输尿管镜气压弹道碎石治疗输尿管结石

目的:探讨输尿管镜气压弹道碎石治疗输尿管结石的疗效。方法:采用输尿管硬镜气压弹道碎石术治疗输尿管结石218例。结果:218例输尿管结石一次碎石成功202例(92.7%),失败16例(7.3%),其中上段输尿管结石移位9例(4.1%),改体外冲击波碎石(ESWL)后成功。输尿管穿孔2例(0.9%)及5例(2.3%)进镜失败的转开放手术治愈。结论:输尿管镜气压弹道碎石术治疗输尿管结石具有微创、安全、可靠、术后恢复快等优点,可作为中下段输尿管结石首选的治疗方法。     

输尿管镜气压弹道碎石治疗输尿管结石78例分析

目的：总结输尿管镜气压弹道碎石术治疗输尿管结石的临床效果。方法：用输尿管镜气压弹道碎石术治疗输尿管结石78例。结果：一次性结石碎石成功75例,占96.1%;碎石失败3例,占3.8%。未成功的3支输尿管结石中改开放性手术取石2例,其余1例改行体外冲击波碎石。结论：输尿管镜气压弹道碎石术治疗输尿管结石安全有效,损伤小,是治疗输尿管结石的首选。     

输尿管镜下气压弹道碎石治疗输尿管结石的临床应用

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石方法和疗效。方法采用输尿管镜下气压弹道碎石术治疗输尿管结石61例。结果一次性结石碎石率97%,1月后结石清除率100%,其中2例结石上移至肾盂,术后给予ESWL治疗。结论输尿管镜下气压弹道碎石治疗输尿管结石疗效确切、安全可靠、组织损伤小,可作为输尿管中、下段结石首选治疗方法。     

输尿管镜气压弹道碎石术治疗输尿管结石461例围术期护理

目的:探讨输尿管镜气压弹道碎石术治疗输尿管结石围术期的护理方法.方法:回顾性分析461例应用输尿管镜气压弹道碎石术治疗输尿管结石患者的护理资料.结果:本组456例治愈,并对治疗护理满意;5例治疗失败.结论:精心的术前准备、熟练的手术配合及细致的术后护理是手术顺利完成及疗效满意的重要保证.     

输尿管镜气压弹道碎石治疗体外冲击波碎石失败的输尿管结石(附41例报告)

目的探讨输尿管镜气压弹道碎石术(URS PL)治疗因体外冲击波碎石(ESWL)失败的输尿管结石的临床疗效。方法回顾性分析采用输尿管镜气压弹道碎石治疗体外冲击波碎石失败的输尿管结石41例的临床资料。结果34例1次碎石成功，成功率达87．2％，发生输尿管穿孔2例。结论输尿管镜气压弹道碎石术是治疗输尿管结石的较为安全有效的方法，对体外冲击波碎石失败的输尿管结石的碎石效果也较满意。     

输尿管镜气压弹道碎石治疗输尿管结石(附268例报告)

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石的临床疗效。方法回顾性分析268例采用输尿管镜气压弹道碎石治疗的输尿管结石患者资料。结果一次性碎石成功率为89.9%(241/268),并发症发生率4.1%(11/268),其中输尿管穿孔9例,泌尿系感染2例。结论输尿管镜气压弹道碎石术创伤小,安全性高,疗效确切,可作为输尿管中、下段结石的首选治疗方法。     

输尿管镜下气压弹道碎石治疗输尿管结石

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法总结输尿管镜下气压弹道碎石术治疗36例40侧输尿管结石的患者临床资料。结果40侧输尿管结石中37侧治疗成功,碎石成功率92．5％（37／40）。术中出现输尿管穿孔1例（2．5％）,留置双J管引流治愈,无输尿管黏膜撕脱、周围脏器损伤等严重并发症。结论输尿管镜下气压弹道碎石治疗输尿管结石疗效确切,创伤小,安全,可以作为输尿管中、下段结石首选治疗方法。     

输尿管镜下气压弹道碎石治疗输尿管结石(附650例报道)

目的:探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法:采用输尿管镜下气压弹道碎石术治疗输尿管结石650例(673侧)。结果:输尿管气压弹道碎石术成功率93·6%(630/673),并发症发生率3·6%(24/673)。结论:输尿管镜下气压弹道碎石术治疗输尿管结石疗效确切,安全,创伤小,并发症少。     

输尿管镜下气压弹道碎石术治疗输尿管结石患者的护理

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石的方法、并发症的预防及护理。方法对464例输尿管结石患者行输尿管镜下气压弹道碎石治疗,并加强围术期护理。结果采用输尿管镜下气压弹道碎石术治疗输尿管结石成功率高达95．5％（443／464）,其中11例患者出现输尿管狭窄,8例患者形成假道,14例患者结石冲回肾盂,提示输尿管镜碎石术失败,改其他方法处理。443例患者随访1～10个月,全部患者在1个月内排净结石。结论输尿管镜下气压弹道碎石术治疗输尿管结石安全、可靠、创伤小、成功率高、并发症少,做好患者输尿管镜下气压弹道碎石术的围术期护理是成功的重要因素之一。     

输尿管镜下气压弹道碎石术治疗输尿管结石疗效观察

目的：探讨输尿管镜下气压弹道碎石术治疗输尿管结石的临床疗效。方法应用输尿管镜下气压弹道碎石术治疗输尿管结石117例。结果104例成功腔内碎石,成功率88.9%;结石移位入肾脏而留置双J管行体外碎石治疗12例;1例输尿管狭窄上镜困难放弃手术,输尿管穿孔2例。结论输尿管镜下气压弹道碎石术是治疗输尿管中下段结石安全有效的方法。     

In vitro and in vivo activities of AM-112, a novel oxapenem

AM-112 [(1'R,5R,6R)-3-(4-amino-1,1-dimethyl-butyl)-6-(1'-hydroxyethyl)oxapenem-3-carboxylate] is a novel oxapenem compound which possesses potent beta-lactamase-inhibitory properties. Fifty-percent inhibitory concentrations (IC(50)s) of AM-112 for class A enzymes were between 0.16 and 2.24 micro M for three enzymes, compared to IC(50)s of 0.008 to 0.12 micro M for clavulanic acid. Against class C and class D enzymes, however, the activity of AM-112 was between 1,000- and 100,000-fold greater than that of clavulanic acid. AM-112 had affinity for the penicillin-binding proteins (PBPs) of Escherichia coli DC0, with PBP2 being inhibited by the lowest concentration of AM-112 tested, 0.1 micro g/ml. Ceftazidime was combined with AM-112 at 1:1 and 2:1 ratios in MIC determination studies against a panel of beta-lactamase-producing organisms. These studies demonstrated that AM-112 was effective at protecting ceftazidime against extended-spectrum beta-lactamase-producing strains and derepressed class C enzyme producers, reducing ceftazidime MICs by 16- and 2,048-fold. Similar results were obtained when AM-112 was combined with ceftriaxone, cefoperazone, or cefepime in a 1:2 ratio. Protection of ceftazidime with AM-112 was maintained against Enterobacter cloacae P99 and Klebsiella pneumoniae SHV-5 in a murine intraperitoneal sepsis model. The 50% effective dose of ceftazidime against E. cloacae P99 and K. pneumoniae SHV-5 was reduced from >100 and 160 mg/kg of body weight to 2 and 33.6 mg/kg, respectively, when it was combined with AM-112 at a 1:1 ratio. AM-112 demonstrates potential as a new beta-lactamase inhibitor.     

HER-2/neu assessment in breast cancer by immunohistochemistry and fluorescence in situ hybridization: comparison of results and correlation with survival.

BACKGROUND: HER-2/neu immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) results guide breast cancer therapy; however, few studies compared the results and no published studies have correlated them with patient outcome. METHODS AND RESULTS: We compared results, cost, and turnaround time in 117 archival, invasive breast carcinomas and compared 50-month survival in 65 of these cases using commercial HER-2/neu IHC and FISH assays. Twenty-one of 112 FISH (19%) and 33 of 117 IHC cases (28%) were positive. Concordance was high overall (88%; 98 of 112 cases) and in IHC 3+ cases (88%; 14 of 16 cases) but low in IHC 2+ cases (35%; six of 17 cases). Survival correlated with IHC results in 3+ cases (P =.02) and FISH cases with signal ratio greater than 4.0 (P =.03), but not in IHC 2+ cases (P=.7). Cost and turnaround time were greater for FISH. CONCLUSION: IHC is appropriate for initial HER-2/neu assessment; however, patients with tumors scored less than 3+, particularly those interpreted as 2+, would benefit from FISH to more accurately assess HER-2/neu status and avoid inaccurate prognostication and inappropriate treatment.     

神经内科住院患者营养风险发生情况及营养支持的现况调查

目的：调查神经内科住院患者营养风险和营养支持情况。 方法：2018年1月~4月抽取某医院神经内科住院患者209例,采用营养风险筛查工具2002(NRS 2002)和自设计问卷调查其营养风险和营养支持情况。 结果：神经内科住院患者营养风险发生率53.6%(112/209),不同年龄段和相关疾病史营养风险发生率差异有统计学意义(P<0.05)。营养支持率仅为20.1%(42/209),存在营养风险患者中,仅有30.4%(34/112)接受了营养支持,而不存在营养风险的97例中也有8例(8.2%)接受了营养支持。42例接受营养支持的患者中,7例仅接受肠内营养(EN),17例仅接受肠外营养(PN),18例接受肠内联合肠外营养(EN+PN)。 结论：神经内科住院患者营养风险发生率高,但营养支持率和合理营养支持率低,临床上应积极进行营养风险筛查,并根据筛查结果指导临床医生选择合理的营养支持方式。     

胃镜、B超、CT在进展期胃癌的应用价值

目的探讨胃镜、B超、CT在进展期胃癌诊断、治疗中的应用价值。方法回顾性分析112例经手术及病理证实的进展期胃癌的胃镜、B超、CT资料。结果112例进展期胃癌,胃镜符合率为100%(112/112),B超符合率96.4%(108/112),CT符合率98.2%(110/112);恶性肿瘤TNM分期:B超符合率78.6%(88/112),CT符合率83.0%(93/112)。结论胃镜检查结合黏膜活检仍然是进展期胃癌首选检查手段,B超、CT检查可对胃癌进行术前TNM分期,三者合理应用能更好地提高进展期胃癌的诊断、指导临床治疗、术后疗效观察及预后判断水平。     

血肾损伤分子1与β2微球蛋白浓度在妊娠期高血压并发早期肾损伤的诊断价值

目的探讨肾损伤分子1(renal injury molecule-1,Kim-1)与β2微球蛋白(β2-Microglobulin,β2-MG)浓度在妊娠期高血压疾病(hypertensive disorder of pregnancy,HDP)并发早期肾损伤的诊断价值。方法回顾性分析2017年7月至2018年10月西安市中心医院收治的HDP并发肾损伤的56例孕妇和同期56名正常孕妇的临床资料,HDP并发肾损伤的孕妇为观察组,同期56名正常孕妇为对照组,比较两组孕妇孕30周、32周、34周、36周时血肌酐(serum creatinine,SCr)、Kim-1、β2-MG浓度的差异,并分析Kim-1、β2-MG联合诊断HDP早期肾损伤的价值。结果观察组孕30周、孕32周、孕34周、孕36周时SCr、Kim-1、β2-MG均呈升高趋势,差异有统计学意义(Kim-1:F组内=11.234、β2-MG:F组内=12.852、SCr:F组内=8.308,P均<0.001)。且观察组SCr[孕30周、孕32周、孕34周、孕36周:(75.35±10.32)、(75.41±10.35)、(77.02±10.50)、(87.78±10.64)μmol/L]、Kim-1[孕30周、孕32周、孕34周、孕36周:(5.68±1.50)、(7.56±1.52)、(8.25±1.62)、(9.65±1.76)ng/L]、β2-MG[孕30周、孕32周、孕34周、孕36周:(0.26±0.07)、(0.29±0.08)、(0.75±0.29)、(1.02±0.38)ng/L]均高于对照组SCr[孕30周、孕32周、孕34周、孕36周:(74.37±10.34)、(74.43±10.40)、(75.10±12.52)、(76.80±11.66)μmol/L]、Kim-1[孕30周、孕32周、孕34周、孕36周:(5.31±1.75)、(5.36±1.77)、(5.39±1.60)、(5.41±1.70)ng/L]、β2-MG[孕30周、孕32周、孕34周、孕36周:(0.25±0.07)、(0.26±0.09)、(0.28±0.08)、(0.27±0.08)mg/L],差异有统计学意义(SCr:F组间=10.254、Kim-1:F组间=16.352、β2-MG:F组间=18.221,P均<0.001)。两组在不同分组与不同时间之间存在交互作用(SCr:F交互=15.632、Kim-1:F交互=25.645、β2-MG:F交互=34.251,P均<0.001)。Kim-1联合β2-MG诊断HDP并发早期肾损伤的灵敏度96.43%(54/56)、特异度94.64%(53/56)、准确率95.54%(107/112),明显优于单独使用Kim-1[88.24%(45/51)、92.86%(52/56)、86.61%(97/112)]、β2-MG[81.13%(43/53)、78.57%(44/56)、77.68%(87/112)],差异有统计学意义(P均<0.05)。结论HDP早期肾损伤孕妇血清Kim-1、β2-MG浓度显著升高,可作为产前监控筛查早期肾损伤的可靠指标,联合检测能提高其诊断准确性。     

Moisture associated skin damage (MASD) in intensive care patients: A Norwegian point-prevalence study

BackgroundCritically ill patients are at risk of developing moisture associated skin damage and pressure ulcers. These conditions may co-exist and be difficult to distinguish, but a simultaneous investigation may provide a true prevalence.ObjectivesTo investigate the prevalence of moisture associated skin damage and associated factors among Norwegian intensive care patients.MethodsA multi-centre one-day point-prevalence study.ResultsTotally, 112 patients participated in the study. Overall, 15 patients (13%, 15/112) had some type of moisture associated skin damage of which six cases (5%, 6/112) were related to faeces and/or urine (incontinence associated dermatitis). Skin breakdown occurred primarily in the pelvic area. Overall, 87% (97/112) had an indwelling urinary catheter. Stools were reported in 42% (47/112) of the patients on the study day, mostly liquid or semi-liquid. Overall, 11% (12/112) had a faecal management system. Only a few care plans for moisture associated skin damage prevention and care existed.ConclusionPatients in this study were vulnerable to skin breakdown in the pelvic area. Nevertheless, a low prevalence of skin breakdown existed. This may relate to intensive care nurses’ qualifications, the 1:1 nurse-patient staffing, the high prevalence of urinary catheters and few patients having stools.     

经腔道超声在急诊时诊断输尿管中下段结石的价值

目的探讨经腔道超声(经直肠或经阴道超声)对急诊时输尿管中下段(盆部及壁内部)结石的诊断价值.方法输尿管中下段结石的急腹症患者,行经腹与经腔道超声检查,最后作分析比较.结果 112例输尿管中下段结石,均经超声、X线平片、静脉肾盂造影及逆行输尿管造影等检查确诊.超声显示率94.6%(106/112),其中经腹超声显示率34.8%(39/112),经腔道超声显示率90.2%(101/112),两者共同显示34例,显示率有显著差异(P＜0.005).结论经腔道超声比经腹超声对诊断急诊时输尿管中下段结石更有价值,是对经腹超声的重要补充,可成为常用检查方法.     

Column-switching LC-MS/MS analysis for quantitative determination of testosterone in human serum

BACKGROUND: An accurate measurement of testosterone is needed in many clinical applications for correct diagnosis and appropriate treatment. Our aim was to develop a fast and robust high-throughput LC-MSMS method for quantification of serum testosterone in women. METHODS: Testosterone was derivatized by oximation and extracted with methyl tert-butyl ether from 200 microL of serum. Further matrix elimination was achieved on-line using a column-switching LC-method. The instrumental analysis was performed on an API4000 tandem mass spectrometer equipped with an Agilent series 1312A binary pump and an Agilent series 1311A quaternary pump. The MRM transitions were 304-->124 and 304-->112 for testosterone and 307-->124 and 307-->112 for d(3)-testosterone. RESULTS: The total analysis time of the column-switching method was 3 min. Linear calibration curves were obtained in the concentration range from 0.035 nmol/L (0.01 microg/L) to 6.92 nmol/L (2 microg/L). Within-day and between-day precision, expressed as the relative standard deviation at four different concentrations ranged from 4.70% to 9.35%. Correlation with the in-house method (solvent-extraction RIA) showed r(2)=0.920. CONCLUSIONS: The presented column-switching method offers a simple, fast and economical analysis of testosterone in human serum. The procedure requires only small sample volumes and is well suited for quantification of testosterone in serum from women and children.     

Detection of BRAF V600E mutation in colorectal cancer: comparison of automatic sequencing and real-time chemistry methodology

Mutation V600E of BRAF, a kinase-encoding gene from the RAS/RAF/MAPK pathway, in colorectal carcinoma (CRC) suggests a sporadic origin of the disease, providing an exclusion criterion for hereditary nonpolyposis colorectal cancer. Here we describe detection of this mutation by real-time chemistry TaqMan MGB probes, confirmed by direct DNA sequencing as the gold standard. DNA was extracted from paraffin-embedded tissue from 112 tumors obtained from the EPICOLON study. Seventy-two tumors were CRC with defective DNA mismatch repair (MMR; microsatellite instability and/or loss of protein expression by immunohistochemical analysis), and 40 were proficient MMR controls. BRAF mutation was detected in 20/72 (27.8%) CRC with defective MMR and in 3/40 (7.5%) proficient MMR controls (P = 0.011). BRAF mutation was detected in 19/51 (37.3%) tumors with loss of MLH1 expression and in none of the tumors with loss of MSH2 expression (0/13). BRAF mutation was not found in cases with germline mutation of MLH1 (4/112) or MSH2 (3/112) genes. The sensitivity and specificity of our real-time chemistry were both 100% for detecting the V600E mutation. Because real-time chemistry methodology has advantages in cost, time, and labor, we consider it a valuable alternative to automatic direct sequencing, particularly for serial measurements.