胰管支架治疗高三酰甘油血症性胰腺炎的疗效：附33例报告

背景与目的 高三酰甘油血症性胰腺炎（HTGP）发病率逐年增高,至今没有相关的治疗指南,目前主要采用以降脂为主的保守治疗,但治疗效果并不理想,病死率和并发症发生率仍然较高,预后也相对较差,因此单纯的保守治疗存在一定局限性。本研究评价胰管支架置入治疗HTGP患者的有效性和安全性,以期为临床治疗提供新的思路。方法 回顾分析作者单位2017年1月—2020年7月所有经胰管支架置入治疗的HTGP患者临床资料,根据纳入与排除标准筛选入组病例。统计纳入病例的胰管梗阻情况;比较入院及治疗48 h后的APACHE II评分、血清甘油三酯（TG）水平、血糖水平;记录治疗后并发症发生率、病死率、新发器官功能衰竭发生率、禁食时间、住院时间、住院花费等。结果 共纳入33例患者,其中男15例,女18例;33例患者平均年龄（37.42±9.69）岁,血清TG水平中位数19.83（11.85~39.18）mmol/L;其中16例存在胰管蛋白栓,胰管蛋白栓在轻、中、重度HTGP中的发生率分别为17%、56%、100%,与无胰管蛋白栓患者比较,有胰管蛋白栓的患者病情更重。2例（6%）发生与ERCP有关的血清淀粉酶升高;3例（9%）发生术后并发症。所有患者通过胰管支架全部治愈,于入院后3（2~5）d恢复经口进食,住院时间中位数为5（3~9）d,治疗48 h后APACHE II评分较入院时降低约70%,发病48 h内行胰管支架置入的患者禁食时间、住院时间较发病48 h后行胰管支架置入的患者分别缩短33%、38%,住院花费减少33%,差异均有统计学意义（均P<0.05）。结论 早期胰管支架治疗可以快速缓解HTGP患者的临床症状、大幅度减少住院时间并改善患者预后,是一种安全有效的治疗新策略。     

腔镜与开放保乳手术治疗早期乳腺癌的近期疗效比较

背景与目的 乳腺癌发病率高，目前以手术治疗为主，保乳手术（BCS）是早期乳腺癌常用的手术方式，但我国保乳率低，传统开放保乳术后切口疤痕仍明显。目前，具有术后美容效果好、患者满意度高的腔镜微创技术已应用于乳腺外科BCS治疗，但因其手术操作难度大、术中定位难等，导致其在国内开展少，研究数据有限。因此，本研究通过比较腔镜BCS与开放BCS治疗早期乳腺癌的近期疗效，探讨腔镜BCS的临床应用价值。方法 回顾性收集中国人民解放军陆军军医大学第一附属医院乳腺甲状腺外科2019年1月—2022年12月681例0~Ⅱ期单侧乳腺癌并接受BCS的患者临床资料，其中79例接受腔镜BCS（腔镜组），602例接受传统开放BCS（开放组）。对两组患者基线资料进行1∶1倾向性评分匹配（PSM）后，比较两组患者的相关临床指标。结果 PSM前，两组间基线资料存在明显差异（部分P<0.05）；PSM后，两组各79例，均衡组间差异后，组间各项基线资料均衡可比（均P>0.05）。与开放组比较，腔镜组手术时间延长（Z=-5.415，P<0.001），住院费用增加（Z=-6.042，P<0.001）。两组在术中出血量、淋巴结清扫数目、引流量和住院时间方面差异均无统计学意义（P>0.05）。在术后30 d并发症中，两组在术中副损伤、出血、感染、皮瓣坏死、皮下积液发生率差异均无统计学意义（均P>0.05），但总并发症发生率腔镜组少于开放组（P=0.043）。Breast-Q量表评分结果显示，腔镜组患者在对术后乳房外形的满意度以及身体健康、性健康方面均优于开放组（均P<0.05）。结论 腔镜技术应用于早期乳腺癌BCS具有术后并发症少、患者满意度高，还可改善患者术后生活质量，是一种可行的手术方式。     

X线引导下置入肠梗阻导管治疗妇科恶性肿瘤所致恶性肠梗阻

目的 观察X线引导下置入肠梗阻导管治疗妇科恶性肿瘤所致恶性肠梗阻（MBO）效果。方法 回顾性分析60例妇科恶性肿瘤术后小肠MBO患者资料,其中30例接受X线引导下肠梗阻导管置入（A组）、30例接受传统鼻胃管置入（B组）,之后均接受持续胃肠减压。对比2组MBO症状缓解情况、排气排便时间及治疗后饮食恢复情况,记录24 h平均引流量、导管留置时间及有无治疗相关并发症,以及治疗后1年内生存情况。结果 对60例均成功置管。A组置管后排气排便、经口进食均早于,导管留置时间短于而24 h平均引流量大于B组（P均＜0.05）,组间肠梗阻症状缓解率差异无统计学意义（P=0.472）。治疗中A组8例出现鼻部轻微出血、4例口咽部不适,B组5例鼻部出血、5例口咽部不适,均未经特殊处理后自行缓解;组间治疗相关并发症差异无统计学意义（P=0.361）。治疗后1年,2组均有28例完成随访、失访2例,A组生存率［25.00%（7/28）］与B组［17.86%（5/28）］差异无统计学意义（P=0.745）。结论 X线引导下置入肠梗阻导管治疗妇科恶性肿瘤所致MBO安全、有效。     

抗凝与其联合介入方法治疗重症颅内静脉血栓形成

目的 对比单纯抗凝与其联合介入方法治疗重症颅内静脉血栓形成（CVT）的效果。方法 根据治疗方法将65例重症CVT患者纳入抗凝组（n=32）或联合组（n=33）,比较组间入院、出院时改良Rankin量表（mRS）评分、患者预后、血管再通率,以及随访期间并发症发生率。结果 组间入院时mRS评分差异无统计学意义（P＞0.05）;联合组出院时mRS评分低于抗凝组（P＜0.05）。出院时（84.85% vs. 59.38%）、出院后6个月（87.88% vs. 65.63%）及12个月（93.94% vs. 75.00%）,联合组预后良好率均高于抗凝组（P均＜0.05）。出院时联合组血管再通率高于抗凝组（100% vs. 75.00%,P＜0.05）。截至随访末,组间并发症发生率差异无统计学意义（15.15%vs. 18.75%,P＞0.05）。结论 对于重症CVT患者,相比单纯抗凝,以抗凝联合介入方法进行治疗可明显减轻症状、改善预后。     

甲状腺微小乳头状癌颈部中央区淋巴结转移的影响因素

目的 观察甲状腺微小乳头状癌（PTMC）颈部中央区淋巴结转移（CLNM）的影响因素。方法 回顾性分析230例接受手术治疗的PTMC患者，根据术后病理显示有无颈部CLNM分为CLNM组（n=75）和非CLNM组（n=155）；以单因素及多因素分析对比2组患者一般资料、超声及手术所见，筛选PTMC颈部CLNM的相关影响因素，并构建logistic回归模型；绘制受试者工作特征（ROC）曲线评估模型预测PTMC患者存在颈部CLNM的效能。结果 组间患者性别、年龄、肿瘤最大径、肿瘤与被膜位置关系及BRAF V600E基因差异均有统计学意义（P均＜0.05）。PTMC患者年龄、肿瘤最大径、肿瘤与被膜位置关系及BRAF V600E基因均为PTMC发生颈部CLNM的独立影响因素（P均＜0.05）；以之构建的模型预测PTMC发生颈部CLNM的曲线下面积（AUC）、敏感度、特异度及准确率分别为0.802、73.33%、77.42%及76.09%。结论 患者年龄、肿瘤最大径、肿瘤与被膜位置关系及BRAF V600E基因均为PTMC发生颈部CLNM的独立影响因素。     

对比观察血管支架植入术与药物治疗青年脑梗死合并大脑中动脉狭窄效果

目的 对比观察脑血管支架植入术与药物治疗青年脑梗死合并大脑中动脉狭窄的效果。方法 71例（30~44岁）脑梗死合并大脑中动脉重度狭窄（狭窄率>70%）患者,分别接受常规口服药物治疗（药物组,n=39）和支架植入术（支架组,n=32）,比较2组相关指标。结果 支架组手术成功率100%,共植入32枚支架。2组患者入组时及随访3、6、12、24个月,改良Rankin量表（mRS）评分、美国国立卫生研究院卒中量表（NIHSS）评分组内比较差异均有统计学意义（P均<0.01）,mRS、NIHSS评分组间比较差异均无统计学意义（P均>0.05）。随访期间药物组终点事件发生率、卒中再发率及再发卒中致残率（mRS评分≥ 2分）分别为20.51%（8/39）、20.51%（8/39）及20.51%（8/39）,支架组分别为6.25%（2/32）、3.13%（1/32）及3.13%（1/32）,2组间终点事件发生率差异无统计学意义（P=0.17）,支架组卒中复发率（P=0.04）及再发卒中致残率（P=0.04）均低于药物组。结论 相比药物治疗,植入支架可降低青年脑梗死合并大脑中动脉狭窄患者卒中复发率及致残率。     

意外胆囊癌二次术后早期复发的危险因素及辅助化疗疗效分析

背景与目的 术后早期复发是胆囊癌预后不良的重要危险因素，越来越多的证据表明辅助化疗可以改善患者的预后。但目前有关意外胆囊癌（IGBC）二次术后早期复发及辅助化疗对患者预后的影响尚未见报道。因此，本文探讨IGBC二次术后早期复发的危险因素及分析辅助化疗对于早期复发和非早期复发患者的疗效，以为临床提供决策支持。方法 回顾性收集2011年1月—2021年12月于西安交通大学第一附属医院肝胆外科因IGBC行意向性根治术的170例患者的临床病理资料，分析患者术后早期复发的影响因素（早期复发定义为二次意向根治术后12个月内），以及患者术后无复发生存（RFS）与总体生存（OS）的影响因素。结果 170例行IGBC意向性根治术后患者，随访期间复发者73例（42.94%）、早期复发者41例（24.12%）。IGBC术后早期复发患者中位OS时间明显短于非早期复发患者（χ²=192.910，P<0.001）。病理分化程度（OR=20.758，95% CI=5.557~80.239）、CA19-9水平（OR=7.920，95% CI=1.557~39.771）及病灶残留（OR=8.050，95% CI=3.062~21.160）是IGBC术后早期复发的独立危险因素（均P<0.05）。病理分化程度（HR=6.160，95% CI=2.877~13.193）、CA19-9水平（HR=2.538，95% CI=1.297~4.965）、手术切除范围（HR=2.111，95% CI=1.154~3.860）、病灶残留（HR=2.571，95% CI=1.547~4.273）是IGBC术后RFS时间的独立危险因素（均P<0.05）。病理分化程度（HR=3.225，95% CI=1.461~7.121）、早期复发（HR=29.558，95% CI=14.250~61.311）、病灶残留（HR=2.416，95% CI=1.361~4.287）是IGBC术后OS时间的独立危险因素（均P<0.05），辅助化疗是术后OS时间的独立保护性因素（HR=0.260，95% CI=0.123~0.551，P<0.05）。按有无病灶残留及是否早期复发分层分析的结果显示，辅助化疗可延长病灶残留患者术后RFS时间及OS时间，亦可延长早期复发患者术后OS时间（均P<0.05）。结论 病灶残留是IGBC二次术后早期复发及预后的独立危险因素，术后辅助化疗可以有效改善病灶残留及早期复发患者的预后。     

机器人辅助袖状胃切除联合胃底折叠治疗肥胖症合并食管裂孔疝的单中心回顾性分析

背景与目的 肥胖症患者常常合并食管裂孔疝并伴有胃食管反流症状，袖状胃切除术后可能造成严重的并发症。机器人辅助系统具有学习曲线短且平缓、手术视野清晰立体以及手术操作精确且稳定等优势，在外科领域得以广泛推广。本研究探究机器人辅助袖状胃切除联合胃底折叠手术的可行性，从而为肥胖症合并食管裂孔疝患者提供更佳的治疗方案。方法 回顾性分析2019年3月—2021年12月期间49例肥胖症合并食管裂孔疝行袖状胃切除及胃底折叠手术治疗患者的临床资料。其中22例行机器人辅助袖状胃切除联合胃底折叠术（机器人组），27例行腹腔镜辅助袖状胃切除联合胃底折叠术（腹腔镜组）。比较两组患者围手术期相关临床指标的差异，并分析机器人组的治疗效果。结果 两组患者术前甘油三酯、术前空腹血糖、术后住院时间、并发症发生率差异无统计学意义（均P>0.05）。与腹腔镜组比较，机器人组平均手术时间延长（169.09 min vs. 143.33 min，P=0.023）、平均手术费增加（6.36万元vs. 5.40万元，P<0.001），但手术操作时间缩短（115.09 min vs. 134.19 min，P=0.047），出血量减少（25.45 mL vs. 40.00 mL，P=0.023）。两组患者术后1个月的BMI、多余体质量减少百分比（%EWL）、甘油三酯、空腹血糖以及GERD评分差异均无统计学意义（均P>0.05）。机器人组术后1个月的%EWL值（26.26%）达到了减重有效的水平，术后1个月的体质量、BMI、甘油三酯、空腹血糖以及GERD评分均较术前明显降低（均P<0.05）。结论 机器人辅助袖状胃切除联合胃底折叠手术能够使肥胖合并食管裂孔疝患者获得良好的减重效果，明显改善患者的代谢和胃食管反流症状，并且安全可靠，具有一定的可行性。但手术费用较高的问题亟待解决，在选择手术方式时应充分考虑患者家庭经济情况。     

对比直接抽吸一次性取栓与支架取栓治疗急性大脑中动脉闭塞的辐射剂量

目的 对比观察直接抽吸一次性取栓（ADAPT）与常规支架取栓治疗急性大脑中动脉闭塞的辐射剂量。方法 回顾性分析54例大脑中动脉闭塞患者,按照不同介入治疗方法分为ADAPT组（n=29）和支架组（常规支架取栓,n=25）;比较2组术中透视时间、空气比释动能（AK）、剂量面积乘积（DAP）、摄影序列数和摄影帧数以及上述指标之间的相关性。结果 ADAPT组透视时间、AK、DAP、摄影序列数和摄影帧数均低于支架组（P均<0.05）。ADAPT组25例（25/29,86.21%）、支架组13例（13/25,52.00%）AK值<1.0 Gy,ADAPT组中AK值<1.0 Gy者占比高于支架组（P<0.01）;ADAPT组22例（22/29,75.86%）、支架组11例（11/25,44.00%）DAP值<100 Gy·cm²,ADAPT组中DAP<100 Gy·cm²者占比高于支架组（P=0.01）。透视时间与DAP（r=0.60,P<0.01）、AK（r=0.69,P<0.01）均呈正相关,DAP与AK呈正相关（r=0.81,P<0.01）。结论 ADAPT治疗急性大脑中动脉闭塞的辐射剂量低于常规支架取栓。     

脊神经射频热凝术治疗成骨性椎体转移瘤并发神经痛的近期疗效

目的 探讨脊神经射频热凝术治疗成骨性椎体转移瘤并发神经痛的近期疗效。方法 回顾性分析2017年10月—2021年5月收治的63例胸腰椎成骨性椎体转移瘤患者的临床资料，所有患者均在药物治疗基础上行脊神经后内侧支射频热凝术治疗。记录手术前后患者镇痛药物服用情况。术前及术后1 d、7 d、1个月采用疼痛视觉模拟量表（VAS）评分、Karnofsky功能状态（KPS）评分评估患者疼痛程度及功能状态。结果 所有患者顺利完成治疗，术后1 d、7 d、1个月的VAS评分较术前明显降低，KPS评分较术前明显升高，差异均有统计学意义（P < 0.05）。患者术后口服镇痛药物剂量较术前明显降低，差异有统计学意义（P < 0.05）。患者术后临床疗效评价优20例、有效30例、无效13例，总有效率为79.4%。结论 脊神经射频热凝术可有效控制成骨性椎体转移瘤导致的神经痛，提高患者生活质量，减少阿片类药物的使用剂量。     

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。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

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.     

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。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

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.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

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。     

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.