Suppression of the Vertical Vestibulo-ocular Reflex in Older Persons at Risk of Falling

A case-control design was used to assess eye-head-trunk coordination for community-dwelling elders performing a stand-walk task. Eighteen elders with a high risk of falling were matched to 18 subjects with low risk on the basis of age, living status (living alone or with someone) and category of residence (independent living or assisted living facility). Standard electro-oculography was used in conjunction with an electromagnetic tracking device to measure eye and head-trunk motion, respectively. For the low-risk group, the mean slope of gaze-head and gaze-trunk relationships was significantly greater than zero (0.91 and 0.64, respectively), whereas high-risk elders did not demonstrate slope magnitudes significantly different from zero (0.52 and 0.16, respectively) due to large inter-subject variations. While the majority of subjects showed some counter-rotation of the eyes with head pitch, a greater percentage of subjects in the high-risk group did not suppress this response and consequently gaze and gaze velocity overcompensated for head pitch. These findings suggest that the vertical vestibulo-ocular reflex is not adequately suppressed during the stand-walk task in elders who are at a high risk of falling. Possible mechanisms contributing to these findings are discussed.     

Ligation of huge spontaneous porto-systemic collaterals to avoid portal inflow steal in adult living donor liver transplantation: A case-report

IntroductionIn adult living donor liver transplantation (LDLT), maintenance of adequate portal inflow is essential for the graft regeneration. Portal inflow steal (PFS) may occur due to presence of huge spontaneous porto-systemic collaterals. A surgical procedure to increase the portal inflow is rarely necessary in adult LDLT.PresentationA 52 years male patient with end-stage liver disease due to chronic hepatitis C virus infection. Preoperative portography showed marked attenuated portal vein and its two main branches, patent tortuous splenic vein, multiple splenic hilar collaterals, and large lieno-renal collateral. He received a right hemi-liver graft from his nephew. Exploration revealed markedly cirrhotic liver, moderate splenomegaly with multiple collaterals and large lieno-renal collateral. Upon dissection of the hepato-duodenal ligament, a well-developed portal vein could be identified with a small mural thrombus.The recipient portal vein stump was anastomosed, in end to end fashion, to the graft portal vein. Doppler US showed reduced portal vein flow, so ligation of the huge lieno-renal collateral that allows steal of the portal inflow. After ligation of the lieno-renal collateral, improvement of the portal vein flow was observed in Doppler US.DiscussionThere is no accepted algorithm for managing spontaneous lieno-renal shunts before, during, or after liver transplantation, and evidence for efficacy of treatments remains limited. We report a case of surgical interruption of spontaneous huge porto-systemic collateral to prevent PFS during adult LDLT.ConclusionComplete interruption of large collateral vessels might be needed as a part of adult LDLT procedure to avoid devastating postoperative PFS.     

Laparoscopic Living Donor Nephrectomy: Low Surgical Risk for High-quality Grafts

Renal transplantation is most important for patients with end-stage renal disease to preserve their survival and quality of life. Living donation has decisive advantages over deceased donor kidney transplantation, and with the continuing organ shortage, it also can reduce the number of patients waiting for an organ. The major problem with living kidney donation is that a healthy person has to undergo a substantial surgical procedure to provide the organ for transplantation; therefore, a nephrectomy technique that is associated with the lowest surgical risk for the donor and the best organ quality for the recipient should be used. Since its introduction by Ratner and colleagues in 1995, laparoscopic donor nephrectomy has become the technique of choice at many major transplant centres. The aim is to achieve less postoperative pain, shorter hospitalisation time, more rapid return to normal activities, a more cosmetically acceptable incision, and, in particular, a greater patient acceptance. All techniques for living donor nephrectomy (open donor nephrectomy, “pure” laparoscopic donor nephrectomy, hand-assisted laparoscopic donor nephrectomy, robot-assisted laparoscopic donor nephrectomy, laparoscopic donor nephrectomy via natural orifice transluminal endoscopic surgery or laparoendoscopic single-site surgery, and retroperitoneoscopic donor nephrectomy) achieve good results, in so far as they are performed at specialised centres. Perioperative complications are rare, and the quality of the grafts is excellent. Renal graft function is specified at up to 96% at 1 yr and 85% at 5 yr after living donor kidney transplantation.Patient summaryLiving donation has decisive advantages over deceased donor kidney transplantation. When performed at specialised centres, living donor nephrectomy achieves good results, with few perioperative complications and excellent graft quality.     

Living donor liver transplantation in Brazil—current state

Currently in Brazil, living donor liver transplantation (LDLT) represents 8.5% of liver transplantation (LT), being the majority pediatric one. Up to now, according to Brazilian Organ Transplantation Association (ABTO) annual report, 2,086 procedures have been done nationwide, most of them in southeast and south regions. Based on national centers reports, biliary complication is the most common recipient postoperative complication (14.5–20.6%), followed by hepatic artery thrombosis (3.1–10.7%) and portal vein thrombosis (2.3–9.1%). Patient and graft overall 5-y survival correspond to 76% and 74%, respectively. Regarding the donor, morbidity rate ranges from 12.4% to 28.3%, with a national mortality rate of 0.14%. In conclusion, Brazilian LDLT programs enhance international experience that this is a feasible and safe procedure, as well as an excellent alternative strategy to overcome organs shortage.     

泛在学习环境下超声医学住培多元反馈教学模式的构建应用

摘要]:目的 对泛在学习环境下超声住院医师规范化培训（简称住培）构建多元反馈教学模式的效果进行评价。方法 选取2019年1月—2020年10月在内蒙古医科大学附属医院超声医学科规培轮转的70名住院医生作为研究对象，按随机数字表法分为对照组和实验组，每组35名，对照组根据专题训练法开展住培教学，期间结合信息化教学手段开展必要的在线教学；实验组带教者通过对大数据时代“互联网+”条件的深入分析与掌握，构造出基于泛在学习环境下的多元反馈教学模式。比较两组学员超声医学专科技术过程性考核成绩，使用教学评估问卷对两组学员进行“教学认可度调查”。结果 实验组学生超声医学专科技术过程性考核中的常见超声技术掌握程度、诊断报告书写、文献分析作业及阅片成绩等方面均明显高于对照组(均P<0.05)；在问卷调查中，实验组学员对泛在学习环境下的多元反馈教学模式普遍满意，各项指标满意度均在80%以上，多项教学指标的满意度优于对照组(P<0.05)。结论 泛在学习环境下的多元反馈教学模式适应“互联网+”大背景下的医学在线课程建设与发展，有利于提高超声住院医师规范化培训教学课