Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery

Background. Ketorolac is approved for the relief of postoperativepain but concerns have been raised over a possible risk of seriousadverse effects and death. Two regulatory reviews in Europeon the safety of ketorolac found the data were inconclusiveand lacked comparison with other non-steroidal anti-inflammatorydrugs. The aim of this study was to compare the risk of seriousadverse effects with ketorolac vs diclofenac or ketoprofen inadult patients after elective major surgery. Methods. This prospective, randomized multicentre trial evaluatedthe risks of death, increased surgical site bleeding, gastrointestinalbleeding, acute renal failure, and allergic reactions, withketorolac vs diclofenac or ketoprofen administered accordingto their approved parenteral and oral dose and duration of treatment.Patients were followed for 30 days after surgery. Results. A total of 11 245 patients completed the trial at 49European hospitals. Of these, 5634 patients received ketorolacand 5611 patients received one of the comparators. 155 patients(1.38%) had a serious adverse outcome, with 19 deaths (0.17%),117 patients with surgical site bleeding (1.04%), 12 patientswith allergic reactions (0.12%), 10 patients with acute renalfailure (0.09%), and four patients with gastrointestinal bleeding(0.04%). There were no differences between ketorolac and ketoprofenor diclofenac. Postoperative anticoagulants increased the riskof surgical site bleeding equally with ketorolac (odds ratio=2.65,95% CI=1.51–4.67) and the comparators (odds ratio=3.58,95% CI=1.93–6.70). Other risk factors for serious adverseoutcomes were age, ASA score, and some types of surgery (plastic/ear,nose and throat, gynaecology, and urology). Conclusion. We conclude that ketorolac is as safe as ketoprofenand diclofenac for the treatment of pain after major surgery. Br J Anaesth 2002; 88: 227–33     

Differential Expression of Distinct Surface Markers in Early Endothelial Progenitor Cells and Monocyte-Derived Macrophages

Bone marrow-derived endothelial progenitor cells (EPCs) play a fundamental role in postnatal angiogenesis. Currently, EPCs are defined as early and late EPCs based on their biological properties and their time of appearance during in vitro culture. Reports have shown that early EPCs share common properties and surface markers with adherent blood cells, especially CD14⁺ monocytes. Distinguishing early EPCs from circulating monocytes or monocyte-derived macrophages (MDMs) is therefore crucial to obtaining pure endothelial populations before they can be applied as part of clinical therapies. We compared the gene expression profiles of early EPCs, blood cells (including peripheral blood mononuclear cells, monocytes, and MDMs), and various endothelial lineage cells (including mature endothelial cells, late EPCs, and CD133⁺ stem cells). We found that early EPCs expressed an mRNA profile that showed the greatest similarity to MDMs than any other cell type tested. The functional significance of this molecular profiling data was explored by Gene Ontology database search. Novel plasma membrane genes that might potentially be novel isolation biomarkers were also pinpointed. Specifically, expression of CLEC5A was high in MDMs, whereas early EPCs expressed abundant SIGLEC8 and KCNE1. These detailed mRNA expression profiles and the identified functional modules will help to develop novel cell isolation approaches that will allow EPCs to be purified; these can then be used to target cardiovascular disease, tumor angiogenesis, and various ischemia-related diseases.     

Influences of Tongue Protrusion on Rhythmical Jaw Movement in Rats

Influences of tongue protrusion on rhythmical jaw movement were examined in lightly anesthetized adult rats. Both medial and lateral branches of the hypoglossal (XII) nerve on the right side were sectioned. The lateral branch of the XII nerve on the left side was also sectioned, and the medial branch was placed on stimulating electrodes. Intermittent electrical stimulation was delivered to the medial branch of the XII nerve to protrude the tongue, which was monitored by a tension-measuring device. Rhythmical jaw movements were elicited by electrical stimulation of the masticatory area of the cerebral cortex and were monitored using a magnet and magnet sensors. The following four major results were obtained: 1) the minimum opening position during cortically evoked chewing was significantly lowered by tongue protrusion, while no change was shown in the maximum opening position, 2) the lowering of the minimum opening position by tongue protrusion was consistent before and after mucosal anesthesia of the oral cavity, 3) the minimum and maximum opening positions were not altered by stimulation of the peripheral cut end of the medial branch of the XII nerve, and 4) the minimum opening position was lowered by stimulation of the central cut end of the medial branch of the XII nerve. These results suggest that the lowering of the minimum opening position by tongue protrusion is probably elicited from afferent signals through the medial branch of the XII nerve.     

血管紧张素Ⅱ-Ⅰ型受体自身抗体水平与子痫前期的关系

目的探讨血清中血管紧张素Ⅱ-Ⅰ型受体自身抗体水平与子痫前期的关系。方法选择2008年4月至2009年9月在河北唐山开滦医院、唐山妇幼保健院、张家口市张北县医院产科住院分娩的141例子痫前期患者作为病例组,选择同期114例正常妊娠妇女作为对照组,用ELISA法检测两组孕妇血清中血管紧张素Ⅱ-Ⅰ型受体自身抗体的水平,比较组间患者的一般情况,对子痫前期的危险因素进行单因素和多因素logistic回归分析。结果 (1)子痫前期患者的血管紧张素Ⅱ-Ⅰ型受体自身抗体水平高于对照组,差异有统计学意义(P<0.05)。子痫前期组年龄、高血压家族史、体质指数、腹围、低密度脂蛋白、甘油三酯水平均高于对照组,而受教育程度、经济收入水平低于对照组,差异有统计学意义(P<0.05)。(2)重度子痫前期组的血管紧张素Ⅱ-Ⅰ型受体自身抗体水平高于轻度子痫前期组,差异有统计学意义(P<0.05)。(3)多因素logistic回归分析结果显示:血管紧张素Ⅱ-Ⅰ型受体自身抗体、低密度脂蛋白、甘油三酯、空腹血糖是子痫前期独立的危险因素,OR值分别为3.397、2.201、4.167、1.638。结论 (1)血清中血管紧张素Ⅱ-Ⅰ型受体自身抗体水平...     

完全型雄激素不敏感综合征中雄激素受体基因突变的检测与分析

雄激素通过靶器官上特异的雄激素受体而起作用，因雄激素受体的异常而导致雄激素的作用障碍，称雄激素不敏感综合征。作者分析了４例完全型雄激素不敏感综合征患者雄激素受体基因的突变。从雄激素不敏感综合征患者外周血中提取基因组ＤＮＡ，以特异的引物对雄激素受体基因进行聚合酶链反应（ＰＣＲ）扩增，对扩增产物进行单链构象多态性分析（ＳＳＣＰ），筛选出突变的外显子，对突变的外显子直接进行ＰＣＲ产物测序。通过ＰＣＲ－ＳＳＣＰ检查发现，３例患者在外显子Ｅ及１例在外显子Ｈ上有突变。测序证实前３例患者出现点突变，形成提前终止密码。另１例在外显子和内含子交界处插入ＡＴ两个碱基。提前终止密码形成可能是雄激素不敏感综合征的常见机制，本结果进一步提供了这方面的证据。迄今尚未见在拼接部位５’端同时插入两个碱基导致剪切异常引起人完全型雄激素不敏感综合征的报道。本研究方法简便实用，可用于雄激素不敏感综合征的临床诊断和基础研究。     

围绝经期的流行病学调查

1990年5～12月在北京东城区40～65岁妇女中进行了围绝经期流行病学调查。随机抽样得调查对象5000余名,应答率97.1％。共有5134名妇女进入分析,其中54.4％已绝经。绝经者中自然绝经占93.8％,手术绝经占5.4％。自然绝经平均年龄49岁。既往月经多,曾用甾体避孕药,肥胖及多次妊娠等与绝经晚有关;而吸烟及绝经前生活中发生重大事件可导致提早绝经。更年期症状不如西方妇女严重,与亚洲一些国家的研究结果接近,表明了种族和社会文化的不同对更年期症状的影响。产次、教育水平、绝经年龄、月经状况、哺乳、绝经时婚姻状态,以及生活中重大事件或环境变化等,均可以其特有方式影响更年期症状的轻重、出现早晚和持续时间。     

Cartilaginous symphysis pubis cysts: report of two cases, technique for removal, and review of the literature

Cartilaginous symphysis pubis cysts are rare. There are 7 cases previously reported in the literature. Patients are commonly asymptomatic or may present with a slow-growing, painless vulvar mass, voiding difficulty, and/or dyspareunia. Two cases were managed at our center over 5 years. We present these 2 cases, a surgical technique for removal, a summary of all reported cases, and some perspectives on the pathophysiologic mechanisms for the origin of this lesion.     

Hemorrhagic complication during placement of tension-free vaginal tape

A 66-year-old para III with a 20-year history of stress urinary incontinence underwent placement of tension-free vaginal tape. Intraoperative arterial bleeding occurred. An expanding hematoma was palpated postoperatively. Interventional radiology performed a pelvic arteriogram with selective bilateral internal iliac arteriograms, a supraselective anterior division and obturator arteriogram, a left external iliac arteriogram, coil embolization of a branch of the left obturator artery, and gel foam embolization of the anterior division of the left internal iliac artery.