孕妇维生素D缺乏及其对胎儿的影响

目的维生素D缺乏累及的人群非常广泛,而且与多种疾病的发生有关,特别是孕妇维生素D缺乏还可能影响到胎儿的健康。目前关于我国女性维生素D的资料报道很少。本研究的目的是了解健康孕妇(孕15~21w)以及同龄未孕对照组妇女维生素D水平以及孕妇维生素D水平对新生儿出生大小的影响。方法本文随机选取单胎妊娠孕妇63例和同龄对照妇女35例,用酶联免疫的方法测定血中25-羟维生素D水平。结果显示99%的检测病例25-羟维生素D水平低于正常值(≥75 nmol/L),有近93%的妇女为维生素D缺乏(50 nmol/L)。孕妇25-羟维生素D水平(28.40±9.19 noml/L)明显低于对照组妇女(38.46±10.77 noml/L;P0.001),两组维生素D缺乏的比率分别为孕妇96.8%,对照组85.7%,但重度维生素D缺乏的病例孕妇组接近半数,而对照组为零。新生儿身长与孕妇25-羟维生素D水平成显著正相关(r=0.323;P0.01。结论我国北方女性特别是孕妇是维生素D缺乏患病的高危人群,而且孕妇维生素D缺乏可能会影响到胎儿的生长发育。应该积极采用有效的措施防治维生素D的缺乏,从而减少维生素D缺乏对健康的影响对提高人口质量将具有重要的意义。     

改良蹲走试验在诊断膝关节半月板损伤中的临床意义

目的 探讨简单易行、诊断率较高的一种物理检查方法,提高半月板损伤术前诊断率。方法 对三种类型膝关节病痛:半月板损伤105例;外伤性滑膜炎180例;良性关节痛180例,采用半月板损伤临床常用的几种物理检查方法,逐一试验排除、对照、记录,再经手术及关节镜证实各类物理检查的阳性率。结果 经改良的蹲走试验,在术前的诊断率最高,阳性率占82％。结论 膝关节半月板损伤物理检查,在术前相当重要,尤其在高科技检查不能全面开展普及的情况下,改良蹲走试验不失为一种较好的物理检查方法。     

血清AFP-L3、GP73检测联合CT扫描在肝细胞癌诊断中的价值

目的:检测肝病患者血清中甲胎蛋白异质体(AFP-L3)和高尔基体蛋白73(GP73)浓度,分析肝病患者病灶CT平扫加增强扫描后经处理技术得到二维及三维重建图像,探讨联合运用AFP-L3、GP73浓度检测与CT扫描两种技术在肝细胞癌(hepatocellular carcinoma,HCC)诊断中的价值。方法:采用酶联免疫吸附法检测肝病患者血清AFP-L3、GP73浓度,运用受试者工作特征曲线(recover operation characteristic,ROC)确定AFP-L3、GP73浓度诊断HCC的cut-off值。分析141例肝病患者总共164个病灶的CT扫描后经处理技术得到二维及三维重建图像而诊断HCC,探讨采用AFP-L3、GP73浓度测定与CT增强扫描及这两种方法联合应用在HCC的检出与定性诊断方面的价值。结果:HCC组AFP-L3浓度(113.58±63.62)ng/ml明显高于良性肝病组[(23.19±34.54)ng/ml,P<0.001],绘制AFP-L3浓度诊断HCC的ROC曲线,AFP-L3浓度38.47ng/ml为诊断HCC的cut-off值,诊断敏感性为81.08%,特异性为88.06%,诊断正确率为87.23%;HCC组GP73浓度(126.55±49.56)ng/ml明显高于良性肝病组[(56.97±26.48)ng/ml,P<0.001],绘制GP73浓度诊断HCC的ROC曲线,GP73浓度69.44ng/ml为诊断HCC的cut-off值,诊断敏感性为75.68%,特异性为91.04%,诊断正确率为88.65%。CT扫描诊断HCC的灵敏度为82.43%,特异度为91.04%,诊断正确率为90.07%。联合AFP-L3、GP73浓度检测与CT扫描诊断HCC的灵敏度为85.14%,特异度为92.53%,诊断正确率为92.19%。结论:联合运用血清AFP-L3、GP73浓度检测及CT扫描两种技术对HCC诊断灵敏度、特异度、诊断正确率较运用单一技术均有所提高,联合运用两种技术对HCC的准确早期诊断具有积极的意义。     

侧向旋转体位护理策略对吸入性肺炎患者吸痰效果的影响

目的：探讨采取侧向旋转体位（LRP）护理策略患者的吸痰效果。方法将30例吸入性肺炎呼吸衰竭行机械通气的患者随机分为观察组与对照组,在常规卧位护理时行吸痰为对照组,观察组在常规卧位吸痰的基础上辅助采取 LRP 护理策略吸痰。分别对2组患者开始观察的第1天和第4天的动脉血氧分压[p（O2）]及第1天和第4天的胸部 X 片的炎性片状影变化进行观察,并对结果进行统计学分析。结果观察组与对照组相比,吸痰前后的p（O2）改善程度呈显著性差异（P ＜0．01）;观察组第4天胸部 X 片炎性片状影大部分被吸收者为13例（86．67％）,对照组为6例（40．00％）,差异有统计学意义（P ＜0．05）。结论机械通气的吸入性肺炎患者痰液淤积时,结合病情及痰液多少在常规吸痰基础上适当采取侧向旋转体位护理策略吸痰,效果明显优于单纯采取常规体位护理策略吸痰法。     

Pharmacokinetics of Sustained-Release and Transdermal Buprenorphine in G?ttingen Minipigs (Sus scrofa domestica)

The opioid buprenorphine has been shown to provide adequate postoperative analgesia in both companion and laboratory animals. However, its use is still hindered by the need for multiple parenteral injections to achieve continuous analgesia. The purpose of the current study was to conduct a pharmacokinetic analysis of 2 new long-acting formulations of buprenorphine—an injectable sustained-release buprenorphine (SRB) and a transdermal buprenorphine (TDB) patch—in healthy Göttingen minipigs by using liquid chromatography–electrospray ionization–tandem mass spectrometry. Administration of 0.18 mg/kg SC SRB and 30 μg/h TDB achieved AUC_0-Tlast of 221.6 ± 26.8 and 25.2 ± 3.9 ng × h/mL, respectively, compared with 9.7 ± 1.4 ng*h/mL for 0.02 mg/kg IV buprenorphine. By using a hypothesized therapeutic plasma buprenorphine concentration threshold of 0.1 ng/mL, therapeutic concentrations were achieved at the first study time point (5 to 30 min) and lasted an average of 8.0 ± 1.3 h for intravenous buprenorphine and 264.0 ± 32.2 h for SRB. TDB achieved therapeutic concentrations in 12 to 24 h after patch application, which lasted until the patch was removed at 72 h. The results of this study suggest that SRB and TDB are long-acting alternatives for pain management, and their use could decrease animal handling and stress, thereby simplifying pain management and improving welfare in laboratory swine.Abbreviation: AUC_0-Tlast, AUC to last quantifiable plasma concentration; C_max, peak plasma concentration; SRB, sustained-release buprenorphine; TDB, transdermal buprenorphine; T_max, time of peak plasma concentration; VAP, vascular access portBuprenorphine is a semisynthetic, partial µ-opioid receptor agonist used for analgesia in many companion and laboratory animal species.^7,29 Its popularity is due to a lower risk of respiratory depression and prolonged analgesia in comparison to pure µ-opioid agonists, such as fentanyl and hydromorphone.^7,29 Buprenorphine is often the analgesic of choice in swine because a single 0.01- to 0.1-mg/kg dose can provide analgesia for as long as 8 to 12 h with minimal adverse effects.^7,33Swine are valuable animal models for cardiovascular, digestive, urinary, and integumentary research.^32,33 As a result, laboratory swine often undergo major surgeries resulting in considerable postoperative pain. To provide analgesia of adequate efficacy and duration throughout the postoperative period, multiple injections of buprenorphine are necessary. Repeated injections and the associated handling and momentary pain can become increasingly stressful to swine with each subsequent injection. In addition, the recurrent peak and trough plasma concentrations associated with multiple parenteral injections potentially result in periods of inadequate pain relief at trough levels. A buprenorphine formulation that can be administered less frequently or in a noninjectable formulation but that can deliver a controlled and constant amount of drug over time potentially would eliminate the disadvantages of repeated dosing.Recently 2 new formulations of buprenorphine have become available: an injectable sustained-release buprenorphine (SRB) and a transdermal buprenorphine (TDB) patch. Both formulations are designed to provide a consistent, controlled release of buprenorphine over the course of several days after a single administration. Recent studies in mice,⁴ rats,⁸ cats,⁵ and dogs²⁴ support the ability of SRB to provide an extended duration of analgesia compared with that of the standard buprenorphine formulation. In addition, therapeutic plasma concentrations have been shown to last as long as 72 h in rats⁸ and 5 d in both macaques²³ and dogs.²⁴ Although SRB has been studied in several animal species, it has yet to be evaluated in swine.TDB has been extensively used in human medicine however, unlike SRB, there are relatively few studies evaluating the efficacy of TDB in animals. High-dose (35, 52.5, and 70 µg/h) and low-dose (5, 7.5, 10, 15, and 20 µg/h) TDB patches, lasting 3 and 7 d, respectively, have been used effectively in humans to treat moderate to severe, chronic pain such as lower back pain and that due to osteoarthritis or cancer.^{6,9,14,20,26,30,31,35} Currently, TDB studies in animals have only been performed by using high-dose patches and have been limited to dogs^1,21,25 and cats.²² In dogs, detectable plasma buprenorphine concentrations have been shown to last 72 h after the application of a single 52.5-µg/h TDB patch²⁵ and 108 h with a 70-µg/h patch.¹ In addition, a 70-µg/h TDB patch has been reported to provide equal postoperative analgesia in dogs that underwent an ovariohysterectomy when compared with 0.2 mg/kg of the standard formulation of buprenorphine administered subcutaneously every 6 h during the postoperative period. ²¹ To date, TDB has not been evaluated in swine.Because of the success seen with both SRB and TDB in other species, further investigation into the pharmacokinetics and clinical efficacy of SRB and TDB in swine is warranted. These buprenorphine formulations have the potential for extended drug delivery with a single administration and thus the potential to positively affect animal welfare by minimizing animal stress. The purpose of this study was to evaluate the pharmacokinetics of these 2 new formulations of buprenorphine compared with a standard dose of intravenous buprenorphine in Göttingen minipigs. We hypothesized that both SRB and TDB would achieve quantifiable plasma buprenorphine concentrations above an estimated therapeutic threshold of 0.1 ng/mL for a longer duration than that of a standard dose of intravenous buprenorphine, thus supporting the use of these new formulations as long-acting analgesics for pain management in swine.     

CTEN 表达与肝癌预后的相关性

目的：探讨只含梭基端的张力蛋白样分子(C-terminal tensin-like protein,CTEN)在肝癌中的表达及其与预 后的关系。方法：采用免疫组织化学的方法检测240例肝癌患者的癌组织和癌旁组织CTEN蛋白的表达;采用卡方检 验、Kaplan-Meier 曲线和COX回归模型,对患者CTEN表达与临床病理特征、5年无复发生存期、总生存期以及预后 的关系进行统计分析。结果：肝癌组织和癌旁组织CTEN蛋白的阳性高表达率分别为55.0%和20%(P<0.001)。CTEN表 达与肝癌肿块大小(P=0.022)、血管侵犯(P=0.007)和TNM分期(P=0.021)正相关。CTEN高表达患者的5年无复发生存期 (P<0.001)和总生存期(P<0.001)明显低于CTEN低表达的患者。COX回归分析显示CTEN高表达是肝癌患者术后复发的 不良预后因子(P=0.001),也是患者死亡的不良因子(P=0.012)。结论：CTEN蛋白可能在肝癌的发生、发展中发挥作 用,是肝癌的不良预后因子。     

机械通气患儿气管插管非计划性拔管预防策略的最佳证据总结

目的 提炼并总结儿科重症监护病房（pediatric intensive care unit,PICU）机械通气患儿气管插管非计划性拔管预防策略的最佳证据,为临床实践提供参考依据。 方法 系统检索国内外计算机决策支持系统、指南网、数据库及相关学会网站中与机械通气患儿气管插管非计划性拔管预防策略有关的文献,检索时限为2010年1月—2022年1月,文献类型包括临床决策、指南、证据总结、系统评价、专家共识。由4名研究者对纳入文献进行评价和证据提取。 结果 共纳入14篇文献,其中指南6篇、专家共识2篇、系统评价6篇。从气管插管非计划性拔管的危险因素、气管插管及气道管理、镇静评估与管理、镇痛评估与管理、谵妄监测与预防、组织管理6个方面总结了25条最佳证据。 结论 该研究总结的最佳证据为PICU机械通气患儿气管插管非计划性拔管的预防提供循证依据。应用证据前,医护人员应评估临床情景及障碍因素,促使证据有效、安全地向临床转化。     

Effects of sevoflurane and propofol on postoperative nausea and vomiting in patients with colorectal cancer placed under general anesthesia: a systematic review and meta-analysis

BackgroundThis study sought to explore the effects of sevoflurane and propofol on postoperative nausea and vomiting (PONV) in patients with colorectal cancer (CRC). Sevoflurane inhalation anesthesia has the advantages of short induction time, stable hemodynamic, stable anesthesia maintenance and short recovery time, and its anesthetic effect is similar to that of propofol, so it is worthy of comparative analysis.MethodsThe PubMed, Cochrane, Web of Science, Embase, clinical research register and CQVIP databases were searched to retrieve the data of randomized controlled trials (RCTs) published between October 2000 and October 2021 on the effects of sevoflurane and propofol on nausea and vomiting after laparoscopic surgery in patients with CRC. Applying the inclusion criteria, the literature selection, data extraction, and quality evaluation assessments were carried out for the included articles. The I² test was used to evaluate the heterogeneity between the studies, and the meta-analysis was performed using RevMan 5.2.6 software provided by Cochrane.ResultsA total of 12 RCTs were included in this meta-analysis. There was statistically significant differences in changes in postoperative heart rate [odds ratio (OR) =3.55, 95% confidence interval (CI): 2.40, 5.27, P<0.00001, I²=0%, Z=6.30], mean artery pressure (MAP) (OR =2.58, 95% CI: 2.04, 3.26, P<0.00001, I²=58%, Z=7.87), the incidence of PONV (OR =1.73, 95% CI: 1.38, 2.17, P<0.00001, I²=46%, Z=4.78), and the incidence of postoperative disturbance of consciousness (OR =2.09, 95% CI: 1.62, 3.07, P<0.00001, I²=63%, Z=5.67) between the experimental group and the control group.ConclusionsCombining anesthesia with sevoflurane and propofol had good prevention and treatment effects for PONV in patients with CRC who underwent a laparoscopy and had a moderate central sedation effect.     

高效液相色谱法常规监测中国胃肠间质瘤患者体内的伊马替尼血药浓度（英文）

伊马替尼目前是胃肠间质瘤的一线治疗用药。由于伊马替尼在不同患者体内血药浓度差异较大,目前指南推荐常规监测伊马替尼的血药浓度以提高伊马替尼的疗效,降低不良反应的发生率。本研究建立了一种简单灵敏快速的高效液相色谱法,采用简单的沉淀蛋白法处理血浆样品,处理后的样品通过色谱柱Inert Sustain C18柱(250mm×4.6 mm, 5μM)进行分离,流动相为25 mM NH₄H₂PO₄ (pH=8)–乙腈(61:39, v/v),柱温为40℃,流速为1mL/min,紫外检测波长为265nm。该方法标准曲线在50–10 000 ng/m L浓度范围内线性良好,日间与日内准确度和精密度在–5.81%–6.33%之间。绝对回收率在92.38%–97.86%之间。稳定性测试和样品再分析结果均符合指南要求。该方法成功用于150名中国胃肠间质瘤患者的常规伊马替尼血药浓度监测。