A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma

Background

Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet.

Methods

Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Outcomes between those who received surgery with the novel method and conventional surgery were compared.

Results

Fifty patients underwent the novel method and sixty received conventional surgery. The operative field around the left RLN was easier to explore with the novel method. The estimated blood loss was less (23.7±8.2 vs. 34.2±10.3 g, P=0.001), and the number of harvested LNs along the left RLN was greater (6.4±3.2 vs. 4.1±2.8 min, P=0.028) in the novel method group, while the duration of lymphadenectomy along left RLN was longer in the novel method group (28.2±3.9 vs. 20.3±2.8 min, P=0.005). The rate of hoarseness in the novel and conventional groups was 10% and 16.7%, respectively. No significant difference in postoperative morbidity related to the left RLN was noted between the groups.

Conclusions

The novel method during semi-prone esophagectomy for esophageal carcinoma is associated with better surgeon ergonomics and operative exposure.     

Hemoglobin A1c,frequency of glucose testing and social disadvantage: Metrics of racial health disparity in youth with type 1 diabetes

Introduction

Black youth with type 1 diabetes (T1D) have higher HbA1c than whites. To understand HbA1c differences, we examined the relationship of psycho-social factors and glucose testing with HbA1c.

现行结核菌检测技术应用于泌尿系统结核诊断的研究进展

泌尿系统结核居于肺外结核第三位,其中最主要的是肾结核。肾结核是由结核分枝杆菌引起的慢性、进行性、破坏性病变,常因其结核症状不典型致使临床诊疗上易漏诊误诊,从而延误治疗时机,给患者泌尿系统带来很大损伤。目前泌尿系统结核的确诊主要依赖于临床表现结合实验室检查、影像学检查等。但是横跨在现有技术与泌尿系统结核临床诊断需要之间的鸿沟依旧为其早期诊断、病情评估和预后监测带来了不可避免的影响,这也阻碍了泌尿系统结核诊断方式更新的探索与发展。伴随着纳米技术和微流体技术的飞速发展,很多检测结核分枝杆菌的生物传感器应运而生。近年来纳米/微流体技术已经被广泛应用于发展现场检测多种疾病的诊断和监测技术方面,这预示着在结核病诊断方面应用纳米/微流体技术也是不可避免的趋势,更为诊断泌尿系统结核寻找更为可靠准确的依据和方法提供了新的契机。以下对泌尿系统结核的临床表现、诊断方法、横跨在现有技术与泌尿系统结核临床诊断之间的鸿沟、结核病诊断的纳米/微流体技术以及纳米/微流体技术能否为泌尿系统结核诊断与监测提供未来前景等方面进行综述。     

IFCC参考方法对两种常规检测系统ALP结果正确度的验证

目的评价常规检测系统测定血清碱性磷酸酶(ALP)的正确度。方法以国际临床化学联合会(IFCC)参考方法和两种常规检测系统(简称A法、B法)同时测定20份新鲜单人份血清样品。按美国临床实验室标准化协会(CLSI)EP9-A2文件评价两种常规检测系统测定结果的正确度,并用改良Bland-Altman图形分析法进行验证,评价常规检测系统与参考方法测定结果的一致性,综合判断常规检测系统的测定结果。按CLSI EP14-A2文件评价A、B两种方法校准品的基质效应。结果 A法、B法与IFCC参考方法测定结果的直线回归方程分别为YA=0.982 9XIFCC+0.010 8,YB=0.938 3XIFCC+0.012 9,平均偏倚分别为-1.1%、-5.5%。A法和B法检测结果的相关方程为YB=0.955 2XA+0.001 36,R2=0.997 6。A法和B法的校准品均存在基质效应,其中A法校准品的基质效应更明显。结论 A法与IFCC参考方法正确度性能一致,B法与IFCC参考方法正确度性能不一致。     

乳胶增强免疫散射比浊法检测血清淀粉样蛋白A的应用评价

目的建立乳胶增强散射免疫比浊法检测血清淀粉样蛋白A(SAA)的即时检验(POCT)方法,并对该法的精密度、线性、准确度等进行评价。方法建立乳胶增强免疫比浊法测定SAA的POCT方法,并根据美国临床实验室标准化协会(CLSI)相关文件对建立的POCT方法进行方法学评价。结果本法的分析灵敏度为3.52 mg/L;批内变异系数(CV)8%、日间CV10%;抗干扰性较强,血红蛋白≤4.0 g/L、胆红素≤400μmol/L、类风湿因子≤1 621 U/L、甘油三酯≤10 mmol/L对测定无影响;与进口N Latex SAA试剂相关性良好(Y=1.052 1X+0.001 5,r=0.998 3);线性范围为5~200 mg/L。结论本法具有简单、快速(3 min内完成检测)的特点,各项分析指标均符合要求,可用于临床患者血清标本的检测。     

改进腹腔引流管管口渗液处理方法的效果

目的：探讨整合医学模式下腹腔引流管管口渗液处理方法改进的效果。方法选取2013年3月—2014年3月行开腹手术后腹腔引流管发生管口渗液的患者218例,将2013年3—9月置管的110例患者分为对照组,将2013年10月—2014年3月置管的108例患者分为观察组,对照组采用传统引流管渗液处理方法,观察组构建并实施整合医学模式,多学科合作,合理选择敷料,改进渗液处理技术,对患者提供个体化的心理咨询。比较两组患者渗液处理时间、换药费用、患者满意度、投诉率和切口感染率。结果观察组患者置管时大量渗液换药时间为（12．56±5．31） min／d,换药费用为（40．45±5.67）元／d;拔管后换药时间为（10．62±2．79）min／d,换药费用为（15．56±5．62）元／d,均低于对照组,差异有统计学意义（t值分别为11．277,9．019,11．715,－19．100;P＜0．05）。观察组患者满意度为100％,对照组为90％;观察组无一例投诉,对照组投诉率为3．6％;观察组引流管处切口感染率为7．4％,对照组为26．4％;两组比较差异均有统计学意义（χ2值分别为11．374,5．546,13．896;P＜0．05）。结论整合医学模式下的引流管管口渗液处理方法简单经济有效,医护患均获益,值得临床推广应用。     

肺炎支原体感染实验室诊断方法研究进展

肺炎支原体是一种介于细菌和病毒之间的微生物.近年来,肺炎支原体感染发病率呈显著上升趋势,严重威胁了小儿的身体健康.因肺炎支原体感染早期不易诊断,故寻求早期敏感性强、特异性高的实验室指标非常重要.本文就有关肺炎支原体感染检测诊断方法的研究情况作一综述.     

Does clinical experience affect the reproducibility of cervical vertebrae maturation method?

Objective:To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE).Materials and Methods:Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T₁ and T₂) at 3 weeks apart. Kendall''s W and weighted Cohen''s kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P < .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated.Results:Kendall''s W at T₁ was SP  =  0.61, PG  =  0.70, and JU  =  0.87; at T₂ it was SP  =  0.78, PG  =  0.85, and JU  =  0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T₁ and 46.3% at T₂. The JU group had the highest Cohen''s κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%.Conclusions:The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.     

An overview of the endodontic curriculum in Fiji from 2009 to 2013

This paper seeks to provide the reader with an overview of the endodontic curriculum in Fiji from 2009 to 2013. It also intends to inform readers of the changes in endodontic teaching, the learning methods utilised, curriculum development, the transition from block teaching to partial block teaching combined with longitudinal teaching, and the future plans for the endodontic module.     

3种固定腹腔引流管方法在肝胆外科护理应用中的效果研究

目的探讨不同的腹腔引流管固定方法在肝胆外科患者护理中的应用效果。方法对250例留置腹腔引流管患者,分别采取3 M医用透气胶布蝶形交叉固定法(A组)、导管固定装置固定法(B组)、3 M弹力胶布高举平台固定法(C组)固定腹腔引流管,分别比较3种固定方法的脱管率、更换间隔时间、费用、皮肤过敏度。结果 A组与B组腹腔引流管脱管率明显多于C组,3组患者脱管率比较差异有显著性(P0.05);A组、B组皮肤过敏率多于C组,3组患者过敏度比较差异有显著性(P0.05);3组平均更换间隔时间中C组更换间隔时间要长于A组和B组(P0.05);3组患者满意度调查,C组的满意度明显高于另2组(P0.05)。结论采用3 M弹力胶布高举平台固定法优于3 M医用透气胶布蝶形交叉固定法及导管固定装置固定,值得临床上推广。