慢性移植肾失功后的移植肾切除手术分析

目的:分析总结因慢性移植肾失功而行移植肾切除手术患者的临床治疗经过,进一步探讨这类手术的安全性和适应证。方法:以慢性移植肾失功患者76例为研究对象,年龄23~72(36.6±13.5)岁,以上患者发生慢性移植肾失功的时间为术后11~91(35.8±24.6)个月,转入血液透析的时间为3~33(10.4±6.2)个月。76例患者均实施了移植肾切除手术,移植肾切除术后随访时间为6个月~5年。结果:平均手术时间50(35~180)min;术中平均出血量450(200~2 600)ml,平均输血量300(400~2 400)ml,其中67例进行了自体血液回收后输血。术后平均引流量250(20~1 100)ml,平均住院时间11(5~23)d。术后主要并发症:切口血肿8例,切口感染10例,消化道出血7例,心衰7例,肺部感染5例,肾上腺危象2例,下肢跛行2例。死亡4例。多数患者的体重指数、血红蛋白及血清白蛋白含量较术前有所提高。结论:慢性移植肾失功后的移植肾切除手术为高风险手术,应积极做好术前准备,同时加强围手术期护理,以降低手术并发症的发生率;积极适时地切除已经完全失功了的移植肾,有助于改善患者身体素质,避免免疫抑制的不良反应,同时有利于减轻患者本人及社会的经济负担。     

盐酸特拉唑嗪治疗中国人群良性前列腺增生患者的多中心临床研究

目的 评价维持剂量盐酸特拉唑嗪治疗中国人群BPH患者的有效性、安全性和依从性. 方法2007年6月至2008年3月在中国32家泌尿外科中心开展了多中心、前瞻性临床研究,方案为口服盐酸特拉唑嗪1～4 mg,1次/d,共4周.主要评价指标是治疗2、4周时患者IPSS变化值;次要指标是治疗4周时Qmax,QOL变化值,治疗2、4周时血压变化值以及4周内脱落率.并通过对不良事件的分析评估其安全性. 结果共纳入1006例BPH患者(FAS集),资料合格者992例(PP集),合并高血压病344例.FAS集患者IPSS从基线的22.32±6.13降至2周时的16.98±5.92以及4周时的14.00±5.52(P＜0.01);PP集患者IPSS从基线的22.32±6.15降至2周时的16.96±5.93及4周时的13.95±5.52(P＜0.01).以IPSS与基线相比下降＞30%定义为有效,2周末有效率为26.54%,4周末为60.64%.治疗4周后Qmax 和QOL均有显著增高,分别改善32%和45%(P＜0.01).对于血压正常或高血压获得控制的患者,盐酸特拉唑嗪对血压的影响较小;而对伴有未治疗或未能控制血压的高血压患者,盐酸特拉唑嗪能一定程度降低血压(P＜0.05).治疗中不良事件发生率低,最常见为头晕(3.68%).研究结束时960例仍继续服药. 结论盐酸特拉唑嗪能有效改善中国人群BPH患者症状,显著提高生活质量,同时具有良好的安全性和依从性.     

简体中文版King健康问卷在膀胱过度活动症患者中应用的信度和效度分析

目的 评价简体中文版King健康问卷(KHQ)在膀胱过度活动症(OAB)患者中应用的信度和效度.方法 采用"WHO-QOL跨文化生活质量研究问卷翻译法"将英文版KHQ翻译成简体中文,随机抽取就诊于泌尿外科门诊的OAB患者,在第0周和第2周对其进行2次简体中文版KHQ问卷调查.通过Cronbach's α系数评价问卷的内部一致性;用组内相关系数(ICC)评价重测信度;计算各问题得分与所属领域得分的Spearman等级相关系数(rs)评价内容效度;用因子分析评价结构效度.结果 48例符合纳入标准的OAB患者参与本研究,40例完成2次调查,男7例,女33例,年龄(49.6±14.3)岁.KHQ各亚量表和各领域均具有较好的内部一致性(Cronbach's α:0.7l8～0.924)、中到高的重测信度(ICC:0.567～0.995,P<0.01)以及中到高的内容效度(r:0.462～0.964,P<0.01).因子分析法显示简体中文版KHQ具有可接受的结构效度.结论简体中文版KHQ具有较好的信度和效度,可作为评估OAB患者生活质量的专用量表.     

慢性阻塞性肺疾病:超级化~3He-MR成像定量分析支气管扩张剂的疗效

目的 3He-MR成像和肺功能检查评价短效支气管扩张药对慢性阻塞性肺疾病(COPD)的疗效。材料与方法本研究经学术审查委员会批准并取得所有病人的书面知情同意。COPD病人14例(现已戒烟),在给予400mg舒喘灵(羟甲叔丁肾上腺素)后平均(25±2)min前和后分别接受超     

乌贼墨对小鼠脾细胞和巨噬细胞NO生成及 IFN-γ分泌水平的影响

目的：探讨乌贼墨对脾细胞和巨噬细胞NO生成及IFN-γ分泌的影响。方法：用Griess法和ELISA法分别检测了经乌贼墨灌胃处理后小鼠脾细胞和腹腔巨噬细胞培养上清中NO和IFN-γ的水平的变化。结果：乌贼墨灌胃处理小鼠后的第4、6天脾细胞及腹腔巨噬细胞(Mφ)可产生较高水平的NO；脾细胞可产生较高水平的IFN-γ，并且小鼠脾细胞NO的产生水平与IFN-γ产生水平呈正相关(r=0．98)；用LPS和L-NMMA(NO抑制剂)分别同乌贼墨灌胃第6d小鼠的脾细胞一起培养，结果显示LPS可协同IFN-γ促NO水平升高。L-NMMA可抑制小鼠脾细胞的NO生成。结论：乌贼墨可促进巨噬细胞NO生成；脾细胞NO的产生与IFN-γ分泌水平呈正相关。     

基于1H-NMR代谢组学的阿胶化学成分差异性分析方法初探

目的 采用氢核磁共振(¹H-NMR)代谢组学技术对不同生产厂家的阿胶酸水解成分进行差异性比较。方法 对5个不同生产厂家的阿胶进行酸水解,然后进行¹H-NMR分析。对所得的¹H-NMR图谱进行化学成分归属指认,并结合相关软件进行多元统计分析,找出差异性化学成分。结果 从阿胶¹H-NMR谱中指认出17种化学成分;通过对A、C、D、E厂家生产的阿胶与B厂家生产的阿胶进行比较分析,找出了相应的差异性成分,主要包括异亮氨酸、羟脯氨酸、精氨酸、亮氨酸、苯丙氨酸、缬氨酸、赖氨酸和乙酰丙酸等。结论 ¹H-NMR代谢组学方法可用于不同厂家阿胶化学成分差异性的分析,为阿胶的质量控制提供新方法和新思路。     

Adoptive immunotherapy evaluating escalating doses of donor leukocytes for relapse of chronic myeloid leukemia after bone marrow transplantation: separation of graft-versus-leukemia responses from graft-versus-host disease

Infusions of large numbers (> 10(8)/kg) of donor leukocytes can induce remissions in patients with chronic myeloid leukemia (CML) who relapse after marrow transplantation. We wanted to determine if substantially lower numbers of donor leukocytes could induce remissions and, if so, whether this would reduce the 90% incidence of graft-versus-host disease (GVHD) associated with this therapy. Twenty-two patients with relapsed CML were studied: 2 in molecular relapse, 6 in cytogenetic relapse, 10 in chronic phase, and 4 in accelerated phase. Each patient received escalating doses of donor leukocytes at 4- to 33-week intervals. Leukocyte doses were calculated as T cells per kilogram of recipient weight. There were 8 dose levels between 1 x 10(5) and 5 x 10(8). Lineage-specific chimerism and residual leukemia detection were assessed using sensitive polymerase chain reaction (PCR) methodologies. Nineteen of the 22 patients achieved remission. Remissions were achieved at the following T-cell doses: 1 x 10(7) (n = 8), 5 x 10(7) (n = 4), 1 x 10(8) (n = 3), and 5 x 10(8) (n = 4). To date, 15 of the 17 evaluable patients have become BCR-ABL negative by PCR. The incidence of GVHD was correlated with the dose of T cells administered. Only 1 of the 8 patients who achieved remission at a T-cell dose of 1 x 10(7)/kg developed GVHD, whereas this complication developed in 8 of the 11 responders who received a T-cell dose of > or = 5 x 10(7)/kg. Three patients died in remission, 1 secondary to marrow aplasia, 1 of respiratory failure and 1 of complications of chronic GVHD. Sixteen patients who were mixed T-cell chimeras before treatment became full donor T-cell chimeras at the time of remission. Donor leukocytes with a T-cell content as low as 1 x 10(7)/kg can result in complete donor chimerism together with a potent graft-versus-leukemia (GVL) effect. The dose of donor leukocytes or T cells used may be important in determining both the GVL response and the incidence of GVHD. In many patients, this potent GVL effect can occur in the absence of clinical GVHD.     

Protein Losing Enteropathy in Severe Atopic Dermatitis in an Exclusively Breast-Fed Infant

Abstract:   We first report a case of protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed 5-month-old infant. Protein losing enteropathy was confirmed by fecal α₁-antitrypsin clearance test and imaged successfully by ^99mTc-human serum albumin scintigraphy. The present case highlights that protein losing enteropathy in severe infantile atopic dermatitis is being a topic of concern and also an issue even in exclusive breast feeding patients.     

Flexion compromises ventilation with the laryngeal tube suction II in children

Background: There are insufficient data as to the influence of the head and neck flexion, extension, and rotation on the ventilation with laryngeal tube suction II^® (LTS II). The purpose of this study was to investigate the influence of the head and neck position on oropharyngeal sealing pressure (primary outcome) and ventilation score (secondary outcome) during ventilation with the LTS II in children. Methods: We studied 33 children scheduled for elective surgery. Oropharyngeal sealing pressure and ventilation score were measured with the head and neck in a neutral position, flexed, extended and rotated to the right. The ventilation score was scored from 0 to 3 based on three items (no leakage with an airway pressure of 15 cmH₂O, bilateral chest excursion, and a square wave capnogram; each item scored 0 or 1 point). Peak inspiratory pressure (PIP) at a tidal volume of 10 ml·kg^?1 and fiberoptic laryngeal views were also assessed in each position. Results: Although the sealing pressure was lower in the extended position [22 (8) cmH₂O] than that in the neutral position [25 (7) cmH₂O], there was no significant leakage during ventilation with a tidal volume of 10 ml·kg^?1. In the neutral, extended and rotated positions, the median ventilation scores were better (3 point respectively) than that with the head and neck flexed (1 point). PIP was decreased with the head and neck extended or rotated but was significantly increased in flexion position. During fibreoptic examination, the vocal cords were more easily seen in extension and right rotation, compared with the neutral position and flexion. Conclusions: Although oropharyngeal sealing pressure is decreased with the head and neck extended, effective ventilation with LTS II can be performed like in the neutral position or the rotated position. While the sealing pressure is maintained with the head and neck flexed, flexion compromises the ventilation with LTS II in children.