多层螺旋 最大C强度投影测量肩脚孟斜倾角的价值

目的:探讨多层螺旋CT(MSCT)最大强度投影(MIP)测量肩胛孟斜倾角的价值。方法:收集成人肩关节标本24侧,用16层螺旋CT扫描仪扫描,MIP测量肩胛孟斜倾角。取MIP重建肩胛骨前后两种冠状位层面,测得两组肩胛盂斜倾角度数,进行统计学处理。结果:肩胛盂斜倾角最小值95．86°,最大值117．78°,两组肩胛盂斜倾角数据分别为106．91°±6．30°,106．60°±6．57°,两种层面肩胛盂斜倾角统计学上无显著性差异。结论:多层螺旋CT最大强度投影测量肩胛孟斜倾角层面选择对测值没有影响;多层螺旋CT MIP测量肩胛盂倾斜角具有较好的可重复性、具有重要价值。     

X线片和多层螺旋CT诊断及鉴别周围型肺癌的对比研究

目的:对比X线平片和多层螺旋CT诊断及鉴别周围型肺癌的效果。方法:选取了100例周围型肺癌患者,所有患者入院后先行X线片检查,后进行多层螺旋CT检查。通过观察并记录X线片与多层螺旋CT对周围型肺癌的影像学特征、临床TNM分期的诊断效果,评价X线平片和多层螺旋CT对周围型肺癌的诊断效果。结果:多层螺旋CT对周围型肺癌的肿块、分叶征、支气管气象征、空洞、胸膜凹陷、血管集束征,胸腔积液的检出率均高于X线片(P0.05)。根据外科病理TNM分期结果,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率为92.0%,X线对周围型肺癌的临床TNM分期诊断符合率为61.0%,多层螺旋CT对周围型肺癌的临床TNM分期诊断符合率明显高于X线(P0.05)。结论:多层螺旋CT对于周围型肺癌各类型影像学征象具有较好的检出率,对周围型肺癌临床TNM分期诊断准确性接近病理诊断结果。     

改良阶梯式截骨法矫正儿童创伤后肘内翻畸形

目的:探讨采用肱骨髁上改良阶梯式截骨联合钢板等内固定治疗儿童肘内翻畸形的临床疗效。方法:回顾性研究我科自2012年1月~2014年12月收治的14例肘内翻畸形患者,其中,男10例/女4例,年龄6~14岁,平均10.3岁,右侧9例/左侧5例。所有病例均有明确的伸直型肱骨髁上骨折病史,在创伤后约1.7年(1~4.5年)行改良阶梯式截骨。通过测量手术前后提携角及肘关节活动度,并依据Flynn临床肘关节功能评定标准对患肢功能进行评价。结果:本组患者术后均获得随访,随访时间12~26个月,平均17.4±2.7个月,肱骨截骨处达到骨性愈合的时间为2.5~4个月(平均2.9±0.6个月),术后畸形矫正良好,获得5.2±1.7°提携角。术后关节活动范围-0.7±1.6~134.5±2.4°,与术前相比,伸展活动的差异无统计学意义(t=0.871,P0.05);而屈曲活动改善明显,差异有统计学意义(t=18.819,P0.01)。末次随访时截骨纠正角度丢失1.4±0.8°。根据Flynn肘关节功能评定标准:优11例/良2例/可1例,优良率92.86%。均无感染、外髁突出、过度肥厚增生的术后瘢痕、血管神经损伤、关节不稳等并发症。结论:本研究针对创伤后儿童肘内翻畸形的手术疗效进行随访,发现改良阶梯式截骨的手术操作相对简单,矫形效果满意,能早期恢复肘关节功能且畸形复发率低,是一种美容效果较好的治疗肘内翻的截骨方式。     

128层螺旋CT 低剂量扫描检查孤立性肺内结节性病灶的研究

目的:探讨多排螺旋CT(128排)低剂量扫描参数下检查孤立性肺内结节的可行性研究。方法:随机连续搜集我院低剂量(30m A)CT肺体检者,发现肺内结节病灶患者13例,对其进一步以常规剂量(350m A)CT精细扫描,比较低剂量扫描及常规剂量扫描肺结节大小差异。结果:两种剂量扫描策略均检查出46枚结节。常规剂量与低剂量测得各部位结节体积分别为:肺尖部:(431.3±92.8)mm~3,(658.4±94.4)mm~3,肺中部:(3025.8±526.7)mm~3,(2989.4±520.4)mm~3,肺底部:(1241.5±438.9)mm~3,(1266.0±447.6)mm~3,肺尖部肺结节大小差异明显,肺中部及肺底部肺结节大小均无显著性差异(P0.05)。常规剂量与低剂量测得结节体积(除外肺尖部位结节5枚)分别为,组1:(39.8±14.6)mm~3,(40.7±15.5)mm~3;组2:(202±106.3)mm~3,(204.1±103.6)mm~3;组3:(4179.7±4410.4)mm~3,(4190.5±4487.2)mm~3。三组组内测量结果均无显著性差异(P0.05)。常规剂量与低剂量测得非实性结节密度[(-68.3±24.2)HU,(-64.6±22.8)HU]及实性结节结节密度[(97.5±69.5)HU,(107.2±90)HU]均无统计学差异(P0.05)。结论:低剂量更加有利于肺内孤立结节患者扫描复查病灶,可以应用推广。     

MSCT 灌注成像在肾细胞癌临床应用价值研究*

目的:探讨肾细胞癌多层螺旋CT(MSCT)灌注成像特征,并研究其临床应用价值。方法:肾癌患者69例,采用64排多层螺旋CT对其肾脏进行平扫及灌注增强扫描,使用renal tumor perfusion软件对图像进行后处理,自动生成时间-密度曲线(TDC),各种灌注图像及感兴趣区(ROI)内的灌注参数,包括血流量(BF)、血容量(BV)、平均通过时间(MTT)及表面通透性(PS),将得到的灌注参数分别进行统计分析。结果:肾癌肿块灌注参数与已测得的正常肾皮质各灌注参数值均存在显著性差异(P值均<0.01),其中,正常肾皮质的BF值、BV值及PS值均高于肾癌组织,MTT值则相反;肾癌肿块灌注参数与已测得的正常肾髓质各灌注参数值同样存在显著性差异(p值均<0.01),正常肾髓质各灌注参数值均低于肾癌组织,而PS值二者之间差别不显著(P<0.05);肾癌患者健侧肾皮髓质灌注参数值与已测得的正常肾皮髓质各灌注参数值及肾癌患者癌旁正常肾皮髓质各灌注参数值,三者之间差异无统计学意义(P>0.05)。结论:多层螺旋CT(MSCT)灌注成像在显示肾脏形态的同时,还可定量测量皮髓质的血流灌注情况,间接反映肾脏生理特征。     

后路短节段椎弓根内固定结合间接复位法在胸腰椎爆裂性骨折中的疗效观察及其影响因素分析

目的:评价后路短节段椎弓根内固定结合间接复位法对胸腰椎爆裂性骨折的疗效及其影响因素,为临床治疗提供参考.方法:通过对2000年6月～2011年3月112例胸腰椎爆裂性骨折接受后路短节段椎弓根内固定治疗的患者,分别对其术前、术后、末次随访拍摄正侧位片,手术前后拍摄CT.X线片上测量伤椎前后缘高度比(AVH、PVH),楔变角(VBA),Cobb's角及矢状面指数(SI); CT片上测量骨块所占椎管矢状径比例并计算骨块回缩率.根据Denis疼痛分级及Oswestry功能评分和Frankel分级对手术前后及末次随访情况进行评估.结果:112例患者VBA、Cobb's角术前、术后及末次随访的结果分别是:VBA:19.4°±7.7°,4.2°±4.7°,6.7°±5.0°;Cobb's角:17.8°±9.3°,2.8°±8.7°,8.8°±8.5°;SI值:16.3°±8.7°,1.9°±4.3°,6.0°±7.1 °,术后及末次随访时伤椎AVH、PVH均较术前显著增加,VBA、Cobb?s角及SI均较术前显著减少,差异均有统计学意义(P＜0.05),且术后与末次随访时各项指标均有不同程度的丢失.末次随访时,仍有2例患者存在括约肌障碍,1例全瘫患者无明显恢复,其余患者均有Frankel l级以上的改善;Oswestry功能障碍评分优82例,良20例,差3例,优良率为97.1％,平均得分11±14,其中有4例发生内固定物断裂.Denis疼痛分级结果为:Pl级61例,P2级40例,P3级10例,P4级1例.椎管中骨块复位率与术后AVH复位值成正相关(P＜0.01),与术后VBA负相关(P＜0.05).结论:后路短节段椎弓根内固定间接复位治疗胸腰椎爆裂性骨折是一种安全有效的方法,临床疗效可靠.     

64排螺旋CT对粗隆间骨折Evans分型的影响研究

目的:探讨64排螺旋CT对粗隆间骨折Evans分型的影响,为临床使用提供参考依据。方法:2015年3月至2017年3月,三甲医院高年资创伤骨科主任医师2名,医师1、医师2分别按照术前X线、术前64排螺旋CT平扫和三位重建结果对128例新鲜闭合单侧粗隆间骨折患者进行Evans分型,分别记为X线分型、CT分型。本院术者依据围术期X线、CT及术中所见骨折情况进行Evans分型(逆粗隆间骨折定义为Ⅴ型)作为最终分型。记录分型结果,计算并对比准确率、误诊率。结果:(1)剔除5例,90.09%(123/128)的患者完成研究。(2)分型结果:X线分型中,3例(最终分型Ⅲ型2例,Ⅳ型1例)无法定型;Ⅰ型正确1例,改为Ⅱ型1例;Ⅱ型正确18例,改为Ⅰ型2例,改为Ⅲ型3例,Ⅳ型2例;Ⅲ型正确45例,改为Ⅱ型7例,改为Ⅳ型1例;Ⅳ型正确19例,改为Ⅱ型3例,改为Ⅲ型15例。CT分型中,Ⅰ型正确3例,Ⅱ型正确29例,Ⅲ型正确64例,改为Ⅳ型1例,Ⅳ型正确22例,Ⅴ型正确3例。(3)CT分型的总准确率、总误诊率优于X线分型(99.19%vs67.48%、0.81%vs30.08%,P0.05)。(4)Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型骨折进行CT分型,准确率高于X线分型(P0.05),误诊率低于X线分型(P0.05);Ⅴ型骨折,两种分型准确率、误诊率相等。结论:64排螺旋CT平扫及三维重建是粗隆间骨折Evans分型较为可靠的辅助检查,可考虑推广运用。     

16层螺旋CT灌注成像对肝硬化血流状态的评估及与肝硬化程度的相关性研究

目的:探讨16层螺旋CT灌注成像对肝硬化血流状态的评估价值及其与肝硬化程度的相关性。方法:选取2014年1月至2016年1月于我院接受诊治的肝硬化患者126例作为肝硬化组,根据Child-Pugh分级分为A组(Child A级,n=35例)、B组(Child B级,n=50例)、C组(Child C级,n=41例)。另选取同期于我院接受体检的健康人员100例作为对照组。应用16层螺旋CT对受试者肝脏、脾脏、主动脉以及门静脉的层面进行CT动态增强扫描,对比CT灌注参数,采用Pearson相关性分析分析CT灌注参数与肝硬化病情严重程度的关系。结果:肝硬化组肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)、肝脏血流量(TBV)以及平均通过时间(MTT)均明显高于对照组,而门静脉灌注量(PVP)、总肝灌注量(TLP)均明显低于对照组(P0.05)。A组患者HAP、HPI均明显高于C组,而PVP与TLP均明显低于C组,差异有统计学意义(P0.05);两组TBV、MTT比较无统计学差异(P0.05);而A组与B组相比以及B组与C组相比,各项CT灌注参数均无统计学差异(P0.05)。肝硬化患者病情严重程度与HAP、HPI均呈正相关关系(P0.05),而与PVP、TLP均呈负相关关系(P0.05)。结论:16层螺旋CT灌注成像对肝硬化血流状态具有一定的评估价值,且CT灌注参数的水平变化与肝硬化患者病情严重程度存在密切相关。     

多层螺旋计算机断层扫描测量成年贵州小型猪腰椎正常数据

目的通过测量成年贵州小型猪腰椎椎体及附件各种径线值,建立贵州小型猪腰椎正常数据。方法选取健康成年贵州小型猪10头(雄性5头,雌性5头),采用西门子双源计算机断层扫描仪(CT)对其进行薄层轴位扫描,经Aquarius iNtuition 4.4进行图像重建,在横断位椎体正中层面测量椎体、椎管横径及纵径,椎弓根的宽度及骨性通道,在矢状位测量椎体、椎弓根高度,并对椎弓根宽度、椎弓根骨性通道与体质量做相关性分析。结果腰1~腰5椎体、椎管横径逐渐变大,而椎体、椎管纵径及椎弓根宽度、高度变化不明显,腰3椎弓根宽度及高度均最大,分别为9.81 mm±0.65 mm,17.77 mm±0.46 mm。椎弓根宽度与体质量均呈显著正相关(r_(L1)=0.96,r_(L2)=0.97,r_(L3)=0.86,r_(L4)=0.73,r_(L5)=0.85;P0.05)。椎弓根骨性通道也与小型猪体质量均呈显著正相关(r_(L1)=0.97,r_(L2)=0.90,r_(L3)=0.89,r_(L4)=0.52,r_(L5)=0.65;P0.05)。结论多层螺旋CT及其后处理软件可以准确测量贵州小型猪腰椎及附件影像资料,为建立小型猪腰椎病理模型提供基础数据。     

256 层CT 冠状动脉造影低剂量技术联合应用的临床价值

目的:探讨前瞻性心电门控扫描、低管电压结合迭代重建算法在256层螺旋CT冠脉造影中的应用价值。方法:回顾性分析行256层螺旋CT冠状动脉成像(CCTA)、体质量指数正常的受检者130例。常规剂量组(A组)50例:应用回顾性心电门控扫描模式,管电压120 kv;低剂量组(B组)80例,心率70次/分者50例,心率≧70次/分者30例:应用前瞻性心电门控扫描模式,管电压100 kv。B组患者原始数据分别应用迭代算法(Idose3)重建及标准滤波反投影法(FBP)重建。比较A、B两组的有效辐射剂量,对各组客观图像质量及主观图像质量进行统计学分析。结果:A、B两组平均有效辐射剂量分别为(15.34±3.89)、(1.43±0.12)m Sv。B组患者应用迭代重建图像噪声降低,差异有统计学意义(P0.05)。应用FBP重建,B组图像噪声高于A组,两者比较差异有统计学意义(P0.05)。各组主观图像质量评分差异无统计学意义(P0.05)。结论:前瞻性心电门控低千伏扫描模式联合迭代重建算法在提供满足诊断的冠状动脉CTA图像的同时,辐射剂量降幅高达90.6%。心率70次/分-85次/分的患者也可行256层CT前门控扫描,降低管电压造成的图像噪声增加可以通过迭代重建弥补。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Feeding the vertebrate retina from the Cambrian to the Tertiary

The retina of the vertebrate eye is metabolically active and requires nutritive support. During the last 540 million years it has evolved into forms as complicated and nutritionally demanding as those found in avian or primate eyes. Diffusion from the choroid is generally able to supply the metabolic needs of thin retinae. However, when the thickness exceeds the limits of diffusion, structures are needed to supplement the vascular supply from the choroid. These supplemental nutritive devices include the choroidal gland, the falciform process and preretinal vascular plexus of fish, the conus papillaris of lizards, the pecten oculi of birds, the intraretinal vessels of mammals and a few novel systems that remain difficult to classify. These vascular systems are among the most variable features of the vertebrate eye. Here, we review classical and recent findings regarding such retinal nutrition systems, propose a three category classification for them based on histologic origins and speculate on the evolutionary forces which drove their development.     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418