老年单侧全髋关节置换术围术期输血风险预测模型的构建

目的分析老年单侧全髋关节置换术围术期输血危险因素并建立风险预测模型。方法回顾性收集于2013年1月至2021年10月在北京协和医院接受单侧初次全髋关节置换术的老年患者467例。将全部数据的70%划分为训练集,30%划分为测试集。根据是否接受围术期输血将训练集中的患者划分为输血组和非输血组。通过单因素与多因素Logistic回归分析患者的人口学特征、手术信息和术前实验室指标,识别围术期输血的危险因素,结合临床经验构建预测模型并绘制列线图。在测试集中使用受试者工作特征(ROC)曲线和校准曲线评估模型性能。结果在纳入的467例患者中,91例(19.5%)患者接受围术期输血。多因素Logistic回归分析显示合并冠心病、手术时间增加和术前低血红蛋白是围术期输血的危险因素(P<0.05)。根据统计分析结果与临床经验,纳入是否合并冠心病、手术时间、术前血红蛋白、年龄和是否美国麻醉医师协会(ASA)分级>Ⅱ级等因素构建预测模型,模型的受试者工作特征曲线下面积(AUC)为0.809。结论老年单侧全髋关节置换术围术期输血风险预测模型的表现良好,可以为临床工作提供帮助。

输血相关急性肺损伤发病机制及防治措施研究进展

输血相关急性肺损伤(TRALI)是输血导致的严重肺部并发症,已成为输血导致死亡的主要原因之一,其病理生理学机制尚未完全阐明,防治也面临巨大挑战。当前研究大多基于各种假说,探究多种效应细胞及效应分子在TRALI中的作用及可能存在的相关机制,本文总结了TRALI发病机制及防治措施的研究进展。

输血相关急性肺损伤动物模型的建立及可溶性CD40配体在其发生机制中的作用

目的建立更符合临床实际情况的输血相关急性肺损伤动物模型并在该动物模型中探究可溶性CD40配体(s CD40L)在输血相关急性肺损伤(TRALI)发生中的作用。方法采用创伤-失血-大量输血的方法建立TRALI动物模型,通过大鼠肺组织病理学改变、伊文斯兰染液漏出量、支气管肺泡灌洗液蛋白漏出量判断大鼠是否发生肺水肿以判断建模是否成功。检测大鼠红细胞储存前后及受血大鼠血浆中s CD40L含量以探讨s CD40L在TRALI发生中的作用。结果 7 d浓缩红细胞(PRBC)组大鼠肺组织病理学改变示肺泡上皮细胞增生、肺泡间隔增厚及间质大量炎性细胞浸润。7 d PRBC组大鼠支气管肺泡灌洗液蛋白漏出量(13.17±5.76)mg明显高于正常对照组(1.21±0.66)mg及生理盐水(NS)对照组(4.94±2.15)mg(F=17.605,P<0.001)。7 d PRBC组大鼠伊文斯兰染液漏出量(0.0109±0.0067)%/min显著高于NS对照组(0.0026±0.0006)%/min(t=2.998,P=0.03)。储存7 d PRBC中s CD40L含量(451.58±73.28)pg/ml显著高于0 d PRBC(277.94±98.18)pg/ml(t=2.834,P=0.03)。7 d PRBC组大鼠血浆s CD40L含量(878.21±125.30)pg/ml明显高于正常对照组(289.78±62.60)pg/ml和NS对照组(418.07±47.68)pg/ml(F=78.715,P<0.001)。结论采用创伤-失血-大量输血的方法成功建立大鼠TRALI模型,接受大量输血的TRALI大鼠血浆s CD40L含量明显高于正常对照组及NS对照组,提示s CD40L可能在TRALI的发生中发挥一定作用。

综合征性脊柱侧凸矫形手术的围手术期管理

综合征性脊柱侧凸是继发于某种特定综合征的一类脊柱侧凸,患者可伴有全身多处发育异常或畸形,脊柱侧凸仅为其临床表现之一,手术是其重要的治疗方法。相较于特发性脊柱侧凸,综合征性脊柱侧凸患者手术麻醉风险更高,围手术期并发症更为常见。因此,术前全面评估优化患者状况、制定个体化麻醉方案、加强术中及术后精细化管理,对患者平稳渡过围手术期,获得良好预后至关重要。本文就综合征性脊柱侧凸矫形手术的围手术期管理进行概述,以期为临床实践提供一定的理论依据。

防治高原特色粳稻“楚粳”水稻白叶枯病的有效药剂筛选

[目的]为了筛选出可用于防治高原特色粳稻水稻白叶枯病的有效药剂。[方法]采用平板抑菌试验进行有效药剂筛选,并对有效药剂进行田间防效评价。[结果]四霉素、喹啉铜·四霉素、中生菌素、噻唑锌对水稻白叶枯病菌均有较好的抑制效果,其EC_(50)值分别为2.694×10^(-4)、3.485×10^(-4)、7.682×10^(-4)、3.983×10^(-3)mg/L。[结论]温室试验和田间试验中都是四霉素的效果最好,温室试验中治愈效果为69.31%,预防效果为73.81%;田间试验中四霉素对日本晴的防效为31.68%,增产率达到94.73%,对楚粳53的防效为44.38%,增产率达到43.44%。

Rationale and study design for one-stop assessment of renal artery stenosis and renal microvascular perfusion with contrast-enhanced ultrasound for patients with suspected renovascular hypertension

Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.

Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis

Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.