教学课程资源库 更多>>

关键词： 21-羟化酶缺陷   先天性肾上腺皮质增生症   身高   生长平衡  

摘要： 21-羟化酶缺陷(21-hydroxylase deficiency,21-OHD)是先天性肾上腺皮质增生症(congenital adrenal hyperplasia,CAH)最常见的类型。21-OHD对儿童生长发育有多方面的影响,包括成年身高低于正常、青春发育提前和代谢相关并发症等。获得尽可能正常的成年身高是21-OHD患者治疗的重要目标。通过尽早诊断、合理使用肾上腺皮质激素治疗、结合辅助药物治疗(如生长激素、促性腺激素释放激素类似物、芳香化酶抑制剂等),并进行规范的治疗监测,可有效减少身高损失,实现生长平衡。

关键词： 骨关节炎   软骨下骨   RB1CC1   成骨   骨代谢   BSP2   硬化   血管形成  

摘要： 背景:骨关节炎以关节软骨的退变和软骨下骨的重建为主要病理特征。骨关节炎的具体发病机制目前仍未清楚,大部分研究以软骨与软骨下骨为主要切入点,探索疾病过程中的分子机制和信号通路变化,为骨关节炎的诊断与治疗提供新的生物靶点和研究方向。目的:探讨在骨关节炎进程中软骨下骨RB1CC1的表达情况。方法:8周龄C57小鼠随机分为实验组和假手术组,实验组又随机分为4周和8周2个亚组。实验组小鼠行右侧膝关节内侧半月板胫骨韧带切除,游离内侧半月板,诱导骨关节炎;假手术组小鼠则仅切开关节囊而不行内侧韧带切除和半月板游离。实验方案于2017-12-13经南方医科大学第三附属医院动物实验伦理委员会批准,批准号为No.44007200038731。结果与结论:与假手术组相比,实验组骨关节炎RSI评分均显著升高,关节软骨面Ⅱ型胶原表达降低,软骨下骨中的RB1CC1表达逐渐升高,RB1CC1与成骨相关指标BSP2的表达趋势有一致性;提示随着骨关节炎进程的发展,软骨下骨的RB1CC1表达逐渐增多,可能与促进软骨下骨增生及重塑有关。

关键词： 良性前列腺增生   加速康复外科理念   围手术期护理   效果  

摘要： 目的探讨加速康复外科理念在良性前列腺增生(BPH)围手术期护理中的效果。方法 92例良性前列腺增生患者,随机分为对照组和观察组,每组46例。对照组围手术期行常规护理,观察组围手术期实施加速康复外科理念。比较两组术后恢复指标,并发症发生情况,术前术后国际前列腺症状评分表(IPSS)评分及视觉模拟评分法(VAS)疼痛评分,护理满意度。结果观察组患者的肛门排气时间、下床活动时间、留置尿管时间、膀胱冲洗时间、住院时间均明显短于对照组,差异具统计学意义(P<0.05)。观察组患者的并发症发生率17.39%明显低于对照组的41.30%,差异具有统计学意义(P<0.05)。两组患者术前IPSS评分及VAS疼痛评分比较,差异无统计学意义(P>0.05);观察组拔除导尿管后的IPSS评分明显低于对照组,且术后1、5 d的VAS疼痛评分明显低于对照组,差异具有统计学意义(P<0.05)。观察组患者服务与技术、环境与指导、关心与爱护的护理满意度分别为97.83%、100.00%、97.83%,均明显高于对照组的80.43%、78.26%、76.09%,差异具有统计学意义(P<0.05)。结论良性前列腺增生围手术期护理中采取加速康复外科理念效果显著,能有效加快术后恢复速度,减轻疼痛及前列腺症状,降低并发症发生率,提高康复质量,并提升了护理满意度,具有积极的临床意义。

关键词： 良性前列腺增生   下尿路症状   膀胱出口梗阻   膀胱出口梗阻指数   尿动力学  

摘要： 目的:评估膀胱出口梗阻指数(BOOI)在BPH诊断中的临床应用价值。方法:回顾性收集分析2016年7月至2018年9月收治并诊断为BPH的199例患者的尿动力学检查结果并计算BOOI,根据BOOI结果分为BOO组、可疑BOO组以及无BOO组,比较3组患者前列腺体积(PV)、国际前列腺症状评分(IPSS)、排尿期IPSS(IPSS-VS)、生活质量(QOL)评分、最大尿流率(Qmax)以及残余尿量(PVR)。使用Pearson直线相关性分析判断BOOI与PV、IPSS、IPSS-VS、QOL、Qmax、PVR之间的相关性。结果:3组之间年龄(P=0.195)、PSA(P=0.380)、IPSS(P=0.380)、IPSS-VS(P=0.380)、QOL(P=0.380)、Qmax(P=0.380)、PVR(P=0.912)均无统计学差异,但BOO组PV[(58.8±30.0)ml]明显大于可疑BOO组[(49.8±33.9)ml]和无BOO组[(45.5±26.0)ml](P=0.031)。Pearson直线相关性分析发现BOOI与IPSS(r=-0.020,P=0.778)、IPSS-VS(r=-0.013,P=0.853)、QOL(r=-0.107,P=0.132)、Qmax(r=-0.130,P=0.066)、PVR(r=-0.056,P=0.433)均无显著相关性,而对于PV,尽管P=0.012,但|r|=0.178<0.4,因此认为BOOI与PV亦无明显相关性。结论:BOOI与PV、IPSS、IPSS-VS、QOL、Qmax以及PVR均无显著相关,单以BOOI结果诊断BOO并不可靠,BOO的诊断需要同时结合临床实际才能做出。

关键词： calcium-sensing receptor (CaSR)   fibroblast growth factor (FGF23)   mammalian target of rapamycin (mTOR)   vitamin D receptor (VDR)   parathyroid hormone (PTH)   uremia  

摘要： Secondary hyperparathyroidism (SHP) is a common complication of chronic kidney disease (CKD) that correlates with morbidity and mortality in uremic patients. It is characterized by high serum parathyroid hormone (PTH) levels and impaired bone and mineral metabolism. The main mechanisms underlying SHP are increased PTH biosynthesis and secretion as well as increased glandular mass. The mechanisms leading to parathyroid cell proliferation in SHP are not fully understood. Reduced expressions of the receptors for calcium and vitamin D contribute to the disinhibition of parathyroid cell proliferation. Activation of transforming growth factor-alpha-epidermal growth factor receptor (TGF-alpha-EGFR), nuclear factor kappa B (NF-kB), and cyclooxygenase 2- prostaglandin E2 (Cox2-PGE2) signaling all correlate with parathyroid cell proliferation, underlining their roles in the development of SHP. In addition, the mammalian target of rapamycin (mTOR) pathway is activated in parathyroid glands of experimental SHP rats. Inhibition of mTOR by rapamycin prevents and corrects the increased parathyroid cell proliferation of SHP. Mice with parathyroid-specific deletion of all miRNAs have a muted increase in serum PTH and fail to increase parathyroid cell proliferation when challenged by CKD, suggesting that miRNA is also necessary for the development of SHP. This review summarizes the current knowledge on the mechanisms of parathyroid cell proliferation in SHP.

关键词： Parathyroid   Hypoparathyroidism   Hyperparathyroidism   Parathyroid Carcinoma   Neonatal Severe Hyperparathyroidism   Post-thyroidectomy Hypocalcemia   Parathyroid Imaging  

摘要： Parathyroid glands are critical for calcium and phosphate homeostasis. Parathyroid disease is relatively rare in the pediatric population, but there are some important pediatric-specific considerations and conditions. This article reviews parathyroid physiology, disorders of hyper- and hypo- function, operative management, and uniquely pediatric diagnoses such as neonatal severe hyperparathyroidism. Advances in preoperative imaging, intra-operative gland identification, and management of post-thyroidectomy hypocalcemia are also presented in detail. This article combines a review of fundamentals with recent advances in care, emphasizing pediatric-specific publications. (C) 2020 Elsevier Inc. All rights reserved.

关键词： Dual energy   Tomography   X-ray computed   Liver cirrhosis   Portal hypertension   Esophageal varices  

摘要： Objective To evaluate noninvasively the severity of esophageal varices (EV) in cirrhotic patients using splenic hemodynamics obtained with dual-energy CT. Methods We retrospectively analyzed 72 cirrhotic patients with EV between December 2018 and June 2019. Patients were divided into three groups: mild (EV1), medium (EV2), or severe (EV3) EV groups based on severity of EV assessed by endoscopy. An additional control group included 20 patients with normal liver CT. All patients underwent contrast-enhanced dual-energy CT. The iodine weight in spleen (IW-S) was calculated as IW-S = IC-S (iodine concentration in spleen) x V-S (spleen volume). Differences between EV and control groups were analyzed using one-way analysis of variance with Welch's correction. Games-Howell test made further pairwise comparison. The diagnostic value of IW-S on high-risk EV (EV2, EV3, or EV1 with red color sign) was evaluated using the ROC curve. p < 0.05 indicated statistical significance. Results The overall difference of IW-S between the control and EV groups was statistically significant (p < 0.001). Patients with more severe EV had higher IW-S values. Pairwise comparisons showed that except for control vs. EV1 groups, the IW-S between any other two groups was significantly different (p < 0.05). With a cutoff value at 1087 mg, the AUC for using IW-S for the detection of high-risk EV was 0.87 (95% CI 0.77 similar to 0.94). Sensitivity and specificity were 84.9% and 84.2%, respectively. Conclusion IW-S obtained with dual-energy CT can noninvasively predict EV severity.

关键词： 预见性护理   肝硬化   食道胃底静脉曲张破裂出血   再次出血  

摘要： 评估预见性护理服务方式运用于肝硬化食道胃底静脉曲张破裂出血患者中的护理干预价值。方法:选择2017年01月--2020年01月本医院住院治疗的68例肝硬化食道胃底静脉曲张破裂出血患者,按照随机数字法分为观察组和对照组各34例,观察组实施预见性护理服务方式,对照组实施常规护理服务方式,对比两组患者再次出血人数发生率。结果:观察组再次出血人数发生率为0(0/34),对照组再次出血人数发生率11.76%(4/34),两组比较差异有统计学意义(χ2=4.250, P=0.039)。结论:肝硬化食道胃底静脉曲张破裂出血患者实施预见性护理,可降低再次出血发生率,表现出较佳护理干预功效,值得临床推广。

关键词： 肾上腺增生   11β-羟化酶缺陷症   性早熟   高血压低血钾  

摘要： 增强对11β-羟化酶缺陷症的认识,提高该病诊疗水平。方法 通过对1例11β-羟化酶缺陷症患者的临床表现、辅助检查及治疗随访情况的观察,结合文献进行回顾性分析。结论 11β-羟化酶缺陷症的早期诊断、合理治疗对患者预后及生活质量提高十分重要;基因型EX1_6 DEL(Het)及c.1145T>C(***382Pro;Het)突变可能与11β-羟化酶缺陷症有关。

关键词： 膝关节退行性骨关节病   X线平片   MR   诊断价值  

摘要： 目的:对比膝关节退行性骨关节病的X线平片与MR两种影像学技术的诊断结果.方法:回顾性分析2018年1月~2019年1月我院收治的64例膝关节退行性骨关节病患者的影像学资料,将关节镜手术结果作为临床诊断的金标准,比较X线平片、MR的检查结果.结果:MR对滑膜增厚、关节积液、半月板变性、骨质增生、软骨下囊变、软组织受损、关节面不平等各种类型的膝关节退行性骨关节病中的诊断准确率均显著高于X线平片(P＜0.05).结论:在膝关节退行性骨关节病的临床诊断中,MR的应用价值要显著高于X线平片,可作为首选影像学技术予以推广.