Ultrasonography-guided percutaneous nephrolithotomy with Chinese one-shot tract dilation technique based on stimulated diuresis: A report of 67 cases

The safety and effectiveness of a novel Chinese one-shot dilation technique based on stimulated diuresis for percutaneous nephrolithotomy (PCNL) were investigated. After the feasibility of the Chinese one-shot dilation based on stimulated diuresis was verified by an animal study, this technique was applied in the clinical practice. A total of 67 patients in our department underwent the modified PCNL from July 2014 to June 2015. After the renal infundibulum was distended by stimulated diuresis, the kidney was punctured under the ultrasonographic guidance via the fornix of the target calyx. The working channel was dilated using a special designed pencil-shaped fascial dilator. The successful access rate, nephrostomy tract creation time, pre- and postoperative hemoglobin values and serum creatinine concentrations, stone-free rate and complications were recorded and analyzed. The renal infundibulum was successfully distended in all of the patients by the diuresis treatment. Under the ultrasonographic guidance, the successful access rate was 100% and the mean tract creation time was 2.0 min (range: 1.5–5.0 min). The stone-free rate right after surgery was 91.0%. Although the postoperative hemoglobin was significantly reduced (P<0.01), transfusion was not clinically necessary. There was no significant difference in serum creatinine concentrations before and after operation (P>0.05). No severe complication occurred during or after the PCNL. It was suggested that this Chinese one-shot dilation technique based on stimulated diuresis is an efficient and safe innovation for PCNL, and is even helpful for those patients with non-dilated pelvicaliceal systems.     

大肠杆菌O157∶H7异硫氰酸荧光素标记抗体的制备及评价

目的:制备高效价、高纯度、特异性好、荧光强度高及稳定的抗大肠杆菌O157∶H7 异硫氰酸荧光素(FITC)标记抗体,初步探讨其在大肠杆菌荧光免疫检测试验中的应用。方法：复苏培养E.coli O157∶H7标准菌株,甲醛灭活制备疫苗免疫家兔。4次免疫后,颈动脉采血分离血清,经辛酸-饱和硫酸铵法粗提后应用蛋白亲和层析柱HiTrap Protein G HP进行 gG纯化,借助SDS-PAGE电泳、BCA试剂盒法、间接ELISA法分别对蛋白纯度、蛋白含量及抗体效价进行测定。应用不同FITC与蛋白量比值以及不同标记反应条件对多克隆抗体进行标记。比较荧光抗体F485/535,结合差异性显著分析对FITC与蛋白量比值及反应条件进行合
理选择,应用标记抗体与E.coli O157∶H7和金黄色葡萄球菌混合菌液反应验证标记效果。结果：HiTrap Protein G进行E.coli O157∶H7多克隆抗体纯化的最佳纯化方法为35%、100%二梯度洗脱,制备抗体效价为1∶25　600,与沙门氏菌、阴沟肠杆菌等8种肠杆菌无交叉反应,最佳FITC与蛋白量比值为1∶10,最佳标记反应条件为20℃、2 h。由最佳条件制得的荧光抗体与E.coliO157∶H7反应明显 ,强荧光连续照射15 min后仍显示高亮度荧光反应,且不与金黄色葡
萄球菌反应。结论：本实验首次制备出纯度高、荧光强度高、持续时间长的E.coli O157：H7 FITC标记多克隆抗体,为E.coli O157：H7荧光免疫检测方法的建立完成了关键步骤。
     

肾结石并脓肾致脓毒症及弥漫性腹膜炎1例并文献复习

目的：探讨肾结石并脓肾致尿脓毒症、弥漫性腹膜炎的临床病理特点与诊治方法。方法：回顾分析1例肾结石并脓肾致尿脓毒症、弥漫性腹膜炎患者的临床资料,并复习有关文献。结果：患者行腹腔探查术,术中可见腹腔约3L恶臭脓性液体,左侧降结肠处腹膜破损,左肾与周围组织粘连严重,左肾盂内可见大量黏稠脓液及数枚褐色结石。结论：肾结石并脓肾可导致尿脓毒症和弥漫性腹膜炎,然后可能引发连锁反应,导致多器官功能衰竭,死亡率大大升高,因此早期诊断十分重要。患者出现腹痛、腹肌紧张等腹部体征难以与外科急腹症相鉴别时,宜早期行剖腹探查术。     

重组人促红细胞生成素对兔脊髓缺血/再灌注损伤后白细胞介素8表达的影响

目的探讨重组人促红细胞生成素(rHuEPO)对兔脊髓神经细胞缺血/再灌注损伤后白细胞介素8(IL-8)表达的影响。方法 44只健康成年新西兰大白兔随机分为3组:假手术组(4只),对照组(20只),rHuEPO处理组(20只),对照组与rHuEPO处理组分别于再灌注6 h,12 h,24 h、48 h、7 d后时间点随机处死4只动物,取L3～L5节段脊髓组织用霉菌抗生物素蛋白-过氧化酶免疫组化染色法(S-P法)及兔抗人IL-8 ELISA试剂盒检测脊髓组织内IL-8的表达。结果 IL-8在无损伤脊髓中即见有表达。随着缺血及再灌注进程的加重,组织中IL-8阳性表达强度逐渐增加。脊髓损伤后24 h表达明显上调并达高峰;高表达持续至损伤后7 d;两组间IL-8水平的变化趋势相同,但在各时间点rHuEPO处理组兔脊髓组织IL-8的含量均低于对照组(P<0.05)。结论 rHuEPO具有抑制脊髓组织炎症反应的作用,能明显抑制兔脊髓缺血/再灌注损伤后的IL-8表达。     

Dracorhodin perchlorate suppresses proliferation and induces apoptosis in human prostate cancer cell line PC-3

The growth inhibition and pro-apoptosis effects of dracorhodin perchlorate on human prostate cancer PC-3 cell line were examined. After administration of 10-80 μmol/L dracorhodin perchlorate for 12-48 h, cell viability of PC-3 cells was measured by MTT colorimetry. Cell proliferation ability was detected by colony formation assay. Cellular apoptosis was inspected by acridine orange-ethidium bromide fluorescent staining, Hoechst 33258 fluorescent staining, and flow cytometry (FCM) with annexin Ⅴ-FITC/propidium iodide dual staining. The results showed that dracorhodin perchlorate inhibited the growth of PC-3 in a dose- and time-dependent manner. IC50 of dracorhodin perchlorate on PC-3 cells at 24 h was 40.18 μmol/L. Cell clone formation rate was decreased by 86% after treatment with 20 μmol/L of dracorhodin perchlorate. Some cells presented the characteristic apoptotic changes. The cellular apoptotic rates induced by 10-40 μmol/L dracorhodin perchlorate for 24 h were 8.43% to 47.71% respectively. It was concluded that dracorhodin perchlorate significantly inhibited the growth of PC-3 cells by suppressing proliferation and inducing apoptosis of the cells.     

膀胱全切术后原位回结肠代膀胱并发尿瘘的原因分析

目的:探讨膀胱全切原位回结肠代膀胱术后新膀胱并发尿瘘的原因及处理措施。方法:对膀胱肿瘤行膀胱全切原位W形回肠代膀胱手术210例,行膀胱全切原位U形乙状结肠代膀胱术26例,术后随访3个月~4年(平均1年),观察新膀胱功能及有无尿瘘并发症并分析其病因和进行相应处理。结果:11例男性,3例女性术后出现新膀胱皮肤瘘;1例女性出现新膀胱阴道瘘。其中>70岁新膀胱瘘发病率为55.6%,≤60岁发病率为1.1%;Ⅱ型糖尿病的患者新膀胱瘘发病率为11.8%,非糖尿病患者为5.9%。经5%碳酸氢钠冲洗新膀胱,改善患者营养状态和严格控制糖尿病患者血糖水平并进行二期手术修补,除1例男性患者术后半年新膀胱皮肤瘘迁延未愈,其余均治愈。结论:全膀胱切除原位回结肠代膀胱术后新膀胱并发尿瘘的原因众多,结合其发病原因加强预防和治疗,是可以大幅减少甚至可以避免的。     

肾上腺偶发瘤的诊治分析

目的：提高肾上腺偶发瘤的诊断和治疗水平。方法：回顾性分析1998年1月～2006年7月收治的48例肾上腺偶发瘤患者的临床资料,并进行术后病理及随访结果分析。46例患者行手术治疗,其中开放手术15例,经腹腔镜治疗31例。结果：手术效果满意。术后病理检查诊断为肾上腺皮质腺瘤27例,肾上腺囊肿5例,肾上腺皮质癌2例,肾上腺髓性脂肪瘤3例,肾上腺嗜铬细胞瘤3例,原发性醛固酮瘤3例,腹膜后原发性淋巴瘤、皮质腺瘤伴灶状髓性脂肪瘤、转移癌各1例。影像学及实验室检查术前获正确诊断者32例（66．7％）。结论：所有肾上腺偶发瘤均应行内分泌功能检查。内分泌功能检查与CT或MRI联合应用对确诊肾上腺占位性病变有较高价值。对于确诊为恶性肿瘤、功能性肿瘤、转移性肿瘤及直径大于3cm的肿瘤,应积极采取手术治疗。腹腔镜手术创伤小,恢复快,为首选术式。对非功能性、直径小于3．0cm的肿瘤,可定期行生化和影像学检查。     

活体亲属供肾移植30例报告

目的 评估活体亲属供肾移植的安全性和效果. 方法 回顾性分析2003年11月至2006年9月30例活体亲属供肾移植的临床资料.其中夫妻间供肾移植2例,直系血缘亲属供肾移植28例.供受体间2条单倍体相同6例、1条单倍体相同22例;HLA全错配1例,4抗原错配1例.供体切取右肾7例、左肾23例,经腹部取肾5例、经腰部25例,均为开放手术取肾.受体再次移植2例,首次移植28例. 结果 30例供体取肾术后7～10 d出院,随访3～6个月,肾功能正常.30例受体中1例因移植肾功能延迟恢复、肺部感染死亡.术后发生排斥反应4例,1例经抗胸腺淋巴细胞球蛋白逆转,3例经甲泼尼龙冲击治疗逆转.术后发生移植肾肾周血肿再次手术止血1例;发生尿瘘2例,均经保守治疗痊愈.29例存活者随访1～4年,其中术后1年发生慢性移植物失功1例,移植肾功能正常28例. 结论 活体亲属供肾移植安全,效果良好,供肾热缺血时间短、组织配型好、排斥反应小、免疫抑制剂用量少、长期存活率高,应积极提倡和推广.     

床边B超监视下注水试验在诊断车祸伤致膀胱破裂中的应用

目的:探讨床边B超监视下注水试验在诊断车祸伤致膀胱破裂中的临床应用价值.方法:对35例车祸伤怀疑膀胱破裂患者使用便携式B超床边监视下行膀胱注水试验进行检查,观察膀胱壁的完整性、膀胱内液体外流声像、腹腔和盆腔积液量及膀胱裂口部位大小的动态变化,分析其临床资料.结果:26例患者经床边B超监视下注水试验明确诊断,9例患者提示膀胱破裂经手术探查或膀胱造影证实.结论:急诊床边B超监视下注水试验可以早期诊断膀胱破裂,具有操作方便、无痛苦、迅速、准确等特点,可以作为诊断车祸伤致膀胱破裂的首选检查方法.