南水北调配套工程大宁调蓄水库西堤防渗墙施工技术

北京市南水北调配套工程大宁调蓄水库工程西堤防渗采用塑性混凝土防渗墙布置,＂两站一抓＂法成槽,＂泥浆下直升＂法浇筑,＂接头管＂法槽段连接。大宁水库西堤防渗墙施工投入足够资源,选择实力强大、信誉良好的施工队伍,为类似工程的施工管理提供了较好的实例。     

Catheter‐related fungal endocarditis caused by Candida parapsilosis in a hemodialysis patient

Fungal endocarditis (FE) is commonly regarded as a rare but fatal disease. The incidence of infective endocarditis (IE) in hemodialysis (HD) patients is thought to be obviously higher than that in the general population. Moreover, IE occurs more likely in HD patients with catheters. With the increase of HD population and extensive use of catheters in HD patients, FE, as a special form of IE, may increase and bring new challenges to clinicians. We reported a case of FE associated with catheter infection in a 44‐year‐old woman on HD. The risk factors and treatment strategies of FE in HD patients were discussed.     

Multiple metastatic infections in a hemodialysis patient with untunneled internal jugular catheter

We present an end‐stage renal disease patient on dialysis with fever. The primary source was right internal jugular vein catheter which had metastatic infections in the body probably via an arteriovenous communication in a cavity in left lung. Patient had right psoas muscle abscess and a left kidney abscess. An ¹⁸F‐fluorodeoxyglucose‐positron emission spectroscopy scan was done to find out left kidney abscess. A search of literature did not reveal many patients of psoas abscess secondary to infection of hemodialysis access.     

Comparison of alteplase (tissue plasminogen activator) high‐dose vs. low‐dose protocol in restoring hemodialysis catheter function: The ALTE‐DOSE study

Hemodialysis catheter (HDC) dysfunction due to thrombosis is common, and dysfunction incidence can reach up to 50% within 1 year of use. Although administration of intraluminal alteplase (tissue plasminogen activator [tPA]) is the standard of practice to pharmacologically restore HDC function, there are no evidence‐based guidelines concerning the optimal tPA dose. The purpose of this study was to compare the efficacy of 1.0‐mg vs. 2.0‐mg tPA dwell protocols in restoring the HDC function in thrombotic dysfunctional catheters. A retrospective, single‐center study was conducted on two independent cohorts of patients; the first (n = 129) received 2.0 mg tPA/catheter lumen, while the second (n = 108) received 1.0 mg tPA/catheter lumen. Kaplan–Meier and Cox regression analyses were performed to compare the catheter survival time between patients who received 1.0 mg tPA and those who received 2.0 mg tPA. Catheter removal occurred in 25 (19.4%) of those catheters treated with 1.0 mg tPA compared with 11 (10.2%) of catheters treated with 2.0 mg tPA (P = 0.05). The hazard ratio (HR) for catheter removal was 2.75 (95% confidence interval [^95%CI] = 1.25–6.04) for the 1.0‐mg tPA cohort compared with the 2.0‐mg tPA cohort. Correction added on 3 December 2012, after first online publication: The tPA cohort values were changed. Female gender (HR = 2.51; ^95%CI = 1.20–5.27) and age (HR = 0.96; ^95%CI = 0.94–0.98) were also associated with catheter survival. Our findings suggest that treatment of dysfunctional HDC with 2.0‐mg tPA dwells is superior to 1.0‐mg tPA dwells.     

改善胶乳三腔双囊胃管质量的生产工艺研究

以浓缩天然胶乳并用20份MG49天甲胶乳作胃管基础管身胶料可有效提高管身硬度和撕裂强度,并解决纯天然胶乳管身硬度不足、临床不易插管的难题,而对产品工艺性能及其他性能无不良影响。用"硝酸钙+工业酒精+表面活性剂"代替"硝酸钙+生粉附型剂+表面活性剂"作凝固体系,可改善胃管球囊胶膜厚度的均匀性。对胃管球囊内表面做适度氯化处理,可克服球囊与胃管管身产生的粘连或粘伤。适当改变绑线位置可有效减少胃管球囊胶膜出现的龟裂纹;球囊绑线处涂覆氯仿值二中~三中(见表9注)、总固体25%~35%的胶料3~4次,可获得较好涂胶效果。     

微电子机械系统在生物医学领域中的应用

本文介绍了国际上微电子机械系统研究的状况以及发展趋势;阐述了目前微电子机械系统在生物医学中的应用和研究开发的方向;并详细地介绍了日本在微小血管检测系统方面所作的研究工作;最后提出了应用于医疗领域中的微电子机械系统的发展前景.     

导尿管抑菌涂层的研究进展

由导尿管引发的尿路感染(CAUTI)是医院常见的感染,在各种院内感染中的占比高达20%~30%,极大地影响了病人的生命健康。目前,基于导尿管表面生物膜生成及无机盐沉积等问题,研究人员提出了多种方法来预防或改善,以实现导尿管的抗菌和抗阻塞性能,如导尿管表面涂层构建、改进导尿管的结构设计、缩短临床使用时间等。综述了近年来导尿管表面抗菌涂层的研究进展,主要从物理改性和化学改性等方面展开。物理改性方法一般通过将聚乙二醇、聚两性离子、抑菌酶等沉积在导管表面,或在导管表面进行仿生微纳结构修饰等,以达到润滑和降低细菌黏附的效果。化学改性方法主要通过将可直接作用于细菌的药物或者因子(包括分子泵抑制剂、抗生素、一氧化氮、抗菌肽等)附着在导尿管表面,以达到抑菌、延长导管堵塞时间等目的。在此基础上,通过对当前导尿管研究趋势的总结及思考,对未来导尿管的功能、抑菌机制及验证等方面进行展望,以期为导尿管抑菌材料的选择和设计提供一定的指导。     

介入医疗用中空纤维成型球囊的结构与性能

球囊导管是用于介入医疗的新型医疗器械之一,其性能决定了整个介入医疗器械的操作性能。研究了原材料、中空纤维和球囊的凝聚态结构和性能,包括元素组成、化学结构、热性能和微观结构形貌。研究表明:中空纤维成型球囊导管的内部微观结构对力学性能影响显著,球囊导管的结构与性能可通过加工工艺来调控。     

Tunneled Catheter–Associated Atrial Thrombi: Successful Treatment with Chronic Anticoagulation

Tunneled dialysis catheter–associated right atrial thrombus (RAT) is a rarely reported complication. We reviewed hospital records of 10 patients from a teaching hospital dialysis unit, in whom RAT was diagnosed by trans‐esophageal echocardiography (TEE). Patients were treated with chronic anticoagulation (heparin followed by warfarin) and followed over time. The group included 7 women; 6 patients were African American, 3 were Caucasian, and 1 was Hispanic. The average age was 52.1 ± 15.3 years. The most common presenting symptom was poor catheter flow on hemodialysis followed by fever and chills. On average, the patients had had 3.4 ± 2.7 catheter insertions before diagnosis of RAT, and the tunneled dialysis catheter (TC) had been in place for a mean of 91 ± 89.4 days when the thrombi were diagnosed. Trans‐thoracic echocardiography (2‐D echo) was done in 4 patients, but it identified RAT in only 1 patient. The catheter tip was at the junction of the superior vena cava and right atrium (SVC/RA) in most patients. Thrombolysis (unsuccessful) was attempted with urokinase in 3 patients, complicated in 2 patients by hemorrhage. After anticoagulation, 90% of the RAT resolved on repeated TEE. One patient had persistent RAT for 23 weeks and underwent surgical thrombolysis, but died postoperatively. We conclude that RAT is a frequently missed complication of a TC. Positioning the tip of the TC at the SVC/RA junction may not prevent RAT. Trans‐esophageal echocardiography is a more sensitive diagnostic tool than 2‐D echo and should be obtained early. Most patients can be successfully treated with anticoagulation alone. Thrombolytic therapy and surgical thrombolysis have high morbidity and mortality.     

Six years of experience with nightly home hemodialysis access

Background: Lynchburg Nephrology Dialysis Incorporated started its nightly home hemodialysis (NHHD) program in September 1997. Purpose: The purpose of this study was to evaluate episodes of exit‐site infections, catheter sepsis, and safety and longevity of accesses for patients doing NHHD. Method: If internal jugular (IJ) catheter was chosen, the patient was started on 2 mg coumadin per day when catheter was placed. If catheter malfunctioned, it was blocked with a thrombolytic agent and coumadin was adjusted to meet a goal international normalized ratio (INR) of 1.5 to 2.25. If the problem persisted, the catheter was exchanged. For catheters, a threaded lock cannula (BD InterLink device, BD) was used to prevent air emboli and infections and a locking device was used to prevent disconnects. If arteriovenous (AV) fistula was used, four buttonholes were established using 16‐gauge needles. If AV graft was used, patients were taught the rope ladder cannulation technique using 16‐gauge needles. Results: As of September 1, 2003, 45 patients have completed training and have performed 27,063 treatments at home. Total catheter time at home was 930 months. Total AV fistula and AV graft times at home were 190 and 20 months, respectively. Upon completion of training, 34 patients were using tunneled IJ catheters, 10 were using AV fistulas, and 1 was using an AV graft. The IJ catheter exit‐site and sepsis infection rates were 0.35 and 0.52 episodes per 1000 patient‐days, respectively. Mean catheter life was 8.5 months with the longest being 66.7 months and the shortest being 0.2 months. The AV fistula and graft exit‐site and sepsis infection rates were 0.16 and 0 episodes per 1000 patient‐days, respectively. Catheter complications included one episode of disconnect due to patient's failure to use the locking device, one episode of central stenosis, and one episode of intracranial hemorrhage, due to prolonged INR, with resolution of symptoms. Conclusion: Data support the fact that tunneled IJ catheters, AV fistulas, and AV grafts are effective and safe permanent accesses for patients on NHHD.