格林-巴利综合征患者血清中髓鞘脂自身抗体水平的测定

应用免疫学方法检测了格林－巴利综合征（ＧＢＳ）病人和正常对照组各３０例的血清中髓鞘脂自身抗体含量，并进行了动态观察。结果显示，ＧＢＳ病人血清中髓鞘脂自身抗体水平明显高于正常对照组（Ｐ〈０．０１），ＧＢＳ患者髓鞘脂自身抗体出现的阳性率为２０％。动态观察发现，ＧＢＳ患者血清中髓鞘脂自身抗体水平的下降与临床症状的改善相一致。     

Evaluation of renal function in patients with a main renal stone larger than 1 cm and perioperative renal functional change in minimally invasive renal stone surgery: a prospective,observational study

Purpose

To compare the perioperative relative renal function and determine predictors of deterioration and recovery of separate renal function in patients with renal stones >10 mm and who underwent mini-percutaneous nephrolithotomy or retrograde intra-renal surgery.

Patients and methods

A main stone >10 mm or stones growing, high-risk stone formers and extracorporeal shock-wave lithotripsy-resistant stones were prospectively included in 148 patients. Patients with bilateral renal stones and anatomical deformities were excluded. Renal function was evaluated by estimated glomerular filtration rate, 99m-technetium dimercaptosuccinic acid and 99m-technetium diethylenetriamine pentaacetate prior to intervention and at postoperative 3 months. Logistic regression analyses were performed to find predictors of functional deterioration and recovery.

Results

The overall stone-free rate was 85.1 %. A third of patients (53/148, 35.8 %) with renal stones >10 mm showed deterioration of separate renal function. Mean renal function of operative sites showed 58.2 % (36.8 %/63.2 %) of that of contralateral sites in these patients. Abnormal separate renal function showed postoperative recovery in 31 patients (58.5 %). Three cases (5.7 %) showed deterioration of separate renal function despite no presence of remnant stones. Improvement rates of the abnormal separate renal function did not differ according to the type of surgery. The presence of hydronephrosis and three or more stones were significant predictors for renal function deterioration. Female gender and three or more stones were significantly correlated with postoperative recovery.

Conclusions

Mini-percutaneous nephrolithotomy or retrograde intra-renal surgery was effective and safe for renal function preservation. Patients with multiple large stones should be considered for candidates of active surgical removal.

     

Dose rectification of an imbalance between DPP4 and GLP‐1 ameliorates chronic stress‐related vascular aging and atherosclerosis?

Exposure to psychosocial stress is a risk factor for cardiovascular disease, including vascular aging and regeneration. Dipeptidyl peptidase‐4 (DPP‐4) exerts many physiological and pharmacological functions by regulating its extremely abundant substrates [eg., glucagon‐like peptide‐1 (GLP‐1), stromal cell‐derived factor‐1α/C‐X‐C chemokine receptor type‐4, etc.]. Over the past decade, emerging data has revealed unexpected roles for DPP‐4 and GLP‐1 in intracellular signaling, oxidative stress production, lipid metabolism, cell apoptosis, immune activation, insulin resistance, and inflammation. This mini review focuses on recent findings in this field, highlighting an imbalance between DPP4 and GLP‐1 as a potential therapeutic target in the management of vascular aging and atherosclerosis in animals under experimental stress conditions.     

抗凝与促凝药物交替应用治疗血栓合并出血患者1例分析

摘 要1例72岁女性患者,因“ 慢性咳嗽、咳痰、呼吸困难10年,加重伴间断发热1个月”入院,诊断为慢性支气管炎急性发作,慢性肺源性心脏病,心功能Ⅳ级,双下肢静脉血栓,血小板减少。患者在治疗中需要权衡抗凝药物与促凝药物的应用,在制定方案时利用房颤出血评分系统结合患者临床实际进行出血风险的评估,同时考虑药物之间的相互作用可能对患者产生的危害和用缜密的临床思维来评估患者的预后,减少了患者用药风险。     

感毒清颗粒治疗普通感冒气虚邪犯证的临床观察

目的 观察和评价感毒清颗粒治疗普通感冒气虚邪犯证的有效性及安全性。方法 采用多中心随机双盲安慰剂对照的临床研究方法,将120例患者随机分为试验组和对照组各60例,试验组予感毒清颗粒每次6 g,每日3次,口服;对照组予安慰剂每次6 g,每日3次,口服;两组服药疗程均为5 d。同时采用全分析集（FAS）和符合方案集（PPS）分析两组治疗5 d后的总体症状缓解率、主要症状总积分、次要症状总积分、所有症状总积分、总体症状缓解时间及中医证候疗效,安全性采用安全性分析集（SS）分析。结果 试验组无脱落,对照组脱落3例;治疗5 d后试验组总体症状缓解率显著高于对照组（P<0.01）,FAS与PPS分析结果一致;试验组在改善主要症状总积分、次要症状总积分和所有症状总积分方面优于对照组（P<0.01）,FAS和PPS分析结果一致;两组总体症状缓解时间比较差异无统计学意义;试验组在改善恶风寒、鼻塞、流涕、倦怠乏力、气短懒言、咽干、咽痛、咳嗽、咳痰症状方面明显优于对照组（P<0.05,P<0.01）,FAS与PPS分析结果一致;试验组中医证候疗效优于对照组（P<0.01）,FAS与PPS分析结果一致。所有患者服药后生命体征、血常规、肝肾功能检查均未出现明显异常;试验组与对照组不良事件发生率差异无统计学意义。结论 感毒清能够有效改善普通感冒气虚邪犯证的症状、缩短疾病病程且安全性良好。     

Foot care knowledge,attitudes and practices among patients with diabetic foot and amputation in St. Kitts and Nevis

About one‐third of admissions to the surgical unit annually are diabetes foot infections in need of amputation In St. Kitts and Nevis. However, the risk factors related to diabetes foot and amputation remain unknown. This study investigated factors associated with diabetic foot and amputation (DFA). Retrospective case control study design, and purposive and quota sampling method was used to recruit the participants. Patients with and without DFA were interviewed at two main hospitals, several primary health centres, and a private doctor's office during July and August 2018. Self‐development questionnaires were applied to assess patients' demographic, physical and behaviour, foot care knowledge, attitudes, and practices related to DFA. Chi‐square, t‐test, and multiple logistic regressions were used to analyse the data. A total of 210 patients were evaluated, 89 had DFA, while 121 did not, with a mean age of 61.10 (SD = 11.85). Participants' responses indicated good knowledge, favourable attitudes, and adequate practices related to foot care. The two items of the questionnaire, ways to maintain blood flow in the lower extremities and wash their feet daily, had significant lower score in DFA group. In multiple logistic regression, knowledge, attitudes, and practices related to foot care were not a significant predictor of DFA. Being male was a predictor of DFA than female (OR = 3.53; 95% CI = 1.65‐7.57; P < .01). Participants who were currently unemployed were less likely to have DFA than those who were employed (OR = 0.38; 95% Cl = 0.17‐0.86; P < .05). Comparing patients with the longest experience of diabetes mellitus (31 years or more) with those who had diabetes for the shortest period of time (between 1 and 10 years) was less likely to have DFA (OR = 0.38; 95% CI = 0.15‐0.97; P = <.05). The combination of these independent variables could explain 29% of the variance in DFA. Based on these findings, strategies to prevent diabetic foot and amputation should focus on male and outdoor heavy worker, and longer duration of diabetes patients which are identified in this study.     

不同加压弹力袜预防ICU老年脑卒中患者DVT效果比较

目的 探讨不同款式的加压弹力袜在ICU老年脑卒中患者的使用效果。方法 选取我院ICU自2017年6月至2018年12月收治的216例老年脑卒中患者作为研究对象,随机分成3组各72例,在给予常规护理基础上分别给予过膝低压弹力袜（15~20 mmHg）,膝下中压弹力袜（20~30 mmHg）,膝下低压弹力袜（15~20 mmHg）;比较3组患者使用不同弹力袜后DVT发生情况、穿着部位出现不适情况及使用依从性情况。结果 3组患者DVT发生率比较,差异无统计学意义（P＞0.05）;3组穿着部位不适情况发生率及依从性比较,差异有统计学意义（P<0.05,P<0.01）,其中,膝下低压组穿着部位不适情况发生率最低,而依从性最高。结论 3种加压弹力袜在降低脑卒中患者DVT发生率方面无差异,而从使用后出现不适情况及依从性的角度膝下低压弹力袜效果更好,在结合患者病情的前提下推荐选用。     

术中 X-线定位在神经内镜切除甲介型蝶窦垂体瘤手术中的应用简

目的探讨术中x-线定位在经神经内镜下甲介型蝶窦垂体瘤手术的应用。方法回顾性分析6例甲介型蝶窦垂体瘤病人的临床资料,均采用神经内镜下垂体瘤切除结合术中X-线定位方法。结果术中X-线定位准确4例;2例发生纵向偏差,均纠正。肿瘤全切除5例,次全切除1例。术后激素水平正常,视力视野改善。出现暂时性尿崩1例,治疗后痊愈。无脑脊液鼻漏、垂体功能低下、蝶窦炎发生,无死亡病例。6例病人随访3年,均无复发。结论神经内镜技术结合术中X-线定位是一种治疗甲介型蝶窦垂体瘤的安全、有效方法。