ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded.ResultsAll of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and 1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up, catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients’ catheter function remained normal.ConclusionsWith increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
Objective To investigate the changes of pulmonary diffusing capacity and pulmonary capillary blood volume in stable COPD patients with mixed ventilation dysfunction, and explore the possible pathophysiological factors. Methods 159 stable COPD patients with mixed ventilation dysfunction were recruited in the study and 36 normal subjects were recruited as control. The Belgium medisoft box5500 was used to determine the pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity. The measured parameters included forced vital capacity ( FVC) , forced expiratory volume in one second ( FEV1 ) ,maximal voluntary ventilation ( MVV) , vital capacity ( VC) , total lung capacity( TLC) , residual volume ( RV) , minute volume of alveolar ventilation ( VA ) , lung diffusing capacity for carbon monoxide ( DLCO) , pulmonary membrane diffusing capacity for carbon monoxide ( DMCO) , and pulmonary capillary blood volume ( Vc) . The above parameters were compared between the COPD patients and the normal subjects. The relationship was analyzed between DLCO% pred, DMCO% pred, Vc% pred and all the ventilation parameters. Results In stable COPD patients with mixed ventilation dysfunction, all parameters of pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity were significantly different from the normal subjects ( Plt;0. 05 or Plt;0.01) . FVC, VC, VA, and DMCO of the COPD patients were about 66% of the calculated value or more. The average TLC%pred was a little higher than the normal. FEV1 , MVV, DLCO and Vc were abnormally lower which were between 36% ～44% . The average RV%pred was 188% of the predicted value. Obvious correlation could be detected between DLCO% pred, DMCO% pred, Vc%pred and FEV1%pred, FEV1/FVC, TLC% pred, RV%pred, RV/TLC and VA% pred etc.Conclusions In COPD patients with mixed ventilation dysfunction, the pulmonary blood capillary is damaged seriously which lead to a significant decrease of the capacity of pulmonary blood capillary, as well as seriously air distribution disturbance and ventilation/bloodstream mismatch. The Vc decline may develope before the impairment of pulmonary diffusing capacity which may contribute to the damaged of DLCO and DMCO.
目的 探讨主要组织相容性复合体(MHC)Ⅱ类基因的反式转录因子（CⅡTA）在多器官功能障碍综合征（MODS）中对MHCⅡ类基因的调控机理。方法 18只雄性家猪随机分为实验组（n=9）和对照组(n=9)。实验组给予失血性休克、再灌注损伤、内毒素血症等复合干扰因素，建立二次打击猪MODS模型； 对照组仅进行麻醉和动静脉插管。7 d后处死存活动物。切取实验组造模成功动物和对照组动物的脾脏组织，用Trizol法提取总RNA。设计CⅡTA和猪MHCⅡ类基因(SLA-DQA)引物序列，逆转录构建cDNA，行实时荧光定量PCR检测。UVP计算机图像分析系统绘出标准曲线并得出2组CⅡTA mRNA和SLA-DQA mRNA的拷贝数。以Pearson法分析MODS动物CⅡTA mRNA和SLA-DQA mRNA表达的相关性。结果 实验组动物死亡7例，有8例发生MODS。对照组动物CⅡTA mRNA的拷贝数为（3.516±1.237）×103，实验组MODS动物为（0.367±0.088）×103，差异有统计学意义（P=0.000）； 对照组SLA-DQA mRNA拷贝数为（5.330±3.053）×103，实验组为（1.376±1.006）×103，差异亦有统计学意义(P=0.002)。MODS动物中CⅡTA mRNA和SLA-DQA mRNA的表达呈正相关(Pearson值为0.499，P=0.017)。结论 MODS模型复制满意。MHCⅡ类基因在MODS中表达下降与CⅡTA的调控有关。
Objective To summarize the recent progress in pathogenetic, diagnostic and therapeutic researches on the intestinal barrier dysfunction (IBD) of severe acute pancreatitis (SAP). MethodsThe advancement of IBD in SAP, which was published recently at home and abroad, was collected and reviewed. Results The pathogenesis of IBD in patients with SAP was complex. Ischemia-reperfusion injury, endotoxin, inflammatory mediators and gastrointestinal hormone played an important role in the process of IBD. There were many ways to detect IBD, and the ratio of lactulose and mannitol, plasma diamine oxidase were relatively ideal markers. Medical therapies, such as treatment of SAP and maintaining the perfusion of intestines, were essential to cure IBD. On this basis, the propulsives, nutritional support and traditional Chinese drugs should be administered reasonably. Conclusions IBD is a sophisticated process of pathophysiology. In recent years, abundant of animal experiments and clinical researches have provided new clue for prevention and cure of IBD, but further researches are still needed on the mechanism of the cells and molecules implicated.
ObjectiveTo explore protective strategies for organ function of fulminant acute pancreatitis (FAP) in early stage. MethodsThe clinical data of 37 patients with FAP admitted to this hospital within 72 h after onset of symptoms between January 2000 and September 2010 were analyzed retrospectively. FAP was defined as presence of multiple organ dysfunction syndrome (MODS) within 72 h after onset of symptoms. A total of 37 patients with a confirmed diagnosis of FAP were divided into two groups based on whether adopting the protective strategies for organ function in early stage or not. Patients treated between January 2000 and May 2004 did not adopt the protective strategies for organ function (Named nonprotection group, n=21); The other patients treated between June 2004 and September 2010 adopted protective strategies for organ function (Named protection group, n=16). With the exception of the protecting strategies for organ function, the patients with severe acute pancreatitisin received standard treatment in two groups. The acute physiology and chronic health evaluation (APACHE) Ⅱ score and multiple organ dysfunction score (Marshall), rate of pancreas infection, and case fatality were compared between two groups. ResultsCompared with the nonprotection group on day 3 after admission, APACHEⅡ score and Marshall score decreased in the protection group (APACHEⅡ score : 15.71±2.95 versus 17.72±3.77, P=0.137; Marshall score: 6.93±2.73 versus 8.06±2.36, P=0.206, respectively). In addition, the case fatality on day 7 and in hospital case fatality in the protection group decreased as compared with the nonprotection group (case fatality on day 7: 18.75% versus 33.33%, P=0.461; in hospital case fatality: 43.75% versus 57.14%, P=0.515, respectively). There was no significant difference of the rate of pancreas infection between two groups (P=1.000). ConclusionsIt from a case of a particular disease perspective, though the difference is not significant, but the observed improvement in prognosis is attributed by protective strategies for organ function of FAP in early stage to a certain degree, however it is verified by needing to more cases.
Objective To review the progress in the diagnosis and treatment of chronic disorders of achilles tendon. Methods Recent l iterature concerning the diagnosis and treatment of chronic disorders of achilles tendon was revi ewed. Results Ultrasonography and MRI were commonly used for diagnoses, and MRI could provide extensive informationfor the choice of therapy protocol. Nonsurgical therapy was the mainstay of treatment for most patients with overuse syndromes, surgical techniques for patients due to no effect in the conservative treatment and with chronic rupture, the cl inical treatment project should be determined based on the cl inical evaluation. Conclusion The surgical indication of chronic disorders of achilles tendon remains controversial, the long-term results of each treatment method are unknown, the randomized prospective studies are still required.
目的 分析反复发作的抗凝血类灭鼠药所致获得性凝血功能障碍的临床特点，探讨其诊治方案。方法 对2009年3月－2010年12月收治的3例抗凝血类灭鼠药所致获得性凝血功能障碍患者的临床表现、实验室检查和治疗转归进行分析，并复习相关文献。 结果 3例患者均以同时出现多部位出血为首发表现，经应用维生素K1、凝血酶原复合物、新鲜冰冻血浆、冷沉淀等治疗，患者病情好转，实验室指标恢复正常。停药（2、5周，3个月）后再次出现多部位出血，再给予维生素K1等治疗，病情可缓解。 结论 维生素K1可作为首选的治疗药物，且对反复发作的患者同样有效。为避免再发性出血，应维持治疗至少3个月。
ObjectiveTo summarize the current research progress on the changes of enteric glial cells (EGCs) in intestinal motility disorders and its possible molecular mechanisms in regulating intestinal motility.MethodThe literatures related to the EGCs and intestinal dysmotility were collected and analyzed.ResultsThe EGCs were involved in the occurrence and development of intestinal motility disorders, and there were abnormalities in the quantity, receptor, and phenotype in the different dysmotility diseases such as the postoperative ileus, Hirschsprung disease, inflammatory bowel disease, diabetes and so on. It could sense the neuronal signals and communicate with the enteric neurons via Ca2+ response and connexin-43 to affect the intestinal motility.ConclusionStudy of role and mechanism of EGCs in intestinal motor dysfunction is helpful to discovery new targets for treatment of these diseases.
Objective To investigate the prevalence of cognitive impairment and identify its influencing factors among lung cancer patients undergoing chemotherapy, providing a scientific basis for targeted interventions. Methods A convenience sample of lung cancer patients receiving chemotherapy at West China Hospital, Sichuan University between April and October 2024 was enrolled. Data were collected using a general information questionnaire, the Mini-Mental State Examination, Nutritional Risk Screening 2002, Hospital Anxiety and Depression Scale, Barthel index, and FRAIL scale. Univariate analyses and multivariate logistic regression were performed to determine factors associated with cognitive impairment. Results A total of 380 patients undergoing chemotherapy for lung cancer were enrolled, and 205 (53.9%) of them had cognitive impairment. Univariate analyses revealed that there were statistically significant differences between the cognitively normal group and the cognitive impairment group in age, educational level, work status, nutritional status, Barthel index, and FRAIL scale score (P<0.05). Multivariate logistic regression showed that advanced age [odds ratio (OR)=1.045, 95% confidence interval (CI) (1.015, 1.075), P=0.002] and FRAIL scale score [OR=1.369, 95%CI (1.165, 1.609), P<0.001] were identified as independent risk factors for cognitive impairment, whereas higher educational attainment served as a protective factor, compared with patients with primary school education or below, patients with junior high school, high school/secondary vocational school, college, or undergraduate education and above had a lower risk of cognitive impairment [OR=0.437, 0.258, 0.243, 0.120, P<0.05]. Conclusions Cognitive impairment is highly prevalent among lung cancer patients undergoing chemotherapy and is significantly influenced by age, educational level, and frailty. Healthcare providers should develop targeted interventions based on these factors to reduce the prevalence of cognitive impairment.