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:The high rate of urogenital dysfunction after traditional total mesorectal excision(TME)has caused doubts among scholars on the standard fashion of dissection.We have proposed the necessity to preserve the ...Background:The high rate of urogenital dysfunction after traditional total mesorectal excision(TME)has caused doubts among scholars on the standard fashion of dissection.We have proposed the necessity to preserve the Denonvilliers’fascia in patients with rectal cancer.However,how to accurately locate the Denonvilliers’fascia is unclear.This study aimed to explore anatomical features of the Denonvilliers’fascia by comparing autopsy findings and observations of surgical videos so as to propose a dissection method for the preservation of pelvic autonomic nerves during rectal cancer surgery.Methods:Five adult male cadaver specimens were dissected,and surgical videos of 135 patients who underwent TME for mid-low rectal cancer between January 2009 and February 2019 were reviewed to identify and compare the structure of the Denonvilliers’fascia.Results:The monolayer structure of the Denonvilliers’fascia was observed in 5 male cadaver specimens,and it was located between the rectum,the bottom of the bladder,the seminal vesicles,the vas deferens,and the prostate.The Denonvilliers’fascia was originated from the rectovesical pouch(or rectum-uterus pouch),down to fuse caudally with the rectourethral muscle at the apex of the prostate,and fused to the lateral ligaments on both sides.The fascia was thinner on the midline with a thickness of 1.06±0.10 mm.The crown shape of the Denonvilliers’fascia was slightly triangular,with a height of approximately 5.42±0.16 cm at midline.Nerves were more densely distributed in front of the Denonvilliers’fascia than behind,especially on both sides of it.Under laparoscopic view,the Denonvilliers’fascia was originated at the lowest point of the rectovesical pouch(or rectum-uterus pouch),with a thickened white line which was a good mark for identifying the Denonvilliers’fascia.Conclusion:Identification of the surgical indication line for the Denonvilliers’fascia could help us identify the Denonvilliers’fascia,and it would improve our ability to protect the pelvic autonomic function of patients undergoing TME for rectal cancer.展开更多
The Denonvilliers’fascia(DVF)plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs.It affects the surgical plane anterior to the rectum in the proce...The Denonvilliers’fascia(DVF)plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs.It affects the surgical plane anterior to the rectum in the procedure of total mesorectal excision(TME).Anatomical and embryological studies have helped us to understand this structure to some extent,but many controversies remain.In terms of its embryonical origin,there are three mainstream hypotheses:peritoneal fusion of the embryonic cul-de-sac,condensation of embryonic mesenchyme,and mechanical pressure.Regarding its architecture,the DVF may be a single,two,or multiple layers,or a composite single-layer structure.In women,most authors deem that this structure does exist but they are willing to call it the rectovaginal septum rather than the DVF.Operating behind the DVF is supported by most surgeons.This article will review those mainstreamstudies and opinions on the DVF and combine them with what we have observed during surgery to discuss those controversies and consensuses mentioned above.We hope this review may help young colorectal surgeons to have a better understanding of the DVF and provide a platform from which to guide future scientific research.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
AIM:To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath(CFS)suspension.METHODS:A retrospective st...AIM:To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath(CFS)suspension.METHODS:A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021.Inclusion criteria included unilateral mild and moderate ptosis,good levator muscle function(>9 mm)and follow-up of at least 6mo.Pre-and post-operative symmetry was graded subjectively for marginal reflex distance 1(MRD1),tarsal platform show(TPS)and eyebrow fat span(BFS).A t-test was used to evaluate MRD1,TPS and BFS asymmetry by calculating delta values.The Bézier curve tool of the Image J software was used to extract the upper eyelid contours,where the symmetry was measured by the percentage of overlapping curvatures(POC).RESULTS:Totally 105 patients(105 eyelids)were included(mild group,n=84;moderate group,n=21).Postoperatively,all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS.The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively,and it decreased to 0.58±0.67 postoperatively in all cases(P=0.0004).In patients with mild ptosis,the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38(P=0.0187).The symmetry of the upper eyelid contour increased in all subgroups of patients,with a POC of 59.39%±13.45%preoperatively and POC of 78.29%±13.80%postoperatively.CONCLUSION:Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1(all subgroups),POC(all subgroups)and TPS(only mild group),whereas BFS is unaffected.展开更多
Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, ha...Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, has shown promising long-term results. However, a standardized post-operative rehabilitation protocol for this procedure in the USA is lacking. Purpose: This study aims to evaluate the outcomes of a comprehensive rehabilitation protocol following SCR with TFL autograft in a cohort of nine patients. Participants and Methods: A prospective observational study was conducted at Concentra Urgent Care, San Francisco. Nine patients, aged 55 - 65 years, underwent SCR with TFL autograft performed by a specialized orthopedic surgeon. Post-operative rehabilitation was managed using a structured protocol, divided into three phases focusing on passive exercises, progressive range of motion, and strengthening. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, forward flexion range of motion (FF-ROM), and Single Assessment Numeric Evaluation (SANE) scores over a six-month period. Results: Significant improvements were observed in pain reduction (mean VAS decrease of −3.67 points, p = 0.01), ROM (mean FF increase of 41.11 degrees, p = 0.014), and SANE scores (mean improvement of 42.11%, p = 0.009), indicating the efficacy of the rehabilitation protocol. Conclusion: The comprehensive rehabilitation protocol following SCR with TFL autograft significantly improved pain, range of motion, and shoulder function in patients, suggesting its potential utility in clinical practice.展开更多
Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigr...Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.展开更多
PURPOSE:Little is known about which urogenital nerves are liable to be injured along surgical planes in front of or behind Denonvilliers’ fascia.METHODS AND RESULTS:Using semiserial histology for five fixed male pelv...PURPOSE:Little is known about which urogenital nerves are liable to be injured along surgical planes in front of or behind Denonvilliers’ fascia.METHODS AND RESULTS:Using semiserial histology for five fixed male pelves,we demonstrated that:1) left/right communicating branches of bilateral pelvic plexuses run immediately in front of Denonvilliers’ fascia;and 2) a lateral continuation of Denonvilliers’ fascia separates the urogenital neurovascular bundle from the mesorectum.Notably,the mesorectum contains no or few extramural ganglion cells.At the level of the seminal vesicles,incision in front of Denonvilliers’ fascia seems likely to injure superior parts of the pelvic plexus and the left/right communication.Moreover,at the prostate level,this incision misleads the surgical plane into the neurovascular bundle.Fresh cadaveric dissections of five unfixed male pelves confirmed that the surgical plane in front of Denonvilliers’ fascia continues to a fascial space for the pelvic plexus containing ganglion cell clusters lateral and/or inferior to the seminal vesicles.CONCLUSIONS:To preserve all autonomic nerves for urogenital function,optimal total mesorectal excision for rectal cancer requires dissection behind Denonvilliers’ fascia.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
PURPOSE: Opinion is divided whether Denonvilliers’fascia lies anterior or posterior to the anatomic fascia propria plane of anterior rectal dissection in total mesorectal excision. This study was designed to evaluate...PURPOSE: Opinion is divided whether Denonvilliers’fascia lies anterior or posterior to the anatomic fascia propria plane of anterior rectal dissection in total mesorectal excision. This study was designed to evaluate this anatomic relationship by assessing the presence or absence of Denonvilliers’fascia on the anterior surface of the extraperitoneal rectum in specimens resected for both nonanterior and anterior rectal cancer in males. METHODS: Surgical specimens were collected prospectively from males undergoing total mesorectal excision for mid and low rectal cancer, with a deep dissection of the anterior extraperitoneal rectum to the pelvic floor. Specimens were histopathologically analyzed using best practice methods for rectal cancer. The anterior aspects of the extraperitoneal rectal sections were examined microscopically for the presence or absence of Denonvilliers’fascia. RESULTS: Thirty rectal specimens were examined. Denonvilliers’fascia was present in 12 (40 percent) and absent in 18 specimens (60 percent). Denonvilliers’fascia was significantly more frequently present when tumor involved (55 percent) rather than spared the anterior rectal quadrant (10 percent; difference between groups 45 percent; 95 percent confidence interval, 30-60 percent; P = 0.024, Fisher’s exact test). CONCLUSIONS: When tumors were nonanterior, rectal dissection was conducted on fascia propria in the usual anatomic plane, and Denonvilliers’fascia was not present on the specimen. It was almost exclusively found in anterior tumors, deliberately taken by a radical extra-anatomic anterior dissection in the extramesorectal dissection plane. Denonvilliers’fascia lies anterior to the anatomic fascia propria plane of anterior rectal dissection and is more closely applied to the prostate than the rectum.展开更多
The experimental research, presented in this study, focuses on athletic tests with the purpose to highlight the elastic deformations of the bones of the lower limbs, intending to verify whether the manually treated an...The experimental research, presented in this study, focuses on athletic tests with the purpose to highlight the elastic deformations of the bones of the lower limbs, intending to verify whether the manually treated anatomical structure increases in elasticity, becoming able to accumulate more energy in the loading phase, to then release it in the final phase of the thrust. Introduction: Too often neglected, the bone tissue is capable of deforming. The deformation has a key role in the cushioning and dissipation of stress, a function that is hindered in the event of fascial tension, which will consequently fall on other structures used for the same purpose (Discs, menisci, cartilage, …). Structures that, in the event of increased mechanical stress, could undergo degeneration, inflammation, and injury. Materials and Method: Randomized double-blind selection of 38 people, 18 in the treatment group and 20 in the control group, men and women, aged between 16 and 35, who have been part, for at least one year, of a sports club, with a large space dedicated to jumping in its training program, have been divided into two groups: the treatment group, which was treated to increase the performance of the jump and the control group subjected to mild manual pressures, without any intention. Results: The treatment group had an increase in Standing Long Jump (SLJ) for 3.67% (p Conclusions: This study has shown that an osteopathic manipulative treatment, aimed at increasing jumping performance, can increase the performance of the SLJ.展开更多
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.
基金Sun Yat-sen University clinical research 5010 program,Grant/Award Number:2016Y9031。
文摘Background:The high rate of urogenital dysfunction after traditional total mesorectal excision(TME)has caused doubts among scholars on the standard fashion of dissection.We have proposed the necessity to preserve the Denonvilliers’fascia in patients with rectal cancer.However,how to accurately locate the Denonvilliers’fascia is unclear.This study aimed to explore anatomical features of the Denonvilliers’fascia by comparing autopsy findings and observations of surgical videos so as to propose a dissection method for the preservation of pelvic autonomic nerves during rectal cancer surgery.Methods:Five adult male cadaver specimens were dissected,and surgical videos of 135 patients who underwent TME for mid-low rectal cancer between January 2009 and February 2019 were reviewed to identify and compare the structure of the Denonvilliers’fascia.Results:The monolayer structure of the Denonvilliers’fascia was observed in 5 male cadaver specimens,and it was located between the rectum,the bottom of the bladder,the seminal vesicles,the vas deferens,and the prostate.The Denonvilliers’fascia was originated from the rectovesical pouch(or rectum-uterus pouch),down to fuse caudally with the rectourethral muscle at the apex of the prostate,and fused to the lateral ligaments on both sides.The fascia was thinner on the midline with a thickness of 1.06±0.10 mm.The crown shape of the Denonvilliers’fascia was slightly triangular,with a height of approximately 5.42±0.16 cm at midline.Nerves were more densely distributed in front of the Denonvilliers’fascia than behind,especially on both sides of it.Under laparoscopic view,the Denonvilliers’fascia was originated at the lowest point of the rectovesical pouch(or rectum-uterus pouch),with a thickened white line which was a good mark for identifying the Denonvilliers’fascia.Conclusion:Identification of the surgical indication line for the Denonvilliers’fascia could help us identify the Denonvilliers’fascia,and it would improve our ability to protect the pelvic autonomic function of patients undergoing TME for rectal cancer.
基金supported by the foundation from 1.the Shenkang Hospital Developing Center of Shanghai,ChinaThe Project of Frontier Technology in General Hospital(No.SHDC12016122)2.234 Climbing Discipline Program of first affiliated hospital of Naval Medical University(No.2019YXK032).
文摘The Denonvilliers’fascia(DVF)plays an important role in rectal surgery because of its anatomic position and its relationship to the surrounding organs.It affects the surgical plane anterior to the rectum in the procedure of total mesorectal excision(TME).Anatomical and embryological studies have helped us to understand this structure to some extent,but many controversies remain.In terms of its embryonical origin,there are three mainstream hypotheses:peritoneal fusion of the embryonic cul-de-sac,condensation of embryonic mesenchyme,and mechanical pressure.Regarding its architecture,the DVF may be a single,two,or multiple layers,or a composite single-layer structure.In women,most authors deem that this structure does exist but they are willing to call it the rectovaginal septum rather than the DVF.Operating behind the DVF is supported by most surgeons.This article will review those mainstreamstudies and opinions on the DVF and combine them with what we have observed during surgery to discuss those controversies and consensuses mentioned above.We hope this review may help young colorectal surgeons to have a better understanding of the DVF and provide a platform from which to guide future scientific research.
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.
基金Supported by Tianjin Key Medical Discipline Construction Project(No.TJYXZDXK-016A).
文摘AIM:To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath(CFS)suspension.METHODS:A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021.Inclusion criteria included unilateral mild and moderate ptosis,good levator muscle function(>9 mm)and follow-up of at least 6mo.Pre-and post-operative symmetry was graded subjectively for marginal reflex distance 1(MRD1),tarsal platform show(TPS)and eyebrow fat span(BFS).A t-test was used to evaluate MRD1,TPS and BFS asymmetry by calculating delta values.The Bézier curve tool of the Image J software was used to extract the upper eyelid contours,where the symmetry was measured by the percentage of overlapping curvatures(POC).RESULTS:Totally 105 patients(105 eyelids)were included(mild group,n=84;moderate group,n=21).Postoperatively,all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS.The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively,and it decreased to 0.58±0.67 postoperatively in all cases(P=0.0004).In patients with mild ptosis,the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38(P=0.0187).The symmetry of the upper eyelid contour increased in all subgroups of patients,with a POC of 59.39%±13.45%preoperatively and POC of 78.29%±13.80%postoperatively.CONCLUSION:Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1(all subgroups),POC(all subgroups)and TPS(only mild group),whereas BFS is unaffected.
文摘Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, has shown promising long-term results. However, a standardized post-operative rehabilitation protocol for this procedure in the USA is lacking. Purpose: This study aims to evaluate the outcomes of a comprehensive rehabilitation protocol following SCR with TFL autograft in a cohort of nine patients. Participants and Methods: A prospective observational study was conducted at Concentra Urgent Care, San Francisco. Nine patients, aged 55 - 65 years, underwent SCR with TFL autograft performed by a specialized orthopedic surgeon. Post-operative rehabilitation was managed using a structured protocol, divided into three phases focusing on passive exercises, progressive range of motion, and strengthening. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, forward flexion range of motion (FF-ROM), and Single Assessment Numeric Evaluation (SANE) scores over a six-month period. Results: Significant improvements were observed in pain reduction (mean VAS decrease of −3.67 points, p = 0.01), ROM (mean FF increase of 41.11 degrees, p = 0.014), and SANE scores (mean improvement of 42.11%, p = 0.009), indicating the efficacy of the rehabilitation protocol. Conclusion: The comprehensive rehabilitation protocol following SCR with TFL autograft significantly improved pain, range of motion, and shoulder function in patients, suggesting its potential utility in clinical practice.
文摘Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.
文摘PURPOSE:Little is known about which urogenital nerves are liable to be injured along surgical planes in front of or behind Denonvilliers’ fascia.METHODS AND RESULTS:Using semiserial histology for five fixed male pelves,we demonstrated that:1) left/right communicating branches of bilateral pelvic plexuses run immediately in front of Denonvilliers’ fascia;and 2) a lateral continuation of Denonvilliers’ fascia separates the urogenital neurovascular bundle from the mesorectum.Notably,the mesorectum contains no or few extramural ganglion cells.At the level of the seminal vesicles,incision in front of Denonvilliers’ fascia seems likely to injure superior parts of the pelvic plexus and the left/right communication.Moreover,at the prostate level,this incision misleads the surgical plane into the neurovascular bundle.Fresh cadaveric dissections of five unfixed male pelves confirmed that the surgical plane in front of Denonvilliers’ fascia continues to a fascial space for the pelvic plexus containing ganglion cell clusters lateral and/or inferior to the seminal vesicles.CONCLUSIONS:To preserve all autonomic nerves for urogenital function,optimal total mesorectal excision for rectal cancer requires dissection behind Denonvilliers’ fascia.
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.
文摘PURPOSE: Opinion is divided whether Denonvilliers’fascia lies anterior or posterior to the anatomic fascia propria plane of anterior rectal dissection in total mesorectal excision. This study was designed to evaluate this anatomic relationship by assessing the presence or absence of Denonvilliers’fascia on the anterior surface of the extraperitoneal rectum in specimens resected for both nonanterior and anterior rectal cancer in males. METHODS: Surgical specimens were collected prospectively from males undergoing total mesorectal excision for mid and low rectal cancer, with a deep dissection of the anterior extraperitoneal rectum to the pelvic floor. Specimens were histopathologically analyzed using best practice methods for rectal cancer. The anterior aspects of the extraperitoneal rectal sections were examined microscopically for the presence or absence of Denonvilliers’fascia. RESULTS: Thirty rectal specimens were examined. Denonvilliers’fascia was present in 12 (40 percent) and absent in 18 specimens (60 percent). Denonvilliers’fascia was significantly more frequently present when tumor involved (55 percent) rather than spared the anterior rectal quadrant (10 percent; difference between groups 45 percent; 95 percent confidence interval, 30-60 percent; P = 0.024, Fisher’s exact test). CONCLUSIONS: When tumors were nonanterior, rectal dissection was conducted on fascia propria in the usual anatomic plane, and Denonvilliers’fascia was not present on the specimen. It was almost exclusively found in anterior tumors, deliberately taken by a radical extra-anatomic anterior dissection in the extramesorectal dissection plane. Denonvilliers’fascia lies anterior to the anatomic fascia propria plane of anterior rectal dissection and is more closely applied to the prostate than the rectum.
文摘The experimental research, presented in this study, focuses on athletic tests with the purpose to highlight the elastic deformations of the bones of the lower limbs, intending to verify whether the manually treated anatomical structure increases in elasticity, becoming able to accumulate more energy in the loading phase, to then release it in the final phase of the thrust. Introduction: Too often neglected, the bone tissue is capable of deforming. The deformation has a key role in the cushioning and dissipation of stress, a function that is hindered in the event of fascial tension, which will consequently fall on other structures used for the same purpose (Discs, menisci, cartilage, …). Structures that, in the event of increased mechanical stress, could undergo degeneration, inflammation, and injury. Materials and Method: Randomized double-blind selection of 38 people, 18 in the treatment group and 20 in the control group, men and women, aged between 16 and 35, who have been part, for at least one year, of a sports club, with a large space dedicated to jumping in its training program, have been divided into two groups: the treatment group, which was treated to increase the performance of the jump and the control group subjected to mild manual pressures, without any intention. Results: The treatment group had an increase in Standing Long Jump (SLJ) for 3.67% (p Conclusions: This study has shown that an osteopathic manipulative treatment, aimed at increasing jumping performance, can increase the performance of the SLJ.
