在线尿素清除率监测对血液透析充分性评价的研究

目的 探讨在线尿素清除率监测对血液透析充分性的评估价值.方法 选取规律血液透析患者65例,其中男38例,女27例,平均透析时间(41±29)个月.透析中血流量200～300ml/min,透析液流量500ml/min,利用在线尿素清除率监测(on-line clearance monitoring,OCM)Kt/V值;同时透析前后取全血检测尿素氮浓度等,根据单室尿素动力模型DaugirdasⅡ公式计算K t/V值,比较2种方法的相关性及不同体质量,超滤量,血流量,血红蛋白,红细胞压积对两者的影响.结果 本组65例患者利用OCM法测得的Kt/V值与采血计算法所得的K t/V值分别为(1.42±0.25)与(1.45±0.25),直线回归分析相关指数 r=0.979,P＜ 0.001.不同体质量≤60kg和＞60kg的2组患者,OCM监测的K t/V值分别为(1.50±0.27)与(1.37±0.22),t =2.09p=0.04采血计算Kt/V值(1.54±0.27)与(1.40±0.22),t=2.23,P=0.03 2者有显著差别.不同超滤量<3kg和≥3kg的2组患者,K t/V值无显著差别OCM法比较t=-1.34,P =0.19采血计算法比较t=-1.52,P=0.13.不同血流量200～250ml/min和260～300ml/min的2组患者,Kt/V值有显著差别OCM法比较t=-9.11p=0.01采血计算法比较 t=-9.13,P=0.01.不同血红蛋白水平Hgb≤110g及Hgb＞110g的2组患者,K t/V值无显著差异OCM法比较t=0.33,P =0.74采血计算法比较t=-0.15,P =0.88.不同红细胞压积水平HCT≤33%及HCT＞33%的2组患者,Kt/V值无显著差异OCM法比较t=-0.50,P =0.62采血计算法比较t=-0.81,P =0.43.结论 采用OCM监测可以很好的反映患者单次透析的尿素清除,有利于短期内调整透析处方,并结合其结果制定个体化的透析方案,以保证患者的透析充分性.     

在线尿素清除率监测及其临床意义

目的 探讨在线尿素清除率监测(OCM)的临床应用价值及在透析充分性评价中的临床意义。方法 采用4008S血液透析机OCM检测了38例维持性透析患者一次血液透析时的尿素清除指数(Kt/V值),并用尿素动力一室模型计算Kt/V值;根据有、无残余肾功能,将38例分为两组对OCM和计算Kt/V值进行比较。结果 38例患者OCM检测Kt/V值为1.13±0.58,计算Kt/V值为1.18±0.17,具有良好的相关性(r=0.887,P<0.01)。尿素动力模型计算二组的Kt/V值有显著差异(P<0.05),而OCM检测其Kt/V值则无显著差异(P>0.05)。结论 血液透析机OCM可作为检测Kt/V,评价透析充分性的简便、可靠的指标,并可避免透析后尿素反弹和残余肾功能的影响。     

在线清除率监测评价维持性血液透析患者透析充分性的研究

目的探讨在线清除率监测(online clearance monitoring,OCM)在评价维持性血液透析患者透析充分性中的应用价值。方法测定111例稳定血液透析患者的在线清除率监测与取血法计算的单室尿素清除指数(sp Kt/V)。通过线性相关分析了解二者的相关性,并建立由OCM推导sp Kt/V的计算公式。通过多元线性回归分析得出影响在线清除率的相关临床因素。结果 OCM的Kt/V值较取血法计算的Kt/V值偏低,在线清除率监测Kt/V(1.22±0.20),取血法计算的Kt/V(1.61±0.35),t=15.182,P0.001。直线相关分析显示,二者具有良好的相关性(r=0.676,P0.001),通过在线清除率监测可以推导出sp Kt/V值。结论在线清除率监测值与取血法Kt/V之间存在良好相关性,可应用在线清除率监测值估算取血法Kt/V值,指导临床治疗。     

在线尿素清除率监测在血液透析中的应用

目的探讨在线尿素清除率监测（OCM）在血液透析中的应用价值。方法采用OCM对维持性血液透析的终末期肾衰竭患者,在透析器F6首次使用及复用第7次时检测尿素清除指数（Kt/V）,与同时应用尿素动力学单室可变容积模型计算Kt/V值进行比较并进行相关性分析。结果透析器首次使用时,OCM检测值（1.25±0.16）低于Kt/V计算值（1.37±0.23）,相关性分析显示两者存在显著的直线相关性（r=0.842,P〈0.001）;透析器复用第7次时,OCM检测值（1.23±0.15）低于Kt/V计算值（1.31±0.17）,相关性分析显示两者存在显著的直线相关性（r=0.667,P〈0.01）;透析器首次使用OCM检测值和复用7次时OCM检测值相比,无统计学意义（t=1.908,P〉0.05）;透析器首次使用Kt/V计算值和复用7次时Kt/V计算值相比,亦无统计学意义（t=1.692,P〉0.05）。结论OCM检测值低于Kt/V计算值,OCM在作为评价尿毒症血液透析患者血液透析充分性指标时,应注意二者的差别。透析器复用7次不影响对小分子物质的清除。     

血液透析不同途径输液对患者毒素清除率的影响

目的探讨血液透析中采用透析器前输液和外周静脉输液对患者毒素清除率的影响。方法采用自身对照法对符合标准的60例血液透析病人分别采用透析器前输液和外周静脉输液,利用联机在线尿素清除率监测器（Onlin Clearance Measurement,OCM）实时监测患者透析时透析机屏幕上尿素清除指数（Kt／V）的曲线变化,记录透析开始后30min、透析2h、透析结束时的Kt／V值。结果透析开始后30min两种途径输液的Kt／V值无明显变化（P〉0．05）,透析2h、透析结束时外周静脉输液的Kt／V值高于透析器前输液的Kt／V值（P〈0．01）,差异有显著意义。结论血液透析中不同的途径补液对患者的毒素清除有影响,透析中采用外周静脉输液较采用透析器前输液的毒素清除率高,可增加患者血液透析的充分性,临床上值得推广使用。     

不同预冲方法对血透患者透析充分性的影响

目的探讨不同预冲方法对维持性血液透析患者透析充分性的影响。方法将67例维持性血液透析患者先采用5次半开放式预冲方法(半开放式组),然后5次透析都采用密闭式预冲方法(密闭式组),通过在线尿素清除率的监测(Online Clearance Monitoring,OCM)测定每次透析的尿素清除指数(Kt/V)。观察透析器的凝血情况,进行自身对照比较。结果半开放式组透析3次后Kt/V有明显的降低,而密闭式组第1-5次都保持在比较稳定的数值,透析5次后两组之间Kt/V差异有统计学意义(P<0.05);半开放式组透析器在复用3-4次后,回血时透析器有凝血现象,与密闭式组比较,凝血分级有明显的区别(P<0.05)。结论采用密闭式预冲方法进行血液透析,操作程序简单,降低了交叉感染的风险,减少了透析器凝血的发生率,保持Kt/V值的稳定,能有效地提高血透患者的透析充分性。     

血液透析超滤量对维持性血液透析患者透析充分性的影响

目的探讨血液透析超滤量对维持性血液透析患者透析充分性的影响。方法根据超滤率高低将40例维持性血液透析患者分为2组：A组（超滤率≤15 mL.h-1.kg-1））23例和B组（超滤率〉15 mL.h-1.kg-1）17例。2组患者均行血液透析治疗。观察2组患者透析超滤量、超滤率及透后血尿素/透前血尿素（R）值、尿素清除指数（Kt/V）值等情况。结果A组透析超滤量、超滤率、R值均明显低于B组（均P〈0.05）,A组Kt/V值明显高于B组（P〈0.05）。结论一定时间内,每次过多的超滤量是影响透析充分性的因素之一。     

输液改变血流量对血液透析充分性的影响

目的探讨输液改变血流量对血液透析充分性的影响。方法选取透析脱水量<800mL的尿毒症患者30例,采用自身对照实验研究,每例患者于上机前、透析过程给予输液(实验组)和透析过程不给予输液(对照组),各进行透析1次。实验组透析上机前输入生理盐水250-500mL,上机后继续输入生理盐水550-750mL,共1000mL,血流量为250mL/min;对照组透析过程不输液,血流量为200mL/min。采用联机在线尿素清除率监测器监测两组患者尿素清除指数(Kt/V)变化及低血压发生情况。结果实验组Kt/V值明显增加,低血压发生率明显降低,与对照组比较,均P<0.05,差异具有统计学意义。结论血液透析过程中通过输液提高患者透析血流量,能防止透析过程发生低血压,并有效提高患者血液透析的充分性。     

增加超滤量及血流量对血液透析充分性的影响

目的 研究增加超滤量及血流量对血液透析充分性的影响及其安全性.方法 选择长期规律透析的慢性肾衰竭尿毒症期病人15例,采用4次不同的血液透析处方进行连续4次血液透析,依据透析处方的不同分为4组：对照组、增加超滤量组、增加血流量组和增加超滤量及血流量组.采集患者血液透析前及血液透析后的血液标本,检测血尿素氮,计算尿素清除指数（Kt/v）,评估透析充分性,监测血液透析过程中的血压情况,比较各组Kt/v及低血压发生情况.结果 各组Kt/v值比较,增加超滤量组（1.275±0.144）与对照组（1.279 ±0.142）相近（P＞0.05）;增加血流量组（1.320±0.147）较对照组增高（P＜0.05）;增加超滤量及血流量组（1.372±0.144）较增加血流量组增高,差异有统计学意义（P＜0.05）.对照组、增加超滤量组、增加血流量组、增加超滤量及血流量组分别发生低血压0、1、2、1例,各组间低血压发生率相当（P＞0.05）.结论 增加血流量可以提高血液透析的充分性,增加超滤量及血流量能进一步提高透析的充分性.     

透析中动脉端输液对血液透析充分性的影响

[目的]探讨血液透析中动脉端输液对血液透析充分性的影响.[方法]选取透析中脱水量少于800 mL的肾衰竭病人38例,采用自身对照实验比较,每例病人透析中输液(实验组)和透析中不输液(对照组)各5次,两种方法隔次采用,监测病人每次透析的尿素清除指数(Kt/V);复用机测定透析器复用后整体纤维血室容积(Tcv).[结果]实验组透析第1次～第5次Kt/V和Tcv都保持比较稳定的数值,实验组Kt/V和Tcv均优于对照组,透析器使用5次后两组之间Kt/V、Tcv值比较差异有统计学意义(P＜0.05).[结论]透析中动脉端输液能保证透析器有效的Tcv值,保持Kt/V值的稳定,能有效地提高血液透析病人的透析充分性.     

洁尔阴含漱预防化疗所致口腔溃疡的效果观察

目的:观察洁尔阴含漱预防口腔溃疡的临床效果.方法:接受化疗的乳腺癌患者50例应用洁尔阴含漱预防口腔溃疡,并与同期住院的50例进行对照.结果:观察组口腔溃疡发生率为40%,以Ⅰ～Ⅱ度为主,无Ⅲ～Ⅳ度;口腔溃疡发生率明显低于对照组(P＜0.05).结论:洁尔阴舍漱预防化疗所致口腔溃疡有较好的效果.     

Modulation of emotion by cognition and cognition by emotion

In this study, we examined the impact of goal-directed processing on the response to emotional pictures and the impact of emotional pictures on goal-directed processing. Subjects (N=22) viewed neutral or emotional pictures in the presence or absence of a demanding cognitive task. Goal-directed processing disrupted the BOLD response to emotional pictures. In particular, the BOLD response within bilateral amygdala and inferior frontal gyrus decreased during concurrent task performance. Moreover, the presence of both positive and negative distractors disrupted task performance, with reaction times increasing for emotional relative to neutral distractors. Moreover, in line with the suggestion of the importance of lateral frontal regions in emotional regulation [Ochsner, K. N., Ray, R. D., Cooper, J. C., Robertson, E. R., Chopra, S., Gabrieli, J. D., et al. (2004). For better or for worse: neural systems supporting the cognitive down-and up-regulation of negative emotion. NeuroImage, 23(2), 483-499], connectivity analysis revealed positive connectivity between lateral superior frontal cortex and regions of middle frontal cortex previously implicated in emotional suppression [Beauregard, M., Levesque, J., and Bourgouin, P. (2001). Neural correlates of conscious self-regulation of emotion. J. Neurosci., 21 (18), RC165.; Levesque, J., Eugene, F., Joanette, Y., Paquette, V., Mensour, B., Beaudoin, G., et al. (2003). Neural circuitry underlying voluntary suppression of sadness. Biol. Psychiatry, 53 (6), 502-510.; Ohira, H., Nomura, M., Ichikawa, N., Isowa, T., Iidaka, T., Sato, A., et al. (2006). Association of neural and physiological responses during voluntary emotion suppression. NeuroImage, 29 (3), 721-733] and negative connectivity with bilateral amygdala. These data suggest that processes involved in emotional regulation are recruited during task performance in the context of emotional distractors.     

子宫肌瘤腹腔镜剥除与开腹剥除的配对研究

目的对比研究腹腔镜与开腹行子宫肌瘤剔除的优点和风险。方法收集2002年5月～2004年5月间48例子宫肌瘤(浆膜下或肌壁间)手术病人。所有病人分成腹腔镜组和开腹组,测定两组的手术时间、手术出血量、术后最高体温、体温恢复正常天数、下床活动时间、肛门排气时间、住院天数、术后用镇痛药与否、术后3d白细胞分类及计数正常与否、术后有无并发症,并进行1∶1的配对研究。结果两组病人无手术并发症,腹腔镜组无中转开腹手术。腹腔镜组手术出血量、术后体温恢复时间、下床活动时间、肛门排气时间、住院天数、镇痛药使用率和血常规正常时间较开腹组少;但手术时间较长,考虑与手术操作熟练程度有关。结论腹腔镜下子宫肌瘤剔除术是一种安全有效的手术方法,较开腹手术损伤小、出血少、恢复快。     

Hemolysis of erythrocytes by granulysin-derived peptides but not by granulysin

Granulysin, a 9-kDa protein localized in human cytolytic T lymphocytes and natural killer cell granules, is cytolytic against tumors and microbes but not against red blood cells. Synthetic peptides corresponding to the central region of granulysin recapitulate the lytic activity of the intact molecule, and some peptides cause hemolysis of red blood cells. Peptides in which cysteine residues were replaced by serine maintain their activity against microbes but lose activity against human cells, suggesting their potential as antibiotics. Studies were undertaken to determine the mechanism of resistance of red blood cells to granulysin and sensitivity to a subset of granulysin-derived peptides. Granulysin lyses immature reticulocytes, which have mitochondria, but not red blood cells. Granulysin lyses U937 cells but not U937 cells lacking mitochondrial DNA and a functional respiratory chain (U937rho(o) degrees cells), further demonstrating the requirement of intact mitochondria for granulysin-mediated death. Peptide G8, which corresponds to helix 2/loop 2/helix 3, lyses red blood cells, while peptide G9, which is identical except that the cysteine residues were replaced by serine, does not lyse red blood cells. Granulysin peptide-induced hemolysis is markedly inhibited by an anion transporter inhibitor and by Na(+), K(+), and Ca(2+) channel blockers but not by Na(+)/K(+) pump, cotransport, or Cl(-) channel blockers. Although recombinant granulysin and G9 peptide do not induce hemolysis, they both competitively inhibit G8-induced hemolysis. The finding that some derivatives of granulysin are hemolytic may have important implications for the design of granulysin-based antimicrobial therapeutics.     

The status of travel by severely handicapped patients by railroads

An essential prerequisite for integrating disabled persons is their mobility. The special transport approach, both in terms of handling capacity and cost involved, is increasingly turning out to be unable to achieve future-oriented solutions in this context. Disabled people wish to use the transport services available to the general public. They therefore demand public transportation policies to provide for their access to the mainstream system, ideally independent of outside assistance. Deutsche Bundesbahn, the German federal railways, in the field of tension between the need to orient its business policies on economic and financial considerations and disabled persons' demands that vehicles and premises be designed in a barrier-free manner, seeks to achieve solutions that are responsive to users' needs and at the same time economically justifiable. On account of the 19th century infrastructure legacy and a wide range of rolling stock in long- and short-distance rail travel, this can however be realized only step by step. The facilities offered to disabled people so far range from free use of short-distance trains to the accessibility-oriented design of coaches for the Intercity Express, the future of the railways in the European rapid transit network. The various services and facilities provided are hoped to foster disabled persons' decision in favour of the environmentally compatible rail mode of travelling.     

地塞米松抑制多核白细胞诱导的角膜基质细胞胶原降解

目的探讨地塞米松对多核白细胞诱导的角膜基质细胞胶原降解作用及机制。方法利用角膜基质细胞三维胶原凝胶培养模型，加入多核白细胞或其培养上清及不同浓度地塞米松，在MEM培养液中培养48h后，通过测定培养上清液中的羟脯氨酸（HYP）的量作为胶原降解的活性单位。免疫印记法分析MMP活性变化。结果在纤维蛋白溶酶原存在的情况下，多核白细胞单独无胶原降解作用，多核白细胞与角膜基质细胞混合培养，及多核白细胞培养上清均能增加角膜基质细胞胶原降解量，差异有显著性（P〈0．01）；多核白细胞培养上清能够刺激角膜基质细胞MMP-1和MMP-3释放，地塞米松依浓度依赖关系减少角膜基质细胞胶原降解量，差异有显著性（P〈0．01）。结论多核白细胞促进角膜基质细胞胶原降解，地塞米松具有抑制多核白细胞诱导的角膜基质细胞胶原降解的作用。