阴道前壁“斜拉桥”式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果比较

目的比较阴道前壁“斜拉桥”式修补术与传统阴道前壁修补术治疗阴道前壁膨出的临床效果。方法2006年1月～2009年10月对30例（斜拉桥式组）阴道前壁膨出施行阴道前壁“斜拉桥”式修补术（将阴道前壁两侧膀胱筋膜分别缝于对侧耻骨降支骨膜上）,与2002年1月-2006年1月35例（传统术式组）阴道前壁膨出行传统阴道前壁修补术（将膀胱筋膜荷包缝合以使膨出的膀胱回缩）进行比较,比较2组手术时间、术中出血量、手术并发症、术后复发率、术后阴道深度、术后性生活满意情况及保持率。结果2组手术时间、术中出血量、术后1周内新发尿潴留无统计学差异（P〉0．05）。术后12个月阴道深度传统术式组为（5．6±1．1）cm显著短于斜拉桥式组（7．5±0．6）em（t=-8．440,P=0．000）。传统术式组术后2年复发率20．0％（7／35）,显著高于斜拉桥式组0（P=0．010）。术后12个月内性生活保持率传统术式组5．7％（2／35）与斜拉桥式组13．3％（4／30）无统计学差异（,=0．395,P=0．530）。结论阴道前壁“斜拉桥”式修补术不用额外材料而将脱垂的组织交叉固定在坚韧有力的骨膜上,借鉴了斜拉桥的构造原理,既加固盆底又经济,且骨膜标志易辨识,手术简单易操作,增加了安全性,临床效果优于传统修复术。     

Bridge to durable left ventricular assist device for refractory cardiogenic shock

Objective

The role of short-term mechanical circulatory support has increased in patients with refractory cardiogenic shock. However, limited data exist on the outcomes of a bridge to a durable left ventricular assist device strategy using short-term mechanical circulatory support.

The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation

ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.     

Extracorporeal Life Support Bridge to Ventricular Assist Device: The Double Bridge Strategy

In patients requiring left ventricular assist device (LVAD) support, it can be difficult to ascertain suitability for long‐term mechanical support with LVAD and eventual transplantation. LVAD implantation in a shocked patient is associated with increased morbidity and mortality. Interest is growing in the utilization of extracorporeal life support (ECLS) as a bridge‐to‐bridge support for these critically unwell patients. Here, we reviewed our experience with ECLS double bridging. We hypothesized that ECLS double bridging would stabilize end‐organ dysfunction and reduce ventricular assist device (VAD) implant perioperative mortality. We conducted a retrospective review of prospectively collected data for 58 consecutive patients implanted with a continuous‐flow LVAD between January 2010 and December 2013 at The Alfred Hospital, Melbourne, Victoria, Australia. Twenty‐three patients required ECLS support pre‐LVAD while 35 patients underwent LVAD implantation without an ECLS bridge. Preoperative morbidity in the ECLS bridge group was reflected by increased postoperative intensive care duration, blood loss, blood product use, and postoperative renal failure, but without negative impact upon survival when compared with the no ECLS group. ECLS stabilization improved end‐organ function pre‐VAD implant with significant improvements in hepatic and renal dysfunction. This series demonstrates that the use of ECLS bridge to VAD stabilizes end‐organ dysfunction and reduces VAD implant perioperative mortality from that traditionally reported in these “crash and burn” patients.     

利福霉素类抗生素的晶型与血（尿）药浓度

目的：探讨利福霉素类抗生素的衍生物（利福平,利福定,利福喷丁）的晶型与血（尿）药浓度的关系。方法：通过正常人空腹口服各不同型晶粉,定时收集血、尿标本,用杯碟法测定血、尿药含量。结果：同一药物的不同晶型粉,显示出各自不同的结构图形、溶解度及生物有效度的特性。结论：凡是稳定的晶型均具恒定的结构及生物有效度,利福霉素类药物的含水量,对其晶型的稳定性至关重要,干燥失重,不是越低越好。     

冠状动脉旁路术后静脉桥狭窄模型的建立

目的建立冠状动脉旁路术后移植静脉桥狭窄的动物模型。方法游离一段兔颈外静脉,与同侧中间剪断的颈总动脉的两断端间行端端连续吻合,每个吻合口12针。术后常规饲喂。结果4周后取材,可见静脉桥管腔狭窄,病理切片示内膜增殖。结论本模型能真实反映冠状动脉旁路术后静脉桥狭窄的情况,是进一步研究防治静脉桥狭窄的理想模型。     

冠状动脉心肌桥患者60例临床分析

目的：观察分析冠状动脉心肌桥患者的临床特征，探讨其治疗方法。方法：应用选择性冠状动脉造影方法诊断冠状动脉心肌桥患者60例。分析其临床表现特点，冠状动脉造影结果，对患者进行随访，了解其治疗及预后情况。结果：60例患者中男性多于女性，有不同程度心前区不适症状。29例患者有不同程度静息心电图异常。冠状动脉造影结果示心肌桥前降支多见。狭窄1级33例，2级21例，3级6例。60例患者均给予药物治疗。随访1年，大部分患者症状减轻。结论：冠状动脉心肌桥患者多表现为非典型心绞痛，通常预后良好，β-受体阻滞剂，非二氢吡啶类钙离子拮抗剂可缓解因心肌桥对壁冠状动脉的压迫所致的心绞痛。     

富血小板血浆联合皮质外骨桥技术治疗萎缩性骨折不愈合患者的疗效

目的 研究富血小板血浆（platelet-rich plasma,PRP）联合皮质外骨桥技术治疗萎缩性骨折不愈合的疗效及对患者肩肘关节功能、生活质量的影响。方法 选择浙江省浦江县中医院和浙江省中医院2015年1月至2021年1月收治的100例萎缩性骨折不愈合患者作为研究对象,采用随机数字表法将患者分为对照组与观察组,每组各50例。对照组采取皮质外骨桥技术治疗,观察组在对照组的基础上联合PRP治疗,比较两组患者治疗后3个月的关节恢复优良率,采用Neer肩关节功能评分（Neer shoulder function score,NSFS）、Mayo肘关节功能评分（Mayo elbow performance score,MEPS）、健康调查简表（the MOS item short from health survey,SF-36）评分评价两组患者治疗前及治疗后3个月的肩肘关节功能及生活质量。结果 观察组患者的骨折愈合时间显著短于对照组（P<0.05）。治疗后3个月,观察组患者的关节恢复优良率达98.00%,明显高于对照组的80.00%,差异有统计学意义（P<0.05）;观察组患者的NSFS、MEPS分别明显高于对照组,差异有统计学意义（P<0.05）,且观察组患者的SF-36评分明显高于对照组（P<0.05）。结论 PRP联合皮质外骨桥技术治疗萎缩性骨折不愈合患者的效果较佳,有利于改善患者的肩肘关节功能和生活质量。     

下颌后牙种植固定桥不同桥体长度和连接体面积时受载的三维有限元分析

目的:探寻种植固定桥桥体长度及连接体横截面积变化时种植体-骨界面和连接体的应力分布情况。方法:在建立下颌单侧后牙游离端缺失种植固定桥三维有限元模型的基础上,选取不同桥体长度和不同连接体面积,施加相同大小轴向载荷,利用有限元分析软件ABAQUS计算并绘制各种情况下的应力分布图像。结果:在载荷相同的情况下,桥体长度及连接体横截面积分别对种植体-骨界面和连接体的应力分布有一定影响。结论:应尽量缩小桥体长度以减小对种植体-骨界面的影响,应增大连接体横截面积以减小对连接体的影响。     

直接法纤维增强复合桥在牙周炎病例中的应用

目的:评价前牙区直接法纤维增强复合桥(FRC bridge)修复单颗切牙缺失伴邻牙松动的牙周炎病例临床应用效果。方法:采用直接法FRC bridge连接所有同颌前牙修复单颗切牙缺失伴邻牙松动的牙周炎病例12例,以弹性义齿修复14例同类病例作为对照,修复后1、6及18个月随访,对临床修复效果以及牙周状况进行评价。结果:修复后1、6或18个月,直接法FRC bridge修复组和对照组解剖外形和边缘适应性均优于弹性义齿修复组(P<0.05);牙周袋探诊深度(PD)及探诊出血指数(BOP)随着观察时间延长而逐渐减小;修复前后PD、BOP、牙齿松动度(TM)差异均存在显著性(P<0.05)。结论:直接法FRC bridge修复单颗切牙缺失伴邻牙松动的牙周炎病例,能达到良好的临床美学修复效果,并可改善邻牙牙周状况。