Neurosurgical robotics: a review of brain and spine applications

Neurosurgery has traditionally been at the forefront of advancing technologies, adapting new techniques and devices successfully in an effort to increase the safety and efficacy of brain and spine surgery. Among these adaptations are surgical robotics. This paper reviews some of the more promising systems in neurosurgical robotics, including brain and spine applications in use and in development. The purpose of the discussion is twofold—to discuss the most promising models for neurosurgical applications, and to discuss some of the pitfalls of robotic neurosurgery given the unique anatomy of the brain and spine.     

重症监测治疗技术对重症手足口病患儿病情及预后的影响

目的：将重症监测治疗技术应用于重症手足口病患儿的救治,以探讨对病情及预后的影响。方法：选择自2009年1月1日-2009年9月6日24时入住我院手足口病重症病房的重症手足口病患儿492例．分析：①发病年龄．性别。（2）最高体温、皮疹、严重表现及并发症等。（3）机械通气患儿的带机时间。机械通气并发症。（4）WBC、血糖、血乳酸、心肌酶、肝功酶．胸片及病原学检查等辅助检查结果。应用重症监测治疗技术及脏器功能支持等。结果：83．7％患儿年龄在3岁以下：100％患儿发热;100％患儿口腔或手、足、臀部有皮疹。神经系统并发症表现为精神差．易惊、肢体抖动,嗜睡;呼吸系统表现为呼吸急促、浅慢,节律不规则;循环系统表现为心率增快、减慢．血压增高或降低、皮肤花斑、四肢皮温低;辅助检查：部分病例出现血WBC、AST．ALT、CK-MB和血糖、血乳酸升高,咽拭子EV71-PCR阳性率36．6％．肛拭EV71-PCR阳性率41．9％。胸片表现为肺纹理增粗。渗出或无明显异常。机械通气患儿147例。492例患儿治愈489例．死亡3例,死亡率0．61％。无1例患儿有机械通气并发症及神经系统后遗症。结论：在本次手足口病救治中。应用重症监测治疗技术对重症患儿各个脏器系统进行监测治疗,可降低死亡率．减少并发症,避免神经系统并发症。     

玻璃化冷冻不同来源卵母细胞的临床研究

目的 探讨玻璃化冷冻对卵巢刺激（ovarian stimulation,OS）和控制性超促排卵（controlled ovarian hyperstimulation,COH）来源的卵母细胞影响.方法 对OS和COH来源的卵母细胞进行玻璃化冷冻,解冻后观察存活率,继续发育潜能及移植后的妊娠率并与COH来源的新鲜卵母细胞进行比较.结果 OS和COH来源的卵母细胞玻璃化冻融后的存活率和继续发育潜能无统计学差异（P＞0.05）,与新鲜卵母细胞差异无统计学意义（P＞0.05）.COH冷冻组和OS冷冻组的妊娠率和种植率分别是25.0%（3/12）、20.8%（5/24）和33.3%（1/3）、12.5%（1/8）.结论 玻璃化冷冻技术可以应用于OS和COH来源的成熟卵母细胞的冷冻保存,对其继续发育潜能和妊娠结局无显著影响.     

男性不育的辅助生殖技术处理:潜在风险与思考

辅助生殖技术是上世纪末出现的治疗男性不育的重要手段,它在男性不育的治疗中有着不可替代的作用,但有关男性不育的辅助生殖技术处理也存在潜在风险,在男性不育的诊疗中如何规避这些潜在风险值得男性生殖健康领域的工作者思考。本文对辅助生殖技术潜在风险进行总结,同时,为提高男性不育的治疗效果,尽量减少辅助生殖技术带来的风险,提出了包括患者的评估、健康教育以及治疗等男性不育规范化处理方面的一些建议,并强调病因处理和抗氧化治疗在男性不育治疗中的重要作用。     

超声稀释法在血液透析血管通路功能评价中的初步应用

目的：探讨超声稀释法在血液透析血管通路功能评估中的临床应用价值,并观察血管通路血流量与患者心输出量的相关性。方法：选择在我院血液净化中心透析龄为3～6月的维持性血液透析患者82例,病情稳定,已排除急性活动性疾病,均采用自体动静脉内瘘作为血管通路。使用Transonic HD02型血液透析监护仪对患者的血管通路进行检测,随访期为6个月,分别监测内瘘再循环率、内瘘通路血流量及心输出量等,并观察血管通路血流量与患者心输出量的相关性。结果：（1）观察0个月,内瘘血流量平均为（994.41±434.98）ml/min,心输出量平均为（6.38±3.14）L/min;随访6个月后复测相关指标,血液透析患者的血管通路血流量和心输出量均有所下降,内瘘血流量平均为（961.19±420.92）ml/min,心输出量平均为（6.12±4.17）L/min,但观察6个月与0个月比较,无统计学差异（P〉0.05）;4例（4.88%）患者出现再循环,均大于5%。（2）观察0个月,血管通路狭窄的发生率为9.76%;观察6个月后,血管通路狭窄的发生率为26.83%,二者比较,血管通路狭窄的发生率有统计学差异（P〈0.05）。（3）血管通路血流量与心输出量呈正相关（P〈0.05）,提示患者低心输出量可能导致血管通路血流量的下降。结论：超声稀释法操作简便、非创伤侵入性、安全实用,适用于血液透析患者血管通路的功能评估,可以前瞻性监测血管通路血流动力学意义上的狭窄,具有临床应用价值。     

Correlation between Hydroxyapatite Crystallite Orientation and Ultrasonic Wave Velocities in Bovine Cortical Bone

The mineral component of bone is mainly composed of calcium phosphate, constituting 70% of total bone mass almost entirely in the form of hydroxyapatite (HAp) crystals. HAp crystals have a hexagonal system and uniaxial elastic anisotropy. The objective of this study was to investigate the effect of HAp crystallite preference on macroscopic elasticity. Ultrasonic longitudinal wave velocity and the orientation of HAp crystallites in bovine cortical bone are discussed, considering microstructure, density, and bone mineral density (BMD). Eighty cube samples of cortical bone were made from two bovine femurs. The orientation of HAp crystallites was evaluated by integrated intensity ratio of (0002) peak using an X-ray diffractometer. Ultrasonic longitudinal wave velocity was investigated with a conventional pulse system. The intensity ratio of HAp crystallites and velocity were measured in three orthogonal directions; most HAp crystallites aligned in the axial direction of the femurs. Our results demonstrate a linear correlation between velocity and intensity ratio in the axial direction. Significant correlation between velocity and BMD values was observed; however, the correlation disappeared if we focused on the identical type of microstructure. In conclusion, differences in microstructure type have an impact on density and BMD, which clearly affects the velocity. In addition, at the nanoscopic level, HAp crystallites aligned in the axial direction also affected the velocity and anisotropy.     

带蒂组织瓣转位修复手部创伤组织缺损

目的探讨手部创伤组织缺损显微外科修复方法及其效果。方法采用食指背侧岛状皮瓣、缝接指神经的背侧支指动脉逆行岛状皮瓣、邻指皮瓣、掌背动脉逆行岛状皮瓣和前臂骨间后动脉逆行皮瓣、髂腹股沟皮瓣、髂骨皮瓣及胸脐皮瓣转位修复手部创伤组织缺损197例。结果组织瓣全部成活，随访3个月至1年，指腹、指端感觉S2-pd：5～7mm，能最大限度保留和恢复手功能与外形。结论带蒂组织瓣转位修复手部创伤组织缺损，效果满意。     

Parametric uncertainty and disturbance attenuation in the suboptimal control of a non‐linear electrochemical process

The optimal control of the hydrogen evolution reactions is attempted for the regulation and change of set‐point problems, taking into account that model parameters are uncertain and I/O signals are corrupted by noise. Bilinear approximations are constructed, and their dimension eventually increased to meet accuracy requirements with respect to the trajectories of the original plant. The current approximate model is used to evaluate the optimal feedback through integration of the Hamiltonian equations. The initial value for the costate is found by solving a state‐dependent algebraic Riccati equation, and the resulting control is then suboptimal for the electrochemical process. The bilinear model allows for an optimal Kalman–Bucy filter application to reduce external noise. The filtered output is reprocessed through a non‐linear observer in order to obtain a state‐estimation as independent as possible from the bilinear model. Uncertainties on parameters are attenuated through an adaptive control strategy that exploits sensitivity functions in a novel fashion. The whole approach to this control problem can be applied to a fairly general class of non‐linear continuous systems subject to analogous stochastic perturbations. All calculations can be handled on‐line by standard ordinary differential equations integration software. Copyright © 2007 John Wiley & Sons, Ltd.     

Differential adoption of laparoscopy by treatment indication

PURPOSE: The diffusion of laparoscopic renal surgery has been gradual. While surgery for benign and malignant kidney disease is usually within the urological domain, donor nephrectomy is multidisciplinary. Therefore, we compared the use of laparoscopy by procedure indication (kidney donor, and benign and malignant kidney disease) to examine potential specialty specific associations with the slow uptake of this technology. MATERIALS AND METHODS: Data on 53,461 patients undergoing nephrectomy for all indications between 1998 and 2003 were abstracted from the Nationwide Inpatient Sample using International Classification of Diseases, 9th Revision, Clinical Modification procedure and diagnostic codes. Generalized estimating equations were fitted to measure the association between laparoscopy use and the procedure indication (kidney donor, benign kidney disease and kidney cancer). RESULTS: The use of laparoscopy varied by treatment indication. In 2003, 33% of kidney donors underwent a laparoscopic approach compared to 22% and 16% of patients with benign and malignant kidney disease, respectively (p <0.0001). After adjusting for patient and hospital differences patients with benign (adjusted OR 0.71, 95% CI 0.58-0.94) and malignant (adjusted OR 0.51, 95% CI 0.35-0.74) kidney disease were significantly less likely to undergo laparoscopic nephrectomy than kidney donors. CONCLUSIONS: These data highlight that the use of laparoscopic renal surgery varies by procedure indication with slower adoption of laparoscopy for malignant or benign indications than for donor nephrectomy. This variation was not readily explained by differences in measurable patient and hospital factors. Further characterization of provider and nonclinical characteristics may provide additional insight into differences in the adoption of this technology, which appears to be a specialty specific phenomenon.     

数字化技术辅助手术治疗 Pilon 骨折疗效分析

目的研究数字化技术辅助手术治疗 Pilon 骨折的疗效。方法选取30例 Pilon 骨折患者,随机分为 A 组和 B 组（各15例）。A 组采用数字化技术辅助手术,将患者计算机断层扫描（CT）数据导入Mimics10．01软件进行三维重建,选择合适术式行模拟复位手术,再进行手术治疗;B 组则采用传统的非数字化技术辅助手术。术后第2天,采用放射学疗效评价标准（Burwell-Charnley 标准）评估患者术后骨折复位情况;术后6个月、12个月,采用临床疗效评价标准（Olerud-Molander 主观评分标准）评估患者术后踝关节功能恢复情况。结果术后第2天,A 组解剖复位及功能复位例数多于 B 组,差异有统计学意义（P＜0．05）;术后6个月、12个月,A 组踝关节功能评分高于 B 组,差异有统计学意义（P＜0．05）。结论数字化技术辅助手术治疗 Pilon 骨折可使骨折块更好复位,术后踝关节功能恢复更好。