Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease that can occur at any age and generally has a good prognosis. Polycythemia vera and nephrotic syndrome are uncommon risk factors for cerebral venous sinus thrombosis. A dilemma exists in the treatment of cerebral venous sinus thrombosis with polycythemia vera and nephrotic syndrome, as some cases are refractory to first-line therapy. Here, we report a patient with CVST who presented with a generalized seizure and was found to have bilateral frontal lobe hemorrhage and subarachnoid hemorrhage. Brain magnetic resonance venography showed extensive cerebral venous sinus thrombosis extending from the superior sagittal sinus to the left internal jugular vein. Further testing revealed that the patient had polycythemia vera and nephrotic syndrome. Anticoagulation therapy had limited effects. He underwent endovascular intervention, including stent thrombectomy, intermediate catheter aspiration, balloon dilatation, and local intravenous thrombolysis, to achieve revascularization. After 9 months of follow-up, the patient had recovered well without any sequelae. This case shows that in patients with critical cerebral venous sinus thrombosis who fail to respond to anticoagulant therapy, stent thrombectomy combined with intermediate catheter aspiration, balloon dilation, and local thrombolysis may be a viable option. This strategy can quickly resolve venous sinus obstruction and improve the prognosis of patients with critical cerebral venous sinus thrombosis.

Acute kidney injury(AKI)is an extremely hazardous clinical syndrome characterized by rapid decline of renal function, with high morbidity and mortality. Renal replacement therapy(RRT) including in vitro blood purification and peritoneal dialysis(PD) is an effective method for the treatment of AKI. The application of peritoneal dialysis in AKI is often overlooked. The article reviews the research progress of peritoneal dialysis for treatment of acute kidney injury.

微课是一种短时间的视频教学,它能够将一个个知识点高度浓缩,精确讲解,使学习更加轻松.伴随着教学改革的深入,微课已经逐渐成为广大医学生喜爱的教学模式.本文以"继发性甲状旁腺功能亢进症"为例,阐述内科学教学中微课的选题及制作,期待为微课在教学应用中的经验交流提供参考.

Objective: The aim of the current study investigate the correlation between the serum level of Pentraxin-3 (PTX-3) and cardio-vascular disease (CVD) in the patients with continuous ambulatory peritoneal dialysis (CAPD) and its clinical significance. Methods: A total of 86 patients with CAPD in our hospital were divided into two groups: Group CVD (45 patients with CVD) and Group non-CVD (41 patients without CVD). Another 82 healthy controls were selected simultaneously as Group CON. The clin-ical data and related biochemical indexes were collected, and the levels of PTX-3 in all the subjects were detected by enzyme-linked immunosorbent assay (ELISA). Results: The serum PTX-3 level in the patients with CAPD was (1.86 +/- 0.25) ng/mL, which was significantly higher than that in Group CON (1.65 +/- 0.34) ng/mL. The serum PTX-3 level in Group CVD was significantly higher than Group non-CVD (P< 0.001). The ROC curves of CVD (with PTX-3 and CRP as the test variables) showed that the AUC of the two indexes had statistical significance (P< 0.05), and PTX-3 was superior to C-reactive protein (CRP); the correlation analysis of PTX-3 in CAPD patients with different indexes showed that PTX-3 was positively correlated with CRP while negatively correlated with body mass index (BMI), TG, Hb, serum albumin (ALB), and KT/V. Conclusions: The serum level of PTX-3 in CAPD-CVD patients is significantly higher than that in CAPD patients without CVD, and the serum level of PTX-3 may be an independent risk factor for CVD.

Objective: To investigate the symptom relief, postoperative complications, and recurrence in the patients with uremic SHPT after subtotal parathyroidectomy (S-PTX), total parathyroidectomy (T-PTX), or total parathyroidectomy combined with auto-transplantation (PTX+AT). Methods: A total of 92 patients with SHPT undergoing parathyroidectomy in our hospital were retrospectively analyzed. The patients were divided into 3 groups according to their surgical procedures and compared the levels of parathyroid hormone (PTH), calcium (Ca), phosphorus (P), etc. before surgery and one week, one month and six months after surgery, and observed postoperative complications, recurrence rate and symptom improvement among these groups. Results: All the symptoms such as bone pain were relieved to varying degrees in the 3 groups. The postoperative serum levels of Ca, P, and intact PTH (iPTH) decreased in all groups than preoperative values (P<0.05). There was no significant difference in the serum Ca and P among the three groups (P>0.05). The levels of PTH in group S-PTX and group PTX+AT were higher than group T-PTX at the 3 postoperative time points (P<0.05). The 6-month follow-up revealed no difference in recurrence rate among the three groups (P>0.05). Conclusion: The three kinds of parathyroidectomy can all safely and effectively treat uremic SHPT. T-PTX is superior in reducing iPTH to the other two groups.

目的 探讨老年腹膜透析(PD)患者残余肾功能(RRF)下降的相关因素.方法 选取以基线24 h尿量≥400 ml为纳入标准,以最终24 h尿量≤100 ml定义为终点事件发生,选取吉林大学第一医院二部肾内科腹膜透析中心年龄≥60岁的65例PD患者是否发生终点事件分两组,比较各项临床指标,并用回归模型分析其与RRF下降的关系.结果 发生终点事件的人数为20例(30.7％),终点事件发生的平均时间为(7.8±2.0)个月.与未发生终点事件组相比,发生终点事件的PD患者,腹膜炎发生、体重指数(BMI)、超滤量、24 h尿量、收缩压、血脂、C反应蛋白及血磷较高,血红蛋白和血浆白蛋白较低.使用Cox逐步回归分析显示,腹膜炎发生、低血红蛋白、高超滤量、高收缩压、高脂血症、高血磷、低血浆白蛋白在影响患者残余肾功能下降中有显著意义.结论 老年PD患者血浆白蛋白、血红蛋白对RRF起保护作用,高收缩压、高脂血症、高血磷、腹膜炎发生、高超滤量为RRF下降危险因素.

The purpose of this study was to summarize the pathogens that cause peritoneal dialysis (PD)-associated peritonitis and to identify risk factors for PD-associated peritonitis. This retrospective study included 115 end-stage renal disease (ESRD) patients receiving PD therapy. Patients were categorized into two groups: peritonitis group (n = 41) and non-peritonitis group (n = 74). Clinical data and laboratory tests were collected from medical records. The multivariate logistic regression model was used to evaluate associations between PD-associated peritonitis and potential risk factors. PD-associated peritonitis occurred 54 times in 41 patients. The most frequently identified pathogen was Gram-positive cocci (57.78%). Multivariate logistic regression analysis showed that serum albumin (β = –0.208, P < 0.001), blood phosphorus concentration (β = –1.732, P = 0.001), gastrointestinal disorders (β = 1.624, P = 0.043), and use of calcitriol (β = –2.239, P = 0.048) were significantly correlated with PD-associated peritonitis. Receiver operating characteristic (ROC) curves showed that the areas under the curve were 0.832 for serum albumin and 0.700 for blood phosphorus concentration with optimal cut-off values of 29.1 g/L for serum albumin and 1.795 mmol/L for blood phosphorus concentration. Gram-positive coccus is the major pathogen responsible for PD-associated peritonitis. Serum albumin <29.1 g/L, blood phosphorus concentration <1.795 mmol/L, and intestinal disorders are risk factors for PD-associated peritonitis, whereas the use of calcitriol can reduce the risk of PD-associated peritonitis.

目的 探讨持续性不卧床腹膜透析(CAPD)患者血正五聚蛋白(PTX)3与心血管疾病(CVD)的相关性.方法CAPD患者80例分为CVD组(41例)和无CVD组(39例),检测血液及腹透液中PTX3和血液C-反应蛋白(CRP)水平.结果CVD组血清PTX3明显高于无CVD组(P<0.001).PTX3、CRP为检验变量的CVD的受试者工作特征(ROC)曲线显示,2个指标的曲线下面积差异有统计学意义(P<0.05),PTX3曲线下面积是0.754(95％CI:0.672～0.859).CVD组血清与腹透液中PTX3无相关性(P>0.05);CVD组CAPD透析时间在36个月以上的患者腹透液中PTX3显著高于透析时间36个月及以下的患者(P<0.05).结论并发CVD的CAPD患者血清PTX3明显升高;CAPD患者血清PTX3与CRP呈正相关,预测CVD PTX3较CRP更敏感;腹透液中PTX3与腹膜透析时间相关.

Tubular epithelial‑myofibroblast transdifferentiation (TEMT) is important in the development of chronic renal failure. The present study investigated whether hepatocyte growth factor (HGF) inhibits TEMT, and whether this function may be associated with the inhibition of angiotensin II (AngII) and the Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway. Human HK‑2 kidney proximal tubular cells were divided into 4 groups and treated with AngII (1x10‑6 M), HGF (8x10‑3 M), AngII plus HGF or control conditions, followed by an assessment of apoptosis induction and the expression levels of α‑smooth muscle actin (α‑SMA), which is a marker of TEMT. as well as the activation level of JAK2, phosphorylated (p)‑JAK2, STAT3 and p‑STAT3 signaling pathways. In HK‑2 cells, α‑SMA mRNA and protein expression levels increased following treatment with AngII, however, decreased expression was observed following exposure to HGF. HGF counteracted the AngII‑induced increase in the expression of α‑SMA in HK‑2 cells. Similar expression profiles were observed for the phosphorylated forms of JAK2 and STAT3, indicating the possible involvement of this signaling pathway. The results demonstrated that treatment of cells with AngII was associated with the induction of apoptosis when compared with the control. By contrast, treatment with HGF attenuated AngII‑induced apoptosis. The results suggested that HGF may inhibit TEMT by inhibiting AngII through the JAK2/STAT3 signaling pathway in HK‑2 cells and HGF may prevent apoptosis induced by AngII. The present study provides a basis for understanding the mechanisms involved in the inhibition of TEMT by HGF, which requires further investigation.

胱抑素C在一系列生理、病理过程中发挥着重要作用,与心脑血管、肿瘤、肝纤维化等疾病有一定相关性. 研究表明胱抑素C广泛参与了糖尿病肾病、高血压肾病、狼疮性肾炎、急慢性肾衰竭等多种肾脏疾病的发生和发展,在肾功能早期损害时升高,是一个反映肾功能的良好标志物,本文就胱抑素C水平与肾脏疾病的研究进展作一综述.

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随着睡眠医学的发展,睡眠问题对人类健康的影响越来越受到公共卫生界的关注和重视. 睡眠障碍与疾病的关系也已成为众多学者研究的热点. 目前关于慢性肾脏疾病( chronic kidney disease,CKD)患者睡眠障碍的研究大多集中于终末期维持性血液透析的患者,但有关早期尚未进行血液透析的CKD患者睡眠障碍的相关研究并未全面展开.

目的：研究阿奇霉素在治疗小儿肺炎支原体感染中的临床效果。方法：将我院2010年5月至2012年5月收治的114例小儿肺炎支原体感染病患者作为研究对象，按照1：1的人数比将其分为实验组和对照组，实验组病患采用阿奇霉素治疗，对照组病患采用红霉素治疗，通过监测记录实验组和对照组两组患儿体征消失时间如：体温恢复、咳嗽好转和肺部罗音的消失时间来评价本次研究的治疗效果，同时通过治疗效果、恢复时间和副作用等情况综合评价临床疗效。结果：实验组在体温恢复、咳嗽好转和肺部罗音的消失时间几个指标上均明显优于对照组，且差异具有统计学意义（ P＜0．05）；综合比较两组有效率分别为实验组89．5％和对照组77．2％，差异具有统计学意义。结论：阿奇霉素治疗小儿肺炎支原体感染效果好、成本低、见效快、毒副作用小，相较于红霉素具有明显优势，值得临床推广。

To create a new quality evaluation system through the course of hemodialysis care quality evaluation analysis. <br> We establish the quality evaluation through a lot of literature review and two rounds of the 40 experts'survey. <br> We work out five level indicators and 17 secondary indicators by sorting out the survey. <br> By analyzing the establishment of a new evaluation system, and the two made an evaluation to major hospitals for research and reference.

Objective To discuse the clinical efficacy Pulmicort and Pitt inhalation in the treatment of asthma,bronchitis were discussed. Methods Extraction Zhangjiagang TCM and Western Medicine Combination Hospital from March 2011 to November 2012 were treated 96 cases of patients with asthma,bronchitis,based on the use of drugs randomly divided into experimental group and control group,each 48 cases. Control group under went routine clinical therapy,the experimental group on the basis of conventional therapy in the control group using Pulmicort can Pitt atomization inhalation therapy. Results Inexperiental group,the total effective rate was 93. 5%,77. 1% in the control group,the various symptoms and signs such as cough,shortness of breath,wheezing sound and wet rales disappeared were significantly shorter,and the differences were statistically significant( P 0. 05). Conclusion Pulmicort Stock Pitt inhalation have a significant improvement in the clinical efficacy and shorter hospital stays.

Several studies have shown that hepatocyte growth factor (HGF) ameliorates chronic renal failure, but its mechanism of action is unclear. This study was designed to test the delivery of HGF in the PCI-neo vector, using the 5/6 nephrectomized rat as a model for chronic renal failure, and to confirm that this protective function is associated with decreased protein expression of transforming growth factor-beta1 (TGF-beta 1). Rats were randomly divided into the following groups: Control (untreated), PCI-neo (vector control), 5/6 nephrectomy, and PCI-neo-HGF. Rats were sacrificed at both the fifth and ninth week after 5/6 nephrectomy. Kidney specimens were used for pathological examination (hematoxylin-eosin staining), and detection of TGF-beta 1 protein (Western blot and immunohistochemistry) expression. Blood urea nitrogen, serum creatinine, and 24-h urinary protein excretion (UPE) were increased, renal interstitium was seriously injured, and TGF-beta 1 protein expression was elevated in 5/6 nephrectomized rats compared to control rats at either time point. Red blood cell and hemoglobin levels decreased in the ninth week after 5/6 nephrectomy. PCI-neo-HGF expression ameliorated the aforementioned changes and decreased TGF-beta 1 expression, not only in the fifth week, but also in the ninth week after surgery. The process of renal injury in the 5/6 nephrectomized rat was consistent with that of chronic renal failure. The increase in TGF-beta 1 expression was maintained after 5/6 nephrectomy. HGF relieved chronic renal failure, this protection was associated with down-regulation of TGF-beta 1 protein expression, and the protective effects were long-term and stable after 5/6 nephrectomy.

目的:探讨布地奈德治疗小儿喉炎的效果。方法:选取收治的60例小儿喉炎患者,分为对照组和观察组,各30例。对照组采用基础治疗,观察组在对照组的基础上给予雾化吸入布地奈德。结果:观察组总有效率为93.33%,对照组总有效率为73.33%(P<0.05),观察组相关临床症状改善时间短于对照组。结论:布地奈德吸入治疗小儿喉炎效果确切,能够有效缩短治疗时间,减少患儿的痛苦。

This study aimed to examine whether hepatocyte growth factor (HGF) can improve renal function in 5/6 nephrectomized rats and investigate whether this function is associated with a decrease in α-smooth muscle actin (α-SMA) expression in rat glomerulus mesangial cells and renal interstitium. Rats were randomly divided into the following groups: control, PCI-neo, sham-operation, 5/6 nephrectomy, and low-dose and high-dose PCI-neo-HGF. Rats were killed in the ninth week after 5/6 nephrectomy, and the kidney specimens were subjected to pathological examination by Hematoxylin–Eosin staining and detection of α-SMA expression by reverse transcriptase-polymerase chain reaction (RT-PCR), Western blot, and immunohistochemistry. The results showed that blood urea nitrogen and serum creatinine levels were increased, renal interstitium was injured, and α-SMA expression was elevated in 5/6 nephrectomized rats compared with that in control. The above changes were ameliorated in the rats injected with PCI-neo-HGF vector. At the molecular level we found that PCI-neo-HGF repressed α-SMA expression in mesangial cells stimulated by lipopolysaccharide. In conclusion, our data suggest that HGF can relieve chronic renal failure, and this protection is associated with the down-regulation of α-SMA expression in mesangial cells and renal interstitium.

肾间质纤维化是各种慢性肾脏病进展至终末期肾衰的共同病变过程,研究如何减缓其进展对保护肾功能具有重大的临床意义。5/6肾切除大鼠模型造模是研究肾小管间质损害的理想模型[1]。血管紧张素Ⅱ（AngⅡ）作为一种血管活性物质可引起肾脏血流动力学异常,但近年来人们更加关注它引起的

<正>中心静脉置管为肾衰竭患者,特别是血管条件不强而且又需要紧急血透的患者,或者危重症患者提供了理想的血管通路,但应用过程中可导致多种并发症,其中置管感染为最常见并发症,重者会导致生命危险。因此,有效预防导管感染极其