不同CRRT方法对减少冠心病合并肾病患者PCI术后造影剂肾病的疗效分析

目的 探讨不同连续肾脏替代疗法（CRRT）对经皮冠状动脉介入治疗（PCI）的冠心病合并慢性肾功能不全患者肾功能改善的临床疗效分析。方法 选取2016年1月（与内文不符）[]至2017年8月在我院进行PCI治疗的肾病患者56例作为研究对象,分为两组,普通组28例实行CRRT治疗时间为PCI术后的12小时,加强组CRRP治疗的时间为PCI术前24 h及PCI术后12 h内。将两组患者慢性健康情况、急性生理情况、造影剂肾病（CIN）发生率、血肌酐水平进行比较。结果 普通组与加强组患者一般资料无明显差异。加强组患者CIN发生率比普通组明显减少(7.14% 比39.28%,P< 0.01)。普通组患者PCI术后24 h血肌酐水平比PCI术前增加［(308.14±45.08)μmol/L比 (254.59±80.44)μmol/L, P=0.02］;PCI术后48 h、72 h血肌酐水平与PCI术前差别不大[(232.49±20.12)μmol/L 比 (247.52±54.81)μmol/L 比 (254.59±80.44)μmol/L, P>0.05]。加强组患者PCI术后24 h血肌酐水平与PCI术前无明显差异[(274.04±71.06)μmol/L比 (286.65±53.04)μmol/L,P>0.05];加强组患者PCI术后48 h、72 h血肌酐水平比PCI术前明显减少［(220.12±23.87)μmol/L比 (286.65±53.04)μmol/L,P=0.01］、［(250.17±44.20)μmol/L比 (286.65±53.00)μmol/L,P=0.02］。结论 实施PCI术前、术后均进行CRRT取得的效果比实施PCI术后进行CRRT的效果更好,能够减少造影剂肾病发生。     

支架治疗动脉硬化性肾动脉狭窄对肾功能影响的前瞻性研究

目的:探讨肾动脉支架置入术,对肾动脉狭窄导致缺血性肾病患者的肾功能影响。方法:2008年1月至2010年1月,对肾动脉狭窄合并有肾功能不全的患者,采用肾动脉支架进行血管腔内治疗。术后1,3,6及12个月定期复查血清肌酐水平。结果:共入选26例患者进行了肾动脉支架治疗,男性14例,女性12例,平均年龄(62±14)岁,术前肾血清肌酐水平为(151.58±11.86)umol/L,术后1个月血肌酐水平为(149.96±16.39)umol/L,与术前差异无统计学意义(P=0.551)。术后3,6及12个月肌酐分别为〔(140.38±27.07)umol/L,P=0.02〕,〔(137.15±30.73)umol/L,P=0.005〕,〔(135.38±33.37)umol/L,P=0.005〕,均低于术前水平,差异具有统计学意义。结论:肾动脉腔内支架成形术,可改善肾动脉狭窄患者的肾功能。     

沙库巴曲缬沙坦对慢性射血分数降低心力衰竭合并肾功能不全患者的肾脏保护作用

【摘要】目的 观察沙库巴曲缬沙坦对合并肾功能不全的慢性心力衰竭（心衰）患者肾功能的影响。方法 连续入选84例慢性心衰合并肾功能不全患者,分为沙库巴曲缬沙坦（ARNI）组48例和对照组36例。ARNI组接受沙库巴曲缬沙坦治疗,对照组接受单一的缬沙坦治疗。观察2组患者服药后6个月和12个月肌酐、估算的肾小球滤过率（eGFR）、尿素氮、尿酸、肾功能恶化（WRF）指标的变化情况。结果 （1）两组患者基线资料比较差异无统计学意义。(2)服药后6个月,对比基线水平,ARNI组肌酐、eGFR的变化值与对照组比较无明显差异(P = 0.254;P = 0.061);尿素氮及尿酸下降值显著高于对照组[-2.62（1.83,3.90）mmol/L vs 0.45（0.29,0.70）mmol/L,P < 0.01;-82.74±149.55 μmol/L vs -7.46±111.69 μmol/L,P = 0.027];服药后12个月,对比基线水平,ARNI组eGFR下降值明显低于对照组[-2.21（1.33,3.49）ml/min/1.73m2 vs -22.11（12.32, 29.67）ml/min/1.73m2,P = 0.023];肌酐升高值明显低于对照组[1.50（0.98,2.07）μmol/L vs 31.65（22.77,42.53）μmol/L,P = 0.043];尿素氮及尿酸下降值也显著高于对照组[-2.80（2.01,4.23）mmol/L vs 0.80（0.58,1.14）mmol/L,P < 0.01;-97.89±133.90 μmol/L vs -6.90±107.36 μmol/L,P = 0.011]。(3)服药后6个月,ARNI组WRF发生率与对照组相比无明显统计学差异（6.25% vs 19.44%,P = 0.132）;服药后12个月,ARNI组WRF发生率显著低于对照组（8.33% vs 25%,P = 0.037）。结论 与单一的缬沙坦比较,ARNI可以延缓、控制合并肾功能不全的慢性心衰患者肾功能的进展,减少WRF的发生。随服药时间的延长,对肾功能的保护作用更显著。     

体外循环与非体外循环下行CABG对肾功能不全患者肾功能影响的比较

目的:比较在体外循环与非体外循环下行冠状动脉旁路移植术（CABG）对患者肾功能的影响。方法: 我院40位择期行CABG的慢性肾功能不全患者,随机分为两组,每组20例,分别在在体外循环与非体外循环下行CABG。术前及术后1、3、7 d测定血肌酐值并计算肌酐清除率。结果: 体外循环组患者术后血肌酐值显著高于非体外循环组,其肌酐清除率较术前显著下降。结论:肾功能不全患者在体外循环与非体外循环下行CABG,前者更易加重肾功能损害。     

体外与非体外循环对冠状动脉旁路移植术后谵妄的影响

比较体外与非体外循环冠状动脉旁路移植术对患者术后谵妄发生率的影响。方法：回顾性分析阜外医院SICU自2020年1月至2021年4月收治的单纯行冠脉搭桥患者信息,根据手术方式分为体外循环组和非体外循环组。比较两组患者的基本信息、基础疾病,术前超声EF值和术前血肌酐水平。终点指标为两组患者住院期间的谵妄发生率。结果：共607例患者纳入本研究,其中体外循环组495例,非体外循环组112例。两组患者年龄、性别比例、基础疾病（高血压、糖尿病、既往卒中史）、术前最后一次EF值、术前血肌酐值均无统计学差异。术中平均搭桥个数两组无统计学差异,体外循环组平均转机时间123.7±46.8分钟,阻断89.9±33.6分钟。术后呼吸机使用时间两组无统计学差异。ICU停留时间体外循环组高于非体外组（3.0±1.8 vs 2.5±1.7天,t：2.603,p：0,009）。术后MACCE事件及CRRT两组均无统计学差异。体外循环组105例患者发生谵妄（21.2%）,非体外循环组14例发生术后谵妄（12.5%）。基于倾向性评分的逆概率加权回归分析提示OR值为2.402（95%CI, 1.337-4.317）,P=0.004。结论：非体外循环冠状动脉旁路移植术可降低术后患者谵妄的发生率。     

高血压合并肾动脉狭窄患者肾动脉支架术对血压的影响

目的评估肾动脉支架术对高血压合并肾动脉狭窄患者血压的影响。方法对患有高血压的67例肾动脉明显狭窄(管腔内径减少≥70%)的患者行肾动脉支架植入术(PTRAS),术后行血压及血肌酐(SCr)的长期随访。结果患者67例植入77枚支架均获成功。所有患者均随访血压及肾功能,平均随访时间(18±6)月,随访患者的收缩压由(171±23)下降至(160±20)mmHg,P<0.05,舒张压由(95±14)下降至(85±13)mmHg,P<0.01;降压药物的种类显著减少[由(2.7±1.6)下降至(1.9±1.4)种,P<0.01]。术前肾功能正常者(SCr<130μmol/L)术后血压下降最为显著[收缩压由(176±33)下降至(159±26)mmHg,P<0.01,舒张压由(98±15)下降至(83±15)mmHg,P<0.01]。而术前肾功能受损者(130≤SCr≤350μmol/L)术后血压无明显改变。术后随访血肌酐及肾小球滤过率较术前无明显改变。结论肾动脉支架植入术有助于肾功能正常的高血压患者血压控制。     

CO2造影在肝门部胆管癌内镜引流中的价值

目的 探讨CO2联合造影剂造影在不可切除的肝门部胆管癌内镜引流中的价值。方法 回顾性分析兰州大学第一医院2010年10月至2015年10月间行内镜引流术治疗的43例不可切除的肝门部胆管癌患者病例资料,根据造影剂选用分为研究组（CO2联合造影剂造影）和对照组（单纯造影剂造影）,研究组23例,对照组20例,比较两组术后总胆红素、白细胞计数、降钙素原及并发症发生率。结果 43例患者内镜操作时间50～70 min,术后研究组48 h和72 h的总胆红素、白细胞、降钙素原均低于对照组[48 h 总胆红素：（173.42±66.78）μmol/L 比（210.81±78.34）μmol/L, P=0.025; 72 h 总胆红素:（104.64±56.35）μmol/L比（159.33±59.59）μmol/L,P=0.023;48 h 白细胞:（11.51±7.78）×109/L比（15.83±6.67）×109/L, P=0.026; 72 h 白细胞:（10.92±5.64）×109/L比（14.72±4.97）×109/L ,P=0.026; 48 h 降钙素原:（0.56±0.18 ）ng/mL比（1.24±0.73）ng/mL,P=0.003; 72 h 降钙素原:（0.42±0.27） ng/mL比（0.90±0.20 ）ng/mL,P=0.001]。术后胆管炎的发生率研究组低于对照组,差异有统计学意义[13.0%(3/23)比40.0%(8/20),P=0.043];两组术后胰腺炎的发生率较低,差异无统计学意义[4.3%(1/23)比10.0%(2/20),P=0.090]。结论 不可切除的肝门部胆管癌内镜引流中采用CO2联合造影剂造影是安全有效的,并且可降低术后胆管炎发生率。     

卡托普利治疗慢性肝病患者肾损害的临床初步观察

目的 为观察血管紧张素酶抑制剂(ACEI)对慢性肝病合并肾功能损害的治疗效果。方法 应用含巯基ACEI-卡托普利治疗16例患者,并以14例作对照。结果 治疗组患者血清尿素氮(BUN)平均值由15.7±3.2mmol/L下降至11.4±5.1mmol/L,P<0.01;血肌酐(Cr)平均值由185.6±70.7μmol/L下降至132.6±44.2μmol/L,P<0.05。其中6例蛋白尿患者有5例尿蛋白阴转。治疗有效率66.7％(8/12),明显高于对照组的21.4％(3/14)。结论初步表明,卡托普利对慢性肝病合并肾功能损害患者有一定疗效,可减少尿蛋白,延缓肾功能减退进程。     

老年动脉粥样硬化性肾动脉狭窄患者支架置入术后肾功能的变化

目的探讨经皮腔内肾动脉支架置入术(PTRAS)治疗动脉粥样硬化性肾动脉狭窄(ARAS)对肾功能的影响。方法经肾动脉造影确诊的ARAS并施行PTRAS患者50例,术后随访3～48(16.3±14.8)个月,回顾性分析PTRAS后患者血清肌酐和再狭窄发生率。结果 50例PTRAS全部成功。与PTRAS前比较,20例(40%)症状改善和26例(52%)症状稳定患者血清肌酐水平明显下降[(151.47±54.86)μmol/L vs(182.50±68.87)μmol/L,P<0.01;(95.56±1 2.87)μmol/L vs(101.37±1 5.53)μmol/L,P<0.05],4例(8%)症状恶化患者血清肌酐水平明显升高(P<0.05)。随访期间再狭窄6例(12%)。结论 PTRAS能够改善老年人肾动脉粥样硬化所致肾功能改变,并使肾功能长期保持稳定。加强对军队老干部PTRAS后的健康教育,可部分提高患者对相关危险因素的控制,减少术后并发症的发生,提高生活质量。     

老年脑梗死患者血同型半胱氨酸水平与颈动脉斑块的相关性

目的　研究70岁及以上老年脑梗死患者血同型半胱氨酸水平（Hcy）与颈动脉斑块之间的关系。方法选择2008年7月～2010年10月本院老年病科收治的≥70岁老年脑梗死患者165例,均行血Hcy水平测定及颈动脉超声检测,并比较不同组别颈动脉斑块与血Hcy水平间的关系。结果　颈动脉斑块组血Hcy水平（22.65±6.17　μmol/L）明显高于正常组（12.20±2.52　μmol/L;P＜0.05）,其中软斑组血Hcy水平（26.71±8.17　μmol/L）明显高于混合斑组（20.31±7.06　μmol/L;P＜0.05）,混合斑组血Hcy水平明显高于硬斑组（19.67±3.80　μmol/L;P＜0.05）。颈动脉斑块危险因素经Logistic回归分析显示血Hcy为颈动脉斑块的独立危险因素。结论　血Hcy水平与老年脑梗死患者颈动脉斑块之间有明显关系,是颈动脉斑块的独立危险因素。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.     

High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. Methods We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART‐naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs. <30 years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV‐infected patients to an additional avoidable risk of DSP. Access to non‐neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.