先天性二叶主动脉瓣畸形27例临床分析

27例住院治疗的先天性二叶主动脉瓣(CBAV)临床分析,结果显示:合并心功能不全21例(78%),合并感染性心内膜炎(IE)12例(44%),与其它心血管畸形并存7例(26%).IE为CBAV的主要死亡原因.本文认为,并发IE或存在明显血流动力学障碍时外科换瓣术为CBAV治疗的根本措施,结果还提示,CBAV一旦心功能失代偿发展迅速,准确掌握外科治疗指征及尽早手术至关重要.     

Relationship between thigh skinfold measurement, hand grip strength, and trunk muscle endurance: Differences between the sexes

This study was conducted to examine the relationship between thigh skinfold measurement, hand grip strength, and trunk muscle endurance and compare this relationship in men and women. The current study included 200 healthy subjects (111 women and 89 men), with a mean age of 31.58±13.78 y. Trunk muscle endurance was evaluated with the use of curl-up, horizontal side bridge, and static back endurance tests. Significant differences were found between women and men in performance of the curl-up and horizontal side bridge tests (P< .05); however, no significant difference was found between the sexes in the static back endurance test scores (P≥.05). The investigators discerned a significant negative correlation between thigh skinfold measurements and all trunk muscle endurance tests in female patients (curl-up,r=−.501; horizontal side bridge,r=−.454; static back,r=−.479;P< .05). A rather weak correlation was found in male patients (curl-up,r=−.348; horizontal side bridge,r=−.182; static back,r=−.330;P< .05). On the other hand, no significant correlation was found between hand grip strength and trunk muscle endurance test scores in female patients (P≥.05), although a significant positive correlation was found in male patients in curl-up and side bridge test results (curl-up,r=.319; horizontal side bridge,r=.307; static back,r=.123;P< .05). The results of this study suggest that women have lower endurance test scores compared with men. The investigators detected the presence of a significant negative correlation between thigh skinfold measurement and trunk muscle endurance tests in both men and women and concluded that there is a positive significant relationship between hand grip strength, curl-up, and horizontal side bridge tests. Additional studies are needed to evaluate the relationship between muscle endurance and physical characteristics as they relate to the sex of the individual.     

A systematic review of simulation in open abdominal aortic aneurysm repair

ObjectiveConcerns about the long-term durability of endovascular aortic aneurysm repair and the requirement for explantation of stents in the case of infection demonstrate the continued need for open abdominal aortic aneurysm (AAA) repair. However, with the increased complexity and decreasing volume of open cases performed, maintenance of skills and training of younger surgeons are challenging. The aim of this review was to identify and to examine studies pertaining to open AAA simulation, with focus on methods and outcomes.MethodsWe performed a systematic review of the literature to identify primary research pertaining to open AAA repair through the use of simulators. The primary outcome was to identify predominant modes of simulator design and validated assessment tools that could demonstrate improvement in trainee skills. Secondary outcomes included identifying participant numbers needed to power studies and whether tools not validated externally contributed to the studies.ResultsThere were 309 unique papers identified, from which five papers met the inclusion criteria. The selected papers used a combination of synthetic (commercial and homemade) and cadaveric simulators. A variety of validated and nonvalidated assessment metrics were used, including Objective Structured Assessment of Technical Skills, global rating scales, and realism surveys. Three of the five papers used blinding as part of their assessments. Mean participant numbers were 30.8 ± 25.7 and with the exception of one paper consisted entirely of surgical trainees in dedicated general or vascular surgery training programs.ConclusionsSeveral options are currently available for open AAA simulation, all of which demonstrate improved scoring metrics after simulator use. Validated scoring systems, the Objective Structured Assessment of Technical Skills in particular, were most frequently used to deliver objective results. Whereas junior trainees derive the most benefit, senior trainees also showed significant improvements, demonstrating that simulation benefits all levels of surgical trainees. Low numbers of participants were sufficient to achieve statistical benefit within individual studies.     

Upregulation of Systemic Inflammatory Pathways Following Anterior Cruciate Ligament Injury Relates to Both Cartilage and Muscular Changes: A Pilot Study

In conjunction with cartilage breakdown, muscle maladaptation including atrophy and increased fibrosis have been observed in the quadriceps following anterior cruciate ligament (ACL) injury. Previously observed upregulated muscle-related proteins in the synovial fluid following ACL rupture allude to cellular communication between the joint and muscle. Therefore, the purpose of this study was to determine whether muscle-related analytes are differentially expressed in the serum. Sixteen patients with an acute ACL tear participated in this IRB-approved study. Serum was obtained at two different time points at a mean of 6 and 14 days post-injury, and serum was analyzed by a highly multiplexed assay of 1,300 proteins. Pathway analysis using DAVID was performed; genes included met three criteria: significant change between the two study time points using a paired t test, significant change between the two study time points using a Mann–Whitney non-parametric test, and significant Benjamini post hoc analysis. Twelve analytes significantly increased between time points. Proteins chitinase-3-like protein 1 (p = 0.01), insulin-like growth factor binding protein 1 (p = 0.01), insulin-like growth factor binding protein 5 (p = 0.02), renin (p = 0.004), and lymphotoxin alpha 1: beta 2 (p = 0.03) were significantly upregulated in serum following acute ACL injury. The current results confirm the inflammatory pattern previously seen in the synovial fluid thought to play a role in the progression of post-traumatic osteoarthritis after ACL injury, and this data also provides further insights into important communication between the joint and quadriceps group, whose function is important in long term health. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:387-392, 2020