逼尿肌尿道外括约肌协同失调的肉毒素A治疗

目的探讨肉毒素A(BTX-A)经尿道尿道外括约肌注射,治疗逼尿肌尿道外括约肌协同失调(DESD)的效果。方法对11例因患DESD致慢性尿潴留和尿失禁患者,行经尿道尿道外括约肌注射100UBTX-A治疗,对治疗前后的残余尿(PVR)、最大尿道压(MUP)、排尿期最大逼尿肌压(MPdet)和国际尿失禁咨询委员会尿失禁评分调查简表(ICI-Q-SF)评分进行比较。结果治疗后,MUP、MPdet和ICI-Q-SF显著降低,PVR显著减少。7~30天达最大疗效,单次注射疗效持续2~3个月,重复注射可持续更长时间。无严重不良反应发生。结论BTX-A尿道外括约肌注射治疗DESD,安全,微创,疗效确切;但需要重复注射维持疗效。     

A型肉毒毒素注射尿道括约肌治疗下尿路功能障碍:单中心14年经验

目的:评价A型肉毒毒素(BTX-A)尿道括约肌注射临床使用效果分析。方法:我院2002年9月~2016年12月对51例有不同程度排尿困难或合并尿失禁的患者尿道括约肌注射BTX-A,注射部位包含尿道外括约肌(29例)、逼尿肌联合尿道外括约肌(16例)和尿道内括约肌联合尿道外括约肌(6例),所有患者治疗前均按国际尿控协会(ICS)标准进行影像尿动力检查,包括膀胱压力、容积、流率测定和尿道压力描记(UPP),指标包含最大尿流率(Q_max)、输尿管反流压(Pdet.reflux)、逼尿肌漏尿点压(DLPP)和最大尿道压力(Pura.max)。排尿后残余尿量(PVR)使用导尿法测定,治疗前查泌尿系超声,治疗后1个月复查上述指标。结果:治疗1个月后,Q_max从(2.7±1.2)ml/s升至(6.4±1.9)ml/s,Pura.max从(75.8±5.5)cmH_2O降至(50.7±4.6)cmH_2O,DLPP从(71.9±22.7)cmH_2O降至(28.4±8.4)cmH_2O,排尿后PVR从(231.3±29.3)ml降至(105.0±16.3)ml,差异均有统计学意义(P<0.05)。治疗前有8例患者泌尿系超声提示单侧或双侧肾积水,并且尿动力提示存在输尿管反流,治疗后1个月复查泌尿系超声,3例肾积水无明显减轻,3例肾积水略减轻,2例肾积水消失。随访1~6个月,疗效持续2~3个月。全部患者未发现严重不良反应发生。结论:BTX-A注射尿道括约肌是治疗下尿路功能障碍一种有效、安全的方法。     

经会阴肉毒素注射治疗脊髓损伤所致逼尿肌外括约肌不协调

目的　观察经会阴肉毒素注射治疗脊柱脊髓损伤所致逼尿肌外括约肌不协调的疗效。　方法　对 3例颈髓损伤和 3例胸髓损伤合并逼尿肌外括约肌不协调患者行经会阴尿道外括约肌肉毒素注射 ,治疗分两次进行 ,间隔 3d ,每次 5 5U。观察治疗前后剩余尿量 ,并于治疗前和治疗后 1个月行尿动力学检查 ,观察尿道压变化。　结果　 3例患者治疗后剩余尿量较治疗前减少 (133.3±70 .9)ml,尿道压较术前降低 (35 .4± 2 5 .8)cmH2 O(1cmH2 O =0 .0 98kPa) ,P均 <0 .0 5。 2例颈髓损伤者自主神经过度反射消失 ;4例患者排便功能改善。 5例疗效持续 3个月 ,1例疗效持续 15个月。6例均未见药物副作用。　结论　经会阴肉毒素注射治疗脊髓损伤所致逼尿肌外括约肌不协调的疗效可靠。     

A型肉毒毒素注射治疗脊髓损伤后逼尿肌尿道外括约肌协同失调症

目的评价A型肉毒素（BTX-A）注射治疗脊髓损伤患者尿道外括约肌协同失调症（DESD）的临床效果。方法脊髓损伤致DESD患者15例。男12例,女3例,平均年龄37岁。临床表现排尿无力、排尿等待,需要压腹以助排尿。200 U BTX-A溶解于8 ml生理盐水,使用尿道镜注射针分8点二平面注射于尿道外括约肌,1ml/点。记录治疗前后排尿症状,尿动力学检查,并观察毒副作用。结果治疗后2个月,尿动力学检查结果显示膀胱贮尿和排尿功能有不同程度改善,15例最大尿流率由（9．2±5．0）ml/s增加至（16．2±7．0）ml/s,单次尿量由（182．5±52．0）ml/次增加至（235．5±40．0）ml/次,剩余尿量由（288．7±122．5）ml下降至（155．4±81．2）ml（P＜0．01）；最大膀胱测压容积、膀胱顺应性及充盈末逼尿肌压力术前分别为（113．0±64．8）ml、（15．2±2．0）ml/cm H2O、（52．7±19．2）cm H2O,术后分别为（205．5±75．6）ml、（22．5±9．3）ml/cm H2O及（37．1±7．3）cm H2O（P＜0．01,P＜0．05,P＜0．01）。治疗前需要坐位排尿的8例患者均可以直立排尿。随访2～7个月,疗效稳定。结论BTX-A注射是一种治疗脊髓损伤患者逼尿肌无反射伴DESD的有效方法,长期疗效有待观察。     

尿流动力学检查对脊髓拴系诊治的临床意义

目的讨论尿流动力学检查在脊髓拴系患者治疗中的重要性.方法对38例脊髓拴系患者行尿流动力学检查、静脉肾盂造影和排泄性膀胱尿道造影,了解患者泌尿系损害情况.结果上尿路损害组最大逼尿肌压(7.45±1.22kPa)明显高于上尿路组无损害组(4.25±1.40kPa),膀胱顺应性(2.6±0.6ml/cmH2O)低于下尿路无损害组(6.7±0.8ml/cmH2O).逼尿肌与括约肌协调组上尿路损害的发生率(16.7%)明显低于逼尿肌与括约肌不协调组(52.1%).结论逼尿肌压升高、膀胱顺应性下降、逼尿肌与括约肌不协调是上尿路损害的高危因素,尿流动力检查可为临床治疗提供指导.     

脑血管意外尿失禁的机制探讨

目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查(包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定)并按Burney分类进行分析,同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中,表现为逼尿肌反射亢进者31例(73.8%):其中外括约肌无抑制性松弛19例(45.2%),逼尿肌-外括约肌不协调3例(7.1%),逼尿肌-外括约肌协调9例(21.4%);逼尿肌反射减低,外括约肌协调者11例(26.2%);无逼尿肌功能正常者。发生膀胱顺应性减低5例(11.9%),发生尿感缺失者11例(26.2%)。初感尿容量(140.00±46.97)ml;膀胱最大容量(293.20±60.71)ml;最大尿道闭合压(65.14±19.83)cmH2O。逼尿肌最大收缩力(Pdetmax)为(60.98±31.11)cmH2O;最大尿流率时逼尿肌压力(Pdet-Qmax)为(35.98±17.46)cmH2O;逼尿肌收缩时间(Tcon)为(86.07±36.09)sec;最大流量(Qmax)为(9.02±5.62)ml/s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶,脑出血与脑梗塞患者的尿动力学表现无明显差异,左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进,部分出现逼尿肌反射减弱,但感觉正常,感觉缺失者较少见;外括约肌功能以无抑制性松弛为主,其次为逼尿肌-外括约肌协调,少数出现不协调;较少出现膀胱顺应性降低。     

A型肉毒杆菌毒素治疗逼尿肌尿道外括约肌协同失调症研究进展

A型肉毒杆菌毒素(botulinumtoxinA,BTX-A)抑制神经末梢释放乙酰胆碱(acetylcholine,Ach),产生去神经化作用,导致暂时性的肌肉麻痹,近年应用其治疗逼尿肌尿道外括约肌协同失调症(detrusorsphincterexternaldyssynergia,DESD),疗效显著。本文就BTX-A在DESD治疗方面作一综述。     

外括约肌气囊扩张术

作者报告用外括约肌气囊扩张术治疗一组男性脊髓损伤后逼尿肌外括约肌协同失调(DESD)的结果。7例患者平均年龄29岁(21-39岁),术前行同步膀胱尿道测压和会阴肌电图检查,均证实为DESD。术后1月和4月作尿流动力学检查进行随访;并对术前、术后膀胱容量,残余尿量以及排尿期尿道内压作一比较。操作方法:先用尿道膀胱镜进行外括约肌检查,并排除膀胱畸形。然后经膀胱镜置人导丝,沿导丝将前列腺气囊扩张管放入膀胱。用无菌造影剂充起定位气囊,在透视下将其拉至外括约肌下1-2cm处,使扩张气囊中点到达外括约肌水平。再用无菌造影剂逐渐充起扩张气囊行外括约肌扩张。起初在扩张气囊中点处可见——“细腰征”形成;但当液体注入15ml,压     

青春期慢性前列腺炎伴膀胱逼尿肌括约肌协同失调的临床分析

目的 探讨青春期慢性前列腺炎伴膀胱逼尿肌括约肌协同失调(DSD)的临床特点及治疗效果.方法 青春期慢性前列腺炎患者43例,均行慢性前列腺炎(CP)症状评分(NIH-CPSI)评估,尿常规、细菌培养,前列腺按摩液常规检查、细菌培养及泌尿系B超检查,行NIH分型.Ⅲ型CP患者组均行尿动力学检查,分析尿流曲线,记录最大尿流率(Qmax)、DSD、残余尿(PVR)、最大尿流逼尿肌压(Pdet max)、最大尿道压(MUP)和最大尿道闭合压(MUCP)等参数.Ⅲ型CP伴DSD患者行生物反馈治疗,或辅以抗生素、α-受体阻滞剂治疗.12周后行NIH-CPSI评分及尿流动力学检查评估疗效.结果 43例青春期CP患者中,Ⅱ型4例(9.30％),Ⅲ A型7例(16.28％),Ⅲ B型30例(69.77％),Ⅳ型2例(4.65％);其中伴DSD患者28例(65.12％),其中Ⅲ A型2例,Ⅲ B型26例.28例Ⅲ型伴DSD患者治疗12周后,疗效评估显示NIH-CPSI总评分较治疗前显著降低,治疗前后分别为(27.24±12.41)分和(6.75±2.13)分,差异具统计学意义(P＜0.05);尿流动力学指标Qmax治疗前后分别为(9.64±4.52)ml/s和(16.16±7.28)ml/s,Pdet max治疗前后分别为(126.74±43.58)cmH2O和(74.57±11.80)cmH2O,MUP治疗前后分别为(112.45±22.73)cmH2O和(66.82±13.92)cmH2O,MUCP治疗前后分别为(96.54±13.60)cmH2O和(51.36±9.74)cmH2O,DSD发生例数治疗前后分别为28例和3例,差异均具统计学意义(P＜0.05),仅PVR治疗前后无变化,治疗前后分别为(8.23±3.79)ml和(7.16±4.02)ml,差异无统计学意义(P＞0.05).结论 青春期CP患者多伴DSD发生,临床表现除下尿路症状外,还出现尿流动力学改变;尿流动力学检查是诊断该疾病并拟定治疗方案的重要指标;盆底生物反馈治疗是该类型CP的主要治疗方法,短期疗效确切.     

含三角区的逼尿肌内BTX-A重复注射术联合间歇导尿治疗成年男性脊髓损伤并NDO和尿失禁的疗效及安全性

目的评估含三角区的逼尿肌内A型肉毒毒素(BTX-A)重复注射术联合间歇导尿治疗成年男性脊髓损伤并神经源性逼尿肌过度活动(NDO)和尿失禁的疗效和安全性。方法回顾性分析2012年1—8月广东省工伤康复医院采用含三角区的逼尿肌内BTX-A重复注射术治疗43例成年男性脊髓损伤伴NDO和尿失禁患者的资料。年龄(29.1±10.7)岁, 术前尿失禁生活质量问卷评分(I-QOL)(39.0±4.8)分, 每日尿失禁(11.9±2.6)次, 每次排尿量(170.7±20.1)ml, 首次出现NDO时膀胱逼尿肌最大压力(81.4±19.6)cmH2O(1cmH2O=0.098kPa), 首次出现NDO时膀胱容量(169.1±40.0)ml。经尿道将300 U BTX-A分30个点注射于包括膀胱三角区的逼尿肌内。留置尿管1～3 d后改为间歇导尿。间隔6～9个月重复注射, 共注射4次。记录每次注射12周后I-QOL、排尿日记及影像尿动力学检查结果, 并观察不良事件。结果患者4次BTX-A注射间隔时间分别为(220.6±27.4)、(222.8±24.2)、(224.4±39.0)d(P=0.13)。与首次...     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.