针刺对备用根猫背根节神经元IGF-Ⅰ表达的影响

目的观察胰岛素样生长因子-I（IGF—I）在正常猫、部分去背根猫及针刺部分去背根猫的L6手术侧背根节（DRG）表达的时空变化，以了解IGF—I与针刺促进脊髓可塑性的关系。方法25只成年健康雄猫随机分为5组：即正常组、备用根术后7d组与14d组（动物行单侧部分去背根手术，即切除一侧L1～L5、L7～S2背根节，保留L6为备用根）、针刺备用根术后7d组与14d组（动物行单侧部分去背根术后针刺L6脊神经外周支配区内的两组穴位）。动物于术后7d、14d分别处死，取各组（手术侧）L。背根节，-20℃恒冷箱切片，片厚20μm，用兔抗IGF—I（1：200）抗体行免疫组化ABC法染色。观察、计数并比较各组背根节IGF—I阳性神经元的分布、含量及时空变化。结果针刺备用根7d组，DRGIGF—I阳性神经元数较术后7d组明显增加（P〈0．05），但仍低于正常水平；针刺14d，DRG阳性神经元比术后14d亦增多（P〈0．01），且恢复至正常水平。与针刺7d组比较，DRGIGF—I阳性神经元在针刺14d时明显增多（P〈0．05）。结论针刺可增加针刺侧DRG内IGF—I阳性中小神经元数。提示针刺后IGF—I在背根节的表达变化可能与针刺促进脊髓可塑性有关。     

侵犯左心房的局部晚期非小细胞肺癌的外科治疗

目的 探讨侵犯左心房的局部晚期非小细胞肺癌的手术适应证、手术方式及术后处理。方法 回顾分析46例侵犯左心房的局部晚期非小细胞肺癌，其中40例在非体外循环下行左心房部分切除，另6例左心房受累范围广泛患者在体外循环支持下行左心房部分切除重建术；动脉插管部位分别为股动脉、降主动脉或升主动脉，静脉插管部位分别为肺动脉或上下腔静脉。结果 1例早期死亡于呼吸衰竭。1例急性肺水肿和3例心律失常均经保守治疗成功。1年、3年生存率分别为78．9％、43．0％。结论 体外或非体外循环方法均能安全有效地完成侵犯左心房的晚期肺癌的根治性切除，长期生存率尚需进一步观察。     

TURBT术治疗T1T2期膀胱癌91例

目的:分析两种手术方法对T1T2期膀胱癌的治疗效果。方法:根据病史、体格检查、B超、3D-CT、膀胱镜活组织检查确诊的T1T2期膀胱癌152例,采用TURBT术(经尿道膀胱肿瘤切除术)91例,膀胱局部切除术61例,分析比较治疗效果。结果:两种手术方法疗效无显著特异性,患者生存率与肿瘤病理分期有直接相关性。结论:T1T2期膀胱癌采用TURBT术与采用膀胱局部切除术疗效相当,但TURBT费用低,创伤少,便于再次手术,有推广意义。     

术后后装放疗、吉西他滨化疗治疗原发性肝癌(英文)

目的探讨术后后装放疗加吉西他滨全身化疗对原发性肝癌的治疗效果。方法 1999年10月～2001年12月,将44例行肝癌切除术的原发性肝癌患者随机分为综合治疗组和对照组,每组22例。综合治疗组术中放置施源管3～6根,确定驻留点3～8个,术后3～10天行后装放疗,单次剂量10Gy,照射2～4次,总剂量20～40Gy。放疗结束3周后,开始吉西他滨化疗,静滴1.4g每周1次,4周为1周期,每周期3次,共6个周期。对照组手术后不放、化疗。手术前后定期查血常规、肝功能、AFP、胸片、B 超或 CT。结果综合治疗组后装放疗后 AFP 转阴率100%(17/17),对照组62.5%(10/16)(P<0.05);6月复发率0,低于对照组27.3%(6/22)(P<0.01);综合治疗组1年复发率18.2%(4/22)、转移率0和1年生存率100%(22/22),与对照组的45.5%(10/22)、13.6%(3/22)和77.3%(17/22)均有显著差异(p<0.05)。结论术后后装放疗加吉西他滨全身化疗是提高原发性肝癌近期治疗效果,降低复发率和转移率的有效手段。     

Postoperative day one serum alanine amino-transferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients

Serum aminotransferases have been used as sur-rogate markers for liver ischemia-reperfusion injury that fol-lows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase (ALT) correlate with patient outcome after liver resection. We assessed whether postopera-tive day 1 (POD 1) ALT could be used to predict patient mor-bidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our in-stitution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient’s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver signiifcantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concur-rent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not cor-relate with patient morbidity after elective liver resection.     

Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update

Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon’s experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.     

The R.E.N.A.L. Nephrometric Nomogram Cannot Accurately Predict Malignancy or Aggressiveness of Small Renal Masses Amenable to Partial Nephrectomy

Introduction/BackgroundThe prediction of histology of SRM could be essential for their management. The RNN is a statistical tool designed to predict malignancy or high grading of enhancing renal masses. In this study we aimed to perform an external validation of the RNN in a cohort of patients who received a PN for SRM.Materials and MethodsThis was a multicentric study in which the data of 506 consecutive patients who received a PN for cT1a SRM between January 2010 and January 2013 were analyzed. For each patient, the probabilities of malignancy and aggressiveness were estimated preoperatively using the RNN. The performance of the RNN was evaluated according to receiver operating characteristic (ROC) curve, calibration plot, and decision curve analyses.ResultsThe area under the ROC curve for malignancy was 0.57 (95% confidence interval [CI], 0.51-0.63; P = .031). The calibration plot showed that the predicted probability of malignancy had a bad concordance with observed frequency (Brier score = 0.17; 95% CI, 0.15-0.19). Decision curve analysis confirmed a poor clinical benefit from use of the system. The estimated area under the ROC curve for high-grade prediction was 0.57 (95% CI, 0.49-0.66; P = .064). The calibration plot evidenced a bad concordance (Brier score = 0.15; 95% CI, 0.13-0.17). Decision curve analysis showed the lack of a remarkable clinical usefulness of the RNN when predicting aggressiveness.ConclusionsThe RNN cannot accurately predict histology in the setting of cT1a SRM amenable to PN.     

Dynamic mechanisms underlying afterdischarge: A human subdural recording study

ObjectiveNo synoptic understanding exists of how and why afterdischarges (ADs) occur following electrical stimulation of the cerebral cortex. Based on human observations, we formulated a general mechanism for the emergence of ADs.MethodsWe retrospectively analysed spectra of AD time-series and control segments of the resting electrocorticogram (ECoG) in 15 epilepsy patients who underwent cortical stimulation mapping. The observations led to the development of phenomenological models for AD emergence and morphology.ResultsAn analytical relationship exists between the spectrum of the baseline ECoG and the ensuing AD, characterised by ‘condensation’ of the main baseline spectral cluster, with variable inclusion of higher harmonics of the condensate.ConclusionsADs arise by synchronisation of pre-existing local field potentials, likely through temporary inactivation of inhibitory interneurons from repetitive stimulation-induced depolarization. The appearance of higher harmonics indicates that ADs are further modulated by recurrent feedback, likely from the entrained activity of single units.SignificanceFor the first time, a putative mechanism is suggested for AD emergence following electrical stimulation of the cerebral cortex. Insight is also offered into several empirical observations regarding ADs, detailed in the main text. More generally, a novel conceptual synthesis emerges between the behaviour of electrically-excited cortex and the physics of nonlinearly coupled multi-oscillator systems.     

Laparoscopic partial cystectomy with mucosal stripping of extraluminal duodenal duplication cysts

Duodenal duplication cysts are rare congenital anomalies.Duodenal duplication should be considered in the differential diagnosis of patients who present with abdominal symptoms with cystic structures neighboring the duodenum.Here,we present an 8-year-old girl with a duodenal duplication cyst treated with partial cystectomy with mucosal stripping performed laparoscopically.Laparoscopic surgery can be considered as a treatment option for duodenal duplication cysts,especially in extraluminal locations.