Реферат
Objective:To explore the risk factors for urethral stricture after transperineal anastomotic urethroplasty (TAU) by retrospectively analyzing patient data and to develop a nomogram to predict the risk of recurrence before the surgery.Methods:Clinical data of patients who underwent TAU because of post-traumatic urethral stricture from January 2016 to December 2017 in West China Hospital, Sichuan University were reviewd. A total of 78 patients were included in the retrospective analysis, with 13 of them having recurrence. The patients in the recurrence group had a median age of 49.8 and 76.9% (10/13) of them had membranous urethral stricture. The proximal urethra end was located above the superior margin of the pubic ramus (higher stricture site) in 53.8%(7/13)of patients in the recurrence group and the length of the stricture measured in the operation was (2.19±0.22) cm. In the non-recurrence group, the median age was (44.8±13.6) years old, 58.5% (38/65) of them had membranous urethral stricture, 21.5% (14/65) had higher stricture site, and the length of the stricture was (2.03±0.11) cm. Both univariate and multivariate logistics analyses were performed to evaluate the risk factors of recurrence of urethral stricture 5 years after surgery. The nomogram was built based on the multivariate logistics analysis. The Concordance Index (C-index), Receiver Operating Characteristic(ROC) curve and Calibration curve were used to evaluate the nomogram.Results:Univariate logistics analysis showed that higher stricture site, history of urethral dilation, smoking, diabetes and total serum protein may be associated with recurrence after surgery. Multivariate logistics analysis further confirmed that higher stricture site ( OR=34.64, 95% CI 3.71-754.53), history of urethral dilation( OR=13.15, 95% CI 1.27-210.00), smoking ( OR=13.75, 95% CI 2.15-166.05) and diabetes ( OR=64.98, 95% CI 3.80-1957.60) were independent risk factors for recurrent urethral stricture while higher total serum protein before surgery was related to lower recurrence risk ( OR=0.78, 95% CI 0.62-0.93). A nomogram was built based on the results. The C-index of the nomogram was 0.923(95% CI 0.908-0.938), the area under curve (AUC) was 0.923 (95% CI 0.855-0.991), and the Brier Score was 0.079. Conclusion:Higher stricture site, history of urethral dilation before surgery, smoking, diabetes and lower total serum protein before surgery are associated with higher recurrence TAU of post-traumatic urethral stricture patients. With the nomogram developed, prediction of the risk of recurrence could be achieved prior surgery.
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Objective:To analyze the expression levels of microRNA-203(miR-203)and fibroblast growth factor-2(FGF-2)in hemangiomas of infancy(HOI)and to explore their clinical significance.Methods:A total of 55 patients with HOI admitted to our hospital from March 2016 to August 2017 were selected as HOI group and divided into proliferative phase(31 cases)and regressive phase(24 cases), normal tissue specimens were taken as control group(34 cases). Real time fluorescence quantitative PCR(qRT-PCR)was used to detect the expression levels of miR-203 and FGF-2 mRNA in HOI tissues.Immunohistochemistry was used to detect the expression of FGF-2 protein in HOI tissues.Clinical indicators of HOI patients included angiogenin(ANG), vascular endothelial growth factor(VEGF), basic fibroblast growth factor(bFGF), glucocorticoid receptor alpha(GRα), glucocorticoid receptor beta(GRβ). Pearson method was used to compare and analyze the correlation between various indicators in children with HOI group.Logistic multivariate regression analysis was used to analyze the related influencing factors of HOI.Results:Compared with the control group(1.01±0.15), the expression level of miR-203 in HOI group(0.73±0.24)decreased significantly( P<0.05), and the proliferative phase(0.72±0.21)was significantly higher than the regression phase(0.59±0.19)( P<0.05); the expression levels of FGF-2 mRNA and protein in HOI group(2.38±0.74)were significantly higher than those in control group(1.02±0.14)( P<0.05), and the regression phase(2.37±0.79)was significantly higher than the proliferative stage(2.03±0.68)( P<0.05); Pearson analysis showed that miR-203 was negatively correlated with FGF-2, ANG, VEGF and bFGF( P<0.05), while FGF-2 was positively correlated with them( P<0.05); Logistic analysis showed that the expression levels of miR-203 and FGF-2 were both influencing factors of HOI. Conclusion:MiR-203 is low expressed in HOI, while FGF-2 is highly expressed.There is a significant difference in the expression changes of the two in HOI stages and it is important for clinical diagnosis of HOI and treatment.