泌尿外科手术演变及相关因素分析

目的探讨泌尿外科病种和治疗方法的演变及其相关因素。方法回顾性调查我院泌尿外科手术5207例次,并制成相关图表。结果5207例次手术中,男性3825例次,女性1382例次。年龄2—101岁,平均68．4岁。二类手术2926例次,三类、四类和特类手术2281例次。早年以膀胱切开取石、膀胱造瘘、睾丸鞘膜翻转等手术居多,近10年来以上尿路结石手术、前列腺手术居多,泌尿系肿瘤上升亦较快。结论专科建设及人才培养的不断加强,先进医疗设备的逐步引进,泌尿外科疾病谱的不断改变,医疗技术在不断提高,手术方式也在不断改进。     

病理性近视眼影像学生物标志物的研究现状

高度近视和病理性近视的患病率正逐年增加,会造成严重的视力损害和社会危害。然而对高度近视和病理性近视的早期诊断、进展预判和治疗效果的评估等问题尚未解决。近年来,影像学技术的不断发展以及多模态成像的应用为病理性近视的诊断、疾病进展的监测及治疗效果的评估提供了有力的依据,尤其部分特异性影像学生物标志物的发现更有助于病理性近视的早期诊治和对其相关机制的认识。因此,本文就眼底照相、光学相干断层扫描和光学相干断层扫描血管造影中的病理性近视影像学生物标志物进行综述。     

2例华法林相关性出血病例分析

本文回顾了2例华法林相关性出血病例，分析了华法林相关性出血的发生特点和出血发生的原因，以减少和避免华法林出血事件的发生。     

保留盆腔神经宫颈癌根治术与传统宫颈癌根治术的比较研究

目的：探讨保留盆腔自主神经的宫颈癌根治术与传统宫颈癌根治术对患者术后生活质量的影响及其手术效果的初步评估。方法：选择皖南医学院第一附属医院2011年1月至2012年09月收治的经国际妇产科学联盟（FIGO）分期为IB～ⅡA的子宫颈癌患者50例，设研究组（n=20）采用保留盆腔自主神经的宫颈癌根治术，对照组（n=30）行传统的宫颈癌根治术，比较两组手术范围、手术时间、术中出血量、导尿管保留天数、残余尿量、肛门排气、排便时间及术后半年性功能恢复情况。结果：对照组与研究组比较，术后第10天残余尿量分别为（201．83±83．00）、（139．75±69．01）mL，保留尿管天数（15．20±2．43）、（11.85±2．08）d；术后肛门排气时间分别为（72．97±16．31）、（59．60±13。37）h，术后肛门排便时间分别为（121．17±23．07）、（91．05±11．66）h，两组相比差异具有统计学意义（P〈0．05）；术后半年性功能随访结果显示：对照组性功能障碍的发生率为86．7％，研究组性功能障碍发生率为45％，两组相比差异有统计学意义（P〈0．05），对术后半年未恢复性生活的患者进行原因调查，发现因“害怕疾病复发”占77．8％；害怕“性交病或出血”占55．6％。研究组与对照组手术时间中位数分别为250（180～330）min和200（150～270）min，术中手术时间、出血量、术中切除主骶韧带、阴道长度及淋巴结清扫数目等指标差异均无统计学意义。结论：保留盆腔自主神经的宫颈癌根治术治疗早期宫颈癌是安全可行的，与传统根治术相比更有利于膀胱、直肠功能的恢复，有助于提高患者术后的生活质量。     

The association between antibiotic use and survival in renal cell carcinoma patients treated with immunotherapy: a multi-center study

BackgroundImmunotherapy improves overall survival (OS) in the second and later lines of renal cell carcinoma (RCC) treatment. Recent studies have suggested that antibiotic (ATB) use either shortly before or after the start of immunotherapy could lead to decreased OS. Herein, we evaluate the impact of ATB use on OS in RCC patients treated with nivolumab in a multi-center cohort from Turkey.MethodsThe data of 93 metastatic RCC patients treated with nivolumab in the second line or later were retrospectively collected from 6 oncology centers. Previous treatments, sites of metastases, International Metastatic RCC Database Consortium risk classification, and ATB use in the three months before (-3) or three months after (+3) the start of immunotherapy were recorded together with survival data. The association of clinical factors with OS and progression-free survival (PFS) was analyzed with univariate and multivariable analyses.ResultsThe median age was 61 (interquartile range 54-67), and 76.3% of the patients were male. The median OS of the cohort was 23.75 ± 4.41, and the PFS was 8.44 ± 1.61 months. Thirty-one (33.3%) patients used ATBs in the 3 months before (-3) or 3 months after (+3) nivolumab initiation. In the multivariable analyses, ATB exposure (HR: 2.306, 95% confidence interval [CI]: 1.155-4.601, P = 0.018) and the presence of brain metastases at the baseline (HR: 2.608, 95% CI: 1.200-5.666, P = 0.015) had a statistically significant association with OS, while ATB exposure was the only statistically significant parameter associated with PFS (HR: 2.238, 95% CI: 1.284-3.900, P = 0.004).ConclusionIn our study, patients with ATB exposure in the 3 months before or 3 months after the start of immunotherapy had shorter OS. Our findings further support meticulous risk–benefit assessments of prescribing ATBs for patients who are either receiving or are expected to receive immunotherapy.     

超声腹腔注水成像技术对大鼠肾上腺髓质增生的研究

目的借助腹腔注水成像技术研究大鼠肾上腺髓质增生(AMH)声像图特征,并与病理结果对比,为腹腔注水成像技术诊断AMH提供声学基础。方法雄性SD大鼠60只,依体质量大小随机分为A、B、C3组,皮下注射利血平0.4mg/(kg.d);a、b、c对照组,每组10只SD大鼠皮下注射等量生理盐水。A、a,B、b,C、c组分别连续注射40、60和80d后停药,用腹腔注水成像技术进行探测,并和病理研究作对照。结果注射60d后B组髓质百分数(34.29%±5.81%)显著高于b组(25.66%±8.94%),t=2.462,P<0.05,C组(36.36%±7.83%)也显著高于c组(24.80%±7.87%)t=3.104,P<0.01,显示注射利血平60dAMH造模成功;超声下B和b组、C和c组肾上腺体积分别为(5.21±0.65)mm×(4.56±0.53)mm×(4.12±0.66)mm和(4.62±0.27)mm×(4.13±0.35)mm×(3.86±0.71)mm、(5.36±0.52)mm×(4.64±0.48)mm×(4.25±0.39)mm和(4.55±0.47)mm×(3.99±0.45)mm×(3.91±0.38)mm,差异显著(t=2.151,P<0.05;t=2.768,P<0.01);超声下中心髓质区范围及回声强度B组显著高于b组(Z=-4.226,P<0.01)、C组显著高于c组(Z=-4.115,P<0.01);镜下见B和C组髓质明显增厚,细胞数增多、密集,呈实质性片状或条索状分布,形成细胞巢。结论大鼠AMH时,声像图主要表现为肾上腺体积增大;中心的髓质回声增高,且回声增高的髓质区范围增大,大部分超过整个肾上腺范围的一半。大鼠肾上腺中心髓质回声的强弱程度及范围可反应髓质增生的程度。     

精神科门诊初诊患者2088例临床特征分析

目的：探讨精神科门诊初诊患者的临床特征。方法对精神科门诊2088例初诊患者的病历资料进行回顾性分析。结果精神科门诊初诊率女性（58．19％）高于男性（41．81％）,来自城镇者（67．00％）高于来自农村者（33．00％）,职业以农民居多（48．04％）,文化程度以初中及以下者居多（77．92％）;病种排前5位者依次为精神分裂症（39．85％）、抑郁症（22．65％）、器质性精神障碍（8．91％）、焦虑症（5．22％）、躁狂症（5．17％）。结论精神科门诊初诊患者的分布受地域、职业、文化程度和病种等多种因素影响,政府及相关职能部门应进一步加大对精神卫生知识普及的宣传力度,以提高社会公众对精神疾病的认知水平。     

66例小儿血流感染血培养病原菌分布与耐药性分析

目的 分析小儿血流感染患者病原菌分布特点及对抗菌药物的耐药情况。方法 对2013年1～6月小儿血流感染患儿血中分离到的66株病原菌进行回顾性分析。结果 血培养阳性菌株分布中革兰阳性菌占84．85％（56/66）,其中凝固酶阴性葡萄球菌（CNS）65．15％（43/66）;革兰阴性菌占15．16％（10/66）。结论 小儿血流感染中首位致病菌为CNS ,且耐甲氧西林凝固酶阴性葡萄球菌（MRCNS ）耐药情况严重,应合理使用抗菌药物,减少细菌耐药性。     

医源性肾出血的超选择性肾动脉栓塞治疗

目的探讨超选择肾动脉栓塞术治疗医源性肾岀血的临床应用价值,方法2003年9月-2011年2月收治17例严重血尿的医源性肾出血患者,行选择性肾动脉数字减影血管造影(DSA),采用超选择插管后用明胶海绵和弹簧圈栓塞治疗,并平均随访6个月以上。结果16例DSA清晰显示患者病侧肾对比剂外溢,均1次栓塞成功,另1例2次栓塞成功,出血均停止。17例全都保留患肾功能和大部分组织,无严重并发症,随访期间所有患各均无血尿复发。结论超选择肾动脉栓塞治疗医源性肾出血成功率高、见效快、创伤小、并发症少,能最大限度地保护正常肾组织,可作为首选治疗方法,具有较高的临床应用价值。     

CD146 gene expression in clear cell renal cell carcinoma: a potential marker for prediction of early recurrence after nephrectomy

Objectives

To investigate whether CD146 gene expression could provide useful information to predict early recurrence after nephrectomy.

Methods

This study included 84 patients with clear cell renal cell carcinoma (cRCC), and 44 subjects without tumor were used as controls. Quantitative RT-PCR was used to measure the CD146 gene expression.

Results

The mean value of CD146 expression in patients with metastatic cRCC (0.0438?±?0.0024) was significantly higher than in those with localized cRCC (0.0374?±?0.0012, P?=?0.018) or in controls (0.0344?±?0.0010, P?=?0.001). Of patients with localized cRCC, those with recurrence had a significantly higher CD146 expression than those without recurrence (P?=?0.029). The univariate analysis showed that CD146 was associated with early recurrence. The recurrence-free survival curve indicated that patients with a high CD146 expression had a significantly higher recurrence rate than those with a low CD146 expression (P?=?0.018).

Conclusions

CD146 gene expression can be useful for predicting early recurrence and stratifying the patients into risk groups for possible adjuvant treatment.