Effects of percutaneous nephrolithotomy in the treatment of medullary sponge kidney with calculi / 中华外科杂志

Objective@#To evaluate the effects of percutaneous nephrolithotomy (PNL) in the treatment of medullary sponge kidney with calculi.@*Methods@#A total of 77 patients (91 renal units) of medullary sponge kidney with calculi (MSK group) and 77 patients (77 renal units) with common kidney stone (control group) received PNL at Department of Urology in Peking University People′s Hospital from September 2006 to February 2016 were analyzed retrospectively. The MSK group included 33 males and 44 females with a mean age of (42.1±13.2) years, the mean stone burden was (3.9±1.8) cm. The control group included 36 males and 41 females with a mean age of (45.3±13.0) years, the mean stone burden was (3.6±1.5) cm. The numbers of tracts, the time of operation, the drop of hemoglobin, the change of creatine, the time of hospitalization, the stone free rate and major complications were compared between the two groups. The measurement data and numeration data were compared with t test and χ2 test.@*Results@#There were no significant differences in sex, age, preoperative urinary tract infection, stone type, and stone burden between the two groups (all P>0.05). The proportion of bilateral renal calculus in MSK group was higher (18.2% vs. 0, χ2=15.400, P=0.000). There were 159 percutaneous channels were established in MSK group while 90 percutaneous channels were established in control group. Compared with the control group, the operation time ((88.1±37.5) minutes vs. (68.5±30.1) minutes, t=3.543, P=0.000) and hospitalization time ((15.1±8.3) days vs. (10.1±3.6) days, t=4.816, P=0.000) were longer, the creatinine level increased ((101.2±62.6) μmol/L vs. (71.3±23.6) μmol/L, t=3.777, P=0.000), the rate of stone free decreased (27.5% vs. 83.1%, χ2=51.840, P=0.000) and the rate of complications increased (29.9% vs. 11.7%, χ2=8.114, P=0.004) in MSK group. There was no statistically difference in hemoglobin drop ((12.5±13.2) g/L vs. (13.0±10.9) g/L, t=-0.260, P=0.795).@*Conclusions@#Using PNL for patients of MSK with calculi has a lower stone free rate and a higher complications. It is an effective method for patients of MSK with large and complex calculi.

Applicatiuon of integration of PBL and CBL teaching methods in kinesiology experiments / 中华医学教育探索杂志

Objective To explore the effect of applying problem-based learning (PBL) and case-based learning (CBL) in the kinesiology experiments. Methods Totally 534-year program undergraduates of Nantong University Medical School were divided into control group (n=26) and experimental group (n=27). The control group received traditional teaching and the experimental group received PBL and CBL teaching. The teaching effect was evaluated by examination and questionnaire. Data were analyzed by SPSS 19.0 and t test was used to compared the average scores of theory and questionnaire, α=0.05. Results The theoretical examination results (89.81 ±1.32) were better than the control group (84.82 ±1.75) (P=0.028). Meanwhile questionnaire survey showed that the experimental group students' evaluation of their teaching methods in promoting learning interest and initiative, combining theory with practice and teamwork con-sciousness were better than the control group students' evaluation of traditional teaching methods (P<0.05). Conclusion The teaching effect of integration of PBL and CBL teaching methods is better than traditional teaching in kinesiology experiments.

Clinical Observation of Hyperbaric Oxygen Combined with Flupentixol and Melitracen in the Treatment of Post-stroke Depression / 中国药房

OBJECTIVE:To investigate the effects of hyperbaric oxygen combined with flupentixol and melitracen on depres-sion improvement,extremity motor function and ability of daily living and activity in patients with post-stroke depression (PSD). METHODS:60 PSD patients were divided into control group and observation group according to random number table,with 30 cases in each group. Both groups received routine clinical treatment,comprehensive rehabilitation therapy and psychotherapy. The control group was additionally given Flupentixol and melitracen tablets,orally,one tablet each time,in the morning;3 days later, one tablet each time,in the morning and noon,for 4 weeks. Other anti-depressive agents were not given during treatment. Observa-tion group was additionally given hyperbaric oxygen,0.12 MPa,for 90 min,qd,5 times a week,for 4 weeks,on the basis of control group. Depression degree [Hamilton depression scale (HAMD) and Self-rating depression scale(SDS)],extremity motor function [Fugl-Mayer motor function assessment (FMA)] and ability of daily living and activity [modified Barthel index (MBI)] were scored in 2 groups before and after treatment,and ADR was observed. RESULTS:After 4 weeks of treatment,HAMD and SDS of 2 groups were decreased significantly compared to before treatment,while FMA and MBI were increased significantly;the improvement of observation group was significantly better than that of control group,with statistical significance(P<0.05). No ob-vious ADR was found in 2 groups. CONCLUSIONS:Hyperbaric oxygen combined with flupentixol and melitracen can effectively improve PSD,relieve negative emotion and improve extremity motor function and ability of daily living and activity.

Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy / 北京大学学报(医学版)

Objective:To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).Methods:In this study,461 patients with type 2 diabetes who received PCNL in Peking Uni-versity People’s Hospital from June 2006 to December 2015 were reviewed.There were 281 males and 180 females with an average age of 57 years were included,of whom,137 were diagnosed with SIRS after PCNL.The demographic data,clinical features,and test results were compared between the patients with SIRS and without SIRS,trying to identify the correlation between their clinical characters and the occur-rence of SIRS.Results:The SIRS was significantly correlated with the patients’preoperative white blood cell counting (×109 /L)[7.76 (4.00 -17.96)vs.6.31 (2.00 -17.40),P <0.001 ],preopera-tional blood glucose level (mmol /L)[7.30 (3.08 -19.90)vs.6.40 (3.42 -16.78),P <0.001], operative time (min)[75 (20 -270)vs.60 (20 -200),P <0.001 ],length of stay (d)[12 (2 -46)vs.11 (3 -29),P =0.019],staghorn stones [38.8% (33 /85)vs.27.7% (104 /376),P =0.042],and preoperational urinary tract infection [36.8% (50 /136)vs.26.6% (81 /304),P =0.032].There was no significant correlation between the SIRS and the patients’age,body mass index, preoperative hemoglobin level,preoperative serum creatinine,and transfusion.In multivariate analysis, abnormal preoperative white blood cell counting (OR =3.194,95% CI:1.531 -6.666,P =0.002), operative time longer than 60 min (OR =1.635,95% CI:1.088 -2.456,P =0.018),and preopera-tional blood glucose level higher than normal 7.1 mmol /L were significantly correlated with the presence of SIRS.Conclusion:The high level of preoperational blood glucose,abnormal preoperative white blood cell counting,and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Clinical feature analysis of premenopausal and postmenopausal female adults with kidney stones / 中华泌尿外科杂志

Objective To analyze clinical characteristics of premenopausal and postmenopausal female patients with kidney stones.Methods The clinical data of 1 194 female adults with kidney stones from December 2004 to December 2014 were analyzed retrospectively.The incidence of kidney stones in different age groups was analyzed firstly.The post-hysterectomy patients or those taking estrogen for breast cancer were excluded, and then 1 166 patients were enrolled.The patients were divided into premenopausal group (464 cases, 39.8％) and postmenopausal group (702 cases, 60.2％), and clinic features of different groups were evaluated.Results The peak age of female patients with kidney stones is between 50 and 59 years old.There were 105 (22.6％) patients in premenopausal group and 204 (29.1％) patients in postmenopausal group complicated with urinary infection.Fifty-eight (12.5％) patients had genitonrinary malformations such as horseshoe kidney, medullary sponge kidney, ectopic kidney, duplex kidney or pyeloplasty for ureteropelvic junction (UPJ) stricture in premenopausal group, as well as 36 (5.1％) in postmenopausal group.Twenty patients (4.3％) had renal insufficiency in premenopausal group, and 66 (9.4％) in postmenopausal group.These differences were statistically significant (P ＜ 0.05).The patients complicated with hydronephrosis (251 vs.346) and ureteral calculi (63 vs.110) of two groups were not significant different (P ＞ 0.05).Multiple factors Logistic analysis indicated that age and urinary infection were statistically significant factors in the occurrence of renal insufficiency (OR =1.037,1.772, P ＜ 0.05).Conclusions The occurrence of genitourinary malformations was higher among premenopausal female patients with kidney stones, while urinary infection and renal insufficiency were more common for postmenopausal patients.Age and urinary infection were the independent factors for the occurrence of renal insufficiency.