机器人辅助腹腔镜与开放肾盂切开取石治疗直径大于2 cm非鹿角形肾结石的对比研究

 目的 探讨经腹达芬奇机器人辅助腹腔镜肾盂切开取石术(robot assisted laparoscopic pyelolithotomy,RALPL)治疗直径大于2 cm的非鹿角形肾结石的可行性和安全性。方法 针对我院2013年6月至2017年6月收治的直径大于2 cm的非鹿角形肾结石患者,回顾性分析其中采用RALPL (48例)与开放肾盂切开取石(open pyelolithotomy,OPL)(44例)手术方式的两组患者的临床资料,就初次结石清除率、平均手术时间、术后Hb降低值、术后下床时间、住院天数等指标进行对比研究。结果 相比OPL组,RALPL组初次结石清除率显著提高(91.66% vs.70.45%,P＜0.05),平均手术时间、术后Hb降低值、术后下床时间、住院天数均显著减少(P＜0.05)。RALPL组患者无Clavien Ⅱ级及以上并发症,OPL组Clavien Ⅱ级并发症2例。结论 经腹RALPL对肾盂、肾盏有良好的视角,能在肾盂低压状态且不损失肾实质的条件下确保较高的初次结石取净率,微创、有效、安全,是直径大于2 cm非鹿角形肾结石(包括合并肾盏结石)的可选适应证。     

从卫生服务供方意向调查的变迁看中医发展危机

为了进一步了解中医的发展状况，通过对2008年与2000年样本地区卫生服务供方的意向调查数据的比较，分析卫生服务供方对中医信仰的变迁。研究发现，卫生服务供方对中医信仰进一步降低，中医成为西医的简单补充。在这种情况下，如何把握中医特色，创新诊疗手段，总结推广中医特效治疗种类和范围，推广适宜技术等尤为重要，逐步提高卫生服务供方对于中医的支持和认可。     

透析用水内毒素含量检测数据调查研究分析

目的符合透析治疗安全的透析用水是血液透析日常治疗开展的基本保障,根据统计分析内毒素含量的变化规律,探索控制透析用水内毒素含量的管理方式。方法对上海市21家血液净化中心(室)2019年3月至2020年2月期间透析用水的内毒素(endotoxin,ET)含量数据进行汇总与统计分析。结果透析用水内毒素含量在全年的春季与夏季中会存在部分偏高的情况,其中春季送检的样本中,ET含量>0.25 EU/ml比例占当季送检样本的0.57%,ET含量在0.03~0.25EU/ml之间的比例占7.34%;在夏季送检的样本中,ET含量>0.25EU/ml比例占当季送检样本的1.13%,ET含量在0.03~0.25EU/ml之间的比例占3.39%,与秋冬两季水平相比,差异有统计学意义(F=11.392,P值<0.001)。结论严格管控透析用水生产、输送过程的每个环节,规范采样流程、加强反渗机日常维护管理、重视水处理系统及配管的日常消毒等措施可减少血液透析相关的不良反应发生,提高患者透析质量。     

微创心脏手术中排气研究

目的探讨微创心脏手术中的排气技术，并评价排气效果。方法选取复旦大学附属中山医院2011年6月至2013年6月收治的56例行微创心脏手术患者为微创组，男31例、女25例，年龄33～7l（57-3±7．2）岁；同期56例行常规胸骨正中切口心脏二尖瓣成形术患者为对照组，男27例、女29例，年龄51～69（53．7±6,8）岁。比较两组患者术后心腔内残留气泡量、心电图异常发生率、术后清醒时间、术后思维能力及脑部并发症发生率等指标。结果微创组心腔内残留气泡量少量占69．6％、中量占30．4％，对照组少量占73．2％、中量占26．8％，两组差异无统计学意义（P〉0．05）。微创组心电图异常发生率与对照组差异无统计学意义（32．1％VS．26．8％，P〉0．05）。微创组术后思维能力评价好85．7％、中12．5％、差1．8％，对照组好78．6％、中19．6％、差1．8％，两组差异无统计学意义（P〉0．05）。两组脑部并发症发生率差异无统计学意义（1．8％vs．1．8％，P〉0．05）。结论采取一系列心脏排气措施可使微创心脏手术的空气栓塞发生率与胸骨正中切口手术相似，在空气栓塞并发症方面无需承担更高的风险。     

核受体PXR在宫颈鳞癌组织及SiHa细胞中的表达及临床意义

目的:探讨核受体孕烷X受体(PXR)在宫颈鳞癌组织的表达及与宫颈鳞癌发生的关系。方法:采用免疫组织化学及细胞免疫化学检测核受体PXR在41例宫颈癌组织及宫颈鳞癌细胞株SiHa中的表达。结果:PXR在宫颈鳞癌细胞株SiHa中有表达;正常宫颈组织有PXR表达,41例宫颈鳞癌组织中PXR的阳性率为59.5%,且宫颈癌组织中明显低表达。结论:PXR的表达水平与宫颈癌的发生有一定的相关性,可能成为今后判断宫颈癌预后有价值的标志物。     

Metastatic chromophobe renal cell carcinoma treated with targeted therapies: A Renal Cross Channel Group study

BackgroundTreatment of non–clear cell renal cell carcinoma (RCC) remains controversial despite several recent prospective studies of targeted therapies (TT). Often Vascular Endothelial growth Factor (VEGF) and Mammalian Target of Rapamycin (mTOR) inhibitors are used, extrapolating the data from use of these agents in clear cell RCC.MethodsWe performed a retrospective data analysis within the Renal Cross Channel Group to determine metastatic chromophobe RCC (mChRCC) outcomes in the TT era. The end-points were overall response, overall survival (OS) and time to treatment failure (TTF). The two latter were estimated using the Kaplan–Meier method.Results91 mChRCC patients from 26 centres were included. Median follow-up from the date of first metastasis was 6.1 years (range: 0–13.9). Median OS was 37.9 months (95% confidence interval [CI]: 21.4–46.8) from the diagnosis of metastatic disease. Among the 61 patients who received TT, 50 (82%) were treated with anti-angiogenic (AA) and 11 with mTOR inhibitors. Median TTF and OS in patients receiving a first line of AA was 8.7 months (95% CI: 5.2–10.9) and 22.9 months (95% CI: 17.8–49.2) versus 1.9 months (95% CI: 1.0–6.0) and 3.2 months (95% CI: 2.3–not evaluable) with mTOR inhibitors, respectively. A stratified log-rank test was used to compare AA and mTOR inhibitors TT, while controlling the effect of the International Metastatic RCC Database Consortium risk group and no significant difference between AA and mTOR inhibitors was observed for TTF (p = 0.26) or for OS (p = 0.55).ConclusionWe report the largest retrospective cohort of patients with mChRCC treated with TT and no significant difference between AA and mTOR inhibitors was observed for TTF and OS.     

HIV Infection,Sexual Behaviors,Sexual Networks,and Drug Use Among Rural Residents in Yunnan Province,China

This cross-sectional study examined HIV prevalence, sexual behaviors, sexual networks, and drug use among 591 participants from a rural community in Yunnan Province, China. Face-to-face interviews were conducted to collect information about sexual behavior, drug use, and sexual networks. Blood samples were collected and tested for HIV. Of the participants, 52.6% were male and 62.6% were Jingpo minority. The HIV prevalence was 5.5% overall and highest among the Jingpo minority (7.7%). Most participants were sexually experienced and 32.5% had had multiple sex partners. About 18.8% had used drugs, with the highest proportion among the Jingpo minority. HIV infection was independently correlated with drug use among males and with multiple sexual partnerships among females. A total of 336 independent sexual network components (mostly small, linear, and acyclic) were constructed. Eighty-percent were dyads involving two members and 20% involved three to 71 members. Coupled with the promotion of condom use, gender- and network-specific efforts are needed for HIV prevention targeting ethnic minorities in Yunnan.     

The case for aflatoxins in the causal chain of gallbladder cancer

Chronic aflatoxin exposure has long been related to hepatocellular carcinoma (HCC). Recently, its association with gallbladder cancer (GBC) was postulated. Here we present the data supporting this hypothesis in Chile, the country with the highest GBC mortality worldwide with age-standardized mortality rates (ASMR) of 10.3 in women and 5.04 in men.The highest GBC rates occur in Southern Chile (ASMR = 18), characterized by: high Amerindian ancestry, associated with high bile acid synthesis and gallstones; high poverty and high cereal agriculture, both associated with aflatoxin exposure. Aflatoxins have been detected in imported and locally grown foods items. We estimated population dietary exposure ranging from 0.25 to 35.0 ng/kg-body weight/day. The only report on human exposure in Chile found significantly more aflatoxin biomarkers in GBC than in controls (Odds Ratio = 13.0).The hypothesis of aflatoxin-GBC causal link in the Chilean population is supported by: genetically-determined rapid cholesterol excretion and high gallstones prevalence (49.4%); low prevalence of HCC (ASMR = 4.9) and low HBV infection (0.15%) the main co-factor of aflatoxins in HCC risk.If the association between aflatoxins and GBC were confirmed, public health interventions based on food regulation could have a substantial public health impact.     

规范化中药箍围护理在毒蛇咬伤病人中的实践

毒蛇咬伤肢体后毒素吸收迅速,引起肢体肿胀疼痛,恰当的局部处理能够提高生存率、减少伤残率、促进病人早日康复。中医认为毒蛇伤人为风毒、火毒、风火毒所致。箍围药古称敷贴,是药粉和液体调制成的糊剂,具有箍集围聚、收束疮毒的作用,已被广泛应用于毒蛇咬伤病人肢体肿痛的救治过程。目前,箍围护理的干预方法及效果参差不齐,没有形成统一的箍围护理     

Pinnacle计划系统静态调强治疗计划导入方法的探讨

目的:探讨Pinnacle计划系统导入静态调强治疗计划的方法。材料和方法:在Matlab软件中读取XiO计划系统通过Dicom传输到Pinnacle7.6c计划系统上的调强计划DicomRT文件,利用现有公开的Pinnacle脚本语言资料,用Matlab程序生成Pinnacle计划系统静态调强治疗计划导入脚本,在Pinnacle系统中运行脚本,验证脚本是否正确导入静态调强治疗计划。结果:解决了诸如控制点的安排,治疗计划系统间坐标系的转换,加速器MLC叶片附值次序等等问题后,成功将XiO计划系统产生的静态调强计划导入Pinnacle治疗计划系统。结论:本研究显示,通过Matlab编程生成脚本的方法方法,将其他治疗计划系统产生的调强计划导入Pinnacle系统是完全可行的。