亲属活体肾移植41例临床总结

目的总结亲属活体供肾移植的临床经验。方法 41例供者均经开放手术取肾,33例取供者左肾,8例取供者右肾。41例受者手术同尸体肾移植,术后采用环孢素A(或他克莫司)、硫唑嘌呤(或霉酚酸酯)及泼尼松预防排斥反应。结果 41例受者均手术顺利,39例肾功能在2～5d恢复正常,2例术中行二次灌注发生延迟肾功能恢复。随访期间存活40例,30例肾功能正常,9例血肌酐稍高,1例术后2年自行停药导致肾衰竭,重新恢复血透治疗。死亡1例,原因为术后2年发生肺部真菌及巨细胞病毒混合感染。急性排异反应1例,经激素冲击后逆转。5例男性受者已结婚生育。41例供者术后均恢复顺利,平均住院时间10d。随访期间肾功能均正常,尿蛋白阴性。结论亲属活体肾移植具有组织配型好、供肾缺血时间短及排异反应少等优点,其效果优于尸体供肾移植。术前对供、受者进行全面综合评估是保证亲属活体肾移植成功的关键。     

78例活体肾移植临床疗效分析

目的:总结分析78例活体肾移植的手术治疗经验和疗效,以期提高该技术的安全性和有效性.方法:回顾78例活体肾移植患者的临床资料,结合术前准备、手术方式、治疗效果、并发症发生情况以及免疫抑制治疗方案,评价移植受者临床疗效及移植供者安全性.结果:78例移植肾供者均顺利渡过围手术期,术后7～15 d出院,随访全部病例肾功能均未见明确异常.69例受者术后3 d内血肌酐降至正常值范围;1例出现DGF经间断血液透析治疗12 d恢复;2例并发急性排斥反应经应用MP治疗后逆转.结论:活体肾移植组织配型好,供肾冷、热缺血时间短,术后并发症发生率低,手术成功率和长期存活率高,是一种安全有效的治疗手段.     

夫妻间活体供肾移植12例临床分析

目的:初步分析夫妻间活体供肾移植的临床特点和治疗经验.方法:回顾我院2006年7月～2009年7月12例夫妻间活体肾移植患者的临床资料,并与同期开展的106例血缘关系亲属活体肾移植术前组织配型情况及术后1个月治疗效果进行比较.结果:12例夫妻间活体肾移植供受者组织配型情况较血缘关系活体肾移植患者情况差.在手术方案及免疫抑制治疗方案相同的情况下,夫妻间活体肾移植术后1个月内手术成功率、术后移植肾功能恢复情况、并发症发生率与血缘关系亲属活体肾移植间均无统计学差异(P＞0.05).结论:夫妻间活体肾移植治疗安全、有效,与血缘关系活体肾移植术后1个月治疗效果相近.     

全身淋巴结X线照射预处理在活体肾脏移植中的应用

目的探讨非清髓性全身淋巴结照射（TLI）预处理在活体供肾肾移植中应用的安全性和有效性。方法共5例受体接受了TLI,平均年龄27岁。供受体的HLA-A、B、DR6个抗原中4个抗原错配1例,3个抗原错配2例,1个抗原错配2例。供肾切取均采用手辅助腹腔镜活体供肾切取手术。TLI治疗从移植手术前5天开始,90cGy／d,共5天。术中和术后的免疫抑制药物方案与同时期的活体或尸体肾移植相同,但剂量略减少。术后定期检测受体外周静脉血白细胞绝对值;流式细胞仪检测T细胞、CD4^＋T细胞、CD8^＋T细胞和Th1、Th2亚群的变化;观察免疫抑制药物的使用情况、移植肾状态、急性排斥反应频率和相关副作用。结果受体外周血白细胞在术后的1～2周达最低值,12周观察期内均未恢复到移植术前水平。T细胞总数和CD4^＋T细胞、CD8^＋T细胞在术后的1～2周内达最低值,300天的观察期内未恢复到移植前水平;在TLI治疗后Th1细胞百分比减少,Th2细胞百分比略有增加,因此Th2细胞相对增多。观察期内未发生移植肾排斥反应,移植肾功能正常。免疫抑制剂使用量低于同时期的其他活体肾脏移植和尸体肾脏移植受体。没有任何感染等并发症发生。结论非清髓性TLI是一种安全有效的免疫抑制治疗手段,可以获得较长时间的免疫抑制状态,在减少肾脏移植排斥反应的基础上,减少了其他非特异性免疫抑制剂的应用,是一个理想的活体肾脏移植的预处理方案。     

亲属活体供肾移植与尸体供肾移植的临床疗效比较

目的：比较亲属活体供肾移植与尸体供肾移植的临床效果。方法：对21例亲属活体供。肾移植者及22例尸体供肾移植者的资料进行分析，比较其临床疗效。结果：两组术后1年内的急性排斥反应发生率分别为14．3％和22．7％；人／肾1年、3年和5年存活率，前者分别为100％／100％、95．2％／100％和90．5％／95．2％，后者分别为100％／100％、90．9％／95．5％和81．8％／86．4％。结论：在HLA配型和免疫抑制方案相同的情况下，亲属活体供肾移植的临床效果优于尸体供肾移植。     

心脏死亡器官捐献者供肾移植的可行性

 目的 总结心脏死亡器官捐献(donation after cardiac death, DCD)肾移植的临床资料,并探讨其可行性。方法 回顾性分析2012-04至2013-12武警总医院28例DCD和52例DCD供肾移植的临床资料。结果 28例DCD属于国际标准Maastricht Ⅲ类,共获取肾脏52个并实施肾移植52例。热缺血时间为(11.2±9.1)min,冷缺血时间为(4.1±2.2)h。12例发生移植肾功能延迟恢复(delayed graft function, DGF),发生率23.08%,均于术后20~72 d肾功能恢复正常。急性排斥反应发生率3.85％(2／52),分别于术后1、2周因移植肾破裂切除肾脏。受者死亡3例(术后3个月因巨细胞病毒性肺炎死亡1例,术后移植肾原发无功能并肺部真菌性肺炎1例,肾破裂术后感染性休克1例)。移植肾存活的47例受者,随访13~23个月,移植肾功能正常。结论 DCD 供体可以扩大供体来源,缓解器官短缺困难,但应注意并发症发生,提高移植效果。     

肾移植中PRA的动态监测及其临床意义

肾移植受者高敏状态是指受者HLA抗原体液致敏,导致肾移植术后发生超急性排斥反应的根本原因。发生超急性排斥反应,给受者精神、经济及社会均带来严重影响,为了筛选出高敏受者,避免发生超急性排斥反应或减少急性排斥反应的发生,提高人/肾存活率,我们对肾移植受者由术前到术后进行了群体反应性抗体(PRA)的动态监测,并按照美国国立器官分配中心(UNOS)制定的HLA交叉反应组配型原则选择供受者,取得了满意效果。1 资料和方法1.1 检测对象 选择我科1998年8月～2001年10月共226例肾移植受者,男156例,女70例,年龄14～68岁。首次移植213例,2次及2次以上移植13例。术后常规使用强的松(Pred)、环孢素 A(CsA)和霉酚酸酯(MMF)三联或CsA+Pred二联治疗。     

亲属供肾活体肾移植供者的围手术期管理

我院已完成9例亲属供肾活体肾移植手术，移植肾均存活良好，供肾者无1例死亡或发生严重并发症，报告如下。     

145例亲属活体供肾移植患者的围手术期护理体会

肾移植是慢性肾功能衰竭终末期的最佳治疗方法,但目前全世界均面临移植器官缺乏这一共同难题.我国尿毒症患者较多,在每年不断增加的尿毒症患者中,只有1%的患者获得移植机会.亲属活体供肾移植具有缺血时间短、排斥反应少、移植肾存活率高等优点,已成为解决供肾器官缺乏的有效途径.我科于2006年7月~2012年7月共行亲属活体供肾移植145例,现将其围手术期护理体会介绍如下.     

少数民族与汉族肾移植受者术后情况比较

目的 分析少数民族肾移植受者术后情况并与汉族受者进行比较,探讨不同民族人群接受肾移植后的差异.方法 回顾性分析1990年-2012年解放军309医院全军器官移植中心接受汉族尸体供肾的89例少数民族受者和100例汉族受者的术前一般资料以及术后移植肾存活情况,并对移植物功能延迟恢复(DGF)发生率、急性排斥反应发生率、肺部感染发生率等进行比较分析.结果 不同民族患者术前一般情况比较差异无统计学意义(p＞0.05).少数民族与汉族受者1年移植肾存活率分别为89.9％、92.0％,术后急性排斥反应发生率分别为22.5％、19.0％,DGF发生率分别为28.1％、27.0％,差异均无统计学意义(p＞0.05).少数民族受者术后肺部感染发生率(30.3％)高于汉族受者(10.0％),差异有统计学意义(P＜0.0l).藏族、回族、满族、蒙古族受者移植术后1年移植肾存活率及DGF、急性排斥反应、肺部感染发生率比较差异无统计学意义(p＞0.05).结论 我国不同民族肾移植受者短期疗效接近,但少数民族受者术后更易发生肺部感染,故应加强术后早期监控.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme