Minimizing Ports During Robotic Partial Nephrectomy

Methods:Data on 11 robot-assisted laparoscopic partial nephrectomies performed by using our technique from February 2015 through June 2015 were retrospectively analyzed. The robotic platform used was DaVinci Xi (Intuitive Surgical, Inc., Sunnyvale, California, USA) with a 3-arm setup. The AirSeal system (SurgiQuest, Milford, Connecticut, USA) was used as a port allowing simultaneous introduction of 2 instruments for the bedside surgeon, obviating the need for an additional (fourth) robotic arm. A long suction-and-irrigation device and atraumatic grasping forceps were used. Both instruments were introduced through the trocar of the AirSeal system, making simultaneous introduction and use possible. We preferred the long suction-and-irrigation device, because it minimizes collision of the instruments.Results:Mean age and BMI of the patients were 55 ±14.6 y and 29.18 ± 6.85, respectively. Seven tumors were on the right side and 4 were on the left. The mean size of the tumors was 32.45 mm (± 11.31). Surgical time was 132.2 minutes (±37.17), with an estimated blood loss and ischemia time of 103.63 mL (±65.92) and 16.72 minutes (±9.52), respectively. One patient had postoperative bleeding that was resolved without transfusion. The median hospitalization period was 3.9 d (±0.53). Loss of intra-abdominal pressure was not observed, and pressure was stable at 10 mm Hg.Conclusion:The AirSeal System and its valveless trocar eliminated the need for an additional port placement in our series. The technique is feasible, safe, and reproducible; therefore, it may be implemented in selected cases of robot-assisted partial nephrectomies.     

人乳头状瘤病毒感染妇女的年龄及其亚型分析

目的分析广州地区人乳头状瘤病毒(HPV)感染阳性妇女的年龄及其亚型分布,为预防HPV感染及宫颈癌的发生提供依据。方法采用核酸分子快速导流杂交基因芯片技术进行HPV分型检测,根据芯片上HPV基因亚型分布图进行阳性或阴性及单重或多重感染判断。结果 4 210例HPV阳性病例中,HPV感染年龄段分布前5位依次为26³0、2130、21²5、3125、31³5、3635、36⁴0、4140、41⁴5岁,分别占25.89%、20.07%、17.91%、13.63%、8.08%;感染率排在前10位的HPV亚型依次为HPV52、16、58、6、11、CP8304、53、68、18、33,分别占阳性病例数的25.44%、17.86%、13.14%、12.71%、9.86%、9.17%、9.05%、6.53%、5.99%、5.82%;其中,单一和多重感染率分别为70.14%、29.86%;随年龄的增长,HPV52、16、58感染率逐渐增加,HPV6、11亚型感染率逐渐下降。结论 HPV感染阳性妇女主要集中在2145岁,分别占25.89%、20.07%、17.91%、13.63%、8.08%;感染率排在前10位的HPV亚型依次为HPV52、16、58、6、11、CP8304、53、68、18、33,分别占阳性病例数的25.44%、17.86%、13.14%、12.71%、9.86%、9.17%、9.05%、6.53%、5.99%、5.82%;其中,单一和多重感染率分别为70.14%、29.86%;随年龄的增长,HPV52、16、58感染率逐渐增加,HPV6、11亚型感染率逐渐下降。结论 HPV感染阳性妇女主要集中在21⁴0岁年龄段,HPV52、16、58、6是最主要的感染亚型,HPV感染以单一亚型感染为主,不同年龄段HPV感染的优势亚型有所不同。     

The long-term outcomes of persistent childhood allergic asthma: A cross-sectional study from western Anatolia: Childhood persistent asthma in western Anatolia

BackgroundProspective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors.ObjectiveThe aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey.MethodsFifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated.ResultsA total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p > 0.05).ConclusionChildhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma.     

Common features of anaphylaxis in children

ObjectiveWe aimed to establish the characteristics of anaphylaxis in childhood.MethodsForty-four patients who had experienced anaphylaxis in a period of 10 years (from 1999 to 2009), were included in the study. Parameters analysed were age, gender, concomitant allergic disease, trigger, setting, clinical symptoms, treatment, prognosis and prophylaxis.ResultsThe total numbers of anaphylaxis cases were 44 in a ten-year period. The ages of patients ranged from 3 to 14 years (11.50 ± 3.87 years) and the majority were male. 33 of the patients (75%) had a concomitant allergic disease. The trigger was determined in 93.2% of the cases, being most frequent: food (27.3%), and SIT (25%), followed by bee sting, medications and others. Respiratory (95.5%), dermatological (90.9%), cardiovascular (20.5%), neuropsychiatric (25%), and gastrointestinal (11.4%) symptoms were seen most frequently. For anaphylaxis triggered by food, the duration of anaphylactic episode was significantly longer (p < 0.05). No biphasic reaction was observed during these attacks. Of our patients, only one developed respiratory failure and cardiac arrest due to SIT, and intensive care support was required.DiscussionAs a trigger for anaphylaxis, the frequency of SIT is so high that it cannot be described by the study group including patients who were followed up in an outpatient allergy clinic.     

Lack of association between methylenetetrahydrofolate dehydrogenase 1 G1958A polymorphism and prostate cancer risk: a meta-analysis

The methylenetetrahydrofolate dehydrogenase 1 (MTHFD1) polymorphism G1958A has been extensively investigated as a potential risk factor for prostate cancer (PCa), but the results have thus far been inconclusive. This meta-analysis was performed to derive a more precise estimation of the association. A comprehensive search was conducted to identify all case–control studies of MTHFD1 G1958A polymorphism and PCa risk. We used odds ratios (ORs) to assess the strength of the association, and 95 % confidence intervals (CIs) give a sense of the precision of the estimate. Statistical analyses were performed using Review Manage version 5.0 and Stata 10.0. A total of six available studies were considered in the present meta-analysis, with 7,493 patients and 36,941 controls. When all groups were pooled, there was no evidence that G1958A had significant association with PCa under additive, recessive, dominant, and allelic models. This meta-analysis suggests that MTHFD1 G1958A polymorphism might not be a risk factor for PCa. However, further large-scale and well-designed case–control studies are necessary to validate the risk identified in the present meta-analysis.     

Ectasia and severe atherosclerosis: relationships with chlamydia pneumoniae, helicobacterpylori, and inflammatory markers

To date, there has been no convincing evidence for an association between Chlamydia pneumoniae or Helicobacter pylori and ectasia. In this case-control study, we have investigated the association of H. pylori and C. pneumoniae seropositivity with ectasia, severe coronary atherosclerosis, and normal vessels, which were so classified by coronary angiography. We have also evaluated the influence of these infections on inflammatory markers such as high-sensitive C-reactive protein (hsCRP) and interleukin 6 (IL-6). Of the 796 patients undergoing coronary angiography for suspected ischemic heart disease, 244 patients were recruited. Of these, 91 had normal vessels, 88 had 3 or more obstructed vessels, and 65 had ectatic vessels without atherosclerosis. Eighty-seven atherosclerotic patients (98.9%) were positive for C. pneumoniae IgG, as were 64 ectatic patients (98.5%) and 76 controls (83.5%) (P < 0.001). Forty-two atherosclerotic patients (47.7%) were positive for C. pneumoniae IgM, as were 43 ectatic patients (66.2%) and 43 controls (47.3%) (P = 0.036). Seventy-two atherosclerotic patients (81.8%) were positive for H. pylori IgA, as were 26 ectatic patients (40.0%) and 44 controls (48.4%) (P < 0.001). High-sensitive CRP levels were significantly higher in ectatic patients (5.639 mg/L) than in controls (4.390 mg/L) (P = 0.032), and IL-6 levels were significantly higher in atherosclerotic patients (33.92 U/L) than in controls (14.01 U/L) (P < 0.001). Interleukin-6 levels were higher in H. pylori seropositive patients, and hsCRP levels were higher in C. pneumoniae seropositive patients, when compared with seronegatives. We suggest that, as in atherosclerosis, C. pneumoniae infection is related to ectasia, with raised CRP levels.