肠减压后腹腔镜辅助右半结肠切除术在右半结肠癌伴肠梗阻中的应用

目的 探讨肠减压后腹腔镜手术与传统开腹手术在右半结肠癌并急性肠梗阻中的可行性与疗效.方法 回顾性分析2019年1月至2020年6月在该院普通外科就诊的53例急性右侧梗阻性结肠癌患者的病历资料.入选患者术前腹部立位平片及腹部CT均明确提示为右半结肠癌伴肠梗阻,不减压均无法建立腹腔镜操作空间,术后病理证实为结肠癌.根据其手术方式分为肠减压后联合入路翻页式腹腔镜辅助右半结肠癌根治术组(腹腔镜组,n=22)和传统开腹手术组(传统开腹组,n=31).比较两组患者的一般资料、手术时间、出血量、切口长度、肛门排气时间、术后住院时间及术后并发症的差异.结果 两组患者基线资料比较差异无统计学意义(P＞0.05).腹腔镜组、传统开腹组患者术中出血量分别为(24.48±7.57)、(69.00±12.87)mL,切口长度分别为(6.80±0.56)、(18.55±1.32)cm,肛门排气时间分别为(40.85±3.60)、(68.43±3.04)h,术后住院时间分别为(6.41±1.74)、(11.71±1.40)d,两组患者上述指标比较差异均有统计学意义(P＜0.05).腹腔镜组、传统开腹组患者手术时间分别为(171.47±9.01)、(185.18±9.40)min,两组患者手术时间及术后并发症(手术切口感染率、吻合口瘘、腹腔内出血、腹腔感染)比较,差异均无统计学意义(P＞0.05).结论 对右半结肠癌并急性肠梗阻患者采用肠减压后联合入路翻页式腹腔镜辅助右半结肠癌根治术具有创伤小、安全、有效等优势.     

Physical Activity and Sedentary Behaviors among Chinese Children: Recent Trends and Correlates

Objective This study was aimed at examining the trends and correlates of physical activity (PA) and sedentary behaviors among Chinese children. Methods A total of 4,341 subjects (6,936 observations) aged 6–17 years who participated in the China Health and Nutrition Survey (2004–2015) were included. Of the subjects, 41％ participated in the survey twice or more. Random-effects ordinal regression models and repeated-measures mixed-effects models were used to examine the PA trends. Quantile regression models were applied to examine the factors influencing PA and sedentary behaviors. Results From 2004 to 2015, the prevalence of physical inactivity among Chinese children aged 6–17 years increased by 5.5％ [odds ratio (OR), 1.51; 95％ confidence interval (CI), 1.19–1.90; P < 0.001]. The PA volume declined by 5.8 metabolic equivalent of task-hr/week (P < 0.001), and the time spent in sedentary behaviors increased by 1.8 hr/week (P < 0.001). Age, ethnicity, and region showed significant effects on the PA volume across the quartiles (P < 0.001). Across the quartiles, sedentary time was significantly higher in the children residing in urban areas (P < 0.001) or areas with high urbanization levels (P ≤ 0.005) than in their counterparts. Conclusions A declining PA trend among Chinese children aged 6–17 years was observed from 2004 to 2015, and certain subgroups and geographical areas are at higher risk of physical inactivity.     

A Risk Prediction Model for Ischemic Stroke in Southern Chinese Population: Impact of Multiple Genetic Variants and Clinical/Lifestyle Factors

With a global prevalence of 7.7 million, ischemic stroke (IS) is one of the leading causes of death and disability worldwide. In China, IS alone contributed to 69.6％? of stroke events and accounted for 37.1％? of the mortality/disability rate[1]. IS is a complex disease that is known to be associated?with?various?genetic?variants?and?clinical and lifestyle risk factors[2]. Genome -wide association studies (GWAS) provided evidence for the?occurrence?of?more?than?160?IS-associated?single nucleotide?polymorphisms?(SNPs).?In?terms?of?clinical risk factors, patients with a history of chronic diseases like hypertension, dyslipidemia, and diabetes mellitus, display a higher risk of developing IS. Among the various lifestyle components, leading a sedentary lifestyle, smoking, and having an unhealthy diet are known to be associated with the risk of IS. Thus, integration of various genetic, clinical, and lifestyle variables might prove to be highly beneficial in the prediction and prevention of IS?at?the?individual?level[3].     

去甲肾上腺素对腹外侧视前区神经元的作用途径研究

目的 研究去甲肾上腺素(NA)对腹外侧视前区(VLPO)中两种类型神经元(促睡眠神经元和中间神经元)的作用途径.方法 采用全细胞膜片钳技术,通过药理学方法在C57BL/6小鼠脑片上,研究NA对VLPO中两种类型神经元兴奋或抑制作用的途径.通过RT-PCR鉴定VLPO脑区NMDA受体表达的类型.结果 电生理结果显示,NA(100 μmol/L)对VLPO中间神经元的兴奋作用能被NMDA受体阻断剂(AP5)阻断(P＜0.05,n = 8),不能被AMPA受体阻断剂(CNQX)和γ-氨基丁酸受体阻断剂阻断.NA(100μmol/L)对VLPO促睡眠神经元的抑制作用均不能被AP5、CNQX和氟马西尼(flumazenil)阻断.RT-PCR结果显示NM-DA 受体的3种亚型(GluN2A、GluN2B、GluN1)在VLPO中均有表达.结论 NA对VLPO中间神经元的兴奋作用是通过谷氨酸能神经元释放谷氨酸引起的间接效应,该兴奋效应由VLPO中间神经元上的NMDA受体介导.     

麻醉前应用抗胆碱能药物的广东省专家共识(2021版)

抗胆碱能药物在临床应用历史悠久,最初被应用于呼吸系统疾病的治疗。目前,抗胆碱能药物作为重要的术前用药,其术前应用是保证临床麻醉安全实施的重要措施,在促进患者术后快速康复中扮演重要角色。目前抗胆碱能药物种类较多,作用机制不同,术前规范并合理使用抗胆碱能药物可防范麻醉及手术因素所致的风险,保证患者围手术期安全,提高围手术期麻醉管理质量。为进一步规范术前抗胆碱能药物使用,受广东省医学会麻醉学分会的委托,本专家共识邀请省内相关领域麻醉专家,根据国内外最新研究进展和专家共识及指南,结合各中心术前应用抗胆碱能药物的临床实践经验,从抗胆碱能药物在临床麻醉中的应用及在围手术期的应用、麻醉前应用抗胆碱能药物的选择与考虑、抗胆碱能药物的用法用量及注意事项等方面,对术前应用抗胆碱能药物的要点进行阐述。     

儿童社会生活能力与学习成绩的探讨

为了探讨儿童社会生活能力与学习成绩之间的关系,本文用《婴儿——初中学生社会生活能力量表》对354名小学生进行了社会生活能力测查,并收集了该学期语文、数学总评成绩。研究结果表明,小学生社会生活能力与学习成绩无关,男女生社会生活能力无显著性差异,女生语文成绩优于男生,数学成绩在男女生之间无显著性差异。     

Efficacy of Metabolic Surgery on HbA1c Decrease in Type 2 Diabetes Mellitus Patients with BMI <35 kg/m2—a Review

High glycated hemoglobin A1c (HbA1c) is strongly correlated with developing type 2 diabetes mellitus (T2DM) complications; this study reviews the efficacy of various types of metabolic surgeries in reducing HbA1c levels in type 2 diabetics with BMI <35 kg/m². An electronic search of MEDLINE databases using terms ‘metabolic surgery’, type 2 diabetes mellitus, BMI <35 kg/m², and related keywords for studies published between 1987 and 2013. Data from 53 articles with 2,258 patients were selected for this review. The weighted mean change in HbA1c was ?2.8 % (95 % CI ?2.8 to ?2.7, p?<?0.01) and weighted mean BMI change was ?5.5 kg/m² (95 % CI ?5.6 to ?5.4, p?<?0.01). There was a strong correlation between weighted percentage mean change in HbA1c and BMI. Adjustable gastric banding and duodenal jejunal bypass were inferior to other surgeries in reducing BMI and HbA1c in BMI <35 kg/m². Metabolic surgery significantly decreases HbA1c in T2DM patients with BMI <35 kg/m² and that the magnitude of HbA1c change may be a useful surrogate of DM control.     

PICC维护网络的建立与管理

目的探讨PICC置管患者携管出院期间的维护方法。方法静脉治疗团队将进修护士、肿瘤专科护士、静疗专科护士及静疗学习班学员纳入网络维护人员,逐步建立PICC维护网点并不断扩大规模,通过建立维护花名册、QQ群、专科护士返基地活动等措施进行管理。结果 PICC维护网络已覆盖到江苏省126所二、三级医院及安徽省3个市县的3所二、三级医院,参与PICC维护网点维护的护士达195人。携管出院患者导管相关并发症(静脉炎、导管堵塞、皮肤湿疹、渗液、非计划拔管)的总发生率由2008年的17.9%下降至2013年的3.5%;借助QQ群解决了近600例置管及维护疑难问题。结论 PICC维护网络的建立,满足了携管出院患者治疗间歇期间的导管维护需求,既增加了维护点医院的经济效益又提升了社会效益。