Background Microendoscopic discectomy （MED） is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because mo...Background Microendoscopic discectomy （MED） is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons＇ learning curve. Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each： A-E. The control group F was ten MED patients treated later by the same medical team （September-October 2006）. All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure. Results Operation times by group were： A, （107±14） minutes; B, （85±13） minutes; C, （55±19） minutes; D, （52±12） minutes; E, （51±13） minutes; and F, （49±15） minutes. Blood loss were： A, （131±73） ml; B, （75±20） ml; C, （48±16） ml; D, （44±17） ml; E, （45±18） ml; and F, （45±16） ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment （JOA） score of each group in improvement rate immediately and one year after operation were as follows （in percentage）： A, （79.8±8.8）/（89.8±7.7）; B, （78.6±8.5）/（88.5±7.8）; C, （80.8±11.3）/（90.8±6.7）; D, （77.7±11.4）/（88.9±9.3）; E, （84.0±8.7）/（89.6±9.0）; and F, （77.8±11.6）/ （86.9±8.4）. Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups. Conclusions Spinal surgeons performing MED become proficient after 10-20 operations, when their skill becomes fairly sophisticated. Patients＇ improvement rate is the same regardless of surgeons＇ phase of lea展开更多
Inherited photoreceptor degeneration in humans constitutes a major cause of irreversible blindness in the world.They comprise various diseases,but retinitis pigmentosa is the most frequently observed.Retinitis pigment...Inherited photoreceptor degeneration in humans constitutes a major cause of irreversible blindness in the world.They comprise various diseases,but retinitis pigmentosa is the most frequently observed.Retinitis pigmentosa is commonly limited to the eye,where there is progressive photoreceptor degeneration,rods and secondarily cones.The mechanisms of cone and rod degeneration continue to be investigated,since most of the mutations causing retinitis pigmentosa affect rods and thus,the secondary death of cones is an intriguing question but,ultimately,the cause of blindness.Understanding the mechanisms of rod and cone degeneration could help us to develop therapies to stop or,at least,slow down the degeneration process.Secondary cone degeneration has been attributed to the trophic dependence between rods and cones,but microglial cell activation could also have a role.In this review,based on previous work carried out in our laboratory in early stages of photoreceptor degeneration in two animal models of retinitis pigmentosa,we show that microglial cell activation is observed prior to the the initiation of photoreceptor death.We also show that there is an increase of the retinal microglial cell densities and invasion of the outer retinal layers by microglial cells.The inhibition of the microglial cells improves photoreceptor survival and morphology,documenting a role for microglial cells in photoreceptor degeneration.Furthermore,these results indicate that the modulation of microglial cell reactivity can be used to prevent or diminish photoreceptor death in inherited photoreceptor degenerations.展开更多
Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and...Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.展开更多
Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to differen...Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.展开更多
AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and c...AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.展开更多
文摘Background Microendoscopic discectomy （MED） is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons＇ learning curve. Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each： A-E. The control group F was ten MED patients treated later by the same medical team （September-October 2006）. All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure. Results Operation times by group were： A, （107±14） minutes; B, （85±13） minutes; C, （55±19） minutes; D, （52±12） minutes; E, （51±13） minutes; and F, （49±15） minutes. Blood loss were： A, （131±73） ml; B, （75±20） ml; C, （48±16） ml; D, （44±17） ml; E, （45±18） ml; and F, （45±16） ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment （JOA） score of each group in improvement rate immediately and one year after operation were as follows （in percentage）： A, （79.8±8.8）/（89.8±7.7）; B, （78.6±8.5）/（88.5±7.8）; C, （80.8±11.3）/（90.8±6.7）; D, （77.7±11.4）/（88.9±9.3）; E, （84.0±8.7）/（89.6±9.0）; and F, （77.8±11.6）/ （86.9±8.4）. Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups. Conclusions Spinal surgeons performing MED become proficient after 10-20 operations, when their skill becomes fairly sophisticated. Patients＇ improvement rate is the same regardless of surgeons＇ phase of lea
基金supported by grants from Fundación Séneca,Agencia de Cienciay Tecnología Región de Murcia,No.19881/GERM/15(to MVS)Spanish Ministry of Economy and Competitiveness,Instituto de Salud Carlos Ⅲ,Fondo Europeo de Desarrollo Regional ‘‘Una 30 Manera de Hacer Europa’’,No.SAF2015-67643-P(to MVS),PI16/00380(to MPVP),RD16/0008/0026(to MPVP),PI16/00031(to MAB)
文摘Inherited photoreceptor degeneration in humans constitutes a major cause of irreversible blindness in the world.They comprise various diseases,but retinitis pigmentosa is the most frequently observed.Retinitis pigmentosa is commonly limited to the eye,where there is progressive photoreceptor degeneration,rods and secondarily cones.The mechanisms of cone and rod degeneration continue to be investigated,since most of the mutations causing retinitis pigmentosa affect rods and thus,the secondary death of cones is an intriguing question but,ultimately,the cause of blindness.Understanding the mechanisms of rod and cone degeneration could help us to develop therapies to stop or,at least,slow down the degeneration process.Secondary cone degeneration has been attributed to the trophic dependence between rods and cones,but microglial cell activation could also have a role.In this review,based on previous work carried out in our laboratory in early stages of photoreceptor degeneration in two animal models of retinitis pigmentosa,we show that microglial cell activation is observed prior to the the initiation of photoreceptor death.We also show that there is an increase of the retinal microglial cell densities and invasion of the outer retinal layers by microglial cells.The inhibition of the microglial cells improves photoreceptor survival and morphology,documenting a role for microglial cells in photoreceptor degeneration.Furthermore,these results indicate that the modulation of microglial cell reactivity can be used to prevent or diminish photoreceptor death in inherited photoreceptor degenerations.
文摘Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.
文摘Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.
文摘AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.
