Neuromonitoring During Robotic Cochlear Implantation: Initial Clinical Experience

During robotic cochlear implantation a drill trajectory often passes at submillimeter distances from the facial nerve due to close lying critical anatomy of the temporal bone. Additional intraoperative safety mechanisms are thus required to ensure preservation of this vital structure in case of unexpected navigation system error. Electromyography based nerve monitoring is widely used to aid surgeons in localizing vital nerve structures at risk of injury during surgery. However, state of the art neuromonitoring systems, are unable to discriminate facial nerve proximity within submillimeter ranges. Previous work demonstrated the feasibility of utilizing combinations of monopolar and bipolar stimulation threshold measurements to discretize facial nerve proximity with greater sensitivity and specificity, enabling discrimination between safe (> 0.4 mm) and unsafe (< 0.1 mm) trajectories during robotic cochlear implantation (in vivo animal model). Herein, initial clinical validation of the determined stimulation protocol and nerve proximity analysis integrated into an image guided system for safety measurement is presented. Stimulation thresholds and corresponding nerve proximity values previously determined from an animal model have been validated in a first-in-man clinical trial of robotic cochlear implantation. Measurements performed automatically at preoperatively defined distances from the facial nerve were used to determine safety of the drill trajectory intraoperatively. The presented system and automated analysis correctly determined sufficient safety distance margins (> 0.4 mm) to the facial nerve in all cases.     

Clinical Experience with Carotid Stump Pressure and EEG Monitoring to Determine Shunt Placement During Carotid Endarterectomy

The authors'' experience with selective shunting during carotid endarterectomy utilizing electroencephalographic and stump pressure measurements is reported. No postoperative neurological deficits occurred in this group of selectively shunted patients. EEG appeared to offer no significant benefit in the management of the patients. Carotid stump pressures alone were reliable in providing the basis for selective shunting.     

Preliminary Clinical Experience with Intraoperative Radiotherapy

Intraoperative radiotherapy is the term applied to the irradiation of unresectable tumors, partially resectable tumors, and regional lymph nodes with external beam radiation at the time of surgical exposure. Since only one treatment is given at the time of surgery, one should consider the intraoperative technique as “boost” therapy which may allow us to raise the conventional external beam dose to the tumor by 50 to 100 percent. At Howard University Hospital and Cancer Research Center, seven advanced-stage cancer patients have been treated since 1976 with single doses of electron beam irradiation in the range of 1,300 to 2,000 rad. The preliminary evaluation of these patients has shown no serious acute radiation reactions.     

Efficacy of Combination Treatment with Intracoronary Abciximab and Aspiration Thrombectomy on Myocardial Perfusion in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Stenting

Purpose

We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Materials and Methods

We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5.

Results

IMR was lower in the combination group than in the IC abciximab group (23.5±7.4 U vs. 66.9±48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5±7.4 U vs. 37.2±26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9±48.7 U vs. 37.2±26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively).

Conclusion

Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT01404507","term_id":"NCT01404507"}}NCT01404507).     

体外循环围术期冠状微循环的观测和意义

目的 :建立活体心脏微循环的观测方法 ,研究猪体外循环围术期冠状微循环的变化规律 ,探讨其临床意义。方法 :小型猪 12头建立体外循环 ,心脏停跳 45min ,再灌注 12 0min。以右心耳的心外膜作为微循环观测窗。分别于体外循环转流前、心脏停跳前、主动脉开放后 5、3 0、60和 12 0min六个时间点 ,用接触式显微镜连接在电视监测器屏幕上观测冠状微血管形态和微血流的动态变化 ;应用激光多普勒微循环血流计测定心肌微区灌流量。结果 :猪体外循环心肌再灌注后 5～60min ,冠状微动脉口径较缺血前显著缩小 (P <0 .0 1) ,微血管中出现搏动性颗粒状血流 ,并有血浆与血细胞分离现象 ,提示有明显的红细胞聚集与毛细血管前括约肌痉挛。再灌注 5～ 3 0min ,心肌微区灌流量亦较缺血前下降 (P <0 .0 5 )。结论 :体外循环心肌缺血 再灌注后出现了冠状微血管痉挛、微血流瘀滞和心肌微区灌流量的下降 ,冠状微循环障碍与体外循环术后心功能不全有一定的相关关系。     

Partial Pericardial Defect Incidentally Discovered During Coronary Bypass Surgery

A 71-yr-old male patient with three vessel coronary artery disease underwent a coronary artery bypass graft. The patient was found to have a large pericardial defect at the apex of the heart that measured approximately 18 cm in circumference. The edge of the pericardial defect impinged on the epicardial coronary arteries. The left phrenic nerve descended via the dorsal boundary of the pericardial defect. Following coronary artery bypass grafting, the pericardial defect was repaired with a polytetrafluorethylene patch. The patient had an uncomplicated postoperative course.     

Functional Development of the Coronary Collateral Circulation During Coronary Artery Occlusion in the Conscious Dog

We studied changes in the coronary collateral circulation during coronary artery occlusion in 14 conscious dogs by: a) determining simultaneous changes in peripheral coronary pressure (PCP) and retrograde flow (RF) after abrupt coronary artery occlusion; b) correlating these functional indices with quantitative anatomic indices (AI) of coronary collateral development (Menick et al: Am Heart J 82:503-510, 1971); and c) observing changes in these indices after repeated reocclusions of a coronary artery. These dogs were subjected to left circumflex coronary artery (LCCA) occlusions for 2 hours to 8 days; pressure tubes were implanted in the aorta and LCCA, the latter tube placed distal to an occlusive cuff for PCP and RF measurements. Afterwards the animals were sacrificed, their hearts injected with a modified Schlesinger's gelatin mass, and AI determined. During 2 to 24 hour LCCA occlusions (11 dogs) mean PCP rose to levels 50 to 80% of prevailing aortic pressure. During repreated 2- to 24-hour occlusions (2 dogs) in the same dog, the rate at which PCP rose increased. Retrograde flow was unchanged during 2- to 24-hour occlusions. Anatomic indices of these dogs were in the same range as those observed in unoccluded controls. When LCCA occlusion was maintained for more than 4 days (3 dogs), mean PCP rose during the first 24 hours and then remained stable; RF did not change until 4 days into occlusion and then increased. Anatomic indices of dogs occluded for more than 4 days were significantly greater (P < 0.001) than those of the 2- to 24-hour occlusion groups. Our study shows that: a) the early PCP rise after occlusion is not associated with an increase in RF, b) RF is a better index of collateral function and c) RF correlated well with the anatomic development of the collateral bed.     

冠心病患者血浆神经肽Y水平的临床观察

选择急性心肌梗死（ＡＭＩ）患者２０例,心绞痛（ＡＰ）患者３０例,并以３０名正常人作对照,动态观察血浆神经肽Ｙ（ＮＰＹ）含量变化。结果显示：对照组ＮＰＹ水平为９２．５０±１１．３３ｎｇ／Ｌ,ＡＭＩ组发病第天为１６３±２４．３６ｎｇ／ｌ,显著高于对照组（Ｐ〈０．００１）;第３天开始下降,第１４天趋于正常（１１０．３３±１７．７９ｎｇ／ｌ）。ＡＰ组心绞痛发作期为１６８．５２±２９．８６ｎｇ／Ｌ,显著高于     

Clinical Experience with Tilavist: An Overview of Efficacy and Safety

A programme of clinical studies was carried out to determine the basic efficacy and safety of 2% nedocromil sodium eye drops (Tilavist) in treating allergic conjunctivitis, in 2,905 patients from 3–76 years of age. Results of all the double-masked placebo comparative studies completed to date - five in vernal keratoconjunctivitis (VKC), five in perennial (PAC) and 16 in seasonal allergic conjunctivitis (SAC) - have been assessed in a statistical overview analysis. Nedocromil sodium, administered four times daily to 153 patients with VKC, was significantly more effective than placebo (155 patients) and in the clinicians' opinion gave good control in 76% of cases, compared with 46% for placebo (p < 0.001). Patients with chronic symptoms of PAC also responded better to nedocromil sodium given four times daily (n = 146) rather than twice daily (n = 86), and significantly more patients (p < 0.001) were effectively controlled by four times daily treatment with nedocromil sodium (72%) than with placebo (47%; n= 156). Twice-daily dosage with nedocromil sodium (n = 677) was adequate for SAC, however, and the treatment was statistically better than placebo (p < 0.01-p < 0.001) whether dosed twice or four times daily. Speed of action was assessed in seven SAC studies in which 79% of all patients (n = 295) using nedocromil sodium had experienced relief of symptoms when questioned, half of them within 15 minutes and 74% during the first hour after dosing. Test treatments were well-accepted by both adults and children, and there were no major adverse events. Minor irritations reported more frequently with nedocromil sodium than placebo were stinging or burning of the eyes on application of the drops and a distinctive taste, noted by 5% of the active treatment group (n = 1,552).     

PPH治疗环状混合痔的诊治体会

目的：探讨吻合器痔上黏膜环间切除钉合术(Procedu for prolapsed and bemor hoids,PPH)治疗重度环状混合痔的临床应用。方法回顾我院2012年5月~2014年4月PPH治疗Ⅲ~Ⅳ度的环状混合痔患者60例临床资料。结果术后肛门平整无水肿,排便后未见痔核脱出及肛门异物感,无肛管缩小和肛门狭窄。结论结果表明环状混合痔可采取PPH加痔核部分切除术,疗效满意,切实可行。     

Adapting a Markov Monte Carlo simulation model for forecasting the number of Coronary Artery Revascularisation Procedures in an era of rapidly changing technology and policy

Background  

Treatments for coronary heart disease (CHD) have evolved rapidly over the last 15 years with considerable change in the number and effectiveness of both medical and surgical treatments. This period has seen the rapid development and uptake of statin drugs and coronary artery revascularization procedures (CARPs) that include Coronary Artery Bypass Graft procedures (CABGs) and Percutaneous Coronary Interventions (PCIs). It is difficult in an era of such rapid change to accurately forecast requirements for treatment services such as CARPs. In a previous paper we have described and outlined the use of a Markov Monte Carlo simulation model for analyzing and predicting the requirements for CARPs for the population of Western Australia (Mannan et al, 2007). In this paper, we expand on the use of this model for forecasting CARPs in Western Australia with a focus on the lack of adequate performance of the (standard) model for forecasting CARPs in a period during the mid 1990s when there were considerable changes to CARP technology and implementation policy and an exploration and demonstration of how the standard model may be adapted to achieve better performance.     

腹股沟疝无张力修补术临床应用

目的探讨腹股沟疝无张力修补术的临床应用。方法对2000年1月-2007年12月收治的673例腹股沟疝行无张力修补术临床资料进行回顾性分析。结果全组病例均Ⅰ期愈合出院,随访1-5年,随访率100％,术后复发6例．复发率0．89％。复发原因中,网塞游走2例,片下复发3例,网片皱缩1例。结论重视围手术期处理及规范化操作可提高腹股沟疝无张力修补术治疗效果及降低术后复发率。     

Change in Positive Affect During Outpatient Cardiac Rehabilitation Predicts Vital Exhaustion in Patients with Coronary Heart Disease

Vital exhaustion is an acknowledged psychosocial risk factor of incident coronary heart disease (CHD) and recurrent CHD events. Little is known about trajectories in vital exhaustion in patients with CHD and the factors predicting this change. We hypothesized that vital exhaustion would decrease during outpatient cardiac rehabilitation and that an increase in positive affect over time would be associated with decreased vital exhaustion at discharge from cardiac rehabilitation. We also explored the role of the patient's sex in this context. Vital exhaustion was reduced during outpatient cardiac rehabilitation, especially in patients who experienced an increase in positive affect over time (p < .001). This relationship was significant in men (p < .001) but not in women (p = .11).     

六指标检测在急性冠状动脉综合征患者中的应用

探讨缺血修饰白蛋白(IMA)、Hcy、Hs-CRP、cTnI、Mb和B型钠酸肽(BNP)水平在急性冠状动脉综合征(ACS)早期诊断中的价值.选择胸痛患者小于3h内、6h测定血清IMA、Hcy、Hs-CRP、cTnI、Mb和BNP水平,并与对照组比较.结果表明,3h组IMA和Mb水平与对照组相比差异有统计学意义(P＜0....     

冠心病患者细胞因子测定的临床意义

目的：探讨了冠心病患者血清IL-6、IL-10、IL-18和TNF-α检测的临床意义。方法：分别应用放射免疫分析和酶联免疫法对71例冠心病患者进行了血清IL-6、IL-10、IL-18和TNF-α水平检测（其中稳定性心绞痛35例、不稳定心绞痛21例、急性心肌梗死15例）,并与35名正常健康人作比较。结果：冠心病患者血清IL-6、IL-10、IL-18和TNF-α水平均非常显著地高于正常人组（P〈0．01）,急性心肌梗死组和不稳定心绞痛组又高于稳定型心绞痛组（P〈0．05）。结论：检测冠心病患者血清中IL-6、IL-10、IL-18和TNF-α水平对疾病的预后观察具有重要的临床价值。     

心型脂肪酸结合蛋白对急性冠脉综合征患者的诊断价值及预后评估的研究

目的探讨心型脂肪酸结合蛋白（H-FABP）对急性冠脉综合征（ACS）患者诊断及预后评估的价值。方法选择急性心肌梗死（AMI）患者108例;不稳定性心绞痛（UA）患者90例;稳定性心绞痛（SA）患者84例;健康对照组60例。患者各组分别在入院时和入院8h后检测血清H-FABP、cTnI和CK-MB水平。结果入院时,AMI组和UA组H-FABP水平高于SA组和对照组（P〈0.05）,AMI组CK-MB水平高于其他三组（P〈0.05）,H-FABP对AMI和UA的诊断阳性率明显高于cTnI和CK-MB（P〈0.05）;入院8h后,H-FABP水平下降,cTnI和CK-MB水平上升,AMI组H-FABP水平高于其他三组（P〈0.05）,AMI组和UA组cTnI和CK-MB水平明显高于SA组和对照组（P〈0.05）,H-FABP对AMI的诊断阳性率与cTnI和CKMB相比差异无统计学意义（P〉0.05）,而对UA的诊断阳性率低于cTnI和CK-MB（P〈0.05）。发生心脏意外事件的ACS患者H-FABP水平明显高于未发生心脏意外事件的ACS患者（P〈0.01）。结论 H-FABP对ACS患者的早期诊断具有较高的准确性;当发病超过8h后,应联合其他心肌酶学指标共同诊断。临床可结合H-FABP水平对ACS患者预后进行评估。     

冠脉造影数字跟踪技术测量冠脉血流速度的临床研究

本研究通过对冠脉生理学分析,结合流体力学原理,利用冠脉造影配套硬件和软件开发,建立血管造影计算机辅助分析系统。应用数字跟踪技术测定冠脉血流速度,并与“金标准”Doppler血流导丝和TIMI氏血流作相关分析和初步临床应用研究80例,结果表明:冠脉造影跟踪法测定LAD的平均流速(17．98±5．66)与Doppler测得的LAD近中断的APV(17．70±5．77)呈正相关(r=0．75,P<0．001),与TIMI氏血流呈负相关(18．58±6．46 cm／s对28±7．5帧,r=-0．51,P<0．05)。研究结果和临床应用表明:该方法所提取的冠脉血流动力学指标具有科学性和实用性,有助于提高常规冠脉造影解剖形态与生理功能相结合的诊断能力,且方法简便易行,节约成本。     

小儿毛细支气管炎的雾化吸入治疗的临床体会

目的观察布地奈德联合利巴韦林雾化吸入治疗小儿毛细支气管炎的临床效果。方法选择我院2010年1月~2013年12月住院治疗的毛细支气管炎患儿80例,随机均分为观察组及对照组。观察组用布地奈德混悬液加利巴韦林雾化吸入治疗,对照组仅用利巴韦林雾化吸入治疗,1个疗程之后去观察比较两组患儿的治疗效果以及不良反应。结果观察组肺部啰音消失时间、憋喘消失时间、咳嗽消失时间都少于对照组,差异具有统计学意义(P<0.05);观察组总有效率明显高于对照组(92.86%vs.76.19%),差异具有统计学意义(P<0.05)。两组都没有观察到明显不良的药物反应。结论应用布地奈德混悬液联合利巴韦林雾化吸入治疗小儿毛细支气管炎,其不良反应较少,效果更为显著,更值得临床推广应用。