BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a hi...BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score 【25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P【0.001), mechanical ventilation (21.3% vs 0%; P【0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P【0.001); more blood was transfused during operation (7 vs 2 units; P【0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P【0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.展开更多
目的 探索低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作用于不同靶区治疗强迫症(obsessive compulsive disorder,OCD)的疗效和预测因素.方法 将93例OCD患者随机分成三组,药物组服用舍曲林治疗,SMA组服用...目的 探索低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作用于不同靶区治疗强迫症(obsessive compulsive disorder,OCD)的疗效和预测因素.方法 将93例OCD患者随机分成三组,药物组服用舍曲林治疗,SMA组服用舍曲林+1Hz,rTMS作用于辅助运动区(supplementary motor area,SMA)、DLPFC组服用舍曲林+1Hz,rTMS作用于右额叶背外侧区(dorsolateral region of the right frontal lobe,right,DLPFC),共,20,次(4,周).治疗前后通过耶鲁-布朗强迫量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表、总体功能评定量表评定疗效和功能,并对相关临床因素进行预测因素分析.结果 治疗后,与药物组相比,SMA组和DLPFC组的有效率、强迫行为和汉密尔顿焦虑量表评分差异均有统计学意义(P<0.05);治疗前耶鲁-布朗强迫量表评分较高可能与rTMS治疗有效呈负相关.结论 低频rTMS作用于SMA和右DLPFC对OCD均有疗效,但无明显差异;治疗前耶鲁-布朗强迫量表评分较高可能是rTMS治疗OCD疗效不佳的预测因素.展开更多
文摘BACKGROUND: Controversy exists over whether living donor liver transplantation (LDLT) should be offered to patients with high Model for End-stage Liver Disease (MELD) scores. This study tried to determine whether a high MELD score would result in inferior outcomes of right-lobe LDLT. METHODS: Among 411 consecutive patients who received right-lobe LDLT at our center, 143 were included in this study. The patients were divided into two groups according to their MELD scores: a high-score group (MELD score ≥25; n=75) and a low-score group (MELD score 【25; n=68). Their demographic data and perioperative conditions were compared. Univariable and multivariable analyses were performed to identify risk factors affecting patient survival. RESULTS: In the high-score group, more patients required preoperative intensive care unit admission (49.3% vs 2.9%; P【0.001), mechanical ventilation (21.3% vs 0%; P【0.001), or hemodialysis (13.3% vs 0%; P=0.005); the waiting time before LDLT was shorter (4 vs 66 days; P【0.001); more blood was transfused during operation (7 vs 2 units; P【0.001); patients stayed longer in the intensive care unit (6 vs 3 days; P【0.001) and hospital (21 vs 15 days; P=0.015) after transplantation;more patients developed early postoperative complications (69.3% vs 50.0%; P=0.018); and values of postoperative peak blood parameters were higher. However, the two groups had comparable hospital mortality. Graft survival and patient overall survival at one year (94.7% vs 95.6%; 95.9% vs 96.9%), three years (91.9% vs 92.6%; 93.2% vs 95.3%), and five years (90.2% vs 90.2%; 93.2% vs 95.3%) were also similar between the groups. CONCLUSIONS: Although the high-score group had signifi-cantly more early postoperative complications, the two groups had comparable hospital mortality and similar satisfactory rates of graft survival and patient overall survival. Therefore, a high MELD score should not be a contraindication to right-lobe LDLT if donor risk and recipient benefit are taken into full account.
文摘目的 探索低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作用于不同靶区治疗强迫症(obsessive compulsive disorder,OCD)的疗效和预测因素.方法 将93例OCD患者随机分成三组,药物组服用舍曲林治疗,SMA组服用舍曲林+1Hz,rTMS作用于辅助运动区(supplementary motor area,SMA)、DLPFC组服用舍曲林+1Hz,rTMS作用于右额叶背外侧区(dorsolateral region of the right frontal lobe,right,DLPFC),共,20,次(4,周).治疗前后通过耶鲁-布朗强迫量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表、总体功能评定量表评定疗效和功能,并对相关临床因素进行预测因素分析.结果 治疗后,与药物组相比,SMA组和DLPFC组的有效率、强迫行为和汉密尔顿焦虑量表评分差异均有统计学意义(P<0.05);治疗前耶鲁-布朗强迫量表评分较高可能与rTMS治疗有效呈负相关.结论 低频rTMS作用于SMA和右DLPFC对OCD均有疗效,但无明显差异;治疗前耶鲁-布朗强迫量表评分较高可能是rTMS治疗OCD疗效不佳的预测因素.
