Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study

Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3–13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.     

基于HMGB1/TLR4/NF-κB信号通路研究木兰脂素对急性鼻窦炎大鼠的治疗作用及机制

目的： 观察木兰脂素对急性鼻窦炎(ARS)大鼠的治疗作用，并探讨其通过高迁移率家族蛋白1/ Toll样受体4/核因子-κB(HMGB1/TLR4/NF-κB)信号通路的调控机制方法： 49只大鼠，随机取9 只作为正常组，40只用鼻窦腔内接种金黄色葡萄球菌法制备ARS模型，36只建模成功大鼠随机分为模型组、木兰脂素低剂量组、木兰脂素高剂量组、阳性组，各9只。木兰脂素低剂量组、木兰脂素高剂量组分别灌胃20、80 mg·kg^-1体质量的木兰脂素，模型组和正常组灌胃等体质量溶媒，阳性组灌胃40 mg·kg^-1 体质量左氧氟沙星，连续7 d。给药前、末次给药后1 h评估各组鼻窦炎症状评分；测定给药后各组血白细胞(WBC)计数及中性粒细胞占比，观察鼻窦黏膜病理组织学变化，检测鼻腔灌洗液中肿瘤坏死因子-α(TNF-α)、白介素(IL)-6水平及鼻黏膜中HMGB1、TLR4、NF-κB mRNA和蛋白表达情况结果： 给药后，木兰脂素低剂量组、高剂量组、阳性组的急性鼻窦炎症状评分及血WBC计数均低于模型组，但仍高于正常组，且木兰脂素高剂量组及阳性组均低于木兰脂素低剂量组，差异均有统计学意义(P＜0.05)，而木兰脂素高剂量组与阳性组比较，差异无统计学意义(P＞0.05)。与给药前比较，给药后木兰脂素低剂量组、高剂量组及阳性组急性鼻窦炎症状评分均降低(P＜0.05)，正常组及模型组给药前后无明显差异(P＞0.05)。与模型组比较，木兰脂素低剂量组、木兰脂素高剂量组、阳性组中性粒细胞占比均降低，且木兰脂素高剂量组低于木兰脂素低剂量组，阳性组低于木兰脂素高剂量组，差异均有统计学意义(P＜0.05)，而阳性组与正常组比较，差异无统计学意义(P＞0.05)。HE染色显示，模型组大鼠纤毛脱落、缺失、排列紊乱，黏膜上皮破损、变性，黏膜内及黏膜下可见大量炎症细胞浸润； 木兰脂素低剂量组、木兰脂素高剂量组及阳性组上述病理变化均减轻，且木兰脂素高剂量组和阳性组炎症反应减轻更为明显。与模型组比较，木兰脂素低剂量组、木兰脂素高剂量组、阳性组鼻腔灌洗液中 TNF-α、IL-6水平及鼻黏膜中HMGB1、TLR4、NF-κB mRNA和蛋白相对表达量均降低，但仍高于正常组，且木兰脂素高剂量组及阳性组均低于木兰脂素低剂量组，差异均有统计学意义(P＜0.05)，而木兰脂素高剂量组及阳性组比较，差异无统计学意义(P＞0.05)结论： 木兰脂素治疗ARS效果显著，可能通过HMGB1/TLR4/NF-κB信号通路抑制鼻黏膜炎症反应。     

锁骨钩钢板内固定术后钢板钩与肩峰匹配性影像学研究

目的通过测量锁骨钩钢板内固定术后患者影像学资料，分析发生肩峰骨侵蚀的原因是否与钢板钩-肩峰匹配度相关。 方法回顾性分析2015年8月1日至2018年8月31日期间在上海市浦东医院骨科就诊的210例患者的影像学资料，210例患者均因肩锁关节脱位或锁骨远端骨折行锁骨钩钢板内固定治疗，其中男110例、女100例；年龄24~76岁，平均（44.60±8.75）岁；肩锁关节脱位70例，锁骨远端骨折140例。测量术后及终末随访患者肩锁关节正位X线片相关数据，按锁骨钩钢板术后是否发生肩峰骨侵蚀，将纳入患者分为3组：无骨侵蚀组（A组）、伴钢板钩移位骨侵蚀组（B组）、不伴移位的骨侵蚀组（C组），分别测量钢板钩-肩峰的匹配度（β），统计分析术后发生肩峰骨侵蚀与钢板钩-肩峰匹配度之间的关系。 结果纳入研究的210例患者术后随访24~64周，平均（32.0±6.5）周。A组患者115例，B组患者54例，C组患者41例。A组匹配度β（3.72±0.48）mm与B组β¹（6.91±0.84）mm比较差异有统计学意义（P<0.05）；A组匹配度β（3.72±0.48）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）；B组匹配度β¹（6.91±0.84）mm与C组β²（5.88±0.65）mm比较差异有统计学意义（P<0.05）。 结论锁骨钩钢板内固定术后是否发生肩峰骨侵蚀与钢板钩-肩峰匹配度β存在明显相关性，钢板钩与肩峰之间的匹配度越好，β值越小，发生肩峰骨侵蚀的可能性更小。     

IL-10 contributes to gemcitabine resistance in extranodal NK/T-cell lymphoma cells via ABCC4

Investigational New Drugs - Background&nbsp;Chemotherapy resistance is a main reason for treatment failure in extranodal NK/T-cell lymphoma (ENKTL). Interleukin-10 (IL-10) is closely related to...     

以宫腔积液为首发症状的胃型宫颈腺癌1例报道并文献复习

宫腔积液指宫腔内液体积存(积水、积血或积脓),是绝经后女性常见体征之一,常于超声检查时发现。持续宫腔积液患者,需宫腔镜检查寻找病因。本文报道1例以宫腔积液为首发症状,经宫腔镜检查确诊为胃型宫颈腺癌的患者。通过病例回顾并文献复习,以期为更多绝经后宫腔积液及宫颈病变的诊断提供参考,避免漏诊及误诊。1病例资料患者67岁,女,主因"绝经18年,不规则阴道出血2月"于2020年5月就诊于首都医科大学附属北京妇产医院妇科微创中心。