Accuracy of intentionally tilted implant placement in the maxilla using dynamic navigation: a retrospective clinical analysis

The aim of this retrospective study was to investigate the accuracy of dynamic navigation for the placement of intentionally tilted implants in the posterior maxilla. The study included 12 patients with edentulism or continuous multiple tooth loss, who had 48 implants inserted under dynamic navigation guidance in the posterior maxilla. Twenty-four implants near maxillary sinuses were intentionally tilted. The average platform deviation was 1.3 ± 0.4 mm (range 0.8–2.3 mm), apex deviation was 1.1 ± 0.5 mm (range 0.2–2.3 mm), and axis deviation was 3.1 ± 1.0° (range 1.8–6.7°). The other 24 implants were axially positioned. The average platform deviation was 1.5 ± 0.5 mm (range 0.7–3.1 mm), apex deviation was 1.3 ± 0.7 mm (range 0.5–3.1 mm), and axis deviation was 3.2 ± 1.5° (range 1.5–7.7°). There was no significant difference in platform deviation, apex deviation, or axis deviation between the tilted implants and implants in the axial position (P > 0.05). This analysis indicates that a dynamic navigation system can be used as a method of guidance to place intentionally tilted implants as accurately as axially positioned implants in the posterior maxilla, thereby preventing damage to the maxillary sinuses and the need to graft bone.     

Tratamiento del síndrome de Budd-Chiari agudo intraoperatorio mediante colocación de prótesis de silicona

Complete liver mobilization for major resections sometimes causes liver tilting due to the release of the suspensory elements of the liver. Rarely this may take to a liver abnormal position with acute obstruction to venous flow at the suprahepatic level (Budd-Chiari syndrome). To avoid this complication, techniques such as post-operative stent implantation have been described. The case of a patient who underwent a complete mobilization of the liver for resection of the inferiour venous cava and a right renal tumor, was reported. After that, an acute Budd-Chiari Syndrome was observed caused of the liver malposition, which was solved with the placement of two silicone prostheses in the liver cell.     

Mechanical Hemolysis Complicating Transcatheter Interventions for Valvular Heart Disease: JACC State-of-the-Art Review

Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approach to diagnosis, and impact of other hematological conditions on the resultant anemia. The importance of a multidisciplinary management is underscored. Laboratory data are provided about subclinical hemolysis that is commonly observed following the implantation of surgical and transcatheter valve prostheses and devices. Finally, clinical scenarios are reviewed and current medical and surgical treatments are discussed, including alternative options for inoperable patients.     

二补助育汤对胚胎着床障碍小鼠子宫血管生成相关因子表达的影响

目的：探讨二补助育汤对胚胎着床障碍模型小鼠子宫内膜形态及血管生成素-1（Ang-1）mRNA、血管内皮生长因子（VEGF）mRNA的表达和定位的影响。方法：24只ICR雌性小鼠随机分为空白组、模型组、戊酸雌二醇组、二补助育汤组，每组6只，用米非司酮建立胚胎着床障碍动物模型，各组给予相应药物灌胃，妊娠第5天处死小鼠后，检测各组妊娠率、平均着床位点数、子宫内膜Ang-1和VEGF mRNA表达量及其蛋白定位。结果：模型组小鼠平均胚胎着床位点数、Ang-1 mRNA、VEGF mRNA表达量明显低于空白组（均P<0.05）；与模型组比较，二补助育汤组平均胚胎着床位点数、Ang-1 mRNA、VEGF mRNA表达量显著提高（均P<0.05）。结论：二补助育汤可提高子宫内膜Ang-1和VEGF蛋白表达量，促进子宫内膜血管生成，从而提高子宫内膜容受性。     

胞饮突评估子宫内膜容受性的研究进展

胚胎植入是一个复杂且受到高度调控的过程,需要囊胚与母体子宫内膜的发育精确同步。胞饮突作为表达于子宫内膜上的一种特殊膜状突起,随月经周期变化表现为不同形态,可分为发育期、成熟期及退化期。目前已有一系列研究证实,胞饮突的数量、覆盖面积及发育阶段等在预测不孕女性种植窗及评估子宫内膜容受性中具有临床价值。胞饮突评分较高、覆盖面积较广且成熟期胞饮突占比较高的女性妊娠结局更佳。其机制可能包括胞饮突通过调节宫腔内容物影响子宫内膜容受性、通过表达植入相关蛋白参与囊胚-子宫内膜相互作用等。然而,对胞饮突精准且客观的评估手段仍待进一步探索,胞饮突评估子宫内膜容受性的精确度也待进一步验证。     

胆总管结石内镜逆行胰胆管造影术后行胆道支架置入和鼻胆管引流并发症的比较

目的探讨胆总管结石患者采用内镜逆行胰胆管造影术（ERCP）取石后同期开展胆道支架置入术或开展经内镜鼻胆管引流术（ENBD），对于防范并发症的价值。 方法按照前瞻性研究原则，选择2017年4月至2019年1月新疆医科大学第一附属医院收治的338例胆总管结石患者，随机分为支架组（170例）与引流组（168例）。两组患者均行ERCP治疗，其中引流组术后同期开展ENBD，支架组患者术后开展胆道支架置入术，对比两组患者腹痛评分、并发症发生情况及预后。 结果两组患者术后均未合并严重出血、穿孔或病死，结石完全清除率差异无统计学意义。与支架组相比，引流组术中胰腺管插管次数，术后4 h血淀粉酶水平、高淀粉酶血症、急性胰腺炎以及并发症总发生率更高，差异有统计学意义（P<0.05），术后24、48、72 h不同时点腹痛测评分值居更高水平（P<0.05）。 结论对于胆总管结石行ERCP治疗的患者，术后予以ENBD、胆道支架置入术的结石完全清除效果对比无明显差异，但胆道支架置入术更能降低术后并发症风险、缓解腹痛症状，患者获益更多。     

人工关节置换术后假体无菌性松动的早期诊断

人工关节置换术(TJA)是临床治疗各种终末期关节疾病最为常用且有效的方法，随着手术量的增大，其并发症越来越得到人们的重视，尤其是假体无菌性松动，严重影响了假体的使用寿命，需要进一步行翻修手术。因此，如何提高假体无菌性松动早期诊断的敏感性和特异性，将对评估假体磨损状态、延长假体寿命以及改善患者生活质量有重要意义。在此，本文对人工关节假体无菌性松动的早期诊断进展作一综述。     

髋臼螺钉对非骨水泥全髋置换术中假体稳定性的影响

目的探讨髋臼螺钉在非骨水泥全髋置换术中对髋臼假体稳定性的影响。 方法回顾性分析2009年8月至2015年8月在深圳市龙岗区人民医院骨科行非骨水泥全髋置换术114例(117髋)病例资料，患者根据术中是否植入髋臼螺钉分成两组，其中A组无螺钉组59髋，B组螺钉固定组58髋。分别在术后3个月、12个月、24个月和末次随访时对病人进行随访，评估并比较影像学的改变及Harris评分。A组57髋B组56髋获得完整随访资料，平均随访(5.7±1.6)年。以Kaplan-Meier法分析两组假体生存率。 结果A组平均手术时间(t＝2.213, P<0.05)、术中出血量均小于B组(t＝2.342, P<0.05)；随访末期，A、B组术后平均Harris评分为(95.0±2.1)分及(93.0±5.5)分(P>0.05)；A、B组术后3个月、12个月、24个月分别有4髋(7.0%)、3髋(5.3%)、1髋(1.8%)和1髋(1.8%)、2髋(3.6%)及2髋(3.6%)出现髋臼周围透亮线；A组1髋术后4年出现骨溶解，B组2髋出现骨溶解。以影像学证明假体松动作为失败标准，计算两组假体平均随访(5.7±1.6)年生存率分别为97%和95%，两者差异无统计学意义(P >0.05)。 结论髋臼骨质条件良好时是否使用髋臼螺钉固定对臼杯的稳定性无明显影响，全髋关节置换术中植入髋臼螺钉不是必需的。