Mixed Reality Combined with Three‐Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Three‐dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59‐year‐old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head‐mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real‐time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.     

Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter‐nerve and inter‐muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered “the gold standard” treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One‐state and two‐state non‐osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri‐operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.     

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients. Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study. According to the type of stent，the patients were divided into two groups, BMS group (n=46) and CS group (n=20). The demographic data, clinical signs and symptoms, and pre-procedure and post-procedure imaging data were followed up and recorded. The primary patency rates were calculated at 1, 3, 6, 9, and 12 months. Results The related symptoms were improved within 2 day post-procedure. The primary patency rates of BMS group in 1, 3, 6, 9 and 12 months were 97.83%, 95.65%, 69.56%, 41.3%, and 34.78% respectively. The rates of CS group were 100%, 100%, 95%, 65%, and 60% respectively. They did not reached statistical significance for primary patency rates between two groups in 1, 3, and 6 months (P＞0.05 respectively). However, from 9 months after procedure, it began to show the significant difference between two groups (P＜0.05). The median patency time of the CS group was (10.30±5.32) months, while BMS group was (8.52±0.49) months. The difference between the two groups was statistically significant (P=0.046). Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect. The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.     

Role of Oxalobacter formigenes in preventing calcium oxalate kidney stones

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.     

经脐单孔腹腔镜右半结肠根治手术的临床研究

目的探讨经脐单孔腹腔镜右半结肠根治手术的临床研究。 方法纳入2015年1月至2018年6月于上海交通大学医学院附属瑞金医院北院普外科接受传统5孔腹腔镜右半结肠切除术和纯单孔腹腔镜右半结肠手术的患者共89例,其中单孔腹腔镜手术45例(单孔腹腔镜组)、传统5孔腹腔镜手术44例(传统腹腔镜组),根据患者的年龄、性别、体质量指数、ASA评分(≤ 2分/>2分)、手术时间、并发症、淋巴结获得数目、病理分期等进行分析。 结果在术中出血量、进食流食时间、术后住院时间方面,单孔腹腔镜组和传统腹腔镜组比较,差异无统计学意义。单孔腹腔镜组的手术时间[166 min(42.0 min)比144 min(37.5 min),P＝0.03]更长。单孔腹腔镜组中出现1例(2.27%)术后吻合口瘘,传统腹腔镜组有1例(2.22%)术后吻合口瘘(P＝0.99)。两组的病理结果相似。单孔腹腔镜组中位随访时间22.5个月、传统腹腔镜组中位随访时间21.9个月。单孔腹腔镜组有3例(6.8%)出现复发、传统腹腔镜组也有3例(6.6%)复发,复发率比较,差异无统计学意义(P＝0.88)。 结论单孔腹腔镜右半结肠癌手术需要在临床和肿瘤学疗效方面与传统五孔腹腔镜手术相当,初步证实是一种安全可开展的手术方式。     

荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究

目的相较于目前常用的改良膨胀萎陷法,探讨荧光染色法判定段间平面在胸腔镜解剖性肺段切除术中的可行性及安全性。 方法回顾性分析解放军总医院第一医学中心胸外科2017年3月至2019年9月行胸腔镜解剖性肺段切除术的157例临床资料,其中荧光染色组60例,女41例、男19例,年龄36～76岁;改良膨胀萎陷组97组,女62例、男35例,年龄27～85岁。荧光染色组采用反向染色法,分离出预切除肺段的肺动脉分支并切断,经外周静脉快速推注吲哚菁绿25 mg行保留肺脏部分的荧光显影从而判定段间平面。改良膨胀萎陷法,在分离出预切除肺段的支气管分支并切断后,双肺通气使肺脏完全膨胀后恢复单肺通气,一段时间后可形成较明显的段间平面。记录两组的临床资料并进行统计学分析。 结果与改良膨胀萎陷组相比,荧光染色组的段间平面形成时间更早、手术时间缩短,两组差异具有统计学意义[20 s(8～25 s)比1 008 s(884～1 200 s),P＝0.031;(103.3±7.3)min比(132.8±10.4)min,P＝0.021];两组的术中出血量、淋巴结清扫数目、术后置管时间、术后住院时间、并发症发生率比较,差异无统计学意义(P均>0.05)。 结论相较于目前常用的改良膨胀萎陷法,荧光染色法术中不需反复膨肺,同样符合肿瘤学要求,是安全、有效的。     

纳布啡复合丙泊酚对腹腔镜腹股沟疝修补术的麻醉效果

目的观察纳布啡复合丙泊酚对腹腔镜腹股沟疝修补术的麻醉效果,并分析其对患者应激、炎症因子的影响。 方法选择2015年10月至2018年10月,广西壮族自治区人民医院行腹腔镜腹股沟疝修补术的182例患者作为研究对象,按随机数字法将其分为2组。研究组患者91例,行钠布啡复合丙泊酚静脉麻醉;对照组患者91例,行芬太尼复合丙泊酚静脉麻醉。对比2组患者的麻醉效果、麻醉起效时间、术后清醒时间以及术后1 d疼痛情况,并通过促甲状腺激素（TSH）与皮质醇（Cor）水平观察患者应激反应,对比炎症因子超敏C反应蛋白（hs-CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的变化情况。 结果2组患者手术麻醉起效时间与术后清醒时间比较,差异无统计学意义（P>0.05）;研究组的术后1 d疼痛评分显著低于对照组,差异有统计学意义（P<0.05）。2组患者术前1 d的hs-CRP、IL-6、TNF-α表达水平比较,差异无统计学意义（P均>0.05）;术后1 d研究组的hs-CRP、IL-6、TNF-α表达水平均显著低于对照组,差异有统计学意义（P<0.05）。2组患者术前1 d的TSH、Cor表达水平比较,差异无统计学意义（P均>0.05）;术后1 d的TSH表达水平比较,差异无统计学意义（P>0.05）,术后1d研究组的Cor表达水平均显著低于对照组,差异有统计学意义（P<0.05）。 结论纳布啡复合丙泊酚作为腹腔镜腹股沟疝修补术麻醉方式能取得较好的麻醉效果,并且能减轻患者术后疼痛,减少应激反应与炎症反应,可作为腹腔镜腹股沟修补术的优选麻醉方式。     

Patients with multiple morphological abnormalities of the sperm flagella harbouring CFAP44 or CFAP43 mutations have a good pregnancy outcome following intracytoplasmic sperm injection

Multiple morphological abnormalities of the sperm flagella (MMAF) are a rare type of male infertility. Mutations in DNAH1, CFAP43 and CFAP44 are the main aetiology of the disorder. Previously, good intracytoplasmic sperm injection (ICSI) outcomes were reported for MMAF patients with DNAH1 mutations. However, the ICSI prognosis for MMAF patients with CFAP43 or CFAP44 mutations was not known. We designed a retrospective cohort study. Molecular genetic testing identified six MMAF patients with biallelic CFAP44 (CFAP44⁺ group) or CFAP43 mutations and 12 patients with homozygous or compound heterozygous DNAH1 mutations (DNAH1⁺ group). A control group consisted of age‐matched, non‐MMAF men. For MMAF patients carrying CFAP44 mutations, the recorded rates of fertilisation, transferable embryos, pregnancy and delivery after ICSI were 76.47%, 88.46%, 50.0% and 50.0% respectively. The fertilisation rate was significantly higher in the CFAP44⁺ group than in the DNAH1⁺ group (76.47% vs. 54.5%, p = 0.0196). There were no statistically significant differences in the rates of transferable embryos, implantation, clinical pregnancy and miscarriage between the CFAP44⁺ group and either the DNAH1⁺ group or the age‐matched control group. Our results support a good ICSI prognosis for MMAF patients carrying CFAP44 or CFAP43 mutations.