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.     

山东省居民高盐饮食对死亡和期望寿命的影响

目的分析山东省居民归因高盐饮食相关疾病死亡和寿命损失。方法利用2016年山东省与原卫生部联合减盐防控高血压项目终末期评估调查获得的24 h尿钠和血压值,结合2016年全省居民死因监测数据,按照比较风险评估理论,计算各类疾病归因分值(PAF)和因高盐饮食导致死亡,利用寿命表法计算归因期望寿命损失。结果2016年山东省因高盐饮食导致死亡32987人,占相关疾病死亡的11.74%,占全部死亡的4.95%。男性因高盐死亡比例(13.51%)高于女性(9.17%)。高盐饮食导致死亡的疾病主要是心脑血管疾病(90.82%),其次为胃癌(8.10%)和慢性肾病(1.08%)。城市居民PAF(13.87%)高于农村(10.87%)。高盐饮食导致山东省居民期望寿命减少0.58岁。高盐饮食所致不同疾病对期望寿命损失作用不同,缺血性心脏病位居首位,其次为脑出血和脑梗死。结论山东省居民归因高盐饮食死亡的比例较高,心脑血管疾病是高盐饮食导致死亡的重要原因。高盐饮食严重影响山东省居民健康,还需加强减盐干预工作。     

颈总动脉内膜-中膜厚度及粥样斑块与冠心病的关系

目的:研究颈总动脉内膜-中膜厚度(CIMT)及粥样斑块检出率与冠心病发病及冠脉病变严重程度的关系。方法:114例具有至少一项冠心病危险因素的患者,按冠状动脉造影结果分为冠心病组(70例)和对照组(44例),测定所有病例的双侧CIMT、颈总动脉内径和颈总动脉粥样斑块情况。结果:两组间各项冠心病危险因素均无显著差异。超声结果显示,冠心病组CIMT、粥样斑块检出率均显著增高(P&lt;0.01),颈总动脉内径略增大,但差异不显著。CIMT≥0.8mm和检出粥样斑块为预测冠心病发病的独立指标(P&lt;0.01)。CIMT和粥样斑块检出率均与冠脉病变严重程度呈正相关,在控制了多项影响因素后,相关性仍显著。结论:CIMT增厚、粥样斑块检出为冠心病发病的独立预测因素,并且与冠脉病变严重程度正相关。     

峡部入路在甲状腺手术中的临床研究

目的探讨甲状腺手术中峡部入路的临床应用。方法将我院2007年8月~2010年8月的229例甲状腺手术患者分为两组。治疗组113例采用峡部入路,对照组116例采用传统入路,均由同一组医生施术。观察记录手术时间、术中出血、术后引流量及术后喉返神经及甲状旁腺损伤情况。结果治疗组在上述观察指标上均优于对照组（P〈0.05）。结论经峡部入路行甲状腺手术可明显缩短手术时间,减少术中出血、术后引流量,降低喉返神经及甲状旁腺损伤的发生率,优于传统甲状腺手术入路。     

Identification of an HLA-A*0201-restrictive CTL epitope from MUC4 for applicable vaccine therapy

Recent research has indicated that MUC4 plays an important role in the development of many tumors and may prove useful as a novel cancer immunotherapy target. We aimed to identify HLA-A*0201-restrictive cytotoxic T lymphocyte (CTL) epitopes of the cancer-associated antigen MUC4. The MUC4 sequence was scanned for immunogenic peptides using HLA-binding prediction software. Dendritic cells (DCs) from peripheral blood mononuclear cells (PBMCs) were induced by cytokines. Five possible CTL epitopes were selected by software analysis, synthesized, and used to pulse mature DCs. The CD8⁺ T cells from PBMCs from an HLA-A*0201 healthy donor were stimulated with autologous MUC4-peptide-loaded DCs and expanded in vitro. T cell activation was assessed by ELISPOT, and cytotoxicity was determined by ⁵¹chromium (⁵¹Cr)-release assays. Our results show that CTLs induced by peptide P01204 could lyse T2 cells pulsed with peptide P01204 and HCT-116 cells (MUC4⁺, HLA-A2⁺). Compared with a control peptide, P01204 increased the number of IFN-γ producing T cells. Overall, these results suggest that P01204 is a novel HLA-A*0201-restrictive CTL epitope of the cancer-associated antigen MUC4. This will provide a foundation for the development of tumor-specific peptide vaccines.     

Relationship between Millitary College Students' Puzzles of Intercourse and Familial Function,Coping Style

目的 了解军校大学生的人际关系困扰状况及其与家庭功能和应对方式的相关.方法 选取石家庄市某军校765名一年级大学生为研究对象,使用McMaster家庭功能评定量表(FAD)、人际关系综合诊断量表和应对方式量表进行调查,通过相关分析和回归分析,探讨人际关系困扰与家庭功能和应对方式的相关性.结果 军校大学生人际困扰总检出率为31.80％；家庭功能和应对方式各因子和人际关系困扰均呈显著相关；Logistic回归分析显示,沟通、情感反应和总的功能以及应对方式的6个因子均进入回归方程.结论 军校大学生人际关系状况不容乐观,家庭功能和应对方式对人际因子状况有显著影响,要加强军校心理教育与人际关系主题辅导.     

胰腺神经内分泌肿瘤的外科治疗

胰腺神经内分泌肿瘤(PNEN)分为功能性和无功能性两大类, 根治性手术是治愈肿瘤和争取患者长期生存的唯一有效手段。局部可切除肿瘤首选手术切除, 手术方式包括局部切除(剜除)术和规则性胰腺切除术。胰岛素瘤和直径小于2 cm无功能性PNEN可行局部切除(剜除)术、保留脾脏的胰体尾切除术或节段胰腺切除术; 直径2 cm及以上或恶性倾向PNEN应行根治性切除术, 同时附加区域淋巴结清扫术, 包括胰十二指肠切除术、胰体尾切除术及中段胰腺切除术等。对于局部进展无法根治切除病变, 功能性PNEN可以选择减瘤术, 尽量切除90%以上的肿瘤, 包括转移灶和原发灶; 无功能性PNEN患者出现黄疸、消化道梗阻和出血等并发症时, 可考虑行肿瘤原发灶切除。肝脏是PNEN最常见远处转移部位, 可分为Ⅰ、Ⅱ、Ⅲ型。对Ⅰ型PNEN患者, 只要无手术禁忌应建议手术切除。对Ⅱ型PNEN患者如考虑行减瘤术, 应尽可能切除全部肝转移灶的90%;对原发灶已切除且不伴有肝外远处转移、分化好(G1/G2) 的患者, 肝移植可以作为一种治疗选择。对无法切除的Ⅲ型PNEN患者, 可选择多种辅助治疗方法。     

有症状和无症状Barrett食管患者胃镜及病理检查探讨

目的观察比较有症状和无症状Barrett食管患者胃镜及病理表现。方法选取笔者所在医院诊断为Barrett食管的患者80例,根据有无临床表现将患者分为两组,每组40例,所有患者均经胃镜检查并活检,观察两组病变形态,长度,增生程度。结果Ⅰ组(无症状组)全周型比例(20%)较Ⅱ组(有症状组)(10%)显著增多(P<0.05);Ⅰ组短节段型(27.5%)较Ⅱ组(55.0%)显著减少(P<0.05);Ⅰ组超短节段型(62.5%)较Ⅱ组(32.5%)显著增多(P<0.05);Ⅰ组与Ⅱ组比较中、重度增生(10%,25%)显著减少,轻度增生(90%,75%)显著增多。结论有症状Barrett食管患者胃镜表现及病理检查较无症状患者严重,对有症状Barrett食管患者检查、诊断应更加重视,以明确诊断,指导治疗和随访。     

健脾愈胃汤联合西药治疗胃溃疡临床价值研究

目的:分析健脾愈胃汤联合西药治疗胃溃疡的临床价值。方法:收集我院2012年10月—2013年10月期间诊治的胃溃疡患者100例作为研究对象,采用随机分组的方式将患者分为观察组与对照组,每组患者各50例。对照组单纯采用西药治疗,观察组在对照组的基础上加用健脾愈胃汤治疗,对两组患者的治疗效果、不良反应发生率进行分析对比。结果:研究结果显示,观察组中治愈28例,占总数的56.0%,显效12例,占总数的24.0%,有效5例,占总数的10.0%,无效5例,占总数的10.0%,效果优良率为80.0%,总有效率为90.0%;对照组中治愈14例,占总数的28.0%,显效14例,占总数的28.0%,有效4例,占总数的8.0%,无效18例,占总数的36.0%,效果优良率为56.0%,总有效率为64.0%,观察组患者的效果优良率和总有效率均显著高于对照组(P<0.05);观察组中有5名患者出现恶心呕吐,不良反应发生率为10.0%,对照组中有4名患者出现恶心呕吐,不良反应发生率为8.0%,两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:健脾愈胃汤联合西药治疗胃溃疡具有良好的临床效果,在胃溃疡的治疗中具有非常重要的临床价值,值得在临床应用上推广。     

山东省居民24小时尿钠钾比与代谢综合征的关系

目的 分析山东省居民24 h尿钠钾比与MS的关系。方法 2011年在山东省采用四阶段分层随机抽样方法抽取18~69岁居民作为研究对象, 测量其血糖、血脂四项、尿钠、尿钾和尿肌酐等指标。依据24 h尿钠钾比值将研究对象按照四分位数法分组, 采用二分类logistic分析钠钾比与MS的关系。结果 1 906名研究对象纳入分析, 其中男性1 003人, 女性903人。MS患病率为24.7%。经多因素logistic模型分析, 与24 h尿钠钾比值<4.3组相比, 4.3~5.6、5.7~8.1和≥8.1组MS患病风险OR值(95%CI)分别为1.27(0.93~1.71)、1.06(0.78~1.46)和1.45(1.06~1.97), 趋势检验显示, P<0.05。在MS各组分中, 中心性肥胖和血压升高风险与24 h尿钠钾比之间存在线性趋势(线性趋势检验P<0.05)。结论 随着24 h尿钠钾比增加, MS患病风险呈上升趋势。