目的 探討末梢灌注指數（TPI）在斷指再植術后對血管危象早期診斷的價值。 方法 對2005年1月－2011年10月31例36個再植指運用Agilent V24C監護儀血氧飽和度探頭進行持續TPI監測，同時觀察記錄術后再植指皮溫、色澤、腫脹程度及毛細血管搏動情況，將發生血管危象的再植指分為危象組（n=4），將未發生血管危象的再植指分為對照組（n=32），分析發生危象前12 h至危象發生時的TPI，每2小時為一時間段，共7個時相，分別記為T1~T7。 結果 對照組各時間點TPI無明顯變化，各時間點比較差異無統計學意義（P＞0.05）；危象組從T4開始，TPI呈逐漸下降趨勢，與前一時間點比較差異均有統計學意義（P＜0.05）。兩組TPI在T1、T2、T3時比較差異無統計學意義（P＜0.05）；從T4開始，危象組TPI均較對照組降低，差異有統計學意義（P＜0.05）。 結論 TPI監測能夠無創、實時、靈敏地反映斷指再植術后再植指血供情況，可早于臨床癥狀以前對斷指再植術后血管危象作出診斷，有較高的臨床應用價值。
Non-rigid registration plays an important role in medical image analysis. U-Net has been proven to be a hot research topic in medical image analysis and is widely used in medical image registration. However, existing registration models based on U-Net and its variants lack sufficient learning ability when dealing with complex deformations, and do not fully utilize multi-scale contextual information, resulting insufficient registration accuracy. To address this issue, a non-rigid registration algorithm for X-ray images based on deformable convolution and multi-scale feature focusing module was proposed. First, it used residual deformable convolution to replace the standard convolution of the original U-Net to enhance the expression ability of registration network for image geometric deformations. Then, stride convolution was used to replace the pooling operation of the downsampling operation to alleviate feature loss caused by continuous pooling. In addition, a multi-scale feature focusing module was introduced to the bridging layer in the encoding and decoding structure to improve the network model’s ability of integrating global contextual information. Theoretical analysis and experimental results both showed that the proposed registration algorithm could focus on multi-scale contextual information, handle medical images with complex deformations, and improve the registration accuracy. It is suitable for non-rigid registration of chest X-ray images.
ObjectiveTo investigate the reliability and safety of the technique of percutaneous left ventricular transapical access guided by cardiac three dimensional CT angiography (3D-CTA) combined with echocardiography applied in structural heart defects.MethodsThe clinical data of 9 patients (7 males and 2 females with a median age of 50 years ranging from 43 to 64 years) with paravalvular leaks closed by percutaneous left ventricular transapical access in West China Hospital, from April 2015 to August 2018, were retrospectively analyzed. We applied preoperative cardiac 3D-CTA to define the puncture site and trace, which was established by combining with real-time guidance of transesophageal echocardiography (TEE/3D-TEE), and an occluder was deployed at the apical access point for hemostasis with real-time guidance of transthoracic echocardiography (TTE).ResultsThe puncture needles were successfully introduced into the left ventricular cavity at one time in all patients without injury of lung tissue, coronary artery or papillary muscle. There was no occluder displacement or apex bleeding. One patient developed pleural effusion caused by intercostal artery injury.ConclusionThat cardiac 3D-CTA is used to define puncture sites and trace with advantages of simplicity and repeatability. A safe access and secure exit of left ventricle can be achieved by combining with real-time guidance of echocardiography. There are acceptable technology-related complications.
ObjectiveTo study the expression of inhibitor of apoptosis proteins (Livin) and aspartate-specific cysteine protease-3 (Caspase-3) in patients with middle ear cholesteatoma and its clinical significance. MethodWe selected 51 patients with cholesteatoma of the middle ear treated between April 2013 and March 2014 in our department to be our study subjects. Streptaridin-perosidase immunohistochemical method was adopted to detect the expression of Livin and Caspase-3 in the middle ear cholesteatoma epithelium and normal skin of external acoustic meatus. SPSS 17.0 software package was used for statistical analysis. ResultsThe expression of Livin in cholesteatoma epithelium was significantly higher than that in the normal skin tissue of the external auditory canal (P<0.05), and the expression of Caspase-3 in cholesteatoma epithelium was significantly higher than the normal skin tissue in the external auditory canal (P<0.05). The expression of Livin and Caspase-3 in cholesteatoma epithelium was positively correlated (r=0.49, P<0.05). ConclusionsThere is a balance between apoptosis and inhibition of apoptosis in normal tissues, and when there is abnormal expression of Livin and Caspase-3 in normal tissues, it will cause cell apoptosis and apoptosis-inhibitory balance disorders, which causes middle ear cholesteatoma.
ObjectiveTo review the current research on the diagnosis and treatment of Haglund syndrome.MethodsThe domestic and foreign literature about Haglund syndrome in recent years was extensively reviewed to summarize and analyze the etiology, anatomy, clinical manifestations, diagnosis, and treatment of Haglund syndrome.ResultsThe etiology of Haglund syndrome is not very clear, and it may be related to local friction and high gastrocnemius muscle tension, and there may be a certain genetic tendency. The local anatomy is more complex and there are many adjacent tissue structures. Haglund malformation may cause the impingement of the posterior heel bursa and Achilles tendon insertion, lead to wear of the posterior heel bursa and the Achilles tendon insertion, and finally result in pain. The FPA (Fowler-Philipp angle), CPA (calcaneal pith angle), PPL (parallel pitch lines), CLA (Chauveaux-Liet angle), and X/Y ratios (ratio of total calcaneal length to calcaneal tuberosity length) measured on X-ray film can be used for the diagnostic measurement of Haglund malformation. Treatment includes conservative and surgical treatment (open Haglund ostectomy, dorsal closed wedge osteotomy of the calcaneus, and arthroscopic Haglund osteotomy).ConclusionBoth open and arthroscopic Haglund ostectomy and dorsal closed wedge osteotomy of the calcaneus can achieve satisfactory results, but minimally invasive treatment is the current development trend. Surgeons should pay attention to the management of the calcification of Achilles tendon insertion and reconstruction of Achilles tendon insertion.
In recent years, 3D printing technology, as a new material processing technology, can precisely control the macroscopic and microstructure of biological scaffolds and has advantages that traditional manufacturing methods cannot match in the manufacture of complex bone repair scaffolds. Magnesium ion is one of the important trace elements of the human body. It participates in many physiological activities of the body and plays a very important role in maintaining the normal physiological function of the organism. In addition, magnesium ions also have the characteristics of promoting the secretion of osteogenic proteins by osteoblasts and osteogenic differentiation of mesenchymal stem cells. By combining with 3D printing technology, more and more personalized magnesium-based biological scaffolds have been produced and used in bone regeneration research in vivo and in vitro. Therefore, this article reviews the application and research progress of 3D printing magnesium-based biomaterials in the field of bone regeneration and repair.