Concept of a fiber guidance instrument for laser-assisted laparoscopic partial nephrectomy

Objective

New developments in laser-assisted laparoscopic partial nephrectomy (LLPN) have created a demand for surgical tools which are compatible with laparoscopic equipment to ensure that laser-assisted technique is safer and reproducible. A concept was developed for a novel laser fiber guidance instrument based upon observations made during minimally invasive LLPN with a modified, commercially available ENT laser guidance instrument.

Patients and methods

Ten patients underwent laser-assisted laparoscopic/retroperitoneoscopic partial nephrectomy by means of fiber-assisted light application of 1318 nm using a surgical diode laser (Eraser; Rolle&Rolle, Austria). Observations made during the laparoscopic procedure were analyzed with a view to developing a novel laser fiber guidance instrument taking into account intraoperative laser-related requirements.

Results

All laparoscopic procedures were completed without any changeovers to open surgery. Tumor locations (kidney: 5 left/5 right) were central (1/10), upper pole (2/10), lower pole (2/10) and middle kidney parenchyma (5/10). The mean operation time and blood loss were comparable to standard techniques. All patients showed a favorable outcome with uneventful postoperative convalescence. A concept for a new instrument was developed taking into consideration the drawbacks associated with the clinical handling of the used modified ENT laser guidance instrument and ensuring that the new instrument is simple, cheap and easy to produce as well as easy to handle.

Conclusion

The in vivo observational study presented here shows that the 1318 nm emitting diode laser is a promising device for LLPN. Laser-based treatment facilitates for both good coagulation as well as cutting effects. The observations made resulted in a concept for an improved instrument. It is therefore conceivable that in the future there will be a wider use of LLPN for selective and precise laser resection of tumors with almost bloodless operation field and adequate fiber manipulation.     

莪术醇对斑马鱼胚胎发育的影响

目的：研究莪术醇对斑马鱼胚胎发育的影响。方法：以孵育6 h的斑马鱼胚胎为实验模型,设空白对照组和莪术醇组,观察记录发育畸形、孵化率、心率、自主运动次数及仔鱼的泳速。结果：莪术醇可致斑马鱼身体弯曲,EC50（96 h）为51.17 mg·L-1;能明显降低胚胎孵化率（P〈0.05）;使心率显著降低（P〈0.05）,且呈剂量依赖性。低浓度莪术醇可显著促进斑马鱼自主运动（P〈0.01）;能明显减小仔鱼的泳速（P〈0.05）。结论：莪术醇对斑马鱼胚胎的发育有一定影响。     

The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis

BACKGROUND: It is estimated that there is at least a 2-fold rise in theincidence of monozygotic twinning after assisted reproductivetechnology compared with natural conception. This can resultin adverse pregnancy outcomes. METHODS: We searched MEDLINE, EMBASE and SCISEARCH for studies that estimatedthe risk of monozygotic twinning and its association with anyparticular assisted reproductive technique. Monozygotic twinningwas defined by ultrasound or Weinberg criteria. A meta-analysisof the proportion of monozygotic twins was performed using bothfixed and random effects models. RESULTS: The search revealed 37 publications reporting on the incidenceof monozygotic twins after assisted reproductive techniques.Twenty-seven studies met the inclusion criteria and were includedin the meta-analysis. The summary incidence of monozygotic twinsafter assisted conception was 0.9% (0.8–0.9%). The incidenceof monozygotic twins in natural conception is 0.4%. Blastocysttransfer and intracytoplasmic sperm injection are associatedwith 4.25 and 2.25 times higher risk of monozygotic twins. CONCLUSIONS: The risk of monozygotic twins in assisted conception is 2.25times higher than the natural conceptions. Larger studies reportingon monozygotic twinning following single-embryo transfer orafter post-natal confirmation of zygosity with DNA analysisare warranted before definitive conclusions can be drawn andguidelines produced. In order to provide adequate pre-conceptionalcounselling, it is important to monitor the incidence of monozygotictwins in both natural and assisted conceptions. We suggest buildinga national multiple pregnancy database based on accurate diagnosisof zygosity.     

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia

PurposeHigh myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery.MethodsWe included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery.ResultsThe study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively).ConclusionsModerately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.     

Presence of antimicrobial resistance in coliform bacteria from hatching broiler eggs with emphasis on ESBL/AmpC-producing bacteria

Antimicrobial resistance is recognized as one of the most important global health challenges. Broilers are an important reservoir of antimicrobial resistant bacteria in general and, more particularly, extended-spectrum β-lactamases (ESBL)/AmpC-producing Enterobacteriaceae. Since contamination of 1-day-old chicks is a potential risk factor for the introduction of antimicrobial resistant Enterobacteriaceae in the broiler production chain, the presence of antimicrobial resistant coliform bacteria in broiler hatching eggs was explored in the present study. Samples from 186 hatching eggs, collected from 11 broiler breeder farms, were inoculated on MacConkey agar with or without ceftiofur and investigated for the presence of antimicrobial resistant lactose-positive Enterobacteriaceae, particularly, ESBL/AmpC-producers. Escherichia coli and Enterobacter cloacae were obtained from the eggshells in 10 out of 11 (10/11) sampled farms. The majority of the isolates were recovered from crushed eggshells after external decontamination suggesting that these bacteria are concealed from the disinfectants in the egg shell pores. Antimicrobial resistance testing revealed that approximately 30% of the isolates showed resistance to ampicillin, tetracycline, trimethoprim and sulphonamides, while the majority of isolates were susceptible to amoxicillin-clavulanic acid, nitrofurantoin, aminoglycosides, florfenicol, neomycin and apramycin. Resistance to extended-spectrum cephalosporins was detected in eight Enterobacteriaceae isolates from five different broiler breeder farms. The ESBL phenotype was confirmed by the double disk synergy test and bla_SHV–12, bla_TEM–52 and bla_ACT–39 resistance genes were detected by PCR. This report is the first to present broiler hatching eggs as carriers and a potential source of ESBL/AmpC-producing Enterobacteriaceae for broiler chicks.     

激光辅助孵化对胚胎移植妊娠结局影响的Meta分析

目的:探究激光辅助孵化(LAH)对行胚胎移植不孕患者妊娠结局的影响。方法:计算机检索Pub Med、Ovid SP、Medline、Cochrane Library、CNKI、CBM、万方和维普等数据库,纳入LAH与其他多种辅助孵化方法和不作任何处理组比较的随机对照试验(RCT),检索年限截至2015年10月,语言不限,按照Cochrane协作组建议对纳入文献行质量评价和异质性分析,数据分析采用Rev Man 5.3.5软件。结果:纳入25个RCT;激光组分别与酸化组、机械组和对照组(不作任何处理)进行比较,继续妊娠率、流产率、活产率等差异均无统计学意义(P0.05);对选择行冻融胚胎移植(FET)的患者,激光组较对照组有较高的种植率及临床妊娠率,差异有统计学意义(P0.000 01;P0.05);但多胎率显著增加(P0.05)。结论:对选择行FET的患者,LAH较不做任何处理更有优势,可以提高种植率和临床妊娠率,值得推广及应用,但LAH会增加多胎发生的风险。     

不同浓度丝裂霉素 C对 LASEK 术后疗效的影响

目的：比较高度近视患者在准分子激光上皮下角膜磨镶术（ LASEK）中分别使用不同浓度丝裂霉素C（MMC）的效果。方法对52例（104只眼）行LASEK的高度近视患者,分成A、B、C三组,三组术中分别使用0．005％、0．01％、0．02％浓度的MMC棉片覆盖激光切削后的基质床。观察术后裸眼视力、角膜上皮愈合时间及角膜上皮下混浊（ Haze ）的形成情况。结果在术后裸眼视力和Haze形成方面：A组与B组、C组分别比较差异均有统计学意义（ P ＜0．05）;B组与C组比较差异无统计学意义（ P ＞0．05）;在角膜上皮愈合时间方面：C组与A组、B组分别比较差异均有统计学意义（ P ＜0．05）;A组与B组比较差异无统计学意义（ P ＞0．05）。结论 LASEK术中采用0．01％MMC可以有效抑制Haze的形成,恢复术后良好视力,且不会明显延迟角膜上皮愈合。     

经上皮准分子激光角膜切削术与准分子激光上皮瓣下角膜磨镶术治疗中高度近视的疗效比较

目的比较经上皮准分子激光角膜切削术(Transepithelial photorefractive keratectomy,Trans-PRK)与准分子激光上皮瓣下角膜磨镶术(Laser-assisted subepithelial keratomileusis,LASEK)治疗中高度近视的临床效果。方法2017年5月至2019年1月,中高度近视患者110例159只眼,根据手术方式不同分为对照组患者55例78只眼,采用LASEK手术治疗,波长193 nm,治疗功率8~10 mW;观察组患者55例81只眼,采用Trans-PRK手术治疗,波长193 nm,治疗功率8~10 mW。随访3个月,采用视觉模拟疼痛评分(visual analogue pain score,VAS)比较两组患者术后1、3和5 d的改变;观察术前和术后3个月最佳矫正视力、裸眼视力及角膜光密度,记录术后感染、角膜上皮下雾状浑浊、眼压升高、散光、角膜穿透等并发症发生情况。结果术后3个月,两组患者最佳矫正视力、裸眼视力及角膜光密度较术前均有改善(P<0.05),且观察组最佳矫正视力低于对照组(P<0.05);裸眼视力和角膜光密度均高于对照组(P<0.05)。观察组术后1、3和5 d的VAS评分均低于对照组(P<0.05)。观察组术后感染、角膜上皮下雾状浑浊、眼压升高、散光、角膜穿透等并发症发生率为3.64%,明显低于对照组的14.6%(P<0.05)。结论与LASEK比较,Trans-PRK更有利于中高度近视患者视力的早期恢复,改善角膜光密度、疼痛更轻,且安全性更高,值得临床推广应用。     

What ecological factors can affect albumen corticosterone levels in the clutches of seabirds? Timing of breeding, disturbance and laying order in rockhopper penguins (Eudyptes chrysocome chrysocome)

Female birds deposit corticosterone into their eggs. Elevated concentrations of this hormone may interfere with the development of their offspring, and mothers should thus regulate corticosterone levels deposited into the eggs adaptively. However, if females are unable to regulate deposition, then the corticosterone concentration in eggs should reflect that in female plasma and should be influenced by stressors to the females. We measured corticosterone levels in the albumen of rockhopper penguins, and assessed their relationship with hatching order, human disturbance and laying date. Rockhopper penguins (Eudyptes chrysocome chrysocome) lay two eggs, of which the second egg (B-egg) is larger and hatches faster than the first egg (A-egg). The chick hatching from the B-egg is also much more likely to survive than its sibling. Albumen corticosterone concentrations were lower in B-eggs. However, as B-eggs contained more albumen than A-eggs, the total corticosterone deposited in the albumen was not significantly different between the two eggs. Daily disturbance by human observers during albumen production did not influence albumen corticosterone levels. Laying date had an effect on total albumen corticosterone through a higher albumen mass. However, we observed a high individual component in the composition of eggs from the same clutch. Thus, more work is required to explore the hypotheses of passive versus active transfer to eggs and to understand the adaptive value of contrary effects on the amount and concentration of corticosterone.     

小鼠体外培养囊胚辅助孵化的初步研究

目的 :探索体外培养和辅助孵化技术对体外发育小鼠囊胚孵出率的影响。方法 :将昆明白种小鼠的 2～ 4-细胞胚于体外培养到囊胚 ,观察比较 :(1 )体外培养囊胚与体内发育囊胚的自然孵化率 ;(2 )体外培养囊胚经辅助孵化后与未行辅助孵化 (对照组 )的体外孵化率。结果 :(1 )体外培养囊胚与体内发育囊胚的自然孵化率分别为 75.4%和 96 .2 % ;有显著差异 (P<0 .0 0 1 )。 (2 )辅助孵化与对照组的体外孵化率分别为 97.7%和 74.0 % ,有明显差异 (P<0 .0 5)。结论 :体外培养对囊胚的孵化有不利影响 ;辅助孵化则能明显提高体外培养囊胚的孵出效率