机械灌注技术在器官移植中的应用

本文就机械灌注的发展以及在器官移植中的应用进展进行介绍,指出供器官短缺是目前移植领域面临的主要问题,但是机械灌注技术的出现为器官保存提供了新的视角,尤其在扩大标准供者、高风险供者及心脏死亡器官捐献供者的应用上发挥优势,提高了供器官质量,并在扩大供体池方面体现出巨大的潜能和前景。     

器官保存技术新进展

随着器官移植医学的飞速发展,对器官保存的要求也越来越高,特别是在目前供者短缺的情况下临床大量应用边缘供者和心死亡供者,这对传统的器官保存技术提出了新的要求。器官保存领域的最新进展主要体现在保存液的改进和保存技术的发展方面,开发高效、价廉且适合我国国情的多器官保存液将是近期我国器官移植界的主要任务之一。     

重视供肝机械灌注研究,推动肝移植高质量发展

随着器官捐献数量不断增加和扩大标准供者(ECD)供肝定义不断拓展,供肝质量必然成为影响肝移植高质量发展的突出问题,也是相关领域的研究重点.最大限度解决器官短缺和推动器官移植高质量发展是我国器官捐献与移植事业发展的方向.近年来,利用机械灌注(MP)对供肝进行灌注、保存、评估及修复,已成为当前国际上提高肝移植质量的研究热点...     

机械灌注在公民逝世后器官捐献供肾质量维护方面的应用研究进展

公民逝世后器官捐献目前已成为我国器官捐献的主要来源,但是由于供者质量的复杂性,扩大标准供者(ECD)供肾占比增加,从而对供肾的可利用性以及肾移植受者术后的长期预后造成很大的影响.加强供肾质量的维护与评估,对于改善供肾质量、增加供肾获取与利用、改善受者和移植肾长期存活具有重要意义.机械灌注保存作为器官保存的重要方式之一,...     

聚乙二醇在器官保存中的应用及作用机制

器官移植是根治终末期器官功能衰竭惟一有效的方法,自20世纪60年代在临床应用以来,移植医学已得到了突飞猛进的发展.然而近年来,器官来源短缺已成为阻碍全球器官移植发展的主要问题.为了扩大供者人群,近年来国内外对于边缘供者的利用明显增加,这对传统的器官保存提出了更高的要求.     

器官捐献协调员在公民逝世后器官捐献供者转运方面的作用

正器官移植已成为挽救器官功能衰竭患者最有效的治疗方法。尽管近年来我国器官移植事业已取得较大进展,但供器官数量与需要进行器官移植的患者人数之间仍存在着长期不平衡~([1])。自2015年1月1日起,我国全面停止使用司法途径器官,公民逝世后器官捐献成为我国移植供器官的主要来源。公民逝世后器官捐献供者从基层医院转运至同城移植医院的过程中,如何对供者进行高效维护和及时转运以保证供器官质量,成为提高供器官利用率和移植成功     

心脏死亡器官捐献供肾维护措施的研究进展

供体短缺问题是影响器官移植发展的主要瓶颈,亲属活体器官和尸体器官捐献是供体的主要来源,心脏死亡器官捐献(DCD)是重要的组成部分。DCD供体质量的改善是目前肾移植领域亟需解决的问题。本文就DCD供肾维护措施——供肾快速获取法、自动胸外按压法、原位灌注法、常温体外膜肺氧合法、低温机械灌注保存法、Lifeport器官灌注运输法进行综述。     

机械灌注在肾移植及器官医学研究领域的应用进展

本文结合最新文献, 对机械灌注在移植肾保存及器官医学领域的研究进展和前景进行综述。机械灌注除了在保存供肾及评估质量方面具有优势外, 还在修复边缘供肾、提高供肾质量、降低移植肾功能延迟(DGF)以及原发性移植物无功能(PNF)等方面具有潜在应用价值。此外, 机械灌注作为一个独特的器官研究平台, 在新兴器官医学研究领域具有广阔应用前景。     

中国移植器官保护专家共识（2022版）

器官移植是目前治疗终末期脏器功能衰竭最为有效的手段。器官短缺是制约器官移植工作开展的全球性问题 ［1］。供者器官获取、保存及移植后缺血再灌注损伤（ischemic reperfusion injury,IRI）是影响移植预后的重要因素。自20世纪器官移植技术开展以来,器官保护技术一直是该领域的研究热点。器官保...     

中国移植器官保护专家共识(2016版)

器官移植是治疗终末期脏器功能衰竭最有效的手段,公民逝世后器官捐献已成为我国移植供器官的主要来源。目前,器官保护技术在临床实践中应用广泛,对提升移植器官质量,改善移植预后发挥关键作用,但实践中相关技术选择及应用缺乏统一共识。因此亟待建立相关临床实践指南,促进我国器官移植工作更规范、有效、安全地开展。中国医师协会器官移植医师分会、中华医学会外科学分会器官移植学组及中国肝移植注册中心科学委员会组织专家,基于国内外移植器官保护的基础与临床实践,根据牛津循证医学证据分级和GRADE推荐意见系统,重点针对肝脏、肾脏、胰腺、小肠、心脏、肺脏,从器官获取、质量评估、保存液选择及器官保存修复、转运手段等方面,同时对新兴的机械灌注保存、修复技术进行讨论,制定《中国移植器官保护专家共识(2016版)》,为临床选择科学、规范的供器官保护策略提供方案。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。