血清Cys C的检测对肾移植术后患者肾功能评价的临床意义

探讨分析血清胱抑素C(Cys C)水平在肾移植术后患者肾功能监测中的应用价值.对25例肾移植成功患者在术前、术后第1、3、5、7、10天的血清Cys C、Scr、β2-MG、BUN水平进行动态监测,同时随机抽取健康体检者中的20例作为对照组.发现移植组的Cys C、Scr、β2-MG、BUN水平在术前均明显高于健康对照组(P＜0.01).这四项指标在手术后第一天都有所下降,且术后第1、3、5、7、10天的水平都比术前低(P＜0.01).四项指标与GFR的关系均为显著性负相关(P＜0.01),其中血清Cys C与GFR的相关性最好.Cys C、Scr、β2-MG、BUN检测后的ROC曲线下面积分别是:0.937、0.838、0.798、0.772,其差异都具有统计学意义(P＜0.05).血清Cys C优于Scr、β2-MG、BUN,在肾移植患者术后的动态监测中具有重要的临床应用价值.     

国内外器官捐献立法的比较研究

基于国内外器官移植供体的来源、捐献的同意原则、器官的获取与分配、法律基础、供体的死亡标准这五大方面的对比,总结了器官移植发达国家相关法律法规的闪光点。完善我国的器官捐献立法可以考虑从扩大器官移植供体来源、引进相对适合我国国情的“柔性推定同意模式”、加快推进具有更高法律效力的“器官移植法”的出台并将脑死亡写入法案,以及培养具有良好职业素养和较强沟通能力的器官移植协调员等多方面出发,以推动我国器官捐献事业的可持续、健康发展。

     

前列腺素E2及其在肾脏调控中的作用

前列腺素E2(PGE2)是最主要的前列腺素化合物,参与几乎所有的细胞代谢活动并介导多种不同的生理病理功能。PGE2的生物学效应是通过与不同的EP受体结合从而激活不同的信号转导通路来实现的。因为各类EP受体在肾脏的高分布,所以近来PGE2在肾脏中的作用日趋引起人们的重视。     

肾移植术前患者应用大剂量促红素的临床研究

探索肾移植术前患者应用大剂量促红素(50 IU.kg-1.day-1)纠正严重贫血以达到手术要求的可行性和有效性。70例尿毒症严重贫血患者据是否有肾移植要求分为A、B组,A组每日皮下注射促红素50IU/kg,待血红蛋白(hemoglo-bin,HGB)上升至80g/L,改为常规剂量维持等待肾移植手术施行。B组按常规剂量应用促红素。治疗期间,监测血常规、血生化、血液流变学、血压等指标及患者出现的各种不良反应。结果显示,两组患者自治疗2、3、4周后血红蛋白值均有显著性差异,血生化、肝功系列值、血液流变学、血压结果差异无统计学差异。因此肾移植术前患者应用大剂量促红素可避免多项肾移植不利因素,可较好地解决肾移植术前贫血这一难题。     

亲属肾移植的伦理学探讨

活体亲属肾移植是当前解决器官匮乏最重要的途径,近年来我国亲属肾移植例数也不断增多。但是亲属肾移植因其具有一定的特殊性,相比尸体供肾移植更为敏感,也更易于引发伦理问题。简要介绍国内外亲属肾移植的研究进展,重点对亲属肾移植的生命伦理学问题加以探讨。     

成人间右半肝活体肝移植的肝中静脉之争

成人右半肝活体肝移植的开展在很大程度上解决了供肝短缺的问题,但随之也引发了右半肝移植物中是否带肝中静脉的技术与伦理之争。本文论述了肝中静脉的解剖,以及右半肝活体肝移植中带与不带肝中静脉的双方观点、理论依据和临床实践经验。     

What motivates men to offer sperm donation via the internet?

To investigate why men offer sperm donation via the internet, a questionnaire was disseminated via 39 Dutch-language websites thought to be visited by potential sperm donors. Nine internet donors completed the survey, men who typically knew the women they were donating to. Their responses were compared with those of a control group of 35 general sperm bank donors who were recruited using flyers in Dutch sperm banks, and who were typically unaware of the identity of the eventual recipients. The findings shed light on the motives and attitudes of internet donors. Both groups of donors indicated that their primary motivation for donating was altruism (>80% of all respondents). However, internet donors had a more pronounced desire to procreate than sperm bank donors (6 out of 9, i.e. 66 vs. 22%, respectively) and more often felt that they had good genes they wished to pass on (5 out of 9, i.e. 55 vs. 31%, respectively). The main reason internet donors gave for donating via the internet was that they wanted to know the prospective parents and be kept up to date on the progress of the offspring conceived from their donations. This distinguishes them significantly from sperm bank donors. A further finding was that they were not prompted to avoid the formal donation circuit for which, by law in the Netherlands, pregnancies resulting from donations have to be registered in a central database. This study is subject to several, in some cases inevitable, limitations, but it provides an interesting starting point that future studies can seek to confirm and extend.     

Managing multiple chronic conditions in Singapore – Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis

Objective: Diabetes mellitus (DM) is the commonest cause of end stage renal disease (ESRD). Despite increasing DM-ESRD prevalence and high dependency on care, there is a lack of literature on DM-ESRD caregivers. We sought to explore the perspectives and experiences of caregivers of patients with DM undergoing haemodialysis in Singapore.

Design: This study employed an exploratory, qualitative design comprising in-depth interviews with caregivers of DM-ESRD patients.

Methods: Semi-structured interviews were conducted with a sample of 20 family caregivers (54.2 ± 12.6 years; 75% female) of DM-ESRD patients. Data were analysed using Thematic Analysis.

Results: Key caregiving challenges identified were managing diet, care recipients’ emotions and mobility dependence. Patients’ emotional reactions caused interpersonal conflicts and hindered treatment management. Difficulties in dietary management were linked to patients’ erratic appetite, caregivers’ lack/poor understanding of the dietary guidelines and caregivers’ low perceived competence. Limited resources in terms of social support and finances were also noted. Physical and psychological well-being and employment were adversely affected by caregiving role.

Conclusion: This study highlights distinctive aspects of the DM-ESRD caregiving experience, which impact on caregivers’ health and challenge care. Disease management programmes should be expanded to support caregivers in dealing with multimorbidity.     

USE OF A TOKEN ECONOMY TO INCREASE COMPLIANCE DURING HEMODIALYSIS

We report the effects of using a token economy to treat noncompliant behavior in a 10-year-old male hemodialysis patient. The results of an ABAB design indicated that the intervention increased compliant behavior during both treatment phases and that compliance was maintained at 3- and 6-month follow-up observations.     

THE EFFECT OF A TOKEN ECONOMY ON DIETARY COMPLIANCE FOR CHILDREN ON HEMODIALYSIS

Adherence to dietary restrictions is a recurring problem for children on hemodialysis. The effect of behavior modification in maintaining dietary control is reported for four patients aged 11 to 18 years. Weight gain, potassium level, and blood urea nitrogen were utilized as criteria measures. A token reinforcement program implemented by the hemodialysis team resulted in significant changes in the dietary pattern of the children. The average weight gain between dialysis sessions for the four subjects during treatment was reduced by 45% and the degree of weight fluctuation was lessened. Potassium levels and BUN were controlled to their appropriate level for subjects who initially exceeded the criterion level. With the withdrawal of weight gain from the contingency system, increase of weight gain between dialysis sessions was noted for all subjects.