微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

痛风患者的健康素养：一项关于东北地区中青年患者的质性研究

背景　痛风是一种代谢性疾病，可以并发肾、心脑血管等多器官疾病，目前痛风发病和预后的影响因素已经得到揭示，但鲜有通过质性研究方法全面评估痛风患者的疾病认知和健康素养状态。目的　探讨东北地区中青年痛风患者的健康素养，并了解痛风患者的一般感知能力及知识需求状况，为增强我国痛风患者的健康素养水平，改善其自身管理能力、提高痛风患者的生活质量提供理论依据。方法　招募2017年3月-2018年3月于大庆油田总医院、大庆市人民医院、大庆市第五医院3家医院确诊为痛风的中青年患者，信息饱和后停止招募，共招募13例患者。采用非结构式与半结构式访谈相结合的方式对患者资料进行收集，采用Colaizzi的现象学资料分析方法进行分析。结果　对访谈资料进行分析，提炼如下主题：痛风患者的疾病感知能力〔包括对痛风的认知及知晓情况较差；严重的疼痛可影响痛风患者的生活质量；自我感知导致疾病发作或加重的原因为饮食习惯及生活方式等〕、就诊状况及行为（包括首次发病对疾病认识缺乏；就医体验不良）、痛风药物管理计划（包括药物选择依从性低、治疗方案的知晓及应对差）、痛风非药物管理计划（包括生活方式的调整、社会资源互动、疾病信息挖掘）。结论　东北地区中青年痛风患者健康素养水平较低，对疾病相关信息获取途径单一，对疾病和治疗判断片面，因此不能有效进行疾病管理，阻碍医疗决策制定。提示根据需求状况、针对具体薄弱环节提升痛风患者的健康素养、提高知识水平对改善患者健康结局很有必要。     

Epidemiology of gout and hyperuricemia in New Caledonia

ObjectivesNew Caledonia is a Pacific island of 270,000 inhabitants with mixed ethnicities, including Polynesians (10.2%), people from European ancestry (27.2%), and Melanesians (39.1%),. This study aimed at determining the prevalence of gout and hyperuricemia in the general population and the various ethnicities of New Caledonia.MethodsA 3-degree random sample of the population aged 18 to 60 years was adjusted according to the 2014 New Caledonia census. Face-to-face planned interviews and physical measurements were performed by trained nurses. All consenting participants underwent capillary measurement of creatinine; all consenting men and only women older than 40 years underwent point-of-care uricemia testing. Gout was defined by a validated algorithm. Two definitions of hyperuricemia were used: capillary level equivalent to plasma uric acid level > 360 μmol/l (6 mg/dl) and > 420 μmol/l (7 mg/dl) and/or urate-lowering drug treatment for both thresholds.ResultsWe included 1144 participants (adjusted mean age 37.7 ± 12.0 years; adjusted sex ratio 50.4% men). The adjusted prevalence of gout was 3.3% (95% confidence interval 2.2–4.9). Prevalence was 6.7% (2.5–16.8), 4.1% (1.8–8.9), and 2.6% (1.4–4.7) for Polynesians, Europeans and Melanesians, respectively, and 1.9% (0.5–6.6) for other ethnicities. Prevalence of hyperuricemia, determined in 658 participants, was 67.0% (61.9–71.6) and 37.0% (32.3–42.0) for the 360- and 420-μmol/l thresholds, respectively, and was significantly greater for Polynesians and Melanesians than Europeans for both thresholds.ConclusionsThe prevalence of gout and hyperuricemia in New Caledonia was high, including in patients of European descent.     

基于数据挖掘方法总结王树声教授治疗上尿路结石的用药经验

目的:运用中医传承辅助平台系统(V2.5)深入分析王树声教授治疗上尿路结石的用药经验，挖掘其核心经验 方组成和辨证用药规律。方法:收集王教授门诊治疗上尿路结石的治疗验方304 首，将方药信息录入系统，采用药物频次统计、 关联规则分析和熵聚类分析等方法分析处方用药规律。结果:304 首处方中涉及中药97 味，用药频次超过100 次的有14 味。所用药物药性多寒、温、平，药味多甘、苦，主归肝、肾、脾经；共得出25 组核心组合和9 首新处方。结论:王教授治疗 上尿路结石以益气固本、清热通淋为主，用药的关键在于“扶正固本”的把握和“祛邪通淋”的权衡，为临证用药和新方 开发提供参考。     

Coexistencia de artritis séptica y microcristalina: un reto diagnóstico. A propósito de 25 casos

ObjectiveSeptic arthritis is a medical emergency and crystal-induced arthritis is a risk factor for its development. If both occur simultaneously, crystal-induced arthritis may mask the diagnosis of infection and delay antibiotic therapy.MethodRetrospective analysis of patients with coexistence of septic and crystal-induced arthritis. We included only patients with isolation of crystals in synovial fluid analysis and positive culture of synovial fluid and/or blood culture.ResultsA total of 25 patients (17 men and 8 women) with a mean age of 67 years. The most commonly affected joint was the knee. In synovial fluid cytological studies, the most frequently identified crystals were monosodium urate. Risk factors included diabetes and chronic renal failure. The most frequently isolated germs were methicillin-sensitive S. aureus (48%), methicillin-resistant S. aureus (12%) and Mycobacterium tuberculosis (12%). In all, 36% of subjects required surgical drainage (excluding those caused by M. tuberculosis). Clinical outcome was favorable in 56%, although intercurrent complications were usual (40%). Mortality was 8%.ConclusionsCoexistence of septic and crystal-induced arthritis represents a diagnostic challenge and requires a high index of suspicion. Gout was the most prevalent crystal-induced arthritis. S. aureus was the most commonly causative pathogen, with a high rate of methicillin-resistant S. aureus infection. If treated early, the outcome is usually favorable, making synovial fluid microbiological study imperative.     

十二指肠镜治疗胆总管结石35例临床分析

目的探讨经十二指肠镜治疗胆总管结石的临床效果和价值。方法经十二指肠镜治疗胆总管结石共35例,其中行EST及取石术32例,行EPBD及取石术3例。EST胆总管取石时根据结石大小决定切开大小,不宜EST或结石较小者可选择EPBD后取石。结果35例均成功取出胆总管结石,取得较好的疗效。EST术中局部渗血4例,当时予电凝或喷洒止血药物即迅速止血,术后急性胰腺炎1例,经适当处理后1周痊愈,EPBD及取石术后未发现明显并发症。结论十二指肠镜治疗胆总管结石是一种微创、安全、有效的治疗方法。     

Distribution of organic matrix in calcium oxalate renal calculi

Summary The quantity of protein and carbohydrate comprising the matrix of calcium oxalate monohydrate (COM) renal stones was found to decrease with distance from the surface of the stone. The average organic concentration of stones 3 to 30 mm in diameter ranged from 5.7% at the surface to 2.7% at the core. This concentration gradient suggests matrix involvement in a “growth front” on stone surfaces with migration of organic material from the “older” interior. The matrix distribution was not readily correlated with density variations or with the presence of hydroxyapatite or calcium oxalate dihydrate. Surface matrix concentrations were greater than amounts predicted by physical adsorption. Electron microscopy confirmed the presence of the organic-rich surface layer and also suggested that increase in stone size occurs predominantly by crystal growth with microcrystal aggregates as growth centers.     

苄丙酮香豆素对实验性大鼠肾草酸钙结石形成的影响

目的：探讨Vit．K拮抗剂苄丙酮香豆素(商品名华法令)对大鼠肾草酸钙结石形成的影响。方法：采用乙二醇饮水和氯化铵灌胃作成石剂，30只Wistar大鼠随机分为对照组(A组)、成石组(B组)、华法令组(C组)。饲养4周后，检测大鼠肾组织钙含量和草酸钙晶体形成、24h尿钙、尿草酸含量及血生化指标。结果：成石组和华法令组肾组织中钙、镁含量，24h尿草酸及尿钙、镁排泄量差异无显著性意义；镜下观察发现：华法令组大鼠肾脏草酸钙结晶形成多于成石组，但组间比较差异无显著性意义。结论：苄丙酮香豆素对大鼠肾草酸钙结石的形成无显著影响。     

输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL），后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例，RLU组20例。PCNL组9例。结果：URSL组碎石成功18例；7例不成功，其中3例改为开放手术，1例改为后腹腔镜取石。2例行ESWL术，1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例，2例滑入肾内，经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功，术后15例有伤口漏尿。PCNL组成功9例，无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小，取石成功率高，在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。     

肾移植术后发生高尿酸血症的机制

目的：探讨肾移植术后发生高尿酸血症的机制及防治策略。方法：分析480例肾移植术后患者的临床资料。结果：肾移植术后移植肾功能正常而血尿酸增高者43例(9％)，其中痛风7例，移植肾肾盂或输尿管结石3例。随访1～5年，1例痛风患者血尿酸及症状控制不理想，余血尿酸均控制在正常水平，未见并发症的发生。结论：高尿酸血症是肾移植术后较常见的问题，发生原因较多，但主要与环孢素A的作用有关；长期降尿酸及碱化尿液治疗安全、有效。