艾瑞昔布超前镇痛用于脊柱手术对患者术后镇痛效果的影响

目的观察艾瑞昔布超前镇痛用于脊柱手术对患者术后镇痛效果的影响。方法选取本院2017年3月～2018年3月收治的110例脊柱手术患者,按随机数表法分为观察组与对照组,各55例。观察组术前30 min口服100 mg的艾瑞昔布,对照组口服相同剂量的安慰剂。术毕予负荷剂量的芬太尼0.001 mg/kg。比较两组术后6 h与12 h的疼痛程度[采用视觉模拟评分法(VAS)评估]、镇静效果(采用Ramesay评分法评估)、芬太尼消耗量、自控按压总次数、不良反应总发生率。结果观察组术后6 h与术后12 h的术后疼痛VAS评分分别为(2.80±0.82)分与(1.85±0.45)分,低于对照组的(3.15±0.91)分与(2.32±0.64)分;观察组的镇静Ramesay评分分别为(2.28±0.59)分与(2.06±0.58)分,低于对照组的(2.63±0.71)分与(2.33±0.70)分,差异有统计学意义(P0.05)。观察组术后0～6 h、6～12 h、12～24 h的芬太尼消耗量及自控按压总次数均低于对照组(P0.05)。观察组的不良反应总发生率为7.27%,低于对照组的21.82%(P0.05)。结论脊柱手术患者采用艾瑞昔布进行超前镇痛可获得良好的术后镇痛效果与镇静效果,芬太尼用量与不良反应均明显减少,具有较高的有效性与安全性,值得推广。     

Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratoma

A case report is presented of a rapidly growing congenital nasopharyngeal teratoma (epignathus) in a preterm infant, leading to severe upper airway obstruction. Prenatal diagnosis by ultrasonography did not reveal the condition because the tumour masses were initially small and there was no polyhydramnios. Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period and should be treated surgically.
Conclusion:  Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period.     

T-, B- and NK-lymphoid, but not myeloid cells arise from human CD34(+)CD38(-)CD7(+) common lymphoid progenitors expressing lymphoid-specific genes.

Hematopoietic stem cells in the bone marrow (BM) give rise to all blood cells. According to the classic model of hematopoiesis, the differentiation paths leading to the myeloid and lymphoid lineages segregate early. A candidate 'common lymphoid progenitor' (CLP) has been isolated from CD34(+)CD38(-) human cord blood cells based on CD7 expression. Here, we confirm the B- and NK-differentiation potential of CD34(+)CD38(-)CD7(+) cells and show in addition that this population has strong capacity to differentiate into T cells. As CD34(+)CD38(-)CD7(+) cells are virtually devoid of myeloid differentiation potential, these cells represent true CLPs. To unravel the molecular mechanisms underlying lymphoid commitment, we performed genome-wide gene expression profiling on sorted CD34(+)CD38(-)CD7(+) and CD34(+)CD38(-)CD7(-) cells. Interestingly, lymphoid-affiliated genes were mainly upregulated in the CD7(+) population, while myeloid-specific genes were downregulated. This supports the hypothesis that lineage commitment is accompanied by the shutdown of inappropriate gene expression and the upregulation of lineage-specific genes. In addition, we identified several highly expressed genes that have not been described in hematopoiesis before.     

Atlanto-axial rotatory fixation: Improved demonstration using spiral CT

Atlanto-axial rotatory fixation (AARF) is an uncommon condition which is often missed at presentation because of its rarity and the relative subtlety of plain film X-ray findings, but early detection and appropriate management are vital for a cure. We describe three cases in which the use of spiral computed tomography scanning with 3D and sagittal reconstructions greatly aided diagnosis and management. The 3D images gave a more graphic picture of the overall alignment of the upper cervical spine and the skull base, while the sagittal reconstructions demonstrated the presence or absence of compensatory atlanto-occipital subluxation. The literature is briefly reviewed.     

Staphylococci resistant to antibiotic therapy

Increasing frequency in antibiotic resistance in Staphylococcus aureus is worrying. In this review, we briefly describe the mechanisms of resistance to antibiotics in staphylococci and we report the current incidence of antibiotic resistance in France. Methicillin-resistance is mostly confined to hospitals. However, spread of multiply resistant strains of staphylococci to the community is a putative threat. Strains with diminished susceptibility to glycopeptides are rare but possibly underestimated because of the in vitro difficulties to detect glycopeptide resistance. A continuous resistance survey is necessary. The problem of multiresistance is different for hospital and community staphylococci. The later strains still remain susceptible to many antibiotics, apart from some exceptions. By contrast, incidence of multiply resistance in hospitals remains high. After a recent decrease, incidence of oxacillin resistance seems to be stabilized. A new and recent feature is the great variety of resistance phenotypes which can be found in methicillin-resistant strains, in particular with gentamicin susceptibility.