A temporary-sustainable team: A new multidisciplinary team model for severe trauma

The treatment of severe trauma, especially multiple injuries, requires multidisciplinary collaboration. The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and emphasizes the need to create a new temporary-sustainable team. It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment. The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency. Overall, a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.     

External validation of the post-varicocele repair semen analysis nomogram to predict total motile sperm count: A multicenter study

Total motile sperm count is an important parameter for predicting the probability of natural pregnancy. We have externally validated the Samplaski's post-varicocele repair semen analysis nomogram to confirm the predictive accuracy of total motile sperm count. A total of 300 patients who had undergone varicocelectomy between July 2016 and July 2019 from 4 treatment centres were included in this validation cohort study. The predictive performance of the externally validated nomogram was revealed by applying the Pearson correlation coefficient (R = 0.328; 95% confidence interval (CI) 0.220–0.435; p < .001). Compared to Samplaski's nomogram result (R = 0.581; 95% CI 0.186–0.729), our study also revealed a statistically significant rate. However, it had a relatively lower correlation coefficient rate. Notably, the predicted total motile sperm count was lower than the observed post-varicocelectomy total motile sperm count. The calibration plot revealed that the discrepancy between the predicted and observed total motile sperm count was plausible. However, it had low explanatory power in this nomogram model. This validation study demonstrates that the post-varicocele repair Samplaski's nomogram predicts a relatively lower total motile sperm count than the observed count.     

正常阴囊及其内容物的超声应用解剖

器官和组织的病理解剖是超声诊断疾病的客观基础。了解阴囊、睾丸、附睾的正常解剖特征和血管分布特点，是超声诊断这类器官疾病的必要条件。文中指出，睾丸大小形态、血管分布、动脉血流速度和阻力指数、附睾的大小、形态以及阴囊壁厚度等等都是诊断和鉴别诊断的主要线索，同时以大量的图片辅助说明。此外还阐述了应用彩色多普勒超声检查阴囊时如何提高仪器灵敏度，尽可能发现更细微、更全面的病变信息的技术要领。     

经皮肾镜取石术治疗肾结石的护理研究

微创经皮肾镜取石术是经皮肾造瘘,建立工作通道,结合气压弹道碎石治疗泌尿系统结石的一种微创手术,因其创伤小、疗效确切、术后恢复快等优点,在临床上广泛应用[1].虽然它是一种微创手术,但也有一定的并发症,加强病人围术期的护理是减少并发症的重要手段之一[2].为此,选择我科2005年12月-2007年12月的30例行微创经皮肾镜取石术病人,探讨其有效的护理措施,为临床诊治和护理提供一定的思路.现介绍如下.     

醋酸去氨加压素致低钠血症性脑病2例

例1为25岁女性宫外孕患者,于输卵管切开取胚术＋盆腔粘连分离术术后静脉滴注醋酸去氨加压素15μg,1次/12 h。第2天静脉滴注醋酸去氨加压素约30 min 时,患者出现谵妄、神志恍惚、抽搐、牙关紧闭,实验室检查血钠为125 mmol/ L（术前为142 mmol/ L）,考虑为醋酸去氨加压素所致低钠血症性脑病,立即停止输注醋酸去氨加压素并给予补钠等对症治疗,约10 min 后患者症状缓解。第2天患者神志清楚,血钠141 mmol/ L。例2为42岁女性患者,于肛周脓肿根治术后静脉滴注醋酸去氨加压素18μg,1次/12 h。用药第4天患者出现头晕、多汗、双手震颤,畏寒、尿少。第5天出现恶心,双眼上翻,双上肢强直阵挛,实验室检查血钠为124 mmol/ L（术前为141 mmol/ L）,头颅 CT 检查示大脑半球白质区广泛水肿,考虑为醋酸去氨加压素所致低钠血症性脑病。停用醋酸去氨加压素,立即给予补钠等对症治疗,1 d 后患者症状消失,血钠138 mmol/ L。     

Marine natural products: Bryostatins in preclinical and clinical studies

Context: Bryostatins represent an important group of pharmaceutically promising substances. These compounds are produced by commensal microorganisms naturally occurring in marine invertebrates, mainly in bryozoans. The most frequently investigated substance is bryostatin-1, which is a highly oxygenated macrolide with a polyacetate backbone.

Objective: The aim of this work was to summarize documented preclinical and clinical effects of bryostatin-class compounds.

Methods: A literature search was made of Medline and Web of Science databases in 2012.

Results and conclusion: Our review showed that bryostatins are potent agonists of protein kinase C. In addition to this, their significant antineoplastic activity against several tumor types has also been established and described. Bryostatin's anticancer activity has been proved against various cancer types. Moreover, significant results have been achieved by using bryostatin-1 in combination with other therapies, including combination with vaccine testing. Concerning other important properties that bryostatins possess, their ability to sensitize some resistant cells to chemotherapy agents, or immunoactivity and further stimulating growth of new neural connections, and enhancing effect on long-term memory are worth mentioning. In particular, some new bryostatin analogs could represent potential therapeutic agent for the treatment of cancer and other diseases in future.     

Surgical treatment of lumbar spondylodiscitis: a comparison of two methods

Purpose

This study evaluates two basic hypotheses: (1) the risk of an isolated dorsal approach to ventral lumbar spondylodiscitis based on clinical and radiographic results and (2) the risk of anterior radical debridement due to using a titanium implant in the site of bone infection.

Methods

Group A consisting of 23 patients was treated only by a dorsal transmuscular approach and group B consisting of eight patients was treated by two-stage posteroanterior surgery. Both evaluated groups were assessed before surgery, six weeks and one year after surgery with the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and Kirkaldy-Willis functional criteria. To evaluate the sagittal balance restoration, measurement by the Cobb modified angle of the affected segment was performed.

Results

Differences (p < 0.001) in group A were found between JOA values before surgery (average 9.30) and at six weeks after surgery (average 11.82) and 12 months after surgery (13.27) and VAS differences before surgery (average 7.39), six weeks after surgery (average 3.82) and 12 months after surgery (average 2.36) in group A. According to the Kirkaldy-Willis functional criteria, 11 patients were evaluated as excellent, nine patients as good and two patients as poor. The values of the JOA score in group B showed an improvement compared with the JOA values before surgery (average 9.38) at six weeks after surgery (average 11.75) and 12 months after surgery (average 13.63), and the VAS score before surgery (average 7.38) was found to have improved six weeks after surgery (average 4.63) and 12 months after surgery (average 2.25). The functional evaluation according to the Kirkaldy-Willis functional criteria assessed three patients as excellent, four patients as good and one patient as fair. Radiographic examinations of group A revealed the following findings before surgery (average 1.75), six months after surgery (average −3.73) and 12 months after surgery (average −0.79) and in group B before surgery (average 3.71), six weeks after surgery (average −8.21) and 12 months after surgery (average −6.45).

Conclusions

The results demonstrate the minimum serious surgical complications and greater loss of sagittal balance without clinical correlation in group A. We did not find any relapse or persistence of the infection in the post-operative period in group B.     

Immunosuppressive Activity of Adipose Tissue-Derived Mesenchymal Stem Cells in a Rat Model of Hind Limb Allotransplantation

Many reports have shown that bone marrow–derived mesenchymal stem cells exhibit immunosuppressive effects in allogeneic transplantation. However, few reports have evaluated the immunosuppressive properties of adipose tissue–derived mesenchymal stem cells (ASCs) in vitro and in vivo. In this study, we investigated the immunosuppressive characteristics of ASCs, and investigated whether ASCs originating from donor rats prolong allotransplant survival in a rat hind limb allotransplantation model. T-cell proliferation stimulated by allogeneic stimuli or mitogen with or without ASCs originating from the donor was assessed in vitro. The effects of cellular contact or soluble factors on the inhibition of T-cell proliferation were also evaluated. In the in vivo study, cultured ASCs (1 × 10⁵) that originated from the donor were injected into recipient animals intravenously immediately after operation, followed by 1 dose per day for 3 consecutive days post-transplantation. When immune rejection occurred, the survival time of allotransplants was determined and rejected tissue was histologically and immunochemically assessed for determining regulatory T-cell infiltration. ASCs inhibited the T-cell proliferation stimulated by alloantigen or mitogen in a dose-dependent manner, and recipient T cells proliferated less in animals treated with ASCs than in controls. Although ASCs were separated from T cells, ASCs persisted to elicit a suppressive effect. ASC culture supernatants did not inhibit T-cell proliferation; however, supernatants obtained from the mixed lymphocyte reaction in the presence of ASCs suppressed T-cell proliferation. ASCs prolonged allotransplant survival time, reduced inflammatory cell infiltration, and induced regulatory T cells. In conclusion, ASCs can exhibit in vitro immunosuppressive properties and prolong allotransplant survival time in a rat hind limb composite tissue allotransplantation model, possibly through the induction of regulatory T cells.