右美托咪定对功能性鼻内窥镜手术患者苏醒期质量的影响?

【目的】研究术中输注右美托咪定对功能性鼻内窥镜手术(FESS)患者苏醒期质量的影响。【方法】选取40例年龄为30~60岁择期全身麻醉下行 FESS 的患者。将入选患者随机分为两组(每组20例)：对照组(C组)和右美托咪定组(D组)。常规麻醉诱导气管插管后,D组给予1μg/kg 右美托咪定10 min内静脉输注完毕,随后以0.2μg/(kg·h)速率输注至手术结束前30 min。C 组以同样方式输注等量生理盐水。两组麻醉维持均采用静脉持续输注异丙酚,七氟醚吸入,适时静注顺式阿曲库铵。当患者平均动脉压(MAP)和心率(HR)较基础值增加超过15%时单次追加芬太尼1.5μg/kg。比较两组患者麻醉前、手术结束时、拔管时、离开麻醉恢复室(PACU)时的 HR、MAP;入 PACU 后的 Riker 躁动评分、VAS 疼痛视觉模拟评分;拔管时间、滞留PACU时间以及术后不良反应情况。【结果】与麻醉前比较,C 组患者拔管时 HR 明显增快(P <0.05)。入PACU后D组 Riker躁动评分和 VAS疼痛视觉模拟评分均低于 C组(P <0.05)。两组拔管时间、滞留PACU时间的差异均无显著性(均P >0.05)。D组术后寒战发生率低于 C 组(P <0.05)。【结论】术中输注右美托咪定可明显改善 FESS患者苏醒期质量。     

尿液红细胞形态筛查在肾脏疾病诊断中的应用

目的通过相差显微镜观察分析尿液中红细胞形态对血尿来源进行判断,并结合肾脏活检病理检查对肾脏疾病做出初步的临床诊断。方法观察分析332例血尿患者尿液中红细胞形态,计算异形百分率,并结合有无尿蛋白、病理管型及相应的尿渗透压、酸碱度等检查结果,初筛血尿的来源,以提高肾脏病诊断的准确性。结果出血部位不同,在尿液中红细胞形态存在一定的差异。未经染色的尿液标本在相差显微镜下可较清楚地显示出差异,容易区分出不同大小形态的红细胞,因此通过尿红细胞形态检查在鉴别血尿来源上具有临床应用价值,可对肾性血尿做出初步判断,但不能作为肾脏疾病的确诊实验。结论利用相差显微镜对红细胞形态和结构进行初筛,并结合有无尿蛋白、病理管型及相应的尿渗透压、酸碱度等检查结果来判断血尿来源,从而指导临床诊断。     

显微相衬技术分析去白细胞悬浮红细胞上清液不同存储期内细胞碎片及微粒的图像变化

目的探索库存去白细胞悬浮红细胞,随着保存时间的延长,红细胞破损或溶血而产生的细胞碎片及微粒变化,为输血安全提供启示性实验基础。方法取不同保存天数(3、7、14、21d)的库存去白细胞悬浮红细胞进行上清液制备,通过显微静态图像分析技术对上清液中的微粒进行观察和形态分析。结果保存3d和7d的样品上清液中可见少量微粒,微粒大小和细胞相仿;从14d开始微粒的数量显著增加,微粒粒径更小,到21d微粒铺满了整个视场,呈现碎片化。结论保存期超过14d的库存去白细胞悬浮红细胞,其上清液的细胞碎片及微粒显著增多,较保存期不到14d的细胞均有显著的差异。这些外源细胞碎片或微粒可能会成为抗原并引起机体的免疫反应,导致输血不良反应发生,建议临床上给患者输注保存期在14d以内的去白细胞悬浮红细胞。     

病毒灭活血浆中亚甲蓝残留量超标原因的研究

目的探讨亚甲蓝光化学法病毒灭活后亚甲蓝残留量结果范围及其原因。方法采用固相萃取法,检测不同规格的病毒灭活血浆中亚甲蓝残留量,并分析亚甲蓝残留量超标的原因。结果统计分析不同规格病毒灭活血浆中亚甲蓝残留量,结果有差异。结论根据亚甲蓝残留量超标存在的原因采取相应措施,加强制备过程中关键控制点的监测,减少亚甲蓝残留量超标现象,保证输血安全。     

Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized,Double-Blind,Placebo-Controlled Study

This 12-week study evaluated the efficacy and safety of capsaicin 8% patch versus placebo patch in painful diabetic peripheral neuropathy (PDPN). Patients aged 18 years or older with PDPN were randomized (1:1) to one 30-minute treatment (capsaicin 8% patch or placebo patch) to painful areas of the feet. Overall, 369 patients were randomized (capsaicin 8% patch, n = 186; placebo patch, n = 183). Percentage reduction in average daily pain score from baseline to between weeks 2 through 8 (the primary end point) was statistically significant for capsaicin 8% patch versus placebo (?27.4% vs ?20.9%; P = .025); improvements in pain were observed from week 2 onward. Versus placebo, patients treated with capsaicin 8% patch had a shorter median time to treatment response (19 vs 72 days) and modest improvements in sleep interference scores from baseline to between weeks 2 through 8 (P = .030) and weeks 2 through 12 (P = .020). Apart from application site reactions, treatment-emergent adverse events were similar between groups. No indications of deterioration in sensory perception of sharp, cold, warm, or vibration stimuli were observed. In patients with PDPN, capsaicin 8% patch treatment provided modest pain relief and sleep quality improvements versus a placebo patch, similar in magnitude to other treatments with known efficacy, but without systemic side effects or sensory deterioration.

Computational model for the analysis of cartilage and cartilage tissue constructs

We propose a new non‐linear poroelastic model that is suited to the analysis of soft tissues. In this paper the model is tailored to the analysis of cartilage and the engineering design of cartilage constructs. The proposed continuum formulation of the governing equations enables the strain of the individual material components within the extracellular matrix (ECM) to be followed over time, as the individual material components are synthesized, assembled and incorporated within the ECM or lost through passive transport or degradation. The material component analysis developed here naturally captures the effect of time‐dependent changes of ECM composition on the deformation and internal stress states of the ECM. For example, it is shown that increased synthesis of aggrecan by chondrocytes embedded within a decellularized cartilage matrix initially devoid of aggrecan results in osmotic expansion of the newly synthesized proteoglycan matrix and tension within the structural collagen network. Specifically, we predict that the collagen network experiences a tensile strain, with a maximum of ~2% at the fixed base of the cartilage. The analysis of an example problem demonstrates the temporal and spatial evolution of the stresses and strains in each component of a self‐equilibrating composite tissue construct, and the role played by the flux of water through the tissue. Copyright © 2013 John Wiley & Sons, Ltd.     

直径≤10 mm进展期大肠癌的内镜和临床病理特点

目的：研究直径≤10mm进展期大肠癌的内镜和临床病理特点。方法：总结12例直径≤10mm进展期大肠癌的临床资料，并与直径＞10mm进展期大肠癌的直镜下特点和临床病理作比较。结果：直径≤10mm进展期大肠癌肉眼似Ⅱc 5例，似Ⅱa 3例，似Is 4例。病灶直径6－10mm，侵犯至肌层8例，侵犯至浆膜层4例。内镜下均有黏膜皱襞集中和表面略有凹陷，以及Vs型的腺管开口型的特点。无一例分布在直肠。淋巴结转移率为33％。结论：直径≤10mm进展期大肠癌可能由表面平坦凹陷型发展而来。此类病灶可以通过黏膜皱襞改变和腺管开口类型来进行辨别。     

Predictive Value of Inflammatory and Coagulation Parameters in the Course of Severe Ulcerative Colitis

Alterations in markers of coagulation have been found in patients with inflammatory bowel disease. Our aim was to study the predictive value of coagulation and inflammatory parameters in the course of severe ulcerative colitis. Twenty-seven patients were included. The disease course was followed for one year. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratio, as well as the clinical predictive value of laboratory variables were calculated. Inflammatory variables, such as ESR, CRP, and leukocyte and platelet count showed poor diagnostic accuracy. Several coagulation parameters, such as fibrinogen and fibrin(ogen) degradation products, were increased in patients with active ulcerative colitis, whereas coagulation factor XIII was decreased. No significant relationship between clinical course and coagulation parameters was demonstrated, though both inflammatory and coagulation parameters were useful in the assessment of disease activity in patients with active ulcerative colitis.     

Intrinsic subthreshold oscillations extend the influence of inhibitory synaptic inputs on cortical pyramidal neurons

Fast inhibitory synaptic inputs, which cause conductance changes that typically last for 10–100 ms, participate in the generation and maintenance of cortical rhythms. We show here that these fast events can have influences that outlast the duration of the synaptic potentials by interacting with subthreshold membrane potential oscillations. Inhibitory postsynaptic potentials (IPSPs) in cortical neurons in vitro shifted the oscillatory phase for several seconds. The phase shift caused by two IPSPs or two current pulses summed non‐linearly. Cholinergic neuromodulation increased the power of the oscillations and decreased the magnitude of the phase shifts. These results show that the intrinsic conductances of cortical pyramidal neurons can carry information about inhibitory inputs and can extend the integration window for synaptic input.     

小剂量罗红霉素对舒利迭治疗稳定期重度慢性阻塞性肺疾病的影响

目的观察小剂量罗红霉素对舒利迭治疗稳定期重度慢性阻塞性肺疾病(COPD)患者的肺功能、体重指数(BMI)、生活质量评分、呼吸困难评分、痰量、6 min步行距离及血清C反应蛋白(sCRP)的影响。方法66例重度稳定期COPD患者随机分为三组:A组(22例),予吸入舒利迭(50/250)1吸/次,每天2次;B组(22例),在与A组相同的治疗上加口服罗红霉素分散片0.15 g/次,每天1次;C组(22例),口服罗红霉素分散片0.15 g/次,每天1次。三组疗程均为3个月,所有患者在治疗前和治疗结束时均进行以下检查:FEV1%、BMI、6 min步行试验、生活质量评分、痰量、呼吸困难评分及检测sCRP。结果三组患者治疗后的FEV1(%)、BMI改善无统计学意义(P0.05),A组6 min步行距离提高、生活质量评分、呼吸困难评分、痰量及sCRP改变无统计学意义(P0.05);B组治疗后患者的6 min步行距离提高(P0.05),生活质量评分和呼吸困难评分及痰量显著减少(P0.05),且sCRP水平亦降低(P0.05),且6 min步行距离、生活质量评分、呼吸困难评分、痰量及sCRP比A组患者改善(P0.05);C组治疗后与治疗前及A组治疗后比较痰量减少及sCRP降低,但C组治疗后6 min步行距离、生活质量评分及呼吸困难评分与治疗前及A组治疗后比较无改善。结论小剂量罗红霉素联合舒利迭对治疗重度稳定期COPD能改善6min步行试验、生活质量评分、呼吸困难评分、痰量及降低sCRP,且与sCRP有关。