舒芬太尼在无痛胃镜手术中的应用

目的探讨舒芬太尼复合丙泊酚在无痛胃镜检查中的可行性和安全性。方法择期无痛胃镜手术80例,随机分成舒芬太尼组（S组）和芬太尼组（F组）,每组40例,分别采用舒芬太尼0．1μg／kg或芬太尼1μg／kg复合丙泊酚行静脉全麻。记录两组患者麻醉前（T0）、置镜后5min（T1）、手术结束时（T2）的MAP、HR、SPO2、手术时间、麻醉药物用量、苏醒时间、体动以及血压下降、低氧血症、心动过缓等术中并发症的发生率。结果两组在手术结束时的HR、MAP低于麻醉前（P〈0．05）;S组置镜后5minHR、MAP低于F组（P〈0．05）;S组苏醒时间、丙泊酚的总用量均低于F组（P〈0．05）;S组术中并发症、术后不良反应较F组少。结论舒芬太尼复合丙泊酚在无痛胃镜检查中能有效抑制机体的应激反应,呼吸抑制轻,比芬太尼能更好地满足门诊无痛胃镜检查的需要,更具优势。     

Delayed-onset of progressive pseudorheumatoid dysplasia in a Chinese adult with a novel compound <Emphasis Type="Italic">WISP3</Emphasis> mutation: a case report

Background

Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal recessive genetic disease that is characterized by pain, stiffness and enlargement of multiple joints with an age of onset between 3 and 8 years old. Mutations in the WISP3 (Wnt1-inducible signal pathway) gene are known to be the cause of PPD.

Case presentation

We present a case of delayed-onset PPD in a Chinese man. The 35-year-old proband presented with an almost 20-year history of pain and limitations in mobility in multiple joints. Based on the clinical manifestations, the patient was diagnosed with PPD; however, there was no specific evidence to confirm this diagnosis. Through mutational analyses, two WIPS3 mutations in exon 4, including a novel frameshift mutation (c.670dupA) in the paternal allele and an already described nonsense mutation (c.756C?>?A, p.Cys252*) in the maternal allele, were identified in the proband. Thus, the patient was diagnosed with PPD. Furthermore, we found that the proband’s son only carried one of the mutations (c.670dupA) and therefore determined that he would not be affected by PPD in the future.

Conclusions

In this case, we successfully diagnosed the disease that the proband was affected precisely after the reunion of clinical diagnosis and genetic analysis. These findings demonstrate the clinical utility of genetic analysis to diagnose skeletal dysplasia and guide genetic counseling.

     

The clinical pattern differentiates ANCA-positive infective endocarditis patients from ANCA-associated vasculitis patients: a 23 years’ retrospective cohort study in China and follow-ups

Clinical Rheumatology - Patients with infective endocarditis (IE) may present rheumatic manifestations concurrent with various autoantibodies and thus mimic antineutrophil cytoplasmic antibody...     

超声引导下胸椎旁神经阻滞和菱形肌-肋间肌阻滞对胸腔镜术后恢复质量的影响

目的 观察超声引导下胸椎旁神经阻滞(TPVB)和菱形肌-肋间肌阻滞(RIB)对胸腔镜手术患者术后早期疼痛及术后康复质量的影响。
方法 选择全麻下行胸腔镜肺癌根治术患者78例,男51例,女27例,年龄50～70岁,ASAⅠ或Ⅱ级。随机分为两组:超声引导下TPVB组(A组)和超声引导下RIB组(B组),每组39例。全麻诱导前,A组、B组分别采用0.33%罗哌卡因25 ml行超声引导下TPVB和RIB。记录阻滞操作时间和阻滞持续时间。记录术后2、6、24静息和活动时VAS疼痛评分。记录术后24 h内舒芬太尼用量和补救镇痛例数。记录开始进食时间、开始下地时间和术后住院时间。记录PACU低氧血症、气胸、穿刺部位出血或血肿、局麻药中毒、术后谵妄、术后肺不张、恶心呕吐等并发症的发生情况。
结果 B组阻滞操作时间明显短于A组(P<0.05)。两组阻滞持续时间、不同时点静息和活动时VAS疼痛评分、术后24 h内舒芬太尼用量、补救镇痛率、开始进食时间、开始下地时间、术后住院时间差异无统计学意义。两组并发症发生率差异无统计学意义。
结论 在胸腔镜肺癌根治术中,行超声引导下菱形肌-肋间肌阻滞的患者术后恢复质量不差于行胸椎旁神经阻滞的患者。     

Differentiation of mesenchymal stem cells into neuronal cells on fetal bovine acellular dermal matrix as a tissue engineered nerve scaffold

The purpose of this study was to assess fetal bovine acellular dermal matrix as a scaffold for supporting the differentiation of bone marrow mesenchymal stem cells into neural cells following induction with neural differentiation medium.We performed long-term,continuous observation of cell morphology,growth,differentiation,and neuronal development using several microscopy techniques in conjunction with immunohistochemistry.We examined specific neuronal proteins and Nissl bodies involved in the differentiation process in order to determine the neuronal differentiation of bone marrow mesenchymal stem cells.The results show that bone marrow mesenchymal stem cells that differentiate on fetal bovine acellular dermal matrix display neuronal morphology with unipolar and bi/multipolar neurite elongations that express neuronal-specific proteins,including βIII tubulin.The bone marrow mesenchymal stem cells grown on fetal bovine acellular dermal matrix and induced for long periods of time with neural differentiation medium differentiated into a multilayered neural network-like structure with long nerve fibers that was composed of several parallel microfibers and neuronal cells,forming a complete neural circuit with dendrite-dendrite to axon-dendrite to dendrite-axon synapses.In addition,growth cones with filopodia were observed using scanning electron microscopy.Paraffin sectioning showed differentiated bone marrow mesenchymal stem cells with the typical features of neuronal phenotype,such as a large,round nucleus and a cytoplasm full of Nissl bodies.The data suggest that the biological scaffold fetal bovine acellular dermal matrix is capable of supporting human bone marrow mesenchymal stem cell differentiation into functional neurons and the subsequent formation of tissue engineered nerve.     

超声引导下腰方肌阻滞在腹膜透析置管术中的应用效果

目的观察超声引导下腰方肌阻滞在腹膜透析置管术中应用的有效性及安全性。方法选择择期行腹膜透析置管术终末期肾病患者90例,男49例,女41例,年龄45～65岁,ASAⅢ或Ⅳ级,随机分为三组,每组30例:A组采用局麻,B组采用0.5%罗哌卡因25 ml行超声引导下腹横肌平面阻滞,C组采用0.5%罗哌卡因25 ml行超声引导下腰方肌阻滞。记录麻醉前(T_0)、阻滞完成后30 min(T_1)、切皮时(T_2)、置管时(T_3)、打隧道穿刺出皮肤时(T_4)和缝合切口时(T_5)的MAP和HR;记录舒芬太尼追加例数,记录T_2—T_5时VAS评分和围术期不良反应的发生情况。结果 T_3—T_4时C组MAP明显低于A组和B组,HR明显慢于A组和B组(P0.05),B组MAP明显低于A组,HR明显慢于A组(P0.05)。T_3—T_4时C组VAS评分明显低于A组和B组(P0.05),B组VAS评分明显低于A组(P0.05)。C组舒芬太尼追加例数明显少于A组和B组(P0.05),A组舒芬太尼追加例数明显多于B组(P0.05)。三组下肢乏力发生率差异无统计学意义,三组均无一例其他不良反应。三组围术期均未发生明显的穿刺并发症。结论超声引导下腰方肌阻滞麻醉应用于终末期肾病患者腹膜透析置管术中效果确切,可减少麻醉性镇痛药的使用,不增加不良反应。     

油菜花的研究进展与产业化应用

油菜(Brassica napus L.)是十字花科芸薹属草本植物,在世界各地广为种植,常以食用油及蔬菜等形式为人们所利用.油菜花(Brassica canpestris)因其富含多种营养成分和生物活性物质,且具有增强免疫功能、抗氧化、降血脂、美容养颜等多种功效,对前列腺疾病、糖尿病及心血管疾病等也具有一定的改善作用,...     

Epidemiology of hospitalizations due to pesticide intoxication-associated acute kidney injury in China

International Urology and Nephrology - There is a paucity of epidemiological data regarding pesticide intoxication-associated acute kidney injury (AKI). Therefore, the aim of this study was to...     

Elevated serum levels of interleukin-10 in adult-onset Still’s disease are associated with disease activity

Clinical Rheumatology - To evaluate the serum levels of the anti-inflammatory cytokine interleukin-10 (IL-10) in patients with adult-onset Still’s disease (AOSD), a rare, systemic, and...