虚拟手术辅助的血管化髂骨肌瓣行下颌骨精确重建

目的评估经虚拟手术辅助的血管化髂骨肌瓣行下颌骨精确重建的术后效果。方法回顾性分析16例患者术前通过虚拟手术模拟下颌骨节段性切除,自动比较双侧髂嵴与健侧下颌骨镜像的形态,选择在形态上最为匹配的髂嵴供区。术中使用立体模型和手术导板来再现术前计划,实际重建效果与虚拟手术结果进行对比。术后1年对患者面部外形进行满意度评估。结果术后随访显示,16例重建的下颌骨均愈合良好、咬合关系正常,实际重建效果与虚拟手术结果基本一致。术后1年患者对面部外形非常满意或满意。结论结合义齿修复,虚拟手术辅助的血管化髂骨肌瓣行下颌骨精确重建能使重建后下颌骨有理想的外形和良好功能。

辅助玻璃体视网膜显微手术机器人系统的研制及应用

背景机器人手术系统已越来越多地用于多个医学领域，也应用于眼科。研究报告显示机器人辅助的手术有许多优点，包括精确性高，灵活性好，减少术者的生理性手颤抖，提高手术的稳定性，缩短学习曲线等，但中国仍无机器人辅助的眼科手术报道。目的从临床实际出发设计和研制辅助玻璃体视网膜显微手术机器人系统并评估其在玻璃体视网膜手术中的应用能力。方法由温州医学院眼科医院与北京航空航天大学共同研制一套辅助玻璃体视网膜显微手术机器人系统，该系统本体具备2个机械手臂，可以握持眼科常用的手术器械，如玻璃体切割头、导光探头、激光笔和23G眼内镊，进行微创的玻璃体视网膜手术操作。由3名低年资眼科医师通过控制器操控机器人2个机械手臂的运动路径对15只离体猪眼行玻璃体切割手术，以验证该系统执行平坦部玻璃体切割和玻璃体后脱离的可行性。玻璃体切割步骤包括制作3个23G巩膜切口、经切口导入手术器械及用曲安奈德诱导和切除玻璃体后脱离。评估手术持续时间、手术成功率和并发症情况。结果15只离体猪眼的玻璃体切割和玻璃体后脱离手术均顺利完成，术中未发现眼球的明显变形，术后未发生医源性视网膜裂孔和视网膜脱离，手术成功率为100％。15只眼手术平均持续时间为（12．76±3．44）min，每个术者平均手术持续时间分别为（13．67±4．23）、（10．83±2．30）和（13．77±1．91）min。结论辅助玻璃体视网膜显微手术机器人系统具有良好的稳定性和精确性，在一定程度上可以代替人手进行玻璃体视网膜手术操作。

计算机辅助设计与制作技术在眼眶爆裂性骨折治疗中的应用及疗效评价

背景 眼眶爆裂性骨折引起明显的眼球形态和功能的异常.眼眶解剖结构复杂,故眼眶骨折修复手术中植入物的设计和制作具有一定的难度,而计算机辅助设计与制作（CADM）技术有望提供一种新的方法,但其临床应用价值有待评估.目的 研究CADM技术在眼眶爆裂性骨折治疗中的应用方法,评价其临床效果.方法 对河南省眼科研究所河南省立眼科医院2006年7月至2012年7月收治的眼眶爆裂性骨折患者74例74眼的手术过程和疗效进行回顾性分析,其中CADM手术者58例58眼,非CADM手术者16例16眼,2个组间患者基线特征,如年龄、性别和眼别均匹配.CADM手术组术眼采用CADM技术进行个体化三维立体植入物的设计和制作并进行眶骨骨折缺损处的填充,非CADM手术组术眼采用常规羟基磷灰石人工骨或多孔聚乙烯高分子合成材料（Medpor）填充法.所有术眼术前均行常规眼部检查以及CT检查,术后随访22～69个月,在随访期间内定期进行眼部临床观察和CT检查.观察指标包括最佳矫正视力、眼球突出度、眼球位置、眼球运动和复视改善情况以及并发症情况.结果 CADM手术组和非CADM手术组术眼术前最佳矫正视力分别为0.71±0.37和0.69±0.41,术后最佳矫正视力分别为0.74±0.38和0.72±0.41,组间差异无统计学意义（F分组=0.043,P=0.837）,术眼手术前后视力的总体比较差异有统计学意义（F时间=13.576,P＜0.01）,其中2个组术眼术后视力均好于术前,差异均有统计学意义（均P＜0.05）.2个组间复视和眼球运动障碍治愈和好转的眼数分布差异均无统计学意义（Z=-0.298,P=0.766;Z=-0.548,P=0.584）.CADM手术组和非CADM手术组术眼术前眼球眼球内陷度值分别为（3.93±0.99） mm和（3.88±0.97）mm,术后分别为（0.91±0.67）mm和（1.84±0.80）mm,组间总体比较差异无统计学意义（F分组=3.558,P=0.063）,各组术眼术后眼球眼球内陷度值均明显低于术前,差异均有统计学意义（均P＜0.05）.CT影像显示,CADM手术组术眼植入物在位,与眶骨骨折缺损处贴合良好,患者眼球位置及外观均恢复正常.非CADM手术组术眼发生植入物翘起并损伤内直肌.随访期内CADM手术组未发现组织感染、排斥反应等不良反应.结论 CADM技术用于眼眶爆裂性骨折的治疗可重建三维立体骨性眼眶,并有效改善患眼位置、眼球运动功能和视觉功能,其疗效优于传统植入物填充术.

巨块型宫颈癌Ⅰb2～Ⅱb期术前全身新辅助化疗的疗效观察

【目的】探讨术前全身新辅助化疗（NAC）对巨块型宫颈癌的疗效。【方法】选择2000年12月至2005年12月邵阳市中心医院初治病理确诊宫颈癌患者35例，采用PVB（顺铂50mg／m^2 d1＋长春新碱1mg／m^2 d1＋博莱霉素20mg／m^2 d1～d3）静脉化疗1～3疗程并化疗后15～20d行子宫广泛切除＋盆腔淋巴结清扫术（观察组）。与同期单纯手术的病人39例为对照组在术后病理及生存率等方面进行分析对比。【结果】观察组患者化疗有效率为80．00％，所有病人阴道切缘均未见癌细胞，术后5年生存率为77．50％。而对照组患者阴道切缘有4例见癌细胞，5年生存率为52．49％，两者对比差异有显著性（P〈0．05）。【结论】经术前全身辅助化疗配合妇科手术治疗宫颈癌可提高病人生存率。

腋下小切口与胸腔镜治疗自发性气胸的疗效评价

目的:探讨胸腔镜与腋下小切口治疗自发性气胸的疗效。方法:143例患者按手术时间和患者自身对手术的选择性分为腋下小切口治疗组(n=96)和胸腔镜治疗组(n=47)。所有病例均为外科治疗适应证。二组均采用肺大泡切除及壁层胸膜机械性磨擦。腋下小切口组加胸顶部胸膜切除术。疗效评价指标包括:术中及术后失血量、术后疼痛及止痛药物用量、术后并发症、住院时间,正常生理功能的恢复、自发性气胸的复发及治疗费用。结果:术中及术后失血量、术后疼痛、止痛药物用量、正常生理功能的恢复、自发性气胸的复发在两组间比较差异无显著性(P>0.05),但在治疗费用方面腋下小切口组低于胸腔镜组(P<0.05)。结论:胸腔镜和腋下小切口对于治疗自发性气胸有着相似的治疗结果,安全、可靠、创伤小、疼痛轻,术后并发症少、复发率低。

肾脏血流灌注的评估:造影增强彩色多普勒时间-强度曲线分析(英文)

背景:超声评价肾脏功能主要通过测量较粗大的肾脏各级动脉的血流参数或肾切面内动脉彩色血流面积所占的比例来推断,误差较大。目的:应用超声仪器随机配置的彩色多普勒时间-强度曲线软件评价肾脏血流灌注情况。设计:动物实验观察。单位:广州市第一人民医院功能检查科。材料:实验于1999-01/2000-04在广州军区广州总医院动物实验室完成,选择8只健康新西兰兔,雌雄各4只,体质量2.5～3.5kg。观察肾脏16个。声学造影剂为全氟显,主要成分为声振白蛋白的微泡,微泡内有一定浓度的全氟丙烷气体。方法:兔外周静脉团注造影剂全氟显后用彩色多普勒能量图、彩色多普勒血流显像和彩色多普勒能量谐波成像连续采集肾脏彩色血流图像,随机配置软件显示时间-强度曲线。主要观察指标:造影增强肾脏血流灌注时间-强度曲线的形态。结果:进入结果分析8只家兔。肾脏血流造影增强的时间-强度曲线呈单峰状,上升支陡直,下降支平缓。调节时间轴上的感兴趣线可作定量分析,回放显示注射造影剂后对应某一时刻的造影增强的彩色多普勒图像。结论:造影增强彩色多普勒血流显像和彩色多普勒能量图的时间-强度曲线能有效的观察肾脏血流灌注特征,既可显示整个肾脏的血流灌注情况,也用于观察低血流灌注区域,发现病灶进一步绘制肾功能图。

采用反求工程和快速原型技术精确定制骨组织工程支架(英文)

背景:组织工程基本原理是从患者获取组织,经体外培养扩增种子细胞,接种在支架内,通过支架引导形成三维外形的组织,最后植入该患者体内以替代病损组织的功能,以后随着新生血管长入,支架逐步溶解,新生组织最终与周围组织完全融合。目的:探讨应用反求工程和快速原型技术定制个体特异的解剖外形骨组织工程支架的可行性,克服常规制作方法的缺陷。设计:定制个体特异的解剖外形骨组织工程支架方法。单位:解放军广州军区广州总医院全军创伤骨科中心。材料:支架CAD设计在广东省机械研究所CAD培训中心完成,支架快速成型制作在广东省龙创域公司完成,快速成型工艺为立体光固化工艺,采用材料为光敏树脂。方法:实验于2004-10/2005-01在广州军区广州总医院全军创伤骨科中心完成。按反求工程的基本原理,采用医学CT/MRI扫描获取患者骨骼的分层图像信息,采用计算机辅助技术进行三维重建和曲面重构建立骨骼感兴趣区域的解剖模型,并在建立的解剖模型的外形轮廓内进行支架内部结构的计算机辅助设计,建立其计算机辅助设计模型,最后采用快速成型工艺精确制作骨组织工程支架的原型。主要观察指标:①CT/MRI扫描三维重建与解剖建模结果。②个体化组织工程支架的内部结构设计结果。③个体化组织工程支架快速成型制作。结果:①经CT/MRI图像三维重建,建立了骨关节解剖模型。②计算机辅助设计软件设计支架内部结构成功地建立了骨组织工程支架的实体模型。③骨组织工程支架CAD模型指导快速成型工艺成功地制作了个体化解剖外形的支架,制作的骨组织工程支架内部结构非常精细,具有高孔隙率和较好的孔隙相互连通性能。结论:采用反求工程和先进制造技术,可以任意制作个体化解剖外形的组织工程支架;在所有快速成型工艺中,以立体光固化成型精度最高,表面光滑、成型质量最好。

女性乳腺癌保乳手术及综合治疗65例

目的:探讨综合保乳治疗在早期乳腺癌中的临床应用价值。方法:对65例临床～期乳腺癌患者采用单切口和双切口法行乳腺癌的保乳切除术加腋窝淋巴结清扫术。术后辅助放、化疗和内分泌治疗,并随访术后近期疗效和美容效果。结果:65例乳腺癌患者术后并发症少,随访8～84个月,局部复发率3.07%,乳房外观美容效果好。结论:早期乳腺癌保乳综合治疗创伤小、疗效确切、形体改变少,能提高生存质量。

断食与肿瘤治疗的研究进展

断食通过下调胰岛素样生长因子-1表达、抑制下游信号通路、降低葡萄糖和有氧糖酵解水平、减少能量供应、促进凋亡、增强肿瘤免疫以及增强放化疗和靶向治疗疗效等对抗肿瘤,还可以通过促进造血恢复以及减轻化疗相关的呕吐、腹泻及心脏毒性等不良反应提高化疗耐受。断食在肿瘤治疗中发挥一定的作用。作为一种全新的肿瘤非药物治疗手段,断食疗法在临床上的应用还需进一步研究探索。

New Periodic Wave Solutions to Generalized Klein-Gordon and Benjamin Equations

By making use of extended mapping method and auxiliary equation for finding new periodic wave solu tions of nonlinear evolution equations in mathematical physics, we obtain some new periodic wave solutions for generalized Klein-Cordon equation and Benjamin equation, which cannot be found in previous work. This method also can be used to find new periodic wave solutions of other nonlinear evolution equations.

Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990-2010

Several advances in genetics, diagnosis and palliation of pancreatic cancer (PC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. PC is relatively common as it is the fourth leading cause of cancer related mortality. Most patients present with obstructive jaundice, epigastric or back pain, weight loss and anorexia. Despite improvements in diagnostic modalities, the majority of cases are still detected in advanced stages. The only curative treatment for PC remains surgical resection. No more than 20% of patients are candidates for surgery at the time of diagnosis and survival remains quite poor as adjuvant therapies are not very effective. A small percentage of patients with borderline non-resectable PC might benefit from neo-adjuvant chemoradiation therapy enabling them to undergo resection; however, randomized controlled studies are needed to prove the benefits of this strategy. Patients with unresectable PC benefit from palliative interventions such as biliary decompression and celiac plexus block. Further clinical trials to evaluate new chemo and radiation protocols as well as identification of genetic markers for PC are needed to improve the overall survival of patients affected by PC, as the current overall 5-year survival rate of patients affected by PC is still less than 5%. The aim of this article is to review the most recent high quality literature on this topic.

Symbolic Computations and Exact and Explicit Solutions of Some Nonlinear Evolution Equations in Mathematical Physics

With the aid of symbolic computation system Mathematica, several explicit solutions for Fisher＇s equation and CKdV equation are constructed by utilizing an auxiliary equation method, the so called G′/G-expansion method, where the new and more general forms of solutions are also constructed. When the parameters are taken as special values, the previously known solutions are recovered.

Estimation of deformed laser heat sources and thermal analysis on laser assisted turning of square member

Laser assisted machining （LAM） has difficulties in estimating temperature after applying a LAM process due to its very small heat input area, large energy and movement. In particular, in the case of laser assisted turning （LAT） process, it is more difficult to estimate the temperature after preheating because it has a shape of ellipse when a laser heat source is rotated. A prediction method and thermal analysis method for heat source shapes were proposed as a square shaped member was preheated. The temperature distribution was calculated according to the rotation of the member. Compared with the results of the former study, the maximum temperature of the calculation results, 1 407.1 ℃, is 8.5 ℃ higher than that of the square member, which is 1 398.6 ℃. In a LAT process for a square member, the maximum temperature is 1 850.8 ℃. It is recognized that a laser power control process is required because square members show a maximum temperature that exceeds a melting temperature at around a vertex of the member according to the rotation.

Catalytic performance and synthesis of a Pt/graphene-TiO_2 catalyst using an environmentally friendly microwave-assisted solvothermal method

A Pt/graphene‐TiO2catalyst was prepared by a microwave‐assisted solvothermal method and was characterized by X‐ray diffraction,scanning electron microscopy,transmission electron microscopy,cyclic voltammetry,and linear sweep voltammetry.The cubic TiO2particles were approximately60nm in size and were distributed on the graphene sheets.The Pt nanoparticles were uniformly distributed between the TiO2particles and the graphene sheet.The catalyst exhibited a significant improvement in activity and stability towards the oxygen reduction reaction compared with Pt/C,which resulted from the high electronic conductivity of graphene and strong metal‐support interactions.

Patterns of local recurrence in rectal cancer after a multidisciplinary approach

Improvements in surgery and the application of combined approaches to fight rectal cancer have succeeded in reducing the local recurrence (LR) rate and when there is LR it tends to appear later and less often in isolation. Moreover, a subtle change in the distribution of LRs with respect to the pelvis has been observed. In general terms, prior to total mesorectal excision the most common LRs were central types (perianastomotic and anterior) while lateral and posterior forms (presa-cral) have become more common since the growth in the use of combined treatments. No differences have been reported in the current pattern of LRs as a function of the type of approach used, that is, neo-adjuvant therapies (short-term or long-course radiotherapy, orchemoradiotherapy versus extended lymphadenectomy, though there is a trend towards posterior or presacral LR in patients in the Western world and lateral LR in Asia. Nevertheless, both may arise from the same mechanism. Moreover, as well as the mode of treatment, the type of LR is related to the height of the initial tumor. Nowadays most LRs are related to the advanced nature of the disease. Involvement of the circumferential radial margin and spillage of residual tumor cells from lymphatic leakage in the pelvic side wall are two plausible mechanisms for the genesis of LR. The patterns of pelvic recurrence itself (pelvic subsites) also have important implications for prognosis and are related to the potential success of salvage curative approach. The re-operability for cure and prognosis are generally better for anastomotic and anterior types than for presacral and lateral recurrences. Overall survival after LR diagnosis is lower with radio or chemoradiotherapy plus optimal surgery approaches, compared to optimal surgery alone.

New Exact Travelling Wave Solutions for Zakharov-Kuznetsov Equation

In this paper, the nonlinear dispersive Zakharov- Kuznetsov equation is solved by using the generalized auxiliary equation method. As a result, new solitary pattern, solitary wave and singular solitary wave solutions are found.

Value of neoadjuvant chemotherapy in advanced ovarian cancer

Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.

Cytoreductive surgery and HIPEC after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

AIM: To reduce postoperative complications and to make possible an optimal cytoreduction, neoadjuvant chemotherapy(NACT) followed by interval debulking surgery has been applied with encouraging results. METHODS: Between December 2009 and February 2012, patients with stage ⅢC-Ⅳ epithelial ovarian cancer(EOC) underwent diagnostic laparoscopy, to assess the feasibility of optimal debulking surgery. The modifi ed Fagotti score was applied to assess the feasibility of resection with zero residual tumor. Patients who were not candidate for upfront debulking surgery were submitted to NACT, then reassessed according to the RECIST 1.1 criteria and submitted to cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) if they showed clinical response or stable disease. The remaining cycles of adjuvant systemic chemotherapy(ASCT) were administered postoperatively, to complete 6 cycles of systemic chemotherapy.RESULTS: Nine patients were included. Clinical response to NACT was complete in 3 patients and partial in 5 patients; one patient had stable disease. All patients underwent CRS resulting in CC0 disease prior to HIPEC. Average operative time was 510 min. Average intensive care unit stay was 2 d. Average postoperative hospital stay was 25 d. No postoperative mortality was observed. One patient experienced pelvic abscess. One patient refused ASCT. The remaining 8 patients started ASCT. Average time to chemotherapy was 36 d. All patients are alive, with an average follow up of 11 mo. Eight patients are disease-free at follow up.CONCLUSION: HIPEC after CRS for advanced EOC is feasible with acceptable morbidity and mortality. NACT may increase the chance for achieving complete cytoreduction. Phase 3 studies are needed to determine the effects of HIPEC on survival.

Semi-blind Channel Estimator for OFDM-STC

Channel state information of OFDM-STC system is required for maximum likelihood decoding.A subspace-based semi-blind method was proposed for estimating the channels of OFDM-STC systems.The channels are first estimated blindly up to an ambiguity parameter utilizing the nature structure of STC,irrespective of the underlying signal constellations.Furthermore,a method was proposed to resolve the ambiguity by using a few pilot symbols.The simulation results show the proposed semi-blind estimator can achieve higher spectral efficiency and provide improved estimation performance compared to the non-blind estimator.

Modeling and Implementing ISO 13584-based Part Library

ISO 13584 (i.e. PLIB) is an international standard for the representation and exchange of CAD part libraries. It aims to provide an application-independent mechanism to enable the share of part library information between applications. In this paper, the approach of modeling part library conforming to ISO 13584 is presented. Also, a prototype of part library management system, i.e. BYL-PLIB, whose implementation is in agreement with ISO 13854 is developed to demonstrate the usefulness of proposed approach.