坎地沙坦联合复方丹参滴丸治疗2型糖尿病Ⅲ期肾病效果观察

目的 观察坎地沙坦与复方丹参滴丸联合治疗2型糖尿病Ⅲ期肾病的疗效.方法 选择2型糖尿病肾病Ⅲ期患者60例,随机分为治疗组和对照组各30例.治疗组:坎地沙坦4 mg,1次/d,复方丹参滴丸15粒,3次/d,疗程3个月.对照组:坎地沙坦4 mg,1次/d,疗程3个月.两组均于受试前、后测定尿微量白蛋白,血清尿素氮(BUN)和血肌酐(Cr).结果 两组在受试3个月后与治疗前比较尿微量白蛋白及BUN、Cr均有降低,治疗组明显优于对照组[治疗组差值分别为(-14.6±8)mg/L、(-11.9±3.3) μmmol/L、(-0.7±0.2)mmol/L,对照组为(-7.1 ±7.8)mg/L、(-8.5±0.8)μmol/L、(-0.4 ±0.1)mmol/L],差异有统计学意义(t值分别为2.213、2.206、2.203、2.302,P＜0.05或P＜0.01).结论 坎地沙坦联合复方丹参滴丸能良好的降低2型糖尿病Ⅲ期肾病患者的尿微量白蛋白及血清尿素氮和血肌酐.     

泼尼松龙联合低分子肝素治疗小儿肾病综合征的疗效及对肾功能指标的影响

目的探讨泼尼松龙联合低分子肝素治疗小儿肾病综合征的疗效及对肾功能指标的影响。方法前瞻性研究选取2015年4月至2017年4月新疆维吾尔自治区人民医院收治的84例小儿肾病综合征患儿,采用随机数字表法将患儿分为对照组与观察组,每组各42例,两组均给予常规的抗感染、利尿消肿、降血压、维持酸碱平衡等方法治疗,对照组在常规治疗的基础上给予泼尼松龙,观察组在对照组基础上加用低分子肝素,对比两组患儿临床疗效、肾功能指标及不良反应发生率。结果对照组临床总有效率为66.19%,观察组临床总有效率为92.86%,观察组与对照组相比,临床总有效率较高,差异具有统计学意义(P0.05)。对照组治疗后血清肌酐、血尿素氮及血清肌酐清除率水平分别为(117.23±5.89)mmol/L、(5.24±1.23)mmol/L、(60.31±4.90)ml/min,观察组治疗后血清肌酐、血尿素氮及血清肌酐清除率水平分别为(110.23±4.90)mmol/L、(4.82±1.03)mmol/L、(63.09±5.11)ml/min,治疗后,观察组与对照组相比,血清肌酐、血尿素氮水平降低,血清肌酐清除率升高更加显著,差异具有统计学意义(P0.05)。两组患儿在治疗期间仅有观察组患儿出现了2例皮下瘀斑,占4.76%,两组患儿在治疗期间均未发生肝、肾功能方面的损害,同时也未见内脏、消化道出血等严重不良反应,皮下瘀斑的患儿经对症处理后恢复正常。结论采用泼尼松龙联合低分子肝素治疗小儿肾病综合征疗效显著,能改善患儿的肾功能指标,有效控制患儿病情,并有较高的安全性。     

小剂量尿激酶联合激素和坎地沙坦治疗中重型肾病综合征

目的观察小剂量尿激酶联合激素和坎地沙坦治疗中重型肾病综合征(NS)的临床疗效和安全性。方法选择临床确诊为原发性NS的患者25例,尿蛋白≥3.5 g/24 h,血肌酐(Scr)≤265μmol/L,随机分为治疗组(UK组,n=13)和对照组(control组,n=12),治疗组接受尿激酶、激素和坎地沙坦治疗,对照组接受激素和坎地沙坦治疗,观察期限为4个月。结果①临床缓解率:UK组临床完全缓解率和部分缓解率分别为53.8%和38.5%,control组分别为25.0%和58.3%。两组疗效比较差异有统计学意义(P0.05)。②与治疗前相比UK组血肌酐明显下降〔(117±23)μmo/L vs(96±12)μmol/L,P0.05〕,control组血肌酐则变化不大〔(121±23)μmo)/L vs(123±19)μmol/L,P0.05〕。③两组患者尿蛋白均较治疗前下降,治疗0、2、4个月时UK组尿蛋白分别为(4.38±0.62)g/24 h、(1.59±0.26)g/24 h、(1.15±0.17)g/24 h,control组分别为(4.36±0.56)g/24 h、(2.24±0.29)g/24 h、(1.53±0.21)g/24 h,UK组尿蛋白下降快于control组,差异有统计学意义(P0.05)。结论小剂量尿激酶联合激素和坎地沙坦能有效改善中重型NS患者的肾功能,减少蛋白尿,治疗效果显著。     

中药离子导入治疗糖尿病肾病的效果分析

目的观察分析中药离子导入治疗糖尿病肾病的临床效果。方法回顾性分析108例糖尿病肾病患者的病例资料,根据治疗方案不同分为对照组和观察组,其中对照组52例。对照组采用常规疗法,观察组在常规疗法基础上采用中药离子导入疗法。分析比较两组患者治疗前后尿清蛋白、尿素氮、血清肌酐、内生肌酐清除率指标、三酰甘油、胆固醇的变化。结果观察组经治疗后尿微量清蛋白(UAE)由(91±14)mg/24 h降至(42±7)mg/24 h,水平明显降低,差异有统计学意义(P0.001);血清肌酐由(6.64±1.55)mmol/L降至(7.43±0.99)mmol/h,水平明显降低,差异有统计学意义(P=0.002);三酰甘油由(1.96±0.32)mmol/L降至(1.30±0.30)mmol/L,水平明显降低,差异有统计学意义(P0.001);胆固醇由(6.34±1.35)mmol/L降至(4.43±0.30)mmol/L,水平明显降低,差异有统计学意义(P0.001);对照组治疗前后尿微量清蛋白、尿素氮、血清肌酐、内生肌酐清除率水平、三酰甘油水平、胆固醇水平均差异无统计学意义(P0.05)。结论中药离子导入疗法能够有效降低糖尿病肾病患者的尿清蛋白、血清肌酐水平,延缓慢性肾衰的进程,且可改善脂代谢。     

前列地尔与肾康中西医结合治疗对慢性肾功能衰竭患者肾功能及血脂的影响

目的 探讨前列地尔和肾康联合对调整慢性肾功能衰竭(CRF)患者肾功能和血脂水平的效果.方法 选择98例CRF患者为研究对象,采用1:1随机对照双盲实验的分组原则分为研究组与对照组(各49例),两组给予优质低蛋白、低脂低盐饮食、控制感染、利尿消肿,纠正酸中毒、降压、纠正电解质平衡失调等常规治疗,治疗组在常规治疗的基础上应用前列地尔注射液20 μg+ 100 ml生理盐水,静脉滴注1次/d;肾康注射液100 ml+ 5％葡萄糖溶液300 ml,静脉滴注1次/d.对照组在常规治疗的基础上加用川芎嗪200 mg+5％葡萄糖注射液250 ml,静脉滴注1次/d.两组疗程均为14 d.比较两组治疗前后肾功能、脂代谢、药物不良反应等.结果 治疗前两组肾功能差异无统计学意义(P均＞0.05),治疗后研究组与对照组血肌酐[(313.7±66.2)、(358.4±53.9) μmol/L]、尿素氮[(15.3±2.9)、(18.4±3.0) mmol/L]、24h尿蛋白[(1.24±0.45)、(1.57±0.39) g/24 h]、内生肌酐清除率(Ccr)[(35.7±5.4)、(28.4±4.3) mmol/L]差异均有统计学意义(t值分别为3.754、7.864、5.873、7.864,P均＜0.05).治疗前两组血脂差异无统计学意义(P均＞0.05),治疗后研究组与对照组甘油三酯[(2.12±1.26)、(2.32±1.34) mmol/L]、总胆固醇[(4.91±1.43)、(5.35±1.31) mmol/L]、高密度脂蛋白胆固醇[(1.39±0.43)、(1.23±0.37) mmol/L]、低密度脂蛋白胆固醇[(2.39±0.68)、(2.73±0.88)mmol/L]差异均有统计学意义(t值分别为3.876、4.661、5.387、8.543,P均＜0.05).两组治疗过程均无药物不良反应产生.结论 前列地尔、肾康注射液联合可显著改善患者的肾功能、脂代谢紊乱等,未发现明显的不良反应,值得临床广泛应用.     

ACEI联合复方丹参注射液治疗糖尿病肾病疗效观察

目的：探讨复方丹参泥射液联合ACEI治疗糖尿病肾病的疗效。方法：收集我院20013.3月-2015年3月初治2型糖尿病合并肾功能异常者73例。该73例患者中，男41例，女32例，年龄45-81岁，中位年龄59岁。所有患者均使用甘精胰岛素作为基础治疗。其中，将患者随机分为ACEI组（n=38）及联合组（ACEI+复方丹参泥射液，n=35）。两组患者年龄、性别分布、治疗前体重指数、空腹血糖（FBG），餐后2h 血糖(2hFBG)、肾功能相关指数等临床基线资料无明显统计学差异。结果：ACEI组治疗前的尿素氮、肌酐、24小时尿蛋白定量分别为12.34±3.13mmol/L，233.41±23.94umol/L，123.33±48.67mg。联合组治疗前尿素氮、肌酐、24小时尿蛋白定量分别为12.11±2.87mmol/L，241.33±30.14umol/L，119.68±50.82mg。ACEI治疗3个月后的尿素氮、肌酐、24小时尿蛋白定量分别为8.15±1.82mmol/L，177.41±38.16umol/L，91.82±19.89mg。联合组3个月后的尿素氮、肌酐、24小时尿蛋白定量分别为5.87±0.91mmol/L，167.47±38.41umol/L，78.46±18.41mg。两个组均较治疗前明显降低（P均<0.05）。但通过组间比较克制：联合治疗组明显低于ACEI组。两者具有明显统计学差异（t=4.441，P=0.032）。结论：ACEI联合复方丹参泥射液可有效控制及保护糖尿病患者肾功能，延缓其向不良方向的转归。     

小柴胡汤加减联合小剂量激素治疗难治性肾病综合征近期疗效及生化指标分析

目的研究小柴胡汤加减联合小剂量激素多靶点治疗难治性肾病综合征近期疗效及生化指标。方法选择难治性肾病综合征患者,随机分为给予小柴胡汤加减联合小剂量激素多靶点治疗的观察组和小剂量激素多靶点治疗的对照组,观察两组患者的治疗效果,检测血肌酐、血尿素氮、血红蛋白、内生肌酐清除率、24h尿蛋白等肾功能相关指标和清蛋白、球蛋白、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）等肝功能指标。结果观察组患者治疗总有效率88.33%,疗效明显好于对照组;其血肌酐[（272.83±23.52）μmol/L]、血尿素氮[（9.32±1.12）μmol/L]、24h尿蛋白[（0.12±0.01）g]、AST[（33.31±3.58）U/L]、ALT[（32.48±3.41）U/L]明显低于对照组,血红蛋白[（117.76±11.98）g/L]、内生肌酐清除率[（101.28±10.33）mL/min]、总蛋白[（69.82±7.32）g/L]、清蛋白[（38.75±4.23）g/L]明显高于对照组。结论小柴胡汤加减联合小剂量激素能够有效地改善肾功能、保护肝功能,对于提高治疗总体有效率具有积极意义。     

泼尼松联合CTX对IgA肾病患者疗效及肾功能指标的影响

目的探讨泼尼松联合环磷酰胺(CTX)治疗原发性免疫球蛋白A(IgA)肾病患者的疗效及对肾功能指标的影响。方法选取本院2013年6月至2015年6月收治的86例IgA肾病患者为研究对象,根据随机数字表将患者分为观察组及对照组各43例。对照组给予泼尼松治疗,观察组在对照组基础上应用CTX治疗,两组均持续治疗12周,对比分析两组患者治疗疗效、肾功能指标的变化。结果观察组总有效率为97.67%,对照组总有效率为79.07%,差异有统计学意义(P0.05)。观察组治疗后尿素氮(BUN)、血清肌酐(Scr),24h尿蛋白分别为(4.33±1.24)mmol/L、(85.36±5.85)mol/L、(1.89±0.24)g低于对照组[(6.32±2.02)mmol/L、(158.25±8.36)mol/L、(4.22±0.32)g],差异均有统计学意义(P0.05),而内生肌酐清除率(Ccr)(85.98±14.02)高于对照组(68.23±12.02),差异有统计学意义(P0.05)。观察组治疗后肾血管指数、肾小球指数、肾小管-间质指数积分及新月体指数分别为(2.12±0.96)分、(2.12±0.88)分、(2.02±0.85)分及0.22±0.08,均低于对照组[(3.02±0.85)分、(3.85±1.22)分、(3.12±0.96)分及0.48±0.10)],差异有统计学意义(P0.05)。两组患者不良反应率比较差异无统计学意义(P0.05)。结论泼尼松联合CTX可提高IgA肾病患者临床治疗效果,改善患者肾功能,且不良反应率低,安全有效,值得临床推广应用。     

佩尼聚醚砜空心纤维透析器对维持性血液透析患者的有效性和安全性分析

目的 观察佩尼聚醚砜空心纤维透析器(PES14HF)对维持性血液透析患者的有效性和安全性.方法 36例血液透析患者分别使用PES14HF和日本尼普洛株式会社生产的聚醚砜空心纤维透析器(PES-150DS)进行透析,每次3.5 h以上.以透析前后血肌酐、尿素氮和β2-微球蛋白等指标的清除及下降率进行疗效评估,以透析前后外周血血红蛋白(Hb)、白蛋白(Alb)等指标的变化进行安全性评估.结果 ES14HF组治疗前后血肌酐分别为(990.2±191.2)、(333.8±89.5)μmol/L,血尿素氮分别为(24.7±4.1)、(7.0±1.9)mmol/L,β2微球蛋白分别为(22.9±1.7)、(13.6±3.3)mmol/L,治疗前后差异均有统计学意义(P均＜0.01).PES-150DS组治疗前后血肌酐分别为(1059.5±179.4)、(395.5±86.1)μmol/L,血尿素氮分别为(25.3±4.8)、(8.1±2.8)mmol/L,β2微球蛋白分别为(22.3±2.9)、(18.0±3.0)mmol/L,治疗前后差异均有统计学意义(P均＜0.01);但2组间治疗前后血肌酐、尿素氮、β2微球蛋白比较,差异均无统计学意义(P均＞0.05).2组透析后血β2微球蛋白均下降,但PES14HF组溶质下降率更明显(P=0.017).结论 佩尼聚醚砜空心纤维透析器PES14HF在维持性血液透析患者中的应用安全、有效.     

胱抑素C测定在肾脏疾病诊断中的临床应用

目的 探讨肾功能损害及肾损伤时血清胱押素C(cystain C)作为早期敏感标志物对临床诊断的价值.方法 采用透射比浊法测定血清cystain C的浓度,同时测定血清肌酐(Scr)、尿素氮(BUN)、肌酐清除率(Ccr).结果 血清cystain C在对照组、肾功能不全组、肾衰组的值分别为0.63±0.41,2.59±1.32,7.13±1.68 mg/L.结论 血清cystain C是反应肾脏损伤的敏感指标,可以替代操作繁琐的内生肌酐清除率来判断肾小球滤过功能.应用cystain C评价异常肾小球滤过率有广泛的前景.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.