新型腰椎经皮椎弓根螺钉植入定位方法及其对放射暴露剂量的影响

 目的 探讨新型腰椎微创定位方法在定位时间、次数及放射暴露剂量方面的优势。方法 2010年5 月至2013年2 月收治腰椎间盘突出症合并腰椎不稳及胸腰椎骨折121例,随机分为两组：68例采用传统定位方法植入经皮椎弓根螺钉,单节段病变41例、双节段病变27例;53例采用自行研制的腰椎微创定位系统,单节段病变34例、双节段病变19例。两组患者性别、年龄、病程、手术节段的差异无统计学意义。结果 传统定位方法组、微创定位方法组术前定位时间分别为（8.26±3.44） min、（3.51±1.82） min,平均定位次数分别为3.57次、1.22次,准确率分别为60.8%及96.2%。两组单节段病变患者植入双枚经皮椎弓根螺钉,术中定位时间分别为（15.12±4.69） min、（5.51±1.32） min,定位次数分别为6.47次、2.45次;双节段病变患者植入三枚经皮椎弓根螺钉,术中定位时间分别为（24.91±7.43） min、（8.84±2.32） min,定位次数分别为11.72次、3.69次。传统定位方法组手术人员颈部、胸部及手腕部检测出的放射暴露剂量分别为（3.09±0.24） Gy、（4.23±0.71） Gy、（5.17±0.62） Gy,微创定位方法组分别为（1.38±0.47） Gy、（2.69±0.33） Gy、（3.21±1.05） Gy。两组定位时间、定位次数及放射暴露剂量的差异有统计学意义。结论 腰椎微创定位系统及定位方法能够简化手术操作,具有定位准确性高、定位时间短、透视次数少、医护人员及患者接受X线射线暴露量低的优点。     

Pulsed 808-nm infrared laser stimulation of the auditory nerve in guinea pig cochlea

Pulsed near-infrared radiation has been proposed as an alternative stimulus for auditory nerve stimulation and could be potentially used in the design of cochlear implant. Although the infrared with high absorption coefficient of water (i.e., wavelength ranged from 1.8 to 2.2 μm) has been widely investigated, the lymph in the cochlea absorbs most of the infrared energies, and only a small part can arrive at the target auditory nerves. The present study is aimed to test whether the short-wavelength near-infrared irradiation with lower absorption coefficients can penetrate the lymph fluid to stimulate the auditory nerves. An 808-nm near-infrared laser was chosen to stimulate the auditory nerve in the guinea pig cochlea. The infrared pulse was delivered by an optical fiber that was surgically inserted near the round window membrane and oriented toward the spiral ganglion cells in the basal turn of the cochlea. The 2-Hz infrared pulses were used to stimulate the cochlea before and after the deafness with different pulse durations (100–1,000 μs). Optically evoked compound action potentials (oCAPs) were recorded during the infrared radiation. We successfully recorded oCAPs from both normal hearing animals and deafened animals. The oCAP amplitude increased with the infrared radiation energy. The preliminary experiment suggests that the near-infrared with lower absorption coefficients can effectively pass through the lymph filled in the cochlea and stimulate the auditory nerve. Further studies will optimize the deafness animal model and determine the optimal stimulation parameters.     

The true stone composition and abnormality of urinary metabolic lithogenic factors of rats fed diets containing melamine

To better understand the toxicity of melamine to humans, the stone composition and urinary metabolic lithogenic factors of rats fed diets containing melamine including the infant’s melamine-induced stone composition were studied. Sixty 4-week-old male rats divided into three groups were, respectively, fed diets containing no melamine (control), 0.1 % melamine, and 1 % melamine for 4 weeks. At the end of experiment, the collected stones and 24-h urines from rats were, respectively, measured with compositions and metabolic lithogenic parameters. The stone from an infant who ingested melamine-adulterated formula was also included in compositional analysis. Across three groups, the stone was only detected in 1 % melamine group, with composition of almost melamine different from the affected infant’s stone composed of melamine and uric acid with a ratio of 1:2. Compared with control group, urine calcium and phosphate excretions were significantly increased in 1 % melamine group. Urine uric acid excretion was significantly increased but citrate excretion was significantly decreased in 0.1?% and 1?% melamine groups. Urine oxalate excretion and pH were indicated without any significant difference. In addition based on urine physicochemical characters, melamine–uric acid stone seems difficult to be formed in the rats due to their characters of urine high-pH and low-uric acid. These results demonstrated that (1) the stone composition of rats fed melamine was not and could not be as that of infants fed melamine-adulterated formula, two species had a different mechanism of melamine-induced stone formation; (2) the exposure of melamine could result in abnormalities of urine metabolic lithogenic factors to rats, perhaps as well as human beings.     

单人经口胆道镜与射频消融术同台诊治不可切除肝外胆管癌的可行性与安全性研究

目的　探讨单人经口胆道镜联合射频消融术（radiofrequency ablation,RFA）同台诊治不可切除肝外胆管癌的可行性和安全性。方法　回顾2013年1月至2022年1月期间在杭州市第一人民医院治疗的90例可疑肝外胆管癌患者资料,根据诊治过程最终纳入69例,分为常规分次组（n=34）：先经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）+细胞刷或单人经口胆道镜检查取得活检组织,待获得阳性病理结果再次行ERCP+RFA;同台诊治组（n=35）：行ERCP经单人经口胆道镜检查胆道并对病灶行直视下活检,对术中快速病理结果确定为恶性肿瘤的患者同台行RFA。对比两组操作成功率、术后胆红素恢复情况、ERCP次数、术后不良事件发生率、住院时间及费用。结果　两组患者均成功完成内镜下RFA,操作成功率100.0%（69/69）。分次组和同台组总胆红素术后下降50%及以上的患者比例差异无统计学意义［52.94%（18/34）比57.14%（20/35）,χ2=0.27,P=0.604］。分次组ERCP次数明显多于同台组［（2.59±0.50）次/人比（1.00±0.00）次/人］,差异有统计学意义（t=3.13,P=0.002）。分次组和同台组术后总体不良事件发生率差异无统计学意义［（67.65%（23/34）比65.71%（23/35）,χ2=2.83 ,P=0.626］。分次组住院时间明显长于同台组,差异有统计学意义［（17.41±9.13） d比（7.91±3.48） d,t=5.32,P=0.001］。分次组住院费用明显多于同台组,差异有统计学意义［（37 127.88±3 763.77）元比（23 980.69±4 767.15）元,t=6.61,P=0.001］。结论　单人经口胆道镜直视下诊断+活检联合RFA同台诊治不可切除肝外胆管癌可减少ERCP次数,并且不增加术后不良事件发生率,是一种安全有效且具有较高成本-效益比的诊治方法。     

Arthroscopic versus mini-open rotator cuff repair: a prospective,randomized study with 24-month follow-up

This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up.