消化道肿瘤凋亡抑制蛋白表达与体外化疗药物敏感性的关系

目的 探讨消化道肿瘤中p53、survivin、bcl-2蛋白表达与肿瘤细胞体外化疗药物敏感性的关系.方法 对84例胃癌和大肠癌进行MTT法体外化疗药物敏感实验和p53、survivin、bcl-2蛋白免疫组化染色,分析3种凋亡抑制蛋白与9种化疗药物对肿瘤细胞抑制的关系. 结果 本组肿瘤中p53、survivin、bcl-2蛋白表达率分别为64%、89%、61%,survivin与Bcl-2蛋白表达具有正相关性(r=0.3027,P＜0.05).p53强表达与紫杉醇、顺铂对肿瘤细胞抑制率明显降低有关(t=2.1282,P=0.0363;t=3.8850,P=0.0002);survivin蛋白强表达时,长春新碱、顺铂对肿瘤细胞的抑制率明显降低(t=2.1693,P=0.0329;t=2.0247,P=0.0046),但奥沙利铂对肿瘤细胞的抑制率明显增加(t=-2.9070,P=0.0047);bcl-2强表达时,氟尿嘧啶、长春新碱、表阿霉素、奥沙利铂对肿瘤细胞的抑制率明显低于弱表达组(t=2.1483～3.2330,P=0.0347～0.0018).结论 消化道肿瘤凋亡抑制蛋白的表达程度与部分化疗药物耐药性有关,评价某种耐药因子与肿瘤化疗药物敏感性的关系时必须考虑其他因素的影响.     

微小RNA-518b在乳腺浸润性导管癌中的表达及其功能

目的 观察miR-518b在乳腺癌中的表达,以及对人乳腺癌细胞株MCF-7增殖、细胞周期、凋亡和侵袭能力的影响.方法 运用定量逆转录聚合酶链反应(PCR)检测乳腺癌及正常组织中miR-518b的表达量,结合临床病理资料,分析其异常表达与各病理因素的相关性.并运用噻唑蓝(MTT)比色法了解其增殖,流式细胞仪分析细胞的周期、凋亡,Transwell 实验观察其对细胞侵袭能力的影响.结果 乳腺癌组织中miR-518b表达水平为2.751 585±5.856 351,正常组织中为7.334841±9.843 424,癌组织中miR-518b表达明显低于正常组织(P＜0.01).miR-518b在乳腺癌中的表达异常与淋巴结转移相关(P＜0.01),与病理分期、肿瘤大小、原癌基因人类表皮生长因子受体2(HER-2)、雌激素受体(ER)、孕激素受体(PR)、p53无明显相关性.在48h浓度为150 nmol/L时,miR-518b对乳腺癌细胞的抑制作用最明显,抑制率为59.9％.与空对照组和负对照组比较,G0/G1期细胞未见明显增多(75.52±1.78)％,S期无明显减少(9.52±0.91)％,早期凋亡细胞比例未见明显升高(2.60±0.06)％(P＞0.05).Transwell实验结果显示随着miR-518 bmimics浓度的增加,穿出小室膜肿瘤细胞大致呈递减趋势,并与对照组差异明显(P＜0.01).结论 miR-518b在乳腺癌患者中异常表达,癌组织中的表达明显低于正常组织,miR-518b对乳腺癌细胞株的增殖和侵袭能力有明显抑制作用,其在肿瘤发生发展中可能担任着抑癌基因的角色.     

微小RNA-146-5p靶向Notch2对非小细胞肺癌增殖、凋亡和侵袭的影响

目的探讨微小RNA(miRNA, miR)-146-5p靶向Notch2对非小细胞肺癌增殖、凋亡和侵袭的影响。方法选取南阳医学高等专科学校第一附属医院2018年5月至2022年5月收治的58例非小细胞肺癌和癌旁组织作为研究对象, 采用荧光定量聚合酶链反应(PCR)分析肿瘤和癌旁组织miR-146-5p表达水平。采用慢病毒建立miR-146-5p过表达非小细胞肺癌A549细胞系, 分别为miRNA对照组和miR-146-5p组。采用细胞计数试剂盒(CCK-8)和体外移植瘤实验分析肿瘤细胞增殖能力, 采用流式细胞术分析细胞凋亡水平;采用Transwell分析细胞侵袭能力;生物信息学和双荧光素酶报告基因分析miR-146-5p靶基因。蛋白质免疫印迹分析靶基因的表达水平。组间数据比较采用t检验。结果癌旁组织中miR-146-5p表达水平(1.09±0.16)明显高于非小细胞肺癌组织表达水平(0.48±0.12), 差异有统计学意义(t=23.940, P<0.05)。miRNA对照组细胞miR-146-5p表达水平(0.96±0.41)明显低于miR-146-5p组细胞(2.69±0.2...     

MiR-26b通过靶基因GSK3β调控高糖诱导的系膜细胞肥大

目的:研究miR-26b调控高糖诱导系膜细胞(MCs)肥大的机制,为其在糖尿病肾病(DN)早期发病机制研究提供新线索。方法:采用生物信息学方法预测调控GSK3β的候选miRNAs;在db/db小鼠肾皮质中验证所有候选miRNAs的表达并分别与GSK3β做pearson相关性分析;以高糖诱导的MCs为载体,采用real-time PCR,观察与GSK3β显著负相关的miRNAs和GSK3β表达水平;转染miR-26b抑制子后,检测高糖诱导的GSK3β以及α-SMA的表达改变。结果:预测到调控GSK3β的候选miRNAs共9个:分别为miR-199a-5p,miR-128,miR-23b,miR-23a,miR-29a,miR-29c,29b,miR-26b,miR-26a;与对照组相比,miR-128,miR-23b,miR-26b,miR-29a,26b在db/db小鼠肾皮质中表达显著上调;其中miR-26b与GSK3β表达水平负相关最显著(r=-0.470 29);高糖诱导的MCs中miR-26b与GSK3β亦呈现显著负相关,miR-26b抑制子部分逆转GSK3β表达水平,同时α-SMA、Ⅳ型胶原表达水平上调。结论:miR-26b可能通过其靶基因GSK3β参与高糖诱导的MCs肥大机制的调控,为DN早期发病机制研究提供了新的思路。     

LncRNA MIR205HG靶向miR-299-3p调控肺癌细胞增殖、凋亡的机制研究

目的 探讨长链非编码RNA MIR205HG(LncRNA MIR205HG)与微小RNA-299-3p(miR-299-3p)的相互关系及其影响肺癌细胞增殖、凋亡的分子机制。方法 检测肺癌组织和细胞中MIR205HG、miR-299-3p的表达。H1299细胞分为si-MIR205HG组、si-NC组、miR-299-3p组、miR-NC组、si-MIR205HG+anti-miR-299-3p组、si-MIR205HG+anti-miR-NC组。MIR205HG与miR-299-3p的相互作用；检测增殖、凋亡及蛋白表达。结果 肺癌组织和细胞系中MIR205HG表达水平升高(P<0.05),miR-299-3p表达水平降低(P<0.05)。MIR205HG能与miR-299-3p特异性结合，可调控miR-299-3p的表达。干扰MIR205HG表达或miR-299-3p过表达后可降低肺癌细胞增殖能力，促进细胞凋亡，且CyclinD1、p21表达降低，Bcl-2、Bax表达增高(P<0.05)。抑制miR-299-3p可逆转干扰MIR205HG表达对肺癌细胞增殖及凋亡...     

肾细胞癌中bcl-2、p53、增殖细胞核抗原表达与细胞增殖和凋亡

目的 探讨肾细胞癌(RCC)中bcl—2、p53、增殖细胞核抗原(PCNA)表达与细胞增殖、凋亡及病理参数之间的关系。方法 应用链霉亲和素辣根过氧化物酶(SABC)法分析34例RCC标本中bcl—2、p53和PCNA蛋白的表达，应用末端脱氧核苷酸转移酶介导的脱氧三磷酸尿苷苦(dUTP)缺口末端标记(TUNEL)法检测细胞凋亡。结果 34例RCC标本中，15(44．1％)例bcl-2阳性表达，表达阳性率与增殖指数(PI)、凋亡指数(AI）及RCC病理学参数无关；仅有3例p53表达阳性；PI为6．0％--24．0％(平均为12．3％)，AI为2．0％--8．0％(平均为5．4％)；PI与肿瘤分级、分期密切关系，AI与肿瘤分级有明显关系。结论 明显增高的PI和AI与肿瘤恶性表型有关，提示在RCC中肿瘤细胞过度增殖伴有频繁的凋亡发生。     

乳腺癌患者骨髓微转移细胞表型及骨髓血u-PA活性的研究

目的 通过检测乳腺癌患者骨髓微转移细胞表型，研究骨髓微环境。方法 采用免疫组化染色检测乳腺癌患者骨髓中肿瘤细胞中的生物学标志及骨髓血浆的u-PA活性。结果 72例乳腺癌患者中，30例（41.7%)存在骨髓微小转移灶。其转移率与原发灶肿块大小（x^2=6.417P=0.040），P53蛋白表达（X^2=5.930,p=0.025）相关。与原发灶肿瘤相比，肿瘤转移细胞的CyclinD1、P53、Ki-67、EGFR蛋白低表达，而p21蛋白高表达。骨髓血浆u-pa活性与肿块大小、腋淋巴结状况密切相关。结论 骨髓中播散肿瘤细胞处于低生长、低增殖的状态。     

microRNA-497 在肝细胞癌中的表达及意义

目的:探讨microRNA-497(miR-497)在肝细胞癌组织中的表达及其意义.方法:收集40例肝细胞癌及对应癌旁组织标本,用qRT-PCR方法检测标本中miR-497的表达;人肝癌SMMC-7721细胞经miR-497模拟物转染后,用MTT和流式细胞术检测其增殖能力与凋亡水平的变化,并用qRT-PCR和Western blot检测miR-497潜在靶点Bcl-w的mRNA与蛋白的表达.结果:miR-497在肝癌组织中的表达水平明显低于其癌旁组织[(1.181±0.779)vs.(14.599±5.266),P＜0.05];转染miR-497模拟物的SMMC-7721细胞增殖能力明显降低,细胞凋亡增加,Bcl-w的mRNA与蛋白表达均明显降低(与未转染的SMMC-7721细胞比较,均P＜0.05).结论:肝癌组织中miR-497表达下调,该下调可能导致靶基因Bcl-w表达升高,从而促进肿瘤的发生与发展.     

miR-30b/Snail调控糖尿病肾病肾小管上皮细胞EMT

目的:探讨miR-30b/Snail调控高糖诱导人源肾小管上皮细胞(HK2)-间充质转化(EMT)的可能机制,为糖尿病肾病(DN)间质纤维化的防治提供新的实验依据及思路。方法:通过生物信息学预测调控Snail的候选miRNAs;在db/db小鼠肾组织中验证所有候选miRNAs的表达并分别与Snail做pearson相关性分析,筛选出与Snail负相关最显著的miRNA;以高糖诱导的HK2细胞为载体,转染该miRNA mimics 72 h后,采用real-time PCR、western blot方法,观察该miRNA、Snail以及EMT相关蛋白的表达改变。结果:调控Snail的候选miRNAs共6个,分别是miR-30b-5p、miR-25-3p、miR-199a-5p、miR-128-3p、miR-22-3p、miR-27-3p,其中miR-30b与Snail存在明显负相关,r2=0.775 49;高糖诱导HK2细胞miR-30b表达下调,肾小管上皮细胞标志蛋白E-cadherin表达减少;过表达miR-30b-5p可抑制HK2细胞Snail表达,同时上调E-cadherin表达,而Vimentin、α-SMA表达下调。结论:miR-30b/Snail参与调控高糖引起的肾小管上皮细胞EMT。     

抑癌基因DLC-1在肿瘤发生中的作用及其表达调控研究进展

DLC-1(frequently deleted in liver cancer 1)基因是一种肿瘤抑制基因,是从肝癌细胞系中首先分离报道的.DLC一1基因在许多肿瘤,如肝癌、非小细胞性肺癌、前列腺癌、乳腺癌等中均表达缺失或下调,而其表达的恢复能够抑制肿瘤细胞的增殖、生长和转移,证实该基因在肿瘤的发生发展过程中发挥重要的生物学作用.就DLC-1基因的结构、功能及其在肿瘤中的相关研究作一综述.     

Emergence delirium in adults in the post-anaesthesia care unit

Background. Emergence delirium in the post-anaesthesia careunit (PACU) is poorly understood. The goal of this prospectivestudy was to determine frequency and risk factors of emergencedelirium in adults after general anaesthesia. Methods. In this prospective study, 1359 consecutive patientswere included. Contextual risk factors and occurrence of deliriumaccording to the Riker sedation scale were documented. Groupswere defined for the analysis according to the occurrence ornot of agitation, then after exclusion of patients with preoperativeanxiety and neuroleptics, or both, and antidepressants or benzodiazepinestreatments. Results. Sixty-four (4.7%) patients developed delirium in thePACU, which can go from thrashing to violent behaviour and removalof tubes and catheters. Preoperative anxiety was not found tobe a risk factor. Preoperative medication by benzodiazepines(OR=1.910, 95% CI=1.101–3.315, P=0.021), breast surgery(OR=5.190, 95% CI=1.422–18.947, P=0.013), abdominal surgery(OR=3.206, 95% CI=1.262–8.143, P=0.014), and long durationof surgery increased the risk of delirium (OR=1.005, 95% CI=1.002–1.008,P=0.001), while a previous history of illness and long-termtreatment by antidepressants decreased the risk (respectively,OR=0.544, 95% CI=0.315–0.939, P=0.029 and OR=0.245, 95%CI=0.084–0.710, P=0.010). Conclusions. Preoperative benzodiazepines, breast and abdominalsurgery and surgery of long duration are risk factors for emergencedelirium.     

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。     

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.     

Effects of intravenous anesthetics on bacterial elimination in human blood in vitro

Backround : Since anesthetics are widely used in critically ill patients, this study investigates anesthetic effects on neutrophil and monocyte function concerning bacterial elimination in human whole blood. Methods : The effects of thiopental (20 and 200 μg/ml), propofol (5 and 50 μg/ml), midazolam (0.15 and 1.5 μg/ml) and ketamine (3 and 30 μg/ml) on elimination of Escherichia (E.) coli from whole blood were investigated in vitro after incubation for 1 h in both clinical (1) (n=10) and 10-fold higher (h) (n=11) concentrations. These data were compared to neutrophil and monocyte phagocytosis (1; n=6) and burst activity (1; n=10, h; n=11), measured by flow cytometry. To enable quantification of the clearance process, a defined number of 10⁵ colony forming units of E. coli were added to the blood assays and bacterial growth was determined. Results : All anesthetics delayed bacterial clearance from the blood in the 10-fold concentration (P<0.05). Thiopental (1+h) and propofol (h) suppressed neutrophil (59±3% and 38±6%) and monocytic (45±6% and 30±11%) oxidative burst (P<0.01). Phagocytosis was reduced even after propofol (1) in polymorphonuclear leukocytes (PMN) (34±9%; P<0.05) and monocytes (35±11%). Ketamine (h) prolonged bacterial elimination (P<0.01), which did correlate with inhibition of monocytic phagocytosis, by 26±14%. Midazolam application (h) resulted in an inhibition of PMN-respiratory burst by 19±6% (P<0.05) and impaired bacterial clearance (P<0.05). Conclusion : Thiopental, propofol, midazolam and ketamine affect E. coli clearance and neutrophil and monocyte oxidative burst and phagocytosis in vitro only in high concentrations, while thiopental inhibited monocytic burst and propofol impaired PMN phagocytosis even in clinically used concentrations. These data suggest that i.v. anesthetics in concentrations recommended for general anesthesia seem to have minor influence on the investigated host defense mechanisms.     

The SCIRehab project: treatment time spent in SCI rehabilitation. Inpatient treatment time across disciplines in spinal cord injury rehabilitation

Background/objective

Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs.

Methods

Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient''s stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline.

Results

Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient''s stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics.

Conclusions

Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.     

Protective effect of a prostaglandin oligomer on liver mitochondria in situ: time-shared measurements of fluorescence and reflectance in the cold-preserved rat liver

The protective effect of a new oligomeric derivative of prostaglandin B₂, known as OC-5186, was evaluated using time-sharing spectrofluorometry in the coldpreserved rat liver. Experiments were divided into three groups: in group A, a 5000 ng dose of OC-5186 was administered via the peripheral vein, 1000 ng via the portal vein, and 200 ng/ml in University of Wisconsin (UW) solution; in group B, the OC-5186 dosage was ten times greater than that in group A; in group C (control group), liver procurement and storage were performed without OC-5186. At 0, 12, and 24 h after cold preservation at 4°C, the liver was perfused for 30 min at 12°C with oxygenized Krebs-Henseleit solution, after which the perfusate was switched to deoxygenized Krebs-Henseleit solution. Time sharing spectrofluorometry was used to follow NADH fluorescence at 450 nm with a 360-nm excitation wavelength, as well as the reflectance of cytochrome aa ₃ with 605 minus 620 nm from oxidation to reduction. Rate constants of NADH fluorescence and cytochrome aa ₃ reflectance were used as indices of integrity of the mitochondrial respiratory chain. In group C, the rate constant of NADH fluorescence decreased significantly (P<0.05) from the control value of 8.31±0.21×10^-3 (sec^-1) to 4.97±0.15×10^-3 and 5.58±0.16×10^-3 (mean±SEM) at 12 and 24 h after cold preservation, respectively. By contrast, in groups A and B, the rate constant of NADH fluorescence was maintained at significantly (P<0.05) higher levels of 6.57±0.54×10^-3 and 7.29±0.48×10^-3, and 6.94±0.44×10^-3 and 6.86±0.44×10^-3 at 12 and 24 h, respectively. The rate constant of cytochrome aa ₃ reflectance between the OC-5186 groups and the control group was not significant. It is concluded that OC-5186 has a protective effect on the mitochondrial respiratory chain against cold-preservation and/or reperfusion injury.     

Fluid absorption in endoscopic surgery

Fluid absorption is an unpredictable complication of endoscopicsurgery. Absorption of small amounts of fluid (1–2 litre)occurs in 5–10% of patients undergoing transurethral prostaticresection and results in an easily overlooked mild transurethralresection (TUR) syndrome. Large-scale fluid absorption is rarebut leads to symptoms severe enough to require intensive care.Pathophysiological mechanisms consist of pharmacological effectsof the irrigant solutes, the volume effect of the irrigant water,dilutional hyponatraemia and brain oedema. Other less widelyknown factors include absolute losses of sodium by urinary excretionand morphological changes in the heart muscle, both of whichpromote a hypokinetic circulation. Studies in animals, volunteersand patients show that irrigation with glycine solution shouldbe avoided. Preventive measures, such as low-pressure irrigation,might reduce the extent of fluid absorption but does not eliminatethis complication. Monitoring the extent of absorption duringsurgery allows control of the fluid balance in the individualpatient, but such monitoring is not used widely. However, theanaesthetist must be aware of the symptoms and be able to diagnosethis complication. Treatment should be based on administrationof hypertonic saline rather than on diuretics. New techniques,such as bipolar resectoscopes and vaporizing instead of resectingtissue, result in a continuous change of the prerequisites forfluid absorption and its consequences.     

Neurolytic thoracic paravertebral block in cancer pain

Background : Paravertebral block has successfully been used in the treatment of acute and chronic pain. The duration of paravertebral block could theoretically be prolonged by using neurolytic agents.
Methods : We retrospectively analyzed the results of neurolytic paravertebral blocks performed in 7 patients suffering from intense cancer-related thoracic pain. Thirty-seven spinal nerve roots were blocked during 20 visits. Nerve roots were identified by eliciting paresthesia radiating to the painful area. Each root was blocked separately. After test block using 0.5% bupivacaine, the paravertebral blocks were performed with 1–4 ml of 7% phenol in aqua.
Results : No technical failures or complications were recorded in the patient files. Pain relief lasted over 2 months after 4 visits (20%), from 1 week to 1 month after 5 visits (25%), and less than 1 week after a single visit (5%). After 9 visits (45%), the results were poor with no significant pain relief.
Conclusion : Neurolytic paravertebral block with phenol doses used in our patients appears to have only limited use. Some patients with pain restricted to a small number of thoracic segments may benefit from its use. Because of complication risks, this technique should be limited to intractable pain in cancer patients with poor prognosis.     

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。