Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

Purpose

To assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD).

Methods

This prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group.

Results

Multiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis.

Conclusions

Risk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.     

腕管综合征神经卡压：内镜下腕管松解与有限小切口松解的效果及安全性评价

BACKGROUND:Existing evidence has shown endoscopic carpal tunnel release is superior to the open release in postoperative recovery time, grip and pinch strength, hospitalization time as well as incidence of postoperative scar tissues. OBJECTIVE: To systematically review the efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndrome. METHODS: A computer-based search of PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, CqVip and Wanfang databases was performed. Randomized controlled trials comparing endoscopic release with mini-open release for patients with carpal tunnel syndrome were included, and the publishing time was up to November 1st, 2015. Two authors independently screened, extracted data and assessed the risk of bias of the included literatures. Then statistical analysis was conducted using RevMan 5.3 software. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials involving 706 patients were included. The results of Meta-analysis demonstrated that: compared with mini-open release, endoscopic release could not only significanthy decrease the hospitalization time postoperative recovery time and complications (P < 0.05), but also achieve better symptom relief (P=0.16). However, there were no significant differences in grip and pinch strength between the two treatments. These results suggest that compared with the mini-open release, the endoscopic release contributes to shorter hospitalization time and postoperative recovery time, better symptom relief and lower risk of complications. But large-sample and high-quality randomized controlled trials are needed to provide more reliable evidence for these findings. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Functional outcomes and health-related quality of life after robot-assisted anterior cruciate ligament reconstruction with patellar tendon grafts

During a short period of time, surgical robots had been propagated for automated tunnel placement in anterior cruciate ligament (ACL) reconstruction. Clinical outcome data are currently unavailable. Between 2000 and 2003, 152 patients underwent ACL replacement with the assistance of the Computer Assisted Surgical Planning and Robotics system (CASPAR, OrtoMaquet, Germany) at our hospital. After minimal invasive pin placement in both the tibia and femur, computed tomography was used to register anatomical landmarks and to plan graft tunnel alignment. The robot was used to drill tibial and femoral tunnels in an outside-in fashion according to pre-operative planning. There was one procedure-specific Serious Adverse Event (i.e., an intraoperative transection of the posterior cruciate ligament). After IRB approval, all patients were invited for a follow-up examination. Data from 100 patients (35 women, 65 men, mean age 35 [SD 11] years, median follow-up 61 [range 42–77] months) form the basis of this report. Side-to-side differences in anterior laxity were measured with the KT-1000 arthrometer. Patient-centered outcomes included the Lysholm-Score, the lower extremity functional scale (LEFS), and the Short Form 36 (SF36). The mean KT-1000 side-to-side difference was 0.89 [95% confidence interval (CI) 0.52–1.26] mm. Eight and five patients had a positive Lachman and pivot shift test, respectively. The Lysholm-Score averaged 86 (95% CI 83–89) points. Excellent, good, fair, and poor outcomes were reported by 38, 32, 20, and 10 patients. The LEFS averaged 85 (95% CI 82–88) points. The mean SF36 Physical Component Score was 48.4 (95% CI 46.5–50.3), indicating residual deficits compared to the population norm. All tibial graft tunnels did not cross the Blumensaat line, but were placed slightly anterior to the optimal center of 42% reported in previous studies. Compared to literature data, robot-assisted ACL reconstruction with BTB grafts may lead to higher knee stability, but poorer functional outcomes. The immense additional efforts with the procedure did not pay off in a benefit to patients.     

白内障手术中前房维持系统的应用效果观察

目的：探讨前房维持系统在白内障术中的应用优势和操作要点。方法：采用前房维持系统与可自行封闭的隧道切口结合对919例(1419眼)白内障患施行手术治疗。结果：证明该系统较传统的双腔抽吸灌注系统更能有效维持前房，更便于清除障质。缩短和简化前房操作时间和程序，术后并发症少，效果好。结论：前房维持系统比传统的双腔抽吸灌注系统在白内障术中具有更大优势，简便易学，适用于各种类型白内障手术。     

基于影像学和临床体征的隧道式拖线术治疗复杂性肛瘘预后因素COX回归分析

目的:通过回顾性研究肛周核磁共振及复杂性肛瘘的临床体征,对比隧道式拖线术治疗复杂性肛瘘一次性治愈和复发病例特点,通过COX模型进行单因素分析影响隧道式拖线术手术预后的因素,提高术前评价的准确性,减少术后不可逆的肛门功能损伤以及术后复发率。方法:纳入2011年1月至2013年12月于上海中医药大学附属龙华医院肛肠外科行复杂性肛瘘隧道式拖线术患者217例。对比一次性治愈组和复发组患者在人口学基本资料、临床体征、肛周核磁共振提取数据的差异,并采用COX回归模型分析影响隧道式拖线手术预后的因素。临床资料采用单因素分析和多因素分析相结合的方法:对于非正态分布的数据,2组数据的总体分布比较采用Mann-Whitney检验。结果:根据单因素分析2组之间的差异,将人口基本资料、临床体征及肛周核磁共振提取数据通过COX模型进行单因素分析,发现与术后复发相关的因素包括BMI、炎症感染肛周肌肉的数量、肛周分泌物量、以及内口位置。结论:经单因素研究分析发现:瘘管位于6-9象限、瘘管延伸范围大于两个象限、炎症波及内括约肌、耻骨直肠肌、肛提肌或坐骨直肠间隙、直肠后深间隙的括约肌间、括约肌上、括约肌外的瘘管,术后容易复发。     

带涤纶套隧道血液透析导管相关感染临床分析

目的回顾性分析带涤纶套隧道血液透析导管相关感染资料,探讨感染发生时间及细菌种类,导管感染发生率,抗生素治疗效果等,为有效防治导管相关感染提供理论依据。方法选择符合导管相关感染诊断标准的患者74例（85例次）,进行抗生素肝素盐水封管及静脉滴注抗生素,有出口感染及隧道感染的还进行局部换药。结果颈内静脉导管相关感染83例次,其中81例次为导管相关血流感染,2例次为皮肤出口及隧道感染;股静脉导管相关感染2例,均为导管相关血流感染。总的导管相关感染发生天数的中位数为368导管日,四分位间距为975导管日。金黄色葡萄球菌占检出细菌总数的32.94%。导管相关感染发生率在1年内为6.5例次/1000导管日,总的导管相关感染发生率为1.29例次/1000导管日。2例患者因基础疾病死亡,其余均临床治愈。结论带涤纶套隧道血液透析导管相关感染的患者,可使用敏感抗生素导管封管及静脉滴注抗生素治疗2-3周,无效者可拔管。检出细菌种类以金黄色葡萄球菌最常见。铜绿假单胞菌较其他菌种抗生素使用时间较长,导管相关感染发生率在1年内最高,带涤纶套隧道血液透析导管相关感染重在预防。     

喉返神经隧道解剖法结合神经监测在腔镜甲状腺手术中的应用

目的:探讨喉返神经隧道解剖法结合神经监测在腔镜甲状腺手术中的应用价值。方法:回顾分析2014年11月至2018年12月施行的141例腔镜甲状腺手术,术中均采用喉返神经隧道解剖法结合神经监测技术。其中甲状腺良性结节93例,甲状腺恶性肿瘤48例;行单侧腺叶切除术52例,单侧甲状腺癌根治术44例,双侧甲状腺癌根治术4例,41例部分切除术。结果:140例手术顺利完成,1例因喉返神经横断伤转开放手术行神经对端吻合;术后9例(9/141,6.38%)暂时性神经麻痹,无永久性声音嘶哑患者。结论:腔镜甲状腺手术中采用喉返神经隧道解剖法结合神经监测技术可快速定位喉返神经,降低手术难度,提高手术安全性,利于腔镜甲状腺手术更好地在基层医院推广普及。     

肝脏面的形态学观测

对52例成人尸肝进行脏面结构观测，检出肝圆韧带隧道14例（26．9％），腔静脉管3例（5．8％），肝门右侧额外裂40例（76．9％），尾状叶下纵沟37例（71．2％），此外，对肝尾状突的长径，肝圆韧带裂，静脉韧带等结构的宽度作了测量，所得数据对解剖结构的数据化及应用解剖学和影像解剖学有参考价值。     

Conservative surgical management of catheter infections in children on peritoneal dialysis

Introduction  Major indications for peritoneal dialysis catheter removal include chronic exit-site infection (ESI) or tunnel infection (TI). No consensus on the optimal treatment of these infections in children exists. Patients  During the last 10 years, 13 patients (7 females, mean age 56 months) on peritoneal dialysis were treated for recurrent ESI (N: 4) or TI (N: 9). Staphylococcus aureus (12 patients) and Pseudomonas aeruginosa (1 patient) were isolated. All patients had a double-cuff straight Tenchkoff catheter and underwent the shaving of the external cuff, with a new tunnel tightly adherent to the catheter, and an exit-site in the opposite abdominal region. A mean follow-up of 31 months/catheter demonstrated no recurrence of ESI and TI. Discussion  Little pediatric experience with cuff shaving exists: reported catheter salvage rates are 48–100%. In our experience, good results were obtained by shaving off the external cuff and re-creating a new tunnel, with a different course, strictly adherent to the catheter. This measure seems to guarantee an effective barrier against infections, while obviating the need of the external cuff. Conclusions  Sometimes, in case of recurrent ESI or TI, the external cuff may facilitate the persistence of bacteria. A conservative surgical treatment offers good results in children.