免疫增强型肠内营养制剂在胃癌术后病人辅助化疗中的作用

目的:观察应用免疫增强型肠内营养制剂对胃癌术后病人辅助化疗中的临床疗效。方法:将84例胃癌术后辅助化疗病人随机分为A、B两组,每组42例。两组病人均于术中放置空肠穿刺造口管,并延期留置空肠造口管直至化疗6个疗程结束。A组每个化疗疗程经空肠造口管给予免疫增强型肠内营养液瑞能,每天1 500ml,共7 d;B组则每个化疗疗程经空肠穿刺造口管给予普通匀浆膳食,每天1 500 ml,共7 d。比较两组病人化疗后营养和免疫指标。结果:化疗后A组血红蛋白、血清清蛋白、前清蛋白及IL-2、NK细胞活性、CD3+、CD4+、CD4+/CD8+水平显著高于B组(P0.05)。结论:在胃癌病人术后辅助化疗期间,应用免疫增强型肠内营养制剂能减少化疗药物对病人营养状况和免疫功能的影响。     

A review of epidural simulators: Where are we today?

Thirty-one central neural blockade simulators have been implemented into clinical practice over the last thirty years either commercially or for research. This review aims to provide a detailed evaluation of why we need epidural and spinal simulators in the first instance and then draws comparisons between computer-based and manikin-based simulators. This review covers thirty-one simulators in total; sixteen of which are solely epidural simulators, nine are for epidural plus spinal or lumbar puncture simulation, and six, which are solely lumbar puncture simulators. All hardware and software components of simulators are discussed, including actuators, sensors, graphics, haptics, and virtual reality based simulators. The purpose of this comparative review is to identify the direction for future epidural simulation by outlining necessary improvements to create the ideal epidural simulator. The weaknesses of existing simulators are discussed and their strengths identified so that these can be carried forward. This review aims to provide a foundation for the future creation of advanced simulators to enhance the training of epiduralists, enabling them to comprehensively practice epidural insertion in vitro before training on patients and ultimately reducing the potential risk of harm.     

Needle tract seeding of papillary thyroid carcinoma after fine-needle capillary biopsy: A case report

BACKGROUNDFine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules. It includes two primary methods: Fine-needle capillary biopsy (FNCB) and fine-needle aspiration biopsy. Needle tract seeding (NTS) is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB. Here, we present an extremely rare case of a papillary thyroid carcinoma (PTC) patient with FNCB-derived NTS. CASE SUMMARYWe report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy. NTS was diagnosed based on clinical manifestations, biochemistry indices, and imaging (computed tomography and ultrasound). Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis. Surgical resection was the main method used to treat the disease. After surgery, thyroid function tests and ultrasound scans were performed every 3-6 mo. To date, no evidence of tumor recurrence has been observed.CONCLUSIONFNCB is a safe procedure as NTS is rare, and can be easily removed surgically with no recurrence. Accordingly, NTS should not limit the usefulness of FNCB.     

Single-Camera Closed-Form Real-Time Needle Tracking for Ultrasound-Guided Needle Insertion

Many common needle intervention procedures are performed with ultrasound guidance because it is a flexible, cost-effective and widely available intra-operative imaging modality. In a needle insertion procedure with ultrasound guidance, real-time calculation and visualization of the needle trajectory can help to guide the choice of puncture site and needle angle to reach the target depicted in the ultrasound image. We found that it is feasible to calculate the needle trajectory with a single camera mounted directly on the ultrasound transducer by using the needle markings. Higher accuracy is achieved compared with other similar transducer-mounted needle trackers. We used an inexpensive, real-time and easy-to-use tracking method based on an automatic feature extraction algorithm and a closed-form method for pose estimation of the needle. The overall accuracy was 0.94 ± 0.46 mm.     

Needle Catheter Jejunostomy complicated by Pneumatosis Intestinalis: a case report

Needle catheter jejunostomy is a technique to allow enteral feeding after upper abdominal surgery. An unusual postoperative complication is pneumatosis intestinalis which can be life-threatening. A case of a 76-year-old man with pneumatosis intestinalis due to needle catheter jejunostomy, in whom diagnosis was made by CT-scan, is described. Needle catheter jejunostomy complicated by pneumatosis intestinalis needs attention and careful treatment. Removal of the catheter seems necessary, although controversy remains.     

Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients

Introduction

The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX.

Materials and methods

All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients.

Results

The average CWT for men on the 2nd ICS-MCL was 38 mm and for women was 52 mm; on the other hand, on the 5th ICS-MAL was 33 mm for men and 38 mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL.

Conclusions

This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT.     

针孔腹腔镜经腹腹膜前疝修补术治疗腹股沟疝的临床疗效

目的探讨针孔腹腔镜经腹腹膜前疝修补手术（NP-TAPP）治疗腹股沟疝的安全性与可行性。 方法回顾性分析2019年1月至2019年12月,大庆油田总医院行腹腔镜手术治疗的85例单侧腹股沟疝患者的临床资料。其中腹腔镜经腹腹膜前疝修补手术（TAPP）组患者53例,NP-TAPP组患者32例,观察记录2组的手术时间、术中出血量、术后住院时间、疼痛评分、腹壁瘢痕满意度及手术并发症等指标并进行对比分析。 结果85例患者均顺利完成手术,2组手术时间、术中出血量、术后住院时间比较,差异均无统计学意义（P>0.05）;NP-TAPP组术后疼痛程度、腹壁瘢痕满意度均优于TAPP组,差异有统计学意义（P<0.05）。2组术后并发症发生率及复发率比较,差异均无统计学意义（P>0.05）。 结论NP-TAPP治疗腹股沟疝安全有效,能最大程度减少手术创伤,提高术后腹壁切口美容效果。