经背腰十二肋小切口活体供肾37例：安全性效果评价

背景：活体供肾肾移植关系到供受者双方的生命,要求手术确保供受者安全,手术风险大,技术要求高,为保证供者的安全,如何选择供肾的切取方式十分关键。 目的：总结37例经背腰十二肋切口亲属活体供肾切取术的临床经验,评价其效果及安全性。 方法：选择广西中医学院附属瑞康医院移植泌尿外科2007-06/2008-08完成亲属活体供肾移植患者40例,其中37例采用经背腰十二肋小切口术式切取亲属活体供肾,回顾分析供、受者相关的临床资料。同期随机抽取尸肾移植40例,将亲属活体间肾移植受者与尸肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率、外科相关并发症发生率等方面进行比较。 结果与结论：37例手术均成功,供肾切取手术时间仅1.0~2.0 h,供肾热缺血时间约15 s,冷缺血时间1.0~2.0 h,术中出血不多,围手术期间未发生外科及内科并发症。受者术后肾功能恢复快,1周左右血肌酐水平均可降至正常。随访至今,所有供、受者均正常生存,移植肾功能均保持在正常范围。活体肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率等方面均显著低于尸肾移植。提示经背腰十二肋切口开放切取供肾手术除了有手术时间、热缺血时间短等优点外,在手术安全性方面也有一定的优势,亲属活体肾移植供肾质量高,术后人/肾存活率高。     

高龄亲属活体供肾移植7例中长期效果：同一机构2年资料回顾分析

背景：随着肾移植中肾供体的短缺,“边缘”供肾提供了一条缓解途径。 目的：观察高龄亲属活体供肾移植的安全性和中长期临床效果。 方法：回顾性分析随访36~64个月的7例≥65岁亲属活体供肾移植的供者和受者的临床资料。 结果与结论：供、受者移植后均恢复顺利,无严重并发症。受者1周内移植肾功能正常、供者肾功能较术前略有增高、但均在正常范围内。无排斥反应发生。5例人/肾正常存活36~64个月;2例移植后≥1年死亡。供者均正常存活,无蛋白尿、高血压,肾功能正常。提示≥65岁高龄亲属活体供肾应经过严格筛选,部分可为临床扩大供肾来源。     

亲属活体供肾与同期尸体肾移植40例比较

背景：近年亲属活体间肾移植数量明显增加,供肾者的安全性及亲属活体供肾的移植质量受到日益重视。 目的：总结40例亲属活体供肾移植的临床经验,评价其效果及安全性。 方法：广西中医学院附属瑞康医院移植泌尿外科在2007-06/2008-08共完成亲属活体供肾移植40例,回顾分析供、受者相关的临床资料。同期随机抽取尸肾移植40例,将亲属活体间肾移植受者与尸肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率、外科相关并发症发生率等方面进行比较。 结果：所有供者手术时间仅1.0~2.0 h,供肾热缺血时间15 s左右,冷缺血时间1.0~2.0 h,围手术期间未发生外科及内科并发症。受者术后肾功能恢复快,前3 d尿量500~1 000 mL/h,1周左右血肌酐水平均可降至正常。随访至今,所有供、受者均正常生存,移植肾功能均保持在正常范围。活体肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率等方面均显著低于尸肾移植。开放切取供肾手术时间短、热缺血时间短,在手术安全性方面也有一定的优势。 关健词：亲属活体供肾;肾移植;供肾切取方式;临床分析;安全性     

老龄供者亲属肾移植120例

背景：为了保证老龄供肾的移植效果，应当慎重选择供者。国内活体肾移植开展较晚，对老龄亲属供肾移植经验仍较欠缺。 目的：对老龄供肾亲属肾移植的效果和安全性进行分析。 方法：纳入120例行活体肾移植的供、受者资料进行回顾性分析，其中夫妻间供肾12例，父母供给子女75例，其他亲属供肾33例，供者 55岁以上52例。比较老年供者和非老年供者移植前血清肌酐值，移植后肾功能恢复状况及并发症发病率等，同时对2组受者的移植前后血清肌酐及并发症进行比较。 结果与结论：两组供者移植后肾功能恢复良好，无显著性差异；两组受者在移植后1周，1个月，1年内比较血清肌酐差异无显著性意义，急性排斥发病率差异亦无显著性意义。提示，老龄供者制定合理入选标准，对供者是安全的，受者和移植肾近期效果良好。     

老龄供者亲属活体肾移植疗效分析

背景：近几年随着各项移植法规相继出台，亲属肾移植数量在国内多个移植中心呈逐渐增多趋势。目前国际上对活体供肾供者尚没有最大年龄的明确限制，由于供器官的极度短缺，国际上很多移植中心开始尝试老龄供者。 目的：探讨老龄供者亲属肾移植的临床疗效及应用特点。 方法：亲属活体肾移植65例按供肾者年龄分为2组：老龄组(n=16)：供者年龄≥55岁；对照组(n=49)：供者年龄<55岁。两组供者平素健康状况良好，心肝肺等重要脏器功能健全，无高血压及糖尿病，移植前查血肌酐清除率均在80 mL/min以上。两组基线资料相似。移植后6个月内进行随访，评价两组受者移植后的肾功能恢复及早期并发症发生情况。 结果与结论：移植后两组受者肾功能恢复良好，急性排斥反应、移植物功能延迟恢复等早期并发症发生率比较，差异无显著性意义(P > 0.05)。提示在目前肾源缺少的情况下，选择老龄供者进行亲属活体肾移植，只要严格供肾纳入标准，可以取得良好的治疗效果。     

不同亲属活体供肾移植94例的临床疗效探讨

目的：探讨不同亲属活体供肾移植的临床疗效。 方法：回顾性分析1999年3月至2008年10月94例亲属活体供肾移植的供、受者临床资料,其中父母给子女供肾35例,兄弟姐妹间供肾53例（含同卵双生姐妹间供肾1例）,妻子给丈夫供肾6例。 结果：所有供者术后恢复良好;所有受者肾功能均恢复正常后出院,其中父母给子女供肾4例受者发生急性排斥反应;兄弟姐妹间供肾3例受者发生急性排斥反应;夫妻间供肾受者中,1例术后第3 d发生加速排斥反应导致肾功能恢复延迟,于术后第5周恢复正常,1例发生急性排斥反应。急性排斥反应经甲泼尼龙冲击或抗淋巴细胞球蛋白治疗后全部逆转。术后随访6个月至10年,所有供者肾功能正常;94例受者中,死亡2例,1例术后2年死于呼吸衰竭,1例术后7年死于心力衰竭。其余受者2例发生慢性移植肾肾病。 结论：亲属活体供肾移植组织配型好、排斥反应发生少、移植肾长期存活率高,其中以血缘亲属供肾移植效果更佳。     

亲属活体肾移植供者选取策略及围手术期的处理体会

目的：探讨亲属活体肾移植供者选取策略及围手术期处理体会。 方法：选择中南大学湘雅二医院泌外器官移植科完成的活体肾移植供受者126对。126名供者中,男32名,女94名,年龄28~64岁。父母捐给子女61例,兄弟姐妹之间捐献56例,夫妻之间捐献6例,儿子捐给父亲1例,侄子捐给舅舅1例,岳母捐给女婿1例。回顾性总结126例亲属活体肾移植供者的手术经过及术后恢复情况。 结果：受者发生肾功能延迟恢复1例;发生急性排斥反应2例,经抗淋巴细胞球蛋白治疗后得到有效控制;供者术后发生肠梗阻1例,予保守治疗后痊愈;1例供者术后发生阻塞性肺炎,经支纤镜吸痰、雾化吸入稀释痰液、鼓励咳痰、行肺部理疗并适当延长抗生素使用时间,肺部感染得到有效控制;1例供肾肾周脂肪组织中发现曼氏迭宫绦虫裂头蚴,术后供受者均服用吡喹酮,随访1年,血嗜酸性粒细胞计数正常,肾周B超未发现异常;供肾结石3例,2例受者随访2年结石无明显增大,亦未出现移植肾积水、肾功能受损害等表现,1例受者于移植后9个月突然出现尿量减少,行经皮肾穿刺输尿管镜下钬激光碎石术,肾功能恢复正常,术后复查移植肾无残石;5例供者术前检查发现单侧肾囊肿,手术选取有囊肿的一侧肾脏,术中对囊肿施行去顶或去盖术,术后供受者均定期随访肾脏B超,平均随访3年,受者移植肾未发现新发囊肿,供者孤立肾亦未发现囊肿;1例供者出院后生活条件较差,生活无节制,于术后3个月患肺结核,至结核病医院治疗,结核病病情好转后无明显诱因猝死,未尸检;几乎所有供者术后均有一过性血肌酐升高,经长期随访,肌酐均恢复至术前正常水平。 结论：亲属活体肾移植供者的选取要结合具体情况综合考虑,“对供者无害”是首要原则。     

畸形肾血管的体外重建在肾移植中的应用

目的 探讨体外重建畸形供肾血管对肾移植临床效果的观察。方法 对15例供肾有畸形的肾移植资料进行回顾性分析,以同期进行的22例正常供肾肾移植病例作为对照组。体外血管重建的方法包括动脉端端吻合(6例)、端侧吻合(3例)、侧侧共干吻合(3例)、利用供体或受体髂动脉及其分支合并及延长供肾动脉(3例)。结果 术后平均随访1年,两组患者均存活;血管重建组2例而对照组3例患者术后出现高血压或高血压加重(P=0.673),但未发现移植肾动脉狭窄;血管重建组和对照组术后肾功能延迟恢复发生率为20.0%和13.64%(P=0.179),急性排斥反应发生率分别为13.33%和4.55%(P=0.385);术后1年两组内有移植肾患者的血肌酐水平分别为(119±11)和(127±8)μmol/L(P=0.658),两组间无显著性差异。结论 选择适当方法进行供肾畸形的血管的重建,不会影响肾移植的效果,并可以大大提高供体器官的利用率。     

同一移植中心2年间亲属活体肾移植38例安全性评估

背景：国内活体器官供者的安全性令人关注,供者移植后并发症,受者移植效果不理想或失败的病例有所发生。因此,必须重视活体肾移植,保证供者的生命安全和生活质量。 目的：探讨亲属活体肾移植的安全性。 方法：回顾性分析38对亲属活体肾移植供受者的临床资料,总结治疗经验。38例供者移植前明确身份,完善检查,充分告知治疗方案,合理手术。38例受者移植前充分透析,改善全身状况后行肾移植,移植后给予他克莫司或环孢素A、霉酚酸酯、皮质激素的三联基础免疫抑制方案治疗。观察肾移植后供受者肾功能变化、并发症发生率,以及受者急性排斥反应发生情况。 结果与结论：亲属活体肾移植等待时间短、花费较少、长期存活率高的优势是明显的,供者的近期和远期风险都很小。尽管如此,进行亲属活体肾移植仍要充分评估供受者的风险,保证供受者的安全。     

亲属活体供肾移植中供者肾功能的评估☆

背景：肾移植前正确有效地评价供者双侧肾脏功能,对于亲属活体肾移植供者及受者的安全十分重要。 目的：探讨亲属活体供肾移植中供者肾功能评估的指标。 方法：173例亲属活体肾移植供者年龄分成老年组(≥55岁)和中青年组(< 55岁),两组供者移植前血清肌酐、总肾小球滤过率、欲保留肾总肾小球滤过率、内生肌酐清除率、血尿素氮反应肾功能指标差异无显著性意义,分析比较移植前后肾功能各指标的变化。 结果与结论：与移植前比较,移植后10 d供者血清肌酐、血尿素氮增高,内生肌酐清除率降低(P < 0.01);移植后1个月留存肾脏总肾小球滤过率增加(P=0.000 0),但与移植前供者双肾比较下降。提示总肾小球滤过率可作为活体亲属肾移植供者肾功能评估的主要指标,但是仍应结合血清肌酐、内生肌酐清除率等指标综合分析。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.