镍钛形状记忆接骨器促进骨折愈合实验研究

目的：对比镍钛记忆合金接骨器（Swan-like memory-compression connector,SMC）与加压接骨板（compression plate,CP）固定下骨折愈合过程的血管形成，探讨SMC内固定下骨折愈合血管形成的特点。方法：25只家犬两侧股骨中段横形截骨，左侧以SMC、右侧以CP固定，术后2、4、8周行X线摄片、光镜、电镜观察。结果SMC组骨折部位血管长入时间明显提前，血管数量较丰富、发育程度优于CP组，8周时SMC组即可见完整血管内壁，内皮细胞发育成熟。结论：与CP相比，SMC组骨折端血管长入的时间较早，保证骨折愈合所需营养成分的供给，有利于促进骨折愈合。     

镍钛形状记忆合金蟹爪式聚髌器的研制及生物力学研究

目的　研究一种治疗髌骨骨折的新的内固定方法。　方法　根据国人髌骨的统计数据 ,采用镍钛形状记忆合金制做蟹爪式聚髌器 ,并进行生物力学研究。　结果　对髌骨横行骨折 ,蟹爪式聚髌器的固定作用明显优于改良张力带钢丝固定 (P <0 .0 0 1) ;对髌骨粉碎性骨折 ,聚髌器的固定作用亦明显优于环形钢丝固定 (P <0 .0 0 1)。　结论　蟹爪式聚髌器设计符合髌骨的解剖和生物力学特点 ,其对髌骨骨折的固定强度可满足临床应用之需要。     

Current strategies for the restoration of adequate lordosis during lumbar fusion

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.     

隆鼻术中扁圆形前鼻孔的联合治疗

目的 探讨隆鼻术中扁圆形前鼻孔塑形的手术方式。方法 2014年12月至2015年5月,对57例先天性鼻孔扁圆横向者,采集术前术后数字图像并测量数据。从鼻外切口入路,通过采用两侧大翼软骨拉拢缝合、鼻小柱-上唇皮瓣推进法、自体软骨/假体植入等,达到全鼻形态的综合塑形。结果 所有患者切口一期愈合,鼻孔方向和角度明显改善,术后效果满意。术后随访6~12个月,可见切口瘢痕隐蔽,鼻孔形态无复发,无并发症出现。结论 通过两侧大翼软骨拉拢缝合、鼻小柱-上唇皮瓣推进,可有效调整鼻孔形态。     

Tocilizumab controls bone turnover in early polymyalgia rheumatica

ObjectivesThis study explores changes in the bone homeostasis by testing the N-terminal collagen type I extension propeptide (PINP) marker for osteo-formation and the carboxy-terminal region of collagen type I (CTX-I) marker for osteo-resorption in patients taking tocilizumab for polymyalgia rheumatica (PMR).MethodsTwenty patients were included in the prospective open-label TENOR study (Clinicaltrials.gov NCT01713842) and received three monthly tocilizumab infusions, followed by corticosteroids starting at week (W) 12. PINP and CTX-I were tested at inclusion (W0), after tocilizumab but before steroid initiation (W12), at the end of the protocol (W24) and were compared to healthy controls. Information regarding disease activity, bone mineral density using scanographic bone attenuation correlation (SBAC), inflammatory parameters and interleukin (IL)-6 levels were collected during the follow-up of the patients.ResultsPMR patients were characterised by a reduction in bone mineral density and a higher level of CTX-I relative to healthy controls matched in age and sex at baseline. PINP levels increased at W12 (P < 0.001, versus W0) following tocilizumab introduction and CTX-I levels decreased at W24 and after steroid initiation (P = 0.001, versus W0). Such modifications explain the altered correlation observed between PINP and CTX-I at W0 (r = 0.255 at W0 versus r = 0.641 in healthy controls) and its correction after treatment (r = 0.760 at W12 and r = 0.767 at W24). Finally, greater changes in PINP were observed in patients whose circulating IL-6 levels decreased after tocilizumab therapy.ConclusionsControl of bone turnover, in part through the inhibition of the IL-6 axis, is observed during tocilizumab and subsequent steroid treatment of PMR.     

Diffusion-weighted MRI and PET/CT reproducibility in epithelial ovarian cancers during neoadjuvant chemotherapy

PurposeTo investigate the reproducibility of diffusion-weighted (DW) MRI and ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG)-Positron emission tomography/CT (PET/CT) in monitoring response to neoadjuvant chemotherapy in epithelial ovarian cancer.Materials and methodsTen women (median age, 67 years; range: 41.8–77.3 years) with stage IIIC-IV epithelial ovarian cancers were included in this prospective trial (NCT02792959) between 2014 and 2016. All underwent initial laparoscopic staging, four cycles of carboplatine-paclitaxel-based chemotherapy and interval debulking surgery. PET/CT and DW-MRI were performed at baseline (C0), after one cycle (C1) and before surgery (C4). Two nuclear physicians and two radiologists assessed five anatomic sites for the presence of ≥ 1 lesion. Target lesions in each site were defined and their apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV-max), SUV-mean, SUL-peak, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were monitored (i.e., 10 patients × 5 sites × 3 time-points). Their relative early and late changes were calculated. Intra/inter-observer reproducibilities of qualitative and quantitative analysis were estimated with Kappa and intra-class correlation coefficients (ICCs).ResultsFor both modalities, inter- and intra-observer agreement percentages were excellent for initial staging but declined later for DW-MRI, leading to lower Kappa values for inter- and intra-observer variability (0.949 and 1 at C0, vs. 0.633 and 0.643 at C4, respectively) while Kappa values remained > 0.8 for PET/CT. Inter- and intra-observer ICCs were > 0.75 for SUV-max, SUL-peak, SUV-mean and their change regardless the time-point. ADC showed lower ICCs (range: 0.013–0.811). ANOVA found significant influences of the evaluation time, the measurement used (ADC, SUV-max, SUV-mean, SUV-max, SUL-peak, MTV or TLG) and their interaction on ICC values (P = 0.0023, P< 0.0001 and P =0.0028, respectively).ConclusionWhile both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy.     

新医改前后四川省卫生资源配置的公平性分析

目的 探讨四川省卫生资源配置的公平性现状,为进一步优化卫生资源配置提供科学的参考依据.方法 运用基尼系数和泰尔指数分析评价2008年和2013年四川省卫生资源的公平性.结果 卫生资源按人口配置的公平性很好,按地理配置高度不公平,人口分布的公平性优于地理分布的公平性;区域间差异是影响卫生资源配置不公平的主要因素;护士配置公平性低于医生的公平性.结论 优化卫生投入结构,调整卫生资源存量;完善区域卫生规划,注重卫生资源配置的地理公平性;加快卫生人才队伍的建设步伐,优化医护结构.     

3.0T MRI水通道蛋白分子成像定量参数对胰腺癌的诊断价值研究

目的探讨3.0T MRI水通道蛋白分子成像定量参数对胰腺癌的诊断价值。方法选取2017年9月～2018年10月我院收治的胰腺癌患者35例作为研究对象。采用GE Discovery MR75 3.0T磁共振扫描仪检测患者肿瘤组织和非肿瘤组织的水通道蛋白扩散系数(ADC_(AQPs))、纯扩散系数(ADC_(slow))和分布扩散系数(DDC),比较肿瘤组织和非肿瘤组织各参数差异及各参数对不同组织的鉴别能力。结果肿瘤组织的ADC_(AQPs)和ADC_(slow)参数值显著高于非肿瘤组织,DDC值显著低于非肿瘤组织,差异有统计学意义(P0.05);与ADC_(slow)和DDC比较,ADC_(AQPs)参数对肿瘤组织和非肿瘤组织的鉴别能力最高;在胰腺癌组织中,ADC_(AQPs)值和ADC_(slow)值呈正相关,和DDC值呈负相关。结论 ADC_(AQPs)是鉴别胰腺癌组织和非胰腺癌组织的最佳参数,3.0T MRI水通道蛋白分子成像可做为早期胰腺癌无创诊断的首选方法。     

Morphological imaging and CT histogram analysis to differentiate pancreatic neuroendocrine tumor grade 3 from neuroendocrine carcinoma

PurposeTo compare morphological imaging features and CT texture histogram parameters between grade 3 pancreatic neuroendocrine tumors (G3-NET) and neuroendocrine carcinomas (NEC).Materials and methodsPatients with pathologically proven G3-NET and NEC, according to the 2017 World Health Organization classification who had CT and MRI examinations between 2006-2017 were retrospectively included. CT and MRI examinations were reviewed by two radiologists in consensus and analyzed with respect to tumor size, enhancement patterns, hemorrhagic content, liver metastases and lymphadenopathies. Texture histogram analysis of tumors was performed on arterial and portal phase CT images. images. Morphological imaging features and CT texture histogram parameters of G3-NETs and NECs were compared.ResultsThirty-seven patients (21 men, 16 women; mean age, 56 ± 13 [SD] years [range: 28-82 years]) with 37 tumors (mean diameter, 60 ± 46 [SD] mm) were included (CT available for all, MRI for 16/37, 43%). Twenty-three patients (23/37; 62%) had NEC and 14 patients (14/37; 38%) had G3-NET. NECs were larger than G3-NETs (mean, 70 ± 51 [SD] mm [range: 18 - 196 mm] vs. 42 ± 24 [SD] mm [range: 8 - 94 mm], respectively; P = 0.039), with more tumor necrosis (75% vs. 33%, respectively; P = 0.030) and lower attenuation on precontrast (30 ± 4 [SD] HU [range: 25-39 HU] vs. 37 ± 6 [SD] [range: 25-45 HU], respectively; P = 0.002) and on portal venous phase CT images (75 ± 18 [SD] HU [range: 43 - 108 HU] vs. 92 ± 19 [SD] HU [range: 46 - 117 HU], respectively; P = 0.014). Hemorrhagic content on MRI was only observed in NEC (P = 0.007). The mean ADC value was lower in NEC ([1.1 ± 0.1 (SD)] × 10⁻³ mm²/s [range: (0.91 - 1.3) × 10⁻³ mm²/s] vs. [1.4 ± 0.2 (SD)] × 10⁻³ mm²/s [range: (1.1 - 1.6) × 10⁻³ mm²/s]; P = 0.005). CT histogram analysis showed that NEC were more heterogeneous on portal venous phase images (Entropy-0: 4.7 ± 0.2 [SD] [range: 4.2-5.1] vs. 4.5 ± 0.4 [SD] [range: 3.7-4.9]; P = 0.023).ConclusionPancreatic NECs are larger, more frequently hypoattenuating and more heterogeneous with hemorrhagic content than G3-NET on CT and MRI.