BACKGROUND & AIMS: BACKGROUND:In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL). METHODS:From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery. RESULTS:Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL. CONCLUSIONS:QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated.

背景与目标： 背景：在某些中心，在某些情况下，姑息性切除术（PR；部分胰十二指肠切除术）优先于晚期胰腺癌的双环旁路手术（DLB）进行推广。这项前瞻性研究将PR与DLB进行了比较，特别关注患者的生活质量（QoL）。
方法：从01/1993年至09/2004年，在前瞻性单中心研究中对姑息性胰腺癌晚期导管腺癌姑息性手术治疗的167例患者进行了分析。 38例接受了PR，129例接受了姑息性DLB。接受DLB的患者分为：（1）局部晚期疾病（LAD-亚组； n = 61; 47％）和（2）转移性疾病（MD-亚组； n = 68; 53％）。使用EORTC QLQ-C30问卷并辅以胰腺癌特定模块评估生活质量。术前和手术后长达12个月收集QoL数据。
结果：PR患者的中位生存期为7.0个月（95％CI 4.09； 9.91），而接受DLB的患者为6.0个月（95％CI 5.39； 6.61）。 PR的死亡率和发病率分别为7.8％和58％，DLB的死亡率为2.6％和42％。 PR后的生活质量比DLB后的生活质量下降更多。 DLB组恢复更快，三个月后达到术前QoL水平，出院时受损程度较小。 LAD子组和MD子组具有相同的QoL水平。
结论：QoL分析显示DLB后有利的QoL数据。此外，两组的生存率没有显着差异，但PR组的发病率和死亡率均升高。因此，需要仔细评估PR在晚期胰腺癌中的应用。

BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

背景与目标： ：这项研究旨在阐明消化道手术后口腔清洁的有效性，包括刷牙，义齿清洁和舌头清洁。受试者包括接受消化道手术的30位年龄在60-98岁（74.9 /-7.8岁）的老年患者。将受试者随机分为干预组和对照组。在干预组中，每天从基线（手术日）开始，在每天的5分钟内，每天进行以下口腔护理，并持续5天：用聚维酮碘漱口，刷牙，使用专用刷子清洁义齿和使用舌刷清洁舌头。在对照组中，受试者仅含聚维酮碘。我们在基线和5天后比较了两组之间的以下变量：口干的感觉，口内气体浓度，肺音，体温和细菌菌群。在干预组中，肺音异常（干音或湿音）的患者数量从1增加到2，对照组从0增加到4（P <0.05）。对照组术前平均细菌种类为3.64 /-1.34，术后为3.50 /-1.74，而干预组术前为3.08 /-0.95，术后为2.62 /-0.65。操作上。在干预组中，细菌种类的数量显着减少（P <0.05）。这些发现表明，接受消化道手术的老年患者的术后口腔护理降低了在口腔中发现的细菌种类的数量。反过来，这种效果可能会改善呼吸功能。

BACKGROUND & AIMS: BACKGROUND:In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN:Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS:Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS:With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.

背景与目标： 背景：在早期肺癌中，越来越多的证据表明，通过电视辅助胸腔手术（VATS）进行肺叶切除术比开放性肺叶切除术具有更大的益处。很少有胸部训练计划能够提供这种技术要求很高的程序的足够经验。本文介绍了新毕业生从开放式开胸手术到VATS肺叶切除术的发展历程。
研究设计：我们的模型涉及从后外侧胸廓切开术到保留肌肉的胸廓切开术，以及最终到VATS肺叶切除术的技术过渡。通过检查VATS肺叶切除术前开胸患者的结局和最初的30例VATS患者的结局来评估该方法。数据是前瞻性收集的。
结果：在进行VATS肺叶切除术之前，通过开胸手术进行了94例主要的肺切除。肺叶切除术的死亡率为1.2％，肺叶切除术的死亡率为0％。保留肌肉的开胸手术的比例从上半部分的17％上升到下半部分的70％。对于最初的30例VATS肺叶切除术患者，平均手术时间为168分钟。失血量中位数为200毫升。开胸手术的转化率为13.3％。死亡率为3.3％，发病率为26.7％。短期随访（平均随访16个月）后，I期肺癌的总生存率为96％。
结论：采用我们的方法，新的胸外科课程毕业生可以安全地过渡到VATS肺叶切除术。获得保留侧肌的开胸手术的经验是过渡过程中的重要一步，因为它提供了类似的手术暴露。需要长期无病和总体生存数据来评估我们使用这种方法的肿瘤学疗效。

BACKGROUND & AIMS: Visual optics is taking on new clinical significance. Given that current refractive procedures can and do induce large amounts of higher order ocular aberration that often affects the patient's daily visual function and quality of life, we can no longer relegate the considerations of ocular aberrations to academic discussions. Instead, we need to move toward minimizing (not increasing) the eye's aberrations at the same time we are correcting the eye's spherical and cylindrical refractive error. These are exciting times in refractive surgery, which need to be tempered by the fact that after all the research, clinical, and marketing dust settles, the level to which we improve the quality of the retinal image will be guided by the trade-off between cost and the improvement in the quality of life that refractive surgery offers.

背景与目标： 视觉光学正具有新的临床意义。鉴于当前的屈光手术可以并且确实会诱发大量的高阶像差，这些像差通常会影响患者的日常视觉功能和生活质量，因此我们不再将对眼像差的考虑引入学术讨论中。相反，我们需要在最小化（而不是增加）眼睛像差的同时，还要校正眼睛的球面和柱面折射误差。在屈光手术中，这是激动人心的时刻，需要通过以下事实来缓和：在所有研究，临床和市场营销尘埃落定之后，我们在提高视网膜图像质量的水平上将取舍于两者之间的权衡取舍。费用和屈光手术所提供的生活质量改善。

BACKGROUND & AIMS: OBJECTIVE:To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery. RESEARCH METHODS AND PROCEDURES:A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria. RESULTS:Percentages of participants who met diagnostic criteria for NES by interview were 1.9% for the strictest definition and 8.9% across all definitions of NES. After interview, full DSM-TR criteria for BED were met by 4.2%; an additional 1.4% reported binge eating at least once per week. Self-reported prevalence of NES and BED were higher. Those with NES or BED had significantly more symptoms of depression and a greater history of psychological complications than the remaining sample. DISCUSSION:The prevalence rates of NES and BED among this population of bariatric surgery candidates were lower than expected based on previous reports. Findings and hypotheses regarding lowered prevalence rates are discussed.

背景与目标： 目的：评估寻求减肥手术的人夜间进食综合征（NES）和暴饮暴食症（BED）的患病率及其相关的行为和心理关联。
研究方法和程序：连续215例极端肥胖者（82％为女性，70％为欧洲裔美国人）完成了体重和生活方式调查，并进行了半结构化访谈，作为术前行为/心理评估的一部分。 NES和BED的诊断基于分级诊断标准。
结果：通过面试满足NES诊断标准的参与者百分率是最严格的定义为1.9％，在所有NES定义中为8.9％。访谈后，满足BED的DSM-TR完整标准的比例为4.2％；另外有1.4％的人表示暴饮暴食每周至少吃一次。自我报告的NES和BED患病率较高。与其余样本相比，患有NES或BED的患者具有明显更多的抑郁症状和更大的心理并发症史。
讨论：该肥胖手术候选人人群中NES和BED的患病率低于以前的报道。讨论了关于降低患病率的发现和假设。

BACKGROUND & AIMS: BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.

背景与目标： 背景：文献报道腹腔镜Roux-en-Y胃旁路术（LRYGBP）的学习曲线约为75-100例。本研究的目的是评估由经验丰富的腹腔镜外科医生缩短进行LRYGBP学习曲线的安全性和可行性。
方法：本研究回顾性分析了2003年4月至2003年9月由经验丰富的腹腔镜外科医生进行的前100例连续LRYGBP病例。在首次协助30例患者之后，外科医生进行了这些病例，前4例病例由经验丰富的腹腔镜肥胖手术医师督导。该研究排除了先前进行胃吻合术和尼森胃底折叠术后完成的两个病例。结果变量包括手术时间，并发症，转化率和死亡率。
结果：前100名LRYGBP患者的平均年龄为42.6岁（范围22-62岁），平均体重指数（BMI）为47.6 kg / m2（范围36-71.8）。并发症包括肠漏1例，小肠梗阻1例，胃空肠狭窄6例，伤口感染8例，伤口血清肿1例和肺栓塞2例，导致1例死亡。一个案例被转换为开放技术。在后50例中，平均手术时间从113分钟（54-238分钟）减少到73分钟（39-145分钟）（P <.0001）。然而，尽管并发症发生率降低（无胃肠道渗出或阻塞，2例胃肠空肠狭窄，2例伤口感染，无肺栓塞/深静脉血栓形成，无死亡率），但死亡率，转化率之间无显着相关性。 ，并发症发生率和外科医生的经验。
结论：有经验的腹腔镜外科医生可以安全地进行结合了LRYGBP的减肥手术。借助适当的高级腹腔镜检查技巧，准备步骤，指导以及适当的病例数量，可以将进行LRYGBP的学习曲线减少到50例。进一步的经验可以显着减少手术时间，并具有可接受的死亡率，并发症和转化率。

BACKGROUND & AIMS: :Fine needle aspiration cytology (FNAC) is an important tool in the investigation of thyroid nodules and has few reported complications. We present the first report of recurrent laryngeal nerve palsy arising as a complication of thyroid nodule FNAC. This complication led to inaccurate diagnosis and unnecessarily radical surgery, with consequent increased morbidity.

背景与目标： ：细针穿刺细胞学检查（FNAC）是甲状腺结节研究中的重要工具，报道的并发症很少。我们提出了作为甲状腺结节FNAC并发症引起的喉返神经麻痹的首例报告。这种并发症导致诊断不准确和不必要的根治性手术，从而增加发病率。

BACKGROUND & AIMS: PURPOSE:Medication and nutrient administration considerations after bariatric surgery are discussed. SUMMARY:Bariatric surgery is categorized by surgical technique (i.e., restrictive procedure or a combination of restrictive and malabsorptive procedures). Roux-en-Y gastric bypass is the most frequently performed bariatric surgery in the United States. Patients who have undergone this surgery are at risk for nutrient deficiencies. Several factors, such as pH and absorption sites, should be considered when providing these patients with appropriate supplementation. Drug solubility and surface area for absorption are also affected by gastric bypass procedures. By bypassing major portions of the small intestine, Roux-en-Y procedures drastically reduce the surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in these patients. The reduced size of the stomach after surgery can place patients at risk for adverse events associated with some medications. Medications implicated in such adverse events include nonsteroidal antiinflammatory drugs, salicylates, and oral bisphosphonates. Drugs that are rapidly and primarily absorbed in the stomach or duodenum are likely to exhibit decreased absorption in patients who have had combination restrictive-malabsorptive procedures. Because reduced drug absorption may result in decreased efficacy rather than toxicity, increased patient monitoring for therapeutic effects can help detect potential absorption problems. CONCLUSION:Selection of appropriate nutrient salts can improve nutrient replacement in patients who have undergone bariatric surgery. Changes in dosage forms based on drug characteristics can improve bioavailability.

背景与目标： 目的：讨论减肥手术后的药物和营养管理注意事项。
摘要：B术手术按手术技术进行分类（即限制性手术或限制性与不良吸收手术的组合）。 Roux-en-Y胃旁路手术是美国最常进行的减肥手术。接受过此手术的患者有营养缺乏的风险。向这些患者提供适当的补充剂时，应考虑几个因素，例如pH值和吸收部位。胃旁路手术也会影响药物的溶解度和吸收表面积。通过绕开小肠的主要部分，Roux-en-Y程序可大大减少吸收的表面积。这些变化可能需要对药物途径或剂量进行控制，以确保充分递送。这些吸收期较长且长期保留在肠道中的药物可能会在这些患者中显示出较低的生物利用度。手术后胃的缩小可能使患者处于与某些药物相关的不良事件的风险中。与此类不良事件有关的药物包括非甾体类抗炎药，水杨酸酯和口服双膦酸酯。在具有限制性限制性吸收不良组合治疗的患者中，快速且主要在胃或十二指肠中吸收的药物很可能表现出吸收减少。由于减少的药物吸收可能会导致功效下降而不是毒性下降，因此增加对患者的治疗效果监测可以帮助发现潜在的吸收问题。
结论：选择合适的营养盐可以改善减肥手术患者的营养补充。根据药物特性改变剂型可以提高生物利用度。

BACKGROUND & AIMS: :The practice of duplicate publication has been condemned widely in the scientific community and several studies have been conducted to establish the level of the problem in various surgical fields. A retrospective review of original articles from the British Journal of Plastic Surgery and Plastic and Reconstructive Surgery during 2000 was conducted, using Medline (PubMed). A total of 431 abstracts were screened, from which 27 index articles related to 33 'suspected redundant' publications. Further evaluation was carried out by comparing the full text versions of these articles and assigning a grade of non-dual, dual, potentially dual and 'salami-slicing'. Only four suspect articles were confirmed as having some degree of redundancy, and these related to three index articles (3/431, <1%). The incidence of duplication in plastic surgery literature seems to be much lower compared to other surgical specialties, providing reassurance for reviewers, editors and readers of these journals.

背景与目标： ：重复出版的做法已在科学界受到广泛谴责，并已进行了多项研究来确定各个外科领域的问题水平。使用Medline（PubMed）对2000年《英国整形外科杂志》和《整形与重建外科杂志》上的原始文章进行了回顾性审查。共筛选了431篇摘要，其中27篇索引文章与33篇“可疑的冗余”出版物有关。通过比较这些文章的全文版本并指定非双重，双重，可能双重和“萨拉米切片”的等级，进行了进一步的评估。仅确认了四篇可疑文章具有一定程度的冗余度，这些文章与三篇索引文章有关（3/431，<1％）。与其他外科专业相比，整形外科文献中的重复发生率似乎要低得多，这为这些期刊的审稿人，编辑和读者提供了保证。

BACKGROUND & AIMS: BACKGROUND:Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. METHODS:We searched our online deidentified departmental quality improvement and patient safety database for adverse outcomes associated with arthroscopic shoulder surgery performed in the beach-chair position for the 11-year period between April 2001 and November 2011, as well as our hospital-system database and a statewide database. This was compared with the total number of such cases, available from our department billing database. RESULTS:The total rate of adverse events was 0.37%. Neurologic abnormalities suggestive of acute cerebral ischemia or hemorrhage did not occur in the immediate perioperative period. One new neurologic deficit was reported, secondary to ischemic stroke, which occurred 24 hours after the surgery. The most frequent complications detected were unplanned return to care (0.067%), local anesthetic systemic toxicity (0.053%), and airway compromise requiring unplanned intubation (0.033%). Complications were infrequent and did not vary in incidence over the course of the study. CONCLUSIONS:This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.

背景与目标： 背景：几例病例报告引起了人们对与全脑低灌注相关的沙滩椅位置肩部手术安全性的严重关注。我们总结了我们在11年中共15014例肩关节镜检查的经验。我们的主要目的是评估术中或术后立即发生的神经系统事件的发生率，其次是与其他围手术期并发症相关。
方法：我们在2001年4月至2011年11月的11年期间，通过在线不确定的部门质量改善和患者安全性数据库搜索了在沙滩椅位置进行的关节镜肩部手术相关的不良结局，以及医院系统数据库和全州数据库。将其与此类案件的总数进行了比较，可从我们的部门账单数据库中获得该数目。
结果：不良反应总发生率为0.37％。围手术期未发生提示急性脑缺血或出血的神经系统异常。据报道，缺血性中风继发于术后24小时，出现了一种新的神经功能缺损。发现的最常见并发症是计划外恢复治疗（0.067％），局麻药全身毒性（0.053％）和需要计划外插管的气道损害（0.033％）。在研究过程中，并发症很少见，发生率也没有变化。
结论：这项回顾性研究表明，当在沙滩椅位置进行手术并伴有区域麻醉，异丙酚镇静和通过自然气道自发呼吸时，很少发生术中或术后中风。

BACKGROUND & AIMS: PURPOSE:To determine whether corneal topical application of mitomycin-C (MMC) results in measurable plasma levels of systemic absorption. SETTING:Madigan Army Medical Center, Refractive Surgery Center, Fort Lewis, Washington, and Micro-Constants Laboratory, San Diego, California, USA. DESIGN:Case-control study. METHODS:The study comprised male and female active-duty soldiers having excimer laser photorefractive keratectomy with MMC. Patients who met inclusion criteria were asked to provide a blood sample immediately after being treated with MMC 0.2 mg/mL (0.02%) for 30 seconds. Human plasma samples were evaluated by liquid chromatography mass spectrometry to determine whether MMC was present. RESULTS:Thirty samples were submitted for evaluation. There was zero detection of MMC in the submitted samples. The quantifiable limit was greater than 10.0 ng/mL. All samples were below this. CONCLUSIONS:In this study of 30 patients with topical application of MMC for refractive surgery, there was no measurable evidence of systemic absorption. Although systemic absorption has been found with use in larger quantities, it was not known whether MMC toxicity concerns could be extrapolated to the refractive surgery population. This information allows counseling of patients on the extremely low likelihood of systemic absorption or toxicity following current techniques for refractive surgery. FINANCIAL DISCLOSURE:No author has a financial or proprietary interest in any material or method mentioned.

背景与目标： 目的：确定局部应用丝裂霉素C（MMC）的角膜是否可测量血浆中的全身吸收水平。
地点：华盛顿州刘易斯堡的马迪根军医中心，屈光手术中心和美国加利福尼亚州圣地亚哥的微常数实验室。
设计：病例对照研究。
方法：该研究包括接受MMC准分子激光屈光性角膜切除术的现役士兵。接受入选标准的患者在接受0.2 mg / mL MMC（0.02％）的治疗30秒后，应立即提供血样。通过液相色谱质谱法评估人血浆样品，以确定是否存在MMC。
结果：提交了30个样品进行评估。在提交的样本中，MMC的检测为零。定量限大于10.0 ng / mL。所有样品均低于此值。
结论：在这项针对30例MMC局部应用屈光手术的患者的研究中，没有可测量的全身吸收证据。尽管已经发现全身吸收的使用量更大，但尚不清楚是否可以将MMC毒性问题推断到屈光手术人群中。该信息使患者可以根据当前屈光手术技术对全身吸收或毒性的可能性极低进行咨询。
财务披露：任何作者都不会对所提及的任何材料或方法具有财务或专有利益。

BACKGROUND & AIMS: :Twenty patients with strabismus and diplopia following surgery for retinal detachment were treated by botulinum toxin injection of the eye muscles. Twelve patients had regained fusion with elimination of diplopia in the primary position at the time of examination, 5 to 96 months after treatment (mean, 24 months). Three patients had partial diplopia elimination, and five patients continued to have diplopia.

背景与目标： ：20例视网膜脱离手术后的斜视和复视患者通过肉毒杆菌毒素注射治疗眼肌。在检查时，治疗后5至96个月（平均24个月），有12例患者恢复了融合，消除了原发性复视。 3例患者消除了部分复视，5例患者继续复视。

BACKGROUND & AIMS: :Hemorrhage is the most preventable cause of posttraumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or resuscitative surgery in austere environments. Revolutions in technology for remote mentoring of ultrasound and surgery may enhance capabilities to utilize the skill sets of non-physicians. Thus, our research collaborative explored remote mentoring to empower non-physicians to address junctional and torso hemorrhage control in austere environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative surgery for torso hemorrhage control, understanding and mitigating physiological stress during such tasks, and the technical practicalities of conducting damage control surgery (DCS) in austere environments. Iterative projects involved randomized guiding of firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS, randomized remote mentoring of MedTechs conducting resuscitative surgery for torso exsanguination in an anatomically realistic surgical trainer ("Cut Suit") including physiological monitoring, and trained surgeons conducting a comparative randomized study for torso hemorrhage control in normal (1g) versus weightlessness (0g). This work demonstrated that firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive firefighter in Memphis could also be remotely mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, both mentored and unmentored MedTechs and trained surgeons completed resuscitative surgery for hemorrhage control on the Cut-Suit, demonstrating practicality for all involved. While remote mentoring did not decrease blood loss among MedTechs, it increased procedural confidence and decreased physiologic stress. Therefore, remote mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that remote mentoring supports diagnosis, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.

背景与目标： ：出血是创伤后死亡的最可预防原因。许多病例在解剖学上可能是可挽救的，但如果没有后勤人员或训练有素的人员在严酷的环境中进行诊断或复苏手术，则仍然致命。超声和手术的远程指导技术的革命可能会增强利用非医师技能的能力。因此，我们的研究合作探索了远程指导，以使非医师能够在严峻的环境中解决交界处和躯干出血的控制问题。重大研究涉及使用远程元素超声（RTMUS）识别躯干和关节血流失血，远程指导复苏手术以控制躯干出血，了解和缓解此类任务期间的生理压力以及在严格的条件下进行损伤控制手术（DCS）的技术实用性环境。迭代项目涉及使用RTMUS随机指导消防员以识别躯干（RCT）和交界处（飞行员）出血，在解剖学上现实的外科培训师（Cut Suit）中进行进行复苏性躯干放血手术的MedTechs的随机远程指导，包括生理监测，以及训练有素的外科医生，对正常（1g）和失重（0g）的躯体出血控制进行比较随机研究。这项工作表明，可以远程指导消防员在模拟器上执行即时躯干RTMUS。消防员和指导者都对自己的能力充满信心，超声波准确率达97％。孟菲斯市的一名初次使用超声的消防员也可以从夏威夷进行远程指导，以在活组织模型中使用RTMUS识别并随后压塞动脉结膜出血。此后，受指导和未受指导的MedTechs以及受过训练的外科医生都完成了复苏手术，以控制Cut-Suit上的出血，证明了所有参与者的实用性。尽管远程指导并没有减少MedTechs的失血量，但它增加了程序的置信度并降低了生理压力。因此，远程指导可能会增加非医师执行心理艰巨任务的可行性。最终，失重的DCS是可行的，与1g的差异不大。总体而言，集体证据表明，远程指导支持诊断，无创治疗以及最终的复苏手术，以挽救那些在严酷环境中放血的人，因此应进行更严格的研究。

BACKGROUND & AIMS: OBJECTIVES:The role of surgery in stage IV gallbladder (GB) cancer is not well established. This study analyses prognostic factors in patients with stage IV GB cancer following surgical resection with the aim of identifying a subgroup of patients who might benefit from surgical resection. METHODS:Clinicopathological details were analysed for 94 patients who were surgically treated for stage IV GB cancer at Seoul National University Hospital. RESULTS:Median survival was 8 months in patients with either stage IVa or IVb disease. Sixteen patients (17.0%) underwent resection with curative intent, which increased overall survival over that in patients undergoing palliative surgery (P < 0.001). No survival benefit was seen following surgery with curative intent in patients with stage IVa disease (P = 0.764). Surgery with curative intent resulted in a survival benefit in patients with stage IVb disease, patients with an isolated liver metastasis near the GB bed (median survival: 31 months vs. 9 months; P < 0.001) and patients with limited numbers of peritoneal implantations (median survival: 20 months vs. 6 months; P = 0.002). Preoperative serum carcinoembryonic antigen (CEA) (P = 0.018), surgery with curative intent (P = 0.045) and adjuvant chemotherapy (P = 0.002) were independent prognostic factors in patients with stage IV GB cancer. CONCLUSIONS:Surgery in combination with systemic chemotherapy may be beneficial in carefully selected patients with stage IVb GB cancer.

背景与目标： 目的：手术在IV期胆囊癌中的作用尚不明确。这项研究分析了手术切除后Ⅳ期GB期癌症患者的预后因素，目的是确定可能从手术切除中受益的患者亚组。
方法：分析了首尔国立大学医院94例行IV型GB癌症手术治疗的患者的临床病理资料。
结果：IVa或IVb期患者的中位生存期为8个月。 16例（17.0％）接受根治性切除术的患者，与接受姑息手术的患者相比，总体生存率有所提高（P <0.001）。 IVa期疾病患者经根治性手术后未见生存获益（P = 0.764）。具有治愈意图的手术可为IVb期疾病患者，GB床附近发生单纯肝转移的患者（中位生存期：31个月对9个月； P <0.001）和腹膜植入次数有限的患者带来生存益处（中位生存期：20个月与6个月； P = 0.002）。 Ⅳ期GB期癌症患者的术前血清癌胚抗原（CEA）（P = 0.018），有根治性手术（P = 0.045）和辅助化疗（P = 0.002）是独立的预后因素。
结论：外科手术结合全身化学疗法可能对精心挑选的IVb GB期癌症患者有益。

BACKGROUND & AIMS: BACKGROUND:In 2013, the Declaration of Helsinki changed to mandate that all research studies involving human subjects, rather than just clinical trials alone, must have a protocol registered in a publicly accessible database prior to the enrolment of the first patient. The objective of this work was to assess the number of research studies involving human participants published in leading journals of plastic surgery that had either published a protocol or registered a protocol with a publicly accessible database. MATERIALS AND METHODS:This systematic review examined all research articles involving human participants published in Plastic and Reconstructive Surgery, The Journal of Plastic Reconstructive and Aesthetic Surgery and The Annals of Plastic Surgery from 1st April 2014-31st March 2015. The primary outcome measure was whether each study had either published or registered a protocol with any mainstream registry database. ClinicalTrials.gov, the International Standard Randomized Control Trial Number (ISRCTN) registry, the WHO (World Health Organisation) International Clinical Trials Registry Platform, The Cochrane Collaboration, the Research Registry, PROSPERO and PubMed were all reviewed. RESULTS:Of 595 included articles, the most common study designs were case series (n = 185, 31.1%). There were 24 randomized controlled trials (RCTs, 4.0%). A total of 24 studies had a protocol registered (4.0%). The most common database to register a protocol was with ClinicalTrials.gov (n = 17). The study design that most commonly had a registered protocol was the RCT (n = 8 of 24, 33.3% of RCTs). Three studies published a protocol in a journal (0.6%). CONCLUSION:Publication or registration of protocols for recent studies involving human participants in major plastic surgery journals is low. There is considerable scope to improve this and guidance is provided.

背景与目标： 背景：2013年，《赫尔辛基宣言》（Declaration of Helsinki Declaration）规定，所有涉及人类受试者的研究，而不仅仅是仅临床试验，都必须在第一个患者入组前在公共可访问的数据库中注册一个方案。这项工作的目的是评估在整形外科的主要期刊上发表的涉及人类参与者的研究数量，这些期刊已经发表了方案或在公共可访问的数据库中注册了方案。
材料与方法：本系统综述审查了2014年4月1日至2015年3月31日发表在《整形与重建外科》，《整形与美学外科杂志》和《整形外科年鉴》上的涉及人类参与者的所有研究文章。主要结果指标是是否每项研究均已在任何主流注册数据库中发布或注册了一项协议。 ClinicalTrials.gov，国际标准随机对照试验号码（ISRCTN）注册表，WHO（世界卫生组织）国际临床试验注册表平台，Cochrane合作组织，研究注册表，PROSPERO和PubMed均进行了审查。
结果：在595篇纳入文章中，最常见的研究设计是病例系列（n = 185，31.1％）。有24项随机对照试验（RCT，4.0％）。共有24项研究已注册方案（4.0％）。注册协议的最常见数据库是ClinicalTrials.gov（n = 17）。最常见的具有注册方案的研究设计是RCT（n = 24中的8，占RCT的33.3％）。三项研究在期刊上发表了实验方案（0.6％）。
结论：主要整形外科杂志中涉及人类参与者的最新研究的协议发表或注册很少。有很大的改进空间，并提供了指导。