个体化下肢小腿假肢接受腔设计的生物力学评价技术研究

作为传递体重、固定假肢的部件 ,接受腔对于小腿假肢使用的舒适性和方便程度有决定性的作用。本研究建立了基于有限元应力分析的小腿假肢生物力学评价技术平台 ,实现了小腿残端 /接受腔 3D几何建模与信息交互、三维有限元自动建模及应力分析。 3D模型与信息交互的实现基于得到广泛支持的OpenGL技术 ,有限元模型的构建采用了专门针对小腿残端 /接受腔结构特点的自动建模方法 ,通过构建档案数据库系统作为整个系统的操作平台。该技术平台可与现有的CAD/CAM系统相结合 ,为接受腔的个体化设计提供生物力学定量化依据。其临床应用将改善传统的设计流程 ,提高设计效率。同时 ,它也是未来构建接受腔设计专家 /智能系统的基础。     

Overview and update on molecular testing in non-small cell lung carcinoma utilizing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples

Lung carcinoma remains one of the most frequent and aggressive human neoplasms. Fortunately, in the last decades, the increasing knowledge of the molecular mechanisms leading to cancer development has allowed the use of targeted therapies with improvement of prognosis in many patients. Clinical management has also changed after the introduction of endobronchialultrasonographic bronchoscopy that allows a conservative staging of lung tumors, avoiding the need of mediastinoscopy for lymph node staging. Lung pathologists and cytopathologists are facing the challenge of giving the more comprehensive prognostic and predictive information with ever smaller tissue or cytological samples. The aim of this review is to summarize the molecular testing for non-small cell lung carcinoma and how pathologists can contribute to the patient's outcome with a conscious management of biological samples.     

碱离子水饮用后血小板聚集率的的变化(附30例报告)

目的:报告30例饮用豪斯牌碱离子水前、后血小板聚集率的变化。方法:饮用碱离子水前、后(2～3月,>3～6月)作比浊法血小板聚集试验,以1分钟、5分钟及5分钟内最大聚集率(Max％)为指标,同时检测部分血粘度指标及凝血因子,并用自动生化仪检测血糖、血脂、主要电解质及部分肝、肾功能。结果:饮碱离子水后,血小板聚集率明显下降,而以疾病组(Max>80％)下降尤为明显,P均<0.001。饮碱离子水后血小板聚集率的下降,部分可能与损伤的血管内皮得到修复有关。主要电解质及部分肝、肾功能无明显异常改变。结论:由于心、脑血管血栓性疾病患者血小板聚集率多明显升高,饮碱离子水后血小板聚集率明显下降,且长期饮用对主要电解质及部分肝、肾功能无明显异常改变,作者认为碱离子水使用方例、安全、有效、价廉,因而对心、脑血管血栓性疾病防治方面可能是一种积极的辅助方法,值得临床进一步探索。     

Surgical revascularization in women

Multiple studies have shown that coronary bypass surgery in women clearly has a higher risk of operative death. The reason for this higher risk remain less clear, however. Although earlier studies suggested that women were at higher risk due to their smaller body size, several recent studies have suggested that a significant component of the higher mortality of women may be late referral for bypass surgery. Complication rates and hospital stay also appear to be higher in women. Although operative mortality is higher, women have similar long-term results from bypass surgery. Thus, coronary bypass surgery is a valuable treatment option for women with advanced coronary disease with excellent long-term outcomes. The short-term outcomes of women referred for bypass surgery may be improved with earlier referral of women for revascularization.     

Bedside hemodynamic monitoring. Its value in the diagnosis of tamponade complicating cardiac surgery.

Cardiac tamponade may be a difficult clinical diagnosis in the early postoperative period in patients undergoing open-hear surgery, particularly when the anterior or lateral pericardium is left open. Bedside monitoring of intracardiac pressures and determination of a "pressure plateau" between right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressures are useful in the early diagnosis of cardiac tamponade. The value of such hemodynamic monitoring in the diagnosis and treatment of cardiac tamponade in three patients with aorta-coronary artery bypass surgery in the early postoperative period is reported. Appropriate therapy, carried out on the basis of these studies, minimized the occurrence of further morbidity or possible death.     

Noninvasive in vivo and in vitro study of the St. Jude mitral valve prosthesis: Evaluation using two dimensional and M mode echocardiography,phonocardiography and cinefluoroscopy

Fifteen patients with clinically normal function of a St. Jude mitral valve prosthesis were studied with two dimensional and M mode echocardiography, Cinefluoroscopy and phonocardiography 8 to 292 days after valve replacement. The valve was readily imaged from the left sternal edge and cardiac apex in all patients. On two dimensional echocardiography from the long axis and four chamber views, minimal end-diastolic and endsystolic distances between the interventricular septum and prosthetic valve were 18 ± 5 mm and 13 ± 3 mm, respectively (mean ± standard deviation). On M mode echocardiography both leaflets were imaged throughout the cardiac cycle from the left sternal edge and their motion relative to the valve ring and to one another was easily evaluated. The apical transducer position permits quantitative assessment of individual leaflet motion. Maximal individual diastolic leaflet excursion was 8.7 ± 1 mm and the velocity of leaflet opening and closure was 364 ±103 and 678 ±115 mm/s, respectively.Asynchronous early closure of the posterior leaflet was observed during long cardiac cycles in six of seven patients with atrial fibrillation; the seventh patient had a rapid ventricular response and no long cardiac cycles. Diastolic fluttering of one or both leaflets was also seen during atrial fibrillation after rotation of the patient from the supine to the left lateral decubitus position. Three of the six patients with asynchronous leaflet closure underwent Cinefluoroscopy, and similar leaflet behavior was documented in all. An atrial systolic wave was inscribed in the valve echogram in six of eight patients with sinus rhythm.Phonocardiography recorded prosthetic valve opening and closing sounds occurring 60 ± 20 ms after aortic closure and 61 ± 12 ms after the QRS complex, respectively. The prosthetic valve opening and closure sound amplitude ratio was 0.11 ± 0.06.A clear plexiglass water bath phantom was fitted to a pulse duplicator and constructed so as to permit in vitro simulation of valve echograms under a variety of conditions. With this method, it was possible to reproduce or approximate all images obtained in patients from both echocardiographic transducer positions.     

Mitral valve replacement early after myocardial infarction: attendant high risk of left ventricular rupture

Between 1969 and 1983, 608 patients underwent mitral valve replacement surgery at Cedars-Sinai Medical Center. Perioperative rupture of the left ventricular myocardium complicated seven operations (1.2%), five of them in the 247 patients with concomitant ischemic heart disease. Six ruptures were fatal. Relative incidences of seven previously hypothesized predisposing factors were determined for patients with and without myocardial rupture. In addition, because of the apparent frequency of association with ischemic heart disease and because all ruptures were posterior or posterolateral, patients were also categorized by prior history of posterior myocardial infarction: 177 patients had none, whereas 49 patients had a remote and 21 patients a recent (less than or equal to 1 month) posterior wall infarct. Four ruptures (accounting for 57% of all ruptures) occurred in the 21 patients (19% incidence) with a recent posterior infarct, compared with only three ruptures in the 587 patients (0.5%) without a recent posterior wall infarct (p = 0.000). None of the factors of age, sex, valve pathology, etiology of valve lesion, concomitant coronary disease, valve substitute or intraoperative myocardial preservation were associated with perioperative rupture. These data establish a low overall incidence of ventricular rupture after mitral valve replacement, high fatality and possible etiologic association with recent posterior wall infarction.     

What I wish I��d known before surgery: BRCA carriers�� perspectives after bilateral salipingo-oophorectomy

We retrospectively studied BRCA carriers with a history of prophylactic bilateral salingo-oophorectomy (PBSO) regarding: (1) their post-operative symptoms, (2) their recollection of pre-operative conversations with their health care providers regarding possible surgical side-effects and (3) what information they would have found helpful to have before surgery. Female BRCA carriers seen through the Yale Cancer Genetic Counseling Program who had PBSO were invited to participate in a questionnaire that assessed their recall of information they received pre-operatively compared with their post-operative knowledge and symptoms related to menopause, cognitive changes, loss of fertility, cancer risks, osteoporosis, heart disease, vasomotor symptoms, urogenital symptoms, sexuality and body image. The questionnaire also elicited written feedback from participants regarding their decision to have PBSO, what they wished they had known before surgery, advice for other BRCA carriers considering this surgery and advice for health care providers who counsel women about PBSO. Two hundred and ninety female BRCA carriers were invited to participate and 113 (39.0%) indicated they were interested. Of those, 99 (87.6%) returned their questionnaire and 98 (86.7%) responses were included in the analysis. The mean age at PBSO was 45.5 years (range: 32–63 years). The five most common “frequent” or “very frequent” post-surgical symptoms were: vaginal dryness (52.1%), changes in interest in sex (50.0%), sleep disturbances (46.7%), changes in sex life (43.9) and hot flashes (42.9%). The majority of women would have found it helpful to have more information regarding the impact of this surgery on their sex life (59.2%), the availability of sex counseling (57.1%) and the risk of coronary heart disease (57.1%). This study illustrates that while health care providers are discussing selected side effects of PBSO, women undergoing this surgery have other concerns that should be addressed. This information provides insights into the informational needs of BRCA carriers considering PBSO.