目的 探讨和观察慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)对精液质量的影响及其临床意义.方法 回顾性选取2021年8月至2022年7月首都医科大学附属北京妇产医院生殖男科门诊伴CP/CPPS症状患者188例,根据是否有病原体感染[包括前列腺小体外泄蛋白(PSEP)、解脲脲原体、沙眼衣原体、细菌培养、白色念珠菌、淋球菌等]进行诊断分类,其中诊断有病原体感染ⅢA-CP组患者52例,无病原体感染ⅢB-CP组患者136例.选取健康男性80例作为对照组.采集所有受试者精液进行检查,包括液化时间、精液量、pH值、精子浓度、活力、形态及精子碎片率(DFI)等.结果 与对照组比较,ⅢA-CP组精液量增多、pH值下降、液化时间延长、精子前向活率降低及DFI升高,差异均有统计学意义(P＜0.05);与对照组比较,ⅢB组液化时间延长、精子前向活率下降及DFI升高,差异均有统计学意义(P＜0.05).结论 Ⅲ A-CP对精液参数影响较大.不育患者应积极查找病因并治疗,提高精液质量以降低不育影响.

目的 探讨儿童肾盏憩室(calyceal diverticulum,CD)的临床特点、诊断及手术治疗方式.方法 回顾性分析2010年1月至2021年10月首都医科大学附属北京儿童医院泌尿外科与包头市第四医院小儿外科收治的7例肾盏憩室患儿临床资料,其中男5例,女2例;就诊年龄8个月至11岁,平均年龄3岁11个月.憩室位于左侧3例,右侧4例;肾上盏4例,肾中盏3例.憩室长径3～9cm,平均6.2 cm.产前超声发现肾脏囊性变3例,腹痛2例,无症状腹部包块1例,体检发现肾脏囊性病变合并高血压1例.3例术前经泌尿系超声检查确诊,4例术中确诊.7例均行手术治疗,其中开放肾盏憩室切除术2例,肾盏憩室剪裁+盏颈扩大术3例,开放和腹腔镜憩室壁翻瓣卷管输尿管端侧吻合术各1例.结果 7例均获随访,随访时间3个月至10年,患儿术后CD相关症状均消失,术前扩张的肾盏憩室均明显缩小,无一例复发;1例合并肾积水患儿术后积水明显减轻,但肾功能恢复较差,肾核素扫描显示分肾功能为20％,目前仍在随访中.结论 肾盏憩室易发生反复泌尿系感染、慢性腹痛、肉眼血尿、结石等,易误诊为单纯性肾囊肿,两者处理方式不同,需加以区分.应根据憩室位置、盏颈狭窄程度采取个体化治疗,包括肾盏憩室切除、盏颈扩大部分憩室切除、憩室壁翻瓣卷管输尿管端侧吻合术.如处理得当通常预后较好,少有复发.

Objective:To summarize the diagnosis, treatment and prognosis of Wilms tumor (WT) rupture in children pre-operation.Methods:The relevant clinical data were retrospectively reviewed for 41 WT children admitted from January 2008 to September 2018.There were 24 boys and 17 girls.The involved side was left (n=20) and right (n=21). The mean age of onset was 42.4(5-93) months.The mean diameter of tumor was 14.0(4.7-25.0) cm and the mean volume of tumor 533.6(29.5-2 056.6) cm 3.They were assigned into two groups of direct operation without preoperative chemotherapy (initial operation, n=13) and preoperative chemotherapy and delayed operation (pre-chemotherapy, n=28). Survival was compared with that of 41 children with non-ruptured stage Ⅲ WT. Results:Among 41 children with preoperative rupture, there were recurrence or distant metastasis (n=10) and 7 died during follow-ups.In initial operation group, there were recurrence or distant metastasis (n=2) and death (n=1). In initial chemotherapy group, there were relapse or distant metastasis (n=8) and death (n=6). Among 41 non-ruptured stage Ⅲ children, there were relapse or metastasis (n=3) and death (n=4). The mean survival time of rupture group was (96.1±9.5) months and the 5-year cumulative survival rate 75.1%.The mean survival time of non-rupture group was (122.3±6.8) months and the 5-year cumulative survival rate 89.6%.No significant inter-group difference existed in overall survival ( P=0.256). The recurrent rate of ruptured group was higher than that of non-ruptured group [24.4%(10/41) vs 7.3%(3/41)] and the difference was statistically significant ( P=0.031). Conclusions:Surgical resection of ruptured tumor followed by radiochemotherapy or preoperative chemotherapy followed by surgery should be adopted according to general status of a child, degree of tumor rupture, tumor size/location and surgeon experiences.The recurrent rate of WT ruptured pre-operation increases.

肾移植术后排斥反应的早期诊断及治疗对于减少移植物损伤至关重要.供者来源性细胞游离DNA(dd-cfDNA)检测是基于二代测序等技术,通过浓度法及绝对定量法检测循环体液中源于坏死、凋亡的供肾组织DNA片段含量,具有监测同种异体移植物损伤的临床应用潜力.相比传统血清肌酐等检测指标,dd-cfDNA检测可提前数周至数月监测到移植物损伤,为临床治疗和延缓移植物失功提供了"时间窗".随着近年来对dd-cfDNA研究的不断深入,dd-cfDNA因其兼具无创性、灵敏度高和能够对治疗效果进行实时评估等特点受到广泛关注.本文综述了目前有关dd-cfDNA检测在肾移植诊疗中多维度应用的研究证据与结论,并讨论了dd-cfDNA未来的研究和临床应用方向,旨在为dd-cfDNA检测广泛应用于我国的临床实践提供参考依据.

目的 探讨乙型肝炎病毒(HBV)感染对男性精液参数及血清生殖激素水平的影响.方法 选择2017—2019年在本院生殖医学科进行辅助生殖治疗的228例男性患者,年龄25～45岁,按血清学乙肝表面抗原(HBsAg)检测结果分为HBV阳性组(76例)和HBV阴性组(152例).结果 HBV阳性组精液常规参数与HBV阴性组相比,差异无统计学意义,但HBV阳性组精子浓度[75.4(46.4～111.8)×106/mL]略低于HBV阴性组[85.4(50.6～135.6)×106/mL].HBV阳性组血清卵泡刺激素(FSH)水平[4.9(3.7～6.6)IU/L]高于HBV阴性组[4.0(3.0～5.7)IU/L],差异具有统计学意义.两组间卵泡刺激素与黄体生成素比值(FSH/LH)以及睾酮分泌指数(TSI)均无显著差异.结论 HBV携带者的血清FSH水平高于未感染者,HBV感染可能是损害男性生育健康的原因之一.

目的 探讨肾移植术后供者来源性人细小病毒B19(HPV-B19)感染的防治策略.方法 回顾性分析2019年1月至2021年8月首都医科大学附属北京友谊医院收治的6例肾移植术后早期高度怀疑供者来源性HPV-B19感染导致纯红细胞再生障碍性贫血(PRCA)患者的临床诊治经过.结果 6例(3对)患者肾脏分别来源于同一供者.患者均于移植后早期出现严重贫血,HPV-B19 DNA检测阳性,骨髓穿刺确诊为PRCA.6例患者均接受输血治疗,在调整免疫抑制方案或剂量的同时,使用大剂量静脉注射免疫球蛋白(IVIG)(总剂量1.5～2.0 g/kg).6例患者贫血均得到明显改善,网织红细胞计数出现逆转性升高为PRCA改善的最早表现.治疗期间所有患者肾功能稳定,未发生明显不良反应.随访过程中,6例患者病情平稳,HPV-B19 DNA仍持续阳性(低水平),IgG抗体持续阴性.4例患者随访超过1年,IgM抗体转为阴性,转阴时间为10～12个月,其余患者IgM抗体仍为阳性.结论 肾移植术后严重的HPV-B19感染可导致PRCA,及时采取治疗措施安全有效.鉴于移植后早期HPV-B19感染存在供者来源可能性,建议供者捐献前筛查HPV-B19.对于阳性供者,其器官经移植后应严密监测受者感染情况并及时采取防治措施.

目的 探讨中国北方部分地区人类免疫缺陷病毒(HIV)合并播散性鸟分枝杆菌复合群(DMAC)感染者的临床特征及预后影响因素.方法 收集于2014年1月至2020年1月在首都医科大学附属北京佑安医院、天津市第二人民医院和石家庄市第五医院住院的HIV合并DMAC感染者的临床资料,另收集同时期于上述三家医院住院的HIV合并播散性结核分枝杆菌(DMTB)感染者的信息,比较两者临床特征,并进一步对HIV合并DMAC感染者进行随访,分析其预后的影响因素.结果 HIV合并DMAC感染者碱性磷酸酶、γ-谷氨酰转肽酶水平及肝肿大发生率、脾肿大发生率、启动抗逆转录病毒治疗(ART)率均高于HIV合并DMTB感染者,胸腔积液发生率低于HIV合并DMTB感染者,差异有统计学意义(P＜0.05).HIV合并DMAC感染死亡患者未启动ART占比、CRP水平、HIV病毒载量高于生存患者,HGB水平低于生存患者,差异有统计学意义(P＜0.05).ART启动情况、血红蛋白、C反应蛋白是HIV合并DMAC感染者的预后影响因素(P＜0.05).结论 临床和影像学特征有助于初步鉴别HIV合并DMAC感染者和HIV合并DMTB感染者,ART对HIV合并DMAC感染者的预后具有重大意义.

目的 探究采用18F-FDG PET/CT预测乳腺癌新辅助化疗治疗疗效的可行性.方法 回顾性分析本院2017年2月至2019年12月收治的85例乳腺癌患者的临床资料,记录新辅助化疗前后原发肿瘤行18F-FDG PET/CT所测量的最大标准摄取值变化率(SUV)最大值,计算18F-FDG PET/CT预测新辅助化疗疗效效能.结果 85例乳腺癌患者中,有28例(32.94％)患者术后病理诊断为pCR,其中Luminal A型2例;Luminal B(HER2-)型5例;Luminal B(HER2+)型5例;HER2阳性型7例;三阴型9例;对85例患者化疗前后进行PET/CT检查,所有患者完成新辅助化疗后,有35例(41.18％)患者达到病理完全缓解;ROC曲线下面积显示为0.811[95％可信区间(confidence interval,CI)0.708～0.914],敏感度60.91％[95％CI,38.74～83.08]、特异度为86.79％[95％CI,74.81～98.77].结论 PET/CT检查可清楚显示乳腺癌的影像学特点,在预测乳腺癌新辅助化疗治疗疗效.

目的 探讨不同感兴趣区(ROI)放置方法对扩散峰度成像(DKI)及体素内不相干运动(IVIM)模型参数测量的影响及其对乳腺非肿块强化(NME)良恶性鉴别诊断价值的影响.方法 回顾性分析行MR检查表现为NME的患者63例(63个病变),MR检查序列包括动态对比增强磁共振成像(DCE-MRI)、IVIM扫描和DKI扫描.所有恶性病灶和部分良性病灶经外科手术或穿刺病理证实,部分良性病灶观察1年未见变化为标准.采用最小ROI测量法和最大面积ROI测量法,测量病灶的标准扩散系数(ADCstand/ADCstand-max)、慢速扩散系数(ADCslow/ADCslow-max)、快速扩散系数(ADCfast/ADCfast-max)、平均峰度值(MK/MK-max)和平均扩散系数(MD/MD-max).勾画ROI时避开囊肿、血肿或坏死区域.对比乳腺NME良恶性病变之间各参数的统计学差异,绘制受试者工作特征(ROC)曲线,比较2种不同方法所测得参数的曲线下面积(AUC).结果 63个病变中,良性病变33个,恶性病变30个.2种方法所测量的ADCstand、ADCstand-max、ADCslow、ADCslow-max、MK、MK-max、MD、MD-max在良恶性病变之间均有显著统计学差异(P<0.001).ROC曲线结果显示:虽然最小ROI测量法所得的ADCslow AUC最大(0.888),且敏感度和特异度分别为78.8％和93.3％,但是2种方法所测量的ADCstand和ADCstand-max(Z=1.578,P=0.115)、ADCslow和ADCslow-max(Z=1.563,P=0.118)、MK和MK-max(Z=0.384,P=0.701)、MD和MD-max(Z=1.038,P=0.299)的AUC均无显著统计学差异.结论 对于NME病变,ADCstand、ADCslow、MK、MD有较高的AUC,有助于乳腺良恶性病变的诊断,且2种方法所得参数的鉴别诊断效能无明显差异.

以下临床实践建议是基于一项相关的系统综述,该综述使用推荐、评估、发展和评价等级(grades of recommendation,assessment, development,and evaluation,GRADE)对证据进行评价,建议在阅读本文的同时阅读该综述.本指南中的建议遵照在大多数情况下应满足大多数患者需求的实践原则.指南中的建议等级分为"强烈推荐"和"有条件推荐"两类,其具体含义和对应用者的意义见表1.关于任何具体治疗的最终判断必须由负责治疗的临床医师和患者决定,同时考虑到患者的个体情况、可用的治疗方案和资源.本文的图1中列出了建议实施的流程图.

Objective:To construct cluster intervention strategy with medical adhesive-related skin injury (MARSI) based on multi-criterion decision analysis (MCDA) .Methods:Literatures related to nursing care of MARSI were systematically searched in Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database, CNKI, VIP database, Wanfang Database and other Chinese and English databases. The retrieval period was from January 1, 2008 to December 31, 2018. A total of 10 correspondence experts used MCDA to assign scores to various nursing measures of cluster intervention strategies for MARSI patients. The recommendation score of each measure was calculated to form the recommendation, and the feasibility of cluster intervention strategy was verified through pre-test.Results:The authority coefficient of 10 letter experts was 0.830 and the positive coefficient of experts was 100%. After consultation with experts, 14 nursing recommendations were drawn up and entered into the item pool of cluster intervention strategies. The top 5 nursing measures were strengthening education and training for medical staff, standardization of application and removal of medical adhesives, application of alcohol-free skin protectants before using medical adhesives, complete skin dryness before using medical adhesive products (≥30 s) and correct description of damage type, color, range, etc.Conclusions:The use of MCDA can scientifically construct MARSI cluster intervention strategies.

Post embolization syndrome (PES) is a common complication after transarterial chemotherapy embolization (TACE) , which affects the prognosis of patients. This article reviews the research status, treatment and nursing of PES, in order to provide a theoretical basis for clinical medical staff to understand and deal with PES.

目的 通过对维持性血液透析患者的横断面研究,探讨患者焦虑状态和不依从性的患病率及两者的相关性.方法 选取2019年1-7月在首都医科大学附属北京天坛医院血液净化中心接受维持性血液透析治疗的患者,应用Zung氏焦虑自评量表(self-rating anxiety scale,SAS)对患者进行测评,收集患者透析间期体质量增长/干体质量(％)、透析前血钾等数据,分析液体限制不依从性、饮食钾限制不依从性、总体不依从性与焦虑状态之间的相关性.结果 最终纳入的82例患者中有焦虑状态者占15.9％(13/82),液体限制不依从者占14.6％(12/82),饮食钾限制不依从者占18.3％(15/82),总体不依从者占29.3％(24/82).焦虑状态患者与非焦虑状态患者相比,液体限制不依从性(38.5％比10.1％,P = 0.019)及总体不依从性(53.8％比24.6％,P = 0.047)比例均明显偏高.多因素logistics回归分析显示,焦虑状态是液体限制不依从性(OR = 5.71,95％CI:1.07～30.38)的独立影响因素.结论 维持性血液透析患者中焦虑状态、不依从性并不少见;焦虑状态是液体限制不依从性的独立影响因素.关注并改善患者精神状态,有潜在临床意义.

中枢神经系统感染人类免疫缺陷病毒(human immunodeficiency virus，HIV)引起的神经认知功能障碍是艾滋病患者常见的并发症。随着HIV感染者接受抗反转录病毒治疗(anti-retroviral therapy，ART)后生存期的延长，人类免疫缺陷病毒相关神经认知障碍(human immunodeficiency virus associated neurocognitive disorders，HAND)的发生率随之升高，这与中枢神经系统内持续的免疫炎症反应密切相关。所以对于HAND的治疗不能仅依赖于ART，还可从其免疫激活相关的机制出发，使用控制免疫激活和炎症反应的药物来辅助ART，以提高HIV感染患者的生命质量。本研究将介绍HAND的免疫学发病机制及其相关治疗的研究进展。

随着我国进入公民逝世后器官捐献时代,伴随潜在恶性肿瘤病史供者的器官捐献案例逐渐增多.欧盟编写的《移植器官质量与安全指南(第6版)》(《指南》)已于2019年出版中文译本.本文对《指南》第9章恶性肿瘤传播的风险进行了解读,以协助我国器官捐献协调员和移植团队筛查存在恶性肿瘤传播风险的供者,以减少供者来源性肿瘤疾病传播的风险.

目的 探讨和观察前列腺小体外泄蛋白(prostatic exosoma!protein,PSEP)指标在男性不育诊断治疗中的应用价值.方法 随机选择我院门诊60例男性不育患者,作为实验组,收集尿液标本后并收取其精液标本.同时选取180例体检男性尿液作为对照组.采用酶联免疫法检测实验组和对照组尿样中的PSEP浓度. (1)分析实验组和对照组PSEP浓度水平的差异;(2)在实验组中,分析PSEP浓度和精液量、精子浓度、精子活性、精子正常形态率、酸性磷酸酶、精浆锌之间的相关性.结果 经测试,实验组PSEP阳性率(62.5％)显著高于对照组PSEP阳性率(1 7.4％)(P＜0.001).在实验组中,PSEP浓度和b级活性精子数量呈显著负相关(P=0.039,r=-0.277),和精子PR (a+b)指标也较明显负相关(P=0.054,r=-0.259);PSEP浓度和精液量呈正相关(P=0.028,r=0.293),PSEP浓度和其他精液指标暂未发现相关性.结论 尿液PSEP在男性不育患者中有较高的阳性率,且PSEP浓度和精子活性呈现负相关;尿液PSEP指标对男性不育诊断中的病因研究分析和指导治疗具有较大临床意义,应继续扩大样本量进一步研究探讨.

目的:通过Meta分析评价中西医结合治疗HBV相关性慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)HBV DNA转阴率的影响.方法:计算机检索建库至2018年12月31日公开发表的中西医结合治疗HBV相关性慢加急性肝衰竭的随机对照试验(RCT)研究文献,双人独立筛选判定后进行文献质量评价,应用Revman 5.3软件对提取的数据进行Meta分析.结果:纳入文献5篇,共计病例368例.Meta分析结果显示,试验组HBV DNA转阴率与对照组HBV DNA转阴率差异无统计学意义[Z=1.62,RR=1.24,95％ CI(0.96,1.62),P=0.10];发表偏倚分析显示纳入文献发表偏倚较小.结论:中西医结合治疗HBV相关性慢加急性肝衰竭在HBV DNA转阴率方面不占优势.

Objective:To investigate the nursing effect of irritant dermatitis around drains after debridement of infected pancreatic necrotic tissue.Methods:A total of 108 patients with post-infectious pancreatic necrosis tissue debridement drains were divided into the experimental group and the control group with 54 patients in each group according to the time of hospital admission. The control group was given routine care and the experimental group was given stepped skin care, including education and training, assessment, skin preparation, and skin protectants and the use of disposable urinary ostomy bags, and the effect was evaluated.Results:The incidence of irritant dermatitis was 20.4% (22/54) in the test group and 40.7% (11/54) in the control group, with a statistically significant difference between the 2 groups ( χ2 value was 5.280, P < 0.05); 4 cases (36.36%) were cured in the experimental group, 5 cases (45.45%) in class I, 2 cases (18.18%) in class Ⅱ, 0 cases in class Ⅲ, and 0,13 cases (59.09%), 8 cases (36.36%), 1 case (4.54%) in the control group, respectively. The difference between the two groups was statistically significant ( χ2 value was 8.353, P < 0.05); In the experimental group, the duration of dermatitis incidence and total nursing time during hospitalization were (18.00 ± 2.25)d and (12.69±1.96)h, respectively, compared with (12.13±5.84)d and (15.79±2.09)h in the control group, which were statistically significant between the two groups ( t value was 29.167, -2.791, all P<0.05); the total cost of care in the experimental group was (570.38 ± 88.01)yuan and (448.79±59.44)yuan in the control group, the difference between the two groups was not statistically significant ( t value was -0.372, P>0.05). Conclusion:The stepped skin care protocol can reduce the incidence of infected pancreatic necrosis after tissue debridement and improve caregivers′ work efficiency.

目的 比较不同剂量羟考酮用于预防七氟烷全身麻醉小儿术后躁动的效果.方法 选择2019年8～11月于北京同仁医院择期行斜视手术的患儿为研究对象,根据羟考酮使用剂量的不同将患儿分为2组,即A组采用羟考酮0.1 mg/kg,B组采用羟考酮0.05 mg/kg.2组患儿均以七氟烷常规全麻,诱导后将羟考酮静脉泵入.分别记录2组患儿的手术时间、七氟烷吸入时间、术后躁动评分、镇痛评分、睁眼时间、恢复室停留时间及不良反应发生率.结果 共入选患儿80例,A组和B组各40例.A组患儿的术后躁动发生率为10.0％,低于B组的32.5％(P<0.05).A组患儿的镇痛满意率为95.0％,高于B组的75.0％(P<0.05).2组患儿其他各项指标比较,差异均无统计学意义(均P>0.05).结论 与0.05 mg/kg羟考酮用量相比,0.1 mg/kg羟考酮用于预防七氟烷全身麻醉小儿术后躁动中效果更好,镇痛更满意.