探讨B超引导在急诊重症患者连续肾脏替代治疗股静脉血滤管留置中的临床价值及安全性

目的探究B超引导在急诊连续肾脏替代治疗(Continuous Renal Replacement Therapy,CRRT)股静脉血滤管留置中的作用效果以及安全性,并分析其应用于临床的价值,为疾病的治疗康复提出指导。方法回顾性选取2015年1月~2016年1月期间,我院急诊收治的CRRT患者共128例,按照随机数表法将其分为对照组(64例)和观察组(64例),对照组采用B超引导,而观察组采用常规盲穿,记录两组患者治疗的结果以及安全性,并对记录数据作统计学的处理分析。结果观察组的一次穿刺成功率,置管成功率,手术操作时间以及不良反应等情况均要好于对照组,差异具有统计学意义(P<0.05)。结论相比于常规盲穿的方法,B超引导在急诊CRRT患者治疗中效果显著,手术操作时间短,置管成功率高,同时不良反应少,安全性好,适合在临床上推广使用,广大医学研究人员应当予以关注。

行CVVH治疗病人不同途径采血检测血钾离子和血钠离子的差异性研究

[目的]探讨行CVVH治疗病人动脉、外周静脉、血滤管采血检测血钾离子和血钠离子的差异性。[方法]选取34例行CVVH治疗病人,同一时间从动脉、外周静脉、血滤管采集血标本,采用血气分析仪检测血钾离子和血钠离子浓度,比较不同途径血钾离子和血钠离子水平的差异。[结果]动脉组、血滤管组与外周静脉组血钠离子浓度比较,动脉组与外周静脉组血钾离子浓度比较差异均无统计学意义(P>0.05)。血滤管组与外周静脉组血钾离子浓度比较差异有统计学意义(P<0.05)。[结论]可采用动脉血代替外周静脉血进行血钾离子和血钠离子的检测,采用血滤管血代替外周静脉血进行血钠离子的检测。

行连续静脉-静脉血液滤过治疗患者两种血乳酸测定方法差异性比较

目的:探讨行连续静脉-静脉血液滤过(CVVH)治疗患者动脉、血滤管采血检测血乳酸的差异性。方法:选取38例行CVVH治疗患者,同一时间从动脉、血滤管采集血标本,采用血气分析仪检测血乳酸,比较不同途径采血血乳酸水平的差异。结果:动脉组、血滤管组血乳酸浓度比较差异无统计学意义(P>0.05)。结论:可采用血滤管血代替动脉血进行血乳酸的检测。

Retrospective Study of Castleman's Disease:A Report of Fourteen Cases and Review of the Literature

OBJECTIVE To enhance the understanding of Castleman’s disease (CD), and to improve its diagnosis and management. METHODS Clinical features and related information on diagnosis and treatment of 14 cases of CD were retrospectively analyzed and the literature reviewed. RESULTS Based on the clinical classification, localized CD was found in 8 of the 14 cases. Both the results of lymph node biopsy and histopathology indicated they were a hyaline-vascular type. The multicentric type CD was detected in 6 cases, among which 4 were plasma cell type and 2 mixed type based on histopathologic examination. There were a variety of clinical situa-tions in the 14 cases, with a lack of specificity. They were previously misdiag-nosed as other diseases, and final diagnosis depended on a histopathologic examination. The 8 patients with localized CD underwent excision, without recurrence up to now. The 6 patients with multicentric-type CD were treated with glucocorticoids or combined chemotherapy, and all achieved remission. CONCLUSIONS CD has complicated clinical manifestations and is difficult to diagnose. Lymph node biopsy is important for early diagnosis. An optimal curative effect can be achieved with a suitable therapeutic option, based on histopathology and clinical classification.

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China

AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

Clinical and hemodynamic profiles of elderly patients with pulmonary arterial hypertension： a single center, prospective study

Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival. Methods In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger （18-65 years） and elderly （〉 65 years） patients with definitive diagnosis of precapillary PAIl were compared. Results A total of 119 patients were analyzed in this study; 43 were elderly （mean age： 71.5 ± 5.5 years）, while 76 were non-elderly （mean age 44.5 ±15.2 years）. During the mean follow-up duration of 26.8 ±25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e＇ and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion （TAPSE; HR： 1.272, 95% CI： 1.079-1.499, P = 0.004） and uric acid （HR： 1.291, 95% CI： 1.042-1.600, P = 0.019） in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide （HR： 1.002, 95% CI： 1.001-1.004, P 〈 0.001） and higher right atrial pressure （HR： 1.128, 95% CI： 1.026-1.241, P = 0.013） values were the only parameters associated with mortality. Conclusions Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.

Low-grade risk of hypercoagulable state in patients suffering from diabetes mellitus type 2

Objective： Diabetes, including type 1 and type 2, is associated with the hypercoagulable state. The aim of this study is to evaluate the concentration of selected hemostatic parameters and vascular endothelial growth factor-A （VEGF-A） in diabetic subjects. Methods： The study was conducted in 62 patients with diabetes. Group I consisted of 27 patients having uncontrolled diabetes with microalbuminuria and Group II included 35 well-controlled diabetic patients. The control group was made up of 25 healthy volunteers. In the citrate plasma, the concentrations of tissue factor （TF）, tissue factor pathway inhibitor （TFPI）, thrombin-antithrombin （TAT） complexes, and D-dimer were assayed. Serum concentrations of VEGF-A, lipid profile, creatinine, and plasma fasting glucose were measured and in the versene plasma the concentration of HbAlc was determined. Results： In the patients with uncontrolled diabetes, higher con- centrations of TF, TFPI, and VEGF-A were observed, as compared with the well-controlled diabetics group and the control group. A significantly lower activity of antiplasmin was reported in patients from Group I as compared with the control group. In Group I, using the multivariate regression analysis, the glomerular filtration rate was independently associated with VEGF-A and dependently associated with total cholesterol. Conclusions： The study showed higher concentrations of TF and TFPI in the patients with uncontrolled diabetes with microalbuminuria, which is associated with rapid neutralization of the thrombin formation, since TFPI inhibits the complex of TF/VIIa/Ca2＋. The manifestation of the above suggestions is the correct TAT complexes and D-dimer, which indicates a low grade of prothrombotic risk in this group of patients, but a higher risk of vascular complications.

Vascular segmentation of neuroimages based on a prior shape and local statistics

Fast and accurate extraction of vascular structures from medical images is fundamental for many clinical procedures.However,most of the vessel segmentation techniques ignore the existence of the isolated and redundant points in the segmentation results.In this study,we propose a vascular segmentation method based on a prior shape and local statistics.It could efficiently eliminate outliers and accurately segment thick and thin vessels.First,an improved vesselness filter is defined.This quantifies the likelihood of each voxel belonging to a bright tubular-shaped structure.A matching and connection process is then performed to obtain a blood-vessel mask.Finally,the region-growing method based on local statistics is implemented on the vessel mask to obtain the whole vascular tree without outliers.Experiments and comparisons with Frangi’s and Yang’s models on real magneticresonance-angiography images demonstrate that the proposed method can remove outliers while preserving the connectivity of vessel branches.