慢性肾衰竭正虚证候演变规律初探

目的 :探讨慢性肾衰竭不同分期的正虚证型演变规律。方法 :按照慢性肾衰竭正虚辨证分型标准制订调查表 ,对 339例住院病例进行证候调查 ,判定正虚类型。结果 :代偿期、失代偿期正虚诸证分布无统计学差异 (χ2 =0 .99,P >0 .0 5 ) ;四期诸证整体比较 (χ2 =10 7.16 ,P <0 .0 1) ,差别有高度统计学意义。结论 :慢性肾衰竭正虚诸证演变大致是脾肾气虚 (气阴两虚 )→脾肾阳虚→阴阳两虚。     

养肝益水颗粒对高血压早期肾损害尿微量蛋白的影响

目的:观察养肝益水颗粒对高血压早期肾损害患者尿清蛋白排泄率(urinary albumin ex-cretion ratio,UAER)、尿微量清蛋白(microalbuminuria,MA)、β2微球蛋白(β2-microglobulin,β2-MG)、α1微球蛋白(α1-microglobulin,α1-MG)、转铁蛋白(transferrin,TRF),免疫球蛋白G(immu-noglobulin G,IgGu)的影响.方法:选择80例符合中医辨证的高血压早期肾损害患者,随机分为治疗组和对照组.两组均给予常规降压治疗.治疗组同时加服养肝益水颗粒.两组疗程均为4周.分别于治疗前和治疗4周后进行UAER、MA、α1-MG、β2-MG、TRF、IgGu测定.结果:治疗后两组UAER、MA、α1-MG、β2MG、TRF、IgGu水平均显著下降,且治疗组与对照纽比较,上述指标的差异具有显著性(P＜0.05,P＜0.01).结论:养肝益水颗粒具有减少高血压早期肾损害尿微量蛋白排出的作用.     

Armanni–Ebstein Lesions in Terminal Hyperglycemia

Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose.     

凯恩斯的基本经济思想及政府干预论

凯恩斯创立了现代宏观经济学体系,对宏观经济学理论的发展作出了极大的贡献。他将经济学研究的重点转向了需求管理,认为有效需求不足是经济萧条与危机的原因,提出通过政府干预扩大有效需求可以使经济恢复均衡。凯恩斯的思想和政策主张对现代市场经济理论与实践的发展产生了深远的影响。     

Fatal renal hemorrhage after extracorporeal shock wave lithotripsy

Renal hematoma is one of the most severe complications of extracorporeal shock wave lithotripsy (ESWL). ESWL is used in the noninvasive treatment of urinary calculosis. The shock waves can lead to capillary damage, renal parenchymal or subcapsular hemorrhage. We present a case with fatal complication and the result of the medico-legal evaluation. A 71-year-old woman was treated by ESWL, renal hematoma was detected during the clinical observation, and the patient died. The death occurred despite close clinical observation as a consequence of a rare complication of ESWL. The mechanism of death was hemorrhagic hypovolemic shock due to renal hemorrhage complications due to ESWL for treatment of renal calculi. This therapeutic complication is a known complication of appropriate treatment.     

芦黄参花胶囊联合福辛普利治疗糖尿病肾病60例

目的 观察中西医结合疗法治疗糖尿病肾病（diabetic nephropathy,DN)的疗效及建立其综合疗效评价体系。方法 纳入Mogensen Ⅲ、Ⅳ期DN患者120例,将其随机分为治疗组（芦黄参花胶囊和福辛普利联合治疗）和对照组（单用福辛普利治疗）,疗程为3个月。比较两组的临床疗效及中医证候疗效,观察治疗前后DN患者尿白蛋白排泄率（urinary albumin excretion rate,UAER）、肾功能、血压、血糖、血脂水平,采用世界卫生组织生存质量量表简表评价患者治疗前后的生存质量。结果 对于Mogensen Ⅲ、Ⅳ期DN患者,治疗组临床疗效及中医证候疗效均显著高于对照组（P<0.05）;治疗组在降低Mogensen Ⅲ期DN患者UAER及血清肌酐、尿素氮水平,提高Mogensen Ⅲ、Ⅳ期DN患者生理健康、心理健康、总的生存质量和满意度评分方面显著优于对照组（P<0.05,或P<0.01）。两组均未见明显不良反应。结论 芦黄参花胶囊和福辛普利联合治疗可有效降低早期DN患者尿蛋白,改善肾功能,提高患者的生存质量,本研究可为DN的防治提供新的疗效评价体系。     

滋肾活血解毒方对慢性肾衰竭大鼠肾内皮素基因表达的影响

目的 :观察滋肾活血解毒方对慢性肾衰竭 (CRF)大鼠残肾组织中ET 1mRNA的影响。方法 :采用 5/ 6肾切除法复制大鼠CRF模型 ,将 50只Wistar大鼠随机分成对照组、保肾康组、洛汀新组、滋肾活血解毒方组 (观察组 )、正常组 ,用RT PCR技术检测各组大鼠残肾组织中ET 1mRNA表达水平。结果 :正常组肾组织中ET 1mRNA表达最弱 (P <0 .0 1) ,对照组肾组织中ET 1mRNA表达最明显 (P <0 .0 1) ,观察组肾组织中ET 1mRNA表达较保肾康组及洛汀新组有明显下降 (P <0 .0 1)。结论 :滋肾活血解毒方可能是通过下调肾脏组织中ET 1mRNA表达水平而改善CRF大鼠肾功能。     

Biting Through an Arteriovenous Hemodialysis Graft: An Unusual Method of Suicide

Abstract:  Patients on long-term hemodialysis often have multiple medical and social problems with associated psychological stress and depression. The suicide rate in this population is higher than the general population, and suicides have been reported following severing or disconnection of hemodialysis vascular access sites. We report a patient on chronic hemodialysis with a history of depression and suicidal ideation who bit into his forearm arteriovenous graft and exsanguinated.     

湿地保护与可持续发展

湿地被誉为“地球之肾”，保护湿地已成为世界上许多国家生态保护的重点，我国作为湿地大国在湿地保护方面面临严峻挑战。湿地作为不同于陆地和水域的独特生态系统，在支撑经济社会可持续发展方面是其他生态系统不可替代的。保护湿地是全社会的共同责任，是实现可持续发展的内在诉求。