乌鲁木齐市无偿献血人群分布及献血动机调查分析

目的探讨乌鲁木齐市无偿献血者的人群分布及献血动机,为今后的无偿献血工作提供实践依据和宣传策略。方法采用问卷调查法,对乌鲁木齐市2 000名无偿献血者进行问卷调查,将调查结果进行统计学分析。结果学生、服务人员、私营业主、城镇户籍及常住本市的外来人口是乌鲁木齐市无偿献血的主力军;"奉献爱心"是公民献血的主要原因(87.2%),不同文化程度、不同职业的无偿献血人群献血动机有明显差异(χ2文化程度=59.780,P<0.05;χ2职业=102.339,P<0.05);"街头宣传"、"周围环境影响"、"大众媒体宣传"是献血人群了解献血知识的主要渠道。结论加强不同形式的宣传力度,挖掘不同人群的血源潜力,建立一支固定的无偿献血队伍。     

无偿献血群体顾客忠诚影响因素研究

目的:通过比较重复献血、既往献血、未献血三类人群的行为学特征和对献血服务质量的感知,为采供血部门修正长期发展规划和献血服务模式提供依据。方法:设计调查问卷针对三类人群进行献血动因、对宣传的印象和意愿、献血服务满意度等方面的调查;对献血服务机构管理层、服务人员理念和献血者认知、感知进行调查对比。结果:三人群在献血动因、健康认知、血站公益性认知、服务感知的方便性、礼貌性、安全性、胜任力、沟通性几方面差异均有统计学意义。固定献血者的认知与感知高于其它两人群。采供血部门管理者与服务提供者对献血服务影响质量的几个维度的认知有较大差异。结论:提高献血服务的满意度,采取社会接受度较高的长期发展的宣传策略,提高人员素质和服务质量,是无偿献血事业持续健康发展的重要条件。     

Postmortale Gewebespende in der Rechtsmedizin

After confirmation of death, tissues can be explanted from the deceased for transplantation purposes within a post-mortem period of 36 h (e.g. cardiovascular, musculoskeletal tissue and skin donations) or 72 h (cornea donation) in accordance with the donors’ wishes expressed while they were alive and depending on the medical and social history. In contrast, an organ donation can only be considered in cases of brain dead patients in whom the cardiovascular function is maintained. Multiple organ donors can also donate tissue although organ donation has priority. In contrast to organ transplantation, tissue transfer does not have to conform to any compatibility requirements, i.e. every donor can donate tissue for any recipient. While organ donation is organized centrally by the“Deutsche Stiftung Organtransplantation” (DSO, German Foundation for Organ Transplantation), tissue donation is not. The“Transplantationsgesetz” (TPG, German Transplantation Act) stipulates that the donor must be reported to the nearest tissue institution; however, this is often neglected due to ignorance of existing structures or not knowing the donor’s wishes. The following text describes the legal, medical and social prerequisites, the organization and process as well as transplantation indications for post-mortem tissue donation.     

Motives for physical activity among active and inactive persons in their mid‐30s

The purpose of this study was to examine the motives for leisure‐time physical activity among active and inactive men and women in their mid‐30s. We used both cross‐sectional and longitudinal designs. Altogether, 2308 participants (mean age 33.9 years, 53.4% women) were identified from the population‐based FinnTwin16 Cohort. Physically active and inactive individuals were identified on the basis of their leisure‐time MET h/day. We evaluated participants' physical activity motivation with a modified version of the Recreational Exercise Motivation Measure. Comparisons between active and inactive individuals were analysed using the Wald test for equality of means, and effect sizes were calculated as Cohen's d. Motives related to mastery, physical fitness, social aspect of physical activity, psychological state, enjoyment, willingness to be fitter/look better than others, and appearance were significantly more important for the active than inactive participants. Conforming to others' expectations was the only item on which the inactive persons scored higher than active persons. The longitudinal results for physical activity were parallel to the cross‐sectional results. This study supports the view that motivation factors differ between active and inactive persons, and that intrinsic motives are associated with consistent leisure‐time physical activity.     

A proposal for an anonymous living organ donation in Germany

In Germany, living organ donation of paired and usually not regenerating organs is restricted by law to related individuals, as well as persons who 'obviously entertain an especially intimate personal relationship'. When this law was adopted in 1997, the intention of the legislator was to guarantee the free will of the donor and to exclude any trade of organs. Since then the transplantation of cadaveric organs has not increased. Additional organs were donated from living donors. However, for a number of reasons only a limited array of transplantation centers use living organ donation as a supply facing a steadily increasing number of patients with chronic renal failure. Living organ donation raises a variety of medical, ethical and legal questions. Although transplantation is a generally accepted therapeutic approach for impaired organ function, doctors do not promote it actively. Prospective donor-recipient pairs use the information obtained via internet and other sources before they contact the clinician. Doctors are hesitant to operate a healthy individual for allowing her or him to profit from this organ loss only emotionally or in an altruistic sense. Often a complex relationship between donor and recipient, as well as tissue incompatibility (ABO, HLA) may be additional reasons to restrain from carrying out living organ transplantation. To improve the chances for good organ function and better life quality of the patients we here propose a model for anonymous living organ donation with special reference to kidney transplantation.     

CT灌注成像评估活体肝移植术后肝脏血液动力学变化

目的：探讨CT灌注成像技术在评估活体肝移植术后肝脏血液动力学变化中的临床应用价值。方法：35例右叶活体肝移植供体,30例右叶活体肝移植术后无SFSS受体及6例伴SFSS受体患者均行肝脏CT灌注成像,测量各组活体肝移植术前供体及术后14天和28天受体肝总血流量（TBF）、肝动脉灌注量（HAP）及门静脉灌注量（PVP）。分析和各组之间灌注参数的差异及相关性。结果：与正常供体捐赠前[（PVP0=（82．5±13．0）ml／（min·100g）]相比,无SFSS受体的患者在术后14天和28天时PVP明显增高[PVP14=（139．7±40）ml／（min·100g）,PVP28=（109．8±19）ml／（min·100g）],差异有极显著性意义（P〈0．001和P=0．008）,但术后28天PVP较术后14天明显降低（P=0．007）。SFSS组术后14天PVP较无SFSS组明显增高[PVP14=（186．0±22．0）ml／（min·100g）],差异有显著性意义（P=0．042）。结论：CT灌注成像能准确评价无SFSS供体血流动力学改变。     

Living related liver transplantation: preoperative magnetic resonance imaging for assessment of hepatic vasculature of donor candidates

Purpose: To evaluate the accuracy of magnetic resonance angiography (MRA) for preoperative assessment of hepatic vascular anatomy in liver donors before living related liver transplantation.

Material and Methods: A total of 55 consecutive living liver donors (mean age 42 years, range 18-68 years) underwent multiphase contrast-enhanced MRA of the hepatic vessels. Two readers categorized vessel visualization on a five-point scale and recorded vascular anatomy or variations thereof for the arterial, portal venous and venous systems. All 55 living liver donors subsequently underwent right hemihepatectomy for hemiliver donation, and preoperative MRA results were correlated with surgical findings.

Results: Overall vessel visualization assessment demonstrated good or very good ratings for the majority of patients. For hepatic arteries, the mean score was 4.4±0.8 (mean±standard deviation), and for the portal venous and venous systems it was 4.6±0.7 and 4.3±0.8, respectively. Among all 55 donors, 16 (29%) demonstrated accessory or replaced hepatic arteries, and seven (13%) and 20 (36%) donors had surgically relevant portal vein (trifurcation or early right posterolateral branching types) and hepatic vein variations, respectively. Correlation coefficients between MRA and surgery were 0.94, 1.00 and 0.91 for hepatic arteries, portal veins and hepatic veins, respectively.

Conclusion: In the preoperative evaluation before living related liver donation, contrast-enhanced MR angiography was a highly accurate, noninvasive tool for visualizing the hepatic vasculature and variations thereof in liver donor candidates.     

心脏死亡器官捐献者供肾移植的可行性

 目的 总结心脏死亡器官捐献(donation after cardiac death, DCD)肾移植的临床资料,并探讨其可行性。方法 回顾性分析2012-04至2013-12武警总医院28例DCD和52例DCD供肾移植的临床资料。结果 28例DCD属于国际标准Maastricht Ⅲ类,共获取肾脏52个并实施肾移植52例。热缺血时间为(11.2±9.1)min,冷缺血时间为(4.1±2.2)h。12例发生移植肾功能延迟恢复(delayed graft function, DGF),发生率23.08%,均于术后20~72 d肾功能恢复正常。急性排斥反应发生率3.85％(2／52),分别于术后1、2周因移植肾破裂切除肾脏。受者死亡3例(术后3个月因巨细胞病毒性肺炎死亡1例,术后移植肾原发无功能并肺部真菌性肺炎1例,肾破裂术后感染性休克1例)。移植肾存活的47例受者,随访13~23个月,移植肾功能正常。结论 DCD 供体可以扩大供体来源,缓解器官短缺困难,但应注意并发症发生,提高移植效果。     

Psychopathology in mountaineering--mental disturbances under high-altitude stress

In the years 1960-1985 psychiatric and psychological research was conducted among a group of 80 Polish alpinists. Experimental research was conducted during the expeditions to the Hindu Kush mountains and to the Andes (1971, 1973-74, 1979, 1985). The aim of the research was to describe the personality of the alpinists, their motivation, as well as mental disturbances caused by staying at high altitudes. On the basis of an interview and the Cattell personality questionnaire, two types of personality were distinguished: the schizoid-psychasthenic type (53 persons, i.e. 66%) and the asthenic-neurotic type (23 persons, i.e. 30%). As regards the motivation for mountain climbing, situational and personality factors were described, among them, the need to experience "powerful situations" and compensating for an inferiority complex. A so called integrational fear which mobilizes the psychophysical capabilities to overcome the hardships of the climb, was described as characteristic of the alpinists. Depending on the altitude and the duration of one's stay at it, the mental disturbances, in most cases took on the form of the neurasthenic syndrome (asthenic or sthenic) at low altitudes (3000-4000 m), the cyclothymic syndrome at medium altitudes (4000-5000 m), and the acute organic brain syndrome at high altitudes (above 7000 m). In 24 (35%) cases, there occurred psychotic disturbances with profound disturbances of consciousness and orientation. These states were accompanied by symptoms of high-altitude deterioration with a break-down in the physical condition, disturbances in the hydro-electrolyte equilibrium, and a considerable loss of bodily weight.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of renal angiography in living potential kidney donors

The angiograms of 258 potential kidney donors were retrospectively reviewed to assess the influence of angiography for deciding whether or not to accept the potential donor for nephrectomy and which kidney to use for transplantation. Twenty-five potential donors were rejected. In only 8 of these was angiography necessary to reveal the pathology. Angiography was found to be important in deciding which kidney to donate. In 81 donors the right kidney was used for donation and in 50 this decision was based on findings at angiography.     

Living donor liver transplantation: complications in donors and interventional management

PURPOSE: To evaluate the incidence of postoperative complications in liver donors and the efficacy of interventional management for treating these complications. MATERIALS AND METHODS: The study included 386 consecutive donors: 219 donors underwent right lobectomy or segmentectomy and 167 donors underwent left lobectomy or segmentectomy. Postoperative status, laboratory data, and radiologic images were reviewed for postoperative complications. Interventional management consisted of percutaneous drainage, ultrasonographic (US)-guided aspiration, percutaneous transhepatic biliary drainage (PTBD) and balloon dilation, transcatheter arterial embolization, or portal vein stent placement. Technical success, clinical improvement, and complications were documented following intervention. RESULTS: In 52 (13.5%) donors, 56 postoperative complications were encountered, including pleural effusion (n = 9), biliary leakage (n = 6), biliary obstruction (n = 5), intraperitoneal abscess (n = 5), active bleeding (n = 5), portal vein stenosis or kink (n = 3), biloma (n = 2), and other complications (n = 21). Complications occurred in 41 (18.9%) right lobe and 11 (7.0%) left lobe donors (P <.001). Twenty-seven (48%) complications were treated with interventional management (percutaneous drainage, n = 10; US-guided aspiration, n = 6; PTBD and balloon dilation, n = 4; transcatheter arterial embolization, n = 4; and stent placement, n = 3) and resolved completely. No procedure-related complications occurred. In one donor with venous oozing, arteriographic images did not show an active bleeding focus; thus, bleeding control with interventional management failed. The remaining 29 complications were treated using medical (n = 27) or surgical (n = 2) management. One donor with acute renal failure has thus far been treated with hemodialysis. CONCLUSION: Although complications from liver donation are not uncommon, most are minor and, with medical or interventional management, have no long-term sequelae. Interventional management seems useful in the treatment of postoperative complications of liver donation.     

Genetic architecture of motives for leisure‐time physical activity: a twin study

The aim of this study was to estimate the contribution of genetic and environmental influences on motives for engaging in leisure‐time physical activity. The participants were obtained from the FinnTwin16 study. A modified version of the Recreational Exercise Motivation Measure was used to assess the motives for leisure‐time physical activity in 2542 twin individuals (mean age of 34.1 years). Linear structural equation modeling was used to investigate the genetic and environmental influences on motive dimensions. The highest heritability estimates were found for the motive dimensions of “enjoyment” [men 33% (95% CI 23–43%), women 53% (95% CI 45–60%)] and “affiliation” [men 39% (95% CI 0.28–0.49%), women 35% (95% CI 0.25–0.43%)]. The lowest heritability estimates were found for others’ expectations [men 13% (95% CI 0.04–0.25%), women 15% (95% CI 0.07–0.24%)]. Unique environmental influences explained the remaining variances, which ranged from 47% to 87%. The heritability estimates for summary variables of intrinsic and extrinsic motives were 36% and 32% for men and 40% and 24% for women, respectively. In conclusion, genetic factors contribute to motives for leisure‐time physical activity. However, the genetic effects are, at most, moderate, implying the greater relative role of environmental factors.     

心脏死亡者供肝移植术后受体早期肝功能恢复不良的影响因素分析

目的 探讨"中国二类"(DCD)和"中国三类"(DBCD)心脏死亡器官捐献(统称为DCD)的供体和受体因素对肝移植术后早期肝功能恢复不良的影响.方法 回顾性分析2013-09至2017-01在解放军总医院第三医学中心实施的211例DCD肝移植的临床资料,主要包括供体和受体的性别、年龄、原发病、血型、体质量指数(BMI)...     

Motives for physical activity in older men and women: A twin study using accelerometer-measured physical activity

Motives for physical activity may vary considerably by age, sex, and the level of physical activity. We aimed to examine motives for physical activity in older men and women with different physical activity levels as well as whether genetic and/or environmental factors explain those motives. Finnish twins (mean age 72.9 years, 262 full twin pairs) self-reported their motives for physical activity. Time spent on moderate-to-vigorous physical activity was monitored using a hip-worn accelerometer. Comparisons between the different physical activity groups of older twins (n = 764-791/motive dimension) were analyzed using the Wald test, and effect sizes were calculated as Cohen's d. Quantitative genetic modeling was used to estimate genetic and environmental contributions. For both sexes, the most frequently reported motives for physical activity were physical fitness, health maintenance, and psychological well-being. Conforming to others’ expectations was more important for men than for women (P < .001, Cohen's d = 0.38), while appearance (P = .001 Cohen's d = −0.24) and psychological well-being (P = .02, Cohen's d = −0.17) were highlighted by women. Most of the motive dimensions differed significantly between the physically active and inactive individuals. It was estimated that 5%-42% of the variation in motives was contributed by genetic factors and 58%-95% by environmental factors. The result that environmental factors contribute in a great deal to motives indicates that interventions to motivate physically inactive older individuals to be physically active can be successful. However, personalized interventions are needed because sex and the level of physical activity were found to be associated with older individuals’ motives for physical activity.     

献血自评量表初步编制及在无偿献血中的应用

目的设计编制一套全面及适合国情的无偿献血行为自评量表,为献血研究提供工具。方法根据无偿献血中取得的经验及相关数据,参照文献,筛选出20个题目(含献血认知、献血前情绪、献血感知3个因子)。调查参加无偿献血的部队官兵及高校学生117例,取得各条目及因子评分等相关数据,并对首次及2次以上献血进行比较。结果发放量表120份,回收率100%,有效率97.5%。两次以上献血27例(A组),首次献血90例(B组)。两组总粗分、总均分、标准分、标准均分及Ⅱ,Ⅲ因子总粗分、总均分均有非常显著差异(P<0.01)。结论自评量表的编制可对献血者心理状况进行评估分析,并为无偿献血筛选血源及心理咨询等提供参考。     

The value of magnetic resonance cholangiography in the preoperative assessment of living liver donors

ObjectiveThe purpose of this study was to investigate the ability of magnetic resonance cholangiography (MRC) in the depiction of biliary anatomy of living liver donors by using intraoperative cholangiography (IOC) as a gold standard.Materials and MethodsBetween 2004 and 2006, 86 potential adult-to-adult living donor liver transplantation donors had preoperative MRC at our institution. Of these, 24 potential donors were excluded due to various clinical factors. A total of 62 of these individuals were selected for liver donation and included in the study. MRC was performed on a 1.5-T scanner with breath-hold, rapid acquisition with relaxation enhancement (RARE) sequence with half-Fourier acquisition (HASTE; Siemens) and free-breathing, three-dimensional turbo spin-echo sequence with respiratory triggering. Thin- and thick-slab imaging techniques were employed with half-Fourier RARE MRC. IOC was performed in all 63 cases. The images of IOC and MRC were classified according to a modified Huang classification, independently. The results of the MRC were then compared with the IOC results.ResultsIOC was used as the reference standard; a total of 43 (69.3%) liver donors were considered to have normal biliary anatomy, whereas 19 (30.7%) were considered to have variants of biliary anatomy. Compared with IOC, MRC correctly revealed biliary anatomy in 59 of 62 (95.1%) donors. The sensitivity, specificity, positive predictive value and negative predictive value of MRC in distinguishing normal and any type of variant biliary anatomy were 84.2%, 100%, 100%, and 93.4%, respectively.ConclusionMRC is an effective imaging technique for the preoperative evaluation of the biliary anatomy in living liver donors. However, MRC and IOC should be considered complementary to one another in order to avoid complications.     

Detection of homologous blood transfusion

The aim of the present study was to improve and validate a flow cytometric method for the detection of homologous blood transfusion in doping control analysis. A panel of eight different primary antibodies and two different phycoerythrin-conjugated secondary antibodies was used for the detection of different blood populations. The flow cytometer used in this study was the BD FACSArray instrument. Mixed red blood cell populations were prepared from phenotype known donors. Linearity, specificity, recovery, precision, robustness and interday-precision were tested for every primary antibody used in the presented assay. The technique of signal amplification was utilized for an improved separation of antigens with weak or heterozygous expression to improve the interpretation of histograms. The resulting method allowed to clearly identify mixed red blood cell populations in homologous blood transfusion samples containing 0.3 - 2.0 % of donor blood.     

Hepatic macrosteatosis: predicting appropriateness of liver donation by using MR imaging--correlation with histopathologic findings

PURPOSE: To retrospectively evaluate the diagnostic performance of magnetic resonance (MR) imaging in predicting the appropriateness of liver donation in potential living liver donors by using histopathologic results as the reference standard. MATERIALS AND METHODS: This study was approved by institutional review board; all patients gave informed consent for the use of MR data for future research. Fifty-seven potential liver donors (40 male, 17 female; age range, 17-57 years; mean age, 32 years) underwent dual-echo 1.5-T MR imaging. Two radiologists qualitatively graded each MR image, with consensus for disagreements. Livers were assigned one of three degrees of hepatic steatosis on the basis of changes in hepatic signal intensity (SI) between in-phase and opposed-phase images. For quantitative analysis, a third radiologist calculated mean hepatic and mean splenic SI by averaging 25 hepatic regions of interest and three splenic regions of interest. Relative SI decrease (RSID) in the liver on opposed-phase images compared with in-phase images was calculated. Linear regression analysis was used to correlate RSID with the degree of total steatosis, macrosteatosis, and microsteatosis. Diagnostic performance for predicting the appropriateness of liver donation was analyzed. RESULTS: Histologic findings of macrosteatosis resulted in 52 patients being categorized as appropriate donors, with the remaining five being categorized as inappropriate donors. RSID was correlated with total steatosis (r = 0.850). When the RSID criterion for inappropriateness of liver donation was set at 20%, the sensitivity, specificity, and accuracy were 100%, 92.3%, and 93%, respectively. When RSID was used, four livers that had been misclassified as inappropriate for transplantation were found to have microsteatosis of various degrees and a less than moderate degree of macrosteatosis at histologic analysis. Qualitative and quantitative analyses were comparably accurate. CONCLUSION: When an RSID criterion of less than 20% was used, dual-echo MR imaging facilitated the correct prediction of appropriateness of liver donation in 53 of 57 patients.     

影像学对活体肝移植供肝的评估

活体肝移植,作为肝移植的一项新技术,提供了等待移植的肝病患者更广阔的供体来源并有效缓解了肝移植的供需失调。影像学在活体肝移植中发挥了重要的作用,它能够有效评估出合适的供体并使外科医生能够更好得制定手术方案。在此我们就计算机断层扫描以及磁共振成像技术在活体肝移植中的应用作一综述。     

Ethical and legal issues in organ transplantation: Indian scenario

In 1994, the Government of India enacted the Transplantation of Human Organs Act (THOA) to prevent commercial dealings in human organs. However, a greater number of scandals involving medical practitioners and others in the kidney trade has surfaced periodically in every state in India. The present regulatory system has failed mainly due to the misuse of Section 9(3) of the THOA, which approves the consent given by a live unrelated donor for the removal of organs for the reason of affection or attachment towards the recipient or for any other special reason. Currently in India, approximately 3500-4000 kidney transplants and 150-200 liver transplants are performed annually. However, the availability of organs from brain-dead persons is very low. As a result, live related or unrelated donors form the main source of organ transplantation. Therefore, physicians and policy-makers should re-examine the value of introducing regulated incentive-based organ donation to increase the supply of organs for transplantation and to end unlawful financial transaction.