Acute Renal Failure after Lung Transplantation: Incidence, Predictors and Impact on Perioperative Morbidity and Mortality

The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up was extended until December 2002. Patients were initially divided into two groups: ARF (doubling of baseline creatinine within 2 weeks after surgery) and NoARF. The ARF group was subdivided into ARFD (dialyzed) and ARFnD (not dialyzed). The incidence of ARF was 56% (166/296), but most cases were ARFnD (n = 143). Independent predictors of ARFD (n = 23) were: baseline GFR (OR 0.98, CI 0.96-0.99, p = 0.012), pulmonary diagnosis other than COPD (OR 6.80, CI 1.5-30.89, p = 0.013), mechanical ventilation > 1 d (OR 6.16, CI 1.70-22.24, p = 0.006) and parenteral amphotericin B use (OR 3.04, CI 1.03-8.98, p = 0.045). Both ARFnD and ARFD were associated with longer duration of mechanical ventilation, increased hospital stay and increased early mortality. One-year patient survival was 92.3%, 81.8% and 21.7% in the NoARF, ARFnD and ARFD groups, respectively (p < 0.0001). After controlling for important covariates, ARFD remained associated with an increased hazard of dying (HR 6.77, CI 4.00-11.44, p < 0.0001). In conclusion, ARF occurs commonly after lung transplantation and affects important clinical outcomes, especially when dialysis is required.     

老年冠心病患者踝臂指数和心脏结构与功能的相关分析

目的探讨老年冠心病患者踝臂指数(ABI)和心脏结构与功能的相关性。方法87例老年冠心病患者,按ABI分组,A组ABI≤0.9,B组ABI>0.9,同时测量2组的心脏结构指标:左心房直径(LAD)、左心室舒张期直径(LVDD)、左心室后壁厚度(LVPW)。左室收缩功能指标:左室缩短率(FS)、左室射血分数(EF)。左室舒张功能指标:EF斜率。结果A、B2组比较,年龄、血脂、血糖、肝功能、肾功能、LAD、LVDD、LVPW和EF斜率均无显著性差异。FS和EF均有显著性差异,A组较B组明显降低(P<0.05)。结论ABI与老年冠心病患者的心脏功能有较好的相关性,对其预后的判定有一定的价值。     

物理疗法治疗慢性疲劳综合征的临床观察

目的:观察与评价两种物理疗法对慢性疲劳综合征的临床疗效。方法:应用随机数字表,随机分为治疗组和对照组。治疗组36例,男12例,女24例;年龄27~65岁,平均50.80岁。对照组36例,男19例,女17例;年龄23~60岁,平均41.37岁。治疗组采用温热理疗床治疗6周。对照组采用腹部推拿手法治疗6周。观察并对比两组治疗前后记忆力或注意力下降,咽痛,颈部僵直或腋下淋巴结肿大、触痛,肌肉疼痛,多发性关节疼痛,反复头痛,睡眠紊乱,劳累后肌痛等症状体征的变化。结果:两组治疗后症状体征积分变化均有统计学意义(P<0.05);两组间疗效变化有统计学意义(P<0.05),对照组优于治疗组。结论:物理疗法对慢性疲劳综合征引起的一系列临床症状及体征具有一定程度的改善效果。     

Calcineurin Inhibitor Withdrawal from Sirolimus-Based Therapy in Kidney Transplantation: A Systematic Review of Randomized Trials

Calcineurin inhibitor (CNI) withdrawal has been used as a strategy to improve renal allograft function, however, it also carries risk of acute rejection. We conducted a systematic review of randomized trials that involved CNI withdrawal from a sirolimus-based immunosuppressive regimen. The search strategy yielded six trials (n = 1047 patients) reported in eight publications. CNI withdrawal from sirolimus-based therapy, was associated with an increased risk of acute rejection (risk difference, 6%; 95% CI 2-10%, p = 0.002) but a higher creatinine clearance (mean difference, 7.49 mL/min; 95% CI 5.08-9.89 mL/min, p < 0.00001) at 1 year compared to continued CNI and sirolimus therapy. Graft loss (relative risk, 0.87; 95% CI 0.46-1.64, p = 0.66) and death (relative risk, 0.88; CI 0.40-1.96, p = 0.76) were similar in both groups at 1 year. Hypertension was significantly reduced in the CNI withdrawal group (relative risk, 0.56; 95% CI 0.40-0.78, p = 0.0006). CNI withdrawal from sirolimus-based therapy is associated with an increased risk of acute rejection in the short term with a significant improvement in renal function and a reduction in hypertension. Longer follow-up is needed to determine if these changes will result in a significant improvement in patient and graft survival.     

中面部牵引成骨术后眶周结构三维位置变化的评估

目的 观察中面部牵引成骨技术对眼眶周围软、硬组织结构的三维空间位置变化的影响.方法 回顾性分析2003年9月至2006年6月接受Le Fort III型截骨+中面部牵引成骨术的8例Crouzon综合征患者CT数据,平均年龄11.9岁,实施影像三维重建后,采用眶耳平面(术前)作为测量的基准平面,分别选择眶上点、眶下点、眶内缘点、眶外缘点、眼球前点、眼球后点,以及上、下、内、外四直肌与眼球的附着点作为评估标志,以双侧耳门上点连线作为颅底宽度基准,记录各个主要标志点至耳门上点连线的矢状距(y轴向)、垂直距(z轴向)以及眼球前点、眼球后点的水平间距(x轴向)变化,行配对t检验,并与健康对照组比较.结果 牵引成骨术前后眼球前点的y轴向及z轴向位置并没有显著性变化,但x轴向间距变化为-3.40 mm;眶下点移动在y轴向平均12.24 mm,z轴向平均4.25 mm;眶内缘点移动在y轴向平均10.11 mm,z轴向平均2.80 mm;眶外缘点移动在y轴向平均9.86 mm,z轴向平均2.31mm;下直肌支点移动,y轴向平均3.63mm,z轴向平均2.98mm.其余各标记点未见有临床意义的位移变化.结论 以Le Fort III型截骨为主的面中部牵引成骨技术,可以使Crouzon综合征患者的术后眼眶内、外、下侧壁均出现明显的前、下方移位,而患者的眼球没有显著性的矢状向位置变化,仅呈现轻度的内移、下降和前上方旋转.     

急性病毒性心肌炎的发病机制和临床特征

急性病毒性心肌炎是由病毒侵犯引起心肌本身的病变,包括病毒感染对心肌的损害、细胞免疫以及多种细胞因子等介导的心肌损害和微血管损伤。这些变化损害心脏功能和结构,而危及生命。且近年发病呈逐年上升趋势,其发病症状隐匿突然,加重了其危害性。本文就急性病毒性心肌炎发病机制和临床特征进行总结。     

Azoospermia in two brothers with Kartagener syndrome:a family history and diagnosis

0This article describes 2 infertile brothers of asoospermia equally associated with co-existing sinusitis,bronchiectasis,and situs inversus and their family history.These two cases were diagnosed as Kartagener syndrome(KS).The patients were not offspring of kin marriages but their family members with scattered bronchi-pulmouary infections were discovered.No one manifests azoospermia,dextrocardia or situs inversus in the paternal family ex-cept two cases reported.No abnormalities were found in their mother-side family.KS should be differentiated from Young's syndrome,cystic fibrosis(CF),and other diseases such as Kallmann's syndrome in male infertility clinic.     

A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca

PURPOSE: To evaluate the effects of dissolvable collagen punctal plugs on the symptoms, tear stability and volume in aqueous deficient dry eyes. METHODS: Sixty-two aqueous deficient dry eye patients of mixed aetiology underwent lacrimal punctal occlusion with dissolvable collagen plugs. The subjects were randomly allocated to one of two treatment groups: group I (n = 36) had their lower puncta occluded and group II (n = 26) had both their upper and lower puncta occluded. The effectiveness of this treatment was clinically assessed by (1). scoring subject symptoms and (2). measuring the tear parameters of tear thinning time (TTT) and tear meniscus height (TMH) as indicators of tear stability and volume, respectively. Following baseline measurements, patients were reviewed at time intervals of 5 and 12 days post-occlusion. A group of age- and gender-matched normals (n = 45) was recruited for comparison (group III). RESULTS: Tear volume and stability were significantly higher in group III compared with I and II at baseline. In the treated groups on both days 5 and 12: (1). symptom score reduced significantly from a median value of 7 to 3 (p = <0.001); (2). tear stability increased significantly from a median value of 3 to 5 s by day 5 (p 相似文献   

支气管扩张症辨证模式初探

目的:探讨支气管扩张症的中医辨证分型规律及证候特点.方法:通过对563例支气管扩张症的临床流行病学调查,采集以症状、体征、舌、脉及相关理化检测为变量的基本信息,以频数分析、聚类分析、方差分析等方法,提炼支气管扩张症的证候分布规律及证候特点.结果:临床上支气管扩张症多见4种证候类型,分别为痰热壅肺证(45.65%)、肝火犯肺证(24.51%)、肺脾气虚证(22.38%)、气阴两虚证(7.46%).结论:较大样本的临床流行病学调查为研究支气管扩张症辨证分型规律提供了科学依据,并可以通过主症判别分析法建立证候识别模式,为临床实践提供依据.