bFGF辅助自体脂肪颗粒注射治疗面部凹陷

目的 观察bFGF辅助自体脂肪颗粒注射面部凹陷的临床效果,寻找治疗面部凹陷的有效方法. 方法 根据入院时间将41例面部凹陷患者随机分为两组,A组2004年4月-2004年12月收治的12例.男5例,女7例;年龄16～49岁.先天性额部凹陷2例,半侧面部萎缩症2例,面部创伤后瘢痕凹陷5例,面部良性肿瘤治愈后凹陷3例.病程2～19年.凹陷部位低于周围正常皮肤(0.52±0.13)cm.凹陷面积(16.0±5.3)cm2.B组2005年1月-2006年5月收治的29例.男14例,女15例;年龄18～52岁.先天性额部凹陷3例,半侧面部萎缩症4例,面部创伤后瘢痕凹陷15例,面部良性肿瘤治愈后凹陷7例.病程2～20年.凹陷部位低于周围正常皮肤(0.58±0.15)cm,凹陷面积(18.0±6.2)cm2.A组采用单纯自体脂肪颗粒注射治疗,B组在A组基础上同时应用bFGF(4 200 IU/10 mL)辅助治疗. 结果 注射后A组获随访6～24个月,平均12.5个月;B组获随访6～24个月,平均13个月.A组1次注射后6例效果满意,～次治疗满意率为50%;余6例于术后6～12个月再次注射,其中2次注射3例,3次注射3例.B组1次注射后24例效果满意,1次治疗满意率为82.8%;5例患者于术后12个月再次注射.两组患者的1次治疗满意率比较,差异有统计学意义(P＜0.05). 结论 面部凹陷是创伤或整形术后常见的并发症,采用bFGF辅助自体脂肪颗粒注射治疗面部凹陷安全有效.     

棉织布与无纺布尘埃粒子数及抗渗液性能比较研究

目的比较棉织布与无纺布制作的手术衣和手术洞巾等在手术铺巾时空气中的尘埃粒子数及术中抗渗液性能，为有效控制外科切口感染和预防医患交叉感染提供参考。方法将棉织布与无纺布制作的手术布类各备15包，包内内容均相同，经灭菌处理。应用尘埃粒子计数仪测定两组铺巾时、铺巾后及收巾时空气中的尘埃粒子数，同时在手术过程中观察其抗渗液性能。结果无纺布组在铺巾时、铺巾后及收巾时产生的尘埃粒子数显著少于棉织布组（P〈0．05，P〈0．01）；其抗渗液率为100％，而棉织布组为0。结论无纺布抗渗液性能优，可减少手术环境中的尘埃粒子数，从而控制外科切口感染；其阻隔防护效能对患者和医护人员具有双重保护作用。     

Proton Therapy for Skull Base Chordomas: An Outcome Study from the University of Florida Proton Therapy Institute

Objectives Skull base chordoma is a rare, locally aggressive tumor located adjacent to critical structures. Gross total resection is difficult to achieve, and proton therapy has the conformal advantage of delivering a high postoperative dose to the tumor bed. We present our experience using proton therapy to treat 33 patients with skull base chordomas. Design Retrospective outcomes study. Setting University of Florida Proton Therapy Institute; 2007 to 2011. Participants A total of 33 patients with skull base chordomas received postoperative three-dimensional conformal proton therapy. The patients were 79% male and 6% diabetic; 27% had received a gross total resection. Main Outcome Measures The gross tumor/tumor bed received a dose between 77.4 CGE and 79.4 CGE. Local control and overall survival were tracked, and radiation toxicity was assessed using a modified Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme. Results Median follow-up for all patients was 21 months. Local control and overall survival rates at 2 years were 86% and 92%, respectively. Grade 2 toxicity was observed in 18% of our cohort in the form of unilateral hearing loss partially corrected with a hearing aid. No grade 2 or higher optic or brainstem toxicities were observed. Conclusions Proton therapy is an effective treatment modality for skull base chordomas.     

免疫介导坏死性肌病的临床和病理特征分析

目的 比较不同肌炎特异性自身抗体(myositis specific antibodies,MSAs)类型的免疫介导坏死性肌病(immune-mediated necrotizing myopathies,IMNM)的临床和病理特征。方法 从中日友好医院2008—2018年住院期间所有行肌肉活检的特发性炎性肌病患者中选取符合以下任一条件的IMNM患者104例:(1)抗信号识别颗粒(signal recognition particle,SRP)抗体阳性;(2)抗3-羟基-3-甲基戊二酰辅酶A 还原酶(3-hydroxy-3-methylglutaryl-coenzyme A reductase,HMGCR)抗体阳性;(3)血清MSAs阴性且病理符合2004年欧洲神经肌肉病中心定义的IMNM病理诊断标准。回顾性收集患者的临床、实验室检查和肌肉病理等信息,比较各组临床及病理特征的差异。结果 所有104例IMNM患者中,肌无力(92.3%)、肌酸激酶升高(92.3%)是IMNM的最常见临床表现,此外,33.7%的IMNM患者合并吞咽困难,46.5%的患者合并间质性肺病(interstitial lung diseases,ILD)。抗HMGCR阳性患者较抗SRP阳性和MSAs阴性患者更容易出现V形疹(30.4% vs. 4.3%和5.9%,P<0.01),抗SRP阳性患者合并ILD发生率高于抗HMGCR阳性和MSAs阴性患者(64.4% vs. 34.8%和29.0%,P<0.01),MSAs阴性患者合并其他结缔组织病更多见(32.4% vs. 8.5%和4.3%,P<0.01)。3组IMNM患者肌肉病理中均可见肌细胞坏死(94.2%)、吞噬(65.4%)和再生(67.3%),肌细胞膜表达主要组织相容性复合物-Ⅰ分子上调(78.8%),肌内膜CD4 ⁺T细胞(68.3%)和CD68 ⁺巨噬细胞(65.7%)浸润。结论 抗SRP抗体阳性、抗HMGCR抗体阳性和MSAs阴性的IMNM患者存在异质性,在临床上开展MSAs检测和肌肉病理检查对区分不同类型的IMNM有指导价值。     

基于梯度矢量流与粒子群优化算法的多模态医学图像配准

目的研究用梯度矢量流与粒子群优化算法实现多模态医学图像配准,提高配准的精度。方法算法对图像配准的特征空间、相似性测度、搜索策略3个方面进行改进：先由原始图像产生梯度矢量流场,作为配准的特征空间;然后提出并计算3种基于梯度矢量流场的相似性测度;最后使用结合了遗传算法交叉机制的粒子群优化算法找到两幅图像的最优变换。结果对仿真及实际医学图像的54次配准实验,表明该方法配准精度优于基于像素的粒子群优化方法和Walsh变换法。结论基于梯度矢量流与粒子群优化算法的图像配准方法能有效地实现多模态医学图像的配准。     

In situ reprogramming to transdifferentiate fibroblasts into cardiomyocytes using adenoviral vectors: Implications for clinical myocardial regeneration

Objective

The reprogramming of cardiac fibroblasts into induced cardiomyocyte-like cells improves ventricular function in myocardial infarction models. Only integrating persistent expression vectors have thus far been used to induce reprogramming, potentially limiting its clinical applicability. We therefore tested the reprogramming potential of nonintegrating, acute expression adenoviral (Ad) vectors.

125I粒子条联合胆道支架植入治疗恶性梗阻性黄疸22例疗效分析

目的研究和探讨125I粒子条联合胆道支架植入治疗恶性梗阻性黄疸的临床疗效。方法2011年6月—2013年9月收治恶性梗阻性黄疸患者40例。行胆道支架植入术治疗患者18例,为对照组;采用125I粒子条联合胆道支架植入患者22例,为观察组。两组均采用经皮肝穿刺胆道引流(PTCD)并胆道支架植入。结果观察组与对照组的平均胆道开通时间分别为(8.7±0.7)和(6.2±0.4)个月,两组比较差异有统计学意义(P<0.05)。观察组与对照组术后平均生存时间分别为(11.4±0.8)和(8.7±0.5)个月,生存时间的差异有统计学意义(P<0.05)。术后近期疗效及并发症两组之间的比较无明显差异(P>0.05),但是远期疗效有显著差异(P<0.05)。结论与对照组相比,观察组的术后生存时间及胆道开通时间明显延长,对于125I粒子条联合支架治疗恶性梗阻性黄疸值得进一步临床研究。     

Experimental and Numerical Investigation of an Axial Rotary Blood Pump

Left ventricular assist devices (LVADs) have become a standard therapy for patients with severe heart failure. As low blood trauma in LVADs is important for a good clinical outcome, the assessment of the fluid loads inside the pump is critical. More specifically, the flow features on the surfaces where the interaction between blood and artificial material happens is of great importance. Therefore, experimental data for the near‐wall flows in an axial rotary blood pump were collected and directly compared to computational fluid dynamic results. For this, the flow fields based on unsteady Reynolds‐averaged Navier–Stokes simulations‐computational fluid dynamics (URANS‐CFD) of an axial rotary blood pump were calculated and compared with experimental flow data at one typical state of operation in an enlarged model of the pump. The focus was set on the assessment of wall shear stresses (WSS) at the housing wall and rotor gap region by means of the wall‐particle image velocimetry technique, and the visualization of near‐wall flow structures on the inner pump surfaces by a paint erosion method. Additionally, maximum WSS and tip leakage volume flows were measured for 13 different states of operation. Good agreement between CFD and experimental data was found, which includes the location, magnitude, and direction of the maximum and minimum WSS and the presence of recirculation zones on the pump stators. The maximum WSS increased linearly with pressure head. They occurred at the upstream third of the impeller blades and exceeded the critical values with respect to hemolysis. Regions of very high shear stresses and recirculation zones could be identified and were in good agreement with simulations. URANS‐CFD, which is often used for pump performance and blood damage prediction, seems to be, therefore, a valid tool for the assessment of flow fields in axial rotary blood pumps. The magnitude of maximum WSS could be confirmed and were in the order of several hundred Pascal.     

Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment

Objectives: To identify patients with benign paroxysmal positional vertigo (BPPV) among patients with severe traumatic brain injury (TBI) and to evaluate the effectiveness of the Particle Repositioning Maneouvre (PRM).

Design and methods: Eighteen months prospective study of 150 consecutive patients with severe TBI referred to an in-patients rehabilitation department.

Interventions: A structured interview emphasizing the possible presence of vertigo followed by a detailed neuro-otological examination. Patients diagnosed with BPPV were immediately treated with the PRM.

Main outcomes and results: BPPV diagnosis was based on a positive Dix-Hallpike positional test. PRM efficacy was determined by repeating the positional test 1 or 2 weeks after treatment. Twenty out of 150 (13.3%) patients complained about positional vertigo. The diagnosis of BPPV was confirmed in 10 patients. Signs and symptoms were completely relieved in six patients after a single PRM, while the other four patients needed repeated treatment for complete resolution of BPPV.

Conclusions: About half of the patients with severe TBI who complain about positional vertigo suffer from BPPV. These patients can be efficiently treated by physical maneouvres improving the rehabilitation outcome.     

改进的PSO算法在重油热解模型参数估计中的应用

针对传统的粒子群算法(PSO)在解决复杂的优化问题时易陷入局部最优这一情况,提出了一种改进的粒子群算法(EPSO),该算法在传统的粒子群算法陷入局部最优的情况下引入了单个粒子的"Hooke-Jeeves模式搜索"操作和粒子之间的"启发式交叉"操作。仿真结果表明:EPSO算法的全局搜索性能和收敛速度比传统的PSO算法有明显的提高。采用EPSO算法进行非线性参数估计所得到的重油热解模型,其预报的平均相对误差比传统的PSO算法得到的模型提高了11.98%,比遗传算法(GA)得到的模型提高了38.76%。