系统评价输尿管镜碎石术联合阻石网篮治疗上段输尿管结石的价值

目的：系统评价输尿管镜碎石术联合阻石网篮治疗输尿管上段结石的有效性及安全性。方法：计算机检索PubMed、Cochrane library、EMBASE、万方、中国知网全文数据库（CNKI）在线数据库,纳入输尿管镜下碎石术（ureteroscopic litho-tripsy,URL）联合NTrap治疗上段输尿管结石的随机对照研究及病例对照研究,文献的方法学质量评价及相关数据的提取由2名评价员独立完成,采用RevMan 5.0软件对终点数据进行分析。结果：共纳入2个随机对照研究及2个病例对照研究,共682例。Meta分析结果表明,URL联合阻石网篮较单独使用URL治疗输尿管上段结石的结石清除率明显提高（OR=4.28,95%CI=2.51～7.28,P＝0.000）,结石移位率及辅助碎石率明显降低（OR=0.09,95%CI=0.01～0.62,P=0.010;OR=0.18,95%CI=0.05~0.67,P=0.010）,平均手术时间差异无统计学意义（WMD=-0.09,95%CI=-10.25～10.06,P=0.990）。结论：URL联合阻石网篮治疗输尿管上段结石能明显提高结石清除率,有效降低结石移位率及辅助碎石率。     

输尿管镜钬激光碎石术联合应用NTrap网篮治疗输尿管上段结石

目的 探讨在输尿管镜钬激光碎石术治疗输尿管上段结石手术中应用NTrap网篮的有效性和安全性.方法 分析在输尿管镜下钬激光碎石术中联合应用NTrap网篮治疗53例输尿管上段结石患者的临床资料,对碎石成功率、结石清除率、并发症等进行统计分析.结果 一次性碎石成功率94.3%,术后1个月结石清除率98.1%.其中1例发生结石移位,2例因输尿管扭曲无法上镜而改开放手术,2例出现输尿管黏膜损伤,4例术后出现发热.结论 输尿管镜钬激光碎石术治疗输尿管上段结石时应用NTrap网篮可以有效防止结石移位,减少术后残留结石的发生,手术安全可靠.     

输尿管软镜治疗输尿管上段结石的系统评价

目的系统评价输尿管软镜治疗输尿管上段结石的有效性和安全性。方法电子检索Medline(1950年1月至2015年8月)、万方数据库(1990年1月至2015年8月)、中国生物医学文献数据库(1978年1月至2015年8月)、Cochrane图书馆临床随机对照试验库(截止2015年第8期)、CNKI数据库和维普中文期刊数据库,收集有关输尿管软镜治疗输尿管上段结石的临床随机对照试验和临床对照试验。两位研究者独立按照临床试验报告统一标准(CONSORT质量评价标准)和非随机研究方法论指数(MINORS量表)对文献进行质量评价并提取数据。结果最终纳入文献8篇,患者799例,其中试验组输尿管软镜取石术(f URL)392例,对照组经皮肾镜取石术(PCNL)407例。Meta合并分析结果显示,f URL相比PCNL可显著缩短术后住院时间(WMD=-2.42,95%CI-2.62~-2.22,P<0.000 01),并减少术后并发症(OR=0.53,95%CI 0.32~0.89,P=0.02),但f URL结石清除率低于PCNL(OR=0.42,95%CI 0.25~0.70,P=0.000 09),且手术时间延长(WMD=22.19,95%CI 20.37~24.01,P<0.000 01)。结论输尿管软镜取石术在减少术后并发症、缩短住院时间的同时降低了结石清除率,并使手术时间延长。     

输尿管镜钬激光碎石术与气压弹道碎石术治疗输尿管上段结石的系统评价

目的探讨输尿管镜下钬激光碎石术与气压弹道碎石术治疗输尿管上段结石的安全性和有效性。方法计算机检索万方、维普、中国知网、Cochrane、PubMed和EMbase数据库,查找所有比较钬激光碎石术和气压弹道碎石术治疗输尿管上段结石的随机对照试验,检索时间均为2000年1月1日-2012年12月31日,按纳入和排除标准由两人分别独立进行随机对照试验的筛选、提取和质量评价,应用RevMan5.1进行Meta分析。结果共纳入9个研究,共1663例患者。Meta分析显示,在住院时间方面,气压弹道碎石术与钬激光碎石术相似,差异无统计学意义[加权均数差（WMD）=0.07,95%可信区间（CI）为（-0.12,0.26）,P=0.48]。与钬激光碎石术相比,气压弹道碎石术的手术时间较长[WMD=7.36,95%CI（1.32,13.41）,P〈0.05],并发症发生率较高[比值比（OR）=2.23,95%CI（1.14,4.37）,P〈0.05],而碎石成功率[OR=0.33,95%CI（0.21,0.52）,P〈0.01]和结石清除率[OR=0.38,95%CI（0.27,0.54）,P〈0.01]均较低。结论气压弹道碎石术与钬激光碎石术两种术式治疗输尿管上段结石相比,虽然在住院时间上相似,但在其他方面钬激光碎石术均优于气压弹道碎石术。     

输尿管镜下碎石术联合阻石锥治疗输尿管上段结石的疗效分析

目的:评估输尿管镜下碎石术联合阻石锥治疗输尿管上段结石的安全性及有效性。方法:将105例输尿管上段结石分为2组,试验组采用输尿管镜下碎石术联合阻石锥,共45例,对照组采用输尿管镜下碎石术,共60例,比较2组患者结石移位率、结石清除率、并发症发生率及手术时间。结果:试验组较对照组结石移位率明显降低,结石清除率明显提高,2组患者手术并发症及手术时间差异无统计学意义。结论:输尿管镜下碎石术联合阻石锥治疗输尿管上段结石能有效阻止结石向上移位,提高结石清除率,且未增加手术并发症。     

体外冲击波和输尿管镜治疗输尿管结石疗效评价的Meta分析

目的: 系统评价体外冲击波和输尿管镜治疗输尿管结石的疗效。方法: 计算机检索 PubMed、EMbase、BIOSIS、International Pharmaceutical Abstracts,并检索Cochrane 图书馆对照试验注册库(2012 年第 9 期)及中国期刊全文数据库(1995年1月至2012年9月),同时检索搜集重要学术会议论文集,系统收集体外冲击波和输尿管镜治疗输尿管结石的随机对照试验。检索时间为1990年1月至2012年9月。由2名评价者共同评价纳入研究质量并提取资料,合并同质研究进行 Meta 分析,采用Revman 5.1软件完成资料分析。结果: 纳入9个研究,共1 399例输尿管结石患者。Meta分析结果显示,输尿管镜腔内碎石(URS)治疗结石在无石率方面优于体外冲击波碎石(ESWL)[OR=0.29,95%CI(0.14,0.57),P<0.01]且ESWL术后再次治疗率高于URS[OR=8.07,95%CI(5.23,12.46),P<0.01]。但URS术后需辅助治疗率要高于ESWL[OR=0.29,95%CI(0.13,0.62),I2=70%,P<0.01]。操作相关并发症URS较ESWL高[OR=0.42,95%CI(0.21,0.84),P=0.01],但URS术后不适症状较ESWL低[OR=0.24,95%CI(0.12,0.50),P<0.01,I2=0%]。ESWL住院时间短于URS[OR=-2.55,95%CI(-3.24,-1.86),P<0.01]。结论: 针对输尿管结石患者采取何种治疗方式为最优,可根据各家临床中心现有设备及患者结石的位置、大小以及有无合并症等综合判断。对于治疗方式的选择,仍需更多、更进一步的随机对照试验来支持验证。     

ESWL与输尿管镜下碎石术治疗肾及输尿管上段结石疗效比较

目的 比较体外震波碎石（ESWL）与输尿管镜下碎石术（URSL）治疗肾及输尿管上段结石的疗效和不良反应.方法 选择2010年1月～2012年12月间951例肾及输尿管上段结石的患者,786例采用ESWL治疗,165例采用URL治疗,对两组患者的结石清除率、发热及血尿并发症等进行分析比较.结果 ESWL组结石清除率显著高于URL组（80.9% vs 55.8%,P＜0.01）;在发热及血尿并发症方面,ESWL组显著低于URL组.结论 体外冲击波碎石对于治疗肾及输尿管上段结石疗效明确.     

输尿管镜与经皮肾镜碎石术治疗输尿管上段结石效果比较

目的:比较经尿道输尿管镜碎石术(URL)与经皮肾镜碎石术(PCNL)治疗输尿管上段结石的效果。方法:对24例采用URL治疗(URL组)和19例采用PCNL治疗(PCNL组)的输尿管上段结石患者手术时间、术后住院时间、术后感染率、结石清除率及并发症发生率进行比较。结果:URL组手术时间和术后住院时间均短于PCNL组(P<0.01),2组术后结石清除率、感染率和并发症发生率差异均无统计学意义(P>0.05)。结论:输尿管上段结石位置偏低、肾脏积水少及不宜全麻的患者,可考虑首选URL手术。PCNL有一定创伤,对输尿管上段嵌顿结石、伴明显肾积水且结石位置近肾盂者,可有较好的疗效。     

输尿管上段结石3种治疗方法的疗效分析

目的:探讨输尿管上段结石的最佳治疗方法?方法:回顾性分析?比较体外冲击波碎石(ESWL)?逆行输尿管镜碎石术(URL)?后腹腔镜输尿管切开取石术(RLU)3种方法治疗的286例输尿管上段结石患者的临床资料?结果:行ESWL治疗163例,结石横径0.7~1.5 cm,平均1.21 cm,1个月碎石清除率88.6%;行URL术65例,结石横径0.8~1.8 cm,平均1.40 cm,1个月碎石清除率92.3%;行RLU术58例,结石横径1.8~2.5 cm,平均1.96 cm,取石成功率100%?结论:输尿管上段结石横径≤1.0 cm的首选ESWL治疗,横径>1.0 cm的应选择URL或 RLU治疗?     

经皮肾镜取石术和输尿管镜取石术治疗复杂输尿管上段结石疗效比较

目的:探讨微创经皮肾镜钬激光碎石术(MPCNL)与经尿道输尿管镜钬激光碎石术(URL)治疗伴患侧肾中重度积水的复杂输尿管上段结石疗效.方法:伴患侧中重度肾积水、复杂输尿管上段结石63例,对30例行MPCNL治疗,33例行URL治疗.结果:MPCNL术成功率96.6%(29/30),手术后1周内结石清除率86.2%(25/29),术后1个月结石清除率为96.5%(28/29);URL术成功率78.8%(26/33),URL手术后 1周内结石清除率19.2%(5/26),术后1个月结石清除率为76.9%(20/26).结论:MPCNL治疗伴患侧肾中重度积水、复杂输尿管上段结石取石成功率高,结石残留率低,URL成功率较低,结石残留率高,MPCNL明显优于URL,有条件医院应作为首选.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.