CT引导下经皮穿刺活检食管占位性病变的有效性及安全性

目的 观察CT引导下经皮穿刺活检食管占位性病变的有效性及安全性。方法 回顾性分析37例接受CT引导下经皮穿刺活检的食管占位性病变患者（37个病灶）,统计取材成功率、穿刺病理诊断率及诊断准确率（以术后病理诊断或随访诊断为最终诊断）和术中、术后并发症。结果 37个病灶均穿刺取材成功并获明确病理诊断,32个病理结果为阳性（肿瘤性病变）、5个为阴性（炎性病变或正常组织）,穿刺病理诊断率100%。32个阳性病变穿刺病理诊断与最终诊断结果均一致;5个穿刺阴性病变中,3个与最终诊断一致,2个术后病理均为胃肠间质瘤,穿刺诊断准确率为94.59%（35/37）,假阴性率40.00%（2/5）。术后2例出现少量气胸、3例穿刺针道少量出血,1周后均自然吸收,并发症发生率13.51%（5/37）。结论 CT引导下经皮穿刺食管占位性病变安全、有效。     

超声引导下经皮细针穿刺抽吸及穿刺活检诊断胰腺占位性病变

目的 观察超声引导下经皮细针穿刺抽吸(FNA)及穿刺活检(CNB)诊断胰腺占位性病变的价值。方法 回顾性分析112例接受超声引导下FNA和/或CNB的胰腺占位性病变患者、共114组穿刺病理,根据穿刺方式将其分为FNA组(n=53)及CNB组(n=61)。以手术病理或临床随访为金标准,对比组间患者一般资料、穿刺及诊断效能差异,分析影响穿刺并发症发生的因素,评价FNA及CNB的价值。 结果 114组病理中,113组(99.12%,113/114)取材满意;FNA组取材满意率为98.11%(52/53),CNB组为100%(61/61)。穿刺过程中38例出现轻、中度疼痛、1例一过性晕厥,未见严重并发症。FNA组并发症及疼痛发生率均低于CNB组(P均<0.05),FNA诊断胰腺占位性病变的准确率和敏感度亦低于CNB(P均<0.05)。logistic回归分析显示,年龄和穿刺方式是并发症的独立影响因素。结论 超声引导下经皮FNA及CNB均可安全有效地诊断胰腺占位性病变;CNB诊断准确率及敏感度较高,而FNA并发症率较低。     

高分辨率微细血流成像引导术前经皮穿刺活检

目的 分析高分辨率微细血流成像（HDMFI）引导穿刺活检的临床价值。方法 回顾性分析46例经手术切除病灶并明确病理诊断的单发占位病变患者,病灶位于浅表31例、腹腔8例、盆腔7例;术前接受超声引导下穿刺活检,最大径<1 cm者接受细针穿刺,≥ 1 cm者接受粗针活检,其中25例以常规CDFI（CDFI组）、21例以HDMFI靶向引导穿刺（HDMFI组）;对比2组取材成功率、诊断符合率及穿刺并发症。结果 对CDFI组共行细针活检16例、粗针活检9例,穿刺61次,其中52次取材成功,22例获得明确病理诊断;HDMFI组细针活检15例、粗针活检6例,穿刺48次,46次取材成功,20例获得明确病理诊断。CDFI组穿刺活检取材成功率、诊断符合率分别为85.25%（52/61）、88.00%（22/25）,HDMFI组分别为95.83%（46/48）、95.24%（20/21）,HDMFI组均高于CDFI组（P均<0.01）。术中及术后均未见穿刺并发症。结论 HDMFI可清晰显示病灶内部微细血流灌注,用于精准引导穿刺效果较CDFI更佳。     

明胶海绵-凝血酶原-碘海醇用于封堵CT引导下经皮肝穿刺活检针道

目的 观察明胶海绵-凝血酶原-碘海醇用于封堵CT引导下经皮肝穿刺活检针道的安全性及可行性。方法 回顾性分析101例因不明原因肝病、肝硬化、肝占位性病变并发凝血功能异常而接受CT引导下肝穿刺活检患者,穿刺取材后均以明胶海绵颗粒-人凝血酶原复合物-碘海醇混合物封堵针道;观察穿刺活检效果、并发症及穿刺前后凝血及肝功能指标。结果 101例均穿刺取材成功,技术成功率及组织学标本充分度均为100%,并均获得明确病理诊断。18例（18/101,17.82%）出现并发症,包括穿刺部位轻微疼痛、封堵剂渗透至肝包膜下或皮下;未见出血、气胸及胆管损伤等严重并发症。穿刺活检前、后凝血及肝功能差异均无统计学意义（P均＞0.05）。结论 明胶海绵颗粒-凝血酶原-碘海醇用于封堵经皮肝穿刺活检针道安全、可靠,可减少出血等并发症。     

CT引导下经胃肠间隙穿刺活检胰腺病变

目的 观察CT引导下经胃肠间隙穿刺活检胰腺病变的安全性及有效性。方法 回顾性分析96例接受CT引导下经胃肠间隙穿刺活检的单发胰腺病变患者,记录穿刺成功率;以手术病理及随访结果为标准,评估穿刺活检病理诊断的有效性,观察其相关并发症。结果 对96例均顺利完成穿刺活检,穿刺成功率100%（96/96）。活检病理诊断的敏感度为97.75%（87/89）,特异度为100%（7/7）,阳性预测值为100%（87/87）,阴性预测值为77.78%（7/9）,准确率为97.92%（94/96）。6例出现并发症,包括3例局限性胰周少量积液、1例少量腹腔积液及2例间歇性发热,后均改善;未见其他并发症。结论 CT引导下活检针经胃肠间隙穿刺活检胰腺病变安全、有效。     

CT引导下肺结节热消融联合术中即时活检的可行性

目的 观察CT引导下热消融肺结节联合术中即时活检的可行性。方法 回顾性分析331例接受CT引导下经皮肺穿刺活检和/或热消融肺结节患者的资料,共373个病灶。其中102例（102个病灶）仅接受CT引导下经皮肺穿刺活检（单纯活检组）,132例（174个病灶）仅接受CT引导下热消融（单纯消融组）,97例（97个病灶）接受CT引导下热消融联合术中即时活检（消融联合活检组）。计算技术成功率,记录并发症;评价活检标本病理诊断阳性率（所取组织标本可获得明确病理诊断判定为阳性）及基因检测标本质量。结果 对331例均顺利完成操作,技术成功率为100%（331/331）。单纯活检组术后6例（6/102,5.88%）咯血,单纯消融组及消融联合活检组术中及术后均未见咯血。单纯活检组5例、单纯消融组11例、消融联合活检组13例发生气胸,3组间差异无统计学意义（P=0.10）;均予CT引导下经皮置管引流。单纯活检组活检组织病理诊断阳性率为73.53%（75/102）,消融联合活检组为82.47%（80/97）,组间差异无统计学意义（P=0.13）。消融联合活检组共16例接受基因检测分析,活检组织标本均达到质控合格标准。结论 CT引导下热消融肺结节联合术中活检可行,可降低出血发生风险,且能满足病理检查及基因检测要求。     

血凝酶封堵针道预防肺穿刺活检并发症

目的 观察血凝酶封堵针道预防肺穿刺活检并发症的价值。方法 回顾性分析155例接受CT引导下经皮肺穿刺活检的单发肺结节患者,将其分为观察组（n=78,退针时以血凝酶封堵针道）与对照组（n=77,直接退针）;完成操作后即刻复查CT,比较组间肺出血级别及肺压缩面积占比。结果 对155例均成功取材,于其中150例（150/155,96.77%）获得明确病理诊断。观察组20例（20/78,25.64%）、对照组38例（38/77,49.35%）发生高级别出血;观察组18例（18/78,23.08%）发生气胸、肺压缩面积占比为0（0,0）,对照组31例（31/77,40.26%）发生气胸、压缩面积占比为0（0,0.76%）;观察组均低于对照组（P均＜0.05）。结论 肺穿刺活检后退针时以血凝酶封堵针道可降低出血及气胸风险。     

超声引导下经锁骨下静脉植入输液港的可行性

目的 观察超声引导下经皮穿刺锁骨下静脉（SCV）植入输液港的可行性。方法 选取196接受输液港植入术的恶性肿瘤患者,其中98例于超声引导下（超声组）、98例于DSA引导下经SCV植入输液港（DSA组）;对比2组总穿刺次数、一次性穿刺成功率,以及术中、术后（随访12个月）并发症发生率。结果 超声组总穿刺次数100次、一次性穿刺成功率97.96%（96/98）,DSA组总穿刺次数117次、一次性穿刺成功率89.80%（88/98）;超声组总穿刺次数少于DSA组（P=0.02）,一次性穿刺成功率高于DSA组（P=0.02）。超声组1例术中出现心律失常,DSA组术中臂丛神经损伤3例、误穿动脉2例、气胸2例;术后随访12个月,超声组2例发生导管异常,DSA组4例静脉血栓形成、3例导管异常、2例切口感染、2例输液座外露;超声组术中及术后并发症发生率均低于DSA组（P均<0.05）。结论 超声引导下经SCV植入输液港穿刺成功率高、并发症发生率低,具有高度可行性。     

钆塞酸二钠增强MRI引导肝脏病灶穿刺活检的可行性

目的 观察钆塞酸二钠（Gd-EOB-DTPA）增强MRI用于引导肝脏病灶穿刺活检的可行性。方法 对15例肝脏病变患者行Gd-EOB-DTPA增强MRI引导下穿刺活检,统计总操作时间及技术成功率（以取样标本满足病理、基因等检测要求为技术成功）,观察术中及术后并发症。以手术病理或随访结果为标准,评估MRI引导肝脏病灶穿刺活检的诊断效能。结果 于Gd-EOB-DTPA增强MRI引导下穿刺15个肝脏病灶,均一次穿刺成功,病灶最大径0.40~2.81 cm,平均（1.58±0.69） cm;肝胆期MRI 13个病灶呈明显低信号、2个呈稍低信号,图像质量均满足操作要求;技术成功率100%（15/15）;总操作时间33~54 min,平均（40.33±6.56） min。5例术中见少量针道渗血,沿针道推入明胶海绵条后止血;其余10例术中、术后均未出现并发症。穿刺标本病理诊断10例肝细胞癌（HCC）、1例结肠癌肝转移、1例肝腺瘤及3例肝脏不典型增生结节伴轻度肝硬化,其中1例穿刺病理结果为肝脏不典型增生结节伴轻度肝硬化者术后病理结果为早期小HCC,其余穿刺病灶病理诊断均与最终临床诊断一致。MRI引导肝脏病灶穿刺活检的诊断敏感度为91.67%（11/12）,特异度为100%（3/3）,准确率为93.33%（14/15）。结论 Gd-EOB-DTPA增强MRI用于引导肝脏病灶穿刺活检安全、可行。     

细针穿刺细胞学检查与粗针穿刺活检术对甲状腺结节的诊断效能比较

背景与目的 彩超引导下细针穿刺细胞学检查（FNAC）是术前评估甲状腺结节良恶性的主要方法,其缺点是取材不足,可能导致误诊或漏诊。粗针穿刺活检术（CNB）可弥补FNAC的不足,但其缺点是增加了疼痛和创伤。因此,本研究比较FNAC与CNB对甲状腺结节诊断的诊断效能及各自特点,以期为临床合理选择提供参考。方法 回顾性分析2020年11月—2022年11月于武汉大学中南医院接受甲状腺手术的552例患者资料,所有患者术前均接受超声检查,并依次行FNAC与CNB,穿刺1周内行患侧甲状腺切除术。收集患者临床资料及甲状腺结节的超声特征、术前细胞学、组织病理学及术后常规病理结果,以术后常规病理为金标准,分析FNAC及CNB诊断效能。结果 总体上,FNAC与CNB对甲状腺结节诊断敏感度、特异度、准确率相近,差异均无统计学意义（88.7% vs. 91.4%,P=0.283;90.6% vs. 97.4%,P=0.226;85.3% vs. 89.1%,P=0.058）;对滤泡性肿瘤的良恶性判别,CNB优于FNAC（P=0.024）。当结节直径≤2.0 cm时,FNAC与CNB诊断效能基本无差异;当结节直径>2.0 cm时,CNB的敏感度明显高于FNAC（95.0% vs. 79.2%,P<0.001）,联合二者诊断可进一步提高敏感度至99.2%。对于钙化结节、囊性变结节、富血供结节的诊断,CNB的敏感度与准确率均高于FNAC（91.0% vs. 88.7%、91.0% vs. 84.8%、92.8% vs. 85.1%;93.2% vs. 88.8%、91.7% vs. 84.8%、93.3% vs. 85.2%）,除对钙化结节的差异无统计学意义外,其余差异均有统计学意义（均P<0.05）;对于缺乏血供结节的诊断,FNAC的敏感度与准确率均高于CNB（92.7% vs. 90.2%,P=0.004;96.2% vs. 90.5%,P=0.005）。结论 CNB与FNAC对直径≤2.0 cm的甲状腺结节的诊断效能相当,但CNB在滤泡性肿瘤的判别方面有一定优势。CNB对直径>2.0 cm、钙化结节、富血供及囊性或囊实性结节甲状腺结节诊断效能优于FNAC,对具备上述特征的结节联合FNAC与CNB检查可在一定程度上提高甲状腺结节术前诊断的准确率。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.