腹膜透析联合血液透析治疗终末期肾病的效果

目的探究分析腹膜透析联合血液透析治疗终末期肾病的临床疗效及其价值。方法研究对象为2012年5月—2019年5月本院医治的80名终末期肾病(ESRD)患者,经由随机方式,把这些对象分别归入试验组(n=40)、对照组(n=40)。对照组ESRD患者予以腹膜透析进行治疗,试验组终末期肾病患者在此基础上联合使用血液透析进行治疗,对比两组终末期肾病患者的治疗效果、不良反应率、生活质量评分和各项血液生化指标。结果经过透析治疗,在疗效方面,相较对照组,试验组对象表现出明显优势,同时不良反应率显著偏低,生活质量评分显著偏高,血液相关生化指标改善显著(P<0.05)。结论腹膜透析联合血液透析治疗终末期肾病具有较好的临床疗效,能够明显改善患者的各项生化指标,且安全性较高,对于提高终末期肾病患者生活质量具有较高价值。     

腹膜透析联合血液透析治疗肾衰竭的效果

目的对慢性肾衰竭治疗中腹膜透析联合血液透析的疗效进行探讨。方法选择收治慢性肾衰竭患者50例,所有患者均于2017年1月-2019年5月在本院接受治疗,随机分为实验组(n=25)和对照组(n=25)。对照组接受单纯腹膜透析,实验组同时接受血液透析治疗,观察两组治疗效果、并发症发生情况。结果治疗前实验组血清尿素氮(17.4±6.2)mmol/L、肌酐(798.4±259.9)mmol/L、白蛋白(34.4±4.7)g/L、血红蛋白(72.1±16.2)g/L,和对照组的(17.6±6.1)mmol/L、(800.2±262.0)mmol/L、(34.2±4.9)g/L、(71.9±16.1)g/L对比差异无统计学意义(t=0.12,P=0.45;t=0.02,P=0.49;t=0.15,P=0.44;t=0.04,P=0.48)。治疗后实验组血清尿素氮(10.3±3.4)mmol/L、肌酐(562.1±240.2)mmol/L、白蛋白(28.1±2.6)g/L、血红蛋白(94.3±17.4)g/L,均明显优于对照组的(12.9±6.0)mmol/L、(683.2±230.3)mmol/L、(30.2±3.3)g/L、(81.9±17.1)g/L(t=2.21,P=0.03;t=2.61,P=0.01;t=2.54,P=0.01;t=2.54,P=0.01)。实验组并发症发生率5.0%,显著低于对照组的27.5%(χ~2=7.44,P=0.01)。结论在慢性肾衰竭患者治疗中应用腹膜透析和血液透析,可明显改善患者肌酐、尿素氮水平,且并发症较少,应用价值较高。     

New insights into the pathogenesis of Peyronie’s disease: A narrative review

Peyronie’s disease (PD) is a benign, progressive fibrotic disorder characterized by scar or plaques within the tunica albuginea (TA) of the penis. This study provides new insights into the pathogenesis of PD based on data from different studies regarding the roles of cytokines, cell signaling pathways, biochemical mechanisms, genetic factors responsible for fibrogenesis. A growing body of literature has shown that PD is a chronically impaired, localized, wound healing process within the TA and the Smith space. It is caused by the influence of different pathological stimuli, most often the effects of mechanical stress during sexual intercourse in genetically sensitive individuals with unusual anatomical TA features, imbalanced matrix metalloproteinase/tissue inhibitor of metalloproteinase (MMP/TIMP), and suppressed antioxidant systems during chronic inflammation. Other intracellular signal cascades are activated during fibrosis along with low expression levels of their negative regulators and transforming growth factor-β1 signaling. The development of multikinase agents with minimal side effects that can block several signal cell pathways would significantly improve fibrosis in PD tissues by acting on common downstream mediators.     

Recommendations for prevention and management of COVID-19 in peritoneal dialysis patients

The World Health Organization characterized coronavirus disease (COVID-19) as a pandemic on March 11, 2020. Peritoneal dialysis patients have a weakened immune system that is associated with a high morbidity of infection. Thus, COVID-19 prevention measures and management for patients on peritoneal dialysis are urgent and critical. Based on published research on COVID-19 and previous clinical practices for similar coronavirus outbreaks, we aimed to make recommendations to manage patients undergoing peritoneal dialysis.     

Short- and long-term outcomes of kidney transplants with kidneys lavaged by retrograde perfusion technique

ObjectiveTo evaluate the clinical safety and efficacy of the retrograde perfusion technique in kidney transplantation.MethodsBetween January 2001 and June 2011, 24 cases of kidney transplantation with kidneys perfused using the retrograde perfusion technique due to renal artery variations or injury were selected as the observation group (retrograde perfussion group, RP group). Twenty-two cases of kidney transplantation via conventional perfusion were chosen as the control group (antegrade perfussion group, AP group). There were no statistically significant differences in donor data between the two groups. Cold ischemia time, warm ischemia time, renal perfusion time, amount of perfusion fluid, acute renal tubular necrosis, wound infection, urinary fistula, graft kidney function, and the 1-year, 3-year, and 5-year survival rates for the grafted kidney in both groups were observed and recorded.ResultsThe kidney perfusion time was shorter in the RP group than that in the AP group (3.14 ± 1.00 vs. 5.02 ± 1.15 min, P = 0.030). There were 10 cases of acute renal tubule necrosis in the RP group and 5 in the AP group. The length of hospital stay was 40 ± 14 d in the RP group and 25 ± 12 d in the AP group. The follow-up time was 3.5–8.5 years (mean 6.25 years). The 1-, 3-, and 5-year survival rates for the grafted kidney were 95.8%, 75.5%, and 65.5% in the RP group and 97.1%, 82.5%, and 68.4% in the AP group, respectively (P>0.05).ConclusionsThis study indicates that retrograde perfusion is safe and practicable for cadaveric kidney harvesting and can be regarded as a better alternative or remedial measure for a poorly perfused kidney due to vascular deformity or injury.     

帕金森病患者共情能力缺陷研究

目的研究帕金森病患者(Parkinson's disease,PD)共情能力损害情况,并进一步探讨其共情能力损害的可能机制。方法采用人际反应指针量表(IRI-C)对30例PD患者和30例年龄及教育程度相匹配的健康对照组(health control,HC组)进行研究。结果与HC组比较,PD患者组IRI-C总分(42.30±9.20),共情性关心(EC)(16.50±2.60),个人痛苦(PD)(2.40±2.03)差异均有统计学意义(t=-3.233,P<0.05;t=-4.424,P<0.05;t=-4.916,P<0.05),且PD组的stroop色字效应与IRI-C总分呈负相关(r=-0.675,P<0.05),汉密尔顿抑郁量表(HAMD)与IRI-C总分及PD分呈正相关(r=0.613;r=0.677,P<0.05)。结论帕金森病患者存在广泛的共情能力缺陷,执行功能障碍及情感障碍可能是导致患者共情能力损害的机制之一。     

尿沉渣检查在肾脏疾病中的临床意义

目的分析尿沉渣检查在肾脏疾病临床诊断中的应用价值。方法选取2016年2月-2019年4月184例医院收治的肾脏疾病患者,随机分为观察组(92例)与对照组(92例)。对照组采用普通显微镜进行尿沉渣检查,观察组采用特殊显微镜进行尿沉渣检查。观察两组患者在红细胞、白细胞、管型以及结晶等方面的阳性率,同时比较两种检查方法在肾脏疾病筛查中的敏感度、特异性与准确性。结果观察组与对照组的红细胞阳性率为97.8%和95.7%、白细胞阳性率为96.7%和92.4%、管型阳性率为81.5%和77.2%、结晶阳性率为81.5%和68.5%,两组间的差异无统计学意义;特殊显微镜检查与普通显微镜检查的诊断敏感性为97.8%和96.7%、诊断特异性为91.3%和67.4%、诊断准确率为91.3%和91.3%,两种检查方法在敏感性和准确率方面的差异无统计学意义,但特殊显微镜检查在诊断特异性方面明显高于普通显微镜检查(P<0.05)。结论尿沉渣检查在肾脏疾病诊断敏感性与准确性方面较高,但特殊显微镜尿沉渣检查的诊断特异性明显高于普通显微镜尿沉渣检查。     

肾脏生化检验中分级式检验的应用研究

目的分析肾脏生化检验中分级式检验的应用效果。方法于2017年1月—2019年1月在医院行肾脏生化检验患者94例,按数字随机表法分为两组,即对照组(n=47)及观察组(n=47),对照组采取常规检验,观察组采取分级式检验;比较两组肾脏生化指标检验结果。结果观察组标本检出阳性率97.87%高于对照组的76.60%,差异有统计学意义(P<0.05);观察组BUN检出阳性率65.96%高于对照组的29.79%,Scr检出阳性率63.83%高于对照组的29.79%;差异有统计学意义(P<0.05);两组患者Cys C检出阳性率比较,差异无统计学意义(P>0.05)。结论肾脏生化检验采取分级式检验,具较高的检出率,临床价值高。     

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.     

Programmed death ligand-1/programmed death-1 inhibition therapy and programmed death ligand-1 expression in urothelial bladder carcinoma

After two decades of unchanged paradigms, the treatment strategies for advanced urothelial bladder cancer have been revolutionized by emerging programmed death ligand-1 (PD-L1)/programmed death-1 (PD1) inhibition therapy. Increased evidence is demonstrating the efficacy of PD-L1/PD1 inhibition therapy in both second-line and first-line settings. However, the percentage of patients who benefit from anti-PD-L1/anti-PD1 therapy is still low. Many questions have been raised in the development of biomarker-driven approaches for disease classification and patient selection. In this perspective, we discuss PD-L1/PD1 expression in urothelial bladder carcinoma, review approved anti-PD-L1/anti-PD1 agents for bladder cancer treatment and current ongoing studies investigating combination treatment strategies, and explore PD-L1 expression status for the evaluation of bladder cancer immunotherapy.     

牙周组织再生术与口腔正畸治疗牙周炎的研究

目的探讨分析牙周组织再生术与口腔正畸治疗牙周炎患者的疗效。方法选择医院2018年1月—2019年1月期间收治的80例牙周炎患者为本次研究对象,将所有患者按照随机数字表法不同分为对照组(n=40)和研究组(n=40),对照组予以牙周组织再生术治疗,研究组采用牙周组织再生术联合口腔正畸治疗,观察两组临床效果,治疗前、治疗后6个月牙周指标和不良反应发生率。结果研究组临床总有效率明显高于对照组(P<0.05),治疗前两组PLI、GI、PD、SBI比较,差异无统计学意义(P>0.05),治疗后6个月两组PLI、GI、PD、SBI均有所下降,且研究组明显低于对照组(P<0.05),两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论在牙周炎患者的临床治疗中,牙周组织再生术联合口腔正畸治疗方案疗效显著,可有效缓解患者临床症状,改善牙周指标,并改善牙齿外观,且安全可靠。     

细节护理对尿毒症血液透析患者的效果研究

目的针对尿毒症血液透析患者护理工作中应用护理细节对其生存质量和并发症的作用予以分析和研究。方法 2017年6月-2018年12月选择本院收治的90例尿毒症透析患者作为研究对象,按照硬币法将所有人随机分为两组,其中常规组45例,细节组45例。采用常规护理对常规组予以护理,在常规护理的基础上,采用细节护理干预措施对细节组予以护理。对两组患者的护理效果进行分析和比较。结果在SF-36评分方面,两组患者护理前比较差异无统计学意义(P>0.05),护理后,细节组明显优于常规组(P<0.05)。在并发症发生率方面,细节组明显低于常规组(P<0.05)。结论采用细节护理干预措施对尿毒症血液透析患者进行护理效果很好,患者的生存质量经过护理后具有很大改善,且并发症也明显减少。     

TenuifolisideB协同NGF促进PC12细胞神经元性分化研究

目的:探讨Tenuifoliside B(TB)的拟神经生长因子活性。方法:取低分化PC12细胞,给予不同浓度的TB(0、30、60、120μM),作用24h后MTT法测定细胞存活率;取低分化PC12细胞,给予不同浓度的NGF(0、5、10、20、40、80 ng/mL)和TB(0、30、60、120μM)作用48h后观察细胞形态变化;取低分化PC12细胞,MAPK/ERK通路抑制剂PD98059(30μM)、SAPK/JNK通路抑制剂SP600125(30μM)、p38MAPK通路抑制剂SB203580(7.5μM)作用后,NGF(5ng/mL)和TB(120μM)作用48 h后观察细胞形态变化。结果:TB(30、60、120μM)对PC12细胞增殖无显著抑制作用;TB(30、60和120μM)单用,对细胞神经突起伸长无促进作用,但TB(120μM)可协同低浓度的NGF(5ng/mL)显著促进PC12细胞的神经元性分化(P<0.01),其神经突起分化率与NGF(80 ng/mL)相当。加入抑制剂SB203580后,TB协同NGF促进PC12细胞神经元性分化的活性受到抑制。结论:TB协同NGF促进PC12细胞神经元性分化可能与p38MAPK通路的调节有关。     

肾上腺皮质激素预防肾移植术后肺部感染的效果评估

目的探究在对肾移植手术后应用肾上腺皮质激素对患者肺部感染控制的效果。方法选择2015年9月-2018年10月间至本院接受肾移植术的80例患者的一般资料进行整理分析,然后根据患者的意愿来进行分组,分别为对照组和试验组,每组中均纳入40例患者。所有患者均采用常规肾移植术方案进行治疗,对照组患者单纯采用术后常规抗生素应用,不对患者进行任何激素或其他药物处理,试验组患者则在此基础上应用肾上腺皮质激素对患者进行抗感染治疗。治疗完成后,评价所有患者手术后的感染事件发生率。记录所有患者术后并发症发生率。结果本次研究成果显示,试验组患者的感染事件发生率为5.00%,低于对照组的27.50%(P<0.05)。同时两组患者在治疗完成后的不良反应差异无有统计学意义(P>0.05)。结论在对肾移植手术后,患者进行抗感染处理时,应用肾上腺皮质激素对患者创口进行处理能够有效改善患者的肺部感染率,同时这种处理方案不会导致患者出现额外的不良反应,具有高度的应用价值是一种优秀且安全的术后抗感染方案。     

后腹腔镜肾部分切除术（LPN）治疗肾肿瘤的临床疗效

目的探讨后腹腔镜肾部分切除术治疗肾肿瘤的临床疗效。方法将收治的84例肾肿瘤患者,随机分组。一组是传统的手术方式组,根据以往的根治术操作进行治疗,一组是后腹腔镜肾部分切除术治疗组,采取的是后腹腔镜肾部分切除术。分析纱布收集测量血量、肾肿瘤手术治疗的时间、住院时间;治疗前后患者生活质量监测水平;并发症。结果治疗后后腹腔镜肾部分切除术治疗组生活质量高于传统的手术方式组,P<0.05。后腹腔镜肾部分切除术治疗组纱布收集测量血量、肾肿瘤手术治疗的时间、住院时间优于传统的手术方式组,P<0.05。后腹腔镜肾部分切除术治疗组并发症低于传统的手术方式组,P<0.05,后腹腔镜肾部分切除术治疗组有2例并发症发生,而传统的手术方式组有8例并发症出现。结论肾肿瘤患者实施后腹腔镜肾部分切除术可获得较好效果。     

连续性肾脏替代治疗对ICU脓毒血症的效果

目的探讨连续性肾脏替代治疗联合血液灌流治疗ICU脓毒血症患者的临床效果。方法选取医院2017年2月—2018年4月收治的60例ICU脓毒血症患者。随机分组,血液灌流治疗组对于ICU脓毒血症患者采取血液灌流治疗,连续性肾脏替代治疗联合血液灌流组则对于ICU脓毒血症患者采取连续性肾脏替代治疗联合血液灌流治疗。比较两组疾病疗效,住院时间,治疗前后ICU脓毒血症患者序贯器官衰竭评分值、血小板计数、APTT、血氧饱和度、平均动脉压、尿素氮以及血肌酐,死亡发生率。结果连续性肾脏替代治疗联合血液灌流组疾病疗效、住院时间、序贯器官衰竭评分值、血小板计数、APTT、血氧饱和度、平均动脉压、尿素氮以及血肌酐相比较血液灌流治疗组更好,P<0.05。连续性肾脏替代治疗联合血液灌流组死亡发生率低于血液灌流治疗组,P<0.05。结论连续性肾脏替代治疗联合血液灌流治疗ICU脓毒血症效果好,可有效改善ICU脓毒血症患者的凝血功能和代谢指标,降低死亡率,缩短住院时间。     

知识点模块网格化模型在肾内科实习生带教中的应用

目的 运用知识点模块网格化构建带教模型，观察其在肾内科实习生中的应用效果。方法 根据《内科学》（第八版）肾内科教学大纲要求，结合肾内科病房常见病、多发病的临床特点，精心挑选相关知识点，以理论为支撑点，以服务于实习带教工作为靶目标，各个知识点之间有临床的关联性，最终形成网格化的诊治分 析模型。将血尿、蛋白尿、高血压、水肿、肾小球滤过率为切入点，设定肾病综合征、系统性红斑狼疮、糖尿病肾病和急、慢性肾功能衰竭为临床知识必须掌握点，从病史、症状、体征和实验室检查几方面来培养实习生的诊疗思维，并通过知识点来关联疾病的诊治，从而帮助他们在有限的肾内科实习期间尽可能掌握肾内科临床知识。结果 本研究开展一年以来，对于来肾内科轮转的51 名实习生进行了模块网格化模型训练，实习生普遍反映该模型有很好的学习效果，让他们了解了肾内科临床重点，并能和理论学习的知识点有机融合在一起，开阔了实习生的诊疗视野，也便于对其他科知识点的学习。结论 基于知识点模块网格化，构建模型在肾内科实习生中有很好的带教作用，学生接受肾内科知识点的记忆增强，并能进一步推广到内科其他内容的实习带教中。     

P(cv-a)CO2与乳酸对休克液体复苏指导作用的研究

目的探究静动脉二氧化碳分压差[P(cv-a)CO2]与血乳酸(Lac)对休克液体复苏的指导作用。方法选取本院收治的40例休克患者,根据相关休克的治疗标准对每位患者进行液体复苏治疗,记录患者复苏前与复苏后6 h的P(cv-a)CO2与Lac水平,按预后将纳入研究组的患者分为存活组及死亡组,比较两组患者在复苏6 h时的乳酸清除率与P(cv-a)CO2水平。结果死亡组患者的P(cv-a)CO2水平高于存活组患者,但死亡组乳酸清除率水平则低于存活组,且上述指标比较差异均具有统计学意义(P<0.05)。结论P(cv-a)CO2与Lac指导休克患者液体复苏具有较好的指导作用。     

微创经皮肾镜钬激光取石术治疗肾结石的效果分析

目的 探究肾结石行微创经皮肾镜钬激光取石术的临床疗效.方法 将本院自2018年6月—2020年1月期间收治的88例肾结石患者通过简单随机化法的方式分为试验组与参照组,两组分别纳入44例患者,参照组患者实施开放性肾切开取石术,试验组患者实施微创经皮肾镜钬激光取石术,对比两组患者术中出血量、手术时间、结石排净时间、住院时间...     

高血压肾损害诊疗进展

高血压肾损害是一种临床常见疾病,已经成为导致终末期肾病的主要原因之一。高血压肾损害不同于其他慢性肾脏疾病,其具有独特的发病机制、临床病理特点,临床诊断及治疗也有所不同。高血压肾损害患者一旦出现蛋白尿,病情进展迅速,患者很快进入终末期肾病。但是高血压肾损害临床诊断与治疗普遍滞后,治疗干预手段有限,很难控制疾病的进展。因此深入研究高血压肾损害的发病机制、临床病理特点、诊断及治疗对于其临床防治具有重要的意义。本文从高血压肾损害病理机制、检测指标、临床病理特点及治疗四个方面对本病进行综述,旨在预防及延缓高血压肾损害的发生进展。