北京大学学报（医学版）最新文献

To investigate the initial experience of coated metal ureteral stent (CMUS) for treatment of pelvic lipomatosis induced hydronephrosis (PLH). The clinical and follow-up data of 8 patients who were diagnosed as PLH treated with CMUS in Peking University People's Hospital from August 2018 to February 2021 were retrospectively analyzed. Inclusion criteria included: Imaging evidence of excessive adipose tissue around the bladder in the pelvic cavity, bladder elevation in an "inverted pear shape", and bladder wall thickening; Cystoscopy indicated follicular hyperplasia of bladder mucosa and biopsy pathology indicated glandular cystitis; Unilateral or bilateral hydronephrosis and ureteromegaly. Exclusion criteria included: Ureteral atresia; Recurrent obstruction of the bladder outlet. Preoperative baseline data included age, gender, serum creatinine, pelvis width and ureteric stent symptoms questionnaire (USSQ) score. Intraoperative data included the location and length of ureteral stenosis observed by retrograde urography. Postoperative follow-up data included serum creatinine, pelvis width, and USSQ score. In the study, 8 patients (11 sides) with PLH were all male, with an average age of (38.7±8.6) years. Unilateral hydronephrosis was found in 5 cases and bilateral hydronephrosis in 3 cases. Preoperative mean serum creatinine was (90.0±10.3) μmol/L, and the mean renal pelvis width was (3.0±1.5) cm. The lower ureteral stricture was found in all cases, and the mean stricture length was (1.9±0.9) cm. Before operation, 3 patients had ureteral Double-J stents, with USSQ scores of 97.0, 68.0 and 100.0, respectively. Five patients underwent retrograde CMUS stenting, and 3 patients retrograde and antegrade. At the last follow-up, the average serum creatinine was (82.0±11.1) μmol/L and the mean renal pelvis width was (1.9±0.5) cm, which were significantly lower than those before operation (t=3.12, P=0.02; t=3.23, P=0.02). In the 3 patients with Double-J stent before surgery, the USSQ scores were 87.0, 62.0 and 89.0, respectively, which were significantly improved after CMUS stenting. The average follow-up time was (10.0±6.3) months. During the follow-up, 1 patient developed CMUS related symptoms, and no stent-associated infection and stent encrustation were found. In one case, the stent migrated to the bladder 3 months after operation, and the hydronephrosis disappeared after 3 months follow-up. CMUS stenting for treatment of PLH has certain efficacy and safety, which can explore a new therapeutic method for the long-term treatment of PLH.

Objective: To discuss the influencing factors of mental resilience in adolescents with depression, and to analyze the interaction between them by using path analysis, in order to determine the reasonable prevention and treatment measures for clinical practice and provide reference for the study of mental resilience in adolescents with depression.

Methods: This survey adopted cross-sectional study and convenience sampling method. General information questionnaire, Connor-Davidson resilience scale (CD-RISC), family assessment device (FAD) and social support rating scale (SSRS) were used to investigate the general information, mental resilience level, family function and social support level of 162 adolescents with depression in Jiaozuo Fourth People ' s Hospital. Multiple linear regression was used to analyze the influencing factors of mental resilience in adolescents with depression. Structural equation model was established by Amos 22.0 software to analyze the influencing factors.

Results: (1) The total score of CD-RISC and the scores of toughness, strength and optimism in adolescents with depression were lower than the domestic norm (P < 0.05). (2) The results of multiple linear regression showed that weight, childhood trauma experience, family structure, family function, parental rearing style, parental marital status, social support and depression degree were the influencing factors of psychological resilience of adolescents with depression (P < 0.05). (3) The model showed that weight, childhood trauma experience, family structure, family function and social support had direct effects on the mental resilience of adolescents with depression, and also had indirect effects on the mental resilience of adolescents with depression through the degree of depression (P < 0.05).

Conclusion: In this study, we found that weight, childhood trauma experience, social support, depression degree and other factors have an effect on the psychological resilience of adolescents with depression. We suggest that school administrators increase the class time and course content of physical education courses, improve the mental health service system, strengthen mental health services for key groups, and formulate corresponding topics for timely counseling. At the same time, encourage them to actively participate in social practice activities, enhance self-confidence, and thus help to improve the level of psychological resilience of adolescents with depression.

Objective: To compare the effects of unilateral thoracic paravertebal block with lidocaine on hemodynamic and the level of consciousness during double lumen endotracheal intubation.

Methods: From June to october 2021, a total of 40 patients American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, aged 19-65 years, scheduled for elective thoracic sugeries in Peking University International Hospital block with under general anesthesia requiring orotracheal intubation were recruited and divided into two groups: The double-lumen endobronchial intubation (group C) and double-lumen endobronchial intubation after thoracic paravertebal block with lidocaine (group P). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy, respectively. Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated.

Results: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BP, HR and RPP. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1-minute in group C compared with the baseline values. Systolic blood pressure (SBP) was not significant change and DBP increased significantly immediately after intubation in group P.HR of both groups after intubation were significantly higher than their baseline values and lasted for 4 min in group C, HR increased significantly immediately after intubation in group P. SBP, DBP, MAP, HR and RPP after intubation in group P were significantly lower than those of group C during the observation period. The value of BIS was similar between the two groups. Compared with group C, the incidence of SBP greater than 30% and RPP greater than 22 000 was significantly lower in group P in the observation period, and no patient in group P developed RPP greater than 22 000. At the end of the incidence of SBP less than 30% of the basal value and HR less than 30% of the baseline, no severe bradycardia occurred in both groups.

Conclusion: During double-lumen endobronchial intubation, unilateral thoracic paravertebal block with lidocaine can provide less hemodynamic response and level of conscionsness.

Objective: To evaluate knee biomechanics of patients about 12 months after anterior cruciate ligament (ACL) reconstruction during cutting and determine the abnormal biomechanical characteristics.

Methods: Sixteen males about 12 months after ACL reconstruction were recruited for this study. Three-dimensional kinematic and kinetic data were collected during cutting movement. Knee joint angles and moments were calculated. Paired t-tests were used to compare the differences in knee biomechanics between the surgical leg and nonsurgical leg.

Results: The peak posterior ground reaction force (surgical leg: 0.380±0.071; nonsurgical leg: 0.427±0.069, P = 0.003) and vertical ground reaction force (surgical leg: 1.996±0.202, nonsurgical leg: 2.110±0.182, P = 0.001) were significantly smaller in the surgical leg than in the nonsurgical leg. When compared with the uninjured leg, the surgical leg demonstrated a smaller knee flexion angle (surgical leg: 38.3°± 7.4°; nonsurgical leg: 42.8°± 7.9°, P < 0.001) and larger external rotation angle (surgical leg: 10.3°± 2.4°; nonsurgical leg: 7.7°± 2.1°, P = 0.008). The surgical leg also demonstrated a smaller peak knee extension moment (surgical leg: 0.092 ± 0.031; nonsurgical leg: 0.133 ± 0.024, P < 0.001) and peak knee external rotation moment (surgical leg: 0.005 ± 0.004; nonsurgical leg: 0.008 ± 0.004, P = 0.015) when compared with the nonsurgical leg.

Conclusion: The individuals with ACL reconstruction mainly showed asymmetrical movements in the sagittal and horizontal planes. The surgical leg demonstrated a smaller peak knee flexion angle, knee extension moment, and knee external rotation moment, with greater knee external rotation angle.

The objective was to report a relatively rare case of fulminant type 1 diabetes (FT1DM) complicated with acute pancreatitis (AP), to summarize the characteristics as well as experience of diagnosis and treatment, and to explore its pathogenesis. Clinical data of a case of FT1DM complicated with AP in the Department of Endocrinology of our hospital were analyzed retrospectively. A 66-year-old male presented with acute fever and abdominal pain, accompanying with the significantly elevated pancreatic enzymes, and his abdominal CT scan showed exudation around the pancreas. The clinical manifestations mentioned above were consistent with the diagnosis of AP. Five days after onset, the patient developed clinical symptoms, such as obvious thirst, polyuria, polyasthenia and fatigue. Meanwhile, his plasma glucose increased significantly and the diabetic ketoacidosis (DKA) occurred. The patient's fasting and postprandial 2 hours C peptide decreased significantly (all 0.02 μg/L), glycated hemoglobin level was not high (6%), and his islet-related autoantibodies were undetectable. Thus, the patient could be diagnosed with FT1DM. After the treatment of fasting, fluid replacement, anti-infection, somatostatin, anticoagulation and intravenous insulin sequential subcutaneous insulin pump, the patient gained the alleviation of pancreatitis, restoration of oral intake, and relatively stable blood glucose levels. Summarizing the characte-ristics of this case and reviewing the literature, FT1DM complicated with AP was relatively rare in FT1DM. Its common characteristics were described below: (1) Most cases started with AP and the blood glucose elevated within 1 week, or some cases had the simultaneously onset of AP and FT1DM. (2) The clinical course of AP was short and relieved no more than 1 week; Pancreatic imaging could completely return to normal within 1 to 4 weeks after onset. (3) The etiology of AP most was idiopathic; The elevation of pancreatic enzyme level was slight and the recovery was rapidly compared with AP of other etiologies. FT1DM could be complicated with AP, which was different from the physiological manifestations of pancreatic disease in general FT1DM patients. Virus infection mignt be the common cause of AP and FT1DM, and AP might be the early clinical manifestation of some FT1DM. The FT1DM patients developed with abdominal pain was easy to be missed, misdiagnosed and delayed, which should receive more attention in clinic.

Objective: To investigate the prevalence of dental caries of 4-year-old children in Miyun District of Beijing by international caries detection and assessment system (ICDAS), to detect the caries activity Cariostat value and to analyze the correlation between the Cariostat value and dental caries.

Methods: Totally 815 children aged 4 years in 7 kindergartens in Miyun District of Beijing were recruited. The clinical examination of all children was conducted by one examiner using ICDAS. The oral de-birs and plaques were collected by one doctor who recorded the Cariostat scores. The results of clinical examination were compared between genders. At the same time, the prevalence of dental caries, the mean d_3-6ft/d_3-6fs and d_1-6ft/d_1-6fs among high Cariostat scores group (2.0-3.0), medium Cariostat scores group (1.5) and low Cariostat scores group (0-1.0) were compared. The distributions of incipient caries in different Cariostat scores groups were compared among children with incipient caries only.

Results: All the children had incipient caries, and 78.3% of the children had cavitated caries with ICDAS score of 3 or above. The mean d_1-2t scores were 9.76±3.65, the mean d_3-6ft scores was 4.64±4.43 and the mean d_1-6ft scores were 14.41±3.42. The incipient caries with ICDAS score of 1-2 were widely distributed, accounting for 67.7% of the total numbers of caries. There was no significant diffe-rence in caries prevalence and caries experience between genders (P>0.05). The proportion of children with high Cariostat scores in boys (43.6%) was higher than that in girls (33%) and the difference was statistically significant (P<0.05). With the increase of Cariostat scores, the prevalence of cavitated caries, the mean d_3-6ft/d_3-6fs and d_1-6ft/d_1-6fs scores in children was on the increase and the difference among the three groups was statistically significant (P<0.05). For children with incipient caries only, the distribution of incipient caries in different Cariostat scores groups was no significant difference (P>0.05).

Conclusion: ICDAS can detect early enamel demineralization of deciduous teeth in children. The prevalence of dental caries among 815 4-year-old children in Miyun District of Beijing is more serious, and incipient caries is widely distributed in children. Cariostat value reflects the status of cavi-tated caries and has no correlation with the distribution of incipient caries. Therefore, the combined application of ICDAS and Cariostat caries activity detection method is helpful for the detection of incipient caries and screening of caries high-risk children, which has great significance for the comprehensive ma-nagement of caries in children and the formulation of early preventive measures.

Objective: To explore the application of ¹⁸F-flurodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in rheumatic diseases, to compare these different imaging features, and to describe the current PET/CT imaging status in clinical practice.

Methods: A total of 486 cases in our department from January 2012 to December 2018 were enrolled in this study, and ¹⁸F-FDG PET/CT examination was performed in all the patients. The clinical use of ¹⁸F-FDG PET/CT was retrospectively analyzed to discuss the clinical application and its imaging characteristics of rheumatic diseases. Categorical data were used to ascertain prevalence statistics, whereas continuous data were used to delineate means and standard deviations. Independent sample t test, Chi square test and Mann-Whitney U test were used for statistical analysis. A P-value of < 0.05 was considered significant.

Results: (1) From 2012 to 2018, totally 486 patients in the Department of Rheumatology and Immunology underwent ¹⁸F-FDG PET/CT examination, accounting for 5.30% of the total number of PET/CT examinations in the whole hospital. In this study, 304 of the 486 patient were female (62.55%), 182 of them were male (37.45%), the average age of the patients was (53.21±18.81) years, and the proportion of the patients aged 45-65 (227/486, 46.71%) was the highest group. (2) Three leading purposes of the PET/CT examination in our department were to exclude cancers (55.56%), assist in diagnosis (24.60%) and evaluate the disease activity (19.84%). (3) Of the 486 patients who underwent ¹⁸F-FDG PET/CT, 327 cases might indicate a differential diagnosis of rheumatic disease, of which, 292 cases were highly suggestive of diagnosis, including 61 cases of myositis, 60 cases of vasculitis, 37 cases of adult still's disease, 32 cases of IgG4 related diseases, 30 cases of rheumatoid arthritis, 22 cases of Sjögren's syndrome, 22 cases of systemic lupus erythematosus, and 9 cases of rheumatic polymyalgia; the remaining 35 cases only prompted the possibility of autoimmune disease. Of the 486 patients, 74 cases suggested the diagnosis of cancers, 25 cases indicated the diagnosis of infectious diseases, while 60 cases could not show any diagnostic values. Ten patients with rheumatic disease were followed up with a post-treatment repeat PET/CT, and the findings in remission showed reduced ¹⁸F-FDG metabolic activity as well as a reduction in the extent of metabolic hypertrophic lesions.

Conclusion: There are some typical sign of ¹⁸F-FDG PET/CT for diffuse connective tissue diseases, therefore ¹⁸F-FDG PET/CT has auxi-liary effect on the classification diagnosis of rheumatic diseases, especially for the exclusion of cancers.

Objective: To investigate the etiological distribution of hydronephrosis caused by upper urinary tract obstruction in adult patients and to improve the diagnostic accuracy for this condition.

Methods: The clinical information of adult patients with newly diagnosed hydronephrosis in Upper Urinary Tract Repair Outpatient Clinic of Peking University First Hospital from May 2020 to May 2021 were prospectively and continuously collected. Patients with ureteral calculi or upper urinary tract tumor were excluded. A total of 767 patients were involved. The underlying causes of upper urinary tract obstruction were identified by senior urological surgeons according to symptoms, medical history, physical examination, and a range of diagnostic imaging techniques including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), retrograde pyelography, antegrade pyelography, radionuclide renogram and ureteroscopy.

Results: Among the 767 patients, 359(46.8%) were male and 408(53.2%) were female. The median age of these patients was 37 years (range, 14-84 years). Hydronephrosis was observed at left-sided in 357 cases(46.6%), right-sided in 251 cases(32.7%), and bilateral in 159 cases(20.7%). The causes of hydronephrosis were classified as follows: (1) Non-iatrogenic factors were found in 464 cases (60.5%). These included urinary malformations in 355 cases(76.5%), infection in 29 cases(6.3%), pelvic lipomatosis and/or cystitis glandularis in 23 cases(5.0%), ureteral endometriosis in 18 cases(3.9%), retroperitoneal fibrosis in 15 cases(3.2%), trauma in 7 cases(1.5%) and other non-iatrogenic factors in 12 cases(2.6%). Some of these patients had multiple non-iatrogenic causes. Among the 355 cases with urinary system malformations, 252 cases (71.0%) had ureteropelvic junction obstruction. (2) Iatrogenic ureteral injuries accounted for 210 cases (27.4%), including 112 cases(53.3%) of urological surgical injuries, 51 cases(24.3%) of radiotherapy for malignant tumor related injuries, 34 cases(16.2%) of gynecological and obstetrical surgical injuries, and 13 cases(6.2%) of general surgical injuries. (3) The cause of hydronephrosis remained unknown in 93 cases(12.1%).

Conclusion: Hydronephrosis in adults due to upper urinary tract obstruction has a diverse range of causes, with urinary malformations and iatrogenic ureteral injuries being significant contributors. Urological surgeon involved in upper urinary tract reconstruction should be familiar with these potential causes to facilitate accurate diagnosis and effective treatment.