腹膜透析感染性腹膜炎的影响因素与护理进展

腹膜透析（PD）特别是持续性非卧床腹膜透析是有效治疗尿毒症的方法之一。而腹膜炎是PD最常见的并发症,也是患者退出PD治疗,导致透析失败的主要原因,对腹膜透析的患者采取相应的护理措施,可有效预防和控制腹膜炎等并发症的发生,不但可减轻患者的痛苦,减少其经济负担,而且可以提高患者的透析效果,改善生活质量,并延长患者的存活期。本文就腹膜透析相关感染性腹膜炎的影响因素及护理进展作一综述。     

腹膜透析相关腹膜炎的诊疗新进展

腹膜透析(PD)相关腹膜炎是PD最常见的并发症,也是导致PD失败的主要原因之一。临床上需早期诊断,积极预防及治疗,加强主动预防理念。一旦发生PD相关腹膜炎,需去除相关因素并合理使用抗生素,及早处理,加强腹膜保护。本文拟就PD相关腹膜炎的诊断、预防、治疗进展作一综述。     

腹膜透析相关感染的诊治

腹膜透析(peritoneal dialysis,PD)相关感染包括腹膜炎、导管出口炎及隧道炎,是PD主要并发症,也是导致技术失败退出PD治疗的一项主要原因.国际腹膜透析学会(international society for peritoneal dialysis,ISPD)曾先后多次制定了PD相关感染的诊治指南,2010年ISPD治疗指南重新修订了腹膜炎发病率的描述指标、导管相关感染及不同致病菌腹膜炎的诊断治疗规范,现将要点综述如下.     

腹膜透析相关性感染流行病学研究进展

腹膜透析相关性感染是腹膜透析的主要并发症.在腹膜透析患者中,大约18％感染相关的死亡与腹膜炎有关.尽管腹膜炎事件直接导致死亡的比率不足4％,但是在16％的腹膜透析患者死亡原因中,腹膜炎是一个"参与的因素".严重而持久的腹膜炎会导致腹膜功能衰竭.腹膜炎是导致患者终止腹膜透析转至血液透析的一个主要原因[1].目前,针对腹膜透析相关性感染的流行病学研究逐渐增多,这为进一步控制腹膜透析相关性感染,减少由此导致的发病率及死亡率提出了一个新的研究方向.     

腹膜透析患者腹膜炎的治疗

腹膜炎是腹膜透析（peritoneal dialysis, PD）最常见的并发症,可导致PD技术失败和患者住院并和患者死亡相关,因此腹膜炎的预防与治疗受到广泛关注[1].2004年国际PD协会组织包括PD、微生物、药物治疗、感染性疾病、免疫学和护理专家在内的顾问委员会,在对大量文献分析研究的基础上进行了第五次修正制定了PD相关感染最新推荐指南.现将腹膜炎治疗介绍如下.     

腹膜透析患者腹膜炎的监测和预防

迄今为止,腹膜炎仍是导致腹膜透析(PD)失败的主要原因,并因此有50%患者转行血液透析治疗。PD患者并发腹膜炎会明显加重残余肾功能的丢失、加重炎症状态和增加营养不良,最终导致PD治疗失败。发生腹膜炎的PD患者预后差异很大,有的治疗后2~3天腹水即转清,有的则持续混浊并因感染无     

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腹膜透析(PD)相关性感染是PD主要的并发症,也是患者退出PD的主要原因。各中心需结合自身情况,遵循指南建议对PD相关感染进行个体化治疗。腹膜炎的治疗目的应该是迅速控制感染以及保护腹膜功能,而不是挽救PD导管。     

影响腹膜透析患者发生腹膜炎的相关因素分析

目的 探讨腹膜透析(PD)患者发生腹膜炎的影响因素.方法 回顾分析2018年1月1日至2020年8月31日在郑州大学第一附属医院规律复查的PD患者的临床资料,根据是否发生腹膜透析相关性腹膜炎(PDAP)将其分为腹膜炎组和对照组,比较2组患者的临床资料,分析PD患者发生腹膜炎的影响因素,绘制受试者工作特征曲线,评估中性粒...     

腹膜上皮-间皮细胞转分化与腹膜纤维化

腹膜透析（PD）治疗终末期肾脏疾病（ESRD）已有30余年，现代PD史的前20年主要致力于PD管道的设计、手术技术及腹膜炎的预防，近10年则主要研究PD液的生物相容性，以减少其对腹膜形态及功能的影响。生物不相容性的PD液、腹膜炎症及腹腔积血可导致急慢性腹膜炎症并损伤腹膜，导致腹膜逐渐纤维化及血管再生，最后失去超滤功能。     

革兰阴性菌性腹膜炎的临床防治策略

腹膜炎是腹膜透析(PD)患者的严重并发症之一,也是引起技术失败甚至死亡的最重要原因。近年来由于PD连接系统的改善,革兰阳性(G )菌感染发生率显著下降,然而G-菌腹膜炎的发生率并未改变,在一些国家和地区甚至呈增加趋势。目前G-菌占所有PD相关性腹膜炎的20%~30%。中山大学附属第     

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.     

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.     

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.     

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.