High incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in Taiwan

AIM: Urothelial carcinoma (UC) can occur multifocally in the whole urothelium. A higher rate of bilateral metachronous upper tract (UT) UC was noted in Taiwan. The incidence and risk factors were largely unknown and hence were explored in the study. METHODS: From January 1977 through June 2003, 462 patients with unilateral UT-UC were studied retrospectively. The cumulative incidence of contralateral recurrence was analysed with the Kaplan-Meier analysis. Potential risk factors for contralateral recurrence including age, smoking, bladder cancer, renal function, diagnostic year etc. were evaluated with the log-rank test. Independent risk factors were identified by using the Cox regression analysis. RESULTS: The median follow-up time was 34 months (6-337). Among the 462 patients, 52 (11.3%) developed metachronous contralateral UC. The 2, 5, and 10-year contralateral disease-free survivals were 93.5%, 84.0%, and 75.7%, respectively. The median time to contralateral recurrence was 31.0 months. With the univariate analysis, only poor renal function (serum creatinine < or > OR =2.0 mg/dL, P < 0.001) and late diagnostic year (before or after 1990, P < 0.001) were risk factors for contralateral recurrence. In the multivariate analysis, poor renal function (hazard ratio: 2.98; 95% confidence interval: 1.67-5.33; P < 0.001) and late diagnostic year (hazard ratio: 4.27; 95% confidence interval: 1.71-10.65; P = 0.002) remained independent risk factors. CONCLUSIONS: The incidence of metachronous UT-UC is high in Taiwan. Patients who had either chronic renal insufficiency or a disease diagnosed after 1990 had a higher risk of contralateral recurrence.     

葡萄球菌属对常用抗生素耐药情况调查

目的了解葡萄球菌属,特别是耐甲氧西林葡萄球菌(MRS)的耐药情况,为临床用药提供参考。方法从2002年1~7月送检的住院病人的血、痰、脓液、分泌物等标本中分离出的金黄色葡萄球菌、表皮葡萄球菌及其他血浆凝固酶阴性的葡萄球菌共105株,并进行药敏和多重耐药分析。结果MRS的分离率较高,为68.6%,耐甲氧西林金黄色葡葡球菌(MRSA)为69.2%;耐甲氧西林表皮葡萄球菌(MRSE)为63.3%。MRS较非耐甲氧西林葡萄球菌(MSS)耐药率明显高,且MRS比MSS多重耐药率高得多;MRSA对四种不同作用机制的抗生素:泰能、阿米卡星、环丙沙星、复方新诺明具有很高的多重耐药率,达到50%以上。结论鉴于MRS的高分离率和多重耐药率,在治疗感染性疾病时,应加强病原学检查,提高标本鉴定的阳性率;在有效的治疗MRS感染的同时还应注意遏制MRS的产生。     

“通督调神固本”电针法对高血压-高血脂复合血管性痴呆模型大鼠学习记忆干预的初步研究

目的:观察电针对高血压-高血脂复合血管性痴呆(HH-VD)模型大鼠学习记忆能力、脑细小血管、海马及基础病理变化的影响。方法:SD大鼠随机分为假手术组、模型组、电针Ⅰ组、电针Ⅱ组和西药组,每组8只。"双肾一夹"法复制高血压模型,喂高脂饲料复制高血压复合高血脂模型,再采用二血管阻断法复制HH-VD模型。电针Ⅰ组取"百会""大椎""脾俞""肾俞"穴,电针Ⅱ组取非经穴,西药组用尼莫地平按20mL/kg灌胃,均每日1次,共治疗15d。对各组大鼠进行行为学检测,并电镜观察海马CA1区突触情况,光镜观察脑组织的病理改变。结果:与假手术组比较,模型大鼠Y迷宫测试其错误次数(EN)、总反应时间(TRT)和达标反应次数(SN)均显著升高(P<0.01);电镜下观察,模型大鼠海马CA1区突触明显减少,突触后致密物质(PSD)浅淡;光镜下模型大鼠脑组织细、小动脉硬化明显。治疗后,电针Ⅰ组、电针Ⅱ组、西药组大鼠的EN、TRT、SN显著降低,与模型组比较差异有统计学意义(P<0.01),电针Ⅰ组、西药组的EN、TRT、SN又低于电针Ⅱ组(P<0.05);电镜观察,电针Ⅰ组海马CA1区突触数目最多,PSD密度大;光镜下电针Ⅰ组脑组织血管形态与假手术组十分接近。结论:"通督调神固本"电针法能改善HH-VD模型大鼠的脑血管异常,增加海马突触数目,增强其活性,有效提高其学习记忆能力。     

参环毛蚓对土壤含水量及pH值因子的选择研究

目的 考察参环毛蚓对土壤含水量、pH值二因子的选择性,建立其生活所需要的土壤含水量、pH值单因子数学模型.方法 在养殖槽内设置不同土壤含水量、pH值区域,由参环毛蚓选择适宜的生活区域.结果 参环毛蚓生活适宜的土壤含水量为18.2%～24.6%,pH值为3.7～5.5.结论 参环毛蚓选择在湿度适中,偏酸性的土壤中生活;高湿及较干燥,强酸性和碱性的土壤不适宜其生活.     

复发性胶质瘤再手术治疗的探讨

目的 探讨复发性胶质瘤患者再手术的效果。方法 对22例复发性胶质瘤患者再手术前的功能状态、两次手术间隔时间及手术切除的程度与术后存活期等资料进行临床和统计学分析。结果 第二次手术前生活能自理或半自理的病人（Kamofsky计分≥60）平均生存期约16月，生活不能自理的病人（Kamofsky计分〈60）平均生存期约6月（P〈0．01）。两次手术间隔时间大于1年者平均生存期约17月，间隔时间小于半年者平均生存期约6月（P〈0．01）。手术肿瘤全切除者平均生存期约15月，次全切除者平均生存期约10月（P〈0．05）。结论 术前功能情况好，手术间隔时间大于1年及术中全切肿瘤者再手术治疗可获得较好效果。     

复合吸收促进剂对葛根素肠吸收及毒性的影响

目的 考察吸收促进剂配伍对葛根素肠吸收的影响,并进一步观察复合吸收促进剂对肠黏膜的毒性.方法 运用外翻肠囊法,采用L9(3)4正交设计试验考察各吸收促进剂的协同作用,确定较理想复合吸收促进剂;运用显微形态学观察复合吸收促进剂对肠黏膜的毒性.结果 复合吸收促进剂:1%壳聚糖、0.02%白芷挥发油、0.06%冰片配伍具有协同作用,可显著提高葛根素的肠吸收;复合吸收促进剂无肠黏膜毒性.结论 1%壳聚糖、0.02%白芷挥发油、0.06%冰片配伍可安全有效地促进葛根素的肠吸收.     

核医学~(131)Ⅰ诊疗患者的管理方法探讨

目的探讨核医学的~(131)Ⅰ诊疗患者管理。方法分析核医学~(131)Ⅰ诊疗患者的现状,依据国家相关法律法规及标准要求,提出患者管理的必要性。结果提出~(131)Ⅰ诊疗患者的综合管理方法。结论应加强核医学~(131)Ⅰ诊疗患者的管理。     

痧斯病(SARS)

严重急性呼吸道综合征(severe acute respiratory syndrome，SARS)是由SARS相关冠状病毒(SCV)引起的一种新的烈性呼吸遗传染病。急性期重症病例肺部病变为严重的急性间质性渗出性炎，类似呼吸窘迫综合征的病理特征。肺外器官主要为出血坏死性炎。临床诊断是一个动态的过程，随着对SARS认识的加深，诊断标准将会不新完善。文中对命名进行了讨论，中文名建议用痧斯病。     

P物质对体外培养大鼠成纤维细胞表皮生长因子及其受体基因表达的影响

目的　探讨P物质 (SubstanceP ,SP)作用于离体培养的大鼠肉芽组织成纤维细胞后 ,对其表皮生长因子(EGF)及受体 (EGFR)基因表达的影响。方法　采用大鼠肉芽组织成纤维细胞培养和逆转录 聚合酶链反应 (RT PCR)技术 ,观察SP在不同浓度 ( 1× 10 -9～ 1× 10 -5mol/L)及不同孵育时间 ( 0、3、6、12、2 4h)情况下刺激大鼠成纤维细胞后 ,成纤维细胞EGF、EGFRmRNA表达的改变情况。结果　SP可上调大鼠肉芽组织成纤维细胞EGF、EGFRmRNA表达。其中 ,SP对EGF的量 效曲线呈双相分布 ,最大效应浓度为 1× 10 -7mol/L。但SP仅在高浓度时 ( 1× 10 -6～ 1× 10 -5mol/L)促进EGFR表达。在最大效应浓度 ( 1× 10 -7mol/L ,1× 10 -5mol/L)时 ,SP对大鼠成纤维细胞EGF、EGFRmRNA表达的上调作用分别于孵育细胞后 6、12h达高峰。结论　SP对大鼠肉芽组织成纤维细胞EGF、EGFR基因表达存在直接影响 ,其表现形式与SP的刺激浓度及孵育时间有关。这种影响可能是SP在创伤愈合过程中发挥调控作用的生物学机制之一。     

Effects of Pharmacological Autonomic Blockade on Dual Atrioventricular Nodal Pathways Physiology in Patients with Slow-Fast Atrioventricular Nodal Reentrant Tachycardia

The purpose of this study was to investigate the atrioventricular AV nodal physiology and the inducibility of AV nodal reentrant tachycardia (AVNRT) under pharmacological autonomic blockade (AB). Seventeen consecutive patients (6 men and 11 women, mean age 39 ± 17 years) with clinical recurrent slow-fast AVNRT received electrophysiological study before and after pharmacological AB with atropine (0.04 mg/kg) and propranolol (0.2 mg/kg). In baseline, all 17 patients could be induced with AVNRT, 5 were isoproterenol-dependent. After pharmacological AB, 12 (71 %) of 17 patients still demonstrated AV nodal duality. AVNRT became noninducible in 7 of 12 nonisoproterenol dependent patients and remained noninducible in all 5 isoproterenol dependent patients. The sinus cycle length (801 ± 105 ms vs 630 ± 80 ms, P < 0.005) and AV blocking cycle length (365 ± 64 ms vs 338 ± 61 ms, P < 0.005) became shorter after AB. The antegrade effective refractory period and functional refractory period of the fast pathway (369 ± 67 ms vs 305 ± 73 ms, P < 0.005; 408 ± 56 ms vs 350 ± 62 ms, P < 0.005) and the slow pathway (271 ± 30 ms vs 258 ± 27 ms, P < 0.01; 344 ± 60 ms vs 295 ± 50 ms, P < 0.005) likewise became significantly shortened. However, the ventriculoatrial blocking cycle length (349 ± 94 ms vs 326 ± 89 ms, NS) and effective refractory period of retrograde fast pathway (228 ± 38 ms vs 240 ± 80 ms, NS) remained unchanged after autonomic blockade. Pharmacological AB unveiling the intrinsic AV nodal physiology could result in the masking of AV nodal duality and the decreased inducibility of clinical AVNRT.