B超引导穿刺的微通道经皮肾镜碎石术治疗肾盏结石

目的 评价B超引导穿刺的微通道( F12F16)经皮肾镜碎石术治疗肾盏结石的安全性和有效性.方法 2009年5月2011年8月共收治ESWL无效及透X线肾盏结石44例(44侧肾结石),其中下盏结石24侧,中盏结石11侧,分支性肾盂上盏合并下盏结石9侧,结石长径(16.14±5.12)mm.采用B超引导穿刺的微通道(F12～F16)经皮肾镜碎石术,气压弹道击碎并清除结石.结果 44例均一期建立通道并碎石,其中单通道36侧肾,双通道9侧肾;经上盏建立通道9个,经中盏11个,经下盏33个.手术时间(49.3±10.9)min,一期手术结石清除率97.73％ (43/44).术后血红蛋白含量较术前下降(9.13±3.7)g/L.围手术期无输血,与手术相关的感染发生率为6.18％ (3/44),主要表现为术后发热,无气胸或腹腔脏器损伤.44例随访6～20个月,平均11.4个月,1例残余结石排出,术后6个月结石复发率为2.27％(1/44),1年结石复发率为6.18％ (3/44).结论 B超引导穿刺的微通道经皮肾镜碎石术治疗肾盏结石有效、安全,是此类结石的首选治疗方法.     

Prospective study of atrial natriuretic peptide for the prevention of radiocontrast-induced nephropathy

Radiocontrast-induced nephropathy (RCIN) is a common cause of hospital-acquired acute renal failure and is associated with a high mortality rate. RCIN is potentially preventable, because administration of the radiocontrast agent is predictable, and a high-risk population has been identified. This multicenter, prospective, randomized, double-blind, placebo-controlled trial was performed to evaluate the efficacy of intravenous atrial natriuretic peptide (anaritide, ANP 4-28) to prevent RCIN. Patients with stable chronic renal failure (serum creatinine greater than 1.8 mg/dL or serum creatinine between 1.5 and 1.8 mg/dL with estimated creatinine clearance of < or = 65 mL/min) were assigned to receive either placebo or one of three doses of anaritide (0.01 microg/kg/min, 0.05 microg/kg/min, or 0.1 microg/kg/min) for 30 minutes before and continuing for 30 minutes after radiocontrast administration. All patients were given intravenous 0.45% saline for 12 hours before the radiocontrast procedure and continuing for 12 hours after the last dose of radiocontrast. Both ionic and nonionic radiocontrast agents were administered. RCIN was defined as either an absolute increase of serum creatinine of > or = 0.5 mg/dL or a percent increase of > or = 25% over baseline. Of the 247 patients who completed the study, 50% had diabetes mellitus. There were no statistical differences in baseline serum creatinine, change in serum creatinine, or the incidence of RCIN. The incidence of RCIN was placebo, 19%; anaritide (0.01), 23%; anaritide (0.05), 23%; anaritide (0.1), 25%. Patients with diabetes mellitus had a significantly greater incidence of RCIN: placebo, 26% versus 9%; anaritide (0.01), 33% versus 13%; anaritide (0.05), 26% versus 21%; anaritide (0.1), 39% versus 8% (diabetic v nondiabetic, P < 0.002). There was no effect in the diabetic or nondiabetic groups by anaritide on the incidence of RCIN. Comparison of the highest-risk group of patients, defined as patients with diabetes mellitus and a baseline serum creatinine > or = 1.8 mg/dL, with the lowest-risk group, defined as patients without diabetes mellitus and a baseline serum creatinine of 1.8 mg/dL or less, did not show a beneficial effect of anaritide administration. In conclusion, administration of intravenous anaritide before and during a radiocontrast study did not reduce the incidence of RCIN in patients with preexisting chronic renal failure, with or without diabetes mellitus.     

HLA配型与肾移植术后早期急性排斥反应的关系

目的 研究ＨＬＡ配型与尸体肾移植术后早期急性排斥反应的关系。方法 将２６２例尸体肾移植受者按ＨＬＡ配型的误配率（ＭＭ）进行分组,统计各组术后１～２个月内急性排斥反应的发生次数。结果 当ＭＭ〉３时,若接受的器官ＨＬＡ抗原／基因为可接受性,术后急性排斥反应的发生率为１６．４％;若供体器官ＨＬＡ抗原／基因具免疫原性,则急性排斥反应的发生率为３３．１％,两者比较,Ｐ〈０．０５。结论 供受者间ＨＬＡ配型越好     

胰岛细胞及肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症四例

目的　观察成人胰岛细胞及肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症的临床效果。方法　对 4例胰岛素依赖型糖尿病合并尿毒症的患者施行成人胰岛细胞及肾联合移植。肾移植为常规术式 ,在移植肾开放血液循环后 ,将分离、纯化、培养好的胰岛细胞注入门静脉中。移植后监测患者的空腹血糖、基础C 酞、糖化血红蛋白及肾功能的变化 ,并与其术前各项指标比较。结果　 4例患者术后在观察期间内胰岛素的用量均较术前减少超过 2 5 % ,且持续 3个月以上 ;空腹血糖基本保持在正常水平 ,基础C 酞也基本维持在正常水平 ,糖化血红蛋白于术后降至正常水平 ;4例患者的移植肾功能良好 ,3例患者已恢复正常工作。结论　成人尸体胰岛细胞及肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症的临床效果较好 ,具有操作简单、安全等优点     

绝经前后女性冠心病患者HDL及LDL颗粒与冠状动脉病变程度的相关性研究

目的探讨绝经前后女性冠心病患者高密度脂蛋白(HDL)颗粒及低密度脂蛋白(LDL)颗粒与冠状动脉病变程度的关系。方法收集经冠状动脉造影确诊的女性冠心病患者79例,根据是否绝经分为绝经前组(n=37)和绝经后组(n=42)。Lipoprint脂蛋白分析仪对HDL颗粒及LDL颗粒进行检测分析,探讨两种脂蛋白颗粒与冠状动脉病变程度的关系。结果与绝经前组比较,绝经后组大颗粒HDL浓度(102.6±45.2 mg/L比143.8±49.7 mg/L,P0.05)及所占比例(23.34%±8.26%比31.15%±7.98%,P0.05)、LDL颗粒平均直径(259.5±8.1比265.7±3.7,P0.05)均降低,小颗粒HDL浓度(124.0±76.8 mg/L比87.0±34.9 mg/L,P0.05)及所占比例(27.26%±12.34%比18.62%±6.53%,P0.05)、LDL B型比例(73.8%比48.6%,P0.05)、Gensini积分(50.88±26.46比30.43±18.54,P0.05)均增高。绝经前组及绝经后组多支病变患者大颗粒HDL浓度、LDL颗粒平均直径均低于单支病变患者,Gensini积分高于单支病变患者;绝经后组大颗粒HDL浓度、LDL颗粒平均直径均低于绝经前组,小颗粒HDL所占比例及Gensini积分高于绝经前组。绝经前组和绝经后组LDL颗粒大小及大颗粒HDL浓度均与Gensini积分呈负相关。结论与绝经前组相比,绝经后组大颗粒HDL浓度较低,小颗粒HDL浓度较高,LDL颗粒平均直径较小,冠状动脉病变程度较严重;大颗粒HDL浓度及LDL平均直径与冠状动脉病变严重程度明显相关。     

Platelet modulation of polymorphonuclear leukocyte shear induced aggregation

A cone and plate viscometer and Coulter Counter were used to study platelet modulation of polymorphonuclear leukocyte (PMNL) aggregation caused by controlled shear stress. As an index of aggregation, the large-particle percentage (LPP) was calculated. This represents the ratio of aggregated cell count to total cell count. PMNL suspensions in buffer (1.0 X 10(7) cells per milliliter, final concentration) did not show any aggregate formation at shear stresses below 150 dynes/cm2 for one minute exposure time (LPP less than 3%). However, there was PMNL aggregation in mixed PMNL and platelet-rich plasma suspensions in this shear stress range. Supernatant plasma from sheared platelets initiated PMNL aggregation at moderate shear stress (150 dynes/cm2 for one minute; LPP, 20.3% +/- 2.5%). In contrast, platelet release factors, such as adenosine diphosphate (2 mumol/L) and serotonin (2 mumol/L) did not cause PMNL aggregation (LPP, 2.9% +/- 1.2% and 3.3% +/- 0.8%, respectively). The use of a cyclo-oxygenase inhibitor (acetylsalicylic acid, 50 mumol/L) did not suppress the aggregation of PMNLs after shear (LPP, 20.1% +/- 2.4%). However, preincubation with nordihydroguaiaretic acid (10 mumol/L), an inhibitor of C-5 and C-12 lipoxygenase, and 6,9- deepoxy-6,9-(phenylimino)-6,8-prostaglandin I1 (U-60257, 10 mumol/L), an inhibitor of C-5 lipoxygenase in human leukocytes, suppressed this aggregation (LPP, 9.1% +/- 2.5% and 10.4% +/- 3.2%, respectively). Also, the formation of lipoxygenase products (5-HETE, 12-HETE, 15-HETE, and LTB4) activated by shear stress was documented by reversed phase- high-performance liquid chromatography (RP-HPLC). These data support the possibility of a cooperation between platelets and leukocytes in shear-induced PMNL aggregation that is dependent on C-12 or C-5 lipoxygenase activity, or both.     

Standardized submaximal exercise testing in never smokers: a normative study

In a population survey on the south‐western coast of Norway, 373 never smokers aged 18–73 years (230 women) without respiratory symptoms performed a standardized, progressive, incremental submaximal bicycle exercise test. All individuals were able to do an exercise involving oxygen uptake of 1·0 l min^–1, 80% of the subjects reached 1·5 l min^–1 and 50% of the subjects reached 2·0 l min^–1. The respiratory frequency (RF), ventilation (VE) and heart rate (HR) for a given oxygen uptake were all higher in women than in men. Significant predictors of failure to reach oxygen uptake of 1·5 and 2·0 l min^–1 were sex, age, body height and weight. Prediction equations are given for respiratory frequency, heart rate and ventilation for an oxygen uptake of 1·0 l min^–1 in women and 1·5 l min^–1 in men; and body height is a strong predictor for all dependent variables. A multiple linear regression analysis in women showed that age was a significant predictor of respiratory frequency (P<0·05), ventilation (P<0·001) and heart rate (P<0·001), while in men age was a significant predictor only of ventilation (P<0·001) during the bicycle exercise protocol.     

Lithium augments GM-CSA generation in canine cyclic hematopoiesis

Cyclic hematopoiesis in gray collie dogs can be cured by lithium treatment. We examined the mechanism of lithium's effect by developing an assay for the canine equivalent of GM-CSF (called GM-CSA). Phytohemagglutinin (PHA)-stimulated canine blood mononuclear cells produce GM-CSA in a dose-dependent manner; this GM-CSA stimulates more neutrophil-containing colonies than does endotoxin-treated dog serum. Production of GM-CSA by PHA-stimulated normal dog cells was not altered by lithium. However, cells from gray collies during their neutrophilic period increased their GM-CSA when lithium (2 mEq/L) was added to low doses of PHA, whereas neutropenic gray collie cells did not. These data suggest that lithium could modulate cyclic hematopoiesis by increasing intramedullary GM-CSA at the time when marrow neutrophilic progenitor cells are at their nadir.