Five simple models for interfering factors test of bacterial endotoxins test

Endotoxins have been credited for over 50% of sepsis cases, with significantly greater mortality.1 A literature indicates wide-spread agreement that early detection of endotoxemia, endotoxin in the bloodstream, is the major key for patient survival from sepsis.2 Today the most popular endotoxin detection system is bacterial endotoxins test （BET）, adopted by most pharmacopoeias. Interference test is a part of the bacterial endotoxin inspection method, used to judge whether the sample can be applied in BET. However, Limuloid resources are exhausted in China, which is an important source for LAL. Here, we reported 5 simple models for interfering factors test in the BET, and compared new models with the United States Pharmacopoeia 36 （USP36）.     

多指标评分正交试验法优选砂烫骨碎补的炮制工艺

目的优选砂烫骨碎补的炮制工艺。方法以总黄酮含量、煎出物含量、膨胀率等项评价指标。并结合收率、去毛、形态与色泽等传统指标,正交设计法优选砂烫骨碎补的炮制工艺。结果砂烫骨碎补的最佳炮制工艺是：用6倍油砂、210℃、加热炮制3min。结论该工艺炮制出的骨碎补质量好,工艺参数量化,可操作性强,为砂烫骨碎补炮制工艺规范化提供了依据。     

Reference value of long-time exercise test in the diagnosis of primary periodic paralysis

Background The long-time exercise test （ET） is used to diagnose the primary periodic paralyses （PPs）.However the reference values of ET are many and various.This study aimed to investigate the reference value of long-time ET in the diagnosis of PPs.Methods We recruited 108 healthy subjects,68 patients with PPs,and 72 patients with other diseases for the study.The procedure of ET was made on the basis of the McManis＆#39; method.Electrical responses were recorded from right abductor digiti minimi （ADM） muscle when stimulation of the ulnar nerve at the wrist.After the compound muscle action potential （CMAP） was monitored,subjects were then asked to contract the muscle as strongly as possible for 5 minutes.CMAPs were recorded for 2 seconds immediately after cessation of exercise,then every 5 minutes for 10 minutes,and finally every 10 minutes for 50 minutes.In general,the CMAP amplitudes will fall below the pre-exercise levels in an hour.The largest decrease was calculated and used as results of ET.Results The CMAP amplitude decreases had no significant differences between groups when the healthy adults were grouped according to age,gender,height,weight and test time.Decreases in PPs patients （57.76%） were significantly more than in healthy subjects （15.21%） and other disease patients （18.10%,P 〈0.001）.Receiver operating characteristic （ROC） curve analysis showed that the best threshold is 35.50%.Conclusions In the long-time exercise test,threshold of 35.50% for the CMAP amplitude decrease was identified for abnormal.The result is not influenced by age,gender,height,weight,and test time.About 7.4% of healthy subjects were abnormal in ET.     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

程丑夫教授运用六君子汤加减治疗疑难杂症验案举隅

程丑夫教授出身中医世家,是全国第五批名老中医学术继承指导老师,主任医师,博士研究生导师,享受国务院特殊津贴。从医40余年来,善于治疗心脑血管疾病、呼吸系统疾病、脾胃病等,在治疗疑难杂症方面尤为突出。笔者有幸跟师门诊,观程师运用六君子汤加减治疗疑难杂症效果显著,现举验案4则来阐述程丑夫教授从脾胃入手治疗疑难杂病的经验。     

社区老年人原发性高血压、冠状动脉粥样硬化性心脏病、脑卒中和糖尿病4种慢性病相关因素分析

原发性高血压、冠状动脉粥样硬化性心脏病、脑卒中和糖尿病在老年慢性病中占有重要地位，以上4种疾病有许多共同的危险因素，为了更有效的了解、控制这些危险因素，并实施有效的干预措施，我们对社区老年健康档案资料进行了调查，并对这4种疾病的危险因素进行了分析，现报道如下。     

New disease severity classification of patients with stable chronic obstructive pulmonary disease in Shanghai

Background The Global Initiative for Chronic Obstructive Lung Disease （GOLD） presented a new ABCD group classification of chronic obstructive pulmonary disease （COPD）.We aimed to examine the association of spirometric classification and the new GOLD classification with exacerbations,and to compare symptoms in different ways.Methods We investigated 848 patients with stable COPD from 24 hospitals.The annual frequencies of acute exacerbation and hospitalization were compared between the old and new classification.The symptom level was assessed using COPD assessment test （CAT） and modified British Medical Research Council （mMRC） questionnaire.Results A total of 848 patients were included in this study.According to spirometric classification,there were 32 patients of grade Ⅰ （3.8％）,315 of grade Ⅱ （37.1％）,366 of grade Ⅲ （43.2％）,and 135 of grade Ⅳ （15.9％）.According to GOLD 2011 classification,there were 59 patients of group A （7.0％）,172 of group B （20.3％）,55 of group C （6.5％）,and 562 of group D （66.3％）.In spirometric classification,the annual frequencies of acute exacerbation and associated hospitalization were respectively 1 （0-3） and 0 （0-2） for grade Ⅰ; 1 （0-5） and 0 （0-2） for grade Ⅱ; 2 （0-6） and 1 （0-3） for grade Ⅲ,and 3 （0-6） and 2 （0-3） for grade Ⅳ.In GOLD 2011,respectively 0 （0-3） and 0 （0-1） （group A）,1 （0-4） and 0 （0-3） （group B）,1 （0-5） and 0 （0-3） （group C）,and 3 （0-6） and 1 （0-3） （group D）.There were no significant difference between group B and C （Z=-1.347,P=0.178; Z=-0.772,P=0.440,respectively）.The coincidence rate using mMRC=1 and CAT=10 as cutoff points was 86.6％ （734/848,x=0.706）,compared with 77.9％ （661/848,K=0.60） using mMRC=2 and CAT=10.Conclusions Lung function test may be a better predictor of acute exacerbation and associated hospitalization of COPD.It is more appropriate to use mMRC=1 as cutoff point for assessing COPD sym     

小儿患者在MRI检查中的护理体会

磁共振成像(MRI)是一种安全又比较先进的影像学检查方法,因其具有鲜明的软组织对比、多参数、多方位成像的优势,以及无骨骼伪影干扰和血管流空效应等特性,特别是没有放射线对人体没有损害,所以对于小儿患者来说是尤为重要的。特别是在小儿中枢系统疾病的诊断中,已经成为不可忽视的临床检查方法。1资料和方法我科自2001年6月至2007年6月,对679例8岁以下的小儿进行头颅的检查,其中男性435例,女性244例。诊断脑发育不良、脑肿瘤、脑炎等疾病的占79%,正常约为15%,其他疾病约占6%。使用美国GE公司S igna 1.5 T超导扫描仪,在所检查的部位常规进行T1W I、T2W I轴位扫描,部分患者进行增强扫描,用Gd-DTPA对患者进行静脉推注,一般速率为2m l/s~3 m l/s,在根据不同部位分别进行Cor T1W I,Sag T1W I,AX T1W I扫描。2护理2.1一般护理尽管磁共振检查已经成为临床检查的重要手段,然而检查时间较长,患者身体全部进入磁体中心,且检查过程中噪音较大,一般患儿不能够很好的合作。为了能够顺利的完成检查,应针对不同的患儿给予不同的护理。首先应向患儿及陪同的家长介绍患者的准备及注...     

Liuwei Dihuang,a traditional Chinese herbal formula,suppresses chronic inflammation and oxidative stress in obese rats

OBJECTIVE： To investigate the anti-inflammatory, anti-oxidative stress, and adipokine-ameliorating effects of Liuwei Dihuang （LWDH）, a traditional Chinese herbal formula, in obese rats. METHODS： After 2 weeks of acclimation with free access to regular rodent chow and water, obese-prone-caesarean-derived （OP-CD） rats were fed a modified AIN-93G diet containing 60% energy from fat. Treatment was performed twice daily by gavage feeding with 500, 1 500, or 3 500 mg/kg body weight LWDH suspended in water （n=12 rats per group）. Twelve obese-resistant-CD （OR-CD） rats were fed the atherogenic diet and gavaged with water, and served as the normal control. Blood biomarkers of inflammation, oxidative stress and adiponectin were measured post-sacrifice and used to determine the treatment effect of LWDH and assess the suitability of OR/OP-CD rats for studying these parameters. RESULTS： After 9 weeks of treatment, LWDH lowered serum C-reactive protein （CRP） and tumour necrosis factor-α （TNF-α） levels. Serum interleukin-6 （IL-6） levels showed a tendency towards reduction, but were not significantly different from the OP-CD control. Liver superoxide dismutase （SOD） activity was increased in response to all three doses of LWDH, while the levels of reduced （GSH） and oxidized glutathione （GSSG） and thiobarbituric acid reactive substances （TBARS） were unchanged. Serum adiponectin levels were increased in response to oral administration of LWDH at the dose of either 500 or 1 500 mg/kg body weight. In addition, comparisons between OR-CD and OP-CD rats revealed differential, and for some biomarkers, conflicting characteristics of high-fat diet-fed OP-CD rats in reference to obese human subjects in terms of inflammatory and oxidative stress biomarkers and circulating adiponectin levels. CONCLUSION： The results show, for the first time, the anti-inflammatory, anti-oxidative stress and adiponectin-ameliorating effects of LWDH in obese rats. The suitability of the OP-JOP-CD rat model as     

Data analysis of 36 cases with intraductal papillary mucinous neoplasm of the pancreas for their clinicopathological features, diagnosis, and treatment

Background Intraductal papillary mucinous neoplasm （IPMN） is a rare pancreatic cystic neoplasm,accounting for 1％ of all exocrine pancreatic neoplasms.This study aimed to summarize the clinicopathological and biological behaviors,as well as the experience in diagnosis and treatment of IPMN.Methods Clinicopathological data were collected from 36 cases with IPMN who were treated in Department of General Surgery,Peking University Third Hospital from May 2001 to July 2011.Results The 36 cases of IPMN patients included 27 males and 9 females （M∶F=3∶1）.The age of patients ranged from 52 to 78 years,with an average of 67.3 years.Regarding tumor location,20 tumors were located in pancreatic head,3 in pancreatic neck,10 in pancreatic body and tail,and 3 in the whole pancreas.All the 36 cases underwent surgical treatment,with 13 cases of pancreaticoduodenectomy,3 cases of middle pancreatectomy,7 cases of tumor resection plus pancreaticojejunostomy,3 cases of distal pancreatectomy,7 cases of distal pancreatectomy plus spleen resection,and 3 cases of total pancreaticoduodenectomy.Of the 36 patients,9 patients underwent the operations under laparoscopy.The 36 cases included main duct type （14 cases,38.9％）,branch duct type （10 cases,27.7％）,and mixed duct type （12 cases,33.3％）.Pathologically,of the 36 cases,there were 7 IPMN adenomas,11 borderline IPMNs,6 IPMN with carcinomas in situ,and 12 IPMNs with invasive carcinomas.All the 36 cases were followed up.During an average of 42 months follow-up period （26-129 months）,no recurrence occurred.Conclusions IPMN,which primarily occurs in male,is a low-grade malignancy which may involve any part of the pancreas,with specific clinicopathological features.IPMN is a different malignancy type from pancreatic ductal carcinoma.Imaging and laboratory examination are helpful for the diagnosis and differential diagnosis.The prediction of invasive IPMN is still difficult.Surgical resection is recommended as the first choice of treatment.Aggressive and proper o     

Evaluation of diuretic and laxative activity of hydro-alcoholic extract of Desmostachya bipinnata （L,） Stapf in rats

OBJECTIVE： In continuation to the growing evidence for therapeutical potential of Desmostachya bipinnata （Linn） Stapf, the current pharmacological study was carried out to evaluate the diuretic and laxative activity of its hydro-alcoholic extract in rats. METHODS： The hydro-alcoholic extract of D. bipinnata whole plant was prepared by using Sox- hlet extractor and subjected to analysis by standard preliminary phytochemical tests. Evaluation of both diuretic and laxative activity was carried out using standard methods as reported earlier. Frusemide （20 mg/kg） was served as positive control for diuretic activity and sennosides （10 mg/kg） served as negative control for laxative activity. RESULTS： The hydro-alcoholic extract showed significant diuretic activity and was found to be the most potent in increasing the urinary output at 500 mg/kg when the effect was compared with that of the standard frusemide （P〈0.01）. Moreover, this extract was found to be most effective in increasing urinary electrolyte concentration （Na＋, K＋, and Cl-） at both doses tested. Whereas the results for laxative activity showed minimal increase of feces output at the dose of 500 mg/kg and the increase was negligible when compared with that of the standard drug sennosides. CONCLUSION： Altogether, the above significant findings validate and support its folkloric diuretic use and lend pharmacological credence to the ethno-medical use of this plant in traditional system of medicine, which demands further studies to investigate its active constituents, as well as its use and safety.     

10%水合氯醛口服在小儿ABR检查前的镇静探讨

在ABR检查中,为了提取并记录到清晰的ABR波形图,除采用高共模抑制比的放大器、滤波、自动排斥系统和平均叠加技术外,更需要患儿制动、安静,以配合检查顺利完成。我院于2006年6月至2007年12月对540例ABR检查的患儿采用口服水合氯醛镇静制动,并结合护理干预,取得较好的效果,现报告如下。1资料与方法1.1资料540例患儿检查前已由小儿科医师确定患儿无镇静药物使用禁忌证。男344例,女196例;年龄45d～6岁,平均年龄1.8岁。1.2方法根据患儿的体重、年龄确定水合氯醛用量。3岁内小儿按照患儿体重计算用量(0.5ml/kg),最多不超过10ml。用一次性注射器吸取10%水合氯醛糖浆(本院制剂室提供),合作的患儿鼓励其自己口服;对不合作的患儿(特别是小婴儿)可用奶瓶或用注射器取下针头,从患儿嘴角注入。家长抱患儿取头高足低斜坡位(30°),头偏向一侧,轻拍患儿诱导入睡,待其入睡后进行检查。3岁以上患儿,采用剥夺睡眠法配合常用量(0.5ml/kg～0.8ml/kg)10%水合氯醛的方法进行ABR检查前镇静,即对所有3岁及3岁以上患儿预约检查,拟定于上午检查者嘱家属晨起时较平常提前3h唤醒患儿,下午检查者取消患儿...     

严重颅脑损伤患者痰液培养及药敏试验分析

严重颅脑损伤患者,由于气管切开插管,加上大剂量应用广谱抗生素,还有机体免疫力下降,易引起呼吸道感染,我们对156例严重颅脑损伤患者,经过一段时间广谱抗生素治疗后,取其痰液进行培养分离、鉴定及药敏试验,结果如下。1材料与方法1.1标本来源来自我院神经外科严重颅脑损伤气管切开插管的患者共156例的痰液,采用无菌操作的吸痰器采集而得。1.2试验及试剂分离的菌株利用V itek32微生物鉴定仪分别用GB、IGPI鉴定卡进行鉴定,药敏试验用的是梅里埃公司药敏卡;全部标本皆接种于沙保罗氏培养基,28℃培养48 h后,挑酵母菌样菌落,涂片染色镜检为酵母样真菌后,按真菌鉴定的操作要求,用无菌生理盐水配成2个麦氏单位的菌液接种于梅里埃公司API-20C真菌鉴定板及ATB-Funyus真菌药敏板,28℃、48 h在微生物鉴定仪上读取结果,试验用的抗生素见表1、表2、表3。1.3质控菌株大肠埃希氏菌ATCC-25922;铜绿假单胞菌ATCC-27853;金黄色葡萄球菌ATCC-29213;白色念株菌AT-PP-14503;热带念株菌ATCC-14085。2结果156例严重颅脑损伤患者,气管切开插管经过一段时间后,取患者的痰液做培养...     

Meta-DiSc软件在诊断试验Meta分析中的应用

准确的诊断是临床实践的基础，如果没有它，医师不能正确地治疗疾病和预测疾病转归，随着循证医学的发展．不少学者致力于诊断试验的Meta分析方法及软件研究。其中，Meta-DiSc软件是一免费软件．可用于多个诊断或筛检试验评价的Meta分析。与另一DOS下操作的诊断试验Meta分析软件Meta-Test相比．它功能强大，可以视窗操作（可运行于Windows95、2000、XP等视窗操作系统下），界面友好，操作简单，易学易用，目前最新版本为1．4。现以实例说明其在诊断试验Meta分析中的应用。     

Interpretation of illness in patients with chronic diseases from Shanghai and their associations with life satisfaction,escape from illness,and ability to reflect the implications of illness

The aim of this study is to analyze how patients with chronic diseases from Shanghai interpret their disease, and how these interpretations influence patients＇ life satisfaction, intention to escape from their illness and their ability to reflect on the implications of their illness. METHODS： A cross-sectional study enrolling 142 patients （mean age （50 ±16） years; 63% men, 37% women） with chronic diseases （60% cancer） was recruited in the Changhai Hospital of Traditional Chinese Medicine, Shanghai, China and surveyed using standardized questionnaires. RESULTS： Patients with chronic diseases from Shanghai interpreted their illness mostly as an Adverse Interruption of Life （55%）, as a Threat/Enemy （50%）, but also as a Challenge （49%）, and only rarely as a Call for Help （18%） or as a Punishment （13%）. Particularly fatalistic negative （i.e., Threat/Enemy, Adverse Interruption of Life） and strategy-associated disease interpretations （i.e., Relieving Break, Call for Help） were moderately associated with patients＇ intention to escape from illness. In contrast, positive interpretations （i.e., something of Value, Challenge） and also the guilt-associated negative interpretation Failure were moderately related with patients＇ ability to reflect on their illness. However, life satisfaction was weakly associated only with the view that illness might be a Challenge. Interestingly, 58% of those who would see their illness as an Adverse Interruption （AI＋） could see it also as a Challenge （Ch＋）. Detailed analyses showed that AI＋Ch＋ patients differ from their AI＋Chcounterparts significantly with respect to their ability to reflect life and implications of illness （F=9.1 ; P=-0.004）.     

益智健脑颗粒联合针灸对阿尔茨海默病大鼠学习记忆的影响

目的观察益智健脑颗粒联合针灸对阿尔茨海默病（Alzheimers disease,AD）大鼠学习记忆的影响。方法将大鼠随机分为假手术组（A组）、模型组（B组）、针灸组（C组）、益智＋针灸组（D组）各10只,B、C、D 3组分别以海马CA1区注射β淀粉样蛋白25-35（Aβ25-35）造模,A组注射等量的双蒸水,各组分别治疗20 d后行Morris水迷宫试验,观察大鼠学习记忆能力变化。结果B组较A组的平均潜伏期明显延长,差异具有统计学意义（P〈0.05）;与B组比较,C组、D组的平均潜伏期明显缩短,过台次数增多,差异具有统计学意义（P〈0.05,P〈0.01）;与C组比较,D组的潜伏期缩短,过台次数增多,差异具有统计学意义（P〈0.05）。结论益智健脑颗粒联合针灸能够提高Aβ25-35介导的AD模型大鼠的学习记忆能力。     

心肺运动试验指导个体化心脏康复的指标

1 心血管疾病康复概述心脏康复（cardiacrehabilitation）起源于20世纪50年代对急性心肌梗死患者处置原则的质疑,心肌梗死患者长期卧床导致全身功能衰退,而运动康复可以纠正机体的废退状态。心脏康复已经被认为是心血管疾病患者能够得到持续治疗的关键[1]。心脏康复的内容包括医学评估、运动疗法、饮食疗法、心理疗法、控制危险因素、健康教育和生活指导障[2]。因此,心脏康复不能单纯从字面上理解为仅为心脏自身的康复,而可以理解为心血管疾病的综合性康复。     

浅谈临床化学检验“危机值”

危机值也被称为“Panic value”。当这种试验结果出现时,说明患者可能正处于有生命危险的边缘状态,此时如能给予及时、有效的治疗,患者生命可以得到挽救;否则,也可能会出现不良后果,因此把这种试验数值称为危机值[1]。大多数实验室已经建立了比较完善的危机值制度及自己的危机值范围。根据2007年度我院生化实验室登记的临床危机值,浅谈危机值的临床应用。参考《中国临床实验室》杂志,结合医院的实际情况,建立了自己实验室的危机值临界值,见表1。表1危机试验及界限值实验单位低值高值标本Glu mmol/L<2.2>22.2血清K mmol/L2.86.5血清Na mmol/L120160血清氯mmol/L<75>125血清氨mmol/L>59血清钙mmol/L<1.75>3.4血清2007年度统计,共登记83例患者(血清正常)的危机值,其中Glu低25例,高28例;血钾低13例,高18例;血氯低5例;血钙低5例;ICU患者居多,占74.5%,内分泌占10.6%,神经内科占8.3%,门诊患者占4.2%,其他科室占2.4%。在电话通知与临床科室联系时,有86.9%的患者的确存在生命危象,出现高糖或低糖昏迷、低钙引起的全身性...     

建立三维健康评估模式的探讨

随着社会经济发展,人类对健康的需求不断提升。全面的身心健康评估模式亟待研究。本文尝试从中医体质、躯体检查和心理测评三方面入手,探讨建立“三维”健康评估模式,为中医“治未病”,促进健康提供科学依据。     

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