屈光度对SMILE术后眼压的预测和校正

目的 探究SMILE术后眼压的预测并校正。方法 回顾性研究+前瞻性验证。纳入2019-12/2021-12于中部战区总医院行SMILE的患者90例(180眼),随机抽取30眼为验证集,余150眼为训练集。前瞻性录入2022-01/2022-09SMILE的51例(102眼)为测试集。首先分析训练集手术前3d、术后1wk、1mo、3mo及6mo的眼压情况,确定眼压稳定期及于术前的眼压变化量(ΔIOP);再选取球柱镜代数和(SC)、球镜度(DS)、柱镜度(DC)及眼压(IOP)、中央角膜厚度(CCT)、角膜平均曲率(Km)、前房深度(ACD),眼压稳定时的变化量(ΔCCT、ΔKm、ΔK1、ΔK2、ΔACD)及个体因素,纳入与ΔIOP相关的因素拟合回归模型;最后建立适合临床SMILE术后眼压预测及校正的公式并作效能验证。结果 除术后1wk、3mo及6moIOP三者间无明显差异外,余时段IOP间差异均有统计学意义(P＜0.05);各因素与ΔIOP拟合最佳回归方程：ΔIOP=0.459IOP_术前-0.183SC-0.041Age+1.292ΔACD-1.270(调节R₂^=0.533,P＜0.001)。仅纳入术前IOP和SC,拟合简化方程：ΔIOP=0.496IOP_术前-0.194SC-2.952(调节R₂^=0.498,P＜0.001);预测和校正公式：IOP_术后预测=0.5IOP_术前+0.2SC+3,IOP_术后校正=IOP_术后+0.5IOP_术前–0.2SC–3。简化公式的效能验证显示良好。结论 SMILE术后3月IOP趋于稳定,且ΔIOP与屈光度相关。SMILE术后IOP可通过简化公式作快速临床预测和校正。     

呼气相胸片的识别研究

根据呼气相胸片中肺部区域灰度较高的特点，通过边缘提取和边缘跟踪确定胸部区域，运用最大类间方差方法确定图像分割的阈值．再提取出肺部区域，然后求出肺部的灰度均值。但这样的结果并不理想。于是在此基础上提出修正方案，即以肺部灰度均值和骨骼灰度均值的比值作为特征值．即比例法。此方法可以较客观的识别呼气相胸片。最后用类间距离对这两种方法进行了量化比较。     

基于模糊连接度的多发性硬化症MR图像自动分割算法

多发性硬化症(MS)是一种严重威胁中枢神经功能的疾病,利用磁共振成像技术能够无损伤地检出其病灶。为了自动地对多发性硬化症病灶进行分割,提出了基于模糊连接度的分割算法,实现了种子点的自动选取。作为多发性硬化症分割的预处理,针对脑部MR FLAIR图像的特征,基于区域增长方法,还提出了脑部组织提取算法。通过对临床患者MR图像的分割实验,表明该分割算法能够比较准确地分割多发性硬化症病灶,其分割效果明显好于模糊C-均值聚类算法和基于马尔可夫场模型的分割算法。该算法还具有无监督、运算速度快、稳健性好等优点,能够应用于多发性硬化症的临床辅助诊断。     

全关节镜下微创复位固定术治疗SandersⅡ、Ⅲ型跟骨关节内骨折的疗效分析

目的 探讨全关节镜下微创复位固定术治疗SandersⅡ、Ⅲ型跟骨关节内骨折的临床疗效。方法 前瞻性随机对照研究。纳入2017年3月—2020年12月徐州仁慈医院足踝外科Sanders Ⅱ、Ⅲ型跟骨骨折患者40例,其中男36例、女4例,年龄18~58（39.6±10.8）岁,左侧22例、右侧18例,Sanders Ⅱ型16例、Ⅲ型24例。40例患者数字表法随机分为关节镜组（采用关节镜下跟骨关节内骨折微创复位、经皮螺钉固定术治疗）、大“L”形切口组（采用传统的大“L”形切口跟骨骨折复位钢板内固定术治疗）,每组20例。观察指标：（1）比较2组患者性别、年龄、体质量指数（BMI）、骨折类型、术前美国足踝外科学协会（AOFAS）踝-后足功能评分等基线资料差异;（2）比较2组患者手术切口长度、手术时间、术中出血量、住院时间、术后切口愈合情况等围术期资料差异;（3）术后观察局部有无麻木感、是否钢板外露、切口皮肤坏死、术后1年是否有创伤性关节炎等手术并发症情况;（4）对比分析2组患者末次随访时AOFAS踝-后足功能评分、Gissnae角和Bohler角。结果 （1）2组患者性别、年龄、BMI、骨折类型、术前AOFAS踝-后足功能评分等基线资料比较,差异均无统计学意义（P值均>0.05）。（2）关节镜组患者的切口长度（0.94±0.08）cm、术中出血量（7.20±1.98）mL、手术时间（41.45±9.96）min、住院时间（8.45±2.01）d,大“L”形切口组患者的切口长度（14.35±1.63）cm、术中出血量（27.35±10.35）mL、手术时间（90.65±12.08）min、住院时间（17.15±6.72）d,关节镜组优于大“L”形切口组,差异均有统计学意义（t=-36.70、-8.54、-14.04、-5.54,P值均<0.001）。（3）术后平均随访12.3个月。术后关节镜组切口均甲级愈合,无创伤性关节炎、足背皮肤麻木。大“L”形切口组20例中,18例患者切口甲级愈合,2例患者切口皮缘坏死、钢板外露,予腓肠神经营养逆行岛状皮瓣修复后伤口愈合;有4例患者术后感足背外侧麻木,经治疗分别于术后8~14个月痊愈。（4）末次随访时AOFAS踝-后足功能评分关节镜组为（92.10±3.16）分、大“L”形切口组为（91.3±2.45）分,术后2组患者跟骨的Gissnae角和Bohler角均在正常范围内,组间比较差异均无统计学意义（P值均>0.05）。结论 与传统的切开复位内固定术相比较,全关节镜下微创手术治疗Sanders Ⅱ、Ⅲ型跟骨关节内骨折,具有手术切口小、手术时间短、内固定牢固、切口愈合好、疗程短、术后瘢痕不明显、功能恢复快等优势。     

YL-1型颅内血肿穿刺针的临床应用

目的探讨YL-1型颅内血肿穿刺针对颅内疾病微创治疗的价值及临床应用。方法回顾性分析本院2005年3月至2007年3月应用YL-1型颅内血肿穿刺针治疗颅内疾病患者58例（高血压幕上脑出血38例;慢性硬膜下血肿12例;急性硬膜外血肿5例;脑积水2例;颅内张力性积气1例）评价YL-1型颅内血肿穿刺针其在颅内疾病的应用价值。结果经采用CT定位YL-1型颅内血肿穿刺针微创手术治疗颅内疾病患者58例,存活51例;死亡4例;术后放弃治疗3例。结论采用YL-1型颅内血肿穿刺针微创手术治疗颅内血肿、积水、积气是简单、有效的微创手术方法。     

Expression of luminal and basal cytokeratins in human breast carcinoma

We have examined basal and luminal cell cytokeratin expression in 1944 cases of invasive breast carcinoma, using tissue microarray (TMA) technology, to determine the frequency of expression of each cytokeratin subtype, their relationships and prognostic relevance, if any. Expression was determined by immunocytochemistry staining using antibodies to the luminal cytokeratins (CKs) 7/8, 18 and 19 and the basal markers CK 5/6 and CK 14. Additionally, assessment of alpha-smooth muscle actin (SMA) and oestrogen receptor status (ER) was performed. The vast majority of the cases showed positivity for CK 7/8, 18 and 19 indicating a differentiated glandular phenotype, a finding associated with good prognosis, ER positivity and older patient age. In contrast, basal marker expression was significantly related to poor prognosis, ER negativity and younger patient age. Multivariate analysis showed that CK 5/6 was an independent indicator for relapse free interval. We were able to subgroup the cases into four distinct phenotype categories (pure luminal, mixed luminal/basal, pure basal and null), which had significant differences in relation to the biological features and the clinical course of the disease. Tumours classified as expressing a basal phenotype (the combined luminal plus basal and the pure basal) were in a poor prognostic subgroup, typically ER negative in most cases. These findings provide further evidence that breast cancer has distinct differentiation subclasses that have both biological and clinical relevance.     

Clinicopathologic features and incidence of invasive lobular carcinoma in Japanese women

Intending to clarify the true Incidence of Invasive lobular carcinoma of the breast In Japanese women as well as the frequency of unilateral multlcentriclty, 362 cases of clinically defined monocentrlc breast cancer without pre-operative biopsy (previously fine needle aspiration or needle biopsy were routinely carried out for every case) were examined by whole mammary gland serial sectioning. On the basis of pathology and the World Health Organization classification of breast tumors, each case was assigned to one of two main histologlc types: Invasive lobular carcinoma (ILC) or Invasive ductal carcinoma (IDC). Invasive lobular carcinoma was further separated into classic and variant types by employing previously published criteria. Twenty-one cases of ILC (5.8%) were diagnosed, which Is more than In most previous Japanese studies. Unilateral multicentric breast carcinoma was detected In 9.5% of ILC and 16.1% of IDC (the difference was found not significant). Microscopically, ILC tumors were found to be, on average, larger than IDC. Patients with classic type ILC tended to be younger than those with variant type or IDC. Estrogen receptor expression was found more frequently In variant type ILC than in classic type. These results suggest that the incidence of invasive lobular carcinoma of the breast In Japanese women is low and that unilateral multicentricity Is not significantly higher in ILC than in IDC.     

Immunocytochemistry of keratan sulfate proteoglycan and dermatan sulfate proteoglycan in porcine tooth-germ dentin

Keratan sulfate proteoglycan and dermatan sulfate proteoglycan have been reported to inhibit collagen fibrillogenesis. We investigated their distribution in order to evaluate the role of proteoglycan in dentinogenesis. Specimens of porcine tooth-germ dentin and erupted teeth were the materials on which antibodies to keratin sulfate and dermatan sulfate proteoglycan were used. Predentin was found to be positive for both antibodies and the reaction ceased in the calcification front. Uniformly thick collagen fibrils (30-70 nm in diameter) were distributed in the predentin matrix, which would become intertubular dentin in the future. Both antibodies reacted positively along these fibrils. In contrast, along the surface layer of dentin in the tooth germ and that in erupted teeth, collagen fibrils of 10-300 nm in diameter were noted occasionally in dentinal tubules whose odontoblastic processes had disappeared and these heterogeneous fibrils were negative for both antibodies. Our findings suggest that keratan sulfate proteoglycan and dermatan sulfate proteoglycan distributed in the predentin inhibit calcification of collagen fibrils in the uncalcified matrix and disappear in the calcification front. It is further suggested that keratan sulfate proteoglycan and dermatan sulfate proteoglycan distributed along collagen fibrils in the predentin matrix maintain uniform thickness, whereas collagen fibrils in dentinal tubules varied in thickness because of the absence of involvement of both proteoglycans. Therefore, keratan sulfate proteoglycan and dermatan sulfate proteoglycan were thought to be involved in both calcification and matrix formation.     

基于离散小波变换提取脑机接口中脑电特征

在脑机接口中，针对脑电特征提取利用单一种类信息、使用数据量大、分类性能较差等缺点，提出一种新颖的基于离散小波变换的方法。分析了小波变换特征提取的特点和特征表示方式，用Daubechies类db4小波函数对脑电信号进行6层分解，抽取小波变换各子带关键的部分逼近系数、小波系数、小波子带系数均值组成特征向量。以分类正确率为指标检验了提取特征的性能。实验结果表明，这种方法能够利用少量数据提取脑电信号本质特征，具有较高的分类性能，为利用脑电识别人的不同意图提供了快速而有效的手段。