Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

INTRODUCTIONInfective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution’s recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes.METHODSWe conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records.RESULTSThere were 14 cases identified. The median age was 59 (range 47–88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.CONCLUSIONCatheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.     

良性前列腺增生细胞因子变化的研究

目的　探讨与细胞增生有关的细胞因子与BPH发生的相关性。方法　人前列腺分对照组 (正常前列腺 )和实验组 (良性前列腺增生 )。常规组织学染色观察组织形态的变化 ,免疫组织化学方法观察bFGF ,VEGF和EGFR在BPH中的改变。结果　BPH的病理变化呈多类型化。BPH的组织中bFGF和VEGF在间质中明显增加 ;EGFR在腺上皮和间质细胞中都增加明显。结论　在BPH的组织异常增殖中 ,间质的增殖可能与bFGF和VEGF的分泌增多关系密切 ,而EGFR与间质和腺上皮的异常增殖均有关。     

Sirolimus allows renal recovery in lung and heart transplant recipients with chronic renal impairment.

BACKGROUND: Until recently, there has been no practical alternative to the use of calcineurin inhibitors (CIs) as primary immunosuppressants in lung transplantation (LTx) and heart transplantation (HTx). Sirolimus (SRL) is a novel powerful immunosuppressant without renal toxicity, a common post-transplant problem associated with CI therapy. METHODS: SRL was used in 20 LTx and 5 HTx recipients >90 days post-transplant, where serious renal impairment was limiting CI dosing. Patients started on 2 to 5 mg/day orally at a median of 1,185 days post-transplant. Dosage adjustments were made according to trough levels, toxicity and perceived efficacy. With SRL initiation, 48% ceased CI therapy and the remainder decreased their dose substantively. RESULTS: After 30 days, 4 of 5 dialyzed patients ceased dialysis and 15 of 20 patients with an elevated serum creatinine (Cr) (mean Cr 0.29 mmol/liter) improved their Cr. The direction of change in Cr at 30 days predicted longer term Cr. The starting Cr did not predict the 30-day or long-term value. There were two bouts of acute and one bout of chronic rejection. There were 35 infectious complications in 16 patients and 24 episodes of potential SRL-related toxicity in 17 patients. These events generally responded to dose reduction or temporary cessation and were level-related. Fifteen recipients presently remain on the drug. None of the 7 deaths could be directly related to toxicity. CONCLUSION: SRL is a useful alternative immunosuppressant, allowing significant CI withdrawal in transplant recipients with renal impairment. Whether the resulting improvement in Cr can be maintained in the long term probably depends on the balance between the extent of acute and chronic renal damage.     

心形吻合术治疗先天性巨结肠的远期效果

目的 总结心形吻合术治疗巨结肠的经验。方法 回顾11年来心形吻合术治疗巨结肠的疗效,技术操作及改进,并发症的发生率和防治。结果 193例手术患者得到随访者152例,早期术后并发症15例,其中尿潴留2例,肠炎10例,吻合口狭窄1例,肠梗阻2例。晚期并发症22例,其中肠梗阻2例,便秘5例,切口疝2例,肠炎6例,7例偶有污粪,无盆腔、腹腔伤口感染、肛门失禁和死亡。结论 心形吻合术能明显减少术后并发症,提高疗效。     

Effects of the 532-nm and 1,064-nm Q-switched Nd:YAG lasers on collagen turnover of cultured human skin fibroblasts: a comparative study

Cultured human skin fibroblasts were irradiated twice successively with the 1.5 J/cm² of 532-nm and 1,064-nm lasers, respectively. The mRNA of procollagen, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), heat-shock protein 70 (Hsp70), interleukin-6 (IL-6) and transforming growth factor beta (TGF-β) were analyzed at 24 and 48 h post-irradiation by using RT-PCR. Both lasers significantly increased the expression of type I and III procollagen, TIMP1, and TIMP2, but decreased MMP1 and MMP2 expression. The 1,064-nm laser initiated TGF-β expression while the 532-nm laser elicited the increase of Hsp70 and IL-6. The increase/decrease rates of procollagen, TIMPs and MMPs for the 1,064-nm laser were higher than that of the 532-nm laser. Thus, both lasers effectively accelerated collagen synthesis and inhibited collagen degradation. Collagen synthesis induced by the 1,064-nm laser might be partly due to the upregulation of TGF-β expression, while the increase of Hsp70 and IL-6 might be partly responsible for collagen synthesis stimulated by the 532-nm laser. With the parameters used in this study, the 1,064-nm infrared laser is more effective in promoting the beneficial molecular activities than the 532-nm visible laser.     

"分段切开,多重挂线术"治疗高位复杂性肛瘘临床研究

目的:观察"分段切开,多重挂线术"治疗高位复杂性肛瘘的临床疗效。方法:将60例高位复杂性肛瘘随机分为治疗组40例,采用"分段切开,多重挂线术";对照组20例,采用传统切开挂线术进行对比观察。结果:显示治疗组与对照组显愈率分别为95%和90%,无明显差异(P>0.05),但两组间的术后疼痛程度、创口愈合时间、肛门功能情况存在显著差异(P<0.05)。结论:在治疗高位复杂性肛瘘时,"分段切开,多重挂线术"与传统切开挂线术相比,具有手术操作简单,对组织损伤小,痛苦小、疗程短、肛门功能保护好等优点,该术式的应用,使得高位复杂性肛瘘治疗更加安全、有效。     

TKA胫骨平台冠状位倾斜度与临床结果

目的研究TKA患者膝关节胫骨平台冠状位倾斜度与临床结果之间的关系。方法回顾性分析我科自2004年1月至2005年2月期间TKA的骨关节炎病例261例。按术后胫骨平台假体内外翻情况分为3组：A组（外翻组）、B组（中立组）和C组（内翻组）。结果 A、B、C三组间在患者性别比例、年龄、体重指数、止血带时间、术后引流量、术后住院时间方面无显著差异。术前膝关节畸形情况各组间无显著差异。各组间术前ROM及HSS评分无显著差异。在术后2周时的膝关节活动度方面,A组与B、C两组间均存在显著差异（P〈0.01）,B组与C组间存在显著差异（P〈0.05）。术后2周时HSS评分,A组与B、C两组间均存在显著差异（P〈0.05）,但B组与C组间无显著差异。术后2年HSS评分A、B、C三组间无显著差异。A组中有1例、B组中有2例,C组中有2例伤口脂肪液化;B组中有3例、C组中有1例术后出现患肢小腿肌间静脉血栓。结论 TKA术后冠状位倾斜度与术前因素、手术因素及手术并发症之间无显著相关性。TKA术后力线对近期临床结果可能有显著影响。通过进一步康复锻炼可弥补力线对长期临床结果的影响。     

Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh stentless bioprosthesis

OBJECTIVE: We investigated outcomes after surgical therapy in patients with active infective endocarditis (AIE) with regard to survival in relation to surgical urgency, valve position, number of valves implanted and abscess formation. We aimed to identify independent risk factors for early mortality. METHODS AND RESULTS: Two hundred and fifty-five patients received Shelhigh bioprostheses between February 2000 and March 2007. A total of 74.1% had native and 25.9% prosthetic AIE. Surgery was regarded as urgent in 57.3% and as an emergency procedure in 38.4%. There was a highly significant difference in survival rate between patients who were operated on urgently versus in an emergency (p<0.0001), between single and double valve replacement (p=0.0206) and between patients with and without abscess formation (p=0.0245). There were two cases of early reinfection (0.78%) and six of late reinfection (2.35%) leading to re-operation. CONCLUSIONS: The survival of patients differs significantly in dependence on their surgical urgency. Better outcome could have been achieved if patients had been referred earlier for surgery and operated upon before heart failure or septic shock developed. Long-term survival was better in patients without abscess formation. The low reinfection rate of Shelhigh bioprostheses in AIE is promising and the early and mid-term results achieved need to be verified in the long-term course.     

实时荧光RT-PCR定量检测前列腺癌组织中AMACR基因表达

目的 建立实时荧光定量逆转录聚合酶链反应(FQ-RT-PCR)检测AMACR mRNA的方法学并检测其在前列腺癌(PCa)组织中的表达.方法 在AMACR基因的2、3外显子之间设计一对引物及MGB探针,将PCR扩增产物与pMD18-T载体连接,构建重组质粒作为定量检测的标准品,建立实时荧光定量RT-PCR方法,然后对32例PCa、60例良性前列腺增生(BPH)及34例其它肿瘤组织进行AMACR mRNA的定量检测.结果 重组质粒经PCR扩增及序列测定,表明克隆成功,该方法灵敏度高,线性范围为5～5×108copies/reaction.AMACR mRNA在PCa组织中表达量显著高于BPH组织(P<0.01)及其他类型肿瘤组(P<0.01).ROC曲线分析结果显示,曲线下面积(AUC-ROC)为0.890,AMACR mRNA诊断前列腺癌的敏感度和特异度分别为81.3%和86.7%.PCa组织中AMACR mRNA表达量及检测阳性率与不同临床分期和病理分级之间的差异尚不具有统计学意义(P值均>0.05).结论 实时荧光定量RT-PCR检测AMACR mRNA的方法具有敏感、特异、准确、重复性好等特点.AMACR mRNA在前列腺组织中的表达对PCa的诊断具有一定的临床应用价值.     

The changes of the interspace angle after anterior correction and instrumentation in adolescent idiopathic scoliosis patients

Background  

In idiopathic scoliosis patients, after anterior spinal fusion and instrumentation, the discs (interspace angle) between the lowest instrumented vertebra (LIV) and the next caudal vertebra became more wedged. We reviewed these patients and analyzed the changes of the angle.