Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of abdominal apoplexy, arousing clinic doctors’ attention to this disease. Methods Two hundred and thirty-two domestic cases with abdominal apoplexy were analyzed retrospectively and related literatures in and abroad were reviewed. Results Abdominal apoplexy occured mainly patients aged 45 to 70 years in China and 50 to 59 years abroad. It was more common in women than in men, and male to female ratio was 1 to 1.4 in China and 1 to 2.5 abroad. There were various etiological factors to this disease. It was usually abrupt, with complicated clinical manifestation. The main symptoms were abdominal pain and hemorrhagic shock with nauseat, vomiting and diarrhea. Preoperative diagnosis rate of abdominal apoplexy was very low, literatures showed only 1.7% in China and 2.3% abroad. There was no particular evaluation approach. Abdominal cavity puncture, combined with CT, ultrasound, MRI and selective abdominal angiography helped to raise diagnosis rate. Overall postoperative mortality was 7.3%. In 7.8% cases, no bleeding site could be found during laparotomy, and the mortality rate was 41.2%. Conclusion Abdominal apoplexy is rarely seen in clinic with low preoperative diagnosis rate and poor prognosis. The first choice management is exploratory laparotomy, and the key is to ligate ruptured vessels.
We reported a 65-year-old female who was admitted to our institute with "recurrent subxiphoid pain accompanied by dyspnea for more than 10 days". Electrocardiogram examination suggested acute extensive anterior ST segment elevation myocardial infarction. Preoperative transthoracic echocardiography suggested ventricular septal rupture. The patient was planned for the repair of ventricular septal rupture with cardiopulmonary bypass. The formation of left ventricular aneurysm was diagnosed by intraoperative transesophageal echocardiography (TEE). The surgeon decided to abdopt the modified incision of left ventricular approach guided by TEE, which greatly improved the prognosis of the patient. The surgery duration was 197 min, aortic cross-clamping time was 56 min, cardiopulmonary bypass time was 69 min, and the patient was safely admitted to ICU after the surgery. Extubation was performed on the first day postoperatively, and the intra-aortic balloon pump support was retreated on the second day postoperatively. Postoperative echocardiography showed that no obvious residual shunt was observed after ventricular septal repairment and ventricular aneurysm resection. The patient was discharged on the 12th day after the surgery. Additionally, the mental condition was good and daily activities were not limited within 6 months postoperatively.
Unicompartmental knee arthroplasty (UKA) has a long history and has many advantages in some aspects over total knee arthroplasty (TKA) for patients with suitable indications, but it has not been established as a treatment at the same level with TKA. Therefore, 80 members of the British Association for Surgery of the Knee (BASK) and the European Knee Society (EKS) were invited to attend a joint meeting with the aim of creating an evidence-based consensus statement on UKA, in London, UK (December 2019). A formal consensus process was undertaken at the meeting incorporating a multiple round Delphi exercise, with group discussion of areas of agreement and disagreement between rounds. Five consensus statements were issued: ① UKA should be offered as a successful alternative to TKA in patients undergoing arthroplasty who meet agreed indications. ② When consenting a patient for UKA, information including the benefits and risks that are specific to UKA, should be tailored to and discussed with the individual patient. ③ Evidence suggests that surgeons should avoid low-volume use of UKA to optimise outcomes for their patients. ④ Surgeons should use the contemporary evidence-based indications and contraindications for medial UKA. ⑤ Knee arthroplasty surgeons should have exposure to and training in UKA. On the basis of full study of the consensus, combined with the Expert Consensus on Perioperative Management of Unicompartmental Knee Arthroplasty in China in 2020, this paper elaborates the meaning of the final evidence-based consensus for clinicians’ reference.
目的 比较股骨近端抗旋髓内钉（PFNA）与动力髋螺钉（DHS）两种方法内固定治疗高龄股骨粗隆间骨折的疗效。 方法 2007年1月－2011年1月分别采用PFNA、DHS治疗高龄股骨间粗隆骨折（EvansⅠ～Ⅳ型）共68例，其中PFNA组36例，平均年龄81.5岁；DHS组32例，平均年龄82.3岁。两组患者在年龄、性别、骨折分型、合并症以及受伤至手术时间方面比较差异均无统计学意义（P＞0.05），有可比性。 结果 术后68例患者均获随访，随访时间6～26个月。与DHS组比较，PFNA组手术时间短、术中出血少，差异有统计学意义（P＜0.05）；PFNA组骨性愈合时间短，但两组差异无统计学意义（P＞0.05）。术后DHS组出现1例髋内翻、1例拉力螺钉切出股骨头颈，PFNA组出现1例主钉退钉，两组术后并发症发生率比较差异有统计学意义（P＜0.01）。术后1年PFNA组髋关节Harris评分显著高于DHS组，差异有统计学意义（P＜0.01）。 结论 PFNA与DHS两种固定方法的骨性愈合时间短、术后并发症少、髋关节功能恢复好，是治疗股骨粗隆间骨折的良好方式，尤其是PFNA能减少手术时间和术中出血量，手术创伤小，对高龄且不能耐受较大手术者可作为一种首选术式。
ObjectiveTo construct a hepatocellular carcinoma (HCC) cell line stably transfected with linamarase (lis) gene from cassava, and to study its biological characteristics. MethodsLis DNA was amplified from cassava by PCR and cloned into the pcDNA3.1(+) plasmid. Then the recombinant plasmid pcDNA3.1/lis was transfected into human HCC HepG2 cell line using lipofectamineTM 2000 and G418 selection. The stably transfected cell lines HepG2/lis was identified by immunofluorescence, RT-PCR, and Western blot. The enzyme activity of lis in cells was assayed by Lambert method. The characteristics of the new cell lines were checked by several methods: the cell growth curve was observed by MTT, cell cycle was analyzed by flow cytometry, and characteristics of tumor formation in vivo were detected in nude mice. ResultsLis from the cassava could stably integrate into eukaryotic cells, and package the same protein as lis with β-glucosidase activity. The stable integration of lis in cells did not interfere with cell morphology, growth characteristics, cell cycle, and tumorigenesis in vivo significantly. ConclusionsA new HCC cell lines transfected with lis is successfully established, which may lay an experimental foundation for the study of HCC treatment by using lis suicide gene system in future.
The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in acetabular reconstruction of total hip arthroplasty (THA). The purpose of this study was to describe the basic stress pathway to provide evidence for clinical acetabular reconstruction guidance of THA. A subject-specific finite element (FE) model was developed from CT data to generate 3 normal hip models and a convergence study was conducted to determine the number of pelvic trabecular bone material properties using 5 material assignment plans. In addition, in the range of 0 to 20 mm above the acetabular dome, the models were sectioned and the stress pathway was defined as two parts, i.e. 3D trabecular bone stress distribution and quantified cortical bone stress level. The results showed that using 100 materials to define the material property of pelvic trabecular bone could assure both the accuracy and efficiency of the FE model. Under the same body weight condition, the 3D trabecular bone stress distributions above the acetabular dome were consistent, and especially the quantified cortical bone stress levels were all above 20 MPa and showed no statistically significant difference (P>0.05). Therefore, defining the basic stress pathway above the acetabular dome under certain body weight condition contributes to design accurate preoperative plan for acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants.
ObjectiveTo systematically review the effects of unicompartmental keen arthroplasty (UKA) and total keen arthroplasty (TKA) in patients with unicompartmental osteoarthritis of the keen. MethodsWe electronically searched PubMed, MEDLINE (Ovid), ProQuest, EBSCO, The Cochrane Library (Issue 10, 2014), EMbase, CNKI, VIP, CBM and WanFang Data from inception to November 2014, to collect randomized controlled trials (RCTs) and cohort studies of UKA versus TKA for patients with unicompartmental osteoarthritis of the keen. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 6 RCTs and 6 cohort studies involving 940 keens were included. The results of meta-analysis indicated that patients underwent UKA enjoyed a quicker rehabilitation to achieve a flexion of 90° (RCT:P<0.05; cohort study:SMD=-1.70, 95%CI -2.07 to -1.34, P<0.000 01), had better range of motion (cohort study:SMD=0.59, 95%CI 0.41 to 0.78, P=0), and were less likely to get DVT (RCT:RR=0.31, 95%CI 0.12 to 0.82, P=0.02), but the patients underwent UKA were more likely to have a revision (RCT:RR=7.59, 95%CI 1.76 to 32.85, P=0.007). The keen scores of the UKA group were similar to the TKA group (RCT:P=0.626; cohort study:MD=1.78, 95%CI -0.09 to 3.65, P=0.06). ConclusionCurrent evidence shows that, compared with patients underwent TKA, patients underwent UKA have a quicker rehabilitation and fewer rates of DVT, and are more likely to have a revision. The medium to long-term follow up result of keen scores in both groups was equivalent. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the safety and feasibility of day surgery program of surgical treatment of mild to moderate gluteal muscle contracture. Methods We retrospectively analyzed the clinical data of the patients who received invasive surgery to release gluteal muscle contracture in West China Hospital of Sichuan University between July 2021 and July 2022. Postoperative telephone follow-up was conducted on the 2nd, 3rd, and 30th day after surgery. The basic conditions, surgery duration, intraoperative blood loss, anesthesia duration, pain score 6 h after surgery, hospitalization expenses, postoperative complications and patient satisfaction were observed. Results A total of 44 patients, 17 males and 27 females, aged 18-51 years with a median age of 30.5 years, diagnosed as bilateral mild to moderate gluteal muscle contracture, were included in this study. All patients except one with unilateral surgery were successfully finished the bilateral surgeries and discharged as planned. The mean surgery duration was (71±13) min, intraoperative blood loss was (20±17) mL, anesthesia duration was (118±21) min. All patients complained mild pain or no pain (Numerical Rating Scale score≤3) except one patient received pain rescue (Numerical Rating Scale score=5) 6 h after surgery. The average hospitalization expenses was (10021.55±1142.10) yuan. Three patients complained the poor wound healing. All patients replied a normal life and work with a good satisfaction and without any severe complications by telephone follow up on the 30th day postoperatively. Conclusion Surgical treatment of mild to moderate gluteal muscle contracture is safe, effective and feasible in the day surgery mode.