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关键词： 经尿道前列腺电切术   经尿道前列腺等离子电切术   良性前列腺增生  

摘要： 目的探讨经尿道前列腺等离子电切术治疗良性前列腺增生的临床效果。方法回顾性分析我院于2015年1月~2019年6月收治的138例良性前列腺增生患者的临床资料,依据患者所接受的治疗方案将其分为对照组(69例)与观察组(69例),对照组患者采用经尿道前列腺电切术治疗,观察组患者采用经尿道前列腺等离子电切术治疗。比较两组患者的手术指标、前列腺症状评分剩余尿量,分析两组患者的阴茎勃起功能障碍发生率、逆行射精发生率。结果观察组患者的手术耗时、术后膀胱冲洗时间以及留置导尿管时间均短于对照组,差异有统计学意义(P<0.05);观察组患者的术中出血量、剩余尿量少于对照组,差异有统计学意义(P<0.05);观察组患者的前列腺症状评分(IPSS评分)、阴茎勃起功能障碍发生率以及逆行射精发生率均低于对照组,差异有统计学意义(P<0.05)。结论经尿道前列腺等离子电切术治疗良性前列腺增生的效果显著,其可促进患者机体康复。

关键词： 前列腺增生   钬激光前列腺剜除术   经尿道前列腺等离子双极电切术   治疗结果   安全性  

摘要： 目的观察钬激光前列腺剜除术(HoLEP)与经尿道前列腺等离子双极电切术(TUPKP)治疗不同体积良性前列腺增生(BPH)患者的疗效及安全性。方法回顾性分析2017年1月至2019年1月重庆医科大学附属第一医院泌尿外科收治的239例BPH患者,其中147例行HoLEP(HoLEP组),92例行TUPKP(TUPKP组)。根据前列腺体积大小将以上两组患者再分别分为3个亚组(Group 1:<30 mL;Group 2:30~80 mL;Group 3:>80 mL)。分别比较HoLEP组与TUPKP组相对应亚组间的基本资料、围术期资料及术后随访指标。结果HoLEP各亚组切除标本质量、组织剜除(切除)率明显高于TUPKP组(P<0.05),血红蛋白下降值、膀胱冲洗时间、导尿管留置时间、术后住院时间明显少于TUPKP组(P<0.05),HoLEP与TUPKP各亚组手术时间无明显差异(P>0.05)。HoLEP组术后尿失禁发生率明显高于TUPKP组(P<0.05),两组输血率、尿道狭窄率、膀胱颈挛缩率无明显差异(P>0.05);术后随访国际前列腺症状评分(IPSS)、生活质量评分(QoL评分)、最大尿流率(Qmax)、排尿量、排尿时间、残余尿(PVR)在HoLEP与TUPKP各亚组间无明显差异(P>0.05),术后随访6个月各亚组IPSS及QoL评分较术前明显降低(P<0.01)。结论HoLEP和TUPKP治疗各种体积大小的前列腺增生均安全有效,HoLEP较TUPKP出血更少,组织剜除更彻底,更利于患者快速康复。

摘要： a video of this article

关键词： steroids   cortisol   Cushing's syndrome   PBMAH   mass-spectrometry   ARMC5  

摘要： Biochemical characterization of primary bilateral macronodular adrenocortical hyperplasia (PBMAH) by distinct plasma steroid profiles and its putative correlation to disease has not been previously studied. LC- MS/MS-based steroid profiling of 16 plasma steroids was applied to 36 subjects (22 females, 14 males) with PBMAH, 19 subjects (16 females, 3 males) with other forms of adrenal Cushing's syn drome (ACS), and an age and sex-matched control group. Germline ARMC5 sequencing was performed in all PBMAH cases. Compared to controls, PBMAH showed increased plasma 11-deoxycortisol, corticosterone, 11-deoxycorticosterone, 18-hydroxycortisol, and aldosterone, but lower progesterone, DHEA, and DHEA-S with distinct differences in subjects with and without pathogenic variants in ARMC5. Steroids that showed isolated differences included cortisol and 18-oxocortisol with higher (P < 0.05) concentrations in ACS than in controls and aldosterone with higher concentrations in PBMAH when compared to controls. Larger differences in PBMAH than with ACS were most clear for co rticosterone, but there were also trends in this direction for 18-hydroxycortisol and aldosterone. Logistic regression analysis indicated four steroids - DHEA, 11-deoxycortisol, 18-oxocortisol, and corticosterone - with the most power for distinguishing the groups. Discriminant analyses with step- wise variable selection indicated correct classification of 95.2% of all subjects of the four groups using a panel of nine steroids;correct classification of subjects with and without germline variants in ARMC5 was achieved in 91.7% of subjects with PBMAH. Subjects with PBMAH show distinctive plasma steroid profiles that may offer a supplementary single-test alternative for screening purposes.

关键词： 经尿道前列腺电切术   良性前列腺增生症   并发症  

摘要： 探讨对良性前列腺增生症(BPH)应用经尿道前列腺电切术(TURP)的价值。方法:回顾性分析56例BPH患者的临床资料,对患者均采取TURP治疗,评价治疗效果。结果:术后1个月在IPSS评分与膀胱残余尿量均较术前时刻降低,最大尿流率较术前提高,对比差异均有统计学意义(P<0.05)。结论:在BPH的治疗中,采取TURP的治疗方式具有满意的效果,值得推广。

关键词： 经尿道钬激光前列腺剜除术   经尿道前列腺电切术   复发性良性前列腺增生   治疗效果  

摘要： 目的:对经尿道钬激光前列腺剜除术(HoLEP)与经尿道前列腺电切术(TURP)治疗复发性良性前列腺增生的效果进行对比分析.方法:选择2019年1月—7月在我院接受治疗的68例复发性良性前列腺增生患者为对象,将其分成实验组及对照组,每组各34例患者.实验组患者采用的是HoLEP治疗法,对照组患者采用TURP治疗法,对两种手术方案的安全性和疗效进行比较分析.结果:HoLEP组患者的留置导尿管时间为(57.89±6.7)h,膀胱冲洗时间为(37.78±2.4)h,住院时间为(2.01±0.78)天,TURP组留置导尿管时间为(74.82±9.8)h,膀胱冲洗时间为(65.63±5.7)h,住院时间为(4.79±1.67)天,HoLEP组患者的导尿管留置时间、住院时间以及膀胱冲洗时间均短于TURP组,差异具有统计学意义(P<0.05).结论:在复发性良性前列腺增生患者的临床治疗中,HoLEP的治疗效果与TURP相当且术后拔管时间短,住院时间短,值得应用.

关键词： Calcium-sensing receptor   Vitamin D receptor   Glial cells missing 2   CKD-MBD   Secondary hyperparathyroidism  

摘要： Background Chronic kidney disease (CKD) disrupts mineral homeostasis and its main underlying cause is secondary hyperparathyroidism (SHPT). We previously reported that calcium-sensing receptor (CaSR) mRNA and protein expression in parathyroid glands (PTGs) significantly decreased in a CKD rat model induced by a 5/6 nephrectomy that were fed a high phosphorus diet. However, there was a significant difference in the severity of CKD between high phosphorus and adequate phosphorus diet groups. Thus, it was unclear whether CKD environment or the high phosphorus diet influencedCaSRexpression, and the underlying mechanism remains largely unknown. Methods CKD was induced in rats with 0.75% adenine-containing diet. CKD and control rats were maintained for 5 days and 2 weeks on diets with 0.7% or 1.3% phosphorus. For gene expression analysis, quantitative real-time polymerase chain reaction was performed with TaqMan probes. Protein expression was analyzed by immunohistochemistry. Results PTG CaSR expression significantly decreased in the presence of a severe CKD environment, even without the high phosphate load. Ki67 expressing cells in PTGs were significantly higher only in the CKD rats fed a high phosphorus diet. Furthermore, among the many genes that could affectCaSRexpression, only vitamin D receptor (VDR) and glial cells missing 2 (Gcm2) showed significant changes. Moreover,Gcm2was significantly reduced at an early stage without significant changes in serum calcium, phosphorus and 1,25(OH)(2)vitamin D, and there was no significant reduction inCaSRandVDRexpressions. Then, significantly elevated Ki67-positive cell numbers were also only observed in the early CKD PTGs with high-phosphorus diets. Conclusions Our data suggest that the cause of the decreased PTGCaSRexpression is the reduction inVDRandGcm2expression;Gcm2 may play a role in the onset and progression of SHPT.

关键词： 良性前列腺增生   经尿道前列腺电切术   经尿道保留前列腺前叶等离子剜除术   效果  

摘要： 比较经血浆摘除术经前列腺前列腺电切术和经前列腺经尿道电切术治疗前列腺增生的临床效果。方法:研究对象为我院接收的前列腺增生患者,主要在2017年11月至2019年12月期间选取56例,患者分组方法为不同手术方法,分为对照组、观察组,各28例。行经尿道前列腺电切术的患者列入对照组,而行经尿道穿刺术以保留前前列腺的患者例入观察组,比较两组的各项手术指标。结果:与对照组相比,观察组的手术时间,永久性导管时间、术后膀胱冲洗时间更短,术中出血量更少(P<0.05)。结论:针对良性前列腺增生患者,积极实施尿道保留前列腺前叶等离子剜除术,能进一步提升治临床效果,减少并发症的发生。

关键词： 严重急性呼吸综合征   继发感染   靶器官   免疫缺陷   免疫细胞   病原特点   病理生理机制   心血管系统  

摘要： 新型冠状病毒感染疾病(COVID-19)是一种由新型冠状病毒(2019-nCoV)引起的传染病,基本特征以肺部炎性病变为主。目前正在全球迅速蔓延。该文比较近二十年间发生的两次人类冠状病毒严重急性呼吸综合征(SARS)和COVID-19的病原特点、受体分布、临床表现和病理改变,试图揭示COVID-19的病理生理机制,为治疗患者和疫情管控提供新思路。分析表明,由于2019-nCoV和SARS冠状病毒在人体细胞上有相同的受体(ACE2),因而它们可能有相同的靶器官,如肺、心血管系统和免疫系统。病理改变除了病毒直接损伤靶器官中的功能细胞外,还与病毒诱导靶细胞产生促炎因子造成局部严重炎性反应有关。同时,促炎因子还过度激活了免疫细胞尤其是单核-巨噬细胞和T细胞,产生大量细胞因子形成细胞因子风暴(cytokine storm)。过量的细胞因子不但加剧了靶器官的炎性反应,还引起T细胞凋亡和免疫功能失调,造成免疫缺陷而不能有效清除病毒并造成继发感染。因此,在重症患者的管理上,除了生命支持及抗感染治疗外,有效控制肺部炎性反应和系统性拮抗细胞因子风暴可能有助于纠正缺氧,避免多器官衰竭乃至死亡。

关键词： 前列腺增生   针灸疗法   综述  

摘要： 查阅针灸治疗良性前列腺增生症(BPH)的相关文献,从文献研究、实验机制研究、临床研究3个方面进行阐述,系统整理了运用普通针刺、电针、火针、灸法、穴位贴敷、穴位埋线及针灸结合等其他综合疗法对BPH的治疗效果,认为针灸疗法具有“疗效突出、性价比高、安全无毒副作用”等优势。并对目前研究中所存在的不足作简要分析,以期完善试验研究,为针灸治疗BPH提供新思路。