In order to protect the integrity and function of the digestive system, duodenum-preserving total pancreatic head resection is becoming the surgical method which was chosen by more and more doctors for benign lesions or low-grade malignant tumors of the pancreatic head. With the development of minimally invasive concepts and techniques, laparoscopic technology has brought unique advantages to this surgery. In this paper, a series of problems such as the development process and indications of laparoscopic duodenum-preserving total pancreatic head resection were discussed, and the core techniques of surgery and how to reduce the occurrence of complications were emphasized. The aim is to improve the therapeutic effect and quality of life of patients through reasonable surgical methods and treatment strategies.
In thoracoscopic pulmonary nodule resection surgery, precise preoperative planning is crucial. Artificial intelligence (AI)-assisted three-dimensional (3D) reconstruction technologies have shown great potential in this area. AI-assisted 3D reconstruction technologies can provide accurate, personalized models of the pulmonary vasculature and bronchial anatomy, assisting surgeons in detailed surgical planning and thus enhancing the precision and safety of surgeries. This article reviews the application progress of AI-assisted 3D reconstruction technologies in pulmonary nodule surgery, including their applications in preoperative diagnosis, surgical planning, and intraoperative navigation, as well as the advancements in AI-assisted 3D reconstruction technologies. It analyzes the technical features of all kinds of 3D reconstruction methods, their clinical applications, and the challenges they face.
Objective To investigate the research advance in repair of the peripheral nerve defect with an acellular nerve allograft. Methods The recent related literature was extensively and comprehensively reviewed. The methods and the effects of the allografts with acellular nerves were analyzed. Results The immunogenicity of the allograft was more significantly relieved by the chemical treatment than by the physicaltreatment. The effect of the chemical treatment on the axon regeneration was better than that of the physical treatment. Conclusion Because of the limitation of the host Schwann cell translation in the longsegment acellular nerve allografts, the effect of Schwann cells is not satisfactory and regeneration of the nerve is limited. So, the recellularized treatment with some related measures can enhance the host Schwann cell translation so that this problem can be solved.
Pleuropulmonary blastoma (PPB) is a kind of rare malignancy which often occurs in children and is related to dysplasia. It always involves in pleura and lung. PPB is misdiagnosed easily because of its special pathophysiological characters and complex biological behavior. Early detection and correct treatment are very important for thoracic surgeon to cure PPB. This paper reviews the advance of pathophysiological characters, molecular genetic characters, clinical manifestation, clinical diagnosis and differential diagnosis, and treatment and prognosis of PPB.
Objective To systematically review the effectiveness of amiodarone in treating repurfusion arrhythmia (RA) after thrombolytic therapy for acute myocardial infarction (AMI), so as to provide high quality evidence for formulating the rational thrombolytic therapy for AMI. Methods Randomized controlled trails (RCTs) on amiodarone in treating RA after thrombolytic therapy for AMI were electronically retrieved in PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CBM, CNKI, VIP and WanFang Data from inception to January, 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs involving 440 patients were included. The results of meta-analysis suggested that, compared with the blank control, amiodarone reduced the incidence of RA after thrombolytic therapy in treating AMI (RR=0.60, 95%CI 0.48 to 0.74, Plt;0.000 01) and the incidence of ventricular fibrillation (RR=0.47, 95%CI 0.26 to 0.85, P=0.01). It neither affected the recanalization rate of occluded arteries after thrombolytic therapy (RR=1.00, 95%CI 0.88 to 1.15, P=0.94) nor decreased the mortality after surgery (RR=0.33, 95%CI 0.10 to 1.09, P=0.07). Conclusion Current evidence indicated that, amiodarone can decrease the incidence of RA. Unfortunately, the mortality rate can’t be reduced by amiodarone. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion
Objective To review current status of surgical treatment for angular kyphosis in spinal tuberculosis and provide reference for clinical treatment. Methods The literature on the surgical treatment for angular kyphosis of spinal tuberculosis in recent years was extensively reviewed and summarized from the aspects of surgical indications, surgical contraindications, surgical approach, selection of osteotomy, and perioperative management. Results Angular kyphosis of spine is a common complication in patients with spinal tuberculosis. If kyphosis progresses gradually, it is easy to cause neurological damage, deterioration, and delayed paralysis, which requires surgical intervention. At present, surgical approaches for angular kyphosis of the spine include anterior approach, posterior approach, and combined anterior and posterior approaches. Anterior approach can be performed for patients with severe spinal cord compression and small kyphotic Cobb angle. Posterior approach can be used for patients with large kyphotic Cobb angle but not serious neurological impairment. A combined anterior and posterior approaches is an option for spinal canal decompression and orthosis. Osteotomy for kyphotic deformity include Smith-Peterson osteotomy (SPO), pedicle subtraction osteotomy (PSO), vertebral column resection(VCR), vertebral column decancellation (VCD), posterior vertebral column resection (PVCR), deformed complex vertebral osteotomy (DCVO), and Y-shaped osteotomy. SPO and PSO are osteotomy methods with relatively low surgical difficulty and low surgical risks, and can provide 15°-30° angular kyphosis correction effect. VCR or PVCR is a representative method of osteotomy and correction. The kyphosis correction can reach 50° and is suitable for patients with severe angular kyphosis. VCD, DCVO, and Y-shaped osteotomy are emerging surgical techniques in recent years. Compared with VCR, the surgical risks are lower and the treatment effects also improve to varying degrees. Postoperative recovery is also a very important part of the perioperative period and should be taken seriously. Conclusion There is no consensus on the choice of surgical treatment for angular kyphosis in spinal tuberculosis. Osteotomy surgery are invasive, which is a problem that colleagues have always been concerned about. It is best to choose a surgical method with less trauma while ensuring the effectiveness.
ObjectiveTo summary the diagnosis and surgical treatment experiences of posterior collicular fracture of medial malleolus. MethodsBetween March 2008 and November 2010, 14 patients having lateral and (or) posterior malleolus fractures with posterior collicular fracture of medial malleolus were treated with open reduction and internal fixation, including 5 males and 9 females with an average age of 44.5 years (range, 27-60 years). The causes of injuries were strain in 9 cases, traffic accident in 3 cases, and falling from height in 2 cases. The course of fracture ranged from 3 to 9 days (mean, 6.5 days). Fourteen cases were lateral malleolus fractures, 10 cases were posterior malleolus fractures. According to Lauge-Hansen classification, there were 8 cases of pronation-external rotation type, 3 cases of pronation-abduction type, and 3 cases of supination-external rotation type. ResultsAll incisions healed by first intention with no complication. The patients were followed up 12-24 months (mean, 16.8 months). The X-ray films showed that all fractures healed from 2 to 4 months after operation (mean, 2.9 months). The range of motion (ROM) of affected ankles was (38.40 ± 3.50)° of flexion and was (16.30 ± 2.41)° of extension, showing no significant difference when compared with ROM of normal side [(40.50 ± 3.48)° and (17.90 ± 2.28)°, P gt; 0.05]. All patients’ ankle function was evaluated by Olerud-Molander’s score criteria for ankle function evaluation, the results were excellent in 7 cases, good in 6 cases, and fair in 1 case. ConclusionSpiral CT plays an indispensable role in diagnosis of posterior collicular fracture of medial malleolus. Surgical reduction and rigid fixation should be performed.
The modernization and internationalization of traditional Chinese medicine (TCM) are the key issues we must face up to. The development of TCM needs to depend on the breakthrough of methods and the innovation of ideology, and the international standardization of scientific research evaluation. The clinical evidence from randomized comtrolled trials (RCT) is valuable and reliable. It has shown that the proportion of RCT identified in TCM journals was less than 30%, and the score of RCT’s quality was less than 3 using Jadad scale. However, the number of systematic reviews on TCM is increasing rapidly after the evidence-based medicine (EBM) was introduced and practiced in China. Until 2004, 43 systematic reviews of TCM were published in China, and the quality of RCT included in those reviews was elevated. It has shown that the efficacy and safety of TCM indicated some advances in treatment of certain kind of diseases. It has been realized that RCT are important in TCM, and improving the quality of RCT is the key step for modernization and internationalization of TCM.
Abstract: Objective To explore the significance of peripheral serum hepatocyte growth factor (HGF) and transforming growth factor-β (TGF-β) in preoperative staging of patients with nonsmall cell lung cancer. Methods Fifty patients, including 30 males and 20 females, with complete clinical data and final pathological diagnosis of nonsmall cell lung cancer were treated in Beijing Chaoyang Hospital from September 2006 to November 2007. Their age ranged from 36 to 76 years old (62.4±10.0 years old). Among the patients, there were 26 patients of adenocarcinoma, 23 patients of squamous cell carcinoma and one patient of large cell carcinoma. Twenty other normal subjects were chosen to form normal control, including 11 males and 9 females, aged from 18 to 67 years old (43.8±14.2 years old). Peripheral serum HGF and TGF-β were measured with enzymelinked immunosorbent assay (ELISA), and the relationship between the level of HGF, TGF-β and preoperative staging was analyzed. Results The peripheral serum HGF and TGF-β level has no relation with patient’s age, sex, smoking history or histology type. The level of HGF in the T2 and T3 patients was significantly higher than that of normal control (373.90±234.00 pg/ml vs. 211.30±154.60 pg/ml, t=2.759, P=0008; 563.80±316.10 pg/ml vs. 211.30±154.60 pg/ml, t=4076, P=0.000). The level of TGF-β in the T-3 patients was significantly higher than that of normal control (3.34±2.80 ng/ml vs. 1.82±0.90 ng/ml, t=2.190, P=0.037). The level of TGF-β in the N1-2 patients was significantly higher than that of the N0 patients (2.60±2.00 ng/ml vs. 1.53±0.74 ng/ml, t=-2.387, P=0.021). TGF-β level (5.97±2.65 ng/ml) in patients with distant metastasis (stage Ⅳ) was significantly higher than that of patients in other stages. Conclusion The HGF and TGF-β level is related to the staging of lung cancer. Such examinations combined before operation may present a reference value for preoperative staging and providing the best treatment plan for the patients.
【摘要】 目的 探讨急性脑梗死对心脏自主神经活性的影响。 方法 Wistar大鼠32只随机分为正常组、假手术组和脑梗死组，脑梗死组用线栓法行右侧大脑中动脉阻塞。脑梗死组和假手术组于术前及术后24 h作心率变异性（HRV）检测，同时检测正常组HRV，将3组的HRV指标进行比较。实验终点取各组心肌组织检测儿茶酚胺和神经肽Y（NPY），进行组间比较。 结果 术后24 h脑梗死组和正常组、假手术组相比，窦性心搏间期标准差、均方根，总功率谱、高频功率谱（HF）、低频功率谱（LF）降低，差异有统计学意义。3组比较LF/HF和分数维无明显差异。脑梗死组心肌组织去甲肾上腺素（NA）和NPY高于正常组和假手术组。 结论 脑梗死引起心脏自主神经总活性降低、自主神经功能受损，自主神经末梢去甲肾上腺素和NPY的异常分泌可能是重要的原因。【Abstract】 Objective To investigate the effect of acute cerebral infarction on cardiac autonomic nervous activity. Methods A total of 32 Wistar rats were divided into normal group, sham operation group and infarction group by random. Experimental cerebral infarction in Wistar rats was induced by intraluminal occlusion of middle cerebral artery. About 24 hours after the occlusion or 24 hours after sham operation, the heart rate variability (HRV) sequences were measured, and the HRV values in the three groups were compared. The levels of catecholamine and neuropeptide (NPY) in myocardium were measured. Results At the 24th hour after the occlusion, the standard deviation and root mean square standard deviation of R-R interval, the total power, high frequency (HF) and low frequency (LF) in infarction group were lower than those in normal and sham operation group. LF/HF and fractal dimension did not differ much among the three groups. The levels of noradrenaline and NPY in myocardium in infarction group were higher than those in the other groups. Conclusion It is suggested that acute cerebral infarction may cause the decrease of autonomic nervous activity and damage of the autonomic nervous function; the abnormal secretion of noradrenalin in autonomic nerve ending and NPY may be the important reasons.