To screen or not to screen? The development of a prediction model for aorto-iliac stenosis in kidney transplant candidates

Screening for aorto-iliac stenosis is important in kidney transplant candidates as its presence affects pre-transplantation decisions regarding side of implantation and the need for an additional vascular procedure. Reliable imaging techniques to identify this condition require contrast fluid, which can be harmful in these patients. To guide patient selection for these imaging techniques, we aimed to develop a prediction model for the presence of aorto-iliac stenosis. Patients with contrast-enhanced imaging available in the pre-transplant screening between January 1st, 2000 and December 31st, 2018 were included. A prediction model was developed using multivariable logistic regression analysis and internally validated using bootstrap resampling. Model performance was assessed with the concordance index and calibration slope. Three hundred and seventy-three patients were included, 90 patients (24.1%) had imaging-proven aorto-iliac stenosis. Our final model included age, smoking, peripheral arterial disease, coronary artery disease, a previous transplant, intermittent claudication and the presence of a femoral artery murmur. The model yielded excellent discrimination (optimism-corrected concordance index: 0.83) and calibration (optimism-corrected calibration slope: 0.91). In conclusion, this prediction model can guide the development of standardized protocols to decide which patients should receive vascular screening to identify aorto-iliac stenosis. External validation is needed before this model can be implemented in patient care.     

张海峰基于体用学说治疗慢性非特异性腰痛经验介绍

慢性非特异性腰痛是康复科门诊常见疾病之一,由于其具体病理机制还未完全阐明,目前临床治疗多以对症治疗为主。张海峰主任结合自身临证经验,根据非特异性腰痛的疾病特点,认为其多是以人体体用关系失和所致。人体以一元之气为“体”,脏腑经络的外在功能为“用”。脾肾亏虚,运化失职,气化失常,气血不充,一元之气虚衰,不荣则痛,发为腰痛;气虚血瘀,阻滞经络,又或再受邪气侵犯,寒湿阻滞,不通则痛,而成本虚标实之证。张主任据此提出通补元气、化瘀止痛的治疗法则,并且结合中西医及康复物理治疗等方法,疗效甚佳。     

Partial nephrectomy should be classified as an inpatient procedure: Results from a statewide quality improvement collaborative

ObjectivesTo examine length of stay (LOS) and readmission rates for all minimally-invasive partial nephrectomy (MIPN) and MI radical nephrectomy (MIRN) performed for localized renal masses ≤7 cm in size (cT1RM) within 12 Michigan urology practices. Both RN and PN are commonly performed in treating cT1RM. Although technically more complex and associated with higher complication rates, Centers for Medicare & Medicaid Services considers MIPN an outpatient procedure and MIRN is inpatient.MethodsWe collected data for renal surgeries for cT1RM at MUSIC-KIDNEY practices between May 2017–February 2020. Data abstractors recorded clinical, radiographic, pathologic, surgical, and short-term follow-up data into the registry for cT1RM patients.ResultsWithin MUSIC-KIDNEY, 807 patients underwent MI renal surgery at 12 practices. Median LOS for cT1RM patients after MIPN (n = 531, 66%) was 2 days and after MIRN (n = 276, 34%) was also 2 days. Among patients undergoing laparoscopic or robotic PN, 171 (32%), 230 (43%), and 130 (24%) stayed ≤1, 2, ≥3 days. Among patients undergoing laparoscopic or robotic RN, 81 (29%), 112 (41%), and 83 (30%) stayed ≤1, 2, ≥3 days. No significant difference was observed between MIPN and MIRN on LOS commensurate with outpatient surgery (≤1-day, OR = 0.97, P = 0.87).ConclusionsLess than one-third of patients had a LOS ≤1-day and LOS was comparable for MIPN and MIRN. Centers for Medicare & Medicaid Services should be advised that MIPN is a more complex surgery than MIRN, most patients receiving a MIPN will require a ≥2-day hospital stay and it would be more appropriate to classify MIPN an inpatient procedure with MIRN.     

Preparation of Iron Carbon Composite Material by Extracting Iron from Bauxite Residue and Its Adsorption of Heavy Metal Cd(II)

Bulletin of Environmental Contamination and Toxicology - An effective method of iron extraction from bauxite residue was explored, and iron was used to prepare iron carbon composite material, which...     

An Environmental Dilemma for China During the COVID-19 Pandemic: The Explosion of Disposable Plastic Wastes

Plastic pollution control has been on top of the political agenda in China. In January 2020, China announced a phased ban on the production and usage of various types of single-use plastics as a solution to environmental pollution problems. However, the outbreak of COVID-19 seems to be a new obstacle to the ban on single-use plastic products. To basically satisfied the daily necessities and contain the spread of SARS-CoV-2 under the background of the regular epidemic prevention and control in China, online ordering, contactless delivery and wearing mask have become an important and feasible way of daily life. However, the unrestrained use of disposable plastic bags, lunch boxes and masks within the nationwide quarantine leads to hundreds of millions of plastics wastes every day. The potential environmental pollution caused by the use of disposable plastic products during the pandemic should arouse social concern. The Chinese government should manage environmental protection in parallel with anti-pandemic endeavors as the situation of the pandemic evolves.

     

隆突性皮肤纤维肉瘤20例临床病理分析

20例隆突性皮肤纤维肉瘤临床特点为发生于真皮内、病程长、常反复局部复发。组织学特征为梭形瘤细胞围绕小血管排列成车辐状结构且遍及整个瘤体;瘤细胞成分单一、核轻度异型、核分裂象少见;瘤体常包裹较多脂肪细胞和皮肤附件;瘤组织常向皮下脂肪呈树枝状浸润性生长。本文介绍了新近的色素型和纤维肉瘤型两个亚型。     

兔中性粒细胞防御素对HL—60细胞毒性及对病毒的直接灭活作用

本研究从新西兰家兔腹腔渗出中性粒细胞溶酶体内提取酸溶性组分，经制备性ＡＵ－ＰＡＧＥ获得纯化的防御素（ＮＰ１和ＮＰ２），ＳＤＳ－ＰＡＧＥ测定分子量为３ｋｄ左右。以ＨＬ－６０细胞作靶细胞，当ＮＰ１或ＮＰ２在１００μｇ／ｍｌ浓度时，可杀死６０％以上的ＨＬ－６０细胞。ＮＰ１（２６０μｇ／ｍｌ）还可直接灭活单纯疱疹病毒Ｉ型和乙型流感病毒，分别使病毒感染滴度降度９８．２％和９０％。本研究结果提示，中性粒细胞可