改良经脐单孔三通道腹腔镜精索静脉高位结扎术的临床应用

目的 探讨改良经脐单孔三通道腹腔镜精索静脉高位结扎术的可行性。方法 2011 年3 月至2013 年3 月对25例精索静脉曲张患者采用改良经脐单孔三通道腹腔镜精索静脉高位结扎术（A 组）,30 例精索静脉曲张患者采用传统三孔法腹腔镜下精索内静脉高位结扎术（B 组）,比较并分析两种术式的手术时间、术后住院时间、术后近期并发症、精液常规变化、术后美容效果等。结果 单侧及双侧手术时间A 组分别为（35.0±8.6）min 及（45.0±11.5）min, B组分别为（18.0±6.5）min 及（25.0±8.2）min,A 组长于B 组,差异有统计学意义（P＜0.05）。术后住院时间A 组为（2.1±0.3）d,B 组为（2.5±0.5）d,差异无统计学意义（P ＞0.05）。两组术后近期并发症发生率及精液改善率均无统计学差异（均P ＞0.05）。A 组手术美容效果优于B 组。结论 改良经脐单孔三通道腹腔镜精索静脉高位结扎术不需专用单孔多通道操作平台,手术操作简化,安全有效,术后腹壁不留瘢痕,值得临床推广。     

Proof of concept: In vitro measurement of correlation between radiodensity and ultrasound echo response of ovine vertebral bodies

An acoustic guidance method for pedicle screw placement during spine fixation surgery was recently investigated, with a view toward preventing complications such as injury to the spinal cord, thecal sac, and spinal nerve roots due to screw misplacement. The method relies upon the change in the ultrasound amplitude reflected at different sites—from the outer posterior cortex, through the pedicle, and towards the distal ventral cortex. The amplitude change was empirically observed through in vitro measurement of ultrasound amplitude at the different sites by inserting a 2.5-MHz single element transducer into a vertebral body through insertion pathway created by an advancing screw. This paper provides a theoretical and experimental rationale behind these empirical findings and distance-dependent correlation coefficients between amplitude and bone mineral density within the vertebral body, which approached 97%.     

On the dynamics of a family of entire functions

We prove that for any bounded type irrational number 0θ1,the boundary of the Siegel disk of fα(z)=e2πiθsin(z)+αsin3(z),α∈C,which centered at the origin,is a quasicircle passing through 2,4 or 6 critical points of fαcounted with multiplicity.     

Distance between toroidal surgeries on hyperbolic knots in the -sphere

For a hyperbolic knot in the -sphere, at most finitely many Dehn surgeries yield non-hyperbolic -manifolds. As a typical case of such an exceptional surgery, a toroidal surgery is one that yields a closed -manifold containing an incompressible torus. The slope corresponding to a toroidal surgery, called a toroidal slope, is known to be integral or half-integral. We show that the distance between two integral toroidal slopes for a hyperbolic knot, except the figure-eight knot, is at most four.

     

Laryngeal sarcoidosis presenting as an isolated submucosal vocal fold mass

Sarcoidosis can affect the larynx as a manifestation of systemic disease or as isolated laryngeal involvement. Classically, laryngeal involvement affects the supraglottis, and less commonly the subglottis, and true vocal fold involvement is rare. The clinical course is often highlighted by frequent exacerbations and remissions that, when associated with vague complaints and constitutional symptoms, are probably the greatest contributor to delayed presentation and diagnosis. We describe an unusual case of sarcoidosis that presented after a long and protracted clinical course as an isolated submucosal vocal fold mass requiring deep biopsy for diagnosis. A review of the literature with emphasis on diagnosis, appropriate airway management, and treatment is presented.     

Boosting Postsurgical Outcomes of Orthotopic Hepatocellular Carcinoma via an EpCAM‐Targeting Theranostic Nanoparticle

Hepatectomy is one of the main treatments for hepatocellular carcinoma (HCC). However, because microscopic tumor residues are often present after surgery, the recurrence rate of HCC remains extremely high. A multimodality imaging‐guided multifunctional nanoparticle, indocyanine‐green–gadolinium–copper sulfide@bovine‐serum‐albumin–epithelial‐cell‐adhesion molecule (EpCAM), is developed for HCC treatment based on a novel theranostic strategy. After intravenous injection of these nanoparticles into HCC‐bearing mice, remarkably selective accumulation and highly efficient retention of the nanoparticles in tumor sites are observed. This is due to the EpCAM's specific targeting ability, which also results in enhanced HCC contrast in a tri‐modal visualization, which unites magnetic resonance, photoacoustic, and fluorescence imaging. Moreover, nanoparticle uptake into the HCC allows photothermal therapy (PTT) as an interoperative adjuvant strategy for further eliminating possible microscopic residues and boosting HCC surgery outcomes. This theranostic strategy not only helps with precise diagnosis of HCC but enables intraoperatively imaging guidance for accurate tumor resection. Moreover, postoperation longitudinal observation demonstrates that intraoperative imaging‐guided resection alongside a PTT‐integrated treatment strategy can result in a significant improvement of overall survival rate. These multifunctional EpCAM‐targeting nanoparticles may respresent a novel theranostic strategy to improve postsurgical HCC treatment.     

Symplectic -handles and transverse links

A standard convexity condition on the boundary of a symplectic manifold involves an induced positive contact form (and contact structure) on the boundary; the corresponding concavity condition involves an induced negative contact form. We present two methods of symplectically attaching -handles to convex boundaries of symplectic -manifolds along links transverse to the induced contact structures. One method results in concave boundaries and depends on a fibration of the link complement over ; in this case the handles can be attached with any framing larger than a lower bound determined by the fibration. The other method results in a weaker convexity condition on the new boundary (sufficient to imply tightness of the new contact structure), and in this case the handles can be attached with any framing less than a certain upper bound. These methods supplement methods developed by Weinstein and Eliashberg for attaching symplectic -handles along Legendrian knots.

     

Equivariant surgery with middle dimensional singular sets. II: Equivariant framed cobordism invariance

Let be a finite group and let be a degree 1, -framed map such that and are simply connected, closed, oriented, smooth manifolds of dimension and such that the dimension of the singular set of the -space is at most . In the previous article, assuming is -connected, we defined the -equivariant surgery obstruction in a certain abelian group. There it was shown that if then is -framed cobordant to a homotopy equivalence . In the present article, we prove that the obstruction is a -framed cobordism invariant. Consequently, the -surgery obstruction is uniquely associated to above even if it is not -connected.

     

Incompressible surfaces in link complements

We generalize a theorem of Finkelstein and Moriah and show that if a link has a -plat projection satisfying certain conditions, then its complement contains some closed essential surfaces. In most cases these surfaces remain essential after any totally nontrivial surgery on .

     

Surgery, Curvature, and Minimal Volume

On a Riemannian manifold X, we consider aK+s, where a is a nonnegative constant, K is the sectional curvature and s is the scalar curvature. It is shown that if X admits a metric with aK+s > 0, then so does any manifold obtained from X by surgeries of codimension 3. This implies the existence of such metrics on certain compact simply connected manifolds of dimension 5 by using the cobordism argument. We also study the corresponding minimal volume problem. As a corollary, we derive that every compact simply connected manifold of dimension 5 and every compact complex surface of Kodaira dimension 1 whose minimal model is not of Class VII collapse with aK+s bounded below.