Antithymocyte globulin use for treatment of biopsy confirmed acute rejection is associated with prolonged renal allograft survival

Antithymocyte globuline (ATG) and OKT3 have been used for treatment of severe biopsy confirmed acute renal allograft rejection (BCAR). We report results on graft and patient survival including 399 subjects diagnosed with BCAR treated with either ATG or OKT3. Multivariable analyses including Banff scores were performed following three different strategies to account for confounding variables. Fifty per cent of subjects in the OKT3 group had a functioning graft 6.3 years after diagnosis of BCAR, but 74% of ATG patients' grafts were still functioning at that time point (log rank P  = 0.006). Median actual graft survival was only 4.6 years in the OKT3 subjects, but 9.5 years for ATG-treated patients (log rank P  = 0.004). Multivariable analysis revealed that the risk for functional graft loss was significantly elevated in the OKT3 compared to ATG patients (HR = 1.79, 95% CI 1.06–3.02, P  = 0.029). The risk for actual graft loss, counting death as event, was also significantly elevated in the OKT3 patients (HR = 1.73, 95% CI 1.09–2.74, P  = 0.019). The hazard of death was not different between the groups (HR = 1.55, 95% CI 0.87–2.77, P  = 0.137). These data suggest that rejecting renal allografts treated with ATG exhibit longer graft survival than OKT3 treated transplant kidneys. Causal inference, however, cannot be drawn from this associational study.     

Survival and sinus rhythm maintenance after modified Cox/maze procedure and mitral valve operation in patients with chronic atrial fibrillation

OBJECTIVE: Sinus rhythm gained after the Cox/maze procedure concomitant with mitral valve operation has demonstrated long-term attrition during the follow-up, no information exists on whether the type of mitral valve operation--(repair vs. replacement)--affects this sinus rhythm maintenance rate. We retrospectively studied patients undergoing concomitant mitral valve operation and Cox/maze procedure to answer this question. METHODS: Between April 1993 and August 1995, 87 consecutive patients--35 men and 52 women (mean age: 59.3 years)--with chronic atrial fibrillation and mitral valve disease underwent the modified Cox/maze procedure and concomitant mitral valve operation, with 56 having mitral valve repair (repair group) and 31 mitral valve replacement (replacement group). Patients were followed up and changes in rhythm studied retrospectively. RESULTS: Follow-up for a mean 51.3 +/- 11.6 months was completed in 82 of 83 long-term survivors (99%). Repair group surgery survival was 98.1 +/- 1.9% at 1 year and 94.2 +/- 3.2% at 5 based on the Kaplan-Meier method. Replacement group surgery survival was 85.7 +/- 5.9% at 1 year and 82.9 +/- 6.4% at 5. Probability in sinus rhythm maintenance for the repair group at 1 year was 88.6 +/- 5.4% and at 5 years was 67.6 +/- 9.1%. Probability in sinus rhythm maintenance for the replacement group at 1 year was 95.7 +/- 4.3% and at 5 years was 65.0 +/- 11.1%. CONCLUSIONS: Medium-term results after the Cox/maze III procedure concomitant with mitral valve operation are good. The attrition of sinus rhythm maintenance appears similar by the completion of 5-year follow-up.     

Risk factors for prostatic inflammation extent and infection in benign prostatic hyperplasia

Aim:To investigate the risk factors for prostatic inflammation extent and infection in patients with benign prostatichyperplasia(BPH)so as to manage prostatic inflammation more efficiently.Methods:Sixty patients with BPHundergoing TURP between September 2005 and December 2005 in West China Hospital of Sichuan University werestudied.Prostate fluid(PF)was collected for the measurement of secretory IgA(SIgA)and complement 3(C3).Prostate tissue were collected for testing bacterial 16S rDNA by real-time PCR,examining SIgA in the tissue andexamining the inflammation.The possible clinical and immune risk factors for prostatic inflammation or infection wereanalyzed by using the logistic regression method.Results:Abnormal white blood cell count in urinalysis,prostaticinfection and a high concentration of C3 in PF are the risk factors for prostatic inflammation extent(P=0.025,0.034 and0.035,respectively and odds ratio[OR]=18.269,8.284 and 1.508,respectively).Risk factors for prostatic infectioninclude the C3 concentration and the concentration of SIgA in PF(P=0.003 and 0.013,respectively,and OR=1.645 and0.993,respectively).Conclusion:The present study suggests that prostatic inflammation is associated with urinarytract infection,prostatic infection and the activated complement and that prostatic infection is associated with theactivated complement and downregulated mucosal immunity in prostates of the patients with BPH.It is also sug-gested that individual immune regulation should be considered in the treatment of prostatic inflammation and infectionof patients with BPH.(Asian J Androl 2006 Sep;8:621-627)     

ERCP术后胰腺炎危险因素的Logistic回归分析及预防措施

目的：探讨ERCP手术后诱发胰腺炎的相关危险因素。方法整群选取2012年1月—2014年1月在该院行ERCP治疗的126例患者,其中诱发PEP患者作为观察组(63例),术后未发生PEP者作为对照组(63例)。对ERCP术后胰腺炎危险因素进行单因素与多因素Logistic回归分析。结果单因素Logistic回归分析中,女性、胰管显影、手术操作时间(≥45 min)、﹥60岁、鼻胆管引流以及胆管支架与PEP发生存在密切关系。多因素Logistic回归分析中,胰管显影与手术操作时间≥45 min(OR值分别为13.417与6.203)为PEP危险因素。结论 ERCP术需注意手术时间、鼻胆管或支架的引流等PEP相关因素。     

颈后路单开门椎管扩大成形术临床疗效影响因素的研究

目的 探讨影响颈后路单开门椎管扩大成形术(ELAP)临床疗效的相关因素. 方法 选取30例采用ELAP治疗并获得24月以上随访的患者,评测患者术前JOA评分、术后末次随访JOA评分,测量患者颈椎管正中矢状径增加距离(SCD)、开门距离(LOS)、开门角度(LOA)、术前颈椎前凸角度(LA),并结合年龄、性别、手术时间、术中出血等参数,研究以上参数之间及其与术后JOA评分改善率的相互影响关系. 结果 患者术前JOA评分平均分为(10.13±2.16),术后JOA评分平均分为(13.97±1.78),JOA评分改善率为(56.22±22.47)％.年龄≥70岁则JOA评分改善率明显下降,与其他年龄组比较,差别有统计学意义(P＜0.05);不同性别组之间JOA评分改善率无明显差别(P＞0.05);术前、术后JOA评分具有显著正相关(P＜0.01);年龄与术前评分间无显著相关,与术后JOA评分具有显著负相关(P＜0.05);SCD,LOS及IOA 3者之间呈显著相关(P＜0.01);LA与SCD,LOS,LOA无相关;术后JOA评分改善率与LOS呈显著相关(P＜0.01),与SCD呈显著相关(P＜0.05). 结论 SCD,LOS及LOA 3者之间呈显著相关;术后JOA评分改善率与LOS,SCD呈显著相关;LOS及SCD对ELAP临床疗效有显著影响.     

全膝关节置换术后康复影响因素的前瞻性队列研究

目的  探讨影响全膝关节置换术（TKA）患者术后康复的相关因素,为预测患者术后康复情况及制定预防控制措施提供科学依据。方法  采用前瞻性队列研究方法,选取2010年1月-2014年6月在该院住院治疗并行TKA的患者310例,组成队列资料。应用Spearman相关性分析及多元Logistic回归的方法,分析人口学因素、临床及手术因素对患者术后功能恢复的影响。结果  310例患者中,12例因故取消或推迟手术,19例于随访期内脱失,最终纳入综合分析患者共279例。Spearman相关性分析结果显示,性别、年龄、体重指数（BMI）、吸烟史、糖尿病史、低白蛋白血症、应用静脉血栓形成危险度（RAPT）评分、基于性能的功能测试（PBT）评分、手术时间、术中出血量、术后疼痛与患者术后康复相关（P <0.05）。多元Logistic回归结果表明,较大的年龄及BMI、糖尿病史、RAPT及PBT评分较差为延长患者住院时间的危险因素;较大的年龄、糖尿病史、低白蛋白血症为罹患术后并发症的危险因素;较大的年龄、糖尿病史为影响术后肢体功能恢复的危险因素,RAPT及PBT评分为术后肢体功能恢复的预测因子。结论  TKA患者术后康复与多种因素相关。临床应重点关注具有上述危险因素的患者,于术前及术中采取有效预防措施,促进患者康复。

     

酒精依赖患者述情障碍的对照研究

目的：探讨酒精依赖患者的述情障碍特征,并与健康对照者进行比较分析。方法选取酒精依赖患者34例,健康对照者35例,应用密西根酒精依赖调查表（ MAST）、多伦多述情障碍量表（ TAS）评定酒精依赖患者的饮酒状况及两组的述情障碍状况。结果（1）与饮酒有关问题中重度者32例,占患者总数的94.12％;（2） TAS总分、酒精依赖患者的描述情感的能力（因子Ⅰ）,认识、区别情绪和躯体感受的能力（因子Ⅱ）及外向型思维（因子Ⅳ）评分显著高于对照组（ P＜0.05）;（3） TAS 总分及其因子Ⅰ、因子Ⅱ评分与 MAST 总分及其工作、社会问题（因子2）、婚姻家庭问题（因子4）均呈正相关（ P＜0.05）;（4） TAS总分及其各因子分影响因素的回归分析：外向型思维因子Ⅳ＝26.512－0.819×日均饮酒量。结论酒精依赖患者存在突出的述情障碍,应引起特别关注。