发作性睡病的延迟诊断及与癫痫的鉴别诊治

发作性睡病是临床少见的睡眠-觉醒节律障碍性疾病,表现为白天反复发作的不可遏制的睡眠,常伴猝倒发作、睡眠瘫痪及入睡前幻觉。临床医师对发作性睡病的认识不足是导致误诊和延迟诊断的主要原因之一。癫痫发作类型复杂多样,与发作性睡病易混淆,二者需相互鉴别,且当二者共患病时,诊断和治疗会更加困难。现通过对发作性睡病的临床特征与延迟诊...     

Delayed gastric emptying after pancreaticoduodenectomy: A study of the national surgical quality improvement program

BackgroundDelayed gastric emptying (DGE) remains common after pancreaticoduodenectomy (PD). Risk factors for DGE have been difficult to identify due to a lack of a standard definition. The purpose of this study was to identify factors associated with DGE using a standard definition across a national cohort of patients.MethodsA retrospective cohort study of patients who underwent PD from 2014 to 2016 within the ACS-NSQIP pancreatectomy-specific module was performed. Multivariable (MV) regression was used to determine perioperative risk factors for DGE.ResultsOf 10,249 patients undergoing PD, 16.6% developed DGE and were older (65.3 vs. 64.3 years), more often male (62.5% vs. 51.9%), overweight/obese (66.7% vs. 61.3%), and American Society of Anesthesiologist (ASA) class 3 (80.0% vs. 76.0%). Rates of pylorus preservation (41.4% vs. 38.7%) were higher, and median operative time (373 vs. 354 min) longer. On MV analysis, age≥65 years [OR 1.26 (95%CI 1.13–1.41)], male sex [OR 1.54 (95%CI 1.38–1.72), body mass index (BMI) > 30 [OR 1.22 (95%CI 1.06–1.40)], ASA class≥3 [OR 1.24 (95%CI 1.08–1.42)], pylorus preservation [OR 1.08 (95%CI 1.02–1.14)], and longer operative time [OR 1.26 (95%CI 1.13–1.40)] remained associated with DGE. Preoperative chemotherapy was associated with decreased risk of DGE [OR 0.77 (95%CI 0.64–0.93)].ConclusionIn this national, multicenter cohort of patients undergoing PD, 16.6% of patients developed DGE based on a standardized definition. Perioperative factors including age, BMI, ASA class, pylorus preservation, and operative time were associated with increased risk of DGE. Further research is warranted to identify opportunities for prevention via preoperative rehabilitation strategies and treatment.     

丹酚酸B预处理的心脏微血管内皮细胞延迟保护作用研究

目的探讨丹酚酸B通过保护心脏微血管内皮细胞(CMEC)抗心肌缺氧损伤作用机制.方法基于缺血预适应延迟保护机制,通过缺氧/复氧的CMEC损伤模型,观察丹酚酸B预处理的CMEC保护作用.结果丹酚酸B预处理与缺氧预处理作用相似,均可提高细胞存活率和SOD活性,降低LDH、NO水平.结论丹酚酸B预处理可激活CMEC内源性延迟保护机制,发挥了拮抗心肌缺血缺氧损伤效应.     

MR测量肥厚性心肌病患者的左心室质量及其回归分析

目的 探讨肥厚性心肌(HCM)病患者左心室质量的相关因子.方法 对22例HCM和20名正常志愿者行心脏电影MR及延迟增强扫描,以Segment软件计算左心室功能参数及延迟强化参数,对左心室质量指数与其他参数行单元及多元回归分析.结果 HCM患者的左心室质量指数远大于正常人(P均＜0.001).多元回归分析结果显示,HCM患者的最大室壁厚度与左心室质量指数相关(β=7.53,P=0.02);在收缩功能保持的HCM患者,左心室质量指数与左心室舒张末期容积指数(β=3.68,P=0.004)及最大室壁厚度(β=5.16,P=0.008)相关.结论 最大室壁厚度是预测HCM患者各期别左心室质量的有效参数.对于收缩功能保持的HCM患者,估测其左心室质量的最佳参数为左心室舒张末期容积指数和最大室壁厚度.     

Prevention of cisplatin-induced delayed emesis: still unsatisfactory

 The incidence of and prognostic factors in cisplatin-induced delayed emesis were evaluated in 522 naive cancer patients. They each received an intravenous combination of ondansetron and one of four different doses of dexamethasone for the prevention of acute emesis and a combination of orally administered metoclopramide plus intramuscular dexamethasone for the prevention of delayed emesis. Despite the best prophylaxis for acute and delayed emesis, 37.4% / 57.1% of patients experienced delayed vomiting / nausea. The presence of acute vomiting / nausea was the main prognostic factor in delayed vomiting / nausea; therefore, a multifactorial analysis of the results achieved during the delayed phase adjusted for those obtained during the acute phase should be carried out in every study evaluating the efficacy of different antiemetic drugs for delayed emesis. Published online: 9 September 1999