惠州地区复发性外阴阴道念珠菌病复发因素分析

目的：探讨复发性外阴阴道念珠菌病（RVVC）病情复发因素。方法：选取确诊为RVVC的患者50例和初次或偶发的外阴阴道念珠菌病（VVC）患者50例，分别对两组患者发病前15项生活和生理状况进行调查对比分析。结果：RVVC组排在前5位的因素依次为：发病前5d内性生活、生理状况差、心理负面情绪、月经来潮和性伴同患生殖器念珠菌病；在生理状况差、心理负面情绪、月经来潮、性伴同患生殖器念珠菌病和性生活频率（≥3次）5个因素，两组间比较差异有统计学意义（P〈0．05），其余因素在两组间无明显差异（P〉0．05）。结论：RVVC患者病情复发与发病前5d内性生活、生理状况差、心理负面情绪、月经来潮和性伴同患生殖器念珠菌病有明显关系。     

Traitements de rattrapage après irradiation prostatique : place de l’urologue

The management of recurrent prostate cancer after radiotherapy or brachytherapy is non-standardized and rapidly evolving. Local recurrence is observed on average in 30% of cases several years following irradiation. A key challenge is to determine the site of recurrence and imaging (MRI and PET choline) coupled to prostate biopsies are important to confirm the local character. Salvage therapy performed by the urologist can then control the situation. Radical prostatectomy subject to strict technical conditions is one of the most efficient local treatments, however it comes at the cost of significant urinary morbidity; minimally invasive therapies (focused ultrasound and cryotherapy) have also their place in specific indications. Each clinical situation should be discussed in pluridisciplinary meetings integrating the oncologic and functional status at recurrence, the risk/benefit ratio of each treatment, the patient's wishes and probability of survival.     

粪菌移植在炎症性肠病中的治疗进展

炎症性肠病(IBD)是肠道慢性、复发性自身免疫性疾病,是由遗传易感的宿主对肠道菌群异常的免疫反应所致。近年来,肠道菌群与IBD患病的关系倍受关注。粪菌移植(FMT)是将健康人肠道菌群移植至病人的胃肠道内,重建具有正常功能的肠道菌群。许多研究结果表明,FMT在IBD治疗中有效。以下就国内外FMT中心发表的FMT在IBD病人中治疗进展作一综述。     

椎间盘摘除联合后外侧融合术治疗再发性腰椎间盘突出的疗效观察

目的观察椎间盘摘除联合外侧融合术治疗再发性腰椎间盘突出的临床疗效。方法 200例腰椎间盘突出患者根据腰椎有无失稳分为研究组和对照组各100例。对照组患者100例术前无腰椎失稳、退变性滑脱,研究组患者100例合并腰椎失稳、退变性滑脱或椎管狭窄,对照组给予患者椎间盘摘除术治疗,研究组患者给予椎间盘摘除联合外侧融合术治疗,应用JOA、ODI、LBOS、VAS评分表进行评分并记录手术优良率。结果 2组患者治疗后JOA、ODI、LBOS、VAS评分均显著优于治疗前(P<0.05),但组间比较差异无统计学意义(P>0.05)。研究组手术优良率为88%高于对照组的85%,但差异无统计学意义(P>0.05)。结论腰椎间盘突出症复发根据病情不同给予针对性治疗,椎间盘摘除联合外侧融合术可改善椎间盘功能,提高手术成功率。     

Approach to the patient with recurrent neprolithiasis

Although recurring nephrolithiasis may not be as common as single-episode disease, it poses greater problems to the patient's daily lifestyle and general future health status. The general need for an adequate history, examination, and radiological assessment is acknowledged, but a more intensive investigative and management approach is required. Investigations for secondary causes are paramount and may lead to identification of unusual metabolic abnormalities and specific therapies. Such medical approaches entail consideration of dietary adjustments to lower the urinary excretion of components of the renal stones, pharmacological therapies to modulate urinary constituents and limit renal stone risk, and monitoring efficacy of the therapy over time. This approach will prevent significant deterioration of renal function and other serious metabolic consequences.     

粪菌移植在儿科应用的研究进展北大核心CSCD

粪菌移植(FMT)可将健康人粪便中的各种肠道微生物、代谢产物和天然抗菌物质等移植到受者肠道内,可重建肠道菌群平衡、修复肠黏膜屏障、控制炎症反应、调节机体免疫,是治疗肠道菌群失调所致疾病的新方法。FMT治疗儿童复发性艰难梭菌感染已写入复发性艰难梭菌感染的诊疗指南。FMT治疗儿童炎症性肠病、孤独症谱系障碍的有效性及安全性较好。     

探讨肝硬化测定肝静脉压梯度和门静脉血管阻力与食管静脉曲张再出血之关系

对有食管静脉曲张 (EV)出血后 ,肝硬化并门静脉高压之患者 2 1例 ,测定肝静脉压梯度 (HVPG)为 (2 2 6± 0 34)kPa;继之对其中之 18例又测门静脉血管阻力 (PVR)为 (0 2 3± 0 0 6 )kPa·ml 1·min·kg。治疗分两组 :手术组(n =10 )和介入组 (n =11) ,前者其HVPG和PVR之两值显著低于后者 ,随访 18个月内再出血率 ,手术组 (30 % )显然低于介入组 (5 4 6 % ) ,但两组之再出血例如以两值中位数相对比则无差异 ,均发生于高值者。再出血例与未再出血例就两值相对比 ,前者显著高于后者 ,差异非常显著 ,PVR尤著 (P <0 0 0 1)。本研究提示HVPG >2 33kPa ,PVR >0 2 2kPa·ml 1·min·kg是EV再出血危险的域值。HVPG与PVR呈正相关。     

Meta-analysis of prevalence of wheezing and recurrent wheezing in infants

Background

Wheezing affects children's quality of life, and is related with asthma in childhood. Although prevalence of wheezing has been previously studied in several countries, there is no reference of worldwide prevalence in infants. The aim of this meta-analysis is to estimate the prevalence of wheezing and recurrent wheezing in infants aged up to two years, and compare the prevalence across world regions.

Una puntuación de riesgo genético predice recurrencias en pacientes jóvenes con infarto agudo de miocardio

Introduction and objectivesTo evaluate whether a genetic risk score (GRS) improves prediction of recurrent events in young nondiabetic patients presenting with an acute myocardial infarction (AMI) and identifies a more aggressive form of atherosclerosis.MethodsWe conducted a prospective study with consecutive nondiabetic patients aged < 55 years presenting with AMI. We performed a genetic test, cardiac computed tomography, and analyzed several biomarkers. We studied the association of a GRS composed of 11 genetic variants and a primary composite endpoint (cardiovascular mortality, a recurrent event, and cardiac hospitalization).ResultsA total of 81 patients were studied and followed up for a median of 4.1 years. There were 24 recurrent cardiovascular events. Compared with the general population, study participants had a higher prevalence of 9 out of 11 risk alleles. The GRS was significantly associated with recurrent cardiovascular events, especially when baseline low-density lipoprotein cholesterol (LDL-C) levels were elevated. Compared with the low-risk GRS tertile, the multivariate-adjusted HR for recurrences was 10.2 (95%CI, 1.1-100.3; P = .04) for the intermediate-risk group and was 20.7 (2.4-181.0; P = .006) for the high-risk group when LDL-C was ≥ 2.8 mmol/L (≥ 110 mg/dL). Inclusion of the GRS improved the C-statistic (ΔC-statistic = 0.086), cNRI (continuous net reclassification improvement) (30%), and the IDI (integrated discrimination improvement) index (0.05). Cardiac computed tomography frequently detected coronary calcified atherosclerosis but had limited value for prediction of recurrences. No association was observed between metalloproteinases, GRS and recurrences.ConclusionsA multilocus GRS may identify individuals at increased risk of long-term recurrences among young nondiabetic patients with AMI and improve clinical risk stratification models, particularly among patients with high baseline LDL-C levels.