Electron beam sterilization does not have a detrimental effect on the ability of extracellular matrix scaffolds to support in vivo ligament healing

Extracellular matrix (ECM) scaffolds have been used to enhance anterior cruciate ligament (ACL) repair in large animal models. To translate this technology to clinical care, identifying a method which effectively sterilizes the material without significantly impairing in vivo function is desirable. Sixteen Yorkshire pigs underwent ACL transection and were randomly assigned to bridge‐enhanced ACL repair—primary suture repair of the ACL with addition of autologous blood soaked ECM scaffold—with either (i) an aseptically processed ECM scaffold, or (ii) an electron beam irradiated ECM scaffold. Primary outcome measures included sterility of the scaffold and biomechanical properties of the scaffold itself and the repaired ligament at 8 weeks after surgery. Scaffolds treated with 15 kGy electron beam irradiation had no bacterial or fungal growth noted, while aseptically processed scaffolds had bacterial growth in all tested samples. The mean biomechanical properties of the scaffold and healing ligament were lower in the electron beam group; however, differences were not statistically significant. Electron beam irradiation was able to effectively sterilize the scaffolds. In addition, this technique had only a minimal impact on the in vivo function of the scaffolds when used for ligament healing in the porcine model. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1015–1023, 2015.     

“桥”式修补术治疗阴道前壁膨出的疗效分析

目的 探讨阴道前壁“桥”式缝合术治疗阴道前壁脱垂的疗效.方法 回顾性分析自2007年7月至2013年5月,采用手术治疗阴道前壁脱垂58例患者的临床资料,其中阴道前壁“桥”式缝合术30例,传统的阴道前壁修补术28例;比较两种术式的近期疗效.结果 阴道前壁“桥”式缝合术的手术时间为(21.50±3.80) min,术中出血量为(30.00 ±3.20)ml,术后复发率为3.33％,与传统术式的手术时间(48.50±3.50) min、术中出血量(74.00±5.60) ml、术后复发率14.29％进行比较,其差异均有统计学意义(P＜0.05).结论 与传统术式比较,“桥”式缝合术治疗阴道前壁脱垂的手术时间短,术中出血少,术后复发率低,近期疗效满意.     

两种手术方法治疗环状混合痔的临床疗效比较

为比较重建皮肤黏膜桥术和单纯外剥内扎术治疗环状混合痔的临床疗效,将90例环状混合痔患者随机分为两组,各45例,一组采用重建皮肤黏膜桥术治疗（治疗组）,一组采用单纯外剥内扎术治疗（对照组）。结果显示,在治愈率方面,两组差异无统计学意义（P〉0．05）;在创面愈合方面,治疗绀明显快于对照组（P〈0．01）．且术后并发症发生率及复发率比对照组低。结果表明．重建皮肤黏膜桥术治疗环状混合痔安全有效,疗效优于单纯外剥内扎术。     

PPH加断桥缝合术治疗环状混合痔的临床疗效

为探讨PPH加断桥缝合术治疗环状混合痔的临床疗效,我们对采用PPH加断桥缝合术治疗（治疗组）与单纯外剥内扎手术治疗（对照组）的环状混合痔患者各38例的临床疗效进行对比分析。结果显示,两组患者术后总有效率均为100％,但治疗组手术时间、住院天数、恢复工作时间明显短于对照组,P〈0．01,患者满意度明显高于对照组,P〈0．05;术后并发症明显少于对照组,P〈0．05。结果表明,PPH加断桥缝合术是治疗环状混合痔的理想术式,能够显著提高患者的满意度。     

冠状动脉心肌桥的外科治疗

目的探讨冠状动脉心肌桥(myocardial bridge,MB)的临床特点,手术适应证,手术方法及手术效果。方法1996年10月至2007年2月,阜外心血管病医院对34例MB患者施行冠状动脉心肌桥手术治疗,其中单纯MB10例;MB合并冠心病4例,心脏瓣膜疾病15例,肥厚梗阻型心肌病3例,马方综合征1例,房间隔缺损1例。34例MB患者均由冠状动脉造影明确诊断。术前心功能分级(NYHA)Ⅱ级30例,Ⅲ级4例。心肌桥位于左前降支32例,后降支1例,回旋支1例,长度为1～6cm。行心肌桥松解术15例,冠状动脉旁路移植术(CABG)19例。结果行心肌桥松解术患者,术中右心室穿孔1例,经修补后治愈;心肌桥松解术同期行二尖瓣置换术患者,左心室破裂死亡1例。无其他并发症发生。术后随访30例,随访时间15～124个月;其中有2例单纯MB患者行松解术后仍有心绞痛症状,均用药物控制。30例MB患者术后心功能分级Ⅰ级25例,Ⅱ级2例,Ⅲ级3例。结论MG的外科治疗可依据心肌桥的长度,位置的深浅及是否合并壁冠状动脉近端粥样硬化,选用心肌桥松解术或冠状动脉旁路移植术,这两种手术方法均可取得较为满意的临床结果。     

寰椎后桥X线观察及临床意义分析

目的 分析寰椎后桥X线片表现及临床意义.方法 收集我院自2002年2月至2009年6月所摄371例颈椎X线片,发现寰椎后桥57例,发生率为15.3%.分析寰椎后桥与相关临床表现的关系.结果 57例寰椎后桥X线片显示全环型31例(单侧桥板23例,双侧桥板8例),半环型26例.57例中伴颈椎椎体失稳者17例,伴颈椎退行性变者37例,有寰椎椎动脉沟环而颈椎X线片未见异常者3例.结论 寰椎后桥是一种先天性解剖变异,它与临床症状之间无明显关系.     

两种义齿修复下颌单侧游离端缺失基牙及缺牙区牙槽嵴应力分布的比较

目的：分析两种不同结构义齿修复单侧游离端缺失时基牙及缺牙区牙槽嵴应力分布特点,为临床义齿选择提供依据。 方法：应用三维有限元方法分别测定并比较应用键槽缓冲式附着体义齿和单端固定桥义齿修复单侧游离端缺失时基牙及缺牙区牙槽嵴应力分布情况。结果: 键槽缓冲式附着体义齿基牙牙根应力峰值(1.42E+5)MPa,基牙牙周膜应力峰值(1.33E+4)MPa,缺牙区牙槽嵴应力峰值(3.49E+5)MPa。单端固定桥义齿基牙牙根应力峰值(1.45E+7)MPa,基牙牙周膜应力峰值(2.25E+6)MPa,缺牙区牙槽嵴应力峰值(1.45E+3)MPa。两种义齿基牙应力峰值均在根中、上1/3及颈部。结论:在游离端缺失修复时, 键槽缓冲式附着体义齿可减少基牙负荷,但牙槽嵴条件要好,两种义齿修复均要注意牙槽嵴健康。     

Ganglioside promotes the bridging of sciatic nerve defects in cryopreserved peripheral nerve allografts

Previous studies have shown that exogenous gangliosides promote nervous system regeneration and synapse formation.In this study,10 mm sciatic nerve segments from New Zealand rabbits were thawed from cryopreservation and were used for the repair of left sciatic nerve defects through allograft bridging.Three days later,1 m L ganglioside solution(1 g/L) was subcutaneously injected into the right hind leg of rabbits.Compared with non-injected rats,muscle wet weight ratio was increased at 2–12 weeks after modeling.The quantity of myelinated fibers in regenerated sciatic nerve,myelin thickness and fiber diameter were elevated at 4–12 weeks after modeling.Sciatic nerve potential amplitude and conduction velocity were raised at 8 and 12 weeks,while conduction latencies were decreased at 12 weeks.Experimental findings indicate that ganglioside can promote the regeneration of sciatic nerve defects after repair with cryopreserved peripheral nerve allografts.     

Isolated skin bridge metastasis following modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy

Separate vulvar and groin incisions have significantly reduced the morbidity of vulvar cancer surgery. We describe a patient with FIGO stage II squamous vulvar cancer, who developed an ipsilateral tumor recurrence in the skin bridge between the vulva and the groin within 7 months of modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy, using triple incisions. The recurrence was treated by wide local excision alone and she remains free of disease 2 years later. Although rare, the potential for failing to excise tumor emboli in the lymphatics of the skin bridge must be recognized when the triple incision technique is used in the surgical treatment of vulvar cancer.     

A Spatially Explicit Nanomechanical Model of the Half-Sarcomere: Myofilament Compliance Affects Ca2+-Activation

The force exerted by skeletal muscle is modulated by compliance of tissues to which it is connected. Force of the muscle sarcomere is modulated by compliance of the myofilaments. We tested the hypothesis that myofilament compliance influences Ca2+ regulation of muscle by constructing a computational model of the muscle half sarcomere that includes compliance of the filaments as a variable. The biomechanical model consists of three half-filaments of myosin and 13 thin filaments. Initial spacing of motor domains of myosin on thick filaments and myosin-binding sites on thin filaments was taken to be that measured experimentally in unstrained filaments. Monte-Carlo simulations were used to determine transitions around a three-state cycle for each cross-bridge and between two-states for each thin filament regulatory unit. This multifilament model exhibited less "tuning" of maximum force than an earlier two-filament model. Significantly, both the apparent Ca(2+)-sensitivity and cooperativity of activation of steady-state isometric force were modulated by myofilament compliance. Activation-dependence of the kinetics of tension development was also modulated by filament compliance. Tuning in the full myofilament lattice appears to be more significant at submaximal levels of thin filament activation.