负压组合式输尿管镜联合输尿管软镜与经皮肾镜治疗复杂性肾结石的比较

目的比较负压组合式输尿管镜联合输尿管软镜与经皮肾镜处理复杂性肾结石的优劣性。方法回顾性收集2020年1月至2022年12月东莞市厚街医院复杂性肾结石患者的资料,根据结石大小1:1倾向性匹配后分为两组,各48例。研究组行负压组合式输尿管镜治疗,对照组行经皮肾镜治疗。比较两组结石大小、术后结石清除率、手术前后肾功能、血清炎症因子水平变化和术后并发症发生率。结果研究组与对照组比较,结石大小分别为[(23.9±2.9) mm vs (24.4±3.0) mm,P=0.399];结石清除率分别为95.83% vs 81.25%,P=0.025;术中出血量[(10.4±3.0) ml vs (61.2±10.1) ml,P<0.001];术后CRP两组分别为[(13.1±1.4) mg/L vs (16.5±1.5)mg/L,P<0.001];术后PCT为[(0.586±0.145) ng/ml vs (0.855±0.149)ng/ml,P<0.001];围手术期总并发症发生率4.17% vs 22.92%,P=0.025,但研究组有1例发生输尿管损伤,放置输尿管支架管痊愈。术后随访1年,研究组没有发生输尿管狭窄。结论负压组合式输尿管镜联合输尿管软镜治疗复杂性肾结石可提升结石清除率,减轻手术引起的炎性反应,降低肾脏的损伤,并发症少,疗效优于经皮肾镜。

A proto-monsoonal climate in the late Eocene of Southeast Asia:Evidence from a sedimentary record in central Myanmar

The Burma Terrane has yielded some of the earliest pieces of evidence for monsoonal rainfall in the Bay of Bengal.However,Burmese ecosystems and their potential monsoonal imprint remain poorly studied.This study focuses on the late Eocene Yaw Formation(23°N)in central Myanmar,which was located near the equator(c.5°N)during the Eocene.We quantitatively assessed the past vegetation,climate,and depositional environments with sporomorph diagrams,bioclimatic analysis,and sequence biostratigraphy.We calculated the palynological diversity and drew inferences with rarefaction analysis by comparing with four other middle to late Eocene tropical palynofloras.Palynological results highlight a high floristic diversity for the palynoflora throughout the section formed by six pollen zones characterized by different vegetation.They indicate that lowland evergreen forests and swamps dominated in the Eocene Burmese deltaic plains while terra firma areas were occupied by seasonal evergreen,seasonally dry,and deciduous forests.This vegetation pattern is typical to what is found around the Bay of Bengal today and supports a monsoon-like climate at the time of the Yaw Formation.Bioclimatic analysis further suggests that in the late Eocene,the Yaw Formation was more seasonal,drier,and cooler compared to modern-day climate at similar near-equatorial latitude.More seasonal and drier conditions can be explained by a well-marked seasonal migration of the Intertropical Convergence Zone(ITCZ),driver of proto-monsoonal rainfall.Cooler temperatures in the late Eocene of central Myanmar may be due to the lack of adequate modern analogues for the Eocene monsoonal climate,while those found at other three Eocene Asian paleobotanical sites(India and South China)may be caused by the effect of canopy evapotranspirational cooling.Our data suggest that paleoenvironmental change including two transgressive-regressive depositional sequences is controlled by global sea level change,which may be driven by climate change and tectonics.The high diversity of the Yaw Formation palynoflora,despite well-marked seasonality,is explained by its crossroads location for plant dispersals between India and Asia.