Two-trocar needlescopic approach to incarcerated inguinal hernia in children

Background

Many studies described the safety and effectiveness of laparoscopy in the treatment of inguinal hernia in children. Needlescopic techniques have been recently used in repairing inguinal hernias, which made this type of surgery more cosmetic and less invasive. However, few reports have described its role in the treatment of incarcerated inguinal hernia. The aim of this study was to assess the feasibility and outcome of needlescopy in the treatment of incarcerated inguinal hernia in children.

Methods

A total of 250 children, comprising 190 boys and 60 girls, who presented with incarcerated inguinal hernia were analyzed. Their ages ranged from 6 months to 6 years (mean age, 2 years). In 170 (68%) cases, manual reduction was successful. One hundred of these patients were subjected to definitive surgery in the same day, whereas the remaining 70 patients were subjected to needlescopy 1 to 3 days later. In 80 (32%) cases, external manual reduction was unsuccessful. These children were subjected to urgent needlescopic reduction and herniorrhaphy. The incarcerated herniae were easily reduced and the contents thoroughly inspected under direct vision. Then the hernia was repaired in the same setting.

Results

In all patients, there was no need to convert the procedure to an open approach. Immediate needlescopic herniorrhaphy in the same session was added without significant increase in operative time. The mean operative time is 10 minutes. There were no intraoperative complications.

Conclusions

The study showed that needlescopic approach to incarcerated inguinal hernia in children is feasible, safe, easy, and preferable to the open surgery. In addition to reduction of incarcerated hernial contents under direct vision, it allows definitive treatment of hernial defect at the same time without significant increase in operative time and hospital stay.     

Barebacking, the Internet, and Harm Reduction: An Intercept Survey with Gay and Bisexual Men in Los Angeles and New York City

Researchers have suggested that intentional unprotected anal intercourse (UAI) among gay and bisexual men (colloquially called barebacking), is on the rise. Further, they have linked this increase in barebacking to the growth of the Internet as a medium for men to meet sex partners. Data were used from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles collected between 2003 and 2004. In total 1178 men who have sex with men (MSM) responded to questions about the use of the Internet, willingness to have unplanned UAI, intentions toward planned UAI, and “barebacker identity.” Compared to nonbarebackers, barebackers spent significantly more time on the Internet looking for sex and looking for dates. Further, HIV-positive barebackers specifically spent the most time online looking for dates. Further analyses of willingness and intentions to have UAI, and the specific sexual behaviors of self-identified barebackers, found evidence of strategic positioning and serosorting, both harm reduction strategies. These data suggest both HIV-positive and HIV-negative barebackers may be engaged in efforts to reduce the risk of HIV transmission when engaged in unprotected sex.     

Gynecomastia: The Horizontal Ellipse Method for Its Correction

BACKGROUND: Gynecomastia is an extremely disturbing deformity affecting males, especially when it occurs in young subjects. Such subjects generally have no hormonal anomalies and thus either liposuction or surgical intervention, depending on the type and consistency of the breast, is required for treatment. If there is slight hypertrophy alone with no ptosis, then subcutaneous mastectomy is usually sufficient. However, when hypertrophy and/or ptosis are present, then corrective surgery on the skin and breast is mandatory to obtain a good cosmetic result. METHODS: Most of the procedures suggested for reduction of the male breast are usually derived from reduction mammaplasty methods used for females. They have some disadvantages, mainly the multiple scars, which remain apparent in males, unusual shape, and the lack of symmetry with regard to the size of both breasts and/or the nipple position. The author presents a new, simple method that has proven superior to any previous method described so far. It consists of a horizontal excision ellipse of the breast's redundant skin and deep excess tissue and a superior pedicle flap carrying the areola-nipple complex to its new site on the chest wall. RESULTS: The method described yields excellent shape, symmetry, and minimal scars. CONCLUSION: A new method for treating gynecomastis is described in detail, its early and late operative results are shown, and its advantages are discussed.     

Steffee槽式钢板治疗腰椎滑脱症

采用Ｓｔｅｆｆｅｅ槽式钢板治疗腰椎滑脱症共１２例，收到良好效果。滑脱度数在２５％～５５％之间，复位率９７％。手术要点：真性滑脱椎弓根钉进钉点靠横突，峡部裂要彻底切新，采用大块植骨．双侧同时复位。一般情况不切除椎板。因复位后可恢复脊柱的三柱结构，临床症状得以解除．骨质疏松是禁忌症。我们认为该钢板具有复位满意，固定可靠，促进融合等优点，是目前治疗腰椎滑脱症较为理想的方法。     

手指延长器在治疗手法难复性Colles骨折的临床运用

目的探讨手指延长器治疗手法复位困难的Colles骨折的临床疗效。方法将20例运用手指延长器治疗的该类骨折患者作为治疗组，另设15例未运用此方法治疗的同类病患者为对照组，对X片显示复位情况、功能恢复状况两组对比。结果治疗组20例优85％，良10％，优良率100％，患者治疗后X片提示复位良好，腕关节活动好，其治疗效果明显优于对照组。结论手指延长器治疗手法复位困难的Colles骨折临床疗效良好，操作简便，适合临床运用。     

复位固定系统治疗胸腰椎爆裂型骨折

目的总结复位固定系统（ＲｅｄｕｃｔｉｏｎＦｉｘａｔｉｏｎＳｙｓｔｅｍ,ＲＦ）治疗胸腰椎爆裂型骨折的临床经验。方法对１５例胸腰椎爆裂型骨折伴不全截瘫病人,采用ＲＦ系统治疗。对其中２例伴有椎间盘中央型突出的病人,采用“桥式潜行减压”,行双侧半椎板切除术。结果经过５～２３个月,平均９个月的随访,１２例病人椎体压缩高度恢复到９０％以上,骨折在３月内全部愈合,神经功能恢复好转率达到９３．３％。结论ＲＦ通过轴向撑开,使骨折达到良好的复位,变窄的椎管,椎间孔管径得到改善,对脊髓及神经根起到减压作用     

A randomized phase I/II safety and immunogenicity study of the Montanide-adjuvanted SARS-CoV-2 spike protein-RBD-Fc vaccine,AKS-452

BackgroundPrevious interim data from a phase I study of AKS-452, a subunit vaccine comprising an Fc fusion of the respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein receptor binding domain (SP/RBD) emulsified in the water-in-oil adjuvant, Montanide™ ISA 720, suggested a good safety and immunogenicity profile in healthy adults. This phase I study was completed and two dosing regimens were further evaluated in this phase II study.MethodsThis phase II randomized, open-labelled, parallel group study was conducted at a single site in The Netherlands with 52 healthy adults (18 – 72 years) receiving AKS-452 subcutaneously at one 90 µg dose (cohort 1, 26 subjects) or two 45 µg doses 28 days apart (cohort 2, 26 subjects). Serum samples were collected at the first dose (day 0) and at days 28, 56, 90, and 180. Safety and immunogenicity endpoints were assessed, along with induction of IgG isotypes, cross-reactive immunity against viral variants, and IFN-γ T cell responses.ResultsAll AEs were mild/moderate (grades 1 or 2), and no SAEs were attributable to AKS-452. Seroconversion rates reached 100% in both cohorts, although cohort 2 showed greater geometric mean IgG titers that were stable through day 180 and associated with enhanced potencies of SP/RBD-ACE2 binding inhibition and live virus neutralization. AKS-452-induced IgG titers strongly bound mutant SP/RBD from several SARS-CoV-2 variants (including Omicrons) that were predominantly of the favorable IgG1/3 isotype and IFN-γ-producing T cell phenotype.ConclusionThese favorable safety and immunogenicity profiles of the candidate vaccine as demonstrated in this phase II study are consistent with those of the phase I study (ClinicalTrials.gov: NCT04681092) and suggest that a total of 90 µg received in 2 doses may offer a greater duration of cross-reactive neutralizing titers than when given in a single dose.     

Addition of fenofibrate to statins is associated with risk reduction of diabetic retinopathy progression in patients with type 2 diabetes and metabolic syndrome: A propensity-matched cohort study

AimThis study aimed to determine the association between fenofibrate added to statin therapy and diabetic retinopathy progression.MethodsIn this propensity-matched study using the Korean National Health Insurance Service cohort (2002–2019), patients with type 2 diabetes and metabolic syndrome (≥ 30 years) receiving statin therapy were matched 1:2 by propensity score into the statin plus fenofibrate group (n = 22,395) and statin-only group (n = 43,191). The primary outcome was a composite of diabetic retinopathy progression including vitreous hemorrhage, vitrectomy, laser photocoagulation, intravitreous injection therapy and retinal detachment.ResultsThe median (quartiles) follow-up duration was 44.0 (27.6–70.6) months. For the primary outcome, the incidence rate per 1,000 person-years was 9.66 in the statin-only group and 8.68 in the statin-plus-fenofibrate group. The risk of the primary outcome was significantly lower (hazard ratio [HR]=0.88; 95% confidence interval [0.81;0.96] P = 0.005) in the statin-plus-fenofibrate group than in the statin-only group. Only patients with pre-existing retinopathy showed benefits from fenofibrate treatment (HR=0.83 [0.73;0.95] P = 0.006). In addition, the statin plus fenofibrate group exhibited significantly lower risks of vitreous hemorrhage (HR= 0.86 [0.75;0.995] P = 0.042), laser photocoagulation (HR=0.86 [0.77;0.96] P = 0.009) and intravitreous injection therapy (HR=0.73 [0.59;0.90] P = 0.003) than those in the statin-only group. There was no significant interaction between the different characteristics at baseline and the treatment effect.ConclusionThe addition of fenofibrate to statins was associated with significantly lower risk of diabetic retinopathy progression than statin therapy alone in patients with type 2 diabetes and metabolic syndrome.     

骨折复位固定器疗法定量问题探讨

本文介绍我们在中西医结合骨折复位固定器疗法基础上,利用我们在生物力学原理指导下研制的卡式骨圆针变形传感器（专利号ZL00201477．7）,对骨折治疗过程定量研究的方法。试图通过定量监测临床骨折愈合过程中断端活动,使骨折复位固定器疗法得到更好的疗效和更广泛的应用。