老年维持性血液透析患者营养状态评估

目的了解老年维持性血液透析患者营养状况及其主要原因,有针对性地进行干预治疗。方法维持性血液透析患者314例分为老龄组和非老龄组,糖尿病组和非糖尿病组,进行人体学测量、生化指标、改良主观营养评估及营养不良-炎症评估四方面测定。结果维持性血液透析患者实际摄入蛋白质及能量低于中国推荐剂量,老龄组上臂围、上臂肌围、尿素氮、肌酐等显著低于非老龄组,而改良主观综合性评估、营养不良-炎症评估及超敏C-反应蛋白较非老龄组明显增高(P<0.05);老龄糖尿病患者营养不良比例较老龄患者、非老龄患者及糖尿病患者均明显升高(P<0.05);而透析充分患者营养不良发生率明显高于透析不充分者(P<0.05)。结论老年维持性血液透析营养不良主要与透析不充分、蛋白质-能量摄入不足及微炎症反应密切相关,同时还受原发病的影响。     

71例维持性血液透析患者死亡原因分析

目的：探讨提高血液透析患者生存率的措施。方法：回顾分析进行维持性血液透析的390例患者的年龄、原发病、死亡原因,存活组与死亡组相关透析指标。结果：死亡患者共71例（男37,女34）,平均（54．3±18.5）岁。老年患者2006年以前占45．3％;2006年以后占48．6%。在导致血透患者死亡的原发病中,糖尿病、高血压有上升趋势;死亡原因主要为心脑血管疾病、感染和恶性肿瘤;高血压、贫血、营养不良、透析不充分是血液透析患者死亡的危险因素。结论：透析患者老龄化趋势明显,导致慢性肾衰竭的原发病中糖尿病、高血压已占主要位置,血透患者的主要死亡原因为心脑血管疾病、感染和恶性肿瘤。     

饮食护理应用于糖尿病肾病维持性血液透析患者对其营养状况的影响

目的分析同时总结糖尿病肾病维持性血液透析治疗患者接受饮食护理的具体方法以及对患者营养状况所产生的影响。方法对于该院在2017年1月—2018年1月所收治的糖尿病肾病患者资料100例施行分析,所选100例患者全部接受维持性血液透析治疗,采取随机法对所选患者加以分组,给予对照组患者常规护理,研究组患者在常规护理基础之上加用饮食护理,对比两组患者接受治疗之后的前白蛋白、血浆白蛋白水平,采取改良定量主观整体评估表记录两组患者的营养状况,将所得各项数据施行统计学计算。结果两组患者接受治疗3个月之后的前白蛋白、血浆白蛋白水平对比差异有统计学意义;两组患者的改良定量主观整体评估表评分对比差异有统计学意义(P0.05)。结论临床中针对接受维持性血液透析治疗的糖尿病肾病患者,在常规护理的基础之上加用饮食护理效果理想,能够显著改善患者的营养状况,应该给予大力的推广与应用。     

血液透析治疗过程中胃肠营养补充对患者营养状态的影响

目的 观察血液透析治疗过程中胃肠营养补充对尿毒症患者营养状态的影响.方法 选择病情稳定的维持性血液透析患者54例,均有不同程度的营养不良.将54例患者随机分为研究组和对照组2组,每组各27例.研究组患者每次透析中经胃肠补充高蛋白、高热量营养液250 ml,观察2个月.采用自身对照及组间对照方式,评估两组患者营养状态的变化.结果 治疗后两组患者蛋白质、热量摄入均较治疗前增加（P＜0.01）,但组间比较差异无统计学意义（P＞0.05）;治疗后研究组患者血清白蛋白及握力增加,分别从（35.72±1.47） g/L到（37.34±0.99）g/L（P ＜0.01）、（24.52±3.07）kg到（26.63±3.04） kg（P ＜0.05）,且分别与对照组治疗后（35.92±1.57）g/L、（24.80±2.01）kg比较,差异均有统计学意义（P＜0.01、P＜0.05）.结论 血液透析治疗过程中胃肠营养补充能在短期内显著增加患者血清白蛋白及手握力,改善患者营养不良状况,且该方式经济、方便,患者依从性及耐受性好.     

血液透析滤过对慢性肾功能衰竭患者血清瘦素水平的影响

目的探讨血液透析滤过对慢性肾功能衰竭患者血清瘦素的清除及血清瘦素水平与营养不良的关系。方法测定41例维持性血液透析患者透析前、后(血液透析组22例,血液透析滤过组19例)及35例对照组血清瘦素、尿素氮、肌酐、白蛋白、总胆固醇和血红蛋白水平,计算体重指数(BM I)。结果维持性血液透析患者透析前血清瘦素水平均较对照组明显增高。血液透析滤过组透析后血清瘦素水平较透析前明显降低。维持性血液透析患者的血清瘦素水平分别与BM I呈正相关,与血清白蛋白呈负相关。结论慢性肾功能衰竭患者存在高瘦素血症,血清瘦素水平升高与营养不良有相关性,血液透析滤过可清除血清瘦素。     

86例维持性血液透析患者住院相关危险因素分析

目的 探讨维持性血液透析（MHD）患者的住院原因及相关危险因素.方法 回顾性分析173例MHD患者的临床资料,分析其中86例患者的住院原因及相关危险因素.结果 86例患者住院的主要原因依次为心血管疾病、脑血管疾病、感染性疾病、消化道出血、血管通路阻塞.住院患者的透析龄、血红蛋白（Hb）和血浆白蛋白（Alb）、透析充分性（Kt/V）明显低于非住院组,住院患者的空腹血糖、透析后平均动脉压（MAP）明显高于非住院组（P均＜0.05）.多元逐步回归分析结果显示,低白蛋白、高血糖、高透析后平均动脉压是MHD患者住院的危险因素.结论 心血管疾病、脑血管疾病、感染性疾病、消化道出血、血管通路阻塞是血液透析患者住院的重要原因.低白蛋白血症、高血糖、高透析后平均动脉压是MHD患者住院的主要危险因素.     

肝硬化患者蛋白质-能量营养不良（PEM）的营养支持治疗

目的观察以植物蛋白为主的混合蛋白饮食对肝硬化患者蛋白质能量营养不良的营养支持作用。方法选择有蛋白质能量营养不良的乙肝肝硬化患者60例,其中观察组30例,给予以植物蛋白为主的高蛋白、高热量食谱;对照组30例给予医院常规食谱,分别于治疗前、治疗4周后观察两组患者血清白蛋白、转铁蛋白（transferrin,TRF）、上臂肌围、体重指数和肌酐身高指数等营养评价指标的变化。结果与治疗前相比,观察组和对照组各项指标均有显著改善。观察组血清白蛋白和转铁蛋白明显上升,与对照组相比有显著差异（P〈0.05）,两组的体重指数均有所上升,观察组上升较为明显,但无统计学差异（P〉0.05）,观察组的上臂肌围和肌酐身高指数明显优于对照组（P〈0.05）。结论高蛋白营养支持饮食有利于改善肝炎后肝硬化患者的蛋白能量营养不良状态。     

左旋卡尼汀对维持性血液透析患者生活质量和贫血的影响

目的 探讨左旋卡尼汀对维持性血透(MHD)患者生活质量和贫血的影响.方法将30例维持性血透患者随机分为治疗组(15例)和对照组(15例).两组透析结束后均使用重组人促红细胞生成素(rhEFO)3000IU皮下注射2～3次/周,而治疗组每次透析后加静脉注射左旋卡尼汀1 g.随访12周,分别在治疗前及治疗12周末给两组患者应用SF36系统进行生活质量评分并检测血红蛋白、红细胞压积、血浆白蛋白的情况.结果治疗后治疗组患者的生活质量评分较治疗前有明显的上升,较对照组治疗后亦有明显的增高,差异均有统计学意义(P<0.01);治疗组的血红蛋白、血细胞比容、血浆白蛋白水平显著高于对照组,差异有统计学意义(P<0.01).结论静脉注射左旋卡尼汀可明显提高维持性血透患者生活质量和促进改善维持性血液透析患者的贫血.     

行为自我管理方法对血液透析患者健康行为方式选择的影响

目的探讨行为自我管理方法在维持性血液透析患者健康行为方式选择中的应用效果。方法将入选的维持性血液透析患者按随机数字分组方法分为实验组99例和对照组97例。实验组采用行为自我管理方法实施健康教育;对照组采用常规教育方法。干预时间为6个月,观察比较两组患者血液透析相关知识掌握程度及第6个月治疗依从性、急诊或住院血透、血透并发症发生率、内瘘功能、血压控制情况。结果实验组对血液透析相关知识的掌握程度、治疗依从性、血压控制显著优于对照组（P均〈0．01）,急诊或住院血透、透析相关并发症的发生率均显著低于对照组（P均〈0．01）。结论自我管理方法能增强维持性血液透析患者的治疗依从性,增强透析过程健康行为的选择,减少透析并发症,提高患者生活质量。     

血液透析对慢性肾衰竭患者心脏功能的影响

目的了解血液透析对慢性肾衰竭患者心脏结构、功能变化的影响,分析其相关危险因素.方法回顾本院2004年1～12月透析治疗的慢性肾衰竭患者76例,分开始进入血液透析组(40例)和维持性血液透析组(36例),应用彩色超声测定左室形态及功能各项参数,测定透析前血压及各项实验室指标.结果开始进入血液透析组患者,超声心动图显示75%出现左室肥厚(LVH),30%左心室收缩功能障碍;维持性血液透析组55.6%出现LVH,左心室收缩功能正常,两组差异有统计学意义.维持性血液透析组血红蛋白、血钙、血磷、钙磷聚集和血浆白蛋白升高,C反应蛋白降低.结论维持性血液透析后,患者左心室功能改善,可能与贫血、营养不良及炎症反应的纠正有关.     

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.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

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.     

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.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.