后腹腔镜肾输尿管全切加腹膜后肾周区域淋巴结清扫与开放手术治疗UUT-TCC疗效比较

目的:探讨后腹腔镜技术与开放手术治疗上尿路移行细胞癌(upper urinary tract transitional cell carcinoma,UUT-TCC)的效果及优势。方法:回顾性分析2009年11月~2012年12月间,我院采用后腹腔镜下肾输尿管根治性切除术加腹膜后肾周区域淋巴结清扫术治疗肾盂输尿管癌患者23例(腹腔镜组),并与同期14例行传统开放性肾输尿管切除术患者(开放术组)的手术时间、出血量、肿瘤学预后等指标进行比较。结果:腹腔镜组患者经术后病理检查,肾盂癌24例,输尿管癌10例,输尿管癌伴膀胱癌3例,其中腹腔镜组和开放组淋巴结转移各1例。同时研究发现:①腹腔镜组与开放术组比较,手术时间缩短,出血量明显减少,术后肠胃功能恢复快,术后住院时间短,差异有统计学意义(P0.05);②两种术式肿瘤学预后在远处转移方面,腹腔镜组更少,差异有统计学意义(P0.05)。结论:后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除并腹膜后肾周区域淋巴结清扫治疗UUT-TCC具有创伤小、痛苦少、术后恢复快等优点,可能有更好的肿瘤学预后。     

Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis,Coagulopathy, Endothelial Dysfunction,and Downregulation of ACE2

Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.     

Vaginal trichomoniasis among HIV patients attending primary health care centers of Jos,Nigeria

ObjectiveTo determine the prevalence of trichomonal infection in HIV/AIDS and non-HIV control group of patients in a population of women with abnormal vaginal discharge.MethodsWe conducted a simple cross-sectional study. Primary health care centers in Jos metropolis and Jos University Teaching Hospital, during December 2006 to December 2007. Seven hundred high vaginal swabs were collected; 350 from HIV positive and another 350 from HIV-negative control group of patients with abnormal vaginal discharge attending primary health care centers in Jos metropolis and analysed for microscopy and culture in Jos University Teaching Hospital. Data on epidemiologic indices from the patients, using structured interviewer-administered questionnaires were collected.ResultsThe rate of trichomoniasis among all participants in the study was 17% (n=120/700). The prevalence rate of trichomoniasis among persons with HIV was 24% while it was found to be 10.3% among HIV negative controls. The difference was statistically significant (χ² =23.172; df=1; P<0.05). The rate of co-infection of Trichomonas vaginalis (T. vaginalis) in bacterial vaginosis was 42% (n=50/120), while it was 24% (n=29/120) in candidiasis. The singles had a 35% high rate of trichomonal infection. The infected women had a median age of 26 years, and a median number of 3 intra-vaginal sex partners per week.ConclusionsThere was a significant statistical difference in prevalence of T. vaginalis between HIV/AIDS group and non-HIV(control) group of patients in the study (P<0.05). Local HIV prevention strategies should target such women with trichomonal infection for intervention efforts, especially in HIV endemic area of sub-continent of Africa to further reduce the burden of HIV in the population.     

荔湾区2010～2013年艾滋病自愿咨询检测结果及影响因素分析

目的探讨艾滋病自愿咨询人群血清学检测结果及其影响因素,为荔湾区今后更好的开展VCT服务提供依据。方法以2010~2013年在荔湾区各VCT门诊接受VCT服务并登记上报的求询者作为研究对象,按照《全国艾滋病检测技术规范(2009)》要求开展HIV抗体初筛检测,阳性标本合做梅毒、丙肝、乙肝检测。采用非条件Logistic回归分析影响艾滋病自愿咨询人群艾滋病感染的相关因素。结果共调查艾滋病自愿咨询检测者6 423人,其中男性2 787人,占43.4%,女性3 636人,占56.6%;年龄集中在(32.4±10.8)岁。HIV抗体阳性98例,占1.5%,其中1例同时呈HIV、梅毒、丙肝、乙肝阳性,合并四重感染率为1%;HIV、丙肝合并感染者有42例,双重感染率为42.9%;HIV、梅毒合并感染有20例,双重感染率为20.4%;HIV、乙肝合并感染有8例,双重感染率为8.16%。经Logistic回归分析显示:对艾滋病自愿咨询检测人群艾滋病感染的影响因素是年龄、职业和人群特征。年龄段在21~60岁,吸毒者、同性恋、阳性配偶者为艾滋病感染的风险人群。结论政府组织与各部门共同担责,改进并完善自愿咨询检测服务,加强对艾滋病感染风险人群检测,向"零"艾滋迈进。     

Arterial or mixed venous lactate measurement in critically ill children. Is there a difference?

Seven critically ill children had simultaneous measurement of whole blood lactate concentrations obtained from a systemic arterial and mixed venous (pulmonary artery) site. An excellent correlation was found ( r = 0.995). The mean difference between arterial and mixed venous values was 0.02 mmol/ 1 and the limits of agreement (±0.22) were —0.20 to 0.24. The differences found were clinically insignificant (two-tailed paired Student's t -test; p = 0.36) and therefore support the continued use of arterial sampling for blood lactate measurement.