Bim和ULBP2的水平对肾母细胞瘤术后患儿复发及预后的影响

目的探讨并分析肾母细胞瘤术后患儿血清中Bim和ULBP2的水平变化,并分析其对患儿术后复发及预后的影响。方法选择行单侧肾母细胞瘤切除术患儿60例,根据不同分期分为2组,分别为中期组(Ⅱ~Ⅲ期,43例)和晚期组(Ⅳ~Ⅴ期,17例),人ELISA试剂盒检测各组患者血清中Bim和ULBP2的含量并进行比较,进一步分析其对患者复发及预后情况的影响。结果与中期组瘤组织相比,晚期组瘤组织中BIM相对表达量均显著降低,ULBP2相对表达量均显著增加(P<0.05);与瘤旁组织相比,两组瘤组织中BIM相对表达量均显著降低,ULBP2相对表达量均显著增加(P均<0.05)。与术前1 d和术后1 h相比,术后1 w两组患儿血清中Bim含量均显著上升,ULBP2含量均显著下降(P均<0.05),而两组患儿术前1 d和术后1 h相比,两指标变化均不具统计学意义(P均>0.05)。与中期组相比,晚期组术前1 d、术后1 h以及术后1 w,患儿血清中Bim含量均显著上升,ULBP2含量均显著下降(P均<0.05)。与中期组相比,晚期组术后复发、肺转移以及死亡等不良预后状况的总发生率显著上升(P<0.05)。肾母细胞瘤患儿预后状况与其根治性瘤肾切除术后血清中Bim的含量呈显著负相关,与血清中ULBP2的含量呈显著正相关(P均<0.01)。结论肾母细胞瘤术后可通过患儿血清中Bim和ULBP2的水平变化对其复发及预后进行评价,其预后状况与根治性瘤肾切除术后血清中Bim的含量呈显著负相关,与血清中ULBP2的含量呈显著正相关。     

Cranio-caudal approach to hepatic veins in laparoscopic central bisectionectomy (with Video)

BackgroundLaparoscopic central bisectionectomy (Couinaud's segment IV, V, and VIII) needs exposure of the RHV and MHV on the surface of the remnant and the resecting side, respectively. Avoiding venous injury is mandatory and laparoscopy-specific cranio-caudal approach to hepatic veins might be helpful [1]. We present this procedure in performing laparoscopic central bisectionectomy.PatientA 45-year-old female was admitted to our hospital with a 6 cm HCC in the segment VIII and IV. Her comorbid disease was non-cirrhotic HBV hepatitis (Child-Pugh grade A) and diabetes (untreated).MethodAfter cholecystectomy, G₄ branches were dissected and cut by extra- or intra-hepatic approach. Hilar plate was dissected and the G_ant was encircled and occluded by a vascular clip. Afterwards, exposure of the MHV was started at its root on IVC [2,3] and extended in cranio-caudal direction [1]. After sufficient space was obtained around the G_ant, the G_ant and the MHV were cut. Parenchymal transection between right anterior and right posterior sections was also started form the root of the RHV to its cranio-caudal direction. Liver resection was finished with full exposure of the RHV.ResultsThe operating time was 380 minutes, and the blood loss volume was 30 ml. Postoperative CT image showed exposure of the RHV and umbilical portion of Glissonean branch, and no fluid retention.ConclusionLaparoscopy-specific cranio-caudal approach to hepatic veins may be useful to avoid split injury of venous branches [4], especially if the hepatectomy requires complete exposure of hepatic vein, such as central bisectionectomy.     

Analysis of proximal bone margins in diabetic foot osteomyelitis by conventional culture,DNA sequencing and microscopy

Multiple approaches were employed to detect pathogens from bone margins associated with Diabetic Foot Osteomyelitis (DFO). Intra‐operative bone specimens of 14 consecutive subjects with suspected DFO were collected over a six‐month study period from Liverpool Hospital. Infected bone and a proximal bone margins presumed to be ‘clean/non‐infected’ were collected. Bone material was subjected to conventional culture, DNA sequencing and microscopy. In total, eight of 14 (57%) proximal bone margins had no growth by conventional culture but were identified in all proximal bone specimens by DNA sequencing. Proximal margins had lower median total microbial counts than infected specimens, but these differences were not statistically significant. Pathogens identified by sequencing in infected specimens were identified in proximal margins and the microbiomes were similar (ANOSIM = 0.02, p = 0.59). Using a combination of SEM and/or PNA‐FISH, we visualized the presence of microorganisms in infected bone specimens and their corresponding proximal margins of seven patients (50%) with DFO. We identify that bacteria can still reside in what seems to be proximal ‘clean’ margins. The significance and implications of clinical outcomes requires further analysis from a larger sample size that incorporates differences in surgical and post‐operative approaches, correlating any outcomes back to culture‐sequence findings.     

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery

Background

The STOP-BANG questionnaire screens for obstructive sleep apnoea (OSA) in surgical patients. In prior research, the association of STOP-BANG scores with comorbidities and outcomes was inconsistent. The objective of this study was to evaluate the validity of the STOP-BANG score.

Surgical strategies for management of infection following knee arthroplasty and arthroscopic procedures

Infection is one of the most feared complications following knee arthroplasty and soft tissue arthroscopic procedures. This article summarizes the current understanding on the management of this rare but devastating problem. The healthcare and economic burden of periprosthetic joint infection (PJI) is highlighted, together with how the classification of infection and host staging can aid decision-making. Surgical treatment options will be described. These consist of ‘debridement, antibiotics and implant retention’ (DAIR), revision arthroplasty (single- or two-stage), as well as salvage procedures (arthrodesis, permanent resection, and amputation). In selected cases, chronic antibiotic suppression may be the only viable option. All implant-related orthopaedic infections must be managed using a multidisciplinary team (MDT) approach, ideally within dedicated bone infection units, in order to optimize clinical outcomes.     

Learning condyle repositioning during orthognathic surgery with a surgical navigation system

Condyle repositioning during bilateral sagittal splint osteotomy (BSSO) is a challenging step for the inexperienced surgeon. We aimed to demonstrate the benefit of navigation for learning the condyle repositioning. We treated 100 patients who underwent a BSSO. A trainee performed the condyle repositioning of one side in two phases. In the first one, the trainee positioned without watching the screen of the Orthopilot Navigation system (ONS). In the second one, the trainee could use the ONS to replace the condyle. Heuristic, anatomical and functional scores of each phase were recorded. Heuristic (17% vs. 75%; p < 0.0001), anatomical (35% vs. 86%; p < 0.0001) and functional (14% vs. 56%; p < 0.0001) scores were significantly greater with the ONS. The ONS is a promising and original intraoperative learning tool for the repositioning of the condyle during BSSO.