2015年 · 第53卷第11期

Cervical spondylosis seriously affects the normal work and life of human beings, and cervical spondylosis of nerve root type accounts for a large proportion of all types of cervical spondylosis. With the deepening of understanding of cervical spondylotic radiculopathy, the standardization of diagnosis and treatment of this disease is more and more important. In 2010, the Beijing Municipal Science and Technology Commission established the "Research on the Standardization of Diagnosis and Treatment of Cervical Spondylotic Radiculopathy" in the key project of "Research on the Standardization of Diagnosis and Treatment of Orthopedic Common Diseases and Rehabilitation Technology", and this consensus was completed under the funding of this project.

With the increase in the number of infertile men and the development of microandrology, Chan et al.^[1]The pioneering longitudinal intussusception microsurgical vasoepididymostomy (LIVE) has become the preferred method for the treatment of epididymal obstructive azoospermia (EOA) in some areas^[2]。 We established a modified single-needle suture LIVE in 2011 and achieved a reasonable recanalization rate^[3]。 From February 2012 to November 2013, we performed modified single-needle suture LIVE surgery on 51 patients with EOA. Now we summarize the intraoperative micromanipulation techniques in order to improve the success rate of the surgery.

One of the methods to shrink the volume of the giant finger (toe) is to cut off the hypertrophic skin, thin it to medium-thick fractured skin, and then implant it back in place after cutting^[1,2]。 Almost all the cut skin comes from the palmar side of the hand or the plantar side of the foot. The area is small but dense, and the shape is irregular. The skin at the tip of the finger (toe) is curly, and it is difficult to lay it straight. Therefore, we have made technical improvement on the existing method of cutting isolated skin into dissected skin. The results of clinical application in more than 30 patients over a period of 2 years show that the cutting quality and efficiency have been significantly improved. The technical points and application experience are now reported as follows.

The effect of pediatric kidney transplantation to adults remains to be determined, and at present, this kind of transplantation is in the stage of exploration and summarization at home and abroad. Our hospital was listed as a pilot unit for donation after cardiac death (DCD) organ transplantation in 2011. after two years of pilot work, it has been officially approved for DCD organ transplantation qualification. In January 2012, our hospital performed the first transplantation of organ donation after the death of a citizen. At present, 41 cases of DCD kidney transplantation have been completed, of which 4 cases were kidney donation from children to adults. The experience is summarized and reported as follows.

Female, 57 years old, admitted to hospital on 16 July 2014 due to "physical examination revealed left adrenal mass for 3 years". The patient had a history of hypertension for 7 years and no history of obvious blood pressure fluctuations. More than 10 years ago, he underwent hysterectomy due to uterine fibroids, and denied his family history of tumor. Three years ago, when I visited the neurology department of our hospital due to cerebral infarction, the abdominal B-ultrasound (July 15, 2011) examined: a nodule with a maximum diameter of 2.0 cm to no echo was seen in the left adrenal gland area, with clear boundaries and no blood flow; A cystic mass with a maximum diameter of 3.3 cm was seen at the upper pole of the right kidney, and a cyst of the left adrenal gland and a cyst of the right kidney was considered. CT plain scan + enhanced scan (July 20, 2011): A small nodule with a maximum diameter of 2.1 cm was seen in the medial branch of the left adrenal gland, 37 HU after plain scan and 48 HU after enhancement. It was considered that adenoma of the left adrenal gland was not excluded and cyst of the right kidney was not excluded. The patient was reviewed regularly and the tumor gradually increased. CT plain scan + enhanced scan (June 16, 2014): 4.1 cm ×3.8 cm mass was seen in the left adrenal gland, with uniform density, and the CT value in the arterial phase of enhanced scan was about 56 HU; Two low-density foci in the upper pole of the right kidney, the larger one is about 5.0 cm ×4.8 cm low-density foci, the CT value of the arterial phase of the enhanced scan is about 13 HU, and the left adrenal mass and multiple cysts in the right kidney are considered (Figure 1)。 There was no palpable tumor in the left kidney area during physical examination, and there were no symptoms of increased nocturia, fatigue and centripetal obesity. Serum cortisol (12:00, 16:00, 20:00), aldosterone (standing, recumbent), renin (standing, recumbent), renin angiotensin II (standing, recumbent) were all normal. Primary preoperative diagnosis: left adrenal mass. On July 23, 2014, laparoscopic left adrenal gland mass resection was performed under general anesthesia. During the operation, the left perirenal fascia was opened, the upper pole of the kidney was freed from the dorsal side of the kidney, and the upper pole area of the kidney was freed along the perirenal fascia and renal capsule level. The adrenal gland was carefully freed. A round mass with a maximum diameter of about 5 cm was seen above the left adrenal gland. The mass adhered to the adrenal gland and the tail of the pancreas, but the boundary was still clear. After carefully freeing the mass with ultrasonic scalpel, the tumor was completely removed 1 cm around the tumor. The surface of the tumor was covered with fat, with an envelope on the surface, and the cut surface showed gray-white fish-like changes. Postoperative pathology showed that the maximum diameter of tumor was 7.5 cm, spindle cell tumor with dense cells, mitotic image 5/50 high power fields, immunohistochemistry: CD34 (+), CD117 (+), Dog-1 (+), Actin (-), CK (-), Desmin (-), S-100 (-), Vimentin (-), Bcl-2 (-), Ki-67 about 5% (+) (Figure 2)。 According to the pathological risk grade of gastrointestinal stromal tumor of digestive tract, it is high-grade risk. Within 3 days after operation, the blood pressure fluctuated from 168 to 180 mmHg/78 to 89 mmHg (1 mmHg =0.133 kPa), and the heart rate was 110 to 140 beats/min; Biochemical examination: total blood amylase 752 U/L. The symptoms gradually improved after giving symptomatic treatment such as lowering blood pressure, controlling heart rate and octreotide, and he was discharged from hospital 14 days after operation. Follow-up for 6 months, during which imatinib mesylate tablets (400 mg/d) were taken regularly, no tumor recurrence was found.

Published onJAMA SurgeryA study of¹, low-grade ductal breast carcinoma in situ performed immediately or shortly after diagnosis did not significantly improve patient survival. Performing surgery for middle-to-high-grade ductal carcinoma in situ does improve survival, but research has raised concerns about overtreatment.

Published inScience Translational MedicineClinicians who rely solely on genomic analysis of patients' tumor tissues to guide cancer treatment may be misled by harmless mutations that exist in patients' normal germ cells and are not related to cancer, a study found¹。

Follow-up data from the Women's Health Initiative trial showed that postmenopausal women who were overweight or obese had an increased risk of developing invasive breast cancer. A study published in JAMA Oncology highlights a dose-effect relationship between elevated body mass index (BMI) and increased relative risk of developing breast cancer¹。

A large prospective cohort study (Seventh Day Adventist men and women) showed that vegetarians had a reduced risk of colorectal cancer¹。