Value of preoperative urine white blood cell and nitrite in predicting postoperative infection following percutaneous nephrolithotomy: a meta-analysis

BackgroundTo evaluate to what degree preoperative urine white blood cell (WBC) and urine nitrite (NIT) values are predictive of postoperative infections following percutaneous nephrolithotomy (PCNL).MethodsA systematic literature search was performed of the PubMed, Embase, Cochrane Library, Wanfang Data, National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (CSTJ or VIP) online databases to identify relevant studies that examined the predictive value of urine WBC or NIT as risk factors for post-PCNL infection, and the search was finished on February 28, 2020. Two independent reviewers screened the relevant studies, extracted necessary data from the eligible case-control studies (CCS), and assessed the quality of included studies through the Newcastle-Ottawa scale (NOS). RevMan 5.3 software and the Stata 16.0 software were used to complete the statistical analysis of data. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs).ResultsAccording to the statistical analysis of 12 eligible studies involving 6113 patients, positive urine WBC (WBC+: OR =3.86, 95% CI: 3.03–4.91, P<0.001) and positive NIT (NIT⁺: OR =7.81, 95% CI: 5.44–11.21, P<0.001) in preoperative tests were identified as independent risk factors for postoperative infections following PCNL.ConclusionsIn summary, as risk factors for postoperative infections, the presence of preoperative urine WBC+ and NIT+ should be evaluated as part of clinical procedure, in order to reduce infections of PCNL.     

磁共振非高斯弥散加权成像评价健康脑白质和脑胶质瘤水弥散微环境的可重复性研究

目的 探讨磁共振22b值(0～ 5000 s/mm2)非高斯弥散加权成像在健康成人脑白质和胶质瘤应用的可重复性.方法 12名健康志愿者和65名胶质瘤患者进行22 b值eDWI(enhanced diffusion weighted imaging)磁共振扫描.前者进行连续2次eDWI扫描,选取基底节层面和半卵圆中心层面深部白质为感兴趣区;后者进行单次eDWI扫描,由2名神经放射医师分别在肿瘤最大层面的肿瘤实质区放置感兴趣区,工作站进行双指数和拉伸指数模型后处理;前者对2次扫描双指数模型拟合的慢弥散系数Dslow(slow diffusion coefficient)、快弥散系数Dfast(fast diffusion coefficient)和快弥散容积分数PF(perfusion fraction of Dfast)以及拉伸指数模型拟合的分布弥散系数DDC(distributed diffusion coefficient)和不均质指数α进行配对t检验、计算变异系数(coefficient of variability,CV)和绘制Bland-Altman(B-A)散点图;后者对2次测量的Dslow、Dfast、PF、DDC和α进行观察者间一致性检验,并计算CV.结果 健康志愿者各参数2次测量配对比较差异均无统计学意义(P＞0.05),CV值均小于5％,B-A散点图绝大多数(≥11/12)测值均位于95％一致性范围内;胶质瘤各参数2次测量一致性系数均大于0.75(P＜0.001),Dfast和PF的CV值最大,范围在5.0％～11.5％之间,其次是DDC和Dslow,α最小,CV值小于2％,除α外,其余参数CV值均随胶质瘤级别增高而增大.结论 健康脑白质评价中非高斯弥散加权成像各参数均具有较好的可重复性;胶质瘤评价中拉伸指数模型α具有最好的可重复性.     

卒中患者脑白质损伤与运动功能的相关性研究

目的 研究卒中偏瘫患者脑白质结构的损伤程度,并探讨脑白质损伤与运动功能障碍的相关性.方法 对17例卒中偏瘫患者和21例健康对照进行大脑DTI数据扫描,应用TBSS方法对两组被试的部分各项异性(FA)、轴向弥散系数(λ1)、径向弥散系数(λ23)进行统计分析;通过约翰霍普金斯白质分区图谱提取卒中患者组的感兴趣区域,并与上肢肢体运动功能评分进行相关分析.结果 卒中患者在患侧皮质脊髓束、额枕下束、钩束、丘脑前辐射、上纵束、胼胝体额部和双侧胼胝体枕部的FA值显著降低(P＜0.005);患侧皮质脊髓束的λ1值也显著降低(P＜0.05),患侧皮质脊髓束、额枕下束、钩束、丘脑前辐射、胼胝体额部以及双侧上纵束、胼胝体枕部的λ23值显著升高(P＜0.01).患侧皮质脊髓束的λ1值与上肢Fugl-Meyer运动功能评分存在显著正相关(P＜0.05).结论 卒中患者脑白质纤维束的结构完整性有明显损伤,患侧皮质脊髓束的λ1值可以反映卒中患者运动功能障碍的程度.     

芥子气经腹腔和气管致大鼠急性肺损伤细胞凋亡的变化

目的  经腹腔和气管建立大鼠芥子气（SM）急性肺损伤动物模型,比较两种大鼠急性肺损伤模型细胞凋亡的差异。方法  选取Sprague Dawley大鼠136只,随机分为5组,正常对照组8只,其他4个组为腹腔SM组、腹腔丙二醇对照组、气管SM组、气管丙二醇对照组,每组32只。腹腔SM组腹腔内注入稀释的SM 0.1 ml（0.96 LD50=8 mg/kg）,气管SM组气管内注入稀释的SM 0.1 ml（0.98 LD50=2 mg/kg）,正常对照组未做任何处理。采用末端脱氧核苷酸转移酶介导的dUTP缺口末端标记测定法（TUNEL）染色和免疫组织化学法及电镜观察,判断细胞凋亡情况。结果  ①腹腔SM组各时间段肺泡间隔TUNEL染色阳性细胞表达率较气管SM组增多（P <0.05）。②腹腔SM组各时间段肺泡间隔凋亡蛋白Bax阳性表达率较气管SM组升高（P <0.05）;腹腔SM组各时间段肺泡间隔凋亡蛋白Bcl-2阳性表达率较气管SM组降低（P <0.05）。③腹腔SM组各时间段肺泡间隔凋亡蛋白酶Caspase-3、Caspase-9阳性表达率较气管SM组增多（P <0.05）。④电镜显示,染毒72 h,腹腔SM组和气管SM组Ⅰ型和Ⅱ型肺泡上皮凋亡细胞形态特征为上皮细胞膜附着的微绒毛断裂缺失,排列紊乱;线粒体嵴模糊,粗面内质网表面附着的核糖体脱离,并游离于细胞质中。结论  SM经腹腔和气管染毒致大鼠急性肺损伤,通过内源性通道引发细胞凋亡调节异常,SM经腹腔染毒大鼠各项细胞凋亡指标比经气管明显升高,推测可能与SM腹膜腔的快速吸收有关。

     

Effect of Zataria multiflora Extract on Total and Differential White Blood Cell Count and Endothelin Level in Blood of Ovalbumin Sensitized Guinea Pigs

Objective: To investigate the effect of hydro-ethanolic extract of Zataria multiflora (Z. multiflora) on endothelin level, total and differential white blood cells (WBC) count of sensitized guinea pigs. Methods: Five groups of guinea pigs sensitized to ovalbumin (OA) were given drinking water alone (group S), drinking water containing three concentrations of Z. multiflora (0.2, 0.4 and 0.8 mg/mL as groups S+Z1, S+Z2 and S+Z3) and dexamethasone (group S+D), n=6 for each group. The endothelin levels as well as total and differential WBC count in blood of sensitized and control guinea pigs were evaluated using enzyme linked immunosorbent assay method, and hemocytometer and Wright-Giemsa''s staining of blood sample smear respectively. Results: Blood endothelin levels, total and most differential WBC count were increased but lymphocytes decreased in sensitized animals compared to controls (all P<0.01). In groups S+D, S+Z2 and S+Z3 endothelin level, total and differential WBC counts were significantly improved compared with group S (P<0.01). Although, all measured parameters in group S+Z1 was lower than group S+D (P<0.01), some parameters in group S+Z3 were greater than in group S+D (P<0.05 to P<0.01). Conclusion: The results showed an anti-inflammatory effect of Z. multiflora extract in sensitized guinea pigs, which may suggest a therapeutic potential for the plant on asthma.     

急性化脓性胆管炎患者血清免疫抑制酸性 蛋白水平的变化及其临床意义

目的 研究急性化脓性胆管炎（APC）患者血清免疫抑制酸性蛋白（IAP）水平,并探讨其临床 意义。方法 选取2017 年1 月—2018 年12 月浙江新安国际医院有限公司和嘉兴市中医医院收治的APC 患 者160 例作为APC组,同期健康体检者160 例作为对照组。测定IAP、中性粒细胞、淋巴细胞、C反应蛋白（CRP）、 白细胞计数（WBC）、碱性磷酸酶（ALP）及直接胆红素（DBIL）水平,计算中性粒细胞/ 淋巴细胞比值 （NLR）。结果 APC 组治疗前IAP、CRP、WBC、ALP 及DBIL 水平和NLR 值高于对照组（P <0.05）。重 症组血清IAP、CRP、WBC、ALP、DBIL 及NLR 高于轻症组（P <0.05）。APC 组治疗后血清IAP、CRP、 WBC、ALP、DBIL 及NLR 低于治疗前（P <0.05）。APC 患者血清IAP 水平与NLR、CRP、WBC、ALP 及 DBIL 呈正相关（r =0.702、0.684、0.573、0.487 和0.526,均P =0.000）。结论 APC 患者血清IAP 水平升高, IAP 水平在APC 病情严重程度、炎症反应及疗效评估中具有一定指导价值。     

The association between white matter changes and development of malignant middle cerebral artery infarction: A case–control study

Disrupted blood–brain barrier (BBB) in patients with ischemic stroke plays a critical role in malignant middle cerebral artery infarction (MMI) development.Cerebral white matter changes (WMC), particularly in the deep subcortical area or in severe one, may be also underlain by disrupted BBB. It is unclear whether the presence of WMC with potential premorbid disruption of BBB makes patients susceptible to MMI. Therefore, this study aimed to clarify any putative relationship between the MMI and WMC in terms of their severity and locations.In this case–control study, patients with infarction in the middle cerebral artery territory were retrospectively reviewed. Brain magnetic resonance images were analyzed according to Fazekas scale, and identified WMC were divided into periventricular WMC (PV-WMC) and deep subcortical WMC (deep-WMC). Patients were scored as having WMC, PV-WMC, deep-WMC, severe PV-WMC, and severe deep-WMC according to the severity and locations. Patients were defined as having MMI if either a progressive conscious disturbance or signs of uncal herniation was recorded in combination with a midline shift >5 mm identified on the follow-up computed tomography.Among 297 patients admitted between July 2009 and February 2015, 92 patients were eligible for final analysis. Compared to patients without MMI, patients with MMI had a higher score of National Institutes of Health Stroke Scale, a larger infarct volume, and an increasingly greater proportion of severe PV-WMC, deep-WMC, and severe deep-WMC, respectively. After adjustment for sex, age, infarct volume, and history of hypertension, severe deep-WMC (odds ratio [OR] = 6.362, 95% confidence interval [CI] = 1.444–28.023, P = .0144) and severe PV-WMC (odds ratio = 5.608, 95% confidence interval = 1.107–28.399, P = .0372) were significantly associated with MMI development.MMI and WMC are significantly associated such that MMI development is more likely when PV-WMC or deep-WMC is more severe. We hypothesize that Fazekas scale-defined severe deep-WMC and PV-WMC may be considered as clinically approachable predictors of MMI development. These findings support that the WMC with potential premorbid disrupted BBB may make patients susceptible to MMI, and further prospective study should be conducted to clarify this hypothesis.