漂洗对脂肪活性的影响

目的比较不同漂洗液和不同漂洗次数对吸脂术所获得的脂肪组织活性的影响。方法通过肿胀吸脂术获得脂肪组织后,分别用生理盐水、平衡液各漂洗0、1、3、5、10次后,用葡萄糖转移实验检测其活性。结果生理盐水组脂肪组织的葡萄糖转移量大于平衡液组,差异具有统计学意义(P<0.05);两组中,漂洗0和1次时的葡萄糖转移量明显低于漂洗3次(P<0.01);生理盐水组中,漂洗3次和5次时的葡萄糖转移量无明显差异(P>0.05),但漂洗10次时的葡萄糖转移量明显低于漂洗3次和5次(P<0.05);平衡液组中,漂洗3次、5次和10次时的葡萄糖转移量无明显差异(P>0.05)。结论通过漂洗可以提高吸脂术所获得的脂肪组织的活性。本实验中,生理盐水的漂洗效果优于平衡液,以漂洗3次为佳。     

Kidney Transplant Ureteroneocystostomy Techniques and Complications: Review of the Literature

Despite a variety of urinary tract reconstructive techniques, urinary complications are the most frequent technical adverse event following renal transplantation. These complications can be associated with substantial morbidity and generate excess cost. In this review we comprehensively discuss 4 techniques of ureteroneocystostomy, compare complications, and evaluate the strengths and weaknesses of each technique focusing on 4 specific urologic complications: urine leak, ureteric obstruction, hematuria, and symptomatic vesicoureteral reflux.     

预移植在胚胎移植中的意义

目的 :评价预移植在胚胎移植中的作用。　方法 :在超声波引导下胚胎移植 114个周期 ,其中 10 1个周期进行预移植。比较预移植与未预移植周期临床妊娠率和胚胎种植率 ;按预移植与实际胚胎放置深度差值分组 ,并比较两组妊娠率和胚胎种植率。　结果 :预移植周期与未预移植周期临床妊娠率和种植率统计学差异无显著性(5 9.4 1%和 6 1.5 4 % ,35 .81%和 31.4 3% ,P均 >0 .0 5 ) ;按预移植与实际胚胎放置深度差值分组后 ,两组妊娠率和种植率统计学差异也无显著性 (6 1.5 4 %和 5 8.6 7% ,4 0 .79%和 34.0 9% ,P均 >0 .0 5 )。　结论 :在胚胎移植技术中 ,预移植不能准确指引胚胎移植深度     

Current Concepts of Fat Graft Survival: Histology of Aspirated Adipose Tissue and Review of the Literature

BACKGROUND: Controversy remains about the longevity of correction in autologous fat grafts and its relation to adipocyte survival. Reported long-term fat graft survival rates differ widely, depending on harvesting method, means of reinjection, injection site, and evaluation methods. OBJECTIVE: To demonstrate histologic findings of aspirated adipose tissue and compare the findings to the reports in the literature. METHODS: Review of the literature and the histology of transplanted fat 7 years after subcutaneous implantation and trypan blue staining to determine the vitality of defrosted adipocytes. RESULTS: Fat cells survive aspiration with a suction machine or syringe equally well. Use of a liposuction cannula or 14-gauge needle gives comparable results. Local anesthesia or tumescent local anesthesia is recommended for the donor site, preferably with addition of epinephrine. CONCLUSION: Clinical longevity of correction after autologous fat transfer is determined by the degree of augmentation resulting from the amount of fibrosis induced and the number of viable fat cells. Survival of aspirated fat cell grafts depends mainly on the anatomic site, the mobility and vascularity of the recipient tissue, or underlying causes and diseases, and less on harvesting and reinjection methods.     

Workhorse Free Functional Muscle Transfer Techniques for Smile Reanimation in Children with Congenital Facial Palsy: Case Report and Systematic Review of the Literature

BackgroundPediatric facial palsy represents a rare multifactorial entity. Facial reanimation restores smiling, thus boosting self-confidence and social integration of the affected children. The purpose of this paper is to present a systematic review of microsurgical workhorse free functional muscle transfer procedures with emphasis on the long-term functional, aesthetic, and psychosocial outcomes.Materials and methodsWe performed a literature search of the PubMed database from 1995 to 2019 using the following search strategy: "facial paralysis"[Title/Abstract] OR "facial palsy"[Title]. We used as limits: full text, English language, age younger than 18 years, and humans. Two independent reviewers performed the online screening process using Covidence. Forty articles met the inclusion criteria. The protocol was aligned with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019150112) of the National Institute for Health Research.ResultsFree functional muscle transfer procedures include mainly segmental gracilis, latissimus dorsi, and pectoralis minor muscle transfer. Facial reanimation procedures with the use of the cross-face nerve graft (CFNG) or masseteric nerve result in almost symmetric smiles. The transplanted muscle grows harmoniously along with the craniofacial skeleton. Muscle function and aesthetic outcomes improve over time. All children presented improved self-esteem, oral commissure opening, facial animation, and speech.ConclusionsA two-stage CFNG plus an FFMT may restore a spontaneous emotive smile in pediatric facial palsy patients. Superior results of children FFMT compared to adults FFMT are probably attributed to greater brain plasticity.     

Diabetes-Specific Dementia: A Structured Literature Review of Cognitive Assessment Methods

Diabetes mellitus is a known risk factor for the development of multiple subtypes of dementia and mild cognitive impairment. Recent research identifies a cause-specific diabetes-related dementia with a unique set of characteristics. Currently, there is no standard cognitive assessment battery recommended to specifically assess dementia that is a direct consequence of chronic diabetes, and some evaluations have been used for decades with minimal revisions, regardless of appropriateness. We performed a systematic review of the dementia/cognition evaluation methods most commonly used in the literature for assessing diabetic patients and identified which cognitive domains are typically assessed in this setting, and whether cognitive changes were more reflective of a vascular pathology, Alzheimer's pathology, or something else entirely. Search results yielded 1089 articles. After screening for appropriateness, a total of 11 full-text articles were assessed. In general, subjects in the reviewed studies were assessed using a variety of testing methods, examining different combinations of cognitive domains. A standard, clear definition of which cognitive domains are the most important to assess in diabetic patients is needed in order to determine what combination of assessment tools are most pertinent. Given the growing subset of the US population, careful reconsideration of cognitive assessment methods is needed to create self-care plans that take into account a specific collection of cognitive challenges for those with diabetes.     

Autologous Fat Grafting: Comparison of Techniques

BACKGROUND: Despite more than a century of reporting in the medical literature, controversy still surrounds both the efficacy and longevity of autologous fat transplantation in subcutaneous soft tissue augmentation. OBJECTIVE: To summarize the existing literature relating to the effectiveness of this procedure and to highlight differences in technique that may play a role in reported treatment successes and failures. METHODS: Review of the literature and reporting of authors' observations and results. CONCLUSION: Autologous fat transplantation can be a gratifyingly effective treatment for subcutaneous augmentation that may produce permanent results in some cases. This article aims to clarify some of the differences in technique employed by doctors in this field and aims to enable the reader to better see the subtle, but sometimes important differences in methods used.     

Effects of Fat Preparation Methods on the Viabilities of Autologous Fat Grafts

Fat grafts are commonly used in plastic surgery, but their unpredictable absorption rates are a considerable disadvantage. Furthermore, no agreement has been reached regarding the method that best enables fat graft survival. This study aimed to evaluate the effects of different preparation methods on fat graft viability. Fat tissue was harvested from the remnants of transverse rectus abdominis musculocutaneous (TRAM) flaps by syringe aspiration. Harvested fat tissue was prepared using three different methods: centrifugation, metal sieve concentration, and cotton gauze concentration. To evaluate the viabilities of fat cells, XTT assays were performed. For the study, 18 nude mice were allocated to three groups: the centrifugation, metal sieve, and cotton gauze groups (6 mice per group). Prepared fat (1 ml) was injected into the nuchal area of the mice, and 12 weeks later, grafts were dissected to determine graft survival rates and subjected to histologic analysis. No significant differences were observed in graft survival rates and histologic findings (necrosis and vascularity) between the three groups. However, histologic analysis found the metal sieve group to have significantly lower fat cell viability and more inflammation than the other two groups. The findings suggest that the closed centrifugation technique has no advantage over the open cotton gauze technique in terms of fat graft viability, and that the metal sieve concentration method is deficient as a preparation method because it can cause grafted fat degradation.     

Sperm Viability: A Comparison of Analytical Methods

Two methods of measuring human sperm viability, the stain exclusion assay and the hypoosmotic swelling (HOS) test, were evaluated. Human sperm were pretreated with 2.0% glutaraldehyde or 0.1% Triton X-100 and compared to untreated controls. Approximately one half of the sperm were found to be viable in the control samples and nearly all sperm were non-viable in the Triton X-100 treated samples by both the stain exclusion and HOS assays. After glutaraldehyde pretreatment, presumably inactivating the spermatozoa, the HOS test revealed that most sperm were not viable, while the stain exclusion test found no difference between glutaraldehyde pretreated sperm and control sperm. Investigations with scanning and transmission electron microscopy demonstrated that the HOS test caused the membrane of the sperm tail to swell and the tail fibers to coil several times within the swollen membrane. It is concluded that the stain exclusion assay merely measures the structural integrity of the sperm membrane, whereas the HOS test also provides an indication of the physiological integrity of the sperm membrane.     

Effect of Smoking on Outcomes of Urothelial Carcinoma: A Systematic Review of the Literature

ContextCigarette smoking is the best-established risk factor for urothelial carcinoma (UC). However, the effect of smoking on outcomes of UC patients remains debated.ObjectiveTo integrate the available evidence regarding the impact of smoking status and smoking exposure on recurrence, progression, cancer-specific mortality, and any-cause mortality in patients with UC of the bladder (UCB) and upper tract UC (UTUC) treated with transurethral resection of the bladder (TURB), radical cystectomy (RC), or radical nephroureterectomy (RNU).Evidence acquisitionA systematic search of the literature was conducted using the Medline, Embase, and Scopus databases, which was limited to articles published in English between January 1974 and March 2013. Articles were also extracted from the reference lists of identified studies and reviews. We selected 29 articles (15 TURB, 7 RC, and 7 RNU) according to predefined inclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-analyses.Evidence synthesisThe majority of studies demonstrated an association with disease recurrence in patients treated with TURB, while evidence for associations with disease progression, cancer-specific mortality, and any-cause mortality was less abundant. While two studies showed no association of smoking with outcomes of T1 UCB, there was mixed evidence for an association of smoking with response to intravesical therapy. For patients treated with RC, there was minimal support for an association of smoking with all outcomes. In a majority of studies of patients receiving RNU for UTUC, smoking was associated with intravesical recurrence, disease recurrence, cancer-specific mortality, and any-cause mortality. There was also evidence for a beneficial effect of smoking cessation on UC prognosis. Finally, findings regarding gender-specific effects of smoking on prognosis were contradictory. We note that there was marked heterogeneity in patient populations and smoking categorizations across studies, precluding a meta-analysis.ConclusionsSmoking may lead to less favorable outcomes for UCB and UTUC patients, and smoking cessation may mitigate this effect. The current evidence base lacks studies on the effects of smoking on prognosis in numerous clinical demographic subgroups of UC patients, as well as prospective investigation of smoking cessation.     

The Non-ossifying Fibroma: A Case Report and Review of the Literature

The non-ossifying fibroma (NOF) is a benign, non-neoplastic lesion most commonly seen in the metaphyses of the long bones in children. While rare, the NOF has been reported in the mandible. The NOF in the extra-gnathic skeleton has a characteristic radiographic appearance, is typically asymptomatic and has a variable histologic make-up. Correlation of the radiographic appearance, clinical presentation and histopathology allows for differentiation of the NOF from odontogenic and non-odontogenic cysts and tumors. We report a new case of this interesting entity and review the radiographic, clinical and histologic features of the gnathic NOF reported in the literature. A thorough search of the English language literature returned a total of 19 cases of NOF involving the gnathic bones.     

腹腔镜直肠癌根治手术路径的规范化及应用前景:附433例报道

目的探讨腹腔镜直肠癌根治术的手术路径及应用前景。方法回顾性分析我院2003年7月至2010年12月期间行腹腔镜直肠癌根治术的433例患者的临床资料,结合文献复习,讨论腹腔镜直肠癌根治手术的路径选择及发展前景。结果 行手助腹腔镜手术5例(1.2%),完全腹腔镜手术(Dixon手术需做左下腹小切口取出标本,Miles手术利用会阴切口取出标本)412例(95.2%),腹部免切口肛门拖出式吻合手术16例(3.7%)。中转开腹手术11例(2.5%)。290例(67.0%)患者获得随访,随访时间1～6年,平均2.7年,发现吻合口或盆腔肿瘤复发7例(2.4%),远处转移22例(7.6%),死亡46例(15.9%),无戳孔转移发生。结论四孔腹腔镜技术仍是临床应用的主流;规范化的腹腔镜直肠癌根治术是保证疗效和操作便利的前提;单孔或经自然腔道的直肠癌根治术是手术进一步微创化的探索方向。     

Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review

Background

The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection.

Methods

A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed.

Results

A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86).

Conclusions

There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.

     

Favorable Outcome of Cerebral Fat Embolism Syndrome with a Glasgow Coma Scale of 3: a Case Report and Review of the Literature

Prognosis of deep coma caused by cerebral fat embolism syndrome (CFES) is rarely reported. We present a case of fulminant CFES which was induced by long bone fracture, with a Glasgow Coma Scale (GCS) of 3/15. The brain magnetic resonance imaging (MRI) revealed abnormal spotty lesions scattered over both cerebral hemispheres and the posterior fossa. Thirty days later, the patient regained consciousness with a GCS of 15/15.     

改良低分子肝素注射方法减少皮下出血的研究进展

介绍改进低分子肝素注射方法减少皮下出血的研究进展,从注射的部位、深度、角度以及压迫时间、力度和注射点间距等方面进行了阐述.提出选择脐周腹壁进行注射、捏起皮肤、垂直近针、注射前不排气、拔针后有效压迫3 min是比较理想的方法.     

Trocar Injuries in Laparoscopy: Techniques,Tools, and Means for Prevention. A Systematic Review of the Literature

Trocar injuries are a possible cause for severe morbidity and mortality when performing laparoscopic surgery. This systematic review investigates the differences in the incidence of complications depending on the method of entry. A meta-analysis of the medical literature was performed. Search results were limited to clinical trials and the following languages: English, French, German, or Dutch. All results that compared the Veress, Hasson, and direct entry technique or compared sharp, blunt, and radially expanding trocars (RET) were included (n = 19). Studies involving pediatric and pregnant patients were excluded. When comparing the Veress needle to direct trocar insertion (DTI), pooled analysis showed a borderline significant reduction for major complications (p = 0.04) based on five events in 2 RCT’s (n = 978) and a reduction in minor complications (p < 0.001) in favor of DTI. RCT’s comparing the Hasson and Veress techniques showed no significant reduction in major complications (p = 0.17), but the Hasson technique showed significantly less minor complications (p = 0.01) and failed entries (p = 0.002). CO₂ leakage was far more common when using the Hasson technique (p < 0.001). Our search method did not reveal any studies comparing the Hasson technique to DTI. When comparing bladed to RET, three studies (n = 408) showed less minor complications when using a RET (p = 0.003) and a qualitative analysis showed a trend toward pain reduction when using RET. This meta-analysis concludes that there are less minor complications and failed attempts when using the Hasson or direct entry technique when compared to the Veress method, but there is limited evidence regarding major complications. RET reduce minor vascular complications when compared to bladed trocars.