Advancement in endovascular therapy of aortoiliac occlusive disease / 中华外科杂志

Aortoiliac occlusive disease (AIOD) refers to the stenosis and occlusion of the distal abdominal aorta and(or) bifurcation of the aortoiliac artery,which is mainly caused by atherosclerosis,leading to pelvic and lower limb ischemia.Open surgery has always been the main treatment for complex AIOD.However,in recent years,with the development of endovascular surgery technologies and medical instruments,its treatment concept has been greatly changed.More and more clinical evidence has proved that the long-term efficacy of endovascular therapy is not inferior to that of traditional open surgery,so minimally invasive endovascular therapy has become the preferred treatment for AIOD.

Advances on the study of movable artificial vertebral body / 中国骨伤

At present, artificial vertebral implants have proven to be effective in the treatment of spinal tumors, infections, fractures and other diseases. However, the fusion artificial vertebral body can cause adjacent intervertebral joint degeneration and loss of original physiological curvature and activity. The movable artificial vertebral body can, to some extent, restore the normal physiological movement and reduce biomechanical changes of the spine, reducing the occurrence of complication. The design of movable artificial vertebral body is to equip movable device when the basis of reliable stability is obtained. According to its principle it can be divided into ball socket joint or elastic deformation. However the overall design of movable artificial vertebral body needs further improvement. Traditional mechanical processing methods are difficult to process complex prostheses and the agreement rate between traditional produced prostheses and lesions was low. While the emerging 3D printing technology can achieve individualized improvement of prosthesis, its slow rate and high cost need to be improved. The materials of movable artificial vertebral body includes metal, ceramics, biomaterials, high polymer materials and so on. Titanium alloy is the main material in metal materials, which is widely used, but its modulus of elasticity is still far from that of human bone and it lacks ideal bone fusion. Ceramic materials are rich in variety but fragile and poor in wear resistance. Biomaterials include autogenous bone, allogeneic bone, etc., with limited source and complicated operation. There are many kinds of polymer and biodegradable materials which obtain excellent and ideal properties. But their properties and applications need to be further studied. The movable artificial vertebral body still needs to be promoted and developed. The clinical experimental data is still insufficient, and long-term curative effect needs to be further observed and studied. This paper reviews the development, advantages, design, processing and materials of movable artificial vertebral bodies and provides useful reference for optimization design, processing and clinical application of movable artificial vertebral bodies.

The diagnosis and therapy of subclinical pituitary adenoma apoplexy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, diagnosis and treatment in patients with subclinical pituitary adenoma apoplexy (SPAA).</p><p><b>METHODS</b>A retrospective analysis of all operated patients with SPAA was performed. There were 50 male and 80 female patients, ranging from 16 to 65 years (average 39 years). Endocrinological hormones were measured in all patients pre- and post-operatively, and pituitary imaging was obtained by CT scan, MRI or both.</p><p><b>RESULTS</b>Transsphenoidal surgery was achieved in 89 patients, and transcranial surgery was achieved in 41 patients. There was no operative mortality. PRL adenomas were the most common tumor type (56.2%). SPAA usually occurred in patients with big or giant adenomas (97%). Hypertension and diabetes mellitus were the possible predisposing factors. Postoperative follow-up ranged from 0.5 to 6 years (mean 3.2 years). Tumor recurrence happened in 8 patients. Only 12 patients required radiotherapy with tumor residual (4 cases) and recurrence (8 cases) after surgery. Long-term thyroid or steroid hormone replacement was necessary in 25% and 20% of patients, respectively, and long-term desmopressin therapy was necessary in 1% of patients.</p><p><b>CONCLUSIONS</b>The incidence of SPAA was higher than acute pituitary apoplexy. PRL adenomas are the most common tumor type. MRI is the best investigative modality of choice. Transsphenoidal surgery is a safe and effective method. The rate of long-term endocrinological hormones replacement therapy of SPAA is lower than acute pituitary apoplexy, and the prognosis of SPAA is better than acute pituitary apoplexy. Radiotherapy is indicated if the tumor residual or recurrence are confirmed by CT or MRI after surgery.</p>