Machining with a Precision Five-Axis Machine Tools Created by Combining a Horizontal Parallel Three-Axis Motion Platform and a Three-Axis Machine Tools

Five-axis working machines are applied in the high-precision machining of complex convex surfaces. Therefore, this study integrated a horizontal parallel three-axis motion platform and a three-axis machine tools to create a reconfigurable precision five-axis machine tools (RPFMT). A DELTA OPEN computer numerical control controller was used as the control system architecture. A human–machine interface and programmable controller were incorporated into the developed tool to achieve automatic online measurement. A suitable cutting tool was selected to calculate the five-axis NC machining code for a complex convex surface. The NC codes were input into the LabVIEW software for five-axis postprocessing conversion. A concave workpiece was cut through rough and finishing machining to verify the accuracy of the produced RPFMT.     

Preparation of Open Porous Hyaluronic Acid Scaffolds for Tissue Engineering Using the Ice Particulate Template Method

A novel method to fabricate highly interconnected porous hyaluronic acid (HA) scaffolds with open surface pore structures was developed by using embossed ice particulates as a template. HA sponges were cross-linked by water-soluble carbodiimide (WSC) and the optimal cross-linking condition was analyzed by infrared spectroscopy. Cross-linking with 50 mM WSC in a 90% (v/v) ethanol/water solvent mixture assured the highest degree of cross-linking and most stable structure and, therefore, was used to cross-link the HA sponges. Observation with a scanning electron microscope showed that the HA scaffolds had funnel-like porous structures. There were large, open pores on the top surfaces and inner bulk pores under the top surface of the funnel-like HA sponges. The inner bulk pores were interconnected with the large, top surface pores and extended into the whole sponge. The pore morphology and density of the large, top surface pores were dependent on the dimension and density of the ice particulates. The size of the inner bulk pores was dependent on the freezing temperature. The funnel-like pore structures of the HA sponges facilitated cell penetration into the inner pores of the sponges and resulted in homogenous cell distribution in the sponges.     

Open versus Laparoscopic Roux-en-Y Gastric Bypass: A Comparative Study of Over 25,000 Open Cases and the Major Laparoscopic Bariatric Reported Series

Background: Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative. Methods: 16 highly experienced "open" bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature. Results: In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in <30 days was 0.7%, deaths 0.25%, and leaks 0.4%. Average length of stay was 3.4 days, and return to usual activity 21 days. Small bowel obstruction was significantly higher with the LRYGBP. Surgical equipment costs averaged ∼$3,000 less for "open" cases. LRYGBP had an added expense for longer operative time. This more than made up for the shorter length of stay with the laparoscopic approach. Conclusions: The higher cost, higher leak rate, higher rate of small bowel obstruction, and similar long-term weight loss results make the "open" RYGBP our preferred operation. If the incision is taken out of the equation (i.e. use of the LSI), the significant advantages of the open technique become even more obvious.     

Alterations of hemostasis after laparoscopic and open surgery

Background: After tissue injury caused by trauma or surgery, alterations of hemostasis are observed and there is a risk for postoperative thromboembolic complications. Laparoscopic surgery, by causing limited tissue injury, appears to be associated with a lower risk for thromboembolism than open surgery. We conducted a prospective randomized study in order to detect potentially existing differences in activation of coagulation and fibrinolytic pathways between open and laparoscopic surgery.

Methods: Forty patients suffering from chronic cholelithiasis were randomly assigned to undergo open (group A n = 20) or laparoscopic cholecystectomy (group B n = 20) by the same surgical and anesthesiology team. Demographic data were comparable. Blood samples were taken (a) preoperatively, (b) at the end of the procedure, (c) 24 h postoperatively and (d) 72 h postoperatively. The following parameters were measured and compared within each group and between groups: platelets (PLT), soluble fibrin monomer complexes (SFMC), fibrin degradation products (FDP), D-dimers (D-D), fibrinogen (FIB), activated partial thromboplastin time (APTT), prothrombin time (PT). Thrombin–antithrombin III complexes (TAT) were measured at 24 and 72 h postoperatively. Prothrombin fragment 1 + 2 (F1 + 2) was measured at 24 and 72 h postoperatively in 11 patients of group A and 13 patients of group B, respectively.

Results: Demographics were comparable between groups. Immediately postoperatively, TAT and F1 + 2 were significantly higher in group A as compared to group B (p < 0.05). They also increased significantly postoperatively as compared to preoperative levels within each group (p < 0.05).

D-dimers were significantly higher in group A as compared to group B (p < 0.01) immediately postoperatively. D-dimers also increased significantly postoperatively in group B as compared to preoperative levels (p < 0.001).

FIB decreased slightly in both groups at 24 h postoperatively but there was a significant increase in group A as compared to group B (p < 0.01).

SFMC were detected twice in group A and only once group B.

FDP levels over 5 μg/ml were detected more often in group A than in group B (p < 0.05). No patient from either group suffered thromboembolism or abnormal bleeding as a postoperative complication.

Conclusions: Open surgery as compared to laparoscopic procedures leads to activation of the clotting system of a higher degree. Although of a lower degree, hypercoagulability is still observed in patients undergoing laparoscopic surgery and, therefore, routine thromboembolic prophylaxis should be considered.     

Use of Anterior Tibial Translation in the Management of Patellofemoral Pain Syndrome in Older Patients: A Case Series

Abstract

The currently most plausible pathophysiologic theory for the etiology of pain in patients with patellofemoral pain syndrome involves abnormal mechanical stress to the patellofemoral joint. At this time, there is no consensus nor is there a sufficient body of research evidence to guide management of patients with patellofemoral pain syndrome. This means that clinicians have to rely to some extent on a mechanism-based approach. Decreased quadriceps flexibility and muscular endurance have been identified as possibly relevant impairments in patients with patellofemoral pain syndrome. Surgical anterior translation of the tibial tuberosity with the Maquet procedure has a proven positive effect on patellofemoral contact forces. This case series studied the effects of a physical therapy management approach that included translating the tibia anteriorly while performing open kinetic chain quadriceps training and manual muscle stretching of the rectus femoris muscle. Outcome measures used included the numeric pain rating scale and goniometric measurement of rectus femoris muscle length in a standardized test position. Anterior tibial translation reduced pain during both interventions and also produced clinically and statistically significant pre- to post-intervention improvements in pain during manual muscle testing and rectus femoris length testing in addition to statistically significant pre- to post-intervention increases in rectus femoris muscle length. The results of this quasi-experimental study indicate the need for future experimental study. Future study should include functional in addition to impairment-based outcome measures, standardization and blinding for the rectus femoris muscle length test (should future researchers chose to again use this outcome measure), a pilot study establishing reliability of outcome measures collected by the therapist, younger subjects, and the collection of longer-term outcome data.     

Full-thickness rectal biopsy in children suspicious for Hirschsprung's disease is safe and yields a low number of insufficient biopsies

Introduction

The diagnosis of Hirschsprung's disease (HD) relies on the histological demonstration of aganglionosis in the bowel wall. Biopsies may be obtained by rectal suction biopsy (RSB) or by transanal full-thickness excision biopsy (FTB). The objective of the present study was to evaluate the frequency of complications and inconclusive biopsies after FTB in children referred with suspicion of HD. The secondary objective was to calculate the frequency of proven aganglionosis.

Association of genetic polymorphisms with personality profile in individuals without psychiatric disorders

Objective

Population-based twin studies demonstrate that approximately 40–50% of the variability in personality dimensions results from genetic factors.This study assessed selected polymorphisms in the COMT Val158Met, MAOA 3′VNTR, 5HTTLPR, 102T/C 5-HT2A, DAT 3′VNTR and DRD2 exon 8 genes and evaluated their association with personality profiles, anxiety levels, and depressiveness in healthy subjects.

Methods

This study included 406 unrelated (mean age 38.51 years), mentally and somatically healthy Caucasian subjects of Polish origin. The prevalence of the gene variants mentioned above and their association with personality profiles, anxiety levels, and depressiveness was assessed using the Temperament and Character Inventory, NEO Five-Factor Inventory, Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory.

Results

The effects of the 5HTTLPR gene on the s/s genotype and empathy (C2) were lowest in the entire group. The effects of gender, age and the HT2A gene for the T/T genotype and attachment (RD3) were highest in women.The effects of gender, age and the DAT gene on the 9/9 DAT genotype, compassion (C4) and cooperativeness (C) were lowest in women. The effects of gender, age and the COMT gene on the Met/Met genotype and neuroticism (NEU) NEO-FFI were also lowest in women.

Conclusions

Our results suggest considerable influence of individual genes on the formation of personality traits.     

柳豆叶治疗开放性骨折感染性创面40例临床总结

应用单味中草药提取物—柳豆叶治疗开放性骨折感染创面的最大特色是快速促进创面微血管衍生肉芽组织生长,能在裸露的骨骼上长出“骨的肉茅岛”.是临床治疗合并骨骼裸露这一类复杂感染创面的简单实用、疗效显著、极富中医伤科特色的外用药物.经系列实验表明,该药的作用机理主要有:1.抑菌;2.增强机体非特异性免疫系统机能,尤其是巨噬细胞的功能有关。     

骨外固定器固定加柳豆叶制剂外敷治疗胫腓骨开放性骨折骨裸露合并严重感染的临床观察

应用自制体外钢板固定和柳豆叶外敷的方法治疗胫腓骨开放性骨折感染、骨裸露不连接这一类复杂创面4例,获得感染创面和骨折良好愈合的效果。疗效的根源在于该疗法的合理性。1.体外钢板的应用解决了骨折端的固定问题,患肢可早期下床活动,骨折端接受适当的压应力是骨痴生长的重要因素之一;2.柳豆叶外用促进了骨裸露创面的愈合,且具有促进骨痂生长的药理作用。     

Effect of Laparoscopic versus Open Gastric Bypass Surgery on Postoperative Pain and Bowel Function

Background: This study was designed to assess postoperative pain and bowel function in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) performed either by open or laparoscopic technique. Methods: We prospectively studied patients scheduled for RYGBP between July 2002 and June 2003. Patients were assigned to the laparoscopic or open procedure by one surgeon. All patients received patient controlled analgesia (PCA) with intravenous morphine and rectal naproxen 500 mg every 12 hours. Postoperative analgesia was assessed daily using a visual analog scale (VAS) at rest, on walking and coughing. The amount of morphine used during the first 48 hours, the time of return of gastrointestinal motility and the time until first oral food intake were recorded. Results: 53 patients were enrolled and studied (laparoscopic group n=33, open group n=20). Patients undergoing laparoscopic RYGBP requested less morphine (P=0.0001) and showed lower VAS pain scores than patients undergoing open RYGBP. The return of bowel movement in the laparoscopic group occurred 1 day earlier than in the open group (P=0.01). The time to first passage of gas (P=0.01) and oral food intake (P=0.06) was shorter after laparoscopic than after open RYGBP. Patients in the laparoscopic group were discharged 1? days earlier than patients in the open group (P=0.01). Conclusion: The laparoscopic RYGBP operation was associated with less postoperative pain and morphine consumption than the open RYGBP, thereby facilitating an earlier recovery of intestinal motility.