BACKGROUND The Turkish Delight technique,initially described by Erol in 2000,involves the use of diced cartilage wrapped in oxidized cellulose(Surgicel^(TM))for nasal grafting in secondary rhinoplasty.CASE SUMMARY Thi...BACKGROUND The Turkish Delight technique,initially described by Erol in 2000,involves the use of diced cartilage wrapped in oxidized cellulose(Surgicel^(TM))for nasal grafting in secondary rhinoplasty.CASE SUMMARY This paper presents a novel adaptation called Diced Cartilage in Capsula,where diced cartilage is wrapped in the periprosthetic capsule material formed from a previous breast augmentation procedure instead of fascia,a technique based on the Diced Cartilage in Fascia method.Utilizing autologous,biocompatible material minimizes foreign body reactions and enhances graft integration.This innovative approach demonstrates the potential for specific practices in cosmetic surgery by optimizing patient-specific resources and improving surgical outcomes.CONCLUSION The report compares traditional Turkish Delight applications with this new method,discussing biocompatibility,technique efficacy,and benefits in rhinoplasty.展开更多
BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.A...BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises,and the fascial composition related to LLND was observed and described.Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC,and their clinical data were analyzed.RESULTS The cadaver study showed that the fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery,and the last three fasciae formed two spaces(Latzko's pararectal space and paravesical space)which were the surgical area for LLND.Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients.The median operating time,blood loss and postoperative hospitalization were 178(152-243)min,55(25-150)mL and 10(7-20)d,respectively.The median number of harvested LLNs was 8.6(6-12),and pathologically positive LLN metastasis was confirmed in 7(35.0%)cases.Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible,effective and safe procedure for treating LALRC.展开更多
Objective: To compare the functional outcomes of patients who had parotid masseter fascia reserved and unreserved flap elevating scheme in parotidectomy, especially the morbidity of Frey's syndrome. Methods: Twent...Objective: To compare the functional outcomes of patients who had parotid masseter fascia reserved and unreserved flap elevating scheme in parotidectomy, especially the morbidity of Frey's syndrome. Methods: Twenty-three patients (group A) had parotid masseter fascia reserved in the parotidectomy, 32 patients (group B) had parotid masseter fascia unreserved in the operation. Compare the morbidity of gustatory sweating syndrome of the two groups. Results: Follow-up after 6 months to 2.5 years, gustatory sweating syndrome occurred in 4 patients of group A (17%), 17 patients in group B (57%). Conclusion: Reservation technic of the parotid masseter fascial in parotidectomy could prevent regeneration of parasympathetic nerve and thus prevent Frey's syndrome post-operation.展开更多
The most recent information on fascial tissue indicates that there are not fascial layers, but polyhedral microvacuoles of connective tissue, which connect the body systems and, by hosting specialized cells, permit se...The most recent information on fascial tissue indicates that there are not fascial layers, but polyhedral microvacuoles of connective tissue, which connect the body systems and, by hosting specialized cells, permit several functions, such as motor, nervous, vascular and visceral. These microvacuoles（a repetition of polyhedral units of connective fibrils） under internal or external tension change shape and can manage the movement variations, regulating different body functions and ensuring the maintenance of efficiency of the body systems. Their plasticity is based on perfect functional chaos： it is not possible to determine the motion vectors of the different fibrils, which differ in behavior and orientation; this strategy confers to the fascial continuum the maximum level of adaptability in response to the changing internal and external conditions of the cell. The present commentary deals with this concept, providing clinical examples of different disease patterns, providing contrary examples in which this adaptability does not occur, and lastly suggesting considerations for the approach to manipulative therapy of the fascial tissue. The fascial continuum is like a flock of birds flying together without a predetermined logic and maintaining their individuality at the same time.展开更多
AIM： To determine the accuracy of high-resolution magnetic resonance imaging （MRI） using phasedarray coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal dis...AIM： To determine the accuracy of high-resolution magnetic resonance imaging （MRI） using phasedarray coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.METHODS： In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging （in-plane resolution, 0.66 × 0.56） with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were evaluated.RESULTS： The overall magnetic resonance accuracy was 85.1% for Tstaging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value, and negative predictive value was 70%, 97.9%, 89.6%, 93.3% and 88.5% for ≤ T2 tumors, 90.5% , 76% , 85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%, 95.5% , 62.5% and 100% for T4 tumors, and 80% , 90.4%, 88%, 70.6% and 9d% for predicting mesorectal fascia involvement, respectively.CONCLUSION： High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.展开更多
AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography(MDCT) as compared with conventional magnetic resonance imaging(MRI), in identifying mesorectal fascia(MRF) invasion in rectal cancer patie...AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography(MDCT) as compared with conventional magnetic resonance imaging(MRI), in identifying mesorectal fascia(MRF) invasion in rectal cancer patients.METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner(ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 m As. Imaging data were reviewed as axial and as multiplanar reconstructions(MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images(DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed.RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91(41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged(45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value(PPV) 80.4%, negative predictive value(NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant(P = 0.02). CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.展开更多
OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients w...OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.展开更多
BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pa...BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.展开更多
Aim： To investigate the feasibility of the autologous fascia graft in urethra defect reconstruction. Methods： In 24 adult male rabbits, a standardized defect （17 mm） was created within the midportion of each ureth...Aim： To investigate the feasibility of the autologous fascia graft in urethra defect reconstruction. Methods： In 24 adult male rabbits, a standardized defect （17 mm） was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained. Results： In the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits. Conclusion： For segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.展开更多
BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique tha...BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.展开更多
BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct...BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not.The time to tracheal extubation and time spent in the post-anesthesia care unit(PACU),intraoperative remifentanil dosage,fentanyl consumption in the PACU,postoperative cumulative fentanyl consumption within 48 h after operation,visual analogue scale at rest and during movement on the first and second days after surgery,and adverse reactions were compared.RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study(block group,n=16;no-block group,n=15).The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group(all P<0.05).Compared with the no-block group,the intraoperative remifentanil dosage was lower,the time to tracheal extubation and the time spent in the PACU were shorter in the block group(all P<0.01).Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group(all P<0.01).The incidence of dizziness was higher in the no-block group than in the block group(P=0.037).CONCLUSION Ultrasound-guided,direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.展开更多
Objective To observe the clinical efficacy of acupuncture at the superficial fascia for cervical type of cervical spondylosis. Methods Acupuncture at the superficial fascia was carried out for 48 patients with cervica...Objective To observe the clinical efficacy of acupuncture at the superficial fascia for cervical type of cervical spondylosis. Methods Acupuncture at the superficial fascia was carried out for 48 patients with cervical type of cervical spondylosis by selecting the tender points on both sides of the cervical vertebral body and on the neck and shoulders. The treatment was conducted for once a day and treatment for 5 times was considered as 1 course of treatment. Two days were free from treatment between courses, and 3 courses were needed in total. The scores of McGill pain questionnaire [MPQ, including three indexes： Pain rating index （PRI）, Visual analogue scale （VAS） and Present pain intensity （PPI） ] of patients before and after treatment were compared, therapeutic effct of cervical type of cervical spondylosis was evaluated. Results According to the comparison before and after treatment, the scores of PRI （29.44±9.26 vs13.15±7.04）, VAS （5.63±2.73 vs 1.23±1.15）, and PPI （3.00±1.24 vs 0.38±0.49） of patients with cervical type of cervical spondylosis reduced significantly （all P〈0.05）, indicating that the differences were statistically significant. Among 48 cases, cured 40 cases （83.33%）, markedly effective 4 cases （8.34%）, effective 3 cases （6.25%）, ineffective i case （2.08%）. The total effective rate was 97.92% （47/48）. Conclusion The curative effect of acupuncture at the superficial fascia for cervical type of cervical spondylosis was satisfactory.展开更多
The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurren...The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery.However,standardized TME causes urogenital dysfunction in more than half of patients,thus lowering the quality of life of patients.Of note,pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction.The anatomy of the Denonvilliers’fascia(DVF)and its application in surgery have been investigated both nationally and internationally.Nevertheless,controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery.Currently,it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection.Herein,this study systematically describes the anatomy of DVF and its appli-cation in surgery,thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.展开更多
BACKGROUND For the management of lateral lymph node(LLN)metastasis in patients with rectal cancer,selective LLN dissection(LLND)is gradually being accepted by Chinese scholars.Theoretically,fascia-oriented LLND allows...BACKGROUND For the management of lateral lymph node(LLN)metastasis in patients with rectal cancer,selective LLN dissection(LLND)is gradually being accepted by Chinese scholars.Theoretically,fascia-oriented LLND allows radical tumor resection and protects of organ function.However,there is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND.Through a preliminary study with a small sample size,we found that fasciaoriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined LLNs.In this study,we increased the sample size and refined the postoperative functional outcomes.AIM To compare the effects of fascia-and vessel-oriented LLND regarding short-term outcomes and prognosis.METHODS We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021.The short-term outcomes included perioperative outcomes and postoperative functional outcomes.The prognosis was measured based on overall survival(OS)and progression-free survival(PFS).RESULTS A total of 105 patients were included in the final analysis and were divided into fascia-and vesseloriented groups that included 41 and 64 patients,respectively.Regarding the short-term outcomes,the median number of examined LLNs was significantly higher in the fascia-oriented group than in the vessel-oriented group.There were no significant differences in the other short-term outcomes.The incidence of postoperative urinary and male sexual dysfunction was significantly lower in the fascia-oriented group than in the vessel-oriented group.In addition,there was no significant difference in the incidence of postoperative lower limb dysfunction between the two groups.In terms of prognosis,there was no significant difference in PFS or OS between the two groups.CONCLUSION It is safe and feasible to perform fascia-oriented LLND.Compared with vessel-oriented LLND,fascia-oriented LLND allows the examination of more LLNs and may better protect postoperative urinary function and male sexual function.展开更多
Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with ...Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with comparison of cT3 substage.Methods:This was a retrospective,multicenter cohort study including cT3 rectal cancer patients undergoing neoadjuvant chemoradiotherapy followed by radical surgery from January 2013 to September 2014.DMRF and cT3 substage were evaluated from baseline MRI.The cutoff of DMRF was determined by disease progression.Multivariate cox regression was used to test the prognostic values of baseline variables.Results:A total of 804 patients were included,of which 226(28.1%)developed progression.A DMRF cutoff of7 mm was chosen.DMRF category,the clock position of the deepest position of tumor invasion(CDTI)and extramural venous invasion(EMVI)were independent predictors for disease progression,and hazard ratios(HRs)were 0.26[95%confidence interval(95%CI),0.13-0.56],1.88(95%CI,1.33-2.65)and 1.57(95%CI,1.13-2.18),respectively.cT3 substage was not a predictor for disease progression.Conclusions:The measurement of DMRF value on baseline MRI can better distinguish cT3 rectal cancer prognosis rather than cT3 substage,and was recommended in clinical evaluation.展开更多
Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforation...Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforations over 5 years follow-up period.Materials and methods:This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations.The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade(CP group)or temporalis fascia(TF group)as the graft via a transmeatal approach and under local anesthesia.Morphological and functional results were recorded at three-and five years follow-up.Demographic profiles including age and sex,surgery side,contralateral disease and graft uptake rate,as well as hearing outcomes,were compared between the two groups.Results:At three years follow-up,graft uptake was 94.87%for perichondrium reinforced cartilage palisade and 80.7%for fascia,respectively,(p¼0.67).At five years follow-up,the uptake rate dropped to 87.17%in the CP group,but to 66.6%in the TF group(p¼0.019).Hearing improved after surgery in both groups,and showed no significant difference between the two groups.Conclusion:Over long-term,perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results.展开更多
Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designe...Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.展开更多
Objective To observe the efficacy of acupuncture in treatment of chronic daily headache（CDH） based on muscular fascia theory.Methods Sixty patients were randomly divided into group A（30 cases） and group B（30 case...Objective To observe the efficacy of acupuncture in treatment of chronic daily headache（CDH） based on muscular fascia theory.Methods Sixty patients were randomly divided into group A（30 cases） and group B（30 cases）.In group A,based on muscular fascia theory combined with the anatomical position of injection site of kreotoxin in treatment of chronic headache,10-16 acupoints were selected on frontal muscle,occipital muscle,temporal muscle,splenius capitis,semispinalis capitis,suboccipital muscle and sternocleidomastoid muscle.0.25 mm×30 mm acupuncture needles were adopted for acupuncture.After acupuncture,2-3 groups of acupoints were selected for electroacupuncture device.In group B,Neiguan（内关 PC 6）,Shulgou（水沟 GV26）,Hegu（合谷 LI 4）,Taichong（太冲 LR 3）,Baihui（百会 GV 20）,Sishencong（四神聪 EX-HN 1）,Fengchi（风池 GB 20）,Wangu（完骨 GB 12） and Tianzhu（天柱 BL 10） were selected for acupuncture.After acupuncture,2-3 groups of acupoints were selected for electroacupuncture device.Acupuncture was conducted once a day in the two groups,five days were one course of treatment,and two days were free from treatment between two courses.The treatment lasted for eight weeks.Daily headache record was considered as efficacy index,and VAS score and the number of days of headache in each month were observed.Results After treatment for eight weeks and follow-up visit for three months,the efficacy of acupuncture treatment for CDH based on muscular fascia theory（group A） was superior to conventional acupuncture（group B）,and the comparison result between the two groups was statistically significant（VAS score between two groups,after treatment：t=2.2864,P=0.0259,follow-up：r=2.6735,P=0.0097;the frequency of attack between the two groups after treatment：t=2.1520,P=0.0364）.Conclusion CDH may be related with muscular fascia dysfunction of head and neck,and the efficacy of acupuncture treatment based on muscular fascia theory was significant.展开更多
BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY Th...BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY This report established that hip surgical procedures can be performed with a fascia iliaca compartment block(FICB)and monitored anesthesia care(MAC)while avoiding neuraxial or general anesthesia.This was a preliminary experience with two geriatric patients with hip fracture,American Society of Anesthesiologists status III,and with many comorbidities.Neither patient could be operated on within 48 h after admission.Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications.Hence,we chose nerve block combined with a small amount of sedation.Intraoperative analgesia was provided by single-injection ultrasound-guided FICB.Light intravenous sedation was added.Surgical exposure was satisfactory,and neither patient complained of any symptoms during the procedure.CONCLUSION This report showed that hip surgery for geriatric patients can be performed with FICB and MAC,although complications and contraindications are common.The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.展开更多
Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive ly...Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive lymphatic drainage and is located in a bony pelvic in close proximity to urogenital and neurovascular structures that are invested with intricate fascial covering. The rectum is encased byfatty lymphovascular tissue(mesorectum) that is surrounded by perirectal fascia that act as barrier to the spread of the cancer and constitute the surgical circumferential margin. Locoregional recurrence after rectal cancer surgery is influenced by tumor-related factors and adequacy of the resection. Local recurrence is associated with incomplete excision of circumferential margin, violation of perirectal fascia, transmesorectal dissection, presence of isolated deposits in the mesorectum and tumor in regional lymph nodes and incomplete lymph node clearance. Hence to eradicate the primary rectal tumor and control regional disease, the rectum, first area of lymph node drainage and surrounding tissue must be completely excised while maintaining an intact fascial envelope around the rectum and preserving surrounding structures. This is achieved with extrafascial dissection and removal of the entire mesorectum including the portion distal to the tumor(total mesorectal excision) within its enveloping fascia as an intact unit. Total mesorectal excision is the standard of care surgical treatment of mid and low rectal cancer and can be performed in conjunction with low anterior resection,abdominoperineal resection, extralevator abdominoperineal resection, and extraregional dissection. To accomplish such a resection, thorough knowledge of the surgical anatomy of the rectum and pelvic structures and fascial planes is paramount.展开更多
文摘BACKGROUND The Turkish Delight technique,initially described by Erol in 2000,involves the use of diced cartilage wrapped in oxidized cellulose(Surgicel^(TM))for nasal grafting in secondary rhinoplasty.CASE SUMMARY This paper presents a novel adaptation called Diced Cartilage in Capsula,where diced cartilage is wrapped in the periprosthetic capsule material formed from a previous breast augmentation procedure instead of fascia,a technique based on the Diced Cartilage in Fascia method.Utilizing autologous,biocompatible material minimizes foreign body reactions and enhances graft integration.This innovative approach demonstrates the potential for specific practices in cosmetic surgery by optimizing patient-specific resources and improving surgical outcomes.CONCLUSION The report compares traditional Turkish Delight applications with this new method,discussing biocompatibility,technique efficacy,and benefits in rhinoplasty.
基金Supported by The National Natural Science Foundation of China,No.81874201.
文摘BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises,and the fascial composition related to LLND was observed and described.Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC,and their clinical data were analyzed.RESULTS The cadaver study showed that the fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery,and the last three fasciae formed two spaces(Latzko's pararectal space and paravesical space)which were the surgical area for LLND.Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients.The median operating time,blood loss and postoperative hospitalization were 178(152-243)min,55(25-150)mL and 10(7-20)d,respectively.The median number of harvested LLNs was 8.6(6-12),and pathologically positive LLN metastasis was confirmed in 7(35.0%)cases.Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible,effective and safe procedure for treating LALRC.
文摘Objective: To compare the functional outcomes of patients who had parotid masseter fascia reserved and unreserved flap elevating scheme in parotidectomy, especially the morbidity of Frey's syndrome. Methods: Twenty-three patients (group A) had parotid masseter fascia reserved in the parotidectomy, 32 patients (group B) had parotid masseter fascia unreserved in the operation. Compare the morbidity of gustatory sweating syndrome of the two groups. Results: Follow-up after 6 months to 2.5 years, gustatory sweating syndrome occurred in 4 patients of group A (17%), 17 patients in group B (57%). Conclusion: Reservation technic of the parotid masseter fascial in parotidectomy could prevent regeneration of parasympathetic nerve and thus prevent Frey's syndrome post-operation.
文摘The most recent information on fascial tissue indicates that there are not fascial layers, but polyhedral microvacuoles of connective tissue, which connect the body systems and, by hosting specialized cells, permit several functions, such as motor, nervous, vascular and visceral. These microvacuoles（a repetition of polyhedral units of connective fibrils） under internal or external tension change shape and can manage the movement variations, regulating different body functions and ensuring the maintenance of efficiency of the body systems. Their plasticity is based on perfect functional chaos： it is not possible to determine the motion vectors of the different fibrils, which differ in behavior and orientation; this strategy confers to the fascial continuum the maximum level of adaptability in response to the changing internal and external conditions of the cell. The present commentary deals with this concept, providing clinical examples of different disease patterns, providing contrary examples in which this adaptability does not occur, and lastly suggesting considerations for the approach to manipulative therapy of the fascial tissue. The fascial continuum is like a flock of birds flying together without a predetermined logic and maintaining their individuality at the same time.
文摘AIM： To determine the accuracy of high-resolution magnetic resonance imaging （MRI） using phasedarray coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.METHODS： In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging （in-plane resolution, 0.66 × 0.56） with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were evaluated.RESULTS： The overall magnetic resonance accuracy was 85.1% for Tstaging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value, and negative predictive value was 70%, 97.9%, 89.6%, 93.3% and 88.5% for ≤ T2 tumors, 90.5% , 76% , 85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%, 95.5% , 62.5% and 100% for T4 tumors, and 80% , 90.4%, 88%, 70.6% and 9d% for predicting mesorectal fascia involvement, respectively.CONCLUSION： High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.
文摘AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography(MDCT) as compared with conventional magnetic resonance imaging(MRI), in identifying mesorectal fascia(MRF) invasion in rectal cancer patients.METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner(ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 m As. Imaging data were reviewed as axial and as multiplanar reconstructions(MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images(DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed.RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91(41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged(45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value(PPV) 80.4%, negative predictive value(NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant(P = 0.02). CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.
文摘OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.
文摘BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
文摘Aim： To investigate the feasibility of the autologous fascia graft in urethra defect reconstruction. Methods： In 24 adult male rabbits, a standardized defect （17 mm） was created within the midportion of each urethra. Two-cm long fascial tube grafts were interposed between the cut ends of the urethra. Twenty-four rabbits were divided into 12 groups. At 0, 3, 10, 15, 21, 30, 45, 60, 90, 120, 150, and 180 days postoperatively, one group was killed. In the first four groups, rabbits were killed and specimens were obtained for histological examination. After 21 postoperative days, in the subsequent eight groups, retrograde urethrograms were carried out to evaluate urethral patency and caliber, then rabbits were killed and specimens were obtained. Results： In the histological study, advancement of the urethral transitional epithelium along scaffold provided by the fascial graft was determined. At the 30th day, the new urethra was completely covered with the transitional epithelium. Fistula formation was observed in two of 24 rabbits. In urethrograms, narrowing was determined in three of 16 rabbits. Conclusion： For segmental urethral reconstruction, fascial graft is a good urethral substitute because of its rapid epithelization capacity, low contraction degree and thinness. We therefore propose the use of fascial grafts for reconstruction of male-urethra defects in humans.
文摘BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.
文摘BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not.The time to tracheal extubation and time spent in the post-anesthesia care unit(PACU),intraoperative remifentanil dosage,fentanyl consumption in the PACU,postoperative cumulative fentanyl consumption within 48 h after operation,visual analogue scale at rest and during movement on the first and second days after surgery,and adverse reactions were compared.RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study(block group,n=16;no-block group,n=15).The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group(all P<0.05).Compared with the no-block group,the intraoperative remifentanil dosage was lower,the time to tracheal extubation and the time spent in the PACU were shorter in the block group(all P<0.01).Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group(all P<0.01).The incidence of dizziness was higher in the no-block group than in the block group(P=0.037).CONCLUSION Ultrasound-guided,direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.
基金Supported by Project of Academic School Studio of Zheng’s Acupuncture Manipulation in GansuState Administration of Traditional Chinese Medicine of the People’s Republic of China:2305135901
文摘Objective To observe the clinical efficacy of acupuncture at the superficial fascia for cervical type of cervical spondylosis. Methods Acupuncture at the superficial fascia was carried out for 48 patients with cervical type of cervical spondylosis by selecting the tender points on both sides of the cervical vertebral body and on the neck and shoulders. The treatment was conducted for once a day and treatment for 5 times was considered as 1 course of treatment. Two days were free from treatment between courses, and 3 courses were needed in total. The scores of McGill pain questionnaire [MPQ, including three indexes： Pain rating index （PRI）, Visual analogue scale （VAS） and Present pain intensity （PPI） ] of patients before and after treatment were compared, therapeutic effct of cervical type of cervical spondylosis was evaluated. Results According to the comparison before and after treatment, the scores of PRI （29.44±9.26 vs13.15±7.04）, VAS （5.63±2.73 vs 1.23±1.15）, and PPI （3.00±1.24 vs 0.38±0.49） of patients with cervical type of cervical spondylosis reduced significantly （all P〈0.05）, indicating that the differences were statistically significant. Among 48 cases, cured 40 cases （83.33%）, markedly effective 4 cases （8.34%）, effective 3 cases （6.25%）, ineffective i case （2.08%）. The total effective rate was 97.92% （47/48）. Conclusion The curative effect of acupuncture at the superficial fascia for cervical type of cervical spondylosis was satisfactory.
基金the Key Project of the Qinghai Provincial Health Commission,No.2019-wjzd-06.
文摘The total mesorectal excision(TME)approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer.This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery.However,standardized TME causes urogenital dysfunction in more than half of patients,thus lowering the quality of life of patients.Of note,pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction.The anatomy of the Denonvilliers’fascia(DVF)and its application in surgery have been investigated both nationally and internationally.Nevertheless,controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery.Currently,it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection.Herein,this study systematically describes the anatomy of DVF and its appli-cation in surgery,thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.
文摘BACKGROUND For the management of lateral lymph node(LLN)metastasis in patients with rectal cancer,selective LLN dissection(LLND)is gradually being accepted by Chinese scholars.Theoretically,fascia-oriented LLND allows radical tumor resection and protects of organ function.However,there is a lack of studies comparing the efficacy of fascia-oriented and traditional vessel-oriented LLND.Through a preliminary study with a small sample size,we found that fasciaoriented LLND was associated with a lower incidence of postoperative urinary and male sexual dysfunction and a higher number of examined LLNs.In this study,we increased the sample size and refined the postoperative functional outcomes.AIM To compare the effects of fascia-and vessel-oriented LLND regarding short-term outcomes and prognosis.METHODS We conducted a retrospective cohort study on data from 196 patients with rectal cancer who underwent total mesorectal excision and LLND from July 2014 to August 2021.The short-term outcomes included perioperative outcomes and postoperative functional outcomes.The prognosis was measured based on overall survival(OS)and progression-free survival(PFS).RESULTS A total of 105 patients were included in the final analysis and were divided into fascia-and vesseloriented groups that included 41 and 64 patients,respectively.Regarding the short-term outcomes,the median number of examined LLNs was significantly higher in the fascia-oriented group than in the vessel-oriented group.There were no significant differences in the other short-term outcomes.The incidence of postoperative urinary and male sexual dysfunction was significantly lower in the fascia-oriented group than in the vessel-oriented group.In addition,there was no significant difference in the incidence of postoperative lower limb dysfunction between the two groups.In terms of prognosis,there was no significant difference in PFS or OS between the two groups.CONCLUSION It is safe and feasible to perform fascia-oriented LLND.Compared with vessel-oriented LLND,fascia-oriented LLND allows the examination of more LLNs and may better protect postoperative urinary function and male sexual function.
基金supported by the National Natural Science Foundation of China(No.82071881,91959116,81971584)National Key R&D Program of China(No.2019YFC0117705)+3 种基金Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(No.ZYLX201803)Beijing Hospitals Authority Ascent Plan(No.DFL20191103)Capital’s Funds for Health Improvement and Research(No.2020-1-2151)Beijing Natural Science Foundation(No.Z200015,Z180001)。
文摘Objective:To forward the magnetic resonance imaging(MRI)based distance between the deepest tumor invasion and mesorectal fascia(DMRF),and to explore its prognosis differentiation value in cT3 stage rectal cancer with comparison of cT3 substage.Methods:This was a retrospective,multicenter cohort study including cT3 rectal cancer patients undergoing neoadjuvant chemoradiotherapy followed by radical surgery from January 2013 to September 2014.DMRF and cT3 substage were evaluated from baseline MRI.The cutoff of DMRF was determined by disease progression.Multivariate cox regression was used to test the prognostic values of baseline variables.Results:A total of 804 patients were included,of which 226(28.1%)developed progression.A DMRF cutoff of7 mm was chosen.DMRF category,the clock position of the deepest position of tumor invasion(CDTI)and extramural venous invasion(EMVI)were independent predictors for disease progression,and hazard ratios(HRs)were 0.26[95%confidence interval(95%CI),0.13-0.56],1.88(95%CI,1.33-2.65)and 1.57(95%CI,1.13-2.18),respectively.cT3 substage was not a predictor for disease progression.Conclusions:The measurement of DMRF value on baseline MRI can better distinguish cT3 rectal cancer prognosis rather than cT3 substage,and was recommended in clinical evaluation.
文摘Objective:To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane(TM)perforations over 5 years follow-up period.Materials and methods:This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations.The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade(CP group)or temporalis fascia(TF group)as the graft via a transmeatal approach and under local anesthesia.Morphological and functional results were recorded at three-and five years follow-up.Demographic profiles including age and sex,surgery side,contralateral disease and graft uptake rate,as well as hearing outcomes,were compared between the two groups.Results:At three years follow-up,graft uptake was 94.87%for perichondrium reinforced cartilage palisade and 80.7%for fascia,respectively,(p¼0.67).At five years follow-up,the uptake rate dropped to 87.17%in the CP group,but to 66.6%in the TF group(p¼0.019).Hearing improved after surgery in both groups,and showed no significant difference between the two groups.Conclusion:Over long-term,perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results.
基金supported by Beijing Municipal Administration of Hospitals Incubating Program (No.PZ2020027)Beijing Talent Incubating Funding (No.2019-4)+3 种基金National Natural Science Foundation of China (No.81773214)Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No.ZYLX202116)2019 Major and Difficult Diseases Chinese and Western Medicine Coordination Capacity Colorectal Cancer Project [No.(2018)275]Science Foundation of Peking University Cancer Hospital-2023 (No.JC202310)
文摘Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.
文摘Objective To observe the efficacy of acupuncture in treatment of chronic daily headache（CDH） based on muscular fascia theory.Methods Sixty patients were randomly divided into group A（30 cases） and group B（30 cases）.In group A,based on muscular fascia theory combined with the anatomical position of injection site of kreotoxin in treatment of chronic headache,10-16 acupoints were selected on frontal muscle,occipital muscle,temporal muscle,splenius capitis,semispinalis capitis,suboccipital muscle and sternocleidomastoid muscle.0.25 mm×30 mm acupuncture needles were adopted for acupuncture.After acupuncture,2-3 groups of acupoints were selected for electroacupuncture device.In group B,Neiguan（内关 PC 6）,Shulgou（水沟 GV26）,Hegu（合谷 LI 4）,Taichong（太冲 LR 3）,Baihui（百会 GV 20）,Sishencong（四神聪 EX-HN 1）,Fengchi（风池 GB 20）,Wangu（完骨 GB 12） and Tianzhu（天柱 BL 10） were selected for acupuncture.After acupuncture,2-3 groups of acupoints were selected for electroacupuncture device.Acupuncture was conducted once a day in the two groups,five days were one course of treatment,and two days were free from treatment between two courses.The treatment lasted for eight weeks.Daily headache record was considered as efficacy index,and VAS score and the number of days of headache in each month were observed.Results After treatment for eight weeks and follow-up visit for three months,the efficacy of acupuncture treatment for CDH based on muscular fascia theory（group A） was superior to conventional acupuncture（group B）,and the comparison result between the two groups was statistically significant（VAS score between two groups,after treatment：t=2.2864,P=0.0259,follow-up：r=2.6735,P=0.0097;the frequency of attack between the two groups after treatment：t=2.1520,P=0.0364）.Conclusion CDH may be related with muscular fascia dysfunction of head and neck,and the efficacy of acupuncture treatment based on muscular fascia theory was significant.
文摘BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY This report established that hip surgical procedures can be performed with a fascia iliaca compartment block(FICB)and monitored anesthesia care(MAC)while avoiding neuraxial or general anesthesia.This was a preliminary experience with two geriatric patients with hip fracture,American Society of Anesthesiologists status III,and with many comorbidities.Neither patient could be operated on within 48 h after admission.Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications.Hence,we chose nerve block combined with a small amount of sedation.Intraoperative analgesia was provided by single-injection ultrasound-guided FICB.Light intravenous sedation was added.Surgical exposure was satisfactory,and neither patient complained of any symptoms during the procedure.CONCLUSION This report showed that hip surgery for geriatric patients can be performed with FICB and MAC,although complications and contraindications are common.The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.
文摘Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive lymphatic drainage and is located in a bony pelvic in close proximity to urogenital and neurovascular structures that are invested with intricate fascial covering. The rectum is encased byfatty lymphovascular tissue(mesorectum) that is surrounded by perirectal fascia that act as barrier to the spread of the cancer and constitute the surgical circumferential margin. Locoregional recurrence after rectal cancer surgery is influenced by tumor-related factors and adequacy of the resection. Local recurrence is associated with incomplete excision of circumferential margin, violation of perirectal fascia, transmesorectal dissection, presence of isolated deposits in the mesorectum and tumor in regional lymph nodes and incomplete lymph node clearance. Hence to eradicate the primary rectal tumor and control regional disease, the rectum, first area of lymph node drainage and surrounding tissue must be completely excised while maintaining an intact fascial envelope around the rectum and preserving surrounding structures. This is achieved with extrafascial dissection and removal of the entire mesorectum including the portion distal to the tumor(total mesorectal excision) within its enveloping fascia as an intact unit. Total mesorectal excision is the standard of care surgical treatment of mid and low rectal cancer and can be performed in conjunction with low anterior resection,abdominoperineal resection, extralevator abdominoperineal resection, and extraregional dissection. To accomplish such a resection, thorough knowledge of the surgical anatomy of the rectum and pelvic structures and fascial planes is paramount.
