一种复合过氧乙酸消毒剂的遗传毒性评估

摘要 目的 评估一种复合过氧乙酸消毒剂的遗传毒性。方法 采用中国仓鼠肺成纤维细胞（CHL）染色体畸变试验和小鼠骨髓嗜多染红细胞微核试验,检测和评价该复合过氧乙酸消毒剂的染色体损伤毒性。结果 在加入和未加入S9活化系统的条件下,该过氧乙酸消毒剂在4~500 μg/ml剂量范围内的染色体数目和结构畸变率均<5%。受试物各剂量组与阴性对照相比,动物骨髓嗜多染红细胞微核率无显著性差异（P>0.05）,动物骨髓嗜多染红细胞与正染红细胞的比值（PCE/NCE）也无显著性差异（P>0.05）。结论 该过氧乙酸消毒剂无明显遗传毒性。     

新型生物可降解材料聚乳酸凝胶的生物相容性

目的：研究新型生物可降解材料聚乳酸凝胶的生物相容性，为此种材料的应用提供生物学依据。方法：实验于2002—11／2003—02在四川大学华西医院移植免疫实验室和动物实验外科完成。通过动物急性毒性试验、溶血试验、遗传毒性试验、肌腱鞘管内及硬膜外长期植入试验测定材料的动物毒性；并通过细胞毒性测定、细胞与材料混合培养，综合评价新材料的生物相容性。结果：聚乳酸凝胶注射入小鼠无急性毒性；材料浸提液无溶血反应(溶血率为0．22％)及遗传毒性(微核率为0．24％)；材料在动物体内长期埋植后局部和全身各器官无组织损伤，局部无明显粘连；材料浸提液(1000，500，100g／L)的细胞毒性及分级与阴性对照差异无显著性意义(P&;gt;0．05)，材料与细胞的混合培养中细胞生长良好。结论：聚乳酸凝胶具有良好的生物相容性。     

长期接触射线辐射石油作业人员142名细胞微控测定分析

目的：染色体畸变是反映电离辐射损伤的敏感指标之一。分析观察长期接触射线的石油化工工作人员染色体畸变和细胞微核率变化。 方法：①选择2000—10／2007—03延安地区的石油作业人员142人，男102人，女40人；年龄25～36岁；其中从事石油化工工作10年以下共86人，10年以上者56人。另选身体健康的企业人员114人做对照，年龄20-38岁。所有受检者对检测项目均知情同意。②检测方法：采用微量全血培养法做染色体培养，常规培养法做微核测定。③评估：进行染色体畸变分析和细胞微核率分析。 结果：①石油化工工作人员组（〈10年和≥10年者）染色体型畸变明显高于对照组（1．07％，1．36％，0．14％，P〈0．01）。〈10年和≥10年者问差异无显著性（P〉0．05）。②石油化工工作人员组（〈10年和≥10年者）微核率明显高于对照组（1．782％，2．098％，0．022％，P〈0．01）。〈10年和≥10年者差异不显著（P〉0．05）。 结论：放射组的微核率随染色体畸变率的增高而增加，两者间存在着密切的相关性。辐射对人体造成的危害不容忽视，应加强对石油工作人员的健康防护。     

多囊卵巢综合征患者降调后抗苗勒管激素水平对妊娠结局的预测价值

【目的】探讨多囊卵巢综合征（PCOS）患者降调后抗苗勒管激素（AMH）水平对妊娠结局的预测价值。【方法】行体外授精／卵胞浆内单精子注射一胚胎移植（IVF／ICSI-ET）PCOS患者37例（PCOS组）,同期单纯输卵管因素不孕行IVF／ICSI-ET患者37例（对照组）,因发生卵巢过度刺激综合征（0HSS）或为避免发生OHSS而取消或放弃移植的患者为取消组。所有患者均使用黄体期长效促性腺激素释放激素激动剂（GnRH-a）方案,降调节后月经来潮d2～d。测血清AMH、性激素水平,阴道B超检查窦卵泡计数（AFc）。【结果】降调节后两组AMH、雄激素（T）、AFC、获卵数、受精卵数比较差异有显著性（P〈0．05）,妊娠率比较无显著性差异（P〉0．05）;PCOS患者取消组AMH水平显著高于阴性妊娠结局组及阳性妊娠结局组（P〈0．05）;发生OHSS的PCOS患者AMH水平显著高于未发生OHSS组（P一0．02）;PC0s组降调节后AMH水平与T、AFC、HCG注射日雌二醇（E2）水平相关系数分别为0．524、0．352、0．524（P〈0．05）;对照组AMH与AFC、HCG注射日E2水平、获卵数、受精卵数、优质胚胎数相关系数分别为0．608、0．418、0．639、0．675、0．581（P〈0．05）。【结论】降调后AMH水平能反映正常卵巢女性降调后窦卵泡水平,提示注射HCG日E。峰水平,预测超促排卵（COH）中促性腺激素（Gn）使用量,获卵数,受精卵数,优质胚胎数。对PCOS患者,调后低水平AMH提示妊娠阴性结局可能,高水平则发生OHSS风险增加。     

乳腺癌术前新辅助化疗104例临床分析

【目的】探讨新辅助化疗对可手术乳腺癌的预后改善作用并新辅助化疗方案、周期数以及生物学指标与疗效的关系。【方法】104例新辅助化疗的乳腺癌患者,治疗前肿瘤穿刺活检标本均检测生物学指标雌激素受体（estrogen receptor,ER）、孕激素受体（progesterone receptor,PR）和原癌基因C-erbB-2。患者采用FAC、TE方案化疗,每3周1次,共1～4个周期,化疗结束后10～14d手术。疗效按UICC实体瘤疗效评定标准进行评价,并统计患者5年生存率。【结果】TE方案有效率及病理缓解率高于FAC方案（P〈0．05）,其5年生存率也高于FAC方案（P〈0．05）;TE新辅助化疗2周期以上的有效率高于2个周期（P〈0．05）,但平均生存时间无显著差异（P〉0．05）;C-erbB-2阴性、ER／PR阴性患者的有效率高（P〈0．05）;以上生物学指标表达的不同情况5年生存率之间无显著差异（P〉0．05）。【结论】对可手术乳腺癌患者术前应给予2个周期以上TE方案化疗;生物学指标中C-erbB-2阴性、ER／PR阴性的患者有效率高。     

大肠癌术后应用草酸铂、氟尿嘧啶联合化疗的疗效

【目的】探讨大肠癌术后辅助化疗的有效方案．【方法】43例大肠癌术后患者分别采用L-OHP＋5-FU／CF方案（A组）治疗20例、DDP＋5-FU／CF方案（B组）治疗23例，比较两组疗效及毒副作用。【结果】A、B两组的1、2年生存率和1、2、3年复发／转移率相比差异均无显著性（均P〉0．05）；两组骨髓毒性发生率分别为55．0％、69．6％（P〉0．05），A组的外用神经炎发生率明显高于B组，B组的恶心呕吐反应发生率明显高于A组（均P〈0．05）。【结论】草酸铂联合5-FU／CF作为大肠癌术后辅助化疗效果较佳，耐受性好．     

高糖-可的松混合液治疗超乳术后角膜水肿的临床疗效

【目的】探讨高糖一可的松混合液对超声乳化术后角膜水肿的治疗作用。【方法】对术后第一天出现角膜水肿的患眼进行随机分组,实验组用高糖一可的松混合液点术眼,每小时一次,对照组用可的松眼药水点术眼,每小时一次,对滴药疗效进行分析评价。【结果】2～4级角膜水肿实验组疗效显著优于对照组,且差异有显著性（P〈0．05）。【结论】高糖一可的松混合液可提高白内障超乳术后2～4级角膜水肿的疗效,缩短患者的住院日期。     

舒利迭治疗妊娠合并支气管哮喘46例疗效观察

【目的】观察舒利迭吸入剂治疗妊娠合并支气管哮喘的临床疗效。【方法】选取2011年1月至2013年1月于本院门诊治疗的80例妊娠合并哮喘患者，按就诊日期的单、双数分为试验组和对照组，试验组46例、对照组34例；试验组采用舒利迭吸入治疗，对照组采用辅舒酮吸入治疗，治疗1周、4周、8周后观察比较两组患者的疗效。【结果】试验组症状缓解，症状消失时间均短于对照组，且两组相比较差异有显著性（P＜0．05）。试验组肺功能指标改变近期优于辅舒酮组，后期无明显差异，试验组与对照组8周后总有效率相比较差异无显著性（ P ＞0．05）。试验组有1例出现咽部不适，对照组1例出现轻度头昏，两组不良反应发生率相比较差异无显著性（ P ＞0．05）。【结论】舒利迭治疗妊娠合并支气管哮喘疗效明显，值得临床推广应用。     

扎莱普隆胶囊治疗失眠症的随机双盲对照试验

【目的】评价国产扎莱普隆胶囊治疗失眠症的有效性和安全性。【方法】采用随机、双盲、双模拟、阳性药平行对照研究。48例失眠症患者随机分为试验组（24例）与对照组（24例），分别口服扎莱普隆胶囊10mg／d或唑吡坦片10mg／d，疗程14d，观察两组疗效及不良反应。【结果】睡眠障碍量表（SDRS）评分在治疗结束时两组较基线均显著减少（P〈0．01）；试验组有效率为58．3％，对照组有效率为45．5％，两组比较差异无显著性（P〉0．05）。扎来普隆较常见的不良反应为头晕、口苦、口干，未出现严重的不良反应。【结论】扎莱普隆胶囊为安全而有效的催眠药物。     

两种体温计消毒方法的对比研究

目的评价肥皂水和75％乙醇进行体温计消毒的效果。方法将240支患者测量腋温后的体温计随机分为两组,实验组和对照组各120例分别用20％肥皂水和75％乙醇消毒体温计,对消毒前后的体温计进行细菌培养检测,统计消毒合格率。结果实验组和对照组消毒前菌落数分别为（42．10±37．93）cfu／cm2和（40．40±36．51）cfu／cm2;消毒后菌落数分别为（0．22±1．56）cfu／cm2和（O．13±1．06）cfu／cm2。消毒前和消毒后两组菌落数比较差异均无统计学意义（t分别为0．35、0．82,P〉0．05）,实验组和对照组各自消毒前后菌落数比较差异均有统计学意义（t分别为12．07、12．08,P〈0．01）。两组体温计消毒后合格率分别为96．7％和98．3％,差异无统计学意义（X2=0．17,P〉0．05）。结论肥皂水和75％乙醇均可用于体温计消毒,效果良好。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."