不同靶浓度异丙酚联合七氟醚在腹腔镜胆囊切除手术中的应用研究

目的研究不同血浆靶浓度异丙酚联合七氟醚气管内插管全麻用于腹腔镜手术中异丙酚对七氟醚MAC的影响及两者的相互关系,探索最佳异丙酚血浆靶浓度及七氟醚MAC,进一步明确联合合理配伍使用的药理特性,减少单独使用的不良反应,为临床麻醉提供参考依据。方法采用随机抽样的前瞻性研究设计,根据术中异丙酚血浆靶浓度的不同,将患者分组,以BIS指数45～50作为麻醉深度客观指标,探讨不同血浆浓度异丙酚靶控输注对七氟醚MAC的影响及其作用方式,与单纯吸入七氟醚维持麻醉进行比较。结果 1组、2组、3组患者在T1、T2、T3、T4时的七氟醚MAC值比4组相对应各时点值明显低,P<0.01;七氟醚MAC值的降低与异丙酚血浆靶浓度的升高之间呈线性关系,直线回归方程为Y=0.782-0.152X,Pearson相关系数r=-0.985。术后随访,各组均无术中知晓和手术记忆发生。术后恶心发生率,1、2、3组均明显低于4组(P<0.05);呕吐发生率,1组和2组明显低于4组(P<0.05)。结论七氟醚吸入麻醉辅以异丙酚靶控输注,能减少七氟醚的用量并能维持适宜的麻醉深度,避免术中知晓和手术记忆,不延长术毕苏醒时间。     

Ginsenoside-Rg1 protects podocytes from complement mediated injury

Aim of the study

Podocytes injury mediated by complement complex C5b-9 is the main feature of membranous nephropathy (MN). Little work has been done to prove that ginsenoside-Rg1 could inhibit this process. Our study aims to investigate the efficacy of ginsenoside-Rg1 in protecting the podocyte from complement mediated injury.

Materials and methods

We chose sublethal C5b-9 induced podocyte injury as the model of MN in vitro. Ginsenoside-Rg1 was given as an intervention. Morphological changes were observed by electron microscope and fluorescence microscope. The production of reactive oxygen species (ROS) was detected by flow cytometry. The expression of the mitogen activated protein kinase (MAPK) including JNK, ERK and P38 was detected by western-blot technique.

Results

Ginsenoside-Rg1 could protect foot processes of podocytes, suppress the damage of F-actin, decrease the production of ROS, and inhibit the activation of P38 kinase pathway.

Conclusion

These results suggest that ginsenoside-Rg1 could protect podocyte from sMAC-induced injury partly because of its antioxidant property and inhibit the activation of P38 kinase pathway.     

3种镇痛药物对异氟烷MACBAR的影响

目的 观察手术患者切皮时不同血浆浓度瑞芬太尼/舒芬太尼靶控输注以及小剂量氯胺酮对异氟烷MACBAR的影响.方法 选择20～55岁,ASAⅠ或Ⅱ级的择期手术患者,采用靶控输注药物诱导入睡,分为单纯异氟烷组(I组)、瑞芬太尼血浆浓度1 μg/L 组(R1组)、瑞芬太尼血浆浓度4 μg/L 组(R4组)、舒芬太尼血浆浓度0.1 μg/L 组(S1组)、舒芬太尼血浆浓度0.4 μg/L 组(S4组)、小剂量氯胺酮组(K组).按序贯试验原则确定给予每例患者的呼气末异氟烷浓度.记录患者切皮后的血压、心率变化.结果 R4和S4组MACBAR低于0.17%终止研究.I组异氟烷MACBAR(1.16%)高于R1组(0.48%)、S1组(0.51%)和K组(0.74%)(P<0.01);与R1组和S1组比较,K组异氟烷MACBAR升高(P<0.01).除K组外,其他3组切皮前血压均显著低于入室时. 结论 靶控输注瑞芬太尼与舒芬太尼可以降低异氟烷的MACBAR.     

Psychometric properties of the Dutch version of the Mental Adjustment to Cancer scale in Dutch cancer patients

Objectives: The measurement of adjustment to cancer is relevant for research purposes and daily practice. In this study, the psychometric properties of the original five subscales and the two recently proposed summary scales of the Mental Adjustment to Cancer (MAC) scale were examined in Dutch cancer patients. Methods: Data from 289 cancer patients were assessed with the Dutch version of the MAC scale and the Hospital and Anxiety Depression scale (HADS); 259 patients completed the MAC scale for a second time. Results: In total, 85.5% of the participants completed the full MAC scale. The internal consistency of the five subscales and the summary scales were mostly similar to the original versions. The test–retest reliability of the Fighting Spirit, Helplessness/Hopelessness, Anxious Preoccupation, Summary Positive Adjustment and Summary Negative Adjustment subscales were moderate and the test–retest reliability of the Fatalism and Avoidance subscales were low. Correlations between the original and the two summary scales of the MAC scale and the depression and anxiety subscales of the HADS indicated good convergent validity. The structure of the five original subscales as well as the structure of the two proposed summary scales was adequate as shown by construct validity using confirmatory factor analyses. Conclusion: The Dutch version of the MAC scale is a feasible questionnaire and appeared to have comparable psychometric properties as demonstrated by studies in the UK. The psychometric properties of the summary scales and Fighting Spirit and Helplessness/Hopelessness subscales seem to be acceptable. This supports the cross‐national usefulness of the MAC scale. Copyright © 2009 John Wiley & Sons, Ltd.     

Mid-arm circumference can be used to estimate children's weights

Introduction

Accurate measurement of children's weight is rarely possible in paediatric resuscitation, and rapid estimates are made to ensure appropriate drug and fluid doses and equipment selection. Weight is commonly estimated from formulae based on children's age, or from their height using the Broselow tape. Foot-length and mid-arm circumference have also been suggested as the basis of weight-estimation formulae.

Objectives

To determine which of age, height, foot-length or mid-arm circumference had the strongest relationship with weight in healthy children, to derive a simple weight-estimation formula from the strongest correlate, and to compare its performance with existing weight-estimation tools.

Methods

This was a population-based prospective observational study of Hong Kong Chinese children aged 1-11 years old last birthday. Weight was measured to the nearest 0.2 kg; height, foot-length and mid-arm circumference to the nearest 0.1 cm. Multiple regression analysis was used to determine the strongest independent relationships with weight, and linear regression analysis derived a weight-estimation formula. Accuracy and precision of this formula were compared with standard age-based and height-based weight-estimation methods.

Results

Mid-arm circumference had the strongest relationship with weight, and this relationship grew stronger with age. The formula, weight [kg] = (mid-arm circumference [cm] − 10) × 3, was at least as accurate and precise as the Broselow method and outperformed the age-based rule in school-age children, but was inadequate in pre-school children.

Conclusion

This weight-estimation formula based on mid-arm circumference is reliable for use in school-age children, and an arm-tape could be considered as an alternative to the Broselow tape in this population.     

AGA technical review: Malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease in patients with human immunodeficiency virus infection

Disorders of the gastrointestinal tract and hepatobiliary system are among the most common complications associated with human immunodeficiency virus (HIV) infection. These disorders not only result in major morbidity but mortality as well. With increasing use of prophylaxis against Pneumocystis carinii pneumonia, the incidence of opportunistic gastrointestinal disorders has increased. ^{[1] , [2] and [3]} Significant progress has been made in the last decade in characterizing the spectrum of pathogens involving the gastrointestinal and hepatobiliary systems, determining the pathophysiological mechanisms of these diverse processes, and defining management options. Despite these encouraging advancements, many questions remain unanswered. The purpose of this review is to evaluate and synthesize the published clinical research pertaining to three important HIV-related complications: malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease. A separate review addresses disorders of the esophagus.⁴ Attention here is focused on etiology and pathogenesis, clinical features, diagnostic strategies, and efficacy of current treatment options. Recommendations for managing patients with these complications are provided based on the weight of the clinical evidence.GASTROENTEROLOGY 1996;111:1724-1752     

Effects of systemic complement activation on renal circulation of rats

Abstract In a variety of immunopathological diseases activation of the complement cascade occurs either systemically or localized in the kidney. To elucidate the functional impact of complement activation upon the renal microcirculation, we administered cobra venom factor of Naja naja kaouthia (CVF) i.v. into thiobarbital anaesthetized female rats. CVF is a potent activator of the alternative pathway of complement by forming the C3-convertase CVF, Bb which cannot be downregulated by the natural inhibitor factors H and I and thereby leads to generation of the anaphylatoxins C3a and C5a and formation of the membrane attack complex (MAC). We utilized creatinine clearance and flowmeter measurements in the normal kidney and intravital microscopy of the split hydronephrotic rat kidney model to observe the microvascular changes. Bolus injection of CVF (100 U kg^-1) resulted in an immediate reduction of RBF (– 68% after 10 min), which remained decreased during the entire experiment (90 min). Systemic blood pressure was significantly reduced only in the early period (– 23% of control: 126 mmHg after 10 min). After an initial anuric phase of 30 min duration, the glomerular filtration rate was significantly diminished by 47%. White cell count was decreased by about 50% after the experiments. Application of the competitive thromboxane A₂-antagonist, BM 13505, reversed all renal and systemic CVF-effects. Continuous infusion of the competitive leukotriene D₄-antagonist, ICI 198615, attenuated the late renal CVF-effects (i.e. 30 min after injection of CVF). Depletion of polymorphonuclear cells (PMN) attenuated the CVF-effects similar to BM 13505. Intravenous administration of CVF in the hydronephrotic kidney model resulted in a massive constriction of the interlobar and arcuate artery, with a fall in glomerular blood flow comparable to the reduction of RBF in the normal kidney. Diameters of the afferent arterioles—most sensitive to many vaso-constricting agents—were not significantly altered. Our results suggest that injection of CVF and the liberation of high amounts of the anaphylatoxins, C3a and C5a, induces the release of TXA₂, which contributes to the early renal effects and the formation of cysteinyl-leukotrienes which play an important role in the late phase of systemic complement activation. Utilizing the split hydronephrotic kidney model we demonstrated the predominant action of complement activation on the large preglomerular vessels for the first time. PMN are seemingly involved in the liberation of secondary mediators which appear to reduce renal blood flow and glomerular filtration.