Initial experience of magnetic seed localization for impalpable breast lesion excision: First 100 cases performed in a single Irish tertiary referral centre

IntroductionWire guided localization has been widely utilized as the standard method of pre-operative localization of breast lesions. Magnetic seeds were developed to counter some of the disadvantages associated with wires. This aim of this study was to assess outcomes following the introduction of magnetic seeds at a tertiary specialist breast centre.MethodsA retrospective review of a prospective database of the first 100 patients who underwent magnetic seed (Magseed) guided breast surgery between November 2018 and November 2019. Data was collected from 17 wire guided cases completed during the trial phase for comparison. The primary outcome measures were successful excision of index lesion and retrieval of the magnetic seed. Secondary outcomes analyzed included time ready for theatre, post-operative complications and breast margin re-excision rate.ResultsOf these 100 cases, 85 patients underwent Magseed guided wide local excision for invasive or in-situ carcinoma and 15 underwent Magseed guided diagnostic excision. The primary lesion was excised, and Magseed was retrieved in all 100 cases. 54% of patients were ready to proceed as the first scheduled theatre case of the day, compared to 0% of wire-guided cases. Amongst therapeutic Magseed guided cases, the re-excision rate for margin clearance was 9.4%.ConclusionMagseed guided breast excision is a new technology that has been implemented with relative ease in our unit. We have shown that magnetic seed guided surgery reliably localizes lesions, is associated with low re-excision rates without an increase in patient morbidity or mortality and results in improvements in theatre planning and efficiency.     

达芬奇机器人周围肺磨玻璃结节术前定位指征的研究

目的探讨肺磨玻璃结节的术前定位指征。方法纳入北部战区总医院自2012年4月至2019年9月收治的192例应用达芬奇机器人手术系统切除肺部磨玻璃结节患者,男95例、女97例,平均年龄(56.47±11.79)岁。所有患者完善术前检查,按术前是否予以定位,分为定位组(n=97)和不定位组(n=95);定位组按磨玻璃实质不同分为纯磨玻璃结节(pGGO)组(n=23),混合磨玻璃结节(mGGO)组(n=74);未定位组分为pGGO组(n=14),mGGO组(n=81)。各个组又根据结节大小及与胸膜距离与能否探查及结节,得出相应的线性函数。结果术前行亚甲蓝定位组的手术时间短于不定位组手术时间。在散点图中描绘结节相对应直径和深度及能否探及到的坐标点,并对所有坐标点进行线性回归得出的线性函数[深度=0.648×直径–1.446(单位为mm)]可作为达芬奇机器人手术pGGO节术前定位的指征;线性函数[深度=0.5595×直径ᒰ0.56(单位为mm)]可作为达芬奇机器人手术mGGO术前定位的指征。结论结果提示该方程可作为临床周围肺磨玻璃结节的术前定位指征。     

三种术式治疗肝细胞癌的近期临床疗效比较

目的比较腹腔镜切除术(LR)、开腹切除术(OR)与超声定位下的射频消融术(RFA)治疗肝细胞癌的近期临床疗效。 方法回顾性分析2010年6月至2018年6月接受手术治疗的152例肝细胞癌患者的病例资料,71例患者纳入LR组,52例患者纳入OR组,29例患者纳入RFA组。采用SPSS 25.0软件分析数据,手术相关指标、VAS评分等计量资料以( ±s)描述,行f检验;近期疗效、并发症等计数资料行χ²检验,P<0.05为差异有统计学意义。 结果三组患者术后3个月治疗总有效率比较,LR组(76.1%)>OR组(73.1%)>RFA组(72.4%),差异无统计学意义(P>0.05)。三组手术时间、术中总出血量及住院时间相比,OR组>LR组>RFA组(P<0.05);术后24 h及1周后VAS评分比较,OR组>LR组>RFA组(P<0.05);OR组并发症总发生率(36.5%)>LR组(29.6%)>RFA组(6.7%),差异有统计学意义(P<0.05);术后随访3个月的复发率比较,OR组(7.7%)0.05)。 结论对分期早且肿瘤小的肝细胞癌患者分别采用LR术、OR术与RFA术治疗,患者近期疗效相当,但RFA术具有损伤小、术后恢复快等优点,可减轻患者术后疼痛程度,安全性更高。但对于瘤体较大且靠近重要血管胆管的肝细胞癌患者,还需进行个体化治疗。     

面向鲤鱼机器人控脑技术的磁共振坐标转换方法研究及应用

为解决鲤鱼脑组织坐标准确定位问题,本文提出一种将鲤鱼脑组织磁共振成像坐标转换为应用脑立体定位仪进行电极植入所需坐标的方法。本研究应用3.0T磁共振成像仪对鲤鱼颅脑成像,自主建立颅脑三维立体定位坐标系、颅骨表面辅助三维坐标系和脑组织内部辅助三维坐标系,经两次坐标转换,将脑电极植入位点磁共振图像坐标转换到三维立体定位坐标系中以引导电极植入。实验分A、B两组,A组为磁共振成像仪结合脑立体定位仪组,B组为脑图谱结合脑立体定位仪组,每组鲤鱼20尾(n=20),分别应用两种方法将电极植入小脑运动区。进行鲤鱼机器人水下实验检验,结果表明A组和B组植入电极准确度分别为90%和60%,A组成功率明显高于B组(P <0.05)。故本文的新方法能够准确定位鲤鱼脑组织的坐标。     

Localization of EFA6 (exchange factor for ARF6) isoform D in steroidogenic testicular Leydig cells of adult mice

EFA6 (exchange factor for ARF6) activates Arf6 (ADP ribosylation factor 6) by exchanging ADP to ATP and the resulting activated form of Arf6 is involved in the membrane trafficking and actin remodeling of cells. Our previous study has shown the selective expression/localization of EFA6D in steroidogenic adrenocortical cells in situ of adult mice. In view of the previous finding, the present study was undertaken to examine its localization in mouse Leydig cells representing another steroidogenic cell species in order to further support the possible involvement of the EFA6/Arf6 cascade via membrane trafficking in the regulation of steroidogenesis and/or secretion. A distinct band for EFA6D with the same size as that of the brain was detected in the testis of adult mice. In immuno-light microscopy, immunoreactivity for EFA6D was seen throughout the cytoplasm in most Leydig cells without any distinct accumulation along the plasmalemma. Lack of immunoreactivity for EFA6D was seen in the seminiferous tubular epithelium. In immuno-electron microscopy, the immune-labeling was seen in sporadic/focal patterns on plasma membranes and some vesicles and vacuoles subjacent to the plasma membranes. More constant and rather predominant is the labeling on numerous mitochondria. No immuno-labeling was seen in lipid droplets. The present study suggests that EFA6D is somehow involved in regulation of the synthesis and/or secretion of testosterone through the membrane-traffic by activation of Arf6. In addition, EFA6D is suggested to play in mitochondria some yet unidentified roles rather independent of Arf6-activation, which remains to be elucidated.     

CT定位下经颅磁刺激对卒中后运动功能障碍的治疗效果

目的:观察CT定位下经颅磁刺激对卒中后运动功能障碍患者的治疗效果。方法:150例缺血型脑卒中患者按入院时间分为观察组（n=75）和对照组（n=75）,两组患者一般资料无显著性差异。观察组患者给予CT定位下经颅磁刺激治疗,对照组患者给予常规经颅磁刺激治疗。于治疗前和治疗8周后评估患者下肢肌力、上下肢运动能力评分、平衡能力、生活能力以及治疗有效性。结果:观察组患者治疗后下肢肌力、上下肢运动能力评分、平衡能力、生活能力显著高于对照组（P<0.05）;观察组治疗有效率显著高于对照组（84.00% vs 68.00%, P<0.05）。结论:CT定位下经颅磁刺激治疗对卒中后运动功能障碍患者疗效显著,其具体机制有待于神经生物学基础研究进一步揭示。