内蒙古自治区器官捐献和移植工作现状与思考

<正>器官移植手术技术的改良、基础研究的突破以及新型免疫抑制剂的成功研发等医学进步,已使器官移植受者生存率和生活质量不断提高,但供器官来源问题始终是器官移植领域最大的困扰~([1])。我国开展公民逝世后器官捐献工作相对较晚,相关法规条例尚不够完善。同时,由于各地人口密度、地域文化、经济发展以及医疗设施和技术的差异,器官捐献工作的发展极不均衡,导致全国移植医疗资源严重失衡和医疗迁徙不断加剧,不仅增加了器官衰竭     

甲状腺手术切口入路、缝合技术与缝合材料选择中国专家共识（2018版）

正随着外科手术技术的发展和人们对美学追求的不断提高,病人对甲状腺术后切口外观的重视程度也越来越高。如何在保证甲状腺手术质量的前提下,最大限度地降低手术对各解剖层次的损伤,减轻切口瘢痕,满足病人的美容要求,一直是外科医生追求的目标。目前,关于甲状腺手术切口入路、缝合技术及缝合材料选择方面的报道并不多,术者多以临床经验和个人习惯进行操作,存在的差异也较大。中华医学会外科学分会组织国内部分专家参考     

乳腺癌术后乳房重建的腹壁缺损修复基本原则及材料选择

乳腺癌根治性切除术后的自体乳房重建目前已被广泛应用于临床,但某些术式的自体乳房重建手术会造成一定程度的腹壁缺损。腹壁缺损导致腹壁正常功能的缺失,进而引起一系列严重的病理生理学改变。目前常用的手术方式有带蒂腹直肌皮瓣和腹壁下深动脉穿支皮瓣的乳房重建。根据乳腺癌术后乳房自体重建术后不同的腹壁缺损的类型,应该在严格遵循腹壁修复的基本原则的基础上,制定相应的手术修补方案。同时根据不同的腹壁缺损范围选择适当的腹壁修复材料。乳房重建术后形成的腹壁缺损通常其腹直肌后鞘和腹膜是完整的,腹直肌前鞘也可能保留,手术方式可选择腹壁不同层次的修复,同时强调应用修补材料进行修复。     

Importance of incorporating standardized,verifiable, objective metrics of organ procurement organization performance into discussions about organ allocation

Identifying and supporting specific organ procurement organizations (OPOs) with the greatest opportunity to increase donation rates could significantly increase the number of organs available for transplant. Accomplishing this is complicated by current Scientific Registry of Transplant Recipients/Centers for Medicare & Medicaid Services metrics of donation rates and OPO performance that rely on eligible deaths. These data are self‐reported and unverifiable and have been shown to underestimate potential organ donors. We examine the limitations of current OPO performance/donation metrics to inform discussions related to strategies to increase donation. We propose changing to a simple, verifiable, and uniformly applied donation metric. This would allow the transplant community to (1) better understand inherent differences in donor availability based on geography and (2) identify underperforming areas that would benefit from systems improvement agreements to increase donation rates.     

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on “high‐dose” inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2‐ to 3‐fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5‐fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.     

连续Z型缝合及可吸收材料填塞在慢性鼻窦炎伴鼻中隔偏曲术中应用

鼻窦炎是鼻窦黏膜的炎症性疾病,多与鼻炎同时存在,也称为鼻-鼻窦炎。症状超过12周的为慢性鼻窦炎,鼻中隔偏曲是指鼻中隔形态上向一侧或双侧或局部突起,并引起相应症状者。鼻窦炎中合并鼻中隔偏曲者并不少见。鼻窦炎伴有鼻中隔偏曲患者行鼻窦开放术时,需行鼻中隔矫正的不在少数;通常是在开放鼻窦的同时行鼻中隔矫正术,伴有下鼻甲肥大的行下鼻甲的骨折外移术或下鼻甲黏膜下骨部分切除术。     

猪胆总管脱细胞基质构建组织工程胆管的生物力学评价

目的　用不同的脱细胞方法对猪胆总管进行处理,比较脱细胞前后的生物力学变化,筛选适宜的脱细胞方法,为组织工程胆管支架材料的应用提供理论依据。 方法　30例猪胆总管,随机分为5组,A组：对照组, B组：0.05 % 胰蛋白酶+核酸酶,C组：0.1 % SDS+核酸酶,D组：1.0 % Triton X-100+核酸酶,E组：1.0 % Triton X-100+0.1 % SDS +核酸酶。在Test Resources生物力学试验机上进行加载一卸载试验和极限抗张强度试验。计算出生物力学材料常数（α1、β1、α2、β2）、弹性模量、极限抗张强度和断裂伸长率等指标。 结果　Ｄ组、Ｅ组的生物力学材料常数（α1、β1、α2、β2）与A组的差异无统计学意义（F = 12.21, P = 0.06）,Ｂ组、C组比A组、D组和Ｅ组的小（P < 0.01）;Ｄ组、Ｅ组的弹性模量比A组的稍增大,但差异不明显（P > 0.05）,Ｂ组、C组比A组的小（P < 0.05）;Ｄ组、Ｅ组的UTS值和SOF值与A组差异不明显（P > 0.05）;B组、C组的UTS值明显小于A组（P < 0.05）,SOF值明显大于A组（P < 0.05）。 结论 应用1.0 % Triton X-100+核酸酶和1.0 % Triton X-100+0.1 % SDS +核酸酶的脱细胞效果好,且不会影响猪胆总管的生物力学特性,是一种比较理想的猪胆总管脱细胞方法。     

Readability,Suitability and Health Content Assessment of Cancer Screening Announcements in Municipal Newspapers in Japan

Background: The objective of this study was to assess the readability, suitability, and health content of cancerscreening information in municipal newspapers in Japan. Materials and Methods: Suitability Assessment ofMaterials (SAM) and the framework of Health Belief Model (HBM) were used for assessment of municipalnewspapers that were published in central Tokyo (23 wards) from January to December 2013. Results: The meandomain SAM scores of content, literacy demand, and layout/typography were considered superior. The SAMscores of interaction with readers, an indication of the models of desirable actions, and elaboration to enhancereaders’ self-efficacy were low. According to the HBM coding, messages of medical/clinical severity, of socialseverity, of social benefits, and of barriers of fear were scarce. Conclusions: The articles were generally wellwritten and suitable. However, learning stimulation/motivation was scarce and the HBM constructs were notfully addressed. Practice implications: Articles can be improved to motivate readers to obtain cancer screeningby increasing interaction with readers, introducing models of desirable actions and devices to raise readers’self-efficacy, and providing statements of perceived barriers of fear for pain and time constraints, perceivedseverity, and social benefits and losses.     

Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin

Aim  To determine the types of periapical lesions associated with root filled teeth with persistent periapical pathosis that required surgical treatment based on specific inclusion and exclusion criteria.
Methodology  Periapical lesions from a consecutive clinical sample of 100 patients were examined histopathologically to determine a definitive diagnosis.
Results  Females were more represented ( n  = 56), the average age was 46.5 years and there were no age differences between gender or lesion type. A diagnosis of periapical granuloma was the most common finding with a similar number present in females ( n  = 40) and males ( n  = 37). A cyst was present in 18% of the cases with a majority of females ( n  = 12) represented in the sample. Evidence of foreign material, with an appearance consistent with endodontic sealer materials, was seen in 25 periapical granulomas, two cysts and one scar. Two periapical scars were seen, one had a history of apicectomy and amalgam root-end filling while the other was associated with extruded root filling material.
Conclusions  By using defined clinical inclusion and exclusion criteria a predictable clinical diagnosis of a persistent periapical lesion due to endodontic origin can be reliably made. Periapical granulomas and cysts were the most common periapical lesions of endodontic origin associated with persistent periapical pathosis with the overall incidence of periapical cysts similar to previous studies. The presence of endodontic material in a high proportion of periapical lesions suggests a cause-effect association with the inference that clinicians should employ canal preparation techniques that limit apical extrusion of material.