乌拉地尔对二氧化碳气腹下腹腔镜手术时血流动力学的影响

目的　探讨乌拉地尔在腹腔镜胆囊切除术(LC)中二氧化碳气腹建立时对血流动力学的影响。方法　选择ASAⅠ~Ⅱ级腹腔镜胆囊切除术病人60例,随机分为乌拉地尔组(A组,n=30)和对照组(B组, n=30)。A组于气腹时经静脉推注乌拉地尔0 3mg/kg。记录A组与B组患者气腹前5 分钟(T1),气腹时(T2),气腹后5分钟(T3),气腹后10分钟(T4),气腹后15分钟(T5)时SBP、DBP、MAP、HR的改变。结果　A组与B组在T1、T2时点各监测值无明显差异;气腹后B组内各时点监测值与T1比较,P<0 .05,或者P<0 .01,有显著性差异;A组各时点与T1比较,无明显差异;气腹后组间比较,B组各时点监测值比A组高,P<0. 05或者P<0 .01,有显著性差异。结论　乌拉地尔能有效的预防二氧化碳气腹时血流动力学的变化。     

红岩草中三种成分的体外抑菌实验及组方优选研究

目的：通过红岩草中连苯三酚、氢醌和没食子酸甲酯等3种成分的体外抑菌作用,验证红岩草的抑菌活性,同时为其成分组方提供依据。方法：采用常量稀释法,测定连苯三酚、氢醌、没食子酸甲酯对导致奶牛乳房炎5种主要致病菌的体外抑菌效果;采用正交试验方法优选3种成分的最佳配比并对其进行验证。结果：连苯三酚对金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌、无乳链球菌和停乳链球菌的最低抑菌浓度分别为160 mg.L-1、80 mg.L-1、1 280 mg.L-1、640 mg.L-1和640 mg.L-1,氢醌对5种细菌的最低抑菌浓度分别为640 mg.L-1、80 mg.L-1、〉1 280 mg.L-1、80 mg.L-1和80 mg.L-1,没食子酸甲酯对5种细菌的最低抑菌浓度分别为12 800 mg.L-1、〉1 280 mg.L-1、640 mg.L-1、〉1 280 mg.L-1和〉1 280 mg.L-1。正交试验结果直观分析显示连苯三酚、氢醌、没食子酸甲酯对于金黄色葡萄球菌、表皮葡萄球菌、大肠杆菌和无乳链球菌的抑菌效果为连苯三酚〉氢醌〉没食子酸甲酯;对于停乳链球菌的抑菌效果为氢醌〉没食子酸甲酯〉连苯三酚。方差分析显示,3种成分对金黄色葡萄球菌、表皮葡萄球菌和大肠杆菌,因素水平间存在显著性差异（P〈0.05）,而对于无乳链球菌和停乳链球菌,因素水平间无显著性差异。结论：氢醌对奶牛乳房炎主要致病菌有较好的体外抑菌作用,3种成分的最佳组方为A3B3C2。     

膝痹宁Ⅱ方内服治疗寒湿痹阻型膝骨关节炎临床疗效的回顾性队列研究

目的 回顾性分析膝痹宁Ⅱ方在内服药物治疗寒湿痹阻型膝骨关节炎中的临床疗效,探索终点事件的影响因素。方法 采用真实世界回顾性队列设计,收集江苏省中医院骨科门诊内服药物治疗寒湿痹阻型膝骨关节炎病案资料。所有患者接受西医常规治疗,根据是否服用膝痹宁Ⅱ方治疗分为非暴露组（573例）和暴露组（427例）,应用IBM SPSS 27.0对筛选出的1 000例基线资料进行描述性分析。依据病案基线资料,采用倾向性评分匹配法匹配出334对,两组共668例病案,比较两组治疗前,治疗2、6、12周后视觉模拟评分法（VAS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总评分、日本膝骨关节炎功能评估量表（JKOM）评分、中医证候积分的变化,不良反应发生情况。根据治疗前后WOMAC总分改善率判定的临床治愈作为终点事件进行多因素logistic回归分析,分析终点事件的影响因素。结果 治疗12周后,与治疗前比较,两组患者VAS、WOMAC总评分、JKOM评分、中医证候积分均显著降低（P<0.01）;与非暴露组比较,暴露组VAS、WOMAC总评分、JKOM评分、中医证候积分显著降低（P<0.01）。治疗12周后,与非暴露组比较,暴露组临床治愈率、显效率更高（χ²=14.36、64.80,P<0.05）。与本组治疗前比较,两组治疗2、6、12周后VAS,WOMAC疼痛、僵硬、功能评分、JKOM评分、中医症状积分显著降低（P<0.01）。与同时间点非暴露组比较,暴露组治疗2、12周后VAS,6、12周后WOMAC疼痛,12周后功能评分明显降低（P<0.05,P<0.01）;暴露组治疗6、12周后JKOM评分降低,治疗2、6、12周后中医症状积分明显降低（P<0.05,P<0.01）。治疗12周后的多因素logistic回归显示影响临床治愈的因素包括病程,饮酒史,高血压,冠心病和服用膝痹宁Ⅱ（P<0.05,P<0.01）。与同时间点非暴露组比较,暴露组治疗2、12周后胃脘不适发生率显著降低（P<0.01）;腹泻、呕吐的发生稍高于非暴露组,但差异无统计学意义。结论 临床应用膝痹宁Ⅱ口服联合常规西药治疗寒湿痹阻型膝骨关节炎疗效优于常规西药治疗,可显著降低VAS、WOMAC总评分、JKOM评分、中医症状积分,其中远期疗效差异更明显,不良反应发生率低。     

Association between systemic lupus erythematosus and Helicobacter pylori seronegativity

OBJECTIVE: Helicobacter pylori is a gram negative spiral bacterium that is clearly associated with a variety of gastrointestinal pathologies. A number of non-gastrointestinal diseases have also been associated with H. pylori. We investigated the prevalence of H. pylori seropositivity as part of a larger serologic survey in a group of 466 patients with systemic lupus erythematosus (SLE) and 466 controls. METHODS: We studied subjects for seropositivity against 5 antigens including mumps, measles, rubella, varicella zoster, and H. pylori. The 466 SLE patients were taken from a total of 290 pedigrees multiplex for SLE and matched to 466 controls for age (+/- 3 yrs), sex, and ethnicity to non-SLE affected individuals, taken mostly from the same collection of pedigrees multiplex for SLE. Assays for seropositivity were performed using a heterogeneous immunoassay technique. Pearson's chi-square was used to test for association of categorical variables and Student t-test for continuous variables. Logistic regression was used to compute the odds ratio for H. pylori seropositivity in patients and controls. RESULTS: There was a significant difference only in H. pylori seropositivity between SLE cases and their controls. The results were not altered by intrafamilial correlation. Subset analysis by race and sex showed that the differences between the African-American female patients with SLE and their matched controls were responsible for this association. Female African-American patients with SLE had a lower prevalence of H. pylori seropositivity compared to controls (38.1% vs 60.2%, OR 0.41, p = 0.0009, 95% CI 0.24-0.69). Of the 113 African-American female SLE patients in the study group, 43 were seropositive for H. pylori. The mean age of onset for SLE was older in the seropositive group (34.4 yrs) compared to the seronegative SLE patients (28.0 yrs) (t = 2.11, p = 0.039). CONCLUSION: Of 5 serologic tests performed, only the frequency of H. pylori seropositivity was different between SLE cases and their controls, and then only in African-Americans. We found an association between being seronegative for H. pylori and the development of SLE in African-American women, who also tend to be younger at the time of disease onset. These findings suggest that there is a possible protective role for H. pylori infection against the development of SLE or that immunoregulatory events leading to H. pylori seropositivity are inversely related to the risk of SLE.     

The impact of managing moderately injured pediatric trauma patients without immediate surgeon presence

Purpose

The purpose of this study was to determine the outcome of “minor resuscitation” trauma patients managed without the immediate presence of a surgeon.

Methods

In 2003, our hospital replaced surgeons with pediatric emergency medicine physicians for level 2 (minor resuscitation) trauma alerts, whereas the level 1 (major resuscitation) alerts remained surgeon directed. We compared patients treated in the 3 years before (period 1) and after (period 2) this change. Patient records were analyzed for discharges, alert upgrades, Injury Severity Score (ISS), time to destination, and mortality.

Results

There were 918 admissions and 93 discharges in period 1 compared with 815 admissions and 652 discharges in period 2. In period 1, 3% were upgraded to level 1 status compared with 9% in period 2 (P < .0001). The mean ISS of admitted patients and the percentage of critical (ISS >15) patients were greater in period 2 (P < .001). The time to inpatient floor was longer in period 2, but the elapsed times to operating room and to pediatric intensive care unit were not significantly different.

Conclusion

Pediatric emergency medicine physicians discharged more patients than the surgeons, but also upgraded more to level 1 status. Level 2 trauma patients can be safely managed without immediate surgeon presence.     

Endoplasmic reticulum stress in murine liver and kidney exposed to microcystin-LR

To investigate the effect of microcystin-LR (MC-LR) on apoptosis based on the endoplasmic reticulum stress (ERS) pathway in mouse liver and kidney, male ICR mice were intraperitoneally injected with 20 μg kg⁻¹ body weight MC-LR for 21 days, and mRNA and protein levels of ERS special molecules in liver and kidney were analyzed using quantitative real-time PCR and western blotting. MC-LR significantly improved mRNA and protein expression of C/EBP homologous protein (CHOP) and cleaved caspase-12 in liver, whereas it inhibited expression of CHOP and caspase-12 in kidney. MC-LR also induced significant down-regulation of B-cell lymphoma/leukemia-2 (Bcl-2) mRNA expression in liver and weak up-regulation in kidney. These results indicated the involvement of the ERS pathway in MC-LR-induced apoptosis of hepatic cells but not in renal cells of mice. The weight changes and histological damage of liver and kidney were in accordance with the appearance of ERS. Our results indicate that ERS plays an important role in hepatic cell apoptosis induced by MC-LR, and is considered as a new pathway of liver toxicity. Its relative special genes might be considered as potentially new biomarkers used for risk assessment of MC-LR in the environment.     

Body mass index does not influence post-treatment survival in early stage endometrial cancer: results from the MRC ASTEC trial

Body mass index (BMI) is a major risk factor for endometrial cancer incidence but its impact on post-treatment survival is unclear. We investigated the relationships of BMI (categorised using the WHO definitions) with clinico-pathological characteristics and outcome in women treated within the MRC ASTEC randomised trial, which provides data from patients who received standardised allocated treatments and therefore reduces biases. The impact of BMI on both recurrence-free survival (RFS) and overall survival (OS) was analysed using the Cox regression models. An apriori framework of evaluating potential biases was explored. From 1408 participants, there were 1070 women with determinable BMI (median=29.1 kg/m(2)). Histological types were endometrioid (type 1) in 893 and non-endometrioid (type 2) in 146 women; the proportion of the latter decreasing with increasing BMI (8% versus 19% for obese III WHO category versus normal weight, p(trend)=0.003). For type 1 carcinomas, increasing BMI was associated with less aggressive histopathological features (depth of invasion, p=0.006; tumour grade, p=0.015). With a median follow-up of 34.3 months, there was no influence of BMI on RFS - adjusted HRs per 5 kg/m(2) were 0.98 (95% CI 0.86, 1.13) and 0.95 (0.74, 1.24), for type 1 and 2 carcinomas; and no influence on OS - adjusted HRs per 5 kg/m(2) were 0.96 (0.81, 1.14) and 0.92 (0.70, 1.23), respectively. These findings demonstrate an important principle: that an established link between an exposure (here, obesity) and increased incident cancer risk, does not necessarily translate into an inferior outcome following treatment for that cancer.