简介：Non-parasitichepaticcystswithbiliarycommunicationarerare.Theclinicalsymptomsinvolvedarenotspecifictothiscondition,therebymakingdiagnosisdifficultandtreatmentcontroversial.Here,wereportacaseof70-year-oldwomancomplainingofabdominalsatiety,combinedwithnon-specificpainintherightupperquadrant.Theabdominalcontrast-enhancedMRI-scanrevealedalargeandthick-walledseptuscysticlesionintheliver.Duringoperation,thebiliaryfistulawasconfirmedinthecystcavity.Asilicageltubewasinsertedviathecysticductforcholangiography,whichdemonstratedcommunicationbetweenthecystandbiliarytract.Weperformedwide-scalecystwallresection;thebiliaryfistulawascompletelyrepairedbytheclosureofcommunicatedbileducts.Thepostoperativecoursewasuneventful,andthepatientwasdischargedwithnosignofcholangitisoranyothersymptoms.Thenovelsurgicalmanagementviawideresectionofthecystwallandclosureofbiliarycommunicationprovedtobeanadequateandeffectiveprocedurefortreatingnonparasitichepaticcystswithbiliarycommunication.

简介：Neurochirurgie,2008Jun21.INTRODUCTION:Neoangiogenesisisacriticalfeaturethatcandifferentiatehigh-gradefromlow-gradeglioma.Conven-tionalMRimagingdoesnotassessthishistologicalfeatureaccurately.Thegoalofthisstudywastoevaluatethegaininrel-ativecerebralbloodvolumemeasurementusingperfusionMRIinthemanagementofcerebralgliomas.MATERIALSAND

简介：AbstractPurpose:Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm.Methods:Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade.Results:A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively.Conclusion:The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

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简介：AbstractThe rate of multiple pregnancy is increasing, mainly because of the widespread use of assisted reproduction techniques and families’ desire for twins. Twin pregnancy accounts for a higher risk of chromosomal abnormalities, structural malformations, and neonatal adverse events than singleton pregnancy. The presence of artery-vein anastomoses, unbalanced placenta sharing, and abnormal cord insertion in monochorionic twins is associated with twin complications such as twin-to-twin transfusion syndrome, selective intrauterine growth restriction, and twin anemia polycythemia sequence. Although many guidelines and studies have established and improved the processes about the antenatal surveillance and management of twin pregnancy, they also raise more controversies and challenges. This review aims to highlight the international consensus on the antenatal care of twin pregnancies and analyze the controversies and predicaments based on the published International Federation of Gynecology and Obstetrics guidelines and research.

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简介：AbstractSince December 2019, a pneumonia caused by a new coronavirus, i.e. COVID-19 occurred in Wuhan, Hubei Province, China. Although the epidemic in China has been bought under control, the global COVID-19 situation is still grim. Severe traumatic brain injury (TBI), as one of critical conditions in the department of neurosurgery, requires an early and effective treatment, especially surgery. There were currently no reliable guidelines on how to perform perioperative protection in TBI patients with suspected or confirmed coronavirus infection. According to the corresponding treatment regulations and guidelines issued by the authorities, we summarized the management strategy of TBI patients in perioperative period during the COVID-19 outbreak based on medical and nursing practice, in order to provide a reference for clinicians.

简介：AbstractMany patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients' quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

简介：摘要Corona virus disease 2019 (COVID-19) is a new disease characterized by lung damage and involvement in multiple tissues and organs in the whole body. Some of the patients may have long-term impairment and dysfunctions, including pulmonary fibrosis, heart, liver, kidney, nerve and immune system. Rehabilitation has certain beneficial effect in the acute stage, and especially in the recovery stage, including improving respiratory function, exercise endurance, self-care in daily living activities, as well as psychological support, etc. Rehabilitation is not offside or absent. A reasonable rehabilitation program needs scientific research to avoid arbitrary conclusions.

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简介：Spinalcordinjury(SCI)isadevastatingconditionthatnotonlyresultsinalossofmotorfunctionsbutalsosevereautonomicdysfunctions(KrassioukovandClaydon,2006).Autonomicdysreflexia(AD)isalifethreateningepisodeoftransienthypertensionthatoccursupto30x/day(11x/dayon

简介：Amlodipine/valsartan(Aml/Val)single-pillcombination(SPC)therapyhasbeenwidelyusedandstudiedinclinicalpracticeinrecentyears.ThisarticlereviewstheChineseandEnglishliteratureontheclinicaluseofAml/ValSPCtherapyinChinesehypertensivepatients.Accordingtofivestudiesconcerningtheefficacyandsafetyofthistreatment,Aml/ValSPCtherapywasmoreefficaciousthanmonotherapywithvalsartan,amlodipine,orthenifedipinegastrointestinaltherapeuticsystem.Thistreatmentshowedgreaterbloodpressure-loweringeffects,ahigherbloodpressurecontrolrate,andahigherresponserate.Aml/ValSPCtreatmentwaswelltolerated,withadverseeventratessimilartothoseofmonotherapywithvalsartanoramlodipineandsignificantlyrareradverseeventscomparedwiththenifedipinegastrointestinaltherapeuticsystem.Aml/ValSPCisahighlyefficaciousandwell-toleratedantihypertensivetreatmentinChinesehypertensivepatients.

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简介：AbstractOne in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.

简介：Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.

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简介：In2014theAmericanCollegeofCardiology/AmericanHeartAssociationissuedfournewguidelinesforcardiovasculardiseasepreventionthatfocusedoncardiovascularriskassessment,lifestylemanagement,obesitymanagement,andbloodcholesterolmanagement.Thedevelopmentofanatheroscleroticcardiovasculardiseaseriskcalculatorformedthebasisoftheriskassessmentguideline,andthelifestylemanagementguidelinefocusedonrecommendinganevidence-baseddietarypattern.Thebloodcholesterolmanagementguidelinespecificallyidentifiedfourgroupsofpatientsshowntobenefitfrommoderate-intensityorhigh-intensitystatintherapyfrompreviousclinicaltrialsandabandonedtheuseofspecificlow-densitylipoprotein(LDL)cholesterol(LDL-C)goallevelsonthebasisofthelackofclinicaltrialevidence.Therecommendationsfortreatmentwithmoderate-intensityorhigh-intensitystatintherapyarebasedonrigorousevidencefromrandomizedclinicaltrials.Guidancehassincebeenprovidedfortheuseofnonstatintherapies,includingcholesterolabsorptioninhibitorandproproteinconvertasesubtilisin/kexintype9monoclonalantibodytherapywhenadequatereductionofLDL-Clevelsisnotachievedwithmaximallytoleratedstatintherapy.TherecentdevelopmentandapplicationofthesetherapieshaveresultedinremarkablereductionsinLDL-Clevelsthatarewelltolerated,andpreliminaryoutcomedataarepromisinginshowingsubstantialatheroscleroticcardiovasculardiseaseeventreductionsbeyondstatintherapy.

简介：AbstractTrauma during pregnancy deserves special attention because of its management objectives, i.e. wellbeing of both pregnant woman and foetus. Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening, mastication and breathing. Hence early restitution of form and function of maxillofacial skeleton is essential. However, the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment. A careful scrutiny of the patient's systemic and gestational status is absolutely essential before, during and after instituting any interventional procedures. We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester (32 weeks). She was treated with inter maxillary fixation using orthodontic brackets & elastics. After successful restitution of occlusion, the patient was advised aggressive physiotherapy which ensured normal mouth opening. Two weeks later, the patient delivered uneventfully. The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion, mouth opening and lower facial height. This article aims at analyzing the contemporary principles in management of maxillofacial trauma in a pregnant woman and clarifying the common misconceptions.

简介：AIM:Toinvestigateandcomparethecytopathologicalandclinicaleffectsofamnioticmembranetransplantation(AMT)andoralmucosalmembranetransplantation(OMMT)insocketcontraction.METHODS:Twelvepatientswhocouldnotbefittedwithocularprosthesisduetosocketcontracturewereincludedinthisstudy.SevenpatientsunderwentAMTand5patientsunderwentOMMT.Thirteenpatientswhohadhealthysocketswereincludedascontrolgroup.Depthofinferiorfornix,degreeofinflammation,extentofthesocketcontractureandsocketvolumeweremeasuredinthepreoperativeperiodandatsixthandtwelfthweekspostoperatively.Impressioncytologyofconjunctivalfornicesandteartransforminggrowthfactorbeta-1(TGFβ1)levelsweredetermined.RESULTS:IntheAMTgroup,socketvolumeandlowerfornixdepthvaluesweresignificantlyhigher(P=0.030andP=0.004respectively)andinflammationlevelsandimpressioncytologystages(P=0.037andP=0.022respectively)weresignificantlylowerinpostoperativeperiodcomparedtopreoperativeperiod.IntheOMMTgroup,nostatisticaldifferenceswerefoundintermsofclinicalparameters,inflammationlevelsandimpressioncytologystagesofpreoperativeversuspostoperativevalues.PreoperativetearTGFβ1levelswerehigherinAMTandOMMTgroupscomparedtothecontrolgroup(25.5ng/mL,26.3ng/mLand21.7ng/mLrespectively).DecreasedtearTGFβ1levelswereobservedinboththeAMTandOMMTgroupspostoperatively(mediandecreasevalue=2.1ng/mLand2.7ng/mLrespectively).CONCLUSION:AMTisassociatedwithpostoperativeimprovementininferiorfornixdepth,socketvolume,inflammationandimpressioncytologylevelsandmaybeamoreproperalternativemethodthanOMMTinthemanagementofsocketcontracture.