垂体中叶素对脓毒症大鼠心脏功能的影响

目的 探讨垂体中叶素(intermedin,IMD)对脓毒症大鼠心脏功能的影响.方法 采用盲肠结扎穿孔术(cecal ligation and puncture,CLP)复制大鼠脓毒症模型,分为5组,分别为假手术组、CLP组、CLP+常规治疗组(CLP+ CT)、CLP+ CT+ E-IMD早期治疗组、CLP+ CT+ L-IMD晚期治疗组,观察早期(CLP结束时)或晚期(CLP 12 h)给予IMD后大鼠心脏功能、心输出量、心脏指数、每搏指数、氧供、氧耗、血气及动物存活时间、存活率的变化.结果 与假手术组比较,脓毒症后大鼠的心脏功能明显降低;采用常规治疗(包括输液、抗感染以及使用血管活性药物),尽管可以提高动脉血压和中心静脉压,但大鼠的心脏功能无明显改善;早期和晚期给予IMD可明显改善心脏功能;氧供和氧耗明显升高,其中早期给予IMD效果更好,与脓毒症大鼠相比,早期给予IMD后,氧供和氧耗分别升高了148.9％和172.2％;72 h内死亡大鼠的平均存活时间达到23.15 h,72 h存活率为31.2％ (5/16).结论 IMD对脓毒症大鼠的心脏功能有较好的治疗作用.     

Struma ovarii: management and follow-up of a rare ovarian tumour

INTRODUCTION

Struma ovarii represents about 1.0% of all ovarian tumours. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management. This study aimed to delineate the management of struma ovarii, its associated complications, and postoperative follow-up and investigations.

METHODS

We retrospectively reviewed cases of benign struma ovarii treated at KK Women’s and Children’s Hospital, Singapore, between January 2000 and May 2011.

RESULTS

A total of 68 patients underwent surgical removal of ovarian cyst or mass (24 cystectomy, 20 salpingo-oopherectomy and 24 total hysterectomy and bilateral salpingo-oopherectomy). Of the 68 surgeries, 39 (57.4%) included intraoperative frozen section sampling or procedures for staging of ovarian malignancy. The majority (73.5%) of surgeries were laparotomies. Histology revealed benign struma ovarii in all (98.5%) but one patient. Only 7 (10.3%) patients had postoperative complications – 3 wound-related, 2 thyroid-related, 1 incisional hernia and 1 nonspecific. The mean length of hospital stay was 4.2 days. During follow-up, 45 (66.2%) patients required no additional investigations. The most common investigation done was ultrasonography (n = 18, 26.5%). While no recurrences were diagnosed histologically, two patients were subsequently found to have complex/dermoid ovarian cysts on the ipsilateral side of the previous struma ovarii on ultrasonography.

CONCLUSION

Simple surgery is recommended for patients with struma ovarii, especially if they have fertility potential. Laparoscopic surgery is the recommended approach due to its shorter recovery time and lower morbidity. Most patients do not require extended periods of follow-up or postoperative investigations.     

Cost-effectiveness analysis of a hospital electronic medication management system

Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS).Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs.Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially.Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.     

Ultra-microstructural changes in iliac artery after bare and magnetic stent implantation in rabbits

Objective To investigate the preventive effect of magnetic stent on coronary restenosis after percutaneous arterial stenting. Methods Twenty rabbits were divided randomly into 2 groups.Bare stent (BS group,n=10) or magnetic stent (MS group,n=10) was implanted in the left iliac artery of the rabbits of the 2 groups,respectively.Aspirin (25rag,qd) was administered orally to the rabbits of both groups from 3 days before stenting until the rabbits were executed.Unfractionated heparin (2500u,qd) was delivered subcuta- neously after stenting for 7 days.Five rabbits of each group were randomly selected to be executed at 7 or 30 days.Structural changes in the injured arteries were studied by optical microscopey,transmissive electronic microscopey and immunohistochemistry.Results At 7 days,more myofibroblasts were found migrating from adventitia to tunica media and intima in BS group than in MS group.Inside the media and intima,large amount of smooth muscle cells of synthetic type were observed.At 30 days after stenting,in magnetic group, most uascular smooth muscle cells (SMCs) under the intima had transformed to contractile type and only little extracellular matrix (ECM) was observed around the SMCs;whereas,in BS group,the SMCs remained to be synthetic type and large amount of ECM was observed around the SMCs,which was composed mainly ofproteoglycans and glycoproteins.Conclusions Magnetic stent can inhibit proliferation and migration of SMCs and reducing the production of ECM,and therefore,may prevent restenosis after coronary stenting.     

WebDISCO: a web service for distributed cox model learning without patient-level data sharing

Objective The Cox proportional hazards model is a widely used method for analyzing survival data. To achieve sufficient statistical power in a survival analysis, it usually requires a large amount of data. Data sharing across institutions could be a potential workaround for providing this added power.Methods and materials The authors develop a web service for distributed Cox model learning (WebDISCO), which focuses on the proof-of-concept and algorithm development for federated survival analysis. The sensitive patient-level data can be processed locally and only the less-sensitive intermediate statistics are exchanged to build a global Cox model. Mathematical derivation shows that the proposed distributed algorithm is identical to the centralized Cox model.Results The authors evaluated the proposed framework at the University of California, San Diego (UCSD), Emory, and Duke. The experimental results show that both distributed and centralized models result in near-identical model coefficients with differences in the range 10^?15 to 10^?12. The results confirm the mathematical derivation and show that the implementation of the distributed model can achieve the same results as the centralized implementation.Limitation The proposed method serves as a proof of concept, in which a publicly available dataset was used to evaluate the performance. The authors do not intend to suggest that this method can resolve policy and engineering issues related to the federated use of institutional data, but they should serve as evidence of the technical feasibility of the proposed approach.Conclusions WebDISCO (Web-based Distributed Cox Regression Model; https://webdisco.ucsd-dbmi.org:8443/cox/) provides a proof-of-concept web service that implements a distributed algorithm to conduct distributed survival analysis without sharing patient level data.     

血清网膜素-1 与糖尿病周围神经病变的相关性

目的 探讨血清网膜素-1 与糖尿病周围神经病变（DPN）的相关性。方法 选取2016 年6 月— 2017 年10 月海南省第三人民医院收治的100 例2 型糖尿病患者,根据是否合并周围神经病变,将其分为 DPN 和无DPN 组,各50 例。另选取同期该院健康体检者50 例作为对照组。测量各组的体重、身高、腰围、 臀围,计算体重指数（BMI）及腰臀比（WHR）;检测空腹血糖（FPG）、空腹胰岛素（Fins）、糖化血红蛋白 （HbA1C）、24 h 尿白蛋白排泄率（24 hUAER）、胱抑素C（Cys-C）、胆固醇（TC）、甘油三酯（TG）、高密 度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）及血清网膜素-1 水平,计算胰岛素抵抗指数（HOMA-IR） 和胰岛β 细胞功能指数（HOMA-β）。结果 各组BMI、WHR、TG、Fins、FPG、HOMA-IR、HbAlc、 血清网膜素-1、HDL-C 及HOMA-β 比较,差异有统计学意义（P <0.05）,DPN 组和无DPN 组患者血 清网膜素-1 水平均低于对照组（P <0.05）,DPN 组患者血清网膜素-1 水平均低于无DPN 组（P <0.05）。 血清网膜素-1 水平与HOMA-β 呈正相关（r =0.496,P =0.000）,与病程、WHR、TG、Cys-C、FPG、 HbA1c 及24 hUAER 呈负相关（r =-0.323、-0.127、-0.173、-0.326、-0.449、-0.328 和-0.331,P =0.009、 0.013、0.035、0.000、0.000、0.000 和0.023）。Logistic 回归分析结果表明血清网膜素-1 是影响DPN 发生的 危险因素[Ol ^ R=1.011（95%CI ：1.003,1.019）,P =0.013]。结论 DPN 的发生、发展可能与血清网膜素-1 水 平降低有关。     

光谱法研究头孢尼西钠与牛血清白蛋白的相互作用

目的 运用荧光和紫外光谱法,在不同的温度下去探讨头孢尼西钠(CS)与牛血清白蛋白(BSA)的相互作用.方法 用Stern-Volmer、Lineweaver-Burk和双对数方程计算了速率常数(Kq)、猝灭常数(Ksv)、静态荧光猝灭缔合常数(KLB)、结合位点数(n)和有效结合常数(Kb).结果 CS能结合BSA.由于生成CS-BSA复合物,头孢尼西钠对BSA的猝灭是静态猝灭机制.热力学参数表明是一个自发过程,其作用力类型主要为静电作用力.BSA的亚螺旋域ⅡA是主要结合位置,离酪氨酸残基更近.有药物负协同作用.同步荧光光谱法表明CS能改变BSA的色氨酸和酪氨酸残基的微环境.结论 CS与BSA发生了静态相互作用,有一个结合位点,为CS的临床研究提供重要的参考依据.     

中医"病证"的涵义辨析

病证是中医临床上的常用术语。病证是在中国传统医药理论指导下,分类归纳出的一类在致病因素作用下具有相同基本病机的机体异常状态。而基本病机是病证分类和归纳的要点,是病证自身组成各要素之间相对稳定的内在联系,体现并贯穿于病证的全过程,是决定病证主症和中医诊治规律的内部依据。病证的含义不同于疾病、证候和症状。正确认识病证含义有助于总结前人临床经验和指导当下临床。