Aortobipopliteal Bypass Grafting for In Situ Replacement of Infected Aortobifemoral Prosthesis

Conventional treatment of an infected aortobifemoral graft includes total graft excision and ex situ bypass grafting, but has been associated with significant perioperative morbidity and mortality. Additionally, the presence of infection in the groin makes limb revascularization problematic. There is increasing evidence that in situ replacement of an infected graft can achieve promising results in selected patients. We present a case of an aortobifemoral graft infection, affecting both the groin as well as the entire pelvis. The patient underwent successful in situ graft replacement with a new aortobipopliteal prosthesis via an alternative extraperitoneal route.     

艾瑞昔布超前镇痛用于脊柱手术对患者术后镇痛效果的影响

目的观察艾瑞昔布超前镇痛用于脊柱手术对患者术后镇痛效果的影响。方法选取本院2017年3月～2018年3月收治的110例脊柱手术患者,按随机数表法分为观察组与对照组,各55例。观察组术前30 min口服100 mg的艾瑞昔布,对照组口服相同剂量的安慰剂。术毕予负荷剂量的芬太尼0.001 mg/kg。比较两组术后6 h与12 h的疼痛程度[采用视觉模拟评分法(VAS)评估]、镇静效果(采用Ramesay评分法评估)、芬太尼消耗量、自控按压总次数、不良反应总发生率。结果观察组术后6 h与术后12 h的术后疼痛VAS评分分别为(2.80±0.82)分与(1.85±0.45)分,低于对照组的(3.15±0.91)分与(2.32±0.64)分;观察组的镇静Ramesay评分分别为(2.28±0.59)分与(2.06±0.58)分,低于对照组的(2.63±0.71)分与(2.33±0.70)分,差异有统计学意义(P0.05)。观察组术后0～6 h、6～12 h、12～24 h的芬太尼消耗量及自控按压总次数均低于对照组(P0.05)。观察组的不良反应总发生率为7.27%,低于对照组的21.82%(P0.05)。结论脊柱手术患者采用艾瑞昔布进行超前镇痛可获得良好的术后镇痛效果与镇静效果,芬太尼用量与不良反应均明显减少,具有较高的有效性与安全性,值得推广。     

Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratoma

A case report is presented of a rapidly growing congenital nasopharyngeal teratoma (epignathus) in a preterm infant, leading to severe upper airway obstruction. Prenatal diagnosis by ultrasonography did not reveal the condition because the tumour masses were initially small and there was no polyhydramnios. Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period and should be treated surgically.
Conclusion:  Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period.     

Budesonide and formoterol inhibit inflammatory mediator production by bronchial epithelial cells infected with rhinovirus

Background Rhinoviruses (RVs) are responsible for the majority of acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations. RVs infect the lower airways and induce the production of pro-inflammatory and remodelling-associated mediators. Budesonide (BUD) and formoterol (FORM) synergize in controlling asthma and COPD exacerbations; however, their effects on virus-induced inflammation and remodelling are less known.
Objective We investigated whether BUD and FORM synergize in suppressing RV-induced inflammation and remodelling in the airways.
Methods In vitro models of RV infection of BEAS-2B and primary normal human bronchial epithelial (NHBE) cells were used. We assessed the effects of individual and combined drugs administered post-infection, at a clinically relevant concentration range (10⁻⁶–10⁻¹⁰  m ), on the production of CCL5, CXCL10, CXCL8, IL-6 and the remodelling-associated VEGF and bFGF, using ELISA and RT-PCR.
Results BUD effectively suppressed RV-mediated induction of all mediators studied, in a concentration-dependent manner. FORM alone suppressed the production of CXCL8 and bFGF. The combination of BUD and FORM had concentration-dependent, additive or synergistic effects in the suppression of RV-induced CCL5, CXCL8 and CXCL10 in both cell types as well as VEGF in NHBE only. Combination treatment also resulted in an enhanced suppression of RV-induced IL-6, and CCL5 at the mRNA level as compared with BUD or FORM alone.
Conclusion BUD and FORM suppress RV-induced chemokines and growth factors in bronchial epithelial cells in a concentration-dependent, synergistic or additive manner. These data further support the combined use of BUD and FORM in asthma and COPD and intensification of this therapy during exacerbations.     

Intravenous levosimendan-norepinephrine combination during off-pump coronary artery bypass grafting in a hemodialysis patient with severe myocardial dysfunction

This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis), unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 μg/kg/min and 0.05 μg/kg/min respectively) started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepinephrine combination helped maintain an appropriate hemodynamic profile, thereby contributing to uneventful completion of surgery and postoperative hemodynamic stability. Although levosimendan is considered contraindicated in ESRD patients, this case report suggests that combined perioperative levosimendan/norepinephrine administration can be useful in carefully selected hemodialysis patients with impaired myocardial contractility and ongoing myocardial ischemia, who undergo off-pump myocardial revascularization surgery.     

Marginal-zone B-cell lymphoma, extranodal-malt-type: report of three cases.

A high proportion of extranodal lymphoid infiltrates are diffuse small lymphocytic proliferations [1, 2] and therefore pose a particularly challenging diagnostic problem [1-4]. Their benign or malignant nature cannot be determined using clinical and radiologic criteria. The application of traditional morphologic criteria (i.e., cytologic maturity and polymorphism favor benignancy, while cytologic atypia and monomorphism favor malignancy) [5, 6], has probably improved diagnostic accuracy. However, these criteria generally have not been helpful in evaluating the large number of lymphoid infiltrates composed of monomorphic collections of small cytologically-mature appearing lymphoid cells [1-4] and, therefore, have not always accurately predicted clinical behavior. Extranodal lymphoid proliferations are also of considerable biologic interest since their pathogenesis and natural history have not been fully elucidated. Localized non-Hodgkin's lymphoma, extranodal-MALT-type. was diagnosed in our Department in three cases: Two arose in the orbit and the third one in the tonsil. The tumors had a typical histologic appearance. The microscopical features and immunohistochemical profile are discussed.     

头孢克肟胶囊人体药动学研究及生物等效性评价

目的：研究头孢克肟胶囊在健康人体内的药动学及生物等效性。方法：以18名健康志愿者为试验对象，采用同体交叉试验方法，分别单剂量口服受试制剂或参比制剂各400mg，采用HPLC法测定血浆中药物浓度。结果：参比制剂和受试制剂的tmax分别为（3．39±0．50）和（3．39±0．50）h，cmax分别为（2．33±0．33）和（2．27±0．25）μg／mL，t1／2分别为（3．92±0．85）和（4．41±0．68）h，AUC0～16分别为（14．61±2．67）和（14．82±2．02）μg·h·mL^-1，AUC0～∞分别为（16．00±3．13）和（16．81±2．62）μg·h·mL^-1。结论：受试制剂与参比制剂生物等效，受试制剂的相对生物利用度为（98．69±13．13）％。