罗哌卡因切口周围局部浸润对大鼠慢性术后疼痛的抑制作用

目的 评价术中不同浓度罗哌卡因切口周围局部浸润对慢性术后疼痛的抑制作用. 方法 雄性SD大鼠30只,体重180 g～220 g,按随机数字表法分为5组,每组6只:假手术组(S组)、生理盐水组(R0组)、0.5％罗哌卡因组(R1组)、0.75％罗哌卡因组(R2组)、1％罗哌卡因组(R3组).按Flatters法制作皮肤/肌肉切开牵拉模型(skin/muscle incision and retraction,SMIR),S组大鼠除未进行SMIR之外其他操作均与其他组相同.应用yon Frey细丝法测定术前及术后1、3、7、10、14、17、21、24、28 d的机械缩足反射阈值(paw withdrawal mechanical threshold,PWMT). 结果 各组术前PWMT基础值差异无统计学意义(P＞0.05);与R0组比较,R1组PWMT于术后1、3、7、10、14、17、24d升高[(20.9±3.7)、(14.8±4.6)、(15.8±4.4)、(13.9±1.6)、(9.8±0.8)、(10.2±1.3)、(10.3±2.7) g](P＜0.05),R2组[(21.0±5.2)、(21.3±3.9)、(15.3±4.1)、(18.4±3.3)、(12.1±1.1)、(11.5±1.6)、(14.1±1.9)、(13.2±3.0)、(9.5±2.4)g]和R3组[(22.2±2.9)、(22.5±4.1)、(22.1±4.7)、(23.8±0.9)、(18.2±3.2)、(15.7±3.2)、(21.3±3.9)、(18.4±4.2)、(21.0±4.2) g]PWMT在术后所有时间点均升高(P＜0.05). 结论 术中罗哌卡因切口周围局部浸润可以抑制慢性术后疼痛.     

“J”状塑型双腔气管导管插管操作对成功率及术后声音嘶哑、咽喉痛的影响

目的 观察双腔气管导管(double-lumen endotracheal tube,DLT)塑型对插管成功率及术后声音嘶哑(声嘶)、咽喉痛的影响,从而为寻求更好的DLT塑型插管提供依据. 方法 择期全身麻醉下行胸科手术患者160例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,参照随机数字表法分成DLT插管塑型组和非塑型组(每组80例),两组根据左右DLT插管各分为两组(A、B、C、D组,每组40例),又根据性别再各分为两个亚组(A1、A2、B1、B2、C1、C2、D1、D2组,每组20例).两组均采用经口明视气管插管,塑型组采用塑成“J”状的DLT进行插管,非塑型组采用未经塑型保留原有弯度的DLT进行插管.观察DLT插管时间、插管尝试次数及插反情况,患者术后声嘶、咽喉痛发生率及严重程度. 结果 塑型组插管时间[(154±6)s]明显短于非塑型组[(185±13)s](P＜0.05);塑型组插管尝试次数[(1.4±0.4)次]明显少于非塑型组[(1.7±0.8)次](P＜0.05);塑型组插反情况(3次)明显比非塑型组少(11次)(P＜0.05),且与性别无关,但左DLT比右DLT易于插反(P＜0.05).患者术后声嘶发生率塑型组(15/80)明显低于非塑型组(33/80)(P＜0.05);患者术后咽喉痛发生率塑型组(15/80)明显低于非塑型组(31/80) (P＜0.05),且与性别有关,女性较男性术后易发生声嘶、咽喉痛. 结论 “J”状DLT塑型插管成功率高、刺激小,可降低患者术后声嘶、咽喉痛发生率,具有一定的临床推广意义.     

基质金属蛋白酶1和3多态性与类风湿性关节炎易感性的Meta分析

目的探讨基质金属蛋白酶1(MMP-1)(-1607 1G/2G)和基质金属蛋白酶3(MMP-3)(-1171 5 A/6A)多态性与风湿性关节炎发病风险的关系。方法本组搜索Pub Med、Medline、Embase、谷歌学术搜索、中国生物医学文献数据库和万方知识服务平台,所有发表的病例对照研究MMP-1(-1607 1 G/2G),MMP-3(-1171 5 A/6A)多态性和风湿性关节炎风险的Meta分析。采用固定或随机效应模型计算优势比(OR)和95%置信区间(CI)对MMP-1(-1607 1G/2G)多态和MMP-3-1171(5 A/6A)多态与RA易感性的关系进行总体评估。所有分析均使用STATA 12.0统计学软件进行处理。结果共有5项独立的研究被纳入当前的Meta分析。在所有五个模型没有发现MMP-1(-1607 1 G/2G)和MMP-3(-1171 5A/6A)多态性与类风湿性关节炎(RA)易感性的明显关联,在白种人和亚洲人的亚组分析中也发现了相同的结论。结论该Meta分析表明,MMP-1和MMP-3多态性与类风湿性关节炎发病无显著相关性。     

开放式完全腹膜外疝修补术在成人腹股沟疝中的临床应用

目的探讨开放式完全腹膜外疝修补术(TEP)在成人腹股沟疝治疗中的临床应用价值。方法 2011年1月至2013年12月,天津市第一中心医院收治52例成人腹股沟疝患者,采用开放式TEP治疗,现对本组患者的手术时间、术后并发症、住院时间及复发情况进行回顾性分析。结果双侧腹股沟疝手术时间46~75 min,平均(55±9)min;单侧腹股沟疝手术时间25~40 min,平均(30±5)min。52例患者术后住院时间3~7 d,平均(4.1±1.3)d,并发症发生率3.8%(2/52),随访6个月至3年,无复发。结论采用开放式TEP治疗成人腹股沟疝,符合疝修补理念及微创手术原则,具有操作简单,手术创伤小,恢复快,费用低等优点,适宜临床推广。     

UrocortinⅠ后处理对缺氧/复氧大鼠心肌线粒体膜电位的影响

目的探讨UrocortinⅠ后处理对缺氧/复氧后成年大鼠心肌细胞线粒体膜电位的影响。方法利用离体心脏灌注装置(MPA)分离成年大鼠心肌细胞,培养24 h后进行细胞计数并随机分为正常组(N组)、缺氧/复氧组(I/R组)、UrocortinⅠ后处理组(UcnⅠ组)、5-羟葵酸拮抗UrocortinⅠ组(5-HD+UcnⅠ组)。N组在预设37℃培养箱中持续培养135 min;余3组均予缺氧40 min,复氧60 min建立缺氧/复氧模型。其中UcnⅠ组在缺氧末复氧前给予UcnⅠ处理30 min;5-HD+UcnⅠ组在UcnⅠ处理前给予特异性线粒体ATP敏感性钾通道(mito-KATP)拮抗剂5-HD处理5 min,余处理同UcnⅠ组。各组于复氧末加入JC-1荧光探针并用激光共聚焦显微镜观察心肌细胞膜电位的变化。结果 N组心肌细胞高膜电位比例均高于其余各组(P<0.01),而UcnⅠ组高膜电位比例高于I/R组和5-HD+UcnⅠ组(P<0.05),I/R组与5-HD+Ucn I组比差异无统计学意义(P>0.05)。结论 UcnⅠ后处理可防止缺氧/复氧后心肌细胞线粒体膜电位的下降,保护复氧后心肌线粒体的膜电位。     

印迹基因IGF2与p53在子宫颈鳞癌、子宫颈上皮内瘤变及子宫颈炎中的表达及意义

目的：探讨IGF2与p53在子宫颈鳞癌、子宫颈上皮内瘤变（cervical intraepithelial neoplasia, CIN）及子宫颈炎中的表达及意义。方法采用免疫组化EnVision两步法检测IGF2与p53在45例子宫颈炎、126例CIN、47例子宫颈鳞癌组织中的表达,分析其与临床病理参数间的关系。结果子宫颈鳞癌组织中IGF2阳性表达显著高于CIN 及子宫颈炎（P<0.05）;p53阳性表达显著高于CIN 及子宫颈炎（P<0.0001）。子宫颈鳞癌组织中IGF2的阳性表达与浸润深度以及淋巴结转移呈负相关（P<0.05）。结论 IGF2、p53的异常表达与子宫颈鳞癌的发生密切相关。     

Long-term Efficacy of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A 5-year Follow-up Study in China

Background:

Subthalamic nucleus deep brain stimulation (STN DBS) is effective against advanced Parkinson''s disease (PD), allowing dramatic improvement of Parkinsonism, in addition to a significant reduction in medication. Here we aimed to investigate the long-term effect of STN DBS in Chinese PD patients, which has not been thoroughly studied in China.

Methods:

Ten PD patients were assessed before DBS and followed up 1, 3, and 5 years later using Unified Parkinson''s Disease Rating Scale Part III (UPDRS III), Parkinson''s Disease Questionnatire-39, Parkinson''s Disease Sleep Scale-Chinese Version, Mini-mental State Examination, Montreal Cognitive Assessment, Hamilton Anxiety Scale and Hamilton Depression Scale. Stimulation parameters and drug dosages were recorded at each follow-up. Data were analyzed using the ANOVA for repeated measures.

Results:

In the “off” state (off medication), DBS improved UPDRS III scores by 35.87% in 5 years, compared with preoperative baseline (P < 0.001). In the “on” state (on medication), motor scores at 5 years were similar to the results of preoperative levodopa challenge test. The quality of life is improved by 58.18% (P < 0.001) from baseline to 3 years and gradually declined afterward. Sleep, cognition, and emotion were mostly unchanged. Levodopa equivalent daily dose was reduced from 660.4 ± 210.1 mg at baseline to 310.6 ± 158.4 mg at 5 years (by 52.96%, P < 0.001). The average pulse width, frequency and amplitude at 5 years were 75.0 ± 18.21 μs, 138.5 ± 19.34 Hz, and 2.68 ± 0.43 V, respectively.

Conclusions:

STN DBS is an effective intervention for PD, although associated with a slightly diminished efficacy after 5 years. Compared with other studies, patients in our study required lower voltage and medication for satisfactory symptom control.     

Clinical Characteristics,Radiological Features and Gene Mutation in 10 Chinese Families with Spinocerebellar Ataxias

Background:

Spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders that primarily cause the degeneration in the cerebellum, spinal cord, and brainstem. We study the clinical characteristics, radiological features and gene mutation in Chinese families with SCAs.

Methods:

In this study, we investigated 10 SCAs Chinese families with SCA1, SCA3/Machado–Joseph disease (MJD), SCA7, SCA8. There were 27 people who were genetically diagnosed as SCA, of which 21 people showed clinical symptoms, and 6 people had no clinical phenotype that we called them presymptomatic patients. In addition, 3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing. Clinical characteristic analyses of each type of SCAs and radiological examinations were performed.

Results:

We found that SCA3/MJD was the most common subtype in Han population in China, and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats; the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score; and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset.

Conclusions:

Collectively our study is a systematic research on SCAs in China, which may help for the clinical diagnosis and prenatal screening of this disease, and it may also aid toward better understanding of this disease.     

Efficacy and Safety of Avandamet or Uptitrated Metformin Treatment in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Alone: A Multicenter,Randomized, Controlled Trial

Background:

At present, China has listed the compound tablet containing a fixed dose of rosiglitazone and metformin, Avandamet, which may improve patient compliance. The aim of this study was to evaluate the efficacy and safety of Avandamet or uptitrated metformin treatment in patients with type 2 diabetes inadequately controlled with metformin alone.

Methods:

This study was a 48-week, multicenter, randomized, open-labeled, active-controlled trial. Patients with inadequate glycaemic control (glycated hemoglobin [HbA1c] 7.5–9.5%) receiving a stable dose of metformin (≥1500 mg) were recruited from 21 centers in China (from 19 November, 2009 to 15 March, 2011). The primary objective was to compare the proportion of patients who reached the target of HbA1c ≤7% between Avandamet and metformin treatment.

Results:

At week 48, 83.33% of patients reached the target of HbA1c ≤7% in Avandamet treatment and 70.00% in uptitrated metformin treatment, with significantly difference between groups. The target of HbA1c ≤6.5% was reached in 66.03% of patients in Avandamet treatment and 46.88% in uptitrated metformin treatment. The target of fasting plasma glucose (FPG) ≤6.1 mmol/L was reached in 26.97% of patients in Avandamet treatment and 19.33% in uptitrated metformin treatment. The target of FPG ≤7.0 mmol/L was reached in 63.16% of patients in Avandamet treatment and 43.33% in uptitrated metformin treatment. Fasting insulin decreased 3.24 ± 0.98 μU/ml from baseline in Avandamet treatment and 0.72 ± 1.10 μU/ml in uptitrated metformin treatment. Overall adverse event (AE) rates and serious AE rates were similar between groups. Hypoglycaemia occurred rarely in both groups.

Conclusions:

Compared with uptitrated metformin, Avandamet treatment provided significant improvements in key parameters of glycemic control and was generally well tolerated. Registration number: ChiCTR-TRC-13003776.