慢性肾脏疾病透明质酸变化的观察及其临床意义的探讨

为了探讨透明质酸(hyaluronic acid,HA)任慢性肾脏疾病中的价值,本文采用HA放免分析法,检测了52例慢性肾脏疾病患者血清HA(SHA)及尿HA(UHA)含量,观察厂血液透析(HD)病人HD前后SHA变化,并用健康成年人HA作对比分析,初步探讨了SHA和UHA在慢性肾脏疾病时变化的临床价值。     

EPCA-2:前列腺癌高特异性血清肿瘤标志物

前列腺特异抗原(PSA)的发现对于前列腺癌的早期诊断具有里程碑意义。PSA筛选的广泛应用使转移阶段的前列腺癌、早期浸润前列腺癌获得了有效的治疗,并降低了疾病的死亡率。但前列腺其他疾患(如BPH、前列腺炎等)亦可有PSA升高,使得PSA的特异性稍显不足。蛋白组学的发展推动了高特异性新肿瘤标志物的发展。细胞核改变是癌症的显著标志。研究发现,不仅人类BPH和前列腺癌的细胞核结构蛋白组分不同,而且大鼠正常前列腺、前列腺癌和转基因小鼠前列腺癌模型的细胞核蛋白组分亦差别明显。作者在前列腺癌核结构蛋白组学研究中发现了两个独立的…     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

慢性肾功能衰竭左心室功能变化的观察

左心室收缩时间间期(STI)的测定和超声心动图(UCG)的检查是反映左心室功能的有效手段。本文对24例慢性肾功能衰竭(CRF)患者所做的STI和UCG的结果进行统计分析,并探讨其临床意义。     

膀胱无功能恶性嗜铬细胞瘤一例报告

患者,女,52岁。1990年3月B超检查时发现膀胱后壁有一肿块入院。患者曾有一次无痛性肉眼血尿,排尿时无任何不适。入院时尿常规阴性,血压17.2/11.3kPa。膀胱镜检:膀胱后壁、输尿管间嵴上方有一球形肿块1.5×1.5cm,其表面粘膜光滑,血管纹理清晰。B超示膀胱后壁有1.2×0.8cm肿块,     

中国HIV-1 CRF01_AE流行株结构基因和调节/辅助基因DNA疫苗的构建和免疫原性研究

目的 构建表达gag-env融合基因和tat-rev-integrase(c-holf)-vif-nef融合基因的DNA疫苗,并评价其免疫原性.方法 按人源密码子使用频率对AE2f株的gag、env、tat、rev、integrase、vif和nef基因序列进行优化,构建真核表达质粒.用Western blot法验证体外表达情况;用ELISPOT法检测小鼠的细胞免疫反应.结果 限制性酶切及DNA测序结果表明两个融合基因质粒构建正确,可以表达相应的融合蛋白.ELISPOT结果显示,Gag-Env特异性的T细胞反应强度为(3010±566)SFC/10~6脾细胞;Tat-Rev-Integrase(C-half)-Vif-Nef融合蛋白特异性的T细胞反应为(948±737)SFC/10~6脾细胞,均显著高于空载体组.结论 构建的表达HIV-1 CRF01_AE流行株gag-env融合基因和tat-rev-integrase(c-half)-vif-nef融合基因的DNA疫苗可以正确表达所编码的融合蛋白并有效地激活机体的T细胞免疫反应.     

脾破裂28例治疗体会

目的:探讨创造性脾破裂的诊断及治疗方法。方法:对28例外伤性脾破裂诊治资料进行分析。结果:28例出现并发症4例,但全部治愈。结论:外伤性脾破裂的诊断,确诊后的损伤分级,是否手术治疗,采取何种手术方法是保证治愈率、降低并发症的关键。     

胆总管探查术中胆总管一期缝合27例报道

目的探讨胆总管探查术中胆总管一期缝合的可行性及临床价值和技术特点。方法回顾分析27例患者应用术中胆道镜进行胆总管探查后行一期缝合情况。结果27例行胆总管一期缝合的患者中胆漏1例，黄疸2例，27例均痊愈。结论胆总管探查术中胆总管一期缝合是安全可行的，但必须注意指征的严格掌握。     

复杂性尿道狭窄的外科治疗

目的 提高复杂性尿道狭窄的治疗效果。方法 复杂性后尿道狭窄采用经会阴或耻骨的尿道端吻合术。复杂性前尿道狭窄采用前尿道劈开,二期尿道成形术。女性尿道闭锁采用双阴唇带蒂皮瓣尿道成形术。结果 ３０例复杂性尿道狭窄手术后,２４例（８０％）排尿通畅,４例（１３％）排尿不畅,２例（７％）失败。结论 开放性手术是复杂性尿道狭窄治疗的首选方法。     

超长段尿道狭窄术后勃起功能的评估

目的 探讨自体组织替代治疗超长段尿道狭窄对勃起功能的影响.方法 回顾性分析2007年1月至2009年1月采用不同自体组织补片(阴囊纵隔、包皮内板、口腔黏膜)Onlay术式替代治疗超长段男性尿道狭窄患者的临床资料,并随访患者ⅡEF-5评分、QOL评分及最大尿流率,并与术前相应情况进行分析.结果 根据研究标准收集23份有效数据.患者术前及术后3、6、12个月QOL评分分别为5.22±0.75、1.22±1.40、1.82±1.17、2.07±0.46,最大尿流率分别为(3.93±3.62)、(22.46±4.65)、(23.81±6.22)、(21.52±7.44)ml/s,术后不同时期均较术前明显改善(P＜0.01).术前及术后3、6、12个月ⅡEF-5评分分别为14.47±9.55、14.70±5.32、14.26±3.29和14.58±3.62,组间比较差异无统计学意义(P＞0.05).9例狭窄部位累及至后尿道者术后3、6、12个月ⅡEF-5评分分别为11.67±2.59、12.35±1.83、13.19±1.67,14例单纯前尿道狭窄者分别为17.79±6.42、16.57±4.78、16.01±3.85,2组间比较差异均有统计学意义(P＜0.05).狭窄累及后尿道患者多元线性回归分析中,年龄、受伤时间及尿道狭窄段长度与替代术后ⅡEF-5评分呈多元线性相关.结论 自体组织替代治疗男性超长段尿道狭窄对勃起功能影响不明显;狭窄段累及后尿道时可能对患者勃起功能产生一定影响.患者年龄和受伤时间对勃起功能有协同影响作用.

Abstract：

Objective To investigate the effect of substitutive reconstruction of long urethral stricture on male erectile function. Methods From January 2007 to January 2009, 23 patients with anterior or posterior long urethral stricture were accepted for a variety of onlay substitutive procedures, including lingual mucosa, perputial skin, and mid-scrotal skin. During the follow-up, data from the International Index of Erectile Function-5 (ⅡEF-5) questionnaire and the Quality of Life (QOL) questionnaire as well as maximal flow rate were recorded. All data were compared with those obtained before surgery. Results Significant improvement in QOL (1.22 ± 1.40, 1.82 ± 1. 17,2.07± 0.46) and maximal flow rate (22.46± 4.65, 23.81 ± 6.22, 21.52 ±7.44 ) could be observed 3, 6 and 12 months after surgery compared with those before surgery (5. 22 ± 0. 75, 3. 93 ± 3. 62)(P＜0.01). No significant differences in the responses to the ⅡEF-5 questionnaire were observed among all patients during the follow-up (P＞0. 05). At the 3, 6 and 12 months after procedure,scores of ⅡEF-5 in patients with anterior urethral stricture ( 17.79 ± 6.42, 16. 57 ± 4. 78, 16.01 ±3.85) were significantly higher than those with posterior urethral stricture (11.67 ± 2.59, 12.35 ±1.83,13. 19±1.67, P＜0.05). In patients with posterior urethral stricture, the multiple linear regression showed that age, time interval of injury and length of stricture were related to the ⅡEF-5score (P＜0.05). Conclusions Substitutive reconstruction for treating the long urethral stricture has little effect on male erectile function. But the location of stricture, especially extended to posterior urethra, may have impact on the erectile function.