大直径球头-骨水泥型人工髋关节置换治疗帕金森患者股骨颈骨折12例

目的：探讨采用大直径球头-骨水泥型人工髋关节置换的方法,治疗老年帕金森患者股骨颈骨折的临床疗效。方法：回顾性病例分析2007年1月至2010年10月收治的帕金森患者合并股骨颈骨折12例,男3例,女9例,年龄65岁至87岁,平均年龄76.17岁。假体类型：人工全髋关节假体2例,人工双极股骨头10例。置换后3个月随访,进行围置换期并发症、影像学、髋关节功能评分（Harris评分）等方法评价手术效果。结果：所有患者均安全度过围置换期,置换术后3周出现脱位1例,无深部感染及深静脉血栓形成,无围手术期死亡病例;骨盆平片上出现髋臼侧透亮线1例,无骨溶解、松动及股骨柄下沉;Harris评分：90分至100分3例,80分至89分5例,70分至79分3例,〈70分1例。结论：大直径球头-骨水泥型人工髋关节置换治疗老年帕金森患者股骨颈骨折可有效改善关节功能,减少并发症,降低脱位率,提高患者生活质量。     

股骨转子间骨折PFNA治疗的注意事项

目的:讲述PFNA-II治疗股骨转子间骨折的手术配合体会。方法:对60例老年患者实施手术,包含术前探访、进入手术室后的进一步安慰、复位、C一臂X线机透视检验复位状况、手术中供应PFNA-II专用器械作骨折内固定、全经过作老年有关作用监护等。结果:PFNA组患者的手术时间、术中出血量明显优于股骨头置换组,P0.05;但2组患者的髋关节的优良率、并发症的出现率和住院时间没有明显性差别,P0.05。结论:PFNA治疗老年股骨转子间骨折手术时间短、小创伤、并发症出现率小,值得临床宣传。     

微创小切口大头金属-金属与常规金属-聚乙烯全髋置换术早期临床疗效的对比研究

目的：比较微创小切口大头金属-金属（large—diameter metal—on—metal,L—MoM）全髋置换术（total hip arthroplasty,THA）与常规金属-聚乙稀假体（metal on polyethylene,MoPE）THA的早期临床疗效。方法：2005年1月至2007年12月经后外侧小切口行L—MoM THA20例（22髋）、常规THA20例（22髋）。对两组分别进行临床功能、影像学评价及并发症评估并相互比较。结果：L—MoM组19例（21髋）、MoPE组18例（20髋）获得随访,平均随访时间14．1月。两组Harris评分、简易12项表（short form-12,SF-12）评分及并发症无显著性差异（P〉0．05）;影像学上股骨头相对髋臼中心的矢量位移L—MoM组较MoPE组显著降低（P〈0．01）,透亮线、股骨柄中置、异位骨化、骨溶解、假体松动、股骨距吸收、假体断裂两组无显著差异（P〉0．05）。结论：经后外侧小切口行L—MoM THA可取得与常规MoPE THA相似的早期临床疗效,并不会增加手术并发症,且髋臼磨损率更低,其中长期临床结果仍有待进一步研究。     

晚期弥漫型色素沉着绒毛结节性滑膜炎行全膝关节置换的初步探讨

目的:探讨晚期弥漫型色素沉着绒毛结节性滑膜炎(Pigmented Villonodular Synovitis,PVNS)行全膝关节置换治疗(Total knee arthroplasty,TKA)及其临床疗效。方法:对2003年2月至2010年10月年收治的16例发生于单侧膝关节(左膝11例,右膝5例)的弥漫型PVNS行滑膜切除术后的TKA。其中男性5例,女性11例,年龄37至66岁,平均57.2岁;4名患者有膝关节外伤史及1至2次患侧膝关节手术史,余病例发病前均无明显诱因;术前平均屈伸活动度为:屈:101°(75°至120°)、伸:-6°(-10°至0°);HSS评分:59.2±7.3。结果:1例患者出现了下肢深静脉血栓、1例患者术后功能恢复较差,余病例均取得较满意的功能恢复。末次随访平均活动度:屈:125°(95°至130°)、伸:-1°(-5°至0°),HSS评分:85.3±8.1,与术前相比有统计学意义(P0.05)。术后随访21至83个月,平均47个月,均未见PVNS复发及假体松动。结论:MRI在该疾病诊断、明确病变范围、术后评估各方面起着重要的作用。对于软骨破坏严重的晚期弥漫型PVNS,TKA应作为首选治疗,但相比其他疾病的TKA治疗,术中需注意更多细节的处理。而术后至抗凝药物应用的间隔时间是否应适度延长、术后是否需应用局部放射治疗仍有待进一步研究。     

关节镜辅助下治疗髌骨复发性脱位48例报告

探讨关节镜辅助下治疗髌骨复发性脱位的效果。2004年4月至2012年12月共收治48例复发性髌骨脱位患者,男23例,女25例;年龄19~55岁,平均28.3岁。平均复发性脱位4次,全部患者均采用关节镜监视下行髌外侧支持带松解、髌内侧支持带紧缩(或内侧髌股韧带重建)、胫骨结节移位手术,术后45例得到平均27.5个月的随访,平均随访3.6次。了解患者主观症状和客观体征,髌骨脱位复发,膝关节正位、髌骨轴位X线片及膝关节功能康复评分。得到随访的38例患者对治疗均满意,无再脱位。4例膝关节活动过多有酸痛感,3例膝关节有10°~15°的屈曲度减少,45例按Lysholm膝关节功能评分:术前(48.8±5.5)分,术后(93.6±3.3)分(p0.05)。依据病情行髌骨内侧髌股韧带重建、外侧支持带松解、结合胫骨结节内移微创手术治疗复发性髌骨脱位是有效的且创伤小、恢复快,可早期康复的一种方法。     

蛛网膜外颅颈区有限骨性减压并硬膜修补治疗Chiari畸形Ⅰ型

目的探讨蛛网膜外颅颈区有限骨性减压并硬膜扩大修补处理成年人Chiari畸形I型的手术效果。方法回顾分析1997年7月-2007年8月收治的成年人Chiari畸形I型患者32例,其中21例合并脊髓空洞,均无颅内感染病史。术中皆未发现蛛网膜黏连,皆行颅颈区有限骨性减压并硬膜扩大修补处理,29例未切开蛛网膜,3例小脑扁桃体下疝严重者行蛛网膜切开,在软膜下吸除小脑扁桃体。结果术后28例得到随访,平均随访4．5年（0．5-10．3年）,临床有效23例,稳定5例,无恶化。合并脊髓空洞患者17例术后复查MRI,15例术后空洞消失或减少,2例无变化。术后发生局部皮下积液1例,急性脑积水1例,均发生在蛛网膜切开病例,分别经腰大池引流和短期脑室外引流治愈。结论对无局部蛛网膜黏连的成年人Chiari畸形I型病例,蛛网膜外颅颈区有限骨性减压并硬膜扩大修补手术的长期效果。     

内固定手术治疗胫骨平台骨折临床分析

目的是探讨内固定手术治疗胫骨平台骨折的临床效果。方法是把符合规范的79例胫骨平台骨折患者分为观察组43例行切开复位内固定手术以及对照组36例行骨外固定架固定手术。结果术后随访8个月到6年,平均18个月,达到4~13个月的骨性愈合时间,平均为8个月。依照Lysholm评分规范,依据骨折复位状况、愈合状况、功能复原状况和并发症等条件评分,优52例,良20例,可3例,差4例,优良率为94%。结论治疗胫骨平台骨折,选取适当的手术时机和手术适应证,尽量复原骨和关节的基础外形构造、轴线等。确保关节的稳定性,术后早期实施功能锻炼,能够显著的改善胫骨平台骨折的治疗结果,复原关节的功能,把并发症的产生减少。     

高粘度骨水泥注入椎体成形术治疗急性重度骨质疏松椎体压缩性骨折

目的：探讨应用高粘度骨水泥对急性重度骨质疏松椎体压缩性骨折（Osteoporotic vertebral compression fracture,OVCF）行经皮椎体成形术（Pereutaneous vertebraplasty,PVP）的临床疗效方法：收集2005年2月至2010年8月急性OVCF患者36例．体位复位后应用高粘度骨水泥行经皮椎体成形术治疗．手术前后进行视觉模拟疼痛评分（VAS）、伤椎高度与后凸畸形的X线片测量结果：全部病例于术均安全完成,术中骨水泥注入量平均3．0ml．术后平均随访16．4（12至30）个月。术后VAS评分较术前改薄（P〈0．05）,椎俸前缘、中线高度及后凸畸形较术前明显恢复（P〈0．0．5）。4例（11．1％）出现骨水泥渗漏．似无临床症状及体征,结论：应用商粘度骨水泥经皮椎体成形术结合体位复位及是治疗急性OVCF可行及有效的方法,     

瘢痕疙瘩术后放射治疗的临床分析

目的：探讨瘢痕瘤切除术后放射治疗中采用不同分割方式的疗效。方法：回顾性分析1998年1月至2003年1月间86例瘢痕瘤切除术后在我科行放射治疗患者的疗效,按分割方式分为A组：12-15GY／2-3次。一周内完成。B组：12-15GY／3-5次。一周内完成。C组：12-15GY／6-8次,两周内完成。均于术后24小时开始放疗。结果：A、B、C组局部控制率分别为96．00％、90．00％、83．87％。组间比较均无统计学意义（P均〉0．05）,PAB=0．16;PAc=0．07;PBC=0．15。结论：瘢痕瘤术后放射治疗的总剂量以10-20GY为宜,分割方式对疗效无明显影响。     

关节镜下钬激光治疗半月板损伤

目的 :总结和探讨关节镜下钬激光治疗半月板损伤的手术疗效。方法 :2 0 0 0年 1月 - 2 0 0 3年 12月 ,对 18例半月板损伤患者行关节镜下钬激光治疗。结果 :随访 6 - 18个月 ,平均 12个月 ,Neer评分法对手术疗效进行分析 ,优良率为 94 .4 %。结论 :关节镜下钬激光治疗半月板损伤操作简便 ,手术时间短 ,有较好术后疗效 ,是一种安全有效的手术工具。     

Computer-Assisted Preoperative Planning for Reduction of Proximal Femoral Fracture Using 3-D-CT Data

This paper describes procedures for repositioning calculations of fractured bone fragments using 3-D-computed tomography (CT), aimed at preoperative planning for computer-guided fracture reduction of the proximal femur. Fracture boundaries of the bone fragments, as ldquofracture lines (FLs),rdquo and the mirror-transformed contralateral femur shape extracted from 3-D-CT were used for repositioning of the fragments. We first describe a method for extracting FLs based on 3-D curvature analysis and then formulate repositioning methods based on registration of bone fragments using the following three constraints: 1) contralateral (CL) femur shape; 2) FLs; and 3) both CL femur shape and fracture lines, as ldquoboth constraintsrdquo. We performed experiments using CT datasets from five simulated and four real patients with proximal femoral fracture. We evaluated the rotation error in reposition calculations and the contact ratio between repositioned fragment boundaries, which are crucial for the recovery of proper functional axes and bone adhesion of fragments, respectively. Experimental results showed that good accuracy and stability were attainable when registration using both constraints was performed after registration using the fracture-line constraint. On average, 6.0deg plusmn0.8deg in rotation error and 89% plusmn 3% in contact ratio were obtained without providing precise initial values.     

Transfer-function analysis of UFCT myocardial time-density curvesby time-varying recursive least squares analysis

Techniques which assume linear, time-invariant systems have been used to characterize indicator dilution pairs. As a basis for fully describing the relation between left ventricular (LV) and myocardial (MYC) time-density curves, produced by an intravenous contrast medium as measured by ultrafast CT, the assumption of time invariance was tested using recursive least squares regression and CUSUM, a test for time variability of regression parameters. Using data from anaesthetized dogs with concomitant microsphere information, constant and time-varying regression models, MYC(t)=b(t)LV(t-1), were generated from time-density curves of flows from two groups: Group 1 (MBF<2 ml/min/gm, n=11) and Group 2 (MBF>2 ml/min/gm, n=10). The time-varying regression models had reduced root mean square error: 0.6±1.1 and 0.5±0.8 versus 7.3±3.5 and 4.1±1.6 for Groups 1 and 2, respectively. Significant time variability (p<0.05) by CUSUM was found in 9/11 Group 1 models and 7/10 Group 2 models. Myocardial blood volume was estimated as the average value of b(t) over the rising portion of the LV curve. Myocardial blood flow was then calculated as myocardial blood volume divided by coronary transit time, determined from gamma variate fits of the LV and scaled, shifted LV curve, with excellent results over a wide range of flows (r=0.93, y=0.92x+0.28, range of 0.4 to 6.7 ml/min/gm). These results show that measurements of increased myocardial blood flow are possible with an intravenous contrast media, and that movement of contrast medium from intravascular space to extravascular space occurs during the course of the contrast medium's first pass     

A wide-dynamic-range, high-transimpedance Si bipolar preamplifierIC for 10-Gb/s optical fiber links

A wide-dynamic-range, high-transimpedance preamplifier IC for 10-Gb/s optical fiber links was developed using a 0.3-μm Si bipolar process. The preamplifier with a limiting amplifier enables a wide dynamic range from 16 μApp to 2.5 mApp and a high transimpedance of 1 kΩ (2 kΩ in the differential output mode). Moreover, careful circuit design achieves a transimpedance fluctuation of 0.5 dBR and an average equivalent input noise current density of 12 pA/√Hz. This preamplifier IC has the highest transimpedance of any Si bipolar preamplifier for 10-Gb/s operation. Thus, the preamplifier is suitable for 10-Gb/s short-haul optical fiber links and can be used to provide a low-cost system     

Simulation of SiGe:C HBTs using neural network and adaptive neuro-fuzzy inference system for RF applications

In this article, the small-signal equivalent circuit model of SiGe:C heterojunction bipolar transistors (HBTs) has directly been extracted from S-parameter data. Moreover, in this article, we present a new modelling approach using ANFIS (adaptive neuro-fuzzy inference system), which in general has a high degree of accuracy, simplicity and novelty (independent approach). Then measured and model-calculated data show an excellent agreement with less than 1.68?×?10^?5% discrepancy in the frequency range of higher than 300 GHz over a wide range of bias points in ANFIS. The results show ANFIS model is better than ANN (artificial neural network) for redeveloping the model and increasing the input parameters.     

Attenuation of eye movements evoked by a vestibular implant at the frequency of the baseline pulse rate

We are developing a vestibular implant to electrically stimulate vestibular neurons in the semicircular canals in order to alleviate vertigo, which is a commonly occurring problem. However, since electrical stimulation causes synchronous (phase-locked) neural responses, such electrical stimulation might also cause inappropriate vestibuloocular eye movements, which might, in turn, cause visual blurring. We investigated the eye movements evoked in the guinea pig using electric stimulation with a constant rate of 250 pulses per second (pps), and measured 0.010(°) peak-to-peak eye movements on an average at 250 Hz, with an average peak velocity amplitude of 8.1(°)/s, which might cause visual blurring. However, after half an hour of stimulation, that component reduced to 1.6(°)/s (0.0020(°) peak-to-peak). The average time constant for this reduction was 5.0 min. After one week of constant stimulation, the 250-Hz response component was only slightly smaller, at 1.2(°)/s (0.0015(°) peak-to-peak). We conclude that although an electrical prosthesis with a resting rate of 250 pps may cause some visual blurring when first turned on, such blurring is very likely to attenuate and be imperceptible within several minutes.     

ALA光动力学治疗对C6胶质瘤细胞凋亡的影响

目的:通过细胞学水平研究不同剂量ALA光动力学治疗对C6胶质瘤细胞细胞凋亡的影响。方法:以不同剂量的ALA(10μg/ml、20μg/ml、40μg/ml、80μg/ml、160μg/ml)与C6胶质瘤细胞一起培养,随后以630nm半导体激光200mW/cm2,照射肿瘤细胞,照射20分钟,及与不用光敏剂单照激光、单用光敏剂不照光、不用光敏剂不照激光空白对照组比较。以流式细胞仪及倒置微镜、电镜观察促使肿瘤细胞凋亡或死亡的差别,寻找促使肿瘤细胞凋亡或死亡的最小合适剂量。结果:对照组没有细胞凋亡,ALA-PDT组随着剂量的增加细胞凋亡数增加。尤其晚期凋亡数明显增加,用药剂量增加至40μg/cc才能达到活细胞少于50%,即使剂量增加到160μg/cc,还是有19.7423的活细胞存在。结论:单纯用ALA激光PDT治疗不能达到完全将肿瘤细胞杀灭,ALA40mg/kg激光光动力学治疗才能得到明显的治疗效果。     

Multiple-object 2-D-3-D registration for noninvasive pose identification of fracture fragments

This paper presents a multiple-object 2-D-3-D registration technique for noninvasively identifying the poses of fracture fragments in the space of a preoperative treatment plan. The plan is made by manipulating and aligning computer models of individual fracture fragments that are segmented from a diagnostic computed tomography. The registration technique iteratively updates the treatment plan and matches its digitally reconstructed radiographs to a small number of intraoperative fluoroscopic images. The proposed approach combines an image similarity metric that integrates edge information with mutual information, and a global-local optimization scheme, to deal with challenges associated with the registration of multiple small fragments and limited imaging orientations in the operating room. The method is easy to use as minimum user interaction is required. Experiments on simulated fractures and two distal radius fracture phantoms demonstrate clinically acceptable target registration errors with capture range as large as 10 mm.     

Resistive switching in a Pt/TiO2/Pt thin film stack – a candidate for a non-volatile ReRAM

In Pt/27 nm thick TiO2/Pt stacks bipolar and unipolar resistive switching (BRS, URS) behavior of were investigated. Depending on the current compliance during electroforming process, BRS or URS could be observed: With a lower current compliance (<0.1mA) asymmetric current-voltage (I-V) curves (BRS) were measured in the voltage range −1.6V to +1.1V, while with a higher current compliance (1 to 10mA) the URS behavior was observed. Furthermore, the permanent transition from BRS to URS was investigated by applying voltage with a higher current compliance (∼3 mA). Preliminary results of microstructural investigations show heavily damaged regions in the stacks.     

A multistage system to detect epileptiform activity in the EEG

A PC-based system has been developed to automatically detect epileptiform activity in 16-channel bipolar EEGs. The system consists of 3 stages: data collection, feature extraction, and event detection. The feature extractor employs a mimetic approach to detect candidate epileptiform transients on individual channels, while an expert system is used to detect focal and nonfocal multichannel epileptiform events. Considerable use of spatial and temporal contextual information present in the EEG aids both in the detection of epileptiform events and in the rejection of artifacts and background activity as events. Classification of events as definite or probable overcomes, to some extent, the problem of maintaining high detection rates while eliminating false detections. So far, the system has only been evaluated on development data but, although this does not provide a true measure of performance, the results are nevertheless impressive. Data from 11 patients, totaling 180 minutes of 16-channel bipolar EEGs, have been analyzed. A total of 45-71% (average 58%) of epileptiform events reported by the human expert in any EEG were detected as definite with no false detections (i.e., 100% selectivity) and 60-100% (average 80%) as either definite or probable but at the expense of up to 9 false detections per hour. Importantly, the highest detection rates were achieved on EEGs containing little epileptiform activity and no false detections were made on normal EEGs