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  • 文章类型: Meta-Analysis
    背景:阻塞性无精子症(OA)是男性不育的重要原因,附睾OA(EOA)是一种常见病。显微外科重建是治疗EOA的常用技术。在本研究中,我们分析了不同级别的显微血管附睾吻合术(MVE)的有效性,并比较了几种MVE技术之间的差异。
    方法:在PubMed中进行了文献检索,WebofScience,和Embase数据库,根据系统评价和荟萃分析指南的首选报告项目。纳入的研究以英语发表,直到2021年5月14日。使用R4.1.2软件评估事件发生率,风险比(RR),95%置信区间(CI)。
    结果:共有51项研究纳入我们的荟萃分析,涉及2853例OA患者。接受MVE的患者的总体平均通畅率为67.20%(95%[CI]:63.30%-71.10%),伴侣的总体平均自然妊娠率为40.05%(95%[CI]:35.30%-45.60%)。汇总结果显示,双侧MVE的通畅率高于单侧MVE(RR=1.42;95%[CI]:1.25-1.61;p<0.00)。对MVE吻合部位的比较表明,尾部/体区有利于通畅率(RR=1.17;95%[CI]:1.04-1.32;p<0.00)。尾部面积也有利于通畅率(RR=1.20;95%CI:1.03-1.41;p<0.04)。与典型的MVE(65.20%,95%[CI]:61.40%-69.10%),保留血管的MVE具有较高的总体平均通畅率(83.60%,95%[CI]:75.40%-91.70%)。
    结论:荟萃分析表明,MVE是EOA患者的一种高成本效益的治疗方法,在不久的将来,尊重船只的MVE可能成为主流。
    Obstructive azoospermia (OA) is an important cause of male infertility, and epididymal OA (EOA) is a common disease. Microsurgical reconstruction is a common technique used in the treatment of EOA. In the present study, we analyzed the effectiveness of microsurgical vasoepididymostomy (MVE) at different levels and compared the differences among several MVE techniques.
    A literature search was conducted in the PubMed, Web of Science, and Embase databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies were published in English until May 14, 2021. The R 4.1.2 software was utilized to evaluate the event rate, risk ratio (RR), and 95% confidence interval (CI).
    A total of 51 studies involving 2853 patients with OA were included in our meta-analysis. The overall mean patency rate of patients who underwent MVE was 67.20% (95% [CI]:63.30%-71.10%), and the overall mean natural pregnancy rate of their partners was 40.05% (95% [CI]: 35.30%-45.60%). The pooled results showed that the patency rate of bilateral MVE was higher than that of unilateral MVE (RR = 1.42; 95% [CI]:1.25-1.61; p < 0.00). A comparison of the anastomotic site of MVE showed that the caudal/corpus area was favorable for the patency rate (RR = 1.17; 95% [CI]:1.04 - 1.32; p < 0.00). The caudal area was also advantageous for the patency rate (RR = 1.20; 95% CI:1.03 - 1.41; p < 0.04). Compared with typical MVE (65.20%, 95% [CI]:61.40%-69.10%), deferential vessel-sparing MVE with a higher overall mean patency rate (83.60%, 95% [CI]:75.40%-91.70%).
    The meta-analyses indicated that MVE is a high- and cost-effective therapeutic method for patients with EOA, and deferential vessel-sparing MVE could be mainstream in the near future.
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  • 文章类型: Journal Article
    在过去的几十年中,外科手术的现场直播(LBSP)在会议和教育会议中越来越受欢迎。这是由于微创手术(MIS)的快速发展,使整个手术领域的传输和传输的简易性和技术有助于向现场观众广播手术。这项研究的目的是更新证据,特别强调与MIS中LBSP相关的患者安全问题。
    使用Medline对文献进行了系统回顾,Embase和Pubmed在所有外科专业的教育活动中使用与LBSP相关的定义搜索词,根据PRISMA准则。我们还合并了先前关于这一主题的准则和立场声明。结果包括关于LBSP的教育价值以及患者安全结果和临床结果捕获的伦理问题的报告。
    共有1230篇摘要被确定,其中27篇论文符合纳入标准(13篇原创文章和14篇立场声明/指南)。所有研究都强调了LBSP的教育益处,但没有明确衡量这些益处。在9项研究中,临床结果没有受到损害,但在其余4项研究中,临床结果较差,包括较低的内窥镜手术完成率和较高的再次手术率。只有9项研究符合LBSP的专用同意书,在LBSP期间没有一致的报告方法来维护患者的机密性。缺乏关于LBSP报告标准化方法的建议,包括14个已发布的指南和立场声明的结果。
    外科手术的现场直播可能具有教育价值,但患者的安全可能会受到影响。从伦理和患者安全的角度来看,需要一个关于LBSP及其结果的标准化报告框架。
    CRD42021256901。
    Live Broadcast of Surgical Procedures (LBSP) has gained popularity in conferences and educational meetings in the past few decades. This is due to rapid advancement in both Minimally Invasive Surgery (MIS) that enable transmission of the entire operative field and transmission ease and technology to help broadcast the operation to a live audience. The aim of this study was to update the evidence with specific emphasis on the patient safety issues related to LBSP in MIS.
    A systematic review of the literature was performed using Medline, Embase and Pubmed using defined search terms related to LBSP in educational events across all surgical specialities, in accordance with the PRISMA guidelines. We also consolidated the prior guidelines and position statements on this topic. Outcomes included reports on the educational value of LBSP as well as patient safety outcomes and ethical issues that were captured by clinical outcomes.
    A total 1230 abstracts were identified with 27 papers meeting the inclusion criteria (13 original articles and 14 position statements/guidelines). All studies highlighted the educational benefits of LBSP but without clear measure of these benefits. Clinical outcomes were not compromised in 9 studies but were inferior in the remaining 4, including lower completion rate of endoscopic surgery and higher rate of re-operation. Only nine studies complied with dedicated consent forms for LBSP with no consistent approach of reporting on maintaining patient confidentiality during LBSP. There was a lack of recommendation on standardised approach of reporting on LBSP including the outcomes across the 14 published guidelines and positions statements.
    Live Broadcast of Surgical Procedures can be of educational value but patient safety may be compromised. A standardised framework of reporting on LBSP and its outcomes is required from an ethical and patient safety perspective.
    CRD42021256901.
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  • 文章类型: Journal Article
    块状皮肤病,羊痘,山痘是牛的法定传染病,绵羊,和山羊,分别,由Capropoxvirus属病毒引起的。他们负责直接和间接的财务损失。这些损失是由动物死亡引起的,接种疫苗的发病率成本,以及对动物和动物产品贸易的限制。控制和根除病毒有赖于及早发现爆发,矢量控制,严格的动物运动,和疫苗接种仍然是最有效的控制手段。迄今为止,减毒活疫苗被广泛使用;然而,保护仍然存在争议。许多疫苗与绵羊的不良反应和不完全保护有关,山羊,和牛。还开发了许多基于组合和重组的疫苗。这里,我们回顾了针对每种反刍动物的羊痘病毒感染以及各自疫苗赋予的针对羊痘病毒的免疫力。我们还回顾了它们对异源感染的相关交叉保护。
    Lumpy skin disease, sheeppox, and goatpox are notifiable diseases of cattle, sheep, and goats, respectively, caused by viruses of the Capripoxvirus genus. They are responsible for both direct and indirect financial losses. These losses arise through animal mortality, morbidity cost of vaccinations, and constraints to animals and animal products\' trade. Control and eradication of capripoxviruses depend on early detection of outbreaks, vector control, strict animal movement, and vaccination which remains the most effective means of control. To date, live attenuated vaccines are widely used; however, conferred protection remains controversial. Many vaccines have been associated with adverse reactions and incomplete protection in sheep, goats, and cattle. Many combination- and recombinant-based vaccines have also been developed. Here, we review capripoxvirus infections and the immunity conferred against capripoxviruses by their respective vaccines for each ruminant species. We also review their related cross protection to heterologous infections.
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  • 文章类型: Case Reports
    BACKGROUND: We report the case of a 43-year-old female patient with systemic lupus erythematosus, class III lupus nephritis, with predialysis creatinine levels around 350 μmol/L (3.95 mg/dL) after partial resection of the left kidney with histologically verified papillary carcinoma in 2010. Preoperative computed tomography of the abdomen revealed a small 8 mm tumor in the left upper kidney pole. The patient was indicated for simultaneous bilateral nephrectomy and orthotopic renal transplantation with the aim to minimize invasiveness of the procedure as well as for curable tumor removal.
    METHODS: The procedure was performed under the full anesthesia trough upper middle laparotomy. As the first step, bilateral transperitoneal nephrectomy was performed. The live donor surgery started in a parallel theater to shorten the cold ischemic time of the graft. The renal graft had singe vessels and ureter; it was placed into the recipient\'s right orthotopic position. End-to-end anastomosis of the right renal vein and artery anastomosis were performed; ureter was anastomosed end-to-end using recipient\'s ureter.
    RESULTS: The postoperative period was uneventful with repeatedly excellent ultrasonography check-up of the graft\'s perfusion. The patient was discharged after 13 days with a good renal function of the graft (urea: 15 mmol/L, creatinine 160 μmol/L [1.80 mg/dL]).
    CONCLUSIONS: Orthotopic renal transplantation is a technically challenging but valid alternative for patients who are unsuitable candidates for heterotopic renal transplantation or in cases where there is a clear benefit of orthotopic renal transplantation.
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