Clinicopathological characteristics,prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma

PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.     

内镜下全腹膜外Sublay修补在腹壁疝中的应用

目的评价腹壁疝内镜下全腹膜外Sublay(TES)手术的效果并总结经验。方法回顾性总结国内10所医院自2016年3月至2019年7月115例腹壁疝内镜下TES手术的患者资料。分析患者情况、疝的特点、手术经过和结果。结果115例计划实施TES的患者中,因严重腹膜破损中转为IPOM修补患者1例,其余均成功手术。可以缝合缺损患者108例(94.74%),需要永久补片固定患者15例(13.16%)。放置引流患者76例(66.67%),中位手术时间为144 min,术中无严重并发症发生。随访时间3~45个月,总并发症发生率为20例(17.54%),其中出现血清肿患者5例(4.38%)。绝大多数患者术后仅出现轻微疼痛,未出现慢性疼痛。结论在腹壁疝的治疗中,对熟悉腹壁解剖的外科医师而言,TES是一种有效、安全的修复手段。在熟悉手术的基础上适应症可逐步拓展。     

Insulin Dependence Increases the Risk of Complications and Death in Total Joint Arthroplasty: A Systematic Review and Meta‐(Regression) Analysis

ObjectivesTo investigate the proportion of insulin‐dependent diabetes mellitus (IDDM) patients among diabetic patients undergoing total joint arthroplasty (TJA) and whether insulin dependence is associated with postoperative complications.MethodsA systematic literature search was performed in EMBASE, PubMed, Ovid, Medline, the Cochrane Library, Web of Science, the China Science and Technology Journal Database, and China National Knowledge Infrastructure from the inception dates to 10 September 2019. Observational studies reporting adverse events with IDDM following TJA were included. Primary outcomes were cardiovascular complications, pulmonary complications, kidney complications, wound complications, infection, and other complications within 30 days of surgery. Secondary outcomes were the proportion of IDDM patients among diabetic patients undergoing TJA and its time trend.ResultsA total of 19 studies involving 85,689 participants were included. Among patients undergoing TJA, 26% of diabetic patients had IDDM. Compared with non‐insulin‐dependent diabetes (NIDDM), the incidences of cardiac arrest (risk ratio [RR], 2.346; 95% confidence interval [CI], 1.553 to 3.546), renal failure (relative risk [RR], 2.758; 95% CI, 1.830 to 4.156), deep incisional surgical site infection (RR, 1.968; 95% CI, 1.107 to 3.533), wound dehiscence (RR, 2.209; 95% CI, 1.830 to 4.156), and death (RR, 2.292; 95% CI, 1.568 to 3.349) were all significantly increased in IDDM. A significant time trend was witnessed for the prevalence of IDDM (P = 0.014). There was no statistical significance for organ/space surgical site infection, thrombotic events (deep venous thrombosis/ pulmonary embolism), and revision rates.ConclusionInsulin‐dependent diabetes is an independent high‐risk factor for increased adverse outcomes relative to NIDDM, suggesting that hierarchical and optimal blood glucose management may contribute to reducing the adverse complications after surgery for these patients. In addition, because the risk of sepsis, deep wound infection, organ/space surgical site infection, urinary tract infection, renal insufficiency, and renal failure significantly increase after TJA in IDDM patients, more active postoperative antimicrobial prophylaxis may be needed on the premise of protecting renal function.     

Influences of Heavy Metals and Salt on Seed Germination and Seedling Characteristics of Halophyte Halogeton glomeratus

Bulletin of Environmental Contamination and Toxicology - Heavy metals pollution and salinization of soils are widely distributed in agricultural soils. This study investigated the effects of five...     

人体血清二噁英化合物检测方法的建立

目的建立人体血清二噁英(polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans,PCDD/Fs)化合物测定方法,为开展二噁英人体健康风险评估提供检测技术手段。方法基于国际二噁英的测定方法—同位素稀释的高分辨气相色谱/高分辨质谱联用法,血清样品经C18柱固相萃取、酸性硅胶柱和活性炭柱净化的前处理方法,用DB-5MS毛细管柱(60 m×0.25 mm×0.25μm)分离,高分辨质谱检测分析。结果本方法的检出限为0.35~3.26 pg/g脂肪计,采用血清国际标准参考物质(SRM 1958)进行方法验证,与SRM 1958给出的参考质量分数值范围对比,17个PCDD/Fs单体浓度测定值均在参考质量分数值范围内,相对标准偏差为2%~19%(n=3)。该方法进一步应用于实际人体血清分析,同位素标记的17个二噁英单体回收率为61%~135%。结论本方法灵敏度和准确度高、方法性能稳定,满足人体血清二噁英检测方法的要求。     

胰弹力蛋白酶I和核糖核酸酶检测的临床价值

目的　探讨人胰弹力蛋白酶Ⅰ (Humanpancreaticelastase 1 ,HPE1 )放射免疫测定 (Radioimmunoassay ,RIA)和核糖核酸酶(Ribonuclease ,RNase)活性检测的临床价值。方法　参照Satake等建立的改良HPE1RIA和Thomas等的改良酸溶性产物法检测 82例正常成年人和 2 2 2例各类患者血清并分析结果。结果　 82例健康成人HPE1值为 2 3.8( 3.4ng L) ,RNase活性为 5 7.0 3( 1 2 .1 6 μ ml) ;急性胰腺炎和胰腺癌HPE1 值明显高于其他疾病 (P <0 .0 1 )。联合检测HPE1 、RNase活性可提高胰腺癌的检出率 ( 92 .47% )。结论　HPE1 RIA对急性胰腺炎有诊断价值 ,联合检测HPE1 、RNase活性检测对胰腺癌诊断有一定的临床价值     

CT引导下经皮经椎弓根脊椎肿瘤穿刺活检

目的探讨在CT引导下经皮经椎弓根行脊椎肿瘤穿刺活检的价值。方法CT引导下选择最佳穿刺点、穿刺角度及深度并随时调整,以确保整个穿刺过程在病变的椎弓根内及椎体内完成。结果所有病例均未发生穿刺并发症。11例所取组织量可满足病理检查要求。1例取材量不足而未能得出满意诊断结果。结论CT引导下经椎弓根行脊椎肿瘤穿刺活检取材准确,操作安全可靠。     

国人无综合征性耳聋患者的线粒体基因组7445A→G突变263例调查

目的 :探讨国人无综合征性耳聋 ( NSD)患者的线粒体 DNA 744 5 A→ G( m t DNA744 5 A→ G)突变的发生情况。方法 :对 32个 NSD家系 12 8例和 135例散发的 NSD患者 ,10 0例正常人 ,以 PCR法检测 mt DNA 744 5 A→ G突变情况。结果 :全部受检者无 mt DNA744 5 A→ G突变发生。结论 :国人 NSD患者的 m t DNA744 5 A→ G突变的发生率较低 ,且明显低于 mt DNA15 5 5 A→ G的突变发生率     

低分子肝素治疗老年人不稳定型心绞痛的疗效分析

目的 观察低分子肝素治疗老年人不稳定型心绞痛的疗效。方法 将１０１例不稳定型心绞痛患者随机分为Ａ、Ｂ两组。在常规治疗基础上Ａ组给予低分子肝素腹部皮下注射;Ｂ组给予等量生理盐水皮下注射。结果 Ａ组心绞痛发作频率比Ｂ组明显减少（Ｐ〈０．０１）。心电图ＳＴ段及Ｔ波较对照组明显改善。Ａ组总有效率９０％,Ｂ组总有效率５４％（Ｐ〈０．０１）。Ａ、Ｂ组治疗期间均未见出血等副作用。结论 低分子肝素治疗老年人不稳定     

慢性光化性皮炎的病因诊断及治疗

目的;探讨慢性光化性皮炎（ＣＡＤ）的病因,诊断及治疗,方法：查阅文献,对引起ＣＡＤ的光敏物、发病机理及治疗进行分析,结果：约１１％的ＣＡＤ患者有光敏物接触史;６２％光敏性隐匿;２７％有慢性皮炎病史;结论：ＣＡＤ发病与光变态反应有关,避光治疗有效。