瑞士EMS碎石清石系统治疗肾结石120例临床分析

目的观察采取瑞士EMS三代碎石清石系统治疗肾结石疗效,并分析其安全性。方法选择本院于2013年1月至2014年1月收治的肾结石患者240例为研究对象(结合临床表现及相关影像学的表现,符合肾结石诊断标准),按照数字随机法分为两组,每组120例。观察组采取瑞士EMS三代碎石清石系统治疗,对照组采取钬激光碎石术治疗,比较两组患者疗效差异。结果经统计,观察组患者手术时间、术中出血量分别为(61.4±27.4)min、(159.4±43.5)m L,均少于对照组,均P<0.05。观察组痊愈89(74.2%),有效29例(24.2%),总有效率118例(98.3%),明显高于对照组105例(87.5%),P<0.05。观察组术后出现腹胀、恶心、呕吐7例,发热11例,感染9例,并发症27例(22.5%)与对照组并发症30例(25.0%)比较无明显差异,P>0.05。结论瑞士EMS三代碎石清石系统治疗肾结石疗效较佳,手术时间短,成功率高,具有重要临床价值。     

Serology and ultrasound for diagnosis of choledocholithiasis

Introduction

Magnetic resonance cholangiopancreatography (MRCP) is not a routine investigation to exclude choledocholithiasis unless there is clinical or biochemical suspicion of common bile duct (CBD) stones. This study attempted to determine which radiological or serological parameters best predicted CBD stones.

Methods

All patients undergoing MRCP from 2005 to 2011 were selected. Patients with pancreatitis were excluded. Liver function tests (LFTs) at admission and prior to MRCP were recorded, as was abdominal ultrasonography and MRCP results. Parameters measured routinely on LFTs included alkaline phosphatase (ALP), alanine transaminase (ALT) and bilirubin. Receiver operating characteristic curve area analysis (area under the curve [AUC]) and chi-squared analysis were undertaken.

Results

Overall, 195 patients were identified, 71 of whom had CBD stones on MRCP. Raised ALP levels on admission demonstrated a correlation with CBD stones (AUC: 0.619, odds ratio [OR]: 3.16, p=0.06). At ultrasonography, a dilated CBD (OR: 3.76, p<0.001) and intrahepatic duct dilation (OR: 5.56, p<0.001) were highly significant predictors. However, only 37% of patients had a dilated CBD on ultrasonography. Ongoing elevation of LFT parameters, particularly ALP (AUC: 0.707, OR: 4.64, p<0.001) and ALT (AUC: 0.646, OR: 5.40, p<0.001), displayed a significant correlation with CBD stones.

Conclusions

Ongoing (even if minor) elevations of liver function test parameters should prompt the need to exclude CBD stones even in the presence of a normal CBD diameter on ultrasonography.     

The effect of bariatric surgery on gout: a comparative study

BackgroundObesity is a risk factor for the development of gout. An increased incidence of early gouty attacks after bariatric surgery has been reported, but the data is sparse. The effect of weight loss surgery on the behavior of gout beyond the immediate postoperative phase remains unclear. The objective of this study was to evaluate the pre- and postoperative frequency and features of gouty attacks in bariatric surgery patients.MethodsCharts were reviewed to identify patients who had gout before bariatric surgery. Demographic and gout-related parameters were recorded. The comparison group consisted of obese individuals with gout who underwent nonbariatric upper abdominal procedures.ResultsNinety-nine morbidly obese patients who underwent bariatric surgery had gout. The comparison group consisted of 56 patients. The incidence of early gouty attack in the first month after surgery was significantly higher in the bariatric group than the nonbariatric group (17.5% versus 1.8%, P = .003). In the bariatric group, 23.8% of patients had at least one gouty attack during the 12-month period before surgery, which dropped to 8.0% during postoperative months 1–13 (P = .005). There was no significant difference in the number of gouty attacks in the comparison group before and after surgery (18.2% versus 11.1%, P = .33). There was a significant reduction in uric acid levels 13-months after bariatric surgery compared with baseline values (9.1±2.0 versus 5.6±2.5 mg/dL, P = .007).ConclusionThe frequency of early postoperative gout attacks after bariatric surgery is significantly higher than that of patients undergoing other procedures. However, the incidence decreases significantly after the first postoperative month up to 1 year.     

钙的作用机理及如何安全补钙的研究现状

钙是人体不可或缺的重要元素,钙的作用机理十分复杂,虽然多年来国内外大量研究已证实钙对机体各个系统正常生理功能的调节作用,但仍有许多问题有待解决。对于人体缺钙及如何安全补钙的问题,尚存在较大争议。本文通过综述形式,总结近年来国内外对钙的作用机理及补钙争议的相关研究,并探讨如何安全补钙及钙剂的选择,期待为大众正确认识“钙”提供依据。     

B超引导下经皮肾镜治疗160例上尿路结石分析

目的 探讨B超引导下经皮肾镜联合气压弹道碎石取石术治疗泌尿系上尿路结石的临床疗效和安全性.方法 回顾分析本院自2010年1月至2013年12月收治的160例泌尿系结石患者的临床资料,B超引导下定位进行经皮肾镜下气压弹道碎石、取石治疗.结果 160例除1例外均一期成功建立经皮肾通道.平均手术时间95min,术中出血平均100mL,平均住院时间12.5d,1次取净结石146例,2次取净5例,总结石清除率为94.4％,无气胸、腹腔脏器损伤等并发症发生.结论 B超引导下经皮肾镜碎石取石术是治疗泌尿系上尿路结石的有效方法,其成功率高、操作简单、患者创伤小、安全,值得临床推广应用.     

双镜联合保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者疗效对比分析*

目的 比较采取双镜联合保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者的疗效。方法 2015年2月～2020年2月我院收治的78例胆囊结石患者,其中36例接受腹腔镜联合胆道镜保胆取石术,另42例接受腹腔镜胆囊切除术,术后随访12个月。采用ELISA法或双抗体夹心免疫发光法检测血清皮质醇(COR)和C反应蛋白(CRP)。结果 观察组手术时间和住院费用分别为(53.3±17.7)min和(3.2±0.5)万元,显著长于或高于对照组【(36.7±10.8)min和(2.3±0.4)万元,P＜0.05】,术后进食和肛门排气时间分别为(2.8±0.9)h和(14.9±3.2)h,均显著短于对照组【分别为(3.3±0.7)h和(19.3±4.1)h,P＜0.05】;在术后3 d,观察组血清CRP和COR水平分别为(11.2±3.1)mg/L和(195.6±30.8)ng/mL,显著低于对照组【分别为(19.0±4.9)mg/L和(211.6±32.7)ng/mL,P＜0.05】;术后2周行超声检查,发现观察组患者胆囊功能完好,无结石残留;随访3个月,观察组患者出现切口感染、腹泻、反流性胃炎、胆道出血和急性胰腺炎等并发症发生率为11.1%,显著低于对照组【31.0%,P＜0.05】;在随访12个月末,观察组结石复发为2.8%。结论 采取双镜联合保胆取石术治疗胆囊结石患者可能更有利于患者胃肠功能的恢复,减少术后并发症的发生,值得进一步探索。     

Laboratory Study on the Stability of Large-Size Graded Crushed Stone under Cyclic Rotating Axial Compression

In this paper, the stability of large-size graded crushed stone used for road base or cushioning under repeated load is investigated. Using an in-house developed device, large-size crushed stone mix was compacted and molded by the vibration and rotary compaction method. Cyclic rotating axial compression was applied, and the shakedown theory was used to study the cumulative deformation of the large-size crushed stone specimens. The effects of gradation parameters on the cumulative strain and stability behavior were analyzed, and the critical stability and failure loads were determined according to the shakedown theory. The test results indicate that there are three obvious instability behavior stages of large-size graded crushed stone under cyclic rotating axial compression: elastic stability, plastic creep, and incremental plastic failure. Large-size graded crushed stone has a higher critical stability load stiffness than conventional-size graded crushed stone. The critical shakedown load of the specimen is mainly affected by the skeleton structure performance, and the critical failure load by the properties of the crushed stone material. Increasing the content and compactness of large-size crushed stone in the specimen can improve the stiffness and stability performance, and to achieve improvements, the content of large-size crushed stone should be controlled between 22% and 26%. The critical shakedown load increases with the increase in the California bearing ratio (CBR) value, while, on the other hand, the CBR value has little relationship with the critical failure load.     

Laboratory Evaluation of the Performance of Stone Mastic Asphalt as an Ungrooved Runway Surface

Many airports are surfaced with grooved Marshall-designed dense graded asphalt. Grooving is required to satisfy regulatory aircraft skid resistance requirements, but introduces the risk of groove-related distress, such as groove closure. Consequently, airports seek an ungrooved runway surface option that performs similarly to dense graded asphalt but allows grooving to be avoided. Stone mastic asphalt is the most viable ungrooved runway surface solution and has been used on runways in Europe and China. However, before being accepted as an ungrooved runway surface in Australia, stone mastic asphalt must be shown to meet regulatory runway aircraft skid resistance requirements, and to otherwise perform similarly to typical dense graded asphalt mixtures for runway surfacing, including deformation resistance, fatigue cracking resistance and durability. Based on laboratory performance-related testing, 10-mm and 14-mm sized stone mastic asphalt mixtures, produced with four different aggregate sources, were found to generally meet the airport asphalt performance requirements. The 14 mm mixture was found to perform better than the 10 mm mixture, particularly regarding surface macrotexture and deformation resistance. It was concluded that airports should consider 14 mm sized stone mastic asphalt as an ungrooved runway surface in the future.     

Pathogenesis of black stones

We used infrared absorption spectroscopy to clarify the characteristics of black pigment in gallstones, which is insoluble and amorphous, and is considered to be a polymer of bilirubin or calcium bilirubinate with tetrapyrrol units. Black stones contain several metallic elemental components that exist as complex compounds with bilirubin. Chemical analysis of gallbladder bile indicates that the mechanism by which unconjugated bilirubin is precipitated depends on the pH level or on bile acid components. Black pigment is formed by the bridging action of mucin, forming complexes with metal ions in the bile. Hemolytic jaundice, liver cirrhosis, and cardiac valve replacement have been implicated in the etiology of black stone formation. In hemolytic jaundice and cardiac valve replacement, overproduction of bilirubin, due to hemolysis, is responsible for black stone formation, while in liver cirrhosis, a high concentration of ionized calcium and increased pH levels are the main factors in such stone formation.