肠造口的规范化实施及造口旁疝的预防策略

肠造口在肠道良恶性疾病治疗和创伤救治中发挥重要作用,其规范化实施是减少造口并发症、提高造口病人生活质量的关键。外科医师首先要建立肠造口是肠道与皮肤吻合口的概念,术前应由外科医师、造口治疗师、病人及家属共同选择造口部位。应采取个体化危险因素评估以决定是否行预防性造口。规范化操作包括：合理选择造口部位、腹部切口大小、腹壁通道宽度以及造口外置高度,良好缝合造口肠管与腹壁各层组织等。造口旁疝是最常见的造口远期并发症。女性、肥胖、糖尿病等是造口旁疝常见的危险因素,多项研究结果表明,腹膜外造口和预防性补片置入能降低造口旁疝发生率。     

数据库研究第五部分:结直肠癌的肿瘤特征

目的分析目前版本的华西肠癌数据库(Database from Colorectal Cancer,DACCA)中有关结直肠癌数据所具有的肿瘤特征。方法本次数据分析选取的DACCA版本为2019年9月26日更新版,其中数据项目包括:手术日期、癌前病变、癌家族史、肿瘤部位、缘距、肿瘤形态、大小、方位、发生、分化、肿瘤病理、Ki-67指数及并发症(梗阻、套叠、穿孔、疼痛、水肿和出血),分别对各选取的数据项目作特征分析。结果按照条件筛选DACCA数据库获得11 898条可分析数据行。11 898条数据中,癌前病变有效数据为1 275条,提示结直肠癌患者有癌前病变的数据为541条(42.4%),没有癌前病变的数据734条(57.6%)。癌家族史有效数据为1 116条,有癌家族史的数据为761条(6.4%)。Ki-67指数有效数据共计1 893条,为0~95%、(59.0±20.1)%。根据"肿瘤发生"的类型划分后,原发性的结直肠癌占绝大多数(92.8%),转移性的结直肠癌最少(0.3%)。按原发性和多原发分别对肿瘤部位、缘距、肿瘤形态、大小、方位、分化和肿瘤病理进行分析,结果显示,肿瘤部位大多都在直肠(76.9%和41.9%),形态中最常见的都为溃疡型(42.4%和51.5%),肿瘤方位为一圈者居多(44.6%和35.0%),分化程度多为中分化(65.4%和61.3%),肿瘤病理大多都为腺癌(77.8%和64.0%)。结论通过DACCA数据库对结直肠癌的肿瘤特征进行更精确细致的分析,有利于在临床工作中确定诊疗计划、判断预后等。     

El problema de la estadificación axilar en el cáncer de mama tras quimioterapia neoadyuvante. Papel de la disección axilar dirigida y tipos de marcadores ganglionares

Targeted axillary dissection (TAD) consists of a new axillary staging technique that combines sentinel lymph node biopsy (SLNB) and clipped lymph node biopsy (CLNB) in the same surgery, in order to re-stage patients with breast cancer and positive axillary lymph nodes undergoing neoadjuvant chemotherapy (NAQT). Prior to the NAQT, the affected lymph node is punctured and a solid marker is left inside echo-guided, in order to biopsy it in the subsequent surgery. There are numerous types of markers: metallic (steel, titanium or polyglycolic acid clips), radioiodine or ferromagnetic seeds, which differ in the method of location (wire, gamma-detection or magnetic probe). The aim of this study is to perform a systematic review about the current status of the TAD, as well as to explain the different techniques and types of axillary marking, based on the current available evidence.     

沼泽红假单胞菌生物转化丹参醇提物转化酶初步定域

目的比较丹参醇提物经沼泽红假单胞菌以及其各细胞部位转化后化学成分的变化,对其转化酶在细胞部位水平上进行初步定域。方法利用沼泽红假单胞菌各细胞部位分别对丹参醇提物进行生物转化,高效液相色谱法(HPLC)分析转化前后主要化学成分的变化,用主成分分析法(PCA)对转化后变化程度进行评估。结果经不同细胞部位转化后,丹参醇提物的化学成分均发生变化。与对照比较,经细胞质、细胞膜化转后化学成分改变最大,表明细胞质、细胞膜含转化酶更多。结论沼泽红假单胞菌对丹参醇提物转化酶主要分布于细胞质、细胞膜上。     

基于YCbCr颜色空间相邻帧差建模的眼睛定位算法研究

目的：研究一种基于YCbCr相邻帧差法检测头部运动及眼睛位移、定位眼睛位置的算法,使之能在基于眼睛状态的疲劳驾驶监测中真正发挥作用。方法：利用YCbCr颜色空间改进相邻帧差法,并依据相邻帧差法对运动物体检测的原理,建立眼睛位移检测的模型。运用该模型检测出后一帧相对于前一帧的眼睛位移量,参照前一帧眼睛所在的矩形区域,框选出后一帧图像中眼睛的候选区域,再利用形态学方法处理,最终得到后一帧图像眼睛的精确矩形区域。结果：本算法的眼睛定位处理速度为14帧/s,较传统眼睛定位算法的9帧/s提升了55%,能确保实时检测到人眨眼瞬间（0.2～0.4 s）的时间间隙,且正确率与传统眼睛定位算法相当。结论：本研究的眼睛定位算法大幅提高了眼睛检测算法的速度,能确保实时检测到人眨眼瞬间（0.20.4 s）的时间间隙,提高疲劳监测指标PERCLOS的检测准确性。     

Effects of a WLAN-based real time location system on outpatient contentment in a Level I trauma center

BackgroundPre-existing wireless local area network (WLAN) infrastructures enable the implementation of a real-time location system (RTLS) in the clinical setting. RTLS enable clinics to capture and process patient position data and link it with clinical data. The improvements in workflow and treatment brought about by RTLS may improve patient satisfaction. The aim of this study was to analyze the impact of a WLAN-based RTLS on outpatient satisfaction in our Level I trauma center.MethodsThis investigation was performed under different study arms (termed “phase”): In phase 0, patient satisfaction was determined (with a questionnaire) without RTLS implementation. In phase I, patient tracking with RTLS was performed, and satisfaction was determined (with a questionnaire); however, medical personnel did not utilize information gathered by RTLS. In phase II, patients were tracked by RTLS and satisfaction was determined (with a questionnaire); however, unlike phase I, the RTLS-acquired data was utilized by medical personnel. Information obtained from the questionnaire included: treatment rendered, subjective estimation of length of visit, subjective estimation of the most time-consuming portions of the clinic visit, subjective estimation of time of medical treatment, overall contentment, and contentment with wait time. In phase I and phase II, position data was automatically collected and analyzed. Statistical analyses were performed using Student's t-test and one-way Anova test. Significance level was set at 0.05.Results and discussionIn total, 1234 patients were included in our study (188 in phase 0, 540 in phase I, and 506 in phase II). Completed questionnaires were collected in 53% (654) of the patients. Statistically significant higher patient contentment and lower subjective wait times were noted in phase II patients as compared to phase I patients. However, no statistical differences in the questionnaire findings were noted between phase 0 and I patients.ConclusionsWLAN-based RTLS can help alleviate process inefficiencies associated with traditional clinic workflow methods, which can lead to improved patient satisfaction.     

眶上神经、血管主干的坐标定位

目的:为临床上手术去除眉间皱纹时防止眶上神经、血管的损伤提供解剖学依据.方法:逐层解剖防腐固定的尸体头部标本,建立相关坐标体系,得出眶上神经内侧支、眶上神经外侧支、眶上动脉主干的体表定位坐标参数,制作出走行范围轨迹.结果:以经过两侧眉弓最高点的水平线为X轴,以经过前正中线的垂直线为Y轴,建立坐标体系,得出在额部左侧面(坐标轴右侧)由(25.14±1.24,10) mm、(25.14±1.24,-10)mm、(28.16±1.23,10) mm、(28.16±1.23,-10)mm4点连线所围成的矩形区域以及在额部右侧面(坐标轴左侧)由(-24.31±2.67,10)mm、(-24.31±2.67,-7.5)mm、(-26.98±1.27,10)mm、(-26.98±1.27,-7.5)mm4点连线所围成的矩形区域为最容易损伤眶上神经、眶上动脉主干的“危险区”.结论:在额眉部有易损伤眶上神经、血管的危险区,临床上在进行额眉部手术时,应尽量保护此区域,尽量减小对眶上神经、眶上动脉的损伤.     

Determination of the Location of the Mental Foramen: A Critical Review

Introduction

The mental foramen (MF) is an important landmark to consider during surgical endodontic procedures. The purpose of this review article was to discuss the variety of techniques that have been developed to determine the location of the MF, to make recommendations for the current best technique available, and to discuss upcoming technologies.

Methods

Articles that have addressed the location of the MF were evaluated for information pertinent to include in this review.

Results

Different technologies have been used to help operators determine the clinical location of the MF. Most of the techniques have shortcomings such as magnification, radiation, and cost. Cone-beam computed tomographic imaging is the best current available imaging technology to determine the accurate location of the MF, but it has shortcomings such as radiation, cost, and not being real time, which means the data must be interpreted at a later time than when the information was computed.

Conclusions

In the future, magnetic resonance imaging and ultrasound technologies seem to provide promising noninvasive imaging techniques.     

基于CBCT的牙槽突裂植骨的三维定量研究

目的：应用锥形束CT（CBCT）对牙槽突裂植骨术后进行三维结构定量分析并探讨牙槽裂移植骨吸收的特点。方法：35例患者均在术后1周、1月、3月、6月、12月进行CBCT扫描,对牙槽突裂移植骨体积三维方向分割测量,并计算移植骨量比率。结果：移植骨量比率在牙槽嵴顶,鼻底以及腭侧部位减少较为明显。骨吸收主要发生在术后3月,术后6月基本稳定。结论：CBCT及其相关软件分析可对移植骨的三维结构进行精确的定位定量分析。     

上颈部囊性病变的MRI分析

目的:探讨MRI检查在上颈部囊性病变中的诊断价值。方法:36例上颈部囊性肿物,术前行穿刺检查和MRI检查以明确囊液性质、嚢肿范围、来源及信号强度。根据囊液性质及MRI检查特点,决定手术方法,术后病理确诊。结果:穿刺囊液为蛋清样黏液23例,为淡黄色水样液体6例,为灰色脓汁样液体5例。另有2例患者不配合未能行穿刺检查。MRI检查T1低信号、T2高信号且囊肿有"尾状征"与口底关系密切者25例,诊断为潜突型舌下腺囊肿,采用口内入路摘除舌下腺,其余11例采用颈部入路。术后病理证实潜突型舌下腺囊肿25例,淋巴管瘤6例,鳃裂囊肿5例。所有术后病理确诊与术前诊断相符,随访3³6月,未见有患者复发。结论:上颈部囊性病变术前MRI检查,有助于术前明确诊断,以正确指导手术,避免盲目颈部探查手术。