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Objective:To evaluate the efficacy of modular flexible ureteroscopy combined with minimally invasive percutaneous nephrolithotomy in patients with complex kidney stones.Methods:From March 2017 to February 2019 in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, 150 patients with complex kidney stones were selected. The patients were divided into group A, group B and group C by sortition method with 50 cases each. Group A was treated with modular flexible ureteroscopy, group B was treated with standard percutaneous nephrolithotomy, and group C was treated with modular flexible ureteroscopy combined with minimally invasive percutaneous nephrolithotomy. The operation time, transoperative bleeding, hospitalization time, calculi clearance 1- and 3-month after operation, procalcitonin (PCT) and C-reactive protein (CRP) 2 h before operation and 1 and 3 d after operation were compared among 3 groups.Results:The operation time, transoperative bleeding and hospitalization time in group C were significantly lower than those in group A and group B: (65.25 ± 7.90) min vs. (99.73 ± 8.52) and (96.11 ± 9.92) min, (33.22 ± 3.70) ml vs. (41.54 ± 3.62) and (45.17 ± 3.30) ml, (3.90 ± 0.90) d vs. (4.77 ± 1.17) and (5.70 ± 1.19) d, the calculi clearance 1- and 3-month after operation was significantly higher than that in group A and group B: 94.00% (47/50) vs. 80.00% (40/50) and 82.00% (41/50), 98.00% (49/50) vs. 84.00% (42/50) and 86.00% (43/50), and there were statistical differences ( P<0.05). There were no statistical differences in PCT and CRP 2 h before operation among 3 groups ( P>0.05); the PCT and CRP 1 and 3 d after operation in group C were significantly lower than those in group A and group B, and there were statistical differences ( P<0.05). There were no statistical differences in all indexes between group A and group B ( P>0.05). Conclusions:Modular flexible ureteroscopy combined with minimally invasive percutaneous nephrolithotomy can effectively improve calculi clearance, reduce surgical trauma, shorten operation time, promote recovery, and have significant therapeutic effects in the treatment of complex kidney stones.
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Objective To evaluate the related factors of magnetic resonance angiography (MRA) abnormality and its prognostic value in patients with tuberculous meningitis (TBM).Methods One hundred and three TBM patients,admitted to our hospital from January 2007 to November 2014,were chosen in our study;their clinical data,laboratory examinations,MRA data and prognoses 6 months after onset were collected;Logistic regression analysis was performed to analyze the related factors of MRA abnormality,and the influence of these factors in prognosis of TBM was investigated.Results MRA was abnormal in 45 patients (43.7％).Logistic regression analysis indicated that age (older than 50 years),focal weakness,hydrocephalus and basal exudates were the related factors of MRA abnormality (OR=7.034,95％CI:1.797-27.536,P=0.005;OR=10.728,95％CI:2.042-56.359,P=0.005;OR=15.007,95％CI:2.572-87.577,P=0).003;OR=4.001,95％CI:1.139-14.056,P=0.031).In 37 patients with infarction in MR imaging,29 had MRA abnormality at admission;in 27 patients having paradoxical reaction of antitubercular agents,17 had MRA abnormality at admission;in 9 patients with poor prognosis,7 had MRA abnormality at admission.Conclusion MRA abnormality is common in TBM patients and it is associated with infarction,paradoxical reaction of antitubercular agents and poor outcomes;patients having elder age,focal weakness as well as hydrocephalus and basal exudates on MR imaging are trended to have MRA abnormality.
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Objective To investigate the characteristics of ocular movement disorders in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), and explore the clinical application of videonystagmograph (VNG) exami?nation in the diagnosis and differential diagnosis of MS. Methods Sixteen MS ,10 NMO and 30 control ( sudden deafness ) patients were enrolled prospectively. Ocular movement disorders including saccades, gaze fixation, smooth pursuits, opto?kinetic nystagmus and spontaneous nystagmus were evaluated by using VNG. Results The positive rate of ocular motility disorders in MS patients detected by VGN was 68.75%. The incidences of abnormalities in saccades, smooth pursuits and optokinetic nystagmus were significantly higher in MS than in control groups (P= 0.000, 0.001 and 0.001, respectively). The positive rate of ocular motility disorders in NMO patients detected by VGN was 80.00%. The incidences of abnormal?ities in saccades, gaze fixation, smooth pursuits and optokinetic nystagmus were significantly higher in NMO than control groups (P=0.000, 0.012, 0.000 and 0.002, respectively). The positive rate of ocular motility disorders was not significant? ly different in MS and MS patients (68.5%vs. 80%,P>0.05). Compared with bedside physical examination, VNG showed a notable higher sensitivity in the detection of ocular motility disorders(68.75% vs. 37.50%). Furthermore, VNG disor?ders might indicate brain lesions undetected by MRI. Conclusion This small sample research indicates that VNG is a valuable tool in the detection of ocular motility disorders as well as brain lesions in MS and NMO patients. However, its role in the differential diagnosis between MS and NMO is not confirmed.
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Objective To explore the role of the polymorphism of HLA-DRB1/DPB1 in patients with multiple scle-rosis (MS) and optica neuromyelitis (NMO). Methods Fifty-three patients with MS, 30 patients with NMO and 93 normal controls were enrolled in the present study. The HLA-DRB1/DPB1 gene polymorphism and allele frequencies were deter-mined by sequencing-based typing. All the subjects were Southern Han Chinese and were born in Southern China. Re-sults The frequencies of DPB1*0501 were higher in NMO patients than in controls, P=0.001, P (corrected)=0.022. The frequencies of DRB1*1602 DPB1*0501 haplotype were higher in NMO patients than in MS patients, P<0.001,P (cor-rected)=0.040. Conclusions There is significant difference in HLA-DRB1/DPB1 gene polymorphism between MS and NMO patients in a Southern Han Chinese population. The HLA-DPB1*0501 allele might be the susceptibility gene poly-morphism of NMO.