ObjectiveTo study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application.MethodsClinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years.ResultsAll 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning.ConclusionPreoperative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.
ObjectiveTo investigate the clinical value of 3D CT combined with CT-guided Hookwire for localizing small pulmonary nodules in thoracoscopic pulmonary segmentectomy.MethodsFrom December 2017 to February 2019, 39 patients received thoracoscopic pulmonary segmentectomy in our hospital, including 14 males and 25 females with a mean age of 51.33±11.17 years. Before operation, we used Mimics Medical 20.0 to re-establish the anatomy of lung and locate the small pulmonary nodules with Hookwire guided by CT. Based on the position of Hookwire needle, 3D CT images and simulated surgical methods, thoracoscopic pulmonary segmentectomy was performed accurately.ResultsThe surgery was successfully completed in 39 patients without a transfer to open procedure. The mean operation time, mean intraoperative blood loss, mean postoperative hospital stay, mean thoracic tube drainage time were 148.97±28.56 min, 27.95±17.57 mL, 6.95±1.68 d, 4.21±1.95 d, respectively. Postoperative complications occurred in 5 patients (12.82%), including atrial fibrillation in 1, pulmonary infection in 1, chylothorax in 1, intrathoracic hemorrhage in 1 and pneumothorax in 1. All actual surgical margins were larger than 3.0 cm.ConclusionThe application of preoperative 3D CT combined with CT-guided Hookwire to localize small pulmonary nodules is helpful for accurate anatomical segmental resection of the lung, making the operation safe .
ObjectiveTo systematically evaluate the application effect of CT-guided Hook-wire localization and CT-guided microcoil localization in pulmonary nodules surgery. MethodsThe literatures on the comparison between CT-guided Hook-wire localization and CT-guided microcoil localization for pulmonary nodules were searched in PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP and CNKI databases from the inception to October 2021. Review Manager (version 5.4) software was used for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of studies.ResultsA total of 10 retrospective cohort studies were included, with 1 117 patients including 473 patients in the CT-guided Hook-wire localization group and 644 patients in the CT-guided microcoil localization group. The quality of the studies was high with NOS scores>6 points. The result of meta-analysis showed that the difference in the localization operation time (MD=0.14, 95%CI −3.43 to 3.71, P=0.940) between the two groups was not statistically significant. However, the localization success rate of the Hook-wire group was superior to the microcoil group (OR=0.35, 95%CI 0.17 to 0.72, P=0.005). In addition, in comparison with Hook-wire localization, the microcoil localization could reduce the dislocation rate (OR=4.33, 95%CI 2.07 to 9.08, P<0.001), the incidence of pneumothorax (OR=1.62, 95%CI 1.12 to 2.33, P=0.010) and pulmonary hemorrhage (OR=1.64, 95%CI 1.07 to 2.51, P=0.020). ConclusionAlthough Hook-wire localization is slightly better than microcoil localization in the aspect of the success rate of pulmonary nodule localization, microcoil localization has an obvious advantage compared with Hook-wire localization in terms of controlling the incidence of dislocation, pneumothorax and pulmonary hemorrhage. Therefore, from a comprehensive perspective, this study believes that CT-guided microcoil localization is a preoperative localization method worthy of further promotion.
An 89 years old male patient was admitted to the First Medical Center of Chinese PLA General Hospital due to chest tightness and shortness of breath for half a month. Severe aortic valve stenosis was found in post admission assessment. We proposed to perform transcatheter aortic valve replacement surgery. Preoperative evaluation showed severe distortion of the descending aorta. We used the double guide wire technique and a 14F long sheath to assist the stepwise balloon expansion, and successfully completed the valve implantation. For patients with severe tortuous aorta, how to successfully complete transcatheter aortic valve replacement, this case may provide some reference.
Objective To study the feasibility of a new method for the cross-leg position maintained by the Kirschner wire internal fixation after the cross-leg flap procedure. Methods From December 2004 to October 2005, 5 patients (4 males, 1 female; aged 14-52 years) were admitted to our department, who suffered from the tibia exposure or the internal fixation plate exposure after operation because of the tibia fracture by trauma for 1-8 weeks. The soft tissue defects ranged in area from 2.4 cm × 2.0 cm to 4.2 cm × 3.0 cm. The soft tissue around the wound in the leg was too poor in condition to perform an operation of the local flap transplantation, but the wound and the tibia had no obvious infection, so an operation of the cross-leg flap transplantation was performed to cover the wounds. The operation was performed with the routine crossleg flap method introduced in the medical literature. After operation the cross-leg position was maintained through a simple internal fixation with two Kirschner wire, which were inserted through the tibia of the cross region of both thelegs, and layers of dressings were placed as a cushion between the crossed legsin case of the crushing skin ulcer formation. The effect of fixation, blood circulation in the cutaneous flap, and the stress of the pedicle were observed postoperatively. After 3-4 weeks the pedicle of the cross-leg flap was cut off; the crossed legs were detached and the Kirschner wire were pulled out. Results All the flaps survived with a good blood circulation and a low pedicle stress. The patients had a relatively comfortable position because all the areas of the legs could be allowed to make some motions except the cross-area ofthe legs. Another advantage of this fixation method was its convenience for observing the blood circulation of the cutaneous flap and for changing the dressings. Neither infection in the holes of the Kirschner wire nor crushing skin ulcer formation in the area of the cross-leg could be observed. The follow-up for 3-18 months revealed that all the flaps were in good condition with no edema, contracture or skin pigmentation. Conclusion The method of usingthe Kirschner wire to maintain the cross-leg position after the crossleg flapprocedure has more advantages than the plaster fixation. This improved method is simpler, and can achieve a tighter fixation in the crossleg area to maintainthe cross-leg position, allowing a micro-motion in other parts of the legs. The patients can have a relatively comfortable posture, and have a more convenient dressing changes and observation on the blood circulation in the flaps.
Objective To compare the results of plate and Kirschner wire fixation in treatment of nonunion of clavicular fracture. Methods From September 1991 to January 2002, 19 patients (9 with plate and 10 with Kirschner wire) were treated. The results were evaluated by reduction, bone union time, recovery of joint function, pain, and correction of deformation. Results The follow-up time was 6-23 months with an average of 11 months. Bone union -occurred after a mean time of 11 weeks. In plate group, 7 patients gained excellent results, 1 good and1 fair. In Kirschner wire group, 3 patients gained excellent results, 3 good, 3 fair and 1 poor. The result of plate is significantly better than that of Kirschner wire fixation(Plt;0.05). Conclusion Plate fixation is a good simple method for treatment of nonunion of clavicular fracture.
Brain-computer interface (BCI) system is a system that achieves communication and control among humans and computers and other electronic equipment with the electroencephalogram (EEG) signals. This paper describes the working theory of the wireless smart home system based on the BCI technology. We started to get the steady-state visual evoked potential (SSVEP) using the single chip microcomputer and the visual stimulation which composed by LED lamp to stimulate human eyes. Then, through building the power spectral transformation on the LabVIEW platform, we processed timely those EEG signals under different frequency stimulation so as to transfer them to different instructions. Those instructions could be received by the wireless transceiver equipment to control the household appliances and to achieve the intelligent control towards the specified devices. The experimental results showed that the correct rate for the 10 subjects reached 100%, and the control time of average single device was 4 seconds, thus this design could totally achieve the original purpose of smart home system.
ObjectiveTo evaluate the effectiveness of the modified intramedullary fixation with two Kirschner wires for extra-articular fracture of the proximal phalangeal base. MethodsBetween June 2012 and November 2015, 18 cases (18 fingers) of fresh extra-articular fracture of the proximal phalangeal base were treated, including 16 males and 2 females with an average age of 31 years (range, 21-57 years). The causes included strike injury in 10 cases, fall injury in 4 cases, mechanical injury in 1 case, twist injury in 1 case, crush injury in 1 case, and cutting injury in 1 case. The injured fingers were little finger in 16 cases, ring finger in 1 case, and index finger in 1 case. Of the 18 cases, 17 had closed fractures and 1 had open fracture. X-ray film showed transverse fracture in 14 cases and transverse-oblique fracture in 4 cases. The time between injury and operation was 3 hours to 4 days (mean, 2 days). After anatomical reduction, two Kirschner wires were used for intramedullary fixation. Functional exercises were done at 2 days after operation. The Kirschner wires were removed at 4 weeks after operation. ResultsAll the wounds healed by first intention. There were no deformation, loosening or breakage of Kirschner wires, and pin tract infection. Postoperative X-ray films showed anatomical reduction of fracture in all cases; no re-displacement happened, and clinical healing was obtained at 4 weeks; bony union was obtained at 8 weeks. All patients were followed up 6-12 months with an average of 8 months. There was no pain in the metacarpophalangeal joint; the range of motion was (88.1±2.3)° at 3 months after operation, showing no significant difference when compared with normal side [(88.8±2.6)°] (t=1.73, P=0.10). The finger flexion and extension were normal; according to the criteria of total active motion of finger, the results were excellent in all cases. ConclusionThe technique of modified intramedullary fixation with two Kirschner wires for extra-articular fractures of the proximal phalangeal base has the merits of convenient operation, little injury, reliable fixation, and excellent effectiveness. This technique is conducive to the recovery of hand function due to the early functional exercises.
Objective To compare the effectiveness of suspension fixation plus hinged external fixator with double plate internal fixation in the treatment of type C humeral intercondylar fractures. Methods Between January 2014 and April 2016, 30 patients with type C (Association for the Study of Internal Fixation, AO/ASIF) humeral intercondylar fractures were treated. Kirschner wire suspension fixation plus hinged external fixator was used in 14 cases (group A), and double plate internal fixation in 16 cases (group B). There was no significant difference in gender, age, injury cause, disease duration, injury side, and type of fracture between 2 groups (P>0.05). Results There was no significant difference in operation time and hospitalization stay between 2 groups (P>0.05). But the intraoperative blood loss in group A was significantly less than that in group B (P<0.05); the visual analogue scale (VAS) score at 1 day and 3 days after operation in group A were significantly less than those in group B (P<0.05). Primary healing of incision was obtained in all patients of 2 groups, and no surgery-related complications occurred. The patients were followed up 6-24 months (mean, 12.3 months) in group A and 6-24 months (mean, 12.8 months) in group B. The self-evaluation satisfaction rate was 85.7% (12/14) in group A and was 81.2% (13/16) in group B at 3 months after operation, showing no significant difference (χ2=0.055, P=0.990). Based on the improved Gassebaum elbow performance score at 6 months after operation, excellent and good rate of the elbow function was 78.6% (excellent in 5 cases, good in 6 cases, fair in 2 cases, and poor in 1 case) in group A and was 81.2% (excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case) in group B, showing no significant difference between 2 groups (χ2=0.056, P=0.990). Heterotopic ossification occurred at 3 months after operation in 1 case of each group respectively. The X-ray films showed bony union in all cases; no loosening or breakage of screw was observed. The bone union time showed no significant difference between 2 groups (t=–0.028, P=0.978). The time of internal fixation removal, the intraoperative blood loss, and VAS score at 1 day and 3 days after operation in group A were significant better than those in group B (P<0.05). Conclusion The suspension fixation plus hinged external fixator and double plate internal fixation for the treatment of type C humeral intercondylar fractures have ideal outcome in elbow function. But the suspension fixation plus hinged external fixator is better than double plate internal fixation in intraoperative blood loss, postoperative VAS score, and time of internal fixation removal.
Ultra-sensitive and quantitative analysis of proteins, nucleic acid, virus and other biochemical species are critical technologies for effective dianosis of disease, as well as medical studies. Silicon nanowires field-effect transistor (SiNWs-FET) biosensor is one of the most promising powerful platforms for label-free, real-time, ultra-sensitive detection of analyte. Here, the working principle of SiNWs-FET biosensor and the applications of SiNWs-FET biosensors in medicine were introduced. Moreover, the methods for enhancing the sensitivity of SiNWs-FET biosensor were discussed. Lastly, the prospecting of SiNWs-FET biosensor was presented.