雾化吸入与静脉输注米力农治疗先天性心脏病患儿术后肺动脉高压效果的比较

目的 比较雾化吸入与静脉输注米力农治疗先天性心脏病患儿术后肺动脉压的效果.方法 先天性心脏病患儿40名,年龄5～14岁,体重15～38 kg,肺动脉压(PAP)30～90mm Hg,随机分为2组(n=20):雾化吸入组和静脉输注组.体外循环结束即刻,雾化吸入组每隔30 min吸入米力农1 mg/ml 10 min,共吸入12 h;静脉输注组先静脉注射米力农负荷剂量10μg/kg,然后以0.5μg·kg-1·min-1的速率静脉辅注12 h.于给药12 h时行血气分析,记录混合静脉血氧饱和度(S(-v)O2);于术前(基础状态)、给药12 h内每隔2 h记录MAP、PAP、肺血管阻力指数(PVRI)和体血管阻力指数(SVRI);记录带管时间和给药12 h内肺动脉高压、肺部感染以及术后低氧血症的发生情况.结果 与静脉输注组比较,雾化吸入组PAP和PVRI降低,S(-v)O2、MAP和SVRI升高,肺动脉高压和肺部感染发生率降低(P＜0.05),低氧血症发生率和带管时间差异无统计学意义(P＞0.05).结论 雾化吸入米力农治疗先天性心脏病患儿术后肺动脉高压的效果优于静脉输注,提示先天性心脏病患儿更宜选择雾化吸入的方法给予米力农.     

双心房输注对二尖瓣置换术患者体外循环后肺动脉压的影响

目的 评价双心房输注对二尖瓣置换术患者体外循环后肺动脉压(PAP)的影响.方法 择期行二尖瓣置换术合并肺动脉高压[平均肺动脉压(MPAP)＞50 mm Hg]的患者20例,年龄22～53岁,体重34～57kg,心功能分级Ⅱ或Ⅲ级,随机分为2组(n=10):右心房输注组(R组)和双心房输注组(B组).麻醉诱导后右颈内静脉穿刺置入Swan-Ganz三腔漂浮导管,监测CVP、PAP、肺毛细血管楔压(PCWP)和CO.R组经中心静脉输注前列腺素E130～150 ng·kg-1·min-1和去氧肾上腺素0.2～0.6μg·kg-1·min-1.B组经中心静脉输注前列腺素E130～150 ng·kg·min-1,经左心房输注去氧肾上腺素0.2～0.6μg·kg-1·min-1.分别于给药前5 min(T0)、给药后5 min(T1)、10 min(T2)、30 min(T3)和60 min(T4)时记录MAP、HR、MPAP、PCWP、CVP和CO,计算肺血管阻力指数(PVRI)、体循环血管阻力指数(SVRI)和CI.结果 与T0时比较,R组T1-4时MAP、MPAP、PCWP和PVRI降低,CI升高(P＜0.05),HR、CVP和SVRI差异无统计学意义(P＞0.05),B组T1-4时MAP、CI和SVRI升高,HR、MPAP、PCWP、CVP和PVRI降低(P＜0.05);与R组比较,B组MAP、CI和SVRI升高,HR、MPAP、PCWP、PVRI和CVP降低(P＜0.05).结论 双心房输注可降低二尖瓣置换术患者体外循环后肺动脉压和肺血管阻力.     

前列腺素E1联合米力农在心内直视手术中的应用

目的 评价前列腺素E1(PGE1)联合米力农在先天性心脏病(CHD)合并肺动脉高压(PH)心脏直视手术中对血流动力学的影响.方法 30例CHD合并PH患儿随机均分为A组和B组.A 组诱导后从肺动脉置管中微泵注射PGE120 ng·kg-1·min-1维持至术毕.B组从颈内静脉加注米力农50μg/kg(负荷量,10 min缓注)后以0.5μg·kg-1·min-1维持至术毕.记录用药前(T0)、切皮时(T1)、心肺转流(CPB)前(T2)、心脏复跳(T3)、CPB结束时(T4)、术毕(T5)各时点的平均动脉压(MAP)、心脏指数(CI)、体循环阻力(SVR)、肺动脉收缩压(PASP)、肺循环阻力(PVR).结果 与T0相比,A组T3时MAP、CI、SVR下降,B组T2、T4、T5时MAP、CI升高,SVR下降.两组在T2～T5时PASP、PVR降低,B组较A组显著降低而MAP、CI明显升高(P<0.05).结论 PGE1联合米力农有效降低PASP及PVR,维护心功能.     

Combined effect of milrinone and NO to treat pulmonary hypertension after cardiopulmonary bypass in congenital heart disease patients

Objective：To investigate the effect of milrinone combined with nitric oxide（NO） on pulmonary artery pressure after cardiopulmonary bypass（CPB） in congenital heart disease（CHD） complicated by pulmonary hypertension（PH）. Methods Twenty-four ASA Ⅱ or Ⅲ patients with CHD and PH （NYHA grade Ⅱ or Ⅲ） undergoing open heart surgery under CPB were randomly divided into three groups（n=8 each）： group N（inhaled NO, n=8）, group M （milrinone group, n=8）and group NM（combined group, n=8）, In group M, the patients received after removal of aortic clamp a loading dose of 50pg/kg milrinone followed by a continuous infusion at 0.5 pg/kg/min till the end of operation. In group N, the patients inhaled 20ppm NO for 45 min after successfully weaning from CPB. In group NM, as aortic clamp removed, a bolus of 50pg/kg milrinone was given and followed by continuous infusion at 0.5 pg/kg/min till the end of surgery, and after successfully weaning from CPB, patients inhaled 20ppm NO for 30mins. Mean pulmonary artery pressures（mPAP）, mean systemic pressure（MAP） and cardic index（CI）, pulmonary vascular resistance index（PVRI）, systemic vascular resistance index（SVRI） values were recorded before operation（T0, baseline）, after weaning from CPB（T1）, at inhaled NO for 15mins（T2）and 30 minutes（T3）, and 15mins（T4） after the termination of NO inhalation.
Results：The 3 groups were comparable with respect to age, body weight, body surface area and CPB time. In NO group, NO inhalation significantly decreased mPAP（22±16）% and PVR by （32±24）% as compared with baseline values at TO （P〈0.05）, but they slightly rebounded after termination of NO inhalation at T4. In group M, milrinone significantly decreased PVRI by（30±12）% as compared with baseline values （P〈0.05）but did not significantly change mPAP. In group NM, milrinone and NO significantly decreased mPAP by （26±4）% and PVRI （31±13）%（P〈0.05） and they did not rebound after termination of NO inhalation.
Conclusions：Milrinone infusion combined with NO inhalation can significantly mPAP and PVR after CPB in patients with CHD and PH. Milrinone can prevent rebound PH after termination of NO inhalation.     

雾化吸入和静脉注射米力农对大鼠急性肺损伤疗效的比较

目的 比较雾化吸入和静脉注射米力农对大鼠急性肺损伤(ALI)的疗效.方法 SD大鼠40只,体重300～350 g,随机分为4组(n=10):对照组(Ⅰ组)、ALI组(Ⅱ组)、米力农雾化吸入组(Ⅲ组)和米力农静脉注射组(Ⅳ组).Ⅰ组经右颈外静脉插管注入0.1%BSA溶液2 ml/kg;Ⅱ组经20 min注入油酸混悬液2 ml/kg;Ⅲ组注入油酸后30 min雾化吸入1 mg/ml米力农10 min,每60分钟重复一次,共4次;Ⅳ组注入油酸后30 min经右颈外静脉注射米力农10 μg/kg,然后静脉输注米力农1 μg·kg-1·min-1 10min,每60分钟重复一次,共4次.各组于第4次治疗结束后放血处死大鼠.于治疗开始即刻、第1次治疗时、第2次治疗时、第3次治疗时和第4次治疗时,记录平均动脉压(MAP)和肺动脉压(PAP),测定动脉血气和混合静脉血气,计算氧合指数(PaO2/FiO2)和肺内分流率(Qs/Qt).回收支气管肺泡灌洗液(BALF),进行中性粒细胞计数,采用Bradford法测定蛋白浓度;测定肺组织湿,干重比(W/D)和髓过氧化物酶(MPO)活性;观察肺组织超微结构.结果 与Ⅲ组比较,Ⅳ组第3次治疗和第4次治疗时MAP和Pa02/FiO2降低,第4次治疗时PAP和Qs/Qt升高,BALF蛋白浓度、中性粒细胞计数和肺组织W/D、MPO活性均升高(P＜0.05).结论 雾化吸入米力农减轻大鼠ALI的作用优于静脉注射米力农,对血液动力学影响小.     

体外循环与非体外循环下冠脉搭桥术患者术中血液动力学的比较

目的比较体外循环(CPB)与非CPB下冠脉搭桥术患者术中血液动力学的变化。方法同期行CPB下冠状动脉搭桥术(CABG)与非CPB下冠状动脉搭桥术(OPCAB)患者各70例,分别为CABG组和OPCAB组,分别在麻醉诱导后手术开始前(术前)和术毕用Swan-Ganz导管监测血液动力学指标。结果与术前比较,两组术毕心率(HR)、平均动脉压(MAP)、肺动脉平均压(PAMP)、肺毛细血管嵌压(PAWP)、中心静脉压(CVP)及左室作功指数(LVSWI)差异无统计学意义(P>0.05),心输出量(CO)、心脏指数(CI)均升高;OPCAB组术毕心搏指数(SVI)升高,体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)降低(P<0.05),CABG组术毕SVI、SVRI、PVRI差异无统计学意义(P>0.05);与CABG组比较,OPCAB组术毕SVRI、PVRI降低(P<0.05)。结论两组患者术后心功能均得到了改善,OPCAB 组在改善心功能、降低体、肺循环阻力方面,优于CABG组。     

瓣膜置换术患者心肺转流后多巴酚丁胺与米力农对心肌应变力的影响

目的探讨瓣膜置换术后早期多巴酚丁胺与米力农对心肌应变力的影响。方法择期心肺转流(CPB)下行瓣膜置换术患者55例,男27例,女28例,年龄40～75岁,ASAⅡ或Ⅲ级,NYHA心功能Ⅱ或Ⅲ级。采用随机数字表法将患者分为三组:多巴酚丁胺组(D组,n=18)、米力农组(M组,n=20)和对照组(C组,n=17)。三组术中麻醉维持均采用全凭静脉麻醉,D组于停CPB15min后经微量注射泵静注多巴酚丁胺4μg·kg~(-1)·min~(-1)至1h结束,M组于同一时点开始经微量注射泵静注米力农0.4μg·kg~(-1)·min~(-1)至1h结束,C组于同一时点开始经微量注射泵静注等量生理盐水至1h结束。分别于麻醉诱导后劈胸骨前(T0)和停CPB后15min(T1)、泵药后30min(T2)和1h(T3)记录血流动力学指标:HR、CVP、CO、LVEF、右室面积变化分数(RVFAC)、心脏指数(CI)、外周血管阻力指数(SVRI)和应变力参数:左室长轴全局纵向应变力(S-LVL)、左室短轴全局环向应变力(S-LVM)和右室长轴全局纵向应变力(S-RV)。结果 T2、T3时D组HR明显快于M组,T3时D组HR明显快于C组(P0.05);T2时D组CI明显高于C组和M组(P0.05)。T2、T3时D组和M组左室短轴环向应变力S-LVM明显高于C组(P0.05);T3时D组S-LVL与M组S-RV明显高于C组(P0.05)。结论 CPB后静脉输注小剂量多巴酚丁胺能够改善S-LVL与S-RV,米力农有助于增加S-LVm与S-RV。     

PGE1与NO对先天性心脏病术后肺动脉高压疗效的对比研究

目的比较静脉应用前列腺素E1(PGE1)和吸入外源性一氧化氮(NO)对先天性心脏病(先心病)术后中重度肺动脉高压的治疗效果.方法对12例术后存在中重度肺动脉高压的先心病病人,进行前瞻性、交叉、随机试验研究.分别应用PGE1(30ngkg-1min-1)、NO(30ppm)、PGE1+NO,检测用药前后心率(HR)、平均动脉压(mSAP)、平均肺动脉压(mPAP)、中心静脉压(CVP)、肺毛细血管嵌压 (PCWP)、心排指数(CI)、肺血管阻力(PVR)和体血管阻力(SVR)等血液动力学参数.同时检测吸入NO前后二氧化氮(NO2)和高铁血红蛋白(MetHb)的浓度.结果 PGE1和NO在降低mPAP和PVR方面均有非常显著的疗效(P＜0.01),但联合应用(PGE1+NO)并未显示出较单纯应用更明显的效果.对mPAP和PVR降低的幅度比较,PGE1和NO之间差异无显著性(P＞0.05).NO对肺血管有更强的选择性,但PGE1在提高CI方面明显优于NO(P＜0.05).吸入NO后,NO2和MetHb的浓度明显高于吸入前(P＜0.01),但仍在正常范围内.结论 PGE1和NO对先心病合并的中重度肺动脉高压均有显著的治疗作用,二者的作用效果相近.考虑到NO的潜在毒性和PGE1在提高心功能方面的良好效果,在临床上首选合适剂量的PGE1更合理可行.     

米力农对心肺转流促炎细胞因子反应及心肌损伤的影响

目的探讨米力农对心肺转流(CPB)诱发的促炎细胞因子反应及心肌损伤的影响。方法24例择期瓣膜替换术病人,随机分成米力农组(M组)和对照组(C组),每组12例。麻醉诱导开始前,M组给予米力农30μg/kg负荷量静注,继以0.5μg·kg-1·min-1持续静脉输注;C组以相同速度输注等量生理盐水。分别于术前(T1)、CPB60min(T2)、CPB结束后2h(T3)、4h(T4)及24h(T5)各时间点测定动脉血中下列各项指标:肿瘤坏死因子α(TNFα)、白细胞介素6(IL6)、白细胞介素8(IL8)、血浆过氧化脂质(LPO)、心肌肌酸激酶同工酶(CKMB)。结果与T1比较,其余各时点两组TNFα、IL6、IL8、LPO、CKMB均明显升高(P<0.05或P<0.01),但M组升高明显低于C组(P<0.05)。结论米力农能有效抑制CPB诱发的促炎细胞因子反应和心肌损伤。     

吸入伊洛前列素行急性肺血管扩张试验在先天性心脏病合并重度肺动脉高压术前评估中的作用

目的 评价吸入伊洛前列素的急性肺血管扩张试验在先天性心脏病(CHD)肺动脉高压(PH)患者心脏外科手术适应证选择中的作用.方法 对2006年6月至2008年12月46例CHD合并重度PH患者的临床资料进行回顾性分析.其中男性15例,女性31例,平均年龄(12±9)岁.所有患者术前均接受心导管检查和吸入伊洛前列索试验,患者平均肺动脉压(mPAP)(80±13)mm Hg(1 mill Hg=0.133 kPa),平均肺小动脉阻力指数(PVRI)(17±10)wood·m2.将吸入伊洛前列素试验肺血管阳性反应定义为在体循环压力不变或上升的情况下,PVRI下降≥20%,并作为选择手术适应证的重要条件.药物试验阳性患者在心脏外科修补术后均放置肺动脉漂浮导管,监测术后肺动脉压力、阻力以及心功能状况.结果 46例患者中,药物试验阳性29例(63.1%),吸药后PVRI由(15±6)wood·m2降至(9-4-4)wood·m2,肺循环体循环阻力比(Rp/Rs)由0.7±0.2降至0.4±0.2(P值均<0.05).药物试验反应阴性者17例(36.9%),吸药后PVRI由(21±10)wood·m2降至(19±9)wood·m2(P<0.05),Rp/Rs由1.0±0.5降至0.9±0.5(P>0.05).23例患者接受了心脏外科手术治疗,全部存活.其中药物试验阳性组21例,术后mPAP降至(27±10)mm Hg.药物试验阴性组仅2例接受外科修补术,术后mPAP均>45 mm Hg.结论 吸入伊洛前列素试验阳性患者术后肺动脉压力和PVRI明显降低,可作为评价合并PH的CHD手术适应证的一种蕈要手段.     

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。