Teaching Furlow palatoplasty: The sticky note method

ObjectiveThe double-opposing Z-plasty (Furlow palatoplasty) procedure is a well-established method for palate repair in children. We propose a simple and easily accessible sticky note model to demonstrate the lengthening in palatal anatomy afforded by this technically challenging procedure.MethodsOur model involves creating a lengthened three-dimensional representation of the Z-plasty through making specified incisions and rearrangements of the palatal layers. The sticky note model was made a total of 20 times and length of the palate model pre and post Z-plasty was measured.ResultsThe average length of the palate pre-procedure was 72 mm. The average length of the palate post procedure was 78.9 mm, showing an increase of 6.9 mm (9.6%).ConclusionOur model provides an accurate and valuable educational tool that will aid in the visualization and understanding of the Furlow palatoplasty procedure.     

Complementarity of Mental Observables

The aim of this note is to complete the discussion on the possibility of creation of quantum‐like (QL) representation for the question order effect which was presented by Wang and Busemeyer (2013). We analyze the role of a fundamental feature of mental operators (given, e.g., by questions), namely, their complementarity.     

Double cystic duct,a review of literature with report of a new case

IntroductionAlthough cystic duct variation is quite common, duplication of cystic duct is an extreme rare variant. We report a case of double cystic duct with literature review. A 33-year old female presented with right upper quadrant pain of three day duration, associated with nausea and poor appetite. The patient reported previous three attacks of right upper quadrant pain within the last two years. On examination: Murphy's sign was positive and the right upper quadrant was tender. Abdominal ultrasound showed multiple gall stones. Oesophago-gastro- duodenoscopy was normal. Under general anesthesia, four port formal laparoscopy was done, double cystic duct was found. Histopathological examination showed features of chronic cholecystitis.Conclusiondouble cystic duct is a very rare variant of the cystic duct anomaly. Identification pre or intraoperatively is very important to prevent ductal injury.     

新鲜周期单囊胚移植314例临床结局

目的 探讨新鲜周期单囊胚移植(single blastocyst transfer,SBT)的可行性。方法 回顾性分析314个新鲜周期行SBT患者的临床资料,从年龄、囊胚分级等方面比较分析临床结局。结果 妊娠组患者的年龄显著低于未妊娠组(P0.001);选择性SBT(elective SBT,eSBT)组的临床妊娠率显著高于非选择性SBT(non-elective SBT,non-eSBT)组(P0.05);年龄≤35岁的患者,eSBT组的临床妊娠率与双囊胚移植(double blastocyst transfer,DBT)组无统计学差异,但多胎妊娠率显著降低(P0.001);而35岁的患者,eSBT组的临床妊娠率低于DBT组(P0.05),组间的多胎妊娠率无统计学差异(P0.05);囊胚扩张和孵化的程度与临床妊娠率显著相关,优质囊胚可获得更好的妊娠结局。结论 妊娠结局与囊胚的质量及患者的年龄显著相关,对于年龄≤35岁,有优质囊胚的患者,可以进行SBT。     

Heart-hand syndrome

Heart–hand syndromes show substantial clinical and genetic heterogeneity. The unusual case of a patient with a heart–hand syndrome consisting of preaxial polydactylia, postaxial syndactylia, parachute mitral valve, mild subaortic stenosis, and double outlet right ventricle is presented and discussed. The importance of distinguishing Holt–Oram syndrome from its phenocopies and other heart–hand syndromes is underlined.     

Treatment of gastrointestinal bleeding in left ventricular assist devices: A comprehensive review

Left ventricular assist devices(LVAD) are increasingly become common as life prolonging therapy in patients with advanced heart failure. Current devices are now used as definitive treatment in some patients given the improved durability of continuous flow pumps. Unfortunately, continuous flow LVADs are fraught with complications such as gastrointestinal(GI) bleeding that are primarily attributed to the formation of arteriovenous malformations. With frequent GI bleeding, antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening events. Small bowel bleeds account for 15%as the source and patients often undergo multiple endoscopic procedures.Treatment strategies include resuscitative measures and endoscopic therapies.Medical treatment is with octreotide. Novel treatment options include thalidomide, angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blockers, estrogen-based hormonal therapies, doxycycline, desmopressin and bevacizumab. Current research has explored the mechanism of frequent GI bleeds in this population, including destruction of von Willebrand factor,upregulation of tissue factor, vascular endothelial growth factor, tumor necrosis factor-α, tumor growth factor-β, and angiopoetin-2, and downregulation of angiopoetin-1. In addition, healthcare resource utilization is only increasing in this patient population with higher admissions, readmissions, blood product utilization, and endoscopy. While some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages, these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.     

双钢板内固定治疗胫骨平台复杂性骨折疗效分析

目的：探讨双钢板内固定治疗胫骨平台复杂性骨折的临床效果。方法回顾性分析39例采用双钢板内固定治疗的Schatzker吁型、遇型胫骨平台骨折,术后随访12~30个月,采用Rasmussen评分标准评定膝关节功能。结果术后塌陷(后髁)1例,余无内固定失败病例,术后膝关节功能优良率89.74%。结论双钢板内固定是目前治疗胫骨平台复杂性骨折比较理想的方法,愈合率高,并发症少。     

探讨Double/Triple Hit淋巴瘤的流式免疫表型特征在疾病诊断及生存结局相关性中的应用

目的：本研究目的是确立二次或三次打击淋巴瘤(Double/Triple- Hit lymphoma,D/THL)流式免疫表型特征,研究与B淋巴细胞白血病(B-LBL)在免疫表型上的差异,并探讨流式免疫表型特征与D/THL生存结局的相关性。方法 采用多色FCI分析法对40例D/THL患者和25 B-LBL患者的样本的免疫表型进行检测和评价,并将流式免疫表型结果与基因亚型以及总体生存率进行统计学对比分析。结果 90%(36 / 40)的D/THL病例CD10表达呈阳性,近一半病例(48%,19 / 40)缺乏表面轻链。45%(18 / 40)的病例CD45表达呈弱阳性, 40%(16 /40)CD19表达呈弱阳性, 43%(17 / 40)CD20表达呈弱阳性。28%(11 / 40)显示伴随CD19和CD20的弱表达,38%(15 / 40)的CD19和CD20表达呈差异化表达(variable expression)。在不同基因亚型之间,除Dim CD45和 BCL2阳性发生率达有差异外(BCL2+/MYC+组Dim CD45发生率明显低于BCL2+/BCL6+/MYC+组(p=0.03);BCL2+/MYC+组中bcl2阳性率为96%,而其它基因亚型组阳性率均为0%),其它表型发生率差异均无统计学意义。与B-LBL相比,B-LBL的CD45和CD20低表达发生率明显高于D / THL(c2 = 20.78、20.83,);CD19和CD20同时弱表达在D / THL发生率稍多(28%D/ THL vs. 10% B-LBL),但差异无统计学意义(c2 = 2.31)。B-LBL的TdT阳性发生率明显高于D / THL(cc2= 30.74,)。对30例已经死亡患者进行了生存分析显示,不同基因型总体生存率无显著性差异(BCL2+ MYC+对BCL6+/MYC+,P=0.08;BCL2+MYC+对BCL2+/BCL6+/MYC+,P=0.13;BCL6+/MYC+对BCL2+/BCL6+/MYC+,P=1.0);Dim CD45和Bcl2阳性预示着与较低的总体生存率(P = 0.01,0.015)相关。 结论D / THL流式免疫表型特征研究有助于D / THL鉴别诊断。对流式免疫表型与疾病结局的生存分析结果,将有利于临床对D／THL整体预后进行危险分层管理,以便能针对特定病人及时采取个体化治疗。     

不同产地冻干地黄中5种重金属及有害元素的含量测定

摘 要 目的： 用火焰原子吸收分光光度计和原子双道荧光光度计分别对不同产地冻干地黄中的Pb、Cd、Cu、As和Hg 5种重金属和有害元素进行检测。方法: 采用硝酸-高氯酸对样品进行消化后,采用原子吸收分光光度法测定Pb、Cd和Cu含量,采用原子荧光光度法测定As和Hg的含量。 结果: 各元素线性关系良好,相关系数均大于0.997 4,平均回收率为97.88%～100.90%,RSD为0.019%～4.20%（n=6）,同时发现10批样品中的4批样品部分重金属和有害元素超过《中国药典》限量标准。 结论:该方法准确度高,操作简便,快捷,适用于冻干地黄中重金属和有害元素的测定。