Evaluation of three-dimensional printing for laparoscopic partial nephrectomy of renal tumors: a preliminary report

Objectives

To investigate the impact of three-dimensional (3D) printing on the surgical planning, potential of training and patients’ comprehension of minimally invasive surgery for renal tumors.

Methods

Patients of a T1N0M0 single renal tumor and indicated for laparoscopic partial nephrectomy were selected. CT data were sent for post-processing and output to the 3D printer to create kidney models with tumor. By presenting to experienced laparoscopic urologists and patients, respectively, the models’ realism, effectiveness for surgical planning and training, and patients’ comprehension of disease and procedure were evaluated with plotted questionnaires (10-point rating scales, 1—not at all useful/not at all realistic/poor, 10—very useful/very realistic/excellent). The size of resected tumors was compared with that on the models.

Results

Ten kidney models of such patients were fabricated successfully. The overall effectiveness in surgical planning and training (7.8 ± 0.7–8.0 ± 1.1), and realism (6.0 ± 0.6–7.8 ± 1.0) were reached by four invited urologists. Intraoperative correlation was advocated by the two performing urologists. Patients were fascinated with the demonstration of a tactile “diseased organ” (average ≥9.0). The size deviation was 3.4 ± 1.3 mm.

Conclusions

Generating kidney models of T1N0M0 tumors with 3D printing are feasible with refinements to be performed. Face and content validity was obtained when those models were presented to experienced urologists for making practical planning and training. Understandings of the disease and procedure from patients were well appreciated with this novel technology.

     

室壁应力与应变的关系评价高血压病左室收缩功能

目的　探索用室壁应力 (stress)与应变 (strain)的关系评价高血压病左室收缩功能的临床价值。方法　研究对象为 5 5例高血压病患者和 3 0例健康人。应用超声心动图计算左室射血分数 (EF)、心指数 (CI)、重量指数 (LVMI)和相对室壁厚度 (RWT) ,并联合袖带肱动脉血压值计算左心室收缩期室壁经线峰值应力 (Pσm)。根据LVMI和RWT将高血压病分为左室正常构型和左室重构两组。在数字化超声工作站中应用定量组织速度成像 (QTVI)获取左室前壁心肌 2个节段长轴应变曲线和峰值收缩应变值 (PSS)。结果　①以EF ,CI表示的心脏收缩功能 ,在高血压病左室正常构型组值中无明显变化 ;而在高血压病左室重构组中下降 ,差异具有极显著意义 (P <0 .0 1)。②Pσm在高血压病两组中较对照组均有增高 (P <0 .0 5～ 0 .0 1) ,两组间比较差异具有极显著意义 (P <0 .0 1)。③高血压病两组左室前壁基底段 (Bas)和中段 (Mid)的 pSS值均显著下降 (P <0 .0 1) ,两组间比较差异具有极显著意义 (P <0 .0 1)。④直线相关分析结果显示高血压病两组Pσm与PSSBas和PSSMid均呈显著负相关。根据正常构型组Pσm与PSSBas直线回归方程计算 ,在相同Pσm水平 ,左室重构组PSSBas的实测值显著低于预测值及实测值与预测值的比值较正常构型组显著下降 ,差     

Kümmell病的临床治疗进展

目的:系统评价自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合相关指标,为成人长骨骨折不愈合治疗提供参考依据。方法:计算机检索PuMed、Embase、Cochrane图书馆、中国知网(CNKI)、万方数据期刊全文数据库及中国生物医学文献数据库(CBM)发表的对于自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合的随机对照试验,检索时间从建库至2019年3月。由2名研究者按照纳入和排除标准独立进行筛选文献,提取资料,并采用Jadad评价量表对纳入的文献进行质量评价。采用RevMan 5.3统计学软件对两种方法的感染发生率、成功愈合率、二次手术率、住院时间及术中失血量进行Meta分析。结果:共纳入7个随机对照试验研究,共652例患者,自体骨移植组有410例,骨形成蛋白组有242例。Meta分析结果显示:自体骨移植组与骨形成蛋白组在感染发生率[RR=1.32,95%CI(0.90,1.93),P=0.16],成功愈合率[RR=0.95,95%CI(0.84,1.08),P=0.43],二次手术率[RR=1.16,95%CI(0.43,3.12),P=0.76]及住院时间[MD=0.69,95%CI(-0.38,1.75),P=0.21]方面比较差异无统计学意义。自体骨移植组术中失血量明显高于骨形成蛋白组[MD=223.00,95%CI(32.72,413.28),P=0.02]。结论:对于成人长骨骨折不愈合的治疗,骨形成蛋白可以获得和自体骨移植一样的骨折愈合率,同时可以明显减少术中失血量。骨形成蛋白可能更适合成人长骨骨折不愈合的治疗。     

Surgical ventricular reconstruction and subendocardial resection for the treatment of refractory ventricular tachycardia

We describe a case of 64-year-old female patient with ventricular tachycardia intractable to medical treatment and acute heart failure following myocardial infarction. Emergency surgical ventricular reconstruction and subendocardial resection was undertaken. We discuss the option of surgical intervention in this difficult and unusual clinical scenario.     

高效液相色谱法测定多维元素片中泛酸的含量

目的建立复合多维元素片中泛酸的含量测定方法。方法高效液相色谱法,C18色谱柱(250mm×4.6mm,5μm);流动相:乙腈-1mL·L-1磷酸水溶液(5∶95);流速:1.0mL·min-1;柱温:25℃;检测波长:200nm。结果泛酸质量浓度在1.32¹32.32μg·mL-1范围内具有良好的线性关系,相关系数r=0.999 9,平均回收率为99.3%,RSD为1.4%(n=12)。结论该方法快速简便,结果准确,适用于多维元素片中泛酸含量测定。     

提高医学院校文科生生物化学教学质量策略探讨

生物化学是医学院校学生一门重要的公共基础课。大多数学生认为生物化学这门课程内容庞杂、名词术语繁多、抽象难懂、学习难度大,尤其对于生物学科与化学学科基础薄弱的文科生来讲,学习过程吃力,学习效果不理想,期末挂科率较高。本研究从文科生学习生物化学遇到的困难及教师面临的教学现状出发,找出问题,探讨具体应对策略,旨在提高学生学习生物化学课的兴趣和效果。     

Regulation of neutrophil migration and superoxide production by recombinant tumor necrosis factors-alpha and -beta: comparison to recombinant interferon-gamma and interleukin-1 alpha

We compared the ability of recombinant human tumor necrosis factor- alpha (rHuTNF-alpha) and tumor necrosis factor-beta (rHuTNF-beta) to stimulate polymorphonuclear neutrophil (PMN) migration and superoxide production. Significant PMN migration occurred across polycarbonate filters after stimulation with rHuTNF-alpha at concentrations ranging from 10(-7) to 10(-10) mol/L and at 10(-7) to 10(-8) mol/L for rHuTNF- beta and N-formylmethionyl-leucyl phenylalanine (FMLP), whereas recombinant human interferon-gamma was only minimally active at 10(-7) mol/L and recombinant human interleukin-1 alpha was inactive at the doses tested. In addition, antibodies to rHuTNF-alpha completely inhibited rHuTNF-alpha but not rHuTNF-beta or FMLP-induced PMN migration. Combinations of rHuTNF-alpha and rHuTNF-beta (at similar molar concentrations) stimulated PMN migration levels comparable to that obtained with rHuTNF-alpha alone. Checkerboard analyses performed by placing different concentrations of rHuTNF-alpha and rHuTNF-beta above and below polycarbonate filters of microchemotaxis chambers demonstrated that rHuTNF-alpha and rHuTNF-beta stimulated both chemotactic and chemokinetic responses by PMN. Additional studies demonstrated that 1 X 10(-8) mol/L rHuTNF-alpha and 3 X 10(-9) mol/L rHuTNF-beta (which represents 10(4) U/mL of each cytokine) were similar in their ability to induce superoxide production by PMNs; however, at ten- to 100-fold lower molar concentrations (10(3) and 10(2) units), rHuTNF-alpha was significantly more active than rHuTNF-beta. At the doses tested, both cytokines were less active than phorbol myristate acetate at stimulating O2- release. The results demonstrate that rHuTNF- alpha and rHuTNF-beta differ quantitatively but not qualitatively in their effects on PMN functions in vitro and suggest that rHuTNF-beta may be less toxic than rHuTNF-alpha in vivo.     

美托洛尔缓释片治疗原发性高血压并舒张压性心力衰竭的疗效观察

目的：探讨美托洛尔缓释片治疗原发性高血压（EH）并舒张压性心力衰竭（DHF）患者的临床疗效。方法：选取2010年7月-2013年4月本院就诊的126例EH合并DHF患者作为研究对象,所有患者给予美托洛尔缓释片治疗12个月。分别观察治疗前后患者的血压、心率、VEGF和hs-CRP水平的变化,同时观察心脏结构、左室功能参数变化及心功能分级的变化情况。结果：治疗后,左室舒张末径（LVEDD）和左室收缩末径（LVESD）显著减小,二尖瓣返流现象显著减轻,左室射血分数（LVEF）、左室高峰充盈数（LVPFR）显著增加,收缩压、舒张压、脉压和心率以及VEGF和hs-CRP、N末端钠肽原（NT-proBNP）均显著降低,上述指标治疗前后比较差异均具有统计学意义（P＆lt;0.05）。结论：美托洛尔缓释片治疗EH并DHF患者,能显著改善患者的心脏功能,治疗效果显著,值得在临床上进一步推广。     

成人阻塞性睡眠呼吸暂停低通气综合征患者的人格特征分析

目的　调查成人阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的人格特征及生活质量,了解该患病群体的心理健康情况。方法　采用明尼苏达多项人格测量表（Minnesota multiphasic personality inventory,MMPI）和简明健康状况调查表（the MOS item short from health survey,SF-36）分别对98例成人OSAHS患者及100例单纯鼾症志愿者进行问卷调查,评价OSAHS患者的人格特征及生活质量情况并进行对照性研究。结果　在MMPI调查中,OSAHS患者在抑郁、疑病、精神衰弱、情绪不稳定、精神分裂临床量表T分高于单纯鼾症组,差异具有统计学意义（P＜0.05）,其中OSAHS组中女性患者的抑郁、疑病、精神衰弱、情绪不稳定、精神分裂、社会内向临床量表T分高于男性患者,差异具有统计学意义（P <0.05）。在SF-36调查中,OSAHS患者在生理职能、一般健康状况、躯体疼痛、精力、社会功能、情感功能、精神健康7个维度的平均评分低于单纯鼾症组,差异具有统计学意义（P＜0.05）。结论  OSAHS患者有较多的心理健康问题,表现更多的易疲劳、注意缺陷,生活质量更低,OSAHS病情越重,心理健康问题越大,女性患者尤重。     

低氧诱导肾细胞癌786-O细胞HIF-1α的表达变化及意义

目的探讨缺氧条件下肾透明细胞癌786-O细胞缺氧诱导因子1α（HIF-1α）的表达变化及意义。方法786-O细胞在缺氧条件下培养不同时间（0、8、16、24h）后,RT-PCR法检测HIF-1α mRNA的转录情况;Western blot法检测HIF-1α蛋白表达变化。结果常氧状态下HIF-1α mRNA和蛋白均有一定表达。缺氧处理一定时间（8、16、24h）后786-O细胞HIF-1α mRNA表达没有明显改变（P〉0．05）,而HIF-1α蛋白表达水平显著升高（P〈0．01）。结论缺氧条件下786-O细胞HIF-1α表达变化主要在翻译水平而非转录水平。在蛋白水平对HIF-1α表达进行调控可作为肾透明细胞癌治疗的新靶点。