Fibrosis Progression According to Epithelial‐Mesenchymal Transition Profile: A Randomized Trial of Everolimus Versus CsA

Markers of epithelial‐mesenchymal transition (EMT) may identify patients at high risk of graft fibrogenesis who could benefit from early calcineurin inhibitor (CNI) withdrawal. In a randomized, open‐label, 12‐month trial, de novo kidney transplant patients received cyclosporine, enteric‐coated mycophenolate sodium (EC‐MPS) and steroids to month 3. Patients were stratified as EMT+ or EMT? based on month 3 biopsy, then randomized to start everolimus with half‐dose EC‐MPS (720 mg/day) and cyclosporine withdrawal (CNI‐free) or continue cyclosporine with standard EC‐MPS (CNI). The primary endpoint was progression of graft fibrosis (interstitial fibrosis/tubular atrophy [IF/TA] grade increase ≥1 between months 3–12) in EMT+ patients. 194 patients were randomized (96 CNI‐free, 98 CNI); 153 (69 CNI‐free, 84 CNI) were included in histological analyses. Fibrosis progression occurred in 46.2% (12/26) CNI‐free EMT+ patients versus 51.6% (16/31) CNI EMT+ patients (p = 0.68). Biopsy‐proven acute rejection (BPAR, including subclinical events) occurred in 25.0% and 5.1% of CNI‐free and CNI patients, respectively (p < 0.001). In conclusion, early CNI withdrawal with everolimus initiation does not prevent interstitial fibrosis. Using this CNI‐free protocol, in which everolimus exposure was relatively low and administered with half‐dose EC‐MPS, CNI‐free patients were overwhelmingly under‐immunosuppressed and experienced an increased risk of BPAR.

     

高压氧治疗对阿尔茨海默病大鼠海马内神经元凋亡及p38丝裂原蛋白激酶表达的影响

目的 评价高压氧治疗对阿尔茨海默病(alzheimer's disease,AD)大鼠海马内神经元凋亡及p38丝裂原蛋白激酶(p38 mitogenactivated protein kinases,p38MAPK)表达的影响. 方法 18只雄性SD大鼠,体重260 g～290 g,采用随机数字表法分为3组(每组6只):生理盐水组(NS组),海马区注射生理盐水;阿尔茨海默病组(AD组),海马区注射Aβ1-40;高压氧组(HBO组),海马区注射Aβ1-40,并于术后1 d～7d行每天1次的高压氧治疗.应用脑立体定位仪于大鼠海马区注射Aβ1-40制备AD模型.于术前1d和术后1、7、14、21 d行水迷宫行为学测试.于术后21 d水迷宫行为学测试结束后处死大鼠,采用苏木精-伊红染色(hematoxylin-eosin,HE)方法染色海马组织病理结构,TUNEL法标记检测凋亡细胞,免疫印迹法(Western bolt)法测定海马内p38MAPK蛋白磷酸化水平. 结果 术后21 d时,与NS组比较,AD组大鼠上台前路程和逃避潜伏期增加[(379±41)、(1 978±120) cm,(16.0±2.8)、(78.4±10.8)s](P＜0.05);与AD组比较,HBO组大鼠上台前路程和逃避潜伏期减少[(1978±120)、(1 246±96) cm,(78.4±10.8)、(51.7±6.2)s](P＜0.05).与NS组比较,AD组和HBO组大鼠海马组织细胞凋亡率[(6.3±13)％,(45.2±5.1)％]及p38MAPK蛋白磷酸化表达升高(0.16±0.06),(0.54±0.10)(P＜0.05);与AD组比较,HBO组海马组织细胞凋亡率[(45.2±5.1)％,(22.5±3.7)％]及p38 MAPK蛋白磷酸化表达下降[(0.54±0.10),(0.31±0.08)](P＜0.05).结论 高压氧治疗可有效缓解AD大鼠认知功能障碍,且能够抑制海马内神经元凋亡,其机制与降低p38MAPK的磷酸化水平有关.     

“J”状塑型双腔气管导管插管操作对成功率及术后声音嘶哑、咽喉痛的影响

目的 观察双腔气管导管(double-lumen endotracheal tube,DLT)塑型对插管成功率及术后声音嘶哑(声嘶)、咽喉痛的影响,从而为寻求更好的DLT塑型插管提供依据. 方法 择期全身麻醉下行胸科手术患者160例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,参照随机数字表法分成DLT插管塑型组和非塑型组(每组80例),两组根据左右DLT插管各分为两组(A、B、C、D组,每组40例),又根据性别再各分为两个亚组(A1、A2、B1、B2、C1、C2、D1、D2组,每组20例).两组均采用经口明视气管插管,塑型组采用塑成“J”状的DLT进行插管,非塑型组采用未经塑型保留原有弯度的DLT进行插管.观察DLT插管时间、插管尝试次数及插反情况,患者术后声嘶、咽喉痛发生率及严重程度. 结果 塑型组插管时间[(154±6)s]明显短于非塑型组[(185±13)s](P＜0.05);塑型组插管尝试次数[(1.4±0.4)次]明显少于非塑型组[(1.7±0.8)次](P＜0.05);塑型组插反情况(3次)明显比非塑型组少(11次)(P＜0.05),且与性别无关,但左DLT比右DLT易于插反(P＜0.05).患者术后声嘶发生率塑型组(15/80)明显低于非塑型组(33/80)(P＜0.05);患者术后咽喉痛发生率塑型组(15/80)明显低于非塑型组(31/80) (P＜0.05),且与性别有关,女性较男性术后易发生声嘶、咽喉痛. 结论 “J”状DLT塑型插管成功率高、刺激小,可降低患者术后声嘶、咽喉痛发生率,具有一定的临床推广意义.     

精囊镜治疗21例顽固性血精的疗效分析

目的探讨应用精囊镜治疗顽固性血精的临床疗效。方法自2011年10月至2013年2月,广东医学院第二附属医院对21例顽固性血精患者行精囊镜检查,入院前血精时间超过半年,经过中西医药物治疗和物理治疗,症状反复出现,入院后行超声及CT排除前列腺肿瘤,使用Wolf 7.5 F输尿管硬镜行精囊镜检查,术后静脉使用抗生素治疗及留置尿管。结果 21例手术均成功,其中4例需使用电切镜切开精阜暴露射精管,手术时间20~43 min,平均25 min,1例术后出现发热,无附睾炎、尿道损伤、直肠损伤、逆行性射精等严重并发症,16例在精囊镜检查后3个月内血精完全消失,3例术后使用中药及抗生素治疗后血精消失,2例仍反复血精。结论采用精囊镜对一些久治不愈的血精患者进行检查和治疗,既可以明确诊断,又可以对精囊进行冲洗,结合药物治疗,具有创伤小、效果好、并发症少等优点,是治疗顽固性血精的有效方法之一。     

Perioperative corticosteroids administration as a risk factor for pressure ulcers in cardiovascular surgical patients: a retrospective study

The aim of this study was to investigate the relationship between perioperative corticosteroids administration and the incidence of pressure ulcers (PUs) in cardiovascular surgical patients. A retrospective analysis was performed on data from consecutive patients who had cardiac surgery in 2012. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between perioperative corticosteroid administration and the incidence of surgery‐related PU (SRPU). A total of 286 cardiac surgery patients were included in this study; of these, 47 patients developed 57 SRPUs, an incidence of 16·4% [95% confidence interval (CI): 12·3–21·2%). The SRPU incidence was significantly higher in corticosteroid‐administered group compared with groups not receiving corticosteroids (43·8% versus 14·8%, Pearson's χ² = 9·209, P = 0·002). The crude odds ratio (OR) was 4·472 (95% CI: 1·576–12·694). After performing multivariate logistic regression analysis, the adjusted OR was 2·808 (95% CI: 1·062–11·769). This result showed that perioperative corticosteroid administration was an independent risk factor for PUs in cardiovascular surgical patients. Therefore, it is recommended that in order to prevent PU perioperative corticosteroids should be administered with caution to cardiovascular surgical patients.     

Lumpy Skin Disease in Iraq: Study of the Disease Emergence

This study intends to report the first emergence of lumpy skin disease (LSD) in Iraq, in addition to describing its related clinical signs. In August 2013, 21 cases of four outbreaks developed clinical signs suggestive of LSD in the Nineveh (Mosul) and Baghdad Governorates, which were considered as the first infected foci of LSD in Iraq. The disease was diagnosed tentatively, on the basis of clinical signs and epidemiological features, and it was confirmed as positive by the polymerase chain reaction and histopathological features. In September 2013, eight new outbreaks of LSD also appeared in Baghdad and Nineveh. In 2014, the disease spread rapidly to the governorates of Kirkuk, Salah Al‐Din, Al‐Anbar, Diyala, Wasit, Babil, Karbala, Najaf, Al‐Diwaniyah, Muthanna, Maysan, DhiQar and Basra. The total number of infected cows and calves reported was 7396 and 227, respectively. The apparent morbidity and mortality rates were 9.11% and 0.51%, respectively, while the apparent case‐fatality rate was 5.56%. Skin nodules, anorexia, reduce in milk production and decrease in bodyweight were the common clinical signs. Moreover, myiasis and mastitis were seen as complications in some infected animals. Attempts were made to stop the distribution of the disease including quarantine and treatment, control over animal movement and arthropod control. Ring vaccination was used in a 10 km radius zone around the outbreak with live sheep pox vaccine. The highly contagious transboundary nature of the LSD, its endemic distribution in the Iraqi neighbouring countries, and the current armed conflict in the area were the possible factors for the disease being introduced into the country. LSD had spread through the Middle East and Gulf peninsula and could be a cause of danger to the rest of Asia and Europe. International precaution, cooperation and exchange of information could guarantee the prevention and further spread of the disease to the rest of Asia and Europe.