单侧上尿路梗阻解除前后肾皮质厚度与肾小球滤过率的关系

目的探讨单侧上尿路梗阻解除前后肾皮质厚度(RCT)与肾小球滤过率(GFR)的关系。方法选取2015年7月-2016年6月该院泌尿外科收治的63例上泌尿道梗阻患者为研究对象。其中,男34例,女29例,年龄22~73(52.21±11.56)岁;手术方式:输尿管镜碎石+取石术24例,一期经皮肾造瘘+二期经皮肾镜取石术(PCNL)21例,一期PCNL 18例。采用腹部增强CT、单光子发射计算机断层(SPECT)扫描分别测量RCT和GFR,根据术前患肾GFR情况分为3组:A组(中度肾损害,15.0 ml/min≤GFR<30.0 ml/min)、B组(重度肾损害,7.5 ml/min≤GFR<15.0 ml/min)、C组(极重度肾损害,GFR<7.5 ml/min),比较3组的手术前后的GFR变化。采用简单线性相关分析A和B组患者术前RCT与各指标的相关性。结果 9例患者因肾积水严重未测量RCT,患者的术前RCT>10 mm 20例,5~10 mm 23例,<5 mm 11例,平均值为(10.75±4.91)mm。A组术前RCT明显高于B组,差异有统计学意义(P<0.05)。3组患者术后1和9个月的GFR均明显高于同组术前,差异均有统计学意义(P<0.05)。A组术后1和9个月的GFR均明显高于另外两组,B组术后9个月的GFR明显高于C组,差异均有统计学意义(P<0.05),但术后1个月B组和C组的GFR差异无统计学意义(P>0.05)。B组术后1个月的GFR恢复值明显低于另外两组,差异有统计学意义(P<0.05),3组术后9个月的GFR恢复值比较差异无统计学意义(P>0.05)。术前RCT与术前GFR(r=0.613)、术后1个月GFR(r=0.697)及恢复值(r=0.552)、术后9个月GFR(r=0.589)及恢复值(r=0.488)均呈显著正相关,差异有统计学意义(P<0.05)。结论解除上泌尿道梗阻后患者的肾功能得到不同程度的恢复,即使是极重度肾功能损伤者,多数均能挽回患肾。术前RCT能有助于判断围手术期的肾功能,尤其是术后肾功能恢复情况。

Relationship between the Plasma Fibulin-1 Levels,Pulse Wave Velocity,and Vascular Age in Asymptomatic Hyperuricemia

Fibulin-1(FBLN-1),an elastin-associated extracellular matrix protein,has been found in blood and may play a role in the pathophysiological processes leading to cardiovascular disease(CVD).We aimed to investigate the relationship between fibulin-1 levels and the risk of CVD by evaluating vascular age derived from the Framingham Heart Study and brachial-ankle Pulse Wave Velocity(baPWV)in patients with asymptomatic hyperuricemia(AHU).In total,66 patients with AHU and 66 gender-and age-matched healthy individuals were enrolled.The plasma fibulin-1 levels were measured by immunochemistry.Patients with AHU presented significantly higher vascular age[median(interquartile range):54(22)vs.48(14)years,P=0.01]and baPWV[mean±SD:1373±223 vs.1291±177 cm/s,P=0.02]than the healthy subjects;however,no significant difference was observed in the plasma fibulin-1 level between the patients with AHU and healthy subjects[median(interquartile range):4018(3838)vs.3099(3405)ng/mL,P=0.31].A correlation between fibulin-1 levels and baPWV was observed only in patients with AHU(r=0.29,P=0.02);and there was also a suggestively statistically significant correlation between fibulin-1 levels and vascular age(r=0.22,P=0.08).However,these associations were rendered insignificant after adjustments for potential confounders.In healthy subjects,no correlation was observed between fibulin-1 levels and CVD risk.This study reveals that plasma fibulin-1 levels may reflect the CVD risk in patients with AHU,but the relationship is not robust.

Evaluating the confidence level of Traditional Chinese Medicine in nursing undergraduates at Chinese medical university

Objective:To observe the confidence level prevailing with regard to the practice of Traditional Chinese Medicine(TCM)among undergraduate nursing students who have undertaken TCM courses at Shanxi Medical University.Methods:This cross-sectional study was conducted at Shanxi University of Chinese Medicine.A questionnaire survey was administered through the Questionnaire Star website(https://www.questionstar.com/).The confidence level was examined from 6 aspects,namely cognition of TCM culture and theory,advantages and characteristics of TCM diagnosis and treatment,feelings about TCM achievements,personal behaviors related to TCM,attitudes toward Western medicine,and the future of TCM.The mean score of the observed items was calculated,and was found to be positively related to the confidence level concerning TCM(the score was between 1 and 5).Results:A total of 120 participants voluntarily enrolled themselves in the study.The results showed that the mean score of observed items were generally about 4.A relatively strong confidence was shown in understating TCM advantages and characteristics in diagnosis and treatment,and also in feelings toward TCM achievements.Conclusions:The majority of nursing undergraduates had confidence in TCM.However,some aspects such as the understanding of TCM culture and the correlation between TCM and Western medicine may need to be improved through education.