维持性腹膜透析患者并发真菌性腹膜炎的易感因素和结局分析

目的分析腹膜透析相关性真菌性腹膜炎(FP)发生率、致病菌、治疗情况和预后。方法回顾性分析2010年1月至2019年10月陆军军医大学第二附属医院腹膜透析中心发生的18例FP,选择与同期收治非真菌性腹膜炎113例比较,记录所有FP患者的临床资料,治疗方法和转归,分析FP发生的易感因素和结局。结果腹膜透析相关性腹膜炎共389例次,FP 18例次,占4.6%。其中白念珠菌6例(33.3%)、近平滑念珠菌5例(27.8%)、无名念珠菌3例(16.7%)、光滑念珠菌2例(11.1%)、热带念珠菌1例(5.6%)和克柔念珠菌(5.6%)1例。与非真菌性腹膜炎相比较,FP组腹透时间更长(P<0.001)、既往抗生素使用率高(P<0.001)、血浆白蛋白(ALB)更低(P<0.001)、C反应蛋白(CRP)更高(P<0.001)、甲状旁腺激素(PTH)和血磷(P)水平更高(P<0.001)。Logistic回归分析结果显示腹透时间越长、1个月内使用抗生素、低ALB和高CRP是发生FP的危险因素(P<0.05)。18例次FP中,14例患者拔管转血透(77.8%),4例患者死亡(22.2%),FP组腹膜透析技术失败率和死亡率明显高于BP组。结论腹透时间越长、既往使用抗生素、低ALB和高CRP是FP的易感因素。FP是腹膜透析的严重并发症,是导致技术失败的主要原因,确诊后早期拔管可降低死亡率。     

腹膜透析病人的预后影响因素

在我国,终末期肾脏病的发病率逐年增加,相应地,腹膜透析病人的数量也在不断增长。明确腹膜透析病人预后的影响因素是临床医师亟待解决的重要课题。尿毒症毒素的积蓄可对腹膜透析病人的心血管系统产生不良作用,影响病人的生活质量。腹膜透析充分性的相关指标对于预测病人的生存率也有一定的指导意义。此外,腹膜炎的发生可使超滤量明显下降,增加病人的死亡率。合并症可能通过加重病人的营养不良状态、促进炎症水平,影响病人的预后。因此,重视病人的尿毒症毒素水平、透析充分性指标与合并症情况,积极防治腹膜炎,将有助于改善腹膜透析病人的预后。     

5例腹膜透析相关的真菌性腹膜炎临床分析

目的探讨腹膜透析患者真菌感染的发生率、致病真菌以及感染的主要因素及处理结果。方法回顾性分析58例腹膜透析患者的临床资料,对真菌感染患者从临床症状、真菌学检查、治疗及预后进行详细的论述,探讨腹膜透析与真菌感染的关系。结果腹膜透析治疗的58例患者中有5例发生真菌性腹膜炎,感染率为8.6%,致病菌4例为白念珠菌,1例为近平滑念珠菌,其中4例患者经抗真菌和拔出腹透管处理,治疗效果较为理想。1例患者因病情危重伴有其他细菌感染,最终死于其他并发症。结论真菌感染是腹膜透析患者较严重的并发症,尽管发生率不高,但如果不及时处理后果严重,早诊断、早治疗并根据实际情况考虑拔除腹透管尤为重要。     

皮炎外瓶霉导致的真菌性腹膜炎1例

报道1例由皮炎外瓶霉(Exophiala dermatitidis,Ed)导致的真菌性腹膜炎。此菌分离于1名长期腹膜透析患者的腹水。皮炎外瓶霉主要引起皮肤及皮下组织、中枢神经系统感染,引起腹膜炎者少见。现对此临床分离株进行真菌学分析、鉴定、药敏实验。患者经拔除透析管,改血液透析,同时抗真菌治疗,口服伊曲康唑0.2g/d,症状明显改善。     

腹膜透析患者相关感染情况调查及护理对策

目的调查腹膜透析患者相关感染情况,探讨护理对策以降低腹膜透析患者相关感染的发生率。方法选取2010年5月至2014年8月宁波市鄞州区第二医院收治腹膜透析患者165例,观察腹膜透析患者相关性感染的发生、感染致病菌的分布以及透析护理中发病情况,分析腹膜透析患者相关感染发生的原因。结果 165例腹膜透析患者共有79例发生108次相关感染,其中腹膜炎32例共41次,出口感染17例共28次,出口处合并隧道感染28例共37次,隧道感染2例共2次;79例感染患者共有58例细菌培养为阳性,阳性率为73.42%。分离出病原菌63株,其中革兰阳性菌40株(占63.49%),革兰阴性菌19株(占30.16%),真菌4株(占6.35%);108次腹膜透析相关感染发生的原因:操作因素共67次,患者因素36次,环境因素3次,原因不明2次。结论腹膜透析患者相关感染的致病菌主要为革兰阳性菌和革兰阴性菌,接触性感染和患者身体因素是腹膜透析患者相关感染的重要原因,采用恰当的护理对策能够有效降低感染发生率,有利于患者生活质量的提高。     

7天健康教育法在降低首次腹透植管患者腹膜炎中的应用

目的探讨7天健康教育方法对首次腹膜透析植管患者腹膜炎的预防及患者对护理满意度的影响。方法将66例首次腹膜透析植管患者随机分为对照组26例和观察组40例,对照组采用传统健康教育法,观察组采用7天健康教育法,比较两组患者腹膜炎的发生率和护理满意度情况,并分析腹膜炎发生诱因。结果 1个月后,观察组患者的护理满意度明显高于对照组;1年后,观察组腹膜炎的发生率明显低于对照组,差异均有显著统计学意义(P0.01)。观察组腹膜炎发生主要诱因是无菌原则不合格,居家操作环境差导致,腹膜炎发生率显著低于对照组(P0.05)。结论 7天健康教育法可有效降低腹膜炎的发生,提高患者护理满意度,从而提高生存质量。     

自制腹透管腹膜透析相关性大肠埃希菌腹膜炎大鼠模型的建立及腹膜AQP1表达研究

目的通过自制腹透管建立一个便利的腹膜透析相关性腹膜炎大鼠模型,研究水孔通道蛋白1 (aquaporin 1,AQP1)在腹膜炎大鼠腹膜表达情况。方法将60只SD大鼠分为3组,第1组为空白组;第2组为穿刺组,以传统方式直接向大鼠腹腔注射腹膜透析液及大肠杆菌菌液;第3组为置管组,采用医用18G静脉留置针,打侧孔消毒灭菌后,从左下腹迷路穿刺置入腹腔后拔出穿刺针芯,贴无菌膜后固定,消毒留置针硅胶帽后注入大肠杆菌,建立腹膜透析相关性大肠埃希菌腹膜炎大鼠模型。建模后饲养大鼠72 h处死,取大鼠壁层腹膜行病理切片观察腹膜炎细胞浸润情况,同时采用免疫组化法检测AQP1在大鼠壁层腹膜的表达情况。结果穿刺组大鼠存活率为50%,置管组大鼠存活率为85%,两组大鼠的存活率比较差异有统计学意义(P0.05),且两组大鼠壁层腹膜病理切片光镜下均观察到大量炎细胞浸润。空白组、置管组的AQP1表达均明显低于穿刺组,差异均有统计学意义(均P0.05)。结论医用留置针置入大鼠腹腔可建立腹膜透析相关性腹膜炎大鼠模型;AQP1在腹膜透析相关性腹膜炎大鼠的壁层腹膜中表达上调,与大鼠的腹膜炎病情变化程度密切相关。     

血液透析和腹膜透析对终末期肾病患者预后的影响及其安全性比较

目的:分析和比较血液透析和腹膜透析终末期肾病患者预后的影响及其安全性。方法:选取2010年1月至2016年4月本医院收治的透析患者246例作为研究对象,将其分为血液透析组和腹膜透析组,比较两组患者治疗后的生存情况及并发症的发生情况。结果:两组患者死亡原因是心力衰竭、消化道出血、重度感染、脑梗死,两组的病死率及死因构成比较差异均无统计学意义(P0.05)。腹膜透析组患者1年、3年、5年生存率均显著高于血液透析组(P0.05),两组患者7年生存率比较差异无统计学意义(P0.05)。首次透析年龄超过60岁的终末期肾病患者中,腹膜透析组1年、3年、5年、7年生存率均显著低于血液透析组(P0.05)。血液透析组心力衰竭、动静脉内瘘闭塞发生率显著高于腹膜透析组(P0.05),腹膜透析组腹膜炎的发生率显著高于血液透析组(P0.05),血液透析组总并发症发生率明显高于腹膜透析组(P0.05)。结论:血液透析和腹膜透析各有优缺点,对终末期肾病患者应个体化选择透析方式,减少并发症,提高生活质量及生存率。     

腹膜透析隧道阿萨希毛孢子菌感染1例

患者女,26岁,确诊慢性肾衰竭尿毒症并维持性腹膜透析7年,腹痛2d入院,腹透液浑浊,全腹压痛、反跳痛。诊断腹膜透析相关性腹膜炎。腹透管隧道分泌物培养结果:阿萨希毛孢子菌。予抗感染治疗,手术拔除腹透管,术后20d好转出院。     

某院校学员浅部真菌病调查分析CSCD

目的了解华北某部队院校学员浅部真菌性皮肤病患病及诊治情况。方法采取浅部真菌病体检筛查、真菌镜检和问卷调查方式。结果回收1733份有效问卷,结果显示:①学员入校后确诊患浅部真菌性皮肤病186例,发病率为10.73%,足癣(147例)发病率最高,总体发病率低于南方地区。②夏、秋季浅部真菌性皮肤病的发病率显著高于冬、春季。③不同服役年限的浅部真菌性皮肤病发病率差异有统计学意义。④70.87%患者使用外用药物治疗,6.80%患者使用外用和口服药物联用,咪唑类药物使用率最高。患者对抗真菌药物的治疗效果满意度50.62%,复发率为51.46%。结论院校学员浅部真菌病发病率较高,加强健康宣教、合理用药指导意义重大。     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.     

肝癌中HBV和HCV基因和抗原的分布及意义

采用原位分子杂交方法检测HCV RNA及HBV X基因;采用免疫组织化学方法研究HCV核心抗原,非结构区C33c抗原及HBxAg在肝细胞肝癌中的定位及分布.结果表明(1)HCV RNA、HBV X基因在肝细胞肝癌组织检出率分别为40%(55/136)和82%(112/136).HCV RNA定位于癌细胞的胞浆内,阳性细胞呈散在、灶状及弥漫分布三种形式;HBV X基因在肝癌细胞中的分布呈胞浆型、核型及核浆型,阳性细胞也呈上述三种分布形式;(2)HCV C33c抗原、核心抗原在肝细胞肝癌中的阳性率为81%(133/164)及86%(141/164).C33c抗原定位于癌细胞及肝细胞的胞浆内;核心抗原既定位于癌细胞核中,又可定位于胞浆中.C33c抗原阳性细胞以灶状分布为主;而核心抗原阳性细     

Selection with two alleles and complete dominance

For a plant selection model with frequency-independent viabilities, fertilities and selfing rates, it is shown that apart from global fixation, for certain parameter combinations a protected polymorphism and facultative fixation (either allele may become fixed according to initial frequencies) may both occur. Facultative fixation requires different selling rates for the dominant and recessive type. Protection of the polymorphism requires resource allocation for male and female function. In this connection the problem of purely genetically caused population extinction is discussed.
For general frequency dependence and regular segregation, the chances for establishment of a completely recessive gene are compared to those of a completely dominant gene. It is proven that the process of establishment of the recessive gene, despite a fitness advantage, may be considerably endangered by drift effects if random mating prevails. The recessive gene may reach the same effectivity in establishment as a dominant gene, only if the recessive homozygote mates exclusively with its own type during the period of establishment.