A new titanium alloy Ti12.5Zr2.5Nb2.5Ta（TZNT） for surgical implant application was synthesized and fully annealed at 700℃for 45 min.The microstructure and the mechanical properties such as tensile properties and fa...A new titanium alloy Ti12.5Zr2.5Nb2.5Ta（TZNT） for surgical implant application was synthesized and fully annealed at 700℃for 45 min.The microstructure and the mechanical properties such as tensile properties and fatigue properties were investigated.The results show that TZNT mainly consists of a lot of lamellaα-phase clusters with different orientations distributed in the originalβ-phase grain boundaries and a small amount ofβphases between the lamella a phases.The alloy exhibits better ductility,lower modulus of elasticity,and lower admission strain in comparison with Ti6A14V and Ti6A17Nb,indicating that it has better biomechanical compatibility with human bones.The fatigue limit of TZNT is 333 MPa,at which the specimen has not failed at 10^7 cycles.A large number of striations present in the stable fatigue crack propagation area,and many dimples in the fast fatigue crack propagation area are observed,indicating the ductile fracture of the new alloy.展开更多
A new near α-titanium alloy Ti12.5Zr2.5Nb2.5Ta （TZNT） for surgical implants was designed. The potentiodynamic technique was performed to investigate the corrosion behaviors of TZNT in Ringer＇s solution, and Ti6A14...A new near α-titanium alloy Ti12.5Zr2.5Nb2.5Ta （TZNT） for surgical implants was designed. The potentiodynamic technique was performed to investigate the corrosion behaviors of TZNT in Ringer＇s solution, and Ti6A14V, Ti6Al7Nb, and TA2 were taken as comparison. The structure of the passive film was analyzed using an X-ray photoelectron spectrometer （XPS）. The results indicate that TZNT possesses better corrosion resistance, when compared with Ti6A14V, Ti6A17Nb, and TA2. The passive film formed on the TZNT surface is composed of oxides, such as TiO2, ZrO2, Nb2O5, and Ta2O5. The elements Zr and Ta are rich, whereas Ti and Nb are poor in the passive film. The addition of Zr, Nb, and Ta with relatively low electrochemical reaction potentials can reduce the anode activity and improve passive properties. Other than that, oxides such as ZrO2, Nb2O5, and Ta2O5 with the nobler equilibrium constants make the passive film more stable.展开更多
BACKGROUND Transcatheter Aortic Valve Implantation(TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement(SAVR) for treating patients with s...BACKGROUND Transcatheter Aortic Valve Implantation(TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement(SAVR) for treating patients with severe aortic stenosis(AS) at intermediate surgical risk.This study aimed to evaluate the cost-utility of TAVI compared with SAVR for severe aortic stenosis with interme diate surgical risk in Thailand.METHODS A two-part constructed model was used to analyze lifetime costs and quality-adjusted life-years(QALYs) from societal and healthcare perspectives.The study cohort comprised severe AS patients at intermediate surgical risk with an average age of 80 years.The landmark trials were used to populate the model in terms of mortality and adverse event rates.All cost-related data and quality of life were based on Thai population.Costs and QALYs were discounted at 3% armually and presented as2021 values.Incremental cost-effectiveness ratios(ICERs) were calculated.Deterministic and probabilistic sensitivity analyses were conducted.RESULTS In comparison to SAVR,TAVI resulted in higher total cost(THB 1,717,132 [USD 52;415.51] vs.THB 893,524 [USD27,274.84]) and higher QALYs(4.88 vs.3.98) in a societal perspective.The estimated ICER was THB 906,937/QALY(USD27,684.27/QALY).From a healthcare system perspective,TAVI also had higher total cost than SAVR(THB 1,573,751 [USD48,038.79] vs.THB 726,342 [USD 22,171.63]) with similar QALYs gained to the societal perspective.The estimated ICER was THB933,145/QALY(USD 933,145/QALY).TAVI was not cost-effective at the Thai willingness to pay(WTP) threshold of THB160,000/QALY(USD 4,884/QALY).The results were sensitive to utility of either SAVR or TAVI treatment and cost of TAVI valve.CONCLUSION In patients with severe AS at intermediate surgical risk,TAVI is not a cost-effective strategy compared with SAVR at the WTP of THB 160;000/QALY(USD 4,884/QALY) from the perspectives of society and healthcare system.展开更多
AIM:To present a technique of transcapsular scleral fixation of the standard capsular tension ring(CTR)through equatorial capsulotomy and in-the-bag intraocular lens(IOL)implantation in subluxated lenses.METHODS:This ...AIM:To present a technique of transcapsular scleral fixation of the standard capsular tension ring(CTR)through equatorial capsulotomy and in-the-bag intraocular lens(IOL)implantation in subluxated lenses.METHODS:This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction,transcapsular scleral fixation of the standard CTR through equatorial capsulotomy,in-the-bag IOL implantation and with at least 6mo follow-up.Preoperative and postoperative best corrected visual acuity(BCVA),intraocular pressure(IOP),complications,and postoperative IOL tilt and decentration were recorded.RESULTS:Nine eyes of 7 patients with a mean followup of 11.0±3.7mo were included in this study.The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively(P<0.001).The IOP was within the normal range postoperatively.The mean tilt of the IOL was 4.30°±2.31°(range,1.0°to 8.9°)and the mean decentration of the IOL was 0.37±0.12 mm(range,0.14 to 0.50 mm).No visually threatened intraoperative and postoperative complications were detected during the follow-up period.CONCLUSION:This is a safe and effective surgical technique for managing patients with severely subluxated lenses.It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.展开更多
Objectives: Cardiac resynchronisation therapy (CRT) has proven its effectiveness in patients with symptomatic heart failure [1,2]. Although rewarding, the procedure of biventricular pacemaker implantation is challengi...Objectives: Cardiac resynchronisation therapy (CRT) has proven its effectiveness in patients with symptomatic heart failure [1,2]. Although rewarding, the procedure of biventricular pacemaker implantation is challenging and subsequently fails in 8%-11% of patients. In patients whose left ventricular (LV) electrode cannot be placed transvenously, surgical implantation of an epicardial electrode can be achieved. Methods: Seventeen patients (14 male, 3 female), among whom LV electrode was failed to be placed transvenously, were included into our study. The epicardial LV electrodes were implanted through anterior mini thoracotomy. The patients were followed up for approximate six months and complications, ejection fraction (EF), New York Heart Association (NYHA) class, QRS durations as well as pacing parameters were recorded. Results: Mean age of the patients was 64.4 ± 7.01 (54-79) years. Preoperative mean EF of the patients was 26.1% ± 3.7%. The LV electrode was placed at the optimal place on the lateral LV wall through left sided mini thoracotomy. The mean duration of the operation was 26.76 ± 8.12 minutes and the mean hospital stay was 2.05 ± 0.42 days. There were no intraoperative or postoperative complications. Only 1 patient had LV electrode displaced on the 3rd postoperative month and the patient was reoperated successfully. The EF on the 6th postoperative month was 29.4% ± 3.81% and NYHA class was 2.58 ± 0.5. The etiology of heart failure had no influence on outcome. Conclusions: Surgical implantation of LV lead is associated with low complication rates and excellent follow-up results without exposure to radiation. Thus epicardial leads can be proposed as equal alternative to transvenous leads.展开更多
Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the temp...Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the template. The purpose of this study was to summarize the complications associated with the use of surgical templates for static computer-aided implant surgery. Methods: Complications were collected during the observation period, and then their implant sites were reanalyzed with simulation software. Results: There were 104 cases during the observation period, 5 cases had complications. Mechanical complications were observed in four cases, including three cases in which the frame of the template fractured during implant placement surgery and one case in which the sleeve fell off the surgical template. In one case, there was an error in the planned position. All cases were mandibular molar cases, and all cases of frame fracture were at the free end defect site. All cases had a Hounsfield unit of more than 700 at the implant site, and some of them had a significantly small jaw opening. Conclusion: Although the spread of CAD/CAM surgical templates has made it possible to avoid problems caused by the position of the implant, it has been difficult to avoid fractures in cases of mandibular free end defects with high Hounsfield unit.展开更多
Background: Implant placement using a conventional surgical guide and digital surgical guide techniques is well documented in the literature. The most frequently reported disadvantages of conventional surgical guide p...Background: Implant placement using a conventional surgical guide and digital surgical guide techniques is well documented in the literature. The most frequently reported disadvantages of conventional surgical guide placement are lack of accuracy in implant placement when compared to three-dimensional assessment in digital technique. Other factors listed are longer time duration and the need for impression techniques. In this case report, the authors present a comparison between the two techniques and the time taken between both cases one done conventionally and another case by digital technique. Case Presentation: For the digital surgical guide, a 44-year-old, male reported with the chief complaint of missing teeth needing replacement was considered. For the conventional technique, a female patient aged fifty-seven who had gone through various dentists with an existing bridge was considered. This patient wanted a good outcome at a reasonable cost. In both cases, molars were missing and needed replacement. The steps for digital flow for a surgical guide and step-by-step conventional methods are both highlighted in this article. Conclusion: Hence the digital technique saved time and was accurate when compared to the conventional in our experience.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Patient’s acceptability of dental implant prostheses may be influenced...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Patient’s acceptability of dental implant prostheses may be influenced the fact that a surgical procedure is involved. Adequate relevant information by the dental professionals pre-surgery, is therefore, paramount to alleviating the fear of surgery and contribute positively to patient’s ability to cope with post-surgical experience. This study, therefore, aimed at evaluating </span><span style="font-family:Verdana;">the postsurgical experience of the dental implant patients. As against what was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">expected, and relate this with the information given pre surgery. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> Post treatment self-completed questionnaires were administered to consented </span><span style="font-family:Verdana;">patients that had dental implants placed between July 2017 and December 2019. The surgical procedure followed the standard protocol and </span><span style="font-family:Verdana;">data related to post-surgical experience were collected one week after the surgery</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">to obtain </span><span style="font-family:Verdana;">information on the level of pain/discomfort and amount of swelling experienced f</span><span style="font-family:Verdana;">ollowing surgery. The effect of the information on coping ability following surgery was also assessed. Data were analyzed using descriptive statistics (</span><span style="font-family:Verdana;">p</span><span style="font-family:Verdana;"> value ≤</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.05)</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Twenty-seven patients received 44 implants to replace 48 teeth. The mean age of the patients was 45</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">16.3</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(SD) years. Teeth mostly replaced were the maxillary central incisors (39.6%). </span><span style="font-family:Verdana;">The majority of the patients 77.7% reported to experience less pain/discomfort </span><span style="font-family:Verdana;">than expected and 66.6% had less swelling than expected. While 29.6% felt they had excellent explanation of what to expect,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">51.9% said they had good explanation.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The post-surgical experience between males and females was not statistically significant</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(pain</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> p</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.08, swelling</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">p</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.64). However, the majority </span><span style="font-family:Verdana;">(8/12) that had good to excellent information preoperatively, had significa</span><span style="font-family:Verdana;">ntly </span><span style="font-family:Verdana;">less discomfort than expected. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Positive, encouraging and satisfactor</span><span style="font-family:Verdana;">y experience of patients following implant surgical procedure is related to adequate and correct information pre-surgery.</span>展开更多
To the Editor:Glaucoma is a leading cause of irreversible blindness worldwide.[1]Trabeculectomy with mitomycin C(MMC)has been the standard surgical intervention for reducing intraocular pressure(IOP)and slow down the ...To the Editor:Glaucoma is a leading cause of irreversible blindness worldwide.[1]Trabeculectomy with mitomycin C(MMC)has been the standard surgical intervention for reducing intraocular pressure(IOP)and slow down the progression of glaucoma.[2]However,some serious complications with devastating consequences can occur after trabeculectomy,such as bleb-related infections,suprachoroidal hemorrhage,vitreous hemorrhage,and malignant glaucoma.Over the last decade,many novel ophthalmic surgical devices have been used in glaucoma.The XEN45 microstent(Allergan,Dublin,CA,USA)is a hydrophilic cross-linked porcine gelatin stent.It is implanted ab-interno.展开更多
Surgical meshes have been employed in the management of a variety of pathological conditions including hernia,pelvic floor dysfunctions,periodontal guided bone regeneration,wound healing and more recently for breast p...Surgical meshes have been employed in the management of a variety of pathological conditions including hernia,pelvic floor dysfunctions,periodontal guided bone regeneration,wound healing and more recently for breast plastic surgery after mastectomy.These common pathologies affect a wide portion of the worldwide population;therefore,an effective and enhanced treatment is crucial to ameliorate patients’living conditions both from medical and aesthetic points of view.At present,non-absorbable synthetic polymers are the most widely used class of biomaterials for the manufacturing of mesh implants for hernia,pelvic floor dysfunctions and guided bone regeneration,with polypropylene and poly tetrafluoroethylene being the most common.Biological prostheses,such as surgical grafts,have been employed mainly for breast plastic surgery and wound healing applications.Despite the advantages of mesh implants to the treatment of these conditions,there are still many drawbacks,mainly related to the arising of a huge number of post-operative complications,among which infections are the most common.Developing a mesh that could appropriately integrate with the native tissue,promote its healing and constructive remodelling,is the key aim of ongoing research in the area of surgical mesh implants.To this end,the adoption of new biomaterials including absorbable and natural polymers,the use of drugs and advanced manufacturing technologies,such as 3D printing and electrospinning,are under investigation to address the previously mentioned challenges and improve the outcomes of future clinical practice.The aim of this work is to review the key advantages and disadvantages related to the use of surgical meshes,the main issues characterizing each clinical procedure and the future directions in terms of both novel manufacturing technologies and latest regulatory considerations.展开更多
BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important fo...BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.展开更多
Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(ope...Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(open trnascanal) approach has not been adapted since first described in the clinical field.we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.Methods: This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal(open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital(Riyadh, Saudi Arabia), which were conducted by the same surgeon.Results: Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16%(21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows:cholesteatoma in 5(3.8%) patients, extrusion of the electrode in 5(3.8%) patients, and tympanic membrane perforation or deep retractions in 5(3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4(3%) patients, recurrent otitis externa infections in 7(5%) patients, and weakness of the posterior canal wall in 1 patient.Conclusion: The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.展开更多
基金supported by the Shanghai Science and Technology Development Founds(No.08QA14035)the Key Project of Shanghai Science and Technology Commission(No.08520513400).
文摘A new titanium alloy Ti12.5Zr2.5Nb2.5Ta（TZNT） for surgical implant application was synthesized and fully annealed at 700℃for 45 min.The microstructure and the mechanical properties such as tensile properties and fatigue properties were investigated.The results show that TZNT mainly consists of a lot of lamellaα-phase clusters with different orientations distributed in the originalβ-phase grain boundaries and a small amount ofβphases between the lamella a phases.The alloy exhibits better ductility,lower modulus of elasticity,and lower admission strain in comparison with Ti6A14V and Ti6A17Nb,indicating that it has better biomechanical compatibility with human bones.The fatigue limit of TZNT is 333 MPa,at which the specimen has not failed at 10^7 cycles.A large number of striations present in the stable fatigue crack propagation area,and many dimples in the fast fatigue crack propagation area are observed,indicating the ductile fracture of the new alloy.
基金supported by the Shanghai Science and Technology Development Foundation, China (No. 08QA14035)
文摘A new near α-titanium alloy Ti12.5Zr2.5Nb2.5Ta （TZNT） for surgical implants was designed. The potentiodynamic technique was performed to investigate the corrosion behaviors of TZNT in Ringer＇s solution, and Ti6A14V, Ti6Al7Nb, and TA2 were taken as comparison. The structure of the passive film was analyzed using an X-ray photoelectron spectrometer （XPS）. The results indicate that TZNT possesses better corrosion resistance, when compared with Ti6A14V, Ti6A17Nb, and TA2. The passive film formed on the TZNT surface is composed of oxides, such as TiO2, ZrO2, Nb2O5, and Ta2O5. The elements Zr and Ta are rich, whereas Ti and Nb are poor in the passive film. The addition of Zr, Nb, and Ta with relatively low electrochemical reaction potentials can reduce the anode activity and improve passive properties. Other than that, oxides such as ZrO2, Nb2O5, and Ta2O5 with the nobler equilibrium constants make the passive film more stable.
基金supported by a grant from the Health Systems Research Institute (Thailand)
文摘BACKGROUND Transcatheter Aortic Valve Implantation(TAVI) has been shown to provide comparable survival benefit and improvement in quality of life to surgical aortic valve replacement(SAVR) for treating patients with severe aortic stenosis(AS) at intermediate surgical risk.This study aimed to evaluate the cost-utility of TAVI compared with SAVR for severe aortic stenosis with interme diate surgical risk in Thailand.METHODS A two-part constructed model was used to analyze lifetime costs and quality-adjusted life-years(QALYs) from societal and healthcare perspectives.The study cohort comprised severe AS patients at intermediate surgical risk with an average age of 80 years.The landmark trials were used to populate the model in terms of mortality and adverse event rates.All cost-related data and quality of life were based on Thai population.Costs and QALYs were discounted at 3% armually and presented as2021 values.Incremental cost-effectiveness ratios(ICERs) were calculated.Deterministic and probabilistic sensitivity analyses were conducted.RESULTS In comparison to SAVR,TAVI resulted in higher total cost(THB 1,717,132 [USD 52;415.51] vs.THB 893,524 [USD27,274.84]) and higher QALYs(4.88 vs.3.98) in a societal perspective.The estimated ICER was THB 906,937/QALY(USD27,684.27/QALY).From a healthcare system perspective,TAVI also had higher total cost than SAVR(THB 1,573,751 [USD48,038.79] vs.THB 726,342 [USD 22,171.63]) with similar QALYs gained to the societal perspective.The estimated ICER was THB933,145/QALY(USD 933,145/QALY).TAVI was not cost-effective at the Thai willingness to pay(WTP) threshold of THB160,000/QALY(USD 4,884/QALY).The results were sensitive to utility of either SAVR or TAVI treatment and cost of TAVI valve.CONCLUSION In patients with severe AS at intermediate surgical risk,TAVI is not a cost-effective strategy compared with SAVR at the WTP of THB 160;000/QALY(USD 4,884/QALY) from the perspectives of society and healthcare system.
基金Supported by Wenzhou Basic Research Foundation(No.2024Y1244).
文摘AIM:To present a technique of transcapsular scleral fixation of the standard capsular tension ring(CTR)through equatorial capsulotomy and in-the-bag intraocular lens(IOL)implantation in subluxated lenses.METHODS:This retrospective consecutive case series included patients with subluxated lenses by more than 180 degrees who underwent lens extraction,transcapsular scleral fixation of the standard CTR through equatorial capsulotomy,in-the-bag IOL implantation and with at least 6mo follow-up.Preoperative and postoperative best corrected visual acuity(BCVA),intraocular pressure(IOP),complications,and postoperative IOL tilt and decentration were recorded.RESULTS:Nine eyes of 7 patients with a mean followup of 11.0±3.7mo were included in this study.The BCVA was significantly improved from 0.64±0.22 logMAR preoperatively to 0.21±0.19 logMAR postoperatively(P<0.001).The IOP was within the normal range postoperatively.The mean tilt of the IOL was 4.30°±2.31°(range,1.0°to 8.9°)and the mean decentration of the IOL was 0.37±0.12 mm(range,0.14 to 0.50 mm).No visually threatened intraoperative and postoperative complications were detected during the follow-up period.CONCLUSION:This is a safe and effective surgical technique for managing patients with severely subluxated lenses.It has achieved favorable outcomes with fewer surgical manipulations and less need for advanced capsular support devices.
文摘Objectives: Cardiac resynchronisation therapy (CRT) has proven its effectiveness in patients with symptomatic heart failure [1,2]. Although rewarding, the procedure of biventricular pacemaker implantation is challenging and subsequently fails in 8%-11% of patients. In patients whose left ventricular (LV) electrode cannot be placed transvenously, surgical implantation of an epicardial electrode can be achieved. Methods: Seventeen patients (14 male, 3 female), among whom LV electrode was failed to be placed transvenously, were included into our study. The epicardial LV electrodes were implanted through anterior mini thoracotomy. The patients were followed up for approximate six months and complications, ejection fraction (EF), New York Heart Association (NYHA) class, QRS durations as well as pacing parameters were recorded. Results: Mean age of the patients was 64.4 ± 7.01 (54-79) years. Preoperative mean EF of the patients was 26.1% ± 3.7%. The LV electrode was placed at the optimal place on the lateral LV wall through left sided mini thoracotomy. The mean duration of the operation was 26.76 ± 8.12 minutes and the mean hospital stay was 2.05 ± 0.42 days. There were no intraoperative or postoperative complications. Only 1 patient had LV electrode displaced on the 3rd postoperative month and the patient was reoperated successfully. The EF on the 6th postoperative month was 29.4% ± 3.81% and NYHA class was 2.58 ± 0.5. The etiology of heart failure had no influence on outcome. Conclusions: Surgical implantation of LV lead is associated with low complication rates and excellent follow-up results without exposure to radiation. Thus epicardial leads can be proposed as equal alternative to transvenous leads.
文摘Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the template. The purpose of this study was to summarize the complications associated with the use of surgical templates for static computer-aided implant surgery. Methods: Complications were collected during the observation period, and then their implant sites were reanalyzed with simulation software. Results: There were 104 cases during the observation period, 5 cases had complications. Mechanical complications were observed in four cases, including three cases in which the frame of the template fractured during implant placement surgery and one case in which the sleeve fell off the surgical template. In one case, there was an error in the planned position. All cases were mandibular molar cases, and all cases of frame fracture were at the free end defect site. All cases had a Hounsfield unit of more than 700 at the implant site, and some of them had a significantly small jaw opening. Conclusion: Although the spread of CAD/CAM surgical templates has made it possible to avoid problems caused by the position of the implant, it has been difficult to avoid fractures in cases of mandibular free end defects with high Hounsfield unit.
文摘Background: Implant placement using a conventional surgical guide and digital surgical guide techniques is well documented in the literature. The most frequently reported disadvantages of conventional surgical guide placement are lack of accuracy in implant placement when compared to three-dimensional assessment in digital technique. Other factors listed are longer time duration and the need for impression techniques. In this case report, the authors present a comparison between the two techniques and the time taken between both cases one done conventionally and another case by digital technique. Case Presentation: For the digital surgical guide, a 44-year-old, male reported with the chief complaint of missing teeth needing replacement was considered. For the conventional technique, a female patient aged fifty-seven who had gone through various dentists with an existing bridge was considered. This patient wanted a good outcome at a reasonable cost. In both cases, molars were missing and needed replacement. The steps for digital flow for a surgical guide and step-by-step conventional methods are both highlighted in this article. Conclusion: Hence the digital technique saved time and was accurate when compared to the conventional in our experience.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Patient’s acceptability of dental implant prostheses may be influenced the fact that a surgical procedure is involved. Adequate relevant information by the dental professionals pre-surgery, is therefore, paramount to alleviating the fear of surgery and contribute positively to patient’s ability to cope with post-surgical experience. This study, therefore, aimed at evaluating </span><span style="font-family:Verdana;">the postsurgical experience of the dental implant patients. As against what was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">expected, and relate this with the information given pre surgery. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> Post treatment self-completed questionnaires were administered to consented </span><span style="font-family:Verdana;">patients that had dental implants placed between July 2017 and December 2019. The surgical procedure followed the standard protocol and </span><span style="font-family:Verdana;">data related to post-surgical experience were collected one week after the surgery</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">to obtain </span><span style="font-family:Verdana;">information on the level of pain/discomfort and amount of swelling experienced f</span><span style="font-family:Verdana;">ollowing surgery. The effect of the information on coping ability following surgery was also assessed. Data were analyzed using descriptive statistics (</span><span style="font-family:Verdana;">p</span><span style="font-family:Verdana;"> value ≤</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.05)</span><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Twenty-seven patients received 44 implants to replace 48 teeth. The mean age of the patients was 45</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">±</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">16.3</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(SD) years. Teeth mostly replaced were the maxillary central incisors (39.6%). </span><span style="font-family:Verdana;">The majority of the patients 77.7% reported to experience less pain/discomfort </span><span style="font-family:Verdana;">than expected and 66.6% had less swelling than expected. While 29.6% felt they had excellent explanation of what to expect,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">51.9% said they had good explanation.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The post-surgical experience between males and females was not statistically significant</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(pain</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> p</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.08, swelling</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">p</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.64). However, the majority </span><span style="font-family:Verdana;">(8/12) that had good to excellent information preoperatively, had significa</span><span style="font-family:Verdana;">ntly </span><span style="font-family:Verdana;">less discomfort than expected. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Positive, encouraging and satisfactor</span><span style="font-family:Verdana;">y experience of patients following implant surgical procedure is related to adequate and correct information pre-surgery.</span>
基金supported by grants from the Program for Zhejiang Leading Talent of S&T Innovation(No.2021R52012)the Key Research and Development Projects of Zhejiang Province(No.2022C03112)the Wenzhou Innovation Team.
文摘To the Editor:Glaucoma is a leading cause of irreversible blindness worldwide.[1]Trabeculectomy with mitomycin C(MMC)has been the standard surgical intervention for reducing intraocular pressure(IOP)and slow down the progression of glaucoma.[2]However,some serious complications with devastating consequences can occur after trabeculectomy,such as bleb-related infections,suprachoroidal hemorrhage,vitreous hemorrhage,and malignant glaucoma.Over the last decade,many novel ophthalmic surgical devices have been used in glaucoma.The XEN45 microstent(Allergan,Dublin,CA,USA)is a hydrophilic cross-linked porcine gelatin stent.It is implanted ab-interno.
文摘Surgical meshes have been employed in the management of a variety of pathological conditions including hernia,pelvic floor dysfunctions,periodontal guided bone regeneration,wound healing and more recently for breast plastic surgery after mastectomy.These common pathologies affect a wide portion of the worldwide population;therefore,an effective and enhanced treatment is crucial to ameliorate patients’living conditions both from medical and aesthetic points of view.At present,non-absorbable synthetic polymers are the most widely used class of biomaterials for the manufacturing of mesh implants for hernia,pelvic floor dysfunctions and guided bone regeneration,with polypropylene and poly tetrafluoroethylene being the most common.Biological prostheses,such as surgical grafts,have been employed mainly for breast plastic surgery and wound healing applications.Despite the advantages of mesh implants to the treatment of these conditions,there are still many drawbacks,mainly related to the arising of a huge number of post-operative complications,among which infections are the most common.Developing a mesh that could appropriately integrate with the native tissue,promote its healing and constructive remodelling,is the key aim of ongoing research in the area of surgical mesh implants.To this end,the adoption of new biomaterials including absorbable and natural polymers,the use of drugs and advanced manufacturing technologies,such as 3D printing and electrospinning,are under investigation to address the previously mentioned challenges and improve the outcomes of future clinical practice.The aim of this work is to review the key advantages and disadvantages related to the use of surgical meshes,the main issues characterizing each clinical procedure and the future directions in terms of both novel manufacturing technologies and latest regulatory considerations.
文摘BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.
文摘Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(open trnascanal) approach has not been adapted since first described in the clinical field.we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.Methods: This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal(open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital(Riyadh, Saudi Arabia), which were conducted by the same surgeon.Results: Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16%(21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows:cholesteatoma in 5(3.8%) patients, extrusion of the electrode in 5(3.8%) patients, and tympanic membrane perforation or deep retractions in 5(3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4(3%) patients, recurrent otitis externa infections in 7(5%) patients, and weakness of the posterior canal wall in 1 patient.Conclusion: The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.
