简介：AbstractBackground:The incidence of uterine cesarean scar defect (niche) is high, and some patients require surgery. Single-port laparoscopy can reduce post-operative pain, and provide better cosmetic effects. This study was performed to evaluate the safety and superiority of single-port laparoscopy-assisted vaginal repair of uterine cesarean scar defect (niche) in women after cesarean section.Methods:This study included 74 patients who were diagnosed with uterine cesarean niche at the Shanghai First Maternity and Infant Hospital from January 2013 to June 2015. Thirty-seven patients underwent single-port laparoscopy-assisted vaginal surgery as the case group, and the remaining patients underwent vaginal repair surgery as the control group. We collected data from the inpatient and follow-up medical records. The clinical characteristics of these two groups were compared. The odds ratios and 95% confidential intervals were calculated for each variable by univariate and multivariate analyses.Results:Patients who underwent single-port laparoscopy-assisted vaginal repair had a significantly longer operation time (2.3 [2.0-2.7] vs. 2.0 [1.6-2.3] h, P = 0.015), shorter gas passage time (1.2 [1.0-1.5] vs. 1.7 [1.0-2.0] days, P = 0.012), shorter hospital stay (3.1 [3.0-4.0] vs. 4.5 [4.0-6.0] days, P = 0.019), and fewer complications (0 vs. 4 cases). Univariate analysis showed that depth of the niche (P = 0.021) the mild adhesiolysis score (P = 0.035) and moderate adhesiolysis score (P = 0.013) were associated with the bladder injury. Multivariate analysis showed that the moderate adhesiolysis score (P = 0.029; 95% confidence interval, 1.318-3.526) was the strongest independent predictor of bladder injury.Conclusion:This study confirmed the safety and superiority of single-port laparoscopy-assisted vaginal repair of uterine cesarean scars.

简介：平坦破裂是的王牌的解剖结构复杂、起作用的暴露和固定是极其困难的。因为那些显然代替了王牌平坦破裂，更靠近的引出被注定引起致丑陋的愈合。有内部固定(ORIF)的开的减小不仅导致解剖减小，而且带复杂并发症。不管哪个方法将被采用，创伤的关节炎或大腿骨的头的脉管的坏死可能发生。以便treatacetabular更有效地断裂，矫形外科医生应该被要求充分为复杂并发症预防掌握theacetabular解剖，简历力学，分类和必要知识。

简介：由美国腹腔镜内镜外科医师协会（SLS）举办的“瓶美多学科峰会Ⅵ-腹腔镜与微创外科”将于2014年2月12～15日在美国夏威夷檀香山举行。会议涉及环太平洋亚太国家普通外科、妇科与泌尿外科腹腔镜和做创外科技术在多学科中诊断与治疗的最新进展。内容涉及最新的和标准的腹腔镜内镜没备，新技术、新概念以及如何提高对患者监护的标准，以及微创外科医师的培训和继续教育等。

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简介：AIMTounderstandtheinfluenceoffrailtyonpostoperativeoutcomesforlaparoscopicandopencolectomy.METHODSDatawereobtainedfromtheNationalSurgicalQualityImprovementProgram(2005-2012)forpatientsundergoingcolonresection[opencolectomy(OC)andlaparoscopiccolectomy(LC)].Patientswereclassifiedasnon-frail(0points),lowfrailty(1point),moderatefrailty(2points),andseverefrailty(≥3)usingtheModifiedFrailtyIndex.30-dmortalityandcomplicationswereusedastheprimaryendpointandanalyzedfortheoverallpopulation.Complicationsweregroupedintomajorandminor.Subsetanalysiswasperformedforpatientsundergoingcolectomy(totalcolectomy,partialcolectomyandsigmoidcolectomy)andseparatelyforpatientsundergoingrectalsurgery(abdominoperinealresection,lowanteriorresection,andproctocolectomy).WeanalyzedthedatausingSASPlatformJMPProversion10.0.0(SASInstituteInc.,Cary,NC,UnitedStates).RESULTSAtotalof94811patientswereidentified;themajorityunderwentOC(58.7%),werewhite(76.9%),andnon-frail(44.8%).Themedianagewas61.3years.Prolongedlengthofstay(LOS)occurredin4.7%,and30-dmortalitywas2.28%.PatientsundergoingOCwereolder(61.89±15.31vs60.55±14.93)andhadahigherASAscore(48.3%ASA3vs57.7%ASA2intheLCgroup)(P<0.0001).Mostpatientswerenon-frail(42.5%OCvs48%LC,P<0.0001).Complications,prolongedLOS,andmortalityweresignificantlymorecommoninpatientsundergoingOC(P<0.0001).OChadahigherriskofdeathandcomplicationscomparedtoLCforallfrailtyscores(non-frail:OR=4.7,andOR=4.67;mildlyfrail:OR=2.51,andOR=2.47;moderatelyfrail:OR=2.94,andOR=2.02,severelyfrail:OR=2.37,andOR=2.34,P<0.05)andanincreaseinabsolutemortalitywithincreasingfrailty(non-frail0.68%OC,mildlyfrail1.39%,moderatelyfrail3.44%,andseverelyfrail5.83%,P<0.0001).CONCLUSIONLCisassociatedwithimprovedoutcomes.Althoughtheoddsofmortalityarehigherin

简介：客观；在脚关节关节上学习远侧的tibiofibularsyndesmosis的分离的影响并且比较各种各样的起作用的方法以便为分开的远侧的tibiofibular韧带联合发现合适的稳定。方法：从1997年7月到2002年7月，我们对待87个病人(64男性和23女性，变老18-54年)与distaltibiofibular韧带联合的分离，在谁之中，79与踝的骨折被相结合。Manipulativereduction，有cancellous螺丝钉的内部固定和有灰浆支持的外部固定在37个病人，有为腓骨的骨折的板和螺丝钉的固定和固定上被执行为34个病人上的远侧的tibiofibular韧带联合的withcancellous螺丝钉，和有peroneus的腱的distaltibiofibular系带的修理渴望我们，分开的distaltibiofibular韧带联合的减小，和有16个病人上的cancellous螺丝钉的固定。当远侧的tibiofibular韧带联合与cancellous螺丝钉被修理时，脚关节关节是为30°的dorsiflexed。并且cancellous螺丝钉在操作以后在8-10星期被拿出。结果：这些病人被跟随在上面为至少二年。药品效果根据病人的抱怨被估计，脚关节的轮廓，功能和无线电报连接；优秀in55病人(63%)，在14个病人(16%)在18个病人(21%)好、公平。distaltibiofibular韧带联合的分离在为长与peroneus的腱修理远侧的tibiofibular系带经历了一个手术的2个病人复发了我们并且恢复。一个cancellous螺丝钉被折断。没有坏死在脚关节榫眼的前面的皮肤发展了。结论:远侧的tibiofibular韧带联合的分离能与各种各样的合理操作被对待。长与peroneus的腱修理我们能为远侧的tibiofibular韧带联合的完全的分离得到优秀结果。

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简介：AbstractThe demand for acquiring different languages has increased with increasing globalization. However, knowledge of the modification of the new language in the neural language network remains insufficient. Although many details of language function have been detected based on the awake intra-operative mapping results, the language neural network of the bilingual or multilingual remains unclear, which raises difficulties in clinical practice to preserve patients’ full language ability in neurosurgery. In this review, we present a summary of the current findings regarding the structure of the language network and its evolution as the number of acquired languages increased in glioma patients. We then discuss a new insight into the awake intra-operative mapping protocol to reduce surgical risks during the preservation of language function in multilingual patients with glioma.

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简介：Objective:Tosummarizetheperi-operativeexperiencefrom53patientswithtraumaticheadinjurieswithGCSscore3-5.Methods:Fifty-threemostseverelyhead-injuredpatientswithGCSscore3-5wereadmittedtoourdepartmentandtreatedoperativelyfromOct.1994toJun.1998andthedatawereanalyzedretrospectively.Results:Thirty-sevencases(69.8%)survived,amongthem28(52.8%)hadagoodrecoveryormoderatedisability,and9(17%)hadseveredeficits.Theother16(30.2%)diedaftertherapy.Conclusions:Theprognosisofmostseverelyhead-injuredpatientscouldbeimprovedbyperi-operativetreatmentincludingpremedicalcare,earlyevacuationofintracranialhematomawithlargedecompressivecraniectomies,intracranialhypertensionmonitoring,moderatehypothermiatherapy,effectivepreventionandtreatmentofcerebralvasospasmandcomplications.

简介：目的：分析非手术疗法治疗腰椎间盘突出症的近期、远期疗效。方法：将165例腰椎间盘突出症患者按随机和单盲法分为牵引组、推拿组，推拿加功能锻炼组，治疗2个疗程后，评定近期疗效。然后将取得显效的102例患者按区组随机和单盲法分为功能锻炼组和对照组，随访1年观察两组复发率，并分别于治疗后6和12个月进行腰椎功能评定。结果：推拿组和推拿加功能锻炼组较牵引组近期疗效显效率差异有显著性(x^2=8．359，P<0．01)。功能锻炼组1年内的复发率明显低于对照组(x^=12．631，P<0．01)。结论：推拿加功能锻炼是防治腰椎间盘突出症的有效方法。

简介：客观：调查成年钝脾的损害的非起作用的管理的指示。方法：回顾的评论在所有成年病人(年龄>15年)上被执行，钝脾的损害从1999～2003在法国承认了到Pellegrinhospital的脉管的外科的部门。我们不管年龄在所有适当病人non-operatively管理了脾的损害。结果：在4年期间，有钝脾的损害的54个连续成年病人在医院里被对待。有稳定的血液动力学的地位的27个病人的一个总数起初non-operatively被对待，哪个2个病人被辜负到non-operativetreatment。非起作用的管理的成功的百分比是92.6%。在54个病人，比55年老的7个of8病人与非起作用的管理被对待。二个案例developingpostoperatively代替膈的感染被合适的治疗愈合。在系列，没有死亡。结论：低档的非起作用的管理脾的损害能与可接受的低失败的率被完成。如果临床并且对外科医生到困难的实验室参数作决定，他们能取决于Resciniti“获得系统与脾的损伤选择成年人的一个子集的sCT(计算断层摄影术)是non-operativemanagement的试用的优秀候选人。比55年老的病人绝对没被禁止收到non-operativemanagement。

简介：AbstractBackground:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients’ tolerance, and reduce postoperative bleeding.Methods:This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients’ tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher’s exact test, and Bonferroni’s multiple comparison tests were used in this study.Results:In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00–26.50 s] vs. 24.00 s [14.50–45.50 s], P = 0.005). Both the AD (99% vs. 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs. 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs. 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients’ tolerance scores.Conclusions:Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.Trial registration:Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321.

简介：Hearinglossisaconditionaffectingmillionsofpeopleworldwide.Conductivehearingloss(CHL)ismainlycausedbymiddleeardiseases.ThelowfrequencyareaisthepivotalpartofspeechfrequenciesandmostfrequentlyimpairedinpatientswithCHL.AmongvarioustreatmentsofCHL,middleearsurgeryisefficienttoimprovehearing.However,variablesuccessratesandpossibleneedsforprolongedrevisionsurgerystillfrustratebothsurgeonsandpatients.Nowadays,increasingnumbersofresearchersexplorevariousmethodstomonitortheefficacyofossicularreconstructionintraoperatively,includingelectrocochleography(ECochG),auditorybrainstemresponse(ABR),auditorysteadystateresponse(ASSR),distortionproductotoacousticemissions(DPOAE),subjectivewhispertest,andopticalcoherencetomography(OCT).Here,weillustrateseveralmethodsusedclinicallybyreviewingtheliterature.

简介：AbstractThe philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%—90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.

简介：通过分析加拿大百年理工学院的"Co-operativeEducation"实习教育模式,了解了"CO-OP"项目的具体运作方式。加拿大高职实习教育重视政府职能的参与,强调学校、企业和学生的三方合作,通过"COOP"项目实现三方共赢,其模式值得我们借鉴。

简介：Cochlearimplantationisauniquemethodtore-constructauditionforpatientswithseveretoprofoundhearingloss.Withincreasingclinicalapplicationofthistechnique,itsrehabilitativeeffectsinpatientshasbecomeanimportanttopicofhearingandspeechrehabilitationresearch.Thisarticleisanoverviewofhearingandspeechrehabilitativetraining,rehabilitativeefficacyevaluationandfactorsaffectingrehabilitationefficacyfollowingcochlearimplantation.

简介：粉末的超声的microfeeding是为在稳固的freeforming和药品的dosing的使用的一个新、有希望的方法。在这个工作，用超声的颤动的控制计算机的microfeeding系统一毛状被造。流动和切换的控制的大量控制的、稳定的率在声学的颤动系统被完成，一致粉末剂量在超声的系统被获得。试验性的结果证明那条嘴直径，传播液体深度，波形，电压振幅，频率和摆动持续时间都影响剂量团。在这些之中，因素，嘴直径，电压振幅和摆动持续时间能是过去常控制剂量团的最好。一种人工的神经网络(ANN)技术被使用预言剂量团。基于这些研究结果，microfeeding的四种类型被建议。

简介：Manyapplicationsofultrasonic-assistedmethodswereusedduringmetalsolidification,buttheycouldnotbeintroducedintoweldpool.Inthispaper,awayofultrasonicassistedTIGweldingisintroduced.Bydirectlyimposedultrasonicvibrationonweldingarc,thevibrationinteractswitharcplasmaandpassestotheweldpool.Measurementresultsshowthatarcpressureissignificantlyincreasedwiththeultrasonicvibrationandthearcpressuredistributionmodelsarechanged.Bead-on-plateweldingtestsonSUS304confirmthatthistechnologycaninfluencethestyleofmetalmeltingandincreaseweldpenetrationdepth.