微视频在ICU气管套管带管出院患者家属健康教育中的应用

目的探讨应用微视频对ICU气管套管带管出院患者的家属实施健康教育的效果。方法选取2018年9月—2020年9月的100例气管套管带管出院患者的家属,根据随机数字表法将其随机分为对照组和试验组各50例,对照组实施常规健康教育和随访;试验组在此基础上将患者出院后面临的共性问题进行归纳总结,制定并应用微视频对其实施健康教育。分别比较两组患者家属在气管套管相关知识知晓率、气管套管护理操作的准确性以及患者气管切开并发症发生率之间的差异。结果试验组家属在气管套管相关知识的知晓率和护理技能的得分均高于对照组家属(P<0.05),但患者气管切开相关并发症发生率低于对照组(P<0.05)。结论应用微视频实施健康教育可有效提高ICU气管套管带管出院患者家属的管路护理水平,提高患者带管期间的安全性。     

Bioequivalence and Food Effect of Dapagliflozin/Saxagliptin/Metformin Extended-release Fixed-combination Drug Products Compared With Coadministration of the Individual Components in Healthy Subjects

PurposeFixed-combination drug products (FCDPs) for patients with type 2 diabetes mellitus (T2DM) may show efficacy comparable to their individual components (ICs) while improving adherence to treatment. This study evaluated the bioequivalence and safety of 2 dapagliflozin/saxagliptin/metformin extended-release (XR) FCDPs relative to their ICs: saxagliptin and dapagliflozin/metformin XR.MethodsThis randomized, open-label, single-dose, single-center crossover study was conducted in 84 healthy subjects aged 18–55 years. The primary objective was to evaluate the fed-state bioequivalence of a dapagliflozin 5-mg/saxagliptin 2.5-mg/metformin 1000-mg XR FCDP and a dapagliflozin 10-mg/saxagliptin 5-mg/metformin 1000-mg XR FCDP relative to the ICs. Secondary objectives included the evaluation of the effect of food on the pharmacokinetic (PK) parameters of saxagliptin, dapagliflozin, and metformin in both FCDPs and characterization of the PK parameters of the active metabolite of saxagliptin, 5-hydroxy saxagliptin, in healthy subjects. PK parameters (AUC_0–∞, AUC_0–t, and C_max) were used to assess the bioequivalence of the 2 FCDPs with their ICs. The C_max and AUC_0–t of the study drugs were compared between female and male subjects to assess sex differences in exposure. Safety and tolerability of both FCDPs and ICs were also assessed with adverse events, vital signs (systolic and diastolic blood pressures and pulse rate), 12-lead ECG, physical examinations, and laboratory assessments.FindingsBoth dapagliflozin/saxagliptin/metformin XR FCDPs were bioequivalent to their ICs. For the dapagliflozin 5-mg/saxagliptin 2.5-mg/metformin 1000-mg XR FCDP, the 90% CI for the geometric mean ratio of dapagliflozin C_max was slightly above the 80%–125% bioequivalence limit, which is unlikely to be clinically relevant. Food delayed the absorption of the study drugs in both FCDPs, which is unlikely to have a clinically relevant impact on efficacy. In both cohorts, exposure was higher in female subjects compared with male subjects, potentially due to the lower body weight of the female subjects. The safety profile and tolerability of the FCDPs were similar to those of their ICs, and no deaths or serious adverse events were reported.ImplicationsThese data support the use of the dapagliflozin/saxagliptin/metformin XR FCDP in patients with T2DM. ClinicalTrials.gov identifier: NCT03169959.     

Impact of donor preprocurement cardiac arrest on clinical outcomes in pediatric deceased donor liver transplantation

PPCA has historically been considered detrimental to donor quality in LT, but transplantation of grafts from this group of donors is now routine. Our study aims to evaluate the outcomes associated with use of donors with a history of PPCA in the pediatric population. This study is a single‐center retrospective analysis of all pediatric LTs performed over an 18‐year period. Donors and recipients were stratified by the presence and length of donor PPCA time. Preprocurement donor and post‐transplant recipient laboratory values were collected to assess the degree of ischemic liver injury associated with each donor group. Cox regression analysis was used to compare survival. The records for 130 deceased pediatric LT donors and corresponding recipients were reviewed. There were 73 (56%) non‐PPCA donors and 57 (44%) PPCA donors. Donors that experienced a PPCA event demonstrated a higher median, pretransplant peak alanine aminotransferase (ALT) level (P < .001). When comparing post‐transplant recipient median ALT levels, donors with any PPCA had lower median peak ALT (P = .15) and day 3 ALT (P = .43) levels than the non‐PPCA group. Rates of early graft loss did not differ. The PPCA group with >40 minutes of ischemia had markedly lower survival at 10 years, but this finding did not reach statistical significance. Liver grafts from donors with or without PPCA demonstrated no statistically significant differences in function or survival. A history of donor PPCA alone should not be used as an exclusionary criterion in pediatric liver transplantation.     

Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

Many lung donor offers are refused despite increasing demand. Portable normothermic ex vivo lung perfusion (EVLP) could increase donor yield by monitoring and reconditioning extended criteria donor (ECD) lungs. We report its use in human lungs declined for clinical transplantation. Ten sets of such lungs were procured from brain-dead donors and underwent 24 hours of normothermic EVLP using a perfusate based on donor whole blood. Hemodynamic and ventilatory data and P:F ratios were measured. Advanced donor age and borderline oxygenation (donor mean P:F 228 ± 73) were the most commonly cited reasons for refusal for transplantation. There was no significant worsening of pulmonary hemodynamics or compliance or significant P:F decline during preservation in the overall cohort. Mean P:F ratio in the overall cohort was 315 ± 88 mm Hg after 24 hours EVLP. At EVLP termination 5/10 lung blocks met standard EVLP thresholds for acceptability for transplant. Eventual EVLP performance was poorly predicted by donor P:F ratio but well predicted by data gathered early in EVLP. Portable normothermic EVLP is useful for transportation, monitoring, and reconditioning of ECD lungs. Early EVLP measurements are more effective than preprocurement donor P:F in predicting eventual allograft performance. We advocate an aggressive strategy of evaluation of ECD lungs using blood-based EVLP.     

Personalizing surgical margins in retroperitoneal sarcomas: an update

Introduction: Tumor biology, as well as completeness of surgical resection, are two important prognostic factors when treating retroperitoneal sarcoma (RPS). A frontline extended surgical approach is associated with improved local control and possibly improved survival. However, this approach has to be tailored to each histological subtype, as the patterns of growth and recurrence risks vary significantly among them.

Areas covered: We provide a review of the literature in RPS, describing the behavior of each of the five main histologic subtypes: well-differentiated liposarcoma (WDLPS), dedifferentiated liposarcoma (DDLPS), leiomyosarcoma (LMS), solitary fibrous tumor (SFT) and malignant peripheral nerve sheath tumor (MPNST). The prognostic factors relevant to oncologic outcomes of RPS, the role of margins and the importance of local control are discussed. Finally, a histologic specific surgical approach to RPS is provided in detail.

Expert opinion: While tumor-related factors are paramount, the only intervenable predictive factor is extent and quality of surgery. The extended surgical approach has been advocated for previously and again we describe it in more detail, tailored specifically to the tumor subtype. The aim of this approach is to maximize the possibility of achieving a complete resection through a standardized approach based on histologic behavior and site of origin.     

临床分离沙门菌的耐药性及超广谱β-内酰胺酶类耐药基因

目的研究北京地区2012—2015年沙门菌临床分离株的血清型分布、耐药状况及超广谱β-内酰胺酶(ESBLs)耐药基因特征。方法采用最小抑菌浓度法测定北京市肠道门诊分离的677株沙门菌株对16种抗菌药物的耐药情况,采用聚合酶链反应(PCR)方法对244株β-内酰胺酶类耐药菌株进行耐药基因检测。结果677株沙门菌分为68种血清型,其中肠炎沙门菌、鼠伤寒沙门菌和山夫登堡沙门菌位居前3位。沙门菌对氨苄西林和阿莫西林/克拉维酸的耐药率分别为42.54%、40.77%,至少耐3种以上抗菌药物的菌株占57.16%。244株对氨苄西林和阿莫西林/克拉维酸耐药的沙门菌,携带至少一种ESBLs基因的菌株174株(71.31%),146株bla_(TEM-1)型,30株bla_(OXA-1)型,18株bla_(CTX-M)型(其中7株bla_(CTX-M-15),6株bla_(CTX-M-55)和5株bla_(CTX-M-14));20株同时携带2种耐药基因。结论该地区沙门菌携带ESBLs耐药基因水平较高,以bla_(TEM-1)为主,同时伴有bla_(OXA-1)和3种bla_(CTX-M)基因亚型,呈现基因多样性。     

延髓型重症肌无力喉肌电指标变化的临床价值

目的探讨延髓型重症肌无力患者电视胸腔镜下胸腺扩大切除术（video-assisted thoracoscopic extended thymectomy,VATET）后喉肌电指标测定的临床价值。方法回顾分析2002年6月～2011年7月我科36例延髓型重症肌无力（延髓型组）行VATET的临床资料,对术前后喉肌电指标进行分析,选取同期36例健康受试者作为对照组。结果延髓型组术前喉内肌肌电振幅（210．68±75．42）μV,较对照组（309．40±55．33）μV明显缩窄（t=6．332,P=0．000）;时程（7．68±0．57）ms较对照（5．42±0．34）mB明显延长（t=-20．431,P=0．000）;募集相最大电位（1132．18±467．19）μV较对照组（1675．00±532．85）μV明显缩窄（t=4．596,P=0．000）,术后2组比较仅时程有明显差异（t=6．375,P=0．000）。延髓型组喉内肌群术后肌电振幅（312．91±69．43）μV,较术前（210．68±75．42）μV明显变宽（t=-5．983,P=0．000）;术后时程（6．19±0．64）m8较术前（7．68±0．57）m8明显缩短（t=10．431,P=0．000）;术后募集相最大电位（1557．67±521．45）斗V较术前（1132．18±467．1）μV明显变宽（t=-3．646,P=0．000）;喉外肌仅肌电振幅差异显著[（139．36±74．26）μV vs．（102．75±63．22）μV,t=-2．252,P=0．027]。术后喉肌电图正常的患者疗效有效率89．3％（25／28）,喉肌电图异常的患者疗效有效率37．5％（3／8）,2组比较有统计学差异（χ2=6．891,P=0．009）。结论延髓型重症肌无力患者肌电指标异常,VATET可有效改善各项指标,缓解相关的临床症状。