Off-clamp Retroperitoneoscopic Tumour Evacuation for Sporadic Renal Angiomyolipomas with High RENAL Nephrometry Scores: A Novel Surgical Technique and Its Outcomes

BackgroundPartial nephrectomy or angioembolisation is commonly used for sporadic renal angiomyolipomas (RAMLs) with high RENAL scores, but there is a risk of reduced renal function, postoperative complications, and recurrence.ObjectiveTo describe a new technique for off-clamp laparoscopic evacuation of sporadic RAMLs with high RENAL scores that promotes maximal renal function maintenance and low postoperative complication and lesion recurrence rates.Design, setting, and participantsA retrospective cohort of patients undergoing off-clamp laparoscopic evacuation for sporadic RAMLs with RENAL scores ≥9 from January 2013 to June 2018 was included.Surgical procedureWe highlighted the curettage, suction, packing, and binding (CSPB) technique, a new off-clamp retroperitoneoscopic evacuation technique for sporadic RAMLs.MeasurementsDemographics, preoperative, intraoperative, and postoperative outcomes were assessed.Results and limitationsA total of 141 cases were included. The median (interquartile range [IQR]) tumour size was 7 (6.2–8.2) cm. The median (IQR) RENAL score was 10 (9–11). The median (IQR) operative time was 80 (65–125) min, with a median (IQR) estimated blood loss of 130 (90–362.5) ml. Conversion to neither open surgery nor standard laparoscopy occurred. The warm ischaemia time was zero for all cases. Postoperatively, 13 minor complications (Clavien grade 1) were recorded. No blood transfusions were reported. The glomerular filtration rate did not change significantly from preoperative period to 12-mo follow-up. Recurrence did not occur at the median follow-up period of 48 (36–60) mo. The retrospective design and lack of a control group are limitations of this study.ConclusionsOff-clamp retroperitoneoscopic tumour evacuation using the CSPB technique is feasible, safe, and effective for treating complex sporadic RAMLs.Patient summaryWe report a curettage, suction, packing, and binding technique for off-clamp retroperitoneoscopic evacuation of sporadic renal angiomyolipomas that leads to complete lesion clearance, excellent renal function preservation, and minimal perioperative complications.     

基于NF-κB相关信号通路探讨常用中药治疗溃疡性结肠炎研究进展

核转录因子-κB(NF-κB)相关信号通路在溃疡性结肠炎的形成与发展中起到很大的作用。研究显示中药单体及单药可以通过NF-κB信号通路介导减少黏膜炎症反应、抑制肠道上皮细胞凋亡、增强肠道黏膜屏障、调节肠道内菌群丰度等抑制溃疡性结肠炎的发展,但具体的作用机制尚不明确。可能与调节TLR4/NF-κB信号通路、JAK2/STAT3/NF-κB信号通路、PI3K/AKT/NF-κB信号通路、NF-κB/NLRP3信号通路等有关。涉及到的常用药物包括黄连、干姜、鸦胆子、黄芪、肉桂、青黛、雷公藤、黄芩、蒲公英、马齿苋、苦参、青蒿等及其提取物小檗碱、6-姜烯酚、鸦胆子苦醇、黄芪多糖、肉桂醛、雷公藤多苷、黄芩苷、苦参总碱、双氢青蒿素等。故围绕NF-κB相关信号通路对常用治疗UC的中药及其单体作一综述,旨在为进一步深入研究提供思路和参考。     

上海市386例心血管病患者积极度现状及其影响因素研究

目的 分析上海浦东新区心血管病患者积极度现状及其影响因素。方法 以上海市某医院2021年2—10月诊治的心血管疾病患者(本研究范围为高血压、高血脂、冠心病、心律失常及外周血管病)为研究对象进行积极度相关问卷调查。利用描述流行病学方法分析心血管病患者积极度现状。使用单因素、多因素分析方法对心血管病患者积极度的影响因素进行分析。结果 386例患者完成调查,男性235例,女性151例,平均年龄(67.12±8.14)岁。心血管疾病患者积极度评分平均为(66.04±10.47)分。在量表的条目中,以我可以为管理自身的健康负责的得分最高,达到(3.27±0.55)分。积极度水平为第4级的构成比最高,201例,占52.07%。多重线性回归分析结果显示男性(β’=0.137)、主动获取相关知识(β’=0.201)、自我效能水平高(β’=0.328)、心血管疾病等级低(β’=0.241)的心血管疾病患者具有更高的积极度。结论 上海市浦东新区心血管疾病患者的积极度相对较高,自我效能水平、性别、是否主动获取疾病的相关知识、合并症情况均对该地区心血管疾病患者积极度产生影响。今后需要继续加强工作,提升该人群的积极度水平。     

乳腺癌复发因素预测模型构建

构建乳腺癌复发因素预测模型,分析最优化算法以及乳腺癌复发特征参数并对相关问题进行探讨,包括随机对照试验应用情况、再复发重要因素以及预测模型算法确定、C5.0算法比较研究等。     

乳癖病证源流考略

对乳癖的病名源流进行初步考证,并梳理了古代医籍中关于乳癖病因病机及证治的论述。乳癖的病名提出约在宋代以前,至明代后期该病名方与妇人乳房肿块建立起确切的联系,清代医家逐步丰富了乳癖的理法方药。     

益气固本调免方治疗脾肾气虚型IgA肾病临床观察

目的观察益气固本调免方治疗脾肾气虚型Ig A肾病的临床疗效。方法将79例脾肾气虚型Ig A肾病患者随机分为2组;对照组(40例)给予基础治疗,治疗组(39例)给予基础治疗和益气固本调免方口服,疗程2个月。结果 1治疗组总有效率为84.6%,对照组为57.5%;两组临床疗效比较有显著性差异(P0.01)。2治疗后两组尿红细胞数和24 h尿蛋白定量较治疗前降低(P0.05,P0.01),且治疗组低于对照组(P0.05)。3治疗后,对照组主要症状和症状总积分较治疗前无明显降低(P0.05);治疗组神疲乏力、腰膝酸软等症状及症状总积分较治疗前显著降低(P0.05,P0.01);两组主要症状和症状总积分有显著性差异(P0.01)。结论益气固本调免方能有效改善脾肾气虚型Ig A肾病患者的临床症状及蛋白尿。     

陆灏运用温胆汤治疗痰热内扰型消渴经验

介绍陆灏教授运用温胆汤加减治疗痰热内扰型消渴的思路和方法,分析温胆汤应用指征与方证,并举验案1则。     

Effect of commercially available green and black tea beverages on drug-metabolizing enzymes and oxidative stress in Wistar rats

The effect of commercially available green tea (GT) and black tea (BT) drinks on drugmetabolizing enzymes (DME) and oxidative stress in rats was investigated. Male Wistar rats were fed a laboratory chow diet and GT or BT drink for 5 weeks. Control rats received de-ionized water instead of the tea drinks. Rats received the GT and BT drinks treatment for 5 weeks showed a significant increase in hepatic microsomal cytochrome P450 (CYP) 1A1 and CYP1A2, and a significant decrease in CYP2C, CYP2E1 and CYP3A enzyme activities. Results of immunoblot analyses of enzyme protein contents showed the same trend with enzyme activity. Significant increase in UDP-glucuronosyltransferase activity and reduced glutathione content in liver and lungs were observed in rats treated with both tea drinks. A lower lipid peroxide level in lungs was observed in rats treated with GT drink. Electrophoretic mobility shift assay revealed that both tea drinks decreased pregnane X receptor binding to DNA and increased nuclear factor-erythroid 2 p45-related factor 2 binding to DNA. These results suggest that feeding of both tea drinks to rats modulated DME activities and reduced oxidative stress in liver and lungs. GT drink is more effective on reducing oxidative stress than BT drink.