人脑脊液中利多卡因的高效液相色谱法测定

目的建立检测人脑脊液中利多卡因的方法。方法采用RP-HPLC法测定人脑脊液中药物浓度,色谱柱为Lichrospher C18（4.6×250 mm,5μm）,流动相为甲醇-水-冰醋酸-三乙胺（62∶38∶0.3∶0.6）,流速1 mL.min-1,检测波长220 nm。结果在0.1-8 mg·L^-1范围内利多卡因峰面积与内标峰面积之比与浓度线性关系良好,最低检测浓度为0.03 mg·L^-1,回收率利多卡因为93.77-95.64%,日内、日间RSD均小于10%。结论本测定方法灵敏、准确、简便,适合于对利多卡因的临床使用监测及药代动力学研究。     

Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer’s versus Normal Saline for acute pancreatitis

IntroductionFluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation.MethodsIn collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables.ResultsWe reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25–0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13–0.81) and local complications (OR 0.42; 95 % CI 0.2–0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant.ConclusionResuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.     

Risk factors associated with heat-related illness among sugarcane farmers in Thailand

Heatstroke is defined as severe symptoms of heat-related illness, which could lead to death. Sugarcane farmers are at high risk of heatstroke under extremely hot outdoor working conditions. We explored the prevalence of heat-related illness symptoms and risk factors related to heat-related illness among sugarcane farmers working in the summer. We conducted a cross-sectional study using questionnaire interviews among 200 sugarcane farmers in Kamphaeng Phet Province, Thailand. The questionnaire addressed demographics, heat-related symptoms experienced during summer at work, and occupational factors. Bioelectrical impedance analysis was used to assess body mass index and body fat percentage. Watson formula equations were used to estimate total body water. The prevalence of heat-related illness symptoms was 48%; symptoms included heavy sweating, weakness/fatigue, dizziness, muscle cramps, headache, and vertigo. Factors associated with heat-related illness included women and clothing. Sugarcane farmers wearing two-layer shirts had a higher risk of heat-related illness. Farmers with fluid intake 3.1–5.0 liters per day had a 79% lower risk of heat-related illness. Our findings demonstrated that sugarcane farmers are at risk of heat-related illness. We confirmed that working conditions, including wearing proper clothing and water-drinking habits, can reduce this risk.     

Leptomeningeal Metastases: New Opportunities in the Modern Era

Leptomeningeal metastases arise from cancer cell entry into the subarachnoid space, inflicting significant neurologic morbidity and mortality across a wide range of malignancies. The modern era of cancer therapeutics has seen an explosion of molecular-targeting agents and immune-mediated strategies for patients with breast, lung, and melanoma malignancies, with meaningful extracranial disease control and improvement in patient survival. However, the clinical efficacy of these agents in those with leptomeningeal metastases remains understudied, due to the relative rarity of this patient population, the investigational challenges associated with studying this dynamic disease state, and brisk disease pace. Nevertheless, retrospective studies, post hoc analyses, and small prospective trials in the last two decades provide a glimmer of hope for patients with leptomeningeal metastases, suggesting that several cancer-directed strategies are not only active in the intrathecal space but also improve survival against historical odds. The continued development of clinical trials devoted to patients with leptomeningeal metastases is critical to establish robust efficacy outcomes in this patient population, define drug pharmacokinetics in the intrathecal space, and uncover new avenues for treatment in the face of leptomeningeal therapeutic resistance.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01261-4.     

Selective Cerebrospinal Fluid Hypothermia: Bioengineering Development and In Vivo Study of an Intraventricular Cooling Device (V-COOL)

Hypothermia is a promising therapeutic strategy for severe vasospasm and other types of non-thrombotic cerebral ischemia, but its clinical application is limited by significant systemic side effects. We aimed to develop an intraventricular device for the controlled cooling of the cerebrospinal fluid, to produce a targeted hypothermia in the affected cerebral hemisphere with a minimal effect on systemic temperature. An intraventricular cooling device (acronym: V-COOL) was developed by in silico modelling, in vitro testing, and in vivo proof-of-concept application in healthy Wistar rats (n = 42). Cerebral cortical temperature, rectal temperature, and intracranial pressure were monitored at increasing flow rate (0.2 to 0.8 mL/min) and duration of application (10 to 60 min). Survival, neurological outcome, and MRI volumetric analysis of the ventricular system were assessed during the first 24 h. The V-COOL prototyping was designed to minimize extra-cranial heat transfer and intra-cranial pressure load. In vivo application of the V-COOL device produced a flow rate-dependent decrease in cerebral cortical temperature, without affecting systemic temperature. The target degree of cerebral cooling (− 3.0 °C) was obtained in 4.48 min at the flow rate of 0.4 mL/min, without significant changes in intracranial pressure. Survival and neurological outcome at 24 h showed no significant difference compared to sham-treated rats. MRI study showed a transient dilation of the ventricular system (+ 38%) in a subset of animals. The V-COOL technology provides an effective, rapid, selective, and safe cerebral cooling to a clinically relevant degree of − 3.0 °C.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01302-y.     

Giant aneurysmal bone cyst of the scapula: A case report

Aneurysmal bone cyst (ABC) is a benign bone tumor affecting mainly children and young adults. It occurs in the metaphysis of the long bones. The scapula is a very rare location. Imaging may be highly suggestive of ABC in cases of an osteolytic, expansive, and hemorrhagic lesion with fluid-fluid levels and thin septa. The diagnosis must systematically be confirmed by performing a biopsy, in order to adopt the best therapeutic strategy. There are several therapeutic means, but wide resection remains the gold standard. The evolution is very variable and can go from spontaneous healing to recurrence with the destruction of the bone. We report a rare case of aneurysmal bone cyst of the scapula in a young patient.     

相对浅的全麻比扩容能更好地预防局部浸润肾上腺素所致的低血压

目的 比较相对浅的全麻与扩容对预防局部浸润肾上腺素所致低血压的效果.方法 90例ASA Ⅰ或Ⅱ级择期行鼻内窥镜手术的患者,随机分为3组,每组30例.全麻诱导后,Ⅰ组靶控输注(TCI)丙泊酚2μg/ml 雷米芬太尼2 ng/ml维持麻醉,Ⅱ组(对照组)和Ⅲ组靶控输注异丙酚4 μg/ml 雷米芬太尼4 ng/ml维持麻醉;Ⅰ组和Ⅱ组20 min内输注羟乙基淀粉5 ml/kg扩容,Ⅲ组输注羟乙基淀粉10 ml/kg扩容.所有患者均接受鼻黏膜局部浸润注射含肾上腺素(5 μg/ml)的利多卡因(1%,4 m1).注射开始后5 min内每隔30秒记录一次平均动脉压(MAP)和心率(HR);同时记录该时段MAP的最低值和最高值,计算MAP最大降低百分比和最大升高百分比.结果 各组均出现了明显的血液动力学变化,特别是在1.5 min时,MAP明显降低并伴随HR明显增快(P<0.05).MAP最大降低百分比:Ⅰ组(14%)<Ⅲ组(24%)<Ⅱ组(26%),Ⅰ组与Ⅱ组、Ⅲ组差异均有统计学意义(P<0.05).MAP最大升高百分比:Ⅰ组(9%)>>Ⅱ组(6%)>Ⅲ组(2%),Ⅰ组与Ⅱ组差异有统计学意义(P<0.05).结论 相对浅的全麻比扩容能更好地预防鼻内窥镜手术中局部浸润注射含肾上腺素的利多卡因所致的低血压.     

术中MR液体反转恢复序列在低级别神经胶质瘤切除术中的应用价值

目的 探讨术中磁共振成像(intraoperative MRI,iMRI)中的液体反转恢复序列(fluid attenuated inversion recovery,FLAIR)在低级别神经胶质瘤(WHO Ⅰ～Ⅱ级)切除术中的应用价值,从而对是否存在残留肿瘤的诊断提供帮助.方法 选取18例低级别神经胶质瘤(low-g...