染料木黄酮对大鼠移植动脉血管平滑肌细胞的影响

目的研究染料木黄酮(Gen)对大鼠移植动脉血管平滑肌细胞的影响。方法以BN大鼠为供者,Lewis大鼠为受者,建立腹主动脉移植模型,将受者随机分为3组。实验组(n=8):受者术后腹腔注射Gen 20 mg·kg~(-1)·d~(-1)×60 d;对照1组(n=8):受者术后腹腔注射溶剂二甲基亚砜0.5 ml×60 d;对照2组(n=6):受者术后不给予任何处理。腹主动脉移植后60 d取移植血管进行组织学观察,测量血管内膜厚度;免疫组织化学染色检测血管平滑肌细胞的增殖和迁移情况;酶联免疫(ELISA)法检测血清中血管内皮生长因子(VEGF)、γ-干扰素(INF-γ)的变化。结果实验组与两个对照组比较,内膜增厚不明显且巨噬细胞浸润减少;血管平滑肌细胞增殖和迁移减少(P均<0.01);两个对照组血清中VEGF、INF-γ表达显著高于实验组(P<0.01)。结论染料木黄酮在预防和治疗移植动脉硬化的过程中,对移植动脉血管平滑肌细胞的增殖和迁移有抑制作用,其机理可能与影响VEGF等的表达有关。     

肝硬化大鼠原位肝移植模型的制作及术后排斥反应的观察

目的 制备肝硬化大鼠的原位肝移植模型,观察术后排斥反应发生情况,为进行其它研究创建一个平台.方法 以皮下注射CCl4联合饮用苯巴比妥钠和乙醇溶液的方法制备大鼠肝硬化模型,应用改良的"二袖套"法建立大鼠原位肝移植模型,同系移植者的供、受者均为SD大鼠(SD实验组),以接受肝移植的正常SD大鼠为对照(SD对照组);同种移植者的供者为Lewis大鼠,受者为BN大鼠(BN实验组),以接受肝移植的正常BN大鼠为对照(BN对照组).术后观察受者的存活情况以及移植肝的组织学变化.结果 肝硬化大鼠门静脉压力为(182.0±10.7)mm H2O,显著高于正常大鼠的(70.8±5.5)mm H2O(P＜0.01),移植后7 d降至(82.7±10.7)mm H2O.同种移植组术后5～12 d,移植肝组织中均可见中、重度急性排斥反应病理改变.同系移植者存活时间中位数均＞100 d;同种移植者中,BN对照组和BN实验组受者肝移植后存活时间中位数均为10 d.结论 以Lewis大鼠为供者、肝硬化BN大鼠为受者制备的肝移植模型术后排斥反应的发生率较高,可作为肝移植后排斥反应相关研究的平台.     

沙利度胺延缓大鼠的慢性移植物血管病

目的 研究沙利度胺对慢性移植物血管病的缓解作用,并探讨其机制.方法 建立大鼠腹主动脉慢性移植物血管病模型.同系对照组的供、受者均为Brown-Norway大鼠(BN大鼠),术后每天以生理盐水灌胃;同种移植组均以BN大鼠为供者,Lewis大鼠为受者,术后每天以生理盐水灌胃,溶剂对照组术后每天以二甲基亚砜灌胃,高剂量组术后每天以沙利度胺200mg/kg灌胃,低剂量组术后每天以沙利度胺100mg/kg灌胃.术后8周,光镜下观察移植血管组织形态学变化;采用免疫组织化学法测定移植血管中白细胞介素9(IL-9)和转化生长因子β(TGF-β)表达情况;采用双抗体夹心酶联免疫吸附试验检测血清血小板衍生生长因子(PDGF)浓度.结果 同种对照组、溶剂对照组、高剂量组和低剂量组均呈现出典型的移植相关血管硬化,内膜明显增生,并呈同心圆增厚,同系对照组、同种对照组、溶剂对照组、高剂量组和低剂量组移植血管内膜厚度分别为(4.12±0.21)、(67.23±6.12)、(53.11±5.71)、(21.28±4.52)和(23.45±3.64)μm,高剂量组和低剂量组移植血管内膜厚度明显小于同种对照组和溶剂对照组(P＜0.05).同系对照组、同种对照组、溶剂对照组、高剂量组和低剂量组IL-9阳性细胞率分别为(12.54±4.56)％、(50.55±6.39)％、(45.26±2.32)％、(27.37±5.29)％和(29.11±3.20)％;TGF-β阳性细胞率分别为(18.12±6.21)％、(49.23±3.23)％、(40.61±4.13)％、(31.71±8.60)％和(29.35±6.85)％,高剂量组和低剂量组IL-9阳性细胞率和TGF-β阳性细胞率均明显低于同种对照组和溶剂对照组(P＜0.05).同系对照组、同种对照组、溶剂对照组、高剂量组和低剂量组血清中PDGF含量分别为0、(998±18)、(745±29)、(287±97)和(299±36)pg/ml,高剂量组和低剂量组血清PDGF含量均明显低于同种对照组和溶剂对照组(P＜0.05).结论 低剂量沙利度胺即可缓解慢性移植物血管病,这种作用可能与组织中TGF-β和IL-9表达下调,以及血清中PDGF浓度下降相关.     

应用吡格列酮抑制大鼠血管移植物慢性病变

目的 研究吡格列酮对血管移植物慢性病变的影响,并探讨其作用机理.方法 制备大鼠腹主动脉移植模型.实验组以Wistar大鼠为供者,SD大鼠为受者,进行腹主动脉移植,术后采用吡格列酮(0.04 g/kg)灌胃8周;同种移植对照组以Wistar大鼠为供者,SD大鼠为受者,进行腹主动脉移植.术后采用牛理盐水灌胃8周;同系移植对照组的供、受者均为SD大鼠,术后采用生理盐水灌胃8周.移植后第8周,取移植腹主动脉段,行HE染色,显微镜F观察组织形态学变化,测量内膜厚度与中膜厚度的比值;采用免疫组织化学法测定移植动脉绀织中细胞问粘附分子-1(ICAM-1)的表达;采用双抗体夹心酶联免疫吸附试验检测血清血小板衍生生长因子(PDGF)浓度.结果 移植后第8周,同系移植对照组的血管内膜无明显变化,同种移植对照组和实验组移植血管组织均呈现出典型的移植相关血管硬化,内膜呈弥漫性向心性显著增生,管腔狭窄,新生内膜见较多血管平滑肌细胞增生,大量成纤维细胞增生,内膜可见少量单核细胞浸润;中膜变薄,内弹力纤维有断裂;外膜见大量单个核细胞,同种移植对照组的病理改变较实验组更加明显.同种移植对照组内膜厚度/中膜厚度比值为1.4140±0.2232,实验组为0.4010±0.0910,二者比较,差异有统计学意义(P＜0.01).同种移植对照组ICAM-1阳性细胞数为(26.114±1.493)个,实验组为(8.943±1.061)个,二者比较,差异有统计学意义(P＜0.01).同种移植对照组的血清PDGF含量为(1023±27)pg/ml,实验组为(265±100)pg/ml,二者比较,差异有统计学意义(P＜0.01).结论 吡格列酮能够延缓移植动脉慢性血管病变的发展,这种作用可能与局部ICAM-1表达下调、血清PDGF浓度下降有关.     

移植物转染血红素氧合酶-1基因抑制慢性移植物血管病

目的探讨移植物转染血红素氧合酶-1（HO-1）基因对慢性移植物血管病的影响。方法克隆HO-1基因，并构建含有HO-1基因的重组腺病毒载体（Ad-HO-1），实验分为4组：A组为同系移植对照组，供、受者均为Lewis大鼠，无特殊处理；B组为同种移植对照组，Lewis大鼠接受未经处理的BN大鼠胸主动脉移植；C组为同种移植空载体对照组，Lewis大鼠接受以空载体（不含HO-1基因）处理的BN大鼠的胸主动脉移植；D组为同种移植实验组，Lewis大鼠接受转染HO-1基因的BN大鼠的胸主动脉移植。于移植后60d取移植动脉，进行组织形态学观察，测量内膜厚度；免疫组化和逆转录聚合酶链反应检测HO-1在移植动脉中的表达。结果A组移植动脉形态正常；B组、C组移植动脉呈移植物血管病表现，血管内膜显著增厚，D组移植动脉呈内膜炎改变，内膜厚度与B组、C组相比，差异有统计学意义（P〈0．01）。免疫组化及RT-PCR检测显示，与A组、B组和C组相比，D组移植动脉可以检测到HO-1基因及其蛋白表达。结论在移植血管中预先转染HO-1基因，能明显缓解移植动脉的纤维化进程以及内膜的增生，对慢性排斥反应所致的移植物血管病具有抑制作用。     

紫杉醇对大鼠移植动脉内膜增生及硬化的抑制作用

目的观察紫杉醇对同种大鼠移植动脉的影响,探讨紫杉醇对移植物动脉硬化的抑制作用及机制。方法以W istar大鼠为受者,SD大鼠为供者,按供鼠、受鼠不同分为3组,每组8对:同系对照组W istar大鼠接受W istar大鼠的胸腹主动脉移植;同种对照组W istar大鼠接受SD大鼠的胸腹主动脉移植;同种实验组W istar大鼠接受SD大鼠的胸腹主动脉移植,术后1~14 d腹腔注射紫杉醇2 mg.kg-1.d-1。两个对照组每日腹腔注射相同体积的生理盐水。术后30 d,取出移植动脉,进行病理学观察,测出管腔面积和内膜截面积,计算再狭窄率,用免疫组织化学方法测定增殖细胞核抗原(PCNA)的表达。结果同种实验组移植动脉内膜厚度、内膜PCNA表达情况均较同种对照组明显减少,外膜炎症细胞浸润程度、管腔再狭窄率均较同种对照组降低,差异有统计学意义。结论紫杉醇能有效抑制同种大鼠移植动脉内膜增生,防止移植物动脉硬化,其作用机制可能与抑制血管平滑肌细胞增殖和减轻对移植物的免疫排斥反应有关。     

并发闭塞性细支气管炎的移植气管组织中核因子κB和肿瘤坏死因子的表达及意义

目的 探讨小鼠移植气管组织中核因子κB(NF-κB)和肿瘤坏死因子-α(TNF-α)的表达及其在闭塞性细支气管炎(OB)中的作用.方法 实验分为实验组和同系移植对照组,实验组受者为C57BL/6小鼠,同系移植对照组受者为Balb/c小鼠,供者均为Balb/c小鼠.将2支供者气管分别移植于受者两侧背部,术后7、14、21 d 2组分别处死受者7只,取移植气管,于光学显微镜下观察并计算移植气管截面的管腔闭塞率.用免疫组织化学法和Western印迹法检测移植气管组织中NF-κB和TNF-α的表达;用凝胶电泳迁移率改变法检测NF-κB的转录活性;用逆转录聚合酶链反应法检测TNF-α mRNA的表达.结果 实验组移植后14 d和21 d时的管腔闭塞率分别为(31±7)%和(80±17)%,并可见移植气管发生OB病理改变,而同系移植对照组未见此改变.免疫组织化学法和Western印迹法结果均显示.实验组各个时点移植气管组织中NF-κB和TNF-α的表达均高于同系移植对照组.实验组移植后7、14和21 d时,NF-κB基冈的转录活性分别为1.35±0.52、1.72±0.43和2.43±0.33,均高于同时点同系移植对照组的转录活性(P＜0.01,P＜0.05,P＜0.05);实验组各时点TNF-α mRNA的表达均高于同系移植对照组(P＜0.05,P＜0.05,P＜0.05).结论 发生OB的小鼠移植气管组织中NF-κB出及其下游靶基因TNF-α的表达升高.     

前臂同种异体移植大鼠模型的建立

目的 建立前臂同种异体移植的大鼠模型.方法 在Brown Norway(BN)大鼠和Lewis大鼠间进行前臂的同种异体移植手术(n=8).供者大鼠的腋动静脉与受者大鼠的颈外静脉、颈总动脉进行吻合,同时,尺神经、桡神经、正中神经进行吻合.对其中5只受者大鼠术后给予环孢素A进行免疫抑制治疗(观察组),3只受者大鼠未给予免疫...     

抗可诱导共刺激分子抗体对大鼠慢性移植肾肾病的影响

目的 探讨应用抗可诱导共刺激分子(ICOS)抗体阻断ICOS-BTRP-1共刺激通路对大鼠慢性移植肾肾病(CAN)的影响及其可能机制.方法 实验分为3组:(1)同系对照组,供、受者均为Wistar大鼠,进行肾移植;(2)同种对照组,以SD大鼠为供者,Wistar大鼠为受者进行肾移植,术后灌胃给予环孢素A(CsA),用10 d;(3)实验组,在同种对照组的基础上,于使用CsA后经腹腔注射抗ICOS单克隆抗体,2 mg/kg,2次/周,共用3个月.各组分别于术后4、8和12周,检测受者血清肌酐;观察移植肾的病理学变化;用免疫组织化学法检测移植肾和受者脾脏中ICOS的表达;检测移植肾组织中ICOS mRNA的表达.另取存活6个月的实验组和同系对照组大鼠,检测其外周血中CD4+CD25+T淋巴细胞的比例.结果 同系对照组术后各个时间点的血清肌酐变化不大;同种对照组血清肌酐明显升高,12周时达(310±18)μmol/L;实验组血清肌酐也呈上升趋势,但上升幅度明显低于同种对照组,至12周时为(122±13)μmol/L.术后12周时,同种对照组移植肾肾小球硬化率和Banff评分(总分)分别为(54.75±3.06)%和8.28±1.41,实验组为(15.05±1.64)%和6.13±1.00,两组比较,差异有统计学意义(P＜0.01).同系对照组受者脾脏边缘区可见ICOS表达,白髓区少见ICOS表达,该组移植肾内未见ICOS明显表达;在同种对照组,移植后各时间点移植肾和受者脾脏中都可见ICOS明显表达;实验组移植肾和受者脾脏内ICOS的表达明显下降,且主要表达于脾脏的白髓区,边缘区很少表达.术后4、8和12周时,实验组各个时间点ICOS mRNA的表达明显低于同种对照组.实验组存活＞6个月者外周血中CD4+CD25+T淋巴细胞的比例平均为13.5%,同系对照组平均为9.1%.结论 应用抗ICOS抗体阻断ICOS-B7RP-1共刺激通路可在一定程度上抑制CAN的进展,其机制可能与移植肾组织ICOS的表达受到抑制及ICOS在受者脾脏内的重新分布有关,其中也可能有CD4+CD25+调节性T淋巴细胞的参与.     

采用经姜黄素处理的未成熟树突状细胞延长大鼠移植肾存活时间

目的 探讨姜黄素(Cur)处理的树突状细胞(DC)诱导同种T淋巴细胞低反应性的效果以及对大鼠移植肾存活时间的影响.方法 体外培养Wistar大鼠骨髓来源的DC,经Cur处理后,以流式细胞仪检测细胞CD11c、CD80、CD86及主要组织相容性复合物(MHC)Ⅱ类抗原的变化,酶联免疫吸附试验测定DC分泌白细胞介素12(IL-12)的水平,混合淋巴细胞反应(MLR)检测其刺激Lewis大鼠T淋巴细胞增殖的能力,二次MLR测定其诱导的T淋巴细胞抗原特异性低反应性.以Wistar大鼠为供者,Lewis大鼠为受者,进行肾移植.术前第7天,经尾静脉给受者输注用Cur处理的供者DC,分设不处理对照组和未成熟DC对照组(经尾静脉注射供者的未成熟DC),术后观察移植肾存活时间及组织学改变情况,第14天检测受者T淋巴细胞对供者成熟DC的反应性.结果 Cur能明显抑制DC共刺激分子CD11c、CD80、CD86及MHCⅡ类抗原的表达以及IL-12的分泌(P＜0.05).同种T淋巴细胞对经Cur处理过的DC刺激的增殖能力明显减低,且这种低反应性具有抗原特异性.对照组和未成熟DC对照组移植肾的存活时间分别为(8.6±2.1)d和(22.4±7.4)d,实验组为(31.5±6.9)d,实验组移植肾存活时间明显长于对照组和未成熟DC对照组(P＜0.05),且其移植肾组织的损伤程度最轻.实验组受者的T淋巴细胞对供者成熟DC刺激的反应性明显低于对照组(P＜0.05),而对第三方无关抗原的刺激保持较高增殖强度.结论 Cur能抑制DC成熟功能,诱导供者特异性的T淋巴细胞低反应性,移植前输注经Cur处理的未成熟DC能显著延长大鼠移植肾的存活时间.     

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。