A “bridge” technique to replace the obstructed single-J stent in the patient with ileal conduit urinary diversion: a case report

The ureteroileal anastomotic stricture is a complication of ileal conduit urinary diversion. To prevent the hydronephrosis and protect the renal function, a single-J ureteral stent may be needed. However, the most common complication of these patients is single-J stent obstruction. To solve this problem, we describe an easy, useful and low-cost technique to replace the obstructed ureteral stent under radiographic guidance without intervention by flexible cystoscopy or percutaneous nephrostomy. The key steps of our procedure are to identify the location of the stricture, to place the super smooth guide wire into pinhole of the obstructed single-J stent and to get the super smooth guide wire and 5-Fr ureteral catheter across the stricture. Our case was a 40-year-old male patient who was diagnosed as pelvic lipomatosis and received ileal conduit urinary diversion 3 years ago. The left-side ureteroileal anastomotic stricture occurred 1 year after surgery. He refused to repair the stricture by open or other minimal invasive surgery. He regularly changed his ureteral stent with intervals of three months. As the stent was obstructed by the stone, the guide wire couldn’t be inserted through the primary ureteral stent. We used our “bridge” technique to solve his problem successfully. No bleeding and no urinary tract infection were observed after intervention. The urine from the ureteral stent was fluent. We think that this “bridge” technique may be a good choice for the replacement of the obstructed single-J stent in the patients of ileal conduit urinary diversion.     

Complete urethral injury in the penile fracture: a case report and literature review

Penile fracture is described as a traumatic rupture of the tunica albuginea caused by blunt injury to the erect penis. It usually occurs as a single rupture of the tunica albuginea in one of two corpora cavernosa; a rupture with urethral injury is an extremely rare condition. Although its diagnosis is usually clinical, ultrasound plays an important role in confirming diagnosis and identifying the site of the injury. Here, we presented a case of penile fracture with complete urethral injury. A 43-year-old male was admitted to the hospital because of trauma to the genital and dysuria following sexual intercourse. After admission, the patient was diagnosed with double penile fracture and complete urethral injury after the physical and B-ultrasound examinations. Emergency surgery to remove the hematoma and repair the urethra was performed. The patient recovered smoothly and was discharged on the third day after operation. After two months’ follow-up, the patient urinated smoothly and achieved an adequate erection without other complications. In this case, consistent with previous studies, emergency surgery for penile fracture is necessary and can preserve the urethral function and sexual function. In addition, there are two lesions in tunica albuginea in this case, so careful search for the penile shaft during the surgery is important to avoid the missed injuries. This report provides evidence of an uncommon and underreported clinical case.     

2016—2019 年天津市河北区流行性感冒监测分析

目的 了解 2016—2019年天津市河北区流感流行特征,为有效防控流感提供相应科学依据。方法 对 2016—2019年天津市河北区流感样病例(Influenza-likecases,ILI)监测资料、病原学监测数据及暴发疫情信息进行分析。结果 2016—2019 年共采集IL咽拭子标本 2 962份,流感病毒核酸检测阳性标本为 715份,阳性率为 24.14%;2016—2019年共报告流感样病例暴发疫情 10起,均发生在中小学校。2016—2019 年天津市河北区流感样病例百分比 (IL%)在每年 11 月—次年 2 月出现一个高峰,呈现明显的季节性特征;2016—2019 年流感病原监测结果显示,天津市河北区流行毒株以甲型 H3N2 型和甲型 H1N1型交替出现为主,2017 年甲型与乙型 Yamagata 系混合流行,2019 年甲型 H3N2 型呈优势毒株。结论 2016—2019 年天津市河北区流感病毒以甲型 H3N2 型和甲型 H1N1 型为主,每年的流行毒株各不相同,呈交替或混合流行。应加强监测和流感防控并提高重点人群流感疫苗接种率。     

内蒙古4盟市后天梅毒报告病例数据质量调查

目的　了解内蒙古自治区梅毒报告病例数据的质量,发现存在的问题,提出改进措施。方法　选取2018年7月1日—2019年6月30日内蒙古自治区4个盟市的30家医疗机构的895例后天梅毒报告病例进行调查,包括核对传染病报告卡、临床和实验室原始资料等,评价其信息质量指标和诊断质量指标。结果　4个盟市的报卡填写完整率、正确率、信息录入正确率、病例报告及时率、过度报告率、重复报告率分别为97.65%、92.63%、89.16%、91.06%、13.85%、3.46%。不同盟市的报告卡的填写正确率、病例报告及时率、过度报告率和重复报告率的差异均有统计学意义（P均＜0.05）。后天梅毒病例诊断正确率为66.93%,不同地区间差异有统计学意义（χ2=45.963,P=0.000）。不同地区间一期梅毒分期正确率、隐性梅毒分类正确率的差异均有统计学意义（P均＜0.05）。皮肤性病科、非皮肤性病科报告病例正确率分别为74.90%、57.63%,差异有统计学意义（χ2=29.967,P=0.000）。结论　内蒙古自治区梅毒疫情报告质量参差不齐,梅毒诊断正确率、分期正确率低,影响梅毒发病率与发病趋势的分析,须加强梅毒报告、诊断标准的培训,切实提高病例数据的质量。     

“三位一体”个案干预模式对北京地区HIV/AIDS患者ART启动时间和治疗依从性影响

目的　本研究探讨了一种由医生、护士和非政府组织共同参与的“三位一体”个案干预模式,用以缩短从确诊HIV感染到开始抗反转录病毒治疗（antiretroviral therapy, ART）的时间,提高患者的依从性,改善ART效果。方法　将2012年1月—2013年12月在北京佑安医院确诊的HIV/AIDS患者作为对照组,接受常规诊疗程序。2015年1月—2016年12月确诊的HIV/AIDS患者作为干预组,接受“三位一体”个案干预模式。比较2组ART启动时间及治疗依从性的差别及可能的影响因素。结果　共纳入患者4906例,对照组1549例,干预组3357例。干预组从确诊到接受ART的中位时间为35 d,远少于对照组的56 d（Z=-10.087,P=0.001）。与对照组相比,干预组患者有更好的治疗依从性（89.2% vs. 95.3%,P=0.000）。 ART启动时间与个案干预模式的实施存在线性关系,且呈负相关。结论　接受“三位一体”个案干预模式的HIV/AIDS患者能更快的启动ART,有更好的治疗依从性和队列保持率,可以在全国实施HIV个案干预模式,减轻AIDS负担。     

我国"乡聘村用"政策典型地区实践经验与启示

目的:分析我国"乡聘村用"政策进展和典型地区实践经验,分析推进"乡聘村用"政策的问题与挑战,为推进乡村医生队伍建设提供政策建议。方法:利用我国卫生健康统计年鉴相关数据进行定量分析;收集我国典型地区政策、报告等资料,进行案例分析。结果:"乡聘村用"在我国具有一定的政策基础,在全国范围内已经具有一定实践规模。从人员资质、人事管理和养老保障及资金来源方式等角度看,在典型地区的实践对推进"乡聘村用"政策的挑战是增加财政支出、乡村医生队伍老龄化和县乡管理能力不足。结论与建议:典型地区经验表明"乡聘村用"政策是转变乡村医生身份、解决乡村医生养老等社会保障问题的有效途径。建议各地借鉴典型经验积极推进"乡聘村用"政策,加大地方财政支持力度;加强县级和乡镇卫生院管理能力;同时,稳步推进政策,避免各类乡村医生之间产生矛盾。     

产科并发症与精神分裂症的病例对照研究

目的 探讨产科并发症与精神分裂症的关系。方法 病例对照研究,单因素、多因素分析。并计算相对危险度和95%的可信限。结果 单因素分析显示,孕期并发症（OR=4.63,95%CI=1.27-20.66）、生产并发症（OR=3.29,95%CI=1.06-11.29)达到统计学意义。特别分层分析,男性生产并发症发生率明显高于对照组。多因素分析,孕期营养差、孕期并发症与精神分裂症有密切的关系,OR（95%CI）分别为3.98(1.13-14.07),4.93(1.44-16.86)。结论 精神分裂症的发生与孕期、生产期环境因素密切相关,孕期、生产期损伤者为精神分裂症的高危人群。     

斯蒂克勒综合征5例分析

目的 探讨斯蒂克勒综合征的眼部及其他临床表现。方法 对一个家第三代５例患者进行临床分析。结果 ５例患者主要眼部表现为不同程度的近视、白内障、玻璃体变性、尖发难治的视网膜脱离。患者身材疲长,下颌稍小,无关节病和脊柱异常。结论 我勒综合征是一种罕见的以眼部症状为特征的遗传性闰病。     

《得心集医案》辨治急难证的思路与方法

总结分析了清代医家谢星焕《得心集医案》辨治急难证的特点：在辨证方面注重天人合一,善于辨别真假错杂之证,尤长于以脉诊决疑释难,妇科难证多求诸奇经八脉;在治疗方面法度严谨,善于化裁古方,急救方法多变,涌吐、针灸、鼻饲、敷脐等多有采用。