Abstract Background The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) applied in gynecology has been developed recent years and been evolving. In this study, we aimed to evaluate the feasibility and effect of the vNOTES hysterectomy for uterus ≥1 kilogram (kg). Methods From January 2019 to March 2020, patients with benign indications in cases of uterus weighing ≥1 kg, underwent vNOTES hysterectomy were studied retrospectively. The patients’ demographics, indications for surgery, operation outcomes and follow-up details were recorded. Results 39 patients were performed vNOTES hysterectomy for large uterus (mean weight 1141.8 gram, range from 1000 to 1720), indications for surgery included bulky uterine myomas or adenomysosis. The mean age was 48 years (range 42–66) and mean BMI was 24 kg/m 2 (range 18.4–38). Mean operating time was 123.3 min (rang 40–400) and the mean estimated blood loss was 206.7 milliliters (range 10–1300). The mean pain assessment was 2.1 (range 0–5). The mean length of stay was 2.4 nights (1–11). 1 patient experienced ureteral injury and was performed ureteral anastomosis. 3 patients were converted to vaginal-assisted trans-umbilicus single-port laparoscopy. The learning curve was analyzed to show that 20 cases were needed to achieve proficiency in vNOTES hysterectomy for large uterus ≥1 kg. Conclusion Our preliminary experience suggested that vNOTES hysterectomy for large uterus weighing ≥1 kg was feasible and safe, meanwhile this procedure had the advantages of all the minimal invasive approach such as fast recovery and aesthetic advantage.
This meta-analysis compared clinical outcomes between standard and high-flexion posterior-stabilized total knee prostheses to evaluate which type of total knee prosthesis was superior. Randomized, controlled trials published until October 2013 comparing standard and high-flexion posterior-stabilized total knee prostheses were reviewed. Methodologic quality was assessed with the Physiotherapy Evidence Database scale. After data extraction, the authors compared results with fixed effects or random effects models, depending on the heterogeneity of the included studies. Eight randomized, controlled trials involving 660 patients met the predetermined inclusion criteria. No statistically significant differences between patients undergoing standard and high-flexion posterior-stabilized total knee prostheses were noted in postoperative range of motion (ROM) (weighted mean difference, −1.43; 95% confidence interval [CI], −4.52 to 1.67; P =.37); flexion angle (weighted mean difference, 0.54; 95% CI, −3.75 to 4.84; P =.80); Knee Society Score (weighted mean difference, 0.92; 95% CI, −0.64 to 2.48; P =.25); Hospital for Special Surgery knee score (weighted mean difference, 0.57; 95% CI, −0.42 to 1.55; P =.26); or Knee Society function score (weighted mean difference, 1.00; 95% CI, −1.49 to 3.49; P =.43). No statistical difference was found between the 2 prosthesis types in complications, involving 21 cases in the standard group and 14 cases in the high-flexion group. The current findings confirm that high-flexion posterior-stabilized total knee prostheses are not superior to standard prostheses in terms of ROM, flexion angle, knee scores, or complications with 5 years or less of follow-up. [ Orthopedics. 2015; 38(3):e206–e212.]
Influenza virus is a negative segmented RNA virus without DNA intermediate. This makes it safer as a vaccine delivery vector than most DNA viruses that have potential to integrate their genetic elements into host genomes. In this study, we developed a universal influenza viral vector, expressing the receptor binding subdomain of botulinum neurotoxin A (BoNT/A). We tested the growth characters of the engineered influenza virus in chicken eggs and Madin-Darby canine kidney epithelial cells (MDCK), and showed that it can be produced to a titer of 5 × 10(6) plaque forming unites/ml in chicken eggs and MDCK cells. Subsequently, mice intranasally vaccinated with the engineered influenza virus conferred protection against challenge with lethal doses of active BoNT/A toxin and influenza virus. Our results demonstrated the feasibility to develop a dual purpose nasal vaccine against both botulism and influenza.
Research Purpose: To compare the stability of sacral fracture fixation with three kinds of internal fixations by using finite element method. Proposed Methods: The L4-L5 and pelvic models were intercepted from previously established and validated complete lumbar pelvic model and modified to simulate the U-shaped sacral fracture model, and fixed using the following three fixation methods. (1) screw with S1S2 passed through, (2) L4L5 pedicle screw + screw for wing of ilium, (3) L4L5 pedicle screw + screw with S1 passed through + screw for wing of ilium. A 500N force was applied for point of action where is in central position of L4 superior end-plate and coupled with superior end-plate surface, then compared the stress, strain and fracture gap separation value of different fixation methods. Results: There is no significant difference on fracture gap separation value and strain on fracture surface in above three fixation methods, however the maximum stress (101.1MPa) produced by the first fixation method is less than the one (291.1MPa) produced by the second method and the one (197.1MPa) produced by the third fixation method. Conclusions: For U-shaped sacral fracture, the prior adoption is the first fixation method to make fix.
Abstract Objective: To compare the biomechanical stability of transsacral-transiliac screw fixation and lumbopelvic fixation for “H”- and “U”-type sacrum fractures with traumatic spondylopelvic dissociation. Methods : Finite element models of “H”- and “U”-type sacrum fractures with traumatic spondylopelvic dissociation were created in this study. The models mimicked the standing position of a human. Fixation with transsacral-transiliac screw fixation, lumbopelvic fixation, and bilateral triangular fixation were simulated. Biomechanical tests of instability were performed, and the fracture gap displacement, anteflexion, rotation, and stress distribution after fixation were assessed. Results: For H-type fractures, the three kinds of fixation ranked by stability were bilateral triangular fixation > lumbopelvic fixation > transsacral-transiliac screw fixation in the vertical and anteflexion directions, bilateral triangular fixation > transsacral-transiliac S1 and S2 screw fixation > lumbopelvic fixation in rotation. The largest displacements in the vertical, anteflexion and rotational directions were 0.57234 mm, 0.37923 mm and 0.13076 mm, respectively. For U-type fractures, these kinds of fixation ranked by stability were bilateral triangular fixation > lumbopelvic fixation > transsacral-transiliac S1 and S2 screw fixation > transsacral-transiliac S1 screw fixation in the vertical, anteflexion and rotational directions. The largest displacements in the vertical, anteflexion and rotational directions were 0.38296 mm, 0.33976 mm and 0.05064 mm, respectively. Conclusion: All these kinds of fixation met the mechanical criteria for clinical applications. The biomechanical analysis showed better bilateral balance with transsacral-transiliac screw fixation. The maximal displacement for these types of fixation was less than 1 mm. Percutaneous transsacral-transiliac screw fixation can be considered the best option among these kinds of fracture fixation.
To compare the clinical outcomes of patients receiving total knee arthroplasty (TKA) using 3D printing technique and conventional surgical methods.From October, 2015 to February, 2017, 17 patients (20 knees) underwent TKA with the assistance of individualized navigation template and 16 concurrent patients (18 knees) matched for age, gender and knee society score received conventional TKA. The operation time, blood loss, and osteotomy data of the femoral condyle and tibia plateau were recorded. The mean femorotibial angle (MFTA) and sagittal tibial component angle (STCA) after the operation and the KSS at the last follow-up were compared between the two groups.All the patients were followed up for 7-23 months, during which no infection or prosthesis loosening or motion was found. In patients receiving surgery with 3D printing technique, the osteotomy data of the femoral condyle and tibia plateau in the actual surgeries were consistent with those in surgical plans (P>0.05). The patients in the 3D group had a significantly shorter operation time and a higher KSS score than those in the conventional group (P<0.05). Significant differences were found between the two groups in postoperative MFTA and STCA (P<0.05).The application of 3D printing technique can simplify the surgical procedure and improve the surgical precision and efficacy of TKA.
Purpose: Age is an important factor for prognostic factor in bladder cancer. However, most clinical studies targeting bladder cancer have limited the upper age limit to 75 years. With the higher age of diagnosis of older patients with bladder cancer, there is a lack of prognostic data for bladder cancer at advanced ages. In this study, we analyzed the prognostic factors of older patients with bladder cancer 75 years or older using Surveillance, Epidemiology, and End Results (SEER) data. Materials and Methods: Clinical parameters that constitute potential risk factors were analyzed by downloading a total of 13,505 patients with bladder cancer from the SEER database using univariate and multifactorial Cox proportional risk regression. Nomogram was constructed based on parameters significantly associated with overall survival (OS). The consistency index (c-index) and area under the curve were used to evaluate the predictive performance of the model. Results: From the SEER database, we analyzed 13,505 cases and found that the median survival time for the whole cohort was 52 months. However, the median survival was 11 months, 8 months, and 6 months in 75 to 79 years subgroup, 80 to 84 years subgroup, and older than 85 years subgroup, when patients were diagnosed with stage IV. OS was poorer in the high histological grade patients. Furthermore, it was found that patients with lymph node metastasis had a significantly unfavorable prognosis than those with negative lymph nodes. The more advanced stage and distant metastases of patients had the shorter survival. Patients who underwent surgery had better overall survival than nonsurgical patients, and chemotherapy had prolonged survival. Conversely, survival was documented to be shorter with radiotherapy than those without radiotherapy. Conclusions: The overall prognosis of older patients with bladder cancer was poor, especially in patients with lymph node metastasis, high histological grade, and advanced stage, while a combination of surgery and chemotherapy could prolong survival.
<b><i>Background:</i></b> In light of the growing number of cancer survivors, the incidence of cardiovascular complications in these patients had also increased, while the effect of apatinib on the pharmacokinetic of cardioprotective drug (carvedilol) in rats or human is still unknown. The present work was to study the impact of apatinib on the metabolism of carvedilol both in vitro and vivo. <b><i>Methods:</i></b> A specific and sensitive ultra-performance liquid-chromatography tandem mass spectrometry method was applied to determine the concentration of carvedilol and its metabolites (4′-hydroxyphenyl carvedilol [4′-HPC], 5′-hydroxyphenyl carvedilol [5′-HPC] and o-desmethyl carvedilol [o-DMC]). <b><i>Results:</i></b> The inhibition ratios in human liver microsomes were 10.28, 10.89 and 5.94% for 4′-HPC, 5′-HPC and o-DMC, respectively, while in rat liver microsomes, they were 3.22, 1.58 and 1.81%, respectively. The data in vitro of rat microsomes were consistent with the data in vivo that the inhibition of 4′-HPC and 5′-HPC formation was higher than the control group. <b><i>Conclusion:</i></b> Our study showed that apatinib could significantly inhibit the formation of carvedilol metabolites both in human and rat liver microsomes. It is recommended that the effect of apatinib on the metabolism of carvedilol should be noted and carvedilol plasma concentration should be monitored.
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