Renal cancer is a common malignant tumor in urology, with complicated pathogenesis and no obvious clinical symptoms. Metastatic renal cancer accounts for 20%-30% of the newly diagnosed renal cancer. The 5-year survival rate for metastatic patients is less than 10%.At present, the main non-surgical treatment means of mRCC include cytokines and targeted drug therapy, and immunotherapy has also become a research hotspot of mRCC. The current status and research progress of mRCC therapy were reviewed. The medical treatment methods of metastatic renal cancer, such as receptor tyrosine kinase inhibitors and mTOR inhibitors; immunotherapies, such as immunosuppressants for PD-1/PD-L1 were also discussed.

目的 探讨糖尿病(DM)对射血分数保留心力衰竭(HFpEF)患者出院前运动耐量的影响.方法 选取2020年1—12月重庆医科大学附属第一医院第一分院收治的60例HFpEF患者作为研究对象,根据是否并发DM分为DM-HFpEF组(n=30)和NDM-HFpEF组(n=30),比较两组患者基线资料,采用6 min步行试验(6MWT)来评价出院前运动耐量的康复程度.结果 两组患者6-MWT后自我感知运动强度量表(Borg量表)评分、血糖、血氧饱和度差异有统计学意义(P<0.05);试验前后血氧饱和度、血糖的差值在两组间差异有统计学意义(P<0.05).两组患者试验后血压、心率及步行距离差异均无统计学意义(P>0.05).结论 DM对HFpEF患者出院前运动耐量有一定的影响,但需大样本临床试验进一步验证.

目的 评价集束化护理对重症患者失禁相关性皮炎的疗效.方法 在Embase、PubMed、the Co-chrane Library、万方、CBM、知网、维普等数据库检索集束化护理与失禁相关性皮炎的相关研究,检索日期截止到2019年12月1日.由两位研究者分别提取数据及评价文献质量.应用Revman 5.3进行数据统计分析.结果 共纳入35篇研究(共计3520例患者,其中常规护理组1760例,集束化护理组1760例).与常规护理组相比,集束化护理可显著减少失禁相关性皮炎的发生(RR=0.33,95％CI:0.27～0.41,P<0.00001),护理时间可明显缩短(WMD=-3.08 h,95％CI:-3.51 h～-2.66 h,P<0.00001),同时亦可减少住院费用(SMD=-5.71,95％CI:-7.29～-4.13,P<0.00001),提高患者满意度(RR=1.21,95％CI:1.15～1.27,P<0.00001).结论 集束化护理可显著减少失禁相关性皮炎的发生,缩短护理时间及减少住院费用,提高患者满意度.

目的 评估采用氯己定尿道口消毒预防重症患者导尿管相关性尿路感染(CAUTI)的效果.方法 计算机检索PubMed,Web of Science,Embase,The Cochrane Library及中国知网、万方、维普等数据库中有关氯己定与CAUTI的文献,检索日期为自建库起至2021年2月28日.采用Cochrane系统评价手册Version 5.1.0质量评价标准评价文献质量,Revman 5.3软件对数据进行统计与分析.结果 共纳入5项研究,共2334例患者,其中对照组1046例,氯己定尿道口消毒组1288例,均为随机对照试验.Meta分析结果显示,与对照组比较,氯己定尿道口消毒并不能显著降低CAUTI的发生率[RR=0.68,95％CI(0.33,1.40),P=0.29]及无症状性菌尿(ASB)的发生率[RR=0.62,95％CI(0.18,2.16),P=0.45].结论 氯己定尿道口消毒并未显著降低重症患者CAUTI和ASB的发生率.

Objective:To evaluate the efficacy of amiodarone in preventing reperfusion ventricular fibrillation (RVF) in patients undergoing cardiac surgery.Methods:This study searched the databases of CNKI, Wanfang, Weipu, Cochrane, Embase, Web of Knowledge and PubMed, and searched the related research of amiodarone to prevent RVF in cardiac surgery patients, the time was until December 2019. Meta analysis was performed using Revman 5.3 software according to established standards.Results:The study included six studies (incorporating 514 patients). According to different intervention methods, 514 patients were divided into three groups, 196 in the amiodarone group, 153 in the lidocaine group, and 165 in the placebo group. The incidence of RVF was significantly lower in the amiodarone group than in the control group ( RR: 0.64, 95% CI: 0.47-0.86, P=0.003, I2=49%), but there was no significant difference between the amiodarone group and the lidocaine group( RR: 1.03, 95% CI: 0.48-2.22, P=0.94, I2=74%). Compared with the control group, amiodarone reduced the defibrillation frequency of RVF, but the difference was not statistically significant ( RR: 0.90, 95% CI: 0.68-1.20, P=0.48, I2=0). There was no difference in the number of defibrillation of RVF between the lidocaine group and the amiodarone groups ( RR: 1.50, 95% CI: 0.90-2.52, P=0.12, I2=38%). Conclusion:Compared with the control group, amiodarone can significantly reduce the incidence of RVF in patients undergoing cardiac surgery.

目的 探讨冠状动脉钙化积分(CACS)与脉压差(PPD)的相关性.方法 回顾性分析2017年1月至2018年6月重庆医科大学附属第二医院收治的906例行冠状动脉血管成像(CCTA)的住院患者的临床资料,按有无高血压分为高血压组(485例)和正常血压组(421例),比较2组患者中不同PPD者CACS情况;再根据CACS结果分为CACS=0(477例)、1～<100(256例)、≥100(173例)3个亚组,分别比较3个亚组患者的PPD水平,以探讨CACS与PPD的相关性.结果 (1)906例患者PPD与CACS呈显著正相关(r=0.146,P=0.008),且高血压组、正常血压组患者PPD与CACS均呈正相关(r=0.103、0.101,P=0.023、0.038).(2)高血压组患者中CACS≥100组患者的平均PPD[(63.60±18.11)mm Hg](1 mm Hg=0.133 kPa)明显大于CACS=0组[(57.49±14.25)mm Hg];正常血压组患者中CACS≥100组患者平均PPD[(54.08±14.19)mm Hg]均明显大于CACS=0组[(47.53±11.48)mm Hg]及CACS为1～<100组[(48.04±12.34)mm Hg],差异均有统计学意义(P<0.05).结论 无论有无高血压疾病的基础,行CCTA的住院患者CACS与PPD均呈正相关.

目的 探讨内镜逆行性胰胆管造影术(ERCP)在腹腔镜胆囊切除术后胆漏及隐匿性胆总管结石诊断和治疗中的应用价值.方法 患者为85岁女性,因"上腹疼痛1月余,复发加重2 d"入院.患者1个月前在某院(简称外院)诊断为胆囊结石伴胆囊炎,并行了腹腔镜胆囊切除术.术后患者一直有上腹隐痛症状,2 d前腹痛加重伴呕吐.外院治疗后腹痛无明显好转,转入重庆医科大学附属第二医院.入院后完善磁共振胰胆管成像(MRCP)等相关检查,初步诊断:(1)急性胰腺炎;(2)胆囊切除术后胆囊积液:感染?出血?胆漏?故拟行ERCP进一步检查 、治疗.结果 ERCP术中造影提示造影剂外溢,考虑胆漏.术中胆道造影未见明显充盈缺损,但取石球囊刮出直径0.4 cm的黄色质软结石1枚,术中安置鼻胆管1根.术后诊断:(1)急性胆源性胰腺炎;(2)胆总管结石;(3)胆囊切除术后胆漏.术后患者腹痛症状明显减轻,1周后复查MRCP见胆囊窝积液明显减少,术后8 d拔除鼻胆管,术后9 d出院.结论 ERCP在诊断及治疗腹腔镜胆囊切除术后发生的胆漏具有明显的优势,并能诊断及治疗隐匿性胆总管结石.

AIM:Todetecttheeffectofspironolactoneonhyperthyroxine-inducedatrialremodeling.METH-ODS:New Zealand rabbits were divided into control group ( C ) , hyperthyroxine group ( H ) and spironolactone group ( S) .Thyroxin was given to the rabbits in group H and group S by intraperitoneal injection for 4 weeks , and then spirono-lactone was given in group S by gavage for 2 weeks.Atrial fibrillation (AF) was induced by "burst"stimulation after ad-ministration.The inducing rate of AF and atrial effective refractory period ( AERP) were tested by intra-cardiac electro-physiologic instrument.The expression of AF-related Ca2+channel (Cav1.2), K+channels (Kv1.5 and Kv4.3) and con-nexins (Cx40 and Cx43) at mRNA and protein levels was detected by real-time PCR, immunohistochemistry and Western blot.RESULTS:Spironolactone reduced the inducing rate of AF .No significant difference of AERP between group H and group S was observed (P>0.05).Compared with group H, the protein expression of Cav1.2 was significant increased in group S (P<0.05).The expression of Kv1.5 at mRNA and protein levels in group S was significantly lower than that in group H (P<0.05), while the protein expression of Kv4.3 in group S was significantly decreased compared with group H (P<0.05).The mRNA expression of Cx43 in group S was significantly decreased compared with group H (P<0.01), whereas the protein expression of Cx 40 in group H was significantly higher than that in group S ( P<0.05 ) .CONCLU-SION:Spironolactone attenuates the hyperthyroxine-induced atrial remodeling in rabbits , and reduces the susceptibility of the myocardium to AF .

临床上去势抵抗性前列腺癌(castrationresistant prostate cancer,CRPC)是前列腺癌死亡的重要原因,近年来美国FDA批准了多种新药用于CRPC的治疗,如新型雄激素合成抑制剂(阿比特龙,TAK-700)、雄激素受体拮抗剂(MDV3100)以及新的免疫疗法(Sipuleucel-T)等.本文就CRPC治疗进展作一综述.

目的 评估CHADS2、CHA2DS2-VASc和自行改良的CHA2DS2-VASc-LA2评分对经食管超声(TEE)检出左心房或左心耳血栓(LAT)的预测价值.方法 纳入2007年6月至2012年6月在我科拟行射频消融术且术前TEE检查、心脏多层CT扫描等相关临床资料完整的非瓣膜性心房颤动(NVAF)患者,共203例,其中TEE提示LAT者39例(血栓组),未检出LAT者164例(对照组).对患者的一般情况、既往病史、入院时检查、CHADS2评分和CHA2DS2-VASc评分进行单因素分析和多因素logistic回归分析,根据logistic回归分析结果,将独立预测因素左心房容积指数(LAVI)≥32 mL/m2记为2分,加入CHA2DS2-VASc评分中组合成新的评分方案CHA2DS2-VASc-LA2.绘制受试者工作特征曲线(ROC),比较CHADS2、CHA2DS2-VASc和CHA2DS2-VASc-LA2评分方案对NVAF患者LAT形成的预测价值.结果 对CHADS2、CHA2DS2-VASc及CHA2DS2-VASc-LA2三种评分进行ROC曲线检测,发现CHADS2诊断价值偏低(AUC=0.661,P=0.002),CHA2DS2-VASc和CHA2DS2-VASc-LA2诊断价值中等(AUC=0.731,P＜0.001; AUC=0.771,P＜0.001).使用CHA2DS2-VASc-LA2评分后血栓组CHADS2评分为0分的3例低危患者分值均有上升,血栓组中无CHA2DS2-VASc-LA2评分为0分者.结论 CHA2DS2-VASc-LA2评分较CHADS2、CHA2DS2-VASc评分系统能更好地预测NVAF低危人群的LAT形成,CHA2DS2-VASc-LA2评分为0分者可避免常规的TEE检查.

目的:本文旨在应用Meta分析的方法评价基因分型指导华法林预防和治疗血栓栓塞性疾病的有效性与安全性.方法:计算机系统检索PubMed、Cochrane图书馆、万方、维普(VIP)、中国知网(CNKI)等数据库有关基因分型指导华法林预防和治疗血栓栓塞性疾病的文献,检索日期由建库截止2014年1月1日.由2位作者独立进行数据提取和文献质量方法学评价.应用RevMan5.2进行统计分析.结果:共有11项研究最终被纳入系统评价,最终对10项随机对照研究(2 905名受试者)进行定量分析.Meta分析结果显示:基因分型组与对照组比较,在国际标准化比值(international normalized ratio,INR)处于治疗范围的时间百分比(SMD=0.11,95％CI=-0.06～0.29,P=0.21),稳定剂量达标率[相对危险度(relative risk,RR) =1.13; 95％ CI=1.00～1.28,P=0.05],抗凝过度(RR=0.95,95％CI=0.83～1.08,P=0.44),出血事件(RR=0.89,95％CI=0.78～1.01,P=0.08),栓塞事件(RR=0.61,95％CI=0.30～1.23,P=0.17)等方面,2组之间的差异均无统计学意义;对INR处于治疗范围的时间百分比和稳定剂量达标率2方面进行亚组分析,结果提示2组之间仍未见统计学差异.对结局指标进行敏感性分析显示结果稳定可靠.结论:基因分型指导华法林预防和治疗血栓栓塞性疾病较对照方案在有效性与安全性方面的优势性证据仍不足.