The relationship between industry and surgery

This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and disadvantages of collaborating with industry and provide practical guides for interactions with industry in terms of clinical research, continuing medical education, and clinical practice. With careful consideration to protect all parties involved, collaboration with industry can be advantageous to surgeons, industry, and patients.     

重视甲状腺切除术的并发症

自Albucasis在西班牙施行第1例成功的甲状腺切除手术之后数百年间，皆因甲状腺切除死于大量和不可控制的出血而未能开展。直至瑞士Theodor Kocher在他4000例甲状腺手术以及对甲状腺解剖和生理研究基础上，提倡轻巧和精细的手术；保留甲状旁腺；并从解剖上辨认喉返神经，     

The current diagnosis of superficial bladder cancer must be reconsidered

The high recurrence and progression rates in superficial bladder cancer are partially related to the deficiencies of the standard conventional diagnostic modalities. Therefore, innovative noninvasive and invasive detection devices have been studied during the last decade. New diagnostic urine markers are under intensive investigation in order to exclude the presence of urothelial cancer, but the value of all these tests is still insufficiently validated in diagnosis and follow-up. With the introduction of 5-amino-levulinic acid fluorescence endoscopy, the efficacy of the detection device has been significantly improved. Flat lesions such as carcinoma in situ can be completely detected besides exophytic tumors. This is of particular importance because the fate of the patient depends to an important extent on these tumor entities. Furthermore, first experimental results using imaging devices like optical coherence tomography and confocal laser scanning microscopy promise new powerful noninvasive tools for 'optical sectioning' of the bladder.     

Nasal septal perforations must and can be closed

In this time of increasing occurrence of septal perforations caused by cocaine abuse, the plastic surgeon who deals mainly in rhinoplasty must learn to treat these defects with sophisticated methods. Too many septal perforations, especially large ones, are not treated because the surgical techniques are difficult. This article describes and illustrates two methods that close all kinds of perforations. Local flaps should be considered obsolete. A perforation up to 4 cm in diameter must be repaired in one step. This includes wide dissection of the mucoperichondrium and mucoperiosteum, suture of the hole on both sides, and interposition of parietal fascia or cartilage, sometimes with the help of bilateral small buccal flaps to cover the gap between the columella and the dissected mucoperichondrium containing the closed perforation on both sides. For closure of perforations greater than 4 cm in diameter, a three-step procedure which uses a composite three-layered buccal flap including ear concha cartilage is described. In the second step, the spoon-shaped flap is fed into the nasal cavity to fill the septal defect. The third step divides the pedicle. In many cases a unilateral or bilateral alotomy or the section of the columellar base may facilitate the suture of the flaps.     

What must be a well-cemented prosthesis?

To avoid cement stem debonding of the Charnley prosthesis, I modified in 1972 the geometry of this prosthesis to subject the cement only to stresses it can resist and protect it against harmful stresses. This was done by giving the stem such a shape that the stresses within the cement would be decreased to a level consistent with its physical properties. On the acetabular size, there has been no modification of the Charnley acetabular component, I only specified how to prepare the acetabulum and implant the socket in order to make it in mechanical harmony with the bone cavity.     

雌激素受体α及β亚型与绝经后骨质疏松的关系

绝经后雌激素水平下降是绝经后骨质疏松症发病的主要原因,随着年龄增长和绝经后体内雌激素水平降低,骨细胞上的ER的数量和功能均降低,可以部分解释绝经后妇女骨质疏松症发生率骤升的现象,骨细胞上的ER与绝经后骨质疏松症发生有重要的关系。ERα和ERβ在不同部位的骨骼及不同的骨细胞中分布有所差异,二者在骨代谢中可能行使着不同的功能,本文就此进行了详细的综述。     

Understanding the research-care demarcation and why it must be revised

BackgroundA clean-cut separation between research and care was artificially created at the time of the Belmont report more than 40 years ago. The demarcation was initially controversial but eventually was implemented for political reasons. We examine why it must be revised.MethodsWe review historical research scandals as well as the theoretical basis for the Belmont demarcation. We then discuss consequences on medical practice and propose an alternative.DiscussionMost research scandals involved abusing human beings supposedly for the sake of science. Belmont commissioners were aware the research/care problem was double-headed. While research subjects should be protected from abuse in the research context, patients need to be protected from unvalidated medical and surgical interventions in the care context. For political reasons the Commission recommended the regulation of research but to leave medical practice untouched. Thus the Commission had to distinguish research from care. The notion of ‘generalizable knowledge’ was introduced to define and regulate research, but the inadvertent result was that by trying to protect research subjects, the regulation has not only failed to protect all other patients, but also encouraged the widespread practice of unvalidated interventions within the care context. The notion of validated care should be re-introduced into a proper analysis of the care-research demarcation, for care research is an integral ingredient of a good medical practice.ConclusionThe research-care demarcation should be revised to leave room for the validated/unvalidated care distinction. Care research, essential to guide medical practice, should be facilitated at all levels.