伽玛刀治疗高危前列腺增生症的临床应用

目的探讨伽玛刀在不适合开放手术或经尿道电切术的高危前列腺增生患者治疗中的应用。方法采用深圳奥沃公司生产的OUR-QGD型立体定向全身伽玛刀治疗20例高危前列腺增生患者。应用国际前列腺症状评分(IPSS)、前列腺重量、最大尿流率(Qmax)、残余尿量作为评价指标。观察上述数据在治疗前后的改变及其临床意义。结果术后随访6个月,IPSS评分由治疗前29分降至19.6分(P<0.01)。前列腺重量平均值均由治疗前的(56.4±4.4)g减少至(54.8±4.3)g(P>0.05)。最大尿流率平均值由治疗前的(6.7±1.8)ml/s增加至(11.5±1.7)ml/s(P<0.01),残余尿量平均值由治疗前的(85.1±27.8)ml降至(50.9±15.6)ml(P<0.01)。结论立体定位体部伽玛刀治疗高危前列腺增生症患者具有简便、安全、无创、痛苦小、并发症少、疗效好,可不需住院等优点,对不愿意接受手术或不宜手术的高危前列腺增生患者不失为一种良好的治疗方法,但费用较高。     

Incidence of Finding Residual Disease for Incidental Gallbladder Carcinoma: Implications for Re-resection

Re-resection for gallbladder carcinoma incidentally discovered after cholecystectomy is routinely advocated. However, the incidence of finding additional disease at the time of re-resection remains poorly defined. Between 1984 and 2006, 115 patients underwent re-resection at six major hepatobiliary centers for gallbladder carcinoma incidentally discovered during cholecystectomy. Data on clinicopathologic factors, operative details, TNM tumor stage, and outcome were collected and analyzed. Data on the incidence and location of residual/additional carcinoma discovered at the time of re-resection were also recorded. On pathologic analysis, T stage was T1 7.8%, T2 67.0%, and T3 25.2%. The median time from cholecystectomy to re-resection was 52 days. At the time of re-resection, hepatic surgery most often consisted of formal segmentectomy (64.9%). Patients underwent lymphadenectomy (LND) (50.5%) or LND + common bile duct resection (43.3%). The median number of lymph nodes harvested was 3 and did not differ between LND alone (n = 3) vs LND + common duct resection (n = 3) (P = 0.35). Pathology from the re-resection specimen noted residual/additional disease in 46.4% of patients. Of those patients staged as T1, T2, or T3, 0, 10.4, and 36.4%, respectively, had residual disease within the liver (P = 0.01). T stage was also associated with the risk of metastasis to locoregional lymph nodes (lymph node metastasis: T1 12.5%; T2 31.3%, T3 45.5%; P = 0.04). Cystic duct margin status predicted residual disease in the common bile duct (negative cystic duct, 4.3% vs positive cystic duct, 42.1%) (P = 0.01). Aggressive re-resection for incidental gallbladder carcinoma is warranted as the majority of patients have residual disease. Although common duct resection does not yield a greater lymph node count, it should be performed at the time of re-resection for patients with positive cystic duct margins because over one-third will have residual disease in the common bile duct. Presented at the 48th Annual Meeting of the Society for Surgery of the Alimentary Tract at Digestive Week 2007, Plenary Session, Washington, DC, March 23, 2007.     

早期胃癌术后复发的临床分析

目的分析早期胃癌术后复发情况，为制定防治策略提供依据。方法收集解放军总医院1983-2005年间发现的早期胃癌308例，其中245例术后进行了随访，对可能影响早期胃癌术后复发的临床病理特征进行单因素及多因素分析。结果30例出现胃癌复发（中位时间28个月），1、3、5、7、10、15年复发率分别为5．49％、8．44％、11．27％、14．83％、16．39％、37．79％。黏膜内癌复发13例（中位时间24个月），1、3、5、7、10、15年复发率分别为4．23％、6．68％、7．75％、9．34％、9．34％、28．24％。黏膜下癌复发17例（中位时间31个月），1、3、5、7、10、15年复发率分别为7．39％、11．14％、16．54％、24．49％、29．69％、64．85％。Cox回归分析提示浸润黏膜下层（P-O．044，OR-2．172）增加术后肿瘤复发危险，癌周黏膜明显肠化（p-0．047，0R-0．460）者术后肿瘤复发较少。30例复发者中23例（76．7％）无根治手术指征，未再次手术治疗；7例（23．3％）有再次根治手术指征，其中4例再次手术治疗，术后病理提示3例为残胃早期胃癌，无淋巴结转移，1例为残胃进展期胃癌，伴区域淋巴结转移（已无瘤存活28个月），另3例因身体原因未再手术治疗。Logistic回归分析提示癌周黏膜明显肠化（P-0．016，OR=17．000）为有再次根治手术指征的独立影响因子。86．7％（26／30）的复发患者至少每1～2年进行一次包括胃镜检查方式在内的复查。结论早期胃癌累及黏膜下层者术后更易出现复发；癌周明显肠化者术后复发较少，即使出现复发，也有再次进行根治手术的可能；每1～2年进行一次复查有助于早期发现残胃再发癌，但对提高复发转移者再次根治手术机会帮助不大。     

The plasma kallikrein–kinin system and risk of cardiovascular disease in men

BACKGROUND: The plasma kallikrein-kinin system (PKKS) has been implicated in cardiovascular disease, but activation of the PKKS has not been directly probed in individuals at risk of coronary heart disease (CHD) or stroke. OBJECTIVE: To determine the involvement of the PKKS, including factor XI, in cardiovascular disease occurring in a nested case-control study from the Second Northwick Park Heart Study (NPHS-II). METHODS AND RESULTS: After a median follow-up of 10.7 years, 287 cases of CHD and stroke had been recorded and 542 age-matched controls were selected. When FXIIa-C1 esterase inhibitor (C1-inhibitor) concentrations were divided into tertiles (lowest tertile as reference), the odds ratios (ORs) at 95% CIs for CHD were 0.52 (0.34-0.80) in the middle tertile and 0.73 (0.49-1.09) in the highest tertile (P = 0.01 for the overall difference; P = 0.01 for CHD and stroke combined). For kallikrein-C1-inhibitor complexes, the ORs for stroke were 0.29 (0.12-0.72) and 0.67 (0.30-1.52) in the middle and high tertiles, respectively (P = 0.02). FXIIa-C1-inhibitor and kallikrein-C1-inhibitor complexes were negatively related to smoking and fibrinogen (P < 0.005). FXIa-inhibitor complexes correlated strongly with FXIIa-inhibitor complexes. CONCLUSIONS: Lower levels of inhibitory complexes of the PKKS enzymes and particularly of FXIIa contribute to the risk of CHD and stroke in middle-aged men. This observation supports the involvement of the PKKS in atherothrombosis.     

Risk factors of type 2 diabetes among Korean adults: The 2001 Korean national health and nutrition examination survey

This study aimed to identify risk factors for type 2 diabetes (T2D) in Korea, a rapidly changing country. Data of 5,132 adults aged 20-85 were used from the 2001 Korean Health and Nutrition Examination Survey. Multiple logistic regression was carried out to identify risk factors for T2D. Three models were specified: (i) socioeconomic and demographic factors (model 1: age, gender, education, poverty income ratio, employment), (ii) behavioral risk factors and covariates (model 2: obesity, physical activity, smoking, alcohol drinking, dietary quality, family history of T2D, co-morbidity) and (iii) socioeconomic, demographic, and behavioral factors (model 3). The prevalence of T2D was 7.4%. Less education (OR 1.41, 95% CI 1.08-1.84), age (OR 2.19, 95% CI 1.56-3.08 in 40-59 yrs, OR 4.05, 95% CI 2.76-5.95 in 60 yrs + comparing to 20-39 yrs) and abdominal obesity (OR 2.24, 95% CI 1.79-2.82) were risk factors for T2D even after controlling for other factors simultaneously. There was a significant association of T2D with ever smoking (OR 1.34, 95% CI 1.06-1.67). The relationship of age with T2D was modified by gender in model 1 and the relationship of smoking with T2D was modified by obesity in model 2. Less educated, older, obese or ever smokers were more likely to have T2D. Gender mediated the relationship of age, and obesity mediated the relationship of smoking, with T2D. Intervention programs for T2D in Korea should take the interactions among risk factors into account.     

血清尿酸水平与冠心病及其危险因子关系的研究

目的:探讨血清尿酸(UA)水平与冠心病(CHD)及其相关因素关系。方法:选择经冠状动脉造影检查证实的冠心病患者187例,冠脉造影正常对照组71例,常规空腹采集静脉血测定血清UA,分析冠心病危险因子、冠状动脉病变程度、病变支数及病变类型与相应UA水平的关系。结果:CHD组的一般资料与对照组无明显差异,但血清UA水平明显高于对照组(P<0.01);在CHD组中,轻度狭窄、中度狭窄及重度狭窄,其UA水平逐渐增高,分别为(418.92±36.52),(450.84±48.65),(487.40±51.62)μmol/L(P<0.01);单支病变、双支病变和三支病变,其UA水平也增高,分别为(426.32±30.78),(455.24±35.34),(480.40±40.12)μmol/L(P<0.01);A、B和C型病变,其UA水平依次增高,分别为(425.85±35.71),(461.65±46.50),(493.41±53.24)μmol/L(P<0.01);结论:血清UA水平的增高与冠心病密切相关,是冠心病发病的危险因素。     

老年肝内外胆管结石的腹腔镜手术治疗

目的 :探讨老年肝内外胆管结石行腹腔镜手术的可行性、特点及围手术期处理。方法 :应用腹腔镜胆总管切开纤维胆道镜取石治疗老年性肝内外胆管结石 2 0例 ,显露肝门 ,切开胆总管 ,取石 ,胆总管均放置T形管引流。结果 :2 0例手术均获成功 ,1例术后肝内胆管残余结石 ,术后 6周经T管窦道纤维胆道镜取石治愈。 1例 16d拔T管后胆汁性腹膜炎 ,开腹引流治愈。结论 :老年性肝内外胆管结石腹腔镜手术 ,患者创伤小 ,安全 ,疗效满意。     

Acute Renal Failure after Lung Transplantation: Incidence, Predictors and Impact on Perioperative Morbidity and Mortality

The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up was extended until December 2002. Patients were initially divided into two groups: ARF (doubling of baseline creatinine within 2 weeks after surgery) and NoARF. The ARF group was subdivided into ARFD (dialyzed) and ARFnD (not dialyzed). The incidence of ARF was 56% (166/296), but most cases were ARFnD (n = 143). Independent predictors of ARFD (n = 23) were: baseline GFR (OR 0.98, CI 0.96-0.99, p = 0.012), pulmonary diagnosis other than COPD (OR 6.80, CI 1.5-30.89, p = 0.013), mechanical ventilation > 1 d (OR 6.16, CI 1.70-22.24, p = 0.006) and parenteral amphotericin B use (OR 3.04, CI 1.03-8.98, p = 0.045). Both ARFnD and ARFD were associated with longer duration of mechanical ventilation, increased hospital stay and increased early mortality. One-year patient survival was 92.3%, 81.8% and 21.7% in the NoARF, ARFnD and ARFD groups, respectively (p < 0.0001). After controlling for important covariates, ARFD remained associated with an increased hazard of dying (HR 6.77, CI 4.00-11.44, p < 0.0001). In conclusion, ARF occurs commonly after lung transplantation and affects important clinical outcomes, especially when dialysis is required.     

椎动脉形态学异常对后循环短暂性脑缺血发作症状持续时间的影响

目的 探讨椎动脉形态学异常对后循环TIA症状持续时间的影响。
方法 回顾性分析2015年10月-2018年3月在中国科学院大学重庆仁济医院神经内科完成头颈部DSA
或CTA的后循环TIA住院患者临床资料，根据症状持续时间分为<10 min组、10～59 min组和≥60 mi n组，
比较椎动脉形态异常各亚型在3组间的差异。通过多因素Logistic回归分析明确椎动脉形态异常与后
循环TIA症状持续时间之间的关系。
结果 共纳入237例患者，其中症状持续时间<10 min组109例（45.99%）、10～59 min组71例（29.96%）
和≥60 min组57例（24.05%）。一般临床资料的比较显示，性别、椎动脉和基底动脉狭窄率≥50%
在3组间差异具有统计学意义（P＜0.05）。椎动脉形态异常中，动脉粥样硬化性椎动脉狭窄（狭窄
率1%～99%）在3组间的差异具有统计学意义（P =0.004），而一侧迂曲、双侧迂曲、一侧优势、一
侧优势合并迂曲和起源异常在3组间差异均无统计学意义；多因素Logi sti c回归分析显示椎动脉
狭窄（OR 2.500，95%CI 1.381～4.525，P =0.002）、基底动脉狭窄率≥50%（OR 12.066，95%CI
1.446～100.668，P =0.021）是TI A症状持续时间延长的独立影响因素。
结论 椎动脉狭窄和基底动脉狭窄率≥50%是影响后循环TIA症状持续时间延长的独立影响因素。