高渗羟乙基淀粉(200/0.5)氯化钠注射液用于择期颅脑手术麻醉效果探讨

目的 探讨高渗羟乙基淀粉(200/0.5)氯化钠注射液用于择期颅脑手术麻醉对患者血流动力学、电解质酸碱平衡及降低颅内压效果的影响.方法 选取行择期胶质瘤切除手术患者120例,以随机抽样方法分为对照组(60例)和高渗组(60例);分别给予常规羟乙基淀粉和高渗羟乙基淀粉(200/0.5)静脉输注,比较两组患者不同时间点心率(HR),平均动脉压(MAP),中心静脉压(CVP),Na+、K+、Ca2+、pH及颅内压(ICP)等指标水平.结果 两组患者T2、T3及T4时间点HR和CVP指标均较T0时间点明显提高,差异有统计学意义(P＜0.05);两组患者T3和T4时间点MAP指标均较T0时间点显著降低,差异有统计学意义(P＜0.05);而高渗组患者T4时间点HR和MAP指标水平均明显优于对照组,差异有统计学意义(P＜0.05);两组患者T1、T2、T3及T4时间点Na+和K+指标水平与T0时间点比较差异有统计学意义(P＜0.05);两组患者T2、T3及T4时间点ICP水平较T0时间点均显著降低,差异有统计学意义(P＜0.05);高渗组患者T4时间点ICP水平显著低于对照组,差异有统计学意义(P＜0.05).结论 高渗羟乙基淀粉(200/0.5)氯化钠注射液用于行颅脑外科手术治疗患者可有效稳定血流动力学,纠正电解质酸碱平衡平衡紊乱,并抑制颅内压升高.     

超声引导下腹横肌平面阻滞复合瑞芬太尼靶控输注在胰管结石体外震波碎石术中的应用

目的 评价超声引导下腹横肌平面阻滞联合瑞芬太尼靶控输注应用于胰管结石体外震波碎石术(ESWL)中的效果。方法 随机选择60例首次接受ESWL治疗胰管结石的患者,分为R组和TR组(每组n=30)。R组患者仅接受瑞芬太尼靶控输注(TCI),TR组患者接受瑞芬太尼TCI前30min接受超声引导下腹横肌平面阻滞。采用Dixon序贯法计算两组患者的瑞芬太尼半数有效量(EC₅₀),记录患者围术期视觉模拟疼痛量表(VAS)、Ramsay镇静量表、血流动力学参数、呼吸参数和不良事件。结果 R组和TR组患者瑞芬太尼EC₅₀分别为3.448ng/ml(95%CI:1.636~3.946)和2.523ng/ml(95%CI:0.744~2.991),差异具有统计学意义(P＜0.05)。两组患者疼痛和镇静评分相当。两组患者血流动力学和呼吸参数均无明显差异。与R组相比,TR组不良事件发生率更低(10% vs 56.7%,P＜0.001),瘙痒发生率更低(6.7% vs 26.7%,P=0.038)。结论 腹横肌平面阻滞联合瑞芬太尼靶控输注可为胰管结石ESWL提供满意的镇痛和镇静,且不良事件发生率更低。     

新型冠状病毒肺炎患者围手术期处理策略与要点

新型冠状病毒肺炎（COVID-19）已发展成全球大流行,对公共卫生安全造成严重威胁。由于其病原体严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可通过飞沫、接触等途径在人与人之间传播,疑似或确诊COVID-19患者在手术室或ICU接受治疗时,如何在实施全面有效治疗的过程中避免病毒进一步播散成为医务人员关注的重点与难点。本文针对SARS-CoV-2的传播特征、围手术期特殊环境及特定操作下的疾病处理和感染控制措施展开讨论。     

便秘症状与肛门直肠测压和结肠传输试验结果的相关性研究:166例临床分析

背景:便秘是最常见的消化系统问题之一,有观点认为不同便秘症状或症状群对慢性便秘的病理生理机制可能有一定提示作用。肛门直肠测压是研究便秘病理生理机制的重要手段。目的:探讨便秘症状与肛门直肠测压和结肠传输试验结果之间的相关性。方法:连续纳入166例功能性便秘患者,行肛门直肠测压和结肠传输试验,并记录其排便次数减少、粪便干结、排便费力、排便不尽感、肛门梗阻感和腹胀症状发生情况。分析上述症状与两项检测结果的相关性。结果:腹胀组直肠最小感觉阈值降低发生率、排便次数减少组和排便费力组直肠推进力不足发生率均显著高于相应症状阴性组(P0.05),直肠肛门抑制反射不良组排便费力发生率显著低于反射正常组(P0.05);结肠慢传输以及肛门括约肌松弛不良、直肠肛门矛盾运动均与便秘症状无关。结论:排便次数减少和排便费力对直肠推进力不足有提示作用,腹胀则与直肠感觉过敏有关。深入细化便秘症状并综合考虑影响粪便性状的因素可能对慢性便秘的病理生理分型具有更好的提示作用。     

江苏省扬中市2017—2019年江滩野鼠感染血吸虫监测

目的 开展江滩野鼠感染血吸虫监测,探索敏感、有效的监测方法,为精准防控血吸虫病提供依据。方法 在江滩有螺环境中采用布设鼠夹的方法捕捉野鼠, 对捕获的野鼠进行解剖,观察有无血吸虫感染,分别计算有效鼠夹率、野鼠捕获率和感染率。结果 2017—2019年,累计在13个江滩有螺环境中布设鼠夹2 800只次,其中2017年4个环境800只次,2018年5个环境1 200只次,2019年4个环境800只次。共捕获野鼠132只,有效鼠夹率96.89%,野鼠捕获率4.87%,2017—2019年野鼠捕获率分别为10.82%、2.55%、2.38%,均未发现野鼠感染血吸虫,感染率为0%。结论 通过连续三年的监测,未发现野鼠感染血吸虫,但应进一步持续开展,建议在血吸虫病传播阻断地区可将野鼠感染血吸虫监测列为常规监测手段之一。     

Fe-vacancy order and superconductivity in tetragonal β-Fe1-xSe

Several superconducting transition temperatures in the range of 30–46 K were reported in the recently discovered intercalated FeSe system (A_1-xFe_2-ySe₂, A = K, Rb, Cs, Tl). Although the superconducting phases were not yet conclusively decided, more than one magnetic phase with particular orders of iron vacancy and/or potassium vacancy were identified, and some were argued to be the parent phase. Here we show the discovery of the presence and ordering of iron vacancy in nonintercalated FeSe (PbO-type tetragonal β-Fe_1-xSe). Three types of iron-vacancy order were found through analytical electron microscopy, and one was identified to be nonsuperconducting and magnetic at low temperature. This discovery suggests that the rich-phases found in A_1-xFe_2-ySe₂ are not exclusive in Fe-Se and related superconductors. In addition, the magnetic β-Fe_1-xSe phases with particular iron-vacancy orders are more likely to be the parent phase of the FeSe superconducting system instead of the previously assigned β-Fe_1+δTe.The iron pnictide superconductors have opened the door to a new way to obtain superconductivity at very high temperatures. β-Fe_1+δSe is remarkable among those superconductors in that it contains the essential electronic and structural constituents required for superconductivity without the conceptual complexity seen in other systems (1). Previous studies showed that the superconducting property of β-Fe_1+δSe made under high-temperature thermodynamic conditions is very sensitive to stoichiometry (1, 2). In the Fe-Se binary phase diagram (2–4), the PbO-type tetragonal structure (the β phase) only stabilized at the Fe-rich side (δ = 0.01–0.04), whereas bulk superconductivity was observed in samples with δ close to 0.01 (5). McQueen et al. showed no superconductivity for samples with δ = 0.03 (5). On the other hand, the fact that only one superconducting phase has been reported in FeSe, unlike the other Fe-As–based superconductors that exhibit clear doping dependence of superconductivity and the absence of superconductivity in FeTe, led to the suggestion that FeTe is the nonsuperconducting parent compound of FeSe (6). Thus, the phase diagram derived from this picture shows very different features compared with other Fe-As–based superconductors (6, 7). In this work, we use low-temperature synthesis methods to prepare β-Fe_1-xSe for a wide range of compositions, which allows for the determination for the composition-dependent electronic behavior for this important superconducting system.The recent discovered alkali/alkaline-intercalated iron selenide (A_1-xFe_2-ySe₂) superconductors with rich superconducting phases, where A = K, Rb, Cs, Tl, attracted great attention not only due to its high superconducting transition temperature (T_c, up to 46 K) (8), but also because of their dissimilar characteristics compared with other iron-based superconductors, especially its seemingly intrinsic multiphase nature and the presence of iron vacancies and orders in the nonsuperconducting regime (9–13). The most frequently observed Fe-vacancy order in A_1-xFe_2-ySe₂ is the × × 1 superstructure, which yields a phase of A_0.8Fe_1.6Se₂ (or A₂Fe₄Se₅). Scanning tunneling microscopy (STM) (11, 14, 15) and transport studies (12, 13, 16, 17) showed that A₂Fe₄Se₅ is an antiferromagnetic (AFM) insulator. Neutron scattering measurements (9) revealed a blocked checkerboard AFM with magnetic moments along the c axis for A₂Fe₄Se₅, ordered at a temperature as high as >500 K, with an unexpected large ordered magnetic moment of ∼3.3 μ_B/Fe at 10 K. Experiments have further shown that the type of vacancy and magnetic orders is highly sensitive to the stoichiometry (x and y) of A_1-xFe_2-ySe₂. Reports have shown the existence of other Fe-vacancy order with the forms × × 1 (10), × 2 × 1 (13, 18), and × × 1 (19). However, the magnetic properties such as the type and transition temperature of the magnetic order are far less studied compared with that of the K₂Fe₄Se₅ phase. In addition, there were also results showing in K_1-xFe_2-ySe₂ samples with a typical T_c = 31 K and additional superconducting phase with T_c = 44 K (20), whereas no clear identification of the new phases was available.The complexity of phases and phase separation during crystal preparation in A_1-xFe_2-ySe₂ make it difficult to conclusively verify the phase-property relationship, even for the superconducting phases. β-Fe_1+δSe, on the other hand, has the simplest structure among all iron-based superconductor families. Several surprising results related to the Fe-Se system appeared in the literature during the last few years, including the enhancement of T_c to about 40 K under high pressure (21–23) and the intriguing extremely high T_c (with a superconducting energy gap of ∼20 meV) in molecular beam epitaxy (MBE)-grown single-layer FeSe (24–26). We also demonstrated the presence of a superconducting-like feature with T_c close to 40 K in samples of nano-dimensional form (27). Therefore, it is quite natural to ask whether the presence of the complex phases observed in A_1-xFe_2-ySe₂ compounds and Fe-vacancy order exist in samples without alkaline metals. Here we present the first discovery of iron vacancies and three types of vacancy orders in tetragonal β-Fe_1-xSe, characterized by analytical transmission electron microscopy (TEM). Our observations imply that an unprecedented phase diagram should be considered in the Fe-Se superconductors.     

肠易激综合征与功能性消化不良重叠的治疗进展

肠易激综合征(irritable bowel syndrome,IBS)与功能性消化不良(functional dyspepsia,FD)重叠的治疗,以益生菌和胃肠动力剂为主;精神心理和行为疗法具有协同作用,能增加胃肠动力,改善患者症状;中药治疗强调整体观念和辩证论治;针刺和物理疗法是有效的非药物疗法,综合治疗能提高临床疗效。     

小金胶囊联合注射用醋酸亮丙瑞林微球治疗卵巢巧克力囊肿的临床研究

目的 探讨小金胶囊联合注射用醋酸亮丙瑞林微球治疗卵巢巧克力囊肿的临床效果。方法 选取2015年5月—2017年1月咸阳市第一人民医院收治的116例卵巢巧克力囊肿腹腔镜手术后患者作为研究对象,前瞻性随机分为治疗组及对照组,每组58例。对照组在术后首次月经来潮第1天皮下注射给予注射用醋酸亮丙瑞林微球。治疗组则在对照组的基础上另口服给予小金胶囊,5粒/次,2次/d。两组均连续治疗6个月,并随访1年。观察两组的临床疗效,比较两组性激素指标［雌激素（E2）、卵泡刺激素（FSH）及黄体生成素（LH）］,子宫动脉血流参数［搏动指数（PI）、收缩期峰值流速/舒张末期流速比值（S/D）及阻力指数（RI）］,卵巢巧克力囊肿标记物水平［抗子宫内膜抗体（EMAb）、基质金属蛋白酶-3（MMP-3）,前列腺素F2α（PGF2α）及核因子κB（NF-κB）］,生活质量指标（生理领域、环境领域、社会关系领域及生活领域评分）和1年复发率。结果 治疗后,治疗组总有效率明显高于对照组（P<0.05）。治疗后,两组性激素指标（E2、FSH及LH）,子宫动脉血流参数（PI、S/D及RI）,卵巢巧克力囊肿标记物水平（EMAb、MMP-3,PGF2α及NF-κB）,生活质量指标（生理领域、环境领域、社会关系领域及生活领域评分）均显著得到改善,且治疗组上述指标的改善程度均明显优于对照组（P<0.05）。随访1年,治疗组复发率明显低于对照组（P<0.05）。结论 小金胶囊联合注射用醋酸亮丙瑞林微球治疗卵巢巧克力囊肿具有较好的临床疗效,值得进行深入研究。     

胰腺肉瘤样癌2例报道

收集苏北人民医院收治的2例胰腺肉瘤样癌患者临床资料并随访6~12个月,同时检索相关文献。结果显示1例未能切除,术后未行放化疗,3个月后死亡。1例行手术切除,术后辅以静脉化疗,8个月后因多脏器转移死亡。胰腺肉瘤样癌少见,无特异性临床表现,恶性程度高,浸润性强,预后差,早期诊断和积极综合治疗可望获得较好的治疗效果、延长患者生存期。     

Antibiogram and plasmid profiling of carbapenemase and extended spectrum Beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Abeokuta,South western,Nigeria

Background

The increased reports of ESBL dissemination from various centres in south western, Nigeria and the recent emergence of carbapenem resistant bacteria prompted the conception of this study.

Objectives

To demonstrate the relationship between high molecular weight plasmids and the expression of antibiotic multi-resistance including ESBL and carbapenemase.

Methods

We investigated 97 isolates of selected organisms consisting of 67 E. coli and 30 Klebseilla spp for the presence of plasmids expressing ESBL including carbapenem-hydrolysing enzymes. Beta-lactamase was determined using acidometric method, while ESBL and carbapenemase activity was determined using the double-disk diffusion test as well as the Modified Hodge test (MHT). Plasmid profiles of ESBL and carbapenemase positive isolates were determined according to standard protocols.

Results

An ESBL prevalence rate of 21.6% and carbapenem- resistance rate of 9.3% was recorded. Antibiotic susceptibility profile of ESBL isolates showed 100.0% resistance against Amoxicillin, Cotrimoxazole and Erythromycin. Moderate susceptibility was recorded against the Quinolone class of antibiotics; Meropenem remained the most active antibiotic against ESBL isolates with 62.5% against E. coli and 60% against K. pneumoniae. The plasmid profiles of our study isolates ranged from 11.8kbp to 35.5kbp.

Conclusion

Due to the relationship between high molecular weight plasmids and multi-drug resistance, we hereby recommend regular molecular surveillance of this form in our study setting.