术前全身免疫炎症指数评价上尿路上皮癌患者术后膀胱复发风险的价值

目的探讨术前全身免疫炎症指数(SII)对上尿路上皮癌(UTUC)根治术后膀胱复发的预测价值。方法收集宁夏医科大学总医院泌尿外科收治的110例UTUC患者临床资料。采用ROC曲线确定SII预测膀胱内复发风险的截断值,比较不同SII患者的临床病理资料及无复发生存期(RFS)。采用Cox比例风险回归分析影响UTUC术后膀胱复发的影响因素。结果ROC曲线显示,SII对UTUC患者RFS评价的曲线下面积为0.688,最佳截断值为410.3×10⁹。肿瘤T分期、淋巴结转移是影响UTUC患者SII的主要危险因素(P<0.05)。SII<410.3×10⁹组与SII≥410.3×10⁹组的膀胱内复发率分别为10.5%、41.5%,Kaplan-Meier生存曲线显示,SII≥410.3×10⁹组患者RFS显著差于SII<410.3×10⁹组(P=0.000)。Cox比例风险回归显示术前肾积水、术前SII是影响UTUC患者术后膀胱复发的独立危险因素。结论术前SII作为一种炎症指标,可用于评价UTUC根治术后膀胱内复发的风险。     

Ⅱ-Ⅲ期结肠癌根治术后复发危险因素分析及其列线图预测模型的应用价值

目的探讨Ⅱ~Ⅲ期结肠癌根治术后复发危险因素及其列线图预测模型的应用价值。方法采用回顾性病例对照研究方法。收集2013年1月至2016年6月西安交通大学第一附属医院收治的228例行根治性切除术治疗Ⅱ~Ⅲ期结肠癌病人的临床病理资料;男118例,女110例;中位年龄为62岁,年龄范围为25~87岁。所有病人行开腹或腹腔镜辅助结肠癌根治性切除术。观察指标:(1)术后复发情况。(2)影响Ⅱ~Ⅲ期结肠癌根治术后复发的危险因素分析。(3)Ⅱ~Ⅲ期结肠癌根治术后复发列线图预测模型的构建及评价。采用门诊或电话方式进行随访,了解病人术后3年复发情况。随访时间截至2019年6月。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用Pearsonχ2检验或Fisher确切概率法。多因素分析采用Logistic逐步回归分析。将独立危险因素引入R 3.6.1软件,构建列线图预测模型。绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价列线图预测模型的区分度。使用R软件绘制校准度曲线图评价列线图预测模型的一致性。结果(1)术后复发情况:228例病人中,53例术后复发,其中局部复发19例,远处转移34例。34例远处转移病人中,肝转移14例、肺转移7例、脑转移4例、多发转移及其他部位单发转移9例。53例病人术后复发时间为12个月(6~19个月)。(2)影响Ⅱ~Ⅲ期结肠癌根治术后复发的危险因素分析:单因素分析结果为肠梗阻、术前癌胚抗原(CEA)、腹腔积液、血管侵犯是影响Ⅱ~Ⅲ期结肠癌根治术后复发的相关因素(χ²=4.463、13.622、10.914、5.911,P<0.05)。病理学N分期是影响Ⅱ~Ⅲ期结肠癌根治术后复发的相关因素(P<0.05)。多因素分析结果显示:术前CEA>5μg/L、腹腔积液、血管侵犯、病理学N分期为N1期或N2期是影响Ⅱ~Ⅲ期结肠癌根治术后复发的独立危险因素(优势比=3.129,3.071,7.634,3.439,15.467,95%可信区间为1.328~7.373,1.047~9.007,1.103~52.824,1.422~8.319,3.498~68.397,P<0.05)。(3)Ⅱ~Ⅲ期结肠癌根治术后复发列线图预测模型的构建及评价:根据多因素分析结果,将术前CEA、腹腔积液、血管侵犯及病理学N分期引入R 3.6.1软件,构建Ⅱ~Ⅲ期结肠癌根治术后复发的列线图预测模型。术前CEA>5μg/L的列线图评分为41.7分,腹腔积液为41.0分,血管侵犯为74.2分,病理学N分期N1期为45.1分、N2期为100.0分,各项危险因素不同取值得分总和对应术后复发概率。绘制ROC评价列线图预测Ⅱ~Ⅲ期结肠癌根治术后复发的能力,其AUC为0.805(95%可信区间为0.737~0.873,P<0.05)。校准曲线图显示Ⅱ~Ⅲ期结肠癌根治术后列线图模型预测复发概率与实际复发概率具有较好一致性。结论术前CEA>5μg/L、腹腔积液、血管侵犯、病理学N分期为N1或N2期是Ⅱ~Ⅲ期结肠癌根治术后复发的独立危险因素;以此构建列线图预测模型有助于预测Ⅱ~Ⅲ期结肠癌根治术后复发风险。     

胸腺瘤患者预后列线图预测模型的建立和验证北大核心CSCD

目的探讨影响胸腺瘤切除术后患者预后的危险因素, 利用列线图建立胸腺瘤患者无进展生存预测模型。方法回顾性分析2010年1月至2019年12月期间在北京同仁医院行胸腺瘤切除术的267例患者的临床病历资料, 对可能影响无进展生存期(PFS)的相关因素进行单因素和多因素Cox回归分析, 利用筛选出的独立危险因素建立胸腺瘤切除术后患者PFS的列线图预测模型, 评价模型的预测能力。结果单因素Cox回归分析结果显示, 年龄、手术方式、切除完整程度、WHO病理分型、TNM分期、术后辅助治疗与胸腺瘤患者术后PFS显著相关(P<0.05)。多因素Cox回归分析结果显示, 仅年龄和TNM分期是影响胸腺瘤患者术后PFS的独立危险因素(P<0.05)。在此基础上建立的胸腺瘤患者预后的列线图预测模型的一致性指数(C-index)为0.866(95%CI:0.809~0.923), 该模型具有显著的预测效能。结论本研究建立并验证了基于年龄和TNM分期构建的列线图预测模型, 排除了其他临床病理因素对预后评估的干扰, 便于临床医师对胸腺瘤切除术后患者预后进行快速个体化评估。     

胸腺瘤患者预后列线图预测模型的建立和验证

目的探讨影响胸腺瘤切除术后患者预后的危险因素, 利用列线图建立胸腺瘤患者无进展生存预测模型。方法回顾性分析2010年1月至2019年12月期间在北京同仁医院行胸腺瘤切除术的267例患者的临床病历资料, 对可能影响无进展生存期(PFS)的相关因素进行单因素和多因素Cox回归分析, 利用筛选出的独立危险因素建立胸腺瘤切除术后患者PFS的列线图预测模型, 评价模型的预测能力。结果单因素Cox回归分析结果显示, 年龄、手术方式、切除完整程度、WHO病理分型、TNM分期、术后辅助治疗与胸腺瘤患者术后PFS显著相关(P<0.05)。多因素Cox回归分析结果显示, 仅年龄和TNM分期是影响胸腺瘤患者术后PFS的独立危险因素(P<0.05)。在此基础上建立的胸腺瘤患者预后的列线图预测模型的一致性指数(C-index)为0.866(95%CI:0.809～0.923), 该模型具有显著的预测效能。结论本研究建立并验证了基于年龄和TNM分期构建的列线图预测模型, 排除了其他临床病理因素对预后评估的干扰, 便于临床医师对胸腺瘤切除术后患者预后进行快速个体化评估。     

脐尿管癌生存的预测模型和改良分期系统的构建：基于SEER数据库的真实世界研究

目的:基于SEER数据库构建并验证脐尿管癌患者的预后列线图模型并建立改良的分期系统。方法:回顾性检索2010—2018年脐尿管癌患者的临床信息,将患者队列随机以6:4比例分配为训练队列和验证队列。在单因素、多因素Cox回归分析以及双向逐步回归分析的基础上,筛选出独立危险因素并建立列线图。分别采用C指数、受试者工作特征(receiver operating characteristic, ROC)曲线和曲线下面积(area under curve, AUC)值、校准曲线、决策曲线分析(decision curve analysis, DCA)来验证列线图预测准确性。最后使用患者新列线图的评分结合生存信息建立新的分期系统。结果:共筛选出413例患者,分为训练队列247例,验证队列166例。经单因素、多因素Cox回归分析和双向逐步回归分析后,确定年龄、N分期、M分期、Mayo分期及Sheldon分期为脐尿管癌的独立预后因素(P<0.05),其中Mayo分期与Sheldon分期二者呈线性相关,因此分别以二者为基础建立列线图预测模型,C指数分别为0.71±0.02、0.71±0.02。对于...     

术前丙氨酸氨基转移酶与天冬氨酸氨基转移酶比值作为胰腺癌根治性胰十二指肠切除术预后标志物的临床研究

目的评估天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值(DRR)对于接受根治性胰十二指肠切除术的胰腺导管腺癌(PDAC)患者术后总生存的预测价值。方法回顾性分析2015年1月至2020年12月于解放军总医院行根治性胰十二指肠切除术且术后病理诊断为PDAC的137例患者临床资料, 其中男性97例, 女性40例, 年龄(58±10)岁。根据DRR最佳生存风险截断值将患者分组, 比较关键临床病理指标的组间差异。采用Kaplan-Meier法进行生存分析, 生存率比较采用log-rank检验。采用多因素Cox分析评估影响预后的危险因素。结果将137例PDAC患者依据DRR最佳截断值1.1分为两组:DRR≥1.1为高DRR组(n=29);DRR<1.1为低DRR组(n=108)。低DRR组患者累积生存率优于高DRR组, 差异有统计学意义(P=0.003)。多因素Cox回归分析结果显示, DRR≥1.1(HR=2.485, 95%CI:1.449～4.261, P=0.001)、术前胆道引流(HR=1.845, 95%CI:1.030～3.306, P=0.039)、淋巴结转移N2分期(HR=2....     

肿瘤突变负荷在评价肝细胞癌预后中的价值和应用

目的：探讨肿瘤突变负荷（TMB）在评价肝细胞癌（HCC）预后中的价值，并建立应用模型。方法：纳入HCC患者107例，根据时间依赖性受试者工作特性（ROC）曲线及曲线下面积（AUC）确定TMB截断值。Cox回归分析TMB与总生存期（OS）的相关性。Kaplan-Meier法构建生存曲线，根据Cox回归分析结果构建列线图预后预测模型，通过校准曲线和决策曲线分析（DCA）验证列线图模型的可靠性。结果：根据时间依赖性ROC曲线和AUC确定TMB最佳截断值为3.3 mut/Mb。Kaplan-Meier结果显示，TMB高的患者OS较差[HR=1.68(1.09,2.59),P=0.020];Cox多因素回归分析结果显示，TMB是HCC的独立预后因子[HR=1.81(1.14,2.87),P=0.011]。将HCC独立预后因子（微血管侵犯、肿瘤转移、TMB）纳入列线图预后预测模型的构建，一致性指数为0.692(0.661,0.724)，校准曲线和DCA证实预后预测模型准确性良好。结论：TMB是HCC的独立预后因子，高TMB患者预后较差；以TMB等独立预后因子建立的预后预测模型准确性良好，有较高的临...     

冠状动脉造影或经皮冠状动脉介入术前患者临床列线图预测术后发生对比剂急性肾损伤的风险

目的构建接受冠状动脉造影(CAG)或经皮冠状动脉介入(PCI)治疗患者术前临床指标的列线图,据此预测术后发生对比剂急性肾损伤(CI-AKI)的风险。方法收集245例接受CAG或PCI治疗患者的术前临床资料。采用LASSO回归方法筛选与CI-AKI相关的临床特征,据以构建列线图预测模型,计算CI-AKI风险分数。绘制ROC曲线,计算风险评分临界值。结果 245例中,34例(34/245,13.88%)发生CI-AKI。LASSO回归分析显示性别、糖尿病史、乳酸脱氢酶水平、超敏C反应蛋白,饮酒年限、慢性肾脏病及其分期、脑卒中史、急性心肌梗死及收缩压是CI-AKI风险评分和预测模型的危险因素。CI-AKI列线图预测效能较好,其风险评分临界值为-1.953。结论列线图可用于术前预测患者接受CAG或PCI治疗后发生CI-AKI的风险。     

微乳头状膀胱癌患者预后模型的建立与内部验证

目的:探讨微乳头状膀胱癌(MPBC)患者预后的独立预测因素,并为其建立可以个体化预测预后的列线图模型。方法:回顾性分析SEER数据库中168例MPBC患者的临床资料,采用Kaplan-Meier法计算总体生存率(OS)和癌症特异性生存率(CSS),采用log-rank检验评价生存差异的显著性;采用Cox多因素回归分析确定CSS的独立预测因素,使用R软件整合所有具有独立预测意义的变量生成列线图,并采用Bootstrap法计算C-index、绘制校准曲线对模型进行内部验证。结果:年龄75岁、黑人患者、婚姻状况异常、T_3和T_4期、≥N_1期和M_1期是CSS的独立危险因素;术后盆腔淋巴结清扫是独立保护因素。预测模型可准确预测患者预后,且其区分度优于TNM分期系统(0.745 vs.0.652)。结论:本研究基于SEER数据库建立了国内外首个可以个体化预测MPBC患者预后的列线图模型;且经内部验证,其预测性能良好。列线图模型的建立将有助于设计临床试验并促进医患沟通。     

全身免疫炎症指数联合预后营养指数对接受根治性切除术的肝细胞癌的预后价值研究

目的 探讨联合全身免疫炎症指数（SII）与预后营养指数（PNI）对接受根治性切除术的肝细胞癌患者预后的预测价值。方法 收集2016年10月至2017年9月蚌埠医学院第一附属医院144例行肝细胞癌根治术的患者临床病理资料与随访信息。使用受试者工作特征（ROC）曲线计算SII和PNI的截断值,并依此将患者分为高SII组、低SII组、高PNI组、低PNI组。分析不同SII、PNI分组与临床病理资料之间的关系,通过单因素和Cox多因素回归模型分析探讨与患者手术预后相关的因素。根据SII和PNI表达水平,将患者分为低SII高PNI组、高SII低PNI组,并将高SII高PNI患者和低SII低PNI患者纳入同一组中。采用Kaplan-Meier曲线进行术后1、3、5年生存分析,ROC曲线评估SII、PNI以及SII+PNI对患者手术预后的预测效能。结果 SII的曲线下面积（AUC）为0.778,对应截断值为301.48。PNI的AUC为0.721,对应截断值为47.60。通过对不同组别进行分析表明,SII与肝硬化、甲胎蛋白（AFP）水平、TNM分期和肿瘤直径相关（P<0.05）,PNI与年龄、...     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.