CYP3A4*1G基因多态性对病人芬太尼镇痛效应的影响

目的 探讨CYP3A4*IG基因多态性对病人芬太尼镇痛效应的影响.方法 择期全麻下子宫肌瘤剔除术或子宫全切手术病人139例,河南籍,汉族,年龄20～50岁,ASA Ⅰ或Ⅱ级.采用聚合酶链反应-限制性片段长度多态性技术,进行CYP3A4*1G多态性位点的检测,根据基因型将病人分成野生型纯合子组、突变型杂合子组和突变型纯合子组.病人清醒后行视觉模拟评分(VAS),当VAS超过3分时,则间断静脉注射芬太尼20 μg,直至VAS≤3分时开始病人自控静脉镇痛,维持VAS不超过4分,记录病人自控静脉镇痛24 h内芬太尼的用量.结果 与突变型纯合子组比较,突变型杂合子组和野生型纯合子组病人自控静脉镇痛24 h内芬太尼用量增多(P<0.05),突变型杂合子组和野生型纯合子组该指标差异无统计学意义(P>0.05).结论 CYP3A4*1G基因多态性是引起芬太尼药效学个体差异的遗传因素之一.     

CYP3A5~*3基因多态性对病人芬太尼镇痛效应的影响

目的 探讨CYP3A5~*3基因多态性对病人芬太尼镇痛效应的影响.方法 择期全麻下行腹式子宫全切术或子宫肌瘤剔除术的病人180例,河南籍,汉族,年龄20～50岁,ASA Ⅰ或Ⅱ级.采用聚合酶链反应-限制性片断长度多态性技术进行CYP3A5~*3多态性位点检测,根据基因型将病人分为野生型纯合子组、突变型杂合子组和突变型纯合子组.病人清醒后行视觉模拟评分(VAS),当VAS评分>3分时,则间断静脉注射芬太尼20 μg,直至VAS评分≤3分时开始病人自控静脉镇痛,维持VAS不超过3分.记录病人自控静脉镇痛24 h内芬太尼的用量.结果 3组病人自控静脉镇痛24 h内芬太尼用量比较差异无统计学意义(P>0.05).结论 CYP3A5~*3基因多态性不是芬太尼静脉镇痛效应个体差异的遗传因素.     

μ阿片受体A118G基因多态性对妇科手术患者疼痛敏感性的影响

目的 μ阿片受体A118G基因(OPRM1 A118G基因)多态性对妇科手术患者电刺激痛敏感性的影响.方法 择期拟行子宫肌瘤剔除术或子宫全切术患者152例,汉族,年龄20～50岁,体重指数19～21 kg/m~2,ASA Ⅰ或Ⅱ级,根据基因型分为野生型纯合子组(A/A组)、突变型杂合子组(A/G组)和突变型纯合子组(G/G组).采用电刺激测定患者痛阈和耐痛阈.使用聚合酶链反应-限制性片段长度多态性技术检测OPRM1 A118G基因多态性.结果 A/A组76例,A/G组56例,G/G组20例;G等位基因频率为31.6%.三组间痛阈差异无统计学意义(P＞0.05);G/G组耐痛阚低于A/A组和A/G组(P＜0.05);A/A组和A/G组耐痛阈差异无统计学意义(P＞0.05).结论 OPRM1 A118G基因突变可导致妇科手术患者耐痛阈降低,对痛阈无影响.     

COMTval158met基因多态性对患者术前焦虑和疼痛敏感性的影响

目的 探讨COMTval158met基因多态性对患者术前焦虑和疼痛敏感性的影响.方法 择期手术患者284例,性别不限,年龄20～ 50岁,体重指数在正常范围,ASA分级Ⅰ或Ⅱ级;另取健康志愿者28名,年龄18 ～ 25岁,体重指数在正常范围.采用苯酚-氯仿萃取法提取DNA.采用聚合酶链式反应-限制性片段长度多态性法进行COMTval158met基因多态性检测.根据患者和健康志愿者基因型分组:野生型纯合子组(G/G组)、突变型杂合子组(G/A组)和突变型纯合子组(A/A组).手术或试验前1d进行焦虑状态评分(SAI评分)和焦虑特质评分(TAI评分);患者或健康志愿者入室后平静10 min,采用电刺激仪测定痛阈与耐痛阈.结果 患者G/G组132例,G/A组110例,A/A组42例.健康志愿者G/G组12名,G/A组11名,A/A组5名.COMTval158met等位基因A突变频率为34.5％.健康志愿者3个基因组痛阈、耐痛阈、SAI评分和TAI评分比较差异无统计学意义(P＞0.05);与G/G组比较,患者A/A组痛阈、耐痛阈降低,SAI评分和TAI评分升高(P＜0.05),G/A组上述指标差异无统计学意义(P＞0.05);与健康志愿者比较,患者G/G组和G/A组SAI评分升高,A/A组痛阈、耐痛阈降低,SAI评分升高(P＜0.05).患者COMTval158met等位基因A与耐痛阈、痛阈呈负相关,与术前SAI评分呈正相关(P＜0.05).结论 COMT val158 met基因多态性与患者术前焦虑程度显著相关,以致引起患者疼痛敏感性增强.     

云南省德宏州傣族和汉族志愿者细胞色素P450 1A2~* 1C基因的多态性

目的 探讨傣族和汉族志愿者细胞色素P450 1A2~*1C(CYP1A2~*1C)基因的多态性.方法 云南省德宏州117名傣族志愿者和112名汉族志愿者纳入本研究.应用聚合酶链反应-限制性片段长度多态性的方法进行CYP1A2-2964位点分型,检测CYP1A2-2964位点的基因多态性.结果 云南省德宏州117名傣族志愿者中,45名为野生型纯合子(G/G);63名为杂合子(G/A);9名为突变型纯合子(A/A);112名汉族志愿者中,63名为野生型纯合子(G/G);44名为杂合子(G/A);5名为突变型纯合子(A/A),傣族与汉族志愿者G-2964A基因型分布差异有统计学意义(P<0.05);G-2964A基因频率经检验分布符合H-W平衡定律;德宏州傣族和汉族志愿者A-2964位点等位基因频率分别为35%(95%可信区间30%～40%)和24%(95%可信区间20%～30%),傣族和汉族志愿者间差异有统计学意义(P<0.05);云南省德宏州傣族志愿者A-2964等位基因频率与其他地区人群比较差异有统计学意义(P<0.05).结论 在云南省德宏州CYP1A2~*1C基因多态性是引起傣族和汉族人药理学特性个体和种族差异的遗传因素之一.     

IL-1β-511基因多态性对病人芬太尼术后镇痛效应的影响

目的 探讨IL-1β-511基因多态性对病人芬太尼术后镇痛效应的影响.方法 择期全麻下行子宫全切术或子宫肌瘤剔除术的病人250例,河南籍,汉族,年龄20～50岁,ASA分级Ⅰ或Ⅱ级.采用聚合酶链反应-限制性片断长度多态性技术进行IL-1β-511基因多态性位点检测,根据基因型将病人分为野生型纯合子组、突变型杂合子组和突变型纯合子组.病人清醒后行VAS评分,当VAS评分＞3分时,间断静脉注射芬太尼20μg,直至VAS评分≤3分时开始PCIA,维持VAS≤3分.记录PCIA 24 h内芬太尼的用量.结果 三组PCIA 24 h内芬太尼用量差异无统计学意义(P＞0.05).结论 IL-1β-511基因多态性不是芬太尼术后静脉镇痛效应个体差异的遗传因素,提示术后24 h内的疼痛与炎性因子无关.     

CYP3A4*1G不同基因型对髋关节置换术后地佐辛复合舒芬太尼自控镇痛效应的影响

目的探讨CYP3A4^*1G多态性对髋关节置换术后地佐辛复合舒芬太尼静脉镇痛效应的影响。方法选取在本院行关节置换术患者150例,男79例,女71例,年龄21~61岁,BMI 16~29 kg/m^2,ASAⅠ或Ⅱ级。根据患者CYP3A4^*1G基因分型检测分为:野生型纯合子(CYP3A4^*1/^*1)基因型组(11组)、突变型杂合子(CYP3A4^*1/^*1G)基因型组(11G组)和突变型纯合子(CYP3A4^*1G/^*1G)基因型组(1G1G组)。所有患者在全麻下行髋关节置换术,术后行地佐辛复合舒芬太尼患者自控镇痛(PCIA)。记录三组患者苏醒即刻、术后12、24和48 h的视觉模拟疼痛(VAS)评分、镇静程度(Ramsay)评分,记录镇静过度的患者例数。记录三组术后0~24和24~48 h地佐辛+舒芬太尼使用量、手术时间和苏醒时间。采用PCR-RFLP对三组患者外周血单核细胞中CYP3A4 mRNA相对表达量进行检测。结果 11组患者93例(62.0%)、11G组患者50例(33.3%)、1G1G组患者7例(4.7%),CYP3A4^*1G最小等位基因频率(MAF)为0.213,等位基因和基因型分布符合Hardy-Weinberg平衡(P=0.933)。三组不同时点VAS评分和Ramsay评分差异无统计学意义,三组均未见镇静过度者。术后0~24 h、24~48 h 1G1G组地佐辛+舒芬太尼使用量明显少于11组和11G组(P<0.05),11组和11G术后0~24 h、24~48 h地佐辛+舒芬太尼使用量差异无统计学意义。三组手术时间和苏醒时间差异无统计学意义。11G组和1G1G组外周血单核细胞中CYP3A4 mRNA相对表达量明显低于11组(P<0.05)。三组恶心呕吐、瘙痒等不良反应发生情况差异无统计学意义。结论与野生型纯合子比较,突变型杂合子和突变型纯合子基因型患者对地佐辛复合舒芬太尼耐受性更低,所需剂量更少。该基因型可作为疼痛个体化治疗的参考指标。     

儿茶酚氧位甲基转移酶G472A基因多态性对病人芬太尼镇痛效应的影响

目的 评价儿茶酚氧位甲基转移酶(COMT) G472A基因多态性对病人芬太尼镇痛效应的影响.方法 择期行腰椎手术患者129例,年龄19 ～ 71岁,体重44～ 78 kg,性别不限,ASA分级I或Ⅱ级.采用聚合酶链反应-限制性片段长度多态性技术进行COMT G472A基因多态性分析.根据基因型将病人分为野生型组和突变型组.病人清醒后行VAS评分,当VAS评分＞3分时,间断静脉注射芬太尼20μg,直至VAS评分≤3分时行PCIA.PCIA药物为芬太尼20 μg/kg+氟比洛芬酯150～250mg或丙帕他莫4～6g,用0.9％氯化钠注射液稀释至75 ml,负荷量3ml,背景输注速率1ml/h,PCA量0.5 ml/次,锁定时间15 min,维持VAS评分≤3分.将氟比洛芬酯或丙帕他莫的用量转换为芬太尼用量,记录PCIA 24 h内和48 h内芬太尼的用量.结果 与野生型组比较,突变型组PCIA 24 h内芬太尼用量差异无统计学意义(P＞0.05),PCIA 48 h内芬太尼用量降低(P＜0.05).结论 COMT G472A基因多态性是引起芬太尼药效学个体差异的遗传因素.     

肾细胞癌患者VEGFR3基因及CYP3A5*1基因单核苷酸多态性研究

目的:分析VEGFR3基因及CYP3A5*1基因单核苷酸多态性(SNP)在肾癌人群的分布特征,评价其与舒尼替尼药物治疗疗效及耐受性的相关性。方法:2012年6月~2013年6月,对198例肾癌患者进行外周血VEGFR3(rs307826)及CYP3A5*1(rs776746)位点的SNP检测,同时采集患者的自然信息、临床资料、治疗经过及预后。应用统计学方法评价中国人群与欧洲人群这两个基因位点SNP分布差异以及两个基因位点的SNP特征与舒尼替尼治疗晚期肾癌的疗效及耐受性的相关性。结果:VEGFR3(rs307826)位点SNP检测结果:野生型纯合子196例、杂合子2例;CYP3A5*1(rs776746)位点SNP检测结果:野生型纯合子115例、杂合子80例,与欧洲人群分布特征的差异有统计学意义(P0.01)。45例患者接受舒尼替尼药物治疗,CYP3A5*1(rs776746)SNP结果:野生型纯合子27例、杂合子18例,舒尼替尼初始剂量均为50mg/d,4/2周给药方案,主要不良反应包括高血压、血小板减低、白细胞减低、甲状腺功能低下等,Ⅲ~Ⅳ级不良反应发生率28.9%,15例患者因不良反应进行了剂量调整。结论:VEGFR3基因及CYP3A5*1基因的SNP分布特征在不同种族存在显著差异,CYP3A5*1(rs776746)位点SNP特征与中国肾癌患者接受舒尼替尼治疗的Ⅲ~Ⅳ级不良反应发生率及药物减量风险相关。     

细胞色素P450 2D6*10基因多态性对曲马多药代动力学的影响

目的 探讨细胞色素P450 2D6*10(CYP2D6*10)基因多态性对曲马多药代动力学的影响.方法 辽宁籍汉族健康志愿者,性别不限,年龄22～45岁,体重50～82 kg,身高161～179 cm,经左肘静脉采血2 ml,采用酚/氯仿抽提法提取全血DNA,采用聚合酶链反应.限制性片段长度多态性进行CYP2D6*10基因分型,分为野生型纯合子组(w/w组,n=5)、杂合子组(m/w组,n=8)和突变型纯合子组(m/m组,n=6).右上肢静脉经3 min注射曲马多1.5 ms/kg.分别于注射前、注射后0.25、0.5、1、1.5、2、3、4、6、8、12、16、24、32 h时取血3 ml,测定血浆曲马多及O-去甲基曲马多浓度.采用非房室模型方法计算曲马多曲线下面积(AUG0→∞)、血浆清除率(CL)、血浆消除半衰期(t1/2)、平均滞留时间(MRT)、血浆代谢率(MR)和0-去甲基曲马多峰浓度(Cmax)、达峰时间(Tmax)、AUc..、MRT.结果 与w/w组比较,m/m组曲马多t..和MRT延长,MR降低,O.去甲基曲马多AUC0→∞减少,m/w组曲马多MR降低(P<0.05或0.01);与m/m组比较,m/w组曲马多MR降低(P<0.01).结论 CYP2D6*10基因多态性是引起曲马多药代动力学个体差异的重要遗传因素之一.     

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。