糖尿病伴脂毒性肾损害的特征、识别与临床处理

1糖尿病脂毒性肾损害的机理关于糖尿病肾病的原因,长期以来认为是“糖毒”的作用：即糖基化终末代谢产物、蛋白激酶C的激活、转化生长因子-β（TGF-β）、活化的促细胞分裂原、蛋白激酶通路、反应性氧化物的堆积、细胞外基质的沉积等,增加肾小管间质纤维化等因素,导致糖尿病肾病（DN）。然而,“糖毒”实验并未复制出人的DN模型。1858年Virchow首先提出脂肪与肾病的关联,描述了Bright’s病肾脏上皮脂肪变性。     

糖尿病心功能异常早期诊断的临床探讨

目的探讨糖尿病人心功能异常的早期诊断。方法使用非侵入性心脏血流动力学监测仪心阻抗图对30例正常人和87例无临床心脏病症状和体征的糖尿病人检测，并进行比较。结果57例患者存在心功能异常：心脏每搏输出量（SV）及每分输出量（CO）减少，血管顺应性（AC）下降，总外周阻力（TPE）增高（P＜0．001）；左室射血时间（LVET）缩短，收缩时间间期（STI）延长（P＜0．05）。直线相关分析显示：年龄（Ag）、平均动脉压（MAP）及体重指数（WI）与AC、SV、LVET分别呈负相关，与TPR及STI正相关；病程（DD）与CO、SV、LVET负相关，与STI正相关（P＜0.01）。结论非侵入性血流动力学测定对糖尿病人心功能减退可提供早期诊断，控制血糖、体重及血压对延缓心脏病变的发生发展具有重要意义。     

糖尿病性水疱病并溃疡一例

糖尿病性水疱病为一较少见的、多发生于糖尿病患者四肢远端的皮肤合并症。国内自1979年报告一例以来,近年已有陆续报告。而水疱继发溃疡,国内报     

高氧与核因子Kappa B

高氧可引起体内活性氧的增加,导致多种细胞和组织的损伤。NF-κB是一种氧化应激敏感性转录调控因子,高氧可以通过对NF-κB的调控,从而调控不同的下游基因和蛋白。本文从高氧介导的活性氧产生、上下游通路对NF-κB的调控及细胞成熟分化对NF-κB的研究进展做一综述。     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.     

金纳米双锥在肿瘤诊疗中的研究进展

金纳米双锥(AuNBPs)作为一种结构较为新颖的纳米材料,具有优越的光学特性,如显著的局部电场增强、宽大的消光截面、良好的光热稳定性等。经多种配体修饰后的AuNBPs可获得对肿瘤的靶向性,在肿瘤的诊断与治疗方面拥有广阔的应用前景。本文就AuNBPs的制备、性质及其在肿瘤的诊断、治疗中的研究现状进行综述。     

负压封闭引流在肢体毁损伤保肢术的急诊应用

目的回顾性分析我院负压封闭引流(vacuum sealing drainage,VSD)治疗肢体毁损伤的病例,探讨肢体毁损伤的急诊治疗方法。方法回顾性研究。2007年3月~2010年12月收治343例开放骨折,21例经急诊行负压封闭引流治疗的肢体毁损伤病例被纳入本研究。男14例,女7例,年龄17~52岁,平均31岁。车祸伤16例,地震伤2例,机器绞砸伤3例。上肢13例,下肢8例。GustiloⅢb型15例,Ⅲc型6例。肢体创伤程度评分(mangled extremityseverity score,MESS评分):9例<6分,6例6~7分,6例>7分。手术按外科清创术原则清创,修复血管、神经、肌腱,组织覆盖骨外露创面,外固定架固定构建肢体稳定性,负压封闭引流吸引封闭创面。结果 21例患者经1~5次负压封闭引流治疗,12例无骨外露,肉芽组织生长良好、创面游离植皮成功;5例骨外露面积小,肉芽组织粗盖骨外露后游离植皮,创面愈合;3例骨外露,行组织瓣转移覆盖创面;1例并发严重感染,截肢。结论负压封闭引流适用于肢体毁损伤的急诊保肢治疗,可控制感染、刺激肉芽组织生长,为二期创面修复提供了良好的条件。     

尿毒症患者透析间期自我管理的健康教育

目的提高尿毒症患者透析间期自我护理的能力及遵医行为,减少并发症发生。方法对我院2010—01—2011-01规律性血液透析的42例患者透析间期实施规范、系统性的健康教育。结果实施健康教育前后进行比较,患者的自我护理能力增强,内瘘闭合发生率降低,透析阀期体质量增加符合要求的比例明显上升,透析相关的并发症如心衰、低血压等明显减少,差异有统计学意义。结论透析间期加强患者自我管理能力,落实系统性健康教育是提高其生存质量、减少并发症、提高治疗依从性的重要方法和途径。