压疮高危患者应用气垫床翻身间隔时间的研究

目的 探讨ICU应用气垫床的压疮高危患者翻身间隔时间,以提高护理工作质量和效率.方法 将212例压疮高危患者随机分为A组(70例)、B组(71例)、C组(71例)三组,应用气垫床后分别采取2 h、3 h、4 h翻身1次,每次翻身时观察患者皮肤变化及压疮发生情况.结果 三组患者压疮发生率比较,差异无统计学意义(P>0.05).结论 压疮高危患者应用气垫床后可以4 h翻身1次,既可以减轻护士的工作量,又对压疮的形成无不良影响.     

不同气垫床翻身间隔时间预防重型颅脑损伤患者压疮效果比较

目的比较不同类型气垫床及翻身间隔时间预防重型颅脑损伤患者压疮的效果。方法将180例压疮高危患者随机分为A、B、C、D、E、F六组,A、B、C组采用喷气式气垫床,翻身时间分别间隔2h、3h、4h;D、E、F组采用动态交替式气垫床,翻身间隔时间同前;连续观察72h,每次翻身观察记录患者皮肤压疮发生情况、压疮前期表现及Braden评分。结果六组患者均未发生压疮。干预后不同时间六组压疮前期发生率比较,差异有统计学意义(P0.05,P0.01);干预72hB组和E组、C组和F组差异有统计学意义(均P0.00313)。六组Braden评分在干预前、干预后各时间段组内比较差异无统计学意义(均P0.05)。组内比较,F组有统计学差异(P0.01)。结论重症颅脑损伤患者应用两种气垫床均能有效预防压疮,动态交替式气垫床效果更优。使用动态交替式气垫床可将翻身间隔时间延长至4h。     

使用减压床垫患者翻身间隔时间的Meta分析

目的通过Meta分析来探讨使用减压床垫患者有效预防压疮的翻身间隔时间。方法计算机检索Cochrane Library、PubMed、维普、万方、中国知网、CBM等数据库。检索时限从建库至2015年10月15日。由2名评价员按纳入与排除标准独立筛选文献,提取资料并评价文献质量后,采用RevMan5.1软件进行分析。结果最终纳入13篇RCT文献,其中英文文献4篇,中文文献9篇,共3 510例患者纳入研究。Meta分析结果显示,翻身间隔时间2h、3h、4h预防压疮效果比较,差异无统计学意义(P0.05);4h与6h翻身1次压疮预防效果比较,差异有统计学意义(P0.05)。2h与4h翻身1次在预防肺炎效果方面差异无统计学意义(P0.05)。结论使用减压床垫患者翻身间隔时间可延长至4h,4h翻身1次不增加压疮和肺炎发生率,可减轻频繁翻身给患者带来的不适,减少护士工作量,节约医疗卫生资源等。     

国内应用低分子肝素治疗急性胰腺炎临床疗效的Meta分析

目的采用Meta分析的方法对低分子肝素治疗急性胰腺炎(AP)的临床疗效进行评价。方法计算机检索VIP(1989~2014年)、WANFANG(1999~2014年)、CNKI(1994~2014年)、CAJD数据库中关于低分子肝素治疗AP的临床随机对照试验(RCT),对符合要求的RCT进行Meta分析。结果最终纳入13篇RCT,有960例患者符合纳入标准。Meta分析结果显示,低分子肝素治疗组的治愈时间[总效应Z=2.79,MD=-1.69,95%CI(-2.88~-0.50),P=0.005],重症化例数[总效应Z=4.19,OR=0.35,95%CI(0.21~0.57),P0.0001],手术例数[总效应Z=2.24,OR=0.54,95%CI(0.31~0.93),P=0.03],并发症[总效应Z=4.28,OR=0.28,95%CI(0.16~0.51),P0.0001],死亡率[总效应Z=2.37,OR=0.40,95%CI(0.21~0.77),P=0.006],均明显优于对照组(P0.05,差异具有统计学意义)。结论在综合治疗基础上,低分子肝素对AP疗效确切,其可缩短AP的治愈时间,减少重症化及手术治疗例数,降低并发症及死亡率的发生。     

金龙胶囊联合经导管肝动脉化疗栓塞术治疗原发性肝癌的疗效和安全性的Meta分析

目的系统评价金龙胶囊联合肝动脉化疗栓塞术(TACE)治疗原发性肝癌临床疗效和安全性。方法检索Cochrane Library、Embase、PubMed、OVID、Scopus、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普数据库和万方数据库,文献检索限定时间均从建库至2021年2月,纳入报道金龙胶囊联合TACE治疗原发性肝癌的随机对照试验,由两人独立筛选文献,提取数据及进行文献质量评价。运用RevMan 5.3软件对提取数据进行Meta分析。结果共纳入19项随机对照试验(共1740例患者),Meta分析结果显示:相比对照组,联合治疗组的客观缓解率更高[OR=2.23,95%CI(1.78,2.80),P <0.001],KPS评分[OR=2.59,95%CI(1.86,3.60),P <0.001],1年生存率[OR=1.77,95%CI(1.14,2.76),P=0.01]、2年生存率[OR=1.76,95%CI(1.12,2.75),P=0.01]优于对照组。此外,金龙胶囊还可提高机体免疫功能,减少不良反应的发生。结论金龙胶囊联合TACE可以提高原发性肝癌的疗效,提高患者的生活质量,减少不良反应的发生。但由于纳入的研究数量有限,金龙胶囊是否能改善肝癌患者长期生存率有待进一步研究,本研究结论尚需更多设计良好、严格执行的大样本随机对照双盲试验加以证实。     

耳穴贴压治疗失眠疗效的Meta分析

目的系统评价耳穴贴压治疗失眠的疗效,为失眠患者的治疗提供参考。方法计算机检索PubMed、Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普期刊资源整合服务平台(VIP)和万方数据知识服务平台(WanFang Data)等数据库中有关耳穴贴压治疗失眠的随机对照试验(RCT),追溯纳入文献的参考文献,文献检索时限为各数据库建库至2014年9月。按照纳入和排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入7篇RCT,合计939例受试者。根据干预时间和对照组的干预方案进行亚组分析。Meta分析结果显示:1以干预时间为亚组分析:干预2周,耳穴贴压组的总有效率高于对照组[OR=10.66,95%CI(5.23,21.74),P0.01];干预1个月,耳穴贴压组的总有效率高于对照组[OR=4.54,95%CI(2.28,9.01),P0.01]。2以对照组治疗方案为亚组分析:与针刺组相比,耳穴贴压组总有效率高于针刺组[OR=7.70,95%CI(3.05,19.48),P0.01];与药物组相比,耳穴贴压组总有效率高于药物组[OR=7.76,95%CI(4.61,13.08),P0.01]。结论耳穴贴压治疗失眠有一定疗效,可提高患者的睡眠质量。但由于本次纳入文献差异性较大,故研究结果需谨慎对待,还需大样本、高质量的文献进一步证实其临床疗效。     

单侧与双侧顺行性脑灌注技术对主动脉手术患者预后影响的系统评价与Meta分析

目的比较单侧与双侧顺行性脑灌注技术对主动脉手术患者预后的影响。方法检索PubMed、EBSCO、Web of Science、Cochrane图书馆、万方数据库、中国知网、中国生物医学文献数据库,检索时间从建库截至2019年1月。纳入比较单侧与双侧顺行脑灌注技术对主动脉手术患者预后影响的临床研究,用纽卡斯尔-渥太华量表(NOS)评价纳入非随机研究质量,用Cochrane风险评估工具评价随机对照研究的质量。应用RevMan5.3软件进行Meta分析。结果最终纳入16篇文献,共4490例患者,其中随机对照研究3篇,倾向性匹配分析2篇,回顾性病例对照研究11篇。3篇随机对照研究均有高风险偏倚,其余13篇NOS评分均6颗星以上。Meta分析结果显示,单侧与双侧顺行性脑灌注相比,永久性神经系统障碍(permanent neurologic dysfunction,PND)(OR=0.93,95%CI 0.74~1.18,P=0.57)、暂时性神经系统障碍(temporary neurologic dysfunction,TND)(OR=1.26,95%CI 0.94~1.69,P=0.12)、急性肾功能损伤发生率(OR=1.11,95%CI 0.79~1.55,P=0.55)、30 d死亡率(OR=0.94,95%CI 0.67~1.32,P=0.72)、住ICU时间(OR=–0.64,95%CI–1.66~0.37,P=0.22)与住院时间(OR=–0.35,95%CI–2.38~1.68,P=0.74)差异均无统计学意义。结论单侧与双侧顺行性脑灌注技术在停循环主动脉手术中对患者术后预后影响无差别。但上述结论受纳入文献质量的限制,需要更多高质量的随机对照大样本研究进一步评价。     

空心钉与接骨板内固定治疗肱骨大结节骨折疗效的Meta分析

目的:比较空心钉与接骨板治疗肱骨大结节骨折的临床疗效。方法:计算机检索PubMed、EMbase、Cochrane图书馆、万方、中国知网、中国生物医学文献数据库、维普中文网等数据库采用空心钉与接骨板治疗肱骨大结节骨折的临床试验文献。检索时间自2010年1月1日至2020年1月1日。根据纳入与排除标准进行独立文献筛选、质量评价及数据提取。采用Revman 5.2软件对所得数据进行Meta分析。结果:共检索了5篇临床随机对照试验文献及12篇回顾性队列研究文献,共1068例患者,其中空心钉内固定治疗559例,接骨板内固定治疗509例。Meta分析显示,两组方式手术时间[MD=-23.03,95%CI(-29.69,-16.36),P<0.0001],术中出血量[MD=-36.39,95%CI(-53.73,-19.04),P<0.0001],住院时间[MD=-1.86,95%CI(-3.09,-0.64),P=0.003],骨折愈合[MD=-2.23,95%CI(-4.27,-0.18),P=0.03],术后感染发生率[OR=0.17,95%CI(0.03,0.97),P=0.05],内固定失效率[OR=3.56,95%CI(1.29,9.81)P=0.01]比较差异有统计学意义。两种方式术后疼痛模拟评分(visual analogue scale,VAS)[MD=-1.34,95%CI(-2.77,0.09),P=0.07],美国肩肘外科协会评分(American Shoulder and Elbow Surgeons,ASES)[MD=0.26,95%CI(-6.43,6.96),P=0.94],Constant肩关节评分[MD=-4.05,95%CI(-8.51,0.42),P=0.08],Constant肩关节评分优良率[MD=-1.30,95%CI(0.46,3.72),P=0.62],Neer肩关节评分优良率[OR=2.04,95%CI(0.97,4.28),P=0.06],总并发症发生率[OR=1.50,95%CI(0.42,5.35),P=0.53],术后疼痛发生率[OR=0.74,95%CI(0.04,14.49),P=0.84]及术后肩峰综合征发生率[OR=0.88,95%CI(0.02,40.63),P=0.95]比较差异无统计学意义。结论:采用空心钉较接骨板治疗肱骨大结节骨折手术时间短,术中出血量少,住院时间短,术后感染发生率更低且更有利于骨折愈合。     

泡沫敷料预防高危风险患者压疮的Meta分析

目的评价使用泡沫敷料联合常规护理预防高危风险患者压疮的有效性。方法检索国内外数据库建库至2013年12月关于泡沫敷料用于预防高危风险患者压疮的随机对照试验(RCT)和类实验研究,文献的筛选与资料提取均由2名评价员独立进行,分歧通过协商或第三方解决。纳入文献的质量依据Jadad量表评价,提取资料用Revman5.0软件进行数据处理和分析。结果共纳入7篇文献,1 611例患者。所纳入研究的偏倚风险较低。Meta分析结果显示:对于存在压疮高危风险患者预防性使用泡沫敷料联合常规护理能有效降低压疮发生率(RR=0.22,95%CI=0.10~0.49,P0.05),但研究间存在一定程度的异质性,可能与预防部位、研究人群、泡沫敷料的来源不同有关。结论预防性使用泡沫敷料联合常规护理能更有效减少高危风险患者压疮的发生,但是由于纳入7篇研究存在一定程度的异质性,泡沫敷料的有效性、具体的使用方法和经济效益还需大样本多中心的RCT研究进一步验证。     

右美托咪定对体外循环心脏手术后患者围术期预后影响的系统评价与Meta分析

目的评价右美托咪定对体外循环心脏手术后患者围术期预后的影响。方法检索PubMed、EBSCO、Web of Science、Cochrane Library、万方数据库、中国知网、中国生物医学文献数据库,每个数据库从建库至2016年12月,查找符合要求的随机对照试验,采用RevMan5.3软件进行Meta分析。结果最终共纳入16项随机对照研究,其中国外文献7篇,国内文献9篇,共1 432例患者。Meta分析结果显示,与安慰剂相比,右美托咪定能够明显降低体外循环下心脏手术后谵妄发生率[RR=0.28,95%CI(0.18,0.44),P0.000 01]、术后心房颤动发生率[RR=0.65,95%CI(0.44,0.98),P=0.04],缩短气管插管拔管时间[RR=–1.96,95%CI(–2.07,–1.86),P0.000 01]、住ICU时间[RR=–0.49,95%CI(–0.74,–0.24),P=0.000 1]及住院时间[RR=–1.24,95%CI(–2.26,–0.22),P=0.02]。右美托咪定组蒙特利尔认知评估量表(Mo CA)评分显著高于对照组[RR=0.88,95%CI(0.42,1.35),P=0.000 2]。结论右美托咪定可显著减少心脏手术后并发症,将其作为心脏手术患者围术期用药是安全有效的。但上述结论受纳入文献质量的限制,需要更多高质量的随机对照双盲研究,以便进一步的评价。     

Mechanisms of distal-nephron Li(+) reabsorption during dietary K(+) restriction in rats

The mechanism by which dietary K(+) restriction induces distal-nephron Li(+) reabsorption was investigated by administration of bendroflumethiazide (BFTZ) or vehicle in conscious Wistar rats. Changes in fractional excretion of Li(+) following administration of amiloride (DeltaFE(Li)) were used as an index of distal tubular Li(+) reabsorption. The results revealed an absence of distal tubular Li(+) reabsorption in K(+)-replete rats (DeltaFE(Li) = 3. 6+/-2.4%), in contrast to K(+) restriction in which DeltaFE(Li) was 24.0+/-2.7%. The distal tubular Li(+) reabsorption in K(+)-depleted rats was significantly reduced by preadministration of BFTZ (DeltaFE(Li) = 9.2+/-0.9%). The fractions of Li(+) and Na(+) reabsorbed in the amiloride-sensitive segment were different in K(+)-replete rats (9+/-6 vs. 60+/-6%), but similar in K(+)-depleted rats (61+/-5 vs. 73+/-4%). BFTZ administration to K(+)-depleted rats resulted in a proportional decrease in these fractions, suggesting competition between Na(+) and Li(+) for reabsorption in the distal-nephron segment during K(+) depletion. These results are compatible with the hypothesis that during K(+) depletion the reabsorption of Li(+ )in the distal-nephron segment is competitively inhibited by Na(+).     

Effect of lithium on cyclosporin induced nephrotoxicity in rats

Psychoactive drugs provide essential intervention in the care of transplant recipients, yet little is known of their interaction with immunosuppressants such as cyclosporin (CSA). Lithium (Li) is an invaluable drug for the treatment of manic disorders in organ transplant patients. As both these drugs are known to produce renal toxicity, the concomitant use of CSA and Li may be potentially harmful. The present study was undertaken to investigate the effect of CSA and Li chloride individually and in combination on renal structure and function of rats. Male Sprague-Dawley rats were divided into the following eight groups of seven animals each: group I, control (vehicle only); group 2, Li (2 mEq/ kg i.p.) alone; group 3, CSA 12.5 mg/kg (subcutaneous); group 4, CSA 25 mg/kg; group 5, CSA 50 mg/kg; group 6, CSA 12.5 mg/kg + Li; group 7, CSA 25 mg/kg + Li; and group 8, CSA 50 mg/kg + Li. The drugs were given once a day for seven days; Li being administered 30 min before CSA. Twenty four hours after the last dose of drugs the animals were sacrificed and blood samples were analyzed for blood urea nitrogen (BUN), serum creatinine (SCr), CSA and Li levels. The left kidney was analyzed for malondialdehyde (MDA) and conjugated dienes (CD) levels and right kidney was used for histopathological studies. Our results showed that Li alone did not produce any significant renal toxicity, whereas CSA dose dependently caused structural and functional changes in kidneys. However, significantly higher structural and functional impairment was observed in the animals treated with Li plus CSA as compared to CSA alone treated animals. Several fold increase in blood Li level was also noticed in the rats concomitantly treated with CSA and Li. A significant increase in MDA and CD in the rats treated with CSA plus Li suggests the role of oxidative stress in drug induced nephrotoxicity. These findings clearly demonstrate that even non toxic doses of Li may significantly exacerbate CSA induced nephrotoxicity in rats. The enhanced nephrotoxicity following concomitant use of these drugs may be attributed to significant increase in the bioavailability of Li and enhanced oxidative stress. Further clinical studies are warranted to investigate the interaction of these nephrotoxic drugs in human subjects.     

中药翁沥通治疗慢性前列腺炎疗效观察

目的：观察中药翁沥通对慢性前列腺炎的治疗作用。方法：将慢性前列腺炎患者80例分为翁沥通组和对照组,对比观察翁沥通治疗2个月后NIH-CPSI评分及前列腺液的变化。结果：翁沥通组患者NIH-CPSI评分明显降低,常规检查前列腺液白细胞明显改善。结论：中药翁沥通治疗慢性前列腺炎有显著疗效。     

A hypothesis linking sodium and lithium reabsorption in the distal nephron.

BACKGROUND: A hypothesis is proposed linking Na(+) and Li(+) reabsorption in the distal nephron. The handling of these two ions in the distal nephron is related because they share the same apical membrane entry mechanism: the amiloride-sensitive Na(+) channel (ENaC). However, the two ions exit the cell through different transport mechanisms: Na(+) via the Na(+)-K(+)-ATPase and Li(+) via the Na(+)/H(+) exchanger. Studies in rats have shown that under normal circumstances hardly any Li(+) is reabsorbed in the distal nephron, so that the urinary excretion of Li(+), expressed as a fraction of the delivery to the early distal tubule (FE(Li dist)), amounts to approximately 0.97. In contrast, during severe dietary Na(+) restriction, FE(Li dist) decreases to 0.50-0.60. Our hypothesis is that the absence of distal Li(+) reabsorption during intake of a normal diet can be explained by a negative driving force for Li(+) entrance across the apical membrane in those segments in which ENaC is active. METHOD: We propose a model that incorporates this concept. RESULTS: The model indicates that the lowering of FE(Li dist) during dietary Na(+) restriction can be explained by activation of apical ENaC in extra sub-segments further downstream. In these extra sub-segments the driving force for Li(+) reabsorption is positive, leading to significant Li(+) reabsorption. During dietary K(+) restriction, FE(Li dist) is reduced to 0.35-0.55. The model shows that this reduction in FE(Li dist) can be explained by hyperpolarization of the apical membrane in ENaC-containing sub-segments, which is known to occur in this condition. CONCLUSION: We conclude that the model may improve current understanding of both Na(+) and Li(+) handling in the distal nephron.     

EFFECT OF LITHIUM ON CYCLOSPORIN INDUCED NEPHROTOXICITY IN RATS

Psychoactive drugs provide essential intervention in the care of transplant recipients, yet little is known of their interaction with immunosuppressants such as cyclosporin (CSA). Lithium (Li) is an invaluable drug for the treatment of manic disorders in organ transplant patients. As both these drugs are known to produce renal toxicity, the concomitant use of CSA and Li may be potentially harmful. The present study was undertaken to investigate the effect of CSA and Li chloride individually and in combination on renal structure and function of rats. Male Sprague-Dawley rats were divided into the following eight groups of seven animals each: group 1, control (vehicle only); group 2, Li (2mEq/kg i.p.) alone; group 3, CSA 12.5 mg/kg (subcutaneous); group 4, CSA 25 mg/kg; group 5, CSA 50 mg/kg; group 6, CSA 12.5 mg/kg + Li; group 7, CSA 25 mg/kg + Li; and group 8, CSA 50 mg/kg + Li. The drugs were given once a day for seven days; Li being administered 30 min before CSA. Twenty four hours after the last dose of drugs the animals were sacrificed and blood samples were analyzed for blood urea nitrogen (BUN), serum creatinine (SCr), CSA and Li levels. The left kidney was analyzed for malondialdehyde (MDA) and conjugated dienes (CD) levels and right kidney was used for histopathological studies. Our results showed that Li alone did not produce any significant renal toxicity, whereas CSA dose dependently caused structural and functional changes in kidneys. However, significantly higher structural and functional impairment was observed in the animals treated with Li plus CSA as compared to CSA alone treated animals. Several fold increase in blood Li level was also noticed in the rats concomitantly treated with CSA and Li. A significant increase in MDA and CD in the rats treated with CSA plus Li suggests the role of oxidative stress in drug induced nephrotoxicity. These findings clearly demonstrate that even non toxic doses of Li may significantly exacerbate CSA induced nephrotoxicity in rats. The enhanced nephrotoxicity following concomitant use of these drugs may be attributed to significant increase in the bioavailability of Li and enhanced oxidative stress. Further clinical studies are warranted to investigate the interaction of these nephrotoxic drugs in human subjects.     

Effects of lithium on cAMP generation in cultured rat inner medullary collecting tubule cells

The effects of lithium (Li) on the cAMP system in rat inner medullary collecting tubule cells were studied. While acute exposure to 5 mM Li was without effect, 10 mM, 25 mM and 50 mM Li significantly decreased AVP-stimulated cAMP formation. In contrast, cells grown in 5 mM Li for 72 hours which caused no morphologic changes enhanced cAMP formation (fmol/microgram protein) in response to both 10 nM AVP (114.5 +/- 9.2 vs. 71.6 +/- 7.4, P less than 0.005) and 100 nM AVP (182 +/- 14 vs. 120 +/- 8.3, P less than 0.001), N = 16. A similar enhancement was observed when cAMP formation was stimulated by a post-receptor agonist, cholera toxin. The role of eicosanoids was examined with 5 microM meclofenamate which reversed Li-enhanced cAMP formation in response to both AVP and cholera toxin. To define the eicosanoid responsible, cyclooxygenase products were measured. Prostaglandin E2 and thromboxane B2 synthesis were unchanged by Li, but the production of prostacyclin was significantly (P less than 0.02) increased. Prostacyclin (3 microM) mimicked the effect of Li to enhance the response to 10 nM AVP as cAMP levels increased from 100 +/- 11 to 173 +/- 13, P less than 0.05. The experiments suggest that acute exposure of Li at concentrations of 10 mM or greater inhibit cAMP formation but prolonged Li exposure enhances cAMP formation by increasing the formation of prostacyclin.     

Reverse pharmacological effect of loop diuretics and altered rBSC1 expression in rats with lithium nephropathy

BACKGROUND: Renal urinary concentration is associated with enhanced expression of rBSC1, a rat sodium cotransporter, in the thick ascending limb of Henle. Increased expression of rBSC1 was reported recently in nephrogenic diabetes insipidus induced by lithium chloride (Li nephropathy). However, the pathophysiological implication of altered rBSC1 expression has not yet been investigated. METHODS: Li nephropathy was induced in rats by an oral administration of 40 mmol lithium/kg dry food. In rats with reduced urinary osmolality to less than 300 mOsm/kg H2O, we examined the expression of rBSC1 mRNA and protein, plasma arginine vasopressin (AVP) and RNA expression of kidney-specific water channel, aquaporin-2 (AQP2), of collecting ducts. Rats with Li nephropathy were treated with furosemide (3 mg/kg body weight), which blocks the activity of rBSC1, and changes in urine concentration, plasma AVP, medullary accumulation of Li ions, and apical AQP2 expression were determined. RESULTS: Rats with Li nephropathy showed increased rBSC1 RNA and protein expression and reduced AQP2 RNA. In these rats, furosemide, which induces dilution of urine and polyuria in normal rats, resulted in a progressive and significant rise in urine osmolality from 167 +/- 11 (mean +/- SD) at baseline to 450 +/- 45 mOsm/kg H2O at three hours after administration, and significant oliguria. In the same rats, plasma AVP decreased significantly from 5.7 to 3.0 pg/mL. In addition, recovery of apical AQP2 expression was noted in a proportion of epithelial cells of the collecting ducts. Although Li+ in the renal medulla was slightly lower in rats with Li nephropathy treated with furosemide, statistical significance was not achieved. CONCLUSIONS: Our results suggest that dehydration or high plasma AVP results in an enhanced rBSC1 expression in Li nephropathy, and that rBSC1 expression is closely associated with the adverse effects of Li ions on collecting duct function.     

海南黎族人颅面骨三维测量的研究

目的 利用三维CT研究海南黎族人颅面骨的结构及特征.方法 CT扫描和三维重建能客观显示两点间距离及三点间角度,并可将三维影像放大增加精确度,通过对80名黎族成年人颅面骨进行三维测量分析,并与汉族人进行比较.结果 黎族人颅面骨数据在性别间存在较大差异,与汉族人相比,黎族人具备眶宽、颅头宽及面阔的面部特征.结论 CT测量及三维重建可准确表述颅面三维结构特征,而颅面骨数据为黎族人进行颌面部整形手术提供了客观参考依据.     

Prevalence of raised sodium-lithium countertransport activity in type 1 diabetic patients.

The prevalence of raised Na+/Li+ countertransport (CT) activity (greater than 0.41 mmol/liter RBC/hr) was assessed in 185 consecutive insulin-dependent diabetic patients attending an outpatient diabetic clinic. Normoalbuminuria was defined as an overnight albumin excretion rate (AER) of less than 20 micrograms/min (N = 121), microalbuminuria as AER between 20 and 150 micrograms/min (N = 35) and macroalbuminuria as AER greater than or equal to 150 micrograms/min (N = 29). The prevalence of elevated Na+/Li+CT (greater than 0.41 mmol/liter RBC/hr) was 21.5, 42.8 and 51.7% (P = 0.0005), in patients with normo-, micro- and macroalbuminuria, respectively. In the whole group, Na+/Li+CT was significantly related to mean blood pressure (MBP; rs = 0.37, P less than 0.001) and AER (rs = 0.38, P less than 0.001). In a multiple regression analysis the significant correlates of AER, as a continuous variable, or of proteinuria (micro + macroalbuminuria), as a categorical variable, were Na+/Li+CT, MBP, duration of diabetes and glycosylated hemoglobin (HbA1). The frequency of normoalbuminuric patients with high Na+/Li+CT activity fell with duration of diabetes. The risk of proteinuria was significantly greater in patients with raised Na+/Li+CT compared to those with Na+/Li+CT within the normal range (odds ratio 3.8, 95% CI, 1.9 and 7.8). A relative excess of patients with proteinuria (micro + macroalbuminuria) was found in the group with elevated Na+/Li+CT and HbA1 above the median value (8.05%) of the whole population (chi 2 = 9.7, P less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)     

以单一高位穿支为蒂逆行股前外侧皮瓣修复小腿大面积软组织缺损

目的探讨采用以单一高位穿支为蒂股前外侧皮瓣逆行转移修复小腿大面积软组织缺损的临床疗效。方法2014年1月-2017年7月,采用以单一高位穿支为蒂逆行转移股前外侧皮瓣修复小腿大面积软组织缺损患者9例,男7例,女2例;年龄24~48岁。小腿软组织缺损面积为10.0cm×7.0cm^35.0cm×15.0cm,其中包括植皮和皮肤牵张修复的面积。将高位穿支穿出点设计在皮瓣近端,以此穿支作为皮瓣的单一营养血管,并将皮瓣旋转点向大腿近端上移,既增加皮瓣血供又可使皮瓣修复范围向小腿远端下移。皮瓣切取面积15.0cm×10.0cm^22.0cm×12.0cm。术后定期进行随访。结果术中皮瓣切取顺利,术后无血管危象发生,皮瓣均顺利成活。患者均获得随访6~12个月,皮瓣外观饱满稍显臃肿,色泽与受区相似,质地柔软,供区无活动障碍。结论采用单一高位穿支为蒂逆行转移股前外侧皮瓣,可将皮瓣旋转点向近端上移,通过增加其血管蒂与膝上外侧动脉吻合支的数量及口径改善皮瓣的供血和回流,皮瓣的成活率不受影响。相比传统逆行股前外侧皮瓣,该皮瓣有较大优势。