Sustained-release rhBMP-2 increased bone mass and bone strength in an ovine model of postmenopausal osteoporosis

Objective  

The purpose of this study was to analyze the local treatment effects of rhBMP-2 combined with fibrin sealant (FS) on bone mineral density, microarchitectural and mechanical properties in osteoporotic ovine spine.     

尿道下裂手术术式的选择(附93例报告)

目的 对尿道下裂进行回顾性研究.方法 2003年5月至2008年9月收治93例确诊尿道下裂患者,根据不同类型分别采用尿道口前移、阴茎头成形法(MAGPI术式)、尿道板纵切卷管法或加盖岛状皮板法(Snodgrass术或Onlay术)、横裁或纵裁包皮岛状皮瓣尿道成形(Duckett术)、阴囊中缝皮管加横裁包皮岛状皮瓣成形尿道(Duplay联合Duckett术)、弧形带蒂阴茎阴囊联合皮瓣尿道成形术治疗不同类型的尿道下裂.结果 治愈82例,并发尿道瘘6例,尿道狭窄5例,治愈率为88.2%(82/93).81例获随访,平均随访时间23.5个月(1～42个月),随访期间患儿排尿正常.结论 尿道下裂术式的选择并无统一标准,应根据术者的经验及患者情况来选择,细心周到的术后护理能降低并发症的发生..     

3.0T术中磁共振成像导航在神经外科手术应用的初步经验

目的 探讨3.0 T术中磁共振成像(iMRI)导航在神经外科手术应用的临床价值.方法 回顾性分析2010年9月至2011年3月,在具备诊断和手术功能的"3.0 T iMRI数字一体化神经外科手术中心"施行的各类颅脑手术122例,包括临床资料、iMRI实时影像导航对手术进程和手术结果的影响等.结果 122例患者手术室内扫描2～4次,平均2.6次.各种扫描图像质量皆优良.iMRI技术使脑胶质瘤(60例)手术全切除率从71.7%提高到90.0%,患者的近期致残率为6.7%,远期致残率3.3%.iMRI技术使垂体大腺瘤(29例)手术全切除率从75.9%提高到93.1%.未发生与应用iMRI数字一体化神经外科手术有关的并发症(如感染等).同期完成2500余人次MRI诊断性检查.结论 3.0 T iMRI神经导航的应用,为脑胶质瘤与垂体大腺瘤手术进程的实时引导、切除范围的精确判断以及脑功能与代谢信息的定量分析提供了客观依据,真正实现了脑肿瘤的最大程度安全切除.

Abstract：

Objective To report the preliminary experience in clinical application of 3.0 T intraoperative magnetic resonance imaging (iMRI) neuronavigation system in China. Methods From September 2010 to March 2011, a consecutive series of 122 patients with intracranial lesions underwent operations in guidance with 3.0 T iMRI. A retrospective analysis was conducted regarding clinical efficiency.Results Among 122 procedures, the numbers of intraoperative scanning were 2-4 times with an average of 2.6.The qualities of images were excellent. Due to the discovery and further possibility of resection of residual tumors, the ratio of gross total resection was increased from 71.7% to 90.0% in cerebral gliomas(n =60), while from 75.9% to 93.1% in macroadenomas (n =29).There were 6.7% of all patients occurred postoperative paralysis, but only 3.3% of patients had persistent paralysis at 1-2months follow-up.There was no iMRI-related adverse event occurred. During the same period, more than 2500 patients underwent diagnostic MRI scanning. Conclusions 3.0 T iMRI neuronavigation system provides high-quality intraoperative structural, functional and metabolic images for real time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.The system is cost-effective.     

经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果

目的 总结多中心应用食管超声引导、经胸微创小切口、非体外循环(CPB)下封堵室间隔缺损(VSD)的临床经验和近、中期随访结果.方法 432例病儿,男235例,女197例;年龄3个月～15岁,平均(3.2±1.9)岁;体重4.0～26.0 kg,平均(13.3±5.6)kg.膜周部VSD 351例,嵴上或嵴内型VSD 57例,肌部VSD 24例(17例多发VSD).VSD直径3～12 mm,平均(5.3±1.6)mm.膜周部VSD,经剑突下或胸骨下端3～4 cm小切口进胸;嵴内或嵴上VSD,经胸骨左缘第3肋间2～3 cm小横切口进胸.暴露右心室表面,在食管超声引导和实时监测下,穿刺右心室游离壁,导引钢丝经右心室腔穿过VSD到达左心室腔,沿导引钢丝导入输送鞘管建立轨道.通过输送鞘管直接将封堵器安放在VSD部位.经食管超声多切面反复评估封堵器的位置和与周边组织的关系,若无异常情况即可释放封堵器.结果 432例中417例封堵成功(96.5%),15例(3.5%)术中改为常规CPB手术.封堵成功者中,选用对称伞238例(57.1%),偏心伞179例(42.9%).13例(3.1%)发生新的微量至轻度三尖瓣反流,11例(2.6%)术后发生不完全右束支传导阻滞,3例(0.7%)术后发生一过性完全性房室传导阻滞.术后383例(91.8%)病儿在2 h内拔除气管插管,3～5天出院.术后416例(96.2%,416/432例)随访12～38个月,平均(19.3±11.6)个月,无近、中期死亡.1例术后6个月发生完全性房室传导阻滞.其余无明显异常.结论 应用食管超声引导、经胸微创非CPB下封堵VSD技术,是一种相对简单有效的治疗方法,近、中期临床结果满意,但远期结果需要进一步观察.

Abstract：

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.     

PICC透明贴辅助治疗浅度烧伤效果观察

目的探讨应用PICC透明贴为二层敷料治疗浅度烧伤患者的临床效果。方法将116例浅Ⅱ度烧伤患者随机分成观察组和对照组各58例。对照组采用传统方法换药,清除坏死表皮后用凡士林纱布和无菌纱布覆盖;观察组用无菌注射器针头刺破水疱,保留疱皮,用凡士林纱布和无菌纱布覆盖后外用PICC透明贴。结果观察组治疗效果显著高于对照组,愈合时间显著缩短,换药疼痛程度显著减轻(均P<0.01)。结论 PICC透明贴用于浅度烧伤换药,创造了湿性愈合环境,可提高治疗效果,减轻患者疼痛。     

看图对话卡在门诊雾化治疗哮喘患儿家长健康教育中的应用

目的探讨看图对话卡在哮喘患儿门诊雾化治疗健康教育中的应用效果。方法将100名在儿科门诊进行雾化治疗的哮喘患儿家长随机分成观察组和对照组各50名,两组均由护士向患儿家长进行常规健康教育,观察组在此基础上再用看图对话卡进行健康教育。结果观察组患儿家长对雾化治疗知识掌握程度及学习兴趣显著高于对照组(P<0.05,P<0.01)。结论看图对话卡的应用提高了健康教育效果,提高了患儿家长对健康教育知识的学习兴趣。     

肺切除术后支气管残端瘘的处理(附2例报告)

目的 探讨肺切除术后发生支气管残端瘘的原因、临床表现、手术时机及处理原则.方法 回顾分析2例肺癌根治术后并发支气管残端瘘的临床表现、诊断、治疗经过及方法.结果 两例患者均痊愈出院,1例采用常规胸腔内闭合支气管残端治愈,1例经纵隔心包内闭合支气管残端得到治愈.结论 支气管残端瘘应尽早诊断、并予以持续胸腔冲洗,抗感染、营养...     

Difference in urinary stone components between obese and non-obese patients

The prevalence and incidence of urinary stone disease have been reported to be associated with body weight and body mass index (BMI). The aim of the study was to determine the difference in stone components among different BMI groups in patients with urolithiasis. Between Dec 2005 and Jan 2008, 907 urinary calculi were collected and analyzed by infrared spectroscopy. Most of the stones had been passed spontaneously, and some were collected during surgical manipulations. The data on patients’ gender, age, BMI at diagnosis, and stone composition were collected. The patients were classified as normal weight (18.5≤ BMI <24), overweight (24≤ BMI <27), or obese (BMI ≥27). Of the 907 patients with urinary stone disease, 27.7% had normal weight, 33.5% were overweight, and 38.8% were obese. The prevalence of calcium oxalate stones in the normal weight, overweight, and obese groups were 23.1, 30.6, and 34.9%, respectively (P = 0.002), and the prevalence of uric acid stones in the different groups was 2.8, 7.2, and 7.7%, respectively (P = 0.002). The prevalence of calcium oxalate and uric acid stones, but not that of calcium phosphate stones, increased with body size. There was a significant correlation between BMI and uric acid stones in the overweight and obesity groups, with odds ratios of 3.28 and 4.35, respectively. The prevalence and incidence of urinary stone disease were found to be associated with BMI. The percentage of uric acid and calcium oxalate stones was higher in obese than in non-obese patients. There was no apparent difference in the prevalence of calcium phosphate stones between obese and non-obese patients.     

Lights, camera, surgery: a novel pilot project to engage medical students in the development of pediatric surgical learning resources

Background/Purpose

It is important to engage junior medical students in the pediatric surgical environment to showcase possible future career choices. Our aim was to assess how the students valued their experience in the realm of clinical learning, exposure to surgical careers, and development of skill sets necessary for creating learning resources.

Methods

A novel pilot project entitled Lights, Camera, Surgery engaged 13 medical students in the production of instructional videos of basic surgical procedures. An electronic survey questionnaire allowed the students to provide formal feedback on the project outcomes.

Results

Of the students who responded, 87.5% expressed appreciation of the enhanced clinical experience. All of the students either agreed or strongly agreed that the project afforded them valuable leadership experience, practical skills in creating educational learning resources, and opportunities to explore careers in surgery. All of the students either agreed or strongly agreed that the project allowed them to gain valuable skills in educational video production. The project videos are now available as educational tools.

Conclusions

Engaging medical students in the production of surgical videos potentially improves leadership skills and promotes the use of educational resources while affording them opportunities to explore pediatric surgery as a future career choice.