16-妊娠双烯醇酮脂质体冻干制剂的制备与质量评价

目的研究16 妊娠双烯醇酮脂质体冻干制剂制备的处方工艺,并对其质量进行评价。方法采用薄膜分散 超声法结合冷冻干燥技术制备16 妊娠双烯醇酮脂质体冻干制剂,通过单因素实验和正交设计实验筛选最佳处方和工艺,并进行初步质量评价。结果最佳处方工艺为：卵磷脂PC 98T用量为 6.5%（W/V）,卵磷脂PC 98T与胆固醇硫酸钠的质量比为 4：1,水化温度为 60 ℃,超声时间2 min,最佳冻干保护剂为7.5%葡萄糖。所制冻干制剂平均粒径（121.3±48.7） nm,Zeta 电位－41.9 mV,包封率（98.7±0.1）%。结论该方法制备的16 妊娠双烯醇酮脂质体冻干制剂处方合理,工艺可行,稳定性好。     

改良法制备5-氟尿嘧啶磁性纳米脂质体

目的 探讨5-氟尿嘧啶磁性纳米脂质体(MNLF)的最佳制备方法,并观察其理化性能.方法 采用正交设计对筛选出的制备工艺进行优化,以磁性脂质体的包封率和粒径分布为指标综合评价,以药物与磷脂的比例、表面活性剂的浓度及油水相的比例、冻融温度等为考察指标,分析了不同制备方法对脂质体性质的影响.最后选用逆向蒸发法结合冻融法制备MNLF,最佳方案为A3B3C2D2及蛋黄卵磷脂(PC):去氧胆酸钠(SD)为10∶ 1,冷冻温度为-10℃,以包封率、外观、粒径变化、渗漏率、胶体ζ电位和pH值等为评价指标,对MNLF的物理化学稳定性进行研究.结果 制备的MNLF的平均粒径为450nm,平均包封率为69.5%,ζ电位为-39.0mV,pH值为6.91,有较好的稳定性,磁响应性好.结论 以改良的逆相蒸发法+冻融法制备的MNLF粒径小、包封率高、磁响应性好.     

HRZ三联抗痨药/TGF-β1 siRNA纳米脂质体的制备及表征

[目的]制备HRZ三联抗痨药/TGF-β1 siRNA纳米脂质体,对其理化性质、药代动力学等进行表征分析。[方法]用反相蒸发法制备PEG2000修饰的异烟肼(H)、利福平(R)及吡嗪酰胺(Z)三联抗痨药脂质体,包裹TGF-β1 siRNA。测定脂质体粒径、电位、包封率并进行电镜观察。[结果]成功制备HRZ三联抗痨药阳离子脂质体,Zeta电位值(28.13±2.4) mV,异烟肼、利福平及吡嗪酰胺包封率分别为90%、88%、37%;随着阳离子脂质体用量的增加,siRNA包裹效果越好,Zeta电位值逐渐由负变正;动态光散射技术(DLS)及透射电镜(TEM)显示,HRZ三联抗痨药/TGF-β1 siRNA纳米脂质体呈球形,大小均匀,粒径为(152.69±59.47) nm。[结论]成功构建HRZ三联抗痨药/TGF-β1 siRNA纳米脂质体,为后续进一步进行体外细胞毒性、靶向TGF-β1基因沉默效应及结核分枝杆菌(MTB)感染宿主细胞体内、体外抗结核实验提供了研究基础。     

紫杉醇长循环热敏脂质体对Lewis肺癌移植瘤的抑制作用

目的 研究紫杉醇长循环热敏脂质体（PLTL）对Lewis肺癌移植瘤的抑制作用。方法 建立小鼠Lewis肺癌模型,将40只荷瘤鼠随机分为5组,空白对照组、模型对照组、紫杉醇注射液（PTX）组、紫杉醇热敏脂质体（PTL）组和PLTL组,每组8只。空白对照组和模型对照组注射0.9%氯化钠溶液,PTX组、PTL组和PLTL组,每只小鼠给药总剂量为紫杉醇20 mg.kg-1,采用0.9%氯化钠溶液稀释,每次注射0.2 mL。除空白对照组外,其他组给药后5 min内立即将小鼠的肿瘤部位固定于（42±0.5）℃的恒温水浴中加热30 min。治疗期间观察移植瘤体生长情况,苏木精-伊红（HE）染色检测肿瘤组织的病理学形态改变,观察肿瘤细胞的形态学变化,采用流式细胞术检测肿瘤细胞的凋亡率,考察PLTL联合局部热疗对小鼠肿瘤的抑瘤作用。结果模型对照组、PTX组、PTL组和PLTL组抑瘤率分别为21.81%,48.87%,57.22%和78.87%,肿瘤细胞凋亡率分别为（20.4±4.2）%,（42.7±3.8）%,（54.6±2.9）%和（69.7±5.0）%,肿瘤组织切片HE染色发现,PLTL组肿瘤细胞凋亡与坏死数量明显增多。结论PLTL与PTX,PTL比较,具有明显的热敏靶向性,与局部热疗相结合显著提高紫杉醇的治疗效果。     

两种曲安奈德新型脂质载体经皮渗透性比较

目的比较曲安奈德（TAA）纳米脂质组装体（TAA LPPs）、TAA乙醇脂质体（TAA Ethosomes）的体外透皮特性。方法制备TAA LPPs和TAA Ethosomes,采用透射电镜观察其形态,激光粒度仪测定其粒径分布,改良Franz单室扩散池进行离体大鼠皮肤渗透实验,测定两种曲安奈德脂质载体的累积透过量及在皮肤内的滞留量。结果TAA LPPs和TAA Ethosomes均呈球形或类球形,平均粒径分别为（99.9±1.3）和（105±1.4） nm。TAA LPPs、TAA Ethosomes和TAA 混悬液的累积透过量分别为（53.59±4.40）,（87.03±4.87）,（30.54±8.61） μg·（cm2）－1,32 h后皮肤内药物滞留分别为（1.02±0.13）,（0.62±0.08）,（0.55±0.17）μg·（cm2）－1。结论与TAA Ethosomes比较,TAA LPPs更利于曲安奈德经皮局部给药,减少药物全身吸收。     

制备人血白蛋白改良载紫杉醇纳米微泡及其特性的实验观察

目的探讨人血白蛋白（HSA）改良载紫杉醇纳米微泡的制备,并观察其性能表征。方法采用薄膜分散法及机械振荡法制备HSA改良的载紫杉醇微泡,观察其外观、形态,检测其粒径大小、分布、Zeta电位及包封率;行CEUS观察兔髂动脉的显影情况。结果HSA改良载紫杉醇纳米微泡外观为乳白色混悬液,光镜下其分布均匀,呈圆球状,平均粒径为（772．9土6．2）nm,表面电位（一13．2士0．3）mV,浓度为（8．64士1．38）×10。／ml;其包封率为（93．51±2．07）％,高于未加入HSA的载紫杉醇纳米微泡[（84．88士4．14）％,P＜0．05]。经外周静脉注射HSA改良载紫杉醇纳米微泡后,兔髂动脉超声增强显影。结论HSA改良载紫杉醇纳米微泡理化性质稳定,药物包封率高,可达到动脉增强显影效果。     

聚酰胺树形分子递送Survivin反义寡核苷酸诱导结肠癌细胞凋亡的研究

目的 观察聚酰胺(PAMAM)树形分子高聚合物介导Survivin反义寡核苷酸(Sur-vivin-asODN)转染结直肠癌SW620细胞的可行性以及对结直肠癌SW620细胞凋亡的影响.方法 制备PAMAM反义基因复合物和阳离子脂质体反义基因复合物,透射电镜观察复合物的形态,激光散射粒径分析仪测定粒径,zeta电位分析仪测定zeta电位,离心法和紫外分光分度仪测定复合物的的包封率、载药率和体外DNA释放速度.将上述两种基因转染复合物转染结直肠癌细胞,测定其转染效率;检测转染后细胞中Survivin蛋白的表达和细胞的凋亡率.结果 PAMAM-Survivin-asODN复合物的粒径小于脂质体-Survivin-asODN复合物的粒径(P<0.01),但zeta电位高于后者(P<0.05);基因载药率、包封率两组差异无统计学意义;PAMAM对DNA持续释放14 d,但脂质体只持续5 d.PAMAM.Survivin-asODN转染结直肠癌细胞的效果强于脂质体-SurvivinasODN(P<0.05).转染后结直肠癌细胞Survivin蛋白的表达低于脂质体复合物(P<0.05),细胞的凋亡率高于脂质体复合物(P<0.05).结论 PAMAM能将Survivin-asODN高效递送到结直肠癌SW620细胞,降低Survivin蛋白表达并诱导结直肠癌细胞凋亡.     

聚酰胺-胺型树形分子脂质体对人结肠癌细胞摄入和细胞毒性的影响

目的 研究聚酰胺-胺型树形分子(PAMAM)脂质体对人结肠癌细胞摄入和细胞毒性的影响.方法 以1,2-二油烯氧基-3-三甲氨基丙烷(DOTAP)和二油酰基磷脂酰乙醇胺(DOPE)为材料制备脂质体,将质粒PEGFP-N1与脂质体和PAMAM混合分别制备PAMAM脂质体/DNA转染复合物和PAMAM/DNA转染复合物.透射电镜观察转染复合物的形态、粒径,zeta电位分析仪测定载质粒纳米粒子的zeta电位,离心法和紫外分光分度仪测定载质粒纳米粒子的包封率,将上述两种载质粒纳米粒子转染人结肠癌细胞SW620、人乳腺癌细胞MCF-7、血管内皮细胞ECV304,流式细胞仪测定增强型绿色荧光蛋白(EGFP)基因的入胞量,MTT法对PAMAM脂质体/DNA复合物和PAMAM/DNA复合物的毒性进行评价.结果 PAMAM脂质体载质粒纳米粒子的粒径与PAMAM载质粒纳米粒子的粒径差异无统计学意义[(192±16)nm比(189±19)nm,P＞0.05],zeta电位前者高于后者[分别为(42±7)mV和(32±7)mV,P＜0.05],包封率两者之间差异无统计学意义[(82±7)%比(84±6)%,P＞0.05].PAMAM脂质体载质粒纳米粒子和PAMAM载质粒纳米粒子转染SW620、MCF-7、ECV304细胞后,PAMAM脂质体/DNA组细胞EGFP基因摄入量高于PAMAM/DNA组,差异有统计学意义(P＜0.05).前者细胞存活率高于后者,差异有统计学意义(P＜0.05).结论 脂质体修饰聚酰胺-胺型树形分子可提高基因转染细胞的效率,降低细胞毒性.     

奥沙利铂长循环脂质体的制备及其对人结直肠癌SW480细胞活性的影响

目的 观察奥沙利铂长循环脂质体的制备以及对结直肠癌SW480细胞活性的影响.方法 通过逆向旋转蒸发法制备奥沙利铂长循环脂质体,检测脂质体的粒径、电位、包封率及外观形态;分析奥沙利铂长循环脂质体对细胞活性的影响.结果 脂质体粒径、电位分别为(151.56±15.57)nm,(-23.68±2.35)mV;包封率为(42.96±6.45)%;细胞对脂质体的摄入在2 h可观察到,平均荧光强度在2 12、24 h分别为198、443、642;2.60 mmol/L的空载脂质体、28.0 mg/L游离奥沙利铂及2.60 mmol/L的奥沙利铂脂质体(含28.00 mg/L奥沙利铂)分别与细胞作用12 h,细胞的活力分别是(84.73±1.73)%、(70.72±2.66)%和(57.69±3.33)%(F=104.428,P＜0.01),同时细胞集落数量减少.结论 奥沙利铂长循环脂质体具有增强对结直肠癌SW480细胞毒性作用.

Abstract：

Objective To investigate the preparation of oxaliplatin long-circulating liposomes and its effect on activity of human colorecal cancer SW480 cells. Methods The rverse-phase evaporation vesicles (REV) method was used to prepare the oxaliplatin long-circulating liposomes. The particle size, electric potential, entrapment efficiency and face shape were analyzed, and the effects of liposomes on activity of cells were also analyzed. Results The particle size and electric potential were ( 151.56 ± 15. 57 ) nmand ( - 23.68 ± 2. 35) mV resepctively. Entrapment efficiency was (42. 96 ± 6. 45 ) %. At 2 h, the uptake of liposomes by cells was observed. At 2, 12, 24 h, immunofluorescent intensity was 198,443 and642 respectively. After cells were treated with 2. 60 mmol/L blank liposomes, 28.00 mg/L free oxaliplatin and 2. 60 mmol/L liposomal oxaliplatin (containing 28 mg/L oxaliplatin), activity of cells was (84. 73 ±1.73 ) %, (70. 72 ± 2, 66 ) % and (57. 69 ± 3. 33 ) % respectively ( F = 104. 428, P ＜ 0. 01 ). Additionally, the number of cell colonies was reduced. Conclusion Oxaliplatin long-circulating liposomes were successfully prepared, and could enhance cytotoxic effects against colorecal cancer SW480 cells.     

慢性肾功能衰竭继发甲状旁腺功能亢进外科治疗临床分析

背景与目的：继发性甲状旁腺功能亢进（SHPT）是慢性肾功能衰竭患者常见的并发症之一。本研究总结43例慢性肾功能衰竭继发性甲状旁腺功能亢进患者行甲状旁腺全切加自体前臂移植术的临床经验,旨在探讨如何改善患者机体的钙磷代谢紊乱, 缓解患者骨痛、皮肤瘙痒及肌无力等症状,改善患者生活质量。 方法：回顾性分析2017年1月—2018年12月在湘南学院附属医院乳腺甲状腺外科接受甲状旁腺全切加自体前臂移植术的43例继发性甲状旁腺功能亢进患者临床资料,比较手术前后临床症状（骨关节痛、皮肤瘙痒、乏力）和血液化验结果（甲状旁腺激素、血钙、血磷、碱性磷酸酶）的变化。 结果：43例患者骨关节痛、皮肤瘙痒、乏力临床症状在术后第1天明显缓解,在术后1个月上述症状消失。术后10 min、第1、7天和第1、3、12个月的甲状旁腺激素水平分别为（279.23±186.51）、（81.62±51.46）、（21.09±14.36） pg/mL和（27.35±12.04）、（33.27±11.08）、（372.65±15.72） pg/mL,均显著低于术前的（2 436.71±825.13） pg/mL（均P<0.05）;术后第1、7天和第1、3、12个月的血钙水平分别为（1.91±0.32）、（1.75±0.35） mmol/L和（1.84±0.29）、（2.04±0.27）、（2.13±0.30）mmol/L均显著低于术前的（2.58±0.31）mmol/L（均P<0.05）;术后第1、7天和第1、3、12个月的血磷水平分别为（1.61±0.50）、（1.18±0.47） mmol/L和（0.99±0.41）、（0.95±0.34）、（1.20±0.35）mmol/L均显著低于术前的（2.17±0.58）mmol/L（均P<0.05）;血碱性磷酸酶水平在术后1、7 d分别为（580.19±223.56）、（678.52±239.43）U/L高于术前（468.43±214.95）U/L,而在术后1、3、12个月分别为（513.62±227.32）、（431.62±215.76）、（316.24±265.15） U/L均低于术前（均P<0.05）。 结论：对具备手术指征的继发性甲状旁腺功能亢进患者,甲状旁腺全切加自体前臂移植术是一种安全、有效的治疗方法,术后积极补钙可减少低钙血症的发生。     

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.     

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。     

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.     

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。     

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。     

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.     

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.