肠旋转不良型左侧阑尾炎腹腔镜切除一例

正患者女,40岁,身高160 cm,体质量52 kg,因2 d前无明显诱因出现左下腹部持续性绞痛,于2018年10月19日急诊入院,体温37.7℃,脉搏112次/分,伴稍恶心,无呕吐、放射痛、发热,无腹泻、血便,无尿频、尿痛等症状。1 d前曾在当地社区医院以"急性肠炎"给予抗感染、解痉等治疗,自觉症状有所缓解,次日午间症状再次加重。查体:左下腹压痛(+)、反跳痛(+),局部腹肌紧张明显。行腹部CT平扫检查示:结肠走行反位,右半结肠位于左上腹,阑尾增粗伴周围渗出,周围间隙模糊,阑尾最粗约1.7 cm,临近盲肠壁稍增厚;胃腔大部分位于右侧,十二指肠垂直下行,可见Ladd束带;肝脏体积明显增大;脾脏受推挤,位于左侧肾上腺前方(图1～3)。诊     

伴皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病一例报告

目的 总结貌似多发性硬化的皮层下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)的临床特点.方法 报告1例经基因检查和周围神经活检确诊为CADASIL的临床资料.结果 患者腓肠神经活检可见有髓神经纤维密度轻度减少,电镜下可见神经束膜小动脉中层平滑肌细胞外大量颗粒性电子致密嗜锇颗粒物质(GOM)沉积.基因检测显示Notch3基因4号外显子Cys117Arg突变.结论 为避免CADASIL的漏诊及误诊,凡遇青年反复脑卒中发作,又无高血压、糖尿病等常见的血管病危险因素,虽无偏头痛病史,亦应注意追问家族史并做基因检测和周围神经活检.     

Population Pharmacokinetics and Dosing Simulations of Ceftazidime in Chinese Neonates

An accurate dosage determination is required in neonates when antibiotics are used. The adult data cannot be simply extrapolated to the pediatric population due to significant individual differences. We aimed to identify factors impacting ceftazidime exposure in neonates and to provide drug dosing guidance to clinicians. Forty-three neonates aged less than 60 days with proven or suspected infections were enrolled in this study. After intravenous administration, blood samples were collected, and plasma ceftazidime concentration was determined using a HPLC method. Pharmacokinetic data were fitted using a nonlinear mixed-effects model approach. One-compartmental model could nicely characterize the ceftazidime in vivo behavior. The covariate test found that the postmenstrual age (day) was strongly associated with systemic drug clearance (L/h), and the effect of body weight (kg) was identified as the covariate on distribution volume (L). Compared with the base model, the addition of covariates improved the goodness-of-fit of the final model. Model validation (bootstrap, visual predictive check, and prediction-corrected visual predictive check) suggested a robust and reliable pharmacokinetic model was developed. Personalized dosage regimens were provided based on model simulations. The intravenous dose should be adjusted according to postmenstrual age, body weight, and minimum inhibitory concentration.     

Visceral adipose tissue is more strongly associated with insulin resistance than subcutaneous adipose tissue in Chinese subjects with pre-diabetes

Aims: To investigate the value of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in a cohort of a community’s residents who were diagnosed as pre-diabetes, and to evaluate the association of VAT and SAT with insulin resistance.

Methods: This study was based on cross-sectional analysis of data from 107 adults. VAT and SAT were assessed by computed tomography. Insulin resistance was defined by homeostasis model assessment of insulin resistance >2.69. The relationship of VAT and SAT with insulin resistance were examined by linear regression. Logistic regression was used to analyze the association of VAT and SAT with insulin resistance.

Results: A total of 87 subjects had VAT ≥100?cm². Thirty-six out of 107 (33.6%) subjects were detected to have insulin resistance, 71 were normal (66.4%), and all had insulin resistance with VAT ≥100?cm². VAT (r?=?0.378, p?r?=?0.357, p?p?=?.003), but that of SAT was lost.

Conclusion: Pre-diabetic subjects with insulin resistance had elevated levels of VAT. VAT was more strongly associated with insulin resistance than SAT in Chinese subjects with pre-diabetes.     

UHPLC-MS/MS测定人血浆中美托洛尔的含量

目的 建立测定人血浆中美托洛尔含量的UHPLC-MS/MS分析方法。方法 采用Agilent RRHD PLUS C₁₈色谱柱（2.1 mm×50 mm,1.8 μm）,0.2%甲酸水溶液-乙腈（68∶32）为流动相。质谱采用电喷雾离子源（ESI）,多反应监测（MRM）,检测离子为正离子,分别选择m/z 268/116、237/194作为美托洛尔和内标（卡马西平）的检测离子对。结果 血浆中美托洛尔在1.012~759.0 ng·mL^-1内线性关系良好（r=0.999 2）。高、中、低浓度美托洛尔的基质效应分别为105.9%,106.1%,106.9%;平均回收率分别为83.0%,99.3%,95.2%。批内精密度RSD≤3.22%,批间精密度RSD≤4.14%。结论 该方法简便、灵敏、快速、准确,适用于血浆中美托洛尔的含量测定。     

Trace and evaluation systems for health services quality in rural and remote areas: a systematic review

Aim

To provide a systematic review of the existing theory, framework, systems and instruments for tracing and evaluating quality in rural health services.

Subjects and methods

We searched six electronic databases up to March 2016. Observational studies of quality assessment of rural health services using theoretical models were included. Ekman’s scale was used to evaluate the quality of the included studies.

Results

A total of 18 studies, published between 2001 and 2015, met the inclusion criteria. The corresponding authors for most of them (7, 44%) are from Chinese institutions and three (3, 17%) from Australian institutions. Five studies (28%) focused on township hospitals. Primary health care quality was reported in five studies (28%), followed by clinical service in four (22%). More than half of the studies (61%) were considered of high quality, and the remainder was of moderate quality. These studies applied 16 theoretical systems, including the model/pattern (4, 25%), method/tool (7, 44%) and framework of the theory (5, 31%). Most of the theoretical models (14, 88%) obtained positive observations. In addition, the conceptual model (6, 36%) and TOPSIS method (2, 13%) were more frequently reported.

Conclusion

Although most of the current studies were considered to have high-quality and positive results, there were limitations in the number of publications and research on theoretical systems. The lacks of unified standards and comprehensive evaluation are important issues that need to be pointed out and resolved.

     

The role of glutamate receptors in attention‐deficit/hyperactivity disorder: From physiology to disease

Attention‐deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children and adolescents, which is characterized by behavioral problems such as attention deficit, hyperactivity, and impulsivity. As the receptors of the major excitatory neurotransmitter in the mammalian central nervous system (CNS), glutamate receptors (GluRs) are strongly linked to normal brain functioning and pathological processes. Extensive investigations have been made about the structure, function, and regulation of GluR family, describing evidences that support the disruption of these mechanisms in mental disorders, including ADHD. In this review, we briefly described the family and function of GluRs in the CNS, and discussed what is recently known about the role of GluRs in ADHD, that including GluR genes, animal models, and the treatment, which would help us further elucidate the etiology of ADHD.     

Euxanthone Impairs the Metastatic Potential of Osteosarcoma by Reducing COX-2 Expression

Osteosarcoma (OS) is one of the most common malignancies of bone. This study was aimed to explore the anti-metastatic effect of euxanthone on OS. Adhesion assay and Transwell assay were used to examine the effect of euxanthone on adhesion, migration and invasion of OS cells. COX-2-over-expressing plasmid was applied to transfect OS cells to assess whether COX-2 affects the anti-metastatic function of euxanthone. PDCD4 knockdown and miR-21 mimic were applied to assess whether euxanthone suppresses the transactivation of c-jun via modulating miR-21-PDCD4 signaling. The effect of euxanthone in vivo was also examined by lung metastasis assay. Euxanthone, a xanthone derivative extracted from Polygala caudata, has been found to exhibit anti-neoplastic activities. In present study, our results showed that euxanthone suppressed cell adhesion, migration, and invasion in OS cells. Our experimental data also showed that repression of COX-2 by euxanthone mediated its anti-metastatic activities. Moreover, our findings revealed that euxanthone modulated the COX-2 expression through the miR-21/PDCD4/c-jun signaling pathway. The anti-metastatic activities of euxanthone were also validated in a pulmonary metastasis model. Taken together, our results highlighted the potential of euxanthone to be used in the treatment of OS. Anat Rec, 302:1399–1408, 2019. © 2018 Wiley Periodicals, Inc.