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In the pelvis, anatomic complexity and difficulty in visualization and access make surgery a formidable task. Surgeons are prone to work-related musculoskeletal injuries from the frequently poor design and flow of their work environment. This is exacerbated by the strain of surgery in the pelvis. These injuries can result in alterations to a surgeons practice, inadvertent patient injury, and even early retirement. Human factors examines the relationships between the surgeon, their instruments and their environment. By bridging physiology, psychology, and ergonomics, human factors allows a better understanding of some of the challenges posed by pelvic surgery. The operative approach involved (open, laparoscopic, robotic, or perineal) plays an important role in the relevant human factors. Improved understanding of ergonomics can mitigate these risks to surgeons. Other human factors approaches such as standardization, use of checklists, and employing resiliency efforts can all improve patient safety in the operating theatre.  相似文献   
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目的利用网状Meta分析系统评价传统外剥内扎术(MMH)、吻合器痔上黏膜环切术(PPH)、选择性痔上黏膜切除术(TST)和多普勒超声引导下痔动脉结扎术(DG-HAL)治疗痔病的手术方式的疗效和安全性,为临床提供参考。 方法检索中国知网、万方数据、中国生物医学网,Pubmed、Cochrane Library、Embase数据库,收集建库至2020年12月关于MMH、PPH、TST和DG-HAL治疗痔病的随机对照试验,提取的资料采用GeMTC 0.14.3软件进行网状Meta分析。 结果最终纳入45项研究,包括43篇两臂实验,2篇三臂实验;共5 847例患者,其中MMH组1 777例,PPH组1 971例,TST组1 205例,DG-HAL组894例。与MMH相比,DG-HAL(MD=-4.16,95% CI:-6.49~ -1.82,P<0.05)和PPH(MD=2.28,95% CI:0.64~3.89,P<0.05)可以显著降低术后疼痛程度,差异均有统计学意义;TST术后尿潴留发生率明显低于MMH(OR=2.08,95% CI:1.23~4.09,P<0.05);相比于MMH(OR=0.01,95% CI:0~0.15,P<0.05)和PPH(OR=0.08,95% CI:0~0.78,P<0.05),DG-HAL术后肛门狭窄发生率低;而PPH(OR=6.56,95% CI:1.20~57.74,P<0.05)和TST(OR=58.25,95% CI:4.37~2 605.94,P<0.05)的术后肛门狭窄发生率均比MMH低,TST优于PPH(OR=8.50,95% CI:1.23~150.91,P<0.05),差异均有统计学意义。术后24 h疼痛评分排序为MMH>PPH>TST>DG-HAL;术后出血发生率排序为MMH>PPH>TST>DA-HAL;尿潴留发生率排序为MMH>PPH>DA-HAL>TST;肛门狭窄发生率排序为MMH>PPH>TST>DG-HAL;复发率排序为DA-HAL>PPH>MMH>TST。 结论四种手术方式治疗痔病的作用机制各有优势,DG-HAL和TST术后疼痛、出血、尿潴留、肛门狭窄等并发症发生率低,术后舒适度和安全性方面有明显优势。术后复发率方面TST最优,DG-HAL最差。  相似文献   
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张磊  钱辰肖  罗国君 《安徽医药》2022,26(4):815-818
目的探讨阿替普酶静脉溶栓治疗急性缺血性脑卒中病人 90 d后预后的相关影响因素。方法纳入 2016年 1月至 2019年 1月在上海市第六人民医院金山分院诊断为急性缺血性脑卒中并进行静脉阿替普酶溶栓的病人,收集病人的基线资料,测定溶栓后 90 d病人改良 Rankin量表( modified Rankin scale,mRS)评分,将病人分为预后良好组( 0~2分)与预后不良组(3~6分)。采用二元 logistic回归分析不良预后的影响因素。结果共纳入病人 112例。其中,男 66例( 58.93%),女 46例  相似文献   
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减毒沙门菌对实体瘤具有广谱的肿瘤靶向特异性,其可通过激活机体抗肿瘤免疫应答改善肿瘤免疫微环境,从而抑 制肿瘤的发展;高度的肿瘤靶向特异性使得减毒沙门菌可作为理想的抗癌药物与影像探针的表达和递送载体,实现肿瘤诊疗一 体化。减毒沙门菌在基础或临床领域已有着广泛的研究与应用,展现了良好的应用前景,未来可期。对减毒沙门菌的抗肿瘤机 制、应用现状及目前所存在的问题展开分析,探讨如何通过遗传工程技术对减毒菌的安全性、靶向性和抗癌效果等方面进行提 升,将促进减毒沙门菌的转化应用,实现免疫学、生物技术等多学科的交叉融合,有望为临床肿瘤生物治疗提供新的研究方向。  相似文献   
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BackgroundPatellofemoral joint cartilage defects are difficult to treat due to their unique thickness and topography.PurposeTo report the postoperative outcomes of patients age 21 and younger treated with particulated juvenile allograft cartilage (PJAC) for full-thickness cartilaginous defects of the patellofemoral joint. The primary aim was to report surgical outcomes and complication rates, as well as return to sport activity. A secondary aim was to provide objective scores of defect restoration by magnetic resonance imaging (MRI) assessment.MethodsA retrospective review of all PJAC cases conducted between 2012 and 2019 at a single tertiary care urban musculoskeletal institution was conducted. Patients 21 years old or younger with minimum clinical follow up of 1 year and postoperative MRI at a minimum of 6 months were included. Cartilage restoration by MRI was independently assessed using the International Cartilage Repair Society’s (ICRS) standardized system.ResultsThirty four patients, 36 knees, were included, with mean age 16.1 ± 3.1 years old. Return to sport rate among patients who participated in a sport preoperatively was 100%. On independent MRI assessment, two thirds of defects achieved an overall grade of normal or nearly normal, while 28 patients (78%) had majority defect fill. Primary graft failure occurred in two cases and one patient experienced a surgical complication.ConclusionRestoration of patellofemoral chondral defects in young patients with particulated juvenile allograft results in satisfactory short-term outcomes and postoperative MRI appearance, along with high rates of return to sport and low rate of complications and graft failure.What is known about the subject: Patellofemoral joint cartilage defects are difficult to treat due to their unique thickness and topography. Several cartilage restoration techniques are available, but these rarely achieve the same mechanical properties as native hyaline cartilage. PJAC is a cell-based technique that has demonstrated promise since its introduction in 2007.What this study adds to existing knowledge: This series of patients adds the largest single cohort of pediatric and adolescent patients who receive PJAC for defects of the patellofemoral joint. Surgeons treating patients in this age group should be aware of every technique, and their respective outcomes.  相似文献   
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宫腔镜下宫腔粘连分离术是治疗宫腔粘连的最常用方法,但术后粘连复发率高,妊娠结局不理想,因此术后常需联合辅助治疗措施改善预后。传统辅助治疗措施主要包括物理屏障以及口服或局部应用药物等,其中宫内放置Foley导管常与口服雌激素联合应用,因其疗效稳定、性价比高等优点在临床上应用已久。近年来以生物制剂和生物材料为基础的多种新型辅助治疗措施逐渐应用于宫腔粘连分离术后,其中富血小板血浆和干细胞等生物制剂在促进子宫内膜修复、改善生殖结局等方面显示出了更好的治疗效果。此外,基于凝胶、支架等生物材料的新型辅助治疗措施也显示出了良好的治疗作用,为难治性宫腔粘连带来了希望。综述宫腔粘连分离术后传统及新型辅助治疗措施的研究进展,为宫腔粘连的综合治疗提供新的临床思路。  相似文献   
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《Acta histochemica》2022,124(4):151895
Cancer is a disease characterised by abnormal cell growth that can invade or spread to other regions of the body. Organoids are three-dimensional ex vivo tissue cultures made from embryonic stem cells, induced pluripotent stem cells, progenitor cells or tissue that serve as a physiological model for cancer research. These are designed to recapitulate the in vivo properties of tumours. Importantly, effective recapitulation of the structure of tissues and function is believed to predict patient response, allowing for the creation of personalised therapy in a timely manner that may be used in the clinic. This Review discusses the pre-clinical model and different types of human organoids as models for the development of high throughput drug screening and also aims to highlight how organoids are shaping the future of cancer research.  相似文献   
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In recent years, thermal ablation has played an increasingly important role in treating various tumors in the clinic. A practical thermochromic phantom model can provide a favorable platform for clinical thermotherapy training of young physicians or calibration and optimization of thermal devices without risk to animals or human participants. To date, many tissue-mimicking thermal phantoms have been developed and are well liked, especially the polyacrylamide gel (PAG)–based phantoms. This review summarizes the PAG-based phantoms in the field of thermotherapy, details their advantages and disadvantages and provides a direction for further optimization. The relevant physical parameters (such as electrical, acoustic, and thermal properties) of these phantoms are also presented in this review, which can assist operators in a deeper understanding of these phantoms and selection of the proper recipes for phantom fabrication.  相似文献   
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