桩道预备后剩余根管充填物的根尖封闭作用评价

目的:比较不同根管充填方法及桩道预备后不同长度的充填材料对根尖的封闭作用,寻找根管充填方法和剩余充填材料的最佳搭配选择,为临床应用提供理论依据.方法:132颗单根管牙随机分为6个实验组(每组各20颗)和2个对照组(每组各6颗).根管预备后A、B、C3组行冷牙胶侧方加压充填,桩道预备后分别剩余4、6、8 mm根管充填物;D、E、F3组行连续波热牙胶充填,桩道预备后分别剩余4、6、8 mm根管充填物;G组(阴性对照组)随机选择不同充填方法及不同长度剩余根管充填物:H组不进行根管充填.利用葡萄糖定量检测微渗漏模型,检测各组从冠方向根方渗漏的葡萄糖浓度(体积).采用SPSS 19.0软件包对数据进行统计学分析.结果:A和D、B和E、C和F比较,冷牙胶侧方加压充填组微渗漏显著大于热牙胶充填组.A和B、A和C、D和E、D和F相比,差异均具有显著性;B和C、E和F相比,无显著差异,说明根尖剩余4 mm和6 mm组间具有显著差异,而剩余6 mm和8 mm组间无显著差异.结论:连续波热牙胶充填技术的根尖封闭性能显著优于冷牙胶侧方加压法.桩道预备后剩余6 mm微渗漏较少.是较合适的剩余充填材料长度.     

Prediction of leakage flow in a shrouded centrifugal blood pump

This article proposes a phenomenological model to predict the leakage flow in the clearance gap of shrouded centrifugal blood pumps. A good washout in the gap clearance between the rotating impeller surfaces and volute casing is essential to avoid thrombosis. However, excessive leakage flow will result in higher fluid shear stress that may lead to hemolysis. Computational fluid dynamics (CFD) analysis was performed to investigate the leakage flow in a miniaturized shrouded centrifugal blood pump operating at a speed of 2000 rpm. Based on an analytical model derived earlier, a phenomenological model is proposed to predict the leakage flow. The leakage flow rate is found to be proportional to h(α) , where h is the gap size and the exponent α ranges from 2.955 to 3.15 for corresponding gap sizes of 0.2-0.5 mm. In addition, it is observed that α is a linear function of the gap size h. The exponent α compensates for the variation of pressure difference along the circumferential direction as well as inertia effects that are dominant for larger gap clearances. The proposed model displays good agreement with computational results. The CFD analysis also showed that for larger gap sizes, the total leakage flow rate is of the same order of magnitude as the operating flow rate, thus suggesting low volumetric efficiency.     

Evaluations of Laparoscopic Proctocolectomy Versus Traditional Technique in Patients With Rectal Cancer

Background:

This was a retrospective study that evaluated the surgical outcomes of laparoscopic surgery (LS) for rectal cancer, in comparison with a case control series of open surgery (OS), during an 8-year period.

Methodology:

Between October 1998 and December 2006, 203 patients with rectal malignancies underwent colectomy; 146 of them had colectomy with the traditional technique (OS), while 57 underwent resection of rectal cancer laparoscopically (LS). The LS group was compared with 60 patients from the OS group (selected from the 146 OS group patients), matched by size, sex, age, anatomical location of the tumor, type, extent of resection, and pathological stage. Data were obtained from patients'' medical records. Statistical analysis was performed with the t test and chi-square test. All data are expressed as mean ± standard error of the mean (SEM).

Results:

Mean age of the LS group was 63.7±12 years versus 69±12 years in the OS group. There were more men than women in both the laparoscopic (33 males, 24 females) and OS groups (35 men, 25 women). The mean follow-up period was 38 months and 78 months for LS and OS groups, respectively. The procedure included low anterior resection (43 in LS and 45 in OS), and 13 patients in both groups underwent abdominoperineal resection and 3 transanal resections (2 in OS and 1 in LS). Mean tumor size was 4.2±2.12cm in the LS versus 5.2±2.02cm in the OS group. Conversion to an open procedure occurred in 4 patients (6.7%), all in the first 20 cases. Postoperative complications developed in 28 patients (11.7%), 13 in the LS group and 15 in the OS group. Median operative time was longer, but median blood loss was significantly lower in the LS group. The length of hospital stay was significantly shorter for the LS group.

Conclusion:

Laparoscopic surgery is feasible and safe for patients with rectal cancer and provides benefits during the postoperative period without increased morbidity or mortality.     

果绿染色试验在评价脑卒中后气管切开并吞咽障碍患者渗漏和误吸的临床应用价值

目的 探讨果绿染色试验在评价脑卒中后气管切开并吞咽障碍患者渗漏和误吸的临床应用价值。方法 选择2018 年1 月至2019 年6 月在浙江省台州医院及温州医科大学附属第二医院住院治疗的脑卒中气管切开后长期不能拔出套管伴吞咽障碍的患者46 例,分别完成果绿染色试验和咽动态造影检查,比较两种检查之间误吸检出率的差别,同时观察进食不同剂量和形状的食物后误吸发生的情况。结果 果绿染色试验与咽动态造影检查轻度渗透、重度渗透及误吸发生率,差异无统计学意义（P＞0.05）,在发生渗漏误吸患者中,随着食物黏稠度的增高误吸的发生率也相应增高,且吞咽10 mL 食量的误吸率较3 mL 量增高,差异有统计学意义（P＜0.05）。结论果绿染色试验可早期发现脑卒中后气管切开并吞咽障碍患者隐匿性误吸,有效提高误吸的检出率,该方法客观、简便、有效,糊状物及减小一口量可帮助患者减少误吸的发生。     

放射性药物静脉注射后注射点按压方法的研究

目的 探讨防止放射性药物注射后血管外漏的方法.方法 将静脉注射药物拔针后护士与患者合作按压的方法（实验组）与护士按压注射眼片刻（对照组1）、护士按压1 min（对照组2）后转交患者继续按压5-10min的药物外漏情况分别进行对比评价,观察不同的按压方法与药物外漏的关系.结果 在护士操作时间相同的条件下,实验组减少了药物血管外漏,两组比较差异有统计学意义（χ2=32.264,P〈0.01）.在不延长护士操作时间的条件下,实验组同样能减少药物血管外漏,两组比较差异有统计学意义（χ2=0.260,P〉0.05）.结论 护、患合作按压方法不增加护士操作时间,同时能够降低药物血管外漏,且患者容易接受.     

The technique and outcomes of central hepatectomy by the Glissonian suprahilar approach

IntroductionCentral hepatectomy (CH) is technically challenging and seldom-used to treat centrally located tumors. However, CH is a parenchyma-sparing resection that may decrease the risk of postoperative liver failure. This retrospective study presents our technique of CH and assesses the outcomes.MethodsAll CH performed in our department over two decades (1997–2017) were identified. Indications and short-term outcomes were compared between the two decades. Long-term outcomes were assessed.ResultsSixty-four patients underwent CH using a suprahilar approach for hepatocellular carcinoma (HCC: n = 30), metastasis (n = 23), intrahepatic cholangiocarcinoma (IHCCA: n = 9) or other diseases (n = 2). CH represented 6% of 1004 major hepatectomies, (7.4% (n = 35) before 2007 vs 5.4% (n = 29) after 2007). The mean operating time was 219 ± 56 min. A perioperative blood transfusion was required in 14 patients (22%). Intraoperative bile duct injuries occurred in 5 patients (8%), and they were repaired. One patient died postoperatively (1,5%). Ten patients (16%) experienced a major complication. Nine patients (14%) suffered from bile leakage, of which 6 healed spontaneously. Only one patient had low grade liver failure. The R0-resection rate was 69%. After 2007, there were no bile duct injuries (0/29 vs 5/35, p < 0.05), and the average hospital stay was shorter but not significantly (11 vs 14 days). Actuarial 5-year survival was 56% for HCC patients and 34% for those with colorectal metastasisConclusionsCH is associated with significant biliary morbidity and may increase positive surgical margins. Nevertheless, it should be recommended in selected patients to avoid the risk of postoperative liver failure.     

椎体成形术中非骨水泥渗漏引起心血管系统的变化

椎体成形术中较严重并发症主要由骨水泥渗漏引起。近年来的研究表明即使在椎体成形术中不发生骨水泥渗漏,患者亦可能出现心血管系统的变化,从而导致严重后果。其原因可能与骨水泥的毒性、神经反射、脂肪栓塞以及椎体内压力变化有关。     

Do induction cooktops interfere with cardiac pacemakers?

AIMS: In induction cooktops, coils produce time-varying magnetic fields that induce eddy currents in the ferromagnetic bottom of a pot or pan, thereby heating it, while the cooktop itself remains cool. Interference with pacemaker sensing could conceivably be produced by voltages induced directly by induction or indirectly by leakage currents. METHODS AND RESULTS: A worst-case pacemaker-patient (PP) model representing left-sided implantation of a unipolar pacemaker was used for measurement of induced voltages, to judge whether induction cooktops could interfere with pacemaker sensing. Eleven induction cooktops of European manufacture were tested using the PP model. The pacemaker sensitivity with respect to 24 kHz voltages, amplitude-modulated at 100 Hz, was investigated in 244 devices. The current passing through the body of a grounded patient touching a metal pot was determined by measuring the voltage from hand to hand and between electrodes placed on the thorax to simulate an implanted unipolar pacing system underneath. The results obtained were complex. If the pot is positioned concentrically with the induction coil, the smallest pot produced the largest stray field, but the induced voltage always remained below the critical value of 100 mV. With eccentrically positioned large pots, voltages of up to 800 mV could be induced. The induced voltage could always be reduced to 相似文献   

The role of the tissue adhesive fibrin seal (FS) in esophageal anastomoses

Following Surgical Removal Of Esophageal Tumors, Leakage And Medistinitis Is A Frequent And Often Fatal Complication. A New Method Has Been Developed To Seal Suture Lines In The Esophagus With Preparations Containing Fibrinogen, Cold Insoluble Globulin, Factor Xiii, Antiplasmin, Platelet Growth Factor, Thrombin, And Calcium Chloride. In Experimental Animals Operated On By Standard Methods, Esophageal Leakage Developed In 50% Of The Animals And Death In 40%. By Contrast, In Treated Animals, Esophageal Leak And Death Developed In Only 20%. More Adhesions Were Found In Treated Animals Than In Control Animals.