Alternative Techniques for Cannulation of Biliary Strictures Resistant to the 0.035" System Following Living Donor Liver Transplantation

Objective

To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique.

Subjects and Methods

Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches.

Results

Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision.

Conclusion

Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.     

第18届国际肝移植学会年会纪要

第18届国际肝移植学会（International Liver Transplantation Society,ILTS）年会于2012年5月16—19日在美国旧金山市举行,来自80多个国家逾1500位学者参与本次学术盛会。本次会议人选口头交流191篇,壁报交流502篇。大会由西班牙巴塞罗那医院Garcia-Valdecasas教授担任主席,美国达特茅斯医学院Freeman教授担任执行主席,美国加州大学旧金山分校Niemann、Ascher、Stock教授担任大会共同主席。来自五大洲肝移植学界的众多专家相聚旧金山,就肝癌肝移植、免疫抑制剂、活体肝移植技术、供肝来源拓展和分配等肝移植领域共同关心的话题在为期4d的会议中广泛交流学术成果与学术观点。本文介绍的研究进展主要来源于大会全体会议报告的内容。     

亲属活体肾移植的伦理学审查:单中心经验总结

目的总结单中心亲属活体肾移植的伦理学审查经验。方法成立北京大学第三医院人体器官移植临床应用与管理伦理委员会(伦理委员会),对130例次在该院拟行亲属活体肾移植的供、受者进行伦理学审查。以国务院《人体器官移植条例》为依据,先对供、受者进行科内初审,然后召开伦理委员会会议进行审查,内容包括移植供、者双方关系是否为亲属,双方术前检查结果是否符合移植要求,供者是否具有完全民事能力,双方是否了解手术风险,供者是否完全自愿捐献,其亲属是否同意,双方是否签署书面知情同意书等。根据审查结果确定能否进行手术。结果 120例次得到批准并顺利完成了肾移植手术,供受双方恢复满意,无发生纠纷。10例次被否决,其中不能确定亲属关系5例次,双方术前检查结果不符合移植要求2例次,供者无完全民事能力1例次,供者配偶不同意移植1例次,非本人真实意愿捐肾1例次。结论成立伦理委员会,严格按照《人体器官移植条例》的要求对拟行亲属活体肾移植的供、受者双方进行伦理学审查可保证器官移植的规范性和医疗安全性。     

超声评估活体肝移植供体肝静脉临床价值的研究

目的 探讨超声在活体肝移植供肝肝静脉评估中的临床价值.方法 回顾性分析17例活体肝移植供体,术前均行超声及CT检查,观测管径大于5mm中肝静脉(MHV)属支及右后下静脉(IRHV)情况.结果 超声发现管径大于5mm MHV属支及IRHV的数目分别为8(S4)、7(S5)、5(S8)、8(IRHV),CT为8(S4)、7(S5)、9(S8)、14 (IRHV),两者的一致率为73.7％ (28/38),将MHVS8属支和IRHV的超声管径标准缩小至4mm再次统计,数目为8(S8)、14 (IRHV),与CT的一致率为97.4％ (37/38).结论 超声可用于评价活体肝移植供肝肝静脉情况.     

高压氧治疗老年性骨质疏松症疼痛的疗效观察

目的：观察高压氧在治疗老年骨质疏松症疼痛及提高生存质量中的疗效.方法：45例老年性骨质疏松症患者,均有自发性疼痛,随机分两组,Ⅰ组为对照组用钙剂治疗,Ⅱ组为治疗组,用钙剂加高压氧治疗。两组在治疗前均测股骨颈及腰椎骨密度（BMD）无明显差异。结果：治疗组在用高压氧治疗2个疗程（20次）后疼痛明显减轻,生存质量明显提高,与对照组相比P〈0．05。结论：药物配合高压氧治疗在缓解骨质疏松症疼痛及提高生存质量方面比单纯药物治疗具有更好疗效。     

Transitions in living arrangements of Canadian seniors: Findings from the NPHS longitudinal data

This paper examines transitions in living arrangement decisions of the seniors using the first six cycles of the Canadian longitudinal National Population Health Survey microdata. Transitions from independent to intergenerational and institutional living arrangements are uniquely analyzed using a discrete-time hazard rate multinomial logit modelling framework and accounted for unobserved individual heterogeneity in the data. Our results show: a) provision of publicly-provided homecare reduces the likelihood of institutionalization, but it has no effect on intergenerational living arrangements; b) access to social support services reduces the probability of both institutional and intergenerational living arrangements; c) higher levels of functional health status, measured by Health Utility Index, reduce the probability of transitions from independent to intergenerational and institutional living arrangements; d) a decline in self-reported health status increases the probability of institutionalization, but its effect on intergenerational living arrangements is statistically insignificant; e) higher levels of household income tend to decrease the probability of institutionalization; and f) the likelihood of transitioning to both intergenerational and institutional living arrangements increases with the duration of survival. Our findings suggest that access to and availability of publicly-provided homecare, social support services and other programs designed to foster better functional health status would contribute positively towards independent or intergenerational living arrangements and reduce the probability of institutionalization.     

强化护理干预对 ICU 患者并发症及生存状态的影响

目的：探讨强化护理干预对ICU患者并发症及生存状态的影响。方法选取我院2013年3月至2014年3月ICU收治的477例患者为研究对象,采用随机数字表法分为对照组237例和观察组240例,对照组给予常规护理,观察组在对照组基础上施行强化护理干预对策,比较两组生活质量SF－36量表以及中心静脉导管相关血行感染（ CRBSI）、压疮形成、呼吸机相关肺炎（ VAP）、昏迷者误吸、肺不张、气压伤等并发症的发生情况。结果护理干预后,观察组患者SF－36各维度得分均显著优于对照组,差异有统计学意义（P＜0.05）;观察组治疗期间并发症的发生率显著少于对照组,差异有统计学意义（P＜0.05）。结论强化护理干预对策能显著改善ICU患者生存质量,降低ICU相关严重并发症的发生率。     

齐拉西酮对精神分裂症患者生活质量的影响

目的比较齐拉西酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法对门诊74例服用氟哌啶醇及72例服用齐拉西酮的精神分裂症患者用生活质量综合评定问卷(GQOLI),阳性症状及阴性症状量表(PANSS),副反应量表(TESS)进行调查、分析。结果齐拉西酮组患者的生活质量优于氟哌啶醇组。结论齐拉西酮治疗精神分裂症更有利于患者提高生活质量和适应社会。     

Disease patterns of outpatient visits by Japanese expatriate children in Thailand

Aim: To clarify the health-related conditions of Japanese expatriate children in Thailand.
Methods: Records of Japanese children who consulted outpatient clinics at Bangkok Hospital in 2005 and 2006 (n = 2141) were analysed, and then compared with data from the patient survey conducted by the Ministry of Health, Labour and Welfare of Japan in 2005 (n = 575 400).
Results: 'diseases of the respiratory system', categorized as chapter X under ICD-10 was the most frequent category in both Thailand and Japan. Although 'certain infectious and parasitic diseases' (chapter I) was the second most frequent category in Thailand, it was infrequent in Japan. In the subcategories of 'diseases of the respiratory system', 'acute upper respiratory infections' was frequent and asthma was infrequent in Thailand. Conversely, 'acute upper respiratory infections' showed a low percentage and asthma was the most frequently observed disease in Japan.
Conclusion: This study examined Japanese children having the same genetic background but divided into two groups according to different living environments. Results demonstrate that children living in Japan contract asthma more frequently than infectious diseases, whereas those living in Thailand show the opposite trend, which supports the hygiene hypothesis that infections may protect against the development of allergic diseases, such as asthma.     

Reduction of disability after stroke is a more informative predictor of long-time survival than initial disability status

Purpose. Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.

Method. BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.

Results. A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (±11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (±28.5) and mean BI effectiveness was 46.9 ± 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 – 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (≧70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 – 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).

Conclusions. BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.