血清超敏C反应蛋白与尿碘水平联合预测先兆流产患者保胎结局的研究

目的观察血清超敏C反应蛋白(hs-CRP)与尿碘水平联合对先兆流产患者保胎结局的预测效能。方法前瞻性选取海南医学院第二附属医院2018年1月至2020年1月收治的112例先兆流产患者作为研究对象,根据保胎结局将患者分为保胎失败组(n=20)与保胎成功组(n=92)。检测两组入院时各主要指标[甲状腺功能相关指标、血清孕酮(P)、β-人绒毛膜促性腺激素(β-HCG)、hs-CRP、尿碘水平],采用Logistic回归分析各主要指标与先兆流产患者保胎结局的关系,并分析入院时血清hs-CRP、尿碘水平对先兆流产患者保胎结局的预测效能。结果保胎失败组P、β-HCG水平低于保胎成功组,hs-CRP水平高于保胎成功组,合并甲状腺功能异常、尿碘水平异常占比高于保胎成功组(P<0.05)。经Logistic回归分析结果显示,先兆流产患者甲状腺功能异常、hs-CRP表达上调、尿碘水平异常是保胎成功的危险因素(OR>1,P<0.05);先兆流产患者P、β-HCG表达上调是保胎成功的保护因素(OR<1,P<0.05);绘制受试者工作特征(ROC)曲线发现,先兆流产患者hs-CRP...     

Association of Albumin and Globulin with Mortality Risk in Incident Peritoneal Dialysis Patients

Background: Nutrition and inflammation have been implicated in predicting mortality in patients on peritoneal dialysis (PD). Serum albumin and globulin can be regarded for the nutritional and inflammatory status. However, there is lack of data to evaluate the synergistic effect of albumin and globulin on mortality prediction. Methods: In 554 patients initiating PD from January 2001 to July 2016, we divided them into four groups by the combination of two categories of low vs. high albumin and low vs. high globulin. The median values for albumin and globulin were chosen to classify them into low or high groups. Their associations with all-cause and cardiovascular (CV) mortality were examined in Cox regression models adjusted for confounding clinical and laboratory data. Results: Patients, 52.91 ± 15.2 years old and 47.8% men, had a median (interquartile range) value of 3.3 (2.9–3.8) g/dL for albumin and 2.8 (2.5–3.2) g/dL for globulin, respectively. Patients with low albumin and high globulin had the highest all-cause mortality and CV mortality, with adjusted hazard ratios of 3.87 (95% CI 1.83–8.20, p < 0.001) and 5.65 (95% CI 2.23–14.34, p < 0.001), respectively, compared with those with a high albumin and low globulin having the lowest mortality rate. Sensitivity analyses further confirmed this relationship. Conclusions: A patient profile of either low albumin or high globulin is linked to a higher risk for mortality, particularly for a profile of both low albumin and high globulin compared with one without either of them. Further studies are needed to explore the mechanisms underlying this phenomenon and how to improve clinical outcomes in those high-risk patients.     

Thermodynamic and Kinetic Binding Behaviors of Human Serum Albumin to Silver Nanoparticles

A nanoparticle, under biological milieu, is inclined to be combined with various biomolecules, particularly protein, generating an interfacial corona which provides a new biological identity. Herein, the binding interaction between silver nanoparticles (AgNPs) and human serum albumin (HSA) was studied with transmission electron microscopy (TEM), circular dichroism (CD), and multiple spectroscopic techniques. Due to the ground state complex formed mainly through hydrophobic interactions, the fluorescence titration method proved that intrinsic fluorescence for HSA was probably statically quenched by AgNPs. The complete thermodynamic parameters were derived, indicating that the interaction between HSA and AgNPs is an entropy-driven process. Additionally, synchronous fluorescence and CD spectrum results suggested the conformational variation it has upon binding to AgNPs and the α-helix content has HSA visibly decreased. The kinetic experiments proved the double hysteresis effect has in HSA’s binding to the AgNPs surface. Moreover, the binding has between HSA and AgNPs follows the pseudo-second-order kinetic characteristic and fits the Freundlich model for multilayer adsorption. These results facilitate the comprehension about NPs’ underlying biological effects under a physiological environment and promote the secure applications of NPs biologically and medically.     

热乙醇法提取猪血白蛋白工艺改良的探讨

目的介绍运用热乙醇法提取高纯度猪血白蛋白的改良工艺流程。方法采用热乙醇法,在合适的恒温时间和pH值的条件下,分离提纯猪血清白蛋白。结果猪血白蛋白的纯度〉97％,回收率〉80％。检测结果显示,其理化指标均符合《中国生物制品规程2000年版》的要求,适合扩大到中试生产。结论该法与低温乙醇法、利凡诺法和盐析法相比,具有工艺简单、成本低、纯度和回收率高的特点。     

Efficacy,safety, and tolerability of mirabegron in patients aged ≥65 yr with overactive bladder wet: a phase IV,double-blind,randomised, placebo-controlled study (PILLAR)

BackgroundThe majority of patients with overactive bladder (OAB) are aged >65 yr. There has been no prospectively designed study assessing treatment efficacy with the β3-adrenoreceptor agonist, mirabegron, specifically in this age group.ObjectiveA phase IV study comparing flexibly dosed mirabegron versus placebo in elderly patients with OAB and urgency incontinence.Design, setting, and participantsCommunity-dwelling patients aged ≥65 yr with OAB for ≥3 mo.InterventionFollowing a 2-wk placebo run in, patients with one or more incontinence episodes, three or more urgency episodes, and an average of eight or more micturitions/24 h were randomised 1:1 to double-blind 25 mg/d mirabegron or matched placebo, for 12 wk. After week 4 or 8, the dose could be increased to 50 mg/d mirabegron/matched placebo based on patient and investigator discretion.Outcome measurements and statistical analysisCoprimary endpoints: change from baseline to end of treatment (EOT) in the mean numbers of micturitions/24 h and incontinence episodes/24 h. Secondary endpoints: change from baseline to EOT in the mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Analysis of covariance (ANCOVA) was used for the mean number of micturitions/24 h, mean volume voided/micturition, and mean number of urgency episodes/24 h. Stratified rank ANCOVA was used for the mean numbers of incontinence episodes/24 h and urgency incontinence episodes/24 h.Results and limitationsStatistically significant improvements were observed for mirabegron versus placebo in change from baseline to EOT in the mean number of micturitions/24 h, mean number of incontinence episodes/24 h, mean volume voided/micturition, mean number of urgency episodes/24 h, and mean number of urgency incontinence episodes/24 h. Safety and tolerability were consistent with the known mirabegron safety profile.ConclusionsMirabegron efficacy, safety, and tolerability over 12 wk were confirmed in patients aged ≥65 yr with OAB and incontinence.Patient summaryWe examined the effect of mirabegron compared with placebo in people aged 65 yr or older with overactive bladder and incontinence. Mirabegron improved the symptoms of overactive bladder compared with placebo. Side effects were similar to those already known for mirabegron.     

留置导尿集尿袋更换时间与尿路感染的相关性研究

目的：探讨留置导尿患者集尿袋更换时间与尿路感染的相关性及护理预防对策；方法：选择我院内科病区脑血管意外留置导尿患者61例，分实验组与对照组在不同间隔时间内予以更换集尿袋，追踪监测尿培养，对出现尿培养阳性结果进行统计学分析。结论：在严格按照护理质控与院内感染要求下，临床上集尿袋更换间隔时间以一周一次较为科学有效。     

糖尿病肾病动态血压模式的特点及其与尿蛋白的关系

目的 :观察糖尿病肾损害不同时期患者的血压模式的变化 ,及其在糖尿病肾病发生机制中所起的作用。方法 :分别选取血糖稳定、临床血压正常的 、 、 期 2型糖尿病肾损害患者 ,进行动态血压测定 ,观察他们日夜血压模式的特点并与正常对照组进行对比。结果 :实验组患者的共同特点为夜间血压的升高及非勺型曲线的出现率增高 ,且后者与尿蛋白的水平成正相关。结论 :糖尿病肾损害患者的血压模式的改变 ,先于血压的升高及尿蛋白的明显增多 ,提示自主神经功能的受损 ,是糖尿病肾病的发病机制之一。     

肾盏憩室误诊为肾囊肿导致术后漏尿的防治探讨（附8例报道）

目的探讨肾盏憩室去顶术后漏尿的治疗方法及预防措施。方法选择2003年至2013年我院收治的8例术后漏尿的患者,术前均误诊为肾囊肿,术后证实为肾盏憩室。在逆行插入D-J管的基础上,1例漏尿自然愈合;7例行手术治疗,其中1例采取微创顺行切开扩大憩室颈的方法,4例行开放手术,2例行腹腔镜手术,术中缝合憩室颈开口,灼烧憩室腔黏膜。结果所有患者漏尿均愈合,患者无发热,无腰痛,B超显示患肾周围无积液,其中6例憩室完全消失,2例可见憩室较术前明显减小。结论肾盏憩室行去顶减压后出现的漏尿不易自行愈合,应采用手术治疗,预后较好。而术前正确诊断肾盏憩室是减少术后漏尿的关键。     

Red blood cell distribution width‐to‐albumin ratio is associated with all‐cause mortality in cancer patients

BackgroundCancer causes a serious health burden on patients worldwide. Chronic low‐level inflammation plays a key role in tumorigenesis and prognosis. However, the role of the red blood cell distribution width (RDW)‐to‐albumin (RA) ratio in cancer mortality remains unclear.MethodsIn this retrospective cohort study, we collected clinical information from cancer patients from the Medical Information Mart for Intensive Care III (MIMIC‐III) version 1.4 database and then calculated RA by dividing RDW by albumin concentration. The primary outcome was 30 days mortality, while secondary outcomes were 90 days and 1 year mortality. Next, we adopted Cox regression models to calculate hazard ratios (HR) together with 95% confidence intervals (CI) for all‐cause mortalities associated with the RA ratio.ResultsFor 30 days mortality, the HR (95% CI) for the high RA ratio (≥5.51) was 2.17 [95CI% (1.87–2.51); p = <0.0001], compared with the low RA ratio (<5.51). In Model 2, we adjusted sex and age and obtained HR (95% CI) of 2.17 [95CI% (1.87–2.52); p = <0.0001] for the high RA ratio (≥5.51) group, compared to that in the low RA ratio (<5.51). In Model 3, adjusting for age, sex, anion gap, hematocrit, white blood cell count, congestive heart failure, SOFA, liver disease, and renal failure resulted in HR (95% CI) of 1.74 [95CI% (1.48–2.04); p = <0.0001] for the high RA ratio (≥5.51) relative to the low RA ratio (<5.51). We also analyzed common diseases in cancer patients but found no significant association.ConclusionTo the best of our knowledge, this is the first study demonstrating that increased RA ratio is independently associated with increased all‐cause mortality in cancer patients.     

女性输尿管完全重复畸形的诊治(附38例报告)

目的探讨女性输尿管完全重复畸形的诊断及治疗。方法回顾性分析2000年1月至2005年12月所收治并获得随访的38例女性输尿管完全重复畸形患者。影像学检查确定诊断,所有患者均进行手术治疗。结果术后取得满意疗效,无进行性肾积水、肾功能损害,尿失禁完全消失。结论影像学检查在女性输尿管完全重复畸形的诊断中意义重大,手术治疗可取得满意疗效。