22例附件扭转保留卵巢手术的临床经验分析

目的探讨附件扭转患者保留卵巢手术的安全性和可行性。方法回顾性分析于我院经手术确诊附件扭转行保留卵巢手术的22例患者的临床资料,并分析手术方案及预后情况。结果患者均成功实施了保留卵巢手术,术后无盆腔炎、肺栓塞等并发症发生;20例患者行腹腔镜手术,2例患者行开腹手术;平均扭转度数(523.64°±235.08°);平均出血量(17.50±11.21)mL;成熟畸胎瘤占多数,占比31.8%(7/22);合并早期妊娠2例,其中1例行开腹卵巢保留手术,现已足月顺娩,另1例行腹腔镜下卵巢保留术+人工流产术,术后40 d月经恢复正常;18例非妊娠患者术后12个月复诊,月经量及经期、周期与术前无明显变化,1例术后第2年足月妊娠剖宫产1女婴;2例月经前期女性,术后1~1.5年月经来潮,且月经正常;术后盆腔超声见患侧卵巢大小正常,有小卵泡或优势卵泡发育。结论附件扭转行保留卵巢手术,具有一定的安全性和可行性,最大程度地保留了年轻女性的内分泌及潜在生殖功能。     

Tumor necrosis factor-α small interfering RNA alveolar epithelial cell-targeting nanoparticles reduce lung injury in C57BL/6J mice with sepsis

BackgroundThe role of tumor necrosis factor (TNF)-α small interfering (si)RNA alveolar epithelial cell (AEC)-targeting nanoparticles in lung injury is unclear.MethodsSixty C57BL/6J mice with sepsis were divided into normal, control, sham, 25 mg/kg, 50 mg/kg, and 100 mg/kg siRNA AEC-targeting nanoparticles groups (n = 10 per group). The wet:dry lung weight ratio, and hematoxylin and eosin staining, western blotting, and enzyme-linked immunosorbent assays for inflammatory factors were conducted to compare differences among groups.ResultsThe wet:dry ratio was significantly lower in control and sham groups than other groups. TNF-α siRNA AEC-targeting nanoparticles significantly reduced the number of eosinophils, with significantly lower numbers in the 50 mg/kg group than in 25 mg/kg and 100 mg/kg groups. The nanoparticles also significantly reduced the expression of TNF-α, B-cell lymphoma-2, caspase 3, interleukin (IL)-1β, and IL-6, with TNF-α expression being significantly lower in the 50 mg/kg group than in 25 mg/kg and 100 mg/kg groups.ConclusionTNF-α siRNA AEC-targeting nanoparticles appear to be effective at improving lung injury-related sepsis, and 50 mg/kg may be a preferred dose option for administration.     

Kienböck's disease: pathophysiology,classification and treatment of this insidious condition

Kienböck's disease is the result of avascular necrosis of the lunate. Whilst no causal aetiology has been identified, several factors have been found to show an association with the condition. These include anatomical aspects such as lunate morphology; wrist biomechanics and vascular supply patterns, which in combination with external influences such as repetitive trauma, maybe a potential cause of the condition. Diagnosis and assessment of severity has historically been made using plain radiographs to stage the condition, however other assessment modalities such as magnetic resonance imaging and direct visualization with wrist arthroscopy have been advocated. Lichtman has sought to amalgamate these diagnostic techniques into a new comprehensive staging tool with the aim of better standardizing and guiding treatment. Whilst no single treatment has been proven to improve the natural outcome of the disease, current recognized treatments, in general, aim to protect the compromised lunate in the early stage of the condition, whilst in the later stages the focus shifts to procedures that either bypass, fuse or excise the affected peri-lunate articulations.     

A systematic review on the utility of ultrasonography in the diagnosis of testicular torsion in acute scrotum patients

IntroductionUltrasound is a valuable tool in establishing the cause of acute scrotum pain. However, its role in testicular torsion (TT) detection remains controversial. This review aims integrate pre-existing data to assess the value of B-mode and colour Doppler ultrasound (CDS) features combined in the detection of TT in acute scrotum pain patients of all ages.MethodsA search through electronic databases, grey literature and hand searching using specific search terms was conducted to identify relevant literature. Search results were subjected to a three-step selection process to ensure the inclusion criteria of this review were met. Statistical data pertaining to the accuracy, sensitivity, and specificity of the B-mode, CDS and combined B-mode CDS features were extracted. These results subsequently underwent a narrative analysis.ResultsFive studies met the inclusion criteria. A variety of B-mode features were identified. Most studies showed that reliance on CDS alone can be prone to false-negative results. The combination of B-mode and CDS features were found to increase the overall sensitivity of ultrasound towards TT (up to 100% in 3 studies). All studies recommended correlation with clinical examination findings. Several limitations in methodology of the included studies were noted: small sample populations and lack of information on the experience of ultrasound practitioners. This highlighted the need for a primary study with a larger sample population to validate the findings of this review.ConclusionThe combination of B-mode and CDS ultrasound is a useful and reliable triage tool in the detection of TT, particularly in equivocal or low suspicion cases but its findings should always be adjunct with clinical examination. Nevertheless, it is noted that appropriate service level agreements, pathways, and training are key factors in ensuring effectiveness of the process.Implications for practiceDedicated training and appropriate departmental protocol are key in ensuring accurate diagnosis across all levels of practice.     

急性脑梗死患者血清CTRP3,CTRP9水平与颈总动脉内膜中层厚度的相关性分析

目的 探讨急性脑梗死(Acute cerebral infarction,ACI)患者血清中补体C1q/肿瘤坏死因子相关蛋白3/9(Complement-C1q/tumor necrosis factor-related protein 3/9,CTRP3/9)的水平变化及其与颈总动脉内膜中层厚度(Carotid intima-media thickness,CIMT)的相关性。方法 选取2015年12月-2019年1月本院收治的102例ACI患者进行研究(ACI组),并选取同时间段内98例体检健康者进行对照分析研究(对照组); 分析比较2组受试者一般资料; 采用酶联免疫吸附法(Enzyme linked immunosorbent assay,ELISA)检测2组受试者血清CTRP3,CTRP9水平; 利用彩色多普勒超声仪检测2组受试者CIMT; Pearson法分析ACI患者血清CTRP3,CTRP9水平与CIMT以及CTRP3与CTRP9水平的关系; 采用Logistic回归分析法ACI患者CIMT的影响因素。结果 ACI组血清低密度脂蛋白-胆固醇(Low density lipoprotein cholesterol,LDL-C)、总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)水平均高于对照组(P<0.05),血清CTRP3,CTRP9、高密度脂蛋白-胆固醇(HDL-C)水平明显均明显低于对照组(P<0.05),CIMT较对照组增加(P<0.05); ACI患者血清CTRP3与CTRP9水平呈正相关(r=0.490,P<0.05),血清CTRP3,CTRP9水平与CIMT均呈负相关(r=-0.461、-0.482,P<0.05); TG,TC,LDL-C水平为ACI患者CIMT增加的危险因素(P<0.05),HDL-C,CTRP3,CTRP9水平为ACI患者CIMT增加的保护因素(P<0.05)。结论 ACI患者血清CTRP3,CTRP9水平均明显降低,两者可能与CIMT相互影响,共同影响ACI发生发展。     

机器人辅助下钻孔减压治疗股骨头坏死与传统手术的对比

文题释义：股骨头缺血性坏死：由创伤性和非创伤性原因引起的股骨头病变的病理过程，临床以髋关节疼痛、功能障碍为主要表现。此病病程长、预后差，易引起股骨头塌陷，引起髋关节退变，股骨头坏死早期可行钻孔减压治疗，后期需要行全髋关节置换。 钻孔减压：即髓芯减压，是在1964年由Arlet和Float首创，空心钻头在克氏针的引导下沿克氏针由股骨大转子外侧向股骨头坏死区域定位，到达股骨头皮质下方。股骨头中间形成孔道使股骨头起到减压的效果。背景：为了延缓早期股骨头坏死的进一步加重，股骨头钻孔减压是一种较好的治疗方法，但传统股骨头钻孔减压手术创伤大。 目的：对比机器人辅助下钻孔减压治疗股骨头无菌性坏死与传统手术疗效的差异。 方法：纳入40例行股骨头无菌性坏死钻孔减压患者进行回顾性对比分析，根据治疗方案分为2组。机器人组在机器人辅助下对18例(26个股骨头)进行股骨头钻孔减压治疗，其中FicatⅠ期13例(18个股骨头)，FicatⅡ期5例 (8个股骨头)；传统手术组共22例患者(29个股骨头)，其中FicatⅠ期15例 (19个股骨头)，FicatⅡ期7例(10个股骨头)。对比2组患者的手术切口、术中透视次数、术中出血量、术中穿刺次数及手术时间，术前及术后1，3，6个月根据Harris评分评估髋关节功能。结果与结论：①所有患者均随访6个月以上；②机器人组术中切口长度、术中出血量、透视次数、术中穿刺次数、手术时间均优于传统组，差异有显著性意义(P < 0.05)；③2组患者术后1，3，6个月Harris评分相比差异均无显著性意义(P > 0.05)；④提示与传统术式相比，机器人辅助下钻孔减压治疗股骨头无菌性坏死的疗效方面并未见明显优势，但其手术切口小，术中透视次数少，创伤小，操作更加安全微创。 ORCID: 0000-0002-1809-7037(罗进) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

High tibial derotation osteotomy for distal extensor mechanism alignment in patients with squinting patella due to increased external tibial torsion

BackgroundThe patellofemoral joint is often affected by torsional disorders of the lower limb, causing pain, instability and knee degeneration. The aims of this study were to determine functional outcomes of patients who underwent a high tibial derotation osteotomy (HTDO) for symptomatic squinting patella due to increased external tibial torsion. Moreover, factors associated with inferior clinical outcomes were investigated.MethodsPatients with symptomatic squinting patella, increased external tibial torsion (>30°) treated with this technique, and with 2 years of follow up were included. Fulkerson and Kujala patellofemoral joint scores were assessed. Age, body mass index, history of prior surgery, increased femoral anteversion, association of lateral retinaculum release and patellar cartilage lesions were analysed.ResultsSixty HTDOs were included in this retrospective study with an average of 66 months of follow up. The mean Kujala score improved from 47.5 preoperatively to 93 postoperatively. The mean Fulkerson score improved from 40.6 to 91.6. Kujala subscores for pain improved from 8.6 to 30.4, for instability improved from 6.4 to 17.9, and their ability to climb stairs increased from 6.9 to 17.9 (all P < 0.0001). Multivariate logistic regression model identified that patient age (P < 0.005) and advanced chondral damage (P < 0.001) were the dominant factors predicting inferior clinical outcomes using Kujala’s score.ConclusionHTDO provided good results regarding the pain symptoms, instability and the ability to climb stairs. Advanced chondral damage and advanced age had negative effects on outcomes.     

Aspects of Langerhans cells and TNF-α in the cutaneous immunity of anogenital warts

BackgroundAnogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α.ObjectiveTo assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented.MethodsThis is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium.Results48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p < 0.001).Study limitationsSmall number of patients analyzed.ConclusionThere was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.