目的 临床观察盐酸氨基葡萄糖和依托芬那酯凝胶治疗膝骨关节炎（KOA）的疗效。 方法 2010年6月－2012年2月，将354例KOA患者随机分为盐酸氨基葡萄糖组（A组）、依托芬那酯凝胶组（B组）和盐酸氨基葡萄糖+依托芬那酯凝胶组（C组）。A组为口服盐酸氨基葡萄糖，750 mg/次，2次/d，疗程6周；B组为依托芬那酯凝胶外用，2次/d，6周为1个疗程；C组为在A组的基础上同时加用B组的方法。 结果 C组在改善行走疼痛、夜间静息痛、晨僵方面优于A、B组，A组优于B组，差异有统计学意义（P＜0.05）。总有效率A组为79.65%，B组67.28%，C组89.38%，差异有统计学意义（P＜0.05）。出现不良反应A组3例，B组3例，C组4例，均较轻微，无严重不良事件发生。 结论 盐酸氨基葡萄糖和依托芬那酯凝胶治疗KOA均安全、有效，联合应用时，疗效进一步增强。
Objective To observe the incidence rate of cardiovascular adverse events and evaluate the safety of dexmedetomidine or midazolan sedation in patients with long-term mechanical ventilation in intensive care unit (ICU). Methods From January 2014 to December 2015, patients admitted to ICU aged ≥18 years with mechanical ventilation time ≥48 hours were randomly divided into dexmetomidine group (group D) and midazolam group (group M). Adverse events such as cardiovascular events during sedation were observed. Results There were 144 cases in group D and 143 cases in group M. Slow heart rate was the prominent manifestation in group D. The incidence of heart rate <50 beats per minute in group D (4.86%) was less than that in group M (6.29%), but there was no statistical difference ( P=0.681). Group D had lower blood pressure (40.28% vs. 72.73%), tachycardia (18.75% vs. 41.96%), arrhythmia (16.67% vs. 34.97%) and 28- day mortality (22.22% vs. 42.66%) than those in group M (P<0.01). No cardiac arrest, sinus arrest, hypertension, hyperglycemia, or hypoglycemia were found in the two groups. Conclusion The long-term sedation of dexmetidine in patients with mechanical ventilation is safe; in cardiovascular adverse events, the 28-day mortality is lower than that of traditional midazolam sedation, and the duration of mechanical ventilation is no longer than that of traditional midazolam sedation, with slightly longer ICU length of stay.
Objective To determine whether fluoxetine, a commonly used selective serotonin reuptake inhibitors (SSRIs), could exacerbate bleeding in a intracerebral hemorrhage (ICH) mouse model. Methods Forty two 12-14 month old female specific pathogen free C57BL/6 mice were selected. Mice were randomly divided into fluoxetine group (fluoxetine pre-treatment) and control group, with 21 mice in each group. After treated with fluoxetine for 7 days, ICH was induced by injecting collagenase Ⅶ-S into the right striatum of middle-aged female mice. Effects of fluoxetine on exacerbating bleeding were evaluated by a combination of histologic, molecular, cellular, and behavioral assessments. Results On the third day after ICH, the hemorrhage volumes of the control group and fluoxetine group were (4.59±1.80) mm3 and (6.09±1.08) mm3, respectively. In middle-aged female mice subjected to collagenase-induced ICH, fluoxetine pre-treatment significantly exacerbated neurological deficit, cerebral hemorrhage volume, myelin damage, hemoglobin and iron deposition, neuronal degeneration, and brain edema (P<0.05). Although there was no significant difference in tail bleeding time between the two groups, fluoxetine pre-treatment might increase tail bleeding time [(276.73±211.06) vs. (438.00±236.79) s; t=−1.686, P=0.055]. Conclusions The use of fluoxetine and more generally of SSRIs, which inhibits platelet aggregation, may exacerbate bleeding after ICH. Thus, patients with depression after ICH may avoid concomitant use of such drugs when choosing an antidepressant.
Objective To evaluate the expression and clinical significance of Survivin in the tissues of laryngeal carcinoma using meta-analysis. Methods The case-control studies published in China about the expression and association of clinical pathogenic features of Survivin in the tissues of laryngeal carcinoma were electronically retrieved in CBM (1994 to October 2012), CNKI (1994 to October 2012), VIP (1989 to October 2012) and WanFang Data (1996 to October 2012). The reviewers independently identified the literature according to inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 25 studies were included, involving 1 333 cases of laryngeal carcinoma and 528 cases of health laryngeal mucosa or polyp of vocal cord. The results of meta-analysis showed that, significant differences were found in groups of laryngeal carcinoma vs. health control, laryngeal carcinoma with vs. without lymphatic metastasis, clinical stages I-II vs. III-IV, cell differentiation G1 vs. G2-G3, T1 and T2 stages vs. T3 and T4 stages, and glottic carcinoma vs. non-glottic carcinoma (Plt;0.05). No significant difference was found in groups of age more than 60 vs. no less than 60, male vs. female, and smoke vs. non-smoke (Pgt;0.05). Conclusion Current domestic evidence shows that Survivin may be associated with the whole course of occurrence, advance and transfer of laryngeal carcinoma, and positively correlated to degree of tumor malignance, which may indicate poor prognosis.
目的 研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。 方法 将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。 结果 实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。 结论 急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
Objective To compare the effectiveness between unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of Kümmell disease. Methods The clinical data of 45 patients with Kümmell disease that met the criteria between January 2014 and February 2016 were analyzed retrospectively. Among them, 26 cases were treated by unilateral PKP (unilateral group), 19 cases were treated by bilateral PKP (bilateral group). There was no significant difference in gender, age, disease duration, injured vertebral segment, bone mineral density (T value), and the preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), anterior vertebral height, and kyphosis Cobb angle between 2 groups (P>0.05). The operation time, intraoperative fluoroscopy times, amount of injected bone cement, and hospitalization time were recorded, and the situation of bone cement leakage was observed. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle were evaluated before operation, at 1 day after operation, and at last follow-up. Results Bone cement leakage during the operation were found in 4 cases (15.38%) of unilateral group and 3 cases (15.79%) of bilateral group without obvious neurological symptoms; there was no significant difference in the incidence of bone cement leakage between 2 groups (χ2=0.000, P=1.000). The operation time, intraoperative fluoroscopy times, and amount of injected bone cement in the unilateral group were significantly lower than those in the bilateral group (P<0.05); but there was no significant difference in the hospitalization time between 2 groups (P>0.05). The X-ray film examination showed that there was no pulmonary embolism in all patients at 1 day after operation. All the patients were followed up 12-24 months, with an average of 16.4 months. There was no complication such as vertebral re-fracture or cement block displacement in the injured vertebra. The VAS score, ODI, anterior vertebral height, and kyphosis Cobb angle at 1 day after operation and at last follow-up were significantly improved when compared with preoperative values in 2 groups (P<0.05); the VAS score and ODI in 2 groups were further reduced at last follow-up when compared with the value at 1 day after operation (P<0.05), but the anterior vertebral height and kyphosis Cobb angle in 2 groups at last follow-up did not change significantly (P>0.05). There was no significant difference in above indexes at 1 day after operation and at last follow-up between 2 groups (P>0.05). Conclusion Both unilateral and bilateral PKP can achieve good effectiveness in treatment of Kümmell disease. But the unilateral puncture technique possesses advantages such as shorter operation time, less radiation dose, and less amount of injected bone cement.
ObjectiveTo investigate the effectiveness of Vesselplasty and percutaneous kyphoplasty (PKP) in treatment of Kümmell disease.MethodsBetween January 2015 and December 2018, 63 patients with Kümmell disease were treated. Among them, 28 cases were treated with Vesselplasty (Vesselplasty group) and 35 cases were treated with PKP (PKP group). There was no significant difference in gender, age, disease duration, bone mineral density (T value), fracture distribution, and preoperative pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI), anterior height of injured vertebrae, and kyphosis Cobb angle between the two groups (P>0.05). The operation time, intraoperative fluoroscopy time, bone cement injection volume, the leakage rate of bone cement, the diffusion area ratio of bone cement, and the complications of the two groups were recorded. VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle were compared between the two groups before operation and at 1 day after operation and last follow-up.ResultsAll patients of the two groups were followed up 12-36 months, with an average of 24.2 months. The operation time, intraoperative fluoroscopy time, bone cement injection volume, and diffusion area ratio of bone cement were significantly lower in the Vesselplasty group than in the PKP group (P<0.05). The leakage rate of bone cement was significantly lower in the Vesselplasty group (7.14%) than in the PKP group (34.29%) (χ2=5.153, P=0.023). At 1 day after operation and last follow-up, the VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle of the two groups were superior to those before operation (P<0.05), and no significant difference between the two groups (P>0.05). During the follow-up, there was no re-collapse of vertebrae, and the adjacent vertebrae fracture occurred in 2 cases of the Vesselplasty group and 5 cases of PKP group. There was no significant difference in the incidence of adjacent vertebrae fracture between the Vesselplasty group (7.14%) and the PKP group (14.29%) (χ2=0.243, P=0.622).ConclusionVesselplasty and PKP have similar effectiveness in the treatment of Kümmell disease. They can effectively relieve the pain symptoms, improve the quality of life, partially restore the height of injured vertebrae, and correct kyphosis. But the Vesselplasty has the advantages of shorter operation time, less intraoperative fluoroscopy time, and less bone cement leakage.