不同浓度七氟烷对老年大鼠认知功能的影响

目的 探讨不同浓度七氟烷对老年大鼠认知功能的影响.方法 18月龄雄性SD大鼠40只,体重500～650 g,随机分为3组,对照组(C组,n=8)吸入空气,1.5%七氟烷组(S1组,n=16)吸入1.5%七氟烷2 h,3.0%七氟烷组(S2组,n=16)吸入3.0%七氟烷2 h.于吸入七氟烷后1、7 d(T1.2)S1组和S2组随机取8只大鼠,采用Y型迷宫实验行认知功能测试,认知功能测试后12 h时处死大鼠,断头取脑,采用RT-PCR方法测定左侧海马N-甲基-D-天冬氨酸受体2B亚基(NR2B)mRNA表达,采用免疫组化法检测右侧海马NR2B蛋白表达.结果 与C组比较,S2组吸入七氟烷后1 d大鼠认知功能减退,右侧海马NR2B蛋白、左侧海马NR2B mRNA表达上调(P<0.05),S1.组上述指标差异无统计学意义(P0.05).结论 吸入1.5%七氟烷后老年大鼠认知功能无明显变化;吸入3%七氟烷后1 d老年大鼠认知功能减退,可能与其上调海马含2B亚基的NMDA受体表达有关.     

反复吸入七氟烷对老年大鼠认知功能的影响

目的 评价反复吸入七氟烷对老年大鼠认知功能的影响.方法 健康Wistar大鼠24只,月龄18月,体重270-450 g,雌雄各半,随机分为3组(n=8):对照组(C组)、2%七氟烷组(S1组)和3%七氟烷组(S2组).C组不吸入七氟烷;S1和S2组分别吸入2%、3%七氟烷,100 min/d,连续5d.于干预结束后1-6d(T1-6)时进行水迷宫实验,记录T1-5时游泳时间和游泳距离及T6时第4象限探索时间和游泳距离.于最后1次水迷宫实验结束后60 min处死大鼠,取海马组织,采用RT-PCR法测定海马N-甲基肌天冬氨酸受体(NMDAR)、NR1和NR2B mRNA的表达.结果 与C组比较,S1组T1时游泳时间和游泳距离延长.T6时第4象限探索时间缩短,NMDAR mRNA表达上调(P<0.05),NRI和NR2B mRNA的表达差异无统计学意义(P<0.05).结论 反复吸入2%七氟烷不会导致老年大鼠认知功能减退;而反复吸入3%七氟烷可导致一过性认知功能减退.     

NMDA受体在七氟烷麻醉致老龄小鼠海马神经元程序性坏死中的作用

目的评价N-甲基-D-天冬氨酸受体(NMDA受体)在七氟烷麻醉致老龄小鼠海马神经元程序性坏死中的作用。方法清洁级健康雄性C57BL/6小鼠90只, 18月龄, 体重27～30 g, 采用随机数字表法分为3组(n=30):对照组(C组)、七氟烷麻醉组(S组)和七氟烷麻醉+NMDA受体拮抗剂盐酸美金刚组(S+M组)。S组和S+M组小鼠连续3 d吸入3%七氟烷2 h, S+M组于每次吸入七氟烷前1 h腹腔注射盐酸美金刚20 mg/kg, C组只吸入纯氧。分别于麻醉前1 d、麻醉后3和7 d时每组随机取10只小鼠行Morris水迷宫实验。Morris水迷宫实验结束后立即处死小鼠取海马, 于光镜下观察病理学结果, 采用流式细胞术测定神经元程序性坏死率和胞浆游离钙离子浓度([Ca2+]i), Wes-tern blot法检测NMDA受体亚型GluN2A、GluN2B和受体相互作用蛋白激酶1(RIP1)的表达。结果与C组比较, S组和S+M组麻醉后各时点逃避潜伏期延长, 穿越原平台位置次数减少, 海马[Ca2+]i和神经元程序性坏死率升高, GluN2A、GluN2B和RIP1表达上调(P<0...     

利多卡因致大鼠惊厥时海马神经元含NR2B亚基的N-甲基-D-天门冬氨酸受体表达的变化

目的 评价利多卡因致大鼠惊厥时海马神经元含NR2B亚基的N-甲基-D-天门冬氨酸(NMDA)受体表达的变化.方法 健康雄性SD大鼠24只,体重220～250 g,6月龄,采用随机数字表发法,将其分为2组(n=12):生理盐水组(N组)和利多卡因组(L组).L组经尾静脉输注2％利多卡因4 mg· kg-1·min-1至大鼠发生RacineⅢ级惊厥,N组以等容量等速率生理盐水替代.于惊厥停止后即刻、6、12 h(T1～3)时取海马,采用免疫印迹和RT-PCR法检测NR2B蛋白及mRNA的表达水平.结果 与N组比较,L组NR2B蛋白及mRNA表达上调.与T1时比较,L组T2,3时NR2B蛋白及mRNA表达下调(P＜0.05).与T2时比较,L组T3时NR2B蛋白表达下调(P＜0.05).结论 利多卡因诱发大鼠惊厥时海马神经元含NR2B亚基的NMDA受体表达上调,该变化可能与利多卡因诱发惊厥发作有关.     

异氟烷对发育期大鼠海马IL-1β mRNA、IL-6 mRNA和TNF-α mRNA表达的影响

目的 探讨异氟烷对发育期大鼠海马IL-1β mRNA、IL-6 mRNA和TNF-α mRNA表达的影响.方法 出生7 d的SD大鼠64只,随机分为2组(n=32):对照组(C组)和异氟烷麻醉组(I组).I组大鼠吸入1.5%异氟烷麻醉6 h,C组吸入空气.I组于麻醉前(T0,基础状态)、麻醉2 h(T1)、4 h(T2)、6 h(T3)、麻醉停止后4 h(L)、6 h(T5)、12 h(T6)、24 h(T7)时,C组在对应时点各取4只大鼠,测定海马IL-1β mRNA、IL-6 mRNA及TNF-α mRNA的表达水平.结果 C组各时点海马IL-1β mRNA、IL-6 mRNA和TNF-α mRNA比较差异无统计学意义(P＞0.05);与C组比较,I组海马T1～5 时IL-1βmRNA表达上调,T2,3 时IL-6 mRNA表达上调,T1～6时TNF-α mRNA表达上调(P＜ 0.05).结论 1.5%异氟烷麻醉可短暂上调发育期大鼠海马IL-1β mRNA、IL-6 mRNA和TNF-α mRNA的表达.     

异氟醚通过上调NMDA受体导致发育期大鼠海马神经元凋亡

目的探讨异氟醚麻醉对新生大鼠海马神经元N-甲基-D-天冬氨酸(NMDA)受体亚基及凋亡的影响。方法新生1d的SD大鼠36只,雌雄不拘,取海马组织进行原代培养。采用随机数字表法将培养海马神经元5d的培养皿随机分为三组:对照组(C组)、异氟醚组(I组)和AP5+异氟醚组(A组),每组12只。I组和A组培养的海马神经元放置在密闭箱中,吸入1.5%异氟醚和纯氧,吸入时间6h,C组不做任何处理。于异氟醚麻醉结束后2、4、6、24h(C组于相应时点),提取海马神经元总mRNA和总蛋白,采用RT-PCR法测定NR2A mRNA、NR2BmRNA和caspase-3mRNA的表达量,采用Westen blot法测定caspase-3蛋白含量。结果与C组比较,异氟醚麻醉结束后2、4和6hI组海马神经元NR2AmRNA和NR2BmRNA的表达量明显上调(P0.05)。与C组和A组比较,I组异氟醚麻醉结束后2、4和6h海马神经元caspase-3mRNA的表达量、异氟醚麻醉后4和6h海马caspase-3蛋白含量明显升高(P0.05)。结论吸入1.5%异氟醚可能通过上调新生大鼠海马神经元NMDA受体导致发育神经元凋亡,阻断NMDA受体可以预防异氟醚导致的发育期海马神经元凋亡。     

孕早期安氟醚麻醉对大鼠子代海马NR2B表达的影响

目的 评价孕早期安氟醚麻醉对大鼠子代海马N-甲基-D-天冬氨酸受体2B亚基(NR2B)表达的影响.方法 孕8～10 d SD大鼠30只,体重200～250 g,采用随机数字表法,将其随机分为3组(n=10):对照组(C组)、吸入安氟醚4h组(E1组)和吸入安氟醚8h组(E2组).E1组和E2组分别吸入1.7％安氟醚4和8h,氧流量为2 L/min,C组吸入等流量氧气.分别于出生后20和30d,采用Morris水迷宫系统测定子鼠的认知功能.于水迷宫实验结束后第2天,取各组子鼠海马组织,分别采用PCR和免疫组化法测定NR2B mRNA及蛋白的表达.结果 与C组比较,E1组和E2组子鼠出生后20和30 d时逃避潜伏期延长,穿越平台次数减少,平台象限停留时间缩短(P＜0.05),海马NR2B mRNA及蛋白表达下调(P＜0.05);与E1组比较,E2组子鼠出生后20和30 d时海马NR2B mRNA及蛋白表达比较差异无统计学意义(P＞0.05).结论 孕早期安氟醚麻醉可降低大鼠子代的认知功能,其机制与抑制大鼠子代海马NR2B表达有关.     

七氟烷和东莨菪碱对老年大鼠海马毒蕈碱受体表达的影响

目的 探讨七氟烷和东莨菪碱对老年大鼠海马毒蕈碱受体表达的影响.方法 健康雄性老年SD大鼠48只,月龄18月,体重560～600 g,随机分为对照组(Con组)、七氟烷组(Sev组)和东莨菪碱组(Sco组),每组16只.Sco组腹腔注射东茛菪碱0.8 mg/kg,Con组和Sev组腹腔注射等容量生理盐水,30 min后Sev组吸入3.0%七氟烷、Con组和Sco组吸入空气2 h.于给药后1、3 d时分别取8只大鼠,采用Y型迷宫实验测试学习记忆能力,然后断头处死,取脑分离海马,采用RT-PCR法检测M1受体和M,受体mRNA的表达,采用免疫组化法检测海马神经元M1受体和M2受体的表达.结果 与Con组相比,给药后1d时Sev组和Sco组学习次数增多、训练时间延长,海马M1受体和M2受体的表达下调(P<0.05);各组间给药后3 d时学习次数、训练时间及海马M1受体和M2受体的表达差异无统计学意义(P>0.05).结论 七氟烷和东莨菪碱均可诱发老年大鼠认知功能一过性降低,其机制与海马M1受体和M2受体表达下调有关.     

不同剂量氯胺酮对老年大鼠认知功能的影响

目的 探讨腹腔注射不同剂量氯胺酮对老年大鼠认知功能的影响.方法 老年SD大鼠40只,15月龄,体重470～570 g,雌雄各半,随机分为4组(n=10),对照组(C组)腹腔注射生理盐水2 ml,K1组、K2组和K3组分别腹腔注射氯胺酮10、20和100 mg/kg(溶于2 ml生理盐水),连续3 d.于停药后1 d(TI)、2 d(T2)、3 d(T3)行水迷宫实验,记录潜伏期及游泳路程.末次水迷宫测试结束后1 h处死大鼠,采用RT-PCR法测定海马N-甲基-D-天门冬氨酸(NMDA)受体亚基NR1 mRNA和NR2BmRNA的表达,免疫组织化学法测定海马NR1和NB2B蛋白的表达.结果 与T1时比较,C组和K2组T2,3时、K1,3组T3时潜伏期缩短,C组T2,3时、K1,2组T3时游泳路程缩短(P＜0.05);与C组比较,K3组T2,3时潜伏期和游泳路程延长,K1组NR2B蛋白表达上调,K3组NR2B mRNA及蛋白表达下调(P＜0.05);各组NR1 mRNA及蛋白表达差异无统计学意义(P＞0.05).结论 亚麻醉剂量氯胺酮对老年大鼠认知功能无明显影响,而麻醉剂量氯胺酮可致老年大鼠认知功能减退,其机制可能与含NR2B亚基的NMDA受体表达下调有关.     

HO-1在七氟烷预处理抑制大鼠氧糖剥夺海马神经元凋亡中的作用

目的 探讨血红素氧合酶-1(HO-1)在七氟烷预处理抑制大鼠氧糖剥夺海马神经元凋亡中的作用.方法 出生48 h内的Wistar大鼠,体外培养海马神经元,随机分为6组,每组108孔,正常对照组(C组):不做任何处理;2%七氟烷预处理组(S1组):2%七氟烷预处理60 min后正常培养24 h;OGD组:缺糖缺氧45 min后复糖复氧,再正常培养24 h以制备氧糖剥夺模型;2%七氟烷预处理+OGD 组(S1+OGD组)和4%七氟烷预处理+OGD组(S2+OGD组):分别经2%、4%七氟烷预处理后制备氧糖剥夺模型;4%七氟烷预处理+ZnPPⅨ+OGD(Z组):4%七氟烷预处理同时在培养液中加入ZnPPⅨ(终浓度10 μmol/L),其余处理同S2+OGD组.正常培养24 h时检测神经元存活率、凋亡率和HO-1蛋白及其mRNA的表达水平.结果 与C组比较,OGD组、S1+OGD组、S2+OGD组和Z组海马神经元存活率降低,凋亡率升高,海马神经元HO-1 mRNA及其蛋白表达上调,S1组海马神经元HO-1 mRNA 及其蛋白表达上调(P<0.01),神经元存活率、凋亡率差异无统计学意义(P>0.05);与OGD组比较,S1+OGD组、S2+OGD组海马神经元存活率升高,凋亡率降低,海马神经元HO-1 mRNA及其蛋白表达上调,Z组上述指标差异无统计学意义(P>0.05);与S1+OGD组比较,S2+OGD组海马神经元存活率升高,凋亡率降低,海马神经元HO-1 mRNA及其蛋白表达上调(P<0.01);与S2+OGD组比较,Z组海马神经元存活率降低,凋亡率升高,海马神经元HO-1 mRNA及其蛋白表达下调(P<0.01).结论 HO-1可能参与了七氟烷预处理抑制大鼠氧糖剥夺海马神经元凋亡的机制.     

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。     

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。     

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.