血液透析联合结肠透析对尿毒症患者Hcy、IS、PCS的影响

目的:探讨血液透析(hemodialysis,HD)联合结肠透析(colon dialysis,CD)对尿毒症患者心血管疾病(cardiovascular disease,CVD)相关蛋白同型半胱氨酸(Hcy)、硫酸吲哚酚(IS)、硫酸对甲酚(PCS)的影响。方法:入选尿毒症维持性血液透析患者50例,其中单纯性血液透析组(HD组)25例,血液透析联合结肠透析组(HD+CD组)25例;HD组每周3次血透,每次4 h,HD+CD组在HD组基础上加用每周2次,每次1 h的结肠透析;总疗程为12周。分别检测两组患者治疗前及治疗后BUN、Scr、UA、Hcy、IS、PCS等变化。结果:HD组治疗前后BUN、Scr、UA、Hcy、IS、PCS差异无统计学意义(P0.05)。HD+CD组透析前后BUN、Scr、UA差异无统计学意义(P0.05),Hcy、IS、PCS明显下降(P0.05);HD+CD组较HD组治疗后Hcy、IS、PCS水平显著降低(P0.05)。结论:HD联合CD能够减轻尿毒症患者CVD相关蛋白Hcy、IS、PCS水平,为尿毒症患者清除此类毒素提供了新的治疗方法。     

血液透析联合结肠透析治疗尿毒症患者高磷血症的临床研究

目的:了解血液透析(HD)联合结肠透析(CD)治疗尿毒症患者高磷血症的疗效,为血透患者控制高磷血症提供新的治疗方法。方法:入选维持性血液透析(MHD)伴高磷血症患者60例,随机分为单纯性血液透析组(HD组)30例,血液透析联合结肠透析组(HD+CD组)30例;HD组维持每周3次血透,每次4 h,HD+CD组在HD组基础上加用每周3次,每次1 h的结肠透析。总疗程为12周。观察治疗前后两组患者食欲、皮肤瘙痒及骨痛临床症状的改善情况。分别检测两组患者治疗前及治疗后肾功能、KT/V、血钙(Ca~(2+))、血磷(P~(3-))、血清全段甲状旁腺激素(iPTH)、1,25二羟维生素D[1,25(OH)_2D_3]及成纤维细胞生长因子-23(FGF-23)。结果:治疗后,HD+CD组较HD组食欲、皮肤瘙痒及骨痛的临床症状改善显著(P0.05)。HD组治疗前后肾功能、KT/V、Ca~(2+)、P~(3-)、1,25(OH)_2D_3及FGF-23差异无统计学意义(P0.05)。HD+CD组透析前后Ca~(2+)及1,25(OH)_2D_3差异无统计学意义(P0.05),但P~(3-)、iPTH及FGF-23有明显下降(P0.05);HD+CD组较HD组治疗后P~(3-)、iPTH、FGF-23水平显著降低,差异有统计学意义(P0.05)。结论:对于尿毒症伴高磷血症患者,结肠透析可有效改善患者高磷血症。     

不同透析膜对维持性血液透析患者外周血Ｔ细胞凋亡的影响

目的 研究终末期肾病(ESRD)患者外周血T细胞凋亡、Bcl-2和Fas的表达、Th1及Th2类细胞因子特征以及不同透析膜对维持性血液透析患者T细胞凋亡的影响。 方法 研究对象包括ESRD未透析(ND)患者10例；维持性血液透析(HD)的患者45例，分别用醋酸纤维素膜(CA)、低通聚砜膜(PS-LF)、高通聚砜膜(PS-HF)进行透析；以及健康对照(C)8例。上述研究对象的外周血T细胞经植物凝集素(PHA)刺激培养24 h后，应用流式细胞术检测其凋亡情况；免疫组化检测T细胞Bcl-2、Fas的表达；ELISA检测细胞培养上清IFN-γ及IL-4的水平。 结果 ND组及HD组T细胞凋亡率高于C组的(6.82±1.64)%。HD各组T细胞的凋亡率以CA组的(12.26±1.21)%最高，PS-HF组(9.00±0.89)%最低(P < 0.05)。ND组及HD组外周血T细胞Bcl-2的表达低于C组(P < 0.05)，Fas的表达高于C组(P < 0.05)；相关分析显示T细胞凋亡与Fas的表达呈正相关，与Bcl-2呈负相关。ND组及HD组IFN-γ的水平均低于C组(P < 0.05)，与T细胞凋亡呈负相关；IL-4的水平高于C组 (P < 0.05)，与T细胞凋亡呈正相关。 结论 ND组及HD组外周血T细胞凋亡加速，Bcl-2、Fas参与T细胞凋亡的发生。 ND组及HD组患者Th类细胞因子失衡，呈Th2细胞因子优势， Th类细胞因子参与T细胞凋亡的调控。HD患者的T细胞凋亡不仅与透析膜的生物相容性有关还与透析膜的通透性有关。     

老年尿毒症患者血液透析滤过临床疗效观察

目的探讨血液透析滤过(hemodiafiltration,HDF)对老年尿毒症患者不同分子量物质的清除率、患者耐受性及临床疗效。方法选择38例行维持性血液透析(maintenance hemodialysis,MHD)的老年尿毒症患者,依经济状况随机分为HDF组和血液透析(hemodialysis,HD)组。HDF组行前稀释HDF 1次/周,HD 2次/周;HD组患者行HD 3次/周。2组HD方案一样,且观察时间均为3个月;观察2组尿素清除指数(Kt/V)、血清肌酐(SCr)、尿素氮(BUN)、血尿酸(uric acid,UA)、β2-微球蛋白(β2-microglobulin,β2-MG)、全段甲状旁腺素(immunoreactive parathyroid hormone,iPTH)、血钾、血钙、血磷、二氧化碳结合力(carbon dioxide combining power,CO_2-CP)下降率及治疗中的并发症和不良反应发生率。结果老年尿毒症患者对HDF治疗效果和耐受性显著优于HD,HDF组的HD并发症和不适症状发生率显著低于HD组(P0.01),HDF治疗后血清β2-MG、iPTH水平显著降低,Kt/V明显增高。治疗前后2组血清BUN、SCr、UA均明显下降,但下降幅度差异无统计学意义。治疗前后2组血钾、血钙、CO_2-CP及酸碱平衡失调均明显改善或纠正(P0.01),但2组间比较其变化幅度差异无统计学意义。结论前稀释HDF、结合HD的方案与单纯HD治疗相比,能有效清除尿毒症患者血中大、中、小分子物质,透析效果显著提高。患者对该法治疗的耐受性明显提高,适用于易出现HD并发症及不适症状的老年尿毒症患者。     

血液透析患者血清成纤维细胞生长因子21与肌少症的关系及相关机制

目的探讨血液透析(hemodialysis, HD)患者血清成纤维细胞生长因子21(fibroblast growth factor 21, FGF21)与肌少症的关系, 并在细胞水平初步探索尿毒症状态下FGF21与骨骼肌代谢相关信号通路的关系。方法该前瞻性观察性研究搜集2018—2019年苏州大学附属第三医院血液净化中心接受HD的患者资料。以ELISA法检测HD患者血清FGF21浓度, 同时根据第四胸椎(the fourth thoracic vertebra, T4)及第一腰椎(the first lumbar vertebra, L1)计算机断层扫描(computed tomography, CT)平面骨骼肌指数(skeletal muscle index, SMI)将患者分为肌少症组及非肌少症组, 分析FGF21与肌少症的关系。体外培养小鼠C2C12成肌细胞, 分别给予健康人血清、健康人血清+不同浓度FGF21、尿毒症血清、尿毒症血清+不同浓度FGF21干预细胞, 并采用Western印迹法检测各组肌肉环指蛋白-1(muscle ring finger protein-1, M...     

血液透析联合血液灌流治疗尿毒症患者周围神经病变的效果

目的 探讨血液灌流联合血液透析对尿毒症周围神经病变的疗效和机制.方法 将54例尿毒症周围神经病变的血液透析患者按数字表法随机分为血液灌流+血液透析组(HD+HP)和常规血液透析组(HD).HD+ HP组行每周连续3次HD+ HP治疗;常规血液透析组(HD)行每周3次常规HD治疗.治疗4周,比较治疗前后两组患者周围神经病变的临床症状、血PTH、β2-MG浓度和正中神经、胫神经、腓总神经的感觉神经传导速度(SCV)变化,分析PTH和β2-MG与SCV的相关性.结果 经过4周的治疗后,HD组患者周围神经病变的临床症状、血PTH、β2-MG、感觉神经传导速度无明显改善,而HD+HP组患者周围神经病变的临床症状、血PTH、β2-MG及SCV均较治疗前有明显改善,其程度显著优于HD组(P＜0.05),PTH和β2-MG与SCV有明显的相关性(P＜0.05).结论 连续短期HD+ HP能有效清除PTH和β2-MG,且对治疗尿毒症周围神经病变有效;PTH和β2-MG在体内蓄积与尿毒症周围神经病变有关.     

血液透析联合血液灌流治疗尿毒症患者皮肤瘙痒的疗效

目的 观察血液透析联合血液灌流治疗尿毒症皮肤瘙痒患者的临床疗效.方法 选择我院72例维持性血液透析伴皮肤瘙痒患者,采用数字表法随机分为观察组(HD+ HP组)和对照组(HD组),每组各36例.对照组采用单纯血液透析(HD)治疗,每周3次,每次4小时;观察组在常规血液透析基础上加用2～3次/月的组合型人工肾治疗[血液透析(HD)联合血液灌流(HP)治疗].检测两组患者治疗前后β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH),并观察两组患者皮肤瘙痒改善情况.结果 治疗2个月后观察组患者血β2-MG、PTH比对照组明显下降,差异有统计学意义(P＜0.05),皮肤瘙痒的程度明显减轻.结论 血液透析联合血液灌流可有效的清除血液中大分子毒素;有效缓解长期血液透析患者皮肤瘙痒症状,改善预后,提高了尿毒症患者生存质量.     

血液透析联合血液灌流治疗尿毒症脑病疗效观察

目的:观察血液透析加血液灌流(HD+HP)对尿毒症脑病患者的治疗疗效作用.方法:对在我院行常规血液透析出现尿毒症脑病患者32例.在常规治疗基础上给予HD+HP治疗,尿毒症脑病显效19例,有效9例,无效4例,总有效率84.6%.结论 HD+HP能有效清除尿毒症毒素,是治疗尿毒症脑病的有救治疗方法.     

血液透析联合血液灌流治疗尿毒症脑病患者的效果及其对毒素清除水平、神经功能及血清神经因子的影响

目的:探究血液透析联合血液灌流治疗尿毒症脑病(UE)患者的效果及其对毒素清除水平、神经功能及血清神经因子的影响。方法:选取我院收治的107例UE患者,根据随机数字表法分组。对照组53例给予单纯血液透析(HD)治疗,观察组54例给予血液透析(HD)联合血液灌流(HP)治疗,对比两组患者疗效。结果:治疗后观察组尿素氮(BU...     

组合型人工肾在透析患者肾性贫血中的疗效观察

目的:探讨组合型人工肾(HP/HD)在治疗血液透析患者肾性贫血中的临床疗效。方法:将维持性血液透析1年以上的患者60例随机分为普通透析HD组30例,组合型人工肾(HP/HD)组30例。HD组采取维持性HD治疗,每周透析3次,每次透析4h,组合型人工肾(HP/HD)组每周行1次HP/HD,HD治疗2次,时间均4 h。所有患者均在上机治疗前后及6个月后空腹采血,观察两组各项指标的变化。结果:治疗后组合型人工肾(HP/HD)组中大分子量毒素β2-MG、iPTH与HD组比较明显下降,与HD组比较Hb明显升高,有统计学差异(P<0.05)。结论:组合型人工肾(HP/HD)增加了对中大分子量毒素的清除,治疗肾性贫血效果优于普通HD。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。