从肝风内动、痰瘀阻络理论探讨虫类药物在心律失常中的临床应用

心律失常是临床常见病症,中医药在辨证思路和治疗方法等方面对于心悸的治疗有着独特的疗效。文章论述肝风内动、痰瘀阻络是导致心悸的重要发病因素,并对虫类药物在治疗心律失常方面进行探讨,为临床治疗心悸病症提供新的诊疗思路,提高临床疗效。     

地佐辛预防瑞芬太尼复合七氟醚麻醉后恢复期躁动的临床效果观察

目的：探讨地佐辛对瑞芬太尼复合七氟醚麻术后躁动的效果。方法选择本院采用瑞芬太尼复合七氟醚麻醉术的患者124例,分为对照组(30例),地佐辛组(33例),芬太尼组(32例)和曲马多组(29例)。观察恢复期的躁动情况并进行量化评分;记录苏醒和拔管的时间;测量拔管即刻(T0),拔管后半 h(T1/2),1 h(T1)时的疼痛视觉模拟评分(VAS)和镇静评分(Ramsay)。结果4组患者苏醒时间和拔管时间无统计学意义。处理组躁动发生及评分均较低,持续的时间较短( P<0.05),地佐辛,芬太尼和曲马多组的疼痛评分和镇静评分与对照组相比均有统计学意义(P<0.05),而地高辛的疼痛改善作用较曲马多明显,镇静作用较芬太尼效果好(P<0.05)。结论地佐辛能够有效的预防瑞芬太尼复合七氟醚麻醉后恢复期躁动的发生。     

Use of Benzodiazepines in Alzheimer’s Disease: A Systematic Review of Literature

Background:

Benzodiazepines are frequently prescribed in patients with Alzheimer’s disease. Unfortunately, studies evaluating their benefits and risks in these patients are limited.

Methods:

Clinical trials focusing on the effect of benzodiazepines on cognitive functions, disease progression, behavioral symptoms, sleep disturbances, and the general frequency of benzodiazepine use were included in this review. Published articles from January 1983 to January 2015 were identified using specific search terms in MEDLINE and PubMed Library according to the recommendations of The Strengthening the Reporting of Observational Studies in Epidemiology initiative.

Results:

Of the 657 articles found, 18 articles met predefined selection criteria and were included in this review (8 on frequency, 5 on cognitive functions, 5 on behavioral and sleep disturbances). The frequency of benzodiazepine use ranged from 8.5% to 20%. Five studies reported accelerated cognitive deterioration in association with benzodiazepine use. Two studies reported clinical efficacy for lorazepam and alprazolam to reduce agitation in Alzheimer’s disease patients. No evidence was found for an improvement of sleep quality using benzodiazepines.

Conclusion:

This systematic review shows a relatively high prevalence of benzodiazepine use but limited evidence for clinical efficacy in Alzheimer’s disease patients. However, there is a paucity of methodologically high quality controlled clinical trials. Our results underscore a need for randomized controlled trials in this area.     

齐拉西酮序贯治疗精神分裂症患者的影响因素分析

目的观察应用甲磺酸齐拉西酮针剂治疗后进行序贯口服剂型治疗精神分裂症患者的疗效及其影响因素,为合理应用序贯治疗方案提供临床依据。方法参照《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ),应用阳性和阴性症状量表(PANSS)评定40例以兴奋激越症状为主的精神分裂症患者的精神症状。在治疗前(基线期)对患者一般状况进行问卷调查。在甲磺酸齐拉西酮针剂肌注治疗72小时后进行口服序贯治疗,在基线期和肌注治疗72小时后进行PANSS评定,采用副反应量表(TESS)评定不良反应,分析疗效及其影响因素。结果 24例患者成功序贯;16例患者因为疗效和耐受性问题序贯治疗效果不好,其中7例换用其他第二代非经典抗精神病药物;9例第二次应用齐拉西酮针剂治疗3天,再次序贯为口服剂型,5例序贯成功,4例换用其他第二代非经典抗精神病药物治疗。结论对第一次序贯治疗不成功的患者可以选择第二次注射治疗,第二次序贯后有部分患者成功。序贯治疗的效果和患者是否首发、体重水平、饮酒习惯有关,还与注射之外的治疗因素,如医生护士和患者的交流、治疗同盟关系建立的质量有关。     

A fully digital approach to replicate functional and aesthetic parameters in implant-supported full-arch rehabilitation

Purpose

The aim of this technical procedure was to use a fully digital technique (FDT) for full-arch implant support rehabilitation. The FDT was used to transfer the provisional restoration parameters to definitive restorations using intraoral scanners.

靶控输注瑞芬太尼与恒速输注右美托咪定用于小儿全凭静脉麻醉苏醒期的临床研究

目的观察靶控输注瑞芬太尼与恒速输注右美托咪定对小儿全凭静脉麻醉苏醒期拔管反应及躁动的影响。方法将90例择期全凭静脉麻醉下行扁桃体腺样体切除术患儿,随机分为对照组(C组)、瑞芬太尼组(R组)和右美托咪定(D组)。麻醉诱导后D组静脉持续输注右美托咪定0.3μg·kg-1·h-1直至气管导管拔出。手术结束前2 min,C组和D组停用异丙酚和瑞芬太尼;R组停用异丙酚,将瑞芬太尼的TCI浓度调整为1.5 ng/ml直至气管导管拔出。记录泵注右美托咪定前(T0)、手术结束时(T1)、拔管前1 min(T2)、拔管时(T3)和拔管后1 min(T4)、5 min(T5)、10 min(T6)的平均动脉压(MAP)、心率(HR);记录停用异丙酚至拔管时间、睁眼时间、拔管时呛咳反应评分;根据儿童麻醉后躁动评分(PAED)和改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS),拔管后每5 min对患儿进行躁动和疼痛评分,记录所得最高值作为监测有效值。结果与T0时比较,C组T2~T6时、R组T5~T6时MAP和HR均显著升高(P<0.05),D组各时点MAP与HR差异无统计学意义;与C组比较,R组T2~T4时、D组T2~T6时MAP与HR均较低(P<0.05);与R组比较,D组T5~T6时MAP与HR较低(P<0.05)。三组患儿拔管时间、睁眼时间比较差异无统计学意义(P>0.05);拔管时呛咳反应评分R组与D组显著低于C组(P<0.05),PAED评分和疼痛评分D组显著低于C组(P<0.05)与R组(P<0.05)。结论靶控输注瑞芬太尼(1.5 ng/ml)与恒速输注右美托咪定(0.3μg·kg-1·h-1),均能有效抑制小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期的拔管反应,且不延长麻醉苏醒时间。恒速输注右美托咪定还能减少患儿术后躁动的发生,更适用于小儿全麻苏醒期。     

术前应用盐酸氢吗啡酮防止腹腔镜胆囊切除术苏醒期躁动的效果

目的观察术前应用盐酸氢吗啡酮在防止腹腔镜胆囊切除术苏醒期躁动的效果。方法选择ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术患者60例,随机分为盐酸氢吗啡酮组(M组)30例和生理盐水组(N组)30例。M组在手术切皮前15 min给予氢吗啡酮2 mg皮下注射,N组在手术切皮前15 min给予生理盐水2 ml皮下注射,观察记录拔管后5、15、30、45 min时的苏醒期躁动评分(RS)。结果 M组和N组在拔管后5 min和15 min时的苏醒期躁动评分(RS)对比有统计学差异(P<0.05)。结论术前应用盐酸氢吗啡酮能有效防止腹腔镜胆囊切除术苏醒期躁动。     

Simple suspension culture system of human iPS cells maintaining their pluripotency for cardiac cell sheet engineering

In this study, a simple three‐dimensional (3D) suspension culture method for the expansion and cardiac differentiation of human induced pluripotent stem cells (hiPSCs) is reported. The culture methods were easily adapted from two‐dimensional (2D) to 3D culture without any additional manipulations. When hiPSCs were directly applied to 3D culture from 2D in a single‐cell suspension, only a few aggregated cells were observed. However, after 3 days, culture of the small hiPSC aggregates in a spinner flask at the optimal agitation rate created aggregates which were capable of cell passages from the single‐cell suspension. Cell numbers increased to approximately 10‐fold after 12 days of culture. The undifferentiated state of expanded hiPSCs was confirmed by flow cytometry, immunocytochemistry and quantitative RT–PCR, and the hiPSCs differentiated into three germ layers. When the hiPSCs were subsequently cultured in a flask using cardiac differentiation medium, expression of cardiac cell‐specific genes and beating cardiomyocytes were observed. Furthermore, the culture of hiPSCs on Matrigel‐coated dishes with serum‐free medium containing activin A, BMP4 and FGF‐2 enabled it to generate robust spontaneous beating cardiomyocytes and these cells expressed several cardiac cell‐related genes, including HCN4, MLC‐2a and MLC‐2v. This suggests that the expanded hiPSCs might maintain the potential to differentiate into several types of cardiomyocytes, including pacemakers. Moreover, when cardiac cell sheets were fabricated using differentiated cardiomyocytes, they beat spontaneously and synchronously, indicating electrically communicative tissue. This simple culture system might enable the generation of sufficient amounts of beating cardiomyocytes for use in cardiac regenerative medicine and tissue engineering. Copyright © 2013 John Wiley & Sons, Ltd.