Objective To assess the efficacy and safety of dexmedetomidine used for intravertebral anesthesia. Methods A search in PubMed Central, EBSCO, Springer, Ovid, CNKI and WanFang Data was conducted from the date of their establishment to February 2011, so as to collect the randomized controlled trails (RCTs) on dexmedetomidine used for intravertebral anesthesia. The reference lists of identified papers were examined for further trials. After the data were extracted and the quality was assessed in accordance with the inclusion and exclusion criteria, the Meta-analysis was conducted with RevMan5.0 software. Results A total of 13 RCTs involving 672 patients were included. The results of meta-analyses showed that compared with saline solution, dexmedetomidine tended to speed up the mean time of sensory block to reach T10 dermatome (MD= –2.39, 95%CI –4.40 to –0.39) and motor block to reach Bromage 3 (MD= –5.30, 95%CI –7.18 to –3.43). It also prolonged the time for two dermatomes regression of sensory blockade (MD=51.14, 95%CI 44.96 to 57.32) and complete resolution of motor blockade (MD=68.46, 95%CI 38.56 to 98.35). Peri-operative bradycardia significantly increased (RR=3.03, 95%CI 1.64 to 5.59) but shivering decreased (RR=0.47, 95%CI 0.28 to 0.80). In comparison with the control group, dexmedetomidine showed no difference in low blood pressure and occurrence of postoperative nausea and vomiting. Conclusion The current evidence shows that dexmedetomidine shortens the time for taking effect, prolongs the duration of intravertebral anesthesia, decreases the occurrence of shivering, and increases the occurrence of bradycardia.
目的 探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治。 方法 回顾性分析山东省菏泽市立医院及曹县人民医院1996年6月至2007年3月共收治的17例患者的临床病理资料。结果 本病临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除； 黏液性囊腺瘤6例，行胰十二指肠切除1例，胰体尾切除5例； 囊腺癌4例，行胰十二指肠切除加淋巴结清扫1例，胰体尾切除术2例，胰体尾加脾切除1例。光镜下浆液性囊腺瘤囊壁由扁平或立方上皮细胞组成； 黏液性囊腺瘤囊壁由高柱状上皮细胞组成，可见乳头状突起； 囊腺癌囊壁细胞核异形明显，可见核分裂象及间质浸润。15例获得B超随访，中位随访时间为42个月（1～129个月），除1例行胰体尾切除加脾切除的老年囊腺癌患者术后6个月死于营养衰竭和 1例胰十二指肠切除患者并发糖尿病外，其余患者生存满意，未见肿瘤复发。结论 B超和CT是本病的主要影像检查方法。加强对本病临床病理特征的认识是提高诊治率的关键。手术切除治疗本病疗效满意。
目的 探讨提高肺热循环灌注质量的技术要点。 方法 2005 年 10 月至 2015 年 6 月我院 42 例（男 23 例、女 19 例，年龄 32～78 岁）恶性胸腔积液患者在电视胸腔镜下行胸膜活检后行肺热循环灌注治疗。采用体外循环机灌注 12 例，专用热循环灌注机 16 例，自行设计简易循环灌注法 14 例，病理检查明确为胸膜转移癌后以 43℃ 0.9%NaCl 与 50 mg 顺铂溶液循环胸腔热灌注 60 min，随访观察胸腔积液的有效控制率、不良反应、患者的生活质量以及生存期。 结果 电视胸腔镜下胸膜活检诊断阳性率达 100.0%，细胞学检查诊断阳性率为 26.2%。全组胸腔积液控制总有效率为 96.5%，完全缓解率为 86.7%，部分缓解率为 9.8%，无效率为 3.5%。3 例分别于热灌注治疗后 4、6、11 个月胸腔积液复发，其余均无胸腔积液复发。39 例患者热灌注治疗后生活质量明显提高，Karnofsky 行为评分超过 80 分。全组中位生存期为 17.5 个月，1 年生存率为 89.3%，其中 7 例生存 3 年以上。手术顺利，除 1 例切口皮下溢液外无明显并发症和手术死亡。 结论 影响灌注质量的因素有肿瘤大小、肺复张程度、切口选择、灌注持续温度、胸腔灌注平面的控制、灌注管口径长度、流量控制、灌注技巧、引流管留置方法。主要防范并发症有切口皮下溢液，出血、发热，术后残腔等。
ObjectiveTo provide the referencefor the guideline development and revision in China, we analyzed the composition of personnel who participated in developing Chinese clinical practice guidelines (CPGs)published in 2017. MethodsCNKI, WanFang Data, CBM and Google scholar were electronically searched to collect Chinese CPGs published from January 1st to December 31st, 2017. Two researchers independently screened literatures, extracted data of interest, such as composition and distribution of personnel, and analyzed the composition of personnel with Microsoft excel 2013. ResultsA total of 54 guidelines were included, and the majority of which are for treatment. Among which, 49 were developed by the associations accounting for 90.7%. Twenty-four (44.4%) guidelines reported the geographical distribution and unit ownership of the guideline developers, such as hospitals, schools, institutions (academies, institutes, laboratories, nursing homes, etc.). Almost all of the guidelines were developed by the cooperative work of experts from multidisciplinary clinical setting, 15 (27.8%) of which mentioned the participation of the methodologist. Among which, 13 (24.1%) of them involved literature retrieval experts, 2 (3.7%) of them involved epidemiologists, 2 (3.7%) of them involved evidence-based medicine experts, 1 (1.9%) of them involved statistical expert. Three of which mentioned external peer review. None of them has systematic review team. ConclusionIn China, the CPG formulation/revision organization is still not considering the importance of multidisciplinary collaboration, methodology researchers, and patients’ participation and external evaluation teams, which will affect the quality, practicability and maneuverability of CPG. We propose that multidisciplinary cooperation should be strengthened in the future while developing CPG, giving full consideration to the importance of medical personnel and the values of patients, and promoting the application of methodology.
ObjectiveTo establish an rabbit model of early steroid-induced avascular necrosis of the femoral head (SANFH) and evaluate its validity with MRI and pathological examination. MethodsTwenty 6-month-old rabbits (weighing, 2-3 kg) were randomly divided into 2 groups (control group and model group), 10 rabbits in each group. Dexamethasone sodium phosphate solution (10 mg/kg) was injected into bilateral gluteus in model group, and the same amount of saline was injected in control group, every 3 days for 14 times. General observation was done after modelling. Osteonecrosis was verified by pathological observation and MRI findings at 6 weeks. ResultsAfter 6 weeks, rabbits did not show obvious changes in control group; increased hair removal, decreased food intake, and slight limp were observed in model group. The MRI results showed normal shape of the bilateral femoral head and no abnormal signals in control group; irregular shape of the bilateral femoral head and a slice of irregular abnormal signals were observed, and necrosis and cystolization of the subchondral bone and sparse changes of trabecular bone were shown in model group. General observation from coronal section of femoral head showed smooth red cartilage surface in control group; on the contrary, the cartilage surface of the femoral head became dull, thin even visible hemorrhage under articular cartilage and necrosis of the femoral head were observed. The histopathological examination indicated that trabecular bone of the femoral head in control group was massive, thick, and close, and osteocytes in the bone lacunae had normal shapes. The osseous trabecular became thinner and broken; karyopyknosis of osteocytes and bone empty lacunae could be obviously seen in model group. The rates of empty lacunae were 8.0%±0.5% in control group and 49.0%±0.3% in model group, showing significant difference (t=21.940, P=0.000). ConclusionEstablishing a model of early SANFH through injecting shortterm, shock, and high dose of dexamethasone, and it can been evaluated effectively with MRI and pathological examination.