血栓弹力图在胃癌患者围手术期监测中的意义

目的：探讨应用血栓弹力图（thromboelastogram ,TEG ）监测胃癌患者围手术期凝血功能的动态变化及其临床意义。方法：选取2014年3 月至2015年5 月期间在新乡市中心医院确诊为胃癌并行手术的178 例患者为试验组,并按肿瘤不同分期、不同浸润深度及有无淋巴结转移进行分组,对所有手术患者进行术前、术后TEG 动态监测,另选取60例健康体检者为正常对照组,行TEG 检测,通过对比分析其围手术期凝血功能变化。结果：实验组术前、术后与对照组比较,其TEG 参数R 、K 值明显减小,Angle、MA、CI值则显著增大,差异具有统计学意义（P < 0.05）。 实验组患者术前、术后对比K 值显著降低;Angle值、MA、CI 显著升高（P < 0.05）。R 、LY30等观测值均无显著变化。肿瘤不同分期、不同浸润深度及有无淋巴结转移的患者相比较,其TEG 监测值均有显著性差异。结论：胃癌患者围手术期表现为高凝状态,且与患者肿瘤分期、浸润深度及淋巴结转移呈正相关。动态监测胃癌围手术期TEG 可为临床提供有价值的凝血信息,并对提高胃癌手术的安全性和降低术后相关并发症有积极的临床意义。     

Evaluation of red blood cell transfusion threshold in the management of brain-dead organ donors

The disparity between the demand and supply of organs has necessitated an expansion of the criteria for organ donation. Consequently, numerous guidelines have been proposed for managing brain-dead organ donors (BDODs) to improve their organ function and the organ procurement rate. Therefore, we aimed to evaluate the previously recommended threshold for red blood cell transfusion in BDODs. Medical records of BDODs were retrospectively reviewed from January 2012 to December 2021. We enrolled BDODs who stayed for more than 24 hours at an hospital organ procurement organization. We analyzed their organ function and the rate of organ procurement according to the hemoglobin concentration. A total of 111 BDODs were enrolled and divided into the following 2 groups: hemoglobin (Hb) ≥ 10 g/dL (45.0 %) and Hb < 10 g/dL (55.0 %). There were no significant differences between the groups in the total bilirubin, creatinine, arterial blood lactate, and the rate of organ procurement. A correlation analysis did not reveal any association between the hemoglobin concentration and organ function of the BDODs. Hemoglobin concentration of 10 g/dL cannot be considered a threshold for red blood cell transfusion. Furthermore, organ function is not correlated with a hemoglobin concentration > 7 g/dL. Restrictive transfusion strategy is appropriate for BDOD management.     

Effect of preoperative tropisetron treatment on postoperative cognitive function: A retrospective cohort study

To investigate the effect of preoperative tropisetron treatment on postoperative cognitive function on the basis of patients’ Mini-Cog scale scores. In this retrospective cohort study, data were retrieved from the medical record database. This research did not involve concerns with patient safety and violation of their interests, and therefore, no ethical review was required. Depending on tropisetron exposure status, patients were assigned to the exposure group (86 patients) and the non-exposure group (74 patients). Patients in the exposure and non-exposure groups were administered tropisetron (10 mg; intravenously 15 minutes before operation) and other antiemetics, respectively. Data on the patients’ demographic characteristics, American society of Anesthesiologists (ASA) classification, comorbid underlying diseases, sleep quality, education level, anesthesia method, duration of fasting, intraoperative blood loss and fluid replacement, intraoperative minimum and maximum systolic blood pressures (SBPs), intraoperative minimum and maximum diastolic blood pressures (DBPs), postoperative Mini-Cog scale (a simple intelligence status assessment scale) score, and postoperative visual analogue scale (VAS) pain score were collected in both the groups. The postoperative Mini-Cog score (as an indicator of cognitive function) and the rate of postoperative cognitive impairment were compared between the exposure and non-exposure groups. A multifactorial logistic regression equation was constructed to analyze the factors associated with impaired cognitive function in the postoperative period. The postoperative cognitive impairment rate in the exposure group was significantly lower than that in the non-exposure group (3.5% vs 16.2%; P < .05). Multifactorial logistic regression analysis suggested that tropisetron was a protective factor for postoperative cognitive function, with a statistically significant effect (odds ratio [OR] = 5.04, 95% confidence interval [CI] = 1.31–19.4). Preoperative tropisetron exposure significantly reduces the incidence of postoperative cognitive impairment in patients, and it is a protective factor for postoperative cognitive function.     

Association between serum cystatin C and early impairment of cardiac function and structure in type 2 diabetes patients with normal renal function

BackgroundType 2 diabetes mellitus (T2DM) patients may have cardiac remodeling and dysfunction from the early stage of disease. This study aimed to determine the association between cystatin C (CysC) and early cardiac functional or structural impairment in T2DM patients without renal dysfunction.MethodsA total of 1135 T2DM patients without renal dysfunction and known heart diseases were included in our study. Cardiac function and structure were evaluated by echocardiography. Patients were diagnosed as left ventricular hypertrophy (LVH), impaired left ventricular (LV) diastolic function, and categorized into four different LV geometry patterns including normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy.ResultsIn multivariate linear regression analyses, CysC was positively associated with interventricular septum, LV mass index, left atrial volume index, E/e'' ratio, and negatively associated with Tissue Doppler e'', E/A ratio (p < .05). As a continuous variable, increasing CysC levels were associated with prevalence of LVH (OR: 1.47, 95% confidence interval [CI]: 1.22–1.77), impaired LV diastolic function (OR: 1.58, 95% CI: 1.33–1.87), concentric hypertrophy (OR: 1.54, 95% CI: 1.23–1.93) and eccentric hypertrophy (OR: 1.34, 95% CI: 1.00–1.80) according to multivariate logistic regression analyses. While as a categorical variable, the highest CysC quartile (CysC > 1.04 mg/L) was associated with LVH (OR: 2.95, 95% CI: 1.74–5.00), impaired LV diastolic function (OR: 4.09, 95% CI: 2.54–6.60), and concentric hypertrophy (OR: 3.26, 95% CI: 2.05–5.18).ConclusionsCysC was significantly associated with early LV remodeling and cardiac functional impairment in T2DM patients with normal renal function. It could be a reliable and convenient biomarker detecting early impairment of cardiac function and structure in T2DM patients.     

认知训练对社区老年人认知功能的干预效果研究

目的 探讨认知训练对社区老年人认知功能的影响。方法 在上海市某街道社区60岁及以上老年人中,按照纳入排除标准共筛查90名老年人,分为认知训练干预组和非认知训练空白对照组。对干预组进行12周(24次)的认知训练,方法为认知训练课程与Lumosity脑功能锻炼软件相结合的综合性认知训练。干预前后的认知功能采用蒙特利尔认知功能评估量表(MoCA)对两组进行测评。结果 干预前,干预组的视空间与执行功能、命名、延迟回忆、定向力4个认知领域的评分及总评分高于对照组(P<0.05),注意、语言和抽象3个认知领域的评分两组间差异无统计学意义(P>0.05)。干预后,干预组视空间与执行功能、注意、抽象、延迟回忆4个认知领域的评分及总评分较干预前提高(P<0.05)。结论 认知训练可以部分提高或保持老年人的认知功能。     

降钙素原和凝血功能对脓毒血症患者预后的评估价值

目的探讨脓毒血症患者的凝血功能状况变化及降钙素原变化趋势与预后的相关性。方法选取本院2015年1月~2016年6月入住急诊ICU的脓毒血症患者作为研究对象,按照预后分为死亡组和存活组。分别检测两组患者血浆凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原和血清降钙素原水平。结果死亡组的PCT和凝血功能水平均高于存活组（P<0.05）,ROC曲线显示血清降钙素原最佳截断点为34.24时,曲线下面积（AUG）为93.4,敏感度87.1%,特异度93.1%;血浆凝血酶原时间最佳截断点为14.75时,AUG为72.5,敏感度54.8%,特异度93.1%;国际标准化比值最佳截断点为1.31时,AUG为72,敏感度48.4%,特异度89.7%;活化部分凝血活酶时间最佳截断点为39.20时,AUG为71.7,敏感度67.7%,特异度86.2%;Fbg最佳截断点为3.31时,AUG为90.3,敏感度58.6%,特异度93.1%。结论降钙素原和凝血功能与脓毒血症病情密切相关,可作为监测病情及预后的重要指标。     

冻融治疗后肝癌库普弗细胞分泌功能的变化

目的探讨冻融治疗后库普弗细胞(KCs)的分泌功能对肝癌细胞的影响及其变化机制。方法将实验分为16组:37℃对照组、三组低温组(0℃、5℃、10℃)、冻融坏死物质组和三组联合刺激组及以上每组分别设置一个平行组。8个平行组分别加入吡咯烷二硫代氨基甲酸酯(PDTC),终浓度为100μmol/ml。ELISA法测定16组KCs上清液中能反映KCs分泌功能的TNF-α、IL-1β和INF-γ的浓度,Western blot检测各组NF-κB蛋白的表达。结果低温和冻融坏死物质联合刺激KCs后,炎性因子TNF-α、IL-1β和IFN-γ的分泌增加(P<0.01),三组低温(0℃、5℃、10℃)与冻融坏死物质联合刺激均表现出叠加效应。低温刺激对NF-κB蛋白的表达无显著影响(P>0.05),联合刺激组和冻融坏死物质组NF-κB蛋白表达明显上调(P<0.05)。NF-κB抑制剂处理后,8组平行组间NF-κB蛋白的表达和炎性因子的分泌水平无明显变化(P>0.05)。TNF-α、IL-1β和INF-γ浓度与KCs上清液中NF-κB蛋白表达呈正相关(r=0.870, P=0.000)。...