TVT及TVT-O治疗女性压力性尿失禁的临床观察

目的:通过对TVT及TVT-O治疗压力性尿失禁36例分析,探讨压力性尿失禁的治疗效果、并发症及预防。方法:统计我院2008年8月～2011年8月收治的36例压力性尿失禁患者,进行分组及回顾性分析总结。结果:TVT-O组的手术时间较TVT组明显缩短,两组比较有统计学意义(P>0.05)。TVT-O组术中出血量少于TVT组,但无统计学差异。TVT-O组并发症较TVT组明显减少。结论:TVT和TVT-O是治疗女性压力性尿失禁的有效术式。临床医师可根据自己的经验选择适合的治疗方法。但TVT更简便、安全,适应证更宽。     

耻骨后顺行与逆行根治性前列腺切除术治疗前列腺癌疗效比较

目的:比较耻骨后顺行与逆行根治性前列腺切除2种手术方式治疗局限性前列腺癌(PCa)的疗效和安全性.方法:用耻骨后顺行与逆行根治性前列腺切除2种术式治疗局限性PCa各35例,比较2组年龄、前列腺体积、前列腺特异抗原、Gleason评分、术中出血量、手术时间、术后病理分期、术后随访时间、手术并发症、术后最大尿流率、术后性生活恢复例数、生化复发时间和生化复发例数.结果:2组均无死亡病例.2组年龄、前列腺体积、前列腺特异抗原、Gleason评分、病理分期、手术并发症、术后随访时间、术后最大尿流率、术后性生活恢复例数、术后并发症发生情况和生化复发例数差异均无统计学意义(P >0.05),但顺行根治性前列腺切除治疗局限性 PCa术中手术时间和术中出血量明显少于逆行根治性前列腺切除术 (P <0.01),最大尿流测定时间、生化复发时间均短于逆行根治性组(P<0.05~P<0.01).结论:耻骨后顺行与逆行根治性前列腺切除术均是治疗局限性PCa安全、有效的方法,但顺行根治性前列腺切除术治疗局限性PCa比逆行根治性前列腺切除术的术中出血更少,手术时间更短.     

How to advise a woman who wants to get pregnant after a sub-urethral tape placement?

Our objective was to make recommendations for the follow-up of pregnancies and the choice of delivery route for patients becoming pregnant after surgical treatment of stress urinary incontinence (SUI) by tension-free vaginal tape (TVT) or trans-obturator tape (TOT). We performed a retrospective survey on pregnancies after surgical treatment of SUI. Nineteen physicians out of 3,400 contacted reported a total of 20 pregnancies after TVT or TOT. Three patients had recurrent SUI during pregnancy. No major complications of the tape occurred during pregnancy. Ten patients out of 20 delivered vaginally, and nine had a caesarean section. Mean follow-up after delivery was 13.8 months (1 to 52). Recurrence of SUI was observed in 3 of 20 (15%) during pregnancy and in 3 of 18 (16.7%) after delivery. The global rate of recurrence was 4 of 18 (22.2%). Recurrence of SUI was two of ten cases after vaginal delivery (20%) and in one of eight after caesarean section (12.5%; p = 0.58). Vaginal delivery did not increase the risk of recurrence.     

无张力性腹股沟疝修补术

采用聚丙烯(Prolene)网片对59制较大的腹股沟疝进行无张力性修补。与传统的修补方法比较，本方法不破坏正常的解剖结构，没有缝合处的张力．并且操作简单、安全；患者疼痛较轻，可很快恢复正常的体力活动。本组除发生切口浅表血肿和硬结各一例外．未发生手术或网片材料引起的并发症。作者认为无张力性疝修补求是一有效的治疗腹股沟疝的方法，特别对复发性或较大的腹腔沟疝效果更为明显。     

Quantification of human skin barrier function and susceptibility to quantum dot skin penetration

Abstract

In this study, we utilize in vivo human skin and a viable ex-vivo human skin model to investigate the effect of a commercial depilatory agent on barrier function. Tape stripping was used as a positive control. The magnitude of skin barrier was quantified by measuring transepidermal water loss values on in vivo human skin and transepithelial electrical resistance measurements and tissue histology on ex vivo skin. The susceptibility to carboxylated quantum dot penetration through ex vivo skin was investigated using fluorescent microcopy analysis of microtomed skin sections and flow cytometry to quantify quantum dot association with live epidermal cells. Results show that depilatory treatment modifies the outside-in barrier sufficiently to allow quantum dots to penetrate the stratum corneum but to a lesser extent than tape stripping. The implications of these finding are discussed.     

TAPP对腹股沟疝患者术后疼痛及生活质量的影响

目的：探讨腹腔镜经腹腹膜前疝修补术（TAPP）对腹股沟疝患者术后疼痛及生活质量的影响。方法：选取平顶山市第一人民医院2018年3月至2020年3月收治的90例腹股沟疝患者,随机分为观察组和对照组,每组45例。对照组患者采取传统无张力疝修补术进行治疗,观察组患者采取TAPP进行治疗,比较两组患者术后指标、疼痛程度、并发症、复发情况以及生活质量。结果：观察组患者术中出血量少于对照组、手术时间、住院时间、重返工作时间短于对照组,差异具有统计学意义（P <0.05）;术后1 d、3 d、1周,观察组患者视觉模拟评分法（VAS）评分低于对照组,差异具有统计学意义（P <0.05）;观察组患者术后并发症发生率明显低于对照组,差异具有统计学意义（P <0.05）;治疗后,两组患者生活质量各项评分均升高,且观察组生活质量各项评分均高于对照组,差异具有统计学意义（P <0.05）。结论：对腹股沟疝患者应用TAPP能够降低对患者的损伤,降低术后疼痛感与并发症发生率,提高患者生活质量。     

肌内效贴结合重复经颅磁刺激对脑卒中后构音障碍的疗效研究

目的：探讨肌内效贴结合高频重复经颅磁刺激对脑卒中后构音障碍的干预效果。方法：选取75例脑卒中后构音障碍的患者,随机分为对照组、肌内效贴组、联合治疗组 3组,每组25例。对照组患者给予常规训练,包括呼吸训练、唇舌操训练、发声发音训练,每天３0min,每周5d,共4周。肌内效贴组在对照组的基础上给予肌内效贴治疗,联合治疗组在对照组的基础上给予肌内效贴联合经颅磁刺激治疗。在治疗前、治疗4周后分别对3组患者进行言语响度、言语清晰度、最长发声时（MPT）检测及Frenchay构音障碍评定,比较3组在言语响度、清晰度、呼吸控制能力及构音器官的运动功能方面的差异。结果：治疗前,3组患者的言语响度、言语清晰度、MPT值及Frenchay构音障碍评分比较差异无统计学意义;治疗4周后,3组言语响度、言语清晰度、MPT值、Frenchay构音障碍评分均高于治疗前（均P＜0.05）。联合治疗组言语响度、言语清晰度、MPT值、Frenchay构音障碍评分高于对照组和肌内效贴组（均P＜0.05）。结论：肌内效贴与经颅磁刺激联合治疗可以改善脑卒中后构音障碍患者的言语响度、清晰度、呼吸控制能力及构音器官的运动功能。     

Topical delivery of l-ascorbic acid spanlastics for stability enhancement and treatment of UVB induced damaged skin

l-Ascorbic acid (LAA) is considered a powerful antioxidant that protects skin from premature aging. Maintaining the stability of vitamin C remains the biggest challenge in cosmeceuticals. Our main aim is the entrapment of high dose of vitamin C in spanlastic vesicles to provide maximum stability and efficacy. LAA-loaded spanlastics were prepared by ethanol injection method and were characterized for entrapment efficiency (EE%), particles size (PS), polydispersity index (PDI), zeta potential, deformability index (DI) and in vivo skin permeation. Selected spanlastics formula composed of span 60 and tween 60 (5:1) showed highest EE% of 89.77 ± 3.61% (w/w), high deformability of 11.13 ± 1.145 as well as good physical and chemical stability for 6 months. Improved drug penetration into stratum corneum (SC) was obtained from spanlastics compared to topical LAA solution. Quantitative real time PCR revealed that MMP2 and MMP9 levels were significantly suppressed in response to LAA spanlastics treated rats by 30.4% and 65.3%, respectively, when compared to the control group after exposure to UV irradiation. Results were confirmed by western blot analysis. Histopathological study of rat skin after UV irradiation revealed that application of LAA-loaded spanlastics provided the highest skin protection compared to UVB and LAA solution treated group which was evident by the normal thick epidermal morphology and the densely arranged dermal collagen fibers. LAA-loaded spanlastics successfully improved LAA stability, skin permeation and antioxidant protection against skin photodamage.     

Short- and long-term complications of open radical prostatectomy according to the Clavien classification system

OBJECTIVE

To assess the use of the Clavien classification system in documenting the complications related to open retropubic radical prostatectomy (RRP).

PATIENTS AND METHODS

The medical records of 995 patients, who had open RRP during a period of 7 years, were reviewed retrospectively. Short‐ and long‐term complications were classified according to the recently revised Clavien classification system. We also compared the results with a recently reported series of laparoscopic and robotic RRP.

RESULTS

The overall complication rate was 26.9%; Grade I, Id, II, IIIa, IIIb and V complications were recorded in 3.4%, 3.9%, 12.8%, 2.6%, 3.8% and 0.3% of cases, respectively. Rectal injuries (10) and postoperative wound infections (24) were included in the Grade I category. Anastomotic leakage was recorded in 39 patients and rated as Grade Id. Grade II included cases of deep vein thrombosis (11), urinary tract infections (42), lymphorrhoeas (22) and haemorrhage requiring transfusion (53). Anastomotic strictures (26) and incisional hernias (38) were included in Grade IIIa and IIIb, respectively. Pulmonary embolism was fatal for three patients (0.3%) of Grade IV and V.

CONCLUSIONS

To avoid incoherence in reporting morbidity data, a reproducible and practical classification system is necessary. The Clavien system could provide, after refinement and validation, a common language among urologists.