2017年 · 第97卷第16期

In the course of more than 30 years of development, 3D printing technology has promoted the development of construction, machinery manufacturing and other fields with huge advantages. With the progress of materials science and medical imaging, 3D printing technology is gradually applied in the medical field, especially in orthopedics and maxillofacial surgery. In recent years, 3D printed heart models have played a unique role in the teaching, technical training, and treatment plan formulation of cardiovascular disciplines. This paper focuses on the application of 3D printing technology in the field of cardiovascular diseases and explores the potential value of this technology.

Since Professor Carl Langenbuch successfully performed the world's first open cholecystectomy in 1882, iatrogenic bile duct injury has followed. At present, the incidence of bile duct injury fluctuates around 0.1%^[1]。 With the successful first laparoscopic cholecystectomy performed by Professor Philippe Mouret in 1987, the laparoscopic era was opened. Laparoscopic cholecystectomy has been widely carried out and has become the "gold standard" of cholecystectomy today. At the initial stage of laparoscopy, domestic and foreign studies have shown that the incidence of bile duct injury is high, close to 0.5%^[2,3]However, with the gradual maturity of laparoscopic technique, the rate of bile duct injury caused by laparoscopic cholecystectomy decreased, but still maintained at about 0.2%^[4], higher than open cholecystectomy. Wong Chi Keung^[5]Academicians once said that iatrogenic bile duct injury is the pain of hepatobiliary surgery. Because benign bile duct stenosis caused by biliary tract injury can cause obstructive jaundice, recurrent cholangitis, secondary intrahepatic bile duct stones, biliary cirrhosis, portal hypertension, and even end-stage biliary tract disease, and lose the opportunity of surgery^[6]。 This is a problem that general surgeons and even specialists in hepatobiliary surgery cannot avoid. At present, surgical treatment is the main treatment for traumatic bile duct stenosis, but patients with bile duct injury often undergo one or even several operations, which makes the anatomy more complicated, the rate of surgical complications is high, and the prognosis of patients is seriously affected. Therefore, traumatic bile duct stricture is an eternal issue in hepatobiliary surgery^[7]。

On September 12, 2012, the Ministry of Health released the "Report on the Prevention and Treatment of Birth Defects in China (2012)" in Beijing, pointing out that the birth defect rate in China is about 5.6%^[1]。 With the full liberalization of the national two-child policy, the childbearing age of parents has also increased, and the further increase of birth defect rate is also expected. Therefore, strengthening the detection and prevention of birth defects has become the consensus of relevant government departments and practitioners. However, in the past year, various prenatal diagnoses, including non-invasive chromosomal aneuploidy abnormality detection, have been widely carried out in various medical and third-party testing institutions, so that 2016 is called the "first year of genetic testing" in China, which actually brings a series of problems that need the attention of management departments and industries.

Since the endocardial pacing electrode has been widely used, due to its obvious advantages over epicardial pacing electrode in electrode performance and inherent trauma to patients, epicardial pacing electrode has been in the substitute position, and it will only be attempted to be applied when the endocardial pacing electrode cannot be implanted. In recent years, the performance of epicardial pacing electrode has been improved obviously, and the development of modern surgical technology also provides a powerful technical guarantee for the application of epicardial pacing electrode. At present, the application of epicardial pacing electrode is increasing day by day, and in some cases it has become the first choice.

Cardiac troponin (cTn) is the most specific and sensitive marker detectable in blood during myocardial tissue injury^[1]Is the best marker for the diagnosis of acute myocardial infarction (AMI) and for risk stratification of heart disease^[1,2,3]。

Intraparenchymal breast lymph nodes are extremely rare structures that can occasionally be found in tissue specimens^[1]There are few domestic related literature reports. One case found in our hospital is reported as follows.

Multiple myeloma (MM) is the second largest tumor of the hematological system, accounting for about 10% to 15% of hematological tumors and 1% of all malignancies. MM is characterized by clonal proliferation of plasma cells and is capable of detecting excess immunoglobulins in blood and urine. The main clinical manifestations are "CRAB" symptoms (increased blood calcium, renal impairment, anemia, bone disease). The main treatments include chemotherapy, radiotherapy, stem cell transplantation, and new therapeutic drugs include protease inhibitors and immunomodulators. Bone pain, hypercalcemia, osteoporosis, osteolytic destruction and pathological fractures in patients with MM due to bone destruction are called myeloma bone disease^[1]。 In the Durie-Salmon staging system, bone lesions are directly related to disease staging and risk stratification^[2]。

Each part of the structure of sperm is closely related to its function. The head holds genetic material, while the tail is an important structure responsible for sperm activity. There are many severe asthenozoospermia that originate from ultrastructural abnormalities in the sperm tail. The tail of normal sperm, like the general flagella, has a "9+2" structure consisting of 9 pairs of peripheral double microtubules and 2 central microtubules; However, what is distinguished from other flagella is that the main sperm segment has outer dense fiber (ODF) and fibrous sheath outside the "9+2" structure, such asFigure 1。 During the clinical examination, we found that most of the sperm tails in some special cases were obviously short, curly or even missing. Usually, the sperm motility rate of these patients was extremely low or even close to 0. Ultrastructural observation of them showed that the tail structure such as fibrous sheath was abnormal. Nowadays, we have named this kind of severe sperm motility disorder caused by abnormal assembly of fibrous sheath and axial filament in sperm tail as fibrous sheath dysplasia (dysplasia of the fibrous sheath, DFS). Recent academic opinions suggest that this syndrome should be more accurately called multiple morphological abnormalities of the sperm flagella (MMAF)^[1], but it has not been recognized by domestic experts, and this article still calls it DFS. Ultrastructural caudal abnormalities associated with DFS are presented differently between cases and even in different spermatozoa of the same case, and data on fertilization, pregnancy and birth rates by assisted reproductive technology in DFS patients are also limited^[2]。 Understanding the different kinds of caudal ultrastructural malformations, genetic basis and existing reproductive outcome data in DFS can help to clarify the etiology, correct diagnosis and treatment.

Sarcoidosis is a non-caseous necrotizing granulomatous disease of unknown etiology that can simultaneously or successively invade multiple systems, involving more than 90% of the lungs and mediastinum^[1]。 Lung cancer is the leading cause of cancer death in developed countries, and the incidence is increasing worldwide. And both diseases sometimes occur in the same individual. Bonifazi et al.^[2]The meta-analysis summary included 27 268 patients with sarcoidosis and 153 patients with lung cancer in 8 cohort studies. It was found that the risk of lung cancer in patients with sarcoidosis varied, and the risk ratio of sarcoidosis combined with lung cancer decreased year by year with increasing follow-up years. However, there is a high degree of heterogeneity between these studies, so the situation of sarcoidosis combined with lung cancer is more complex. The author searched PubMed, CNKI and Wanfang databases, and found 5 case reports of 6 patients with sarcoidosis or sarcoidosis-like reaction combined with lung cancer in China^[3,4,5,6,7]。 The incidence rate of sarcoidosis or sarcoidosis-like reaction combined with lung cancer is not high, and the clinical understanding is insufficient at present, and the mechanism of its occurrence is unknown, so it is easy to miss or misdiagnose. The epidemiology, possible pathogenesis and pathological characteristics, diagnosis, treatment and prognosis of sarcoidosis complicated with lung cancer are summarized as follows.