Determination of Clinical Cut-Off Values for Serum Cystatin C Levels to Predict Ischemic Stroke Risk

Background: The association between cystatin C and risk of ischemic stroke is inconsistent and the cut-off values of cystatin C are diverse in different articles. We aimed to investigate the association between cystatin C levels and the development of ischemic stroke and to explore the clinical cut-off values of serum cystatin C levels for ischemic stroke. Methods: This prospective cohort study included 7658 participants from the China Health and Retirement Longitudinal Study who were free of cardiovascular diseases and cancer at baseline. A decision-tree model was used to find reasonable cut-off values for cystatin C levels. Logistic regression models were used to analyze the association between different levels of cystatin C and the risk of ischemic stroke. Results: The whole cohort was divided into the following 3 groups according to the decision tree: group-low (<.901 mg/L), group-moderate (.901～1.235 mg/L), and group-high (>1.235 mg/L). After 4 years of follow-up, we identified 156 cases of ischemic stroke. After adjusting for potential confounding factors, the odds ratios (95% confidence intervals) of ischemic stroke were 1.637 (1.048-2.556) for group-moderate and 2.326 (1.285-4.210) for group-high) compared with the low group of cystatin C. Subgroup analyses showed that the association between cystatin C levels and the incidence of ischemic stroke was more pronounced in males or old people than in females or young people. Conclusions: We found 2 suitable cut-off values for serum cystatin C levels and found that high levels of cystatin C were associated with an increased risk of ischemic stroke.     

Efficacy of liposomal bupivacaine versus bupivacaine in port site injections on postoperative pain within enhanced recovery after bariatric surgery program: a randomized clinical trial

BackgroundUse of liposomal bupivacaine (LB) in surgery is reported with decreased postoperative opioid requirements. The efficacy of LB versus standard bupivacaine injections at laparoscopic port sites during bariatric surgery is unknown.ObjectivesTo determine whether there was a difference in postoperative hospital opioid requirements after port site injections of LB versus standard bupivacaine during laparoscopic bariatric surgeries. Primary endpoint was total in hospital opioid use expressed as morphine-equivalent use. Secondary endpoints included home opioid use, pain scores, hospital length of stay, and adverse events.SettingAcademic-affiliated private practice.MethodsA 2-group randomized, double-blinded trial from November 2017 to August 2018 with patients randomly assigned to receive either LB or bupivacaine alone at trocar site injections during laparoscopic Roux-en-Y gastric bypass (LRYGB) or vertical sleeve gastrectomy (VSG). All patients underwent enhanced recovery after bariatric surgery protocols.ResultsAll patients undergoing LRYGB or VSG assessed for eligibility. Of 682 patients undergoing LRYGB or VSG, 231 met inclusion criteria, 52 patients excluded intraoperatively. Among 231 patients (mean age, 39.2 years; 79% women; mean body mass index 45.0), 179 patients (77%) completed the trial. Patients randomly assigned to receive either LB (n = 89) or bupivacaine alone (n = 90) at trocar site injection during LRYGB or VSG. Postoperative morphine-equivalent use were similar (LB 8.3 [standard deviation 4.0–13.9] versus bupivacaine group 7.5 [standard deviation 3.6–13.1] P = .94) with highest requirement in first 4 hours after surgery. There was no significant difference in length of stay, pain scores, or complications. There were more patients in the bupivacaine group that did not take pain medications on postoperative days 2 to 4 (P = .032, P = .23, P = .005, respectively). There were more patients in the bupivacaine group 48.1% (n = 39) compared with the LB group 34.2% (n = 27) that did not consume any narcotic tablets at home but this not found to be statistically significant (P value = .07).ConclusionsAmong patients undergoing primary bariatric surgery under enhanced recovery after bariatric surgery protocol, there was no significant difference in postoperative hospital opioid use in those receiving LB compared with standard bupivacaine. A greater percentage of patients in the standard bupivacaine group did not require any narcotics at home, which was significant on postoperative days 2 to 4. To become completely opioid free after bariatric surgery, resources should be focused on multimodal approaches instead of reliance on type of anesthetic medication used.     

COX-2和MMP-2蛋白的表达对肺癌预后的影响

背景与目的：研究发现,环氧合酶-2(cyclooxygenase-2,COX-2)和基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)蛋白在肿瘤组织中的表达多有增高,而实验和临床研究提示,这两种蛋白的抑制剂可抑制肿瘤的生长、发展。本研究旨在探讨COX-2和MMP-2蛋白在人肺癌组织中的表达及其对患者预后的影响。方法：应用免疫组化方法检测42例肺癌组织中COX-2和MMP-2蛋白的表达情况,通过生存曲线法比较阳性组和阴性组患者的预后情况。结果：COX-2和MMP-2蛋白的阳性率分别为3l％和62％;COX-2蛋白阳性组患者的生存期明显较阴性组短(P=0．019);MMP-2蛋白阳性组淋巴结癌转移的发生率明显较阴性组高(P=0．009),而患者生存期则明显较阴性组短(P=0．001);COX-2蛋白与MMP-2蛋白的表达之间无相关性(P=0．257)。结论：COX-2和MMP-2蛋白的表达与肺癌患者的预后相关,其高表达提示患者预后不良。     

马融教授治疗小儿扁桃体炎的经验

马融教授治疗小儿急、慢性扁桃体炎以"清、消、补"为治疗法则,注重辨证论治,临证分为实热乳蛾和虚火乳蛾.实热乳蛾在疾病初期,邪热在表,尚未入里者,治以疏风清热、宣肺利咽,方用银翘散加减;若表邪未解,入里化热,尚未成腑实者,治以清热解毒、消肿散结,方用消瘰丸加减;若表邪已解,里热炽盛,腑实便结,当泻火解毒、消肿散结,方用凉膈散加减.虚火乳蛾根据症状又分为2种情况,或治以甘寒养阴、清肺利咽、软坚散结,方用养阴清肺汤加减;或治以益气健脾、活血化瘀,方用补中益气汤加减.     

MoMa脑保护装置在颈动脉狭窄支架置人术中的作用

目的 探讨颈动脉狭窄支架置人术中使用MoMa脑保护装置的作用.方法 回顾性分析2008年12月-2010年5月,对6例颈内动脉重度狭窄的患者行颈动脉支架置人术并使用MoMa脑保护装置的临床资料.结果 ①6例患者的临床症状均获得改善,NIHSS评分较术前提高1-2分.②保护装置的滤网中均可见捕获的小斑块,无一例患者发生栓子脱落事件,颈内动脉重度狭窄均得到改善（残余狭窄率均〈30%）.③术后3d及3个月复查头部MRI,均未发现新发的缺血病灶.有1例在使用Moma脑保护装置过程中,血液从颈外动脉逆流而加用远端脑保护装置;1例术后出现急性冠状动脉综合征,经积极治疗后好转.6例患者术后3个月复查颈部血管彩超均未发现再狭窄.结论 对颈动脉重度狭窄的患者行支架置人术时,使用MoMa脑保护装置是相对安全、有效的,但尚需大样本病例的进一步研究.     

马云枝治疗中风合并再生障碍性贫血的临床经验

目的：探讨马云枝老师治疗中风合并再生障碍性贫血的临床经验。方法：通过观察马云枝老师以培元固本为原则,方用八珍汤加减（党参30 g,黄芪90 g,生白术15 g,川芎15 g,当归10 g,生熟地黄各12 g,茯苓30 g,陈皮10 g,石菖蒲15 g,远志15g,炙甘草3g）治疗中风合并再生障碍性贫血的临床疗效,总结其临床经验。结果：马老认为西药治疗以抗感染,清除脑内自由基为主,中药以健脾益气养血,化痰通络为主,培元固本。结论：培元固本法能明显改善患者临床症状,疗效显著,并提高生存质量。     

马宝东教授治疗痛风经验

痛风是临床常见病、多发病,发病率逐年升高,发病人群逐渐年轻化。可以导致痛风性肾损害等多种并发症。马宝东教授发挥中医整体观念、辨证论治的特色,运用中医药疗法,在痛风疾病的治疗中取得较好的临床疗效。     

肉苁蓉花序挥发物的GC-MS成分分析

目的:研究肉苁蓉花序挥发物的种类和相对含量,为其综合利用和种子繁育提供依据。方法:利用动态顶空套袋吸附法和气相色谱-质谱联用分析方法,研究近自然状态下肉苁蓉花期花序挥发物成分。结果:现蕾期到盛花期共从肉苁蓉花序中鉴定出40种挥发性化合物。现蕾期主要为烃类与绿叶挥发物,随着肉苁蓉花序上花朵开放,部分挥发物相对含量消失或减少,部分化合物相对含量增加,并出现一些新化合物。初花期和盛花期肉苁蓉花序主要挥发性成分为芳香性酯类与苯环类化合物,其相对含量较现蕾期显著增加。结论:肉苁蓉花序的挥发性成分种类多,且随开花进程出现种类和相对含量的变化,构成了肉苁蓉不同花期的香韵。     

马万千老中医基于体质辨识运用食疗方治疗便秘临床经验总结

便秘是临床常见病证,马万千名老中医认为便秘与体质因素关系密切,通过长期临床发现,便秘患者体质多为气虚质、阳虚质、阴虚质、气郁质和湿热质,马万千老中医根据其临床经验,运用药食同源的药物,综合考虑口味等因素,针对不同的体质制定不同的食疗方,不仅治疗便秘,同时改善患者体质,取得了良好的临床疗效,值得临床推广。     

论名医成才与中医高等教育

源于中国五千年文明史的中国医学,实际上是一门不能完全等同于西方医学而具备人文特点的学科。这门学科因为其独特的发展过程,故具有较强的哲学性、实践性和经验性的特点,使其成为独立于自然科学之外的一门科学学科。其基本理念的不同也让西医教育的模式化阻碍了中医教育的发展和提高,应用多学科知识研究发展中医是中医教育的必由之路。