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本帖最後由 小康人家 於 2011-2-28 11:04 編輯
不惑之禍 發表於 2011-2-28 10:49 
別的不知道，至少方打肖打對了，否則還要有多少病人受騙。新鮮人自己還是個醫生，都不懂這些。
請再看看國外對肖傳國的評價吧，半年前的， 不算太舊吧？？
Congrats to Dr. Xiao, results of Xiao Procedure in US published, and,
unfortunately, seriously questioned in the Journal of Urology.
08-19-2010, 02:21 AM
The Beaumont Hospital in Michigan is one of the first American institutes that took up clinical trials of the controversial Xiao Procedure. We have previously questioned their clinical outcomes and their misleading propaganda in our Open Letter of Complaint against the Xiao Procedure.
More recently, the hospital has also become the first institute to publish clinical results of Xiao Procedure in an established scientific journal. Dr. Kenneth Peters and his coauthors wrote in the Journal of Urology of their results:
At 1 year 7 patients (78%) had a reproducible increase in bladder pressure with stimulation of the dermatome. Two patients were able to stop catheterization and all safely stopped antimuscarinics. No patient achieved complete urinary continence. The majority of subjects reported improved bowel function. One patient was continent of stool at baseline and 4 were continent at 1 year. Of the patients 89% had variable weakness of lower extremity muscle group at 1 month. One child had persistent foot drop and the remainder returned to baseline by 12 months.
In their conclusion, they noted that 「more patients and longer followup are needed to assess the risk/benefit ratio of this novel procedure.」
The Journal, however, appears to be less than impressed. It published two pieces of editorial comments to accompany the paper, both are quite negative. In one, Dr. Eric Kurzrock of UC Davis Children』s Hospital wrote:
The authors present the first North American experience with lumbar to sacral nerve rerouting for patients with spina bifida. The results from this study and previous animal and clinical studies by Xiao clearly demonstrate that nerve rerouting produces a somatic-autonomic or cutaneous/bladder reflex with stimulation of the lower extremity dermatome. What is also clear is that the clinical benefit of the procedure is not at all similar to previous reports.
Although the authors did an excellent job of following the patients and characterizing their changes, the results are hard to validate without a control population going through the same rigorous surveillance regimen. In particular the improved bowel continence and minimal changes in bladder compliance may not be statistically significant. The fact that most patients were still on clean intermittent catheterization and none achieved complete urinary continence is troubling in light of the report of 87% success with 110 children with spina bifida presented by Xiao. One has to wonder if most of these children are not voiding volitionally or using the newly developed cutaneous reflex, and how much reinnervation has a role in this surgery. Is it possible that unilateral denervation of the S3 ventral motor nerve produced improved compliance and continence, as previously reported in numerous clinical series?
I congratulate the authors for taking on this challenge. I hope this study leads to a rebirth or refocus regarding neurosurgical treatments of neuropathic bowel and bladder. I strongly agree with the authors that this procedure should remain on a research protocol only.
In another, Dr. John Park of University of Michigan was even more blunt:
One of the most curious findings is the discrepancy between urodynamic data and subjective voiding. One patient exhibited a decrease in capacity and an absence of reflex arc, and yet he subjectively reported improved bladder and bowel function! I could not help but speculate that his voiding after the procedure could simply be the bladder emptying via intra-abdominal pressure generation against an open bladder neck, given his preoperative stress incontinence. Xiao reported that more than 87% of 110 patients gained sensation and continence within 1 year (reference 7 in article). In comparison, the current patients undergoing the identical procedure with the help of Xiao himself only showed a modest improvement in objective urodynamic studies and subjective reporting. Unless the innovators provide a sound argument and data for the validity of the procedure, there is a great danger of its improper and rapid adaptation by patients and the medical community at large.
Along with the editorial comments, Dr. Piet Hoebeke of Ghent University Hospital in Belgium also commented on Beaumont』s results in his editorial, seemingly with some sense of humor:
… in this issue of The Journal the results of the study by Peters et al (page 702) are the first to challenge the excellent, previously published results of nerve rerouting that showed up to 85% success.8 Despite proof that nerve rerouting can create a novel reflex arc generating a detrusor contraction, this group learned that after 1 year no patient became continent and only 2 of 9 were able to stop catheterization. Effects on bladder compliance and cystometric bladder capacity were remarkable despite stopping antimuscarinic treatment. Persistent foot drop cannot be considered a minor complication in children who are already motor disabled. Although promising, this study cautions us that further controlled studies are needed before this nerve rerouting procedure can be used more routinely.
Finally, We cite below how Beaumont described their one-year results in a much more 「promising」 way in their press release and their project information for the NIH grant they were rewarded in 2009.
Beaumont sees results in nation』s 1st urinary nerve rewiring surgeries for spina bifida patients
4/17/2008
Seven children from across the United States are gaining bladder control through a revolutionary, first-in-the-nation nerve rerouting surgery for patients with spina bifida. The surgeries were conducted in 2007 at Beaumont Hospital in Royal Oak, Mich.
The children previously required the insertion of a catheter to empty their bladder or endured significant incontinence. But as a result of the surgery, they are beginning to void on their own and are also seeing improvement in bowel function. Initially they signaled the bladder to urinate by scratching or pinching their leg or buttocks. But, remarkably, in most patients the brain was able to take over and control urination normally.
This will allow them to attend school without being catheterized and to play with other children without the embarrassment of soiling themselves. It also means fewer urinary tract infections resulting from catheterization, and reduces their need for antibiotics for infection control.
…
Possible side effects of the surgery include mild postoperative spinal fluid leakage, lower extremity weakness and headache. Recent changes in the surgical technique have dramatically decreased the incidence of these complications. Standard risks associated with any surgery may include bleeding and infection.
Project Information
Project Number: 1R01DK084034-01
Our preliminary data are very promising, and with 9 subjects now 12 months post procedure, 7/9 subjects are voiding either voluntarily or by stimulating the new reflex mechanism.
http://sci.rutgers.edu/forum/showthread.php?t=139130
上為原文鏈接。任何人都歡迎查閱。
本文正說明了他的目的是打擊可能有大成就的中國科學家！！ |
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