Fertility Outcome After Renal Transplantation: A Single-Center Experience

BackgroundWomen suffering from kidney disease are more prone to fertility problems, due to uremia. Fortunately, their fertility rate increases dramatically after renal transplantation. This study analyzes the predictors/risk factors of successful pregnancy with live birth outcome while presenting an overview of the 7-year experience of a single center.MethodsThis retrospective cohort study includes 239 women of reproductive age (18–40 years) who underwent renal transplantation in a tertiary Turkish clinic between October 1, 2011, and August 24, 2017. The subjects were invited to take part in a survey questioning their obstetric characteristics and they were assessed in 2 groups: fertile and infertile. Multivariable linear regression analysis was conducted to determine the predictors of a successful pregnancy.ResultsThirty-five 35 patients wished to become pregnant: 12 got pregnant spontaneously, while 21 failed to become pregnant (spontaneously). The mean age of the patients at the survey was 34 ± 7. Regular menstrual cycles after renal transplantation, tacrolimus-mycophenolate mofetil maintenance protocol, and age at transplantation were found to be predictors of spontaneous pregnancy. The duration of peritoneal dialysis was significantly longer in the infertile group (48 vs 12 months).ConclusionEnd-stage renal disease's negative impacts, including menstrual abnormality and fertility problems, can be overcome by successful kidney transplantation with appropriate immunosuppression. Minimizing the duration of peritoneal dialysis, particularly in patients who desire future fertility, may be accepted as a logical management strategy.     

儿童外科教学方法实践及探讨

目的探讨儿童外科的教学特点及教学方法,提高儿外科医生的总体执业水平,促进儿童外科学的发展。方法通过分析四川大学华西医院多年儿童外科疾病的临床教学实践经验,总结出适合医学生、初级儿童外科专科医生的实用的教学方法及经验。结果结合儿童外科特有的疾病特点所总结出的故事式讲述教学、典型病例教学、漫画形式学习、比较学习法及多媒体素材教学五种方式是非常适合儿童外科教学的方法。能够加深记忆,提高兴趣,轻松快捷,事半功倍的掌握相关医学专业知识。结论独特有趣的儿童外科教学方法可提高医学生及儿童外科初级从业者的学习兴趣、专业知识和执业水平。     

安亭地区3199名妇女妇科普查分析

目的了解安亭地区已婚妇女健康状况，并进行分析，提出相应干预措施。方法2005年10月，按上海市妇女所制定的妇科病体检标准，开展普查普治工作，由区妇幼所承担普查任务。检查项目包括妇科、乳房、阴道分泌物、宫颈脱落细胞及B超检查等。结果妇科常见病主要为慢性宫颈炎，其次为阴道炎。慢性宫颈炎中宫颈糜烂占首位，宫颈脱落细胞检查发现50岁组巴氏Ⅱ级发生率占第1位。结论保障妇女身心健康，建议定期开展妇女病普查，普及防病知识，增强妇女自我保健意识，加强更年期保健，倡导健康生活方式。     

腹腔镜下胆总管探查术22例临床分析

目的探讨腹腔镜下胆总管探查术的方法及避免副损伤的措施.方法应用Olympus腹腔镜及操作器械一套.全麻下进行,体位及穿刺点均与腔镜胆囊切除相同.穿刺证实胆总管后,对胆总管直径＞1.5 cm者用针式电钩直接切开;胆总管直径＜1.2 cm者用剪刀切开,纵行切开1.0～1.5 cm,直视下用常规器械或胆管镜网篮取石,胆总管Ⅰ期缝合.结果本组22例中,21例成功,1例由于胆囊三角区粘连紧密,镜下缝合胆总管困难中转开腹手术.结论腹腔镜下胆囊切除,胆总管探查与传统开腹手术比较具有微创特点,胆总管Ⅰ期缝合更体现微创外科的优势.     

Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial

To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic, intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty. Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients, and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best). Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO₂ and higher PO₂ at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary functions, patients feel less pain, and patient satisfaction is comparable to that with GA. Electronic Publication     

Facilitation of discrimination transfers under amphetamine: the relative control by S+ and S− and general transfer effects

Rats were trained in a Y-maze on a two-choice simultaneous black-white discrimination with either black or white as S⁺. Animals were then transferred to one of three discrimination tasks. In task 1 (New S^–), a new stimulus, either vertical or horizontal stripes, was substituted for the original S^–. In task 2 (New S⁺), a new stimulus, either vertical or horizontal stripes as in task 1, was substituted for the original S⁺. In task 3 (New S⁺/S^–) animals were trained on horizontal-vertical discrimination. The pre-trial administration of 1 mg/kg d-amphetamine facilitated the acquisition of the original black-white discrimination with both black as S⁺ and white as S⁺. Likewise, the drug improved performance in all three transfer conditions. However, the course of learning in the three transfer tasks was different in the placebo- and amphetamine-treated animals. Amphetamine-treated animals were disrupted more by a change in S⁺ than by a change in S^–, whereas the opposite pattern was evident in the placebo controls. When both discriminative stimuli were changed, placebo animals exhibited pronounced decrement in performance, whereas amphetamine animals exhibited excellent learning. The implications of these findings for the effects of amphetamine on discrimination learning are discussed.