经皮脊柱内镜技术与传统开放手术治疗腰椎间盘突出症并发症的系统评价与Meta分析

目的 :系统分析经皮脊柱内镜技术与传统开放手术治疗腰椎间盘突出症的相关的并发症发生率及其特点。方法:两位作者独立对MEDLINE、Cochrane library、Pubmed数据库、Web of Science、中国期刊全文数据库(CNKI)、万方数据库和Embase数据库进行关于经皮脊柱内镜技术和传统开放手术治疗腰椎间盘突出症相关的并发症的随机对照试验(RCT)及队列研究进行搜索。语种不限。两位作者独立评估各研究的质量,且将各研究中的术中和术后各种并发症(术后感觉异常、神经根直接损伤、硬脊膜损伤、术区伤口并发症、椎间盘复发、髓核部分残留、相关并发症的额外手术及其他并发症)等提取整理为电子基线表,并将这些研究的数据通过Revman 5.3软件进行Meta分析与综合,以评估两种手术技术在各种并发症方面的统计学意义。结果:共有24篇研究最终被纳入,共计2797例患者被纳入分析。经皮脊柱内镜技术与传统开放手术比较:两者的术后感觉异常[OR=0.84,95%CI(0.57,1.24)]的发生率相等。前者相关并发症的额外手术[OR=1.15,95%CI(0.79,1.66)]的发生率略高,但无统计学差异(P0.05);后者椎间盘复发[OR=1.03,95%CI(0.67,1.61)]、其他并发症[OR=0.88,95%CI(0.53,1.46)]的发生率高于前者,但亦无统计学差异(P0.05);前者髓核部分残留[OR=2.82,95%CI(1.36,5.85)]的发生率较高,差异有统计学意义(P0.05);后者神经根直接损伤[OR=0.28,95%CI(0.09,0.80)]、硬脊膜损伤[OR=0.34,95%CI(0.17,0.70)]、术区伤口并发症[OR=0.31,95%CI(0.14,0.70)]的发生率较高,差异有统计学意义(P0.05)。结论:相对于传统开放手术治疗腰椎间盘突出症,经皮脊柱内镜技术在减少神经根损伤、硬脊膜损伤及术区伤口并发症方面占有明显优势,但在防止手术部位髓核残留方面受限于经皮内镜技术特点,差于开放手术。     

中国4250例门静脉高压症手术的Meta分析

目的 系统分析中国4250例门静脉高压症患者接受断流术、分流术和分流断流联合术治疗的疗效.方法 通过对万方数据、中国学术期刊网全文数据库CNKI检索1980-2011年有关断流术、分流术、分流断流联合术治疗门静脉高压症的文献进行统计并行Meta分析.结果 共17篇文献筛选入Meta分析,结果显示远期存活率:联合组高于断流组[OR=1.73,95％ CI( 1.23,2.44),P＜0.01],分流组与断流组相当[OR =0.87,95％CI(0.63,1.20),P=0.40],联合组与分流组相当[ OR=1.73,95％ CI(0.95,3.13),P=0.07];再出血率:分流组低于断流组[OR=0.46,95％ CI(0.35,0.61),P＜0.01],联合组低于断流组[OR=0.25,95％ CI(0.18,0.35),P＜0.01],联合组与分流组相当[ OR=0.72,95％ CI(0.40,1.29),P=0.27];肝性脑病发生率:分流组高于断流组[OR=3.57,95％ CI(2.43,5.23),P＜0.01],联合组低于分流组[OR =0.37,95％ CI(0.20,0.69),P＜0.01],联合组与断流组相当[ OR=1.58,95％CI (1.02,2.43),P=0.04].结论 影响门静脉高压症患者长期生存的惟一因素是肝脏储备功能.分流术、断流术及分流断流联合术3种术式各有利弊,因此应根据患者的肝功能储备选择适宜的术式.     

脑卒中后睡眠障碍影响因素的Meta分析

目的 探讨脑卒中后睡眠障碍的影响因素.方法 在PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库搜索相关文献,检索时限为建库至2021年1月3日,采用RevMan 5.3软件进行Meta分析.结果 共纳入10项研究,其中8项横断面研究、2项队列研究,共2 938例患者.Meta分析结果显示,卒中史[OR=1.30,95％CI(1.07～1.60)]、高血压[OR=2.20,95％CI(1.80～2.68)]、糖尿病[OR=1.55,95％CI(1.32～1.83)]、冠心病[OR=1.34,95％CI(1.09～1.65)]、高脂血症[OR=1.36,95％CI(1.14～1.62)]、吸烟史[OR=1.36,95％CI(1.07～1.73)]是脑卒中后睡眠障碍的主要影响因素(P＜0.05,P＜0.01).结论 脑卒中患者发生睡眠障碍的影响因素较多,应采取针对性措施预防和降低卒中后睡眠障碍的发生和发展.     

腰椎后路椎体间融合术与后外侧融合术治疗腰椎退行性疾病的系统评价

[目的]系统评价腰椎后路椎体间融合术(posterior lumbar interbody fusion)对比后外侧融合术(posterolateral fusion)治疗腰椎退行性疾病的术后疗效.[方法]计算机检索PubMed、EMBASE、CNKI、CBM等数据库、学术会议资料和学位论文等.全面收集有关两种方法治疗腰椎退行性疾病的文献.制定文献纳入及排除标准,由2名研究者分别独立筛选文献,按照Cochrane Handbook 5.1进行严格的质量评估,并用Revman 5.2软件进行Meta分析.[结果]经过筛选,共有6篇研究符合纳入标准,包括487例患者被纳入分析.Meta分析结果显示,PLIF组的融合率＞ PLF组[OR=3.90,95％ CI (2.05,7.40),P＜0.001],但PLIF组术后1年ODI评分＜PLF组[WMD=-3.86,95％ CI(-7.59,-0.t3),P=0.04],差异具有统计学意义(P＜0.05);而两组在手术时间[WMD=15.85,95％CI(-16.25,47.96),P=0.33]、术中失血量[WMD=-90.57,95％ CI(-292.50,111.36),P=0.38]术后并发症[OR =0.99,95％CI (0.22,4.47),P=0.99]、二次手术率[OR =0.87,95％ CI (0.52,1.45),P=0.25]无统计学差异(P＞0.5).[结论] PLIF手术方式的骨融合率较高,但术后1年ODI评分低于PLF组,且两组在手术时间、术中失血量、术后并发症、二次手术率方面结果相似.     

腹主动脉瘤破裂腔内治疗的荟萃分析

目的 系统评价血管腔内修复术(vascular edovascular repair,EVAR)治疗腹主动脉瘤破裂(ruptured abdominal aortic aneurysms,RAAA)的有效性与安全性.方法 计算机检索PubMed、MEDLINE、EMBASE、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库及中国期刊全文数据库等数据库,并辅以手工检索近年发表的中文期刊.对纳入文献采用RevMan 5.0.18软件进行Meta分析.结果 纳入9篇文献.1篇随机对照试验(RCT),8篇队列研究共2402例患者,Meta分析结果显示:与开放手术比较,血管腔内修复术可明显降低术后30 d死亡率[OR =0.47,95％ CI(0.39,0.57),P＜0.01]和并发症发生率OR=0.47,95％ CI(0.39,0.57),P＜0.01.血管腔内修复术与开放手术相比,在术后早期再手术率[ OR=0.86,95％ CI(0.55,1.33),P=0.5]及中期死亡率[OR=1.24,95％ CI(0.46,3.37),P＜0.67]方面差异无统计学意义(P＞0.05).结论 对于合适的腹主动脉瘤破裂的患者,腔内治疗是可行的,并且逐渐显现出相对传统开腹手术更大的优势,短期疗效较好,术后并发症相对较少.     

骨水泥型股骨头置换治疗高龄患者股骨颈骨折有效性与安全性随机对照研究的Meta分析

目的 通过Meta分析对骨水泥型股骨头置换治疗高龄患者股骨颈骨折的有效性与安全性进行评价. 方法 计算机检索PubMed、Embase、Cochrane图书馆、中国期刊全文数据库、维普中文科技期刊数据库等,检索时间均为建库至2012年12月,获取骨水泥型股骨头置换(骨水泥组)与非骨水泥型股骨头置换(非骨水泥组)治疗高龄患者骨质疏松性股骨颈骨折的随机对照试验.比较两组患者的术后关节功能、病死率、并发症发生率、手术时间、术中出血量及再手术率等.采用RevMan 5.2统计学软件进行Meta分析. 结果 共纳入7篇随机对照试验,共1108例患者1115髋.文献质量评价结果显示纳入研究质量较高.Meta分析结果显示:与非骨水泥组比较,骨水泥组患者术后关节功能恢复良好,假体相关并发症发生率更低[OR =0.15,95％ CI(0.09,0.26),P＜0.001],但手术时间延长[MD=7.43,95％ CI(5.37,9.49),P＜0.001].两组患者局部并发症发生率、其他并发症发生率、病死率、术中出血量及再手术率比较差异均无统计学意义(P＞0.05). 结论 与非骨水泥型股骨头置换术相比,骨水泥型股骨头置换治疗高龄患者股骨颈骨折虽然手术时间延长,但术中出血量未见明显增加,且具有术后关节功能恢复快、假体相关并发症少等优点,同时不增加病死率及再手术率.     

人工髋关节置换与内固定治疗老年股骨颈骨折国内研究的Meta分析

目的 对国内有关人工髋关节置换(HA)与内固定(IF)治疗老年股骨颈骨折的文献进行Meta分析,以期为临床治疗提供依据. 方法 计算机检索PubMed、OVID MEDLINE、中国生物医学文献数据库、万方数据库、维普数据库和中国知网等,检索文献发表时间为2000年至2012年,获取采用HA和IF治疗国内60岁以上老年股骨颈骨折患者疗效比较的相关文献.比较HA和IF治疗老年股骨颈骨折的安全性及疗效指标,包括术后1年死亡率、再手术率、一般并发症、主要并发症及功能恢复情况.采用Stata 10.0统计学软件进行Meta分析. 结果 共纳入24篇文献(随机对照试验4篇,非随机对照试验20篇),包括2738例患者.HA组与IF组患者术后1年死亡率之间比较差异无统计学意义[OR=0.97,95％ CI(0.44,2.11),P=0.929].HA组患者术后一般并发症[OR =0.48,95％CI(0.31,0.74),P=0.001]、主要并发症[OR=0.35,95％ CI(0.27,0.44),P＜0.001]及再手术率[OR=0.24,95％ CI(0.18,0.33),P＜0.001]均明显低于IF组,而术后髋关节功能恢复则明显优于IF组[OR=2.15,95％ CI(1.73,2.67),P＜0.001],差异均有统计学意义. 结论 对于国内老年股骨颈骨折患者,HA的疗效优于IF.     

急性跟腱断裂术后早期功能锻炼与制动的Meta分析

目的 对急性跟腱断裂术后早期功能锻炼与制动的疗效进行Meta分析. 方法 按照Cochrane系统评价方法,计算机检索MEDLINE(1966年至2011年1月)、EMbase(1966年至2011年1月),Cochrane图书馆(2011年第1期)、Cochrane协作网肌骨创伤组试验数据库(2011年1月)和中国生物医学文献数据库(1978年1月至2011年1月),手工检索中文骨科期刊的相关文献(创刊至2011年1月),收集急性跟腱断裂术后早期功能锻炼与制动的所有相关随机对照试验(RCTs)及半随机对照试验(CCTs),提取有效数据采用RevMan 4.2.8进行Meta分析,以比较急性跟腱断裂术后早期功能锻炼与制动的术后满意率、跟腱再次断裂发生率、感染率、并发症发生率、术后6周跟腱延长率、术后12周跟腱延长度的评价、小腿肌力、踝关节活动度的差异.结果 共纳入4个RCTs,3个CCTs.Meta分析显示,与术后制动相比,急性跟腱断裂术后早期功能锻炼的满意率增加(RR=1.27,95％ CI(1.01,1.61),P=0.04),术后并发症发生率降低[RR =0.43,95％ CI (0.22,0.83),P=0.01],差异有统计学意义;而两种方法术后跟腱再次断裂发生率[RR=0.59,95％ CI (0.20,1.80),P=0.92]、术后感染率[RR=0.70,95％ CI (0.26,1.86),P=0.48]、术后6周[SMD=1.50,95％ CI(-3.40,6.40)]和12周跟腱延长度[SMD=- 0.25,95％ CI(- 5.64,5.14)l及踝关节活动度无显著差异. 结论 与术后制动相比,急性跟腱断裂术后早期功能锻炼提高患者满意率,降低并发症发生率,且不会增加跟腱再次断裂和感染的风险,对术后6周和12周跟腱延长度、小腿肌力和踝关节活动度无明显影响.     

手术治疗胃肠胰腺神经内分泌瘤肝转移的Meta分析

目的 通过对胃肠胰腺神经内分泌瘤肝转移患者手术与非手术治疗对照研究的系统分析,探讨手术治疗胃肠胰腺神经内分泌瘤肝转移的价值.方法 检索Cochrane图书馆、PubMed、Medline、Embase、中国生物医学文献数据库、万方数据库中的相关随机研究,按照Cochrane推荐的文献纳入标准筛选文献,并对纳入文献进行质量评估,共有10组研究中心的1 567例患者的数据纳入进行Meta分析.结果 单纯手术切除治疗与药物（奥曲肽）治疗、全身放化疗、经动脉治疗、射频消融术等非手术治疗胃肠胰腺神经内分泌瘤肝转移相比较,3年生存率（OR：0.07,95％CI：0.02,0.22;Pheterogeneity=0.93,P＜0.00001）及5年生存率（OR：0.19,95％ CI：0.15,0.24;Pheterogeneity=0.11,P＜0.00001）差异具有统计学意义,手术治疗组的3、5年生存率明显优于非手术治疗组.结论 手术切除是治疗胃肠胰腺神经内分泌瘤肝转移的首选治疗方法,其安全有效且较其他非手术治疗在生存期方面具有较好的优势.     

桡骨远端关节内骨折手术与非手术治疗的Meta分析

目的 通过Meta分析比较桡骨远端关节内骨折手术与非手术治疗的疗效.方法 通过检索1988年1月至2008年6月关于桡骨远端骨折于术与非手术治疗对照研究的文献(共5篇),采用循证医学Meta分析对患者腕关节功能,骨折复位后X线位置、患者满意度及并发症进行综合分析.结果 Meta分析发现:与非手术治疗相比,手术治疗能明显改善腕关节功能(OR=0.23,95%CI 0.11-0.48,P<0.05)、可以良好复位(OR=0.20,95%CI 0.10-0.39,P<0.05)、减少并发症的发生(OR=0.29,95%CI0.17-0.49,P<0.05),但患者满意度方面低于非于术治疗(OR=0.32,95%CI 0.14-0.75,P=0.009).结论桡骨远端关节内骨折应采用手术治疗,同时应该关注患者的要求及期望值.     

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。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

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。     

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.     

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.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

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.     

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。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。