Outcomes of obese compared to non-obese veterans undergoing open inguinal hernia repair: a case–control study

Hernia - The optimal approach for inguinal hernia repair in the obese remains elusive. Minimally invasive techniques show equivocal results compared to the open method. None of the current analyses...     

Surgical Treatment and Proposed Modified Classification for Harrington Class III Periacetabular Metastases

ObjectivesThis study aims to: (i) evaluate the outcome of patients with Harrington class III lesions who were treated according to Harrington classification; (ii) propose a modified surgical classification for Harrington class III lesions; and (iii) assess the efficiency of the proposed modified classification.MethodsThis study composes two phases. During phase 1 (2006 to 2011), the clinical data of 16 patients with Harrington class III lesions who were treated by intralesional excision followed by reconstruction of antegrade/retrograde Steinmann pins/screws with cemented total hip arthroplasty (Harrington/modified Harrington procedure) were retrospectively reviewed and further analyzed synthetically to design a modified surgical classification system. In phase 2 (2013 to 2019), 62 patients with Harrington class III lesions were classified and surgically treated according to our modified classification. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) 93 scoring system. The outcome of local control was described using 2‐year recurrence‐free survival (RFS). Owing to the limited sample size, we considered P < 0.1 as significant.ResultsIn phase 1, the mean surgical time was 273.1 (180 to 390) min and the mean intraoperative hemorrhage was 2425.0 (400.0 to 8000.0) mL, respectively. The mean follow‐up time was 18.5 (2 to 54) months. Recurrence was found in 4 patients and the 2‐year RFS rate was 62.4% (95% confidence interval [CI] 31.6% to 93.2%). The mean postoperative MSTS93 score was 56.5% (20% to 90%). Based on the periacetabular bone destruction, we categorized the lesions into two subgroups: with the bone destruction distal to or around the inferior border of the sacroiliac joint (IIIa) and the bone destruction extended proximal to inferior border of the sacroiliac joint (IIIb). Six patients with IIIb lesions had significant prolonged surgical time (313.3 vs 249.0 min, P = 0.022), massive intraoperative hemorrhage (3533.3 vs 1760.0 mL, P = 0.093), poor functional outcome (46.7% vs 62.3%, P = 0.093), and unfavorable local control (31.3% vs 80.0%, P = 0.037) compared to the 10 patients with IIIa lesions. We then modified the surgical strategy for two subgroup of class III lesions: Harrington/modified Harrington procedure for IIIa lesions and en bloc resection followed by modular hemipelvic endoprosthesis replacement for IIIb lesions. Using the proposed modified surgical classification, 62 patients in the phase 2 study demonstrated improved surgical time (245.3 min, P = 0.086), intraoperative hemorrhage (1466.0 mL, P = 0.092), postoperative MSTS 93 scores (65.3%, P = 0.067), and 2‐year RFS rate (91.3%, P = 0.002) during a mean follow‐up time of 19.9 (1 to 60) months compared to those in the phase 1 study.ConclusionThe Harrington surgical classification is insufficient for class III lesions. We proposed modification of the classification for Harrington class III lesions by adding two subgroups and corresponding surgical strategies according to the involvement of bone destruction. Our proposed modified classification showed significant improvement in functional outcome and local control, along with acceptable surgical complexity in surgical management for Harrington class III lesions.     

经口入路机器人甲状腺手术的研究进展

近年来,甲状腺疾病的发病率逐年上升,其中青年女性患者占较大比例.随着年轻患者对美容的要求提高,多种入路的内镜甲状腺手术已广泛成功开展.这些术式尽管避免了在颈部做切口,并取得了较好的美容效果,但不可避免地在其他部位留下切口瘢痕.经口入路手术被认为是真正无痕的手术,具有更好的美容效果,随着近年来达芬奇手术系统的不断完善,经口入路机器人甲状腺手术也取得较大发展.与其他术式相比,经口入路机器人甲状腺手术具有多种优势,如提供中线入路、最低程度地减少组织损伤、3D高清放大视野、手臂震颤过滤及7个自由度Endo-wrist等.因此,本综述对近年来经口机器人甲状腺手术的研究进展进行总结,为临床甲状腺疾病的治疗提供学习借鉴.     

臀上动脉深上支髂骨骺移植的解剖学研究

目的 :为带血供的髂骨骺移植提供解剖学依据。方法 :在 40侧经动脉灌注红色乳胶的成人臀部标本以及 2侧儿童标本上 ,观测臀上动脉深上支的行程、分支及滋养支 ;选用 5 0块髋骨 ,观察髂骨嵴前外侧部的滋养孔。结果 :儿童臀上动脉深上支的分支、分布与成人相似 ,位于臀中肌深面和臀小肌上缘 (相当臀前线 ) ,循髂骨嵴弓形向前 ,达髂前上嵴 ,沿途分出平均 (4 .2± 1.1)支外径 0 .5～ 1.1mm的髂嵴支 ,分布髂嵴骨膜 ,并发细小分支进入滋养孔。从髂前上棘至结节区 ,在距髂嵴缘下方 2cm范围内 ,平均有(2 2 .4± 6.7)个滋养孔。结论 :以臀上动脉深上支及其分支为蒂 ,在髂嵴前部可切取带骺骨瓣 ,以修复长管骨骨骺缺损。     

甲状腺肿的专家诊断与咨询系统

本文通过对１７４８３例甲状腺肿大中五种甲状腺病病例的收集、分析、整理、统计与提炼，确定了诊断原则，建立了知识库、病例库和正反双向混合推理机制，完成了用Ｔｕｒｂｏ－Ｐｒｏｌｏｇ语言编制。采用适用于表示医学产生式知识表示方法所开发的专家诊断与咨询系统，为教学、临床工作及家庭保健提供了有价值的软件。经临床病例验证，该软件准确、可靠、有很强的实用价值，对人工智能的研究、临床及教学的现代化，提高人们的保健水     

MTT法检测极低频弱磁场对SY细胞的影响

本文采用 MTT 示踪法,检测极低频弱磁场对 SY 细胞有无影响。结果发现:频率固定为50Hz 时变化磁场幅值,在150uT、300uT 下细胞吸光度值有明显降低;幅值固定为150uT 时变化磁场频率,在25Hz、50Hz、75Hz 磁场照射下吸光度值均有不同程度下降,而在10Hz、60Hz、100Hz、300Hz、500Hz 磁场照射下没有变化;幅值固定为300uT 时变化磁场频率,在500Hz、75Hz、100Hz、300Hz、磁场照射下吸光度值均有不同程度下降,而在10Hz、25Hz、60Hz、500Hz 磁场照射下没有变化。     

Effects of prolactin on HLA- DR and CD40 expressions by human thyrocytes

Objective To study the effects of prolactin (PRL) on HLA- DR and CD40 expressions by human thyrocytes, and to investigate the possible mechanisms for PRL to affect the de velopment of Graves’ disease (GD). Methods Thyrocytes in secondary culture, which were from GD thyroid glands and the tissu es adjacent to the lesions of multinodular goiter and adenoma (control group), w ere treated respectively with ovine PRL (oPRL), interferon- γ (IFN- γ), interl ukin- 4 (IL- 4) and oPRL plus IFN- γ (10 U/ml) or IL- 4 (5 ng/ml) for 7 days . HLA- DR and CD40 expressions on the thyrocytes were determined by immunofluor escent staining and flow cytometry. Results oPRL (12. 5 ng/ml-1000 ng/ml) had no significant direct effect on HLA- DR or C D40 expression. It did not significantly affect the stimulation of HLA- DR exp ressions on the two groups of thyrocyte treated with IFN- γ or on GD thyrocytes treated with IL- 4. oPRL could antagonize the stimulation of CD40 expressions by IFN- γ and the inhibition by IL- 4 on both groups of thyrocytes. The antago nizing effects were related to the concentrations of PRL. IFN- γ- stimulated p ercentages of CD40［+］ thyrocytes and delta mean fluorescence intensity (dMF) in both thyrocyte sources were significantly reduced in the presence of 200 ng/ml oPRL (both GD and Control: P&lt;0. 01 and P&lt;0. 05, respectively; Contro l: P&lt;0. 05) and 1000 ng/ml oPRL (GD: P&lt;0. 01; Control: P&lt;0. 05). oPRL caused significant increasing in IL- 4- inhibited percentages of CD40［+］ ce lls from the two groups of thyrocytes at 12. 5 ng/ml and 1000 ng/ml and dMF fr om GD thyrocytes at 1000 ng/ml (P&lt;0. 05). Conclusions PRL can exert indirect effects on CD40 expressions on thyrocytes by antagonizing the modulatory actions of IFN- γ and IL- 4 with dose- related effects. This m ay be one important mechanism for PRL to affect the development of GD.     

恒温恒压电烫仪建立小鼠烫伤模型的实验研究

目的：寻求理想的建立小鼠不同深度烫伤模型的方法。方法：研制了恒温恒压电烫仪,分别以80度,0．5kg,2cm为统一的致伤温度,致伤压力,致伤直径,同时严格控制其他各个因素,以致伤时间为唯一可变因素,通过改变致伤时间,在小鼠背部建立不同深度的烫伤模型,并于烫伤后即时,4h,12,24h和48h取材病检。结果：建立浅II度,深II度及III度烫伤创面模型的致伤时间分别为5s,8s和12s;汤伤创面深度随病程逐渐加深,直至伤后24h才稳定,伤后48h的组织学改变类似伤后24h,结论：烫伤创面深度应以伤后24h创面深度稳定后的深度为诊断标准,本方法操作简单,所建模型稳定,重复性好,不失为一种建立小鼠不同深度烫伤模型的较为理想的方法。     

卵巢恶性肿瘤VEGF mRNA和bFGF mRNA的表达及其意义

应用原位分子杂交技术研究卵巢恶性肿瘤组织中VEGFmRNA和bFGFmRNA的表达及其意义。结果发现 :浆液性腺癌和内胚窦癌两者表达阳性率高于粘液性腺癌和颗粒细胞瘤 ;临床分期Ⅰ期和未转移病例两者表达阳性率低于临床分期Ⅲ～Ⅳ期和转移病例。结果提示VEGFmRNA和bFGFmRNA表达与卵巢恶性肿瘤病理类型、临床分期和转移发生关系密切 ,阳性表达者可能预后较差。