Impalement Injury with Transanal Prolapse of Bowel Content Due to Intraperitoneal Rectal Tear

A 48-eight-year-old female patient came with prolapse of small intestines per rectum (Fig. 1) due to impalement injury with iron rod at a construction site. As the patient was hemodynamically unstable, she was taken for emergency laparotomy. A large rent in the intraperitoneal rectum was found (Fig. 2), with prolapse of intestines. Luckily for the patient, there was no other intra-abdominal organ injury. As there was no fecal contamination at all, a decision against proximal colostomy was made. The rent was closed in two layers after re-placing the small bowel contents with thorough lavage. Patient made a swift recovery thereafter.Open in a separate windowFig. 1Patient presented with prolapse of bowel contents per rectum due to injuryOpen in a separate windowFig. 2Intraoperative picture showing the perforation involving the rectum     

小干扰RNA特异性沉默c-myc基因对人胰腺癌SW1990细胞生物学影响

目的 观察小干扰RNA(siRNA)沉默c-myc基因的表达对人胰腺癌细胞株SW1990细胞生物学影响.方法 用siRNA沉默胰腺癌SW1990细胞中c-myc基因,用实时定量反转录聚合酶链反应(RT-qPCR)及Western blot技术检测c-myc mRNA及蛋白的表达量;噻唑蓝(MTT)法检测siRNA沉默c-myc基因对SW1990细胞增殖的影响;膜联蛋白V/碘化丙锭(Annexin V/PI)双染流式细胞术检测沉默c-myc基因细胞凋亡水平;Transwell细胞迁移实验检测siRNA沉默c-myc基因对SW1990细胞迁移能力的影响.结果 靶向c-myc的特异性siRNA可以高效抑制人胰腺癌SW1990细胞c-myc基因表达,在mRNA水平(0.263±0.048)较转染对照质粒组(0.970±0.012)明显降低,c-myc蛋白质表达量及细胞增值率均较转染对照质粒组明显降低;转染后48 h c-myc siRNA组细胞凋亡率为(19.90±2.09)％,明显高于siRNA阴性对照组(4.93±0.25)％和空白对照组(4.40±0.34)％;Transwell实验结果示细胞穿膜数c-myc siRNA组[(34.3±1.2)个]较siRNA-NC组[(68.3±5.8)个]和空白组[(72.3±1.2)个]均明显降低.结论 c-myc siRNA能够显著抑制c-myc基因在人胰腺癌SW1990细胞中的表达,降低细胞的增殖和迁移能力,促进细胞的凋亡.     

Electrical synapses connect a network of gonadotropin releasing hormone neurons in a cichlid fish

Initiating and regulating vertebrate reproduction requires pulsatile release of gonadotropin-releasing hormone (GnRH1) from the hypothalamus. Coordinated GnRH1 release, not simply elevated absolute levels, effects the release of pituitary gonadotropins that drive steroid production in the gonads. However, the mechanisms underlying synchronization of GnRH1 neurons are unknown. Control of synchronicity by gap junctions between GnRH1 neurons has been proposed but not previously found. We recorded simultaneously from pairs of transgenically labeled GnRH1 neurons in adult male Astatotilapia burtoni cichlid fish. We report that GnRH1 neurons are strongly and uniformly interconnected by electrical synapses that can drive spiking in connected cells and can be reversibly blocked by meclofenamic acid. Our results suggest that electrical synapses could promote coordinated spike firing in a cellular assemblage of GnRH1 neurons to produce the pulsatile output necessary for activation of the pituitary and reproduction.Development and function of the reproductive system in vertebrates depends on the timing and levels of signaling by gonadal sex steroids (1, 2). Production of these steroids is controlled by neurons expressing gonadotropin-releasing hormone (GnRH1), which comprise the final output of the brain to the hypothalamic-pituitary-gonadal axis. During vertebrate development, GnRH1 neurons originate outside the central nervous system in the olfactory placode and migrate into the basal forebrain (3–6). These neurons signal to the pituitary via the decapeptide GnRH1 to effect the release of the gonadotropins, follicle stimulating hormone and luteinizing hormone, which in turn stimulate steroid production by the gonads. It has long been known that this release depends on coordinated, pulsatile GnRH1 release, not simply elevated levels (7, 8), requiring some level of synchronization in the output of these neurons. Episodic activation of the pituitary gonadotropes has been observed in multiple vertebrate taxa, including mammals and fish (9–12), however, mechanisms that underlie this required coordinated activity of GnRH1 neurons are unknown. Synchrony could in principle derive from coincident input from a “pacemaker” neural population, from direct coupling of GnRH1 neurons, or from a combination of mechanisms. Gap junction-mediated coupling has been suspected to play a role, as synchronous firing can be observed in neurons mechanically isolated from brain slices and in cultures of embryonic mouse and primate neurons, and immortalized mouse GnRH1 neurons express the connexin proteins that constitute gap junctions (13–15). However, no evidence for gap junctions among adult GnRH1 cells in vivo has been found (16, 17).To search for the origin of synchrony among these neurons, we used a unique model system for analysis of GnRH1 neurons, Astatotilapia burtoni, a cichlid fish. GnRH1 neurons in males of this species exhibit dynamic morphological plasticity caused by changes in their social status (18–21). Here we use transgenic dominant male A. burtoni to perform paired recordings from GnRH1 neurons, and report that they are reciprocally connected by electrical synapses. These findings suggest that gap junctions contribute to the coordinated firing of these neurons necessary for reproductive function.     

B-Lynch缝合术治疗8例剖宫产后出血体会

目的探讨B-Lynch缝合术治疗剖宫产后出血的效果。方法对8例剖宫产后出血患者采用B-Lynch缝合术治疗,回顾性分析患者的病历资料。结果 8例患者均经B-Lynch缝合术成功止血,无1例因血液循环不良或再出血手术或子宫切除。子宫复旧、月经复潮时间无异常。结论剖宫产后子宫收缩乏力性出血药物治疗无效时,B-Lynch缝合术操作简单易行,止血效果可靠,尤其适合在基层医院开展。     

Small renal masses in the era of personalized medicine: Tumor heterogeneity,growth kinetics,and risk of metastasis

Small renal masses (SRMs) represent a heterogeneous group showing a variety of clinical and biological behaviors. The best treatment for SRMs has been the focus of much debate over the past decades. Present strategies include surgery (partial or radical nephrectomy), local treatments (radiofrequency and cryoablation), or active surveillance. The choice among these therapeutic options is based on patient clinical features such as age or comorbidities rather than on tumor characteristics. Several studies have recently focused on the molecular behavior of SRMs. They showed that SRMs present histotype and nuclear grading heterogeneity, together with not unvarying growth kinetics and risk of recurrence or metastasis, suggesting that personalized approaches should be designed to optimize the management of these patients. At present, several studies are in course to identify predictive biomarkers to guide the decision-making process in this subpopulation. In this review, we summarized the data on growth kinetics, tumor heterogeneity, and risk of metastasis in patients with SRMs, with focus on the current role of biopsies and imaging in the management of these patients.     

超声心动图对继发性三尖瓣反流术疗效的评价

【摘要】〓目的〓通过超声心动图比较继发性三尖瓣反流患者行三尖瓣缝线成形术和成形环成形术的早期和中期效果,评价两种三尖瓣成形方法的疗效。方法〓回顾性分析我院2008年1月~2013年6月行三尖瓣成形术治疗的,并能追踪到而且进行了随访的继发性三尖瓣反流患者 175 例,根据成形方法分成两组:缝线成形术组 143例(82%),使用成形环成形术组 32 例(18%),分别于术前、术后一个月、术后一年通过超声心动图测量左室射血分数(LVEF)、三尖瓣反流束面积(TRA)、三尖瓣反流分数(TRF)、右室前后径(RVD)、右房上下径(RAD1)及右房左右径(RAD2),比较术前、术后半个月及术后1年时各参数的变化。结果〓两组患者,与术前相比,所有患者术后一个月TRA、TRF及RVD、RAD1及RAD2均显著降低(P<0.05),LVEF无显著变化(P>0.05);术后1年,缝线成形术组的患者TRF较术后一个月显著增加(P<0.05),其余指标无明显变化(P>0.05);而使用成形环组术后一年,所有指标较术后一个月无显著变化(P>0.05)。结论〓三尖瓣成形环成形术治疗三尖瓣反流,在术后中期仍可维持良好的疗效。超声心动图对三尖瓣反流的程度可提供半定量信息,在术前及术后随访中有着重要的应用价值。     

Barbed Sutures and Tendon Repair—a Review

Introduction

Traumatic tendon lacerations are a common problem encountered by hand surgeons worldwide. Although the use of barbed suture to repair tendon lacerations has gained theoretical popularity in recent years, there is little information available regarding the safety, efficacy, longevity, or complications encountered when used in tenorraphy. In this study, we review the available literature on the use of barbed suture in tendon repair.

Methods

Studies conducted between 1980 and 2014 were identified using several databases, including EMBASE, SCOPUS, MEDLINE, and Web of Science. Keywords used to search for appropriate studies included the following: barbed, v loc, quill, tendon, tendon injuries, suture, tenorraphy, injury, and laceration, in various combinations.

Results

Our initial literature search identified 47 articles, and 8 were deemed appropriate for review after applying our exclusion criteria. The data from each of the articles is reviewed for the following major categories:

1. Maximum load to failure
2. Mode of failure
3. Load to 2-mm gap
4. Change in cross-sectional area
5. Type of repair

Conclusions

Barbed suture tenorraphy has a myriad of theoretical advantages, supported by varying ex vivo studies, as compared to traditional techniques. However, due to the non-uniformity in current studies and the lack of available data in a live model, we are unable to argue for or against barbed suture tenorraphy. We believe our review provides the most in-depth analysis of barbed suture tenorraphy to date, illuminates the potential advantages of using barbed sutures, and highlights the need for further investigation into this technique.     

Difficult esophageal atresia: Trick and treat

Although most patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) may benefit from “standard” management, which is deferred emergency surgery, some may present unexpected elements that change this paradigm. Birth weight, associated anomalies, and long gap can influence the therapeutic schedule of the patients with EA/TEF and can make their treatment tricky. As a consequence, detailed information on these aspects gives the power to develop a decision-making process as correct as possible. In this article, we will review the most important factors influencing the treatment of patients with EA/TEF and will share our experience on the diagnostic and therapeutic tips that may provide pivotal help in the management of such patients.     

Rapid construction of sigmoid bladder augmentation using absorbable staples: Long-term results and comparison to standard colocystoplasty in children with neurogenic bladder

ObjectiveAbsorbable staples facilitate detubularization and reconfiguration of the bowel when performing augmentation colocystoplasty. We compared the outcomes of stapled sigmoid augmentation with standard sutured colocystoplasty.Materials and methodsBetween 2003 and 2011, 108 children underwent bladder augmentation at our institution. Colocystoplasty was used in 30 patients (27.8%). Medical charts of children who underwent stapled (n = 8) or sutured (n = 22) sigmoid augmentation were compared with regard to patient demographics and surgical complications, including anastomotic leak and urolithiasis.ResultsEight children with underwent stapled sigmoid colocystoplasty. Average age at surgery was 8 years (range 4–17 years). Time to detubularize and refashion the bowel segment prior to augmentation was consistently under 5 min. Average length of follow-up was 44 months (range 12–80 months). One patient experienced anastomotic leak. Two of eight children (25%) in the stapled anastomosis cohort developed bladder stones. Twenty-two patients underwent standard sigmoid augmentation during the same time period (average age 8.2 years; range 4–16 years). One of 22 (4.5%) experienced anastomotic leak. Seven of 22 (31.8%) developed cystolithiasis.ConclusionsComplications from stapled sigmoid anastomosis are similar to those from standard colocystoplasty. Use of absorbable staples decreases operating time by avoiding bowel spatulation and suturing, and should be considered in pediatric patients undergoing colocystoplasty.