背景:Topping-off技术通过将腰椎融合和棘突间动态内固定系统(Coflex)结合,在实现充分减压的同时也能够对相邻节段予以保护。目前将Topping-off技术应用于腰骶区需要融合同时相邻节段存在退变的年轻患者的相关力学研究尚未见报道。目的...背景:Topping-off技术通过将腰椎融合和棘突间动态内固定系统(Coflex)结合,在实现充分减压的同时也能够对相邻节段予以保护。目前将Topping-off技术应用于腰骶区需要融合同时相邻节段存在退变的年轻患者的相关力学研究尚未见报道。目的:建立腰骶交界区Topping-off有限元模型,分析邻近节段生物力学及全腰椎活动度的变化趋势。方法:随机选择1名健康年轻男性志愿者,既往无腰部外伤史及腰痛病史,经签署志愿同意书后,行薄层CT扫描,获取影像学资料。将图像信息导入计算机,依次通过Mimics、Geomagic Studio 12.0、HyperMesh、Abaqus对图像信息进行分析建立全腰椎模型,即健康组模型。验证模型的有效性后,在健康组模型的基础上改变L4-S1椎间盘材料属性建立椎间盘中度退变模型,并在退变模型的基础上分别建立融合模型和Topping-off模型。然后分别计算4组模型在施加400 N的预载荷和10 N m的扭转力矩后L2-L5节段活动度变化趋势及L4/L5椎间盘、髓核以及关节突关节的应力变化。结果与结论:①Topping-off模型与融合模型腰椎活动度较退变模型减小,且Topping-off模型比融合模型减小更明显;②融合模型术后L4-L5活动度较退变模型显著增加,L2/L3、L3/L4节段活动度相比退变模型并无明显改变;Topping-off模型L4-L5活动度较退变模型减小,L2/L3、L3/L4节段活动度相比退变模型在前屈及后伸体位下均有一定程度增加;③相比退变模型,融合模型L4-L5节段在前屈、后伸、左旋、左侧弯4个体位下,椎间盘、髓核、关节突关节应力均增大,而Topping-off模型纤维应力在4个体位下均降低;④说明Topping-off技术不仅能够降低上位相邻节段椎间盘、髓核和关节突的关节应力,而且能够减少相邻节段过度活动,增加上位其他节段的活动度,进而在代偿腰椎活动度的同时延缓相邻节段退变。展开更多
AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed ...AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed patients diagnosed with cholangiocarcinoma between January 1997 and December 2007 at the University Malaya Medical Centre in Malaysia.The clinical data and associated outcomes were collected using a structured proforma.RESULTS:Of the 69 patients diagnosed with cholangiocarcinoma,38 (55%) were male;mean patient age was 61 years.Twelve patients (17%) had intrahepatic,38 (55%) had perihilar and 19 (28%) had distal tumors.Only 12 patients underwent curative surgery,including seven R0 resections.Only one patient died within 30 d after surgery.The overall median survival was 4 mo,whereas the median survival of R0 resected patients was 16 mo.The overall 1-,2-and 3-year cumulative survival rates were 67%,17% and 17%,respectively.Survival rates were significantly associated with curative resection (P=0.002),intrahepatic tumor (P=0.003),negative margin status (P=0.013),early tumor stage (P=0.016),higher tumor differentiation (P=0.032) and absence of jaundice (P=0.038).Multivariate analysis showed that tumor location was a significant independent predictor of patient survival.CONCLUSION:Curative,margin-negative resection of early stage,well-differentiated intrahepatic tumors is associated with improved patient survival.展开更多
Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the ...Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.展开更多
AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response...AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.展开更多
Surgical tumor resection is a common approach to cancer treatment.India Ink tattoos are widely used to aid tumor resection by localizing and mapping the tumor edge at the surface.However,India Ink tattoos are easily o...Surgical tumor resection is a common approach to cancer treatment.India Ink tattoos are widely used to aid tumor resection by localizing and mapping the tumor edge at the surface.However,India Ink tattoos are easily obscured during electrosurgical resection,and fade in intensity over time.In this work,a novel near-infrared(NIR)fluorescent marker is introduced as an alternative.The NIR marker was made by mixing indocyanine green(ICG),biocompatible cyanoacrylate,and acetone.The marking strategy was evaluated in a chronic ex vivo feasibility study using porcine tissues,followed by a chronic in vivo mouse study while compared with India Ink.In both studies,signal-to-noise(SNR)ratios and dimensions of the NIR markers and/or India Ink over the study period were calculated and reported.Electrocautery was performed on the last day of the mouse study after mice were euthanized,and SNR ratios and dimensions were quantified and compared.Biopsy was performed at all injection sites and slides were examined by a pathologist.The proposed NIR marker achieved(i)consistent visibility in the 26-day feasibility study and(ii)improved durability,visibility,and biocompatibility when compared to traditional India Ink over the six-week period in an in vivo mouse model.These effects persist after electrocautery whereas the India Ink markers were obscured.The use of a NIR fluorescent presurgical marking strategy has the potential for intraoperative tracking during long-term treatment protocols.展开更多
This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psy...This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psychological care, correct operation, close observation and infection prevention during treatment can effectively optimize the use of external diaphragm pacemakers, improve respiratory muscle function, and the quality of life after lung cancer surgery in elderly patients.展开更多
In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant...In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.展开更多
[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例...[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例仅对L5S1行椎间融合术(融合组);59例采用Topping-off技术,L5、S1椎间融合术同时在L4、5棘突间置入Coflex(Topping-off组)。比较两组术前及随访时VAS、ODI及MRI上L4、5节段椎间盘相对信号强度(relative signal intensity,RSI)变化情况。[结果]融合组与Topping-off组患者临床症状均有显著改善,末次随访时两组的ODI及VAS评分均较术前明显下降,差异均有统计学意义(P<0.01),但相同时间点两组间的差异无统计学意义(P>0.05)。末次随访时MRI上Topping-off组L4、5节段椎间盘相对信号强度(RSI)显著高于融合组,两组间差异有统计学意义(P<0.05)。[结论]腰椎融合术及Topping-off技术对于伴节段不稳或伴有剧烈腰痛的腰椎间盘突出症均有良好且相似的临床疗效,但对于已合并上位邻近节段退变的患者,Topping-off技术缓解患者临床症状的同时更有助于延缓邻近节段椎间盘的退变。展开更多
In this study, the interaction between diode laser radiation and chicken soft tissue was studied in vitro by a high-speed digital video camera. We used a diode laser with a wavelength of （980 ±10）nm and average...In this study, the interaction between diode laser radiation and chicken soft tissue was studied in vitro by a high-speed digital video camera. We used a diode laser with a wavelength of （980 ±10）nm and average power of 10 W. The diode laser was operated in continuous wave （CW） and pulsed modes. In CW mode, the average laser radiation power was 10 W; in pulsed mode, the average laser radiation power was I0 W and the peak power was 20 W. Diode laser radiation was delivered to soft tissue （chicken meat） using a quartz optical fiber with either a clear distal end （clear tip） or a distal end containing an optothermal converter （hot tip）. Application of the diode laser in pulsed mode resulted in crater depths and areas of collateral damage in soft tissue about 1.6 times greater than those observed in CW mode at treatment with the clear tip. Significant differences in the crater depth and collateral damage width of chicken meat were not found after hot-tip treatment with the diode laser in CW and pulsed modes. Soft tissue treated with the hot tip showed crater depths about 3.4 times greater than those observed after treatment with the clear tip. Hot tip treatment further resulted in collateral damage widths about 2.7 times lower than those obtained after treatment with the clear tip.展开更多
文摘背景:Topping-off技术通过将腰椎融合和棘突间动态内固定系统(Coflex)结合,在实现充分减压的同时也能够对相邻节段予以保护。目前将Topping-off技术应用于腰骶区需要融合同时相邻节段存在退变的年轻患者的相关力学研究尚未见报道。目的:建立腰骶交界区Topping-off有限元模型,分析邻近节段生物力学及全腰椎活动度的变化趋势。方法:随机选择1名健康年轻男性志愿者,既往无腰部外伤史及腰痛病史,经签署志愿同意书后,行薄层CT扫描,获取影像学资料。将图像信息导入计算机,依次通过Mimics、Geomagic Studio 12.0、HyperMesh、Abaqus对图像信息进行分析建立全腰椎模型,即健康组模型。验证模型的有效性后,在健康组模型的基础上改变L4-S1椎间盘材料属性建立椎间盘中度退变模型,并在退变模型的基础上分别建立融合模型和Topping-off模型。然后分别计算4组模型在施加400 N的预载荷和10 N m的扭转力矩后L2-L5节段活动度变化趋势及L4/L5椎间盘、髓核以及关节突关节的应力变化。结果与结论:①Topping-off模型与融合模型腰椎活动度较退变模型减小,且Topping-off模型比融合模型减小更明显;②融合模型术后L4-L5活动度较退变模型显著增加,L2/L3、L3/L4节段活动度相比退变模型并无明显改变;Topping-off模型L4-L5活动度较退变模型减小,L2/L3、L3/L4节段活动度相比退变模型在前屈及后伸体位下均有一定程度增加;③相比退变模型,融合模型L4-L5节段在前屈、后伸、左旋、左侧弯4个体位下,椎间盘、髓核、关节突关节应力均增大,而Topping-off模型纤维应力在4个体位下均降低;④说明Topping-off技术不仅能够降低上位相邻节段椎间盘、髓核和关节突的关节应力,而且能够减少相邻节段过度活动,增加上位其他节段的活动度,进而在代偿腰椎活动度的同时延缓相邻节段退变。
文摘AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed patients diagnosed with cholangiocarcinoma between January 1997 and December 2007 at the University Malaya Medical Centre in Malaysia.The clinical data and associated outcomes were collected using a structured proforma.RESULTS:Of the 69 patients diagnosed with cholangiocarcinoma,38 (55%) were male;mean patient age was 61 years.Twelve patients (17%) had intrahepatic,38 (55%) had perihilar and 19 (28%) had distal tumors.Only 12 patients underwent curative surgery,including seven R0 resections.Only one patient died within 30 d after surgery.The overall median survival was 4 mo,whereas the median survival of R0 resected patients was 16 mo.The overall 1-,2-and 3-year cumulative survival rates were 67%,17% and 17%,respectively.Survival rates were significantly associated with curative resection (P=0.002),intrahepatic tumor (P=0.003),negative margin status (P=0.013),early tumor stage (P=0.016),higher tumor differentiation (P=0.032) and absence of jaundice (P=0.038).Multivariate analysis showed that tumor location was a significant independent predictor of patient survival.CONCLUSION:Curative,margin-negative resection of early stage,well-differentiated intrahepatic tumors is associated with improved patient survival.
文摘Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.
文摘AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.
基金This work is spported by the National Istitutes of Health under award rumbers 1RO1BB020610 and R21EB024707spprted by the Intramua Research Progam of the National Insites of Health,Natioial Cancer Istitutet Center for Cancer Reearch.
文摘Surgical tumor resection is a common approach to cancer treatment.India Ink tattoos are widely used to aid tumor resection by localizing and mapping the tumor edge at the surface.However,India Ink tattoos are easily obscured during electrosurgical resection,and fade in intensity over time.In this work,a novel near-infrared(NIR)fluorescent marker is introduced as an alternative.The NIR marker was made by mixing indocyanine green(ICG),biocompatible cyanoacrylate,and acetone.The marking strategy was evaluated in a chronic ex vivo feasibility study using porcine tissues,followed by a chronic in vivo mouse study while compared with India Ink.In both studies,signal-to-noise(SNR)ratios and dimensions of the NIR markers and/or India Ink over the study period were calculated and reported.Electrocautery was performed on the last day of the mouse study after mice were euthanized,and SNR ratios and dimensions were quantified and compared.Biopsy was performed at all injection sites and slides were examined by a pathologist.The proposed NIR marker achieved(i)consistent visibility in the 26-day feasibility study and(ii)improved durability,visibility,and biocompatibility when compared to traditional India Ink over the six-week period in an in vivo mouse model.These effects persist after electrocautery whereas the India Ink markers were obscured.The use of a NIR fluorescent presurgical marking strategy has the potential for intraoperative tracking during long-term treatment protocols.
文摘This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psychological care, correct operation, close observation and infection prevention during treatment can effectively optimize the use of external diaphragm pacemakers, improve respiratory muscle function, and the quality of life after lung cancer surgery in elderly patients.
文摘In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.
文摘[目的]在MRI上观察采用Topping-off技术置入棘突间装置(Coflex)后椎间盘的退变情况,并评价近期临床效果。[方法]2007年8月~2014年11月,107例L5/S1间盘脱出合并L4、L5间盘退变,在本院行手术治疗并随访2年以上的患者纳入本研究。其中48例仅对L5S1行椎间融合术(融合组);59例采用Topping-off技术,L5、S1椎间融合术同时在L4、5棘突间置入Coflex(Topping-off组)。比较两组术前及随访时VAS、ODI及MRI上L4、5节段椎间盘相对信号强度(relative signal intensity,RSI)变化情况。[结果]融合组与Topping-off组患者临床症状均有显著改善,末次随访时两组的ODI及VAS评分均较术前明显下降,差异均有统计学意义(P<0.01),但相同时间点两组间的差异无统计学意义(P>0.05)。末次随访时MRI上Topping-off组L4、5节段椎间盘相对信号强度(RSI)显著高于融合组,两组间差异有统计学意义(P<0.05)。[结论]腰椎融合术及Topping-off技术对于伴节段不稳或伴有剧烈腰痛的腰椎间盘突出症均有良好且相似的临床疗效,但对于已合并上位邻近节段退变的患者,Topping-off技术缓解患者临床症状的同时更有助于延缓邻近节段椎间盘的退变。
文摘In this study, the interaction between diode laser radiation and chicken soft tissue was studied in vitro by a high-speed digital video camera. We used a diode laser with a wavelength of （980 ±10）nm and average power of 10 W. The diode laser was operated in continuous wave （CW） and pulsed modes. In CW mode, the average laser radiation power was 10 W; in pulsed mode, the average laser radiation power was I0 W and the peak power was 20 W. Diode laser radiation was delivered to soft tissue （chicken meat） using a quartz optical fiber with either a clear distal end （clear tip） or a distal end containing an optothermal converter （hot tip）. Application of the diode laser in pulsed mode resulted in crater depths and areas of collateral damage in soft tissue about 1.6 times greater than those observed in CW mode at treatment with the clear tip. Significant differences in the crater depth and collateral damage width of chicken meat were not found after hot-tip treatment with the diode laser in CW and pulsed modes. Soft tissue treated with the hot tip showed crater depths about 3.4 times greater than those observed after treatment with the clear tip. Hot tip treatment further resulted in collateral damage widths about 2.7 times lower than those obtained after treatment with the clear tip.
