Application of passive image-free navigation system for total knee arthroplasty / 中国骨伤

Total knee arthroplasty(TKA) has been the final clinical treatment of knee osteoarthritis at the final stage, postoperative limb and prosthesis alignment restoration directly affect clinical effect. In recent years, computer-assisted surgery has been used in TKA and obtained satisfied results. There paper has investigated that the use of computer-assisted systems could improve soft tissue balance after TKA, improve accuracy of installation of prosthesis, recover limb alignment and decrease intro-blood loss, postoperative fat embolism. Although computer-assisted navigation is not mainstream, with the continuous improvement of technology and innovation, the computer-assisted surgery could exert a more important role in TKA, and considerably beneficial effect on improvement of postoperative clinical effects.

Effect of nutritional intervention on quality of life of patients with head and neck cancer treated by radiotherapy / 肿瘤研究与临床

Objective To explore the effect of nutritional intervention on nutritional status,weight,physical strength and quality of life of patients with head and neck cancer treated by radiotherapy.Methods 77 patients with head and neck malignant tumors treated by radiotherapy were divided randomly into two groups,nutritional intervention group (NI) had 38 cases and control group (CG) had 39 cases.The status of nutrition,weight,physical strength and quality of life before radiotherapy,the end of radiotherapy and 3 months after radiotherapy in two groups were compared.Results The nutritional risks in two groups had no difference before radiotherapy.At the end of radiotherapy,the assessment score of the nutrition in NI was significantly lower than that in CG [(5.41±2.36) scores vs.(6.92±2.74) scores,t =4.935,P ＜ 0.05],and the average weight in NI was significantly higher than that in CG [(57.07±8.01) kg vs.(46.53±9.82) kg,t =2.670,P ＜ 0.05].At the end of radiotherapy and 3 months after radiotherapy,the physical strength in NI [(57.07± 8.01),(41.48±7.92) kg] were significantly higher than those in CG [(36.43±6.48),(37.94±8.03) kg] (t =2.670,P =0.021;t =2.361,P =0.037);the index of quality of life in NI [(51.37±6.56),(52.07±6.23) scores] were also significantly higher than those in CG [(46.93±6.98),(48.13±7.12) scores] (t =2.292,P =0.041;t =2.076,P =0.037).Conclusion Nutritional intervention can effectively maintain the nutritional status of head and neck cancer patients with radiotherapy,and improve continuously the physical strength and the quality of life.

Study on the wound healing efficacy of negative pressure wound therapy combined with topical oxygen therapy on the traumatic chronic wounds / 医学研究生学报

Objective To evaluate the wound healing efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy ( TOT ) on the traumatic chronic wounds , and to explore new conception and method for traumatic chronic wounds . Methods Sixty-four patients with traumatic chronic wounds were randomized into two groups ( n=32 ) .Patients in the control group were treated by NPWT , and those in the intervention group were treated by NPWT and NPWT with TOT 3L/min.The treatment time lasted 12 days, and the dressing and tubes were changed every three days in the two groups .After 12 days, all the pa-tients were treated by standard moist therapy or surgery until healing or three months .Indicators of observation: The pressure ulcer scale for healing (PUSH) scores and granulation covered rate at 0, 3, 6, 9, and 12 days were measured, and healing rate and healing time during three months were calculated in the two groups . Results The PUSH scores were declined with intervention time during 12 days in the two groups , indicating the treatment was effective , but there was no significant difference between the two groups ( P>0 .05 ) .The granulation covered rate was increased with intervention time , and the granulation covered rate was higher in the intervention group than in the control group(P<0.001).The healing rate was higher in the intervention group than in the control group (87.50%vs 59.38%, P<0.05 ).The healing time of 14 days was shortened in the intervention group compared with the control group (P<0.001). Conclusion NPWT combined with TOT is an effective and feasible method for complicated traumatic chronic wounds , which can en-hance granulation growth , rise healing rate and shorten healing time .

The 15-Year Evolution of the Thoracoscopic Anterior Release: Does It Still Have a Role?

STUDY DESIGN: Retrospective. PURPOSE: To determine how the indications for anterior thoracoscopic release and fusion have evolved over time. OVERVIEW OF LITERATURE: Anterior release was commonly performed to correct severe spinal deformities before the advent of pedicle screw fixation. The thoracoscopic approach significantly reduced the morbidity, as compared to open thoracotomy procedures. METHODS: We reviewed charts and radiographs of pediatric spinal deformity patients who underwent thoracoscopic release/fusion for their deformity from 1994 to 2008. Indications for the thoracoscopic procedure were assigned to one of the following categories: hyperkyphosis, large/stiff scoliosis, crankshaft prevention, and 'other'. We analysed indications grouped in 3-year intervals to determine how the indications for this procedure evolved over the past 15 years. RESULTS: One hundred and thirty-eight patients (mean age, 15 years; range, 2-28 years) underwent the procedure, with 160 identified indications. The frequency of thoracoscopic anterior release/fusion decreased after peaking in the years 2000-2002. Initially, hyperkyphosis was the most frequent indication (15/33, 45%; 1994-1996), but declined to an intermittent indication since 2006. The use of thoracoscopy to prevent crankshaft has also declined, but remains an indication for the most immature cases (2/17, 12%; 2006-2008). Severe or rigid scoliosis is currently the most common indication for thoracoscopic release/fusion at our center (11/17, 65%; 2006-2008). CONCLUSIONS: The indications for a thoracoscopic anterior release/fusion has evolved with our increased understanding of this procedure and improved posterior fixation with pedicle screw instrumentation. Thoracoscopy in select spinal deformity patients still has an important role despite its less frequent use, as compared to the past decade.

Using genomics to improve fruit quality

New fruit varieties are needed to satisfy consumers, and the industry is facing new challenges in order to respond to these demands. The emergence of genomic tools is releasing information on polymorphisms that can be utilized to expedite breeding processes in species that are difficult to breed, given the long periods of time required to get new varieties. The present review describes the current stages of the ongoing efforts that are being taken to apply these technologies to obtain varieties with improved fruit quality in species of the family Rosaceae.

Expansão rápida da maxila assistida cirurgicamente: revisão sistemática sobre as alterações dentárias, esqueléticas e a estabilidade / The amount of dental and skeletal expansion and stability aftersurgically assisted rapid maxillary expansion: a sistematic review

Objetivo: nesta revisão sistemática objetivou-se responder o quanto ocorre de efeito esquelético, alveolar e inclinação dos molares, imediatas e a longo prazo, descritas para a expansão rápida da maxila assistida cirurgicamente (Ermac). Método: selecionou-se em bases de dados as pesquisas clínicas cujas avaliações incluíram-se telerradiografi as em norma frontal póstero-anterior (PA), modelos de estudo e tomografi as. Realizaram-se buscas em bases de dados eletrônicas (PubMed, MedLine, MedLine in process, Cochrane Database of Systematic Reviews, Bireme, Lilacs, SciELO) e de forma manual. Resultados: para a seleção inicial incluíram-se os títulos e resumos pertinentes aos temas. Após a leitura completa dos textos, realizada por dois pesquisadores, apenas 14 artigos foram selecionados por cumprirem todos os critérios de seleção avaliados. Conclusão: pode-se observar que após a Ermac há certo grau de recidiva, contudo, sem ocorrência de recidiva total para as medidas esqueléticas e medidas dentárias estudadas.

Objective: this systematic review aimed to answer how much expansion occurs skeletal changes, alveolar changes, and molars tip, immediate and long term described for the surgically assisted rapid palatal expansion (Sarpe). Method: the clinical studies searched must included records as posteroanterior cephalometric (PA), dental casts and computer tomographic (CT) scanning. The searches were performed in databases (PubMed, MedLine, MedLine in process, Cochrane Database of Systematic Reviews, Bireme, Lilacs, SciELO) and manual. Results: the initial selection included the titles and abstracts relevant themes. After the full reading of the texts for two researches, only 14 articles were selected by meet all of the methodological criteria evaluated. Conclusion: it can be observed that after Sarpe there is a certain degree of relapse, however without total relapse for analyzed dental and skeletal measures.

Avaliação da intensidade das rugas periorbitais por processamento digital de imagens: um estudo de validação / Periorbital wrinkle severity evaluation using digital image processing: a validation study

Introdução: Dermatologistas podem avaliar a qualidade da pele de um paciente através de suas rugas faciais. Existem diversos métodos descritos para quantifi car as microelevações e rugas da pele. Objetivo: O objetivo deste estudo é utilizar a tecnologia de processamento de imagem para avaliar a área das rugas e sua correlação com a avaliação do dermatologista. Material e Métodos: Cento e setenta e um voluntários selecionados aleatoriamente, com idades variando de 18 a 69 anos, de ambos os sexos, com pele tipos II-IV de Fitzpatrick e I-IV de Glogau, participaram deste estudo. Fotografi as digitais foram tiradas sob duas condições diferentes: com as rugas relaxadas (RR) ou contraídas (RC). Foram tiradas pelo menos seis fotografi as para determinar a reprodutibilidade de cada método. Seis dermatologistas avaliaram as fotografi as e marcaram as rugas dos pacientes com uma caneta digital. Determinou-se a intensidade das rugas por três diferentes métodos de processamento de imagens. A avaliação quantitativa da intensidade das pregas cutâneas e a consistência inter e intramétodo foram estabelecidas e comparadas à avaliação manual. Resultados: A variabilidade dos dermatologistas foi de 61,49%. A concordância intratestes variou de 4,4 a 31%. O método do gradiente obteve os melhores resultados e detectava as condições das rugas (p < 0,001), tendo apresentado também uma correlação positiva com a avaliação manual. Conclusões: As rugas periorbitais foram identifi cadas. Os dermatologistas demonstraram precisão interna, mas baixa exatidão. O processamento digital do operador de Sobel é um instrumento válido e confi ável para a avaliação quantitativa de rugas.

Introduction: Dermatologists get an idea of how old a patient is by looking face's wrinkles. Different methods exist to quantify skin microrelief and wrinkles. Objective: To use imaging process technology to assess the wrinkle area and its interrelation with dermatologist determination. Material and methods: One hundred seventy-one volunteers, randomly selected, aged 18­69 years, both gender, Fitzpatrick skin type II­IV, with Glocau I­IV were selected. Digital photography was obtained. Two different conditions, relaxed or contract wrinkle condition (CWC), and at least six repeated pictures for repeatability capacity of each method. Six participating dermatologists evaluated the pictures and ascertained patients' wrinkle using a digital pen. Wrinkle intensity was done by three different image processing methods. Quantitative assessment of facial skin folds intensity, and inter- plus intra-method consistency were determined and compared to manual evaluation. Results: Dermatologists variability was 61.49%. Intra-tests agreement varied from 4.4 to 31%. The gradient method had the best results and could detect the wrinkle conditions (p < 0.001). Also, this method had a positive correlation with the manual assessment. Conclusions: Periorbital wrinkles could be determined. Dermatologists had internal precision but low accuracy. Sobel Operator digital processing is a valid and reliable instrument for quantitative wrinkle assessment.

Clinical Efficacy of Body Mass Index as Predictor of In Vitro Fertilization and Embryo Transfer Outcomes

The aim of this study was to evaluate the clinical efficacy of body mass index (BMI) as a predictor of in vitro fertilization and embryo transfer (IVF-ET) outcomes. Two hundred twenty-three IVF-ET cycles in 164 patients under 37 yr using GnRH agonist long protocols were included in this retrospective study. All of the selected cases were divided into two groups by a cutoff of 24 kg/m2 and these two groups were compared in regard to the outcomes of IVF-ET. There were no significant differences between group 1 (BMI or = 24 kg/m2) in age, basal serum FSH level, estradiol (E2) level and endometrial thickness on hCG day, number of retrieved oocytes and transferred embryos. However, higher doses of gonadotropins were used in group 2 (30.8+/-12.7 ampoules vs. 35.4+/-15.3 ampoules, p=0.051). The clinical pregnancy rate was significantly lower in group 2 (25.9% vs. 10.5%, p=0.041) and implantation rate tended to be lower in group 2 (12.7% vs. 6.8%, p=0.085). BMI > or = 24 kg/m2 can be a candidate prognosticator of IVF-ET outcomes.

Initial experience of image integration system guiding catheter ablation for right atrial tachycardia occurring after atriotomy of structural heart disease / 中国介入心脏病学杂志

Objective To investigate the mechanisms of right atrial tachycardia(AT) occurring after atriotomy of structural heart disease under the guidance of image integration system(CartoMerge system) and explore the efficacy of catheter ablation by using the aboved technique.Methods From January 2005 to December 2006,forty consecutive drug-refractory patients presenting with AT underwent complete electroanatomic mapping of spontaneously occurring and inducible right ATs.The ablation strategy was to avoid visible anatomic anomaly under the guidance of image integration system and to transect the isthmus,usually targeting the narrowest portion of the isthmus.Patients were followed up on an outpatient basis with clinical evaluation and 24-hour Holter recordings being performed at three months,six months,and afterwards on a yearly basis.Results Three main tachycardia mechanisms were identified: single-loop macroreentrant atrial tachycardia(MAT)(n=36),double-loop MAT(n=16),and focal AT(n=4).In most MATs,critical isthmus areas were identified most frequently the cavotricuspid isthmus(CTI)(n=35) and the surgical incision isthmus(n=36).Surgical incision causing obvious morphological anomalies including scar-like anomaly,pouch-like anomaly,and node-like anomaly could be visible by image integration technique in 12 patients,which had the electrophysiological characteristics of a surgical incision(a CDP or scar).A mean number of 19.5?10.1 radiofrequency(RF) applications were delivered to terminate the circuit.During a follow-up of 18?10 months the RF ablation was acutely successful in all patients.Eight patients(20%) had an early recurrence of MAT and needed an additional ablation procedure.Conclusion Image integration system not only allows reconstruction of AT mechanisms,but also represents an advance in the accurate localization and ablation of the arrhythmogenic substrate of postsurgical AT.Three-dimensional MR/CT images of RA can be successfully extracted and registered to anatomically guide catheter ablation in RA.The display of real and detailed anatomic information during the procedure enables tailored RF ablation to individual distorted anatomy related with surgical incision.

Laparoscopic Splenectomy for Splenic Tumors

PURPOSE: Laparoscopic splenectomy (LS) is the procedure of choice in treating hematologic diseases, however there are controversies concerning malignancy and splenomegaly. This study was performed in order to examine the safety and efficacy of LS and hand-assisted laparoscopic splenectomy (HALS) in the management of patients with various splenic tumors and splenomegaly. METHODS: Fifteen patients who had undergone laparoscopic splenectomy for suspected splenic tumors between May, 1998 and December, 2000 were evaluated. We conducted a review, recording previous abdominal surgery, diagnostic work up, size of spleen, accessory spleen, type of surgery, morbidity, mortality, and length of hospital stay. A retrograde analysis was conducted using the medical records of the patients. RESULTS: The average splenic length was 22.4 cm (range, 14~37 cm), and the average weight was 1,210 gm (range, 210~3,700 gm). There were two types of operations performed. LS was accomplished in 7 cases and HALS in 8 cases. All operations were completed without any conversion to open surgery. The average intraoperative blood loss was 153.5 ml (range, 45~830 ml). The average postoperative stay was 5.2 days (range, 3~9 days). Only one complication (subphrenic abscess) developed (7%), which was resolved by percutaneous drainage. No deaths occurred. The pathologic findings were lymphoma (4), hemangioma (4), islet cell tumor (2), lymphangioma (3), myelofibrosis (1), and hematoma (1). CONCLUSION: LS and HALS are safe and feasible procedures for the treatment of most neoplastic splenic diseases with splenomegaly. HALS is an alternative approach for overcoming the technical and oncological challenges that often accompany malignant splenic diseases such as splenomegaly, perisplenitis and hilar lymphadenopathy. As the indications for LS including HALS are expanded, the role of LS and HALS in various splenic tumors will become more clearly defined.