无管化微创经皮肾镜取石术治疗体外冲击波碎石术后输尿管上段石街

目的 评价无管化微创经皮肾镜取石术（MPCNL）治疗体外冲击波碎石（ESWL）术后输尿管上段石街的疗效及并发症.方法 利用无管化MPCNL治疗ESWL术后输尿管上段石街患者31例,并统计手术时间、结石清除率、术中出血量和并发症等情况.结果 本组患者平均手术时间21.6min,一期结石清除率100％,无输血患者,无感染等严重并发症发生.结论 在严格把握手术指征前提下,利用无管化MPCNL治疗ESWL术后输尿管上段石街是安全有效的.     

输尿管软镜联合微创经皮肾镜治疗鹿角形肾结石(附26例报告)

【摘要】〓目的〓报告输尿管软镜联合微创经皮肾镜治疗鹿角形肾结石的疗效和治疗经验。方法〓收集鹿角形肾结石患者26例,术前常规检查双肾多排CT平扫加增强扫描,三维重建。行输尿管软镜联合微创经皮肾镜治疗。统计手术时间,结石残余率。结果〓所有手术顺利完成,无输尿管穿孔、气胸、肠道损伤及大出血等严重并发症发生。术后复查KUB示一期手术结石取净率为81%(21/26),手术时间60~150 min,平均95±13 min。7例结石残余,术后第5~7天行二期手术,结石取净率为92.3%(24/26),手术时间30~150 min,平均45±11 min。2例结石残留患者行术后1月行体外冲击波碎石治疗后完全排出。术后住院5~12 d,平均6.5 d。结论〓输尿管软镜联合微创经皮肾镜治疗复杂肾结石安全、有效。     

微创经皮肾镜穿刺取石术治疗ESWL术后输尿管上段石街

目的：评价微创经皮肾镜穿刺取石术治疗ESWL术后输尿管上段石街的疗效及并发症。方法：采用微创皮肾镜穿刺取石术治疗ESWL术后输尿管上段石街患者36例,并统计手术时间,结石清除率,术中出血量和并发症等情况。结果：本组平均手术时间18min,一期结石清除率100%,无输血患者,无严重并发症发生。结论：微创经皮肾镜穿刺取石术治疗ESWL术后输尿管上段石街安全有效。     

上尿路结石微创治疗现状与进展

输尿管结石根据结石的位置、大小、数目等可分别采用输尿管镜取石或碎石、体外冲击波碎石术（ESWL）或二者联合应用治疗,碎石以激光碎石效果更佳.微创经皮肾镜取石术（PCNL）是治疗肾及输尿管上段复杂性结石的首选微创方案.而对于各种原因无法行ESWL,及输尿管镜取石或治疗失败者,采用腹腔镜手术治疗可取代大部分开放手术.     

微创经皮肾镜取石术联合Ⅱ期逆行输尿管软镜治疗复杂性肾结石的疗效观察

目的探讨微创经皮肾镜取石术联合Ⅱ期输尿管软镜治疗复杂性肾结石的安全性及可行性。方法收集2010年1月至2014年12月收治的122例复杂性肾结石患者的资料,其中78例多发性肾结石,44例肾铸型结石,结石直径范围为1.5~5.0cm,其中74例患者出现不同程度的尿素氮及肌酐水平升高;所有患者均行Ⅰ期微创经皮肾镜碎石术,术后3~5d再行Ⅱ期逆行输尿管软镜取石术,收集所有患者术前、术后各项生化指标并获取随访资料。结果患者Ⅰ期微创经皮肾镜手术时间为30~180min,术后均有结石残留;Ⅱ期输尿管软镜手术时间20~100min,Ⅱ期结石总清除率为93.44%(114/122),余8例患者术后行体外冲击波碎石治疗后结石均排出;随访1~18个月后,所有患者均未见残余结石梗阻、石街及移位等。结论微创经皮肾镜取石术联合Ⅱ期逆行输尿管软镜可以应用于复杂性肾结石的临床治疗。     

输尿管镜下U-100双频双脉冲Nd：YAG激光治疗输尿管结石210例临床分析

目的探讨输尿管镜下U-100双频双脉冲掺钕钇石榴石（Nd：YAG）激光碎石治疗输尿管结石的疗效。方法应用U-100双频双脉冲掺钕钇石榴石（Nd：YAG）激光经输尿管镜治疗输尿管结石210例,其中输尿管上段结石54例,中、下段结石141例,一侧输尿管多发结石15例。结果总碎石成功率97．1％（204／210）,其中输尿管上段结石成功率92．6％（50／54）,中、下段结石成功率97．2％（137／141）。激光平均工作时间为6．1（1．8～9．0）min。平均手术时间23．5（2-41）min。结论输尿管镜下U-100双频双脉冲掺钕钇石榴石（Nd：YAG）激光碎石术治疗输尿管结石,是一种高效、安全、操作简便及组织损伤甚微的手术方法。     

输尿管上段结石的治疗选择

近年来,泌尿外科微创手术的发展使得输尿管上段结石的临床治疗发生巨大变化.体外冲击波碎石术(ESWL)、逆行输尿管镜碎石术(URS)、微创经皮肾镜顺行取石术(MPCNL)、后腹腔镜输尿管切开取石术(LUL)等微创治疗方法逐渐代替传统的开放手术.     

泌尿外科

肾脏、输尿管：输尿管镜气压弹道碎石术与ESWL治疗输尿管结石的疗效比较；微创经皮肾镜取石术治疗小儿复杂性肾结石；钬激光碎石术治疗输尿管结石；微创经皮肾镜取石术治疗鹿角状结石；采用微创经皮肾穿刺输尿管镜碎石取石术治疗复杂性上尿路结石……     

微创经皮肾镜碎石后输尿管残留结石的门诊处理

目的探讨微创经皮肾镜碎石术（min im ally invasive percutaneous nephrolithotomy,MPCNL）术后输尿管残留结石的门诊处理效果。方法直径〈10 mm输尿管残留结石,出院等待观察;直径≥10 mm输尿管残留结石或输尿管石街,门诊体外冲击波碎石术（extracorporeal shock wave lithotripsy,ESWL）治疗;经等待观察或ESWL治疗失败或仍有残留结石的患者,门诊局麻下行输尿管镜取石或碎石术。结果43例结石直径〈10 mm中,31例在等待观察期间自行排出结石,3例在拔双J管时带出结石,9例局麻下采用输尿管镜取出结石。24例结石直径≥10 mm中,18例ESWL碎石成功,4例局麻下采用输尿管镜取石,2例采用输尿管镜气压弹道碎石术,取净残留结石。本组未见严重血尿、发热、输尿管穿孔、肾绞痛等较重并发症。结论根据患者病情门诊采取适当的措施,处理MPCNL术后输尿管残留结石有效、安全。     

体外冲击波碎石在治疗结石形成导致双J管滞留中的价值

目的探讨体外冲击波碎石术在在治疗结石形成导致双J管滞留的应用价值。方法 2003年1月～2012年1月对31例经皮肾镜气压弹道碎石术、输尿管镜检查及碎石术后结石形成导致双J管滞留者采用体外冲击波碎石,电压从6kV开始,根据患者耐受力逐渐增加至7 kV,冲击次数3000～3500次,时间约90 min。冲击从膀胱端开始,依次为输尿管、肾盂,重点冲击肾盂输尿管连接部,当透视发现结石与双J管分离且结石直径〈3 mm治疗结束。结果 22例1次ESWL后双J管顺利拔出;5例2次ESWL后拔出;2例2次ESWL后仍不能拔出,改行输尿管镜后顺利拔出;2例由于结石较大且合并肾盂结石改行微通道经皮肾镜取石术后顺利拔出双J管。31例术后随访6个月,26例无结石复发,5例复发肾结石（4例行排石药物治疗,1例行体外冲击波碎石治疗,结石均顺利排出）。结论对于结石形成导致双J管滞留,ESWL是一种简单、安全、有效的治疗方法。     

Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire

Several versions of the 24-item Roland Morris Disability Questionnaire (RMDQ) have been proposed; however, their responsiveness has not been extensively explored. The objective of this study was to compare the responsiveness of four versions of the RMDQ. Perceived disability was measured using the 24-item, two 18-item and an 11-item RMDQ on 1,069 low back pain patients from six randomised controlled trials. Responsiveness was calculated using effect size, Guyatt’s responsiveness index (GRI) and receiver operating characteristics (ROC) curves. Effect size analyses showed that both 18-item versions of the RMDQ were superior to the 24- and 11-item versions of the RMDQ. GRI showed that the 24- and 18-item versions of the RMDQ were similar but more responsive than the 11-item. ROC curves revealed that the 11-item was less responsive than the other three versions, which had similar responsiveness. The results of this study demonstrate that the 24-item and both 18-item versions of the RMDQ have similar responsiveness with all having superior responsiveness to the 11-item.     

Rupture of the Achilles tendon, cause - prognosis - therapy - late results

Reports about 147 ruptures of the Achilles tendon which were mainly caused by sports activities (85%). The authors also report on the operative methods used in our clinic, and on the long-term results (up to 16 years) of our cases. The complication rate was relatively low, and reoperations were necessary in a few cases. Healing of the Achilles tendon was achieved in every case. The disability to work was relatively short. Most of the patients were able to resume their former sports activity.     

MMP-2、TIMP-1、TIMP-2的表达与星形细胞肿瘤生物学行为的演进

目的探讨基质金属蛋白酶2（MMP-2）和基质金属蛋白酶抑制剂（TIMP-1，TIMP-2）在人脑星形细胞的肿瘤中的表达及其与肿瘤临床生物学行为的关系。方法采用免疫组织化学S—P法检测10例正常组织和52例星形细胞肿瘤组织中MMP-2、TIMP-1和TIMP-2的表达情况。结果MMP-2、TIMP-1、TIMP-2在正常脑组织中阳性着色只位于内皮细胞胞浆和基底膜；在星形细胞肿瘤中，还见于部分瘤细胞的胞浆。52例不同病理级别星形细胞肿瘤中MMP2、TIMP-1、TIMP-2阳性表达率（χ^2=6．222～10．185，P〈0．05）和阳性表达强度（H=7．966～10．353，P〈0．05）差异均具有显著性。结论MMP-2、TIMP-1和TIMP-2在星形细胞肿瘤中的表达与星形细胞肿瘤的侵袭性生物学行为的演进密切相关。     

Spiegel and Wycis - the early years

The field of human stereotactic surgery was introduced by Ernest A. Spiegel and Henry T. Wycis by a historical paper in Science in 1947. Spiegel was a conservative Vienna trained experimental neurologist who fled the Nazis to Temple Medical School in Philadelphia. Wycis was a huge flamboyant but brilliant neurosurgeon who started as Spiegel's student and then became his collaborator. They described a Horsley-Clarke apparatus that could be used in human stereotactic surgery. It relied on internal cerebral landmarks, which made it accurate enough to be used in humans. The fields of human neurophysiology, pneumoencephalography, radiology, and electrophysiology had advanced enough to provide for the first time the required technology. At the time of their initial publication, they had probably already performed surgery for psychiatric illness, pain, movement disorders, and aspiration of tumor cysts. The first decade after their publication was a remarkably productive time for them and the other pioneers who entered the field.     

蚁附蠲痹超细微粉对RA—MsPGN大鼠肾功能的影响

目的：观察蚁附蠲痹超细微粉对RA—MsPGN大鼠模型肾功能的影响。方法：通过检测大鼠24h尿量、尿蛋白量和血清尿素氮和肌酐水平以及肾脏病理形态学检查反映肾功能的变化。结果：RA—MsPGN模型大鼠与正常组相比24h尿量和尿蛋白量以及血清肌酐水平均显著升高，血清尿素氮水平二者之间无差异；病理形态学检查见模型组动物肾小球系膜细胞增殖、系膜基质显著增多，并伴有不同程度的毛细血管袢受挤压现象；而蚁附蠲痹超细微粉各剂量组均能显著降低大鼠24h尿量、尿蛋白量和血清肌酐水平；对肾小球系膜细胞的增殖和系膜基质的增多均有良好的抑制作用，对血清尿素氮水平无明显影响。结论：蚁附蠲痹超细微粉对RA—MsPGN大鼠肾功能有良好的保护作用。     

Caspase Inhibition Prevents the Increase in Caspase-3, -2, -8 and -9 Activity and Apoptosis in the Cold Ischemic Mouse Kidney

Prolonged cold ischemic time is a risk factor for the development of delayed graft function. The adverse impact of cold ischemia may be associated with tubular cell death in the kidney. Caspase-3 is a major mediator of apoptotic cell death. We hypothesized that caspase inhibition would reduce apoptosis and other features of cold ischemia. Kidneys of C57BL/6 mice were perfused with cold University of Wisconsin solution containing a pancaspase inhibitor or vehicle via the left ventricle. The contralateral right kidney was used as a control. The left kidney was stored for 48 h at 4 degrees C to produce cold ischemia. Caspase-3 activity was massively (100-fold) increased in cold ischemic kidneys compared with controls. On immunoblot analysis, the processed form of caspase-3 was increased in cold ischemic kidneys compared with controls. The increase in caspase-3 was associated with significantly more renal tubular apoptosis and brush-border injury. In addition, caspase-2, -8 and -9 activities were increased in cold ischemic kidneys. The pancaspase inhibitor prevented the formation of the processed form of caspase-3 and the increase in caspase activity, and reduced apoptosis and brush-border injury. Caspase inhibition may prove useful in kidney preservation.     

bag-1，bcl-2基因表达与乳腺癌的发生及预后

目的探讨抗凋亡基因bag-1和bcl-2在乳腺癌组织中的表达及意义，了解肿瘤细胞凋亡的特点。方法采用免疫组化SABC法观察了100例乳腺癌与10例乳腺良性肿瘤及10例正常乳腺组织的石蜡标本切片中bag-1和bcl-2的表达，并进行统计研究。结果Bag-1在乳腺癌组织、乳腺良性肿瘤中，正常乳腺组织中阳性表达率分别为85．0％、10．0％、10．0％，差异有显著性（P〈0．05），其表达与不同病理类型及临床分期无关（P〉0．05）。bcl-2在乳腺癌组织、乳腺良性肿瘤、正常乳腺组织中阳性表达率分别为46．0％、80．0％、90．0％，差异有显著性（P〈0．05）。其表达与不同病理类型及临床分期亦无关（P〉0．05）。对100例乳腺癌进行随访，bag-1阳性表达者5年生存率为78．7％，bag-1阴性表达者5年生存率为8．5％，两者差异有显著性（P〈0．05）。bcl-2阳性表达者5年生存率为43．6％，bag-1阴性表达者5年生存率为46．8％，两者差异无显著性（P〉0．05）。结论bag-1在乳腺癌组织中高表达，bcl-2在乳腺癌组织中低表达，bag-1、bcl-2在乳腺癌组织中的表达与肿瘤的临床分期、病理分型等无关。bag-1阳性表达者预后好，而bcl-2的表达与预后无关。