肝动脉插管化疗栓塞联合门静脉化疗对肝细胞癌病人术后生存期的影响

目的 探讨肝动脉插管化疗栓塞(transcatheter arterial chemoembolization,TACE)联合门静脉化疗(portal vein chemotherapy,PVC)对肝癌术后病人生存期的影响.方法 总结天津医科大学附属第三中心医院肝胆外科2000年1月至2007年7月符合研究条件的原发性肝细胞癌切除术病人168例.其中,术后联合TACE和PVC组48例,单纯TACE组26例,单纯PVC组50例,未做特殊处理(对照)组44例.全部病人随访17～96个月.将各组1、3、5年生存率进行对比研究.结果 TACE联合PVC治疗组术后1、3、5年的累积生存率与TACE组无明显统计学差异(P＞0.05),与PVC组和对照组比较差异显著(P＜0.05);TACE组术后1、3年的累积生存率与PVC组、对照组比较差异有统计学显著性(P＜0.05),但5年累积生存率无明显统计学差异(P＞0.05);PVC组与对照组之间术后1、3、5年累积生存率无明显统计学差异(P＞0.05).结论 在肝癌切除后,联合TACE和PVC治疗对术后生存期的影响与单纯TACE治疗无明显差别,但明显高于单纯PVC组和对照组.     

比较TACE+微波消融+程序性死亡受体-1与TACE+微波消融治疗原发性肝癌

目的 比较TACE+微波消融（MWA）+程序性死亡受体-1（PD-1）与TACE+MWA治疗原发性肝癌（PHC）的价值。方法 回顾性纳入接受TACE+MWA+PD-1（观察组）或TACE+MWA治疗（对照组）的PHC患者各40例,比较组间基线资料、疗效和并发症。结果 2组患者基线资料差异均无统计学意义（P均>0.05）。观察组与对照组客观缓解率（ORR）分别为90.00%和72.50%,疾病控制率（DCR）分别为97.50%和95.00%;组间差异均无统计学意义（P均>0.05）。观察组与对照组中位总生存期（OS）分别为30.80个月和15.70个月,中位无进展生存期（PFS）分别为23.35个月和6.80个月;观察组OS和PFS均长于对照组（P均<0.05）。组间并发症发生率差异均无统计学意义（P均>0.05）,且均经相关对症治疗后好转。结论 TACE+MWA+PD-1联合治疗PHC效果优于TACE+MWA。     

DC-CIK免疫治疗联合TACE介入治疗晚期肝癌的临床研究

【摘要】〓目的〓探讨DC-CIK细胞免疫治疗联合介入治疗晚期肝癌的临床疗效。方法〓选择晚期原发性肝癌患者112例为研究对象,根据患者自愿情况分为TACE联合DC-CIK细胞免疫治疗组(A组,n=64)和TACE治疗组(B组,n=48),观察治疗前后血常规、肿瘤标志物、免疫功能及治疗效果。结果〓A组缓解率明显高于B组(78.12% VS 47.92%);治疗前后CD3+、CD4+、CD8+、CD19+、NK、CD3+/CD4+、CD3+/CD8+增加或减少值均高于B组;随访6个月、12个月,A组死亡病例明显低于B组(6.25% VS 16.67%, 1.78% VS 12.82%),但两组18个月的死亡病例数比较没有差异。结论〓TACE联合DC-CIK细胞免疫治疗一定程度上可改善免疫功能,提高近期疗效。     

槐耳颗粒在三阴性乳腺癌术后辅助治疗的临床研究

目的:探讨槐耳颗粒辅助治疗对三阴性乳腺癌患者免疫功能及术后生存状态的影响。方法:将95例改良根治术后行辅助化疗的三阴性乳腺癌患者非随机分为观察组(56例)及对照组(39例),观察组的患者于化放疗同时及后期口服槐耳颗粒(每日3次,每次20 g,持续1.5年),对照组在辅助治疗过程中不使用任何中药制剂。比较两组在治疗及随访期间的生存质量、无病生存时间(DFS)及术后3、6个月与1、2年血清T细胞亚群的构成比。结果:与对照组比较,观察组Karnofsky评分(KPS)提高率明显增加,DFS明显延长(均P0.05)。两组术后各时间点CD3~+细胞百分率无明显差异(均P0.05),但观察组CD4~+细胞百分率、CD4~+/CD8~+比值、NK细胞百分率在术后各时间点均明显高于对照组(均P0.05)。与术前比较,观察组术后3个月CD3~+细胞百分率减少(P0.05),但6个月后恢复(均P0.05),术后6个月至2年的CD4~+、CD4~+/CD8~+比值、NK细胞均明显增高(均P0.05);对照组术后3~6个月CD3~+、NK细胞百分率明显降低(均P0.05),1年后开始恢复(均P0.05),术后3个月至1年的CD4~+百分率、CD4~+/CD8~+比值均明显降低(均P0.05)。结论:三阴性乳腺癌患者在辅助治疗阶段服用槐耳颗粒有助于免疫功能的改善、生存质量的提高以及无病生存时间的延长。     

树突状细胞-细胞因子诱导的杀伤细胞过继免疫联合化疗对胃癌根治术后患者的临床疗效分析

目的探讨树突状细胞(DC)-细胞因子诱导的杀伤(CIK)细胞过继性免疫治疗联合化疗对胃癌根治术后患者的安全性及临床疗效。方法收集2014年1月至2016年1月期间在兰州大学第一医院接受DC-CIK细胞过继性免疫治疗联合XELOX或FOLFOX方案化疗的48例胃癌根治术后患者作为研究组,另外收集同期仅进行XELOX或FOLFOX方案化疗的48例胃癌根治术后患者作为对照组。评价2组患者治疗前后的免疫功能状态、毒副反应及生活质量并比较2组患者的远期疗效。结果①2组患者性别、年龄、临床分期等基线资料比较差异无统计学意义(P0.05)。②外周静脉血中CD3+、CD3+CD4+、CD3+CD8+、CD3–CD56+(NK细胞)及CD3+CD56+(NKT细胞)在研究组的治疗前后比较差异无统计学意义(P0.05),而其在对照组治疗后较治疗前显著下降且明显低于研究组(P0.05)。③研究组和对照组治疗后的外周静脉血中CEA、CA19-9及CA724含量均明显低于治疗前(P0.05)且研究组在治疗后明显低于对照组(P0.05)。④研究组的白细胞减少、血小板减少及腹泻发生率明显低于对照组(P0.05)。⑤研究组患者治疗后在躯体功能、情绪功能、角色功能、认知功能及社会功能方面均较对照组显著改善(P0.05)且研究组治疗后在躯体功能和情绪功能方面较治疗前改善明显(P0.05)。⑥研究组的无进展生存时间明显优于对照组(P0.05),而总生存时间2组间比较差异无统计学意义(P0.05)。结论 DC-CIK细胞过继性免疫治疗联合化疗能够显著改善胃癌根治术后患者免疫状态及生活质量,减轻化疗不良反应,提高远期疗效,延长无进展生存时间。     

肝癌根治性切除术后联合DC－CIK治疗的临床研究

目的探讨肝癌根治性切除术联合DC－CIK治疗对原发性肝癌患者的疗效。 方法自2011年6月至2014年6月对收治的原发性肝癌患者84例进行前瞻性研究,随机分为DC－CIK组和对照组,各36例。两组患者均给予肝癌切除术和肝动脉介入治疗,DC－CIK组在此基础上给予DC－CIK治疗。采用SPSS22.0进行统计分析,共随访3年,两组患者生活质量(QOL)、细胞因子和AFP等计量资料差异采用独立样本t检验分析;两组患者1～3年生存率(OS)、复发率和毒性反应等计数资料采用卡方检验分析;两组患者无疾病进展时间采用生存函数分析。P<0.05表示差异有统计学意义。 结果两组患者术后1～3年OS比较差异无统计学意义(P>0.05)。与对照组比较,DC－CIK组患者术后3年时复发率低于对照组(69.1%比47.6%, P＝0.046);无疾病进展时间显著延长[(48.9±2.9)比(38.9±3.4)月,P＝0.034]。两组患者术前AFP水平无统计学差异(P>0.05),术后12周时DC－CIK组患者AFP水平显著低于对照组。与对照组比较,DC－CIK组术后12周时CD4^＋T细胞、CD4^＋/CD8^＋、CD3^＋ CD56^＋NKT细胞显著增高(P<0.05)。两组患者治疗前后QOL评分、不良反应差异均无统计学意义(P>0.05)。 结论肝癌根治术切除联合DC－CIK治疗有助于提高免疫系统对肿瘤细胞的杀伤作用,改善生活质量、延长无疾病进展时间、降低术后复发率。     

CD90和胰岛素样生长因子1受体在原发性肝癌中的表达

目的 探讨干细胞表面标志物CD90和胰岛素样生长因子1受体(insulin-like growth factor 1 receptor,IGF1 R)在肝癌中的表达情况及其与原发性肝癌的关系.方法 应用免疫组化S-P法检测36例原发性肝癌中CD90、IGF1R的表达,并以20例肝脏血管瘤患者的正常肝组织作对照.随访33例患者,Kaplan-Meier法对患者中位生存期和生存率进行分析.结果 原发性肝癌组织CD90、IGF1R蛋白的阳性表达率分别为63.89％( 23/36)、52.78％( 19/36),显著高于正常肝组织(0/20)、5％ (1/20),二者比较差异有统计学意义(P＜0.05).CD90在UICC临床分期Ⅲ、Ⅳ期中阳性表达率(79.17％)比Ⅰ～Ⅱ期(33.33％)明显增高(P＜0.05),低分化组阳性表达率(76.92％)比高中分化组(56.52％)明显增高(P＜0.05).IGF1R在UICC临床分期Ⅲ、Ⅳ期的患者中阳性表达率(70.83％)比Ⅰ～Ⅱ期(16.67％)明显增高(P＜0.05),低分化组阳性表达率(84.62％)比高分化组(37.38％)明显增高(P＜0.05).CD90阳性表达和IGF1R阳性表达呈显著正相关(P ＜0.05).CD90阳性者术后中位生存期为85 d,而阴性者术后中位生存期为505 d(P ＜0.05),IGF1R阳性者术后中位生存期为100d,而阴性者术后中位生存期为408 d(P ＜0.05). 结论 CD90、IGF1R可能与肝癌的发生发展相关.     

辅助性肝动脉化疗栓塞术对原发性肝癌切除手术预后的影响

目的 研究辅助性肝动脉化疗栓塞(TACE)对原发性肝癌切除术后患者预后的影响,为临床评估术后合理选择辅助性TACE提供参考.方法 回顾性分析福建医科大学附属泉州第一医院2002-2008年311例原发性肝癌患者的临床资料.利用COX回归模型逐步分析,Kaplan-Meier法分析辅助性TACE对肿瘤直径≤5 cm高危组(76例)、低危组(91例)以及肿瘤直径＞5 cm高危组(65例)、低危组(78例)患者预后的影响.低危组定义为肿瘤单发且无血管侵犯;高危组定义为肿瘤多发和(或)血管侵犯.结果 在肿瘤直径＞5 cm高危组,术后行辅助性TACE者总生存期高于术后未行辅助性TACE者(P＜0.05).其他亚组术后是否行辅助性TACE对总生存期无明显影响(P＞0.05).结论 辅助性TACE对于肿瘤直径＞5 cm的高危组肝癌术后患者是有受益的.     

经导管动脉化疗栓塞术联合125I粒子植入治疗原发性肝癌的临床效果

目的 研究经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合¹²⁵I粒子植入治疗原发性肝癌的效果。方法 选取广州皇家丽肿瘤医院2022年10月至2023年8月收治的70例原发性肝癌患者为研究对象,根据随机数字表法分为对照组(TACE治疗)和研究组(TACE联合¹²⁵I粒子植入治疗),各35例。比较两组患者的疾病缓解率、不良反应发生率、复发率,以及治疗前后的T细胞亚群(CD4+T细胞、CD8+T细胞)、炎症因子水平。结果 与对照组相比,研究组疾病缓解率更高(91.43%),复发率更低(5.71%),差异有显著性(P <0.05)。治疗前,两组T细胞亚群及炎症因子水平无显著差异(P> 0.05);治疗后,研究组CD4+T细胞、白介素-8水平低于对照组,CD8+T细胞、干扰素-γ水平高于对照组,差异有显著性(P <0.05)。两组不良反应发生率无显著差异(P> 0.05)。结论 TACE联合¹²⁵I粒子植入治疗原发性肝癌,疗效显著,且安...     

射频消融术联合经导管肝动脉化疗栓塞术治疗原发性肝癌

目的探讨射频消融术(RFA)联合经导管肝动脉化疗栓塞术(TACE)治疗原发性肝癌(肝癌)的效果。方法选取2013-01—2016-01间在灵宝市第一人民医院接受治疗的28例肝癌患者。将接受RFA治疗的患者设为对照组,将行TACE联合RFA治疗的患者作为观察组,各14例。比较2组治疗效果。结果 (1)术后2组患者的临床症状均明显缓解,AFP较术前下降,均未出现严重并发症。术后1个月观察组患者的疾病控制率优于对照组,差异有统计学意义(P0.05)。(2)观察组1 a、2 a生存率和中位生存期均优于对照组,2组差异有统计学意义(P0.05)。结论与单纯RFA比较,采用RFA联合TACE方法治疗手术切除困难的肝癌,可延长患者的生存期。     

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。     

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.     

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。     

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.     

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。