A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with sepsis.However,the pathogenesis underlying SA-AKI remains unclear.We hypothesized that the source of infection affects development of SA-AKI.We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.METHODS:Between January 2013 and January 2018,113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups:those with pulmonary infections and those with other sources of infection.For each patient,we collected data from admission until either discharge or death.We also recorded the clinical outcome after 90 days for the discharged patients.RESULTS:The most common source of infection was the lung(52/113 cases,46%),followed by gastrointestinal(GI)(25/113 cases,22.1%)and urinary(22/113,19.5%)sources.Our analysis showed that patients with SA-AKI had a significantly worse outcome(30/52 cases,P<0.001)and poorer kidney recovery(P=0.015)with pulmonary sources of infection than those infected by another source.Data also showed that patients not infected by a pulmonary source more likely experienced shock(28/61 cases,P=0.037).CONCLUSION:This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner.Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.     

Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma

Objective  The effect of coexistent chronic lymphocytic thyroiditis (CLT) on prognosis in papillary thyroid carcinoma (PTC) patients remains controversial. We evaluated the influence of coexistent CLT on prognostic outcome and the association of coexistent CLT with clinicopathological parameters.
Design  A retrospective study with a median follow-up of 70 months.
Patients and measurements  Patients with PTC who underwent total thyroidectomy followed by ¹³¹I remnant ablation between 1995 and 2003 at Asan Medical Center, Seoul, Korea were enrolled. CLT was diagnosed histopathologically.
Results  Among 1441 patients, 214 (14·9%) had coexistent CLT. A greater female preponderance was noted in the patients with CLT compared with those without CLT ( P  <   0·01). Mean tumour size in the patients with CLT was smaller than that in patients without CLT (2·0 ± 1·2 vs . 2·2 ± 1·4 cm; P  =   0·02). One hundred and fifty-one (12·3%) patients without CLT had recurrence, whereas 14 (7·1%) patients with CLT had recurrence during the follow-up period ( P  =   0·016). In patients with cervical lymph node metastases, those with coexistent CLT showed a significantly lower recurrence rate than those without CLT ( P  =   0·012). However, this association was lost on multivariate analysis adjusting for other clinicopathological predictors for recurrence.
Conclusions  In this study, CLT was commonly associated with PTC and was associated with smaller size of the primary tumour at presentation. CLT was also associated with a reduced risk of recurrence during follow-up, although this was not significant after adjustment for other prognostic factors.     

大孔吸附树脂分离纯化土茯苓总黄酮

目的:研究大孔吸附树脂分离纯化土茯苓总黄酮的工艺条件。方法:以土茯苓总黄酮收率为指标,通过考察静态和动态吸附实验,筛选了大孔吸附树脂分离纯化土茯苓总黄酮的最佳工艺条件。结果:D101大孔树脂对土茯苓总黄酮的静态饱和吸附容量为45.6 mg.g^-1(干树脂);最佳动态吸附、洗脱条件为土茯苓总黄酮提取液pH 6.00±0.20,质量浓度4.2 mg.mL^-1,吸附流速2 mL.min^-1,上样量15 mL;吸附后的树脂柱先以100 mL纯化水洗脱后,再用100 mL pH 8.00±0.20的60%乙醇以3 mL.min^-1流速洗脱。结论:D101型大孔树脂在所确定的工艺条件下,可较好的分离纯化土茯苓总黄酮,其回收率达到90%以上,且纯化后土茯苓总黄酮含量达到62.6%,是纯化前的近2倍。     

膝关节镜下重建修复膝关节交叉韧带

目的探讨膝关节镜下对急慢性前、后交叉韧带（ACL、PCL）断裂的重建治疗,以期恢复膝关节稳定性。方法在关节镜下使用自体或异体的骨-髌腱-骨、肌腱重建修复断裂的前、后交叉韧带。结果2001年2月至2007年7月共治疗前、后交叉韧带20例,术后平均随访12个月,效果良好。结论早期关节镜下重建修复断裂的前,后交叉韧带,手术创伤小,病人能最大限度的恢复膝关节稳定性和运动功能。     

P16和cyclinD1在鼻咽癌及癌前病变中表达的临床意义

目的 研究鼻咽癌及癌前病变组织中P16和cyclinD1蛋白的表达、相互关系及其意义.方法 采用免疫组化EnVision法,分别检测60例鼻咽癌、28例癌前病变及30例鼻咽粘膜慢性炎组织中P16和cyclinD1蛋白的表达情况,分析两者在不同病变组织中的表达以及与鼻咽癌临床病理特征的关系.结果 P16蛋白在鼻叫粘膜慢性炎组织的表达率高达90%(27/30),并随着病变进展,从癌前病变(不典型增生)至鼻咽癌,其阳性表达率呈下降趋势分别为64.3%(18/28)和283%(17/60);其中癌前病变和鼻咽癌与鼻咽粘膜慢性炎组织比较有统计学意义(P<0.05),并且P16蛋白的低表达与临床分期和淋巴结转移有关.cyclinD1蛋白在鼻咽粘膜慢性炎、癌前病变和鼻咽癌组织的阳性表达率分别为10%(3/30)、57.1%(16/28)和63.3%(38/60).其中鼻咽癌与鼻咽粘膜慢性炎组织比较有统计学意义(P<0.05),而鼻咽癌与癌前病变比较则无统计学意义(P>0.05),cyclinD1蛋白的过表达与临床分期和淋巴结转移无关.P16、cyclinD1蛋白的阳性表达率在鼻咽癌组织中呈负相关性(P<0.05).结论 P16、cyclinD1在鼻咽粘膜癌变过程中起着重要作用,P16基因的畸变或缺失可能参与鼻咽癌的发生发展过程;cyclinD1的过表达是鼻咽癌发生的早期事件.     

角膜内皮移植术

角膜内皮移植是一种新的治疗角膜内皮病变的手术方法,主要是采用健康的角膜内皮片替代病变内皮层.该方法因为几乎不改变患者的角膜曲率和屈光状态,损伤小,视力恢复快,近年来在临床上逐渐被推广应用,取得较好愈后效果.该方法是角膜移植手术不断精细化和向屈光性手术转化的具体体现.角膜内皮移植术后良好的屈光效果和可能的低排斥率,使其有望成为角膜内皮病变治疗的重要方式.但是,目前内皮移植手术仍然需要完善,改进植入方法以减少脱片率和内皮细胞损失率,利用飞秒激光等进一步提高屈光效果,以及观察术后免疫排斥率是今后眼科学者的研究重点.     

急性视网膜坏死综合征的误诊分析

目的 分析急性视网膜坏死综合征(Acute retinal necrosis syndrome,ARN)临床诊断中存在的问题.方法 收集1998年1月至2006年10月中山眼科中心确诊住院治疗、以往资料完整的114例ARN病人的临床资料,重点分析初诊时误诊、漏诊原因,发病至确诊时间、确诊前诊断、治疗等情况.结果 114例(141眼)ARN病人的盲目率(42/141)为29.79%;初诊时,Ⅰ、Ⅱ、Ⅲ-Ⅳ期误诊率分别为61/70(87.14%)、23/25(93.0%)、13/19(73.68%),发病至确诊时间最短为3 d,最长为420 d,平均为46.16 d.结论 ARN综合征漏诊、误诊率较高,急需提高ARN的早期确诊率使病人保存部分有用视力.     

农村贫困地区2002年至2006年县级卫生机构人员流动状况调查

Objective To probe into the HR development of healthcare professionals in poor rural areas. Methods 51 county-level healthcare institutions from 13 counties in six provinces were sampled to study the turnover from 2002 to 2006. Results The number of healthcare professionals per 1 000 population in the poor counties investigated was in average lower than that of counties in the same province; the inflow of personnel was higher than that of outflow. Of the inflow, 43. 50％ were fresh university graduates, and 40. 58％ were transferred from other organizations, 95.83％ have degrees of technical secondary schools and above, and 87. 17％ were healthcare professionals. 70. 44％ of the outflow were retirees, and 22. 33％ were transferred outside; 28. 00％ have only senior high school degrees or below, 69. 74％ were healthcare professionals. Conclusions The quality of healthcare personnel has been improved to some extent; but the risk of brain drain remains a challenge. An appropriate mechanism of personnel turnover should be built, and graduates from medical schools should be directed to reinforce healthcare teams in poor areas.     

IL-lB基因多态性和H.pylori感染对胃酸分泌的影响

目的通过研究IL-1B基因多态性和幽门螺旋杆菌（Helicobacter pylori，H．pylori）感染对胃酸分泌的影响，探讨IL-1B基因多态性与胃癌发生的可能机制。方法（1）采用PCR-限制性片段长度多态性（restriction fragment length polymorphism，RFLP）分析法检测胃癌低发区广东省117名健康志愿者IL-IB-511基因多态性。（2）采用ELISA方法检测上述人群的H，pylori感染率。（3）胃液分析方法分别检测上述人群不同基因型个体胃酸分泌的差异。结果基础酸排量（basal acid output，BAO）和最大酸排量（maximal acid output，MAO）在H．pylori阳性组与阴性组间无明显差异；在IL-1B-511T／T和C／C和C／T各基因之间，MAO、BAO均无明显差异。结论本研究未发现IL-1B基因多态性、H．pylori感染与胃酸的关系，提示IL-1B基因多态性途径可能不是通过影响胃黏膜IL-1β的产生量进而影响胃内酸分泌的。     

膝关节镜术后吗啡和玻璃酸钠关节内注射镇痛效果的评估

目的观察膝关节镜手术后关节腔内应用不同药物镇痛作用的差异。方法60例在硬膜外麻醉下行膝关节镜手术患者，随机分为3组（n=20），术后向关节腔内注入不同的药物。B组：0．375％的布比卡因；M组：2mg吗啡；BMH组：0．375％的布比卡因、吗啡2mg和玻璃酸钠30mg。记录术后第6、12、24、48h患者屈膝关节90。的视觉模拟评分（VAS）、病人满意度和副作用。结果术后第6、12、24、48h患者屈膝90。VAS评分M、BMH组均显著低于B组，BMH组较M组低，统计学差异均有显著性（P〈0．05）；术后镇痛满意度，M、BMH组较B组高，组间差有显著性（P〈0．05）；M组有1例恶心，余无其他副作用。结论关节腔内联合注射布比卡因、吗啡和玻璃酸钠可有效缓解膝关节镜术后疼痛，其镇痛效果优于单独应用。