血液透析带隧道带涤纶套导管功能不良致导管更换的危险因素分析

维持性血液透析( MHD)患者常因自身血管不能满足动静脉内瘘手术条件、左心室射血分数<30％或预期生存时间短等原因而使用带隧道带涤纶套导管( TCC)作为MHD血管通路.在TCC使用过程中会因各种原因导致TCC更换,当TCC发生导管功能不良、导管相关性感染、导管涤纶套完全脱出/不完全脱出、导管破损等情况时均需更换TCC...     

经皮颈静脉插管建立血管通路

经皮颈静脉插管建立血管通路李立关键词经皮静脉插管；血液透析；血管通路１经皮颈静脉插管的发展史加拿大多伦多Ｗｅｌｌｅｓｌｅｙ医院已停止使用锁骨下静脉插管建立临时性血管通路，主要原因有两方面：①锁骨下静脉插管易导致锁骨下静脉狭窄和血栓形成，严重影响同侧动...     

利用中心静脉病变侧废用静脉建立对侧动静脉瘘1例

中心静脉病变是血液透析血管通路并发症中的难题, 可引起严重的临床症状并影响患者血液透析质量及生活质量。我们利用患者中心静脉病变侧废用静脉建立对侧移植血管动静脉瘘, 2周后移植血管动静脉瘘成功穿刺行血液透析治疗, 不仅解决了患者静脉高压及后续血管通路难题, 而且保留了更多的血管资源。     

股浅-腘静脉移植术的临床应用

高分子合成材料重建血管的远期通畅率,尤其作为静脉移植物仍不尽人意。螺旋合成管在治疗上腔静脉非恶性阻塞性病变虽获得了良好效果,但螺旋管的缝制耗时,技术要求精细,有的血管本身质量欠佳,亦影响了临床应用。故生物血管中自体大隐静脉替代中小动脉仍最有临床应用价值。股浅-腘静脉作为大中血管移植物,管腔口径匹配,长度充分,利用率高。 一、股静脉的应用解剖 股静脉为腘静脉的向上延续,分上下二段,上段即股总、髂外和髂总静脉,侧支循环有同侧和对侧两组。同侧组由髂内静脉及其分支如闭孔肌静脉和臀静脉,腰升静脉,髂外和髂总动脉伴行静脉以及股外     

应用腔内血管成形术更换血液透析长期导管

目的:探讨应用腔内血管成形术(PTA)更换维持性血液透析(MHD)患者带隧道和涤纶套透析导管(TCC)的疗效及安全性。方法:回顾性分析蚌埠医学院第一附属医院2017年10月至2019年10月收治的12例MHD合并TCC并发症患者的临床资料,行数字显影血管造影技术(DSA)下原导管腔内和(或)狭窄段血管球囊扩张术并行新导管更换术。观察术后即时和6个月内导管功能情况。结果:12例患者在行导管更换时发现6例导管嵌顿,经PTA治疗后顺利拔管;全部患者PTA后均成功行再置管术,术后导管即时透析血流量250 ml/min,术后随访3个月时初级通畅率为100%,6个月初级通畅率为75%。结论:腔内治疗TCC并发症患者行拔管和再置管手术创伤小,成功率高,患者耐受性较好,能很好解决MHD患者通路不足问题。     

老年人常见透析血管通路及其运用

随着尿毒症患者的逐年增多,血液透析已经成为肾衰竭患者的重要选择之一,建立并维护稳定可靠的血管通路成为透析顺利进行的重要前提。由于高并发症率、预期寿命的缩短和生存质量的下降等各种因素的影响,使得老年尿毒症患者透析血管通路的建立和选择较青年人更为复杂,本文着眼老年人血管的特点及中心静脉留置导管、自体动静脉内瘘及移植血管搭桥瘘几类血管通路在老年人和青年人中使用的差异性,对老年人透析血管通路的选择进行分析讨论。     

套管针置管方法的改进

套管针可快速输液输血 ,也可做留置针保留 ,目前已在临床广泛应用。但由于其针体较长 ,在进针过程当中套管容易打折 ,从而导致穿刺失败 ,重复穿刺增加患者的痛苦。我们经2年的观察与实践 ,对套管针置管方法做了改进 ,提高了置管的成功率。现介绍如下操作方法 :选择四肢较大较粗血管 ,如大隐静脉、桡侧浅静脉、肘正中静脉等。选择好血管后 ,扎好止血带 ,常规消毒 ,进针角度与普通静脉穿刺相同。见回血后 ,再进 12mm ,保证套管全部进入血管后 ,松开止血带 ,一手固定针芯不动 ,一手顺血管方向缓慢置管 ,进入合适的深度后 ,连接输液通路 ,固定好…     

血液透析用血管通路的现状和进展

多年血液透析的实践证明,随着血液净化的广泛开展,制备一个理想的动静脉血管通路越来越显得重要。血液净化患者的寿命和康复能力同医疗效果有直接关系,而良好效果的获得又与静脉血管通路的使用寿命密切相关。对于慢性透析患者制备一个好的动静脉瘘,保护动静脉瘘减少并发症的发生,     

吲哚布芬预防血液透析患者带隧道和涤纶套导管功能不良的临床研究

目的 观察吲哚布芬对血液透析患者使用带隧道和涤纶套导管(TCC)功能不良的预防作用。方法 纳入使用TCC作为维持性血液透析(MHD)血管通路的患者80例，随机分为对照组39例和治疗组41例。对照组口服阿司匹林，治疗组口服吲哚布芬。比较两组患者一般临床资料、实验室检查结果、TCC使用寿命、拔管原因、导管功能不良情况、导管首次血栓形成时间、治疗前、治疗1个月及随访结束PLT计数及凝血功能、抗PLT药物相关不良反应。结果 对照组TCC中位使用寿命为72周，治疗组为92周，两组患者TCC使用寿命生存曲线存在差异(χ²=22.98,P<0.001)。与对照组相比，治疗组导管功能不良率降低2.601/1 000导管日，血栓形成导致导管功能不良率降低2.683/1 000导管日，导管首次血栓形成时间延长(P<0.05)。治疗前、治疗1个月及随访结束时，两组患者PLT计数及凝血功能组间及组内比较差异均无统计学意义(P>0.05);均未出现出血性并发症。结论 吲哚布芬通过预防和减少血液透析患者TCC血栓形成，降低导管功能不良发生率、延长导管使用寿命，且无明显不良反...     

门静脉高压侧支循环与血管内皮细胞生长因子

新近发现门静脉高压侧支循环形成与血管内皮细胞生长因子(VEGF)诱导的血管生成有一定的关系,这对传统认为的门静脉压力增高引起被动的血管通道开放的理论提出了挑战．研究提示在门静脉高压动物中VEGF／VEGF-R2 通路促进了门静脉系统侧支血管和高动力循环的形成．从而证实门静脉高压症侧支循环形成不仅归咎于连接门体静脉系统的分支血管, 而且是VEGF依赖的血管生成结果．现就近来这方面研究的文献作一综述．     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.