疝环充填式无张力疝修补术治疗腹股沟疝

目的：总结应用疝环充填式无张力疝修补术治疗腹股沟疝的临床经验。方法：采用美国巴德公司的疝环充填物及网状补片,对28例腹股沟疝进行无张力疝修补术。结果：与传统疝修补术相比,疝环充填式无张力疝修补术具有创伤小,术后疼痛轻、恢复快等优点。全组28例病人随访2－14个月,未见复发。结论：疝环充填式无张力疝修补术具有操作简便,创伤小、恢复快、复发率低等优点,是一项更符合人体解剖结构的良好手术方法。     

Effects of Posterior Tibial Slope on a Posterior Cruciate Retaining Total Knee Arthroplasty Kinematics and Kinetics

BackgroundIt has been hypothesized that increasing posterior tibial slope can influence condylar rollback and play a role in increasing knee flexion. However, the effects of tibial slope on knee kinematics are not well studied. The objective of this study is to assess the effects of tibial slope on femorotibial kinematics and kinetics for a posterior cruciate retaining total knee arthroplasty design.MethodsA validated forward solution model of the knee was implemented to predict the femorotibial biomechanics of a posterior cruciate retaining total knee arthroplasty with varied posterior slopes of 0°-8° at 2° intervals. All analyses were conducted on a weight-bearing deep knee bend activity.ResultsIncreasing the tibial slope shifted the femoral component posteriorly at full extension but decreased the overall femoral rollback throughout flexion. With no tibial slope, the lateral condyle contacted the polyethylene 6 mm posterior of the midline, but as the slope increased to 8°, the femur shifted an extra 5 mm, to 11 mm posterior of the tibial midline. Similar shifts were observed for the medial condyle, ranging from 7 mm posterior to 13 mm posterior, respectively. Increasing posterior slope decreased the posterior cruciate ligament tension and femorotibial contact force.ConclusionThe results of this study revealed that, although increasing the tibial slope shifted the femur posteriorly at full extension and maximum flexion, it reduced the amount of femoral rollback. Despite the lack of rollback, a more posterior location of condyles suggests lower chances of bearing impingement of the posterior femur and may explain why increasing slope may lead to higher knee flexion.     

Congenital Pseudarthrosis of Femur and Sciatic Nerve Palsy with Congenital Constriction Band Syndrome: Report of the First Case in Literature

Congenital constriction band syndrome has varied clinical presentations ranging from small, incomplete skin deep constriction band to in utero amputation. Pseudarthrosis of underlying bone most commonly tibia has been reported by many authors. We report the first case of congenital pseudarthrosis of the femur with congenital constriction band syndrome. Nine-day-old female presented with the constriction band in the left thigh with open pseudarthrosis of the femur. The left femur had gross recurvatum deformity and the posterior apex of the pseudarthrosis was exposed via skin ulceration. She had an ipsilateral paralytic clubfoot. She was treated with single-stage excision of constriction band and Z-plasty. Spontaneous union of the femur was achieved at 3 months. Procurvatum deformity of the femur improved gradually over 3 years. This happens to be the first and only reported case of congenital pseudarthrosis of the femur with sciatic nerve palsy due to congenital constriction band.     

Safety and effectiveness of REALIZE adjustable gastric band: 5-year prospective study

BackgroundThe long-term safety results of the REALIZE (Ethicon Endo-Surgery, Inc., Cincinnati, OH) adjustable gastric band collected in this prospective, multicenter study in patients with morbid obesity are presented.ObjectivesTo determine the reoperation rate, including band revisions, replacements, and explants, resulting from a serious adverse device-related event through years 4 and 5. Various efficacy measures were also assessed as secondary objectives.SettingNine academic and/or private institutions.MethodsThe participating institutions enrolled 303 patients, who were then assessed on an annual basis, with 231 patients completing 5 years of follow-up. The study parameters included reoperation rates, changes in percentage of excess weight loss (%EWL), and changes in body mass index (BMI), as well as parameters of diabetes and dyslipidemia. Quality of life was assessed using the Short Form (SF)-36 and the Impact of Weight on Quality of Life-Lite questionnaires.ResultsThe reoperation rate due to a serious adverse event in this population at 5 years after implantation with the REALIZE gastric band was 8.9%. The most common serious adverse event was band slippage, which affected 6.9% of the study population. The mean %EWL was 35.6% ± 26.84%, and the decrease in mean BMI was ?7.01 ± 5.45 kg/m² at 5 years. Patients experienced improvements in mean glycated hemoglobin and serum lipid levels, in addition to improvements in the quality of life measures.ConclusionNo new safety concerns were identified during the 5 years of follow-up. Although the results of this study did not meet the predefined safety criteria of 8% or less, the safety profile and long-term effectiveness observed in this study are consistent with those in the current literature.     

Postbariatric hypoglycemia: symptom patterns and associated risk factors in the Longitudinal Assessment of Bariatric Surgery study

BackgroundPostbariatric hypoglycemia (PBH) can be a devastating complication for which current therapies are often incompletely effective. More information is needed regarding frequency, incidence, and risk factors for PBH.ObjectivesTo examine hypoglycemia symptoms following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and baseline and in-study risk factors.SettingMulticenter, at 10 US hospitals in 6 geographically diverse clinical centers.MethodsA prospective, longitudinal cohort study of adults undergoing RYGB or LAGB as part of clinical care between 2006 and 2009 were recruited and followed until January 31, 2015, with baseline and annual postoperative research assessments. We analyzed baseline prevalence and post-operative incidence and frequency of self-reported hypoglycemia symptoms as well as potential preoperative risk factors.ResultsIn all groups, postoperative prevalence of hypoglycemia symptoms was 38.5%. Symptom prevalence increased postoperatively from 2.8%–36.4% after RYGB in patients without preoperative diabetes (T2D), with similar patterns in prediabetes (4.9%–29.1%). Individuals with T2D had higher baseline hypoglycemia symptoms (28.9%), increasing after RYGB (57.9%). Hypoglycemia symptoms were lower after LAGB, with 39.1% reported hypoglycemia symptoms at only 1 postoperative visit with few (4.0%) having persistent symptoms at 6 or more annual visits. Timing of symptoms was not restricted to the postprandial state. Symptoms of severe hypoglycemia were reported in 2.6–3.6% after RYGB. The dominant risk factor for postoperative symptoms was preoperative symptoms; additionally, baseline selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor use was also associated with increased risk in multivariable analysis. Weight loss and regain were not related to hypoglycemia symptom reporting.ConclusionHypoglycemia symptoms increase over time after RYGB, particularly in patients without diabetes. In a small percentage, symptoms can be persistent or severe and require hospitalization. Preoperative hypoglycemia symptoms and SSRI/SNRI use in RYGB patients without diabetes is associated with increased risk of symptoms.     

Tension band plates have greater risks of complications in temporary epiphysiodesis

PurposeThis study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS).MethodsThis retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau.ResultsIn total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile versus -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients.ConclusionMore implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended.Level of evidenceLevel III     

Metaphase quality can be monitored by automatic counting of bands

A high quality of cytogenetic preparations is important for maintaining a high standard in the cytogenetic laboratory. In the past, quality has been assessed by visual counting or estimation of the number of bands on chromosomes. In this paper we have counted bands automatically during karyotyping by using the Magiscan chromosome analysis system. A high correlation between automatic and visual counting was found, the automatic counting was reproducible and count figures were comparable when the karyotyping machines were operated by different technicians. The automatic counting procedure has now been included in our routine for 1 year. The highest numbers of bands were counted on slides from peripheral blood, with fewer bands for amniotic fluid and the lowest number for cells from chorionic villi. All three cell types showed significant variations in band number over time, which may be due to changes in weather conditions and/or the reagents used for cell culture, harvest and staining. It is concluded that the automatic counting procedure may be used to monitor the quality of metaphases over time and to set limits for band number on routine preparations acceptale for analysis.     

液体表面张力系数及测量精度的分析

分子之间的相互作用产生分子力,阐述表面张力形成的基本原理。对表面张力系数的测量进行分析,讨论提高测量精度的方法。