Past, present, and future of pancreatic surgery

The advances in the surgical treatment of pancreatic disease in the 20th century were built on careful anatomic and physiologic studies dating to the early 1800s. Operations for neoplastic diseases developed in the 1930s by Whipple, Trimble, and others allowed pancreatic malignancies to be removed with ever increasing safety. Endocrine tumors of the pancreas were described and treated surgically. Patients with pancreatitis now have a number of surgical alternatives available for their individual circumstances. The future of surgery for pancreatic disease lies in the results of the human genome project and the fields of genomics and proteomics that resulted. The rapidity with which knowledge of gene expression is advancing owing to new technologies such as the microarray biochip is amazing. The future of pancreatic surgery is bright.     

Past accomplishments and future directions: risk prevention in anesthesia and surgery

Anesthesiology has served as a model for patient safety in health care and was the first medical profession to treat patient safety as an independent problem. Anesthesiology has implemented widely accepted guidelines on basic monitoring, conducted long-term analyses of closed malpractice claims, developed patient simulators as meaningful training tools, and addressed problems of human error. The National Surgical Quality Improvement Program is the first national, validated, and peer-controlled program that uses risk-adjusted outcomes for the comparative assessment and improvement of the quality of surgical care. The program has reduced postoperative complications in the Veterans Administration, at both national and local levels. It is becoming more evident that processes and events during surgery can be important determinants of long-term outcomes after anesthesia and surgery.     

Pubovaginal slings: Past, present and future

Renewed interest in the pubovaginal sling procedure for stress urinary incontinence has occurred in response to recent reports of poor durability and inconsistent efficacy associated with simple cystourethropexy. Many of the failures are felt to represent patients with an unrecognized component of intrinsic sphincteric deficiency. Historically slings have a favourable cure rate, but have been perceived as having unacceptably high rates of prolonged urinary retention and secondary detrusor instability. This article reviews the preoperative evaluation and indications for pubovaginal slings, describes the evolution of the current techniques, and discusses choice of sling material, surgical approach, results and complications. It is hoped that this review will stimulate interest in this versatile but technically challenging procedure.     

Laparoscopic urology: Past,present, and future

Laparoscopy has begun to have a significant impact on the management of urologic problems. Although initially limited to diagnostic pediatric problems, it has more recently been used to resolve myriad adult urologic conditions. Indeed, during the past year laparoscopic urology has moved well beyond the diagnosis of the undescended testicle and has been successfully used for pelvic lymphadenectomy, varicocelectomy, ureterolysis, drainage of a pelvic lymphocele, bladder suspension, and nephrectomy. Future applications of laparoscopy in urology may well include nephroureterectomy, cystectomy, and creation of an ileal conduit.

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Resumen La laparoscopia ha comenzado a tener un impacto significativo en el manejo de los problemas urológicos. Aunque inicialmente apareció restringida a problemas pediátricos, más recientemente se utiliza para el manejo de numerosas condiciónes urológicas en el adulto. Ciertamente en el ultimo año, la urología laparoscópica ha avanzado bastante más allá del diagnóstico del testículo no descendido y ha venido a ser utilizada en linfadenectomía pélvica, varicocelectomía, ureterolisis, drenaje de linfoceles pélvicos, suspensiónes de la vegiga y nefrectomía. Las aplicaciónes futuras de la urología laparoscópica bien podrían incluir la nefroureterectomía, la cistectomía y, aÚn, la construcción de un conducto urinario ileal.

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Résumé La chirurgie coelioscopique fait son apparition en urologie. Limitée au début aux problèmes diagnostiques chez l'enfant, elle a été utilisée plus récemment pour résoudre plusieurs problèmes urologiques chez l'adulte. En effet, les techniques coelioscopiques sont utilisées non seulement pour faire le diagnostic de testicule aberrant, mais aussi pour réaliser des lymphadénectomies, des cures des varicocèles, des urétèrolyses, un drainage de lymphocèle pelvien, une suspension de la vessie et une néphrectomie. Dans l'avenir, on peut espérer voir la réalisation de l'urétèronéphrectomie, la cystectomie, voire mÊme la création d'une néo iléale.

     

枕颈部外科临床研究的过去、现在和将来

正枕寰枢椎连接是具有高度灵活性的解剖结构,临床上通常称为枕颈部结构,有其特征性的生物力学功能,其活动幅度占整个颈椎屈伸及旋转活动的50%。枕寰复合结构包括前寰枕膜、后寰枕膜和两侧的寰枕关节。枕寰关节由寰椎侧块的上关节面和枕骨髁构成,成马鞍状,属于滑膜关节,并与枢椎连接形成完整的解剖结构及生物学功能单位。因此,许多因素都可能导致枕颈部结构稳定功能丧失,在脊柱外科领域,枕颈部外科越来越受到临床     

Past, present and future of the surgery of the sympathetics.

Surgery of the autonomic nervous system has been used during more than a hundred years for different indications. The trend is in both parasympathetic and sympathetic surgery towards less invasive and more reversible methods. Thus in gastroenterology the bactericides have displaced vagotomies, and in sweating and blushing more and more sophisticated and atraumatic methods have emerged to displace sympathectomies. Even vagal stimulation has come forward to compete with sympathetic ablations in some indications, like depression. The side effects, and especially the late manifestation of some side effects have also raised ethical discussions of the justification of this kind of life quality or life style surgery. In this review, different indications and methods are discussed in the light of future needs and ethical demands.     

PTSD: Past, present and future implications for China

There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-III, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy,including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.     

Functional genomics in osteoarthritis: Past,present, and future

Osteoarthritis (OA) is a common complex disease of high public health burden. OA is characterized by the degeneration of affected joints leading to pain and reduced mobility. Over the last few years, several studies have focused on the genomic changes underpinning OA. Here, we provide a comprehensive overview of genome‐wide, non‐hypothesis‐driven functional genomics (methylation, gene, and protein expression) studies of knee and hip OA in humans. Individual studies have generally been limited in sample size and hence power, and have differed in their approaches; nonetheless, some common themes have started to emerge, notably the role played by biological processes related to the extracellular matrix, immune response, the WNT pathway, angiogenesis, and skeletal development. Larger‐scale studies and streamlined, robust methodologies will be needed to further elucidate the biological etiology of OA going forward. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 34:1105–1110, 2016.