• 【使用5至7个插入的微刺激器进行卒中后上肢康复:植入程序,安全性和恢复功能的功效。】 复制标题 收藏 收藏
    DOI:10.1016/j.apmr.2008.05.010 复制DOI
    作者列表:Davis R,Sparrow O,Cosendai G,Burridge JH,Wulff C,Turk R,Schulman J
    BACKGROUND & AIMS: OBJECTIVE:To investigate the feasibility of implanting microstimulators to deliver programmed nerve stimulation for sequenced muscle activation to recover arm-hand functions. DESIGN:By using a minimally invasive procedure and local anesthesia, 5 to 7 microstimulators can be safely and comfortably implanted adjacent to targeted radial nerve branches in the arm and forearm of 7 subjects with poststroke paresis. The microstimulators' position should remain stable with no tissue infection and can be programmed to produce effective personalized functional muscle activity with no discomfort for a preliminary 12-week study. Clinical testing, before and after the study, is reported in the accompanying study. SETTING:Microstimulator implantations in a sterile operating room. PARTICIPANTS:Seven adults, with poststroke hemiparesis of 12 months or more. INTERVENTION:Under local anesthesia, a stimulating probe was inserted to identify radial nerve branches. Microstimulators were inserted by using an introducer and were retrievable for 6 days by attached suture. Each device was powered via a radiofrequency link from 2 external cuff coils connected to a control unit. MAIN OUTCOME MEASURES:To achieve low threshold values at the target sites with minimal implant discomfort. Microstimulators and external equipment were monitored over 12 weeks of exercise. RESULTS:Seven subjects were implanted with 41 microstimulators, 5 to 7 per subject, taking 3.5 to 6 hours. Implantation pain levels were 20% more than anticipated. No infections or microstimulator failures occurred. Mean nerve thresholds ranged between 4.0 to 7.7 microcoulomb/cm(2)/phase over 90 days, indicating that cathodes were within 2 to 4 mm of target sites. In 1 subject, 2 additional microstimulators were inserted. CONCLUSIONS:Microstimulators were safely implanted with no infection or failure. The system was reliable and programmed effectively to perform exercises at home for functional restoration.
    背景与目标: 目的:探讨植入微刺激器以提供程序性神经刺激以进行顺序肌肉激活以恢复手臂功能的可行性。
    设计:通过微创手术和局部麻醉,可以安全舒适地将5至7种微刺激器植入7名卒中后轻瘫患者的手臂和前臂的radial骨目标神经分支附近。微刺激器的位置应保持稳定,没有组织感染,并且可以进行编程,以产生有效的个性化功能性肌肉活动,而不会进行为期12周的初步研究。在研究之前和之后的临床测试报告在随附的研究中。
    地点:在无菌手术室中植入微刺激器。
    参与者:七名成年人,卒中后偏瘫为12个月或更长时间。
    干预:在局部麻醉下,插入刺激探针以识别radial神经分支。通过使用导引器插入微刺激器,并通过缝合线将其恢复6天。每个设备都通过射频链路由连接到控制单元的2个外部袖带线圈供电。
    主要观察指标:在目标部位达到低阈值,并使植入物不适感降至最低。在运动的12周内对微刺激器和外部设备进行了监测。
    结果:七名受试者植入了41种微刺激器,每名受试者5至7个,时间为3.5至6个小时。植入疼痛水平比预期高20%。没有发生感染或微刺激器故障。在90天内,平均神经阈值范围在4.0至7.7微库仑/ cm(2)/阶段之间,表明阴极位于目标部位的2至4 mm之内。在1名受试者中,插入了2个额外的微刺激器。
    结论:微刺激器被安全植入,没有感染或失败。该系统可靠且编程有效,可以在家中进行锻炼以恢复功能。
  • 【经尿道输尿管造口术作为辅助性抗反流方法,适用于患有严重反流的神经源性膀胱的接受膀胱增大的儿童。】 复制标题 收藏 收藏
    DOI:10.1016/j.jpurol.2019.12.006 复制DOI
    作者列表:Jacob TJK,James Sam C,Jacob Kurian J,Karl IS,Kisku SMC,Sen S
    BACKGROUND & AIMS: INTRODUCTION:Transureteroureterostomy (TUU) provides urinary drainage of both renal systems to the bladder via a single ureter and is useful in selected situations of complex urological reconstructions. Herein we discuss its use, advantages and complications in children with neurogenic bladders and high-grade (4/5) reflux who have undergone augmentation cystoplasty. PATIENTS AND METHODS:Children with neurogenic bladder complicated by unilateral or bilateral high-grade vesicoureteric reflux (VUR), who underwent TUU along with augmentation cystoplasty (BA), were selected from two institutions. Eighteen children with an average age of 5 years at presentation were identified from a retrospective chart review. RESULTS:All had bilateral hydroureteronephrosis (HUN) of which there were 30 refluxing megaureters. While BA reduced bladder pressure, VUR was managed by refluxing to non-refluxing TUU in six cases with unilateral VUR and unilateral reimplantation with TUU to the reimplanted ureter in 12 cases of bilateral VUR, thus minimizing reimplantation to 12 of 30 ureters. The average time of follow-up was 51 months. Follow-up cystograms showed complete resolution of VUR in all. HUN improved/stabilized in all but one child. Serum creatinine remained normal in all but two cases. Other advantages of TUU include the use of the distal ureter as a catheterizable channel and ease of undiversion when the ureter has been diverted as a ureterostomy. An unusual complication of a TUU site stricture is discussed and the innovative technique of using a cecal patch to salvage the anastomosis is detailed. CONCLUSION:We conclude that a TUU is a safe and useful adjunctive procedure in children undergoing BA for neurogenic bladder with high-grade VUR, minimizing the need for ureteric reimplant in an unhealthy bladder.
    背景与目标: 简介:经尿道输尿管造口术(TUU)可通过单个输尿管将两个肾脏系统的尿液引流至膀胱,在某些复杂的泌尿系统重建情况下很有用。在这里,我们讨论了其在接受了扩大性膀胱成形术的神经源性膀胱和高位(4/5)反流的儿童中的使用,优点和并发症。
    患者与方法:从两个机构中选择接受TUU并同时行膀胱扩大成形术(BA)的神经源性膀胱并发单侧或双侧高级别膀胱输尿管反流(VUR)的儿童。通过回顾性图表审查确定了18名平均年龄为5岁的儿童就诊。
    结果:所有患者均患有双侧输尿管肾盂积水(HUN),其中有30例回流的大输尿管。虽然BA降低了膀胱压力,但在6例单侧VUR的情况下,通过回流至非回流TUU来处理VUR,而在12例双侧VUR的单侧再植入输尿管的情况下,将TUU单侧再植入,从而最大限度地减少了再植入30例输尿管中的12例。平均随访时间为51个月。随访的膀胱造影显示所有VUR均已完全消退。除一名儿童外,所有儿童的HUN均得到改善/稳定。除两例外,其余所有患者的血清肌酐均保持正常。 TUU的其他优点包括将远端输尿管用作可导管插入的通道,当输尿管已被转移为输尿管造口术时,易于转移。讨论了TUU部位狭窄的异常并发症,并详细介绍了使用盲肠贴片修复吻合的创新技术。
    结论:我们得出结论,对于接受高级别VUR的神经源性膀胱BA的患儿,TUU是一种安全而有用的辅助手术,可最大程度地减少不健康膀胱中输尿管再植的需要。
  • 【3叶螺旋桨泵的性能,可在丰坦循环​​失败时提供腔肺帮助。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2008.06.026 复制DOI
    作者列表:Throckmorton AL,Ballman KK,Myers CD,Frankel SH,Brown JW,Rodefeld MD
    BACKGROUND & AIMS: PURPOSE:We hypothesized that a propeller pump design would function optimally to provide cavopulmonary assist in a univentricular Fontan circulation. DESCRIPTION:The hydraulic and hemolysis performance of a rigid three-bladed propeller prototype (similar to a folding propeller design) was characterized. Pressure and flow measurements were taken for flow rates of 0.5 to 3 liters per minute (LPM) for 5,000 to 7,000 revolutions per minute (RPM) using a blood analog fluid. Hemolysis testing was performed using fresh bovine blood for 2 LPM at 6,000 RPM for a 6-hour duration. EVALUATION:The prototype performed well over the design operating range by producing a pressure rise of 5 to 50 mm Hg. Plasma free hemoglobin concentration remained less than 15 mg/dL. The normalized index of hemolysis peaked during the first hour, and then remained less than 10 mg/dL thereafter. CONCLUSIONS:A propeller pump has the pressure-flow characteristics and minimal risk of hemolysis and venous pathway obstruction which make it ideal for temporary cavopulmonary assist. This type of device has the potential to provide a new therapeutic option for patients with failing univentricular Fontan physiology as a bridge-to-recovery or transplantation.
    背景与目标: 目的:我们假设螺旋桨泵的设计可以最佳地发挥功能,以在单心室芳坦循环中提供腔肺辅助。
    描述:表征了刚性三叶螺旋桨原型的液压和溶血性能(类似于折叠式螺旋桨设计)。使用血液模拟液,以每分钟0.5至3升(LPM)的流量进行压力和流量测量,每分钟5,000至7,000转(RPM)。使用新鲜牛血以6,000 RPM的速度进行2 LPM的溶血测试,持续6小时。
    评估:通过产生5至50 mm Hg的压力上升,该原型在设计工作范围内表现良好。血浆游离血红蛋白浓度仍低于15 mg / dL。溶血标准化指数在第一个小时达到峰值,然后保持低于10 mg / dL。
    结论:螺旋桨泵具有压力流量特性,溶血和静脉通路阻塞的风险最小,因此非常适合临时腔肺辅助。这种类型的设备有可能为单心室Fontan生理功能不佳的患者(作为通往康复或移植的桥梁)提供一种新的治疗选择。
  • 【诺伍德手术后肺动脉的发育:Blalock-Taussig分流器与右心室-肺动脉导管之间的比较。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2008.06.016 复制DOI
    作者列表:Caspi J,Pettitt TW,Mulder T,Stopa A
    BACKGROUND & AIMS: BACKGROUND:The Norwood-Sano procedure for hypoplastic left heart syndrome (HLHS) has been associated with improved postoperative hemodynamics and outcome. This study compared the effect of a Blalock-Taussig shunt with right ventricular-pulmonary artery (RV-PA) conduit before bidirectional Glenn on the development of the PAs. METHODS:Between January 2000 and June 2007, 42 patients with HLHS underwent bidirectional Glenn: 19 (mean age, 7 +/- 1.5 months) had a Blalock-Taussig shunt (3.5 mm in 15; and 4 mm in 4); 23 patients (mean age, 5 +/- 1 month) had RV-PA conduit (5-mm tube). Patients underwent postoperative cardiac catheterization and echocardiograms. RESULTS:Total PA (Nakata) index was 192 +/- 10 mm2/m2 in the Blalock-Taussig group and 238 +/- 18 mm2/m2 in the RV-PA conduit group (p = 0.03). In the RV-PA conduit patients, the left and right PAs had comparable diameters. In the Blalock-Taussig group, the left PA was smaller than the right (p = 0.02). The mean PA pressure at the end of the operation was 14 +/- 2 mm Hg in the Blalock-Taussig group and 11 +/-1 mm Hg in the RV-PA conduit group (p = 0.06). Persistent pleural effusion occurred in 4 Blalock-Taussig patients (21%) and in 1 (4%) with RV-PA conduit (p < 0.05). Postoperative arterial oxygen saturation was 80% +/- 2% in the RV-PA conduit group and 74% +/- 2% in the Blalock-Taussig group (p < 0.05). CONCLUSIONS:The Norwood procedure with RV-PA conduit may have favorable effects on the development of the PA due to even distribution of pulmonary blood flow.
    背景与目标: 背景:Norwood-Sano手术治疗左心发育不全综合征(HLHS)与改善术后血流动力学和预后相关。这项研究比较了双向双向Glenn之前Blalock-Taussig分流器与右心室-肺动脉(RV-PA)导管对PA发育的影响。
    方法:在2000年1月至2007年6月之间,对42例HLHS患者进行了双向Glenn治疗:19例(平均年龄7 /-1.5个月)进行了Blalock-Taussig分流术(15mm时3.5mm; 4mm时4mm)。 23例患者(平均年龄5 /-1个月)使用RV-PA导管(5毫米管)。患者接受了术后心脏导管检查和超声心动图检查。
    结果:Blalock-Taussig组的总PA(中和)指数为192 /-10 mm2 / m2,RV-PA导管组的总PA(中和)指数为238 /-18 mm2 / m2(p = 0.03)。在RV-PA导管患者中,左PA和右PA具有可比较的直径。在Blalock-Taussig组中,左PA小于右PA(p = 0.02)。手术结束时,Blalock-Taussig组的平均PA压力为14 /-2 mm Hg,RV-PA导管组的平均PA压力为11 / -1 mm Hg(p = 0.06)。持续性胸腔积液发生在4例Blalock-Taussig患者(21%)和1例(4%)RV-PA导管中(p <0.05)。 RV-PA导管组的术后动脉血氧饱和度为80%/-2%,Blalock-Taussig组为74%/-2%(p <0.05)。
    结论:RV-PA导管的Norwood手术可能由于肺血流的均匀分布而对PA的发展产生有利的影响。
  • 【瓣膜保留术成功治疗了巨大的瓦萨尔瓦动脉瘤破裂窦-病例报告。】 复制标题 收藏 收藏
    DOI:10.1186/s13019-020-1061-1 复制DOI
    作者列表:Pólos M,Șulea CM,Benke K,Ágg B,Kovács A,Hartyánszky I,Merkely B,Schäfers HJ,Szabolcs Z
    BACKGROUND & AIMS: BACKGROUND:Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. CASE PRESENTATION:A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. CONCLUSIONS:Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.
    背景与目标: 背景:窦静脉窦动脉瘤(SVA)是一种罕见的心脏异常,其发病率不到心脏直视手术病例的1%。它的进化通常是沉默的,偶然发现或在其急性破裂时被发现。由于未破裂的巨型SVA伸入心腔或冠状动脉受压,可能会导致异常的临床表现,并经常伴有各种严重程度的主动脉瓣关闭不全。 SVA的金标准治疗包括完全替换主动脉根部和瓣膜。但是,在某些情况下,阀保持程序可能被证明是更合适的选择。
    病例介绍:一名68岁的男性患者,由于Valsalva动脉瘤的右窦大(> 5cm)而出现呼吸困难。动脉瘤占据了右心室的大部分,并伴有严重的主动脉瓣关闭不全。病情的外科治疗包括保留瓣膜的根部重建程序(重塑技术),并通过缝合线瓣环成形术通过主动脉瓣环的外部稳定来完成。经过平稳的干预,患者表现良好,病情得到改善。术后1个月进行的经胸超声心动图检查显示主动脉瓣完全干competent,无反流。
    结论:尽管主动脉根和瓣膜完全置换被认为是大型SVA并发主动脉瓣关闭不全的最安全方法,但如果主动脉根未扩张而主动脉瓣未钙化,则不应该忽视瓣膜保留程序。通过应用瓣膜成形术完成的重塑技术进行瓣膜保留术,可减少主动脉瓣膜功能不全,避免与植入瓣膜有关的副作用。
  • 【串联亲和纯化(TAP)方法:蛋白质复合物纯化的一般程序。】 复制标题 收藏 收藏
    DOI:10.1006/meth.2001.1183 复制DOI
    作者列表:Puig O,Caspary F,Rigaut G,Rutz B,Bouveret E,Bragado-Nilsson E,Wilm M,Séraphin B
    BACKGROUND & AIMS: :Identification of components present in biological complexes requires their purification to near homogeneity. Methods of purification vary from protein to protein, making it impossible to design a general purification strategy valid for all cases. We have developed the tandem affinity purification (TAP) method as a tool that allows rapid purification under native conditions of complexes, even when expressed at their natural level. Prior knowledge of complex composition or function is not required. The TAP method requires fusion of the TAP tag, either N- or C-terminally, to the target protein of interest. Starting from a relatively small number of cells, active macromolecular complexes can be isolated and used for multiple applications. Variations of the method to specifically purify complexes containing two given components or to subtract undesired complexes can easily be implemented. The TAP method was initially developed in yeast but can be successfully adapted to various organisms. Its simplicity, high yield, and wide applicability make the TAP method a very useful procedure for protein purification and proteome exploration.
    背景与目标: :鉴定生物复合物中存在的成分需要将其纯化至接近均一。纯化方法因蛋白质而异,因此无法设计适用于所有情况的通用纯化策略。我们已经开发了串联亲和纯化(TAP)方法作为一种工具,即使在其天然水平表达时,该方法也可以在复合物的天然条件下进行快速纯化。不需要复杂的组成或功能的先验知识。 TAP方法需要将TAP标签的N端或C端融合到目标靶蛋白上。从相对少量的细胞开始,可以分离出活性大分子复合物并将其用于多种应用。可以容易地实现各种方法的变型,以专门纯化包含两种给定组分的复合物或减去不希望的复合物。 TAP方法最初是在酵母中开发的,但可以成功地适应各种生物。它的简单性,高收率和广泛的适用性使TAP方法成为蛋白质纯化和蛋白质组学探索中非常有用的程序。
  • 【验证心包液中可卡因和代谢物的气相色谱-质谱分析方法的有效性。】 复制标题 收藏 收藏
    DOI:10.1093/jat/31.2.75 复制DOI
    作者列表:Contreras MT,González M,González S,Ventura R,Valverde JL,Hernández AF,Pla A,Vingut A,Segura J,de la Torre R
    BACKGROUND & AIMS: :A method is described for the simultaneous quantification of cocaine, benzoylecgonine, and cocaethylene in pericardial fluid. Pericardial fluid samples from autopsy casework involving cocaine-related deaths and deaths unrelated to drug abuse were collected. The extraction of cocaine and its metabolites was performed using Bond-Elut Certify columns. Pericardial fluid samples were adjusted to pH 7 and applied to the pre-conditioned cartridges. After the washing steps, compounds were eluted with a mixture of chloroform/isopropanol (80:20) with 2% ammonium hydroxide. The dry extracts were derivatized with pentafluoropropionic anhydride and hexafluoroisopropanol and analyzed by gas chromatography-mass spectrometry using electron impact ionization and selective ion monitoring acquisition. Deuterated internal standards were used. The analytical method developed was linear, sensitive, selective, accurate, and sufficiently precise to be applied routinely in forensic toxicology. In this study, the procedure has been successfully applied to a number of forensic cases involving cocaine intoxication.
    背景与目标: :描述了一种同时定量心包液中可卡因,苯甲酰芽子碱和可卡因的方法。从涉及可卡因相关死亡和与药物滥用无关的死亡的尸检案例中收集心包液样品。可卡因及其代谢物的提取使用Bond-Elut Certify色谱柱进行。将心包液样品的pH值调节至7,然后将其施加到预处理过的药筒上。洗涤步骤后,将化合物用氯仿/异丙醇(80:20)与2%氢氧化铵的混合物洗脱。将干燥的提取物用五氟丙酸酐和六氟异丙醇衍生化,并通过使用电子碰撞电离和选择性离子监测采集的气相色谱-质谱分析。使用氘代内标。所开发的分析方法是线性,灵敏,选择性,准确且足够精确的,可常规用于法医毒理学。在这项研究中,该程序已成功应用于许多涉及可卡因中毒的法医案件。
  • 【机械腔静脉辅助在MRI衍生的患者特定font门构型中的稳定流动分析。】 复制标题 收藏 收藏
    DOI:10.1111/j.1525-1594.2012.01510.x 复制DOI
    作者列表:Downs EA,Moskowitz WB,Throckmorton AL
    BACKGROUND & AIMS: :This numerical study examined the performance of an intravascular axial flow blood pump for mechanical hemodynamic support of patients in the setting of Fontan failure, which presently has few treatment options. Three anatomically accurate geometries of the total cavopulmonary connection (TCPC) were generated using patients' magnetic resonance imaging data. These patient-specific geometries, as well as an idealized version with cylindrical vessels, were computationally analyzed with and without a pump in the inferior vena cava. Pressure flow characteristics, energy gain calculations, and blood damage analyses were performed for each model. The pump produced pressures of 1-14 mm Hg for 1500-4000 revolutions per minute, flow rates of 1-4 L/min, and pulmonary artery pressures of 8-24 mm Hg. Comparison of pump performance among the four models showed minimal intermodel differences (<5% deviation) in the pressure rise generated by the pump, the IVC pressure, and the energy imparted to the system by the pump. Blood damage analysis showed maximum fluid scalar stress values of 372 Pa or less, and the blood damage index was less than 2% in all of the models. These results suggest that this axial flow blood pump performs consistently in a variety of TCPC vessel geometries with low risk of blood trauma.
    背景与目标: :这项数值研究检查了在Fontan衰竭的情况下血管内轴流式血液泵对患者进行机械血流动力学支持的性能,目前尚无治疗选择。使用患者的磁共振成像数据生成了总腔肺连接(TCPC)的三个解剖学精确的几何形状。在下腔静脉中有无泵的情况下,对这些特定于患者的几何形状以及带有圆柱形血管的理想版本进行了计算分析。对每个模型进行压力流量特性,能量获取计算和血液损伤分析。泵以每分钟1500-4000转的速度产生1-14 mm Hg的压力,1-4 L / min的流速以及8-24 mm Hg的肺动脉压力。四个模型之间的泵性能比较显示,泵产生的压力上升,IVC压力和泵传递给系统的能量之间存在最小的模型间差异(偏差小于5%)。血液损伤分析显示所有模型的最大液体标量应力值为372 Pa或更低,血液损伤指数小于2%。这些结果表明,这种轴流式血泵在各种TCPC血管几何形状中均具有一致的性能,且血液外伤的风险较低。
  • 9 Procedure for the decerebration of the rat. 复制标题 收藏 收藏

    【大鼠去脑程序。】 复制标题 收藏 收藏
    DOI:10.1016/0361-9230(78)90016-3 复制DOI
    作者列表:Sapru HN,Krieger AJ
    BACKGROUND & AIMS: :A procedure for the decerebration of the rat was devised. The internal and external carotid arteries were ligated under halothane anesthesia. A transection was made at the mid-collicular level of the brain and the transected forebrain was removed. The posterior communicating arteries were occluded by suction and oxidized cellulose was packed around these vessels. The cut surface of the brain was covered with oxidized cellulose and the cranial cavity was filled with cotton balls. Head-up tilt, carotid occlusion and sodium cyanide responses indicated that the orthostatic, baro-, and chemo- reflexes were intact in these preparations. The stability of the preparation (for at least 8-10 hr) and the integrity of these reflexes indicate that the decerebrate rat may be a suitable alternative for studies involving brain stem regulatory mechanisms in this species when it is desirable to avoid general anesthetics.
    背景与目标: :设计了大鼠去脑程序。在氟烷麻醉下结扎颈内动脉和颈外动脉。在大脑的中枢神经层横切,切除横断的前脑。抽气阻塞了后交通动脉,氧化纤维素堆积在这些血管周围。大脑的切面被氧化的纤维素覆盖,颅腔内充满了棉球。抬头向上倾斜,颈动脉闭塞和氰化钠反应表明这些制剂的体位性,气压反射和化学反射完好无损。制剂的稳定性(至少8-10小时)和这些反射的完整性表明,当需要避免全身麻醉时,去脑大鼠可能是该物种脑干调节机制研究的合适选择。
  • 【[我们最近使用无张力阴道胶带(TVT)程序进行的真正尿毒症尿失禁的外科手术治疗的数据]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Basta A,Pityński K,Kolawa W
    BACKGROUND & AIMS: UNLABELLED:There exist many surgical procedure for the treatment of urinary incontinence. Most of them require relatively extensive surgery and several days hospitalization. The advantage of tension-free vaginal tape procedure is a possibility to be performed on an ambulatory basis and under local anesthesia. OBJECTIVES:The aim of the study was to evaluate the results and morbidity of TVT procedure in genuine urinary stress incontinence. MATERIAL AND METHODS:The study group consists of 26 women, aged 39-69, suffering from genuine stress incontinence class I to III according to Stamey classification. The operation was carried out under epidural anesthesia. The procedure was performed as described by Ulmsten at al. The period of follow-up ranged from 3 to 20 month. RESULTS:The mean time of procedure was 26 minutes (range 18-43). The stay in hospital in 23 patient (88.46%) did not exceed 2 days. Three patients experienced urinary retention lasting four days requiring catheterization. No patients had bladder perforations or severe blood loss. No evidence of defect healing or rejection of the tape was found. Twenty four patients (92.31%) of patients were completely cured, 2 patients (7.69%) had considerably improved urinary continence. CONCLUSIONS:Our early study indicate that TVT procedure is effective and safe method of the surgical treatment of urinary stress incontinence in women.
    背景与目标: 贴标签:存在许多用于治疗尿失禁的外科手术方法。他们中的大多数需要相对广泛的手术和几天的住院治疗。无张力阴道带手术的优点是可以在非卧床和局部麻醉下进行。
    目的:本研究的目的是评估TVT手术在真正的尿液压力性尿失禁中的结果和发病率。
    材料与方法:研究小组由26名年龄在39-69岁的女性组成,根据Stamey分类,他们患有真正的压力性尿失禁I至III级。手术是在硬膜外麻醉下进行的。该过程按照Ulmsten等人的描述进行。随访期为3到20个月。
    结果:平均手术时间为26分钟(范围18-43)。 23名患者(88.46%)的住院时间不超过2天。三名患者经历了持续四天的尿retention留,需要导尿。没有患者有膀胱穿孔或严重失血。没有发现缺陷修复或胶带被拒收的证据。 24例患者(92.31%)完全治愈,2例患者(7.69%)尿失禁明显改善。
    结论:我们的早期研究表明,TVT手术是治疗女性尿失禁的有效且安全的方法。
  • 【手术后ERCP后胰腺炎与血清淀粉酶水平变化之间的关系。】 复制标题 收藏 收藏
    DOI:10.3748/wjg.v13.i28.3855 复制DOI
    作者列表:Ito K,Fujita N,Noda Y,Kobayashi G,Horaguchi J,Takasawa O,Obana T
    BACKGROUND & AIMS: AIM:To clarify the relationship between the change of serum amylase level and post-ERCP pancreatitis. METHODS:Between January 1999 and December 2002, 1291 ERCP-related procedures were performed. Serum amylase concentrations were measured before the procedure and 3, 6, and 24 h afterward. The frequency and severity of post-ERCP pancreatitis and the relationship between these phenomena and the change in amylase level were estimated. RESULTS:Post-ERCP pancreatitis occurred in 47 patients (3.6%). Pancreatitis occurred in 1% of patients with normal amylase levels 3 h after ERCP, and in 1%, 5%, 20%, 31% and 39% of patients with amylase levels elevated 1-2 times, 2-3 times, 3-5 times, 5-10 times and over 10 times the upper normal limit at 3 h after ERCP, respectively (level < 2 times vs >or= 2 times, P < 0.001). Of the 143 patients with levels higher than the normal limit at 3 h after ERCP followed by elevation at 6 h, pancreatitis occurred in 26%. In contrast, pancreatitis occurred in 9% of 45 patients with a level higher than two times the normal limit at 3 h after ERCP followed by a decrease at 6 h (26% vs 9%, P < 0.05). CONCLUSION:Post-ERCP pancreatitis is frequently associated with an increase in serum amylase level greater than twice the normal limit at 3 h after ERCP with an elevation at 6 h. A decrease in amylase level at 6 h after ERCP suggests the unlikelihood of development of post-ERCP pancreatitis.
    背景与目标: 目的:阐明血清淀粉酶水平的变化与ERCP后胰腺炎的关系。
    方法:在1999年1月至2002年12月之间,进行了1291次与ERCP相关的程序。在手术前和手术后3、6和24小时测量血清淀粉酶浓度。估计了ERCP后胰腺炎的发生频率和严重程度,以及这些现象与淀粉酶水平变化之间的关系。
    结果:ERCP后胰腺炎发生在47例患者中(3.6%)。 ERCP后3小时,淀粉酶水平正常的患者中发生胰腺炎的比例为1%,淀粉酶水平分别为1-2、2-3、3、3的患者中分别有1%,5%,20%,31%和39%发生胰腺炎ERCP后3 h分别为正常上限上限的5倍,5-10倍和10倍以上(水平<2倍vs>或= 2倍,P <0.001)。在143例患者中,ERCP术后3 h血脂水平高于正常水平,随后6 h升高,其中26%发生胰腺炎。相比之下,在45名患者中,有9%发生了胰腺炎,其水平在ERCP后3 h高于正常水平的两倍,然后在6 h降低(26%vs 9%,P <0.05)。
    结论:ERCP后胰腺炎常常与血清淀粉酶水平升高超过ERCP后3小时正常极限值的两倍,并在6小时升高有关。 ERCP后6小时淀粉酶水平降低表明ERCP后胰腺炎发展的可能性很小。
  • 【泌尿外科癌症手术中特定于程序的血栓形成和出血风险:系统评价和荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1016/j.eururo.2017.03.008 复制DOI
    作者列表:Tikkinen KAO,Craigie S,Agarwal A,Violette PD,Novara G,Cartwright R,Naspro R,Siemieniuk RAC,Ali B,Eryuzlu L,Geraci J,Winkup J,Yoo D,Gould MK,Sandset PM,Guyatt GH
    BACKGROUND & AIMS: CONTEXT:Pharmacological thromboprophylaxis involves balancing a lower risk of venous thromboembolism (VTE) against a higher risk of bleeding, a trade-off that critically depends on the risks of VTE and bleeding in the absence of prophylaxis (baseline risk). OBJECTIVE:To provide estimates of the baseline risk of symptomatic VTE and bleeding requiring reoperation in urological cancer surgery. EVIDENCE ACQUISITION:We identified contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. We used studies with the lowest risk of bias and accounted for use of thromboprophylaxis and length of follow-up to derive best estimates of the baseline risks within 4 wk of surgery. We used the GRADE approach to assess the quality of the evidence. EVIDENCE SYNTHESIS:We included 71 studies reporting on 14 urological cancer procedures. The quality of the evidence was generally moderate for prostatectomy and cystectomy, and low or very low for other procedures. The duration of thromboprophylaxis was highly variable. The risk of VTE in cystectomies was high (2.6-11.6% across risk groups) whereas the risk of bleeding was low (0.3%). The risk of VTE in prostatectomies varied by procedure, from 0.2-0.9% in robotic prostatectomy without pelvic lymph node dissection (PLND) to 3.9-15.7% in open prostatectomy with extended PLND. The risk of bleeding was 0.1-1.0%. The risk of VTE following renal procedures was 0.7-2.9% for low-risk patients and 2.6-11.6% for high-risk patients; the risk of bleeding was 0.1-2.0%. CONCLUSIONS:Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without PLND in low-risk patients). For "close call" procedures, decisions will depend on values and preferences with regard to VTE and bleeding. PATIENT SUMMARY:Clinicians often give blood thinners to patients to prevent blood clots after surgery for urological cancer. Unfortunately, blood thinners also increase bleeding. This study provides information on the risk of clots and bleeding that is crucial in deciding for or against giving blood thinners.
    背景与目标: 背景:药理学上的血栓预防包括在较低的静脉血栓栓塞(VTE)风险与较高的出血风险之间进行权衡,这一权衡主要取决于在不进行预防的情况下VTE和出血的风险(基准风险)。
    目的:提供对泌尿外科癌症手术中有症状的VTE和出血需要重新手术的基线风险的估计。
    证据获取:我们确定了当代观察性研究,报告了有症状的VTE或泌尿外科手术后出血。我们使用偏倚风险最低的研究,并考虑了血栓预防措施的使用和随访时间,以得出手术4周内基线风险的最佳估计值。我们使用GRADE方法评估证据的质量。
    证据综合:我们纳入了71项研究,报告了14种泌尿系统癌症的程序。前列腺切除术和膀胱切除术的证据质量一般中等,其他手术的证据质量很低或非常低。血栓预防的时间长短不一。膀胱切除术中VTE的风险较高(各风险组之间为2.6-11.6%),而出血的风险较低(0.3%)。前列腺切除术中VTE的风险因手术而异,从不进行盆腔淋巴结清扫术(PLND)的机器人前列腺切除术中的0.2-0.9%到延长PLND的开放式前列腺切除术中的3.9-15.7%。出血的风险为0.1-1.0%。低危患者肾手术后发生VTE的风险为0.7-2.9%,高危患者为2.6-11.6%;出血风险为0.1-2.0%。
    结论:某些手术(例如开放式和机器人膀胱切除术)需要延长血栓预防措施,但其他手术(例如低危患者中不使用PLND的机器人前列腺切除术)则应予以延长。对于“近距离呼叫”程序,决策将取决于关于VTE和出血的值和偏好。
    病人总结:临床医生经常给患者使用血液稀释剂,以防止泌尿外科手术后的血液凝块。不幸的是,血液稀释剂也会增加出血。这项研究提供了有关血凝块和出血风险的信息,这对于决定是否使用稀释剂至关重要。
  • 【方丹手术的荟萃分析:心外导管与心内外侧隧道。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2018-05-01
    来源期刊:Herz
    DOI:10.1007/s00059-017-4553-6 复制DOI
    作者列表:Zheng J,Li Z,Li Q,Li X
    BACKGROUND & AIMS: :This meta-analysis was designed to determine the effect of an intracardiac lateral tunnel (ILT) versus an extracardiac conduit (ECC) on patients undergoing a Fontan procedure. A search of the literature in PubMed, Embase, China Academic Literature, and Wanfang databases yielded 23 studies comprising approximately 1000 patients for analysis. There were statistically significant differences between ILT and ECC in the frequency of early sinus node dysfunction, early total arrhythmias, late supraventricular tachycardia, late sinus node dysfunction, late total arrhythmias, and need for pacemaker. By contrast, no statistically significant differences between the two methods were found in takedown, protein-losing enteropathy, thromboembolic events, early supraventricular tachycardia, early mortality, and total mortality. We conclude that an ECC confers some advantages over an ILT, although the underlying mechanism remains unclear.
    背景与目标: :本荟萃分析旨在确定心脏内外侧隧道(ILT)与心脏外导管(ECC)对接受Fontan手术的患者的影响。在PubMed,Embase,中国学术文献和Wanfang数据库中对文献进行搜索后,得出23项研究,包括大约1000例患者以进行分析。 ILT和ECC在早期窦房结功能障碍,早期总心律不齐,晚期室上性心动过速,晚期窦房结功能障碍,晚期总心律不齐和需要起搏器的频率上有统计学差异。相比之下,两种方法在下陷,蛋白质丢失性肠病,血栓栓塞事件,早期室上性心动过速,早期死亡率和总死亡率方面没有统计学上的显着差异。我们得出的结论是,尽管底层机制仍然不清楚,但ECC相对于ILT具有一些优势。
  • 【白内障手术期间术中光学相干断层扫描术指导的水解剖过程评估。】 复制标题 收藏 收藏
    DOI:10.4103/ijo.IJO_2255_19 复制DOI
    作者列表:Yadav S,Mukhija R,Pujari A,Tandon R
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【基于IFCC参考测量程序的HbA1c改进的HPLC-电喷雾电离/质谱法。】 复制标题 收藏 收藏
    DOI:10.1373/clinchem.2007.100875 复制DOI
    作者列表:Kaiser P,Akerboom T,Molnar P,Reinauer H
    BACKGROUND & AIMS: BACKGROUND:Monitoring of hemoglobin A(1c) (HbA(1c)) is important in the management of diabetes. The IFCC reference measurement procedure for HbA(1c) is based on the ratio of glycated to nonglycated N-terminal hexapeptides of the beta-chains of hemoglobin after digestion with Glu-C endoproteinase. We developed a modification of the original reference measurement procedure with HPLC-electrospray ionization/mass spectrometry (ESI/MS). METHOD:We performed chromatographic separation of the hexapeptides using a C12 reversed-phase column and a binary gradient system consisting of a mixture of H(2)O/acetonitrile/formic acid. RESULTS:Using this method, we obtained higher signal intensities and improved system stability compared with the reference measurement procedure. In the range of 3% to 14% HbA(1c), intralaboratory CVs were 0.71% to 1.86%. Deviations from IFCC target values were -0.87 to 1.00 relative %. These values fulfill acceptability criteria for HbA(1c) determination set by the IFCC Working Group on HbA(1c) Standardization. CONCLUSIONS:This procedure for the determination of HbA(1c) improves the existing reference measurement procedure.
    背景与目标: 背景:血红蛋白A(1c)(HbA(1c))的监测在糖尿病的管理中很重要。 HbA(1c)的IFCC参考测量程序是基于用Glu-C内蛋白酶消化后的血红蛋白β链糖基化与非糖化N末端六肽之比。我们使用HPLC-电喷雾电离/质谱(ESI / MS)对原始参考测量程序进行了改进。
    方法:我们使用C12反相柱和由H(2)O /乙腈/甲酸的混合物组成的二元梯度系统对六肽进行了色谱分离。
    结果:与参考测量程序相比,使用这种方法,我们获得了更高的信号强度和更高的系统稳定性。在3%至14%的HbA(1c)范围内,实验室内CV为0.71%至1.86%。与IFCC目标值的偏差为-0.87至1.00相对%。这些值满足IFCC HbA(1c)标准化工作组设定的HbA(1c)确定可接受标准。
    结论:该测定HbA(1c)的程序改进了现有的参考测量程序。

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