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1。简介: 盂肱关节是一个复杂的的衔接。它具有最小的骨性约束，并依赖于一个复杂的平衡之间的紧张关系，支持软组织的正常功能。这个重要的关系，使肩部有一个大的职能范围内的议案。当这种平衡是耦合的，出现不同程度的功能障碍。一个如一个大的撕裂，肩袖功能的丧失，可引起优越的盂肱骨头的翻译。这改变了盂肱关节的旋转中心和其后，其余肌肉的紧张时刻武器，减少功能。此外，在肱骨头的位置和接触压力的后续变化变化，可导致渐进损伤的关节软骨和造成痛苦的关节炎。在这些情况下，使用标准肩部关节置换术已提供次优的，有时甚至是灾难性的结果。 反向总肩膀关节置换术（RTSA）提供了解决这些复杂的问题，提供显着的改善疼痛，运动和功能的范围。 RTSA的设计medializes旋转中心和肱骨带来一个更处于劣势。这在生物力学的改变，恢复三角肌腹和功能的杠杆臂的张力，提高能力，在太空中移动手臂的三角肌。此外，痛苦的关节炎软骨的过程中删除，显着改善了患者的痛苦。 2。病例报告: 这名患者是一名71岁的健康女性，与15年之前的"小开"肩袖的历史。在过去的一年中，她经历了与相关的，在他的运动范围减少疼痛加剧，在她的肩膀和弱点。她的活跃绑架是主动前屈30 °，40 °，积极外旋10 °和积极的内部轮岗，以她的臀。她修改的熊拥抱测试表明，在肩胛下肌腱最小的弱点，她有一个负角风机的签署和负滞后测试。她被动运动范围呈前屈75 °，以积极的落臂试验。神经血管的考试，否则正常，有没有感染与前肩袖修复的迹象。 3。治疗/诊断过程: 这个病人的影像学初步评估应包括肩胛插座视图，Grashey查看和腋窝查看。根据盂的外观，与CT扫描进一步研究，可能需要评估骨的侵蚀，发育不良的存在，可用骨量量。在我们的病人中，最初的X光片，具有优越的迁移证明肱骨下降acromio肱骨距离适中退行性改变。有没有明显的骨损失盂。结合病人的病史，体格检查和影像学分析与pseudoparalysis肩袖关节病。进一步的诊断研究，将不会显示在这名病人。 考虑任何病人的任何重大关节置换术前应采取一个保守的措施的过程中。这些应包括医疗用消炎药物治疗，皮质类固醇激素注射到通信肩峰和囊内空间，并加强物理治疗和运动范围。此疗程后，病人必须进行评估，为他们的痛苦，目前的功能，逼真的功能需求和欲望，提高生活质量和相关的合并症。反向总肩关节置换术的后续技术与程序相关的风险，如果被确定为预期收益的病人接受，都可以使用。 4。反向共肩关节置换术<ol><li>病人被放置到的beachchair位置和手臂是prepped和披在标准方式。 </li><li>标准的肩胸切口和方法是露出肩袖和肩峰下空间。钝性分离是用于劣质表面三角肌从任何粘连组织的基本自由。 </li><li>肩袖撕裂和维修的可能性进行评估检查。如果组织的出现可以修复，修复和传统的关节置换术可以考虑的。否则，任何无用的袖口，可以切除</li><li>腋神经识别和保护肩胛下肌腱不释放原点是确定和小结节和发布任何粘连的肌腱被释放，从近端</li><li>劣质胶囊释放肱骨近端肱骨外旋脱臼吨他肱骨头从关节</li><li>位于髓腔使用的条目锥子，这是由肱骨小头切除术指导和更换版本在0 °肱骨近端切。髓内指南将需要拆下来完成的削减</li><li>干骺端和骨干扩孔大小适合病人的解剖</li><li>试用组件进行组装，并在适当的版本与削减保护放入肱骨盂准备</li><li>盂唇切除，前伪劣胶囊释放拉钩是放在揭露盂</li><li>这次演习的指南，是用来放置中央钻孔，用6毫米钻头</li><li>盂是在准备为基础，创建一个外设槽板扩</li><li>中心孔，然后扩大到7.5毫米为8mm中央PEG和底板放置，影响与髓盂平齐</li><li>然后放入底座与跨皮质固定螺钉。前部和后部的螺丝有一个用于放置30 °弧和标准皮质骨螺钉。上，下分别与30 °弧锁定在上，下飞机的螺丝螺钉固定</li><li> glenosphere然后影响到底板和中央的螺丝拧紧安全glenosphere </li><li>试用衬垫，然后放置到审判肱骨干，是减少和肩膀。 ROM和稳定的考试，然后做和作出必要的调整</li><li>审判植入物，然后从肱骨中删除，最后组件组装和插入到肱骨影响在适当的版本</li><li>肩膀是减少和期末考试的ROM和稳定是</li><li>肩胛下肌腱修复肱骨近端和伤口是在标准的方式关闭</li></ol> 5。成果: 在6个月的跟进这个病人排名的10个零出视觉类比量表她手术后的疼痛。她运动的活动范围包括前屈140 °，外旋25 °和内部轮岗，她的臀。这名患者在最后一次随访无术中或手术后的并发症。 6。结论: 在笔者的经验，RTSA提供了可靠的缓解疼痛，改善运动范围和功能结果肩袖关节病的病人。这名患者，这种手术的结果感到满意。

<ol>
	<li>Boileau, P., Sinnerton, R. J., Choinard, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroplasty+of+the+Shoulder.">Arthroplasty of the Shoulder.</a> J Bone Joint Surgery Br. 88, 562-575 (2006).</li><li>Boileau, P., Watkinson, D., Hatzidakis, A. M., Hovorka, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neer+Award+2005:+The+Grammont+reverse+shoulder+prosthesis:results+in+cuff+tear+arthritis,+fracture+sequelae,+and+revision+arthroplasty.">Neer Award 2005: The Grammont reverse shoulder prosthesis:results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.</a> J Shoulder Elbow Surg. 15, 527-540 (2006).</li><li>Boileau, P., Watkinson, D. J., Hatzidakis, A. M., Balg, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grammont+reverse+prosthesis:+design,+rationale,+and+biomechanics.">Grammont reverse prosthesis: design, rationale, and biomechanics.</a> J Shoulder Elbow Surg. 14, 147S-161S (2005).</li><li>Cuff, D., Pupello, D., Virani, N., Levy, J., Frankle, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+shoulder+arthroplasty+for+the+treatment+of+rotator+cuff+deficiency.">Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.</a> J Bone Joint Surg Am. 90, 1244-1251 (2008).</li><li>Edwards, T. B., Boulahia, A., Kempf, J. F., Boileau, P., Nemoz, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+rotator+cuff+disease+on+the+results+of+shoulder+arthroplasty+for+primary+osteoarthritis:+results+of+a+multicenter+study.">The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study.</a> J Bone Joint Surg Am. 84, 2240-2248 (2002).</li><li>Frankle, M., Siegal, S., Pupelo, D., Saleem, A., Mighell, M., Vasey, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=There+reverse+shoulder+prosthesis+for+glenohumeral+arthritis+associated+with+severe+rotator+cuff+deficiency.+A+minimum+two-year+follow-up+study+of+sixty+patients.">There reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.</a> J Bone Joint Surg Am. 87, 1697-1705 (2005).</li><li>Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty.+Survivorship+analysis+of+eighty+replacements+followed+for+five+to+ten+years.">Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.</a> J Bone Joint Surg Am. 88, 1742-1747 (2006).</li><li>Martin, T. G., Lanotti, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty+for+acute+fractures+and+failed+management+after+proximal+humerus+fractures.">Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humerus fractures.</a> Orthop Clin North Am. 39, 451-457 (2008).</li><li>Wall, B., Nove-Josserand, L., O'Conner, D. P., Edwards, T. B., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty:+a+review+of+results+according+to+etiology.">Reverse total shoulder arthroplasty: a review of results according to etiology.</a> J Bone Joint Surg Am. 89, 1476-1485 (2007).</li><li>Werner, C. M., Steinmann, P. A., Gilbart, M., Gerber, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+painful+pseudoparesis+due+to+irreparable+rotator+cuff+dysfunction+with+the+delta+III+reverse-ball-and-socket+total+shoulder+prosthesis.">Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the delta III reverse-ball-and-socket total shoulder prosthesis.</a> J Bone Joint Surg Am. 87, 1476-1486 (2005).</li></ol>

使用RTSA的肩袖关节病疼痛，运动功能的结果和分数范围的显着改善。整体病人的满意度从目前的文献中的80-95％不等。 RTSA的所有程序一样，也不是没有风险。并发症的初步报告，高达60％高。技术提高了并发症的发生率都有所下降。

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reverse total shoulder arthroplasty

反向总肩关节置换术，最初核定使用肩袖关节病，以及无慢性关节炎患者谁不适合肌腱转移重建pseudoparalysis。这些患者的传统手术方式的选择是有限的，功能结果分优次灾难性的。反向肩膀关节置换术的使用已被发现，有效地恢复这些患者功能和缓解他们与疾病斗争相关的症状。程序可以通过两种方法，肩胸或superolateral。与假体的使用相关并发症的发生率从8-60％不等，较近期的价格下跌是获得经验丰富的报告。挽救一个失败的反向肩关节假体的选择是有限的，往往有明显的残疾。使用这种假肢的迹象，继续进行评估，包括其修订关节置换术，肱骨近端骨折和肿瘤。细致的病人选择是至关重要的，因为与程序相关的重大风险。

Watch this Scientific Journal Video about Reverse Total Shoulder Arthroplasty at JoVE.com

Reverse Total Shoulder Arthroplasty

表示反向总肩关节置换术是治疗不能与传统的关节置换术或其他程序处理的条件。这些主要包括退行性和致残的条件与不可挽回的肩袖及肩膀正常的生物力学耦合损失。

反向共肩关节置换术

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

Universidad San Sebastian

Research

JoVE Journal

Medicine

43.0K 次观看.  Case Western Reserve University. 表示反向总肩关节置换术是治疗不能与传统的关节置换术或其他程序处理的条件。这些主要包括退行性和致残的条件与不可挽回的肩袖及肩膀正常的生物力学耦合损失。

视频: Reverse Total Shoulder Arthroplasty

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

SynCardia全人工心脏植入术

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

科研

医学

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. 
In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. 
Due to the patient's grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient's ventricles and great arteries required modifications to the TAH during implantation.
With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification.

This is a case report of a patient with congenitally corrected transposition of the great arteries (CCTGA) who received a total artificial heart (TAH) as a bridge to heart transplant. The TAH was successfully implanted with modifications to accommodate the patient's congenitally malformed heart.

的全人工心脏的先天性心脏病植入

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.
The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.
We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

Differential diagnostics in painful arthroplasty is crucial for treatment success. Joint aspiration is routinely performed preoperatively. Multiplex polymerase chain reaction of the joint aspirate and the sonication fluid, a feasible tool for quick pathogen detection from these samples is described.

翻修术中的新诊断: 种植超声和多重聚合酶链反应

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ventricular assist devices (VADs) for support of the left ventricle. However, certain clinical scenarios warrant biventricular mechanical support. One strategy for some patients is the excision of both ventricles and the implantation of two VAD pumps as a total artificial heart (TAH). This has recently been made possible by the improvements in device design and the small profile of centrifugal devices. This TAH approach remains experimental with many important challenges such as the device settings to balance the right and left circulation, the orientation of the devices and the outflow graft with their influence on hemolysis and stability, and the outcome of chronic support using such an orientation. This protocol aims to provide a reproducible approach for total artificial heart replacement with two intracorporeal centrifugal VADs in a cow model.

Here, we present a protocol using two centrifugal pumps as a total artificial heart replacement.

两体内心室辅助装置作为全人工心脏的应用

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short stems, differing in design and function. Calcar-guided short stems provide an anatomical curvature in the medial calcar region, thus, positioning is done individually alongside the calcar in the "round-the-corner" technique. Depending on the level of the neck's osteotomy, stems can be aligned individually in a large bandwidth of varus- and valgus anatomies. This differs from conventional total hip arthroplasty and potentially includes a severe learning curve. Given that a great variety of caput-collum-diaphyseal (CCD)-angles can be retained, the reconstruction of femoro-acetabular offsets can be achieved precisely. However, particularly extensive varus- and valgus positioning has raised concerns in regard to stability and bone remodeling. The purpose of the present manuscript is to showcase the implantation technique in calcar-guided short-stem THA and to summarize short-term clinical and radiological results.

This protocol describes the round-the-corner technique and the individualized stem-positioning of calcar-guided short stems alongside the medial calcar, depending on the level of the osteotomy. This differs from conventional total hip arthroplasty and includes a learning curve.

股骨引导下短茎全髋关节置换术的个体化茎定位

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The extent of diuresis or fluid removal is frequently determined by physical examination which is subject to inaccuracies.
Bedside ultrasound (US) is a portable tool that brings real-time diagnostic imaging to the patient's bedside. This versatile modality makes it possible for the clinician to investigate patients' extravascular and intravascular volume states. The extravascular volume, particularly in the case of pulmonary edema, can be quantitatively assessed by US of the anterior chest. Intravascular volume is estimated by visualizing the inferior vena cava (IVC) caliber. Taken together, the degree of extravascular lung water and the IVC caliber provide objective data that can guide the clinician to determine the level of diuresis needed to effectively yet safely treat pulmonary edema. 
The objective of this article is threefold: 1) to summarize the findings of previous studies on the efficacy of portable US to guide fluid management, 2) to describe a proposed ultrasound protocol to help guide fluid management, and 3) to elucidate techniques that address the measurement of intravascular and extravascular volumes using portable US.

We describe an imaging protocol that enables the clinician to visualize, in real-time, the patient&#39;s intravascular and extravascular space volumes and set diuresis and fluid removal parameters accordingly for the safe and efficient treatment of pulmonary edema.

床边超声在肺水肿患者导液中的效果: 反瀑布协议

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, mice undergo RR upon removal of the aortic constriction. In this paper, we describe a step-by-step procedure to perform a minimally invasive surgical aortic debanding in mice. Echocardiography was subsequently used to assess the degree of cardiac hypertrophy and dysfunction during LV remodeling and RR and to determine the best timing for aortic debanding. At the end of the protocol, terminal hemodynamic evaluation of the cardiac function was conducted, and samples were collected for histological studies. We showed that debanding is associated with surgical survival rates of 70-80%. Moreover, two weeks after debanding, the significant reduction of ventricular afterload triggers the regression of ventricular hypertrophy (~20%) and fibrosis (~26%), recovery of diastolic dysfunction as assessed by the normalization of left ventricular filling and end-diastolic pressures (E/e&#39;&#160;and LVEDP). Aortic debanding is a useful experimental model to study LV RR in rodents. The extent of myocardial recovery is variable between subjects, therefore, mimicking the diversity of RR that occurs in the clinical context, such as aortic valve replacement. We conclude that the aortic banding/debanding model represents a valuable tool to unravel novel insights into the mechanisms of RR, namely the regression of cardiac hypertrophy and the recovery of diastolic dysfunction.

Here we describe a step-by-step protocol of surgical aorta debanding in the well-established mice model of aortic-constriction. This procedure not only allows studying the mechanisms underlying the left ventricular reverse remodeling and regression of hypertrophy but also to test novel therapeutic options that might accelerate myocardial recovery.

研究左心室反向改造由主动脉脱体在啮齿动物

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been implicated in impacting long-term cancer outcomes, possibly through modulation of adrenergic-inflammatory responses that impact cancer cell behavior and immune cell function. Emerging evidence suggests that propofol-based total intravenous anesthesia (TIVA) may be beneficial for long-term cancer outcomes when compared to inhaled volatile anesthesia. However, the available clinical findings are inconsistent. Preclinical studies that identify the underlying mechanisms involved are critically needed to guide the design of clinical studies that will expedite insight. Most preclinical models of anesthesia have been extrapolated from the use of anesthesia in in vivo research and are not optimally designed to study the impact of anesthesia itself as the primary endpoint. This paper describes a method for delivering propofol-TIVA anesthesia in a mouse model of breast cancer resection that replicates key aspects of clinical delivery in cancer patients. The model can be used to study mechanisms of action of anesthesia on cancer outcomes in diverse cancer types and can be extrapolated to other non-cancer areas of preclinical anesthesia research.

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

This paper describes a method for modeling total intravenous anesthesia (TIVA) during cancer resection surgery in mice. The goal is to replicate key features of anesthesia delivery to patients with cancer. The method allows investigation of how anesthetic technique affects cancer recurrence after resection surgery.

癌症切除手术中全静脉麻醉的 体内 小鼠模型

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

机器人辅助全直肠系膜切除术和盆腔外侧淋巴结清扫术治疗局部晚期中低直肠癌

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

混合现实在定制翻修髋关节置换术中的应用:第一份病例报告

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...