免疫吸附治疗抗肾小球基膜抗体疾病的观察与护理5例

抗肾小球基膜抗体(抗-GBM)疾病是由抗-GBM介导的主要累及肺、肾的自身免疫性疾病,临床表现为急进性肾炎,合并肺出血或仅表现为急进性肾炎,预后差,患者常常迅速进入终末期肾衰(ESRF)或死于肺出血[1].本研究所2001年11月～2003年2月应用葡萄球菌A蛋白免疫吸附(IA)方法治疗5例抗-GBM疾病,探讨IA对抗-GBM抗体水平的影响及其临床技术与护理,对提高抗肾小球基膜抗体(抗-GBM)疾病提供科学的临床护理依据.     

早产低体重及极低体重儿的术中护理

抗肾小球基膜抗体(抗-GBM)疾病是由抗-GBM介导的主要累及肺、肾的自身免疫性疾病，临床表现为急进性肾炎，合并肺出血或仅表现为急进性肾炎，预后差，患者常常迅速进入终末期肾衰(ESRF)或死于肺出血。本研究所2001年11月～2003年2月应用葡萄球菌A蛋白免疫吸附(IA)方法治疗5例抗-GBM疾病，探讨LA对抗-GBM抗体水平的影响及其临床技术与护理，对提高抗肾小球基膜抗体(抗-GBM)疾病提供科学的临床护理依据。     

血浆置换在新月体型肾小球肾炎中的临床疗效分析

目的探讨血浆置换治疗新月体型肾小球肾炎的临床疗效。方法选择本院肾内科收治的经肾活检确诊的新月体型肾小球肾炎、急进性肾小球肾炎早期患者,入院后给予甲泼尼龙琥珀酸钠、环磷酰胺、硫唑嘌呤等抑制免疫炎症、抗凝、纠正贫血以及行血浆置换等治疗,行血浆置换治疗期间给予患者静推地塞米松磷酸钠注射液抗过敏,葡萄糖酸钙注射液预防低钙血症等治疗,每次置换血浆2 000 ml,调整血液流速为60 ml/min,间隔2 d/次,共3次。结果患者行3次血浆置换治疗后,复查抗GBM抗体(–),血常规:Hb 61g/L,肾功能:Cr 625μmol/L,BUN 25.2 mmol/L,UA 476μmol/L。结论新月体型肾小球肾炎、急进性肾小球肾炎患者早期给予大剂量糖皮质激素联合血浆置换治疗,可提高疾病治愈率,快速达到治疗效果。     

血浆置换在肾脏疾病中的应用

血浆置换(PE,Plasma exchange)是指从体内清除大量的血浆(通常2-5L),同时输入新鲜冰冻血浆或贮存血浆。PE已广泛应用于某些循环因子所致疾病的治疗,并取得了一定的疗效,主要应用于治疗急进性肾炎,包括抗肾小球基底膜抗体性肾炎(即抗-GBM肾炎)、免疫复合物介导的肾炎和寡免疫复合物型新月体肾炎;此外还应用于血栓性血小板减少性紫癜(TTP)、骨髓瘤相关性急性肾功能     

血液净化联合DNA免疫吸附治疗重症系统性红斑狼疮的效果

目的探讨连续性血液净化联合DNA免疫吸附配合泼尼松片、环磷酰胺治疗重症系统性红斑狼疮的效果与安全性。方法选取80例系统性红斑狼疮重症患者作为研究对象,将其均分为试验组与对照组。在常规药物治疗基础上,对照组应用DNA免疫吸附治疗,试验组给予连续性血液净化联合DNA免疫吸附治疗。对比分析两组疗效、肾功能指标及抗核抗体情况。结果试验组的总有效率(95.00%)明显高于对照组(62.50%)(P0.01)。治疗2个月后,试验组的血尿素氮(5.31±1.25)mmol/L、血清肌酐(98.58±21.17)μmol/L明显优于对照组的血尿素氮(7.23±1.33)mmol/L、血清肌酐(128.38±25.76)μmol/L,差异具有统计学意义(P0.05)。试验组ANA(1.62±0.41)、抗ds-DHA抗体(0.91±0.42)明显低于对照组2.21±0.69和1.21±0.62(P0.05)。试验组患者不良反应发生率(7.50%)明显低于对照组(27.50%),差异具有统计学意义(P0.05)。试验组抗核抗体敏感性为30.00%,明显低于对照组的62.50%,差异具有统计学意义(P0.05)。结论血液净化联合DNA免疫吸附配合泼尼松片、环磷酰胺治疗重症系统性红斑狼疮的效果显著,改善患者肾功能,安全可靠,值得临床推广。     

DNA免疫吸附治疗狼疮性肾炎的临床观察

目的观察DNA免疫吸附柱对狼疮肾炎患者的临床疗效。方法选择32例活动性狼疮肾炎患者,随机分为常规治疗组和免疫吸附组各16例。常规治疗组应用糖皮质激素（甲泼尼龙、泼尼松龙）及免疫抑制剂（环磷酰胺）治疗,免疫吸附组在常规治疗组的基础上,予以DNA免疫吸附柱进行血液吸附,每半月1次,连续6次。治疗前及免疫吸附末次治疗后,分别收集患者血标本,测定抗核抗体（ANA）、抗双链DNA抗体（ds-DNA）的清除效果及对患者血常规、血沉、免疫球蛋白、补体、肾功能等影响程度,并观察记录临床表现情况。结果DNA免疫吸附治疗后患者的症状和体征均明显改善;ANA抗体滴度吸附后明显下降[1：2000及1：300,P〈0.001];抗ds-DNA抗体吸附后明显下降[（36.5±10.4）IU/ml及（19.4±10.3）IU/ml];免疫球蛋白显著下降（P〈0.05）;血常规、血沉、补体等无明显影响。结论DNA免疫吸附治疗狼疮性肾炎特异性强,毒副反应较少,能明显改善临床症状,可能成为狼疮性肾炎多靶点疗法新的联合治疗手段。     

免疫吸附治疗抗肾小球基膜抗体疾病的护理

目的 探讨免疫吸附(protein A immunoadsorpition,IA)治疗抗肾小球基膜抗体(anti-glomerular basement membrance,抗-GBM)疾病的疗效及护理方法。方法 5例确诊抗-GBM疾病患接受IA治疗,隔日1次。IA治疗前或同时应用激素,治疗后口服霉酚酸酯(MMF)。结果 IA治疗第1个疗程10次后,3例患血清抗-GBM抗体转阴,1例仍阳性,但较治疗前下降62．5％;进行第2个疗程后,抗-GBM抗体转阴。治疗后4例肺出血迅速消失;4例治疗前需血液透析的患,治疗后1例摆脱透析,另3例肾活检病理显示,100％新月体形成仍需维持性血液透析,1例治疗前不需血透肾功能保持稳定。结论 IA能有效降低血清抗-GBM抗体水平,迅速缓解肺出血,但改善肾功能疗效受肾脏损害程度的影响。在治疗过程中需加强护理,严密观察病情变化：     

结肠透析治疗60例慢性肾功能衰竭的疗效分析

目的 观察结肠透析治疗慢性肾功能衰竭的疗效.方法 将120例慢性肾功能衰竭患者随机分为2组,每组各60例,A组为结肠透析组,在常规治疗的基础上应用结肠透析机治疗;B组为常规治疗组,给予慢性肾功能衰竭的常规治疗.观察期为4周,观察血肌酐、尿素氮和24 h尿蛋白定量,以血肌酐的变化判断透析的疗效.结果 A、B组均可明显降低慢性肾功能衰竭患者的血肌酐水平,血肌酐分别由(363.97±82.34)μmol/L降为(280.87±87.52)μmol/L和(371.73±87.46)μmol/L降为(339.90±68.59)μmol/L,A组的治疗效果明显优于B组(P＜0.05);对A组不同期的患者进行疗效对比,发现肾功能代偿期和失代偿期的疗效明显好于肾功能衰竭期,而前两者之间的疗效差别不明显.结论 结肠透析治疗慢性肾功能衰竭疗效确切,尤其对血肌酐＜443 μmol/L的患者能达到更好的治疗效果.     

两种抗体同时阳性的急进性肾小球肾炎1例

急进性肾小球肾炎(RPGN)是一组表现为血尿、蛋白尿及进行性肾功能减退的临床综合征,肾活检病理通常表现为新月体肾炎。根据免疫病理特征可分为3型:Ⅰ型为抗肾小球基底膜(GBM)抗体型,抗GBM抗体阳性;Ⅱ型为免疫复合物型;Ⅲ型为寡免疫复合物型;因80%的Ⅲ型RPGN患者常合并有抗中性粒细胞抗体(ANCA),故又称ANCA相关性肾小球肾炎[1]。本院于2012年5月收治了1例anti-GBM和ANCA同时阳性的RPGN的患者,作者对此进行分析,现报道如下。     

抗中性粒细胞胞浆抗体在肾脏疾病中的诊断价值

目的：探讨抗中性粒细胞胞浆抗体（ANCA）在肾脏疾病中的诊断价值。方法选取2008年9月至2012年8月于本院肾病科住院进行ANCA检测的823例患者的临床资料及检测结果，对照血清来源于输血科献血人员。结果不同肾病患者的阳性率由高到低分别为，微动脉炎（28．6％）、狼疮肾炎（20．4％）、血管炎（19．2％）、慢性肾功能不全（18．3％）、急进性急性肾小球肾炎（17．2％）、肾炎（16．6％）、急性肾功能衰竭（8．2％）、肾病综合征（3．0％）。结论 ANCA检测对肾脏疾病有一定的诊断意义，主要表现在微动脉炎、狼疮肾炎、血管炎、慢性肾功能不全及急进性肾小球肾炎的诊断。     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."