Opened vs. laparoscopic radical nephrectomy in renal adenocarcinoma cost comparison

PurposeTo undertake a cost comparison (cost minimization) between transperitoneal laparoscopic and opened nephrectomy in renal adenocarcinoma treatment.MethodRetrospective study on the first 26 patients submitted to LN without intra or postoperative complications in the period 2002-2003, using as control 22 patients treated with ON with the same characteristics and in the same period. Demographic variables were evaluated (age, sex, tumor size, etc.), intraoperative (operative time and fungible material used) and postoperative (length of stay in Postanaesthesic Care Unit, Acute Pain Unit needs and hospital stay). Our Hospital costs plus those imputed during year 2003 to the Urology Service, as well as the cost of fungible material for the same year were applied, carrying out a comparison of costs between both groups.ResultsThere were no differences between the demographic variables between both groups except in the tumor, bigger size in the opened nephrectomy (p=0,001). Transperitoneal laparoscopic was 29,4 % globally more expensive than opened nephrectomy. The transperitoneal laparoscopic intraoperative cost (operating room, anesthesia and fungibles) the exceeded in 151,6 % to that of the opened nephrectomy, whereas in the opened nephrectomy the postoperative cost was a 63 % higher than in the transperitoneal laparoscopic cases.ConclusionsTransperitoneal laparoscopic in our Center is more expensive than opened nephrectomy due to a major occupation of operating room and that the specific fungible material used at the surgical act has a very high cost. It would be necessary to drastically reduce surgical time and decrease fungible material expenses, thus transperitoneal laparoscopic procedure could be competitive in our Hospital.     

The effects of maternal smoking on pregnancy outcome and placental histopathology lesions

ObjectiveTo study the effects of maternal smoking on pregnancy outcome and placental histopathology findings.Materials & methodsMaternal and labor characteristics and pathological reports were compared between term placentas of complicated and uncomplicated pregnancies of: heavy smokers (>10 cigarettes per day, H-smokers), moderate smokers (<10 cigarettes per day, M-smokers) and non-smokers (controls, N-smokers).ResultsBirth-weights were lower in the H-smokers and M-smokers as compared to the N-smokers (p < 0.001), with a higher rate of small for gestational age (SGA): 18.2%, 19.2% and 11.4%, respectively (p = 0.01). Deliveries among smokers were characterized by higher rates of abnormal fetal heart rate tracings during labor as compared to non-smokers (p = 0.01). Rates of placental maternal and fetal stromal-vascular supply lesions was similar between the groups.ConclusionsMaternal smoking is associated with higher rates of SGA. Tobacco’s potential influence is probably through the disruption of normal placental epigenetic patterns, not expressed in placental histopathology lesions.     

辅助性T细胞17及调节性T细胞比例失衡与子宫内膜异位症研究现状

子宫内膜异位症(EMs)是目前严重困扰育龄期女性的常见疾病，因其发病机制复杂，病因尚未阐明，以及其易种植、复发等类似肿瘤的特性，迄今尚无确切诊治手段。最新研究发现，EMs属于一种自身免疫性疾病，与T细胞免疫密切相关。CD4^＋T细胞的2个重要亚型，辅助性T细胞(Th)17与调节性T细胞(Treg)比例(Th17/Treg)失衡及其所致的腹腔内环境稳态失衡，均与EMs发生、病变程度及其导致不孕等临床特征有关。笔者拟就Th17/Treg与免疫内环境失衡在EMs中的最新研究现状进行阐述。     

Association of prenatal and early life exposure to tetrachloroethylene (PCE) with polycystic ovary syndrome and other reproductive disorders in the cape cod health study: A retrospective cohort study

BackgroundTetrachloroethylene (PCE) is an organic lipophilic solvent with possible neuroendocrine toxicity. The objective of this study was to determine the association of prenatal and early childhood exposure to PCE-contaminated drinking water and development of adult-onset Polycystic Ovary Syndrome (PCOS), endometriosis, difficulty conceiving and miscarriage.MethodsFive-hundred exposed and 331 unexposed female participants born between 1969 and 1983 completed questionnaires on demographic and lifestyle characteristics, and reproductive disorders. Residential locations from the prenatal period through five years of age were used to estimate early life PCE exposure with water modeling software.ResultsFor any early life exposure to PCE, the adjusted risk ratio for PCOS was 0.9 (95% CI: 0.5-1.6). No statistically significant associations were observed for increasing levels of exposure with PCOS or the other reproductive disorders.ConclusionNo meaningful associations were found among adult women with early life exposure to PCE-contaminated drinking water and adult-onset reproductive disorders.     

Cognitive functions in children exposed to antiepileptic drugs in utero - Study in Georgia

ObjectiveThe cognitive teratogenicity of antiepileptic drugs (AEDs) has gained increasing attention in the last decade. The objective of the current study was to assess the effects of AED fetal exposure on the cognitive development of children of mothers with epilepsy from Georgia in a controlled study taking into consideration major confounding factors.MethodsA prospective cohort group was formed from children and mothers registered in the Georgian National AED-Pregnancy Registry. The study group's age- and gender-matched control children without fetal AED exposure were selected retrospectively. The Intelligence Quotient (IQ) using the Wechsler Adult Intelligence Scale – revised (WAIS-R) was assessed in mothers. The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-4) were used to assess intellectual functioning for children of both study and control groups. Linear regression analysis was performed to detect association of AED exposure on the cognitive performance of children.ResultsIn total, 100 children aged 36 to 72 months were evaluated. The IQ of WWE was significantly lower compared to women without epilepsy in all modalities. Exposure to valproate (VPA) (n = 18) was associated with lowest cognitive performance regarding Full Scale IQ (FSIQ) (β, − 12.04; p = 0.006) and verbal comprehension (VCI) (β, − 8.89; p = 0.019). Maternal FSIQ, maternal performance IQ (PIQ), and child's age at first phrases were independent factors associated with the cognitive development of children.ConclusionsMultivariate analysis showed VPA to be an independent predictor for decreased cognitive performance. Maternal FSIQ, PIQ, and child developmental achievements were significant confounders for cognitive performance in children.     

Novel mutation in the ASXL3 gene in a Chinese boy with microcephaly and speech impairment: A case report

BACKGROUNDBainbridge-Ropers syndrome (BRPS) is a severe disorder characterized by failure to thrive, facial dysmorphism, and severe developmental delay. BRPS is caused by a heterozygous loss-of-function mutation in the ASXL3 gene. Due to limited knowledge of the disease and lack of specific features, clinical diagnosis of this syndrome is challenging. With the use of trio-based whole exome sequencing, we identified a novel ASXL3 mutation in a Chinese boy with BRPS and performed a literature review.CASE SUMMARYA 3-year-old Chinese boy was referred to our hospital due to progressive postnatal microcephaly and intellectual disability with severe speech impairment for 2 years. His other remarkable clinical features were shown as follows: Facial dysmorphism, feeding difficulties, poor growth, motor delay, and abnormal behavior. For the proband, regular laboratory tests, blood tandem mass spectrometry, urine gas chromatographic mass spectrometry, karyotype, hearing screening, and brain magnetic resonance imaging were performed, with negative results. Therefore, for the proband and his unaffected parents, trio-based whole exome sequencing and subsequent validation by Sanger sequencing were performed. A novel nonsense variant in exon 11 of the ASXL3 gene (c.1795G>T; p.E599*) was detected, present in the patient but absent from his parents. Taking into account the concordant phenotypic features of our patient with reported BRPS patients and the detected truncated variant located in the known mutational cluster region, we confirmed a diagnosis of BRPS for this proband. The rehabilitation treatment seemed to have a mild effect.CONCLUSIONIn this case, a novel nonsense mutation (c.1795G>T, p.E599*) in ASXL3 gene was identified in a Chinese boy with BRPS. This finding not only contributed to better genetic counseling and prenatal diagnosis for this family but also expanded the pathogenic mutation spectrum of ASXL3 gene and provided key information for clinical diagnosis of BRPS.     

表达性艺术治疗临床应用研究进展

介绍近年来国内外表达性艺术治疗在各临床领域的应用进展。指出表达性艺术治疗已在多个国家和地区不同的临床专业领域逐渐开展,研究方法上以病例研究居多,具体艺术形式和媒介、实施方法、评价指标等差异较大。