Phosphate end dialysis value : a misleading parameter of hemodialysis efficiency

Despite low end dialysis serum phosphate levels (P_e) the control of phosphate retention remains often unsatisfactory in dialyzed patients. In order to assess the value of P_e in dialyzed children as an indicator of dialytic phosphate removal, we studied serum phosphate kinetics over the period of dialysis and post dialysis and compared these with urea kinetics. A multicenter study was conducted in the 21 French pediatric hemodialysis units and included 144 children under 15 years of age. Blood urea and phosphate concentrations were measured at the beginning, at 45 min later, at the end of dialysis, and 30 min post dialysis. At 60 min and at 360 min post dialysis measurements were made only for a subgroup of 12 children. From the serum levels, reduction ratios for urea (URR) and phosphate (PRR) and post dialysis rebound for urea (PDUR) and phosphate (PDPR) were calculated. URR (over the dialysis session, 72%±9%) was higher than PRR (47%±12%). Moreover, urea removal continued throughout the dialysis period, while most of the reduction in phosphate occurred in the initial dialysis period. Post dialysis urea rebound was limited to the 60th min post dialysis, whereas post dialysis phosphate rebound occurred until the 360th min post dialysis; by this time the serum phosphate levels had almost reached the predialysis levels. In summary, serum phosphate kinetics over dialysis and post dialysis periods in children appear to be misleading for the quantification of phosphate removal, i. e., phosphate clearance is a poor indicator of dialytic phosphate removal. Received September 21, 1995; received in revised form and accepted June 11, 1996     

锯齿缘断离术式选择与疗效的关系

报告５０例（５３眼）锯齿缘断离视网膜脱离的临床特点与术式，正确地选择术式视网膜复位率达１００％，其中１次复位率为９０．５７％，讨论了４种术式的适应症，作用原理和复位率。认为正确选择术式与疗效有密切关系。     

哺乳妇女单次注射迪波盖司通~长效避孕针后血清和乳液中MPA浓度变化

目的:探讨中国妇女哺乳期使用迪波盖司通后血清和乳液醋酸甲羟孕酮(MPA)浓度变化。方法:10名产后哺乳妇女单次注射迪波盖司通(含MPA150mg),在注射后的第1、2、4、6、8、10和12周采集血样和乳液样本,用放射免疫方法测定MPA。结果:血清MPA浓度于注射后第1周最高,到第2、4周时下降明显,第4周后浓度下降趋势逐渐缓慢。乳液MPA浓度在第1周为最高,第2周比第1周降低了约1/2,之后10周平均浓度变化波动在5.09-8.15ng/ml之间。观察期间乳液/血清MPA浓度比值和曲线下浓度面积比值均为0.55。对象之间和同一对象不同时间点乳液/血清MPA浓度存在明显个体差异。结论:哺乳期使用迪波盖司通,将导致血液和乳液中含有一定量的MPA。     

青少年近视患者配戴渐进多焦眼镜的视光学检查现状初步分析

目的:调查青少年近视患者配戴渐进多焦眼镜的现状,分析其对眼部参数的影响。方法:随机抽查配戴渐进光眼镜的近视患者214名,对其进行视光学检查,包括屈光度、斜视度、AC/A率、辐接近点和融合范围等项目,并调查其心理感受。其检查结果与256名年龄相匹配的戴用单焦眼镜的近视患者相对照,分析其变量的变化。结果:配戴渐变多焦眼镜的近视患者中140例无不适感觉,满意程度明显高于对照组;屈光度平均为-3.5D,约半数患者(48.6％)存在不同程度的外隐斜,其中8位是间歇性外斜患者,没有融合能力,辐辏近点大于20 cm;平均AC/A率为(2.95±1.49),平均融合力为+16.41°～-7.06°,平均辐转近点为(72.63±24.42)mm。实验组除AC/A率低于对照组(t=3.52,P<0.05),且与屈光度无明显相关(r=-0.0318,P>0.05)外,其余检查与对照组之间没有显著性差别。结论:渐进多焦眼镜可以引起AC/A率降低,并有可能通过掩饰间歇性外斜患者 的症状而耽误其治疗。因此,渐进多焦眼镜虽然普遍受青少年近视患者欢迎,但验配中仍存在适应证选择问题,青少年在验配时最好在医生的指导下进行。     

Urethral closure function in women with prolapse

In 19 patients with different types of severe descensus, all without clinical evidence of stress incontinence, urethral stress pressure profiles and stress tests were done before and after repositioning of the prolapse. In 13 of the 19 patients, continence was artificial, because during repositioning they showed leakage of urine; however, 6 of the patients remained continent. The pressure transmission ratios decreased in different parts of the urethra in all the patients when repositioning with a gynecological speculum was done. The drop was most significant in those patients who lost urine after repositioning, showing poor urethral function. In women with genito-urinary prolapse, a test of urethral function is essential, even if there is no clinical evidence of incontinence after removal of the descensus. In cases of severe stress incontinence under this condition, a procedure for bladder neck stabilization should be added to routine prolapse surgery.     

焦痂提取液中丙二醛含量对线粒体呼吸及内膜能化作用的影响

大鼠背部20％光辐射Ⅲ度烧伤7天后的焦痂提取液及1:4、1:8稀释液能对正常大鼠肝线粒体呼吸产生明显的抑制作用,相同方法制成的正常皮提取液只呈轻度抑制,1:4稀释液已无抑制作用,两者丙二醛含量相差悬殊,丙二醛含量与抑制率呈相关,但进一步分析表明这种相关为共存现象,丙二醛含量增高不是呼吸率下降的直接原因。丙二醛增高与膜脂双层的破坏有关,内膜能化作用实验表明,当膜脂受到一定程度破坏时,能化作用受到抑制。然而在能化作用未表现异常时,呼吸率已呈一定程度抑制,故呼吸率抑制还受到提取液其他组分的影响。     

Evaluation of the percentage of sperm motility at 24 h and sperm survival ratio for prediction of in vitro fertilization

Summary. The present study was carried out to investigate the predictive value of the percentage of sperm motility after 24-h incubation and sperm survival ratio from semen and inseminated sperm suspension using grading of motility by WHO criteria with respect to the fertilization of oocytes in vitro. A total of 789 oocytes from 85 cases were inseminated and the mean fertilization rate obtained was 72.5%. There was no significant correlation between all of the sperm motility results with fertilization rate in vitro. All sperm motility results were not significantly different between the non-fertilizing group and the fertilizing group and also between the group of fertilization rate ≤ 25th percentile (fertilization rate ≤62.5%) and the group of fertilization rate >62.5%. However, the initial percentage of rapid progressive sperm motility and progressive motility in semen and inseminated sperm suspension at 24 h gave significant differences between the group of fertilization ≤ 50th percentile (fertilization rate ≤80%) and the group of fertilization rate >80%. Overall accuracy using these parameters for prediction of fertilization rate >80% was only about 60%. In conclusion, the percentage of sperm motility at 24 h and sperm survival ratio in both semen and inseminated sperm suspension have no practical value in predicting fertilization rate in vitro. Moreover, detailed motility grading cannot improve the predictivity of these sperm motility parameters.     

等速离心训练对肩关节内外旋肌的肌力平衡及神经肌肉控制能力的影响

背景 肩关节内外旋肌肌力失衡会增加肩部运动损伤的风险,研究等速离心训练(IET)能否提高肌力平衡并改善神经肌肉控制能力具有重要的损伤预防意义。目的 探讨IET对健康青年人肩关节内外旋肌的肌力平衡及神经肌肉控制能力的影响。方法 2020年12月至2021年11月在复旦大学附属中山医院招募32例健康青年志愿者为研究对象,随机将其分为试验组(n=16)和对照组(n=16)。试验组接受4周IET,对照组接受4周连续被动运动训练(2次/周)。采用Biodex System 4 Pro多关节等速肌力测试与训练系统(美国Biodex公司)对两组研究对象的优势侧肩关节内、外旋肌群进行训练干预,分别在60(°)/s、120(°)/s速度下进行,干预前1周、干预结束后1周对两组肩关节内外旋肌的功能性比率(FR)、加速时间(AT)和达峰力矩时间(TPT)进行评估并比较。结果 试验组全部完成了4周的训练干预和评估,对照组2例中途退出。最终共30例研究对象数据纳入统计学分析。在60(°)/s和120(°)/s速度下,试验组干预后FR高于对照组(P<0.001),试验组干预后FR高于干预前(配对t检验：t<...     

中性粒细胞/淋巴细胞比值对冠状动脉旁路移植术后心肌损伤的影响

探讨患者术前中性粒细胞/淋巴细胞比值（NLR）对非体外循环下冠状动脉旁路移植术（OPCABG）后心肌损伤以及临床预后的影响。方法 选取2014年1月—2019年12月我院收治的314名行OPCABG的患者,依据患者术前NLR的三分位数分为高比值组（NLR＞2.8,n=102）、中比值组（2.8≥NLR≥1.6,n=106）以及低比值组（NLR＜1.6,n=106）。分别检测患者术前基线、术后8 h及术后24 h肌酸激酶同工酶（CKMB）及肌钙蛋白（CTnI）水平。结果 高比值组患者术后心肌损伤发生率显著高于中比值组及低比值组（P＜0.05）。高比值组术后CKMB峰值显著高于中比值组［2.1(1.2～13.0) ng/mL vs2.0(1.0～7.3) ng/mL, P=0.047］及低比值组［2.1(1.2～13.0) ng/mL vs1.1(0.9～1.6) ng/mL, P＜0.001］。且高比值组患者术后CTnI峰值同样显著高于中比值组［0.075(0.010～0.185) ng/mL vs 0.020(0.000～0.103) ng/mL, P=0.011］,以及低比值组［0.075(0.010～0.185) ng/mL vs0.010(0.000～0.030) ng/mL, P＜0.001］。术前NLR较高是术后患者CTnI升高的独立危险因素（OR：2.809; 95%CI:1.326～5.954; P=0.007）。高比值组患者1年不良心血管事件发生率显著高于中比值组及低比值组（HR：1.80; 95%CI:1.16～2.79; Log Rank P=0.021）。结论 患者术前中性粒细胞/淋巴细胞比值升高是非体外循环冠状动脉旁路移植术后心肌损伤的独立危险因素,而且会增加患者不良心血管事件     

中性粒细胞与淋巴细胞比值预测高龄卒中预后的价值

探讨中性粒细胞与淋巴细胞比值（NLR）对≥80岁急性缺血性脑卒中患者90 d预后的价值。方法 纳入2019年1月—2021年6月发病7 d内、≥80岁的缺血性卒中患者476例的相关信息、影像结果、随访结果,按照入组患者NLR的四分位数间距分为Q1组（NLR ＜2.97）、Q2组（ 2.97≤NLR ＜4.49）、Q3组（ 4.49≤NLR ＜7.94）、Q4组 （NLR≥7.94）,每组119例。根据不良结局发生率绘制K-M曲线,比较各组在不同时期的生存概率。采用Cox多因素回归分析影响患者不良预后的因素。结果log-rank检验显示,四组患者的生存率存在差异,Q4组的90 d生存率显著低于Q1组(P＜0.05)。多因素Cox回归分析显示,校正危险因素后,高NLR和高NIHSS评分是90 d死亡率的独立危险因素(P＜0.05)。根据ROC曲线,高NLR预测患者90 d死亡曲线下面积为0.74。结论 高NLR为影响≥80岁高龄急性缺血性卒中患者90 d预后的独立危险因素,对高龄急性缺血性脑卒中患者的90 d预后有预测价值