Objective:To evaluate primary retroperitoneal liposarcoma surgeries in combination with involved bowel resection .Methods:Clinical data of primary retroperitoneal liposarcoma patients admitted for surgery at Peking University International Hospital from Jan 2015 to July 2019 were retrospectively reviewed.Results:Twenty-four patients undergoing resectional surgeries combining with bowel resection were included for the study, of which 6 cases underwent right hemicolectomy, 8 did left hemicolectomy, 6 did sigmoidectomy, 2 did proctectomy and 8 did small bowel resection. The post operative morbidity was 38%. 2 of 24 had anastomotic fistula. There was no mortality. Final pathology disclosed well differentiated liposarcoma in 13 and dedifferentiated liposarcoma in 11 cases. 18 cases were confirmed with bowel infiltration pathologically. All patients were followed up after the surgery. After a median of 25 months following up, 8 cases developed recurrences and 3 deceased. Two-year overall survival and progression free survival probability were 91% and 71% respectively. Dedifferentiated liposarcoma as a pathological type was found as the only risk factor associated to poor progression free survival ( Z=2.02, P=0.042). Conclusion:Combining resection of primary retroperitoneal liposarcoma with involved bowel was relatively safe, with low morbidity, increasing tumor clearance. Dedifferentiated liposarcoma is associated wth poor prognosis.

<正>大面积感染性伤口的治疗和护理,一直以来都比较棘手。如何更简单、有效并快捷的处理大面积感染性伤口成为研究热点。康惠尔清创胶是一种无色透明的水胶体敷料,具有提供自溶性无痛清创,覆盖保护创面的作用。康惠尔银离

OBJECTIVE To study the fluid distribution abnormalities in patients on hemodialysis and fluid shift between intracellular and extracellular compartment during hemodialysis (HD). METHODS Eighty stable end stage renal disease patients on maintenance hemodialysis were selected. Conventional low flux dialyses at dialysate sodium concentration of 138 mmoL/L were performed for all of the patients. Fresenius polysulphons or Gambro hemophon dialyzers were used. All of the patients showed no clinical signs of over ultrafiltration during HD sessions and dry body weights were considered adequate. Intracellular water (ICW), extracellular water (ECW) and total body water (TBW) were measured and standardized by body weight (nICW, nECW, nTBW) before and after HD sessions. Sixty-seven cases of sex, age and body weight matched normal individuals were used as controls. Bio-impedance spectrum (BIS) analysis (Xitron, Technologies, San Diego, CA, USA) was used in body fluid measurement. Pre and post HD nICW, nECW, and nTBW were compared with these of the controls. RESULTS There were no differences in age, post-dialysis body weight and body mass index between patients on hemodialysis and the controls. Patients on hemodialysis had less nICW [male (0.28+/-0.05) vs (0.33+/-0.04), P<0.01; female (0.22+/-0.03) vs (0.27+/- 0.04), P<0.001], more nECW [male (0.28+/-0.02) vs (0.25+/-0.02), P<0.001; female (0.25+/-0.03) vs (0.23+/-0.01), P<0.05], and less nTBW [male (0.56+/-0.04) vs (0.58+/-0.05), P<0.05; female (0.47+/-0.05) vs (0.49+/-0.03), P<0.05] compared with the controls. The average ultra-filtration volume was (2.2+/-0.9)L. After dialysis, there was an increase in nICW [male (0.28+/-0.05) vs (0.30+/-0.05), P<0.001; female (0.22+/-0.03) vs (0.25+/-0.03), P<0.001), an decrease in nECW [male (0.28+/-0.02) vs (0.26+/-0.03), P<0.001; female (0.24+/-0.03) vs (0.21+/-0.03), P<0.001],and decrease of ECW/ICW ratio [male (1.06+/-0.30) vs (0.89+/-0.25) P<0.001; female (1.10+/-0.17) vs (0.88+/-0.17) P<0.001] which reached the levels of the normal individuals (0.79+/- 0.10 for male, 0.86+/-0.10 for female]. CONCLUSION Our results show that (1) Before HD sessions, patients on HD had less nICW and more nECW; (2) During conventional low flux HD sessions at dialysate sodium concentration of 138 mmoL/L, fluid shifted from extracellular space to intracellular space.(3) nECW and ECW/ICW ratio from normal population are reasonable for evaluation of dry weight in patients on hemodialysis, but nTBW and nICW are not.

Objective To clarify the factors that influence plasma homocysteinemia (tHcy) and the effect of high dose folic acid treatment on hyperhomocysteinemia(HHcy) in hemodialysis(HD) patients. Methods 77 stable HD patients were divided into 4 groups, receiving folic acid 0, 5, 15 or 30 mg per day respectively for at least 3 months without vitamin B12 supplementation. Plasma folic acid(sFA) and vitamin B12(VitB12), whole blood folic acid(tFA) were determined by radioimmunoassay. tHcy was examined by high performanceliquid chromatography. Plasma totalcholesterol (TC), triglycerine(TG), highdensity lipoprotein(HDL), low density lipoprotein(LDL), albumin(Alb), creatinine(Scr) and urea were detected by routine methods. Effects of folic acid treatment on sFA and tFA, relationship among sFA, tFA and tHcy, factors influencing tHcy were observed as well. Results Folic acid treatment could effectively increase sFA and tFA. sFA and tFA were negatively non-linear related to tHcy. When sFA was greater than 200 ng/ml, further increment of sFA and tFA leaded to no further decrease of tHcy. Conclusions The proper dosage of folic acid for control of HHcy in hemodialysis patients is 5-15 mg/d. Oral folic acid with HD treatment cannot totally normalize tHcy in hemodialysis patients.

目的研究在血液透析单位实施预防控制措施能否有效地减少丙肝和乙肝感染的发生.方法研究对象为实施预防控制措施前及后2年在我院的血液透析病人丙肝及乙肝感染的发生情况.预防控制措施包括除尽可能减少输血次数外,强调了两班透析之间透析机的化学消毒;对丙肝或乙肝感染者实行隔离透析,分池复用透析器;严格消毒及操作规程;对HCV-RNA阳性者给予α-干扰素治疗;对乙肝"两对半"阴性者给予基因重组乙肝疫苗注射.结果实施预防措施后2年的随访结果表明,无新增加的乙肝患者,丙肝感染者增加1例.结论预防控制措施对于减少血透病人丙肝及乙肝感染发生率具有重要作用.