Objective To explore the effects of percutaneous renal biopsy(PRB) on the etiological diagnosis and therapeutic regimen of patients with acute renal failure(ARF),so as to further improve the diagnostic and therapeutic levels of ARF.Methods From Nov.1992 to Dec.2007,176 patients were admitted in the Renal Division of Nanfang Hospital.All the patients matched the diagnostic criteria and were clinically diagnosed as ARF:within 48h the serum creatinine(SCr) ascended(≥26.5?mol/L) and increased by more than 50%,and the urine volume of less than 0.5ml/kg?h persisted in 6 hours.All the patients were undergone PRB and the clinical data were analyzed retrospectively.Results The final etiological diagnosis rate elevated from 64.2%(113/176) before PRB to 96.6%(170/176) after PRB.The coincidence of etiological diagnosis before and after PRB was 95.6%(108/113).Of 176 cases,170 were finally diagnosed as ARF,and the 6 remainders who were clinically misdiagnosed as ARF were finally diagnosed as chronic renal insufficiency(CRI).The therapeutic regimen for 83 patients was supplemented and for another 10 patients was modified after PRB,the total adjusted rate was up to 52.8%(93/176).After PRB,8 patients were finally diagnosed as IgA nephropathy,of them one case was specifically diagnosed as IgA protractedly leading to CRI,6 cases were ARF complicated with IgA,and one case was crescent formation induced by IgA nephropathy that leading to ARF.Conclusion PRB is a very useful technique for the etiological diagnosis of ARF on determining the therapeutic regimen and defining the prognosis.

Objective To explore the clinical effect of the elderly far lateral lumbar disc herniation via Quadrant channel system under the Wiltse approach. Methods Thirty-three elderly patients suffering from far lateral lumbar disc herniation were treated by surgery, among whom 18 patients were treated by Quadrant minimally invasive channel system (Quadrant group), and 13 patients were treated by percutaneous transforaminal endoscopic discectomy (PTED group). The patients were followed up for 12 months, and the operation time, blood loss and length of incision were investigated. The JOA scores were compared preoperatively and postoperatively. Results The patients in two groups were followed up for 24 months, except 1 patient withdrew in Quadrant group. The incision length and blood loss in PTED group were superior to those in the Quadrant group:2.0-2.5 cm vs. 0.7 cm, (46.50± 15.20) ml vs.(23.87±6.58) ml, P<0.01, but the operation time in PTED group was longer than that in Quadrant group: (77.17 ± 8.71) min vs. (63.20 ±10.87) min, P<0.01.The two groups had achieved good curative effect, while JOA score in PTED group was superior to the Quadrant group 1 week after operation ( P<0.05), but in 3 month and 12 month two groups had no significant difference ( P>0.05). Conclusion Surgical treatment on elderly far lateral lumbar disc herniation via quadrant channel under wiltse approach is an effective method, and can achieve similar effect with PTED.

BACKGROUND: This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability. METHODS: This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability. RESULTS: STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min. CONCLUSION The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
Reproducibility of Results ; Surveys and Questionnaires ; Practice Guidelines as Topic ; Humans