经皮肾穿刺肾镜结合电子胆管镜取石术治疗复杂性上尿路结石疗效观察

目的：探讨经皮肾穿刺肾镜结合电子胆管镜取石术治疗复杂性上尿路结石的临床疗效。方法选取31例复杂性上尿路结石患者为研究对象,采用经皮肾穿刺肾镜结合电子胆管镜治疗,术中采用第4代EMS碎石清石或钬激光碎石。结果31例患者手术时间为45 min~180 min,平均（100.6±40.8）min;术中出血量15~160 mL,平均（80.4±15.5）mL;无术中、术后大出血,无1例中转开放手术。Ⅰ期结石清除27例,Ⅱ期结石清除4例,结石总取净率为90.3%（28/31）;1例患者术后1个月予体外冲击波碎石治疗,结石总排净率为93.5%。1例术后出现高热,经抗感染、对症治疗后控制。无血气胸及周围脏器损伤等并发症发生。结论经皮肾穿刺肾镜结合胆管镜取石术是一种安全有效的治疗复杂性上尿路结石的方法,可提高清石率,降低结石残留。     

经皮肾镜下应用第三代弹道超声波碎石清石系统治疗复杂性肾结石

目的：总结经皮肾镜下应用第三代弹道超声波碎石清石系统治疗复杂性肾结石的经验。方法：回顾性分析152例应用经皮肾镜取石术（PCNL）结合第三代弹道超声波碎石清石系统治疗复杂性肾结石患者的临床资料。结果：152例患者手术过程均顺利,其中,148例一次取石成功,4例需二次PCNL清石;平均手术时间120min;肾造瘘管留置时间平均7d．术后平均住院时间9d;术后发生大出血1例,经夹闭肾盂造瘘管和静脉注射止血药后恢复;结石清除率为94％。结论：经皮肾镜下应用第三代弹道超声波碎石清石系统治疗复杂性肾结石具有创伤小、住院时间短、结石清除率高、并发症少、恢复快等优点,是治疗复杂性肾结石的较好方法。     

经皮肾镜混合动力碎石清石术治疗复杂性肾结石

目的:探讨超声引导下经皮肾镜混合动力(超声联合气压弹道)碎石清石术治疗复杂性肾结石(肾及肾盂输尿管连接部结石)的方法、疗效及术后观察。方法:在B超引导下,经皮肾镜建立工作通道,在F20.8号肾镜下,使用EMS瑞士3代碎石清石系统治疗38例复杂性肾结石。结果:38例病例中,肾结石26例、肾盂输尿管连接部结石12例,手术时间45~182 min,平均92 min,结石粉碎率99.9%,结石取净率89.4%,术后随访1~3个月无结石复发及肾功能损害。结论:经皮肾镜混合动力碎石清石术微创、安全,能最大限度地保护肾功能,是一种治疗复杂性肾结石的可靠方法。     

经皮肾镜气压弹道碎石术治疗复杂性上尿路结石

目的 探讨经皮肾镜气压弹道碎石治疗复杂性上尿路结石的疗效及安全性.方法 对58例接受经皮肾镜气压弹道碎石治疗复杂性上尿路结石患者的临床资料进行了回顾性分析.结果 58例患者中54例成功行一期取石术,2例中转开放手术;2例手术失败,一期手术取净结石48例,二期手术取净结石6例,结石总取净率88.7%,手术时间58-185mi n,平均(114±32)mi n;术中出血量25-610mL,平均(77±21)mL;肾造瘘管留置时间平均7d,术后平均住院8.5d,未出现严重的并发症.结论 经皮肾镜气压弹道碎石具有损伤小、恢复快、住院时间短、结石清除率高、并发症少等优点,是治疗复杂性上尿路结石的首选方法.     

超声引导经皮肾镜气压弹道联合超声碎石清石术治疗复杂上尿路结石

目的 探讨超声定位引导经皮肾镜气压弹道联合超声碎石清石术治疗复杂上尿路结石的安全性及其疗效.方法 2005年6月-2009年10月,采用在新型微创经皮肾镜(F20.8)下超声联合气压弹道碎石清石术治疗1 088例复杂上尿路结石患者,其中肾多发结石583例,部分或完全鹿角状结石387例,感染性结石35例,孤立肾结石13例,合并肾功能不全(氮质血症)43例,肾盏憩室结石27例,均在B超引导下穿刺并扩张建立F24皮肾通道,在肾镜下应用瑞士EMS三代气压弹道联合超声碎石清石系统进行碎石并吸出体外,术中B超检查示有残留结石的患者,则在B超引导下进入结石位置肾盏进行碎石.结果 866例患者一期经皮肾镜碎石(PCNL)取净所有结石,一期净石率为79.6%.一期手术的时间为20～180 min,平均手术时间为(45.2±4.7)min;术中失血量为10～450 mL,平均失血量为(40.3±3.5)mL.术后泌尿系X线平片检查显示115例(10.6%)有残留的直径5 mm的结石,行二期PCNL取石;76例(7.0%)患者接受三期PCNL取石.29例(2.7%)术后行辅助体外冲击波碎石治疗.9例术后出现严重出血,8例行超选择性肾动脉栓塞止血后好转,1例因术后严重迟发性出血止血效果不理想行肾切除;1例术后出现肾周巨大血肿,行保守治疗后好转.结论 采用经皮肾镜下超声联合气压弹道碎石清石术治疗复杂上尿路结石安全、高效,术中应用B超检查残留结石简便、易行,并能帮助引导肾镜清除残留结石,可显著提高复杂上尿路结石的治疗效果.     

经皮肾镜联用输尿管镜气压弹道碎石和超声碎石术治疗输尿管上段结石37例

目的 探讨经皮肾镜联用输尿管镜气压弹道碎石联合超声碎石术治疗输尿管上段结石的方法和疗效.方法 应用EMS第三代气压弹道/超声碎石清石系统,应用微创经皮肾穿刺术治疗输尿管上段结石37例.结果 37例患者中,34例一期取净结石;1例合并肾积脓,经皮肾造瘘术后二期取净结石;2例肾内有结石残留,经体外冲击波碎石治愈.一期结石清除率91.9%(34/37).平均手术时间70 min,平均住院8.0天.术中、术后均未出现严重并发症.结论 经皮肾镜联用输尿管镜气压弹道联合超声碎石清石术疗效好、创伤小,可作为治疗输尿管上段结石的一种常用方法.     

经皮肾镜超声弹道碎石术治疗复杂性肾结石20例分析

目的 观察经皮肾镜超声弹道碎石术(PCNL)治疗复杂性肾结石的疗效.方法 复杂性肾结石患者20例,其中完全性鹿角状结石5例,不完全性鹿角状结石12例,多发性肾结石3例,结石平均直径2.7 cm,均采用经皮肾镜联合超声弹道碎石清石系统治疗.结果 20例患者中1次取净结石17例(85.0%),行二次PCNL术或辅以体外冲击...     

超声引导经皮肾镜应用第三代超声/弹道碎石机治疗上尿路结石

目的:探讨超声引导经皮肾镜应用第三代超声/弹道碎石清石系统治疗上尿路结石的临床疗效。方法:回顾性分析我院自2006年10月～12月经皮肾镜应用第三代超声/弹道碎石清石系统治疗上尿路结石39例的临床资料(超声/弹道碎石组),并以我院自2006年1月～9月微创经皮肾穿刺气压弹道碎石术治疗上尿路结石126例的临床资料作为对照组(气压弹道碎石组),比较两组患者的平均手术时间、平均结石处理时间、一期结石清除率及平均手术失血量的差异。结果:超声/弹道碎石组的平均手术时间、平均结石处理时间均较对照组短(P<0.05);超声/弹道碎石组的一期结石清除率高于对照组(P<0.05);超声/弹道碎石组的平均手术失血量较对照组少(P<0.01)。结论:超声引导经皮肾镜超声/弹道碎石取石术是治疗上尿路结石的安全、高效的方法,临床效果显著。     

在B超引导下经皮肾镜气压弹道联合超声碎石术治疗上尿路结石126例

目的探讨在B超引导下经皮肾镜气压弹道联合超声碎石术治疗肾和输尿管上段结石的手术效果。方法对126例上尿路结石患者进行在B超引导下经皮肾镜碎石术,分析其在B超引导下对手术的影响。结果126例患者均为一期穿刺碎石取石,123例取净,3例术后复查KUB显示残留小结石。Ⅰ期手术结石取净率98％。结论B超在行经皮肾镜气压弹道联合超声碎石术治疗上尿路结石穿刺时,有方便、清楚等优点     

B超引导经皮肾镜气压弹道联合超声碎石术治疗上尿路结石

目的探讨B超引导下经皮肾镜气压弹道联合超声碎石术治疗上尿路结石的安全性、可靠性及临床疗效。方法 2009年10月～2010年10月,对本组84例（92侧）患者行经皮肾镜气压弹道联合超声碎石清石系统治疗上尿路结石的临床资料进行分析,对一期治疗效果及手术并发症进行总结。结果所有患者均成功建立皮肾通道并一期碎石,平均手术时间76分,一次取净结石率94.5%（87/92）,5侧有结石残留,辅助施行体外冲击波碎石或排石治疗后治愈。随访1～3个月,无严重手术并发症及后遗症。结论经B超引导下采用经皮肾镜气压弹道联合超声碎石术处理上尿路结石具有安全及疗效可靠的特点,值得临床推广应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.