Is the corrected-creatinine model for end-stage liver disease a feasible strategy to adjust gender difference in organ allocation for liver transplantation?

BACKGROUND: The Model for End-stage Liver Disease (MELD) scoring system is used for organ allocation in liver transplantation. Female cirrhotic patients have lower glomerular filtration rates (GFR) than males for the same creatinine (Cr) level. Correcting the Cr in females for the same GFR as in males shows that females have lower MELD scores and therefore a lower priority for liver transplantation; however, there has been no outcome data that justifies this modification. METHODS: We investigated 472 cirrhotic patients, comparing the mortality rate between males and females in relation to MELD and corrected-Cr MELD. RESULTS: Compared to females, male patients had a higher MELD (14.5+/-5.5 vs. 13.8+/-5.7) and significantly higher GFR (61.7+/-21.4 vs. 54.7+/-25.6 mlLmin/1.73 m, P=0.0002) because their Cr value was higher (1.4+/-0.4 vs. 1.3+/-0.5 mg/dL, P=0.0002). The corrected-Cr MELD score in females was higher (15.7+/-6.3) compared to the MELD in their original counterpart (P<0.0001) and the males (P=0.060). Female and male patients had a similar 3-month mortality rate (6.7% vs. 6.3%) and MELD (21.9+/-8.6 vs. 21.7+/-8.9) among deceased patients. At 6 months, female patients tended to have a lower mortality (12.5% vs. 14.7%) and a lower MELD (18.9+/-7.7 vs. 19.4+/-8.5) in deceased patients. However, at 9 and 12 months, females had a consistently higher mortality (25% vs. 21.2% and 37.5% vs. 31.3%, respectively) but lower MELD scores than males by 0.3-1 point. CONCLUSIONS: Using corrected-Cr MELD, which would prioritize female patients for liver transplantation, may only be justified in predicting intermediate-term (9- and 12-month), but not short-term (3- and 6-month) mortality.     

不同钙浓度腹膜透析液对长期CAPD患者矿物质和骨代谢影响的分析

目的观察腹膜透析液钙离子浓度对持续性不卧床腹膜透析(CAPD)患者矿物质和骨代谢的影响。 方法回顾性分析我院腹膜透析中心行CAPD治疗2年以上的123例患者,根据腹膜透析液钙离子浓度分为低钙腹膜透析液组(LCD组,钙离子浓度为1.25 mmol/L)和标准钙腹膜透析液组(SCD组,钙离子浓度为1.75 mmol/L),观察不同钙浓度腹膜透析液对患者血清钙、磷、全段甲状旁腺激素(iPTH)、颈动脉厚度、心脏瓣膜钙化及骨痛、皮肤瘙痒等情况的影响。使用SPSS 18.0统计软件包进行数据处理。 结果2组患者治疗前人口学特征、腹膜转运特性、钙磷代谢等指标的基线水平差异无统计学意义(P>0.05)。治疗2年后,2组患者血钙浓度及达标率较治疗前均显著增高(P<0.05),SCD组血钙浓度增幅高于LCD组,但差异无统计学意义(0.26±0.31 mmol/L与0.17±0.29 mmol/L, t＝1.621,P＝0.108);2组间治疗后血清钙、磷、iPTH平均水平及其达标率、颈动脉厚度、心脏瓣膜钙化比例、骨痛及皮肤瘙痒累计发生率差异均无统计学意义(P>0.05);LCD组活性维生素D使用比例显著高于SCD组(χ² ＝6.373,P<0.05)。 结论采用低钙与标准钙腹透液治疗2年,对CAPD患者矿物质和骨代谢的影响无显著性差异。     

Mixed Spectral Element Method for 2D Maxwell's Eigenvalue Problem

It is well known that conventional edge elements in solving vector Maxwell's eigenvalue equations by the finite element method will lead to the presence of spurious zero eigenvalues. This problem has been addressed for the first order edge element by Kikuchi by the mixed element method. Inspired by this approach, this paper describes a higher order mixed spectral element method (mixed SEM) for the computation of two-dimensional vector eigenvalue problem of Maxwell's equations. It utilizes Gauss-Lobatto-Legendre (GLL) polynomials as the basis functions in the finite-element framework with a weak divergence condition. It is shown that this method can suppress all spurious zero and nonzero modes and has spectral accuracy. A rigorous analysis of the convergence of the mixed SEM is presented, based on the higher order edge element interpolation error estimates, which fully confirms the robustness of our method. Numerical results are given for homogeneous, inhomogeneous, L-shape, coaxial and dual-inner-conductor cavities to verify the merits of the proposed method.     

重视供肝机械灌注研究,推动肝移植高质量发展

随着器官捐献数量不断增加和扩大标准供者(ECD)供肝定义不断拓展,供肝质量必然成为影响肝移植高质量发展的突出问题,也是相关领域的研究重点.最大限度解决器官短缺和推动器官移植高质量发展是我国器官捐献与移植事业发展的方向.近年来,利用机械灌注(MP)对供肝进行灌注、保存、评估及修复,已成为当前国际上提高肝移植质量的研究热点...     

多巴胺联合去甲肾上腺素对感染性休克患者肾脏功能的影响

目的研究多巴胺与去甲肾上腺素联合应用对感染性休克患者肾脏功能的影响。方法选择1996年以来在我科ICU接受治疗的感染性休克患者87例,以去甲肾上腺素最大泵注速率分为3组:其中A组28例(0．5～0．9μg·kg-1·min-1),B组30例(1．0～1．5μg·kg-1·min-1), C组29例(1．6～2．0μg·kg-1·min-1)。测定记录所有患者的平均静脉压(MAP)、心率(HR)、尿量、血尿素氮(BUN)、肌酐(CRE)、尿白蛋白(U-ALB)和β2微球蛋白(Uβ2-MG)定量及APACHEⅢ评分。结果治疗前,3组患者均有低血压、心动过速和少尿,多数患者CRE、BUN、U-ALB、Uβ2-MG和APACHEⅢ评分高于正常值上限。经过抗休克治疗,所有患者的MAP、HR、尿量及BUN、CRE均恢复到正常范围,U-ALB、Uβ2-MG定量及APACHEⅢ评分也有所恢复,但仍高于正常。结论在感染性休克的治疗中,应以恢复脏器血流灌注为首要目标,以容量复苏为主,必要时辅以多巴胺、去甲肾上腺素等血管活性药物来维持循环稳定。     

研讨式学习沙龙在护理骨干培训中的应用

目的探讨研讨式学习沙龙在心血管重症监护部门中层护理骨干培训中的应用及效果。方法通过研讨式学习沙龙,从心血管基础理论及临床病例处理方法等方面,对30名护理骨干进行为期1年的专业培训。首先由学员进行专题小讲课,指导教师组织小组学员就理论专题展开讨论,联系临床实际释疑解惑;然后进行1～2个临床病例的深入分析和讨论,掌握相关情况下的观察、分析和处理方法 ;最后进行前次学习内容的考核。结果培训前后学员的笔试成绩、知识技能水平以及护士长对其临床能力的评价较培训前显著提高(均P0.01);100%学员认为培训提高了理论水平及临床综合分析能力。结论研讨式学习沙龙提供了宽松的学习场所,学员和教师间、学员与学员间可以自由交流,共同分享彼此的经验和知识,对于护理骨干整体专业素质的提高具有一定的积极意义。     

Clinical application of alpha1 adrenoceptor antagonist Naftopidil to the treatment of chronic non-bacterial prostatitis]

OBJECTIVE: To study the efficacy and safety of alpha1 adrenoceptor antagonist Naftopidil in the treatment of chronic non-bacterial prostatitis. METHODS: An opened, self-controlled, multicentral clinical trial was conducted. One hundred and six cases of patients who had been diagnosed as chronic non-bacterial prostatitis (NBP) were treated with Naftopidil (25 mg once a day) for 4 weeks. The efficacy was evaluated by the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and the WBC in the examination of prostatic secretion (EPS) after the treatment. RESULTS: After 4 weeks therapy, 105 cases were evaluable. After treatment, NIH-CPSI total score were averagely decreased 12.0 points (P <0.001), symptom score 7.9 points (P <0.001) and QOL score 4.1 points (P <0.001). There was a statistically significant difference in WBC count ([(15.2 +/- 15.1)/HP vs (9.5 +/- 12.0)/HP, P < 0.01] and max flow rate(MFR) [(19.2 +/- 4.8) ml/s vs (22.7 +/- 4.9) ml/s, P < 0.01]. The total effective rate were 84.8% in the whole group. The clinical adverse rate was 3.81%, including 3 cases of mild dizziness and 1 case of mild inappetence. CONCLUSION: alpha1 adrenoceptor antagonist Naftopidil is effective and safe for the treatment of chronic non-bacterial prostatitis.     

Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis.

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction.     

新型组合型肝肾支持系统治疗西藏小型猪急性肾衰模型的实验研究

目的：评估新型组合型肝肾支持系统治疗西藏小型猪肾衰模型的安全性及有效性。方法将5头西藏小型猪采用结扎双侧肾动脉的方法构建肾衰模型,造模后治疗组用新型组合型肝肾支持系统进行治疗（CRRT模式）,对照组造模后不进行治疗,在治疗0、4、8h抽取静脉血进行内毒素、生化检测及需氧菌培养厌氧菌培养,观察造模前后、治疗前后西藏小型猪的各项生化指标的变化;实验过程中每2小时记录仪器的各项压力监测指标。结果两组实验动物肾衰模型均构建成功,治疗组经过新型组合型肝肾支持系统治疗后,一般情况改善;对照组动物一般情况持续恶化。实验动物在实验过程中,心电图未出现明显异常,两组动物在0 h时生命体征差异无统计学意义（P＞0．05）,其余时段治疗组心率和呼吸频率明显低于对照组（P＜0．05）,而血氧饱和度和平均动脉压明显高于对照组（P＜0．05）;造模前两组实验动物的生化指标差异无统计学意义（P＞0．05）;造模后两组动物与造模前相比差异有统计学意义（P＜0．05）;治疗组经肝肾支持系统治疗后,各项生化指标明显下降,与治疗前相比,差异有统计学意义（P＜0．05）;而对照组未出现明显变化。内毒素水平均低于0．5 EU／mL ,动静脉端需氧、厌氧菌培养结果显示未见细菌生长。病理检查见明显的肾小管上皮肿胀、肾小管坏死。结论新型组合型肝肾支持系统用于治疗西藏小型猪肾衰模型是安全、有效的,可进一步尝试用于临床试验。     

有创-无创序贯与单纯有创机械通气治疗创伤性ARDS的回顾性研究

目的 建立序贯机械通气治疗创伤性急性呼吸窘迫综合征(ARDS)的模式,并比较与单纯有创机械通气的差异.方法 选取2010年8月至2015年5月入住该中心的创伤性ARDS并需机械通气的患者64例.分为两组,有创组32例采取单纯有创机械通气治疗,序贯组32例采取有创-无创序贯性机械通气治疗.比较序贯组拔管前与拔管24 h后血气分析结果;两组间呼吸机相关肺炎(VAP)发生率、镇静剂使用量、有创通气时间、总机械通气时间、ICU住院时间及伤后28 d临床结局.结果 序贯组的VAP发生率、有创通气时间、总机械通气时间、ICU住院时间及临床预后均优于对照组,差异有统计学意义(P＜0.01).结论 有创-无创序贯通气模式治疗创伤性ARDS,具有良好的临床疗效,可显著改善患者预后.