Role of arachidonoylethanolamine in blood pressure regulation in volume-resistant patients on peritoneal dialysis

In this study we explored the possible role of arachidonoylethanolamine (AEA) in regulating blood pressure in patients on continuous ambulatory peritoneal dialysis (CAPD). One hundred and five patients on CAPD were enrolled. Volume status was evaluated by the overhydration (OH) value obtained by bioimpedance analysis. OH?<?2.0?kg was defined as normal volume (NV) and OH????2.0?kg as high volume (HV). Home mean systolic blood pressure <130?mmHg was defined as controlled hypertension (CHT) and ??130?mmHg as uncontrolled hypertension (UHT). The patients were divided into four subgroups: (1) controlled hypertension with normal volume (CHT-NV), (2) controlled hypertension with high volume (CHT-HV), (3) uncontrolled hypertension with normal volume (UHT-NV), and (4) uncontrolled hypertension with high volume (UHT-HV). AEA was measured by ultra performance liquid chromatography-tandem mass spectrometry. AEA was significantly higher in the HV group as compared with the NV group (P?<?0.05). In addition, AEA was also significantly higher in the CHT-HV group as compared with the UHT-NV group (P?<?0.05). These results may suggest a compensatory function of AEA and TRPV1 pathway to lower blood pressure during volume expansion in CAPD patients.     

三磷酸腺苷抑制肿瘤坏死因子-α诱导的肌源性干细胞凋亡及机制

目的 探讨三磷酸腺苷(ATP)对肌源性干细胞(MDSCs)凋亡的抑制作用及其机制.方法 采用差速贴壁法分离新生小鼠MDSCs,利用40μg/L肿瘤坏死因子(TNF)-α诱导MDSCs凋亡,100 μmol/L ATP抑制细胞凋亡.经流式细胞仪检测MDSCs的凋亡率和半胱氨酰天冬氨酸特异性蛋白酶( Caspase) -3/8的表达.结果 TNF-α诱导后,脱壁细胞明显增多,MDSCs的凋亡率由5.17％升至31.58％,增加了5倍,Caspase-3染色阳性细胞率由5.01％增至19.25％,Caspase-8染色阳性细胞率由2.97％增至8.58％.ATP作用后,MDSCs的凋亡率降至12.06％,减少了2/3,Caspase-3染色阳性细胞率降至9.86％,Caspase-8染色阳性细胞率降至6.96％,但仍高于对照组.结论 ATP能抑制MDSCs表达Caspase-3/8,减轻TNF-α诱导的MDSCs凋亡.     

硬膜外麻醉时皮肤电传导变化的临床观察

目的探讨硬膜外麻醉时皮肤电传导(SC)基态值和反应波的变化。方法选择25例ASAⅠ或Ⅱ级下肢手术患者。记录硬膜外给药前(T0)、给予1%利多卡因5ml后5min(T1)、给予0.75%罗哌卡因10ml后5、10、15、25和45min(T2～T6)时的SC基态值(SC0)、针刺非阻滞区SC反应波的振幅差值(SC1)和痛觉阻滞区的SC反应波的振幅差值(SC2)。使用ROC曲线、逻辑回归分析评价SC反应波的振幅差值区分痛觉阻滞区和非阻滞区的准确性。结果与T0时比较,T3～T6时的SC0及SC1的均值明显降低(P<0.05),T1～T6时SC2明显低于SC1(P<0.05)。SC反应波的振幅差值ROC曲线下面积为0.928±0.017(P<0.01),特异性与敏感性分别为78%和88%,预测整体准确率84%。结论 SC基态值及反应波振幅差值的变化对定位硬膜外麻醉平面有一定指导作用。     

血浆置换联合化疗对噬血细胞综合征疗效观察

目的:评价血浆置换联合化疗与单纯化疗对噬血细胞综合征的临床疗效。方法:采用回顾性研究,选取2008-02～2010-03在我院确诊并治疗的21例噬血细胞综合征患者为研究对象,采用单纯化疗(对照组)12例,血浆置换联合化疗(实验组)12例,观察其临床疗效及副作用。结果:对照组5例为临床有效,1例获临床缓解,3例疾病活动,3例为疾病再活动,有效率为50%;实验组7例为临床有效,3例获临床缓解,1例为疾病活动,1例为疾病再活动,有效率为83.3%;两组比较,差异有统计学意义(P<0.05)。结论:血浆置换联合HLH化疗对噬血细胞综合征治疗疗效确切。     

公立医院人事制度改革之我见

公立医院人事制度改革是卫生事业单位改革的重要内容和组成部分。用人制度改革和分配制度改革是人事制度改革的关键问题和核心内容。本文将侧重围绕这两个问题，谈谈认识。     

MRI contrast agents: Basic chemistry and safety

Magnetic resonance imaging (MRI) contrast agents are pharmaceuticals used widely in MRI examinations. Gadolinium‐based MRI contrast agents (GBCAs) are by far the most commonly used. To date, nine GBCAs have been commercialized for clinical use, primarily indicated in the central nervous system, vasculature, and whole body. GBCAs primarily lower the T₁ in vivo to create higher signal in T₁‐weighted MRI scans where GBCAs are concentrated. GBCAs are unique among pharmaceuticals, being water proton relaxation catalysts whose effectiveness is characterized by a rate constant known as relaxivity. The relaxivity of each GBCAs depends on a variety of factors that are discussed in terms of both the existing agents and future molecular imaging agents under study by current researchers. Current GBCAs can be divided into four different structural types (macrocyclic, linear, ionic, and nonionic) based on the chemistry of the chelating ligands whose primary purpose is to protect the body from dissociation of the relatively toxic Gd³⁺ ion from the ligand. This article discusses how the chemical structure influences inherent and in vivo stability toward dissociation, and how it affects important formulation properties. Although GBCAs have a lower rate of serious adverse events than iodinated contrast agents, they still present some risk. J. Magn. Reson. Imaging 2012;36:1060–1071. © 2012 Wiley Periodicals, Inc.     

第一跖趾关节镜在矫治拇外翻中的应用进展

随着技术和器械的不断发展,小关节关节镜技术日趋成熟.在足踝领域,第一跖趾关节镜治疗拇外翻的方法被越来越多的医师应用于临床,并取得了一定成效.它不仅可以用于诊断,也可以用于治疗.由于是新技术,它也不可避免的存在一些问题和局限性.本文将对第一跖趾关节镜在矫治拇外翻中的应用进展做一综述.     

One‐Year Clinical Outcome of a Randomized Trial of Polymer‐Free Paclitaxel‐Eluting Stents Versus Biodegradable Polymer‐Based Rapamycin‐Eluting Stents in Patients with Coronary Heart Disease

Background: More widespread use of drug‐eluting stents (DES) to treat coronary heart disease (CHD) has recently generated more attention to thrombosis, which was relative to the polymer. Polymer‐free and biodegradable polymer‐based stents are more frequently studied, but their efficacy on preventing detrimental clinical events is unclear. Methods and Results: To assess whether polymer‐free paclitaxel‐eluting stent (YINYI stent) was noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents (EXCEL stent) in preventing detrimental clinical cardiovascular events, a total of 167 consecutive CHD patients requiring DES implantation were randomly divided into the YINYI group (n = 82) and the EXCEL group (n = 85). The primary end‐point was major adverse cardiac events (MACE). The secondary end‐points included stent thrombosis events, all‐cause mortality, and rehospitalization. The study was designed to test the noninferiority or equivalence of the YINYI stent compared with the EXCEL stent with respect to one‐year MACE according to a noninferiority or equivalence margin of 0.1. One‐year MACE was 6.10% in the YINYI group versus 5.88% in the EXCEL group. The lower limit of the one‐sided 95% confidence interval was ?0.0582 (P = 0.002 from the test for noninferiority). The 95% confidence interval for the equivalence test was [?0.0698, 0.0742] (P₁=0.004 and P₂=0.007 from 2 times the 1‐sided test for equivalence). There was no statistically significant difference in thrombosis events, all‐cause death, and rehospitalization (all P > 0.05). Conclusions: In this small randomized trial, polymer‐free paclitaxel‐eluting stents appear to be noninferior or equivalent to biodegradable polymer‐based rapamycin‐eluting stents. (J Interven Cardiol 2012;25:604–610)     

Using Interrupted Time Series Design to Analyze Changes in Hand, Foot, and Mouth Disease Incidence during the Declining Incidence Periods of 2008-2010 in China

ObjectiveTo identify patterns of hand, foot and mouth disease (HFMD) incidence in China during declining incidence periods of 2008, 2009, and 2010.MethodsReported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System (NDRS) and analyzed. An interrupted time series (ITS) technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years.ResultsOver 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level (P<0.0001) when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 (all P<0.005), but not 2009 to 2008.ConclusionIncremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.     

双气囊小肠镜诊断不明原因消化道出血的临床研究

背景:双气囊小肠镜(DBE)是诊断不明原因消化道出血(OGIB)的常用方法,不同地区OGIB病因有所差异。目的:评价DBE诊断OGIB的有效性和安全性,分析湖北地区OGIB患者的病因特点。方法:收集2006年12月～2012年1月武汉大学人民医院诊断为OGIB的216例患者,并接受DBE检查,对诊断结果、治疗、随访、并发症等进行回顾性分析。结果:DBE的诊断率为80.6%(174/216),并发症发生率为1.9%(4/216),DBE对76.8%(166/216)患者的治疗策略产生影响。湖北地区常见的OGIB病因依次为憩室/重复畸形(23.1%)、肿瘤(21.8%)、溃疡/糜烂(21.8%)、息肉(5.6%)等。结论:DBE是一种安全、有效的OGIB诊断方法。湖北地区OGIB病因以憩室/重复畸形、肿瘤、溃疡/糜烂较为常见。