Analysis of early mortality and related risk factors in maintenance hemodialysis patients

Objective To analyze the early mortality and related risk factors of new hemodialysis patients in Zhejiang province, and provide basis for reducing the death risk of hemodialysis patients. Methods The early mortality and related factors of new hemodialysis patients from January 1, 2010 to June 30, 2018 were retrospectively analyzed using the database of Zhejiang province hemodialysis registration. The early mortality was defined as death within 90 days of dialysis. Cox regression model was used to analyze the related risk factors of the early mortality in hemodialysis patients. Results The mortality was the highest in the first month after dialysis (46.40/100 person year), and gradually stabilized after three months. The early mortality was 25.33/100 person year. The mortality within 120 days and 360 days were 21.40/100 person year and 11.37/100 person year, respectively. The elderly (≥65 years old, HR=1.981, 95%CI 1.319-2.977, P＜0.001), primary tumor (HR=3.308, 95%CI 1.137-5.624, P=0.028), combined with tumors (not including the primary tumor, HR=2.327, 95%CI 1.200-4.513, P=0.012), temporary catheter (the initial dialysis pathway, HR=3.632, 95%CI 1.806-7.307, P＜0.001), lower albumin (＜30 g/L, HR=2.181, 95%CI 1.459-3.260, P＜0.001), lower hemoglobin (every 0.01 g/L increase, HR=0.861, 95%CI 0.793-0.935, P=0.001), lower high density lipoprotein (＜0.7 mmol/L, HR=1.796, 95%CI 1.068-3.019, P=0.027) and higher C reactive protein (≥40 mg/L, HR=1.889, 95%CI 1.185-3.012, P=0.008) were the risk factors of early death for hemodialysis patients. Conclusions The early mortality of hemodialysis patients is high after dialysis, and gradually stable after 3 months. The elderly, primary tumor, combined with tumors, the initial dialysis pathway, lower albumin, lower hemoglobin, lower high density lipoprotein and higher C reactive protein are the risk factors of early death for hemodialysis patients.     

Additional bedtime H2‐receptor antagonist for the control of nocturnal gastric acid breakthrough: A Cochrane systematic review

OBJECTIVES: To assess the effectiveness and safety of additional bedtime H₂‐receptor antagonists (H₂RAs) in suppressing nocturnal gastric acid breakthrough (NAB) via a systematic review. METHODS: Eligible trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2004), MEDLINE (January 1966–June 2004), EMBASE (January 1980–June 2004) and CINAHL (January 1982–June 2004). Additional hand‐searching was conducted on the proceedings of correlated conferences, eight important Chinese journals and references of all included trials. All randomized controlled trials evaluating H₂RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. RESULTS: Only two randomized crossover studies, comprising 32 participants, met the inclusion criteria. Because the design, dosage and duration of the treatments were different between the studies, it was not possible to conduct meta‐analysis. There were no consistent conclusions found between the two included studies in evaluating H₂RAs for the control of NAB. CONCLUSIONS: No implications for practice at this stage can be concluded. Appropriately designed large‐scale randomized controlled trials with long‐term follow up are needed to determine the effects of additional bedtime H₂RAs in suppressing NAB.     

高住高练低训对足球运动员红细胞CD35数量及活性变化的影响

目的:通过观察4周模拟海拔3000米高住高练低训(HiHiLo)过程中红细胞CD35数量及红细胞C3bRR、ICR的变化,探讨HiHiLo对机体红细胞CD35数量及活性的影响。方法:将16名足球专项运动员随机分为实验组(高住高练低训)和对照组(低住低训)。实验组每晚入住低氧房(O2浓度14.2%,相当于海拔3000米高度)10小时,每周2次低氧房内72%VO2max蹬功率自行车运动30分钟;对照组每周2次正常条件下80%VO2max蹬功率自行车运动30分钟。两组每周同时进行3次由同一教练执导的专项训练。实验期共4周。分别于实验前、入住低氧房10小时、实验2周末、3周末和4周末清晨抽取受试者肘静脉血,采用流式细胞仪检测红细胞CD35几何平均荧光强度,采用红细胞免疫花环试验检测红细胞C3b受体花环率(RBC-C3bRR)和红细胞免疫复合物花环率(RBC-ICR)。结果:实验4周后,实验组和对照组CD35数量较实验前分别下降了4.9%和10.5%(P<0.05),红细胞C3b受体花环率较实验前分别下降了16.7%和24.9%(P<0.01),红细胞IC花环率较实验前分别升高了29.9%(P<0.05)和32.4%。结果表明:(1)HiHiLo对人体红细胞CD35数量的影响不如对红细胞CD35活性的影响明显;(2)HiHiLo影响RBC-C3bRR和RBC-ICR较低住低训更明显,HiHiLo3周后实验组运动员出现临床上的继发性免疫低下现象,4周末有所好转。     

大鼠脑血肿周围组织半胱氨酸天冬氨酸蛋白酶3表达变化与尼莫地平的影响

目的：观察脑出血后血肿周围半胱氨酸天冬氨酸蛋白酶3的表达。及尼莫地平对其的影响。方法：实验于2004—07在大连医科大学中心实验室进行。取120只SD雄性大鼠随机分为3组：①尼莫地平组（n=50）：尾壳核注射自体股动脉血50μL复制脑出血模型，造模即刻腹腔注射尼莫地平1．6mg／kg（即8μL／g），以后每天1次。②模型组（n=50）：同前造模，术后腹腔注射等量生理盐水。③假手术组（n=20）：手术，但进针人尾壳核后不注血。各组分为术后6，24，48，72h、5d 5个时间点。造模动物醒后进行Bederson评分，评估其行为和神经功能缺陷（0—3分。评分越高，神经功能缺陷越重，评分≥2分为造模成功）。人组动物在以上5个时间点进行Bederson评分后，麻醉状态下处死取脑，经尾壳核行冠状切片，行免疫组化测定半胱氨酸天冬氨酸蛋白酶3表达。结果：80只大鼠进入结果分析。①Bederson评分：模型组、尼莫地平组大鼠醒后迅速出现偏瘫，24h后评分趋于稳定，至72h之间评分最高，然后逐渐下降，5d时仍有体征。模型组、尼莫地平组各时间点评分均高于对照组（P〈0．01），尼莫地平组术后48，72h评分低于模型组（P〈0.05）。②血肿周围组织半胱氨酸天冬氨酸蛋白酶3表达：假手术组进针侧脑组织表达很少，模型组6h后即有表达，24h达高峰，持续72h后逐渐下降，5d后仅有少量表达；尼莫地平组动态变化趋势与模型组相同，但各时间点的数值均较低，尤其是术后24～72h（P〈0．01）。结论：①脑出血后血肿周围组织中半胱氨酸天冬氨酸蛋白酶3表达升高，提示其与脑出血血肿周围组织损伤有一定关系。②尼莫地平降低脑出血后血肿周围组织中半胱氨酸天冬氨酸蛋白酶3表达，从而减轻细胞凋亡程度，对神经细胞起到保护作用，降低神经功能缺陷。     

颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

网络环境下医学专题检索服务的深化

分析网络环境下图书馆定题服务的现状和价值，提出跟踪服务的方式，进行分阶段的、具体的定题服务，并实例分析分阶段定题服务的优势。     

重度苯妥英钠中毒的药学监护

目的首先确定中毒药物,然后通过测定血药浓度以了解中毒程度,为重度苯妥英钠中毒患者临床抢救治疗提供依据。方法间隔一定时间采集患者静脉血,萃取血中药物,在211 nm处以反相高效液相色谱法定性,明确中毒药物并测定血药浓度。结果在苯妥英中毒患者中最高血药浓度为68.94 mg.L-1,接近治疗浓度上限的3.5倍。结论患者为重度中毒,危及生命,需临床药师与临床医师积极配合,施行全程药学监护。     

胆囊结石伴胆囊癌的诊治分析

目的探讨胆囊癌与胆囊结石的关系及胆囊结石伴胆囊癌的诊断和治疗特点。方法对1993年1月至2004年12月间收治的27例胆囊癌合并胆囊结石患者进行回顾性临床分析。结果27例胆囊癌合并胆囊结石患者,男10例,女17例,男女之比为1:1.7。平均年龄68.5岁,其中60岁以上22例。临床症状最常见为腹痛(85.2%)。既往有明确胆结石病史患者15例,入院后发现胆结石的有12例。行B超检查的23例,诊断胆囊癌的有12例(52.2%)。CT结合增强扫描检查12例,诊断胆囊癌的有8例(66.7%)。行肿瘤根治切除者8例,根治率29.6%。随访13例,随访期为3个月~7年,获随访者的平均存活时间为12个月。结论胆囊结石是胆囊癌的发病因素之一,胆囊癌早期诊断困难,晚期治疗效果差,伴胆囊结石的胆囊癌关键是要引起重视,不能满足胆囊结石的诊断而遗漏胆囊癌。对胆囊结石患者要密切随访,高危患者要尽早手术。     

美托康注射液与都可喜联合治疗椎基底动脉供血不足的疗效观察

目的观察美托康注射液与都可喜联合治疗椎基底动脉供血不足的临床疗效。方法随机将87例病人分为治疗组（45例）和对照组（42例），治疗组应用美托康注射液250ml静滴，1a／d，同时加服都可喜1片，2次／d；对照组应用复方丹参注射液30m1加入5％葡萄糖注射液500ml静滴，1次／d；两组均连用10d，其余常规治疗相同。结果治疗组痊愈26例，有效18例，总有效率98％；对照组痊愈15例，有效24例，总有效率93％。治疗组疗效优于对照组（P〈0．05）。结论美托康注射液与都可喜联合治疗椎基底动脉供血不足有良好临床疗效，可于临床广泛应用。