条件可控下小尿管负压引流治疗慢性阻塞性肺病并发气胸的临床研究

目的探讨条件可控下小尿管负压引流在慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)合并自发性气胸治疗中的应用价值,为临床上COPD合并气胸患者治疗提供参考。方法对257例COPD并发自发性气胸病人,采用随机分组的方法,以条件可控下小尿管负压引流治疗的128例为治疗组,传统的外科肋间放橡胶管的129例作为对照组,进行治疗观察。结果肺复张时间(指插管自肺完全复张时间)治疗组少于对照组。治疗组伤口感染少于对照组。结论条件可控下小尿管负压引流治疗COPD并发气胸疗效好,并发症少,且方便可行,值得临床推广应用。

结扎法与切开缝合法在小儿尿道下裂术后小尿瘘修复中的应用效果比较

目的:比较结扎法与切开缝合法治疗小儿尿道下裂术后小尿瘘的临床效果,探讨适宜的手术方式。方法:回顾性分析2011年5月至2015年1月福建医科大学附属协和医院收治的35例尿道下裂术后小尿瘘(<3mm)患儿的临床资料,按照瘘口手术方式不同分为结扎组和切开缝合组,结扎组采用瘘管结扎法,切开缝合组采用瘘口周围切开缝合法。结扎组19例(25个瘘口),切开缝合组16例(24个瘘口),比较两组患儿术后尿瘘发生率及修复成功率。结果:结扎组术后再瘘2例共3个瘘口,修复成功率为88.0%(22/25);切开缝合组术后再瘘4例共5个瘘口,修复成功率为79.2%(19/24);结扎组术后再瘘发生率低于切开缝合组,修复成功率高于切口缝合组,但差异均无统计学意义(均P>0.05)。两组患儿术后均无一例尿道狭窄或憩室发生。结论:结扎法与切开缝合法在小儿尿道下裂术后小尿瘘手术修补中的疗效相当,而对于具有一定瘘管形态者,推荐进行结扎法治疗,因其操作更简便且疗效亦好。但对于无明显瘘管、瘘口周围组织菲薄者,应选用切开缝合法治疗。

结扎法与切开缝合法治疗小儿尿道下裂术后小尿瘘的临床效果对比分析

目的探究在对小儿尿道下裂术后出现小尿瘘患儿的治疗中,结扎法和切开缝合法的不同修复效果。方法方便选取2015年1月—2017年6月在该院进行治疗的小儿尿道下裂术后出现小尿瘘患儿40例,分为研究组和对照组,各20例,其中研究组患儿通过结扎法治疗,对照组患儿通过切开缝合法治疗。结果研究组术后出现再瘘情况患儿3例,其中再瘘瘘口1处2例,2处1例,对照组出现再瘘情况患儿5例,其中再瘘瘘口1处4例,2处1例,两组患儿术后修复成功率分别为100.00%和90.00%,差异无统计学意义(χ~2=0.10;P=0.749 3)。结论在小儿尿道下裂术后出现小尿瘘患儿的治疗中,结扎法和切开缝合法对患儿的修复效果并无明显差异,如果患儿的瘘管形态较为清晰明显,则推荐使用操作简单的结扎法;如果患儿瘘管形态不清晰,则推荐使用切开缝合法进行修复。

Ammonia Volatilization Losses from Urea Applied to Wheat on a Paddy Soil in Taihu Region, China

Ammonia volatilization losses from urea applied as a basal fertilizer and a top dressing at tillering stage in a wheat field of Taihu Region, China, were measured with a micrometeorological technique. Urea as fertilizer was surface broadcast at 81 (low N) and 135 (high N) kg N ha-1 as basal at the 3-leaf stage of the wheat seedling on December 2002, and 54 (low N) and 90 (high N) kg N ha-1 as top dressing on February 2003. Ammonia volatilization losses occurred mainly in the first week after applying N fert…

Ultrastructure and histochemistry of rat myocardial capillary endothelial cells in response to diabetes and hypertension

Insufficient growth and rarefaction of capillaries, followed by endothelial dysfunction may represent one of the most critical mechanisms involved in heart damage. In this study we examined histochemical and ultrastructural changes in myocardial capillary endothelium in two models of heart failure streptozotocin-induced diabetes mellitus （STZ） and NO-deficient hypertension in male Wistar rats. Diabetes was induced by a single i.v. dose of STZ （45 mg/kg） and chronic 9-week stage was analysed. To induce NO-deficient hypertension, animals were treated with inhibitor of NO synthase Lnitroarginine methylester （L-NAME） （40 mg/kg） for 4 weeks. Left ventricular tissue was processed for enzyme catalytic histochemistry of capillary alkaline phosphatase （A1Ph）, dipeptidyl peptidase IV （DPP IV）, and endothelial NO synthase/NADPH-diaphorase （NOS） and for ultrastructural analysis. In diabetic and hypertensive rats, lower/absent A1Ph and DPP IV activities were found in focal micro-areas. NOS activity was significantly reduced and persisted only locally. Quantitative evaluation demonstrated reduction of reaction product intensity of A1Ph, DPP and NOS by 49.50%,74.36%, 20.05% in diabetic and 62.93%, 82.71%, 37.65% in hypertensive rats. Subcellular alterations of endothelial cells were found in heart of both groups suggesting injury of capillary function as well as compensatory processes. Endothelial injury was more significant in diabetic animals, in contrast the adaptation was more evident in hypertensive ones. Concluding： both STZ-induced diabetes- and NO-deficient hypertension-related cardiomyopathy were accompanied by similar features of structural remodelling of cardiac capillary network manifested as angiogenesis and angiopathy. The latter was however, predominant and may accelerate disappearance of capillary endothelium contributing to myocardial dysfunction.

Kidneys in chronic liver diseases

Acute kidney injury(AKI),defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL,occurs in about 20% of patients hospitalized for decompensating liver cirrhosis.Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state,reduced effective blood volume and stimulation of vasoconstrictor hormones.The most common causes of AKI in cirrhosis are pre-renal azotemia,hepatorenal syndrome and acute tubular necrosis.Differential diagnosis is based on analysis of circumstances of AKI development,natriuresis,urine osmolality,response to withdrawal of diuretics and volume repletion,and rarely on renal biopsy.Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients.AKI is one of the last events in the natural history of chronic liver disease,therefore,such patients should have an expedited referral for liver transplantation.Hepatorenal syndrome(HRS) is initiated by progressive portal hypertension,and may be prematurely triggered by bacterial infections,nonbacterial systemic inflammatory reactions,excessive diuresis,gastrointestinal hemorrhage,diarrhea or nephrotoxic agents.Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy.The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion,which is effective in about 50% of patients.The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt,renal vasoprotection or systems of artificial liver support.

Preventive and therapeutic effects of Aerva lanata(L.) extract on ethylene glycol-induced nephrolithiasis in male Wistar albino rats

Objective Nephrolithiasis is a common urological disease. This study aims to evaluate the preventive and therapeutic effects of hydro-alcoholic extract of Aerva lanata(L.) roots(HAEAL) on ethylene glycol-induced nephrolithiasis in rats.Methods Fifty grams of shade-dried coarsely powdered Aerva lanata(L.) root was successively extracted with organic solvents in increasing order of polarity [petroleum ether(60-80 ℃), chloroform, and ethanol] using a Soxhlet apparatus, and then concentrated. Physical tests including nature, color, odor, and texture were performed on the herbal suspension. In vitro nephrolithiasis assessment was performed by nucleation assay, aggregation assay, and crystal growth assay. Thirty adult male Wistar albino rats were randomly divided into five groups(six rats in each group). Group 1: negative control group without induction or treatment till day 28. Group 2: positive control group receiving a daily oral solution of 0.75% ethylene glycol till day 14, and mixed with distilled water till day 28. Group 3: standard group receiving a daily oral solution of 0.75% ethylene glycol till day 14 and Cystone(750 mg/kg) from day 15 to day 28. Group 4: low dose HAEAL group receiving a daily oral solution of 0.75%ethylene glycol till day 14, and 400 mg/kg HAEAL from day 15 to day 28(1 mL per day). Group 5: high dose HAEAL group receiving a daily oral solution of 0.75% ethylene glycol till day 14,and 800 mg/kg HAEAL from day 15 to day 28(1 mL per day). Urine(urine volume, pH value,appearance, odor, and turbidity) examination and serum test were performed. On day 29, the kidneys were dissected, and histopathology examination was performed to determine the degree of tubular injury.Results The suspension showed stability and aroma with no turbidity at room temperature.The suspension did not show changes in color and odor until day 3, indicating that the preparation was stable for 72 h. Body weight decreased in the positive control group indicating stone formation and changes in water intake. Both standard and HAEAL treatments restored the body weight to normal levels after treatment, indicating the beneficial effects of the treatment. Histopathological examination revealed no significant findings in the negative control group, whereas the positive control group showed inflammation in the kidney parenchyma.Compared with positive control group, there was increase in urine volume and excretion of urinary constituents such as calcium and oxalate(P < 0.01) as well as improved clearance rate(P < 0.05) in HAEAL treatment groups, in addition, the urine pH value of HAEAL groups was increased.Conclusion HAEAL reduced nephrolithiasis formation and had a diuretic effect, which could be used to promote the expulsion of stones. Further studies are needed to enhance the stability of the suspension for the production of better pharmaceutical formulations.

再次尿道成形术治疗先天性尿道下裂术后严重并发症

目的：了解先天性尿道下裂行各种尿道成形术失败后，利用膀胱粘膜行尿道成形术的疗效。方法：将严重狭窄和（或）无法修补的尿瘘瘢痕组织彻底切除，取膀胱粘膜片形成尿道，正位开口于龟头，新尿道内置多孔硅胶支架管作引流。结果：２８例中，２３例治愈，３例有小尿瘘需作尿瘘修补，２例完全失败，再次作粘膜尿道成形术治愈。结论：各种类型先天性尿道下裂尿道成形失败后，可用膀胱粘膜移植尿道成形。