The train has left: Can surgeons still get a ticket to treat structural heart disease?

With the disruptive advancement of catheter-based technologies and minimally invasive techniques in structural heart disease, surgeons must obtain necessary skills to continue to serve this large patient population. We believe that surgeons are uniquely positioned to offer the full spectrum of therapy in structural heart disease (transcatheter, minimally invasive, and complex redo interventions), making them comprehensive valve specialists. Given the variability in structural heart training, we urgently recommend the establishment of a standardized curriculum and pathways for surgical trainees to gain proficiency in transcatheter technologies.     

疏肝和胃汤对功能性消化不良大鼠血胃动素和胃泌素的影响

目的:观察疏肝和胃汤对功能性消化不良(FD)大鼠血中胃动素(MOT)和胃泌素(GAS)的影响,从该方对胃肠激素的调节作用方面揭示其促胃动力作用机制.方法:采用夹尾激怒法制作FD大鼠模型.实验设立了空白对照组,模型组,疏肝和胃汤大、中、小剂量组及对照组,各组治疗后取血,应用放射免疫法检测血中MOT及GAS的含量.结果:模型组血中MOT、GAS含量显著降低,经治疗后,疏肝和胃汤组及对照组均明显升高,与模型组比较差异有统计学意义(P＜0.05～0.01),而疏肝和胃汤组及对照组之间差异无统计学意义.结论:疏肝和胃汤升高血中MOT和GAS的含量,并通过其效应而发挥促胃动力作用,可能是该方促进胃排空的作用机制之一,其机制可能与莫沙比利有相似之处.     

三黄煎剂改善乳腺癌患者手术创面炎性反应状态30例临床研究

目的:观察三黄煎剂改善乳腺癌围手术期患者创面炎性反应临床功效,探讨其促进患者恢复与改善乳腺癌预后的作用。方法:将30例乳腺癌患者随机分为观察组与对照组,每组病例数各15例。对照组予以基础治疗,实验组在基础治疗同时于术前1 d起至术后第7天,每天口服三黄煎剂一剂,分早晚各服1次,2组分别于手术当天、术后第1天、第3天、第7天评估中医症状与炎性反应症状积分及腋窝引流量、ELISA法测定腋窝引流液相关指标白介素-2(IL-2)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平。结果:观察组对中医症状积分与炎性反应积分于术后第3天显著改善,与对照组比较,有统计学意义(P0.05),腋窝引流量显著减少,引流液中炎性反应指标术后第1天均显著上升,观察组术后第3天即显著下降,第7天CRP、IL-6、IL-2R含量恢复至术前水平,术后7天对照组仍显著高于术前,术后第3天、第7天,观察组引流液中炎性反应指标含量显著低于对照组,二者之间的差异存在统计学意义(P0.05)。结论:三黄煎剂有效改善术后中医临床症状与炎性反应表现,显著降低乳腺癌手术创面炎性反应水平,有利于术后恢复并潜在改善乳腺癌预后。     

Clinical and radiological outcomes following surgical hip dislocation for paediatric hip pathologies,a prospective cohort study

BackgroundSurgical Hip Dislocation (SHD) is a powerful tool in the armamentarium of any surgeon treating conditions affecting the hips of children presenting with sequelae of a number of common conditions including Legg-CalvéPerthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). Risks associated with the procedure are well described. We investigated to assess if SHD is associated with significant surgical risk and if it improved clinical outcomes for patients.MethodsWe conducted a prospective cohort study. We reviewed 18 (11 males and 7 females; mean age 13.7 years (6–17) with symptomatic hip pathology, secondary to femoroacetabular impingement (FAI) between 2017 and 2021. All patients underwent a surgical hip dislocation approach and femoral head-neck osteochondroplasty, Head Split osteotomy or both. Clinical improvement was assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The minimum follow-up was 6 months (mean, 22 months; range, 6–42 months).ResultsWOMAC scores improved at final follow-up from 10 to 3 for pain, 33 to 10 for function, and 4 to 2 for the stiffness subscales. All radiographic measures improved significantly of the postoperative X-rays. No patients developed osteonecrosis, implant failure, deep infection, or nonunion.ConclusionSurgical Hip Dislocation, in the short term, we found improvement in WOMAC scores and radiographic indices with a low complication rate.