经皮肾镜气压弹道碎石术与开放手术治疗鹿角形肾结石的比较

目的比较经皮肾镜碎石术(PCNL)与开放手术治疗鹿角形肾结石的有效性和安全性。方法回顾性分析我院自2003年6月至2008年12月收治120例鹿角形肾结石患者的临床资料,其中PCNL组79例,开放手术组41例,比较两种治疗手段的手术时间、术中出血量、术后住院天数、结石排净率、并发症发生率等指标。结果 PCNL组与开放手术组的手术时间、术中出血量、术后住院天数差异均有统计学意义(P0.05),结石排净率、术后并发症发生率差异无统计学意义(P0.05)。结论 PCNL是治疗肾鹿角型结石的一种安全有效的治疗方法。     

Standardization of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve in Thyroid Operation

Background  

The lack of standardized procedures of intraoperative neuromonitoring (IONM) during thyroid operations may lead to highly variable results, and many of these results can cause misleading information and, conversely, increase the risk of recurrent laryngeal nerve (RLN) injury. Therefore, standardization of IONM procedures is necessary.     

Sciaticum majus foramen and sciaticum minus foramen as the path of SWL in the supine position to treat distal ureteral stone

The purpose of the study is to evaluate the efficacy and safety of shock wave lithotripsy (SWL) using sciaticum majus foramen and sciaticum minus foramen as the path to treat distal ureteral stone in supine position. Between December 2006 and November 2008, 243 cases of distal urinary calculi were treated in our department using SWL or ureteroscopy. 189 cases for SWL were treated in supine position. The shockwave target on the stone in distal ureter via sciaticum majus foramen and sciaticum minus foramen, avoiding the sacroiliac joint. 54 cases were underwent ureteroscopy combined with holmium:YAG laser lithotripsy. The stone-free rate and the efficacy quotient (EQ) for SWL and ureteroscopy was 81.5%, 0.68; 94.4%, 0.78; respectively (p = 0.02). The retreatment rate for SWL and ureteroscopy was 14.6%, 0, respectively. The number of the shocks ranged from 600 to 3,000 (mean 2,566.3 ± 378.8). The energy per pulse of SWL ranged from 8 to 12 kV (mean 10.7). SWL in the supine position using sciaticum majus foramen and sciaticum minus foramen as the path is a choice of the treatment of distal ureteral stones with an excellent success rate and low side effect.     

Family Functioning,Marital Satisfaction and Social Support in Hemodialysis Patients and their Spouses

A growing number of studies have demonstrated the importance of marital quality among patients undergoing medical procedures. The aim of the study was to expand the literature by examining the relationships between stress, social support and family and marriage life among hemodialysis patients. A total of 114 participants, including 38 patients and their spouses and 38 healthy controls, completed a survey package assessing social support, stress, family functioning and marital satisfaction and quality. We found that hemodialysis patients and spouses were less flexible in family adaptability compared with the healthy controls. Patients and spouses had more stress and instrumental social support compared with healthy people. Stress was negatively associated with marital satisfaction. Instrumental support was not associated with family or marital outcomes. The association between marital quality and support outside of family was positive in healthy individuals but was negative in patients and their spouses. Family adaptability was positively associated with support within family as perceived by patients and positively associated with emotional support as perceived by spouses. In conclusion, findings suggest that social support may promote adjustment depending on the source and type. Future research should pay more attention to the types and sources of social support in studying married couples. Copyright © 2014 John Wiley & Sons, Ltd.     

Solid Organ Transplantation From Hepatitis B Virus–Positive Donors: Consensus Guidelines for Recipient Management

Use of organs from donors testing positive for hepatitis B virus (HBV) may safely expand the donor pool. The American Society of Transplantation convened a multidisciplinary expert panel that reviewed the existing literature and developed consensus recommendations for recipient management following the use of organs from HBV positive donors. Transmission risk is highest with liver donors and significantly lower with non‐liver (kidney and thoracic) donors. Antiviral prophylaxis significantly reduces the rate of transmission to liver recipients from isolated HBV core antibody positive (anti‐HBc+) donors. Organs from anti‐HBc+ donors should be considered for all adult transplant candidates after an individualized assessment of the risks and benefits and appropriate patient consent. Indefinite antiviral prophylaxis is recommended in liver recipients with no immunity or vaccine immunity but not in liver recipients with natural immunity. Antiviral prophylaxis may be considered for up to 1 year in susceptible non‐liver recipients but is not recommended in immune non‐liver recipients. Although no longer the treatment of choice in patients with chronic HBV, lamivudine remains the most cost‐effective choice for prophylaxis in this setting. Hepatitis B immunoglobulin is not recommended.     

Body mass index,waist‐to‐hip ratio,waist circumference and waist‐to‐height ratio cannot predict male semen quality: a report of 1231 subfertile Chinese men

There were controversial results between obesity‐associated markers and semen quality. In this study, we investigated the correlations between age, obesity‐associated markers including body mass index (BMI), waist‐to‐hip ratio (WHR), waist‐to‐height ratio (WHtR) and waist circumference (WC), the combination of age and obesity‐associated markers, semen parameters and serum reproductive hormone levels in 1231 subfertile men. The results showed that BMI, WC, WHR and WHtR were positively related to age, and there were also positive relations between BMI, WHR, WC and WHtR and between sperm concentration (SC), total sperm count (TSC), progressive motility (PR), sperm motility and per cent of normal sperm morphology (NSM). However, age, each of obesity‐associated markers and the combination of obesity‐associated markers and age were unrelated to any of semen parameters including total normal‐progressively motile sperm count (TNPMS). Age, BMI, WHR, WC and WHtR were negatively related to serum testosterone and SHBG levels. However, only serum LH and FSH levels were negatively related to sperm concentration, NSM and sperm motility. In a conclusion, although age and obesity have significant impacts on reproductive hormones such as testosterone, SHBG and oestradiol, semen parameters related to FSH and LH could not be influenced, indicating that obesity‐associated markers could not predict male semen quality.     

注射用华蟾素对大鼠心率及心电图的影响

目的观察注射用华蟾素对大鼠心率及心电图的影响,为该药在临床应用时监控心脏的不良反应提供实验依据。 方法大鼠经颈外静脉插管后恒速蠕动泵给药,标准肢体Ⅱ导联监测大鼠的心率及心电图;比较给药前后心率及心电图的变化。 结果静脉注射华蟾素注射液与注射用华蟾素中、大剂量30 min后均可使大鼠心率加快,分别为:(469±40),(466±29) 和(484±40)次·min-1,与空白对照组[(411±17)次·min-1]比较,差异有统计学意义(P＜0.05),但随后恢复正常。少数大鼠可偶致心律失常(期前收缩、传导阻滞等),且相比于空白对照组[P-R间期:(46.90±3.90) ms,Q-T间期:(61.29±9.46) ms],给药后能明显缩短心电图的P-R间期[华蟾素注射液组(39.70±2.54) ms,注射用华蟾素中剂量组(37.70±3.77) ms,注射用华蟾素大剂量组(39.30±7.12) ms]和Q-T间期[注射用华蟾素中剂量组(55.13±4.67) ms,注射用华蟾素大剂量组(51.75±11.53) ms](P＜0.05),而对QRS与S-T段无明显改变。 结论注射用华蟾素对大鼠心脏有一定的毒副作用,可引起心率加快,偶发心律失常。     

术前新辅助化疗结合肠内营养对胃癌患者肿瘤细胞增殖活性的影响分析

目的探讨术前新辅助化疗结合肠内营养对胃癌患者肿瘤细胞增殖活性的影响效果。 方法将2012年7月至2014年7月收治的132例进展期胃癌患者,随机分为观察组（术前新辅助化疗联合肠内营养）和对照组（单纯予以新辅助化疗）,各66例,采用流式细胞仪检测两组患者肿瘤标本的细胞增殖情况,通过CD4、CD8、CD4/CD8、NK细胞的检测评价两组患者的免疫功能,检测血清学指标以及营养风险筛查（NRS评分）进行营养评价。 结果治疗前,两组患者的肿瘤细胞增殖活性、免疫指标、营养状况均差异无统计学意义。治疗后,观察组患者的CD4、CD4/CD8、NK、总蛋白、白蛋白、前白蛋白、转铁蛋白、血红蛋白均较对照组增加明显,DI、SPF、PI、CD8、NRS评分降低明显,差异有统计学意义（P<0.05）。 结论术前新辅助化疗结合肠内营养可较好地降低肿瘤细胞的增殖活性,改善其免疫水平及营养状况。     

500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil

IntroductionLiver transplantation is the standard treatment for end-stage liver disease. Brazil holds the third highest number of liver transplants performed per year, but center maldistribution results in high discrepancies in accessing this treatment. In 2012, an interstate partnership successfully implemented a new liver transplantation program in the middle west of Brazil. Here, we report the results of the first 500 liver transplants performed in this new program and discuss the impacts of a new transplant center in regional transplantation dynamics.MethodsWe reviewed data from the first 500 consecutive deceased donor liver transplants performed in the new program during an 8-year period. We analyzed data on patients’ clinical and demographic profiles, postoperative outcomes, and graft and recipient survival rates. Univariate survival analysis was conducted using log-rank tests to compare the groups.ResultsAlmost half (48%) of the procured organs and 40% of the recipients transplanted in our center were from outside our state. Recipient 30-day mortality was 9%. Overall recipient survival at 1 year and 5 years was 85% and 80%, respectively. Mortality was significantly associated with higher Model for End-Stage Liver Disease (P < .001) but not with the presence of hepatocellular carcinoma (P = .795).DiscussionThe new transplantation program treated patients from different regions of Brazil and became the reference center in liver transplantation for the middle west region. Despite the recent implementation, our outcomes are comparable to experienced centers around the world. This model can inspire the creation of new transplantation programs aiming to democratize access to liver transplantation nationwide.