山东省淄博市1983—2003年肾综合征出血热流行趋势及流行特征分析

1983年淄博市首次发现肾综合征出血热(HFRS),1986年疫情达历史高峰;之后疫情总体呈下降趋势,现将近20年来淄博市HFRS的流行情况分析如下。1.资料与方法:人间疫情资料来源于各区县疫情报告统计,人口资料来源于淄博市统计局统计年鉴,数据用Excel 2000软件分析。2.结果: (1)流行趋势:①1983-2003年全省共发病15 507例,年均发病率为22.13/10万;病死116例,病死率为0.56%;发病率波动在0.27/10万～76.51/10万之间。20世纪80年代发     

Ethical aspects of withdrawing/withholding renal replacement therapies on patients in acute renal failure in an intensive care unit

The majority of patients being treated for acute renal failure in intensive care units have multiple medical problems. Accordingly, the withdrawal of renal replacement therapies should be considered as part of a general decision about whether to initiate or continue with treatment per se. Several guidelines on withdrawing and withholding therapy have been produced and some common themes emerge: concerns to avoid euthanasia, potential for benefit, patient consent (shared decision‐making), team consensus/decision‐making, and the provision of appropriate palliative care and resource implications. Each of these is considered in turn, although the word limit for this paper does not permit detailed exposition.     

电镜下的乙型肝炎表面抗原

本文对81例乙型肝炎病人的肝活检组织进行了电镜观察,发现HBsAg的阳性率达93.8％。电镜下,HBsAg细丝不仅有一般的管状细丝型,还有分枝管型和管泡型,而且CAH病人肝组织不易找到HBsAg丝(易见者仅9％),CPH,CLH则多数(79.5％)为易见及可见,二者有高度显著性差异(P<0.01)。     

The effect of increasing the dietary fibre content of diets of patients with chronic renal failure treated by haemodialysis at home

The study described tested the hypothesis that increasing amounts of dietary fibre (DF) in the diet of patients on haemodialysis (HD) may achieve positive clinical benefit without adversely affecting serum potassium and plasma phosphate. The current diet of 20 home HD patients was supplemented with 15g unprocessed wheat bran incorporated into three 'bran muffins' eaten daily for a trial period of 28 days. During this period patients reported an improvement in bowel habit. Serum potassium decreased slightly but not significantly ( P =0.242) but there was a significant rise in plasma phosphate ( P =0.004). These findings suggest that when increasing DF in devising HD dietary regimes, plasma phosphate is possibly the more sensitive biochemical variable following introduction of wheat bran.     

同种原位肝移植围手术期的处理

目的 总结我院自1999年8月以来,开展的3例同种异体原位肝移植（Orthotopic livertransplantation,OLT）围手术期的处理过程及经验体会。方法　2例原位肝移植、1例肝-肾联合移植术。均在术前12h口服环孢霉素A（CsA）和骁悉（MAP）,术中用甲基强的松龙（MP）1000 mg静脉冲击防止排斥,术后MP+CsA+MAP三联用药。结果 ①文中3例病人手术均获成功,其中2例原位肝移植病人存活至今,生活质量良好。肝肾联合移植病人于术后第76d死于严重混合感染。②移植肝的功能维护是肝移植术后处理的重点,其中包括急性排斥反应的诊断和处理,以及其它可能引起肝移植肝功能损害、衰竭等问题的处理。③全身非移植器官的功能恢复:包括呼吸系统、感染、出血、胸水、腹水等并发症的处理过程。结论 肝移植围手术期的处理是肝移植成功与否的关键,其中包括肝移植的排斥反应及各系统的功能支持与维护。     

The expression of 3-fucosylated-N-acetyl lactosamine carbohydrate determinants in renal tumours

The distribution in renal tumours of 3-fucosyl-N-acetyl lactosamine has been studied by using the monoclonal antibodies AGF 4.36 and AGF 4.48 and immunoperoxidase methods on tissue sections. Seven of 19 nephroblastomas and 12 of 30 renal cell carcinomas contained the epitope. In nephroblastomas the epitope was found on the terminals of type B tubules in six cases and in one case on the type A or neoplastic tubules. In renal carcinoma the antigen was found on the surface of tumour cells. The results suggest that in kidneys bearing nephroblastomas ureteric bud elements may grow into the tumour from the adjacent kidney.     

Sensory axonopathy in hereditary distal spinal muscular atrophy

A girl of 14 year is presented with a distal spinal muscular atrophy (SMA) with autosomal recessive inheritance. The technical findings are in agreement with the diagnosis. Light microscopical examination of sural nerve biopsy, including teased fiber studies and morphometry, showed no abnormalities. Electron microscopical investigation however demonstrated axonal pathology. The question arises if distal SMA is a distal axonopathy mainly of motor nerves, but to some extent also of sensory nerves.     

慢性乙型肝炎中可溶性白细胞介素2受体与其它血清学指标的关系

目的 :探讨血清可溶性白细胞介素 2受体 (sIL 2R)在慢性乙型病毒性肝炎 (慢乙肝 )中的发病机制及sIL 2R与肝纤维化指标、肝功能的相关关系。方法 :对 312例肝活检病人按组织病理学炎症和纤维化程度进行分级分期 ,同时检测了病人血清sIL 2R、肝功能及肝纤维化相关指标。结果 :血清sIL 2R均值较对照组明显增高 (P <0 .0 1) ,增幅随着肝脏病理炎症和纤维化程度的加重而逐渐加大 ,各组间比较差异有显著性 (P <0 .0 5或P <0 .0 1)。sIL 2R与血清白蛋白 (A)呈显著负相关 ,与血清脯氨酸肽酶 (PLD)、Ⅳ型胶原 (CⅣ )、层粘连蛋白 (LN)、透明质酸 (HA)、Ⅲ型前胶原氨基端肽 (PⅢNP)、肝功指标中的TB、DB、G、ALT、AST、AKP、γ GT呈显著正相关 (P <0 .0 5或P <0 .0 1)。结论 :慢乙肝病人血清sIL 2R水平与A呈显著负相关 ,与PLD、CⅣ、LN、HA、PⅢNP呈显著正相关 ;sIL 2R的血清水平能反映肝脏组织学病变的程度 ,可作为判断肝组织炎症和纤维化程度的参考指标。     

Leptin, lipid and lipid metabolism-related hormones in chronic renal failure in Arabia

SUMMARY: In patients with chronic renal failure (CRF), hyperleptinaemia has been widely reported, but the exact mechanisms leading to elevated leptin levels are unclear. Impaired renal clearance of leptin and the influence of other hormones may be important. In this study, we measured serum leptin levels in 150 patients on haemodialysis, peritoneal dialysis or in the predialysis phase of CRF. Furthermore, we measured plasma levels of insulin, growth hormone (GH) and insulin-like growth factor 1 (IGF-1), as well as plasma levels of triacylglycerols and total low density lipoprotein (LDL)- and high density lipoprotein (HDL)-cholesterol. We observed significantly elevated levels of leptin, particularly in female patients, and leptin was shown to correlate significantly with insulin, total and LDL-cholesterol and log triacylglycerols. Leptin was inversely correlated with GH concentrations, but was not correlated with IGF-1 levels. Despite the multiple correlations established between leptin levels and other variables, only hyperinsulinaemia in CRF seems to be important as a determinator of leptin levels.