重组腺病毒介导MDA-7/IL-24对Hep3B选择性杀伤和抑制增殖的研究

目的观察黑色素瘤分化相关基因7（MDA-7／IL-24）基因对人肝癌细胞Hep3B和正常的肝细胞L02的作用，并且探讨其该作用机制。方法将携带人MDA-7／IL-24基因的腺病毒Ad.mda-7感染人正常肝细胞L02和肝癌细胞Hep3S，逆转录-聚合酶链式反应（RT—PCR）和ELISA方法观察MDA-7／IL-24基因的表达，噻唑蓝染色法（MTT）观察MDA-7／IL-24对肝癌细胞的生长抑制，Hoechst染色和Annexin-V和PI双染后流式细胞仪检二种细胞的凋亡，利用PI染色后流式细胞仪检测细胞周期，RT-PCR方法检测bcl-2的表达变化。结果Ad．mda-7能介导外源基因MDA-7／IL-24在肝癌细胞株Hep3B和正常细胞L02中高效表达，细胞培养上清液中MDA-7／IL-24蛋白的表达（Hep3B：L02分别为790：810ng／L）。MDA-7／IL-24能明显抑制肝癌细胞的生长（抑制率分别是83％和1．2％），能促进肝癌细胞的凋亡（58％：2．2％），阻滞肝癌细胞在G2／M期（48．29％：7．95％）。而对正常的肝细胞没有促凋亡和增殖阻滞作用；能明显的抑制Hep3B的凋亡抑制基因bcl-2的表达。结论Ad．mda-7能介导MDA-7／IL-24基因在人肝癌细胞中高效表达，选择性的杀伤肝癌细胞Hep3B，促进细胞增殖阻滞，其机制是通过抑制bcl-2的表达诱导肿瘤细胞凋亡。     

凋亡抑制基因survivin在膀胱癌组织中的表达

目的探讨新的凋亡抑制基因survivin在膀胱癌组织中的表达及其与膀胱癌生物学特性的相关性。方法应用免疫组织化学链霉素抗生物素蛋白-过氧化酶连接法（SP），检测survivin在42例膀胱癌组织、8例正常膀胱组织中的表达。结果Survivin在正常膀胱组织中不表达；42例膀胱癌组织有28例表达阳性，阳性率为66．7％。病理分级Ⅰ-Ⅲ级膀胱癌survivin阳性表达率分别为33．3％、76．2％、88．9％，差别有统计学意义（P〈0．05）；临床分期T1-T3膀胱癌的阳性表达率分别为60．9％（14／23）、66．7％（8／12）、85．7％（6／7），差别无统计学意义（P〉0．05）；无复发与有复发膀胱癌的阳性表达率分别为53．8％（14／26）、87．5%（14／16），差别有统计学意义（P〈0．05）。结论Survivin阳性表达引起的细胞凋亡抑制在膀胱癌的发生、发展中起一定作用，其过度表达可能提示膀胱癌预后不良。     

Survivin在食管癌中的表达及其与bcl-2表达关系的相关研究

目的 探讨Survivin在食管癌组织中的表达及其与bc1-2蛋白表达的相关性。方法应用免疫组织化学SP法，检测Survivin、bc1-2蛋白在68例食管癌组织和20例正常食管组织中的表达。结果 Survivin蛋白在正常食管组织中低表达或不表达，68例食管癌组织中，49例表达阳性，占72．1％。Survivin蛋白表达与分化程度、淋巴结转移密切相关（P〈0．05）。食管癌组织bc1-2蛋白表达阳性、阴性组中，Survivin蛋白阳性表达率分别为94．7％（36／38）和43．3％（13／30），两者比较．差异有统计学意义（P〈0．05）。Survivin蛋白表达与bc1-2蛋白表达密切相关。结论 Survivin在食管癌组织中表达上调，通过抑制细胞凋亡，在食管癌的发生中起到重要作用；凋亡相关基因bc1-2的上调与Survivin的表达可能在食管癌变中起协同作用。     

血管内皮生长因子及其受体Flt-1和KDR在原发性胆囊癌的表达及其与临床病理特征的关系

目的探讨血管内皮生长因子（VEGF）、Flt-1和KDR的表达与原发性胆囊癌临床病理特征的关系。方法对21例原发性胆囊癌和10例胆囊腺瘤样息肉新鲜组织标本采用逆转录-聚合酶链反应（RT-PCR）和免疫组织化学染色在mRNA和蛋白水平检测VEGF、Flt-1和KDR在原发性胆囊癌和胆囊腺瘤样息肉的表达情况，并分析VEGF、Flt-1和KDR免疫组织化学阳性表达的病例与胆囊癌肝浸润、淋巴转移、病理分级和Nevin分期等临床病理特征的相关性。结果在胆囊癌和胆囊腺瘤样息肉组织中VEGF mRNA阳性表达率为90．47％（19／21）和20％（2／10）；Flt-1mRNA阳性表达率为71．42％（15／21）和0％（0／10）；KDR mRNA阳性表达率为85．71％（18／21）和10％（1／10）；两组差异有统计学意义（P〈0．05）。免疫组织化学染色VEGF蛋白检测阳性表达率为80．95％（17／21）和20％（2／10）；Flt-1蛋白阳性表达率为60．90％（13／21）和10％（1／10）；KDR蛋白阳性表达率为76．19％（16／21）和10％（1／10），两组差异有统计学意义（P〈0．05）。VEGF、Flt-1和KDR蛋白的阳性表达率在胆囊癌肝浸润、淋巴转移和NevinⅣ、Ⅴ期组明显高于无肝浸润、无淋巴转移和NevinⅠ、Ⅱ、Ⅲ期组（P〈0．05），而在高、中和低分化组三者的阳性表达率无统计学意义（P〉0．05）。结论原发性胆囊癌组织中VEGF、Flt-1和KDR在mRNA和蛋白水平均存在高表达，VEGF、Flt-1和KDR蛋白的阳性表达同胆囊癌肝浸润、淋巴转移和Nevin分期明显相关，但与病理分级无明显相关。     

Doxycycline抑制人肝癌细胞系HepG2生长的实验研究

目的：观察多西环素（Doxycycline）对人肝细胞性肝癌细胞系HepG：生长抑制和凋亡的作用，并初步探讨其作用机制。方法：不同浓度的Doxycycline（5、10、20、30和50mg／L）对体外培养人肝癌细胞系HepG：进行不同的时间干预（24、48和72h），MTT法测定细胞生长抑制率，TUNEL法检测细胞凋亡率，免疫细胞化学检测Fas、FasL及MMP-2蛋白表达的变化。结果：Doxycycline作用HepG2细胞48h和72h后，细胞生长被明显抑制，与无药对照组比较差异有统计学意义（P〈0．001），且呈时间、浓度依赖趋势。其细胞凋亡率较无药对照组也明显升高（P〈0．01）；20mg／L Doxycycline作用于癌细胞48h后，实验组FasL蛋白阳性表达较无药对照组明显升高，MMP-2蛋白阳性表达较无药对照组明显降低，两组差异均有统计学意义（P〈0．01），而Fas蛋白表达则差异无统计学意义（P〉0．05）。结论：Doxycycline对人肝癌细胞系HepG2具有明显的生长抑制和促凋亡作用，其机制可能与下调MMP-2、上调FasL从而启动Fas／FasL膜受体途径有关。     

膀胱移行细胞癌组织中聚集素、Ki-67蛋白表达和细胞凋亡的测定

目的 探讨聚集素在膀胱移行细胞癌组织中的表达及其与细胞增殖和凋亡的关系。方法制作87例膀胱移行细胞癌组织的组织芯片,分别应用免疫组织化学和末端脱氧核苷酸转移酶介导缺口末端标记方法,检测膀胱移行细胞癌组织中聚集素和Ki-67蛋白表达及细胞凋亡情况,分析聚集素蛋白表达与肿瘤分化、临床分期等病理特征及肿瘤细胞凋亡、增殖及Ki-67蛋白表达的关系。结果43％（37／87）患者为聚集素蛋白过度表达,且聚集素蛋白表达与肿瘤细胞的分化程度、肿瘤的浸润深度均有显著的相关性（r分别为14．1,10．2,P均〈0．01）;71％（20／28）低分化（G3）和62％（23／37）浸润型（T2-4期）患者的肿瘤组织聚集素蛋白过度表达,过度表达率明显高于分化较好（G1-2,29％,17／59）和浅表型（Ta-1期,28％,14／50）者。聚集素蛋白表达与肿瘤的凋亡指数（AI）呈负相关（r=7．31,P〈0．01）,但与Ki-67的表达水平无关;聚集素过度表达的肿瘤,57％（21／37）表现为低AI值（≤1．2％）,而聚集素正常表达的肿瘤,则72％（36／50）为高AI值。结论膀胱移行细胞癌组织中聚集素蛋白过度表达与肿瘤的分化程度和浸润深度呈正相关,与肿瘤细胞的AI呈负相关。     

肾细胞癌bc1－2、P53、ER、PR的表达及临床意义

为了更好地选择估价肾细胞癌预后的指标，应用免疫组化技术检测５４例肾细胞癌中ｂｃ１－２、Ｐ５３蛋白及雌、孕激素受体的表达。ｂｃ１－２阳性３８例（７０．４％），Ⅰ、Ⅱ级肿瘤阳性３３例，Ⅲ、Ⅳ级肿瘤阳性５例（Ｐ＜０．０５）；Ｐ５３蛋白阳性１０例（１８．３％），对照组无一例阳性（Ｐ＜０．０５）；ＥＲ、ＰＲ阳性分别为２９例（５７．７％）、３９例（７３．７％）。ｂｃ１－２蛋白表达与ＥＲ、ＰＲ呈正相关（Ｐ＜０．０１，ｒ＝０．４５２），与Ｐ５３蛋白表达呈负相关（Ｐ＜０．０１，ｒ＝－０．４２１）。结果提示：ｂｃ１－２蛋白的表达有助于肾细胞癌预后的评估     

酪氨酸激酶Syk在肝癌中的表达及与血管生成的关系

目的探讨酪氨酸激酶Syk在肝细胞性肝癌中的表达及对肿瘤微血管生成的影响。方法采用RT-PCR检测Syk mRNA在肝细胞性肝癌及癌旁正常组织中的表达，免疫组化SABC法检测标本中CD34的表达反映肿瘤的微血管密度（MVD）。结果24例癌旁正常组织中Syk mRNA均表达阳性，32例肝细胞性肝癌中Syk mRNA表达率为46.9％（15／32），其中低分化组阳性表达率23．1％（3／13），明显低于高分化组阳性表达率63．2％（12／19）（P〈0．05）。肿瘤微血管密度（MVD）检测：低分化组（Ⅲ级Ⅳ级为49．2±3.6，54±4.3），明显高于高分化组（Ⅰ级Ⅱ级为13．6±4．5，32.3±3．2）与正常组织（5．9±1．7），有显著统计学意义（P〈0．05）。Syk mRNA的表达与CD34的表达明显负相关（r=-0.97）。结论肝细胞性肝癌中Syk基因的缺失对癌组织血管的生成起重要的作用。     

表观沉默蛋白Bmil在结直肠癌组织中的表达及其对结直肠癌细胞增殖和凋亡的影响

目的研究人结直肠癌中表观沉默蛋白Bmil表达与结直肠癌病理特征的关系,探讨Bmil蛋白对结直肠癌细胞增殖凋亡的影响。方法应用免疫组织化学技术检测85例结直肠癌组织及其邻近正常肠黏膜中Bmil蛋白表达：用BmilsiRNA转染结肠癌细胞系SW480．运用MTY法检测细胞增殖状态：流式细胞仪观察其对细胞凋亡的影响．Westemblot检测Bmil及Bcl-2蛋白的表达。结果结直肠癌组织中Bmil蛋白表达的阳性率为56．5％（48／85）．明显高于正常肠黏膜[17．6％（15／85）]（P〈0．05）;其阳性表达与肿瘤分化程度、分期及淋巴结转移有关（P〈0．05）。SW480转染BmilsiRNA后,细胞增殖受到抑制,凋亡明显;转染24、48和72h后,其抑制率分别为13．1％、16．5％和18．3％．细胞凋亡率分别为15．7％、45．6％和40．2％：同时,Bmil表达水平在转染48h后下降,Bcl-2表达水平也降低（P〈0．01）。结论结直肠癌中Bmil表达与肿瘤病理学特征关系密切,阻断Bmil表达可抑制结肠癌细胞的增殖．促进其凋亡。     

肝癌及癌旁组织中p16的表达及其临床意义

目的 探讨抑癌基因p16在肝癌及癌旁中的表达及意义。方法 应用免疫组化方法对50例肝细胞癌（HCC）及癌旁肝硬化组织（44例）手术切除石蜡包埋标本进行p16基因蛋白表达的测定，结合临床病理指标（Child分级、肿瘤大小、Edmondson分级、转移及生存期）进行分析。结果 p16基因在HCC中的阳性表达48％（24／50），癌旁91％（40／44）。p16基因表达与HCC的分化程度密切相关（p=0.014），在分化Ⅰ-Ⅱ级中P16阳性率59％（19／32）明显高于Ⅲ-Ⅳ级的27.8%（5／18）。结论 p16基因在HCC的发生及分化中起重要的调控作用，且P16的失活可能发生在HCC的早期。     

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。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

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.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

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。     

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.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

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.     

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。     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92