标准通道经皮肾镜气压弹道碎石与联合钬激光碎石术治疗复杂性肾结石的疗效比较

目的:比较标准通道经皮肾镜气压弹道碎石及气压弹道联合钬激光碎石术治疗复杂性肾结石的疗效。方法:回顾性分析本院2019年3月至2020年3月采用标准通道经皮肾镜气压弹道碎石与标准通道下经皮肾镜气压弹道联合钬激光碎石术治疗的170例复杂性肾结石患者的临床资料,按照手术碎石方式不同,随机分为对照组(78例)、观察组(92例)...     

经皮肾镜气压弹道碎石结合钬激光治疗复杂性肾结石

目的:探讨采用经皮肾镜气压弹道碎石结合钬激光碎石治疗复杂性肾结石的疗效。方法:回顾性分析2003年6月~2006年3月采用经皮肾碎石取石术治疗38例复杂性肾结石患者的资料。结果:一期取石29例,结石清除率76.3%(29/38);二期取石9例,结石清除率89.5%(34/38)。平均手术时间110min,术中估计失血量平均80ml,2例术后需输血,15例术后48h内发热。无肾切除、肾盂穿孔、气胸、感染性休克等并发症发生。结论:经皮肾镜气压弹道碎石联合钬激光碎石治疗复杂性肾结石,具有创伤小、恢复快等优点,是一种安全有效的方法。     

单通道经皮肾镜取石术结合输尿管软镜治疗鹿角状肾结石

目的:探讨单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石的手术效果.方法:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石96例.结石大小2.9cm×3.4 cm～3.8 cm×5.5 cm,平均3.5 cm×4.2 cm.结果:96例均采用单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石,一期手术平均手术时间为118 min;结石清除率为82.3%(79/96),二期手术平均手术时间为55 min,结石总清除率92.7%(89/96).7例患者残留结石,大小0.3～1.0 cm,其中5例术后1个月接受ES-WL治疗.术后随访7例残留结石患者2～6个月,结石清除5例.结论:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石具有手术时间短、结石清除率高、创伤小、并发症少、周围脏器损伤风险小等优点,可作为鹿角状肾结石的治疗方法.     

三种微创碎石术治疗复杂性输尿管上段结石的临床对比研究

目的:探讨经皮肾镜、经尿道输尿管镜气压弹道碎石术及经尿道输尿管镜钬激光碎石术治疗复杂性输尿管上段结石的临床疗效及安全性。方法:选取150例复杂性输尿管上段结石患者,随机分为A组、B组及C组,每组50例,分别行经皮肾镜、经尿道输尿管镜气压弹道碎石术及经尿道输尿管镜钬激光碎石术。对比3组患者手术时间、术后血红蛋白减少值、住院时间、一次性结石清除率、二次手术率、手术前后患侧肾脏肾小球滤过率水平、术后并发症发生率等。结果:A组手术时间显著短于B、C组(P0.05);B、C组患者术后血红蛋白减少值、住院时间均显著优于A组(P0.05);3组患者一次性结石清除率、二次手术率及术后患侧肾脏肾小球滤过率水平差异无统计学意义(P0.05);C组患者术后并发症发生率显著低于A、B组(P0.05)。结论:相较经皮肾镜、经尿道输尿管镜气压弹道碎石术,经尿道输尿管镜钬激光碎石术治疗复杂性输尿管上段结石可有效减少术中创伤、加快术后康复进程,并有助于降低术后并发症发生风险。     

经皮肾镜下气压弹道碎石联合超声碎石术治疗复杂性肾结石疗效观察

目的：评价经皮肾镜下气压弹道碎石联合超声碎石术处理复杂性肾结石的疗效。方法：自2003年9月～2004年4月采用经皮肾镜下气压弹道碎石联合超声碎石术Ⅰ期治疗肾结石38例42侧。结果：平均手术时间85min，结石处理时间62min，结石清除率88．1％；5例多发性结石或铸形结石患者经皮通道小角度的肾盏内有直径小于1cm结石残留，辅助施行体外冲击波碎石治疗。随访1～3个月，无严重手术并发症。结论：经皮肾镜下气压弹道碎石联合超声碎石术处理大的复杂性肾结石具有高效、安全的特点，结石清除率高，值得临床推广应用。     

经皮肾镜气压弹道超声联合碎石治疗复杂性肾结石

目的 探讨经皮肾镜气压弹道超声联合碎石术治疗复杂性肾结石的方法、疗效,进一步提高结石清除率,减少并发症.方法 回顾性分析应用经皮肾镜气压弹道超声联合碎石术治疗42例(47侧)复杂性肾结石患者的临床资料,对手术操作方法、结石清除率、并发症等进行评价.结果 42例(47侧)患者均成功建立F22-24经皮肾通道,无中转开放病...     

超声引导下经皮肾镜气压弹道联合超声碎石术治疗复杂性上尿路结石

目的评价超声引导经皮肾镜气压弹道联合超声碎石术处理复杂性上尿路结石的疗效。方法 2009年1月至2009年8月采用超声引导经皮肾镜气压弹道联合超声碎石术治疗复杂性上尿路结石51例56侧。结果全部病例均一期手术成功,50侧行单通道取石,4侧行双通道取石,2侧行多通道取石,平均手术时间85min,一次取净结石率87.5%(49/56),7侧行二次手术清除残余结石,二次术后残余结石直径均小于1.0cm,辅助施行体外冲击波碎石或排石治疗。随访1～3个月,无严重手术并发症。结论超声引导经皮肾镜具有定位准确,工作通道建立方法安全简便的特点。气压弹道碎石联合超声碎石术处理复杂上尿路结石具有碎石高效安全、结石清除率高、创伤小、恢复快、并发症少等特点。     

输尿管镜碎石取石术治疗23例经皮肾术后肾中上盏残余结石

目的 探讨输尿管镜钬激光联合气压弹道碎石取石术治疗经皮肾术后肾中上盏残余结石的疗效.方法 用钬激光治疗仪结合Fr8.0/9.8输尿管硬镜下联合气压弹道碎石取石术治疗经皮肾术后肾中上盏残余结石23例,观察其疗效.结果 23例患者共有结石103枚,结石大小8 ～ 36mm,结石寻及率100.0％,一次结石粉碎成功率98.1％,无严重并发症发生.结论 输尿管镜碎石取石术治疗经皮肾术后肾中上盏残余结石是一种可行的疗效优良、安全、经济的微创方法.     

经皮肾镜气压弹道碎石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476例接受经皮肾镜气压弹道碎石治疗的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476例患者中471例成功行一期取石术，5例中转开放手术；一期手术取净结石290例，二期手术取净结石83例，三期手术取净结石49例，结石总取净率88．7％，手术时间58—246min，平均（114±32）min；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较好的微创方法。     

超声引导下经皮肾镜碎石术治疗复杂性肾结石

目的探讨超声引导下经皮肾镜碎石术（PCNL）治疗复杂性肾结石的临床应用。方法在超声引导下对89例上尿路结石患者行经皮肾穿刺建立碎石通道,经通道于输尿管镜下行气压弹道碎石取石术。结果所有患者均穿刺成功,经单通道或双通道行Ⅰ期或Ⅱ期PCNL,结石总清除率94.19%,手术平均时间80 min,未出现严重并发症。结论超声引导下,选择合适穿刺点和穿刺路径建立经皮肾镜碎石通道,有助于提高PCNL治疗上尿路结石的手术时效,拓宽其适应证范围。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。