Myasthenia gravis is an autoimmune disease,which is usually mediated by antibodies to acetylcholine re-ceptors at the neuromuscular junction.It is commonly treated with cholinesterase inhibitors such as pyridostigmine bro-mide.Although cardiovascular events with the drug are rare,it is very important to early recognize disease changes and be alert to potential cardiovascular events in patients with myasthenia gravis.Therefore,we report a case of an elderly female patient with myasthenia gravis developing acute myocardial infarction and then sudden cardiac death following anticholines-terase therapy,and discuss the possible causes of adverse cardiovascular events based on this case.

脑桥中央髓鞘溶解症（CPM）是以脑桥基底部对称性脱髓鞘为病理特征的脱髓鞘疾病，一般由快速纠正慢性低钠血症引起。在没有异常血清钠浓度的情况下，血清渗透压紊乱的患者中很少出现这种情况。本文报道了一例罕见的糖尿病酮症酸中毒高血糖所致CPM患者。本例患者整个病程过程中血清钠浓度始终保持在正常范围。患者因头痛2 d、发热伴意识不清1 d余入院，初步考虑颅内感染，但经过进一步完善腰穿行脑脊液化验、病原学2代测序及培养最后排除了颅内感染。完善头颅磁共振可见典型CPM影像学表现，诊断为糖尿病酮症酸中毒所致CPM。进一步通过文献复习可知高血糖所致脑桥中央髓鞘溶解临床中较为少见，而糖尿病酮症酸中毒所致CPM目前国内文献鲜见报道。本病例提示我们即使在没有血清钠紊乱时，高血糖也可能导致脑桥中央髓鞘溶解。因此，在临床实践中当遇到血糖控制不佳，同时出现意识改变、四肢瘫等神经系统症状的糖尿病患者时需考虑到CPM可能。及时完善头颅影像评估进行早期诊断和治疗，可以迅速改善症状，避免遗留严重后遗症。

急性缺血性脑卒中是世界范围人口死亡和功能障碍的重要原因之一,严重威胁人类的健康和正常生活.大量研究表明,远端缺血后适应对脑缺血/再灌注损伤有保护意义,主要的作用有抑制炎性反应、保护血-脑脊液屏障、改善脑循环、减少脑梗死体积等.本文主要介绍远端缺血后适应在急性缺血性脑卒中的潜在作用和神经保护机制,旨在为远端缺血后适应临床应用提供理论依据.

目的 探讨碘海醇致颅神经损伤临床特点、诊治要点及误诊原因、防范措施.方法 回顾分析碘海醇致颅神经损伤2例的临床资料,并复习相关文献.结果 2例均为女性,分别因蛛网膜下腔出血和脑梗死采用碘海醇造影行神经介入治疗.术后均急起瞳孔散大、眼球活动障碍及眼球肿胀等,1例误诊为脑疝,1例未能明确诊断,均予甘露醇脱水治疗,效果不佳.后经完善头颅CT和MRI检查后,考虑碘海醇致颅神经损伤,予糖皮质激素等治疗后,均病情好转出院.结论 采用碘海醇造影介入治疗后患者出现颅神经损伤,需考虑碘海醇不良反应,要及时完善相关医技检查,以减少或避免其误诊误治,并积极正确处理,以防止病情恶化.

肾癌在成年人恶性肿瘤发病率中约占3％,峰值发病率在60～70岁.肾部分切除术(partial nephrectomy,PN)近年已成为治疗局限性肾肿瘤的金标准 [1].自1991年,Clayman完成了首例腹腔镜肾切除术以来 [2],腹腔镜广泛应用于肾疾病的治疗.近年,随着科技的进步和新设备的应用,尤其是高清及3D腹腔镜、机器人的使用,使肾部分切除术向更加精准化、微创化的方向发展.

目的 研究前列腺癌(PCa)患者血清中肿瘤坏死因子-α(TNF-α)及核因子κB(NF-κB)的诊断价值.方法 选取2015年1月～2018 年 1月广西科技大学附属柳州市人民医院(以下简称“我院”)诊治的PCa患者100例作为PCa组,选取我院同期诊治的良性前列腺增生(BPH)患者40例为BPH组,选取我院同期体检的健康人群40名为健康对照组.应用电化学发光法检测各组血清总PSA(tPSA)水平,酶联免疫吸附试验(ELISA)检测各组血清TNF-α和NF-κB水平,受试者工作曲线(ROC)分析各指标在PCa中的诊断价值.结果 BPH组与PCa组患者血清tPSA比较,差异有统计学意义(P＜0.05).PCa组TN F-α、NF-κB水平高于健康对照组、BPH组,差异均有统计学意义(均P＜ 0.05).PCa组患者TNF-α、NF-κB表达与病理分级、Gleason评分及肿瘤分期有关(均P＜0.05),与年龄、初始tPSA及是否存在远处转移无关(P＞0.05).TNF-α、NF-κB及联合检测的敏感性分别为75.1％、79.2％及81.3％,特异性分别为71.5％、80.1％及82.4％.ROC曲线的曲线下面积分别为0.713、0.753及0.832,联合诊断的诊断效能大于任一单一指标的诊断效能.结论 PCa患者血清TNF-α、NF-κB表达升高,联合检测患者血清TNF-α、NF-κB对tPSA处于诊断灰区的PCa有较高的诊断价值.

目的:探讨人类异常纺锤体样小头畸形相关蛋白(abnormal spindle-like microcephaly-associated protein,ASPM)在肾透明细胞癌中的表达情况以及其诊断预后的价值.方法:利用癌症基因组图谱(The Cancer Genome Atlas,TCGA)数据库的RNA-Seq数据和临床数据,分析ASPM基因与肾透明细胞癌患者临床病理特征以及生存预后的关系.结果:总体534例肾透明细胞癌样本的癌和癌旁组织中的ASPM的表达水平分别为6.62±1.34和3.59±1.41,差异有统计学意义(P＜0.001).72例配对的肾透明细胞癌和癌旁组织中的ASPM表达水平分别为6.89±1.14和3.59±1.41,差异有统计学意义(P＜0.001).ROC曲线分析结果表明,ASPM基因可作为一个灵敏度和特异度较高的肾透明细胞癌诊断指标(敏感性为94.2％,特异性为90.3％,AUC=0.935).ASPM基因表达与肾透明细胞癌患者临床病理特征的关系显示,ASPM表达与性别、肿瘤分级、T分期、M分期、临床分期均有显著性差异(P＜0.001).生存分析发现总体534例样本中ASPM低表达者和高表达者的总体生存时间分别为(1 421.85±984.72)d和(1 279.89±976.68)d,比较差异有统计学意义(Log-rank=14.69,P＜0.001).结论:ASPM在肾透明细胞癌中高表达,且临床特征密切相关,其高表达对判断肾透明细胞癌的生存预后及其诊断具有参考价值.

目的:探讨超声刀及Ligasure在腹腔镜根治性肾根治术处理肾蒂血管中的应用及安全性.方法:选取选取柳州市人民医院2010年1月～2017年12月期间治疗的局限性肾癌(T1N0M0～T2N0M0)患者60例,随机数字表法分为两组,各30例,均采用腹腔镜下均腹膜后入路进行手术,术中处理肾蒂血管时观察组采用Hem-o-Lok夹闭后用超声刀及Ligasure切断,对照组采用采用Hem-o-Lok夹闭后用冷刀切断.统计对比两组手术时间、术中失血量、术后肾窝引流量、住院时间以及手术相关并发症等指标.结果观察组手术时间、住院时间均短于对照组,且术中失血量、术后肾窝引流量均少于对照组,差异有统计学意义(P＜0.05).观察组并发症发生率与对照组比较差异无统计学意义(P＞0.05).结论:证明超声刀及Ligasure对肾脏血管止血满意,治疗效果好,安全性高,费用低廉,值得推广.

Objective To explore the efficacy of single versus double J ureteral stent placement in the treatment of recurrent benign ureteral stricture.Methods From January 2012 to December 2016,26 patients with recurrent benign ureteral stricture in the Department of Urology,Liuzhou General Hospital,Guangxi Zhuang Autonomous Region were selected as the research objects and divided into the single J ureteral stent group and the double J ureteral stent group by random number table.The clinical efficacy was compared between the two groups after stent placement.Before and after 3 months of stent placement,the levels of serum creatinine and hydronephrosis were compared between the two groups.Results After stent placement,the total effective rate in double J ureteral stent group was higher than that in single J ureteral stent group,but with no statistically significant difference (P ＞ 0.05).Before and after stent placement,there were no statistically significant differences in the levels of serum creatinine between the two groups and within groups (P ＞ 0.05).In the single J ureteral stent group,there was no statistically significant difference in hydronephrosis before and after stent placement (P ＞ 0.05),but after stent placement,that in the double J ureteral stent group was lower than that of before stent placement and that in the single J ureteral stents group,with statistically significant differences (P ＜ 0.05).Conclusion The efficacy and the drainage of double J ureteral stent placement in the treatment of recurrent benign ureteral stricture are better than those of single J ureteral stent placement.However,the long-term effects and mechanisms need to be further studied and verified by large samples.

脑血管病是当今世界严重影响人类生活质量及威胁人类生命的疾病,它是指各种原因导致的脑血管性疾病的总称,包括脑卒中、脑血管性痴呆、颅内血管畸形、颅内异常血管网病等.微小RNA(microRNA,miR)是机体自身合成的一类长约20~25个核苷酸的单链非编码RNA分子,它通过分解或抑制靶RNA,从而调控转录后基因的表达.据统计,约1% 的人类已知基因可能编码miRNAs,而miRNAs可能调控人类基因组中1% ~30% 的基因,由于其强大、特异的基因调控能力,现已广泛应用于基因功能的基础研究和人类疾病模型的研究,包括药物靶标的筛选、候选药物的潜在副作用分析、基因治疗的测试和功能缺失筛选等.迄今为止,没有有效的工具来控制与脑血管病相关的病理生理过程,因此miRNAs被认为是未来脑血管病治疗的一个非常有前途的目标.

目的:观察输尿管硬镜扩张后留置两根双J管治疗良性输尿管狭窄中远期疗效.方法:对2012年1月-2016年7月在我院就诊的17例良性输尿管狭窄患者,采用输尿管硬镜扩张后留置两根双J管引流,3～4个月后根据患者病情决定拔除或者继续更换双J管,随访12～48个月,平均随访22.5个月,观察患者的疗效.结果:14例患者拔除双J管后均无腰胀、发热、血尿等症状,B超示患者肾积水改善,2例患者拔管后发热腰痛,改定期更换双J管,1例肾积水加重,肾功能差,最后切除患肾,总有效率82.4％.结论:输尿管硬镜扩张后留置两根双J管治疗良性输尿管狭窄安全可靠,中远期疗效好,可有效预防输尿管再发狭窄.

Objective To screen stable express A30P a-synuclein PC12 cell as the research object,and to preliminarily investigate the activity of different glycogen systhesis kinase 3β (GSK3β) for the regulation of autophagy pathway causes a-synuclein autophagy level change and its effects on cell growth.Methods The vector of A30P a-synuclein was used to transfect to PC12 cells.G418 was used to screen stable expressed cells.Liposome method was used to transfect GSK3β-expressed plasmid,GSK3β silence plasmid,and blank plasmid into these cell lines,and stable expressed activity of GSK3β cell lines were screened.Western blot was used to detect the expression of GSK3 β after transfection and verify the transfection efficiency.Western blot was used to test groups of cells in LC-3 Ⅱ,Beclin1,and a-synuclein expressions.Methyl thiazolyl tetrazolium (MTF) method was used to detect the change of cell proliferation.Terminal dexynucleotidyl transferase (TdT) mediated dUTP nick end labeling (TUNEL) method was used to detect apoptosis.Results (1) When GSK3β expressed group was compared to GSK3β silence group,blank plasmidgroup,and blank control group,the expressions of LC-3 Ⅱ and Beclin1 were significantly increased (P ＜ 0.05),the expression of a-synuclein was significantly reduced (P ＜ 0.05),the results of MTT and TUNEL showed that the cells were the decrease of apoptosis and increase of cell proliferation,with a statistically significant difference (P ＜ 0.05).(2) When GSK3β silence group was compared to GSK3β express group,blank plasmidgroup,and blank control group,the expressions of LC-3 Ⅱ and Beclin1 were significantly reduced (P ＜ 0.05),the expression of a-synuclein was significantly increased (P ＜ 0.05),the results of MTT and TUNEL showed that the cells were the increase of apoptosis and decrease of cell proliferation,with a statistically significant difference (P ＜0.05).Conclusions (1) Activation of GSK3β activity can improve the level of cell autophagy,enhance the ability of alpha-synuclein degradation,and promote cell survival.(2) Inhibition of GSK3β activity can reduce the level of cell autophagy,weaken the ability of alpha-synucleindegradation,and reduce cell survival.(3) Autophagy is closely related to the pathogenesis of Parkinson's disease (PD).The improvement of the level of autophagy and enhancing of the degradation of asynuclein is a new way of the future treatment of PD.

目的:对比前列腺增生并急性尿潴留急诊导尿失败后耻骨上膀胱穿刺造瘘和输尿管镜辅助下留置尿管两种治疗方法的临床疗效.方法:对50例老年前列腺增生并急性尿潴留急诊导尿失败的患者,随机均分两组,一组采用传统的耻骨上膀胱穿刺造瘘(膀胱穿刺造瘘组),另一组采用在输尿管镜辅助下留置导尿管(输尿管镜导尿组),比较两组手术时间,手术并发症发生率,术后疼痛视觉模拟评分(VAS),膀胱刺激征,尿路感染率等指标.结果:膀胱穿刺造瘘组在手术时间上要短于输尿管镜导尿组,两组比较有显著差异(P＜0.05);但输尿管镜导尿组在手术并发症发生率和术后疼痛VAS评分方面要少于膀胱穿刺造瘘组,两组比较有显著差异(P＜0.05);膀胱刺激征和尿路感染率,在短期内(7 d)两组比较差异不明显(P＞0.05).结论:输尿管镜辅助下留置导尿管虽然在手术时间上稍长,但操作简单安全,患者痛苦小,手术并发症少,较传统耻骨上膀胱穿刺造瘘术的临床疗效好.

Objective To study the role of HSP90 in and the effect of salvianolic polyphenol on focal cerebral ischemia/reperfusion (I/R) injury.Methods A rat cerebral I/R injury model was established by Longa occlusion.Seventy-five SD rats were divided into control group,model group,inhibitor group,salvianolic polyphenol treatment group,and I/R injury +inhibitor group (15 in each group).After I/R injury model was established,the infarction size in different groups was measured amd expressions of HSP90,Akt and P-Akt protein were detected by Western blot.Results The infarction size was significantly smaller in control group and salvianolic polyphenol treatment group than in model group (P＜0.05) and was significantly larger in inhibitor group than in I/R injury+inhibitor group (P＜0.05).The expression level of HSP90 and p-Akt protein was significantly lower in model group than in control group and was significantly higher in salvianolic polyphenol treatment group than in model group (P＜0.05,P＜0.01).The expression level of p-Akt protein was significantly lower in inhibitor group than in model group and in I/R injury+inhibitor group than in salvianolic polyphenol treatment group (P＜0.05).Conclusion HSP90 protects nerves against injury through the Akt/P-Akt pathway in cerebral I/R injury.

Prostate cancer (PCa) is one of the malignant tumor that affect older men with high morbidity and mortality.The number of PCa patients in our country increased year by year,therefore it is of great significance for early diagnosis and treatment.Prostate specific antigen (PSA) plays an important role in the diagnosis,treatment and prognosis of early PCa.The related parameters of PSA (F/TPSA,CPSA,PSAV,PSAD and PSATZ) in this article which is applied to the value of early diagnosis PCa were reviewed,which aimed to provide theoretical basis for clinical diagnosis of Pca.

Objective To explore the effect of epithelial-mesenchymal transition(EMT)regulation protein in prostate cancer(PCa)invasion and metastasis and its diagnostic value of clinical prognosis.Methods Totally,48 cases of PCa tissue samples(PCa group)and 50 cases of benign prostatic hyperplasia(BPH)tissue samples(BPH group)were collected.Expression levels of N-cadherin and E-cadherin were detected by immunohistochemical SP method in tissue samples,the relationship between N-cadherin,E-cadherin and clinical data in PCa patients was analysed.PCa patients were followed up,the overall survival(OS)was recorded,with OS serving as evaluation index.The prognostic factors were evaluated by univariate and multivariate Cox proportional hazards model.EMT was induced by TGF-β1 in DU-145 cells line.The cell proliferation ability was detected by cell proliferation assay.Cell invasion and migration ability was detected by Transwell.E-cadherin and N-cadherin protein expression was detected by Western blotting.Results In PCa group,the expression of N-cadherin was significantly higher than that in the BPH group,and the expression of E-cadherin was significantly lower than that in the BPH group(both P<0.05).The N-cadherin high expression rate was significantly higher in tumor with diameter≥2.5 cm than that in the tumor with diameter<2.5 cm;N-cadherin high expression rate in stage ⅣPCa patients was significantly higher than that in stage Ⅱ and Ⅲ PCa patients;the high expression rate of N-cadherin was significantly higher in patients with lymph node metastasis than in those without lymph node metastasis;the high expression rate of N-cadherin was significantly higher in patients with distant metastasis than in those without distant metastasis(all P<0.05).The E-cadherin high expression rate was significantly lower in patients with Gleason score≥7 than in those with Gleason score≤6;the high expression rate of E-cadherin was significantly lower in patients with lymph node metastasis than in those without lymph node metastasis;E-cadherin high expression rate was significantly lower in patients with distant metastasis than in those without distant metastasis(P<0.05).The overall survival was significantly lower in N-cadherin high expression patients than in N-cadherin low expression patients(P=0.024);the overall survival was significantly higher in E-cadherin high expression patients than in E-cadherin low expression patients(P=0.017).Univariate and multivariate analysis showed that T4 stage tumors,high expression of N-cadherin and low expression of E-cadherin were independent risk factors for overall survival(all P<0.05).Cell proliferation test showed that,absorbance value in DU-145 group in 24-96 h was significantly higher than that of normal control(NC)group(P<0.05).Transwell results showed that the number of transmembrane cells in DU-145 group was significantly higher than that in NC group(P<0.05).Western blotting showed that,N-cadherin proein expression was significantly higher in DU-145 group than in NC group,E-cadherin proein expression was significantly lower in DU-145 group than in NC group(both P<0.05).Conclusion EMT is related to proliferation,invasion and migration of PCa,and N-cadherin and E-cadherin can be regarded as one of the predictors of clinical prognosis of PCa.

目的 比较经直肠超声(TRUS)引导下经会阴与经直肠前列腺穿刺活检术后并发症的发生率,探讨发生原因及处理方法.方法 2013年1月～ 2015年7月我院泌尿外科收治的111例直肠指捡异常和(或)PSA＞4ng/mL和(或)TRUS、CT或MRI检查发现异常的患者随机分成经会阴组(n=56)与经直肠组(n=55),分别予经会阴和经直肠系统性穿刺活检,每例8～9针,随访并发症发生情况并比较两组并发症的发生率.结果 经会阴组与经直肠组前列腺癌穿刺阳性率分别为42.86％及38.74％,两组差异有统计学意义(P＜0.05).经会阴组与经直肠组的总并发症发生率分别为12.50％及60.00％,两组差异有统计学意义(P＜0.01).经会阴组与经直肠组血尿发生率分别为5.36％及25.45％,两组差异有统计学意义(P＜0.01).经会阴组与经直肠组感染发生率分别为1.79％及14.55％,两组差异有统计学意义(P＜0.05).结论 TRUS引导下经会阴前列腺穿刺活检精确、安全.

Objective To study the PERK/ eIF2a pathways and Caspase 3 in the mechanism of action of ischemia reperfusion injury in rats and the effect of atorvastatin. Methods Produce the ischemia reperfusion model rats by Middle cerebral artery embolism method which were divided into the ischemia reperfusion group,control group,atorvastatin interven-tion group and eIF2a suppression group. To observe the changes of ischemic brain,specimens were treated with TTC stai-ning,the PERK,Caspase-3 protein expression and protein phosphorylation eIF2a were detected by western-blot. Results Compared with the control group,after ischemia reperfusion,PERK protein expression and protein phosphorylation eIF2a in-creased,the expression of Caspase 3 was enhanced,and the expression of PERK protein and phosphorylation eIF2a was re-lieved after atorvastatin intervention. The expression of Caspase-3 and phosphorylation eIF2a was inhibited by inhibitor Salu-brinal,which had no effect no PERK. Large cerebral infarction in ischemia reperfusion group was visible by TTC staining af-ter ischemia reperfusion. Cerebral infarction volume was significantly narrowed by atorvastatin intervention or inhibitor Salu-brinal. Conclusion Cell apoptosis was related to the PERK/ eIF2a / Caspase 3 pathways after endoplasmic reticulum stress,atorvastatin can reduce the damage of cerebral ischemia reperfusion.

Objective :To explore the early diagnosis and effective treatment of Fournier syndrome .Methods :A total of 16 cases of Fournier syndrome from January 2009 to December 2015 were retrospectively analyzed .16 patients under‐went surgical treatment including incisions ,aggressive debridement ,and antibiotic therapy ;of them ,7 patients received vacuum sealing drainage(VSD) therapy .Results:13 cases were cured ,3 cases died of multi‐organ failure .The average hospital stay in 7 cases without VSD was(34 .8 ± 6 .5)days;the average hospital stay in 6 cases with VSD was(26 .8 ± 5 .3)days .The average hospital stay of the two groups were significant differences (P<0 .05) .Conclusion:The early di‐agnosis of Fournier syndrome and timely aggressive surgical debridement are critical for improving survival .In combina‐tion with a series of comprehensive treatments ,the prognosis is generally good .If available ,VSD may be used to pro‐mote the healing of tissue wound and shorten average hospitalization .

Golgi stress is caused by the stress reaction of cerebral ischemia and reperfusion,which lead to the change of the function of the protein processing and transportation and secretion of Golgi protein.Golgi stress is closely related to variety signal transduction pathway in cells.We review the related literature in recent years,and summarize the research progress,The results indicated that Golgi stress plays a role by the signal pathway of phosphoinositide,protein kinase C/protein kinase D,RAS/MAPK kinase,cAMP/PKA kinase,and so on.It is involved in the pathogenesis of ischemic stroke,spinal cord injury,and neurodegenerative diseases.