PIM-1在前列腺癌组织中的表达及其与PSA的关系

目的:探讨PIM-1蛋白在前列腺癌组织中的表达及其与PSA复发之间的关系。方法:利用免疫组化SP检测68例前列腺癌和37例良性前列腺增生(BPH)组织中PIM-1蛋白的表达。结果:在前列腺癌组织中PIM-1蛋白表达的阳性率为67.65%(46/68);BPH组织中40.54%(15/37),两组表达的差异有显著意义(P<0.05)。PIM-1蛋白表达的阳性率在前列腺癌Gleason分级中6分33.33%(7/21),7分75%(21/28),8～10分94.74%(18/19),组间比较差异有显著性(P<0.05)。临床分期中在Ⅰ、Ⅱ、Ⅲ、Ⅳ期PIM-1蛋白表达率分别为47.62%、53.85%、73.33%、94.74%,36个月随访PSA复发状况采用Kaplan-Meier方法分析,PIM-1蛋白表达与有无复发分别是78.26%(36/46)和45.45%(10/22),差异有显著性(P<0.05)。结论:前列腺癌中PIM-1蛋白表达与前列腺癌的Gleason分级、临床分期以及PSA复发有密切关系,提示PIM-1基因在前列腺癌演化和进展中有重要作用,可能是前列腺癌的预后指标。     

显微外科与腹腔镜两种手术治疗精索静脉曲张的疗效及并发症的对比观察

目的:比较显微外科与腹腔镜途径精索静脉结扎术治疗精索静脉曲张的疗效及并发症。方法:将72例精索静脉曲张患者随机分为显微外科精索静脉结扎术组(36例)和腹腔镜精索静脉结扎术组(36例),比较术前、术后3个月的精液质量、术后并发症,以及术后配偶妊娠率。结果:显微外科组手术时间明显长于腹腔镜组(P<0.05);术后住院天数显微外科组为(2.2±0.7)d,腹腔镜组为(2.8±0.8)d,两组无明显差别;两组术后精子浓度、存活率和(a+b)级精子百分率均较术前明显提高(P均<0.05),但两组间无统计学差异。配偶妊娠率显微外科组为65.2%,腹腔镜组57.1%。术后阴囊水肿发生率显微外科组为0,腹腔镜组为16%;复发率两组无明显差异(P>0.05)。结论:与腹腔镜精索静脉结扎术比,显微外科精索静脉结扎术创伤更小、恢复更快、麻醉经济、术后并发症少、复发率低,是更值得推广的安全有效的术式。     

Misdiagnosis of an atypical cyclops lesion 4 years after single-bundle anterior cruciate ligament reconstruction

Development of a cyclops lesion is a well described complication after anterior cruciate ligament (ACL) reconstruction. It commonly results in gradual extension loss during the early postoperative course, and magnetic resonance imaging (MRI) of the soft tissue nodule attached to the ACL graft is needed. Cyclops lesions are easy to diagnose based on the symptoms and MRI findings. Previous study showed that 78.6% of cyclops lesions had extension loss within 6 weeks postoperatively, and the diagnosis of 92.8% cases of cyclops lesions was established within 6 months.This article describes a case of misdiagnosis of a cyclops lesion 4 years after ACL reconstruction as a meniscal lesion combined with a meniscal cyst. The patient was asymptomatic for 4 years and then presented with a locked left knee and pain at the inferior pole of the patella during an attempt to gently extend the knee. Magnetic resonance imaging revealed a lateral meniscal cyst. The knee locking was released suddenly 2 days preoperatively. The authors had attributed the missed diagnosis to an atypical history and symptoms and an associated meniscal cyst.The purpose of this article is to help prevent misdiagnosis of atypical cyclops lesions. Cyclops lesions should be considered in the differential diagnosis of patients who present with gradual or sudden loss of extension after ACL reconstruction, regardless of how much time has passed postoperatively.     

封闭式负压引流联合反植皮一期闭合开放性创伤截肢创面的临床分析

目的对比观察封闭式负压引流技术(vacuum sealing drainage,VSD)联合反取皮和直接反取皮治疗开放性创伤截肢创面的疗效。方法 2005年3月-2010年6月,应用随机单盲法对收治的60例四肢开放性骨折截肢患者分别采用一期VSD联合反取中厚皮片植皮(试验组,30例)与一期单纯反取中厚皮片植皮覆盖截肢创面(对照组,30例)治疗。两组患者性别、年龄、致伤原因、截肢部位、皮肤缺损面积、术前白蛋白指数及受伤至就诊时间等一般资料比较差异均无统计学意义(P>0.05)。试验组截肢后剪除多余残肢皮肤应用皮鼓取皮制成中厚交错筛网状皮片,植于截肢创面,表面用VSD覆盖,24 h不间断吸引持续7～10 d;对照组截肢后直接行反取中厚皮片覆盖创面,术后常规换药。结果试验组患者于术后平均8 d去除VSD装置。试验组皮片存活率(90.0%)、创面感染率(3.3%)及再截肢率(0)、换药次数[(2.0±0.5)次]、住院时间[(12.0±2.6)d],均显著优于对照组[分别为63.3%、20.0%、13.3%、(8.0±1.5)次、(18.0±3.2)d],比较差异均有统计学意义(P<0.05)。两组患者均获随访,随访时间1～3年,平均2年。末次随访时,试验组瘢痕面积、瘢痕分级及创面两点辨别觉均优于对照组,差异有统计学意义(P<0.05)。两组患者残肢均未见明显肿胀;术后试验组患肢疼痛发生率、残肢长度均优于对照组(P<0.05),而患肢残端形状比较差异无统计学意义(P>0.05)。两组残肢与健侧相比较,均存在肌肉废用性萎缩、肌力下降,各组健侧与患侧肌力比较差异均有统计学意义(P<0.05),但两组患侧间比较差异无统计学意义(P>0.05)。结论与单纯反取中厚皮片比较,VSD联合反取中厚皮片能够一期关闭截肢创面并对创面进行引流,降低感染发生,促进皮片与创面良好贴附,提高了皮片存活率,降低了截肢平面,利于假肢佩戴,是一期处理截肢创面的理想方法之一。     

轴状脂肪移植的实验和初步临床研究

目的通过与Coleman方法比较,探讨轴状脂肪移植方法的可行性。方法采用Coleman方法及轴状脂肪移植方法,分别于11例拟行头面部脂肪移植患者的下腹部抽取脂肪。取3～4周龄免疫缺陷裸鼠48只,雌雄不限,体重8.6～12.2 g;随机分为两组,每组24只。以背部皮下间隙为移植受区,实验组移植0.5 mL轴状脂肪移植方法获得的人体脂肪组织,对照组移植0.5 mL Coleman方法获得的人体脂肪组织。术后大体观察实验动物背部外观,于1、2、4、8周两组随机处死6只裸鼠,取出背部皮下移植脂肪进行大体、组织学及免疫组织化学染色观察,并于取出脂肪前后对裸鼠称重,计算移植脂肪重量。脂肪抽取术后即刻取脂肪组织进行葡萄糖转移实验和脂肪细胞活性测定。2010年5月-2011年10月,临床应用面部轴状脂肪移植治疗11例局部凹陷性畸形。结果术后实验组裸鼠背部隆起样外观基本维持,对照组2周时已趋于平坦。两组植入脂肪重量相似(P>0.05);除术后2周外,其余各时间点实验组残余脂肪重量均显著高于对照组(P<0.05)。组织学观察示实验组细胞形态保持良好,血管分布均匀;对照组细胞破坏再吸收显著,血管集中分布于移植组织边缘。术后实验组完整脂肪细胞计数均明显多于对照组,除术后2周外其余各时间点组间比较差异均有统计学意义(P<0.05)。实验组毛细血管计数均少于对照组,术后1、2周比较差异有统计学意义(P<0.05),但4、8周时差异无统计学意义(P>0.05)。轴状脂肪移植方法抽取的脂肪组织葡萄糖转移量为(1.462±0.080)mmol/L,显著高于Coleman方法抽取的脂肪组织(1.153±0.199)mmol/L(t=3.317,Ρ=0.021);且轴状脂肪移植方法抽取的脂肪组织细胞活性更佳。临床应用患者均获随访,随访时间2～9个月;随访期间受区未见明显萎缩及塌陷。结论与Coleman方法比较,轴状脂肪移植方法获得的脂肪组织可保持原结构和良好活性,移植术后能更早与受区建立血液循环,术后组织再吸收率低,形态维持时间长。     

Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial

Background

Tadalafil improved lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; LUTS/BPH) in clinical studies but has not been evaluated together with an active control in an international clinical study.

Objective

Assess tadalafil or tamsulosin versus placebo for LUTS/BPH.

Design, setting, and participants

A randomised, double-blind, international, placebo-controlled, parallel-group study assessed men ≥45 yr of age with LUTS/BPH, International Prostate Symptom Score (IPSS) ≥13, and maximum urinary flow rate (Q_max) ≥4 to ≤15 ml/s. Following screening and washout, if needed, subjects completed a 4-wk placebo run-in before randomisation to placebo (n = 172), tadalafil 5 mg (n = 171), or tamsulosin 0.4 mg (n = 168) once daily for 12 wk.

Measurements

Outcomes were assessed using analysis of covariance (ANCOVA) or ranked analysis of variance (ANOVA) (continuous variables) and Cochran-Mantel-Haenszel test or Fisher exact test (categorical variables).

Results and limitations

IPSS significantly improved versus placebo through 12 wk with tadalafil (−2.1; p = 0.001; primary efficacy outcome) and tamsulosin (−1.5; p = 0.023) and as early as 1 wk (tadalafil and tamsulosin both −1.5; p < 0.01). BPH Impact Index significantly improved versus placebo at first assessment (week 4) with tadalafil (−0.8; p < 0.001) and tamsulosin (−0.9; p < 0.001) and through 12 wk (tadalafil −0.8, p = 0.003; tamsulosin −0.6, p = 0.026). The IPSS Quality-of-Life Index and the Treatment Satisfaction Scale–BPH improved significantly versus placebo with tadalafil (both p < 0.05) but not with tamsulosin (both p > 0.1). The International Index of Erectile Function–Erectile Function domain improved versus placebo with tadalafil (4.0; p < 0.001) but not tamsulosin (−0.4; p = 0.699). Q_max increased significantly versus placebo with both tadalafil (2.4 ml/s; p = 0.009) and tamsulosin (2.2 ml/s; p = 0.014). Adverse event profiles were consistent with previous reports. This study was limited in not being powered to directly compare tadalafil versus tamsulosin.

Conclusions

Monotherapy with tadalafil or tamsulosin resulted in significant and numerically similar improvements versus placebo in LUTS/BPH and Q_max. However, only tadalafil improved erectile dysfunction.

Trial registration

Clinicaltrials.gov ID NCT00970632     

Staged single-tract minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney

The aim of this study was to evaluate the outcome of staged single-tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy as a minimally invasive option in the treatment of staghorn stone in patients with a solitary kidney. A total of 24 patients with staghorn stone in a solitary kidney were treated with single-tract MPCNL and flexible ureteroscopy by a single surgeon. All the patients underwent single-tract MPCNL through a 20 F tract and had most of the intrarenal calculi removed at the first stage. The second stage of retrograde flexible ureteroscopy was performed 3–5?days later, after the drainage was cleared. The preoperative patient, characteristics, stone size, operative time, renal functional status and postoperative outcomes were then evaluated. Sixteen patients were partial staghorn (66.7?%), and other eight were complete staghorn (33.3?%). The overall stone-free rate was 83.3?% after the second-stage procedures, and only four patients had significant residue. The hemoglobin drop ranged from 1.1 to 3.7?g/dl, and three patients required blood transfusion. The mean serum creatinine value was 1.7?±?0.5?mg/dl before surgery and 1.3?±?0.4?mg/dl at the end of the follow-up period with statistical significance (P?<?0.05). None of the patients had increased serum creatinine, and needed dialysis at the end of the follow-up period. Staged single-tract MPCNL and flexible ureteroscopy are safe and effective for the management of staghorn stone in patients with a solitary kidney and even in patients with impaired renal functions.     

小儿输尿管膨出症的治疗

目的探讨各种方法治疗输尿管膨出症的疗效,寻找影响预后的有关因素。方法 31例输尿管膨出症,男4例,女27例;左侧15例,右侧12例,双侧4例。其中单一输尿管膨出2例,重肾并输尿管膨出29例。VCU检查18例,3例发现中—重度反流,31例均行超声和IVU及CT检查。结果术后随访0.5～3 a,2例单一输尿管膨出症行膨出切除输尿管膀胱再植术,29例重肾中,4例经膀胱行输尿管膨出切除输尿管膀胱再植术。3例中—重度反流,2例行输尿管膨出切除加上半肾切除术,1例行上半肾切除术,术后因反流持续存在,需再次手术;其余22例均行上半肾切除术,术后2例因严重尿路感染行输尿管残端切除术。结论输尿管膨出的治疗应根据输尿管膨出的类型、肾功能、有无反流决定手术方式,对于大多数重肾,单纯上半肾切除预后良好,若术前VCU检查有中—重度返流,应行完全重建术。     

Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) in Chinese patients with congenital bilateral absence of vas deferens

BackgroundGenetic testing of the cystic fibrosis transmembrane conductance (CFTR) gene is currently performed in patients with congenital bilateral absence of vas deferens (CBAVD). This study was conducted to investigate the role of mutations in the CFTR gene in CBAVD-dependent male infertility.Methods73 Chinese patients diagnosed with CBAVD were studied. The entire coding regions and splice sites of 27 exons of the CFTR gene were sequenced in 146 chromosomes from the 73 CBAVD patients. Screening was carried out using PCR, gel electrophoresis and DNA sequencing to identify novel variants of the entire coding regions and boundaries of the 27 exons.ResultsFive novel nonsynonymous mutations, three novel splice site mutations and one deletion were identified by sequencing. Apart from the novel variants, we also found 19 previously reported mutations and polymorphism sites. Thirty-four patients (46.57%) had the 5T variant (6 homozygous and 28 heterozygous) and in two of them it was not associated with any detectable mutation of the CFTR gene. All potential pathogenic mutations are not contained in the 1000 Genome Project database. In total, the present study identified 30 potential pathogenic variations in the CFTR gene, 9 of which had not previously been described.ConclusionsMost patients with CBAVD have mutations in the CFTR gene. A mild genotype with one or two mild or variable mutations was observed in all the patients. These findings improve our understanding of the distribution of CFTR alleles in CBAVD patients and will facilitate the development of more sensitive CFTR mutation screening.     

Sequential versus concurrent anthracyclines and taxanes as adjuvant chemotherapy of early breast cancer: a meta-analysis of phase III randomized control trials

PurposeWe performed a meta-analysis of Phase III randomized trials to compare treatment outcomes for early-stage breast cancer patients receiving adjuvant chemotherapy with sequential or concurrent anthracyclines and taxanes.MethodsAll Phase III randomized trials comparing adjuvant chemotherapy of sequential or concurrent anthracyclines and taxanes in early-stage breast cancer patients were considered eligible. A total of three trials that enrolled 8728 women were analyzed. A pooled analysis was accomplished and event-based risk ratios (RR) with 95% confidence intervals (95%CI) were derived. The significant differences in disease-free survival (DFS) and overall survival (OS) were explored. A heterogeneity test was applied as well.ResultsAmong three eligible trials, significant differences in favor of sequential regimen were seen in DFS (RR: 0.90; 95%CI: 0.84 to 0.98; P = 0.01) and in OS (RR: 0.88; 95%CI: 0.79 to 0.98; P = 0.02).ConclusionConsidering all the available Phase III trials, sequential adjuvant chemotherapy for early breast cancer seems to add a significant benefit in both DFS and OS over concurrent regimens.