肾结石ESWL后肾脏血肿的原因分析

目的:探讨肾结石ESWL后肾脏血肿的原因。方法:对2008年5月~2012年6月5例肾结石ESWL后肾脏血肿的临床资料进行分析并文献复习。结果:采用上海交通大学JDPN-ⅤB型液电式碎石机治疗后引起肾脏血肿3例,深圳惠康HK.ESWL-109型电磁式碎石机治疗引起2例。体型肥胖并高血压2例(其中1例糖尿病)。2例因输尿管结石梗阻感染行输尿管镜取石术后行同侧肾结石ESWL后出现肾脏血肿,2例行一侧输尿管结石ESWL后行对侧肾结石ESWL后出现肾脏血肿,1例右输尿管上段结石ESWL后部分结石上移肾内行肾结石ESWL后出现肾脏血肿。4例保守治疗痊愈(肾包膜下血肿2例,肾包膜破裂肾周血肿2例);1例肾周大血肿腹膜后扩散,输血3 500ml,行高选择性肾动脉分支栓塞治愈。结论:ESWL并非绝对安全、没有重大并发症,只有掌握合适的适应证才安全可靠,在治疗前后需要仔细观察和评估。导致肾脏血肿的易患因素有凝血功能异常、抗凝药物的使用、糖尿病、高血压、老年患者、心脏病、肥胖等因素。高低能量冲击波的交替使用,有助于提高碎石的成功率及安全性。绝大多数患者可以通过保守治疗治愈,少数需要肾动脉栓塞治疗,个别严重患者需要肾切除来挽救生命。     

输尿管镜下超声与气压弹道碎石术治疗输尿管上段结石并急性梗阻性尿毒症的比较

目的 比较输尿管镜下超声碎石术与气压弹道碎石术治疗并发急性梗阻性尿毒症的输尿管上段结石的临床疗效及其优缺点.方法 回顾性分析我院2009年5月至2012年5月的104例输尿管上段结石并发急性梗阻性尿毒症患者的临床资料.采用输尿管镜下超声碎石术（组1）和输尿管镜下气压弹道碎石术（组2）治疗的患者各52例,统计并比较两组的住院时间、手术时间、术中出血量、结石清除率及并发症发生情况.结果 两组患者术后肾功能均在短期内恢复正常,组1与组2相比较,组1结石清除率高、手术时间短、住院时间短、术后感染率低,组间比较差异有统计学意义（P＜0.05）.两组均无输尿管穿孔、撕脱等并发症.结论 输尿管镜下超声碎石术治疗输尿管上段结石并发急性梗阻性尿毒症是一种安全、有效的理想手术方法,不增加手术并发症.     

The dose–effect relationship in extracorporeal shock wave therapy: the optimal parameter for extracorporeal shock wave therapy

Background

Extracorporeal shock wave therapy (ESWT) has been demonstrated to have the angiogenic effect on ischemic tissue. We hypothesize that ESWT exerts the proangiogenesis effect with an energy density–dependent mode on the target cells.

Materials and methods

Endothelial progenitor cells (EPCs) of rats were obtained by cultivation of bone marrow–derived mononuclear cells. EPCs were divided into five groups of different energy densities, and each group was furthermore subdivided into four groups of different shock numbers. Thus, there were 20 subgroups in total. The expressions of angiogenic factors, apoptotic factors, inflammation mediators, and chemotactic factors were examined, and the proliferation activity was measured after ESWT.

Results

When EPCs were treated with low-energy (0.04–0.13 mJ/mm²) shock wave, the expressions of endothelial nitric oxide synthase, angiopoietin (Ang) 1, Ang-2, and B-cell lymphoma 2 increased and those of interleukin 6, fibroblast growth factor 2, C-X-C chemokine receptor type 4, vascular endothelial growth factor a, Bcl-2-associated X protein, and caspase 3 decreased. stromal cell-derived factor 1 changed without statistical significance. When cells were treated with high-energy (0.16 mJ/mm²) shock wave, most of the expressions of cytokines declined except the apoptotic factors and fibroblast growth factor 2, and cells lead to apoptosis. The proliferation activity and the ratio of Ang-1/Ang-2 reached their peak values, when cells were treated with ESWT with the intensity ranging from 0.10–0.13 mJ/mm² and shock number ranging from 200–300 impulses. Meanwhile, a minimal value of the ratio of Bax/Bcl-2 was observed.

Conclusions

There is a dose–effect relationship in ESWT. The shock intensity ranging from 0.10–0.13 mJ/mm² and shock number ranging from 200–300 impulses were the optimal parameters for ESWT to treat cells in vitro.     

Efficacy of poly(adenosine diphosphate-ribose) polymerase inhibition in extracorporeal shock wave-induced renal injury

Objectives: Extracorporeal shock wave lithotripsy (ESW) induces renal damage by excessive production of free oxygen radicals. Free Oxygen radicals cause cellular injury by inducing nicks in DNA. The enzyme poly(adenosine diphosphate-ribose) polymerase (PARP) involved in the process of repair of DNA in damaged cells. However, its activation in damaged cells can lead to adenosine triphosphate depletion and death. Thus, we designed a study to evaluate the efficacy of 3-aminobenzamide (3-AB), a PARP inhibitor, against extracorporeal shock wave induced renal injury. Methods: Twenty-four Sprague-Dawley rats were divided into three groups: control, ESW, ESW?+?3-AB groups. All groups except control group were subjected to ESW procedure. ESW?+?3-AB group received 20?mg/kg/day 3-aminobenzamide intraperitoneally at 2?h before ESW and continued once a day for consecutive 3 days. The surviving animals were sacrificed at the 4th day and their kidneys were harvested for biochemical and histopathologic analysis. Blood samples from animals were also obtained. Results: Serum ALT and AST levels, serum neopterin and tissue oxidative stress parameters were increased in the ESW group and almost came to control values in the treatment group (p?p?Conclusion: Our data showed that PARP inhibition protected renal tissue against ESW induced renal injury. These findings suggest that it would be possible to improve the outcome of ESW induced renal injury by using PARP inhibitors as a preventive therapy.     

Preoperative Characteristics of Auditory Brainstem Response in Acoustic Neuroma with Useful Hearing: Importance as a Preliminary Investigation for Intraoperative Monitoring

We classified the results of preoperative auditory brainstem response (ABR) in 121 patients with useful hearing and considered the utility of preoperative ABR as a preliminary assessment for intraoperative monitoring. Wave V was confirmed in 113 patients and was not confirmed in 8 patients. Intraoperative ABR could not detect wave V in these 8 patients. The 8 patients without wave V were classified into two groups (flat and wave I only), and the reason why wave V could not be detected may have differed between the groups. Because high-frequency hearing was impaired in flat patients, an alternative to click stimulation may be more effective. Monitoring cochlear nerve action potential (CNAP) may be useful because CNAP could be detected in 4 of 5 wave I only patients. Useful hearing was preserved after surgery in 1 patient in the flat group and 2 patients in wave I only group. Among patients with wave V, the mean interaural latency difference of wave V was 0.88 ms in Class A (n = 57) and 1.26 ms in Class B (n = 56). Because the latency of wave V is already prolonged before surgery, to estimate delay in wave V latency during surgery probably underestimates cochlear nerve damage. Recording intraoperative ABR is indispensable to avoid cochlear nerve damage and to provide information for surgical decisions. Confirming the condition of ABR before surgery helps to solve certain problems, such as choosing to monitor the interaural latency difference of wave V, CNAP, or alternative sound-evoked ABR.     

剪切波弹性成像在乳腺良恶性病变中的应用进展

乳腺癌发病率逐年上升,且趋于年轻化。鉴别乳腺良恶性病变是预防、诊断及治疗乳腺癌的重点。剪切波弹性成像是一项新的超声定量技术,已在乳腺、甲状腺、腮腺、睾丸等组织病变呈现出重要临床应用价值。本文就剪切波弹性成像对鉴别诊断乳腺良恶性病变的应用进展进行综述。     

超声对原位劈离式肝移植术前供肝评估价值初探

目的初步探讨超声对原位劈离式肝移植(ISSLT)术前供肝评估的价值。 方法回顾性分析5例脑死亡器官捐献供者接受供肝在体劈离术前的超声检查资料。5例供者术前均行常规二维超声、彩色多普勒超声和剪切波弹性成像检查,酌情行超声造影。 结果常规二维超声显示肝实质回声细小2例,略粗略强2例,增粗增强1例。5例供者肝内动脉、门静脉主干及其属支、肝中静脉及其属支彩色多普勒超声均显示良好。5例供者右肝前叶剪切波成像弹性值为2.67～4.35 kPa。2例供者行超声造影,1例未见异常,1例肝动脉解剖变异。术中所见肝脏血管情况与超声评估相符。病理结果示5例供肝肝小叶结构大致正常,均未见脂肪变性。 结论超声可以作为ISSLT术前供肝评估的首选影像学方法,了解供肝大小、质地、脂肪变性、血管变异等情况,剪切波弹性成像及超声造影从硬度、微循环灌注检测两方面进一步评估供肝质量,作为常规超声的有效补充。     

实时剪切波弹性成像在拉米夫定治疗乙肝纤维化过程中的疗效评估作用

目的探讨实时剪切波弹性成像在评估拉米夫定治疗乙肝纤维化临床疗效中的作用。方法选取2017年1月～2018年1月我院收治的80例乙肝纤维化患者,根据随机数字法分为对照组和观察组,每组40例。对照组采用常规治疗,观察组在对照组的基础上给予拉米夫定进行治疗,治疗6个月。比较两组治疗前后肝功能、肝纤维化指标,利用实时剪切波弹性成像评估两组治疗前后肝脏弹性模量值及肝穿刺活检情况,并进行比较。结果两组治疗后AST、ALT、TBIL水平均明显低于治疗前,差异有统计学意义(P0.05);观察组治疗后AST、ALT、TBIL水平均明显低于对照组,差异有统计学意义(P0.05);两组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于治疗前,差异有统计学意义(P0.05);观察组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于对照组,差异有统计学意义(P0.05);与治疗前相比,两组治疗后肝穿刺活检结果均有好转,尤其是汇管区、肝小叶内炎症及肝纤维化改善明显。结论实时剪切波弹性成像作为肝脏硬度定量检测的无创性技术,可用于拉米夫定治疗乙肝纤维化临床疗效评估的重要方法。     

脉搏波传导速度及其在中医脉诊研究中的应用

论述脉搏波传导速度(PWV)的临床应用及在中医脉诊研究中的应用进展。PWV是脉搏波传导距离与传导时间的比值,作为评价动脉硬化的指标,当前临床应用以臂踝脉搏波传导速度(ba-PWV)和颈股脉搏波传导速度(cf-PWV)为主,主要用于心血管疾病、糖尿病、肾脏疾病等的诊断和风险评估,可较好地反映血管损伤程度、预测发病率及病死率。在中医脉诊研究中,PWV和脉图指标密切相关,两者联合可应用于中医脉象分类,亦有助于临床诊断和预防。     

实时剪切波弹性成像技术在慢性肾病中的应用价值

目的探讨实时剪切波弹性成像技术(SWE)在无创诊断慢性肾病(CKD)的临床价值。方法选取我院临床确诊为CKD患者200例作为观察组,并选取40例同期入院健康体检的正常健康人群为对照组,两组均使用实时剪切波弹性成像技术检测肾脏弹性模量值,检测观察组患者血肌酐(Cr)、血尿素氮(BUN)数值,并根据血肌酐数值进行CKD分期。比较两组人员左肾中下极肾皮质和肾窦及肾髓质的杨氏模量值,并比较不同CKD分期中不同左肾中下极肾实质杨氏模量值的差异。结果观察组患者左肾中下极肾皮质和和肾窦及肾髓质明显高于对照组,差异有统计学意义(P0.05);观察组患者左肾中下极各个区域杨氏模量值相比,差异有统计学意义(P0.05);对照组左肾中下极肾窦部杨氏模量值明显低于皮质及髓质杨氏模量值,差异有统计学意义(P0.05)。CKD1期患者与CKD2期患者左肾中下极各个区域杨氏模量值比较,差异无统计学意义(t=1.21,P=0.22);其余各期左肾中下极各个区域杨氏模量值比较,差异有统计学意义(P0.05)。随着慢性肾病患者病情的加重,其肾皮质和肾髓质区域杨氏模量值也会逐渐增加,差异有统计学意义(P0.05)。观察组Cr、BUN、UA较对照组明显增高,差异有统计学意义(P0.05)。结论临床采用实时剪切波弹性成像技术检测慢性肾病患者可更好地判断患者肾脏弹性模量值,同时通过观察患者血液生化指标,有助于临床疾病无创诊断和病情判断。