枸橼酸咖啡因与氨茶碱对早产儿不同时相血糖值的影响比较

目的观察并比较枸橼酸咖啡因及氨茶碱对早产儿不同时相血糖的影响程度。方法选择新生儿监护室诊断为原发性呼吸暂停的出生胎龄＜34周的早产儿172例，采用随机数字表法分为咖啡因组与氨茶碱组各86例。比较两组早产儿用药前及用药后15、30min、1、1.5、2、4、6、12、12.5、24.5、36.5和48h血糖的变化。结果两组早产儿用药后除6、12和48h血糖值比较差异均无统计学意义（均P＞0.05），其他用药后时相比较差异均有统计学意义（均P＜0.05）。咖啡因组早产儿用药后30min血糖值上升，至1h达峰值，后逐渐回落；用药后30min、1、1.5、2及24.5h血糖值与用药前比较差异均有统计学意义（均P＜0.05）。氨茶碱组早产儿用药后血糖值上升，30min达峰值，后逐渐回落；用药后15、30min、1、1.5、2、4、6、12.5、24.5、36.5h血糖值与用药前比较差异均有统计学意义（均P＜0.05）。结论枸橼酸咖啡因可引起早产儿血糖升高，但升高幅度较氨茶碱小、持续时间也较短。     

Maximizing Breast Cancer Therapy with Awareness of Potential Treatment-Related Blood Disorders

In this review we summarize the impact of the various modalities of breast cancer therapy coupled with intrinsic patient factors on incidence of subsequent treatment-induced myelodysplasia and acute myelogenous leukemia (t-MDS/AML). It is clear that risk is increased for patients treated with radiation and chemotherapy at younger ages. Radiation is associated with modest risk, whereas chemotherapy, particularly the combination of an alkylating agent and an anthracycline, carries higher risk and radiation and chemotherapy combined increase the risk markedly. Recently, treatment with granulocyte colony-stimulating factor (G-CSF), but not pegylated G-CSF, has been identified as a factor associated with increased t-MDS/AML risk. Two newly identified associations may link homologous DNA repair gene deficiency and poly (ADP-ribose) polymerase inhibitor treatment to increased t-MDS/AML risk. When predisposing factors, such as young age, are combined with an increasing number of potentially leukemogenic treatments that may not confer large risk singly, the risk of t-MDS/AML appears to increase. Patient and treatment factors combine to form a biological cascade that can trigger a myelodysplastic event. Patients with breast cancer are often exposed to many of these risk factors in the course of their treatment, and triple-negative patients, who are often younger and/or BRCA positive, are often exposed to all of them. It is important going forward to identify effective therapies without these adverse associated effects and choose existing therapies that minimize the risk of t-MDS/AML without sacrificing therapeutic gain.

Implications for Practice

Breast cancer is far more curable than in the past but requires multimodality treatment. Great care must be taken to use the least leukemogenic treatment programs that do not sacrifice efficacy. Elimination of radiation and anthracycline/alkylating agent regimens will be helpful where possible, particularly in younger patients and possibly those with homologous repair deficiency (HRD). Use of colony-stimulating factors should be limited to those who truly require them for safe chemotherapy administration. Further study of a possible leukemogenic association with HRD and the various forms of colony-stimulating factors is badly needed.

     

血清血管紧张素转换酶的水平在阻塞性睡眠呼吸暂停低通气综合征患者中的变化研究

目的检测阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者中血清血管紧张素转换酶(ACE)水平的变化及其临床意义。方法设置OSAHS组(n=40)和健康对照组(n=40),测定并比较患者的血压、血脂和血清ACE水平在两组间的差异;分析ACE水平与患者病情变化、血压、血脂的相关性。结果 OSAHS患者在体重、BMI指数、颈围、腰围、AHI、收缩压、舒张压、TC、LDL-C和血清ACE方面高于健康人(P体重=0.002,P颈围=0.024,P腰围=0.038,PBMI=0.019,PAHI=0.001,P收缩压=0.001,P舒张压=0.001,PTC=0.017,PLDL-C=0.010,PACE=0.039),在LSa O2上低于健康人(PLSa O2=0.001)。OSAHS患者的收缩压、TC、ACE在轻中度和中重度之间均存在统计学差异(P收缩压=0.018、0.043,PTC=0.045、0.034,PACE=0.030、0.001),相关性分析显示,OSAHS患者中血清ACE与收缩压和TC均呈正相关(r=0.35,P=0.017;r=0.28,P=0.044)。结论 OSAHS患者血清ACE能反映患者病情的变化,并与血压和血脂具有一定相关性。     

鼻塞式同步间歇正压通气(NIPPV)联合布地奈德雾化治疗新生儿急性呼吸窘迫综合征疾病的临床应用研究

目的:分析鼻塞式同步间歇正压通气(NIPPV)联合布地奈德雾化治疗ARDS(新生儿急性呼吸窘迫综合征)疾病的临床应用效果。方法:纳入病例是2017年5月—2019年11月收治的104例ARDS新生儿,随机平均分为两组。参照组52例采纳CPAP(持续气道正压通气通气)治疗,实验组52例采纳NIPPV+布地奈德雾化治疗,对比两组呼吸机通气时间、用氧时间、住院时间、血气指标以及并发症发生情况。结果:实验组呼吸机通气时间、用氧时间、住院时间均明显短于参照组,差异有统计学意义P<0.05;实验组治疗3 d后PaCO2明显低于参照组,实验组治疗3 d后PH以及PaO2明显高于参照组,差异有统计学意义P<0.05;实验组并发症发生率(3.85%,2/52)明显低于参照组(21.15%,11/52),差异有统计学意义P<0.05。结论:NIPPV+布地奈德雾化可有效缩短ARDS患者机械通气时间,改善血气指标,降低并发症发生率,值得借鉴。     

玉液汤对2型糖尿病肥胖患者肠道菌群及脂质代谢的影响

目的：探讨玉液汤对2型糖尿病肥胖患者肠道菌群及脂质代谢影响。方法：选取2017年2月至2019年2月广州市中医医院收治的2型糖尿病肥胖患者106例作为研究对象，按照就诊顺序分为对照组和观察组，每组53例。2组均给予基础治疗+药物治疗，观察组再加用玉液汤治疗。观察2组治疗前、完成治疗后肠道菌群、脂质代谢、中医症状积分、血糖相关指标、体质量、腰围、体质量指数(BMI)变化并比较。结果：2组治疗前各指标比较差异无统计学意义（P>0.05），完成治疗后观察组患者的中医症状积分、FINS、HOMA-IR、HbAlc、BMI、腰围、体质量、TC、TG、LDL-C、肠杆菌、酵母菌、肠球菌、畏寒肢冷、腰膝酸软、脘腹2组患者治疗后HDL-C、双岐杆菌、乳杆菌、拟杆菌均较治疗后明显上升，且观察组高于对照组（P<0.05）。结论：玉液汤能改善2型糖尿病肥胖患者脂质代谢和临床症状，降低血糖，能调节肠道菌群紊乱，从而提高疗效。     

Extracorporeal blood purification treatment options for COVID-19: The role of immunoadsorption

The activation of the innate and adaptive immune systems by SARS-CoV-2 causes the release of several inflammatory cytokines, including IL-6. The inflammatory hypercytokinemia causes immunopathological changes in the lungs including vascular leakage, and alveolar edema. As a result of these changes in the lungs, hypoxia and acute respiratory distress syndrome occur in patients with COVID-19. Even though there are clinical trials on the development of therapeutics and vaccines, there are currently no licensed vaccines or therapeutics for COVID-19. Pharmacological approaches have shown poor results in sepsis-like syndromes caused by the hypercytokinemia. Suppressing the cytokine storm is an important way to prevent the organ damage in patients with COVID-19. Extracorporeal blood purification could be proposed as an adjunctive therapy for sepsis, aiming to control the associated dysregulation of the immune system, which is known to protect organ functions. Several extracorporeal blood purification therapies are now available, and most of them target endotoxins and/or the cytokines and aim improving the immune response. For this purpose, plasmapheresis and immunoadsorption may be an important adjunctive treatment option to manage the complications caused by cytokine storm in critically ill patients with COVID-19.     

Ensayo clínico para determinar si el momento de administración del ácido tranexámico en la cirugía de prótesis total de rodilla con torniquete influye en el sangrado perioperatorio

Background and objectivesThe ideal timing of tranexamic acid administration in total knee arthroplasty with tourniquet remains unclear. Our primary objective was to prove if administering it before surgical incision, instead of before releasing the tourniquet, reduces postoperative bleeding. A second objective was to determine whether a second dose reduces post-operative bleeding.Material and methodsA prospective, double-blind clinical trial was performed on 212 patients scheduled for total knee arthroplasty. They were randomised into 4 groups. Tranexamic acid was administered before the surgical incision in “pre-induction groups” (1 and 2), and just before the tourniquet release in “pre-release groups” (3 and 4). Groups 2 and 4 received a second dose 3 hours post-surgery. Main outcome was postoperative bleeding (visible blood loss and calculated total bleeding). Secondary outcomes were haemoglobin variations, complications and transfusion rate.ResultsThe mean calculated total bleeding was 1563 ml (95%CI: 1445 to 1681) in preinduction groups versus 1576 ml (95%CI: 1439 to 1713) in pre-release groups (P = .9); 1579 ml (95%CI: 1452 to 1706) in single-dose groups versus 1559 ml (95%CI: 1431 to 1686) in double-dose groups (P = .82). One patient was transfused. The mean haemoglobin at discharge was 10.4 g/dl (95%CI: 10.2 to 10.7) in singledose groups versus 10.8 (95%CI: 10.6 to 11.1) in double-dose groups (P = .06).ConclusionsThere were no differences in bleeding or transfusion regarding the time of tranexamic acid administration. The second dose had not impact on outcomes.Trial registration: EudraCT 2016-000071-24.     

糖尿病患者腹部手术围手术期的处理

糖尿病已成为全球威胁人类健康的三大慢性非传染性疾病之一。需要外科手术的患者占所有糖尿病患者的25%,其围手术期病死率、并发症以及住院时间较正常人明显增加,因此对于糖尿病患者围手术期的处理方案显得尤为重要。但目前对于围手术期血糖控制范围仍众说纷纭,综合各研究结论,笔者认为将血糖控制在7.8~10 mmol/L是一个较为理想的范围。在患者术前、术中及术后应联合多学科制定各项相应的治疗方案,围手术期尤为注意避免患者发生低血糖和电解质紊乱的发生。也亟待后续大规模的随机对照试验进一步确定有效的血糖控制目标。     

The preventive role of wheat germ oil against sertraline‐induced testicular damage in male albino rats

Sertraline is an antidepressant medication used extensively in the therapy of depression. The present investigation was intended to estimate the actual protective role of wheat germ oil on sertraline‐caused testicular injury in albino rats. Sertraline (human therapeutic dose, 15.63 mg/kg) was orally administrated to rats for 28 successive days. Sertraline‐administered rats were concurrently supplemented with wheat germ oil (human therapeutic dose, 68.75 mg/kg) for 28 successive days. Sertraline administration induced an elevation in testicular DNA damage and acute testicular damage illustrated by the histopathological alterations including marked degeneration and necrosis of germ cells lining seminiferous tubules, as well as interstitial oedema, congestion of interstitial blood vessel. Wheat germ oil administration potentially mitigated the histopathological alterations of sertraline‐administered rats. Lipid peroxidation, oxidative stress biomarker, showed a significant elevation in testicular tissue of sertraline‐administered rats. Furthermore, glutathione content and catalase activity were decreased in testicular tissue of sertraline‐administered rats. Serum testosterone level was elevated in sertraline‐administered rats. Wheat germ oil significantly reduced lipid peroxidation of testicular tissue and improved the antioxidant defences. Finally, wheat germ oil has a preventive role against testicular damage induced by sertraline in rats probably via its potential to prevent reactive oxygen species.     

2016至2018年某医院真菌血流感染者流行病学特征及耐药性分析

目的分析真菌性血流感染的病原菌分布以及耐药特征，为真菌血流感染的早期合理用药提供理论依据。 方法回顾性分析武汉大学人民医院2016年1月至2018年12月收治的真菌性血流感染者的菌群、科室分布以及耐药性。 结果入组192例真菌血流感染者的血培养样本中共分离192株真菌，其中白色念珠菌检出率为31.77%（61/192），其次热带念珠菌检出率为18.75%（36/192）；重症医学科检出率最高为33.85%（65/192）。所有菌株均对两性霉素B敏感，对其他抗菌药物耐药率分别为5-氟胞嘧啶4.49%（9/192）、伊曲康唑5.73%（11/192）、氟康唑10.94%（21/192）和伏立康唑11.46%（22/192）；除两性霉素B外，2016至2018年真菌对其他抗菌药物的耐药率均逐年上升，其中2018年所分离192株光滑念珠菌对伊曲康唑耐药菌率达46.7%。 结论真菌血流感染病原菌以念珠菌属为主，对目前抗真菌药物具有较高敏感性，但耐药率逐年上升，加强监测血培养病原菌变化及耐药趋势对指导临床用药至关重要。