2014年 · 第94卷第03期

In recent years, there are more and more papers on clinical and basic research using magnetic resonance (MR) technology. In view of some common problems, this paper puts forward some suggestions on how to choose topics and how to standardize the experimental design.

In traditional open surgery or endoscopic surgery, the surgeon directly senses the texture of tissue or tumor with the touch of the hand or indirectly senses the texture of tissue or tumor through the instrument, whether the ligation line is tight, etc. This tactile perception information is transmitted to the hand, which is called force feedback. Force feedback is crucial in surgery. However, in recent years, this tactile force feedback that we have become accustomed to has completely disappeared in robot-assisted surgery. How to make up for this deficiency, we can only visually observe the deformation of tissue after stress to judge the softness and hardness of tissue texture, and observe the tension of suture to determine whether the knot is tight. After a period of training and adaptation, the surgeon can skillfully determine this information through visual perception and brain judgment, which we call visual force feedback. We have studied and applied visual force feedback such as tightness of clamp tissue, weight of pulling organs and force of pushing and stripping blood vessels under the robot, among which knotting operation is the most representative. How to use visual force feedback to skillfully complete the knotting operation under the robot? When tying the first knot, pay attention to whether the tissue or blood vessels are appropriately tightened, whether the knot is tight, and whether the tension of the thread is appropriate. After tying the second knot, pay attention to the tightness of the knot and the tension of the thread, so as to avoid the tightness of the knot and the suture breaking. The sign to determine that the knot is tight is that, in the case of a monofilament thread, there is no gap between the two single knots; If it is a braided thread, the thread strand cannot be clearly seen at the thread knot, and the thread at the thread tip is obviously thinner. After a period of operation, knotting will become more skilled and handy. After about half a year to one year, the application of this visual force feedback can reach its highest level, that is, it feels that there is really strong feedback on the hand, and when the wire is tight, there will be a feeling that the wire can't be pulled. In fact, this kind of visual feedback also exists in life. For example, when we take the conveyor belt at the airport or the escalator in the shopping mall, we don't get used to it at first, and we will trip or even fall down. After we are proficient, we will walk freely. However, when the conveyor belt or escalator does not move, you will instead feel uncomfortable or feel tripped when you walk up. Therefore, there is reason to believe that a full understanding of visual force feedback and continuous practice will help to master robot-assisted surgery faster and easier.

osteoporosis (OP) is a disease of the skeletal system characterized by decreased bone strength leading to increased fracture risk^[1]。 According to the estimated data in 2006, the number of OP patients in China over 50 years old is as high as 69.44 million, and about 210 million patients have low bone mass^[2]。 The male-to-female ratio of crude incidence of hip fractures was approximately 1:1.2 and the age-standardized incidence was approximately 1:1.6 for people over 50 years of age^[3]。 In Sweden, the prevalence of OP was higher in males than in females, approximately 34.7%^[4]。 In China, the mortality rate of elderly hip fracture within one year is 20%, and the disability rate is as high as 50%^[2]。 The high incidence and mortality of hip fractures in the male population and their impact on quality of life highly suggest that OP is also an elderly male disease and must receive the same attention and standardized treatment as female patients.

high frequency oscillations (HFOs) are high frequency signals in EEG recordings, which are closely related to normal or abnormal brain function, and have received much attention in recent years. In this paper, the classification, mechanism and clinical application of HFOs in epilepsy are reviewed, aiming to improve the understanding of HFOs and promote its research.

The incidence of twin transfusion syndrome (TTTS) in monochorionic twin pregnancies ranges from 10% to 15%, and the untreated fetal and neonatal mortality rate is as high as 80% to 100%. At present, the commonly used treatment methods for TTTS include amniotic fluid reduction, diaphragmatic perforation, selective placental communicating vessel laser electrocoagulation (SLPCV) and selective fetal reduction^[1]。 SLPCV is currently recognized as the treatment of choice.

The patient was an 85-year-old female who experienced dull pain in the lower abdomen with vaginal bleeding for half a day without obvious trigger in the past 2 months. The patient found a 15 cm diameter anechoic area on the right side of the uterus in B-ultrasound examination in the local hospital, so he went to the Second Affiliated Hospital of Suzhou University and was admitted to the hospital with a "pelvic mass". Gynecological examination: A mass with a diameter of 15 cm can be palpable above the uterus, with medium texture and poor mobility. MRI examination revealed a multilocular cystic space-occupying lesion in the right ovary, 10 cm ×11 cm ×15 cm in size. Multiple fine compartments were found in the lesion, and the thickness of the compartments was uneven. No irregular thickening and isosignal wall nodules were found. The contents of the sac were T₁WI showed low signal, T₂WI-SPAIR showed high signal, and the signal intensity of cystic fluid in each chamber was different. A nodular abnormal signal focus was seen in the anterior and upper part of the lesion, showing T₁WI slightly lower signal (Figure 1), T₂WI-SPAIR was significantly low-signal, 4.5 cm ×4.2 cm ×3.8 cm in size (Figure 2), a capsule is visible around the lesion with clear boundaries. The cyst wall and septum of the lesion were moderately enhanced by enhanced scan, but the cyst fluid was not enhanced. Most of the anterior and upper nodules of the lesion were not enhanced obviously, and only a few flocculate enhancements were seen inside (Figure 3)。 The surrounding structures such as the uterus and bladder change under pressure. MRI diagnosis of ovarian mucinous cystadenoma is possible, but Brenner's tumor is not excluded. Pathological examination revealed one cyst, 13 cm in diameter, with multilocular section, and mucoid fluid flowing from the cyst. The pathological picture shows the morphology of Brenner's tumor. Pathological diagnosis: right ovarian mucinous cystadenoma and Brenner's tumor (occasionally pathological mitosis) (Figure 4)。