术中超声辅助股浅静脉瓣膜戴戒术治疗下肢深静脉瓣膜功能不全

目的研究术中加用多普勒超声辅助股浅静脉瓣膜戴戒术治疗原发性下肢深静脉瓣膜功能不全(PDVI)的疗效和应用价值。方法对2001年6月起至2006年6月第四军医大学西京医院经静脉顺行造影证实为PDVI的87例临床资料进行分析。分为两组:A组(44例)行术中联合多普勒超声的股浅静脉瓣膜戴戒术加曲张静脉剥脱术。B组采用传统股浅静脉瓣膜戴戒术加曲张静脉剥脱术。以瓣膜返流持续时间评价即时效果,以癌胚抗原蛋白(CEAP)临床分类与临床记分做随访评价疗效。结果A组病人戴戒前后术中超声检测显示静脉瓣返流持续时间戴戒后较戴戒前明显缩短(P<0.01)。CEAP分组结果显示A组手术有效率达95.0%(38/40),B组有效率为76.7%(33/43),两组有效率比较差异有显著性意义(P<0.01)。A、B两组术后临床记分均明显下降,差异有显著性意义(P<0.01)。结论股浅静脉瓣膜戴戒术采用术中多普勒超声检查进行辅助能够有效提高手术的针对性,提高疗效。     

肝移植术后西罗莫司的替换治疗

目的 探讨肝移植术后应用西罗莫司的抗排斥替换治疗效果。方法 回顾性分析50例肝移植或肝肾联合移植患者替换西罗莫司前后肝肾功能的改善情况及副作用和排斥反应的发生率。34例联合应用小剂量FK506，9例联合应用骁悉，2例联合应用新山地明。5例术后远期患者，替换前仅用FK506，替换后单用西罗莫司。结果 24例患者因肝功能不良而替换西罗莫司，其中16例（66．7％）肝功能明显改善；18例患者肾功能不良，其中13例（72．2％）在2个月内肾功能明显好转；8例患者因大剂量应用FK506但其浓度未达到6ng／ml而替换西罗莫司，移植术后肝肾功能恢复良好，未出现排斥反应。本组中应用西罗莫司后出现急性排斥反应3例（6％），改用FK506后急性排斥反应治愈。11例（22％）出现白细胞及血小板减少，9例（18％）胆固醇和甘油三酯升高。这些副作用均在西罗莫司应用1月后出现，当停药或对症处理后消失。本组中未出现肝动脉血栓形成、伤口愈合不良等并发症。结论 肝移植术后应用钙调磷酸酶抑制剂发生肝肾功能不良或不能达到理想药物浓度时，西罗莫司是有效的抗排斥替代药物。     

Vitamin D insufficiency and subclinical atherosclerosis in non-diabetic males living with HIV

Introduction

Vitamin D insufficiency (VDI) has been associated with increased cardiovascular risk in the non-HIV population. This study evaluates the relationship among serum 25-hydroxyvitamin D [25(OH)D] levels, cardiovascular risk factors, adipokines, antiviral therapy (ART) and subclinical atherosclerosis in HIV-infected males.

Methods

A cross-sectional study in ambulatory care was made in non-diabetic patients living with HIV. VDI was defined as 25(OH)D serum levels <75 nmol/L. Fasting lipids, glucose, inflammatory markers (tumour necrosis factor-α, interleukin-6, high-sensitivity C-reactive protein) and endothelial markers (plasminogen activator inhibitor-1, or PAI-I) were measured. The common carotid artery intima-media thickness (C-IMT) was determined. A multivariate logistic regression analysis was made to identify factors associated with the presence of VDI, while multivariate linear regression analysis was used to identify factors associated with common C-IMT.

Results

Eighty-nine patients were included (age 42±8 years), 18.9% were in CDC (US Centers for Disease Control and Prevention) stage C and 75 were on ART. VDI was associated with ART exposure, sedentary lifestyle, higher triglycerides levels and PAI-I. In univariate analysis, VDI was associated with greater common C-IMT. The multivariate linear regression model, adjusted by confounding factors, revealed an independent association between common C-IMT and patient age, time of exposure to protease inhibitors (PIs) and impaired fasting glucose (IFG). In contrast, there were no independent associations between common C-IMT and VDI or inflammatory and endothelial markers.

Conclusions

VDI was not independently associated with subclinical atherosclerosis in non-diabetic males living with HIV. Older age, a longer exposure to PIs, and IFG were independent factors associated with common C-IMT in this population.     

Association of metabolic syndrome and chronic kidney disease among Uygur adults in Moyu country in Xinjiang Uygur Autonomous Region

Objective To examine the effects of different compositions of metabolic syndrome[Overweight and (or) obesity, hyperglycemia, hypertension, dyslipidemia] on chronic kidney disease. Methods A total of 1552 health data were collected from the survey of chronic kidney diseases among Uygur adults in Moyu country in Xinjiang Uygur Autonomous Region and the relationship between metabolic syndrome and chronic kidney disease was analyzed by using SPSS 15.0 software package. Results Before and after adjusting of age and gender, the prevalence of metabolic syndrome was 14.18% and 14.45% (95% CI 14.30%-14.60%). The prevalence of albuminuria (7.27% vs 3.83%,χ2=5.42, P=0.02), reduced estimated glomerular filtration rate (9.55% vs 3.45%,χ2=16.96, P=0.00) and chronic kidney disease(13.64% vs 6.76%,χ2=12.52, P =0.00) increased in residents diagnosed as metabolic syndrome than those without metabolic syndrome. The prevalence of chronic kidney disease increased with the increasing number of metabolic syndrome elements. Conclusions The prevalence of chronic kidney disease is associated with the accumulation of metabolic syndrome compositions. Early intervention on metabolic risk factors may reduce the risk of chronic kidney disease.     

Predicting Renal Function Outcomes After Partial and Radical Nephrectomy

Background

Partial nephrectomy (PN) is generally favored for cT1 tumors over radical nephrectomy (RN) when technically feasible. However, it can be unclear whether the additional risks of PN are worth the magnitude of renal function benefit.

非孕期与孕期腹腔镜下改良式宫颈环扎术治疗宫颈机能不全的疗效比较

目的 探讨非孕期与孕期腹腔镜下改良式宫颈环扎术（MLTCC）治疗宫颈机能不全的安全性及疗效。方法 回顾性分析2014年1月至2018年12月于沈阳市妇婴医院因宫颈机能不全行MLTCC的患者共92例,按手术时机分为非孕期组（n=58）和孕期组（n=34）。比较两组手术相关指标、术后妊娠情况及新生儿结局,同时比较MLTCC不同环扎参数对妊娠结局的影响。结果 非孕期及孕期手术成功率分别为86.7%、94.3%。孕期组术中失血量多于非孕期组（80.0 mL vs.22.5 mL,P=0.002）。两组宫颈环扎手术时间、术后住院时间、围手术期及远期并发症发生率、手术成功率、妊娠晚期宫颈长度、术后妊娠结局（分娩孕周、晚期流产率、早产率、足月产率）及新生儿结局（新生儿存活率、体质量、患病率）比较,差异均无统计学意义（P均>0.05）。不同环扎参数（环扎带数量及打结数目）下分娩孕周、新生儿体质量及妊娠晚期宫颈长度比较,差异均无统计学意义（P均>0.05）。结论 MLTCC可有效改善宫颈机能不全患者术后妊娠结局;与孕期手术相比,非孕期手术可获得相似效果,但手术风险更小;双重环扎及增加环扎带打结数量对术后妊娠结局均无明显影响。     

Effect of Electroacupuncture on Spermatogenesis in Rats with Oligozoospermia of Insufficiency of Shen (Kidney) Essence Syndrome

Objective: To assess the effect of electroacupuncture(EA) on expression of cytoskeletal proteins from Sertoli cells(SCs) and spermatogenesis in rats with oligozoospermia of insufficiency of Shen(Kidney)essence syndrome(OIKES).Methods: Twenty healthy male Sprague-Dawley rats were randomly assigned to four groups using a random number table: control,tripterygium glycosides(TG) treatment,sham and EA groups(n=5 in each group).A rat model of OIKES was established by oral gavage with TG.The EA group was treated with TG and received EA at Shenshu(BL 23) and Zusanli(ST 36) acupoints for 20 min,once daily for 30 days,while the sham group received EA at identical acupoints with skin penetration without stimulation.After 30 days,the ?nal body weight and coef?cients for the testis and epididymis were calculated and sperm parameters were measured.Immunohistochemical analyses were performed to detect expression of vimentin and α-tubulin in SCs and proliferating cell nuclear antigen(PCNA) immunoreactivity in germ cells.Apoptosis in germ cells was quanti?ed by the transferase biotin-dUTP nick end labeling assay.Results: Compared with the control group,the final body weight and testis/epididymis coefficients of rats in the TG-treated group were not significantly different,but the sperm count and motility were lower(P0.05).Expressions of vimentin and α-tubulin were also signi?cantly weaker(P0.01).The PCNA immunoreactivity of germ cells was decreased(P=0.059),whereas the apoptotic index of germ cells was increased signi?cantly(P0.01).In contrast,EA at BL 23 and ST 36 acupoints signi?cantly improved the ?nal body weight as well as the sperm count,concentration and motility(P0.01 or P0.05).EA increased expression of vimentin and α-tubulin in SCs markedly,and signi?cantly enhanced PCNA immunoreactivity with decreased apoptosis in germ cells(P0.01 or P0.05).Conclusions: EA at BL 23 and ST 36 acupoints has protective effects on spermatogenesis in rats with OIKES.This effect seems to be achieved by attenuating TG-induced disruption of cytoskeletal protein in SCs.     

低氧预处理人脐带间充质干细胞治疗早发性卵巢功能不全小鼠的效果研究

目的 探索人脐带间充质干细胞（human umbilical cord mesenchymal stem cells,hUCMSCs）及其经低氧预处理后对早发性卵巢功能不全（premature ovarian insufficiency,POI）小鼠的治疗作用。方法 从脐带中分离、培养出hUCMSCs,利用白消安和环磷酰胺诱导形成小鼠POI模型,分别使用正常hUCMSCs和经低氧预处理的hUCMSCs对POI小鼠进行治疗。实验结束时,测量各组（n=15）小鼠血浆中雌二醇（estradiol,E2）、卵泡刺激素（follicle stimulating hormone,FSH）及抗苗勒管激素（anti Mullerian hormone,AMH）浓度,对卵巢进行组织病理学检查,计数卵泡数量。结果 经过hUCMSCs和低氧预处理hUCMSCs治疗的小鼠血浆E2及AMH浓度,与模型对照组比较,呈升高趋势;且AMH浓度差异有统计学意义（P<0.05）;与模型对照组比较,hUCMSCs和低氧预处理hUCMSCs治疗组小鼠卵巢组织中生长卵泡明显增多、闭锁卵泡明显减少（P<0.05）;卵巢颜色红润,尺寸增大,几乎没有坏死点,卵泡大、透明度好,整体来看与正常对照组卵巢状态相似;且经低氧预处理hUCMSCs治疗的小鼠,其生长卵泡和闭锁卵泡数量更趋于正常。结论 hUCMSCs移植及hUCMSCs低氧预处理后移植治疗均能够有效恢复POI小鼠的激素浓度,促进卵巢功能的恢复。     

基于慢性肾脏病管理的精准分级诊疗应用实践

分级诊疗制度是优化基本医疗卫生制度的重要步骤,但落地实施时遇到阻碍,因存在转诊标准不一、空间不连贯和时间滞后等问题,医联体模式推进存在难度。上海市浦东新区人民医院联合7家社区卫生服务中心,构建了一套以信息化为支撑的川沙医联体慢性肾脏病（CKD）专病精准分级诊疗管理方案。以CKD病种为例,基于指南梳理CKD患者的疾病管理规律,建立医疗信息联通共享、转诊规则标准的CKD专病分级诊疗知识库,设计区域CKD专病分级诊疗系统,构建了基于医院-社区联动管理的专病分级诊疗一体化管理模型。且实证应用评价显示,基于CKD知识库的专病分级诊疗模式,可以精准定位易发和高危人群,及时筛查评估CKD早期患者,提升CKD患者的健康管理和诊疗效率。