Objective To systematically analyze and compare the research literature of thoracic surgery simulation-based medical education (SBME) at home and abroad, and provide ideas for the future development of thoracic surgery SBME in China. Methods Using word frequency analysis and cluster analysis as analysis methods, CiteSpace visualization software and Excel statistical software as tools, the domestic and foreign SBME literature retrieved from PubMed and CNKI databases were visualized and statistically analyzed respectively. Results A total of 2 491 domestic and foreign literature on SBME in thoracic surgery were included. The annual number of foreign publications showed an increasing trend. The top three countries in terms of number of publications were the USA (n=581), Canada (n=105) and Germany (n=57); "cardiac surgery", "medical knowledge medical knowledge" and "medical education" are the hotspots of research in the direction of thoracic surgery simulation, while "lung cancer", "surgical training" and "3D printing" were still in the process of explosion. The core research themes were endoscope simulation trainer, scenario-based simulation teaching methods, standardized patients and virtual reality models. Conclusion Domestic SBME in thoracic surgery should learn from foreign development experience, keep up with the frontier and integrate cutting-edge technology, innovate the curriculum and offer non-technical skills teaching, and improve the system and focus on software construction.
Objective To assess the efficacy and safety of Lanthanum Carbonate for hyperparathyroidism in dialysis patients. Methods We searched MEDLINE (1996 to April 2006); EMBASE (1996 to April 2006); Cochrane Central Register of Controlled Trials (Issue 1, 2006); CBM disc; VIP and CNKI. We also checked the references of relevant studies. Randomized controlled trials (RCTs) comparing Lanthanum Carbonate with placebo and standard therapy were eligible for inclusion. Quality assessment and data extraction were done by two reviewers independently. Meta-analysis was conducted using The Cochrane Collaboration’s RevMan 4.2.8. Results Six RCTs were included. Lanthanum Carbonate was found to be more effective than placebo in treating hyperparathyroidism of dialysis patients (OR 4.74, 95%CI 2.66 to 8.45; Plt;0.0001) and the incidence of all drug-related adverse events was similar between Lanthanum Carbonate and placebo-treated group (OR 1.23, 95%CI 0.74 to 2.04; P=0.42). The meta-analysis also showed that the efficacy of treating hyperparathyroidism of dialysis patients was similar between Lanthanum Carbonate and conventional phosphate binders (OR 0.97, 95%CI 0.74 to 1.27; P=0.81) and the incidence of all drug-related adverse events was also similar (OR 1.29, 95%CI 0.62 to 2.47; P=0.49). However, serum calcium level was lower in the Lanthanum Carbonate group than in the conventional phosphate binders group. Conclusion Lanthanum Carbonate is effective and well-tolerated in treating hyperparathyroidism of dialysis patients with end-stage renal disease(ESRD). The incidence of hypercalcemia induced by Lanthanum Carbonate is significantly lower than that of the conventional phosphate binders. However, more large-scale, randomized, double-blinded trials are required to investigate the long-term safety and efficacy of Lanthanum Carbonate.
【摘要】 目的 探討生理鈣透析液對持續性不臥床腹膜透析（CAPD）患者鈣磷代謝的影響。 方法 回顧性分析2008年1月-2009年12月腹膜透析患者的鈣磷指標，資料齊全的患者中使用鈣濃度為1.25 mmol/L的腹膜透析液（生理鈣組）的患者有30例，使用鈣濃度為1.75 mmol/L的透析液（標準鈣組）患者30例。對兩組患者鈣磷代謝指標進行比較。 結果 治療前后兩組的血磷、鈣磷乘積和全段甲狀旁腺素差異均無統計學意義（Pgt;0.05）；治療后標準鈣組血鈣較前升高，差異有統計學意義（Plt;0.05），而生理鈣組治療前后血鈣差異無統計學意義（Pgt;0.05）。 結論 不同含鈣濃度腹膜透析液對機體鈣磷代謝的影響是不同的，在高鈣、高磷、低轉運骨病的腹膜透析患者中使用鈣濃度為1.25 mmol/L的生理鈣透析液減輕了鈣負荷，為臨床醫生使用含鈣磷結合劑提供了治療空間。【Abstract】 Objective To investigate the effects of physiological calcium dialysate on the calcium and phosphorus metabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods We retrospectively analyzed the clinical data of 60 patients having undergone CAPD in West China Hospital of Sichuan University between January 2008 and December 2009. The patients were divided into two groups with 30 in each by calcium concentration of the dialysate: the physiological calcium dialysate group (1.25 mmol/L) and the standard calcium dialysate group (1.75 mmol/L). The metabolism indexes of calcium and phosphorus for the two group of patients were compared. Results Levels of Serum phosphate, calcium-phosphate product and immoreactive parathyroid hormone (iPTH) of all the patients in both groups before and after treatment showed no significant differences (Pgt;0.05). Serum calcium increased significantly in patients treated with standard calcium dialysate (Plt;0.05), while it did not change significantly in patients treated with physiological calcium dialysate (Pgt;0.05). Conclusions Dialysate with different concentrations of calcium provides different influence on the metabolism of calcium and phosphorus. Changing calcium concentration to 1.25 mmol/L in the dialysate can lower the calcium load for patients with hypercalcium and/or hyperphosphate with low bone turnover, providing treatment space for clinical doctors to use binders containing both calcium and phosphorus.
目的 總結腎移植術后肺部感染的臨床表現、病原學及救治措施，以提高其治愈率。 方法 對四川大學華西醫院50例次腎移植術后肺部感染住院患者的病歷資料進行回顧性分析。 結果 共收集42例（50例）次腎移植肺部感染患者，痰培養檢出病原體38例次（76%），未檢出12例次，其中細菌感染17例次（44.7%），真菌感染7例次（18.4%），巨細胞病毒感染19例次（38%），支原體感染6例次（12%），混合感染10例次（20%）。肺部感染發生在腎移植術后1個月以內者3例（7%），1～6個月者16例（38%），6個月以后者23例（55%）。50例次感染患者中48例次經積極治療搶救后好轉出院，有2例患者死亡。 結論 腎移植術后肺部感染患者的病原體與腎移植術后時間有一定的規律性。對于腎移植術后肺部感染，救治成功的關鍵是早期病原體及CT檢查，及時給予綜合治療措施，包括經驗性抗生素治療措施，及時調整免疫抑制劑方案，加強全身支持。
【摘要】 目的 探索持續非臥床腹膜透析（CAPD）患者年齡與營養狀況的關系，為營養教育提供指導。 方法 對2007年8月-2010年1月腹膜透析177例患者的臨床資料進行回顧性分析，包括血紅蛋白（HGB）、血清白蛋白（ALB）、年齡、體重指數（BMI）、腹膜平衡試驗（PET）、尿素清除指數（Kt/V）、24 h尿蛋白、腹透液漏出蛋白、標準化每日蛋白質分解率（nPCR）等，分析年齡與營養狀況的關系。 結果 老年組（≥60歲）和中青年組（lt;60歲）ALB分別為（31.54±5.91）、（33.24±4.75）g/L，老年組ALB較低（Plt;0.05）；老年組Kt/V值1.95±0.63和HGB水平（95.25±22.89） g/L均高于青年組（Plt;0.05）。兩組患者營養不良與BMI、PET、每日蛋白漏出總量、nPCR無關。 結論 CAPD老年患者（≥60歲）更容易發生營養不良，且老年組低蛋白血癥與透析充分性無明顯關系。故應加強老年CAPD患者的飲食營養管理指導，設計合理的飲食。【Abstract】 Objective To investigate the relationship between age and nutrition status of the patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide instructions for nutrition education. Methods We retrospectively analyzed the clinical data of 177 patients having undergone CAPD in the Department of Nephrology of West China Hospital between April 2007 and January 2010. Clinical parameters collected included hemoglobin (HGB), serum albumin (ALB), age, body mass index (BMI), results of the peritoneal equilibrium test (PET), urea clearance index (Kt/V), 24-hour urinary protein, protein loss in the peritoneal dialysate, normalized protein catabolic rate (nPCR). Relationship between age and nutrition status in these patients were analyzed. Results Plasma albumin was (31.54±5.91) g/L and (33.24±4.75) g/L respectively in patients of or older than 60 years old (the elderly group) and in patients younger than 60 years old (the younger group). Compared with the younger group, patients in the elderly group had lower ALB (Plt;0.05), but higher Kt/V 1.95±0.63 and hemoglobin level (95.25±22.89) g/L (Plt;0.05). In addition, malnutrition in both groups was not associated with BMI, PET results, daily protein loss in the peritoneal dialysate or nPCR. Conclusions Patients of or older than 60 years old undergoing CAPD are more likely to develop malnutrition, indicating that hypoalbuminemia is not associated with dialysis inadequacy. We advocate enhancing diet nutrition education in elderly CAPD patients and providing them with balanced diet regime.
Objective To explore the medical insurance quota payment of dialysis treatment for outpatients with end-stage renal disease in Chengdu from following aspects, evaluation indexes and reasonable amount, so as to provide scientific basis for the payment of single disease. Methods A questionnaire survey was conducted to collect the cost information of patients, and to formulate the assignment of evaluation indexes according to the therapeutic principles and statistical results; Delphi method was adopted to determine the assignment and the standard of quota payment. Results A total of 17 dialysis organizations approved by Chengdu municipal medical insurance were involved in this study. Of 700 questionnaires distributed, 686 were retrieved. After excluding 26 questionnaires for incomplete filling and incorrect treatment information, a total of 660 questionnaires were included actually, accounted for 94.28% of all informants. The results of survey showed that, the hemodialysis treatment rate accounted for 84% (555/660) of all informants, while the peritoneal dialysis treatment rate accounted for 16% (105/660). By assessing the project assignment of outpatient dialysis treatment, the minimum annual payment of hemodialysis was RMB 118 242.75 yuan, while that of peritoneal dialysis was RMB 96 498.00 yuan. Conclusion The quota payment of outpatient dialysis shows b evidence after adopting the treatment project assignment. The grading quota payment of outpatient dialysis enables the medical insurance fund to be more reasonably used.
Objective To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis (PD) catheter implantation. Methods Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups: the local filtration anesthesia (LF) group and the TAP group. The two groups got the ultrasound guided TAP block (The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound), then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group (33.3%) (P=0.034). The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF group (P values=0.001, 0.037, 0.000, 0.001, 0.029, 0.035, and 0.000, respectively). The TAP group consumed less sufentanil during the operation and showed a higher satisfaction of the operation doctors. There were no significant differences in the PD catheter related complications and adverse events between the two groups. Conclusion The ultrasound-guided TAP block can be an effective and safe anesthesia method for PD catheter implantation. Because of the limitation of small sample size of this study, a multiple center study with larger sample size is suggested.
Objective To investigate the change of pathogenic distribution and drug resistance in peritoneal dialysis associated peritonitis (PDAP). Methods The clinical data of all the patients undergoing continuous ambulatory peritoneal dialysis and suffered from PDAP between January and December in 2014 was retrospectively collected, and the pathogens, drug resistance, outcomes and underlying causes were analyzed. Results A total of 64 patients had 72 cases of PDAP. Only 36 strains (50.0%) had positive culture results, among which 24 strains (66.7%) were Gram-positive bacteria strains, 7 strains (19.4%) were Gram-negative bacteria strains, and 5 strains (13.9%) were fungi. For Gram-positive bacteria strains, the resistance rates to vancomycin, linezolid and rifampicin were all 0%; the resistance rate to levofloxacin, gentamycin and cefazolin was 14.3%, 26.3% and 50.0%, respectively. For Gram-negative bacteria strains, the resistance rates to amikacin and imipenem were both 0%; the resistant rate to gentamycin, ceftazidime, levofloxacin and ampicillin was 28.6%, 28.6%, 42.9% and 100.0%, respectively. Conclusions The pathogenic spectrum and drug resistance in PDAP have been markedly changed. Selection of antibiotics should be chosen according to the characteristic of the pathogenic spectrum and drug resistance of each center. Great effort is still needed to improve the culture positive rate of the effluent dialysate and to improve the recovery rate of peritonitis.