重组人促红细胞生成素后处理对体外循环瓣膜置换术患者肾保护作用

【目的】评价重组人促红细胞生成素（rHuEPO）后处理对体外循环（CPB）心脏瓣膜置换术患者肾保护作用。【方法】择期CPB心脏瓣膜置换术患者60例,年龄18～65岁,体质量45～75kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为EPO组和对照组。EPO组于主动脉开放后立即给予rHuEPO300IU／kg,对照组主动脉开放后给予等容积生理盐水。于麻醉诱导前（T0）,主动脉开放后1d（T0）、3d（T2）和5d（T3）采集桡动脉血样,检测术后血红蛋白（Hb）、血肌酐（SCr）浓度、血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）浓度及肾小球滤过率（eGFR）,记录重症监护室观察时间、住院时间及术后d1,d3,d5尿量等。【结果】与对照组比较,EPO组术后血清SCr显著下降（P〈0．05）、eGFR升高（P〈0．05）、NGAL浓度降低（P〈0．05）及急性肾损伤（AKI）发生率降低（P〈0．05）;术后重症监护室观察时间、住院时间及术后Hb浓度在两组间差异没有统计学意义（P〉0．05）。【结论】rHuEPO后处理能减轻体外循环瓣膜置换术患者肾损伤,降低术后AKI的发生率。     

C-MET is expressed in the majority of penile squamous cell carcinomas and correlates with polysomy-7 but is not associated with MET oncogene amplification,pertinent histopathologic parameters,or with cancer-specific survival

We assessed c-MET expression and oncogene amplification in a cohort enrolling 92 surgically treated penile squamous cell carcinomas (PSCCs). A tissue microarray was constructed for c-MET immunohistochemistry (IHC) and chromogenic silver in situ hybridization (SISH). Two independent pathologists evaluated IHC by employing the breast cancer scoring rules, and scored the presence of MET oncogene amplification and/or polysomy-7. Eighty study cases (87%) showed c-MET expression. No study case had MET oncogene amplification, but 42 patients (45.7%) had polysomy-7. Polysomy-7 showed a significant positive correlation with c-MET expression (ρ = 0.323, p = 0.002). Neither c-MET expression nor polysomy-7 was associated with histopathologic parameters or with cancer-specific survival (median post-surgical follow-up 32 months). Our data suggest that the majority of PSCCs exhibit c-MET expression which is not associated with oncogene amplification, but might be attributable to polysomy-7. Further studies should investigate the expression and activation of downstream molecules functionally involved in c-MET pathway signaling, and clarify the so far unresolved role of c-MET inhibitors as potential targeted therapies in PSCCs with metastatic dissemination.     

Clinical Applications of 3‐Dimensional Printing Technology in Hip Joint

Three‐dimensional (3D) printing is a digital rapid prototyping technology based on a discrete and heap‐forming principle. We identified 53 articles from PubMed by searching “Hip” and “Printing, Three‐Dimensional”; 52 of the articles were published from 2015 onwards and were, therefore, initially considered and discussed. Clinical application of the 3D printing technique in the hip joint mainly includes three aspects: a 3D‐printed bony 1:1 scale model, a custom prosthesis, and patient‐specific instruments (PSI). Compared with 2‐dimensional image, the shape of bone can be obtained more directly from a 1:1 scale model, which may be beneficial for preoperative evaluation and surgical planning. Custom prostheses can be devised on the basis of radiological images, to not only eliminate the fissure between the prosthesis and the patient's bone but also potentially resulting in the 3D‐printed prosthesis functioning better. As an alternative support to intraoperative computer navigation, PSI can anchor to a specially appointed position on the patient's bone to make accurate bone cuts during surgery following a precise design preoperatively. The 3D printing technique could improve the surgeon's efficiency in the operating room, shorten operative times, and reduce exposure to radiation. Well known for its customization, 3D printing technology presents new potential for treating complex hip joint disease.     

计算机导航辅助下保留关节治疗肢体恶性骨肿瘤

目的 探讨应用计算机导航辅助下保留关节治疗肢体恶性骨肿瘤的意义. 方法 2008年 9 月至2011年3月,行保留关节人工假体和大段异体骨置换术治疗12例股骨远段、胫骨近段和胫骨远段恶性肿瘤患者,其中男7例女,5例;年龄12～59 岁,平均26.7岁,病变位于股骨远段干骺端8例,胫骨近段干骺端3例,胫骨远段骺端1例,骨肉瘤7例软骨,软骨肉瘤3例,血管内皮瘤1例,梭形细胞肉瘤1例 .术前采用增强CT和MRI在计算机导航工作站上设计术前方案,明确病灶侵犯的髓内范围和骨外范围,设计截除瘤骨的范围并标记,术中计算机导航指引下,注册定位,按术前设计截断瘤骨,保留关节及韧带组织,装配特制人工假体8例和大段异体骨置换4例. 结果 12例患者全部按术前计划完成手术,术后肿瘤标本经病理验证达到广泛切除.所有患者随访7～37个月,平均21个月.按肌肉骨与软组织肿瘤协会(MSTS)患肢功能评价体系评分,术后肢体功能恢复92％～96％,平均94％.术后无伤口及关节感染发生,无局部复发和远隔转移发生. 结论 计算机导航技术可以在术中精确实现术前设计的肿瘤外科切边界,避免盲目扩大肿瘤切除范围和损失重要的骨骼关节节结构从而为患肢关节结均重建创造条件,提高肢体功能恢复水平.     

Non-invasive and minimally invasive staging of regional lymph nodes in penile cancer

Introduction  The management of the regional lymph nodes in penile cancer patients, particularly when these lymph nodes are impalpable, remains controversial. Prophylactic bilateral inguinal lymphadenectomy is associated with high morbidity and is often unnecessary. However, there is no non-invasive or minimally invasive staging technique that can determine the lymph node status of penile cancer patients with 100% accuracy. Methods  We reviewed the current literature to examine the role of non-invasive and minimally invasive techniques for staging regional lymph nodes in penile cancer with particular reference to clinically impalpable disease. Results  Cross-sectional imaging (un-enhanced CT and MRI) modalities have a role in the assessment of patients with palpable inguinal basins and in locating distant metastases, but are unreliable in staging impalpable regional lymph nodes. The spatial resolution of lymphotropic nanoparticle enhanced MRI (LNMRI) and positron emission tomography (PET)/CT are limited to several millimetres and so these modalities cannot reliably detect micro-metastases (<2 mm). Ultrasound (US) and fine-needle aspiration cytology (FNAC) are indicated in staging palpable inguinal basins but are unreliable in isolation in the assessment of impalpable lymph nodes. They are, however, useful as an adjunct to dynamic sentinel lymph node biopsy (DSLNB) in lowering false-negative rates. Conclusions  While we await staging modalities that can equal the results of DSLNB with fewer disadvantages, histological staging in the form of DSLNB remains the best minimally invasive staging modality we can offer at risk patients presenting with clinically node negative groins.     

阴茎原位癌的诊断及治疗

目的：提高Bowen病及增殖性红斑的诊治水平。方法：分析18例Bowen病及增殖性红斑患者临床病理资料。发病年龄32～72岁，平均49岁。病程3个月～3年，平均1．5年。10例行局部病变切除术或包皮环切术，8例电凝治疗。结果：15例随访4～48个月，2例在阴茎头未治疗区出现新的病变，外涂5％5．氟脲嘧啶软膏治疗治愈后随访3及9个月无复发；13例治愈无复发。结论包括较深层组织的病理活检是鉴别Bowen病或增殖性红斑与阴茎癌以及其他男性外生殖器疾病的关键，局部病变手术切除，5-氟脲嘧啶软膏外涂可有效治疗Bowen病或增殖性红斑。     

The correction of rheumatoid ulnar drift by silicone prostheses with tendon transfer

Summary Fifty hands with rheumatoid ulnar drift treated by resection of the metacarpal heads and replacement with silicone prostheses were studied. The procedure is outlined which consists of an arthroplasty using a silicone prosthesis with tendon transfer. The complications are also studied and the results evaluated. Of the cases studied 20% were excellent, 40% were good, and 40% fair.

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Résumé Cinquante mains rhumatoïdes avec coup de vent cubital ont été traitées par résection des têtes métacarpiennes et remplacement par prothèses. La technique est décrite, qui consiste en une prothése de silicone et un transfert tendineux. Les complications sont également étudiées et les résultats évalués avec un recul d'1 à 8 ans. Les résultats sont les suivants: 20% excellents, 40% bons et 40% moyens.

     

应用阴囊皮瓣矫治小儿隐匿阴茎

目的 探讨利用阴囊皮瓣矫治小儿隐匿阴茎的疗效.方法 于阴茎腹侧纵行切开狭窄环,距冠状沟约0.5 cm环状切开包皮内板,将包皮脱套至阴茎根部.完全切除异常附着筋膜,裁剪包皮包绕冠状沟.于阴茎阴囊交界处向阴囊两侧切开,将两侧阴囊皮瓣上移覆盖阴茎根部.缝合包皮,重建阴茎阴囊角,阴囊成形.结果 2009年3月至2011年7月采用阴囊皮瓣矫治隐匿阴茎患儿24例,术后尿道外口粘连2例,经尿道扩张后排尿正常;包皮远端轻度坏死1例,经门诊换药2周后好转,余21例手术效果良好.随访6个月至2年,所有患儿均未发现阴茎回缩,阴茎外观塑形良好,勃起时无侧弯、旋转.结论 应用阴囊皮瓣矫治小儿隐匿阴茎可最大程度地显露阴茎,塑形效果良好,并发症较少,是一种较为理想的手术方法.