Fifteen years’ experience of intestinal and multivisceral transplantation in the Nordic countries

Abstract

Objective. Intestinal and multivisceral transplantation have gained acceptance as treatment modalities for patients with: intestinal failure and life-threatening complications of parenteral nutrition (PN), rare cases of vascular abdominal catastrophes and selected cases of low-grade neoplastic tumors such as neuroendocrine pancreatic tumors and desmoids involving the mesenteric root. The aim was to describe the survival and nutritional outcome in the transplanted Nordic patients and the complications attributed to this procedure. Method. The authors included all Nordic patients transplanted between January 1998 and December 2013. Information on patients transplanted outside the Nordic region was collected through questionnaires. Results. A total of 34 patients received different types of intestinal allografts. Currently, there are two Nordic transplant centers (n = 29) performing these procedures (Gothenburg, Sweden n = 24, Helsinki, Finland n = 5). The remaining five patients were transplanted in the USA (n = 3) and the UK (n = 2). Most patients were transplanted for life-threatening failure of PN (70%) caused primarily by intestinal motility diseases (59%). Allograft rejection was the most common complication and occurred in 79% of the patients followed by post-transplantation lymphoproliferative disorders (21%) and graft-versus-host disease (18%). The 1- and 5-year survival was 79% and 65% respectively for the whole cohort and nutritional autonomy was achieved in 73% of the adults and 57% of the children at 1 year after transplantation. Conclusion. This collective Nordic experience confirms that intestinal transplantation is a complex procedure with many complications, yet with the possibility to provide long-term survival in selected conditions previously considered untreatable.     

军医大学预选卫生士官军体教学思考

本文就预选卫生士官在军体教学中存在的问题进行分析和探讨,并提出全程化和多样化的军体教学做法和对策。     

Polymorphism in the C-reactive protein (CRP) gene affects CRP levels in plasma and one early marker of atherosclerosis in men: The Health 2000 Survey

The gastrointestinal hormone gastrin is measured in plasma in physiological, pathophysiological and diagnostic investigations. In the diagnosis of hypergastrinaemic diseases such as gastrinomas and gastric achlorhydria, measurement of gastrin concentrations in circulation is crucial. Gastrin circulates, however, not as a single peptide but as a mixture of peptides of different lengths and amino acid derivatizations. Moreover, in hypergastrinaemia the peptide pattern changes. Consequently, diagnostic gastrin measurements require immunoassays that recognize the pathological plasma patterns, which are characterized by a predominance of the large peptides (gastrin‐34 and gastrin‐71) and less, if any, of the shorter main form of gastrin in normal tissue, gastrin‐17. Alternatively, and in specific cases, “processing‐independent assays” (PIA) for progastrin may be considered, since hypersecreting gastrin cells also release substantial amounts of biosynthetic precursors and processing intermediates. Recently, gastrin kits that do not take the pathological plasma patterns into account have been marketed and may miss the diagnosis. Therefore, proper diagnosis of gastrinomas and other hypergastrinaemic diseases requires insight into cellular gastrin synthesis and peripheral metabolism, and also into the design of useful immunoassays. This review discusses the art of measuring gastrin in plasma with adequate diagnostic specificity.     

The neurotoxicity of intrathecal lidocaine is enhanced in postpartum compared to virgin rats

During the perinatal period, the pharmacokinetics and pharmacodynamics of drugs may be altered. Data about the neurotoxicity of intrathecal local anesthetics in the peripartum period are lacking. So we hypothesized that the neurotoxicity of intrathecal lidocaine during perinatal period may be changed. Therefore, we designed the present study to determine whether the neurotoxicity of intrathecal lidocaine in postpartum rats would be different from that in nonpregnant, virgin rats. Postpartum and nonpregnant rats randomly received an intrathecal infusion of lidocaine 50 mg/mL in saline, lidocaine 20 mg/mL in saline, or saline for 1 h at a rate of 1 μL/min. Four days after drug infusion, the rats were assessed for persistent impairment of sensory and motor function (MF) using the tail‐flick (TF) test, paw pressure test, and MF score. Spinal cords and nerve roots were obtained for light and electron microscopic examinations, and the injury scores were compared between groups. The TF latencies and the mean nerve injury scores of the postpartum group were significantly higher than those of nonpregnant group. Lidocaine induced a dose‐dependent impairment in TF latencies and nerve injury scores. There was no significant interaction between postpartum and the drug. Our results suggest that the neurotoxicity of intrathecal lidocaine is enhanced in rats during the early postpartum period compared with nonpregnant, virgin rats.     

中西医结合治疗肾移植术后肺感染18例临床观察

目的 观察中西医结合治疗肾移植术后肺感染患者的效果。方法 将34例肾移植术后肺感染患者。随机分为治疗组（18例）和对照组（16例）。治疗组采用中药清瘟败毒饮加减,激素、抗病毒、抗细菌、对症及支持疗法等联合用药,对照组未给予中药治疗,其余处理与治疗组相同。结果 治疗组18例,痊愈15例,好转2例,死亡1例,治愈率为83．3％,总有效率为94．5％;对照组16例,痊愈8例,好转2例,死亡6例,治愈率为50．0％,总有效率为62．5％;两组疗效比较差异有显著性（P〈0．05）。结论 中西医结合治疗肾移植术后肺感染具有较好的治疗作用。     

石英纤维桩在前牙残根残冠修复中的应用

目的总结分析石英纤维桩全冠修复的临床效果。方法选择合适病例,对经过完善根管治疗的28例患者共36颗前牙使用石英纤维桩、全瓷冠(或者树脂冠),观察6个月～2年,评价临床修复效果。结果 28例36颗前牙均美观自然,牙龈颜色正常。结论石英纤维桩具有美观、不易发生根折的优点。     

Successful reproduction of adenoviral gizzard erosion in 20-week-old SPF layer-type chickens and efficacious prophylaxis due to live vaccination with an apathogenic fowl adenovirus serotype 1 strain (CELO)

Recently, outbreaks of adenoviral gizzard erosion (AGE) have been documented in pullets and layers housed free range and in enriched cage systems characterized by increased mortality and a negative impact on egg production. In the present study the pathogenicity of a fowl adenovirus serotype 1 (FAdV-1) field strain as well as the aetiological role of a FAdV-8a strain, both isolated from AGE affected pullets, were investigated in vivo in 20-week-old specific-pathogen-free (SPF) layer-type chickens. Furthermore, the efficacy of a single (week 17) and double (week 14 and 17) application of a live vaccine consisting of an apathogenic FAdV-1 (CELO strain) against challenge with virulent FAdV-1 was investigated.For the first time, AGE was successfully reproduced in adult birds after oral infection of 20-week-old SPF birds with a virulent FAdV-1 field isolate, characterized by pathological changes of the gizzard from 7 days post challenge onwards. In addition, a negative impact of the FAdV-1 infection on the development of the reproductive tract was observed. Thus, confirming the pathogenicity and aetiological role of FAdV-1 in the development of AGE and economic losses due to AGE in layers. In contrast, no pathological changes were observed in birds infected with FAdV-8a.Independent of a single or double application of the live FAdV-1 vaccine strain CELO, no gross pathological changes were observed in gizzards post challenge with the virulent FAdV-1, indicating that complete protection of layers against horizontal induction of AGE was achieved. Nonetheless, virulent FAdV-1 was detected in cloacal swabs and gizzards in both vaccinated groups post challenge determined by the application of an amplification refractory mutation system quantitative PCR used to differentiate between vaccine and challenge strains.     

加用复方龙星片治疗感冒后咳嗽的临床研究

[目的] 通过用复方甲氧那敏胶囊和加用复方龙星片的方法分别治疗感冒后咳嗽,观察两组的临床疗效。[方法] 将符合入组条件的80例患者在服用复方甲氧那敏胶囊(商品名:诺尔彤)的基础上,采用随机数字表法随机分为常规治疗组(对照组)40例,加用复方龙星片组(治疗组)40例,服药14 d为1个疗程。[结果] 治疗组临床总有效率为90.00%,对照组为80.00%,两组在总体疗效上差异有统计学意义(P<0.05);治疗组在日间咳嗽、夜间咳嗽、咳痰量、咽痒、喘息的改善情况要好于对照组,差异有统计学意义(P<0.01);而两组在气短的症状改善上差异无统计学意义(P>0.05);治疗组的起效时间快于对照组;治疗后两组的生活质量评分比治疗前都有了很大的提高,而治疗组提高明显高于对照组,两组间的差异有统计学意义(P<0.05)。[结论] 经加用复方龙星片治疗感冒后咳嗽疗效明显优于对照组。