肾移植受者手术前后脂蛋白(a)的变化及其与急性排异的关系

目的观察肾移植受者脂蛋白(a)[Lp(a)]在手术前后的变化以及与急性排斥反应(AR)的发生和肾功能恢复的关系.方法对43例接受同种异体肾移植术患者Lp(a)进行连续监测.结果患者移植前Lp(a)和三酰甘油(TG)显著高于对照组(P＜0.01、P＜0.05);载脂蛋白Al(ApoA1)显著低于对照组(P＜0.01).术后随时间延长,患者的Lp(a)呈持续性下降趋势,2周降至与对照差异无显著性.但不同组间差异明显.排斥组术前、术后Lp(a)均高于稳定组(P＜0.05、P＜0.01);而中毒组与稳定组差异无显著性(P＞0.05).在术前Lp(a)≥300 mg/L的高Lp(a)患者中有55.6%术后发生AR,明显高于正常Lp(a)水平的患者,差异具有非常显著性(x2=8.246,P＜0.01).结论肾移植患者术后Lp(a)明显降低,Lp(a)水平与AR之间存在着一定的关联,动态监测肾移植受者手术前后Lp(a)的变化对AR的发生具有提示作用.     

肾移植受者动态监测血清RANTES临床意义研究

选取我院2006年1月~2012年1月收治的51例肾移植患者,采用典型的夹心法酶联免疫吸附法监测肾移植受者术前、术后不同时间段血清RANTES的浓度。结果其中31例均恢复稳定,7例急性排斥反应(AR),7例环孢中毒,6例急性肾小管坏死(ATN)。(1)术后外周血RANTES均高于肾移植术前组,且有明显差异(P<0.01);(2)在肾移植术后急性排斥组RANTES出现两次高峰,第1次为1~4d为肾移植术后初期,第2次出现于肾移植术后5~10d为AR时期,且第2次高峰大于第一次高峰,存在明显差异(P<0.05),AR时期的RANTES明显高于同期不同组的RANTES水平,有明显差异(P<0.01),经治疗后明显降低,在治疗初期RANTES水平与同期稳定组比较明显低,且有统计学意义(P<0.01);(3)Cs A中毒外周血RANTES水平表现呈逐渐降低趋势,中毒高峰期的RANTES水平与同期稳定组明显降低,有明显差异(P<0.01);(4)急性ATN组术后外周血RANTES水平呈降低趋势,但与同期稳定组比较无明显差异(P>0.05)。RANTES在肾移植术后AR中起着重要作用,动态监测有助于早期发现AR。RANTES是肾移植术后敏感指标,而不是特异性指标,动态监测有助于鉴别AR、ATN与Cs A药物中毒。     

肾移植受者血清sFas和sFasL变化及在早期急性排异反应预测中的应用

背景:细胞凋亡在移植免疫和移植物功能丧失发生过程中起十分重要的作用,其中Fas/FasL系统被认为是细胞凋亡参与肾移植的急性排异反应过程的主要途径之一。目的:分析肾移植受者术后血清sFas和sFasL水平变化及其在预测早期急性排异反应中的应用价值。方法:肾移植受者80例分为肾功能稳定组(49例)、急性排斥反应组(23例)和环孢素A中毒组(8例)。另选择性别、年龄与肾移植受者相匹配的健康体检者50例为对照组。肾移植受者术后均常规使用环孢素A+硫唑嘌呤+泼尼松三联免疫抑制治疗。发生急性排斥反应时给予每日甲基强的松龙6～8mg/kg冲击治疗,3d为1个疗程。采用ELISA法检测患者手术前后的血清sFas和sFasL水平。结果与结论:肾移植组患者手术前的血清sFas和sFasL水平均明显高于对照组(P<0.05)。急性排斥反应组血清sFas、sFasL水平高于相同时间段肾功能稳定组(P<0.05)。环孢素A中毒的肾移植患者术后各时间点血清sFas、sFasL水平变化与肾功能稳定组基本相同,差异无显著性意义。提示动态监测血清sFas、sFasL水平可能对早期诊断及鉴别诊断肾移植急性排斥反应具有重要参考价值。     

肾移植受者手术前后血液生化指标改变特征的调查

目的 分析比较肾移植受者手术前后血液生化指标的水平,调查肾移植受者血液生化特征的改变,并探讨其临床意义.方法 应用全自动OLYMPUS AU600生化分析仪测定72例肾移植受者术前后血液生化指标水平,同时与65例正常人进行比较.结果 (1)肾移植受者术前谷丙转氨酶、谷草转氨酶、甘油三脂与正常对照组相相比无显著性差异(P＞0.05),总蛋白、白蛋白、球蛋白、总胆固醇明显低于对照组,而尿素氮、肌酐、尿酸明显高于正常对照组.(2)术后谷丙转氨酶、谷草转氨酶、尿酸、总胆固醇、甘油三脂水平与对照组相比无显著性差异(P＞0.05),总蛋白、白蛋白水平仍低于正常对照组(P＜0.01),尿素氮、肌酐高于正常对照组(P＜0.01).(3)比较受者手术前后血清谷丙转氨酶、谷草转氨酶、总蛋白、白蛋白水平不存在显著性差异(P＞0.05);术后血清中球蛋白、尿素氮、肌酐、尿酸水平明显低于术前(P＜0.01),总胆固醇、甘油三脂水平高于术前(P＜0.01).结论 肾移植受者术后血中大部分生化指标均在正常参考范围内;手术的实施对受者肝功能无明显损害;肾移植手术能明显改善受者严重衰竭的肾功能,但与正常对照组相比仍有差异;受者血中低蛋白水平有待改善.     

肾移植受者血浆C反应蛋白变化的研究

目的：探讨肾移植前后外周血C反应蛋白(CRP)的表达水平与肾移植排斥反应的关系。方法：采用胶乳增强免疫透射比浊法，监测91例肾移植受者手术前及术后3、6、9、15d的血浆中的CRP的变化情况。结果：肾移植术后CRP表达水平与术前比较差异无显著性意义(P>0．05)，发生排斥反应时的CRP显著升高；排斥时的CRP表达水平为(13．02±1．54)mg／L，与术前、术后无排斥时及排斥反应控制后比较，差异有极显著意义(P<0．01)，同期稳定组无明显变化【(6．01±1．17)mg／L】。结论：C反应蛋白作为一种急性时相反应物，它与肾移植排斥反应密切相关，监测其表达水平对排斥反应有重要临床意义。     

血液透析和腹膜透析方式与肾移植术后并发症发生的关系：204例回顾性分析

目的:由于移植肾源不足,大多数晚期尿毒症患者术前需要透析治疗。探讨血液透析和腹膜透析方式与肾移植受者术后并发症发生的关系。方法:选择2000-01/2005-12南昌大学第一附属医院泌尿外科收治的肾移植受者204例,术前透析时间大于3个月,均知情同意。按照移植术前透析方式分为两组:①血液透析组(n=122)术前采用血液透析治疗,透析10￣12h/周,手术前1日透析1次。②腹膜透析组(n=82)术前采用标准连续非卧床腹膜透析治疗,直至手术当日,在术前4￣6h排空腹透液。术后3个月拔管。两组都采用同种异体尸肾移植,术后1年内随访记录两组患者术后超急性排斥反应、急性排斥反应、细菌感染、移植肾功能延迟恢复的发生情况以及人/肾1年存活率,并进行对比分析。结果:204例肾移植受者全部进入结果分析。①两组患者肾移植术后1年内超急性排斥反应的发生率及人/肾1年存活率差异无显著性意义(P>0.05)。②血液透析组患者肾移植术后1年内急性排斥反应、细菌感染的发生率低于腹膜透析组(14.8%,25.6%;13.9%,23.2%,P均<0.05),移植肾功能延迟恢复发生率高于腹膜透析组(40.2%,20.7%,P<0.05)。结论:肾移植前腹膜透析、血液透析各有优缺点。血液透析患者的感染率低,移植肾急性排斥反应发生率低;而腹膜透析患者术后肾功能恢复较快,肾功能延迟恢复的发病率低。     

免疫抑制剂用药依从性管理对肾移植受者移植肾功能的影响

目的 探讨免疫抑制剂用药依从性管理对肾移植受者移植肾功能的影响。方法 选取肾移植受者110例,随机分为观察组55例和对照组55例。根据随访结果,最终观察组纳入55例,对照组纳入54例。对照组采取常规随访模式;观察组实施为期半年的定期随访,并进行用药依从性教育和管理。采用Morisky问卷进行依从性调查,比较2组患者血药浓度、肌酐、估算肾小球滤过率、急性排斥发生情况。结果 观察组依从性好患者比率高于对照组,差异有统计学意义(P<0.05)。观察组血药浓度不达标发生率低于对照组,差异有统计学意义(P<0.05)。在术后6个月,2组血肌酐、估算肾小球滤过率比较,差异有统计学意义(P<0.05)。2组急性排斥反应发生率比较,差异无统计学意义(P>0.05)。结论 加强肾移植受者用药依从性管理对保持良好的移植肾功能有重要作用。     

心脏死亡器官捐献与亲属捐献肾移植术后的 临床观察和护理

目的 观察心脏死亡器官捐献(donation after cardiac death,DCD)与亲属捐献肾移植术后的临床指标,并总结护理体会.方法 选取在该院行DCD或亲属捐献肾移植术的受者93例,其中DCD肾移植受者60例,亲属捐献肾移植受者33例.比较两组在肾移植术后发生移植肾功能延迟恢复(delayed graft function,DGF)、活检证实的急性排斥反应(biopsy-proven acute rejection,BPAR)、外科并发症及感染性并发症的发病率.结果 DCD肾移植受者术后发生DGF的比例显著高于亲属捐献的肾移植受者(P<0.05),但DGF平均恢复时间、BPAR及其他并发症的发生率之间差异无统计学意义(P>0.05).结论 DCD可作为有效的供肾来源之一,DCD肾移植术后应转变传统的护理模式,加强对DGF等并发症的护理.     

肾移植受者血清群体反应性抗体水平与术后早期排斥反应间的关系

目的探讨肾移植受者血清群体反应性抗体（PRA）水平与术后早期排斥反应间的关系。方法对256例肾移植受者术前测定其血清PRA水平,并对PRA与术后早期排斥反应（超急性、加速性、急性排斥反应）之间的关系进行分析。结果PRA阴性组、轻度致敏组、高致敏组3组间术后早期排斥反应发生率差异有统计学意义（χ^2=78.23,P〈0.01）,组间两两比较,差异有统计学意义（q=-8.32～-2.87,P〈0.05、0.01）。男性组PRA阳性率低于女性组（χ^2=14.18,P〈0.01）;无输血史组PRA阳性率低于有输血史组（χ^2=5.39,P〈0.05）;有妊娠史组与无妊娠史组PRA阳性率比较差异无显著性（χ^2=0.66,P〉0.05）;二次移植组PRA阳性率明显高于初次移植组（χ^2=20.10,P〈0.01）。结论输血、再次移植是PRA阳性的危险因素。随着PRA水平的升高,术后早期排斥反应的发生率升高。肾移植受者血清低水平的PRA可降低术后早期排斥反应的发生,提高人、肾生存期。     

流式细胞微球捕获技术检测肾移植受者外周血细胞因子的应用

目的 应用流式细胞微球捕获技术检测肾移植受者外周血细胞因子,分析其在巴利昔单抗应用前后、肾移植手术前后以及移植物排斥反应发生时的含量变化及临床意义.方法 72例肾移植受者根据术后移植物功能状况分为2组:肾功能稳定组53例,急性排斥反应组19例.根据巴利昔单抗使用与否分为2组:巴利昔单抗使用组32例,巴利昔单抗未使用组40例.采集72例肾移植受者术前、术后、急性排斥反应发生时和30名健康供者的外周血,应用流式细胞微球捕获技术分析IFN-γ、TNF-α、IL-10、IL-5、IL-4、IL-2共6种细胞因子含量.对肾移植供者与受者组、肾移植受者术后功能稳定组与急性排斥反应组、术后4周巴利昔单抗使用组与未使用组、巴利昔单抗使用前后细胞因子含量进行比较.结果 术前肾移植受者组外周血TNF-α、IL-10、IL-5、IL-4、IL-2分别为(1.65±0.10)、(2.55±0.19)、(1.88±0.14)、(1.85±0.12)、(2.12±0.09)ng/L,低于健康供者组的(3.04±0.17)、(3.33±0.26)、(4.03±0.25)、(2.73±0.16)、(4.03±0.26)ng/L,差异有统计学意义(t值分别为6.890、2.375、7.851、3.955、7.153,P值分别为<0.01、<0.05、<0.01、<0.01、<0.01);术前肾移植受者组IFN-γ含量为(2.50 ±0.18)ng/L,健康供者组为(3.00±0.24)ng/L,差异无统计学意义(t=1.625,P>0.05).肾功能稳定组IFN-γ、IL-10分别为(2.71±0.11)、(3.91±0.52)ng/L,低于急性排斥反应组的(3.30±0.36)、(12.01±5.35)ng/L,差异有统计学意义(t值分别为5.061、11.465,P值分别为<0.01、<0.05).使用巴利昔单抗的肾移植受者,在巴利昔单抗使用后IFN-γ、TNF-α和IL-10分别为(2.78±0.17)、(1.58±0.07)、(2.77±0.24)ng/L,与使用前的(2.90±0.21)、(1.67±0.12)、(2.45±0.16)ng/L比较,差异有统计学意义(t值分别为5.605、6.011、4.126,P值分别为<0.01、<0.01、<0.05).术后4周巴利昔单抗使用组IFN-γ、IL-10、IL-4分别为(2.90±0.31)、(9.08±0.16)、(2.73±0.11)ng/L,与未使用组的(3.28±0.11)、(4.17±0.21)、(2.11±0.20)ng/L比较,差异有统计学意义(t值分别为4.268、4.263、3.762,P值分别为<0.01、<0.01、<0.05).结论 流式细胞微球捕获技术使用微量标本可同时检测6种细胞因子.联合检测肾移植受者外周血中的细胞因子能够为临床诊疗提供更有意义的指导依据.     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Expanded timed up and go test with subjects with stroke: reliability and comparisons with matched healthy controls

Faria CD, Teixeira-Salmela LF, Silva EB, Nadeau S. Expanded Timed Up and Go test with subjects with stroke: reliability and comparisons with matched healthy controls.ObjectivesTo investigate the intra- and interrater reliabilities of the Expanded Timed Up and Go (ETUG) test with subjects with stroke and to compare the ETUG scores between subjects with stroke and healthy control subjects.DesignCross-sectional.SettingResearch laboratory.ParticipantsStroke participants (n=48; mean age ± SD, 59.29±15.84y) and healthy controls (n=48), matched by age, sex, and levels of physical activity.InterventionsNot applicable.Main Outcome MeasuresThe time spent to complete the ETUG in absolute (s) and ratio values regarding the percentages of the total time. Intraclass correlation coefficients (ICCs), Student t tests, and 95% confidence intervals were employed to investigate the reliability and differences between the groups (α<.05).ResultsBoth intra- and interrater reliabilities showed significant and excellent results for both groups for the absolute values (0.86≤ICC≤1.00; P<.001) and ratio values (0.55≤ICC≤0.99; P<.001). The mean time, in seconds, for all of the ETUG activities was higher for the subjects with stroke than for the control subjects (3.15≤t≤5.78; P<.001). However, when the comparisons considered the ratio values, no significant differences between the groups were found (0.45≤t≤1.15; 0.25≤P≤0.65). These results were confirmed by the 95% confidence interval.ConclusionsSubjects with stroke spent more time in all of the ETUG activities when compared with control subjects. All of the activities appeared to contribute similarly to the poorer performances observed in subjects with stroke, because the ratio values were similar between the groups. Considering the positive intra- and interrater reliability results, the ETUG could be applied to assess the functional mobility of both groups.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001