Medical Informatics and Opportunity for Anesthesiologists

This is the fifth year that we are organizing the anesthesia symposium/debate during the annual meeting of the Chinese Society of Anesthesiologists. The member of the symposium consists a team from China lead by Dr. Buwei Yu, the immediate past president of the Chinese Society of Anesthesiologists （CSA, http：//www. csaol.cn） and a team from US lead Dr. Lee Fleisher, the current president of the Association of University of Anesthesiologists （AUA, http：llwww.auahq.orgl）. The first symposium was held in Shanghai with the focus on providing anesthesia in day surgical centers and out of operating room settings. The second symposium was held in Beijing with the focus on evidence based anesthesiology.     

甲状腺再手术的时机及入路方式探讨

目的探讨甲状腺再手术的时机及手术入路方式。方法对我院2000年1月至2006年1月收治的94例甲状腺再手术患者的临床资料进行回顾性分析,主要分析再手术的时机及手术入路方式与操作难易程度的关系。结果本组病例行双侧甲状腺全切除术16例,一侧甲状腺切除并峡部切除术27例,一侧甲状腺切除术并对侧大部切除45例,单侧残余甲状腺切除加部分颈前肌群切除5例,单侧全切加同侧颈淋巴结清扫1例,再手术时间与初次手术相距4d～28年。手术入路:正中入路34例,胸锁乳突肌内侧入路23例,经胸骨舌骨肌、胸骨甲状肌间侧入路25例,正中入路加侧入路12例。手术时间1.5～2.5h,平均2.0h。结论甲状腺包块切除术后病理诊断甲状腺癌的再手术患者尽早手术。结节性甲状腺肿复发再手术的患者应作好充分术前准备,合并呼吸困难的甲状腺再手术患者采用正中入路易于松解气管前瘢痕粘连,缓解气管压迫症状;无呼吸困难症状者采用侧入路或正中入路与侧入路结合,简化手术操作、减少手术并发症。     

初次关节置换术后引流拔除时机的研究进展

尽管缺乏确切的证据支持,但目前临床上绝大部分骨科医生在关节置换术后仍常规应用闭式负压引流(closed suction drainage,CSD),以达到预防切口血肿,减少切口延迟愈合及深部感染机率的目的.但对于拔除引流管的最佳时机,目前仍无统一标准.长期以来,留置引流至24 h引流量小于50 ml时,予以拔出引流管,一般引流管留置48～72 h不等,但有学者认为,若术后切口引流时间超过24 h,会增加术后感染的机会.作者对近年关于初次关节置换术后引流管拔除时机研究的文献做一综述,发现术后24 h拔除引流管对机体最有利.     

急性坏死性胰腺炎的手术时机及手术指征

探讨急性坏死性胰腺炎(ANP)的手术时机及手术指征。方法:对1985年以来手术治疗ANP119例进行了回顾性分析。结果:将发病2周以内手术者定为早期手术,2周以后手术者为晚期手术。发现早期手术病例中病理所见多为局灶性坏死(占75.6％),术后并发症以循环及胰外脏器功能紊乱为主,术后死亡率达28.2％;而晚期手术者系全胰坏死型(占53.7％),术后并发症以胰周局部脏器病变为主,死亡率降至12.3％。结论:对ANP应尽可能采用晚期手术。     

Bioengineered Lungs: A Challenge and An Opportunity

Lung biofabrication is a new tissue engineering and regenerative development aimed at providing organs for potential use in transplantation. Lung biofabrication is based on seeding cells into an acellular organ scaffold and on culturing them in an especial purpose bioreactor. The acellular lung scaffold is obtained by decellularizing a non-transplantable donor lung by means of conventional procedures based on application of physical, enzymatic and detergent agents. To avoid immune recipient's rejection of the transplanted bioengineered lung, autologous bone marrow/adipose tissue-derived mesenchymal stem cells, lung progenitor cells or induced pluripotent stem cells are used for biofabricating the bioengineered lung. The bioreactor applies circulatory perfusion and mechanical ventilation with physiological parameters to the lung during biofabrication. These physical stimuli to the organ are translated into the stem cell local microenvironment – e.g. shear stress and cyclic stretch – so that cells sense the physiological conditions in normally functioning mature lungs. After seminal proof of concept in a rodent model was published in 2010, the hypothesis that lungs can be biofabricated is accepted and intense research efforts are being devoted to the topic. The current experimental evidence obtained so far in animal tests and in ex vivo human bioengineered lungs suggests that the date of first clinical tests, although not immediate, is coming. Lung bioengineering is a disrupting concept that poses a challenge for improving our basic science knowledge and is also an opportunity for facilitating lung transplantation in future clinical translation.     

New Year, New Opportunity and New Commitment

A new year is with us again. The Year of 2009 is starting.
Above all, we hope that the Year of 2009 will bring to all of you and your families best wishes, as well as a happy and harmonious New Year.