后外侧入路经皮内窥镜下腰椎椎间融合术治疗腰椎滑脱症的临床疗效分析

目的 :分析后外侧入路经皮内窥镜下腰椎椎间融合术(posterolateral endoscopic lumbar interbody fusion,PELIF)治疗腰椎滑脱症的安全性和早期疗效。方法:回顾性分析2018年3月～2019年9月我科行PELIF治疗的22例轻度腰椎滑脱症患者。其中男性9例,女性13例;年龄为36～77岁,平均55.1±11.3岁。单节段滑脱21例,双节段滑脱1例。Ⅰ度滑脱19个节段,Ⅱ度滑脱4个节段。手术时间170.7±23.4min,术后随访12～29个月,平均20.3±3.0个月。手术前、术后2周、术后6个月和末次随访时采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评价临床疗效。术前、术后2周和末次随访时拍摄腰椎X线片并测量手术节段椎间隙高度、腰椎前凸角、手术节段前凸角、腰椎滑脱率,术后12个月通过CT评估融合率。同时记录随访期间手术并发症。结果:术前患者腰痛VAS为7.14±0.83分,术后2周为3.23±0.69分,术后6个月为2.91±0.53分,末次随访为2.32±0.57分;术前腿痛VAS为6.82±0.80分,术后2周为2.91±0.61分,术后6个月为2.60±0.50分,末次随访为2.28±0.63分;术前ODI为(65.60±10.28)%,术后2周为(19.59±6.54)%,术后6个月为(15.95±5.27)%,末次随访为(13.45±3.63)%;术后2周、6个月和末次随访时腰痛、腿痛VAS评分及ODI均较术前明显降低(P0.05)。术前手术节段椎间隙高度为9.23±2.11mm,术后2周为11.77±2.07mm,末次随访为11.04±1.67mm,差异有统计学意义(P0.05);腰椎前凸角术前、术后2周、末次随访差异无统计学意义(P0.05)。手术节段前凸角术前为12.39°±8.42°,术后2周为15.17°±8.90°,末次随访为15.09°±6.44°,差异有统计学意义(P0.05);腰椎滑脱率术前为(39.70±6.01)%,末次访为(14.50±2.88)%,差异有统计学意义(P0.05);本组病例滑脱复位率为59.9%。术后12个月时,所有病例均获得骨性融合。1例神经根袖损伤,另有一过性腰大肌无力1例,经保守治疗均获得痊愈;无感染、血肿、内固定失败等其他并发症。结论:PELIF治疗腰椎滑脱症安全可靠,短期临床疗效满意,但其远期疗效仍需进一步随访观察。     

椎间盘造影在决定腰椎融合节段中的作用

目的 评估椎间盘造影术在决定选择腰椎间融合节段中的应用价值.方法 对17例下腰痛(共56个椎间盘)进行椎间盘造影.根据临床症状、辅助检查、椎间盘造影结果制定手术计划,采用椎间盘切除,腰椎间融合术.术前、术后给予VAS、ODI评分以及影像学评估.结果 本组均成功进行了椎间盘造影.椎间盘造影阳性20个,其中MRI显示只有17个为异常椎间盘.在椎间盘造影阴性的36个椎间盘中,18个MRI显示正常.MRI检测症状椎间盘的假阴性率为15%,假阳性率为50%.17例均接受了腰椎间融合术.ODI评分,术前平均51%,术后1周,1、3、6、12个月结果平均为15%,融合率100%,无一例发生并发症.VAS术前平均7分(6～9分),术后平均2分(0～4分),临床效果良好.结论 椎间盘造影术可避免不必要的腰椎融合,临床症状、辅助检查结合椎间盘造影可以提供更多的信息以更准确地选择融合节段.     

后路融合治疗腰椎滑脱与不稳症的临床疗效分析

目的探讨后路融合术治疗腰椎滑脱与不稳症的疗效。方法2000年1月至2010年1月应用后路椎弓根钉系统融合治疗腰椎滑脱症与不稳症122例,为单节段融合术,其中腰椎滑脱症75例,腰椎退变性不稳症47例。术后应用X线评价植骨融合情况,视觉疼痛评分（visualanaloguescale,VAS）、侯树勋等疗效标准评价腰腿痛程度及社会、生活功能情况。结果本组122例随访22～64个月,平均（33．2±6．4）个月,122例中109例获骨性融合,骨融合率89．34％。下腰痛VAS术前为（6．85±1．35）分,术后为（3．15±1．02）分;腿痛VAS术前为（8．21±1．82）分,术后为（4．35±1．12）分。Oswestry功能障碍指数术前为（68．5±14．5）％,术后为（13．5±1．5）％。按侯树勋等的疗效评价标准评定,优50例,良53例,可14例,差5例,优良率84．43％。结论后路融合术治疗腰椎滑脱症和不稳症的疗效令人满意。     

急性创伤性腰椎滑脱症的临床特征及后路手术治疗

目的 :探讨急性创伤性腰椎滑脱症的临床特征及后路手术治疗的近期疗效。方法 :回顾分析2009年8月~2013年6月收治的9例急性创伤性腰椎滑脱症患者临床资料。男5例,女4例;年龄平均36.5±±16.3岁(21~60岁);致伤原因:重物砸伤3例,高处坠落伤4例,交通事故伤2例。术前神经功能Frankel分级为:E级1例,D级4例,C级3例,B级1例。X线片示L4滑脱3例,L5滑脱6例。滑脱程度根据Meyerding分级:Ⅰ度2例,Ⅱ度4例,Ⅲ度2例,Ⅳ度1例。9例患者均行后路椎弓根螺钉内固定和椎间植骨融合术,术后随访行腰椎正侧位X线片及CT三维重建评价滑脱复位及植骨融合情况;通过疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)进行疗效评价。结果:9例术后均获随访,随访时间平均35.0±11.6个月(12~58个月)。术后2周及末次随访时VAS(2.6±0.6、2.1±0.4)、ODI(16.2±2.5、15.3±2.1)评分均较术前(7.3±1.2和69.7±12.3)显著改善(P0.05),术后2周和末次随访间比较差异无统计学意义(P0.05);术后随访内固定位置良好,CT三维重建显示患者植骨均融合,融合时间平均9.6±?个月(6~12个月);末次随访时腰椎X线侧位片示滑脱Meyerding分级:0度6例,Ⅰ度2例,Ⅱ度1例;末次随访时神经功能Frankel分级:E级6例,D级2例,C级1例。结论:急性创伤性腰椎滑脱均为严重创伤所致,易发生在L5和L4,均伴韧带及关节囊损伤、关节突及附件或峡部骨折,经后路椎弓根内固定和椎间融合术可获得良好的影像学及临床疗效。     

经椎间孔入路椎间融合术治疗腰椎滑脱症疗效分析

目的对经椎间孔入路腰椎融合术治疗腰椎滑脱症的临床疗效进行评估。方法自2005年9月至2009年10月采用经椎间孔入路腰椎融合术治疗腰椎滑脱症29例（34节段）,获得538个月随访（平均21.27个月）,通过测量椎体滑移距离及日本矫形协会（Japan orthopaed ics assoc iation,JOA）评分来评估临床疗效。结果随访大于12个月的21个病例均见明确的椎间骨融合,术前椎体滑移距离3.613.3 mm,平均（5.7±3.9）mm,术后椎体滑移距离为05.3 mm,平均（2.9±0.8）mm,两者比较P〈0.01;术前JOA评分为（13.4±4.2）分,术后JOA评分为（23.7±3.7）分,两者比较P〈0.01。结论经椎间孔入路腰椎融合治疗腰椎滑脱症具有手术简单、创伤小及融合率高等优点,短期疗效满意。     

双侧小切口椎旁肌间隙入路在下腰椎融合术中应用

[目的]探讨双侧小切口椎旁肌间隙入路在下腰椎融合术中的应用价值。[方法]自2008年6月～2009年10月,选择性对32例单节段下腰椎疾患行椎弓根螺钉加椎间融合器内固定术,均采用双侧小切口椎旁肌间隙即Wilt-se多裂肌和最长肌肌间隙入路。其中男性14例,女性18例;年龄37～65岁,平均51.2岁;病变节段:L3、46例,L4、517例,L5S19例;病种类型:腰椎退行性不稳12例,极外型或椎间孔型椎间盘突出7例,腰椎滑脱5例,椎间盘原位复发5例,椎间盘源性疼痛3例,均表现为严重的下腰痛伴单侧肢体出现放射症状或无双下肢症状。根据Oswe-stry功能障碍指数(ODI)评分和伤口视觉模拟法(VAS)疼痛评分来评估疗效。[结果]手术平均时间106 min,术中平均出血量319 ml,术后平均引流量137 ml,住院平均天数13.5 d。术前ODI评分为(37.3±6.1)分,术后3个月时为(19.1±4.7)分,末次随访时为(11.8±3.7)分;术前VAS疼痛评分为(7.2±1.2)分,术后3个月时为(2.5±0.7)分,末次随访时为(2.1±0.9)分,统计分析显示术前和术后3个月或末次随访时的ODI、VAS评分差异均有统计学意义(P<0.05)。所有病例均获得24个月以上随访,影像学检查示良好的椎间骨性融合现象。[结论]双侧小切口椎旁肌间隙入路行下腰椎融合术能有效地保护椎旁肌,并达到减压、融合目的,是较实用并容易推广的腰椎后路"微创"手术方式。     

内镜下经椎间孔腰椎椎体间融合术治疗退变性腰椎滑脱症

[目的]探讨内镜下经椎间孔入路腰椎椎体间融合术治疗退变性腰椎滑脱症的疗效。[方法]2005年1月～2005年12月,在内镜辅助下经椎间孔入路行腰椎体间植骨融合、椎弓根钉复位内固定术治疗单节段退变性腰椎滑脱症患者17例。男10例,女7例;年龄35～68岁,平均47.6岁。L4椎体滑脱11例,L5椎体滑脱6例;根据Meyerding滑脱分类:Ⅰ度滑脱10例,Ⅱ度滑脱7例。伴有L4、5椎间盘突出7例、椎管狭窄5例,L5S1椎间盘突出4例。[结果]17例手术顺利,手术时间平均160min;术中失血量平均120ml;平均住院时间8d;无神经损伤,无中转开放手术。围手术期发生椎间隙感染1例。17例病人获得随访,时间12～24个月,平均16.2个月。融合率100%。ODI评分术前平均为48.3%,术后3个月平均为16.5%,术后6个月平均为14.0%,优良率97.5%。[结论]内镜下经椎间孔入路腰椎椎体间融合术治疗退变性腰椎滑脱症,手术切口短、创伤小、出血少,术后功能恢复快,临床效果满意。     

自锚式腰椎侧方融合器在斜外侧椎间融合术治疗腰椎融合术后邻近节段病中的应用

目的 :评价自锚式腰椎侧方融合器在斜外侧椎间融合(oblique lateral interbody fusion,OLIF)术治疗腰椎融合术后邻近节段病中的应用效果。方法:2014年3月～2020年3月在我院治疗的腰椎融合术后症状性邻近节段退变患者35例,其中采用自锚式腰椎侧方融合器行斜外侧椎间融合术13例(OLIF组),男7例,女6例;年龄48～75岁(56.2±15.4岁)。采用后方经椎间孔腰椎椎间融合(transforaminal lumbar interbody fusion,TLIF)术22例(TLIF组),男12例,女10例;年龄38～76岁(48.2±24.5岁)。比较两组患者的手术时间、术中出血量、术后引流量、住院时间和并发症发生率,在术前、术后3个月和末次随访时采用视觉模拟评分(visual analogue scale,VAS)评定腰痛和腿痛情况、Oswestry功能障碍指数(Oswestry disability index,ODI)评定临床疗效。结果:OLIF组的手术时间、术中出血量、术后引流量、住院时间均小于TLIF组,差异均有统计学意义(P0.05)。OLIF组术后出现并发症3例(23.1%),TLIF组术后出现并发症5例(22.7%),两组并发症发生率无统计学差异(P0.05)。术后随访12～72个月(35.4±21.9个月),OLIF组术前、术后3个月和末次随访时的腰痛、腿痛VAS评分和ODI分别为7.6±1.1分、7.8±1.1分、(58.9±10.8)%,1.7±0.3分、1.8±0.2分、(19.6±1.5)%和0.7±0.3分、0.7±0.3分、(18.3±0.7)%;TLIF组分别为8.0±1.0分、8.0±1.0分、(57.4±11.5)%,1.8±0.3分、1.9±0.3分、(20.9±1.2)%和0.5±0.1分、0.5±0.2分、(19.2±0.8)%;两组术后3个月及末次随访时的腰、腿痛VAS评分及ODI均较术前显著性改善(P0.05),两组同时间点比较差异均无统计学意义(P0.05)。结论:应用自锚式腰椎侧方融合器行OLIF治疗腰椎融合术后邻近节段病安全、有效,并能够缩短手术时间和住院时间,有利于早期康复。     

一期后路手术治疗腰椎布鲁杆菌性脊柱炎合并腰椎滑脱的疗效

目的探讨腰椎布鲁杆菌性脊柱炎合并腰椎滑脱外科治疗方法并评价其临床疗效。方法回顾性分析2015年7月至2019年3月首都医科大学附属北京地坛医院收治的16例腰椎布鲁杆菌性脊柱炎合并腰椎滑脱患者的临床资料,其中男性14例,女性2例,年龄46~68岁,平均(59.2±6.5)岁,均采用一期后路病灶清除、复位、减压、内固定、椎间植骨融合术。术后随访12~36个月,平均为(25.0±8.1)个月。记录手术后滑脱复位率、复位丢失率、植骨融合率及并发症发生率。同时,比较手术前后视觉疼痛评分(VAS)、日本骨科学会腰痛评分(JOA)、自主生活能力Oswestry功能障碍指数(ODI)及红细胞沉降率(ESR)、C-反应蛋白(CRP)、虎红平板凝集试验(RBP)以评估临床疗效。结果16例患者VAS评分由术前[8.0(8.0,8.8)]分降至术后2周[2.0(1.3,2.0)]分及术后1年[0.0(0.0,1.0)]分。JOA评分由术前平均(11.8±3.6)分升至术后2周平均(18.6±2.3)分及术后1年平均(23.6±2.7)分。ODI指数由术前平均(88.5±5.6)%降至术后2周平均(35.7±3.1)%及术后1年平均(9.3±5.7)%。ESR由术前[35.5(14.5,43.0)]mm/h降至术后2周平均(12.9±5.3)mm/h及术后1年平均(9.2±3.6)mm/h。CRP由术前平均(20.3±10.2)mg/L降至术后2周平均(7.6±3.1)mg/L及术后1年平均(3.5±1.7)mg/L。术后2周及术后1年,VAS、JOA、ODI、ESR、CRP与术前差异均有统计学差异(P均<0.001);术后1年,VAS、JOA、ODI、ESR、CRP与术后2周差异均有统计学意义(P均<0.001)。术后2周滑脱复位率平均为(91.2±6.7)%,术后1年复位丢失率为[8.0(5.0,9.8)]%。末次随访时,所有患者均获得骨性融合,无内固定松动、断裂等情况发生,且无复发。结论一期后路病灶清除、复位、减压、内固定、椎间植骨融合手术治疗腰椎布鲁杆菌性脊柱炎合并腰椎滑脱可行,通过重建脊柱稳定性来缓解患者疼痛、治愈病灶以及提高生活质量。     

微创通道下简化治疗伴邻近节段退变腰椎滑脱症的疗效分析

目的:探讨微创通道辅助下治疗伴邻近节段退变腰椎滑脱症的治疗方法及临床疗效。方法:2014年4月至2016年1月,36例单节段腰椎滑脱症伴邻近节段退变患者接受微创通道下简化手术治疗(目标神经靶点减压、邻近节段椎间或椎板间小关节融合、单边内固定),其中退变性腰椎滑脱23例,峡部裂性腰椎滑脱13例,MeyerdingⅠ度16例,Ⅱ度17例,Ⅲ度3例。采用腰痛视觉模拟(VAS)评分、功能障碍指数(ODI)、JOA评分评估临床效果。结果:36例患者术中出血230~480 ml,平均340 ml;术后出血15~80 ml,平均43 ml;手术时间176~240 min,平均193 min;术中X线暴露时间2~6 s,平均3.6 s。2例术中硬膜囊撕裂,没有出现神经损伤表现。30例获得随访,时间12~17个月,平均15.2个月。术前、术后5 d及术后3个月随访时腰背痛VAS评分分别是7.6±1.7、1.9±0.4、0.8±0.4,术后5 d、术后3个月与术前比较差异有统计学意义(P0.05)。术前及术后3个月ODI评分分别为35.9±1.2和3.7±0.7,差异有统计学意义(P0.05)。术前、术后5 d及术后1、3个月JOA评分分别为13.2±0.4、24.4±0.4、27.4±0.1、27.9±0.5,术前与术后5 d及术后1、3个月比较差异有统计学意义。结论:微创通道下治疗伴邻近退变的腰椎滑脱症是一种安全有效,创伤小,操作简化,康复快的微创治疗方法。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.     

Artificial organs 2010: a year in review

In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.     

Avaliação do clube de revista de anestesiologia por meio de mudanças semânticas

Background and objectives

The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically.

Methods

This study reports the performance of medical residents in anesthesiology from the Clinics Hospital – University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree–disagree–not sure–agree–totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis – difficulty index and discrimination power.

Results

Residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51), July 2012 (n = 66) and December 2012 (n = 56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating “totally agree” from “agree” increased the difficulty indices, but did not improve the discrimination power.

Conclusions

The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.