Anatomic Diversity Encountered During Laparoscopic Hand-Assisted Transperitoneal Donor Nephrectomy: A Case Report of Complete Caval Duplication

Introduction

Laparoscopic donor nephrectomy is widely used to retrieve a kidney for transplantation. Preoperative evaluation of the donor is of crucial importance to the recipient. In particular, vascular anatomy should be assessed with the help of modern imaging modalities. We present a hand-assisted laparoscopic nephrectomy of a kidney donor with a complete duplex vena cava.

Online adaptive algorithm for optimal control of structures subjected to travelling loads

The problem of adaptive optimal semiactive control of a structure subjected to a moving load is studied. The control is realised by a change of damping of the structure's supports. The results presented in the previous works of the authors demonstrate that switched optimal controls can be very efficient at reducing the vibration levels of the structure. On the other hand, these controls exhibit a high sensitivity to changes of the speed of the travelling load. The aim of this paper is to develop an algorithm that enables real‐time adaptation of the optimal controls according to both the measured speed of the travelling load and the estimated state of the structure. The control objective is to provide smooth passage for the vehicles and reduce the material stresses on the carrying structures. The designed adaptive algorithm uses reference optimal controls computed for constant speeds and a set of functions describing the sensitivity of the system dynamics to the measured parameters. The convergence of the algorithm, as well as aspects of its implementation, is studied. The performance of the proposed method is validated by means of numerical simulations conducted for different travelling speed scenarios. In the assumed objective functional, the proposed adaptive controller can outperform the reference optimal solutions by over 50%. The practicality of the proposed method should attract the attention of practising engineers.     

“过酸伤肝”与原发性骨质疏松症的相关性研究

《周礼》云：“疾医以五药养病,凡药以酸养骨。”《内经》云“味过于酸,肝气以津。”酸味善走筋,而酸味收敛,多食则筋易拘急;肝藏血而主筋,肝气受损,则筋伤血瘀,筋脉失养,运动不利,故发骨痿;过酸伤肝理论长期从饮食摄入方面影响着骨质疏松症的防治。现代研究认为,酸性环境会打破成骨细胞与破骨细胞之间的平衡;肝脏功能受损会引起骨代谢的紊乱,酸负荷也会导致骨代谢异常,但其中的关联尚不清楚。该文探讨“过酸伤肝”与原发性骨质疏松症之间的相关性,为骨质疏松症的防治提供思路。     

围绝经期及绝经后女性血红蛋白和血脂与骨质疏松的相关性

目的 研究围绝经期及绝经后女性体内血红蛋白和血脂水平(TG、LDL-c、HDL-c)与骨质疏松症的关系。方法 选取2016年1月至2020年1月在淄博市市级机关医院老年医学科住院的围绝经期及绝经后患者68例,按照骨密度检测结果分为骨质疏松组、骨量减少组、正常组;用方差分析和非参数检验分析的方法比较各组之间的差异。结果 骨量减少组的平均血红蛋白水平最高,骨质疏松组次之,正常组最低;骨量减少组与正常组和骨质疏松组之间的血红蛋白水平均存在显著差异(P<0.05);但正常组和骨质疏松组之间的平均血红蛋白水平不存在显著性差异(P>0.05)。血脂指标比较中,甘油三酯(TG)具有最大的组间差异性(P<0.01);其中骨量减少组的甘油三酯水平最高,其次是骨质疏松组,正常组最低。经非参数检验分析,正常组的甘油三酯水平与骨量减少组和骨质疏松组相比,仍然具有非常明显的显著性差异。甘油三酯低密度脂蛋白胆固醇(LDL-c)和高密度脂蛋白胆固醇(HDL-c)均没有明显的组间差异。结论 血红蛋白水平可能与骨质疏松相关,但呈双向作用,对围绝经期及绝经后女性人群来说,过高的血红蛋白水平所带来的铁负载...     

Training and teaching of vagus nerve stimulation surgery: Worldwide survey and future perspectives

ObjectiveVagus nerve stimulation (VNS) therapy has been used for more than two decades to treat drug resistant epilepsy and depression and most recently received FDA approval for stroke rehabilitation. Expanding indications will renew the interest in the technique and increase the number of surgeons to be trained. The aim of this study was to survey surgeons with substantial expertise on optimal teaching and training approaches.MethodsAnonymous forms comprising 16 questions were sent by e-mail to surgeons with substantial expertise. Statistical analyses were used to compare the answers of the most experienced surgeons (>5 years) with the less experienced ones (<5 years).ResultsFully-completed forms were collected from 57 experts from 20 countries. The placement of the helical coils was deemed to be the most difficult step by 36 (63.2%) experts, and the use of optical magnification during this step was deemed necessary by 39 (68.4%) experts. Vocal cord palsy should be largely avoidable with proper surgical technique according to 44 (77.2%) experts. The teaching tool considered the most useful was mentoring (38, 66.7%). The future of VNS surgery teaching was deemed to be in anatomical workshops (29, 50.9%) and surgical simulation (26, 45.6%). Overall, answers did not vary significantly according to experience.ConclusionsVNS surgery should be mastered by actively participating in dedicated practical training courses and by individual mentoring during actual surgery, which is still the best way to learn. This study highlights the need for a formal training course and possible specific accreditation.     

低氧及运动致大鼠骨骼肌形态学改变的实验研究

目的观察低氧及低氧复合运动时,大鼠体重及腓肠肌显微、超微结构的变化,旨在探讨低氧状态下适当运动对骨骼肌的影响。方法建立大鼠低氧及低氧复合运动模型,运用光镜及透射电镜观察大鼠腓肠肌显微、超微结构的变化。结果低氧复合运动组较低氧安静组大鼠体重差异有显著性意义(P<0.05)。低氧复合运动组骨骼肌结构正常,线粒体数量增加,骨骼肌纤维增粗,毛细血管增生。结论低氧复合适当的运动能够维持骨骼肌的正常形态,增强骨骼肌的有氧代谢,起到保护骨骼肌的作用,从而提高骨骼肌的低氧适应能力,促进低氧习服。     

Spaced education improves the feedback that surgical residents give to medical students: a randomized trial

Background

Surgery residents teach medical students; feedback is one critical teaching skill. We investigated whether feedback given by surgery residents to students could be improved through an online spaced education program.

Methods

Surgery residents were randomized to receive either a weekly spaced education e-mail during a 9-month period containing teaching bullets on how to provide effective feedback, or no intervention. Medical students rated the frequency and quality of feedback they received from the residents.

Results

Students reported 45% (67 of 149) of the spaced education residents gave frequent feedback, compared with 31% (55 of 175) of control residents (relative risk [RR], 1.43; P = .016). Students reported resident feedback was “helpful in their learning” in 92% (132 of 143) of their evaluations of spaced education residents, compared with 82% (132 of 161) of their evaluations of control residents (RR, 1.13; P = .01).

Conclusions

Educational programs using feedback bullets e-mailed weekly can significantly improve the frequency and quality of feedback that surgical residents provide medical students.     

Positive evidence against human hippocampal involvement in working memory maintenance of familiar stimuli

Subjects (n = 40) performed a delayed item recognition task for visually presented letters with three set sizes (1, 3 or 6 letters). Accuracy was close to ceiling at all set sizes, so we took set size as a proxy for WM load (i.e. the amount of information being maintained in WM). Functional magnetic resonance imaging (fMRI) signal associated with the delay period increased in a nearly linear fashion with WM load in the left inferior frontal gyrus/anterior insula (possibly Broca's area, BA 44/45), right anterior insula, bilateral caudate, bilateral precentral gyrus (BA 6), bilateral middle frontal gyrus (BA 9/46), bilateral inferior parietal lobule (with foci in both BA 39 and 40), left superior parietal lobule (BA 7), medial frontal gyrus (BA 6), anterior cingulate gyrus (BA 32) and bilateral superior frontal gyrus (BA 8). These results lend support to the idea that at least some of the cortical mechanisms of WM maintenance, potentially rehearsal, exhibit a scaling with WM load. In contrast, the delay-related fMRI signal in hippocampus followed an inverted U-shape, being greatest during the intermediate level of WM load, with relatively lower values at the lowest and highest levels of WM load. This pattern of delay-related fMRI activity, orthogonal to WM load, is seemingly not consonant with a role for hippocampus in WM maintenance of phonologically codable stimuli. This finding could possibly be related more to the general familiarity of the letter stimuli than their phonological codability per se.     

解剖性后腹腔镜下肾上腺切除术的阶段性培训方法

目的 建立解剖性后腹腔镜下肾上腺切除术(ARA)的培训方法,评估其安全性和有效性. 方法 5名无开放性肾上腺手术经验的青年医师接受3个阶段腹腔镜培训:①模拟箱训练定向转移、切割及缝合,共300 h;②动物模型训练辨认和游离组织、切割止血及精细缝合打结,共120 h;③临床实践:初期仅为导师扶持腹腔镜,再独立完成简单的腹腔镜手术如肾囊肿去顶术,最后在导师指导下独立完成30例ARA.学员作ARA病例的选择由导师负责,与导师最初的选择一致(除外肾上腺嗜铬细胞瘤).记录患者术前资料包括性别、年龄、体质量指数、肿瘤位置、肿瘤大小、肿瘤病理类型,记录5名学员共完成150例ARA(学员组)总的中转开放率、手术时间、估计出血量、平均住院时间、手术并发症,并与导师最初完成30例ARA(导师组)的相应参数进行比较.采用SPSS 12.0软件进行数据处理,计数、计量资料分别采用x2和t检验(除手术时间为偏态分布,采用非参数检验).结果学员完成ARA患者的术前资料均与导师组患者资料相匹配(P值均>0.05).每名学员都成功实施了30例ARA,无中转开放手术者.学员组150例平均手术时间为82(59～133)min,短于导师组30例的手术时间132(73～230)min(P<0.01).学员组150例ARA的估计出血量为(62.2±22.0)ml,平均住院时间(4.8±1.3)d,与导师组30例ARA的估计出血量(63.9±21.1)ml和平均住院时间(4.5±1.4)d比较,差异无统计学意义(P>0.05).学员组与导师组围手术期并发症发生率比较差异无统计学意义(8.0%和13.3%,P>0.05),但学员组术中轻微并发症发生率(1.3%)低于导师组(10.0%,P<0.05). 结论 阶段性培训方法能安全、有效地使青年泌尿外科医师掌握ARA.     

腹腔镜肾盂成形术的多模培训模式

目的：介绍一项腹腔镜肾盂成形术（Laparoscopic Pyeloplasty,LP）的多模培训模式,并评价其安全性、可行性和有效性。方法：该多模培训模式包括模拟器、动物模型和手术室培训三部分,5位具有不同开放肾盂成形术和腹腔镜经验的学员参加了这项培训,我们对5个学员参加培训过程中的相关数据和学员独立完成手术的5组LP患者的围手术期数据进行了评价。结果：5位学员均成功地完成了整个培训,并成功地独立完成了5例LP。所有患者手术均未转开放手术,均未输血,无患者死亡。模拟器培训和动物模型培圳所需的时间,学员1（3周,7天）比学员5（4周,8天）少,学员4（2周,6天）比学员2（3周,8天）和学员5（4周,8天）少。在手术室培训中,各学员训练每个手术步骤所需的手术例数相当。5位学员独立完成手术的5组患者手术时间、估计失血量、术后住院时间和围手术期并发症的差异均无统计学意义（P〉0．05）。结论：该项多模培训模式是安全、可行和有效的,并适合于没有开放肾盂成形术和腹腔镜经验的学员进行LP培训。