A national study of burnout among American transplant surgeons

This study examines burnout in a national sample of transplant surgeons. Data analyses were conducted on a sample of 209 actively practicing transplant surgeons. Measures included the Maslach Burnout Inventory, a demographic survey, and the Surgeon Coping Inventory. Burnout was reflected in 38% of surgeons scoring high on the Emotional Exhaustion dimension, whereas 27% showed high levels of Depersonalization, and 16% had low levels of Personal Accomplishment. Several significant predictors of emotional exhaustion were identified and included questioning one's career choice, giving up activities, and perceiving oneself as having limited control over the delivery of medical services (R2= 0.43). Those who perceived themselves as having a higher ability to control delivery of medical services and who felt more appreciated by patients had lower levels of depersonalization and were less likely to question their career choice (R2= 0.16). Surgeons with high personal accomplishment experienced greater professional growth opportunities, perceived their institution as supportive, felt more appreciated by patients, and were less likely to question their career (R2= 0.24). The prioritization of goals to reflect both professional and personal values accounted for a significant amount of the variance in predicting both emotional exhaustion and personal accomplishment in separate regression equations. Recommendations to decrease burnout would include greater institutional support, increased opportunities for professional growth, and greater surgeon control over important services to facilitate efficient work. Coping strategies to moderate stress and burnout are also beneficial and should include prioritizing goals to reflect both professional and personal values.     

Impact of aberrant arterial anatomy and location of anastomosis on technical outcomes after liver transplantation

Variations in donor and recipient arterial anatomy frequently present challenges for surgeons when attempting to establishproper arterialinfiowduring liver transplantation. Wereviewed our dataon233 adult primary liver transplants, conducted from January 1996 through December 2001, to determine the impact of these variations on the outcomes after liver transplantation. Twenty-four (10.3%) arterial complications were encountered at a mean of 2.27 months after transplant. Carrel patches for the anastomoses were not used in 33 patients (14%), which had no relation to arterial complications (P = 0.7). Sixty-one donors (26.2%) had at least one aberrant artery, which had no relation to arterial complications. However, use of donor celiac artery for anastomosis was significantly associated with higher arterial complications (16% versus other choices, P = 0.03). Furthermore, use of common hepatic recipient artery was associated with higher arterial complications (16%, P = 0.03).There were 58 total biliary complications (24.8%). Biliary complications were associated with the presence of arterial complications (P = 0.01). In conclusion, aberrant donor arterial anatomy was not associated with an increased rate of arterial complications; however, choice of location of arterial anastomosis may be a significant factor. Biliary complications were associated with arterial complications. Presented in part at the Fourth Annual Meeting of the American Hepato-Pancreato-Biliary Association, Miami, Florida, February 27–March 2, 2003.     

Hepatocellular carcinoma arising in a pigmented telangiectatic adenoma with nuclear β-catenin and glutamine synthetase positivity: case report and review of the literature

Telangiectatic hepatocellular adenoma is a rare, recently recognized subtype of hepatocellular adenoma that is often underrecognized by pathologists. We report a case of hepatocellular carcinoma arising within a pigmented telangiectatic hepatocellular adenoma in a noncirrhotic man with diffuse glutamine synthetase and nuclear β-catenin positivity. This case highlights malignant transformation of telangiectatic adenomas, and describes a previously unreported association between pigment deposition and telangiectatic adenoma. Radiology, gross pathology, and histopathology are shown. Review of the literature with attention to β-catenin and glutamine synthetase staining, malignant transformation, patient characteristics, the presence of Dubin-Johnson-like pigment, and genetic characteristics of telangiectatic adenomas are discussed.     

The sesame lignan sesamin attenuates vascular dysfunction in streptozotocin diabetic rats: Involvement of nitric oxide and oxidative stress

The effect of chronic administration of sesamin was studied on aortic reactivity of streptozotocin diabetic rats. Male diabetic rats received sesamin for 7 weeks after diabetes induction. Contractile responses to KCl and phenylephrine and relaxation response to acetylcholine were obtained from aortic rings. Maximum contractile response of endothelium-intact rings to phenylephrine was significantly lower in sesamin-treated diabetic rats relative to untreated diabetics and endothelium removal abolished this difference. Meanwhile, endothelium-dependent relaxation to acetylcholine was significantly higher in sesamin-treated diabetic rats as compared to diabetic ones and pretreatment of rings with nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester significantly attenuated the observed response. Two-month diabetes also resulted in an elevation of malondialdehyde and decreased superoxide dismutase activity and sesamin treatment significantly improved these changes. Therefore, chronic treatment of diabetic rats with sesamin could prevent some abnormal changes in vascular reactivity in diabetic rats through nitric oxide and via attenuation of oxidative stress and tissue integrity of endothelium is necessary for its beneficial effect.     

补骨脂总香豆素的平喘作用

目的：研究补骨脂总香豆素的止喘作用。方法：豚鼠ip12．5mg/kg的补骨脂总香豆素,同时设立氨茶碱和生理盐水作对照,观察其豚鼠过敏性哮喘和组胺性哮喘潜伏期及死亡率的影响。结果：补骨脂总香豆素对过敏性哮喘和组胺性哮喘的潜伏期均有显著的延长作用（P＜0．01和P＜0．05）;显著降低动物死亡率（P＜0．05）。结论：补骨脂总香豆素对哮喘有明显的拮抗作用。     

ADAMTS13-binding IgG are present in patients with thrombotic thrombocytopenic purpura

Functional assays are commonly used to measure the antibodies of ADAMTS13 found in patients of thrombotic thrombocytopenic purpura (TTP). In this study we used an enzyme-linked immunoassay to analyze the ADAMTS13-binding IgG levels in six groups of individuals: normal, random hospitalized patients, acute TTP, TTP after receiving plasma therapy, TTP in remission, and other types of thrombotic microangiopathy (TMA). The results showed that ADAMTS13-binding IgG levels were elevated in 100% of the acute TTP group, 75% of the TTP group after receiving plasma therapy, and 40% of the remission group. Overall, the ADAMTS13-binding IgG levels correlated with the inhibitory activity levels againstADAMTS13 (r = -0.69, P < 0.0001). The assay also detected elevated IgG binding levels in 5% - 15% of the normal, random, and other TMA control groups. Addition of purified ADAMTS13 protein to the plasma samples suppressed the IgG binding in each of the acute TTP patients, but in none of the non-TTP groups. Serial measurement in a patient that had two exacerbations of TTP within the first three weeks revealed that the ADAMTS13 activity levels remained <0.1 U/ml during this period, and the ADAMTS13-binding IgG remained elevated, suggesting that ADAMTS13 analysis may provide valuable insight to the disease status during the course of therapy. Analysis of ADAMTS13-binding IgG is helpful for the diagnosis and management of TTP.     

白细胞介素6对人冠状动脉平滑肌细胞基质金属蛋白酶系统分泌平衡的影响

目的:研究表明,白细胞介素6等多种炎症因子与急性冠状动脉综合征斑块的稳定性下降有着密切联系;金属蛋白酶组织抑制因子的分泌失衡,也可能是斑块稳定性的原因之一。实验拟证明白细胞介素6对人冠状动脉平滑肌细胞的基质金属蛋白酶3及金属蛋白酶组织抑制因子1分泌平衡的影响。方法:实验于2006-12/2007-04在解放军第三○五医院老年病中心实验室完成。①实验材料:人冠状动脉平滑肌细胞(Casecade公司);白细胞介素6(PeProtech公司)。②实验过程:培养人冠状动脉平滑肌细胞,传代至5～7代。一期:分别加入0和10μg/L白细胞介素6(0μg/L为对照组)刺激人冠状动脉平滑肌细胞,分别孵育2,4,8,24,36h,收集细胞培养液上清。二期:分别采用0,5,10,50μg/L白细胞介素6刺激人冠状动脉平滑肌细胞(0μg/L为对照组),6h后收集细胞培养液上清。③实验评估:应用酶联接免疫吸附剂测定方法检测细胞培养液上清内基质金属蛋白酶3、金属蛋白酶组织抑制因子1的表达量。结果:①加入白细胞介素6后,基质金属蛋白酶3、金属蛋白酶组织抑制因子1的表达量在2h时开始增加,并随时间的延长而不断增加;随着白细胞介素6剂量的增加,表达量均不断增加。②基质金属蛋白酶3/金属蛋白酶组织抑制因子1在2h开始升高,8h达到顶峰,而后缓慢下降,与对照组比较,P均<0.05;随着白细胞介素6剂量的增加,表达量均不断升高,10μg/L和50μg/L组与对照组比较,P<0.05。结论:白细胞介素6可使人冠状动脉平滑肌细胞分泌不稳定斑块标记物--基质金属蛋白酶3、金属蛋白酶组织抑制因子1及基质金属蛋白酶3/金属蛋白酶组织抑制因子1增加,且呈剂量和时间依赖效应,说明炎症可能是急性冠状动脉综合征发生发展的机制之一。     

Carcinoma ex microcystic adenoma of the pancreas: a report of a novel form of malignancy in serous neoplasms

Serous cystic neoplasms of the pancreas are generally considered benign lesions. Malignant counterparts have been occasionally described, and the diagnosis of malignancy is based solely on the presence of synchronous or metachronous metastases to the lymph nodes or liver, direct tumor invasion into adjacent organs, or vascular invasion. However, these malignant serous cystic tumors are lined by benign-appearing glycogen-rich cuboidal cells, which have been morphologically indistinguishable from benign microcystic serous cystadenoma in all the cases reported so far. We report a unique case of microcystic serous cystadenoma giving rise to carcinoma with distinctive histologic features including signet ring-like cells and solid nests. We believe that this case represents the first case of a cytologically malignant neoplasm arising from a benign serous cystadenoma (carcinoma ex microcystic serous cystadenoma).     

内镜下扩张治疗食管贲门癌术后吻合口狭窄43例

目的：总结食管-胃-空肠吻合口狭窄内镜下扩张治疗的疗效及经验．方法：对43例食管癌贲门癌术后食管胃和食管空肠吻合口狭窄患者行国产Savary-Gilliard探条扩张器胃镜下扩张术,术后进行局部活检,其中5例置放了食管支架．结果：所有病例扩张术后吞咽困难stooler分级明显提高,吞咽困难解除,近期有效率100%,扩张术后活检病理证实3例复发．12例行4-7次扩张,2例吻合口狭窄仍再发．结论：胃镜下探条扩张器治疗食管胃空肠吻合口狭窄安全有效,少部分经多次连续规则扩张仍狭窄再发者可置放食管支架,扩张术后应常规活检以排除局部癌症复发．