精液中性粒细胞弹性蛋白酶的研究进展

影响男性生殖的因素很多,生殖道感染是其中重要因素之一。精液中性粒细胞弹性蛋白酶(polymor-phonuclear neutrophil elastase,PMNE)作为男性生殖道感染尤其是隐性感染诊断的重要炎症指标,对男性生育能力有潜在的负面影响。精液PMNE浓度不仅与精液白细胞数、精浆ROS水平显著相关,而且与其他炎症相关细胞因子如IL-6、IL-8、TNF-α水平等密切相关。PMNE对精子质量亦有影响,可以削弱精子活力,影响精子形态和DNA完整性等。精液中存在PMNE抑制剂,可与PMNE形成复合物,两者比例的失衡可以促进慢性炎症的发生,进而可能导致男性不育。检测精液PMNE的方法主要为酶免疫分析法,但检测方法仍需标准化,诊断标准尚需统一。     

精子凋亡率与精子密度、活率、活力及活性氧关系探讨

目的 探讨精子凋亡率与精子密度、活率、活力与精浆活性氧关系.方法 分析85例男性不育患者精液样本,采用计算机辅助精液分析进行精液参数检测,采用Annexin V/PI染色法检测精子凋亡率,采用TBA法测定精浆活性氧.结果 精子凋亡率与精子密度之间有显著负相关性(P＜0.01);与精子活率之间无显著相关性(P＞0.05):与精子活力之间有显著负相关性(P＜0.05);与精浆活性氧之间有显著正相关性(P＜0.05).结论 精子捌亡率与精子密度和活力有相关性,精子凋亡率增加可能是少、弱精子症患者不育的原因之一,精浆活性氧升高可能是精子凋亡率增加的原因之一.     

精浆酸性磷酸酶和γ-L-谷氨酰转肽酶检测的比较及其与精液参数的相关性研究

目的:对精浆酸性磷酸酶(ACP)和γ-L-谷氨酰转肽酶(γ-GT)活性检测进行比较,并分析ACP和γ-GT活性与精液参数的相关性。方法:133例精浆标本,分别检测ACP活性和γ-GT活性。随机留取2例精浆标本,1例用于ACP批内检测,另1例用于γ-GT批内检测。随机留取4例标本,2例用于ACP批间检测,另2例用于γ-GT批间检测。用计算机辅助的精液分析(CASA)系统分析精液标本的精液量、pH、精子密度、活动率、a+b级活动精子百分率等参数。同时分析ACP和γ-GT活性与精液参数的相关性。结果:精浆ACP活性和γ-GT活性呈显著性正相关(r=0.570,P=0.000)。ACP的批内变异系数(CV)为13.72%,批间CV分别为13.80%和15.49%。γ-GT批内CV为7.68%,批间CV分别为7.76%和9.73%。精浆ACP活性和γ-GT活性均与pH值呈显著负相关(r=-0.330,P=0.000;r=-0.388,P=0.000)。γ-GT活性与精子密度呈显著正相关(r=0.165,P=0.045),而ACP活性与精子密度无显著相关(r=0.048,P=0.546)。ACP活性和γ-GT活性均与精子活动率、(a+b)级活动精子百分率、精液量、禁欲时间以及年龄无显著相关性。结论:精浆γ-GT活性检测的精确性高于ACP活性检测,两者与精液参数的相关性基本类似。提示精浆γ-GT活性检测比ACP活性检测更适合用来评价前列腺功能。     

Ⅲ型前列腺炎患者精液参数、锌浓度及抗菌活性的变化

目的:探讨Ⅲ型前列腺炎(CP/CPPS)患者精液常规参数、锌浓度及抗菌活性的关系。方法:对60例CP/CPPS患者和20例健康男性进行精液常规参数、锌浓度及抗菌活性的检测。结果:CP/CPPS患者精液液化时间、精子活力、精浆抗菌活性及精浆锌离子浓度与对照组相比,差异有显著性(P均<0.01)。CP/CPPS患者精子活力与精浆锌离子浓度间有显著相关性(r=0.272,P=0.015)。精浆抗菌活性与精浆锌离子浓度间有显著相关性(r=0.449,P<0.01)。结论:CP/CPPS患者精液液化时间延长,精子活力下降,精浆锌浓度和抗菌活性降低。精浆抗菌活性与精浆锌浓度、精子活力间有显著相关性。     

精浆弹性蛋白酶水平与精液主要参数和精子功能的相关性分析

目的:探讨精浆弹性蛋白酶与精液主要参数和指标的关系。方法:用酶联免疫吸附法(ELISA)检测精浆中的弹性蛋白酶,按照WHO人类精液实验室手册要求进行精液常规分析、精子形态分析,检测精子顶体酶活性、精浆抗体(AsAb)、解脲支原体等,分析弹性蛋白酶与男性不育相关因素的关系。结果:209例男性不育患者中,43例患者精浆弹性蛋白酶≥290ng/ml,设为炎症组;166例患者精浆弹性蛋白酶<290ng/ml,设为非炎症组。炎症组的精子密度、精子活动率、a+b级活力精子率、精子顶体酶阳性率均低于非炎症组(P<0.05);而精子畸形率、精浆抗体(AsAb)、解脲支原体阳性率均高于非炎症组(P<0.05)。两组的精液量、PH值和液化时间差异无统计学意义。结论:精浆弹性蛋白酶水平与精液质量有密切的关系,生殖道感染是导致男性不育的重要原因。     

人精浆中端粒酶活性测定及其临床意义

目的 观察精浆端粒酶活性(TA)在不同类型男性不育症患者中的变化,以及与精浆生殖激素浓度、精液中精子数量和质量之间的相互关系.方法 随机选取110例男性不育症患者与30例生育者,应用酶联免疫吸附(ELISA)方法,对其精浆TA进行检测;应用放射免疫分析(RIA)方法对其精浆T、FSH、LH浓度进行检测;按WHO规定的方法,定量分析精液中的精子密度、精子活率、(a+b)级精子活力百分率、精液中白细胞数量.结果 不育症组精浆TA和T浓度均明显低于生育组(P均<0.01);不育症组精浆FSH和LH浓度均明显高于生育组(P均<0.05).在不育症组中,随着精液中精子数量的递减,TA水平亦呈现明显的逐渐下降趋势;精浆中TA与T浓度之间存在明显的相关性(P<0.01),.与FSH和LH浓度之间无相关性(P>0.05);精子活力、活率正常组精浆TA均高于不良组(P<0.01);WBC精液组精浆TA高于非WBC精液组(P<0.05).结论 精浆TA水平与精子数量和质量存在一定的相关性,同时与精子发育密切相关的睾酮浓度有协同促进作用,端粒酶在人类生殖发育中发挥着重要作用.检测精浆TA水平对于进一步了解、预防和治疗某些病理状态下所致的生殖能力低下有重要意义.     

男性超体质量与精液参数及精浆TNF-α、IL-6水平的相关性

目的检测超体质量男性精浆中细胞因子TNF-α、IL-6水平含量,探讨其水平改变与超体质量的相关性及其对精液质量各参数的影响。方法从上海交通大学医学院附属瑞金医院生殖医学中心门诊就诊的男性患者中选取25例为超体质量组;另选取正常健康男性25例为对照组。对两组精液质量进行分析,用ELISA法检测精浆中TNF-α、IL-6水平含量。结果对照组精液体积、前向运动精子及正常形态精子都明显高于超体质量组(P0.01);对照组精液浓度高于超体质量组,但无统计学意义。对照组精浆IL-6、TNF-α水平明显著低于超体质量组(P0.01)。精浆IL-6、TNF-α均与体质量指数(BMI)呈正相关性(P0.01),前向运动精子、精液体积和正常形态精子均与BMI呈负相关(P0.01),TNF-α、IL-6与正常形态精子之间呈负相关(P0.05)。结论男性超体质量患者精浆TNF-α、IL-6水平显著增加,其产生的毒性作用可引起精子形态和功能的改变,继而导致男性不育的发生。检测精浆中TNF-α、IL-6水平可为临床分析超体质量或肥胖所导致男性不育的病理机制提供重要的诊断依据。     

真菌对自然杀伤细胞内干扰素-γ和白细胞介素-4表达的影响

目的 探讨烟曲霉、白假丝酵母菌的不同菌体形态对脐血来源细胞因子诱导自然杀伤(NK)细胞内干扰素(IFN)-γ和白细胞介素(IL)-4表达的影响.方法 将NK细胞与真菌(烟曲霉孢子或菌丝、白假丝酵母菌孢子或菌丝)按10∶1的比例直接混合或隔离培养分为若干实验组,另设一个NK细胞空白对照组.培养6h后通过流式细胞仪检测各组NK细胞内IFN-γ和IL-4的表达.采用方差分析或SNK-q检验比较各组间IFN-γ和IL-4的表达.结果 空白对照组NK细胞内IFN-γ的表达率为(15.11±2.60)％,NK细胞与烟曲霉菌丝、白假丝酵母菌孢子和菌丝直接接触后细胞内IFN-γ的表达率分别为(20.12±0.53)％,(20.69±0.34)％,(20.8±0.37)％,间接接触后细胞内IFN-γ的表达率分别为(21.40±0.53)％,(20.57±1.09)％,(20.20 ±0.51)％,细胞内IFN-γ的表达较空白对照组显著升高(P均＜0.01);而NK细胞与烟曲霉孢子直接、间接接触作用后细胞内IFN-γ的表达率分别为(14.33±0.98)％,(14.97±1.53)％,与对照组比较差异无统计学意义(P值均＞0.05).空白对照组NK细胞内IL-4的表达率为(1.23±0.05)％,NK细胞与烟曲霉孢子和菌丝、白假丝酵母菌孢子和菌丝直接接触后细胞内IL-4的表达率分别为(1.25±0.06)％,(1.21±0.03)％,(1.22±0.46)％,(1.26±0.1 1)％,间接接触后细胞内IL-4的表达率分别为(1.21±0.06)％,(1.25±0.04)％,(1.27±0.03)％,(1.26±0.1)％,真菌刺激对NK细胞胞内IL-4的表达无显著影响(P值均＞0.05).结论 真菌刺激可抑制NK细胞胞内IFN-γ的释放,但对IL-4的释放无显著影响.     

miR-34b在男性不育患者精浆中的表达及其临床意义

目的研究精浆游离miR-34b在体外不同条件下的稳定性及其与男性不育症患者精液参数的关系。方法选取男性不育症患者80例和同期因女方因素不孕前来检查的生育力评估正常的健康男性20例为正常对照组,将8例正常的精液标本分别在室温和-80℃下放置,以不同时间点检测精浆miR-34b的稳定性。采用实时荧光定量PCR检测精浆游离miR-34b的相对含量,精子浓度及精子活力用计算机辅助精子分析系统,精子存活率采用低盐膨胀实验检测,正常精子形态百分率采用Diff-Quick染色法。分析男性不育症组和正常对照组精液参数及miR-34b表达量的差异,对精浆游离rniR-34b在男性不育组精浆中的诊断价值进行ROC曲线分析,并采用Pearson直线相关分析miR-34b与男性不育组精液各参数的相关性。结果精浆游离miR-34b在室温和低温下不同时间点表达量无明显变化(F=0.13,P=0.97;F=0.35,P=0.84)。与正常组比较发现,男性不育组精浆游离miR-34b表达下调(P0.01)。两组的精子浓度、精子存活率、前向运动精子百分率(PR)和正常形态精子百分率均有差异(P0.01)。ROC曲线显示miR-34b能够较好的区分不育组与健康对照组,曲线下面积分比(AUC)为0.85(0.79-0.95,95%)。Pearson直线相关分析发现男性不育患者精浆miR-34b表达量与精子密度(r=0.28,P0.05)、精子活率(r=0.56,P0.01)、前向运动精子百分率(r=0.41,P0.01)正相关,与精子形态无相关性(r=O.15,P0.05)。结论精浆miR-34b在室温下稳定,并能在-80℃条件下长期保存,在男性不育患者精浆中表达下调,并与精子浓度、精子存活率、前向运动精子百分率呈正相关,与精子形态无相关性。     

特发性弱精子症患者血清及精浆瘦素水平与精子活动力的关系

目的 通过研究特发性弱精子症(idiopathic asthenospermia,IAS)患者以及精液参数正常人群的血清、精浆瘦素,探讨瘦素与精子运动能力的关系.方法 IAS患者54例及精液参数正常者30例作为对照.常规CASA精液分析,放射免疫法检测血清及精浆瘦素.结果 排除体重指数差异的影响,(IAS患者与精液参数正常者体重指数比较差异无统计学意义,P>0.05),IAS患者血清瘦素水平与正常对照差异无统计学意义(P>0.05),而IAS患者精浆瘦素显著高于正常对照(P<0.05);精子活动率及精子活力与血清瘦素水平之间均无显著相关性(r=-0.213,P=0.249及r=-0.167,P=0.154),IAS患者的精子活动率及活力与精浆瘦素水平显著负相关(r=-0.31,P=0.034及r=-0.47,P=0.025).结论 IAS患者精浆瘦素水平显著增高,可能对精子运动能力有调控作用.     

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.