作者要感谢KMMU第二附属医院提供与这项工作相关的病例和医疗记录。这项研究没有资金支持。

本文所述手术方法已获得昆明医科大学附属第二医院伦理委员会批准，患者手术视频的使用已授权。从患者那里获得知情同意书，并使用患者数据进行介绍。
1. 操作仪器
<ol><li>确保显示摄像头系统和钬激光器工作正常。</li>
</ol>2. 操作准备
<ol><li>使用以下纳入标准选择本研究的参与者。<ol><li>所有被诊断患有无精子症或少精子症并同意手术的患者。</li>
		<li>精液体积小于 1.5 mL，pH<7.2。精浆果糖 ≤13 μM/单次射精。</li>
		<li>磁共振成像（MRI）显示射精管区域有囊肿，双侧精囊腺肿大（图1）。 注意：很难通过成像准确识别前列腺囊肿和射精管囊肿。当精囊扩张的宽度大于 17 mm10 时，我们通常通过手术确认诊断。</li>
		<li>性激素水平在正常范围内。睾丸体积大于 15 mL（单个睾丸体积）。 注意：睾丸体积 >15 mL 的目的是排除由某些睾丸因素引起的无精子症。使用超声报告数据和 Lambert 公式测量睾丸体积：长 x 宽 x 高 x 0.71。</li>
		<li>没有影响手术安全性的疾病，如高血压和高血糖控制不佳、呼吸系统疾病等。</li>
	</ol></li>
	<li>使用以下排除标准将参与者排除在本研究之外。<ol><li>有尿道狭窄、急性尿路感染、严重凝血障碍或其他麻醉禁忌症的患者。</li>
		<li>睾丸体积小于 12 mL。</li>
	</ol></li>
	<li>手术前 30 分钟静脉注射抗生素以防止感染。通常，使用 1.5 g 头孢呋辛钠和 100 mL 0.9% 氯化钠溶液。</li>
</ol>3. 操作程序
<ol><li>使用舒芬太尼 （0.3 μg/kg）、丙泊酚 （2 mg/kg） 和罗库溴铵 （0.8 mg/kg） 将患者置于截石术中进行麻醉诱导。药物起效后进行气管插管，连接麻醉机进行机械通气。</li>
	<li>用异丙酚（2mg / kg / h），瑞芬太尼（0.15μg/ kg / min）和2%七氟醚维持，以达到BIS值40-60。间歇性注射罗库溴铵以促进正性肌力松弛。用碘水对下腹部和会阴区域进行 3 次消毒。</li>
	<li>将精囊镜连接到显示系统。将内窥镜插入尿道外口，小心地将其推进到后尿道。尿道粘膜看起来光滑而微红，证实了尿道在视野内的准确定位并延伸到后尿道。</li>
	<li>如果成功，检查尿道的凸起结构（称为精丘）是否可见。在精髓丘的两侧，检查射精管的两个小开口（图2A）。</li>
	<li>引导一根电线 （Bard） 穿过患侧的射精管开口，进入射精管囊肿。在手术过程中观察充满浑浊液体的重要区域（图2B）。</li>
	<li>用生理盐水冲洗囊肿，直至视力清晰，检查精管是否有异常开口。通过异常的射精管囊肿开口进入同侧精囊，显示多个蜂窝状导管腔（图2C）。</li>
	<li>使用 40 W 钬激光，将射精管的直径扩大到约 5 mm，促进改善冲洗液的循环并提供更清晰的视野（图 2D）。</li>
	<li>沿尿流方向切开射精管口，可能有利于保留抗尿反流机制。</li>
	<li>识别并探索患侧异常射精管开口的对称位置。</li>
	<li>进入健康侧的精囊进行进一步探索。轻轻将其插入囊肿左下方和右侧的精囊中。需要注意的是，确切的位置可能会有所不同（图2E）。</li>
	<li>使用钬激光精确切开和扩大对侧人工开口，使内窥镜顺利通过。这标志着手术的关键终点，两侧输精管中的精子通过受影响侧射精管的开口有效释放（图2F）。</li>
	<li>浸泡 Fr18 导管并用生理氯化钠连续冲洗，以防止血凝块阻塞导管。</li>
</ol>4. 术后护理
<ol><li>术后第1天， 连续冲洗膀胱6小时，并根据需要补充葡萄糖和电解质。</li>
	<li>在手术后第2 天拔 除导管。确保患者在手术后没有明显的疼痛;相反，他们能够忍受导管的主要不适，无需药物即可控制。术后不要对没有预先存在感染的患者使用抗生素。住院2天。</li>
	<li>指导患者增加饮水量，尿频，出院后尽快射精，目标是每周1-2次。此外，密切观察精液量。</li>
</ol>5. 跟进
<ol><li>在手术后第 3个月进行精液分析，以确保满足呕吐时间要求，并在3个月后主要通过电话访谈进行随访。</li>
	<li>使用自动精子活力测试仪和自动精液血浆生化仪进行精液样本。将手术前获得的精液分析结果与术后第 3 个月的精液分析结果进行比较。</li>
</ol>6. 统计分析
<ol><li>使用GraphPad软件分析结果，并表示为平均值±标准差。 使用Shapiro-Wilk检验进行正态性检验。如果术前和术后差异呈正态分布，则使用配对 t 检验进行分析;否则，请使用非参数检验 （Mann-Whitney）。通过配对 t 检验分析术前和术后数据之间的差异。当P<0.05时，统计学差异显著。</li>
</ol>

精囊镜激光辅助手术治疗射精管阻塞

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作者声明他们没有竞争利益。

TURED是治疗射精管囊肿引起的射精管阻塞的主要手术方法，其主要手术方式是用电切口切除囊肿后，以释放压力并渣滓精管11。研究对象在访问期间被问及他们的病史，并且都有正常的性活动频率（每周 1-2 次），没有性功能障碍或血精症。术前精液检查显示，均有精子，但精子数量少于正常值，精液量减少。结合患者的睾丸体积、精浆果糖和影像学检查，足以支持精膜远端不完?...

射精管梗阻是男性生殖系统的一种罕见疾病，据报道发病率为 1%-5%1,2。射精管囊肿是射精管阻塞的主要原因。典型EDO患者的精液检查显示四个显着特征：1.精液量小于2 mL，梗阻严重程度与精液量减少直接相关;2.少精子症，双侧完全梗阻导致无精子症;3.精液pH值降低;4. 精浆果糖水平降低，有时甚至降至 0 mM/L3.EDO引起的男性不育症可以通过手术治疗，保守治疗效果较差4。过去，主要方法是经尿道切除射精管。尽管这种方法具有减少创伤和减少术中并发症等好处，但手术切除藰膜会破坏远端射精管的正常生理结构。这反过来又增加了术后并发症的风险，如尿流、附睾炎、逆行射精和尿失禁5。同时，手术过程中的热量产生可能导致射精管、精囊甚至直肠的损伤，电切口的热效应可能会引起新的梗阻6。
verumontanum 是男性生殖系统中至关重要的解剖元件，确保射精过程中精液的精确和有序排出，同时也有助于防止逆行流动。目前尚不清楚TURED的缺点是否可以通过保留痈来改善。一些研究试图利用激光辅助内窥镜治疗 EDO，同时保留 verumontanum 2,7,8,9。尽管手术方法各不相同，但术后精液恢复非常成功，并发症极少。这表明保留附睾头可能是有益的。然而，他们使用的方法相对复杂，不会干预健康的射精管，这可能会增加复发的风险。因此，我们提出了一种简单有效的手术方法。
在这项研究中，精囊镜通过导线器引导进入患侧的射精管囊肿。然后，使用钬激光扩大患侧射精管开口，以确保其具有足够大的流出通道。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Camera system</td>
			<td>Karl Storz, Germany</td>
			<td>TC200EN</td>
			<td>Endoscopic camera system</td>
		</tr>
		<tr>
			<td>Fr18 Cathete</td>
			<td>Zhanjiang City Shida Industrial Co., Ltd.</td>
			<td>2660476</td>
			<td>Drainage of urine</td>
		</tr>
		<tr>
			<td>Fr6/7.5 vesiculoscope</td>
			<td>Richard Wolf, germany</td>
			<td>8702.534</td>
			<td>Operative procedure</td>
		</tr>
		<tr>
			<td>iodophor</td>
			<td>Shanghai Likang Disinfectant Hi-Tech Co., Ltd.</td>
			<td>31005102</td>
			<td>Skin disinfection</td>
		</tr>
		<tr>
			<td>Nitinol Guidewire 0.035&#34;</td>
			<td>C. R Bard, Inc. Covington, GA&#160;</td>
			<td>150NFS35</td>
			<td>Guide</td>
		</tr>
		<tr>
			<td>Propofol</td>
			<td>Sichuan Kelun Pharmaceutical Research Institute Co., Ltd.</td>
			<td>H20203571</td>
			<td>Induction and maintenance of anesthesia</td>
		</tr>
		<tr>
			<td>Remifentanil</td>
			<td>Yichang Humanwell Pharmaceuticals CO,Ltd.</td>
			<td>H20030200</td>
			<td>Maintenance of anesthesia</td>
		</tr>
		<tr>
			<td>Rocuronium bromide</td>
			<td>Zhejiang Huahai&#160; Pharmaceuticals CO,Ltd.</td>
			<td>H20183264</td>
			<td>Induction and maintenance of anesthesia</td>
		</tr>
		<tr>
			<td>Sevoflurane</td>
			<td>Jiangsu Hengrui Pharmaceuticals Co., Ltd.</td>
			<td>H20070172</td>
			<td>Maintenance of anesthesia</td>
		</tr>
		<tr>
			<td>Slimline EZ 200</td>
			<td>LUMENIS, USA</td>
			<td>0642-393-01</td>
			<td>Dissect capsule wall</td>
		</tr>
		<tr>
			<td>Sodium Chloride Physiological Solution</td>
			<td>Hua Ren MEDICAL TECHNOLOGY CO. Ltd.</td>
			<td>H20034093</td>
			<td>Flushing fluid</td>
		</tr>
		<tr>
			<td>Sufentanil</td>
			<td>Yichang Humanwell Pharmaceuticals CO,Ltd.</td>
			<td>H20054171</td>
			<td>Induction and maintenance of anesthesia</td>
		</tr>
		<tr>
			<td>Syringe 50 mL&#160;</td>
			<td>Double Pigeon Group Co. Ltd.</td>
			<td>20163141179</td>
			<td>Inject 0.9% sodium chloride solution into the vesiculoscope</td>
		</tr>
		<tr>
			<td>VersaPulse PowerSuite 100W Laser System</td>
			<td>LUMENIS, Germany</td>
			<td>PS.INT.100W</td>
			<td>Provide energy</td>
		</tr>
	</tbody>
</table>

treatment of ejaculatory duct obstruction by seminal vesiculoscopy assisted flow modification

经尿道射精管切除术 （TURED） 是治疗射精管囊肿引起的射精管阻塞 （EDO） 的主要手术方法。通常需要术中切除verumontanum以暴露射精管。然而，保留verumontanum结构可以更好地模拟正常的生理解剖结构。维持藜膜可能会增加术后远端射精管瘢痕形成的风险，导致复发性梗阻或精液量减少。因此，我们尝试了一种保留verumontanum的新技术，与TURED相比，它相对更容易，更安全。以下是程序步骤：1.通过尿道外口将6F精囊镜引入verumontanum附近，定位患侧射精管的开口，并将导丝引入囊肿。这一成功的步骤保留了verumontanum，最大限度地保留了远端射精管中的抗反流机制。2.钬激光将患侧射精管开口扩大至5mm，降低术后射精管开口闭合的可能性，简化手术过程。3.在囊肿内创建一个窗口以进入对侧精囊，然后使用钬激光将开口燃烧并扩张至5毫米，将对侧射精管重定向到囊腔。这种修改保留了健康侧射精管的开口，并为精液提供了新的流出通道，降低了术后精液量减少的风险。患者术后无并发症，住院时间较短，精液量有所改善。因此，这种手术方法简单而有效。

本研究共纳入 5 名患者，年龄从 27 岁到 34 岁不等（中位数为 31 岁），病程为 6 至 15 个月（平均 9 个月）。随访时间为 12 至 48 个月（平均 24.8 个月）。所有患者均顺利完成手术。平均手术时间为26分钟，平均住院时间为2天。5例均出现单侧EDO和对侧精囊扩张。与患者有关的人口统计信息，包括术前和术后数据，如表1所示。精囊镜检查手术后 1 个月射精管的代表性图像已在补充?...

Watch this Scientific Journal Video about Advanced Treatment of Seminal Duct Blockage Employing Endoscopy-Mediated Semen Channel Refluviation at JoVE.com

作者聚焦： 采用内窥镜介导的精液通道再激流治疗精管阻塞的先进治疗 

本方案介绍了精囊内镜联合钬激光治疗射精管囊肿引起的射精管梗阻的临床应用。

精囊镜辅助血流调整治疗射精管梗阻

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

本研究的范围主要是膀胱镜辅助精管分裂的临床效果。在治疗精管囊肿引起的精管梗阻。我们澄清说，该手术采用通道，这是一种非常有效的手术方法。目前的主要挑战是射精管囊肿引起的射精管阻塞的发生率非常低。并且很难积累足够的患者来与其他外科手术进行大量对照研究。与其他手术方法相比，该方法可以更好地保留的远端解剖结构。并且不太可能引起异常射精的并发症。润滑异常。而损失，阻塞的风险增加率较低。未来，我们将专注于改进内窥镜技术。更纤细、更清晰的内窥镜，用于精髓疾病的诊断和治疗。

treatment-ejaculatory-duct-obstruction-seminal-vesiculoscopy-assisted

Research

JoVE Journal

Medicine

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

2.0K 次观看.  The Second Affiliated Hospital of Kunming Medical University. 本研究的范围主要是膀胱镜辅助精管分裂的临床效果。在治疗精管囊肿引起的精管梗阻。我们澄清说，该手术采用通道，这是一种非常有效的手术方法。目前的主要挑战是射精管囊肿引起的射精管阻塞的发生率非常低。并且很难积累足够的患者来与其他外科手术进行大量对照研究。与其他手术方法相比，该方法可以更好地保留的远端解剖结构。并且不太可能引起异...

视频: 作者聚焦： 采用内窥镜介导的精液通道再激流治疗精管阻塞的先进治疗 

Accuracy in Dental Medicine, A New Way to Measure Trueness and Precision

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base for dental restorations. The current limitation of many reference scanners is the lack of accuracy scanning large objects like full dental arches, or the limited possibility to assess detailed tooth surfaces. A new reference scanner, based on focus variation scanning technique, was evaluated with regards to highest local and general accuracy. A specific scanning protocol was tested to scan original tooth surface from dental impressions. Also, different model materials were verified. The results showed a high scanning accuracy of the reference scanner with a mean deviation of 5.3 &#177; 1.1 &#181;m for trueness and 1.6 &#177; 0.6 &#181;m for precision in case of full arch scans. Current dental impression methods showed much higher deviations (trueness: 20.4 &#177; 2.2 &#181;m, precision: 12.5 &#177; 2.5 &#181;m) than the internal scanning accuracy of the reference scanner. Smaller objects like single tooth surface can be scanned with an even higher accuracy, enabling the system to assess erosive and abrasive tooth surface loss. The reference scanner can be used to measure differences for a lot of dental research fields. The different magnification levels combined with a high local and general accuracy can be used to assess changes of single teeth or restorations up to full arch changes.

Accuracy is a major demand in dental medicine. To verify accuracy, reference scanners are needed. This article presents a new reference scanner with an adjusted scanning method to acquire a broad variety of dental morphologies with high trueness and precision.

精度在牙科医学，一种新的方法来测量正确度与精密度

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base ...

科研

医学

Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well as to excrete bilirubin and other metabolic products. In the liver, the experimental obstruction of the extrahepatic biliary system initiates a complex cascade of pathological events that leads to cholestasis and inflammation resulting in a strong fibrotic reaction originating from the periportal fields. Therefore, surgical ligation of the common bile duct has become the most commonly used model to induce obstructive cholestatic injury in rodents and to study the molecular and cellular events that underlie these pathophysiological mechanisms induced by inappropriate bile flow. In recent years, different surgical techniques have been described that either allow reconnection or reanastomosis after bile duct ligation (BDL), e.g., partial BDL, or other microsurgical methods for specific research questions. However, the most frequently used model is the complete obstruction of the common bile duct that induces a strong fibrotic response after 21 to 28 days. The mortality rate can be high due to infectious complications or technical inaccuracies. Here we provide a detailed surgical procedure for the BDL model in mice that induce a highly reproducible fibrotic response in accordance to the 3R rule for animal welfare postulated by Russel and Burch in 1959.

Disruption of bile flow results in severe inflammatory cholestatic liver injury with a characteristic time-dependent sequence of morphological alterations. Here we present a protocol for the surgical ligation of the common bile duct in mice that allows to induce a strong fibrotic response after 21 to 28 days.

胆管结扎小鼠：感应炎性肝损伤和纤维化的阻塞性胆汁淤积

In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well ...

A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction

Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive nephropathy induced by unilateral ureteric obstruction (UUO), which can either be irreversible (UUO) or reversible (R-UUO). In the irreversible UUO model, the ureter may be obstructed for variable periods of time in order to induce increasingly severe renal inflammation and interstitial fibrotic scarring. In the reversible R-UUO model the ureter is obstructed to induce hydronephrosis, tubular dilation and inflammation. After a suitable period of time the ureteric obstruction is then surgically reversed by anastomosis of the severed previously obstructed ureter to the bladder in order to allow complete decompression of the kidney and restoration of urinary flow to the bladder. The irreversible UUO model has been used to investigate various aspects of renal inflammation and scarring including the pathogenesis of disease and the testing of potential anti-inflammatory or anti-fibrotic therapies. The more challenging model of R-UUO has been used by some investigators and does offer significant research potential as it allows the study of inflammatory and immune processes and tissue remodeling in an injured and scarred kidney following the removal of the injurious stimulus. As a result, the R-UUO model offers investigators the opportunity to explore the resolution of kidney inflammation together with key aspects of tissue repair. These experimental models are of relevance to human disease as patients often present with obstruction of the renal tract that requires decompression and are commonly left with significant residual kidney impairment that has no current treatment options and may lead to eventual end stage kidney failure.

The murine model of irreversible unilateral ureteric obstruction (UUO) is presented together with the model of reversible UUO in which the ureteric obstruction is relieved by anastomosis of the severed ureter into the bladder. These models enable the study of renal inflammation and scarring as well as tissue remodeling.

的不可逆和可逆单侧输尿管梗阻小鼠模型

Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive ...

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Transcanalicular 二极管激光辅助泪囊鼻腔吻合术治疗原发性鼻泪管阻塞

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte retrieval with routine gynecological surgery. OP-IVM is suitable for patients undergoing benign gynecological surgery who have the need for fertility preservation (FP) or infertility treatments such as in vitro fertilization and embryo transfer (IVF-ET). In the operating room, patients undergoing benign gynecological surgery are first anesthetized and receive ultrasound-guided immature follicle aspiration (IMFA) treatment. As the subsequent gynecological surgery is performed, the cumulus-oocyte complexes (COCs) are examined, and the immature COCs are transferred into the IVM medium and cultured for 28-32 hours in the IVF laboratory. After assessment, mature oocytes in the MII stage will be selected and cryopreserved in liquid nitrogen for FP or fertilized by intracytoplasmic sperm injection (ICSI) for IVF-ET. By combining IVM with gynecological surgery, immature oocytes that would have been discarded can be saved and used for assisted reproductive technology (ART). The procedure, significance and critical aspects of OP-IVM are described in this article.

In vitro maturation (IVM) before gynecological operation (OP-IVM) combines IVM following oocyte retrieval with routine gynecological surgery and serves as an extension of conventional IVM applications for fertility preservation.

OP-IVM：将卵母细胞取回后的体外成熟与妇科手术相结合

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte ...

Quality-Controlled Sputum Analysis by Flow Cytometry

Sputum, widely used to study the cellular content and other microenvironmental features to understand the health of the lung, is traditionally analyzed using cytology-based methodologies. Its utility is limited because reading the slides is time-consuming and requires highly specialized personnel. Moreover, extensive debris and the presence of too many squamous epithelial cells (SECs), or cheek cells, often renders a sample inadequate for diagnosis. In contrast, flow cytometry allows for high-throughput phenotyping of cellular populations while simultaneously excluding debris and SECs.
The protocol presented here describes an efficient method to dissociate sputum into a single cell suspension, antibody stain and fix cellular populations, and acquire samples on a flow cytometric platform. A gating strategy that describes the exclusion of debris, dead cells (including SECs) and cell doublets is presented here. Further, this work also explains how to analyze viable, single sputum cells based on a cluster of differentiation (CD)45 positive and negative populations to characterize hematopoietic and epithelial lineage subsets. A quality control measure is also provided by identifying lung-specific macrophages as evidence that a sample is derived from the lung and is not saliva. Finally, it has been demonstrated that this method can be applied to different cytometric platforms by providing sputum profiles from the same patient analyzed on three flow cytometers; Navios EX, LSR II, and Lyric. Furthermore, this protocol can be modified to include additional cellular markers of interest. A method to analyze an entire sputum sample on a flow cytometric platform is presented here that makes sputum amenable for developing high-throughput diagnostics of lung disease.

This protocol describes an efficient method for dissociating sputum into a single cell suspension and the subsequent characterization of cellular subsets on standard flow cytometric platforms.

通过流式细胞术进行质量控制痰液分析

Sputum, widely used to study the cellular content and other microenvironmental features to understand the health of the lung, is traditionally analyzed ...

DUCT: Double Resin Casting followed by Micro-Computed Tomography for 3D Liver Analysis

The liver is the biggest internal organ in humans and mice, and high auto-fluorescence presents a significant challenge for assessing the three-dimensional (3D) architecture of the organ at the whole-organ level. Liver architecture is characterized by multiple branching lumenized structures, which can be filled with resin, including vascular and biliary trees, establishing a highly stereotyped pattern in the otherwise hepatocyte-rich parenchyma. This protocol describes the pipeline for performing double resin casting micro-computed tomography, or &#34;DUCT&#34;. DUCT entails injecting the portal vein and common bile duct with two different radiopaque synthetic resins, followed by tissue fixation. Quality control by clearing one lobe, or the entire liver, with an optical clearing agent, allows for pre-screening of suitably injected samples. In the second part of the DUCT pipeline, a lobe or the whole liver can be used for micro-computed tomography (microCT) scanning, (semi-)automated segmentation, and 3D rendering of the portal venous and biliary networks. MicroCT results in 3D coordinate data for the two resins allowing for qualitative as well as quantitative analysis of the two systems and their spatial relationship. DUCT can be applied to postnatal and adult mouse liver and can be further extended to other tubular networks, for example, vascular networks and airways in the lungs.

Double resin casting micro-computed tomography, or DUCT, enables visualization, digitalization, and segmentation of two tubular systems simultaneously to facilitate 3D analysis of organ architecture. DUCT combines ex vivo injection of two radiopaque resins followed by micro-computed tomography scanning and segmentation of the tomographic data.

DUCT：双树脂铸造，然后进行微型计算机断层扫描，用于3D肝脏分析

The liver is the biggest internal organ in humans and mice, and high auto-fluorescence presents a significant challenge for assessing the ...

A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, preserving the vasal vessels during MVE might better simulate the normal physiological structure and be meaningful for patients who have undergone varicocelectomy. Nevertheless, preserving the vasal vessels might elevate the risk of increasing the tension of anastomosis, affecting the patency rate and leading to delayed postoperative bleeding. Therefore, we developed a novel vessel-sparing MVE to make it safer. Here is a summary of the improvements to the procedure. 1) The retrograde dissociation of the vasal vessels on the proximal testicular side was adopted as the main method, and the anterograde dissociation of the vasal vessels on the distal testicular side was adopted as a supplement to dissociate the vasal vessels to be preserved. This improvement ensures the blood supply to the vas deferens that will be used for anastomosis and also provides longer vasal vessels, which reduces the tension of anastomosis. 2) By fixing the vas deferens to be anastomosed and the broken end of the vas deferens, the free vasal vessels get fixed, which resolves the problem of transmission of vas tension to the vasal vessels and reduces the risk of vasal vessel hemorrhage. 3) Dissociation of the vas deferens after opening the tunica vaginalis increases the mobilization of the vas deferens, which also makes the new procedure easier to complete. The evaluation of the outcomes of this new procedure showed that no significant postoperative complications occurred in the patients, and the patency rate was no different from that of the conventional procedure. Therefore, this new, improved procedure can be considered safe, with satisfactory postoperative results.

Here, we present a protocol to preserve the vasal vessels in microsurgical vasoepididymostomy. The surgical security is enhanced by preserving the vasal vessels using a retrograde-anterograde dissociation and fixing the vasal vessels.

一种改良的血管保留显微外科血管附睾造口术

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, ...

Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm fluoroscopy to place the screw freehand and requires several guide wire adjustments, which increases the operation time and radiation exposure. Repeated drilling can also cause damage to the blood supply and bone quality of the femoral neck, which can be followed by complications such as screw loosening, nonunion, and femoral head necrosis. In order to make fixation more precise and reduce the incidence of complications, our team applied robot-assisted orthopedic surgery for screw placement using the femoral neck system to modify the traditional procedure. This protocol introduces how to import a patient's X-ray information into the system, how to perform screw path planning in software, and how the robotic arm assists in screw placement. Using this method, the surgeons can place the screw successfully the first time, improve the accuracy of the procedure, and avoid radiation exposure. The whole protocol includes the diagnosis of femoral neck fracture; the collection of intraoperative X-ray images; screw path planning in the software; precise placement of the screw under the assistance of the robotic arm by the surgeon; and verification of the implant placement.

This article introduces a method of robot-assisted orthopedic surgery for screw placement during the treatment of femoral neck fracture using the femoral neck system, which allows for more accurate screw placement, improved surgical efficiency, and fewer complications.

骨科机器人辅助股骨颈系统治疗股骨颈骨折

Cannulated screw fixation is the main therapy for femoral neck fractures, especially in young patients. The traditional surgical procedure uses C-arm ...

Endolymphatic Duct Blockage as a Surgical Treatment Option for M&#233;ni&#232;re's Disease

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing and equilibrium. After a regular mastoidectomy, the posterior semicircular canal is identified, and Donaldson's line is determined. This is a line through the horizontal semicircular canal, crossing the posterior semicircular canal. The endolymphatic sac is usually found at this site under the posterior semicircular canal. The bone of the endolymphatic sac and the dura are thinned until the sac is skeletonized, after which the endolymphatic duct is identified. The duct is then blocked with a titanium clip. Using a computerized tomography (CT) scan, the position is confirmed. Follow-up visits take place 1 week, 6 weeks and 1 year after surgery. To this day, only one prospective trial assessing this method has been conducted, comparing this new method to endolymphatic sac decompression. Results of the duct blockage are promising, with 96.5% of the patients free of vertigo after 2 years. However, further research is required.

Endolymphatic duct blockage is a relatively new surgical method for patients suffering from M&#233;ni&#232;re's disease. Following a regular mastoidectomy, the endolymphatic duct is identified and ligated using a regular titanium hemoclip. The effectiveness of this procedure is currently being assessed in a randomized trial.

内淋巴管阻塞作为梅尼埃病的手术治疗选择

Endolymphatic duct blockage is a relatively new treatment option for M&#233;ni&#232;re's disease, aiming to reduce vertigo attacks while sparing hearing ...

Methods Article

精囊镜辅助血流调整治疗射精管梗阻