血管内介入治疗颅内动脉瘤48例临床分析

目的探讨血管内介入治疗（Endovascular treatment,EVT）对颅内动脉瘤（Intracranial aneurysms,IAs）的疗效。方法2010年1月-2012年3月巴中市中心医院行EVT治疗IAs患者48例共52个IAs．回顾性分析患者的临床资料并评定栓塞疗效。结果52例IAs中,46例（88．5％）IAs为100％栓塞,5例（9．6％）为95％-99％栓塞,1例（1．9％）为〈95％栓塞。45例中小型IAs中,41例（91．1％）IAs为100％栓塞,3例（6．7％）为95％-99％栓塞,1例（2．2％）为〈95％栓塞;6例大型IAs中,4例（66．7％）为100％栓塞,2例（33.3％）为95％-99％栓塞;1例巨大型IA为100％栓塞。术中3例出现脑血管痉挛,1例出现IA破裂。EVT治疗后100％栓塞的46例IAs中,随访期内35例（76．1％）仍为100％栓塞,10例（21．7％）为95％-99％栓塞,1例（2．2％）为〈95％栓塞;5例95％-99％栓塞的患者中,随访期内1例（20％）为100％栓塞,2例（40％）为95％-99％栓塞,2例（40％）为〈95％栓塞。结论EVT弹簧圈治疗IAs栓塞效果较好,特别是100％栓塞的患者;但术中有发生IAs破裂等严重并发症的可能,应尽量避免;术后随访很重要,对于栓塞效果不理想的患者可行再次手术。     

CT评估暴力性损伤

了解使用ＣＴ评估暴力性损伤的价值;材料和方法１４例暴力损伤者施行急诊ＣＴ检查。对损伤原因,ＣＴ诊断和临床处理进行比较和分析;结果：损伤原因中１４．２９％为枪击,２８．５７％为殴斗,２１．４３％为刀砍和刺伤,其它损伤占３５．７１％;损伤部位３５．７１％为胸部,２１．４３％为脑部,１４．２９％为颈椎,７．１４％为腰部;临床处理２１．４３％为清创,３５．７１％为手术,２１．４３％为引流,７．１４％为局部固定,其它占１４．２９％。结论：ＣＴ为头颅损伤的首选放射学检查方法,而对于其它部位损伤,ＣＴ可作为一种选择和补充的检查手段。     

1603名航天从业人员吸烟状况调查分析

目的：了解航天从业人员吸烟与被动吸烟状况,为制定有针对性的控烟措施提供依据。方法采用自行设计的调查问卷,对1603名航天从业人员进行关于吸烟、被动吸烟状况调查。结果吸烟者463人,吸烟率为28．88％,男性吸烟率为51．04％,女性吸烟率为2．98％。被动吸烟者870人,被动吸烟率为54．27％,男性被动吸烟率为61．81％,女性被动吸烟率为45．47％。各工种吸烟率：工人33．68％,机关人员25．47％,技术人员27．39％,工人吸烟率最高,差异有统计学意义（ P＜0．01）。吸烟者吸烟史平均为（13．69±10．43）年,每日吸烟量平均为（13．47±8．99）支。开始吸烟的阶段为工作47．95％,在校47．73％,待业6．26％。55．72％首次吸烟受同学、同事影响。吸烟者中有戒烟意愿的占54．86％,戒烟成功率仅为3．02％,曾在戒烟门诊咨询的占2．59％。结论航天从业人员吸烟、被动吸烟率高,戒烟成功率低,采取有针对性的控烟措施非常必要。     

肝包虫病的B超检出与分析

本文分析了海拔3719m的高原牧区综合性医院就诊,住院患者中肝包虫病的B超检出率及其特点。总检出率为2.89％,藏族牧民检出率为4.27％,移居者中检出率为0.81％,差异极为显著(P<0.001)。经手术证实的87例肝包虫囊肿有如下特点:①累及右叶的多为81.61％;②1000ml以上的巨大囊肿多,为55.17％;③类型中以子囊孙囊型的多,为57.47％;④囊肿合并感染的多,为37.93％;⑤伴有其它脏器的包虫病者多,为30.11％。B超是检出和诊断肝包虫病首选的检出方法,诊断准确率为98.85％。     

56例多原发癌的临床回顾性研究

目的：探讨多原发癌（MPC）的发病特点、早期诊断、治疗和预后。方法：对我院2002年1月～2007年12月收治的56例MPC临床资料进行回顾性分析。结果：MPC发生率为3．66％,其中双重癌为2．95％、三重癌为0．59％、四重癌为0．13％;两癌发病间隔时间在3年以内者占59．40％,在5年以内者占72．50％。首发癌和重复癌均以消化系统癌最常见,其次是泌尿生殖系统癌。本组MPC早期诊断率为40．00％,首癌早期诊断率为46．40％,重复癌早期诊断率为34．80％。76．80％经外科或内镜手术治疗,3年生存率为52．10％,5年生存率为26．70％,生存期最长的达18年余。结论：加强对NPC发病规律的认识,做到早期诊断、积极治疗,可延长生存期、改善预后。     

柔道运动创伤的流行病学调查

对国家队等10支柔道队共225名运动员进行了运动创伤调查。调查结果表明损伤发生年龄集中在16～20岁;总患病率为70.67％,人均患病率为117.3％。在检出的伤病中,以急性转慢性伤为主,占47.33％。损伤好发部位依次为膝关节(发病率35.1％)、腰(22.67％)、肩(13.78％)、踝(11.56％)、肘(10.22％);前五位伤病依次为膝关节半月板损伤(发病率12.89％,其中外侧半月板伤6.67％,内侧半月板伤6.22％)、腰肌肌肉筋膜炎(11.11％)、膝关节内侧副韧带损伤(8％)、踝关节外侧副韧带损伤(7.56％)、肩袖损伤(4.89％);损伤发生地点以运动场为主,占87.88％;以专项训练时受伤最多,占79.55％,其中以技术失误致伤及误伤最多,占50％。伤病对训练有影响的占38.25％。治疗总有效率为66.66％。建议加强运动场的医务监督,提高专项技术训练水平,重视加强对急性伤的治疗,以降低损伤发病率。     

3种分割式放疗对鼻咽癌患者远期疗效的比较

目的比较常规分割、伞程超分割、后程加速超分割3种方法放射治疗鼻咽癌患者的远期疗效及晚反应组织损伤的发生率。方法128例首程放疗的鼻咽癌患者随机分为常规分割治疗（CFR）组、全程超分割治疗（FHR）组、后程加速超分割治疗（LAHR）组。鼻咽部总剂量：CFR组70～72Gy／7～7．5周,每天照射1次,每次2Gy;FHR组80．5～82．8Gy／7-7．5周,每天照射2次,间隔6h以上,每次1.15Gy;LAHR组先常规分割照射38-40Gy／3．5～4周,再加速超分割照射33-36Gy／2～2．5周,每天2次,间隔6h以上,每次1．5Gy。结果1、3、5年的局部控制率CFR组为87．3％、69．8％、58．1%,FHR组为88．0％、80．0％、75．0％,LAHR组为100％、86．0％、83．7％,1、3年局控率3组无显著性差异,但5年局控率IAHR组和FHR组明显高于CFR组（P〈0．05）。1、3、5年的总生存率CRF组为95．3％、62．7％、53．5％,FHR组为97．6％、76．2％、61．9％,LAHR组为100％、86．1％、69．8％,无显著性差异。1、3、5年无瘤生存率CFR组为79．1％、41．9％、35．6％,FHR组为85．7％、57．1％、38．1%,LAHR组为95．4％、62．8％、58．1％,有显著性差异（P〈0．05）。听力下降发生率CFR组为31.3％．FHR组为25．0％,LAHR组为22．7％;张口困难发生率CFR组为41.9％,FHR组为35．7％,LAHR组为27．9％;放射性脑病发生率CFR组为9．3％,FHR组为7．1％,LAHR组为7．0％;3组的晚反应发生率无显著性差异。结论LAHR和FHR组5年局部控制率和无瘤生存率明显高于CFR组,但3种分割放疗方式对鼻咽癌患者5年总生存率和晚正常组织损伤发生率无明显影响。     

三阴性乳腺癌钼靶与超声特征探讨

＿目的：探讨三阴性乳腺癌（TNBC）钼靶X线和超声影像特征。方法：回顾性分析54例TNBC患者的钼靶X线和超声影像资料。结果：TNBC 肿瘤组织学分级高,在钼靶 X 线上常表现为肿块（69．8％）,很少表现为肿块伴钙化（15．1％）、单纯钙化（1．9％）、局限性非对称致密（9．4％）或结构扭曲（3．8％）。肿块形状主要为圆形或椭圆形（62．2％）,很少表现为不规则形（17．8％）。肿块常为清晰边缘（35．6％）,毛刺边缘（11．1％）少见。在超声检查中,TNBC 主要表现为肿块（87．0％）,很少表现肿块伴钙化（9．3％）、单纯钙化（0％）或结构扭曲（3．7％）。肿块形状主要为圆形或椭圆形（51．9％）,其次是不规则形（48．1％）。肿块常为清晰边缘（48．1％）,毛刺边缘（5．8％）少见。肿块内部回声以低回声和混杂回声为主,肿块后方回声衰减少见,弹性评分多为4或5。结论：TNBC钼靶X线和超声表现更倾向于良性肿瘤的特点,了解其影像特征有助于提高TNBC的诊断水平。     

新型作训鞋及其对踝关节损伤防伤性能的研究

通过对部队训练伤的流行病学调查发现,踝关节为最易损伤的部位之一。训练伤的月发生率为3.55％～5.89％,其中最多发生在外侧副韧带(71.79％),尤其是距腓前韧带。为了提高鞋对足踝部的保护作用,我们依据载荷踝关节内外侧副韧带的生物力学实验数据,设计制作了一种新型作训鞋。鞋底外侧比内侧高,坡度3°;后比前高,坡度5°,足弓垫高7～10mm。经部队近万名官兵3个月的现场试穿,重复流行病学调查,结果实验组3个月踝关节损伤总发生率为2.9％～15.2％(平均8.8％);对照组为18.5％～49.3％(平均30.7％),其保护率为79.5％。     

对飞行员抗荷生理训练复训方法的几点修改尝试

1991～1995年在我院参加抗荷生理训练的飞行员中,复训人数所占比例呈逐年增加的趋势。1991年为36.3％、1992年为47.2％、1993年为80.0％、1994年为78.7％、1995年为87.0％。预计,今后抗荷训练的对象仍主要是复训人员。因此我们认为,应根据实际情况,     

连梅饮中黄芩苷和小檗碱的含量测定

目的探讨连梅饮中黄芩苷和小檗碱的含量测定方法。方法采用RP—HPLC／UV法测定连梅饮中黄芩苷和小檗碱的含量;色谱柱：Agilent HC C18柱（250×4．6mm,5μm）;乙腈：0．05mol／L磷酸二氢钾溶液梯度洗脱;检测波长275nm;流速1ml／min。结果黄芩苷在0．448—112μg／ml的浓度范围,小檗碱在0．424～106μg／ml的浓度范围内线性良好：低和高浓度的黄芩苷和小檗碱的精密度（RSD）分别为3．88％、4．84％、4．63％、2．29％;加样回收率分别为（104．3±1.3）％、（97．7±6．9）％;连梅饮中黄芩苷的含量为（2．67±0．012）mg／ml,RSD为0．45％（n=3）;小檗碱的含量为（2．47±0．014）mg／ml,RSD为2．98％（n=3）。结论本方法快速、简便、准确,可用于测定制剂中黄芩苷和小檗碱的含量。     

Use of nicotinamide as an internal standard for gas chromatographic quantitation of heroin in illicit forensic drug seizures in Pakistan

A precise and economical method using nicotinamide as an internal standard for the quantitation of heroin in illicit forensic drug seizures in Pakistan was developed and validated by gas chromatography coupled with a flame ionisation detector. The retention time of heroin hydrochloride was 6.06 ± 0.2 min using a HP-5 (5% phenyl methyl siloxane) column and 99.9% nitrogen carrier gas. The method showed good linearity (r² =?0.9986) in the range of 0.05–95 mg/ml of heroin hydrochloride. Limits of detection and quantitation were 0.02 mg/ml and 0.05 mg/ml of heroin hydrochloride respectively. Accuracy at three concentrations (20, 50 and 95 mg/ml) ranged from 97–103% and precision ranged from ±1.2–2.5% CV. Forty-five samples seized by the Anti-Narcotics Force of Pakistan were analysed and adulterants were also identified. The proposed method is economic, rapid and involves very little sample preparation, facilitating high throughput that can also be employed for detection of adulterants in heroin seizures.     

甘草酸二铵注射液相关物质含量及其测定方法研究

 目的 建立高效液相色谱法测定甘草酸二铵的相关物质的含量.方法 采用反向C18柱,以0.01 mol/L磷酸溶液-乙腈(60:40)作为流动相,流速为1 ml/min,测定波长λ为252 nm,浓度为0.5 mg/ml,进样量为10 μl.结果 高效液相色谱法测定三个浓度的加样回收率分别为98.83%、99.68%、99.47%.含量测定结果 为100%.结论 采用高效液相色谱法测定甘草酸二铵注射液含量,精密度高,重组性好,结果 准确.     

噻吩诺啡及其活性代谢产物的药代动力学研究

目的建立灵敏、专一的可同时测定比格犬血浆中噻吩诺啡及其代谢产物葡萄糖醛酸结合物含量的方法。方法采用HPLC-MS/MS法测定比格犬血中原型和代谢产物的浓度,分析在比格犬中的药代动力学参数。结果噻吩诺啡和代谢产物线性范围分别为0.02～50 ng/ml和0.2～500 ng/ml,定量下限分别为0.02 ng/ml和0.2 ng/ml,日内和日间精密度均小于9%,回收率均大于60%,在样品贮存、处理和分析过程中稳定性良好。比格犬单次口服噻吩诺啡0.2、0.6、1.8 mg/kg后,原型的Cmax分别为1.42、2.08、4.82 ng/ml,AUC分别为8.60、13.24和26.10μg.h/L,Tmax约为0.55～0.65 h,t1/2为10～13 h,MRT约为10～12 h;其代谢产物(噻吩诺啡葡萄糖醛酸结合物)的Cmax分别为1.78、5.03、7.09μg/L,AUC分别为9.37、22.34、41.40μg.h/L,Tmax为0.47～1.1 h,t1/2为18～40 h,MRT在11～17 h。比格犬口服0.2 mg/kg噻吩诺啡生物利用度为12.65%。结论本研究首次报道了噻吩诺啡及其葡萄糖醛酸结合物在比格犬中药代动力学研究,证明药物在犬体内的吸收和转化较快,单次口服盐酸噻吩诺啡低、中、高3种剂量后原型及其葡萄糖醛酸结合物药代动力学过程均符合一级吸收二房室模型。     

Detection of imidacloprid in biological fluids in a case of fatal insecticide intoxication

Here, we describe a high-performance liquid chromatography/photodiode array detector method for the detection of imidacloprid in biological fluids in a case of suicide by ingestion of liquor mixed with Admire® Flowable insecticide (containing 20% imidacloprid). A plastic bottle containing a cloudy liquid (concentration of ethanol in the liquid was 150 mg/ml and that of imidacloprid was 50 mg/ml) was found near the decedent. The biological fluids collected at autopsy were prepared by deproteinization with acetonitrile. Zolpidem was used as an internal standard. The concentrations of imidacloprid in femoral blood and cerebrospinal fluid were 105 and 58.5 μg/ml, respectively. Ethanol was also detected in the samples, with concentrations of 1.0 mg/ml in femoral blood and 1.4 mg/ml in cerebrospinal fluid.     

Analysis of oseltamivir active metabolite, oseltamivir carboxylate, in biological materials by HPLC-UV in a case of death following ingestion of Tamiflu

An HPLC-UV method was established for determination of oseltamivir carboxylate, an active metabolite of oseltamivir, in biological materials. Oseltamivir carboxylate and floropipamide (internal standard) were extracted by using a mixed mode cation exchange extraction cartridge. The recovery yields of oseltamivir carboxylate from spiked blood at concentrations 0.1microg/ml and 1.0microg/ml were 103.8+/-16.9% and 95.0+/-4.3%, respectively. Linearity was obtained in the concentration from 0.1 to 3.0microg/ml. The detection limit was 0.04microg/ml (S/N=3). This method was applied to a case of death from falling after ingestion of a Tamiflu capsule containing 75mg of oseltamivir. Concentration of oseltamivir carboxylate in the femoral blood was 0.4microg/ml. The highest concentration in all specimens was in the liver at 18.3microg/g. In all brain samples, the concentrations were not higher than the quantification limit (0.1microg/g).     

盐酸表阿霉素-紫杉醇复方脂质体的制备

目的进行盐酸表阿霉素-紫杉醇复方脂质体的制备工艺研究并建立同时测定两药含量的高效液相色谱方法。方法采用薄膜分散-pH梯度法制备复方脂质体。Venusil MP C18色谱柱（250cm×4.6mm,5μm）;流动相：乙腈-甲醇-10mmol/L磷酸盐缓冲液（pH2.5）（36∶32∶32）;检测波长：227nm;流速：1.0ml/min。结果盐酸表阿霉素与紫杉醇出峰时间分别为4.2、14.8min;线性方程分别为Y=216300X-34525（r=0.9998,0.1~25μg/ml）,Y=161480X-84107（r=0.9998,0.3~75μg/ml）。盐酸表阿霉素和紫杉醇的回收率均在99%~101%范围内,日内和日间RSD均〈2%。制备的复方脂质体平均粒径162nm,盐酸表阿霉素与紫杉醇的含量分别为0.27、0.83mg/ml;包封率分别为98.6%、95.5%。结论本研究制备的复方脂质体粒径较小,包封率较高,建立的高效液相色谱法可以同时测定盐酸表阿霉素和紫杉醇的含量。     

Herniography: comparison of morbidity and image quality after use of high and low osmolality contrast media

The morbidity and image quality after administration of three different contrast media were compared in 229 patients referred for herniography. Sixty patients received metrizoate 150 mg I/ml, 92 received metrizoate 200 mg I/ml, and 77 patients, ioxaglate 200 mg I/ml. Patient discomfort was single-blindedly assessed based on an arbitrary verbal rating scale. The number of patients with pain increased with the osmolality of the contrast media. Metrizoate 200 induced pain in 57% of the patients, metrizoate caused pain in 39%, and ioxaglate 200 in 18%. Hernia patients who received metrizoate 200 had pain significantly more often (72%) than patients without hernia (45%). Seven patients, predominantly young men, had a vasovagal reaction associated with the administration of contrast media. The image quality was sufficient after all injections of 200 mg I/ml. The results indicate that low osmolality contrast media with an iodine concentration of about 200 mg I/ml are well suited for herniography.     

Systematic and local reactions during phlebography of the leg with special reference to postphlebographic complications. Randomized, prospective, intraindividual double-blind study of iopamidol and ioxithalamate (250 mg I/ml) using the 125I-fibrinogen test: II

The rate of positive 125I-fibrinogen accumulations after typical ascending phlebography was significantly less (9/40 = 23%) with iopamidol compared with ioxithalamate (16/40 = 40%). The iodine content of the contrast media used in this intraindividual study (40 patients) was 250 mg/ml. With the 125I-fibrinogen uptake accepted as a method of reference, the clinically observed postphlebographic symptoms of thrombophlebitis were false positive in 1/6 and false negative in 3/4 of the cases. These incidences were registered for both contrast media. With the lowered iodine content (250 mg/ml), too, pain reactions were seen in approx. 50% during the injection of the ionic agent, but in none of the cases using the non-ionic agent. Not one of the commercial contrast media can be regarded as "ideal" at this time. Nevertheless, it can be concluded, that non-ionic contrast media with iodine content of 250 mg/ml are highly effective in preventing acute and delayed reactions. Moreover, this concentration seems to be adequate for optimal imaging in phlebography.     

HPLC法测定左卡尼汀氯化钠注射液中左卡尼汀的含量

目的建立测定左卡尼汀氯化钠注射液含量的HPLC法。方法采用Diamonsil C18（200mm×4.6mm,5μm）色谱柱,以庚烷磺酸钠-磷酸盐缓冲液-乙腈（555mg：955ml：55ml）为流动相,检测波长为225nm,流速1ml/min。结果左卡尼汀在200~2000ng范围内线性关系良好（r=0.9998）,平均回收率为97.88%,RSD为1.07%。结论本方法快速、准确,可用于注射用左卡尼汀的含量测定。