肖传国医院开始盈利了。给天使妈妈基金会捐了几十万,剩下的怎么花?为20个主要国家作200例免费手术吧。唯一条件是:该国知名医学院的神经外科医生和泌尿外科医师必须陪这10个病人来深圳,和我一起上台为这10个病人手术,学会肖氏手术,然后带病人回国随访报告结果。我亲自作的手术有效率至少80%是有把握的,这样就可避免个别笨学徒再出现Tuite团队的错误。 这样最多两年就可全球推广开了。 在国际上推广新手术,没钱是寸步难行,比如在美国,要么申请到NIH基金,要么有富翁捐款。过去在协和当主任十几年,每月收入不够1万,不够交税。 掌握的研究经费不少,但不能用于病人手术费。就是蒙个院士本本到手,也耻于捞钱。现在老子有这么多钱了,可以作自己想做的事了。塞翁失马焉知非福,这真是老天爷的安排?有意思。 下文是今天给美国泌尿外科杂志交稿的给主编的信,宣布了全球200免费肖氏手术计划。 几位美国著名大学的著名教授均同意参加,共襄盛举。感谢党感谢国家,好久不写、不改英文文章了,还是贴出来给医学同行们参考指正。 Xiao Letter to the Editor.docx JU-S-18-00420.pdf
【 Bladder Re-Innervation:State of the Art Xiao review article.pdf 】美国的四所大学医院开展了肖氏反射弧手术临床应用研究(纽约大学医学院,贝蒙特大学医学院,路易桑拿州立大学医学院,南佛罗里达大学儿童医院),三所报告成功,一所失败后,著名的Springer/Nature 旗下的CURRENT BLADDER DYSFUNCTION REPORTS杂志主编邀请我写篇综述向世界同行介绍肖氏手术,题目是杂志定的 。刚刚线上刊出,供同行参考。美国神经外科杂志也已全文 接受 并将于近日发表 我给总编的信以及 确保肖氏手术成功的指导原则。 在人品、道德和学术上,我是被 方舟子方玄昌柴会群贾鹤鹏 一伙利用全国媒体抹黑到极致了。仅新语丝对我方方面面的污蔑文章至少1千多篇。你去辩解澄清?累死你无用不说,正中圈套。最好的办法就是我09年在清华讲座并一直高调宣扬的那张幻灯:【本教授行医30余年、作学问三十余年(妈的,都四十年了),虽非完人,基本无瑕。谁发现任何对我的攻击属实,奖励5万】,这不,吹吹牛就把复杂问题立马简单化了。 在科学学术上,同样道理。你和方舟子方玄昌柴会群贾鹤鹏及其教徒这伙不知神经为何物,且心地歹毒,决心置你于死地的混混争辩学术?那就上当了:你认可了他们的学术地位和资格。但是,若遇到真正的学术同行,如丹麦的团队、佛罗里达的团队,却固执,有时甚至是愚蠢,学术上的论争效果有限,这种情况怎么办?直接了当吹牛打擂台呗:-)。我在这篇综述里,以及给美国神经外科杂志总编的信里,都直截了当的表明: ACH医院Tuite医生的20名参与肖氏术双盲临床试验的病患:10名做了肖氏术的病患中最终确定无效者,再加上另10名未做肖氏术的病患,统统欢迎来中国免费做肖氏术,并承诺一年内至少80%的有效率、或如Peters试验一样的效果。同时告诉全世界(国际性吹牛):脊膜膨出大小便失禁过去是绝症,但现在对我们而言,治好它和治好疝气一样简单、有效、可靠、安全。 所以,年初佛罗里达Tuite团队完全无效的文章一出,方舟子一伙欣喜若狂,我也是心中窃喜:终于有了一个直接向国际神经外科学界展示肖氏手术的机会和绝好平台了。于是立即给那美国神经外科杂志写了那封信。美国的外科医生们并没有系统的科研训练,那双盲文章质量奇差,漏洞像筛子, 1234一条条列出,如何反驳?只能接受我的信全文发布(他们仅删改了一些过激词语)。国际泌尿学界大概也是觉得神经外科这帮兄弟太不懂装懂,太过分,在Tuite文章发表后的一个星期,立即邀请我写篇综述,题目 Bladder Re-Innervation:State of the Art是杂志总编定的:-) 至于那华人医生Jea非学术的恶意诽谤,律师已起诉。鉴于Tuite配合Jea对我的污蔑诽谤,遵照美国“you scrach my back, I scrach yours”原则,来而不往非礼也,I have to fuck back. 我向霍普金斯大学和美国GENERAL INSPECTOR OFFICE举报了他们的双盲研究违反伦理,违反法律,涉嫌套取保险基金,文章数据涉嫌造假。这些单位在初步调查系统评估后,已正式立案调查。
昨天有人把丹麦的截瘫病人肖氏手术后一年半结果告诉我:10例完全无效。我当即判断一定是出了根本性错误,而能让所有10例病人术前术后完全无变化的只有持续应用神经阻断剂。当时只看到他们的摘要,但根据其结果中完全没有尿流动力学检查指标中最重要最主要的逼尿肌收缩压力这一项,我判断他们犯了德国同行同样的错误,就是继续坚持用神经阻断剂。今天收到全文,果然如此! 尤其令人啼笑皆非的是:他们自己也不能排除神经阻断剂导致了失败,但却试图解释肖氏手术是再生节前神经纤维,而胆碱能神经阻断剂是阻断节后神经纤维与膀胱肌肉的联系,应该影响不大。老大!你把灯头和灯泡之间塞了一层绝缘塑料,我把供电火线接得再好,电能到灯泡吗???这也说明:世界最好的美国泌尿外科杂志主编和审稿人基本不懂神经学。 我一再、反复在论文、综述、大会讲座、他们直接来我医院学习时强调成功实施肖氏手术的注意事项,其中最重要的是:停用神经阻断剂!他们也知道,还诚实的在他们文章中一条条列出,但就是不照办。 这是一篇思路清晰、技术先进、数据准确、统计无误、讨论到位的论文。可惜,理论基础错了,一错全错,此文在科学上半点价值都没有了。但所作的这些病人并非没有价值了:最优秀的丹麦神经外科医生做的手术肯定没问题,神经再生已经众多基础和临床研究证实也不会有问题,所以新的神经反射弧应该已经建立,只不过现在处于被人为阻断的状态。我会给美国泌尿杂志去封letter of Comments, 指出问题,建议丹麦方面立即停用神经阻断剂,一个月后再按设计复查尿流动力学、测试肖氏反射弧效果,然后再发表结果,撤销现文,以免误导。 以下英文是从论文中直接copy,尤请注意红色字体部分:(还是翻译出来方 便 大家) 【肖一直推荐严格的肖氏手术病人选择标准:包括术前术后电生理评估;病人知情;停用神经阻断剂(抗胆碱能神经);膀胱最大容量不超过700毫升;必要时膀胱造瘘直到肖氏反射弧开始起作用而自行排尿。尽管这些标准的正式杂志发表是在本研究开始后,我们基本遵循了这些标准的大部分,但没有限制膀胱最大容量,也没有停用神经阻断剂因为我们认为此药对病人18个月研究期里的健康至关重要。考虑到(肖氏反射弧)神经再生发生在节前纤维涉及节前神经元的N受体,而抗胆碱能神经阻断剂主要作用于节后神经元的M受体(阻断节后神经与膀胱肌肉的联系--译者注),我们虽然不能排除应用此神经阻断剂可能减弱了这新建立的神经反射,但也不相信此阻断剂能完全消除此新的神经反射弧。 Rigorous criteria for patient selection have been recommended by Xiao8. These include pre- and peroperative electrophysiological evaluation, patient education, discontinuation of anticholinergics, maintaining bladder capacity below 700 mL and leaving a suprapubic catheter in situ until reflex arch voiding was established. Although first published after beginning of the present study most criteria were met, save the upper limit of bladder capacity and cessation of anticholinergic medication, as we judged that the medication was essential for patient wellbeing throughout the 18 month study time. As reinnervation occurs at the level of the preganglionic (nicotinic) receptors, and anticholinergics mainly target postganglionic (muscarinic) receptors, we cannot exclude that treatment may have diminished the reflex but do not believe it would have abolished it completely. 】
【科普一下脊柱裂脊髓膜膨出的发病率、生存率、致残率、致残原因】 (题目中写肖氏反射弧手术只为好归档和吸引眼球) 请注意:1,死亡原因主要为尿毒症,2,很少病人能活到成年,3,肖氏反射弧手术主要解决这2个问题。 一、发病率:平均约为千分之一新生儿,请注意中国北方接近千分之六新生儿 脊柱裂脊髓膜膨出发病率 【 Botto LD , et al. Neural Tube Defects. N Eng J Med. 341(20):1509-1519,1999 】 二、脊柱裂婴儿的 5 年存活率和致残率 5 年平均大手术 3 次 Althouse R, Wald N. Survival and handicap of infants with spina bifida. Arch Dis Child. 1980 Nov;55(11):845-50. 【摘要】 年 5 年存活率: 37% ( 79/213 新生儿) 存活的79个患儿残废率:52人严重伤残,14人中度伤残。(66/79) 年平均大手术 6 一项随访研究调查了从 1965 年到 1972 年出生于英国牛津郡和伯克希尔西部的 213 名先天性显性脊椎裂(包括 encephalocele and occipital meningocele )患儿。 有脊膜膨出的患儿, 5 年的存活率是 36% ( 107 个婴儿中仅有 39 人存活 5 年以上); 仅有脊柱裂而无脊髓膜膨出的婴儿, 5 年的存活率是 60% ( 50 个婴儿中有 30 人存活 5 年以上);对那些脊髓和脊髓膜几乎都有膨出而不能列入上述两种分类的婴儿, 5 年的存活率只有 18% ( 56 个这样的婴儿仅有 10 人存活 5 年以上)。对那些存活下来的儿童通过 Lorber 标准评估了他们的伤残程度: 存活下来的 49 名脊膜膨出的儿童(包括脊髓脊膜膨出)有 41 人( 84% )属于严重伤残, 4 人( 10% )属于中度伤残,只有 3 人( 6% )是没有伤残;存活下来的 30 名脊柱裂患儿中, 11 人( 37% )属于严重伤残, 10 人( 33 )属于中度伤残,剩下的 9 人( 30% )没有伤残 。 当这种病变发生在头部时(脑膜膨出)更容易导致严重伤残( 75% , 8 名婴儿中有 6 人);仅有脊柱裂患儿的严重伤残率是 23% ( 22 名婴儿中只有 5 人)。 脊膜膨出并存活至少 5 年的患儿,前 5 年平均住院至少 6 个月,并且接受平均至少 6 次大的外科手术 。比较起来, 仅有脊柱裂的患儿(存活至少 5 年),住院的时间少三分之一,平均大手术次数少于 3 次 。在本研究期间对患儿采用现在普遍使用的选择性治疗方案。所有婴儿在出生前均进行产前检查。因此,本研究结果可能有助于评估产前筛检脊髓膜膨出型脊柱裂的意义。 【 Abstract 】: A follow-up study was carried out on 213 infants born with spina bifida cystica (including encephalocele and occipital meningocele) from 1965 to 1972 to women resident in Oxfordshire and the western part of Berkshire. The 5-year survival rate was 36% (39/107) for those with open lesions, 60% (30/50) for those with closed ones, and 18% (10/56) for those with lesions which could not be classified (not known) but which were probably nearly all open. The extent of handicap among these survivors was assessed by means of criteria described by Lorber; among those with open lesions (including 'not known') 84% (41/49) were severely handicapped, 10% (4/49) were moderately handicapped, and only 6% (3/49) had no handicap; among those with closed lesions, 37% (11/30) were severely handicapped, 33% (10/30) were moderately handicapped, and the remaining 30% (9/30) were not handicapped. Closed head lesions (encephalocele or occipital meningocele) were more often associated with severe handicap (6/8; 75%) than were closed spinal lesions (5/22; 23%). The children with open lesions who survived for at least 5 years spent, on average, at least 6 months in hospital during the first 5 years of their life and had, on average, at least 6 major surgical operations. In comparison, those with closed lesions spent one-third less time in hospital, and had fewer than half as many operations. During the period of the study a selective treatment policy was adopted typical of that commonly practised now, and all the infants were born before antenatal screening had been introduced. Our results therefore may be helpful in assessing the benefits to be expected from antenatal screening for open spina bifida. 三、先天性脊柱裂脊膜膨出患者足畸形、行走障碍、皮肤溃疡的原因 【摘自:美国医学专业教科书 http://www.scribd.com/doc/48902221/Spina-bifida 】 脊柱裂都导致不同程度的神经和肌肉骨骼损伤,症状可表现为全身瘫痪,或局部麻木,或轻度功能障碍或无明显功能障碍【 15 】。 脊柱裂发生的解剖学位置决定相应运动神经和感觉神经的功能障碍区域。虽然在童年时代, 隐性闭合不全可能不会被发现,随着年龄增长,身高增长,脊髓向其正常位置( L1-L2 )的上升过程中,原发性发育障碍或继发性肿瘤均可导致脊髓不能上升到 L2 位置,这种情况叫 脊髓栓系综合征:患者可发生足畸形,步态障碍,脊柱侧弯,和括约肌功能障碍 。【脊膜膨出患者一出生基本均有脊髓栓系综合征。一生可能需要多次作栓系松解手术以缓解下肢症状—译者注】 足畸形者,因为骨畸变和足部生物力学的改变,更易产生溃疡 骨畸形能改变处于足底的天然脂肪垫(脂肪垫的作用是把受力均匀地分布在较大区域)。这样,在步行中着地时和足跟抬升期会产生过量的局部压力,可能造成在骨突起部位的皮损或角质增生。 这些足部变化会使得足部溃疡的机会增加两个数量级 。剪切力,压力和摩擦力也都可能有导致骨突起异常区域皮肤破损、溃疡。 溃疡风险与风险因子成正比:外周神经病变患者的溃疡风险高 1.7 倍,同时有外周神经病变和足畸形者风险高 12 倍,同时有外周神经病变加足畸形患者加截肢患者风险高 36 倍 。 【英文原文】 【 http://www.scribd.com/doc/48902221/Spina-bifida 】 Spina bifida is associated with varying degrees of neurologic and musculoskeletal impairment and ranges from complete paralysis and/or paresthesia to minimal or no impairment. The anatomic level of the lesion generally correlates with the motor and sensory deficit. Although the occult dysraphic state may go undetected in early childhood, as the spinal cord ascends to its normal position in life (L1-L2), patients may later present with foot deformities, gait disturbances, scoliosis, and sphincter dysfunction. The failure of the spinal cord to ascend secondary either to primary malformation or to secondary tumor is known as tethering of the cord. Foot deformities make the foot more vulnerable to ulceration via bony deformities and altered foot biomechanics. Bony deformities alter the natural protective fat pads located on the plantar surface of the foot, which normally protect the foot by distributing weight-bearing forces evenly over a large area. Excessive focal pressure developed during the midstance and heel-rise parts of the gait cycle may cause skin loss or hypertrophy of the stratum corneum (callus) over bony prominences. These changes in the foot increase the possibility of ulceration by two orders of magnitude. Shearing, pressure, and frictional forces also all play a role in the breakdown of the cutaneous barrier, since they are concentrated over the abnormal bony prominences. The risk of ulceration is proportional to the number of risk factors and is increased by 1.7 in persons with peripheral neuropathy, by 12 in patients with peripheral neuropathy and foot deformity, and by 36 in those who have peripheral neuropathy, foot deformity, and previous amputation, as compared with those without risk factors.