131I-抗CEA单抗在结肠癌模型及结肠癌患者体内的生物学分布

目的观察131I-抗CEA单抗(C50)在结肠癌生物体内的生物学分布,评估131I-C50在机体内的导向作用及其稳定性.方法采用改良氯胺T法以131I-C50进行荷人结肠癌裸鼠及结肠癌患者体内生物学分布及肿瘤放免显像研究.每鼠腹腔内注射131I-C50 100 μL(3 700 kBq).1,2,3,4和6天后显像并测定各脏器的放射性分布;每例结肠癌患者静脉注射131I-C50 1 mg (160 MBq),48～72小时后采用单光子发射型计算机辅助断层仪(SPECT)进行扫描显像,2～3天后于术中采集肿瘤及正常组织并检测其放射性分布.结果荷人结肠癌裸鼠注射标记抗体后48小时肿瘤区即有放射性浓聚,随着时间的推延,影像渐趋清晰,本底逐渐下降.第6天结束时,瘤/肠和瘤/血放射性计数比值(T/NT)分别为10.40±0.69和0.70±0.08,均达最大值.131I-C50在结肠癌患者体内不同组织的生物学分布则显示:131I-C50在瘤区明显集聚,T/NT多数达5以上.显像结果清晰,血本底很低.结论 131I-C50在生物体内能与肿瘤抗原发生特异性结合,具有很好的导向性,且在内环境下稳定性好,为临床结肠癌导向诊断与治疗提供了可靠的依据.     

^131I-抗CEA单抗在结肠癌模型及结肠癌患者体内的生物学分布

目的 观察^131I-抗CEA单抗(C50)在结肠癌生物体内的生物学分布．评估^131I-C50在机体内的导向作用及其稳定性。方法 采用改良氯胺T法以^131I-C50进行荷人结肠癌裸鼠及结肠癌患体内生物学分布及肿瘤放免显像研究。每鼠腹腔内注射^131I-C50 100μL(3700kBq)。1,2,3,4和6天后显像并测定各脏器的放射性分布;每例结肠癌患静脉注射^131I-C50 1mg(160 MBq),48～72小时用采用单光子发射型计算机辅助断层仪(SPECT)进行扫描显像,2～3天后于术中采集肿瘤及正常组织并检测其放射性分布。结果 荷人结肠癌裸鼠注射标记抗体后48小时肿瘤区即有放射性浓聚．随着时间的推延．影像渐趋清晰,本底逐渐下降。第6天结束时,瘤／肠和瘤／血放射性计数比值（T/NT)分别为10.40±0.69和0.70±0.08．均达最大值。^131I-C50在结肠癌患体内不同组织的生物学分布则显示：^131I-C50在瘤区明显集聚,T／NT多数达5以上。显像结果清晰,血本底很低。结论 ^131I-C50在生物体内能与肿瘤抗原发生特异性结合．具有很好的导向性,且在内环境下稳定性好,为临床结肠癌导向诊断与治疗提供了可靠的依据。     

125Ⅰ标记抗C-erbB-2单抗对荷人乳腺癌裸鼠的定位诊断及生物学分布

目的研究125I标记抗C-erbB-2单克隆抗体ICR12（简称125I-ICR12）及正常小鼠IgG（简称125I-mIgG）在荷入乳腺癌探鼠体内的分布,为放射免疫显像（RII）及临床应用提供依据。方法每鼠尾静脉注射抗体92．5KBq／0．1ml,于注射后24、48、96、120／小时分批处死,测定肿瘤和血液、肝、肺等重要脏器的单位重量放射性比值（T／NT）、各组织摄取百分比（％ID／g）及定位指数（LI）。结果125I-ICR12注射后24～120／小时内,肿瘤部位出现选择性放射性浓聚;T／NT在120／小时最高,为19．374。125I-mlgG未出现放射性浓聚,呈全身分布。结论ICR12在荷人乳腺癌裸鼠体内,对过度表达C-erbB-2的乳腺癌具有亲和力,可望用作乳腺癌诊断、预后判断的导向载体。     

抗人膀胱癌单克隆抗体188Re标记及荷瘤裸鼠体内放射性分布

目的　制备放射免疫导向药物用以诊断和治疗膀胱癌。　方法　通过 2 巯基直接还原标记法将放射性核素188Re(188铼 )标记抗人膀胱癌单克隆抗体BDI 1,标记产物188Re BDI 1经尾静脉注入荷人膀胱癌裸鼠体内 ,检测其在裸鼠体内的放射性分布。　结果　188Re BDI 1的标记率为30 % ,放射化学纯度为 90 % ,免疫活性分数为 5 8.6 8%。在裸鼠体内 ,肿瘤对188Re BDI 1的摄取率在2 3h达到高峰 ,以后随时间推移 ,逐步下降。 2 3h时T/NT比值 (肿瘤与正常组织的放射性计数之比 )明显增加 ,平均T/NT为 4.42 ,最大为 16 .19(肿瘤 /肌肉 ) ,随时间推移T/NT比值有所下降 ,48h时T/NT比值仍保持在高水平 10 .41(肿瘤 /肌肉 )、70h时T/NT比值 3.41(肿瘤 /肌肉 )。结论　188Re BDI 1在裸鼠体内对膀胱癌移植瘤有靶向定位作用。188Re BDI 1有可能成为膀胱癌放射免疫显像和治疗的导向药物。     

^126碘标记7α—乙烯雌二醇—3—醋酸酯在荷人乳腺癌裸 …

为探讨测定乳腺癌细胞内雌激素受体，以判断肿瘤对内分泌治疗的敏感性和预后，利用＾１２５碘标记１７α－乙烯雌二醇－３－醋酸酯在不同ＥＲ含量的荷人乳腺癌裸鼠体内进行生物学分布研究，观察其与受体含量的关系，淡进一步进行肿瘤ＥＲ显像奠定基础。每只鼠尾静脉注射示踪剂９２．５ｋＢｑ，２小时后处死，测定其肿瘤及重要组织器官每克组织中放射改性摄取率及肿瘤与非肿瘤放射性比值。     

多体位放射免疫显像诊断膀胱癌

目的　评价膀胱灌注99mTc BDI 1多体位放射免疫显像诊断膀胱癌的临床价值。　方法　采用99mTc BDI 1111～ 2 2 2MBq对 39例膀胱癌患者和 8例其他患者进行膀胱灌注多体位放射免疫显像 ,计算肿瘤组织与非肿瘤组织放射性计数之比 (T/NT值 )。　结果　膀胱癌患者不同体位γ显像在肿瘤部位有明显放射性浓聚 ,膀胱癌显像阳性率 (灵敏度 )为 94.1% ,特异性为 87.5 %。多体位放射免疫显像可显示直径 <1.0cm(0 .5～ 0 .8cm)的肿瘤 ,T/NT值与膀胱移行细胞癌的形态 (乳头状 /非乳头状 )有关。　结论　多体位放射免疫显像有利于肿瘤的早期诊断 ,可测定肿瘤体积 ,判断肿瘤位置和预后     

裸鼠乳腺癌淋巴转移模型的CEUS表现

目的通过CEUS观察裸鼠MDA-MB-231乳腺癌原位肿瘤及腋窝淋巴结的增强情况。方法雌性5周龄BALB/C裸鼠8只,于2只裸鼠右侧第二对乳腺脂肪垫下分别注射0.1ml MDA-MB-231乳腺癌细胞悬液,成瘤2周后,解剖取得肿瘤块后原位种植于另外6只裸鼠乳垫下,建立裸鼠乳腺癌淋巴转移模型。通过大体和常规超声观察原位肿瘤和同侧腋窝肿大淋巴结情况,在接种后第6周,采用经鼠尾静脉和经肿瘤周围皮下分别注射0.1ml SonoVue超声造影剂进行CEUS检查,造影结束后解剖裸鼠获得原始肿瘤及肿大淋巴结进行病理检查。结果 1接种后第6天,6只裸鼠接种部位均长出肿瘤,成瘤率100%(6/6),常规超声观察原始肿瘤内血流较丰富,后期出现液化坏死灶和微小钙化灶,大体和常规超声观察均未发现明显腋窝肿大淋巴结;2经鼠尾静脉CEUS示所有裸鼠的原始肿瘤均为不均匀增强,肿瘤内出现范围不等的充盈缺损区,病理诊断原始肿瘤块为浸润性癌;3经肿瘤周围皮下CEUS检出1枚腋窝淋巴结(病理结果为转移性淋巴结),表现为不均匀增强,裸鼠解剖后共检出3只裸鼠各有1枚腋窝转移性淋巴结,以病理结果为金标准,CEUS对乳腺癌转移淋巴结的检出率为33.33%(1/3)。结论 CEUS在裸鼠乳腺癌淋巴转移模型中具有一定的应用价值。     

~(131)-碘标记抗人肝癌单抗对荷人肝癌裸鼠的放射免疫显像及体内生物学分布

目的:碘标记的抗人肝癌单克隆抗体 TIGTC-Ⅲ(以下简称~(131)-Ⅰ-Ⅲ)及正常小鼠IgG(以下简称I-mIgG)进行裸鼠人原发性肝癌(PHC)的体内肿瘤放射免疫定位(RII)及体内生物学分布研究.方法:每鼠从尾静脉注射7.4×10~5Bq,注人后第24、48、96、168小时行全身照相.观察肿瘤摄取标记抗体的能力,并计算生物半衰期,同时测定肿瘤与各器官组织的放射性比值(T/NT).结果:TICTC-Ⅲ能选择性地积聚于肿瘤组织.肿瘤对其摄取率明显高于MlgG,T/NT值在注射后96小时最高.TIGTC-Ⅲ的体内存留时间明显长于 mIgG.结论:TIGTC-Ⅲ在裸鼠体内对人原发性肝癌细胞具有较高的亲合力,是一种可能有效的导向载体.     

~(99m)Tc-HL91乏氧显像对胃癌血管正常化窗口的判断

目的 探讨~(99m)Tc-HL91乏氧显像在胃癌血管正常化窗口(NWTV)的监测与判断中的价值.方法 使用~(99m)Tc-HL91对40只裸鼠肿瘤组织行乏氧显像,随机将裸鼠分成治疗组(n=20)按400 μg/每次腹腔注射DC101与对照组(n=20)注射同体积的生理盐水,利用感兴趣区(ROI)技术计算出注射后5 min到8 h的靶和非靶组织放射性比值(T/NT),取最大T/NT代表肿瘤乏氧状态,与对照组比较动态监测抗鼠血管内皮细胞生长因子受体2的单克隆抗体(DC101)治疗后1～14 d的胃癌乏氧变化并定位NWTV.结果 对照组开始显影时间和达到最大T/NT时间在第1～14天间无明显区别,治疗组第1天肿瘤显影时间为(30.12±0.11)min,T/NT峰值时间为(6.26±0.36)h.第2天起肿瘤显像时间和T/NT峰值时间逐渐减少,至第5天后与对照组间无明显区别.与对照组肿瘤乏氧逐渐缓慢增加不同,治疗组肿瘤乏氧呈波浪式增加.DC101治疗后第2天肿瘤乏氧(6.23±0.26)下降,到第5天肿瘤乏氧(0.24±0.14)几乎消失,在第8天(6.36±0.14)再次开始逐渐增加,NWTV出现在DC101治疗后第2天至第8天.结论 ~(99m)Tc-HL91乏氧显像能无损伤性监测抗血管生成治疗后肿瘤的乏氧变化,精确定位胃癌的NWTV.     

靶向干扰骨架蛋白Transgelin抑制胰腺癌裸鼠移植瘤的生长

目的 探讨靶向干扰骨架蛋白Transgelin对人胰腺癌裸鼠移植瘤生长的影响.方法 设计并体外合成靶向Transgelin的短发夹RNA(shRNA)真核表达质粒,将其转染人胰腺癌细胞BxPC3,采用RT-PCR、Western印迹法检测转染前后Transgelin表达的变化.成功造模胰腺癌裸鼠24只,按皮下注入细胞不同均分为3组:实验组(接种BxPC3/shRNA)、阴性对照组(接种空质粒转染细胞BxPC3/Neo)和空白对照组(接种未转染细胞BxPC3).每周测量肿瘤大小,术后第28天处死所有裸鼠,计算瘤体体积,治疗前、后裸鼠体重的变化以及抑瘤率.免疫组织化学法检测移植瘤组织切片中Transgelin和增殖细胞核抗原(PCNA)蛋白的表达.结果 实验组、阴性对照组和空白对照组在各时间段的肿瘤体积增长差异有统计学意义(均P ＜0.05).实验组在第21,28天肿瘤体积显著小于阴性对照组和空白对照组(均P＜ 0.05).实验组第28天瘤重为(0.74±0.21)g,阴性对照组为(1.42±0.28)g,空白组为(1.59±0.24)g.实验组瘤重与阴性、空白对照组相比差异均有统计学意义(均P ＜0.05),抑瘤率达53.5％.实验组PCNA指数显著低于阴性对照组和空白对照组(均P＜0.05).结论 靶向封闭Transgelin基因能明显抑制胰腺癌细胞BxPC3在裸鼠体内的增殖及肿瘤生长.     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre

BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.