微量元素锌对汞暴露大鼠学习记忆的影响

 目的探讨微量元素锌对汞暴露大鼠神经系统高级功能的影响.方法应用Y形迷宫试验作为学习记忆的监测标准,比较汞暴露大鼠、兼汞及锌暴露大鼠和对照组的学习记忆能力的差别.结果汞暴露大鼠学习记忆能力与对照组比较明显降低(P＜0.05),而同时暴露汞和锌两种元素的大鼠学习记忆能力较单独汞暴露大鼠有所提高,且较高剂量锌暴露组效果更加明显(P＜0.05).结论给与动物一定剂量的锌元素可以拮抗汞对神经系统高级功能的损害,为锌对中枢神经的保护性作用提供了依据.     

局麻下经皮肾碎石术对高危肾结石患者的疗效与安全性探讨

目的：探讨B超引导局麻下经皮肾取石对高危。肾结石患者的疗效与安全性。方法：依据术前美国麻醉医师协会（ASA）评分,将91例行局麻下经皮肾镜取石术肾结石患者分为高危组（ASAUI或Ⅳ）23例和低危组（ASAI或11）68例,所有患者均运用微通道（F18）PCNL钬激光碎石术。记录并比较两组年龄、体质指数、合并疾病数量、结石平均体积、手术时间、术中出血量、结石清除率、平均术后住院时间及手术并发症。结果：高危组与低危组的平均年龄[（56．0士12．3）、（52．0±11．6）岁]、体质指数[（29．2土4．5）、（28．5±4．8）]、结石总体积[（3．12±1．13）、（3．27土1．45）cm^3]、术中平均估计失血量[（126±20）、（112±23）m1]、手术时间[（57±25）、（62±28）min]及主要并发症发生率（12．7％、13．5％）之间差异均无统计学意义（P〉0．05）。高危组与低危组在平均合并疾病数量[（4．7±1．8）、（1．4±0．7）]、平均术后住院天数[（8．5土3．7）、（6．2±2．3）d]、结石清除率（72．5％、91．3％）之间差异有统计学意义（P〈O．05）。结论：局麻下经皮肾取石对高危肾结石患者同样安全可行。     

Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study

BackgroundHypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated.ObjectiveTo evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality.MethodsWe carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period.ResultsMovement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input–output recruitment were similar.ConclusionsThis pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.     

微波辐射对小鼠联合型学习记忆功能及海马组织结构的影响

目的 探讨微波辐射对联合型学习记忆功能及海马组织结构的影响。方法 将小鼠按随机数表法分为假辐射组和微波辐射组,各27只。采用2.856 GHz、8 mW/cm²微波辐射C57BL/6N小鼠15 min,建立微波辐射动物模型。采用Morris水迷宫和穿梭箱行为学实验,研究微波辐射对小鼠空间学习记忆和联合型学习记忆功能的影响。观察海马组织病理学变化,研究微波辐射后海马组织超微结构改变。结果 Morris水迷宫结果表明,微波辐射后小鼠反向空间探索实验跨越平台次数减少,由(3.60±0.79)次降至(2.55±0.47)次(t = 2.21,P= 0.046);穿梭箱实验结果表明,辐射后小鼠平均主动逃避率显著下降(t = 2.70,P<0.05),平均主动潜伏期和总电击时间显著延长(t = -3.09、-3.02,P < 0.05)。辐射后8 d,海马CA3和DG区部分神经元核固缩,海马CA3区神经元凋亡、突触间隙模糊、胶质细胞肿胀、血管周隙增宽。结论 微波辐射可引起小鼠空间参考记忆能力及联合型学习记忆能力下降,海马组织形态学病理改变是其功能障碍的结构基础。     

Prediction of the response to photodynamic therapy in patients with chronic central serous chorioretinopathy based on optical coherence tomography using deep learning

PurposeTo assess the prediction of the response to photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSCR) based on spectral-domain optical coherence tomography (SD-OCT) images using deep learning (DL).MethodsRetrospective study including 216 eyes of 175 patients with CSCR and persistent subretinal fluid (SRF) who underwent half-fluence PDT. SD-OCT macular examination was performed before (baseline) and 3 months after treatment. Patients were classified into groups by experts based on the response to PDT: Group 1, complete SRF resorption (n = 100); Group 2, partial SRF resorption (n = 66); and Group 3, absence of any SRF resorption (n = 50). This work proposes different computational approaches: 1st approach compares all groups; 2nd compares groups 1 vs. 2 and 3 together; 3rd compares groups 2 vs. 3.ResultsThe mean age was 55.6 ± 10.9 years and 70.3% were males. In the first approach, the algorithm showed a precision of up to 57% to detect the response to treatment in group 1 based on the initial scan, with a mean average accuracy of 0.529 ± 0.035. In the second model, the mean accuracy was higher (0.670 ± 0.046). In the third approach, the algorithm showed a precision of 0.74 ± 0.12 to detect the response to treatment in group 2 (partial SRF resolution) and 0.69 ± 0.15 in group 3 (absence of SRF resolution).ConclusionDespite the high clinical variability in the response of chronic CSCR to PDT, this DL algorithm offers an objective and promising tool to predict the response to PDT treatment in clinical practice.     

Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function

Background

While radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes.

Objective

Demonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP).

Design, setting, and participants

We performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction.

Surgical procedure

Our approach to RARP has been described previously. A single-console robotic system was used for all cases.

Outcome measurements and statistical analysis

Expanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function.

Results and limitations

Greater surgeon experience was associated with better 5-mo sexual function (p = 0.007) and a trend for better 12-mo sexual function (p = 0.061), with improvement plateauing after 250–300 cases. Additionally, younger patient age (both p < 0.02) and better preoperative sexual function (<0.001) were associated with better 5- and 12-mo sexual function. Moreover, trainee robotic console time during nerve sparing was associated with worse 12-mo sexual function (p = 0.021), while unilateral nerve sparing/non–nerve sparing was associated with worse 5-mo sexual function (p = 0.009). Limitations include the retrospective single-surgeon design.

Conclusions

With greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement.     

全胸腔镜房间隔室间隔缺损修补手术学习曲线

目的 总结全胸腔镜下心脏手术的学习曲线.方法 回顾性收集2004年10月至2010年1月由同一术者连续完成的125例全胸腔镜下房间隔缺损、室间隔缺损修补手术病例资料,按手术先后顺序分为A、B、C、D、E5组,每组25例,从各组手术时间、体外循环时间、主动脉阻断时间、中转开胸率及手术并发症等指标比较手术效果.结果 各组病例年龄、性别、体重、病种及手术方式差异无统计学意义(P＞0.05).手术时间、体外循环时间、主动脉阻断时间3项指标A、B组明显长于C、D、E组(P＜0.05),A、B两组间差异无统计学意义(P＞0.05),C、D、E3组之间差异亦无统计学意义(P＞0.05).各组中转开胸率及手术并发症发生率比较差异均无统计学意义(P＞0.05).结论 全胸腔镜房间隔、室间隔缺损修补术的学习曲线约为50例.     

限制单孔腹腔镜技术发展的因素分析

经脐单孔腹腔镜技术不但具有传统腹腔镜手术的优点,还有手术瘢痕隐蔽、手术标本更易于取出等优势,近几年在微创手术领域发展迅速。但是由于手术操作难度较大,特殊学习曲线以及手术适应证等原因导致该手术方式并未广泛应用于临床,本文从医生的观念、手术操作的瓶颈、学习曲线和设备条件、手术适应证的限制、手术潜在的隐患等限制单孔腹腔镜全面开展的因素进行阐述与探讨。     

基于翻转课堂理念的《中药学》混合式教学模式初探

目的:探讨基于翻转课堂理念的《中药学》混合式教学模式的应用及成效。方法将学生随机分为甲、乙两组,分别采用翻转课堂的混合教学模式与传统教学模式,比较两种模式对学生平均成绩及教学满意度的影响。结果甲组单元测试总成绩及客观题成绩、形成性评价总成绩及课堂抢答、讨论发言成绩、综合性平均成绩及各分数段人数变化均明显高于乙组(P<0.05或P<0.01);两组间的满意度差异极显著(P<0.01)。结论基于翻转课堂理念的的混合教学模式确实能极大地发挥学生在学习过程中的主体地位,提升教学效果。可为今后的深入探索提供借鉴。     

基于深度学习的用户健康词表构建方法研究

对基于深度学习的用户健康词表构建方法进行系统探索,阐述实验工具、过程及结果,对利用深度学习方法构建用户健康词表的适用性、结果影响因素进行探讨,指出该方法具有较高适用性但尚待提高应用成熟度。