘突出症的效果。方法 2010-02—2012-12收治的60例腰椎椎间盘突出患者随机分为MED组30例,行MED手术,MED神经根鞘内注射组治疗30例,行MED手术并在神经根鞘杰注入5 mg地塞米松。记录两组手术前后疼痛视觉模拟量表(visualanalogue scale,VAS)评分、直腿抬高角度及术后恢复正常工作的时间,术中、术后并发症发生情况。结果与治疗前比较,两组患者治疗后VAS评分明显减低,直腿抬高角度明显升高,差异有统计学意义(P0.05);与MED组比较,MED神经根鞘内注射组患者治疗后VAS评分及直腿抬高角度的改变更明显,差异有统计学意义(P0.05);MED神经根鞘内注射组患者治疗后恢复正常工作时间明显短于MED组患者(P0.05);MED神经根鞘内注射组患者出现2例并发症,发生率6.7%,术中硬脊膜撕裂并出现脑脊液漏1例,术后因侧隐窝减压不充分和瘢痕粘连再手术1例;MED组患者出现切口感染1例,发生率为3.3%(P0.05)。结论后路脊柱显微内镜结合鞘内注射类固醇激素治疗腰椎椎间盘突出,能显著改善术后疼痛、恢复肢体活动范围及更早的恢复日常生活。     

Crime displacement in digital drug markets

Background Crackdowns on urban sites with concentrated criminal activity are sometimes followed by geographical relocation of crime. Is this also the case in cyberspace, where illegal websites and online networks can be wiped clean, but also quickly rebuilt and replaced on new servers and URLs?Methods I address this question in three steps. First, I measure MDMA trade in a large digital market for drugs, before and after the arrest of a leading MDMA seller in the same market. Second, I count the number of available digital drug markets and vendor shops in the period February 2014–June 2018, to see if websites closed by police were replaced by new ones. Third, I track the digital movement and trading activities of individual drug sellers, before and after law enforcement shut down two large markets.Results After police arrested a leading MDMA seller, other MDMA sellers filled most – but not all – of the gap. A major law enforcement crackdown reduced the number of available markets, but new ones were created, and market counts eventually surpassed the previous peak. When law enforcement shut down two big markets, many of the sellers relocated to other e-commerce sites and continued high-earning operations there.Conclusion Arrests and market closures redirect digital drug trade to other sellers and markets. Hot spot policing in cyberspace might produce temporary results, but is arguably ineffective in the long run, as actors use information and communication technology’s unique capacities to reorganize.