急诊科尿源性脓毒症的临床回顾性研究

目的:回顾性研究急诊科住院患者的尿路感染及其所致脓毒症的临床及病原学特征。方法:选取2014年1月至2017年8月上海交通大学医学院附属仁济医院急诊病房及急诊ICU收治住院的106名诊断为"尿路感染"的患者,结合出院诊断及新版脓毒症诊断标准再评估,分为"尿脓毒症组"(n=45)和"非脓毒症组"(n=61),收集和比较一般临床资料、实验室指标、病原学分类及特征。结果:1)尿脓毒症组上尿路感染、泌尿系统梗阻以及上尿路梗阻并感染的发生率均显著高于非脓毒症组(P=0.042,P=0.011,P=0.035)。2)尿脓毒症组白细胞计数(P=0.002)、C反应蛋白(P0.001)、降钙素原(P=0.028)、肌酐(P0.001)、D-二聚体(P0.001)、APACHE II评分(Acute Physiology and Chronic Health Evaluation II,APACHE II)(P0.001)均明显高于非脓毒症组,而血清白蛋白(P0.001)、血小板(P0.001)计数、Glasgow评分(P0.001)均显著低于非脓毒症组;3)尿脓毒症组急性肾脏功能障碍(28/45,62.22%)发生率最高,凝血系统功能障碍发生率次之(25/45,55.56%)。中段尿培养中以屎肠球菌占比最高(11/40,27.5%),其次为大肠埃希菌(8/40,20%)。结论:上尿路感染与泌尿系统梗阻是发生尿脓毒症的危险因素,相较于非脓毒症患者,尿脓毒症患者炎症指标、肌酐、D-二聚体、APACHE II评分水平更高,白蛋白、血小板及Glasgow评分更低,肾功能障碍与凝血功能障碍在尿脓毒症患者中更多见。临床需对中段尿培养肠球菌阳性的患者引起重视。     

脑梗死复发患者血清同型半胱氨酸、白蛋白和尿微量白蛋白的变化及其影响因素分析

目的:研究脑梗死复发患者血清同型半胱氨酸(Hcy)、白蛋白(ALB)和尿微量白蛋白的变化及脑梗死复发的影响因素。方法:将2013年2月至2016年2月我院收治的脑梗死复发患者63例记为复发组,另取同期住院治疗的未复发脑梗死患者57例记为非复发组。比较两组患者血清Hcy、ALB、尿微量白蛋白水平和基本资料,并采用多因素Logistic回归分析脑梗死复发的影响因素。结果:复发组血清Hcy、尿微量白蛋白水平高于非复发组,复发组血清ALB水平低于非复发组(P0.05)。经Pearson相关性分析可得:脑梗死复发患者血清Hcy与尿微量白蛋白水平呈正相关关系,ALB与Hcy、尿微量白蛋白水平呈负相关关系(P0.05)。复发组高血压、脑白质疏松、脑血管病家族史人数占比高于非复发组(均P0.05)。经多因素Logistic回归分析可得:血清Hcy、尿微量白蛋白水平以及高血压均是脑梗死复发的独立危险因素(P0.05),而血清ALB水平是脑梗死复发的保护性因素(P0.05)。结论:脑梗死复发患者的血清Hcy、尿微量白蛋白水平升高,而血清ALB水平降低,上述三项指标的异常改变可能共同促进了脑梗死的复发,值得临床重点关注。     

Histoplasma capsulatum Recovery from the Urine and a Short Review of Genitourinary Histoplasmosis

Although virtually any organ can be involved in disseminated histoplasmosis, the recovery of Histoplasma capsulatum from the urine is a rare finding. Here we describe that a renal transplant recipient had H. capsulatum recovered from urinary sediment. The organism was also recovered from urine cultures. The potential implications of this finding are discussed, and the literature on genitourinary histoplasmosis is reviewed.     

The human urinary proteome reveals high similarity between kidney aging and chronic kidney disease

Aging induces morphological changes of the kidney and reduces renal function. We analyzed the low molecular weight urinary proteome of 324 healthy individuals from 2–73 years of age to gain insight on human renal aging. We observed age‐related modification of secretion of 325 out of over 5000 urinary peptides. The majority of these changes were associated with renal development before and during puberty, while 49 peptides were related to aging in adults. We therefore focussed the remainder of the study on these 49 peptides. The majority of these 49 peptides were also markers of chronic kidney disease, suggesting high similarity between aging and chronic kidney disease. Blinded evaluation of samples from healthy volunteers and diabetic nephropathy patients confirmed both the correlation of biomarkers with aging and with renal disease. Identification of a number of these aging‐related peptides led us to hypothesize that reduced proteolytic activity is involved in human renal aging. Finally, among the 324 supposedly healthy individuals, some had urinary aging‐related peptide excretion patterns typical of an individual significantly older than their actual age. In conclusion, these aging‐related biomarkers may allow noninvasive detection of renal lesions in healthy persons and show high resemblance between human aging and chronic kidney disease. This similarity has to be taken into account when searching for biomarkers of renal disease.     

宫颈癌根治术泌尿系损伤的临床分析

目的：手术是治疗早期宫颈癌的主要手段,本文回顾性分析宫颈癌根治术泌尿系损伤的发生率、探讨防治措施,以减少泌尿系损伤的并发症,提高患者生活质量。方法：对新疆肿瘤医院2003年1月-2008年1月收治的482例早中期子宫颈癌行根治术的患者进行回顾性分析。其中Ia期6例,Ib期131例,IIa期142例,IIb期;鳞癌：440例,腺癌：31例,其他类型：11例。结果：发生泌尿系损伤9例,发生率为1．9％。其中输尿管损伤7例,膀胱损伤2例,其发生率分别为1．5％,0．4％。结论：宫颈癌根治手术致泌尿系损伤是少见但较严重的并发症,对输尿管损伤及时发现及时修补可以避免术后尿瘘的发生,严格操作步骤仍然是子宫颈癌根治术泌尿系损伤防治的关键问题。     

三聚氰胺泌尿系统结石大鼠模型的研究

目的观察工业原料三聚氰胺连续给药诱发SD大鼠尿结石的成模情况。方法60日龄SPF级SD大鼠130只,雌雄各半,体质量（200＋24）g,随机分为给药5个组和空白对照组各20只,溶媒对照组10只。给药组分别给予三聚氰胺0．05、0．1、0．2、0．3、0．4g／（kg·d）连续灌胃;溶媒对照组灌胃10g／L甲基纤维素蒸馏水2mL／（只·d）,空白对照组灌胃无菌水2mL/（只·d）。采用体视显微镜观察大鼠肾脏、输尿管和膀胱形态改变,比较各组肾脏、膀胱的质量和脏器指数,观察大鼠CREA、BUN、UA、Ca、P、Mg含量变化。结果0．4g／kg组给药20d,0．2、0．4g／kg组给药30d,肌酐高于空白对照组;0．4g/kg组给药30d,尿素氮、尿酸高于空白对照组。给药20d各组血钙、磷、镁均偏低。给药30d,0．05、0．2、0．3、0．4g／kg组左肾质量比空白对照组增加。各组肾脏大小、颜色均与正常对照组比较接近,未见结石和明显黄色沉淀物,但有部份肾脏在皮、髓质交界处有点状或片状出血灶。输尿管未见结石。部分膀胱粘膜充血,部分雄性大鼠出现膀胱结石,其中给药20d各组雄性大鼠出现率为52％（13／25）,30d各组出现率为56％（14／25）,膀胱结石颜色多为淡黄色混合白色、白色。结论（0．05～0．4）g/kg三聚氰胺连续给药30d,对肾脏损害轻微,可诱发雄性大鼠产生膀胱结石。     

Inhibitory effects of various L-type and T-type calcium antagonists on electrically generated, potassium-induced and carbachol-induced contractions of porcine detrusor muscle

The inhibitory effects of different calcium antagonists on contractions of isolated porcine detrusor muscle were investigated. Suppression of the maximum potassium-induced contraction and electrically generated contractions by nifedipine, verapamil and diltiazem were investigated. Furthermore, concentration–response curves of carbachol after pretreatment with the L-type antagonists nifedipine, verapamil, diltiazem, nimodipine and the T-type antagonist mibefradil at different concentrations were performed. Nifedipine significantly reduced the potassium-induced maximum contraction to 89, 60, 21, 8 and 4% (10⁻⁹–10⁻⁵ M). Verapamil and diltiazem significantly reduced it to 64, 30 and 5% (10⁻⁷–10⁻⁵ M) or 79, 27, 7 and 1% (10⁻⁷–10⁻⁴ M), respectively. Nifedipine, verapamil and diltiazem significantly reduced the electrically generated contraction to 55, 36, 34 and 25% (10⁻⁷–10⁻⁴ M), 71, 32 and 2% (10⁻⁶–10⁻⁴ M), 96, 78, 38 and 5% (10⁻⁷–10⁻⁴ M), respectively. pD2 values of nifedipine, verapamil and diltiazem amounted to 7.07, 5.56 and 5.40 and differed significantly. After pretreatment with nifedipine at 10⁻⁶ M, the concentration–response curve of carbachol was nearly suppressed. The effects of nimodipine, verapamil and diltiazem were smaller. Mibefradil caused only at 10⁻⁵ M a significant reduction. All investigated L-type calcium antagonists were strong inhibitors of the examined contractions. Nifedipine showed the biggest inhibitory effect.     

Glycerol-, inositol-, and reducing end hexose-containing oligosaccharides in human urine

Ten previously unreported oligosaccharides have been purified from the urines of human subjects using a combination of gel filtration, ion exchange, and thin-layer chromatographies. Their structures were determined by direct probe mass spectrometry, methylation analysis, and proton NMR spectroscopy of the permethylated oligosaccharide alditols.On the basis of composition, the oligosaccharides could be divided into three groups. Five oligosaccharides containing glycerol were characterized as glucosyl1-1glycerol; glucosyl1-1glycerol; galactosyl1-1glycerol; glucosyl-1-1(fucosyl-1-2)glycerol and/or fucosyl-1-1(glucosyl-1-2)glycerol; and glucosyl-1-1(galactosyl-1-2)glycerol or galactosyl-1-1(glucosyl-1-2)glycerol. Four inositol-containing oligosaccharides were characterized as galactosyl1 (fucosyl1)inositol,N-acetylgalactosaminyl1 (fucosyl1)inositol, fucosyl1-2galactosyl1 (N-acetylgalactosaminyl1)inositol and fucosyl1-2galactosyl1-4-N-acetylglucosaminyl1(N-acetylgalactosaminyl1)inositol. Finally, galactosyl1-3(fucosyl1-2)galactosyl1-6galactosyl1-4(fucosyl1-3)glucose, an oligosaccharide with glucose at its reducing end, was tentatively identified. The significance and possible origins of the carbohydrate structures are discussed.