Objective To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery. Methods The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc. Results 3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress. Conclusion The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.
It has been 20 years since the first transcatheter aortic valve replacement (TAVR) was performed internationally in 2002, and the development of TAVR technology in China has also been more than 10 years. The reliability of TAVR has been clinically proven, and it has also brought good benefits to patients with aortic stenosis. With the gradual progress of technology, TAVR has a trend to surpass surgical aortic valve replacement and become the mainstream surgery for patients with aortic stenosis. This article will review the relevant issues in the development of TAVR technology in recent years, based on existing research, and provide certain clinical references for the future development of TAVR technology.
Pulmonary hypertension (PH), characterized by diverse etiologies and intricate pathological mechanisms, is a complex cardiopulmonary vascular disorder featuring high morbidity and mortality. Percutaneous pulmonary artery denervation (PADN) represents an emerging interventional treatment method, which shows good prospects in the clinical practice of PH. The PADN has attained preliminary achievements in terms of safety and efficacy. Nevertheless, its long-term prognosis, the characteristics of the appropriate patient populations, and the optimization strategies combined with targeted pharmacotherapy remain to be further explored. This article reviews the current clinical applications of PADN as well as the challenges it confronts.
Glucocorticoids are the first-line therapy of many neurological disorders, with the treatment regimen varying across types and characteristics of neurological disorders. This article reviews the national and international guidelines and expert consensuses in the past decade on glucocorticoids treatment for neurological disorders, and summarizes recommendations from the latest Chinese guidelines and consensuses. In summary, the most frequently used pulse therapy of glucocorticoids in China is intravenous infusion of high-dose (usually 1000 mg/d) methylprednisolone in a short period (often <5 d), followed by gradual tapering, bridging with oral prednisone or direct discontinuation. The treatment regimen for children and juveniles is similar to that for adults but the dose is adjusted by body weight. Pharmacodynamics of glucocorticoids should be considered for the treatment of perinatal women. To provide appropriate glucocorticoids treatment for patients with neurological disorders, clinicians should fully understand features of each neurological disorder and clinical characteristics of individual patient.
Objective To promote the clinical application of parenteral and enteral nutrition preparations in hospitalized patients. Methods Domestic and foreign articles about parenteral and enteral nutrition support were enrolled to make a review. Results Nowadays, parenteral and enteral nutrition played an important role in the medical treatment of perioperative and critically ill patients. Rational nutrition support could improve the condition of patients with nutritional risk and result in better clinical outcomes. Different enteral nutrition formulations should be used according to the diseases. Supplementally parenteral nutrition may also be useful in combination with enteral nutrition to reach the required intake targets. We should pay attention to the application of glucose, lipid emulsion, amino acids, vitamins, and so on, when performed parenteral nutrition support. Conclusion It is necessary to standardize parenteral and enteral nutrition support in the work of clinical practice, including the application of nutrition support and selection of nutrition preparations.
ObjectiveTo report an improved classification system of Kümmell’s disease and its clinical application.MethodsBased on CT and MRI, an improved classification system of Kümmell’s disease was proposed in terms of the integrity of sagittal endplate, the integrity of posterior wall of vertebral body, and the degree of vertebral compression. Between January 2011 and March 2018, the improved classification system was used to evaluate and guide the treatment of 78 patients with Kümmell’s disease. There were 13 males and 65 females. The mean age was 69.1 years (range, 54-85 years). The mean disease duration was 4.0 months (range, 1-8 months). The mean T value of bone mineral density was −3.66 (range, −3.86- −3.34).The fractures located at thoracic vertebrae in 47 cases and lumbar vertebrae in 31 cases. According to the modified classification system of Kümmell’s disease, there were 11 cases of type A1, 13 cases of type A2, 2 cases of type A3, 10 cases of type B1, 18 cases of type B2, 4 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 11 cases of type C3. According to the classification results, the patients of types A and B were treated with percutaneous kyphoplasty (PKP), while the patients of type C were treated with PKP or intra- vertebral fixation according to the degree of vertebral reduction. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate clinical efficacy. The heights of the anterior, middle, and posterior edges of the vertebrae and the Cobb angle were measured to evaluate the reduction of the injured vertebrae and the improvement of kyphosis deformity. The complications were recorded.ResultsThe statistical analysis showed that the improved classification system has good consistency. All patients were followed up 12-36 months (mean, 24.3 months). The heights of anterior, middle, and posterior edges of the vertebrae, Cobb angle, VAS score, and ODI of all types of patients at last follow-up showed significant differences when compared with those before operation (P<0.05). After operation, 4 patients of type A2 had different degree of vertebral height loss; 2 patients of type B2, 3 patients of type C1, and 2 patients of type C2 developed asymptomatic bone cement leakage during PKP; 2 patients of type B3 and 3 patients of type C2 underwent percutaneous internal fixation and vertebral augmentation due to bone cement loosening.ConclusionThe modified classification system of Kümmell’s disease can be used to guide treatment of Kümmell’s disease, but the number of clinical application cases is limited, and further application and observation are needed.
Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
This consensus aims to elucidate the applications of 3D fluorescence technology in thoracic surgery, summarizing its clinical value and prospects in areas such as sub-lobar resection, mediastinal structure protection, and lymph node dissection, providing a reference for the clinical practice of 3D fluorescence technology in thoracic surgery. Furthermore, this consensus is committed to advancing the research and innovation of domestically produced 3D fluorescence medical endoscopes. It seeks to clarify clinical practice needs and technical development directions, promote the widespread application of high-quality domestic medical endoscopes, and support the independent innovation and development of China's medical equipment industry.
[Abstract]The rapid development of domestically produced high-end medical endoscopes, particularly those incorporating 4K ultra-high-definition and fluorescence imaging, has shown significant promise in minimally invasive thoracic surgery. This expert consensus systematically delineates the clinical applications and value of these advanced technologies in various thoracic procedures, including wedge resection, anatomical segmentectomy, and bronchial sleeve resection. Furthermore, it establishes a scientific, quantitative evaluation system for these domestic thoracoscopes. The proposed framework comprises four primary indicators (reliability, efficiency & cost-effectiveness, clinical performance, and service & support) and 14 secondary indicators, each with a defined weight. This consensus aims to provide technical guidance for clinicians, direct future research and development for manufacturers, and ultimately promote the widespread adoption of high-quality domestic medical endoscopes, thereby advancing the national medical equipment industry.
Objective To investigate the relationships between the bony structures, nerve, and indentations of ligamentum flavum of the upper lumbar spine by using CT three-dimensional reconstruction technique, in order to guide the unilateral biportal endoscopy (UBE) technique via contralateral approach in the treatment of upper lumbar disc herniation (ULDH). Methods Twenty-one ULDH patients who were admitted between June 2019 and July 2021 and met the selection criteria were selected as the research subjects. There were 12 males and 9 females with an average age of 62.1 years (range, 55-72 years). The disease duration was 1-12 years (mean, 5.7 years). There was 1 case of L1, 2, 4 cases of L2, 3, and 16 cases of L3, 4. The CT myelography data of T12-S3 segment was saved in DICOM format and imported into Mimics21.0 software for three-dimensional reconstruction. The relationship between the intersection (point Q) of spinous process and the inferior margin of lamina, the indentation of superior margin of ligamentum flavum, the inferior margin of nerve root origin, intervertebral space, and foramen were observed. The Mimics21.0 software was used to create a 3-mm-diameter cylinder to simulate the UBE channel and measure its abduction angle (∠b1), as well as measure the following lumbar vertebra-related indicators: in L1,2-L3,4 segments, the vertical distance from the point Q to the inferior margin of the contralateral lumbar pedicle of the same lumbar vertebra (a1), the superior margin of the contralateral pedicle of the lower lumbar vertebra (a2), the lower endplate of the same lumbar vertebra (a3), the upper endplate of the lower lumbar vertebra (a4); the vertical distance from the lower endplate of lumbar vertebra to the inferior margin of the lumbar pedicle (c1), the vertical distance from the upper endplate of the lower lumbar vertebra to the superior margin of the lumbar pedicle (c2); the vertical distance from the inferior margin of the nerve root origin to the superior margin (d1) and the inferior margin (d2) of the lumbar pedicle, respectively; the vertical distance from the intersection (point P) of the indentation of superior margin of ligamentum flavum and the medial margin of the lumbar pedicle to the superior margin (e1) and the inferior margin (e2) of the lumbar pedicle, respectively; the horizontal distance from the lateral margin of the dural mater (f1) and the narrowest part of the lumbar isthmus (f2) to the facet joint space, respectively. Thirteen of the patients included in the study chose the UBE surgery via contralateral approach. There were 8 males and 5 females with an average age of 63.3 years (range, 55-71 years). The disease duration was 2-12 years, with an average of 6.2 years. There were 3 cases of L2, 3 and 10 cases of L3, 4. The perioperative complications and surgical decompression were recorded. And the effectiveness were evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and short form-36 health survey (SF-36) score. Results The imaging results showed that there was no significant difference in a1, a3, a4, e1, e2, f1, and f2 between segments (P>0.05), and there were significant differences (P<0.05) in a2 and c2 between L1, 2 and L3, 4 segments, in ∠b1 and d2 between L1, 2, L2, 3 segments and L3, 4 segments, and in c1 and d1 between L1, 2 and L2, 3, L3, 4 segments. The 87.30% (110/126) of point Q of L1, 2-L3, 4 segments corresponded to the inferior articular process, and 78.57% (99/126) of the lower endplate corresponded to the level of the isthmus. All 13 patients completed the UBE surgery via contralateral approach, and none were converted to open surgery. All patients were followed up 12-17 months (mean, 14.6) months. The VAS score of low back pain and leg pain, ODI, and SF-36 score at 6 and 12 months after operation significantly improved when compared with those before operation (P<0.05), and further improved at 12 months after operation when compared with 6 months after operation (P<0.05). The imaging review results showed that the herniated disc was removed and the dura mater was decompressed adequately. Conclusion The point Q, the superior margin of ligamentum flavum, and lumbar pedicle can be used as the markers for the treatment of ULBD with UBE surgery via contralateral approach, making the procedure safer, more precise, and more effective.