维持性血液透析目前是肾功能衰竭终末期患者的主要治疗方法.在血液透析过程中,肝素药物是主要的抗凝药物,而在使用过程中肝素诱导血小板减少症(heparin-induced thrombocytopenia,HIT)是其严重的不良反应之一,对患者的预后造成严重的影响,严重者甚至导致死亡.目前研究显示10％血液透析患者血浆中存在HIT抗体,而HIT发生率为0.5％～5.0％[1-2].本研究探讨1例维持性血液透析过程中出现HIT患者治疗过程,现报道如下.

目的:探讨应用全胸腔镜联合非气腹腹腔镜食管癌根治术治疗食管癌的临床效果.方法:选择2015年1月至2017年4月期间在太原市中心医院接受治疗的70例食管癌患者作为研究对象.将这70例患者随机分为传统组与微创组.对传统组患者采用传统的开放式食管癌根治术进行治疗,对微创组患者采用全胸腔镜联合非气腹腹腔镜食管癌根治术进行治疗.然后,比较两组患者的各项临床指标及术后并发症的发生率.结果:与传统组患者相比,微创组患者手术的时间、入住ICU的时间、住院的时间更短,其术中的出血量、术后并发症的发生率更低,其术中淋巴结清扫的数目更多,差异有统计学意义(P<0.05).结论:应用全胸腔镜联合非气腹腹腔镜食管癌根治术治疗食管癌的效果显著,可有效地缩短手术的时间,降低患者术后并发症的发生率.

Objective To evaluate the characteristics of hypothyroidism in patients with type 2 diabetes mellitus (T2DM) and to explore its influence factors.Methods This study retrospectively consulted the medical records of 1483 T2DM inpatients (483 combined with hypothyroidism)in the Second Affiliated Hospital of Xi'an Jiao Tong University from 2014 to 2016.General information of 2 groups was collected.Results The incidence of hypothyroidism in patients with T2DM was 32.57％,among them,subclinical hypothyroidism M was 24.88％.The incidence of hypothyroidism was higher in women than in men(19.08％ vs 13.49％,P＜0.001) and increased with age (P＜0.05).There were significant differences in age [(57.05 ± 11.17) vs (59.23 ± 11.35) years],triglyceride[(4.20 ± 1.82) vs (4.79 ± 1.23) mmol/L],positive anti-thyroid peroxidase [15.58 (8.94,37.22) vs 13.42 (8.24,21.42)U/L] and anti-thyroglobulin antibody[24.01(14.28,86.68) vs 18.07 (11.92,27.56) μg/L] and urine microalbumin [10.50 (1.29,25.20) vs 11.00 (10.50,22.18) mg/L] between the two groups.Multivariate non conditional logistic regression analysis showed that age [OR 0.424,95 ％ CI (0.284,0.631)] was the risk factor of T2DM combined with hypothyroidism.Conclusion In the past two years,the prevalence of hypothyroidism in T2DM patients is 32.57％ with higher risk in women and elders in Xi'an city.

目的探讨分析经导管介入治疗先天性心脏病的临床疗效.方法选取我院收治的先天性心脏病患儿68例,均符合行导管介入治疗条件,对其临床资料进行回顾性分析.对患儿术后3 d/30 d/90 d以及1年随访指标情况进行总结,随访具体内容包括：体检结果/超声心电图结果以及心电图结果等.结果所有患儿平均手术时间为(116±36)min,平均曝光时间为(27.8±9.2)min,住院平均时间为(8.2±2.3)d.随访结果显示,所有患者术后无并发症发生记录,无死亡病例.患儿房间隔缺损(ASD)封堵后最大右心室压力,术后较术前有明显改善(<0.05)；且患儿动脉导管未闭(PAD)封堵后,左心房内径/舒张期左心室内径以及收缩期左心房内径,术后均较术前明显降低(<0.05).结论采用导管介入治疗患儿房间隔缺损(ASD)以及动脉导管未闭(PAD)等先天性心脏病,临床疗效显著,具有创伤面积小/恢复出院时间短/术后并发症少以及安全可靠等诸多优点,具备临床推广应用价值.

The 133 cases of non-stopped the experience of clinical treatment of coronary artery bypass grafting, and the cases were analyzed retrospectively, and explore the factors related to the operation. 131 cases of postoperative recovery well, 1 case died of lung function failure, 1 case died of kidney failure. Visible, non-stopped coronary artery bypasses grafting with good clinical therapeutic effect.

AIM: To investigate the effect of silymarin on homocysteine-induced cell viability and apoptosis in human umbilical vein endothelial cells (HUVECs). METHODS: Cell viability was analyzed by using MTT and LDH assay. Apoptotic cells were detected by using DNA fragmentation and flow cytometric analysis. The level of intracellular reactive oxygen species (ROS) and the potential of mitochondrial membrane were determined by flow cytometric assay. The activity of caspase-3, -6 and -9 were measured with microplate spectrofluorometer. Protein levels were examined by Western blotting. RESULTS: Treatment of cultured HUVECs with HCY for 48 h induced a significant decrease in cell viability, and the percentage of apoptosis increased to 76.8%. The level of intracellular ROS and activity of caspase-3, -6 and -9 enhanced, and the red/green ratios of mitochondrial membrane decreased. However, simultaneous treatment with silymarin exhibited cytoprotective effects, reduced formation of the DNA ladder, prevented the levels of Bax and Bcl-2 proteins and the accumulation of ROS as well as caspase-3, -6 and -9 activation, reconverted the potential of mitochondrial membrane, and the percentage of apoptosis/necrosis was significantly decreased to 12.7% in a dose-dependent manner. CONCLUSION: These results demonstrate that silymarin has the protective capacity to antagonize HCY-induced apoptosis in HUVECs. The antiapoptotic action of silymarin may be partially dependent on an anti-oxidative stress effects, inhibition of caspases activity, and maintenance of mitochondria function.

AIM:To investigate the effects of grasp seed procyanidins(GSP) on homocysteine-induced proliferation and migration in vascular smooth muscle cells(VSMC) and related molecular mechanisms.METHODS: Cell count and -TdR assay were used for detecting cell proliferation and DNA synthesis,ELISA assay was used for detecting inflammatory response,DCFH-DA assay for examining the levels of reactive oxygen species(ROS),Western blotting for detecting protein expression.RESULTS: Homocysteine(0.1-1 mmol/L) increased VSMC proliferation and migration,and the levels of ROS were in a dose-dependent manner.The results of Western blotting showed that homocysteine significantly increased the expression of MCP-1,IL-6 and TNF-α.However,Compared with control group,in GSP(5-20 g/L) group,the increased VSMC proliferation,migration and the production of ROS and the expression of MCP-1,IL-6 and TNF-α mediated by homocysteine were markedly suppressed.EMSA showed that in GSP treatment group,the NF-κB activation was also almost completely inhibited.CONCLUSION: GSP inhibits homocysteine-induced VSMC proliferation,migration and inflammatory response through interfering with ROS dependent on NF-κB signal pathway.