绿激光前列腺汽化术治疗高龄高危良性前列腺增生症的疗效观察

目的 探讨经尿道绿激光前列腺汽化术(PVP)治疗高龄高危良性前列腺增生症(BPH)的有效性及安全性.方法 采用PVP治疗高龄高危BPH患者120例,观察平均手术时间、术中出血量、术后留置导尿管时间及手术并发症,记录并计算手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及剩余尿量(RUV)等指标的差异.结果 120例患者均安全度过围术期,平均手术时间(52.6±5.8)min,术中出血量(20.4±9.5)ml,26例术后未留置导尿管,94例术后留置导尿管(24.5±15.9)h.IPSS及QOL分别由术前(28.5±3.8)分及(5.0±0.8)下降至(7.2±1.8)分及(1.5±0.6)分,Qmax由术前(5.2±3.1)ml/s增加至术后(15.2±4.3)ml/s,RUV由术前(118.6±15.2)m1下降至术后(16.5±4.6)ml,手术前后比较差异均有统计学意义(t值分别为8.28、8.19、7.52、9.41,P均＜0.05).结论 PVP是治疗BPH的一种独特、安全、有效的微创手术方法,手术操作简单、时间短、出血少、术后恢复快、并发症发生率及病死率低,尤其适用于高龄、伴发全身其他疾病的高危BPH患者.

Abstract：

Objective To explore the efficacy and safety of greenlight photoselective vaporization of prostate (PVP) in high-risk elder patients with benign prostatic hyperplasia (BPH). Methods A total of 120 high-risk elder patients with BPH underwent PVP procedure. The operating time, blood 1oss, indwelling catheterization and operation-related complications were monitored. The variables such as international prostate symptom score (IPSS), Quality of life (QOL) score, maximum urinary flow rate (Qmax) and residual urine volume (RUV) were recorded and compared pre- and post-operatively. Results All the 120 patients had a good peri-operative condition. The mean operating time was (52. 6 ± 5.8 )min, intraoperative blood loss was (20.4 ±9.5) ml. Among the 120 cases,26 did not received postoperative catheterization. In the other 94 cases received postoperative catheterization, the mean catheterization time was (24. 5 ± 15.9) hour. IPSS and QOL scores decreased from (28.5 ± 3.8) and (5.0 ± 0.8) preoperatively to (7.2 ± 1.8) and (1.5 ± 0.6)postoperatively. Qmax increased from ( 5.2 ± 3.1 ) ml/s to ( 15.2 ± 4.3 ) ml/s, and RUV decreased from ( 118.6 ± 15.2) ml to ( 16. 5 ± 4. 6) ml. There was significant difference for these parameters before and after the operation (Ps ＜ 0. 05 ). Conclusion The PVP is considered to be a safe, effective and minimally invasive procedure to treat BPHin high-risk elder patients. It is easy to manipulate, with advantages of shorter operating time,less blood loss, better tolerance and rapid recovery, especially for high-risk elder patients with BPH.     

心肌肥厚与非肥厚高血压患者冠状动脉造影分析

目的分析伴ST-T改变高血压左心室肥厚（LVH）和非LVH患者与冠心病的关系。方法比较分析伴ST-T改变高血压LVH患者106例,非LVH患者130例冠状动脉造影（CAG）结果。结果伴ST-T改变高血压LVH患者和非LVH患者CAG阳性率分别52.8%和37.7%（P〈0.05）。CAG显示1支病变、2支病变和3支病变的发生率LVH患者分别为15.1%、23.6%和14.2%,非LVH患者分别为14.6%、12.3%和10.8%。冠状动脉中度狭窄、重度狭窄和完全闭塞LVH患者分别为37.7%、9.4%和5.7%,非LVH患者分别为25.4%、8.5%和3.8%。结论伴ST-T改变高血压LVH患者冠心病发生率较非LVH患者高,2支病变和中度狭窄的发生率较非LVH患者要高（P〈0.05）。     

应用一氧化氮合酶抑制剂NG-甲基-L-盐酸精氨酸可促进严重脓毒性休克患者康复

本研究旨在评估一氧化氮合酶抑制剂 5 4 6 C88对脓毒性休克患者应用的安全性和有效性。采用多中心、随机、双盲对照法选取欧洲、南北美洲和大洋洲 4 8个 ICU病房中确诊脓毒性休克 (确诊时间 <2 4 h)的 312例患者进行研究。实验预期目标是72 h治疗期结束后 ,观察患者血液动力效应 ,即达到休克缓解、平均动脉压≥ 70 mm Hg(1m m Hg=0 .133k Pa)。患者分为两组 ,常规血管治疗药物限用去甲肾上腺素和多巴胺 ,并维持平均动脉压 >70 mm Hg,于 72 h内分别静脉注射 5 4 6 C88(5 mg· kg- 1· h- 1 )和对照剂质量分数为 5 %的葡萄糖 0 .1m l· kg…     

蓝萼甲素调控NOD样受体蛋白3对大鼠心肌细胞缺血再灌注细胞焦亡的影响

目的探究蓝萼甲素(GLA)调控NOD样受体蛋白3对H9C2心肌细胞缺血再灌注诱发细胞焦亡的影响。方法将H9C2心肌细胞分为对照组(control组);缺氧复氧组(H/R), 建立大鼠心肌细胞体外缺血再灌注模型(缺氧4 h, 复氧4 h), GLA低剂量(5 μmol/L)组和高剂量(10 μmol/L)组分别预处理大鼠心肌细胞24 h后, 在进行H/R处理。通过细胞计数试剂盒(CCK-8)、检测乳酸脱氢酶(LDH)检测细胞活性;蛋白免疫印迹法(Western blot)检测焦亡相关蛋白:NOD样受体蛋白3(NLRP3)、裂解的半胱氨酰天冬氨酸特异性蛋白酶-1(cleaved-Caspase-1)、凋亡相关斑点样蛋白(ASC)、Gasdermin蛋白家族D(GSDMD)以及N端GSDMD(N-Gasdermin D, N-GSDMD)的表达。通过实时荧光定量聚合酶链反应(RT-qPCR)检测NLRP3 mRNA的表达水平;组间比较采用单因素方差分析。结果 H/R组细胞活性低于对照组(1.000比0.401±0.026, F=916.488, P<0.05), GLA低剂量组、高剂量...     

单侧双通道与单通道内镜下ULBD手术治疗腰椎管狭窄症的效果与安全性比较

目的 比较单侧双通道与单通道内镜下单侧入路双侧减压(ULBD)手术治疗腰椎管狭窄症(LSS)的效果和安全性。方法 选择2019年7月至2022年8月西安国际医学中心医院骨科收治的100例LSS患者作为研究对象，按随机数表法将患者分为观察组和对照组，每组50例。对照组患者给予单通道内镜技术治疗，观察组给予单侧双通道内镜下ULBD治疗。比较两组患者的治疗效果及手术情况，比较两组患者术前、术后2周的视觉模拟疼痛(VAS)评分、日本骨科协会(JOA)评分，并统计两组患者的并发症发生情况。结果 观察组患者的治疗总有效率为90.00%，明显高于对照组的74.00%，差异具有统计学意义(P<0.05)；观察组患者的手术时间、术后下床活动时间分别为(59.89±4.19) min、(2.98±0.51) d，明显短于对照组的(75.29±4.31) min、(4.01±0.49) d，差异均具有统计学意义(P<0.05)；术后，两组患者的JOA均升高，且观察组为(22.81±3.19)分，明显高于对照组的(19.28±3.01)分，而VAS评分均降低，且观察组为(2.09±0.37)分，明...     

术前抗结核治疗时间对腰椎结核手术效果的影响

目的 探讨术前不同抗结核治疗时间对腰椎结核手术效果的影响。方法 回顾性分析2015年1月至2021年1月于宝鸡市中医医院接受手术联合术前抗结核治疗的88例腰椎结核患者的临床资料，其中45例术前接受2周的四联抗结核治疗(A组)，43例术前接受4周的四联抗结核治疗(B组)。比较两组患者的手术一般情况、治疗前后疼痛视觉模拟(VAS)评分、腰椎Oswestry功能障碍指数(ODI)、血沉(ESR)、C-反应蛋白(CRP)水平、影像学参数、肝肾功能指标[直接胆红素(DBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、尿素氮(BUN)、血肌酐(Scr)、血尿酸(Ua)]、术后并发症及末次随访时神经功能改善情况。结果 所有患者均顺利完成手术；A组患者的住院时间为(14.39±3.10) d，明显短于B组的(16.20±3.41) d，医疗费用为(6.31±0.98)万元，明显少于B组的(7.16±1.43)万元，差异均有统计学意义(P<0.05)；两组患者术后3个月的VAS评分、ODI指数、血清ESR、CRP及后凸cobb角较术前明显改善，差异均有统计学意义(P<0.05)，但两组患...     

失活剂烧伤致乳磨牙早失及恒牙胚丧失2例

Devitalization has been widely used in the root canal therapy of primary and permanent teeth in China more than ten years ago. With the development of local anesthetic drugs and injection technologies, this treatment method with high potential risks has been gradually abandoned. However, a questionnaire survey targeted all the participants at the 2018 China Pediatric Dentistry Conference showed that the devitalizer utilization proportion was still as high as 38.1% (383/1 005), even though the ratio was much lower than 75.5% (105/139) in 2003. These doctors had pay more attention to tissue burn caused by devitalizer marginal leakage or direct leakage, and know how to identify and handle with devitalizer burn. Devitalizers were usually made of arsenic trioxide, metal arsenic or paraformaldehyde, which have cytotoxicity, allergenicity, mutagenicity, carcinogenicity, and teratogenic effects on animals. Marginal leakage of devitalizers have high risks of causing soft and hard tissue necrosis. Most of the dentists have an understanding of the potential damages of arsenic-containing devitalizers, so they will choose parafor-maldehyde with relatively less toxicity. Paraformaldehyde has a certain self-limitation, and there are few cases reported, so some dentists lack of vigilance. Paraformaldehyde can also causes tissue necrosis if leakage happens, and the treatment methods are similar to that of arsenic-containing devitalizers. When handling with devitalizers burn, the necrosed soft and hard tissue, for example gingiva, alveolar bone or teeth that cannot keep, must be completely removed until fresh blood appears, then rinse with large amount of saline and seal with iodoform gauze. This paper described two cases of devitalizer burn during the root canal treatment of primary molars, both of the doctors failed to identify the devitalizer burn symptoms in the early stage, thus didn’t do proper treatments immediately after burning. Resulting in the necrosis of large area of gingiva and alveolar bone, loss of primary molars and permanent tooth germs 1-2 months after devitalizer burn. This paper reported these two cases in detail in order to warn dentists the high risks of using any kind of devitalizers, help them learn how to identify and treat devitalizer burn, and remind them to stop using devitalizers as soon as possible.