肾移植患者血清脂类水平测定的意义

目的：为了探讨肾移植后病人脂类代谢紊乱和并发心血管疾病的因素。方法：分析了４９例肾移植（ＲＴ）病人血清中的脂类各组分水平,并与慢性肾功能衰竭（ＣＲＦ）透析病人、正常健康人群作比较。结果：ＲＴ病人血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白Ｂ（ａｐｏＢ）均明显高于ＣＲＦ和健康组,而高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、载脂蛋白Ａｌ（ａｐｏＡＩ）则无显著性差异。同时通     

急性胰腺炎患者血脂和载脂蛋白水平的初步观察

本文测定了２３例急性胰腺炎（ＡＰ）患者和２３例健康对照组的血清甘油三酯（ＴＧ）与胆固醇（ＴＣ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、极低密度脂蛋白胆固醇（ＶＬＤＬ－Ｃ）和载脂蛋白（Ａｐｏｓ）ＡⅠ、Ｂ１００、ＣⅡ、ＣⅢ。结果表明与对照组比较，ＡＰ患者的ＴＧ（Ｐ＜０．０１）、ＬＤＬ－Ｃ（Ｐ＜０．０５）和ＡｐｏＢ１００（Ｐ＜０．０１）明显增高；与治疗前相比较，ＡＰ患者用大承气汤为基本方的中西医结合治疗措施治疗后的ＴＧ、ＬＤＬ－Ｃ和ＡｐｏＢ１００未能降低（Ｐ＞０．０５）。提示ＡＰ患者存在脂质和Ａｐｏｓ的异常，特点是高ＴＧ及ＬＤＬ－Ｃ增高，ＡｐｏＢ１００明显增高。     

载脂蛋白E的基因多态性,异常脂血症和胆囊结石病的关系

为从分子遗传学水平探讨胆囊结石病的发病机理，采用聚合酶链反应等方法研究了８７例胆囊结石患者和５０例非结石者的ａｐｏＥ基因表型及等位基因频率，并分析了不同ａｐｏＥ基因表型的胆囊结石患者的血脂质代谢特征。结果显示：Ｅ２／３表型胆囊结石患者血脂质代谢最明显的特征是甘油三酯（ＴＧ）和极低密度脂蛋白胆固醇（ＶＬＤＬＣ）升高，低密度脂蛋白胆固醇（ＬＤＬＣ）降低；Ｅ３／３表型胆囊结石患者脂质代谢最典型的特征是高密度脂蛋白胆固醇（ＨＤＬＣ、ＨＤＬ２Ｃ、ＨＤＬ３Ｃ）显著下降；Ｅ３／４基因表型胆囊结石患者与Ｅ２／３、Ｅ３／３患者比较，ＶＬＤＬＣ轻度下降、ＬＤＬＣ轻度升高。由此表明：同一ａｐｏＥ基因表型胆囊结石患者的血脂质变化比非结石者突出，不同ａｐｏＥ基因表型的胆囊结石患者有不同的血脂变化特征，ε２等位基因可能是国人胆囊结石病的一个高危易患因子。     

阿魏酸钠对犬心脏停跳复苏后脑组织TXB_2、6-keto-PGF_(1a)及MDA含量的影响

研究了阿魏酸钠对犬心脏停跳１０分钟复苏后４小时脑组织中血栓素Ｂ２（ＴＸＢ２）、６－酮－前列腺素Ｆ１ａ（６－ｋｅｔｏ－ＰＧＦ１ａ）及丙二醛（ＭＤＡ）含量的影响。１７只犬随机分为非缺血对照组（Ａ组）、缺血再灌注常规治疗组（Ｂ组）及缺血再灌注阿魏酸钠治疗组（Ｃ组）。结果发现，Ｂ组ＴＸＢ２、ＭＤＡ含量及ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１ａ比值均较 Ａ组明显升高（Ｐ＜０． ０１）。 Ｃ组 ＴＸＢ２、ＭＤＡ含量及 ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１ａ比值升高幅度均较Ｂ组明显低（Ｐ＜０．０１）。表明阿魏酸钠可明显抑制犬心脏停跳复苏后脑组织花生四烯酸代谢及脂质过氧化反应。     

老年周围动脉粥样硬化闭塞症载脂蛋白测定的临床意义

为探讨老龄周围动脉粥样硬化闭塞症（ＰＡＳＯ）患者血清载脂蛋白的变化及与中西医结合治疗的关系，作者利用免疫透射比浊法及酶法，检测４０例老年周围动脉粥样硬化闭塞症患者及３０例健康对照组ａｐｏＡ１、ａｐｏＢ、ＨＤＬ－Ｃ水平。结果表明本病患者存在低水平ａｐｏＡ１和ＨＤＬ－Ｃ及高水平的ａｐｏＢ，ＨＤＬ－Ｃ随Ⅰ、Ⅱ、Ⅲ期逐渐降低，ａｐｏＡ、ａｐｏＢ、ＨＤＬ－Ｃ水平随病情好转渐趋于正常水平。提示本病患者存在载脂蛋白的代谢异常，ａｐｏＡ１、ａｐｏＢ、ＨＤＬ－Ｃ联合测定可协助临床医师判断ＰＡＳＯ进程、了解治疗效果。     

脂质与肾脏疾病的关系

肾脏疾病常伴脂蛋白异常，如肾病综合症、慢性肾功能不全等。肾病综合征脂质代谢异常包括总胆固醇升高、ＬＤＬ胆固 醇升高、甘油三酯水平升高以及ＶＬＤＬ和ＩＤＬ水平增高，脂蛋白异常可能主要与肝脏合成增加以及清除下降有关。不同肾脏疾病肾脏脂质沉着已有报道［１，２］，Ｌｅｅ等［２］通过活检观察到脂质沉积在免疫因素、非免疫因素所致肾小球疾病占２０％－３３％，６２％肾小球有ａｐｏＢ沉积，免疫组化分析显示肾小球有ａｐｏ（ａ）和ａｐｏ－Ｂ１００沉积［３］。这些现象使我们有理由相信脂质在肾小球疾病的发生发展中起重要作…     

脾切除对脂质代谢影响的实验研究

目的 探讨脾切除对脂质代谢的影响,以及保留部分和自体脾移植是否对脂质代谢产生有益的作用。方法 将３５只大鼠随机均分为普通饮食组（ＯＦ）、高胆固醇饮食组（ＡＣＦ）、脾切除＋高胆固醇饮食组（ＳＴ）、部分脾切除＋高胆固醇饮食组（ＨＳＴ）、脾切除＋自体脾移植＋高胆固醇饮食组（ＳＴＳＡ）。观察血脂变化。结果 ＡＣＦ组血清甘油三酯（ＴＧ）,胆固醇（ＣＨＯＬ）呈升高趋势。ＳＴ组血清ＴＧ,ＣＨＯＬ进一步升高,高密     

氧化低密度脂蛋白刺激人肾小球系膜细胞产生单核细胞趋化蛋白-1由核因子-κB活化调控

目的 研究核因子ＫＢ（ＮＦ－ＫＢ）在氧化低密度脂蛋白（Ｏｘ- ＬＤＬ）诱导的体外培养的人肾小球系膜细胞表达单核／巨噬细胞趋化蛋白－１（ＭＣＰ－１）中的作用。方法 采用凝胶迁移率变动分析检测ＮＦ－ＫＢ的ＤＮＡ结合活性变化，以免疫组织化学观测细胞内ｐ６５的核转位，用细胞ＥＬＩＳＡ法检测细胞内 ＭＣＰ－１及ＩＫＢα蛋白含量变化。结果 不同浓度（１０、２５、５０、１００μｇ／ｍｌ）Ｏｘ－ＬＤＬ刺激肾小球系膜细胞均可引起细胞ＮＦ-ＫＢ的ＤＮＡ结合活性增强、ＩＫＢα蛋白表达下降以及ＭＣＰ－１蛋白表达增强，以５０μｇ／ｍｌ刺激１ｈ ＮＦ－ＫＢ活化及ＩＫＢα表达减弱最明显，作用２４ｈＭＣＰ-１表达水平最高。ＮＦ－ＫＢ俯活化的同时伴有ｐ６５核转位。上述效应可被ＮＦ－ＫＢ特异性抑制剂吡咯二硫氨基甲酸酯（ＰＤＴＣ）所抑制。结论Ｏｘ－ＬＤＬ刺激人肾小球系膜细胞产生ＭＣＰ－１是由ＮＦ－ＫＢ调控，ＮＦ－ＫＢ参与了脂质肾损害的发病过程。     

核素动态肾显像和CDFI监测犬肾移植排斥的评价

目的：通过动物实验，对￣（９９ｍ）Ｔｃ－ＤＴＰＡ动态肾显像和彩色多普勒血流成像（ＣＤＦＩ）在肾移植检查中的应用做一评价。方法：建立犬异体肾移植模型，应用以上两项技术，对１５只犬异体肾移植后进行连续监测。结果与结论：（１）￣（９９ｍ）Ｔｃ－ＤＴＰＡ动态肾显像诊断早期排斥标准：Ｋ／Ａ比值＜３，Ｂ／Ｋ比值＜１，其阳性预测率为１００％，随着排斥加重，Ｋ／Ａ比值进行性降低，肾显像模糊；（２）ＣＤＦＩ诊断急性排斥标准：ＲＩ值＞０．８，其阳性预测率为８２％，严重排斥时，肾内弓形动脉闭塞消失，肾动脉舒张期血流反向。     

胰岛素样生长因子—1与腹膜透析患者营养状况

目的　（１）探讨胰岛素样生长因子１（ＩＧＦ１） 与腹膜透析营养状况的关系。（２） 探讨透析充分性、腹膜转运特性、残余肾功能对腹膜透析患者营养状况和血胰岛素样生长因子１ 水平的影响。方法　收集３６ 例持续性不卧床腹膜透析（ＣＡＰＤ）患者,采血测ＢＵＮ、Ｃｒ、白蛋白、补体、转铁蛋白、ＩＧＦ１,并纪录身高、体重对患者进行营养评估。测定残余肾功能、２４ 小时透析液肌酐与血肌酐浓度比值（Ｄ／Ｐ） 、总肌酐清除率（Ｔｃｒ）、尿素清除指数（Ｋｔ／Ｖ）。结果　（１） 患者血ＩＧＦ１ 水平与白蛋白、转铁蛋白、补体密切相关,血白蛋白高者ＩＧＦ１ 水平亦高。（２）Ｔｃｒ≥６０ Ｌ·周－１·（１．７３ｍ２）－１ 组ＩＧＦ１、转铁蛋白、白蛋白显著高于Ｔｃｒ＜６０ Ｌ·周－１·（１－７３ｍ２） －１组。Ｄ／Ｐ≥０－８１ 组白蛋白显著低于０－６５≤Ｄ／Ｐ＜ ０－８１、Ｄ／Ｐ＜ ０－６５ 组。残余肾功能高于２ ｍｌ／ｍｉｎ 组ＩＧＦ１、白蛋白水平显著高于残余肾功能小于２ｍｌ／ｍｉｎ 组。结论　（１）ＩＧＦ１ 是评价腹膜透析营养状况的早期敏感指标。（２） 透析充分性、腹膜转运特性、残余肾功能是影响腹膜透析患者营养状况的重要因素。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.