Peroxyacetyl Nitrate Inhalation

The eyes of rhesus monkeys and humans were exposed to long-pulsed ruby and neodymium, Q-switched ruby and neodymium, and helium-neon (He-Ne) lasers to determine retinal damage thresholds. Rabbit eyes were exposed to a carbon dioxide (CO₂) laser to determine corneal damage thresholds. The data were gathered simulating accidental field exposures.

The experimental data show that the white human fundus is appreciably less sensitive to damage from laser radiation compared to the rhesus monkey fundus. In general, the human threshold data obtained are considerably higher than some of the recommended safe levels.

Corneal damage levels caused by CO₂ laser radiation were reported. The data were shown to be consistent with a simple thermal model.

We emphasize that we are presenting experimental observations and are not recommending energy levels for “safe” laser exposures.     

Psychiatric Principles in Medical Interviewing

Asymptomatic splenomegaly is clinically intriguing. The commonest conditions found in Mayo Clinic patients with splenomegaly are portal hypertension, agnogenic myeloid metaplasia, Gaucher's disease, and splenic cyst, but differential diagnosis may be difficult. The physician may have to use laboratory and liver function studies, angiography, liver biopsy, and even surgical exploration to determine the etiology of the condition.     

大洋彼岸的涛声：新型冠状病毒下的挑战与反思

澳大利亚的全科医生具有行业自律性,体现在其自行制定行业标准、自主进行资质考核及自主执业等方面,也体现在The Medical Republic这一共享平台上。Leon Piterman是Monash University的全科医学教授,从事全科医学临床服务近40年,研究方向为慢性病管理、心理健康、医学教育。Piterman教授建议我国的全科医生应培养“共和”思想,以为全科医学领域提供更多的平等交流机会。目前Piterman教授定期为The Medical Republic撰写文章,本刊深受“医学共和”思想的启发,特邀本刊主编Monash University的杨辉教授对Piterman教授的文章进行编译,并进行连载刊登！医者有两只翅膀,一是丰富的医学知识和精湛的医疗技术,二是厚重的人文情怀。新型冠状病毒肺炎（新冠肺炎）疫情下,医学人文展示出独特的内涵。本期Piterman教授基于全科医生视角,从医学人文角度探讨新冠肺炎疫情引发的人们生活和心理巨变、医疗伦理辩论、个人利益与集体利益选择、全科医学服务挑战,希望能为全科同仁带来思考与启示。     

Renal transplantation in old recipients from expanded criteria donors selected by kidney biopsy

Background

In Spain, the number of ideal kidney transplant donors has fallen, with at the same time an increase in the number of older recipients on the waiting list.

Aim

To analyze the results of expanded criteria cadaveric donor kidney transplants into older recipients using grafts selected by kidney biopsy.

Patients and methods

We studied 360 kidney transplant recipients who had been followed to December 2009: 180 in the study group and 180 in a control group composed of younger patients who received grafts from non-expanded criteria donors between 1999 and 2006. A paraffin-embedded kidney biopsy was evaluated by the percentages of sclerosed glomeruli, arteriolar hyalinosis, intimal wall thickening, interstitial fibrosis, and tubular atrophy.

Results

Significant differences were observed in donor age (63.50 ± 5.46 vs 31.90 ± 13.29 years; P < .001) and recipient age (58.40 ± 8.80 vs 40.71 ± 13.23 years; P < .001). Donor renal function was significantly worse among the expanded criteria group (90.80 vs 108.11 mL/min/1.73 m²; P = .006), remaining so over time in the recipient (at 1 year: 42.08 vs 63.71 [P < .001]; at 3 years: 41.25 vs 62.31 [P < .001], and at 7 years: 38.17 vs 64.18 [P < .001]). Censored 7-year graft survivals were 73% versus 87% (P < .001) with similar patient survivals (90.5% vs 95%; P = .39).

Conclusions

Selection of expanded criteria donors by kidney biopsy resulted in good renal function as well as graft and patient survivals at 7 years in older recipients.