P16和视网膜母细胞瘤蛋白在高砷煤引起的砷中毒患者皮损中的表达

目的 研究P16和视网膜母细胞瘤蛋白(Rb)在高砷煤引起的砷中毒患者皮损中的表达.方法 采用免疫组化SP法检测46例高砷煤引起的砷中毒患者皮损中P16和Rb蛋白的表达.结果 高砷煤引起的砷中毒患者皮损中P16蛋白的表达缺损率为59.7%,其表达随病损的加剧而减低,并与临床分级和病理分型明显相关(P<0.01).Rb蛋白的阳性表达率为60.9%,与临床分级相关(P<0.05).P16蛋白的阳性表达与Rb蛋白呈负相关(P<0.01).结论 P16蛋白表达降低和P16-Rb通路的失活可能与高砷煤引起的砷中毒患者皮损的发生密切相关.     

后腹腔镜肾输尿管全切加腹膜后肾周区域淋巴结清扫与开放手术治疗UUT-TCC疗效比较

目的:探讨后腹腔镜技术与开放手术治疗上尿路移行细胞癌(upper urinary tract transitional cell carcinoma,UUT-TCC)的效果及优势。方法:回顾性分析2009年11月~2012年12月间,我院采用后腹腔镜下肾输尿管根治性切除术加腹膜后肾周区域淋巴结清扫术治疗肾盂输尿管癌患者23例(腹腔镜组),并与同期14例行传统开放性肾输尿管切除术患者(开放术组)的手术时间、出血量、肿瘤学预后等指标进行比较。结果:腹腔镜组患者经术后病理检查,肾盂癌24例,输尿管癌10例,输尿管癌伴膀胱癌3例,其中腹腔镜组和开放组淋巴结转移各1例。同时研究发现:①腹腔镜组与开放术组比较,手术时间缩短,出血量明显减少,术后肠胃功能恢复快,术后住院时间短,差异有统计学意义(P0.05);②两种术式肿瘤学预后在远处转移方面,腹腔镜组更少,差异有统计学意义(P0.05)。结论:后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除并腹膜后肾周区域淋巴结清扫治疗UUT-TCC具有创伤小、痛苦少、术后恢复快等优点,可能有更好的肿瘤学预后。     

Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis,Coagulopathy, Endothelial Dysfunction,and Downregulation of ACE2

Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.     

经皮腔内顺行球囊扩张结合内切开术治疗肾盂输尿管连接部梗阻

目的观察经皮腔内顺行球囊扩张结合内切开术治疗肾盂输尿管连接部梗阻(UPJO)的疗效。方法回顾分析2010年3月至2012年9月我院采用经皮腔内顺行球囊扩张结合内切开术治疗肾盂输尿管连接部梗阻23例患者的病例资料并行随访。结果患者23例,男性14例,女性9例;年龄21~71岁,平均(39±10.5)岁;左侧10例,右侧13例;原发性UPJO 18例(合并肾结石12例),经皮肾镜碎石术后2例,肾盂输尿管连接部结石开放取石术后1例,开放肾盂成形术后1例,腹腔镜肾盂成形术后1例,狭窄段长度均不超过2cm。所有患者均手术成功,围手术期无严重并发症发生。17例患者纳入随访,其中原发性UPJO患者12例,经皮肾穿刺取石术(PCN)术后患者2例,开放输尿管切开取石术后1例,腹腔镜下肾盂成形术后1例,开放肾盂成形术后1例,术后随访7~31月,未见复发。结论经皮腔内顺行球囊扩张结合内切开术是治疗UPJO安全、有效的手术方式,具有微创、患者耐受度好、术后恢复快的特点,可有选择性地作为治疗UPJO的初始治疗手段。     

钛夹联合内镜下黏膜切除术治疗重度胃黏膜脱垂症的临床观察

目的：观察钛夹联合内镜下黏膜切除术对重度胃黏膜脱垂症的治疗效果及安全性。方法：对53例经胃镜确诊的重度胃黏膜脱垂症患者采用钛夹联合内镜下黏膜切除术治疗,并分别于术后4周、8周行临床症状随访和胃镜复查。结果：53例患者治疗成功率100％,4周有效率98．1％,8周有效率100％,无出血、穿孔等并发症发生。结论：钛夹联合内镜下黏膜切除术治疗重度胃黏膜脱垂症疗效确切,安全性高,是目前比较先进的微创治疗方法之一。     

Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft - surgical technique

The standard approach to reconstruct the medial patellofemoral ligament (MPFL) is by mini-open incision at its patellar insertion and femoral origin. At the medial patella rim, the MPFL insertion may be visualized in most cases by dissection during surgery. On the femur, it is more difficult to localize the MPFL remnants by a mini-open incision due to soft tissue covering the anatomical origin. Therefore, the femoral MPFL origin is usually identified by intraoperative lateral fluoroscopy. However, the insertion and origin of the MPFL at the patella and femur might be directly visualized using an arthroscopic extraarticular approach from the knee joint through a window of the synovial layer. This is especially helpful on the femoral side but also at the patella to find the individual anatomical MPFL footprints. Arthroscopic extraarticular reconstruction may then be performed using one additional medial mid-parapatellar portal. The major advantages of this technique are an individualized anatomical procedure, which is minimal invasive and cosmetically appealing. The aim of this study was to describe the arthroscopic extraarticular approach to the MPFL insertion at the patella and origin at the femur through synovial windows and to explain the procedure of arthroscopic MPFL reconstruction with a gracilis tendon autograft. Level of evidence Expert opinion, surgical technique, Level V.     

Vaginal trichomoniasis among HIV patients attending primary health care centers of Jos,Nigeria

ObjectiveTo determine the prevalence of trichomonal infection in HIV/AIDS and non-HIV control group of patients in a population of women with abnormal vaginal discharge.MethodsWe conducted a simple cross-sectional study. Primary health care centers in Jos metropolis and Jos University Teaching Hospital, during December 2006 to December 2007. Seven hundred high vaginal swabs were collected; 350 from HIV positive and another 350 from HIV-negative control group of patients with abnormal vaginal discharge attending primary health care centers in Jos metropolis and analysed for microscopy and culture in Jos University Teaching Hospital. Data on epidemiologic indices from the patients, using structured interviewer-administered questionnaires were collected.ResultsThe rate of trichomoniasis among all participants in the study was 17% (n=120/700). The prevalence rate of trichomoniasis among persons with HIV was 24% while it was found to be 10.3% among HIV negative controls. The difference was statistically significant (χ² =23.172; df=1; P<0.05). The rate of co-infection of Trichomonas vaginalis (T. vaginalis) in bacterial vaginosis was 42% (n=50/120), while it was 24% (n=29/120) in candidiasis. The singles had a 35% high rate of trichomonal infection. The infected women had a median age of 26 years, and a median number of 3 intra-vaginal sex partners per week.ConclusionsThere was a significant statistical difference in prevalence of T. vaginalis between HIV/AIDS group and non-HIV(control) group of patients in the study (P<0.05). Local HIV prevention strategies should target such women with trichomonal infection for intervention efforts, especially in HIV endemic area of sub-continent of Africa to further reduce the burden of HIV in the population.     

综合ICU呼吸机相关性肺炎病原菌分布及耐药性研究

目的：分析综合重症监护病房（IC U ）呼吸机相关性肺炎病原菌的分布及耐药特性,为临床抗菌药物的合理应用提供依据。方法对解放军306医院综合IC U病房2012年1～12月进行机械通气大于48 h的122例患者进行回顾性分析,统计并分析呼吸机相关性肺炎病原菌分布特点及其耐药性。结果122例机械通气患者确诊为呼吸机相关性肺炎55例,发病率为45．08％。共检出病原菌122株,其中革兰阴性菌78株（63．93％）,前3位依次为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌,其中4株肺炎克雷伯菌为产超广谱β内酰胺酶（产ESBL ）。革兰阳性菌19株（15．57％）,主要为金黄色葡萄球菌,检出1株耐万古霉素菌株;真菌25株（20．49％）,主要为白色念珠菌。革兰阴性菌对氨苄西林、环丙沙星、亚胺培南、头孢曲松、优立新耐药明显。与不产ESBL菌株相比,产ESBL肺炎克雷伯菌对绝大多数常用抗菌药物耐药,而对亚胺培南和哌拉西林/他巴唑相对敏感。结论该院综合IC U呼吸机相关性肺炎的主要病原菌为革兰阴性菌,分析其耐药特性可为临床经验性治疗呼吸机相关性肺炎及合理使用抗菌药物提供依据。