兔附件扭转模型的建立及其意义探讨

目的建立一种操作简单、病变典型、稳定性好的兔在体附件扭转模型并探讨保留卵巢术后卵巢的病理变化和iNOS的改变。方法40只日本大耳白兔采用随机数字法分为附件扭转(adnexal torsion,AT)模型组(n = 32)和对照组(n = 8)。模型组兔将左侧附件按顺时针方向扭转3周,避开血管,以4/0丝线横穿扭转形成的3个螺旋圈后固定于左侧腹壁,然后再将之分成4组,每组8只,分别于扭转24、48、72、96h后解除扭转后取双侧卵巢;对照组假手术后96h后取双侧卵巢。所有切除之右侧卵巢组织行病理学研究的内对照,左侧卵巢取1/2行病理检测,另1/2行iNOS生化水平检测。结果左侧附件扭转3周固定左侧腹壁24 h后可见卵巢充血、炎细胞浸润、细胞水肿;48h见较多的炎细胞浸润,细胞结构紊乱;72 h见大量炎细胞浸润,结构损坏和局灶性坏死;96 h见弥漫性细胞坏死;卵巢组织病理评分呈现相同的时相性变化。各组iNOS生化检测水平(左侧vs.右侧),AT组 ［24 h (3.542±0.987) vs. (1.521±0.214)U/mgprot,P<0.01;48 h (4.986±1.321) vs. (1.832±0.321) U/mgprot,P<0.01;72 h (7.991±1.832) vs. (1.124±0.357)U/mgprot,P<0.01;96 h (6.991±1.227) vs. (1.732±0.572)U/mgprot,P<0.01］。且AT组卵巢均有iNOS不同程度表达,72 h组表达达高峰,96 h下降。 结论成功地制备兔附件扭转模型,方法简单、病变典型、重复性好,可模拟女性附件扭转的病理生理过程,对进一步研究附件扭转具有重要意义。初步认为附件扭转72h后卵巢发生不可逆改变,是临床处理附件扭转并保留卵巢的时间临界点。      

左心室应变和扭转对冠心病患者心脏功能水平的关系研究

【摘要】目的 应用斑点追踪技术检测冠心病患者左心室应变和扭转情况,研究左心室应变和扭转对冠心病患者心脏功能水平的关系。方法 选取我院于2016年10月到2017年10月收治的冠心病患者70例,按照纽约临床心功能分级积分(NYHA-P)分为纽约临床心功能分级正常组38例,心功能分级异常组32例,以及再选择体检正常的志愿者30位作为对照组,比较受检者的NYHA-P、左室射血分数(LVEF)、总体心肌整体径向应变(GRS)、纵向应变(GLS)、左室心肌收缩期心肌扭转角度(TA)。结果 冠心病患者组与对照组比较,LVEF、GLS、GRS、TA降低。心功能分级正常组与异常组相比,LVEF、GLS、GRS、TA降低。心功能正常组GLS、GRS、TA与LVEF无相关性,与NYHA-P相关。心功能异常组GLS、GRS、TA与LVEF及NYHA-P都相关。心功能分级异常组以GLS-14.75%截断点判定患者NYHAP积分高于4.5分的灵敏度为87.45%,特异度为72%,Youden指数最高为0.653。结论 左心室应变和扭转与冠心病患者心脏功能水平相关,可以有效评价冠心病患者的临床心脏功能水平。     

EZ取钉器的生物力学测试和临床初步应用

目的 通过生物力学测试和临床初步应用验证EZ取钉器对断钉、打滑螺钉的取出效果。方法 采用新鲜尸骨标本,股骨、胫骨、尺桡骨各4具,并随机分为两组：A组为起子取螺钉扭力组;B组为骨髓腔内灌骨水泥固定螺钉组,其中B1为螺钉打滑时最大扭力组;B2为EZ取钉器一个手柄时取钉器最大扭力组;B3为两个手柄时取钉器的最大扭力组,制成4种生物力学测试模型,内固定螺钉分为4.5 mm和3.5 mm两种类型。在万能材料试验机上测试实验标本,施加轴向载荷2 kN,测量扭转拔出螺钉时的最大扭矩值、扭角及螺钉拔出时功耗大小和效率。实验数据经统计学处理, 进行组间比较。并用EZ取钉器在12例患者中初步应用。结果 A组最大拔出扭矩为1.42～1.96 N·m,B1组为2.87～3.27 N·m,B2组为3.06～4.83 N·m,B3组为4.12～8.36 N·m,各组间均呈显著性差异（P<0.05）。其相对应各组的扭角均值分别为1.59°、0.77°、0.28°和0.16°,各组间有明显差异（P<0.05）。螺钉拔出（旋出）时,各组的功耗均值分别为12、21、32和45J;对应各组间的功率（机械效率）分别为0.20、0.35、0.53和0.75 J/s,组间呈明显差异（P<0.05）。在12例临床断钉和打滑螺钉患者中初步应用,均成功取出,未出现术后并发症。结论EZ取钉器具有足够的抗扭强度和刚度,夹持力大,拔钉稳定可靠,是取出骨骼中断钉和打滑螺钉较理想的工具。     

睾丸扭转50例临床分析

目的探讨睾丸扭转的早期诊断与治疗方法。方法对运用彩色超声检查确诊为睾丸扭转的50例患者的临床资料进行回顾性分析。结果 5例行睾丸切除术,45例手术复位并行睾丸固定术。术后随访3年,25例患者术后睾丸发生不同程度的萎缩,但尚未发现生育能力受限者。结论彩色多普勒超声检查是早期诊断睾丸扭转的可靠方法,早期诊断、及时治疗对提高睾丸存活率有重要意义。     

斑点追踪显像技术评价心肌扭转与心肌梗死范围相关性的实验研究

目的 应用斑点追踪显像技术评价急性心肌梗死(AMI)再灌注前、后左室心肌扭转,借以比较多个常规扭转指标与梗死范围的相关性,找出最能反映梗死范围的扭转指标.方法 小型猪15只,结扎左前降支120 min,分别检测结扎前、结扎后120 min、解除结扎后30 min、60 min、90 min、12 h各时间点常规超声指标以及扭转数据并进行比较.氯化硝基四氮唑蓝染色后计算心肌梗死范围.结果 AMI后心尖及左室各旋转/扭转角度指标均显著下降,再灌注12 h无明显改善.AMI即刻,左室整体扭转角度峰值及心尖整体旋转角度峰值与梗死范围的相关性明显优于同期其他扭转指标,相关系数分别为-0.81和-0.69(P均＜0.01);再灌注12 h相关性依然较好.结论 在AMI即刻及再灌注12 h内,左室整体扭转角度峰值及心尖整体旋转角度峰值是反映心肌梗死范围最敏感的扭转指标.

Abstract：

Objective To investigate the most sensitive markers of left ventricular(LV) torsion which can reflect infarct size by assessing the relationship between routine markers of LV torsion and infarct size using speckle tracking imaging (STI).Methods Fifteen open-chest pigs underwent 120 minutes of left anterior descending (LAD) ligation followed by 12 hours of reperfusion.Rotation and torsion of LV were obtained by STI before LAD occlusion,LAD occlusion immediately,and 30,60,90 minutes and 12 hours after reperfusion.Infarct size was measured by nitrotetrazolium blue chloride staining.Results LAD ligation resulted in a dramatic decrease in both subepicardial and subendocardial peak apical rotation or peak LV torsion.Twelve hours after reperfusion,all of the peak rotation and torsion remained significantly reduced (P ＜ 0.01 versus AMI).At AMI,peak bulk LV torsion and peak bulk apical rotation inversely correlated with infarct size (r = - 0.81,P ＜0.01; r = - 0.69,P ＜0.01).There existed the good relationship at 12-hour follow-up after reperfusion.The relationship was superior to that of other torsion markers.Conclusions Peak bulk LV torsion and peak bulk apical rotation are the most sensitive markers of LV torsion which can reflect infarct size.     

Functioning gonadotroph adenoma with severe ovarian hyperstimulation syndrome: A new emergency in pituitary adenoma surgery? Surgical considerations and literature review

The authors reported 2 cases of functioning gonadotroph pituitary adenoma (FGPA) revealed by an ovarian hyperstimulation syndrome (OHSS) in young women. In the first case, OHSS was observed after GnRH analog injection. Pelvic echography revealed multiple voluminous ovarian cysts. Dopamine agonist posology failed in estradiol hypersecretion control, which necessitated endoscopic endonasal transsphenoidal surgery. The patient experienced improvement in pelvic pain as estradiol hypersecretion decreased during the first few postoperative days. Outcome was favorable, and her menstrual cycle was normal after two months. The second case was a young girl with spontaneous pelvic pain and elevated plasma FSH and estradiol levels. FGPA was confirmed on cerebral MRI. Dopamine agonists were introduced, and surgical removal of the pituitary tumor was scheduled for 7 days later. In the meantime, the patient was admitted and underwent surgery for bilateral adnexal torsion related to OHSS. The pituitary tumor was removed one week later. Outcome was favorable, and estradiol and FSH plasma levels were normal after 3 months. The ovarian cysts were no longer visible on echography after 3 months. Given the lack of efficacy of the current standard medical therapy, surgical removal of pituitary adenomas is the reference treatment for FGPA. The authors suggest that severe OHSS related to FGPA should be considered as a relative surgical emergency and that surgery should not be unduly delayed, given the unpredictable risk of adnexal torsion, particularly in case of voluminous ovarian cysts. The authors performed a literature review on this topic.     

睾丸扭转评分法及标准化流程在提高诊治效率的应用

目的提高基层医院对睾丸扭转的诊治效率。方法收集2011年9月至2017年4月确诊的睾丸扭转患者31例(A组),回顾分析诊治效率;前瞻性纳入2017年5月至2019年1月按标准化流程收治的急诊急性阴囊疼痛患者43例(B组),并采用五要素七分评分法诊断睾丸扭转和采用与中山大学附属第一医院教学平台共建的区域"三基"培训体系的标准化诊治流程,对比两组的诊治效率。结果A组睾丸扭转病例从就诊至临床确诊时间为20~60 min,从入院后至急诊手术时间60~160 min,其中70%患者行睾丸切除,30%行睾丸固定;B组中睾丸扭转确诊时间为5~25 min,入院至手术室45~60 min,B组的诊治效率较高(P<0.001),其中56%患者行睾丸切除,44%为睾丸固定,两组睾丸切除率比较差异无统计学意义(P>0.05)。结论睾丸扭转评分法可快速有效诊断,标准化救治流程可有效缩短患者救治时间,可操作性强,二者联合可以提高基层医院对青少年睾丸扭转的诊治效率。     

Diagnostic accuracy of hand-held Doppler in the management of acute scrotal pain

We evaluate the reliability of hand-held Doppler (HHD) in the management of acute scrotal pain of 24 h or less duration. Between October 2003 and December 2004, patients presenting with acute scrotal pain were enrolled in this prospective study. After clinical examination, all patients had a HHD assessment. Presence or absence of Doppler arterial signals and its intensity were recorded. A blinded assessor corroborated HHD findings with the clinical, ultrasound, operative findings and final diagnosis. Primary outcome measured were sensitivity and specificity of HHD in the diagnosis of testicular torsion. Twenty-five patients presented during the study period with acute scrotal pain. The final diagnosis was testicular torsion in nine, epididymitis in 13, twisted cyst of Morgagni in two and Henoch–Schoenlein purpura in one patient. The HHD predicted all patients of testicular torsion correctly, preoperatively. HHD is a reliable diagnostic tool in the management of patients with acute scrotal pain.     

Surgical correction of lumbar scoliosis: a comparison of different techniques. Results

Summary Vertebral rotation is at the basis of structural scoliosis. Its measurement gives the possibility to evaluate the surgical correction. Three groups of five lumbar scolioses (means angle 45°) were treated with rotation of the convex rod (group 1), bending in situ (group 2) and bending associated with rotation of the convex screws (group 3). Cobb angle improvement was the same with the three techniques. The Vertebral Rotational Angle (VRA) and the most suitable Intervertebral Rotational Angle (IRA) were used for this study. IRA (difference of rotation between two consecutive vertebrae) stays the same whatever the reference axis and VRA depends on conditions of measurement. IRA is improved of 15% in group 1, 35% in group 2 and 54% in group 3.In situ bending associated with the rotation of the convex screws is a good method for correcting the torsion of the scoliotic lumbar spine.