Carto三维标测系统指导下心房颤动/扑动个体化消融原则的临床分析

目的 探讨个体化消融原则的临床效果及右房的作用.方法 房扑/房颤患者82例,男性42例,女性40例,年龄18～77(48.5±10.3)岁,左房内径26～52(35.4±5.3)mm.其中53例为阵发性房颤,14例为持续性房颤,15例为典型房扑.所有患者在Carto指导下进行个体化消融原则,以房扑/房颤被终止且不被诱发、肺静脉电位消失为消融终点.随访成功的定义为未服用抗心律失常药物、无任何症状性房性心律失常发作至少3个月.结果 ①随访时间3～28(13.4±3.3)个月,房扑和阵发性房颤消融随访成功率88.2%,持续性房颤仅为57.1%(P<0.05).2例有心包压塞,1例合并假性动脉瘤.无肺静脉狭窄等血管严重并发症.②阵发性房颤53例,其中10例为局灶性房早、短阵房速诱发的房颤(4例病灶位于右房内),8例行靶静脉线性消融,这类亚组手术无任何心律失常发作.其余43例阵发性房颤患者均行环肺静脉线性消融术,合并典型(4例)和非典型(6例)房扑者外加三/二尖瓣峡部消融.③15例典型房扑(4例为持续性房扑)患者,均行三尖瓣峡部消融,4例合并房颤者外加双侧肺静脉线性消融.④14例持续性房颤均经历了消融由房颤转变为房扑的过程,6例被消融终止和8例电复律复为窦律,半数分别进行了三/二尖瓣峡部消融和冠状静脉窦内消融,2例合并了起源于右房的房扑和房速.结论 Carto指导下房颤/房扑个体化消融可获得较好的临床疗效,右房的作用不能忽略.     

The Effect of Therapeutic Horseback Riding on Social Functioning in Children with Autism

This study evaluated the effects of therapeutic horseback riding on social functioning in children with autism. We hypothesized that participants in the experimental condition (n = 19), compared to those on the wait-list control (n = 15), would demonstrate significant improvement in social functioning following a 12-weeks horseback riding intervention. Autistic children exposed to therapeutic horseback riding exhibited greater sensory seeking, sensory sensitivity, social motivation, and less inattention, distractibility, and sedentary behaviors. The results provide evidence that therapeutic horseback riding may be a viable therapeutic option in treating children with autism spectrum disorders.     

下肢矫形手术应用微机图像技术辅助设计的应用研究

[目的]应用医学图像处理软件,在计算机屏幕上进行下肢矫形手术的设计,对手术后状况进行预测,并检验该软件的临床应用效果.[方法]自主开发一套基于数字X线的矫形外科手术设计与预测模拟软件,并将该软件应用于下肢矫形手术的组织测量分析、手术方案设计与手术效果模拟.2001年1月～2006年12月,共为28例下肢长骨畸形患者进行截骨矫形手术,患者分为实验组和对照组,分别使用计算机辅助法和传统手工方法设计手术方案.其他术前术后处理均按常规进行,两组患者无差别.术后拍摄患肢X线片与术前的设计方案进行比较,分别计算两种设计方法下手术效果与术前设计的符合程度,并进行统计学分析.[结果]该软件测量误差小,构建的骨切除量参数准确,模拟效果逼真.手术效果与设计方案的符合率明显优于传统方法设计组,统计学处理差别有显著性.[结论]在下肢矫形手术前的病例分析中应用医学图像处理软件能够对骨组织同时进行测量分析和手术模拟设计,可进行手术模拟并设计切除骨量.系统操作方法易于为外科医生掌握使用,具有临床实用性.     

睾丸精子行ICSI改善严重畸形精子症患者治疗结局5例报告

目的:探讨利用睾丸精子行卵细胞胞质内单精子注射(ICSI)治疗严重畸形精子症患者(精液或附睾液精子畸形率≥99%)的可行性,改善辅助生殖技术治疗结局。方法:回顾性分析5例严重畸形症精子患者(附睾液精子,n=4;精液精子,n=1)利用不同来源精子行ICSI治疗的临床资料,并比较睾丸精子组与非睾丸精子组(附睾液精子和精液精子)之间受精率、卵裂率、优质胚胎率、妊娠率以及种植率的差异。结果:5例严重畸形精子症患者取精液精子或附睾液精子行ICSI治疗后无1例妊娠,而改用睾丸精子行ICSI治疗后4例成功妊娠。睾丸精子组与非睾丸精子组之间受精率、卵裂率及优质胚胎率均无显著差异(P>0.05),而睾丸精子组妊娠率和种植率均显著高于非睾丸精子组(P<0.01)。结论:对应用附睾精子或精液精子行ICSI治疗失败的严重畸形精子症患者改用睾丸精子治疗可有效改善其治疗结局。     

ORIGINAL ARTICLE: Prenatal Priming of Cord Blood T Lymphocytes by Microbiota in the Maternal Vagina

Problem In the vagina of women at the reproductive age, more than 170 strains of bacteria and yeasts are found. The effect of vaginal flora on neonatal T cells is yet to be investigated. Method of study We analyzed CD45RA and CD45RO expression on neonatal CD4+ T cells and cytokine production in CBMC cultures (interferon‐γ (IFN‐γ ), interleukin‐4 (IL‐4) and IL‐12) related to vaginal bacteria isolated from a maternal vagina. We collected vaginal swabs from 36 women at the first stage of the delivery and cord blood from their newborns. IFN‐γ, IL‐4, and IL‐12 in stimulated CBMC were measured and the expression of CD45RA/CD45RO on CD4+ T cells was assessed. Results We noted the difference in CD45RO CD4+ expression and IL‐12 levels between the newborns whose mothers were or were not colonized with Lactobacillus in the vagina (newborns whose mothers were colonized with Lactobacillus: CD45RO‐10%±3; IL‐12‐0.2 pg/mL ± 0.05; newborns whose mothers were not colonized with Lactobacillus: CD45RO‐6%±3; IL‐12‐2.0 pg/mL ± 0.7). Conclusion Our results may indicate that lactobacilli in maternal vagina influence the development of neonatal immune system. Yet, more research is needed using specified bacterial antigens.     

Interval from prostate biopsy to robot‐assisted radical prostatectomy: effects on perioperative outcomes

OBJECTIVE

To determine whether shorter intervals (<4 and 6 weeks) between prostate biopsy and robot‐assisted radical prostatectomy (RARP) have a detrimental effect on perioperative outcomes, as recent studies showed that open RP shortly after prostate biopsy does not adversely influence surgical difficulty or efficacy, but RARP relies solely on visual cues rather than tactile sensation to determine posterior surgical planes of dissection.

PATIENTS AND METHODS

A series of 559 patients undergoing RARP from March 2004 to July 2007 was retrospectively reviewed. The interval between prostate biopsy and RARP was determined and patients with intervals of ≤4 weeks were compared to those >4 weeks. Patient characteristics and perioperative outcomes were analysed to determine statistically significant differences between the groups. This comparison was then repeated with a ≤6‐ vs >6‐week interval, and examined with a multivariate logistic regression analysis.

RESULTS

In the ≤4‐week group (27 patients) vs the >4‐week group (509 patients), there was a significantly (P < 0.05) higher rate of complications (18.5% vs 6.9%). In the ≤6‐week group (81 patients) vs the >6‐week group (455 patients) there was a smaller but still significantly higher rate of complications (13.6% vs 6.4%). These results were still significant when controlling for patient and disease characteristics and the ‘learning curve’. There was also a significantly higher rate of transfusion in the ≤6‐week group (3.7%) than the >6‐week group (0.7%).

CONCLUSIONS

Our data suggest that RARP should be delayed after prostate biopsy; RARP within 6 weeks of biopsy was associated with a greater risk of complications even when controlling for disease and patient characteristics.     

The 7‐year outcome of the tension‐free vaginal tape procedure for treating female stress urinary incontinence

OBJECTIVE

To evaluate the long‐term results and predictive risk factors for efficacy after the tension‐free vaginal tape (TVT) procedure for treating female stress urinary incontinence (SUI).

PATIENTS AND METHODS

Inall, 306 women (mean age 50.7 years, sd 8.7) who had a TVT procedure for SUI were selected and followed ≥7 years (mean 92.3 months, range 84–110) after surgery. We analysed the long‐term results, the variables predictive of cure rates, and patient satisfaction.

RESULTS

The overall 7‐year cure rate was 84.6%, with a satisfaction rate of 69.3%. The cure rates were lower in patients with high‐grade SUI (50% in grade III, 82.8% in grade II and 90.7% in grade I; P < 0.001). On multivariate analysis, there were no independent risk factors related to cure rate, and urgency was the only factor independently associated with patient satisfaction (P = 0.008; odds ratio 2.47). Seventy‐one patients (23.2%) had complications at the 1‐month follow‐up after surgery, but only eight (2.6%) had complications at the 7‐year follow‐up, including mesh exposure in six and de novo urgency in two.

CONCLUSION

The absence of long‐term adverse events associated with the TVT procedure, and high subjective and objective 7‐year success rates with no independent predictive factors affecting the long‐term cure rate, make the TVT procedure a recommendable surgical treatment for female SUI.     

An analysis of the causes of bladder neck contracture after open and robot‐assisted laparoscopic radical prostatectomy

OBJECTIVES

To evaluate the difference in outcome of bladder neck contracture (BNC) and its causes between large groups of patients undergoing open radical prostatectomy (ORP) and robot‐assisted laparoscopic prostatectomy (RALP).

PATIENTS AND METHODS

We analysed 200 consecutive RPs performed by one surgeon for prostate cancer, 100 by ORP and 100 by RALP, between March 2003 and September 2007. The operative techniques of bladder neck repair and urethro‐vesical anastomosis were different. The ORP patients had a conventional stomatization and ‘racquet handle’ repair of the bladder if necessary, with mucosal eversion and a direct circular interrupted ‘end‐to‐end’ suture anastomosis between the bladder and urethra. The RALP patients had no bladder neck reconstruction or mucosal eversion and their anastomosis was by the continuous suture ‘parachute’ technique.

RESULTS

There was no BNC in the RALP group, whilst 9% of the ORP group developed a BNC (P < 0.005). Apart from surgical technique, other variables, including patient age, previous transurethral resection of the prostate, Gleason score, T stage, urine infection rate, urinary leakage, blood loss, drain tube removal, anastomotic suture material, catheter type and catheter removal times were statistically comparable in both groups.

CONCLUSION

This series suggests that the major factor involved in the cause of bladder neck contracture after ORP, relates to the stomatization or ‘racquet handle’ bladder neck repair, and the end‐to‐end anastomosis between the urethra and stomatized bladder. Mucosal eversion might also contribute. Normal postoperative urinary leakage when the anastomotic apposition is good seems unlikely to be a significant aetiological factor in the development of BNC. Prolonged urinary leakage results from an anastomotic gap, which heals by second intention, thereby causing scarring and BNC. The RALP ‘parachute’ technique, which expands the anastomosis towards the bladder, appears to protect against BNC. Mucosal eversion is not necessary in the parachute repair.