A Critical Analysis of Orthotopic Bladder Substitutes in Adult Patients with Bladder Cancer: Is There a Perfect Solution?

Context

Orthotopic bladder substitute (OBS) has been popularized over the past 2 decades as a diversion following radical cystectomy for invasive bladder cancer. Various reports, mostly single-center experiences, are published on patients with OBS.

Objective

This study reviews the literature regarding indications, postoperative care, complications, quality-of-life measures, as well as functional and oncologic outcomes that have been published on patients with OBS.

Evidence acquisition

An English-language literature review of the Medline database (1990 to January 2010) of published data on patients with OBS following radical cystectomy for bladder cancer was undertaken. Articles that included surgery for noncancer etiology were excluded.

Evidence synthesis

Indications and patient selection criteria have significantly widened over the past 2 decades. Comparable oncologic data have been reported between patients with OBS versus other diversions. Secondary urethral tumors seem less common in patients with OBS compared with those with conduits or continent cutaneous diversions. Durable daytime and nocturnal continence is achieved in 85–90% and 60–80%, respectively. Continence is inferior in elderly patients with OBS. Urinary retention remains significant in the female patients, ranging from 25% to 50%. Complications including electrolyte disturbances, altered sensorium and drug metabolism, mucus retention, rupture, urinary tract infections, and upper tract deterioration are reviewed.

Conclusions

Indications for OBS following radical cystectomy in patients with invasive bladder cancer have significantly widened over the past 2 decades. An OBS should be offered to both male and female patients in the absence of contraindications. Good long-term functional and oncologic outcomes can be achieved in patients with OBS treated in high-volume institutions by experienced surgeons with specific knowledge in the field. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.     

功能性消化不良与社会心理因素的相关性

功能性消化不良发病率居高不下,症状顽固,许多患者都伴有不同程度的焦虑抑郁情绪,严重影响了患者的生活和工作,本文就其最新的一些研究内容做一综述。     

不同分型功能性消化不良患者病理生理机制的比较研究

目的 比较不同分型功能性消化不良(FD)患者是否具有不同的病理生理机制.方法 评价80例FD患者[罗马Ⅲ标准,男∶女为22∶58,平均(44.2±14.6)岁]消化不良症状的严重程度和分型,并行多种胃肠功能检查.结果 上腹痛综合征(EPS)、餐后不适综合征(PDS)和混合型三组间在胃排空功能、胃肌电活性、自主神经功能、液体负荷试验同步胃内压测定以及心理评定方面的差异均无统计学意义(P值均＞0.05).餐后饱胀感与胃半排空时间呈正相关(偏相关系数为11.5,P=0.043).早饱与最大饮入量呈负相关(偏相关系数为-6.8,P=0.033).结论 本研究发现罗马Ⅲ分型方法 可能并不能有效地将有不同病理生理机制的FD患者区分开,从而采取有针对性的治疗.     

生物反馈训练对功能性便秘患者临床症状、心理状况和生活质量的影响

Objective To explore the effects of biofeedback training on clinical symptom,psychological state and quality of life in patients with functional constipation (FC).Methods Forty-nine patients with FC diagnosed by Rome Ⅲ were enrolled and received biofeedback training Bowel symptom measure, Zung's self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Chinese version of the MOS 36-item short form healthy survey (SF-36) were recorded to assess the effects before and aftertreatment.Results After biofeedback training, clinical symptom of patients with FC was greatly improved:there was a very significant decrease in total and subscales scores of bowel symptom including spontaneous frequency of bowel movements, straining effort, sensation of anorectal obstruction/blockage, stool consistence and bloating.Patients with FC also improved their quality of life as well as psychological status after biofeedback.All subcategories of SF-36 including general health, physical function, bodily pain, role physical, vitality, social function, role emotion and mental health showed marked increase.Compared to the scores before biofeedback training, SAS (41.0 ±8.1 vs 46.5 ± 11.9) and SDS (44.0 ±8.2 vs 51.2 ±11.5) scores decreased significantly after biofeedback training Conclusion Biofeedback training can improve clinical symptom, psychological status and quality of life in patients with FC.     

中药敷贴联合按摩点穴治疗老年功能性便秘的随机对照临床研究

目的观察中药敷贴联合按摩点穴治疗老年功能性便秘的临床疗效。方法将68例符合罗马Ⅲ诊断标准的老年功能性便秘患者随机分为治疗组（35例）和对照组（33例）,分别采用中药敷贴联合按摩点穴、麻仁软胶囊治疗。两组疗程均为20天。随访3个月,通过便秘症状评估量表积分变化情况评价临床疗效。结果治疗组总有效率为94.29%,对照组为84.85%;组间临床疗效比较,差异无统计学意义（P〉0.05）。两组治疗后各项症状积分及总积分均明显降低（P〈0.05）;组间治疗后比较,排便时间和腹胀积分差异有统计学意义（P〈0.05）。治疗组随访时排便间症状积分增加（P〈0.05）,其余症状积分及总积分与治疗后差异无统计学意义（P〉0.05）;对照组随访时各项症状积分及总积分与治疗后比较,差异均有统计学意义（P〈0.05）。组间随访时比较,各项症状积分及总积分差异均有统计学意义（P〈0.05）。结论中药敷贴联合按摩点穴疗法对老年人功能性便秘具有较好的临床疗效。     

分别基于行为疗法和口服帕罗西汀在治疗功能性腹痛综合征中的临床研究

目的探讨功能性腹痛综合征（FAPS）患者症状与精神心理状态的联系,比较分别基于行为疗法与口服帕罗西汀在治疗FAPS中的作用。方法以症状自评量表（SCL-90）评价FAPS患者和健康志愿者的心理状态,并与国内常模比较。将确诊为FAPS患者随机分为松弛行为疗法组和口服帕罗西汀组,记录每位患者治疗前后的症状（严重程度及影响程度）评分及相关因子分值,采用样本非参数检验进行统计学分析。记录患者及健康志愿者性别、是否绝经、年龄、文化程度、经济状况、对目前工作生活满意度及过去6个月有无重大负性事件,采用非条件Logistic回归分析发病危险因素。结果FAPS患者SCL90评价阳性率显著高于健康志愿者,部分因子分值高于国内常模,焦虑因子与FAPS症状严重程度呈显著相关,精神病性与强迫因子呈显著相关（P〈0.05）。治疗2周后,组内比较显示帕罗西汀组症状显著改善,组间比较显示帕罗西汀改善疼痛优于松弛疗法。治疗8周后,组内比较显示松弛疗法和口服帕罗西汀改善症状与焦虑因子分值差异均有统计学意义（P〈0.01）;组间比较差异无统计学意义（P〉0.05）。非条件Logistic回归分析,负性事件为密切相关危险因素。结论口服帕罗西汀治疗FAPS的短期疗效优于行为疗法,8周后2种方法总体疗效无显著差异;松弛行为疗法更易于患者接受,且成本/效益比优于口服药物。     

曲美布丁联合复方阿嗪米特治疗功能性消化不良的临床疗效观察

目的探讨曲美布丁联合复方阿嗪米特治疗功能性消化不良的临床效果。方法 102例肝硬化并静脉曲张破裂出血患者被随机分为实验组（n=52）和对照组（n=52）,对照组单纯给予复方阿嗪米特治疗,实验组给予曲美布丁联合复方阿嗪米特治疗。结果实验组显效率为80.8%,总有效率为96.2%,临床效果显著优于对照组（P〈0.05）。结论曲美布丁联合复方阿嗪米特应用于功能性消化不良的治疗,能显著提高临床效果、改善患者生活质量,值得在临床上应用和推广。     

Herbst矫治器前移下颌对成年大鼠髁状突中Ⅲ型胶原表达的影响

目的探讨Herbst功能矫治器引导成年大鼠下颌前伸,对其髁状突组织中Ⅲ型胶原表达水平的影响,进一步明确Herbst矫治器对成年大鼠髁状突组织改建的作用.方法 60只14周龄雄性SD大鼠随机分为实验组和对照组;实验组大鼠全天佩戴自制Herbst矫治器引导下颌前伸,对照组不佩戴矫治器.于时间点3、7、14、21和30 d分别处死各组大鼠,取右侧髁状突组织,使用免疫组化方法检测髁状突中Ⅲ型胶原蛋白的表达情况.结果对照组髁突软骨Ⅲ型胶原表达较低;3 d实验组髁突后部Ⅲ型胶原表达较相应对照组强（P〈0.05）,其余各实验组均明显强于相应对照组（P〈0.01）.实验组Ⅲ型胶原在30 d时表达最强.结论 Herbst矫治器能够诱导成年大鼠髁状突发生适应性改建.     

胫骨平台骨折手术治疗的疗效分析

目的总结胫骨平台骨折手术治疗的临床经验。方法回顾分析2005年1月至2008年12月39例胫骨平台骨折患者的手术治疗过程及预后。结果 35例患者获随访,随访时间12个月至60个月(平均36个月),均按KDLMERT膝关节功能评定标准进行评分,结果优22例、良6例、可5例、差2例,优良率达80%。结论不同类型的胫骨平台骨折,可采用不同的手术方式。术后有效地关节功能锻炼可提高手术疗效。     

Disrupted Activity in the Hippocampal�CAccumbens Circuit of Type III Neuregulin 1 Mutant Mice

Neuregulin 1 (Nrg1), a schizophrenia susceptibility gene, is involved in fundamental aspects of neurodevelopment. Mice lacking any one of the several isoforms of Nrg1 have a variety of schizophrenia-related phenotypes, including deficits in working memory and sensorimotor gating, loss of spines in pyramidal neurons in the ventral subiculum, loss of dendrites in cortical pyramidal cells, loss of parvalbumin-positive interneurons in the prefrontal cortex, and altered plasticity in corticolimbic synapses. Mice heterozygous for a disruption in exon 7 of the Nrg1 gene lack Type III (cysteine-rich-domain-containing) isoforms and have sensorimotor gating deficits that may involve changes in the activity of a circuit involving projections from the ventral hippocampus (vHPC) to medium spiny neurons in the nucleus accumbens (nACC). To explore the neural basis of these deficits, we examined electrophysiological activity in the nACC and vHPC of these mice. Under urethane anesthesia, bursts of spontaneous activity propagated from the vHPC to the nACC in both wild-type and mutant mice. However, these bursts were weaker in mutant nACC, with reduced local field potential amplitude and spiking activity. Single units in mutant nACC fired less frequently within the bursts, and more frequently outside of the bursts. Moreover, within-burst nACC spiking was less modulated by vHPC activity, as determined by phase-locking to the low-frequency oscillatory components of the bursts. These data suggest that the efficacy of vHPC input to the nACC is reduced in the Type III Nrg1 heterozygotes, supporting a role for Nrg1 in the functional profile of hippocampal–accumbens synapses.