非阿片类镇痛复合静脉全麻在鼾症手术患者中的疗效

目的:观察三重措施预防为基础,联合非阿片镇痛药复合静脉全麻在行鼾症手术患者术后恶心呕吐的应用效果。方法:选择择期行鼾症手术男性病人80例,随机分为两组:吸入麻醉组(inhalation group, IHLA组)和静脉麻醉组(intravenous group, TIVA组),每组40例,两组均采用三重措施预防恶心呕吐,IHLA组采用以舒芬太尼为基础复合七氟烷吸入麻醉,TIVA组以氯胺酮和右美托咪定镇痛基础上丙泊酚全凭静脉麻醉。评估两组病人恶心呕吐危险系数,采用李克特量表(Likert scale),记录并分析两组患者术后6~8 h在麻醉后监测治疗室(post anesthesia care unit, PACU)及病房24 h恶心呕吐发生情况及补救用药用量。结果:两组患者一般临床资料、恶心呕吐风险评分、手术时间、术后恢复期补救用药量人数无显著差异(P>0.05);IHLA组在PACU恶心呕吐发生率为39.5%,TIVA组发生率为18.9%,两者相比有显著性差异(P<0.05);IHLA组病房24 h恶心呕吐严重程度高于TIVA组,两组术后需要补救应用抗呕吐药物用量无显著差异(P>0.05)。结论:以三重措施预防为基础,与吸入麻醉相比,非阿片类镇痛药复合静脉麻醉可以减少肥胖病人鼾症手术术后恶心呕吐发生率和严重程度,降低围术期风险,有利于患者早期恢复。     

胃肠道手术患者术后感染病原菌及感染危险因素分析

目的探究胃肠道手术患者术后感染病原菌及其感染高危因素,为该类患者的治疗提供参考。方法选择2017年1月至2019年10月于我院行胃肠道手术的106例患者为研究对象,检测感染患者病原菌分布,同时检测感染与非感染患者肠道菌群情况,分析患者术后感染的相关危险因素。结果 106例胃肠道手术患者中感染18例(16.98%),共分离出病原菌23株,其中革兰阴性菌占52.17%(12/23),以大肠埃希菌(34.78%,8/23)为主;革兰阳性菌占43.48%(10/23),以金黄色葡萄球菌(26.09%,6/23)为主;真菌占4.35%(1/23)。感染患者肠道大肠埃希菌、肠杆菌数量均明显高于未感染患者,双歧杆菌数量明显低于未感染患者(均P0.05)。Logistic分析显示,年龄60岁、急诊手术、普通手术室、参观手术人数3人、手术时间2 h、接台手术均为胃肠道手术患者术后感染的独立危险因素(均P0.05)。结论胃肠道手术患者术后感染风险较高,同时会出现肠道菌群失衡。重视患者高危因素对提高患者手术效果,调整肠道菌群失衡和改善患者预后意义重大。     

心脏手术后视幻觉发生与肠道菌群变化的研究

目的探究心脏术后患者视幻觉症状发生情况及体内肠道菌群变化。方法选取2020年1月-2021年1月中国科学院大学宁波华美医院接受择期体外循环心脏手术的成年患者21例作为研究对象。分别在术前、术后第1次或第2次排便、术后6～8 d进行微生物分析和粪便短链脂肪酸(SCFAs)浓度测定。采用实时荧光定量PCR法检测肠道菌群组成,高效液相色谱检测SCFAs。术后1周进行视幻觉评价。结果21例患者中,视幻觉3例。与术前相比,术后第1和第2份粪便样本的微生物总数显著降低(P<0.05)。在专性厌氧菌中,第一次术后粪便样本中的球形梭菌数量、柔嫩梭菌数量显著低于术前样本。兼性厌氧菌中,术后第1次和第2次标本的乳酸杆菌总数均显著降低。植物乳杆菌数量在第1次术后粪便样本中较低。L. sakei数量在第2次术后标本中明显下降。术后第1次粪便样本中肠杆菌科的数量明显高于术前样本。与术前相比,术后第1次粪便样本中的肠球菌数量显著升高。术后第2次粪便标本中葡萄球菌数量明显高于术前标本。术后视幻觉组葡萄球菌数量明显高于非视幻觉组,第2次术后粪便样本中术后视幻觉组葡萄球菌数量也明显高于非幻视觉组。视幻觉组的假单胞菌数量明显高于非视幻觉组和术后第2次粪便样本。术后第1次粪便标本中,视幻觉组肠杆菌数量高于非视幻觉组。视幻觉组术后第一次粪便样本中总SCFAs浓度显著低于非视幻觉组。以上差异均具有统计学意义(P<0.05)。结论心脏手术后视幻觉的发生与肠道菌群变化存在一定联系,表现为肠道内肠杆菌科和肠球菌属数量增多,乳杆菌数量降低,同时还伴随着SCFAs浓度的降低。     

Progress of Gastric Cancer Surgery in the era of Precision Medicine

With the development of genomics, the update of modern imaging technology and the advent of artificial intelligence and big data, the surgical treatment of gastric cancer has gradually stepped into precision medicine. Precision surgery treatment of gastric cancer is based on accurate molecular typing and staging using modern molecular diagnostic technology and imaging, and the formulation of precise and individualized surgical treatment plans, with the concept of minimally invasive and accelerated rehabilitation surgery running through it. For intermediate-stage gastric cancer, we have adopted a comprehensive treatment approach including traditional radiotherapy and chemotherapy, targeted therapy and immunotherapy. Utilize artificial intelligence and big data technology to improve the standardization and interconnectivity of specialty data and realize the transformation of evidence-based medicine. Promoting the standardization, standardization and individualization of gastric cancer surgical treatment, providing patients with precise diagnosis and treatment, and further improving patients'' prognosis are the opportunities and challenges in the development of gastric cancer surgery.     

Design of a resilient ring for middle ear’s chamber stapes prosthesis

Abstract

This paper presents the process of designing a new elastic element replacing a membrane in the chamber stapes prosthesis (ChSP). The results of the study are volume displacement characteristics obtained for the prosthesis and physiological stapes. Simulation tests on a 3D CAD model have confirmed that a properly designed ring can stimulate perilymph with the same or greater efficacy as the physiological stapes footplate placed on the elastic annular ligament. The ChSP with a new elastic element creates a good chance of improving hearing in patients suffering from otosclerosis.     

Exploration of disease mechanism in acute kidney injury using a multiplex bead array assay: a nested case–control pilot study

Background: Acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) causes increased morbidity and mortality.

Objective: To evaluate the plasma profile of biomarkers potentially involved in AKI development following CPB.

Methods: In a nested case–control study, plasma levels of 27 biomarkers in 11 AKI cases were compared with 25 controls.

Results: Pre-CPB, plasma levels of epidermal growth factor and macrophage inflammatory protein-1β, 2?h following CPB, soluble vascular cell adhesion molecule-1 (sVCAM-1), fractalkine and macrophage inflammatory protein-1α, and at later time points, sVCAM-1 and interleukin-6 were associated with AKI.

Conclusion: Biomarkers associated with AKI following CPB may merit further study.     

额底纵裂入路手术对鞍上第三脑室底垂体瘤的疗效分析

目的：分析经额底纵裂入路治疗鞍上第三脑室底垂体瘤的疗效,探讨其临床适用性。方法：选择从2011年1月~2013年1月与我院行额底纵裂入路手术治疗的30例鞍上第三脑室底垂体瘤的患者,术中行单侧额或双侧额弧形切口,根据术中所见肿瘤位置,由终板、视神经一颈内动脉等存在的生理间隙处切除肿瘤,观察所有患者的手术疗效。结果：所有患者术中可见肿瘤位于鞍内鞍上,部分或全部突入第三脑室底,其中有6例患者伴有脑积水。术中肿瘤全切23例,次全切5例,大部切除2例,无手术死亡病例。术前25例患者视力减退,术后23例患者视力均获得不同程度改善,仅1例暂无明显变化。术后19例出现电解质紊乱,患者经治疗后均已纠正;12例出现不同程度的尿崩症,给予患者药物治疗后,病情得到缓解。术后随访6个月,23例肿瘤全切患者病灶无复发,另外4例次全切者病灶也无明显变化,仅1例次全切和2例大部切除患者于术后行伽马刀再次治疗。结论：经额底纵裂入路治疗鞍上第三脑室底垂体瘤可以达到视野清晰,直观下进行肿瘤切除,手术效果好,并发症较少,适合临床长期推广应用。     

腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的临床观察

目的：探讨腹腔镜胆囊切除术治疗高龄患者急性胆囊炎的应用价值。方法：回顾性分析2005年1月．2011年12月我院收治的210例65岁以上因急性胆囊炎实施胆囊切除术的老年患者的临床资料,按手术方式分为腹腔镜组（LC组）和剖腹胆囊切除术组（OC组）,分析和比较两组患者的手术时间、术后肠功能恢复时间及住院时间,术中出血、腹腔引流量和术后并发症的发生情况。结果：与OC组比较,LC组的手术时间、术后肠功能恢复时间及住院时间均显著缩短,差异有统计学意义（P〈0．01）;但两组之间术中出血、腹腔引流量和术后并发症的发生率差异均无统计学意义（P〉0．05）。LC组中转开腹10例,占7_35％;其中粘连严重导致胆囊三角解剖不清6例,无法控制的出血2例,结石嵌顿胆囊管2例。结论：老年急性胆囊炎患者在条件合适的情况下行腹腔镜胆囊切除术治疗有助于患者更快地恢复．具有较强的临床应用价值。     

Association between rs10118757(A/G) in methylthioadenosine phosphorylase gene and coronary artery disease in Chinese Hans

Studies focusing on the association of gene methylthioadenosine phosphorylase (MTAP) with the risk of coronary artery disease (CAD) and myocardial infarction (MI) are limited.     

Infection Status of Hydatid Cysts in Humans and Sheep in Uzbekistan

Uzbekistan is endemic of cystic echinococcosis (CE). In order to estimate endemicity of CE, we collected data from emergency surgery due to CE in 2002-2010 and also investigated the prevalence of hydatid cysts in the liver and lungs of sheep at an abattoir in Uzbekistan from July 2009 to June 2010. In 14 emergency hospitals, 8,014 patients received surgical removal or drainage of CE during 2002-2010, and 2,966 patients were found in 2010. A total of 22,959 sheep were grossly examined of their liver and lungs, and 479 (2.1%) and 340 (1.5%) of them were positive for the cyst in the liver and lungs, respectively. Echinococcus granulosus is actively transmitted both to humans and sheep, and CE is a zoonotic disease of public health priority in Uzbekistan.