Correlation of tensile strength with bursting pressure in the evaluation of intestinal anastomosis

BACKGROUND: Although bursting pressure and tensile strength have long been measured to evaluate anastomotic techniques, it has yet to be clarified whether or not they are correlated, what implications they have, and which should be used as a gold standard. MATERIAL AND METHODS: Using an experimental model to estimate pressure and tension in the same colonic anastomosis, the following variables were measured in 48 rats between days 0 and 14: bursting pressure (BP); minimal tensile strength (MITS) necessary to break a part of the anastomosis, and maximal tensile strength (MATS) needed to disrupt the whole anastomosis. Also, circulatory wall tension (CWT) was derived from BP and the anastomotic circumference (AC), and longitudinal wall tension (LWT) from MITS and AC. These variables were compared using correlation and regression analysis. RESULTS: During the lag phase (days < or = 4) there was poor correlation between pressure-related and tension-related variables whereas highly significant correlations were noted in the subsequent fibroplastic phase (day > or = 5). It was shown by regression lines that positive MITS and MATS were expected when BP was zero. CONCLUSION: Contrary to the previous assumption, no correlation was found between BP and tensile strength in the critical postoperative period. Based on our present and previous studies, measurement of MITS is recommended to evaluate the healing of colonic anastomosis.     

Lateral radiography of the knee with single-leg standing

The purpose of this investigation was to accomplish reproducible radiography of single-leg standing lateral radiography of the knee by adjusting lateral rotation using a ruler to measure foot position. After preliminary assessment of three-dimensional CT of the knees of normal volunteers, the best adjustment of external rotation was estimated. A ruler was made for use in adjusting the angle of knee rotation by measuring foot rotation. Based on the foot rotation measured by this ruler, the positioning of radiography was adjusted to correct rotation. Rotation was estimated by the distance between the posterior edges of the lateral and medial femoral condyles. Fifteen-degree and 17.5-degree rotations were used for correction. Correction of rotation was 17 degrees on average. This helped not only to correct external rotation in the initial radiography but also to correct rotation for repeat radiography. Our method is quantitative and highly reproducible, and it increases the success rate of lateral knee radiography.     

A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction

Seventy patients with patellar tendon or hamstring tendon autografts for single-incision anterior cruciate ligament reconstruction were evaluated at least 2 years after surgery. All reconstructions were performed by the same surgeon, and metal interference screws were used for fixation of all grafts. No significant differences were noted between groups for Lysholm score, reduction in activity, KT-1000 arthrometer findings, quadriceps muscle size, return to sports, or ability to jump and do hard cuts and pivots. Significantly more patients in the patellar tendon group had patellofemoral pain at 6 months after surgery than did the hamstring tendon patients (48% versus 20%), and at last follow-up the incidence of patellofemoral pain was 42% and 20%, respectively. Fourteen patients in the patellar tendon group and seven in the hamstring tendon group had loss of motion (approximately 5 degrees ). Four patients (two in each group) had treatment failures and their results were not included in the clinical examination data. At 2 years' follow-up, 97% of patients with patellar tendon grafts and 100% of patients with hamstring tendon grafts rated their results as good or excellent. We found that hamstring tendon grafts performed similarly to patellar tendon grafts, although fewer patients in the hamstring tendon group had patellofemoral pain and loss of motion.     

Liposome-mediated transfer of vascular endothelial growth factor cDNA augments survival of random-pattern skin flaps in the rat.

Tissue engineering is an application for gene therapy that is in its infancy. We show that simple liposomal-mediated gene transfer could result in a potentially useful biological effect in the field of wound healing. cDNA encoding the 165 amino acid form of vascular endothelial growth factor complexed to commercially available liposomes was injected into rat skin 1 week before raising a random pattern 3 x 10 cm flap. The flap survival was enhanced by 14 percent, and was accomplished without accessing the arterial inflow of the territory. These results were statistically significant (p<0.002) and reproducible. No adverse effects were seen. Histological analysis of the angiogenesis localized much of the new vessel formation to the area around the hair follicles. Polymerase chain reaction amplification of extracted flap tissue confirmed the presence of the transgene.     

Developmental pattern of the neuronal intermediate filament inaa in the zebrafish retina

α‐Internexin is a member of the neuronal intermediate filament (nIF) protein family, which also includes peripherin and neurofilament (NF) triplet proteins. Previous studies found that expression of α‐internexin precedes that of the NF triplet proteins in mammals and suggested that α‐internexin plays a key role in the neuronal cytoskeleton network during development. In this study, we aimed to analyze the expression patterns and function of internexin neuronal intermediate filament protein‐alpha a (inaa), the encoding gene of which is a homolog of the mammalian α‐internexin, during retinal development in zebrafish. Via in vitro and in vivo studies, we demonstrated that zebrafish inaa is an α‐internexin homolog that shares characteristics with nIFs. An immunohistochemical analysis of zebrafish revealed that inaa was distributed dynamically in the developing retina. It was widely localized in retinal neuroepithelial cells at 1 day postfertilization (dpf), and was mainly found in the ganglion cell layer (GCL) and inner part of the inner nuclear layer (INL) from 3–9 dpf; after 14 dpf, it was restricted to the outer nuclear layer (ONL). Moreover, we demonstrated for the first time that inaa acted distinctively from the cytoskeletal scaffold of zebrafish cone photoreceptors during development. In conclusion, we demonstrated the morphological features of a novel nIF, inaa, and illustrated its developmental expression pattern in the zebrafish retina. J. Comp. Neurol. 524:3810–3826, 2016. © 2016 Wiley Periodicals, Inc.     

Cauda equina hemangioblastoma at L5 vertebral level related to von Hippel-Lindau disease

Hemangioblastoma (HB) is uncommon, with only a few cases of hemangioblastoma with von Hippel-Lindau disease (VHL) located in cauda equina previously reported. We describe a case of hemangioblastoma misdiagnosed as nerve sheath tumour in the cauda equina.     

A screening model for low bone mass in elderly Japanese men using quantitative ultrasound measurements: Fujiwara-Kyo Study

Screening for low bone mass is important to prevent fragility fractures in men as well as women, although men show a much lower prevalence of osteoporosis than women. The purpose of this study was to establish a screening model for low bone mineral density (BMD) using a quantitative ultrasound parameter and easily obtained objective indices for elderly Japanese men. We examined 1633 men (65-84 yr old) who were subjects of the Fujiwara-Kyo Study. Speed of sound (SOS) at the calcaneus was determined, and BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine (LS), total hip (TH), and femoral neck (FN). Low BMD was defined as >1 standard deviation below the young adult mean, in accordance with World Health Organization criteria. We performed receiver operating characteristic (ROC) analysis to identify a better screening model incorporating SOS and determined the optimal cutoff value using Youden index. Prevalences of low BMD at the 3 skeletal sites were 27.8% (LS), 33.5% (TH), 48.6% (FN), and 43.3% at either LS or TH. The greatest area under the ROC curve (0.806, 95% confidence interval: 0.785-0.828) and smallest Akaike's information criterion were obtained in the multivariate model incorporating SOS, age, height, and weight for predicting low BMD at all skeletal sites. This model predicted low BMD at TH with the sensitivity of 0.726 and specificity of 0.739, whereas a similar model predicted low BMD at LS with much lower validity. We conclude that the multivariate model for TH could be used to screen for low BMD in elderly Japanese men.     

内镜下乳头括约肌小切开联合气囊扩张术对胆总管结石患者的疗效观察

目的 观察乳头括约肌小切开联合气囊扩张术对胆总管结石( CDS)患者的疗效.方法 将我院2010年1月至2011年9月间的161例CDS患者分为3组,54例行内镜下乳头括约肌切开术(EST组),54例行内镜下乳头气囊扩张术(EPBD组),53例行内镜下乳头括约肌小切开联合气囊扩张术(sEST+EPBD组),均根据实际情况在乳头治疗后行取石篮取石和(或)气囊取石,部分患者以碎石篮碎石后取石.结果 与EST组比较,sEST+EPBD组术后并发症的发生率显著降低,出血发生减少,较EPBD组提高了一次取石的成功率,明显降低了术后高淀粉酶血症的发生率.结论 应用乳头括约肌小切开联合气囊扩张术治疗胆总管结石,术后并发症减少,在胆总管结石取石治疗中更为有效、安全.     

EUS和ERCP、MRCP在可疑胆总管结石诊断中的临床价值

目的：评价内镜超声检查（EUS）,内窥镜逆行胆胰管造影（ERCP）和磁共振成像胆胰管造影（MRCP）在诊断可疑胆总管结石的临床价值。 方法：自2009年6月至2010年3月我院收治的胆总管结石可疑病例共93例。93例病例全部经内镜超声检查（EUS）,内窥镜逆行胆胰管造影（ERCP）和磁共振成像胆胰管造影（MRCP）方法进行诊断,前瞻性研究三项诊断方法的临床诊断价值。 结果：联合两种以上诊断方法,可大幅提高胆总管患者的诊断准确率。EUS对胆总管结石检出的灵敏性为83.8%,特异性73.7%;ERCP对胆总管结石检出的灵敏性为89.2%,特异性84.2%;MRCP对胆总管结石敏感性为93.2%,特异性100%。 结论：MRCP无论在胆总管结石可疑患者检出的特异性或灵敏性上,都显著高于另EUS和ERCP方法,显示MRCP在诊断胆总管结石可疑患者具有较大的临床优势。胆总管结石可疑患者首先可行MRCP筛查,阴性者可进一步实施ERCP或EUS检查确认。     

益气活血方对气虚血瘀型冠心病模型大鼠的影响研究

目的探讨益气活血方对气虚血瘀型冠心病模型大鼠的影响。方法32只SD大鼠随机分为空白组、模型组、益气活血方组和芪参益气滴丸组,每组8只。除空白组外,各组均采用“游泳力竭+控制饮食+结扎冠状动脉左前降支”制备病证结合气虚血瘀型冠心病动物模型,时间均为11 d。造模结束后,分别灌胃予以相应干预14 d。采集大鼠心电图,进行Morris水迷宫、旷场实验并HE染色、Masson染色,并采用ELISA检测血浆纤溶酶原激活物抑制剂-1(plasminogen activator inhibitor-1,PAI-1)、血管性假血友病因子(von Willebrand factor,vWF)、组织型纤溶酶原激活剂(tissue-type plasminogenactivator,t-PA)的含量。结果与空白组比较,模型组心电图ST段抬高;Morris水迷宫实验潜伏期延长(P<0.01),穿台次数显著减少(P<0.01);旷场实验水平得分、垂直得分减少(P<0.05),中心活动时间延长(P<0.05),角落活动时间、周边活动时间均减少,焦虑程度降低(P<0.05或P<0.01);心肌细胞排列较紊乱,在梗死灶周围出现核破裂,血浆中PAI-1、vWF水平明显增高(P<0.05或P<0.01),t-PA水平明显降低(P<0.05)。与模型组比较,益气活血方组心电图ST段恢复正常;Morris水迷宫潜伏期显著缩短(P<0.01),穿台次数显著增加(P<0.01);旷场实验中心活动时间减少(P<0.05),角落活动时间延长(P<0.05),焦虑程度增高(P<0.05);梗死灶周围心肌细胞排列整齐,心肌细胞凋亡指数降低(P<0.05);血浆中PAI-1、vWF水平均降低(P<0.05或P<0.01),t-PA水平增高(P<0.05)。结论病证结合动物模型更能满足中西医结合研究的需要;益气活血方能有效修复气虚血瘀型冠心病模型大鼠心肌细胞损伤并改善记忆力减退、健忘、疲劳及反应迟钝的症状,且改善高凝状态的机制与调节vWF、PAI-1、t-PA水平有关。