5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat

Chronic kidney disease (CKD) is a global problem. Slowing CKD progression is a major health priority. Since CKD is characterized by complex derangements of homeostasis, integrative animal models are necessary to study development and progression of CKD. To study development of CKD and novel therapeutic interventions in CKD, we use the 5/6th nephrectomy ablation model, a well known experimental model of progressive renal disease, resembling several aspects of human CKD. The gross reduction in renal mass causes progressive glomerular and tubulo-interstitial injury, loss of remnant nephrons and development of systemic and glomerular hypertension. It is also associated with progressive intrarenal capillary loss, inflammation and glomerulosclerosis. Risk factors for CKD invariably impact on endothelial function. To mimic this, we combine removal of 5/6th of renal mass with nitric oxide (NO) depletion and a high salt diet. After arrival and acclimatization, animals receive a NO synthase inhibitor (NG-nitro-L-Arginine) (L-NNA) supplemented to drinking water (20 mg/L) for a period of 4 weeks, followed by right sided uninephrectomy. One week later, a subtotal nephrectomy (SNX) is performed on the left side. After SNX, animals are allowed to recover for two days followed by LNNA in drinking water (20 mg/L) for a further period of 4 weeks. A high salt diet (6%), supplemented in ground chow (see time line Figure 1), is continued throughout the experiment. Progression of renal failure is followed over time by measuring plasma urea, systolic blood pressure and proteinuria. By six weeks after SNX, renal failure has developed. Renal function is measured using ''gold standard'' inulin and para-amino hippuric acid (PAH) clearance technology. This model of CKD is characterized by a reduction in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), hypertension (systolic blood pressure>150 mmHg), proteinuria (> 50 mg/24 hr) and mild uremia (>10 mM). Histological features include tubulo-interstitial damage reflected by inflammation, tubular atrophy and fibrosis and focal glomerulosclerosis leading to massive reduction of healthy glomeruli within the remnant population (<10%). Follow-up until 12 weeks after SNX shows further progression of CKD.     

医学生实习中外科基本操作常犯错误及对策分析

目的：探讨医学生临床实习中在基本操作上常犯的错误,并对此提出建议和纠正措施,旨在进一步提高临床带教水平及临床教学质量。方法i总结我院临床医学专业实习生进行常见的外科临床基本操作考核成绩的情况,对错误类型等进行统计并提出合理的解决措施。结果：共考察学生90名,其中外科换药方法欠佳者22人（24．4％）,消毒铺巾存在问题24人（26．6％）,缝合存在问题32人（35．5％）,打结存在问题38（42．2％）人,拆线存在问题19（21．1％）人。结论：加强医学生外科实习期间的无菌观念培养及强化手术基本操作是临床教学的重要环节。     

Outcome of stand-alone thoracoscopic epicardial left atrial posterior box isolation with bipolar radiofrequency energy for longstanding persistent atrial fibrillation

Introduction

Catheter ablation of longstanding (> 1 year) persistent atrial fibrillation (AF) is associated with poor outcome. This might be due to remodelling and fibrosis formation, mainly located in the posterior left atrial (LA) wall. Therefore, we adopted a thoracoscopic epicardial box isolation of the posterior left atrium using bipolar RF energy with intraoperative testing of conduction block.

Methods and results

Bilateral thoracoscopic box isolation was performed with a bipolar RF clamp. Entrance block was defined as absence of a conducted electrogram within the box, while exit block was confirmed by pacing at 10.0 V/2 ms. Ablation outcome was evaluated after 3, 6, 12 and 24 months with 12-lead ECGs and 24-hour Holter recordings.Twenty-five consecutive patients were included (58 ± 7 years, persistent AF duration 1.8 ± 0.9 years). Entrance block was achieved in all patients and exit block confirmed if sinus rhythm was achieved. After 17 ± 7 months, 76 % of the patients (n = 19) were free of AF recurrence. One patient died within 1 month and was considered an ablation failure. Four patients with AF recurrences regained sinus rhythm with additional catheter ablation or antiarrhythmic drugs.

Conclusions

Treatment of longstanding persistent AF with thoracoscopic epicardial LA posterior box isolation using bipolar RF energy with intraoperative testing of conduction block is feasible and highly effective.     

网络云交互技术辅助外科实践教学的创新应用探索

目的:探索传统教学模式结合网络云交互技术在外科实践教学中的应用效果。方法:于我校2011级五年制临床医学专业本科生中选取76人,随机平均分为两组,分别采取单纯传统大课教学模式、传统教学结合网络云交互技术教学模式;课程结束后进行闭卷理论考试和实践操作考试,综合两项成绩进行评定。同时向两组学员发放调查问卷,以此评价使用网络云交互技术辅助教学的效果。结果:采取传统教学结合网络云交互技术教学模式组的成绩优于采取单纯传统教学模式组,两组成绩差异具有统计学意义(P0.05)。结论:在传统教学模式的基础上添加网络云交互技术更能激发学生的学习兴趣,大大提高了学习效率,更有利于本科生外科实践的教学以及教学资源的整合及教学档案的建立。     

Comparative study on different therapies on patients with primary central nervous system lymphoma

Objective

To compare and analyze three therapies on patients with primary central nervous system lymphoma (PCNSL), aiming to provide evidences for future treatment and prognosis.

术前TFF1、HSP70、ASPH与原发性肝癌患者手术切除术后早期复发的关系研究

摘要 目的：研究术前三叶因子1（TFF1）、热休克蛋白70（HSP70）、天冬氨酸-天冬酰胺β羟化酶（ASPH）与原发性肝癌（PHC）患者手术切除术后早期复发的关系。方法：选取2018年1月～2019年12月我院收治的83例PHC患者,均行手术切除治疗,术后均随访2年,根据是否复发分为复发组49例以及未复发组34例。比较两组术前TFF1、HSP70、ASPH水平差异,收集患者基线资料,采用多因素Logistic回归分析PHC患者手术切除术后早期复发的危险因素,采用受试者工作特征（ROC）曲线分析术前TFF1、HSP70、ASPH水平预测PHC患者手术切除术后早期复发的效能。结果：复发组术前TFF1、HSP70、ASPH水平均高于未复发组（P＜0.05）。复发组肿瘤直径≥5 cm、肿瘤数目为多发、有血管侵犯的患者比例高于未复发组（P＜0.05）。多因素Logistic回归分析结果显示：肿瘤直径≥5 cm、多发肿瘤、血管侵犯及术前TFF1、HSP70、ASPH高水平是PHC患者手术切除术后早期复发的危险因素（均OR＞1,P＜0.05）。ROC曲线分析结果显示：术前TFF1、HSP70、ASPH联合检测预测PHC患者手术切除术后早期复发的曲线下面积为0.815,明显高于上述三项指标单独检测的0.704、0.713、0.707。结论：术前TFF1、HSP70、ASPH与PHC患者手术切除术后早期复发密切相关,联合检测三项指标水平可能有助于预测PHC患者手术切除术后早期复发。     

Excessive increase of serum interleukin 6 jeopardizes host defense against multi-bacterial infection

Serum interleukin 6 (IL-6) is elevated among patients who have undergone surgery, trauma, and thermal injury. It is well known that the greater the increase of serum IL-6, the higher the incidence of post-injury morbidity and mortality is. However, it has not been determined whether the physiological effects of IL-6 increase the rate of morbidity and mortality or if IL-6 is just a bystander that only indicates the severity of the injury. To elucidate this, we planned to investigate the effect of IL-6 on a multi-bacterial infection, one of the most frequent post-injury complications. CDF1 male mice were administered recombinant human IL-6 (hIL-6) continuously at a dose of 0, 1, or 10 microg/day. The mice then underwent cecal ligation without puncture that induced slow multi-bacterial infection. The survival rate of mice receiving 10 microg/day of hIL-6 was significantly lower (38.5%) than the rate of those receiving 0 (83.3%) or 1 (92.3%) microg/day of hIL-6. The result of this study showed that only excessive increases in serum IL-6, to levels that were observed among patients who underwent severe injury or extensive surgery with high incidence of post-injury infection, jeopardize the host's defense against bacterial infection.     

Monitoring surgical performance using risk-adjusted cumulative sum charts

The cumulative sum (CUSUM) procedure is a graphical method that is widely used for quality monitoring in industrial settings. More recently it has been used to monitor surgical outcomes whereby it 'signals' if sufficient evidence has accumulated that there has been a change in the surgical failure rate. A limitation of the standard CUSUM procedure in this context is that since it is simply based on the observed surgical outcomes, it may signal as a result of changes in the referral pattern, such as an increased proportion of high-risk patients, rather than due to a change in the actual surgical performance. We describe a new CUSUM procedure that adjusts for each patient's pre-operative risk of surgical failure through the use of a likelihood-based scoring method. The procedure is therefore ideally suited for settings where there is a variable mix of patients over time.     

脊髓型颈椎病的发病机制及治疗的研究进展

在中老年人群中脊髓型颈椎病是造成脊髓功能障碍的主要原因,其发病机制复杂,主要有静态和动态因素、缺血、内皮细胞损伤和血脊髓屏障的破坏、炎症及细胞凋亡等学说,每一种学说并不能够完美的解释脊髓型颈椎病的发病机制,仍需进一步实验研究探索其机制。对于进行性发展的脊髓型颈椎病多采用手术治疗,手术方式主要有前路、后路及前后路联合手术,如何选择手术方案仍是临床医生关注的焦点,本文就该病的发病机制及手术治疗的相关进展作一综述。