保留迷走神经主干的门奇断流术治疗门静脉高压症32例报告

探讨保留迷走神经主干门奇断流术（VPPD）的手术方法及治疗效果。方法：通过尸体解剖，了解食管下端迷走神经前后主干走行，设计出该术式的游离曲线，在临床上应用32例，并与同期施行的，资料比较完整的门奇断流术（PD）32例和门奇断流术加幽门成形术（PD加PP）16例进行比较。结果：手术死亡率和术后再出血率VPPD组分别为3．1％和6．3％，PD组分别为6．3％和9．4％，PD加PP组均为6．3％，3组无明显差异（P＞0．05）。胃肠功能恢复时间VPPD组平均3．5d，较PD组平均5.7d和PD加PP组平均4.2d明显快（P＜0．02），食后饱胀率和肠胃反流发生率在VPPD组均为6．3％，PD组分别为46．9％和18．8％；PD加PP组分别为12．5％和100％，3组有极显著性差异（P＜0．05）。胃液滞留，突发性腹泻和远期胆囊结石发生率PD组分别为25％，15．6％和7．1％，PD加PP组分别为12．5％，18．8％和6．3％，而VPPD组无一例发生。结论：VPPD能较好地维持胃的正常动力学及肝胆，肠道系统的生理功能，最大限度地减少术后并发症的发生，疗效优于PD和PD加PP。     

肝功能Child—PughC级的门静脉高压症患者急诊断流术后疗效分析

目的 对16例肝功能Child-Pugh分级C级的门静脉高压症患者实施急诊断流术后的疗效进行分析，期望在手术时机，适应症，防止并发症等方面提出一些见解。方法 16例Child-PughC级门静脉高压症患者，均是乙型肝炎后肝硬化，急诊内窥镜证实为食管下段曲张静脉破裂大出血时，采用“脾切除加贲门周围血管离断术”实施急诊止血，术后积极配合以内科为主的综合治疗措施，结果 （1）死亡率，术后复发出血率，门静脉高压性胃粘膜病变（PHG）发生率分别为12.5%,6.25%,6.25%。（2）生存者随访至今无一例出现严重的并发症。结论 （1）Child-PughC级门静脉高压症患者发生食管曲张静脉破裂大出血时并非手术禁忌，但需要严格掌握其适应症，并重视手术前准备及围手术期处理；（2）术后复发出血和发生PHG均可以非手术疗法治愈。     

A technic for reconstructing the digestive tract after pancreatoduodenectomy

A technic for the reconstruction of the alimentary tract after pancreatoduodenectomy is presented with the aim of separating the biliary and pancreatic fistulas when it occurs. The advantages and possible hazards of this kind of reconstruction are discussed.     

Individuals With Chronic Neck Pain Have Lower Neck Strength Than Healthy Controls: A Systematic Review With Meta-Analysis

ObjectiveThe aim is to verify whether there is difference in neck strength between healthy individuals and individuals with chronic neck pain.MethodsThe PubMed, Embase, and Scopus databases were searched. Two independent reviewers selected relevant full articles comparing neck strength between healthy individuals and individuals with chronic neck pain. Two independent reviewers extracted the data from the full articles selected. A meta-analysis was used to assess standardized mean differences in neck strength based on a random-effects model (Prospero number CRD42017081502).ResultsThe search returned 3554 results; 15 articles were included. The chronic neck pain group showed lower neck strength compared with healthy individuals. The standardized mean difference was -0.90 (95% confidence interval [CI] = -1.13 to -0.67) for flexion, -0.79 (95% CI = -0.99 to -0.60) for extension, -0.74 (95% CI = -1.03 to -0.45) for right lateral flexion, and -0.75 (95% CI = -1.04 to -0.46) for left lateral flexion.ConclusionBased on this meta-analysis with a 3a level of evidence, individuals with chronic neck pain have lower neck strength for flexion, extension, and the lateral flexion of the neck than healthy controls.     

CAD/CAM or conventional ceramic materials restorations longevity: a systematic review and meta-analysis

PurposeThis systematic review and meta-analysis aimed to evaluate the difference in longevity of tooth-supported ceramic prostheses designed by conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques.Study selectionTwo reviewers searched the Web of Science, PubMed, SCOPUS and LILACS databases between 1966 and October 2017. Clinical studies that compared the survival rate of CAD/CAM against conventional restorations were included.ResultsEleven randomized controlled trials and three prospective studies were included, n = 14. Three types of tooth-supported restorations were searched in the included studies: single crown, multiple-unit and partial ceramic crown. The follow-up of patients in the studies ranged from 24 to 84 months. A total of 1209 restorations had been placed in 957 patients in the included trials, and failures were analyzed by type and material restoration. From a total of 72 restoration failures, the CAD/CAM system resulted in a 1.84 (IC95%: 1.28–2.63) higher risk than conventional manufacturing of ceramic restoration. Nevertheless, when drop-outs were included as a failure risk, the CAD/CAM system resulted in a risk of 1.32 (IC95%: 1.10–1.58). Multilevel analysis of tooth-supported ceramic restorations, considering drop-outs as successes, resulted in rates of 1.48 and 2.62 failures per 100 restoration-years for the controls and CAD/CAM groups, respectively. Considering drop-outs as failures, we found rates of 4.23 and 5.88 failures per 100 restoration-years for the controls and CAD/CAM groups, respectively.ConclusionsThe meta-analysis results suggest that the longevity of a tooth-supported ceramic prostheses made by CAD/CAM manufacturing is lower than that of crowns mad by the conventional technique.     

Plants popularly used for loosing weight purposes in Porto Alegre, South Brazil

In this study, 14 herbalists (herb sellers) were interviewed about popular use of plants with weight loss purpose in Porto Alegre, a South Brazil city. For all identified species, scientific data were reviewed aiming to establish a correlation between popular use and biological properties. Seventy-eight samples were reported as having weigh loss properties. These samples come from 23 species and Asteraceae encompasses the greatest number of representatives. The greatest number of herbalist's citations was Baccharis articulata. The majority of plants have traditional use in Brazil but none is explicitly cited for loosing weight purposes. The pharmacological data are mainly from animal and in vitro studies and do not straight related to obesity. Only Ilex paraguariensis presents clinical data of efficacy in the treatment of obesity. Seven species present pre-clinical data that indicate a potential role in the control of certain conditions which are associated with obesity, such as hyperlipidemia (Campomanesia xanthocarpa, Cuphea carthagenensis, Cynara scolymus, Hibiscus sabdariffa, Ilex paraguariensis) and high levels of blood glucose (Achyrocline satureioides, Baccharis trimera, Campomanesia xanthocarpa). In conclusion, scientific data found are insufficient to guarantee the efficacy and safety of these plants for treating obesity. However, some of them present activities which could be useful to treat certain obesity comorbidities and deserve further studies.