Using gas chromatography and mass spectrometry to determine 25-hydroxyvitamin D levels for clinical assessment of vitamin D deficiency

Vitamin D is responsible for multiple metabolic functions in humans. Rickets are the most common disease caused by vitamin D deficiency. It is caused by poor calcium intake resulting in poor serum-ionized calcium. The purpose of this study is to develop a rapid, sensitive, and feasible method to determine the 25-hydroxy-vitamin D3 (25(OH)D3) levels in blood samples for clinical assessment. In this study, gas chromatography coupled mass spectrometry with trimethylsilyl derivatization (TMS-GC-MS) is the most suitable protocol for quantitative analyses of 25(OH)D3. Performance of method was evaluated and compared with liquid chromatography and immunoassay. Method validation has been carried out with plasma specimens. The limit of quantitation of TMS-GC-MS method is 1.5 ppb with good linear correlation. Furthermore, the dietary intake and nutritional status of vegetarian and non-vegetarians in Taiwan were assessed by our validated method. As a result, this vitamin D nutrition survey demonstrates that most Taiwanese people have insufficient vitamin D. Due to dietary habits; the male vegans may have the highest risk of vitamin D deficiency.     

Stoma Adjustable Silicone Gastric Banding versus Vertical Banded Gastroplasty for the Treatment of Morbid Obesity

Background: Among gastric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the results of two different gastric restrictive procedures: vertical banded gastroplasty (VBG) and stoma adjustable silicone gastric banding (ASGB). Methods: Between 1991 and 1996, 51 patients were treated surgically for morbid obesity: 27 underwent VBG and 24 underwent ASGB. Preoperative body weight (BW), body mass index (BMI) and percentage of ideal body weight (% IBW) were (mean ± SD): 145.7 ± 45.3 kg; 53.9 ± 15.9 kg/m²; 249.1 ± 73.5% respectively in the VBG group. Corresponding figures for the ASBG group were 132.5 ± 22.7 kg; 46.9 ± 7.8 kg/m² and 207.2 ± 35.0%. Results: In the VBG group, the median follow-up period was 26 months (range: 7-47). Eighteen months after the operation BW, BMI, % IBW and percentage of excess weight loss (% EWL) were 85.5 ± 26.8 kg, 31.9 ± 9.8 kg/m², 145.4 ± 43.9% and 74 ± 1% respectively. Complications included incisional hernia (n = 1), and bowel obstruction (n = 1). One patient died of acute myocardial infarction on the third postoperative day. In the ASGB group, median follow-up time was 19.7 months (range: 18-26). At 18 months postoperation BW, BMI, % IBW and % EWL values were 86.6 ± 20.6 kg 30.6 ± 6.6 kg/m2 140.6 ± 29.3% and 64 ± 1% respectively. Gastric wall erosion occurred in two patients and the bands had to be removed. These patients underwent VBG 6 months later. Complications encountered in this group were incisional hernia (n = 1), outlet stenosis and reflux esophagitis (n = 1), reservoir leakage (n = 1) and gastrointestinal bleeding (n = 1). Two patients died of pulmonary embolism and acute gastrointestinal bleeding. Conclusions: Weight reduction was not statistically significant between the two groups. ASGB was easier to perform and less invasive than VBG.     

输卵管积水造口术对体外受精与胚胎移植的影响

【目的】探讨在体外受精与胚胎移植 (IVF ET)之前输卵管积水患者行输卵管造口术对IVF ET治疗效果的影响。【方法】回顾分析 1999年 2月至 2 0 0 1年 1月因女性输卵管因素不孕行IVF ET治疗的 90 8个周期的资料。按输卵管积水患者在IVF ET前是否治疗分 3组 ,A组 :输卵管积水未手术治疗行IVF ET 2 3个周期 ,B组 :在IVF ET之前行输卵管积水造口术 (腹腔镜下或开腹 ) 2 2个周期 ,C组 :对照组 (输卵管阻塞 ,未发现输卵管积水 ) 86 3个周期。【结果】A组、B组、C组的IVF ET的种植率分别为 9 7%、17 9%、16 7% ,临床妊娠率分别为 2 1 7%、4 0 9%、39 2 %。A组的种植率及临床妊娠率比其它组低 ,经 χ2 检验 ,有统计学意义。【结论】输卵管积水未治疗行IVF ET的种植率及临床妊娠率较低 ,但在IVF ET之前行输卵管造口术可改善IVF ET的种植率及临床妊娠率     

头颈部良性神经源性肿瘤1H MRS的表现特点

目的：探讨头颈部良性神经源性肿瘤在单体素^1H MRS上的表现特点。材料和方法：共收集经单体素。HMRS检查，并经手术病理证实的头颈部神经源性肿瘤14例（神经鞘瘤11例，神经纤维瘤2例，颈动脉体瘤1例）。采用点分析波谱法（PRESS：TE=144ms，14例）和激励回波法（STEAM：TE=30ms，11例）进行。HMRS空间定位，以胆碱和脂质代谢物为标准评价所有肿瘤。波谱图上，胆碱和脂质分别在3．2ppm和0．9—1．4ppm区域识别。结果：采用PRESS后，14例神经源性肿瘤中检测出胆碱代谢物者11例，检出脂质代谢物者6例。胆碱和脂质代谢物同时检出者5例，仅检出胆碱者6例，仅检出脂质者1例，胆碱和脂质均未检出者2例。采用STEAM后，11例肿瘤中检出胆碱代谢物和脂质者分别为3例和8例。结论：头颈部良性神经源性肿瘤的单体素。HMRS表现具有多样性，多数肿瘤以长TEPRESS上胆碱峰的显示为特点，长TEPRESS能较STEAM更好地检出良性神经源性肿瘤内的胆碱代谢物。     

小针刀辅助自体脂肪颗粒移植在面部除皱及凹陷充填中的应用

目的探讨小针刀辅助自体脂肪颗粒注射除去额部、眉间、鼻唇沟等部位皱纹及充填面部凹陷的效果。方法利用自制小针刀,离断真皮与其下方的"纤维粘连",然后用自体脂肪颗粒注射除皱和充填凹陷部位。结果本组共68例。修复面积最大约10cm×8cm,最小约1.5cm×0.5cm。随访45例,随访时间3～18个月,效果满意或基本满意。结论小针刀辅助自体脂肪移植具有操作简单、快捷、价廉、安全、无排异、不留瘢痕、术后恢复快等优点,患者易于接受,是除去额部、眉间、鼻唇沟等部位皱纹及填充面部凹陷的有效方法。     

老年人肺功能与年龄增长的关系

目的: 探讨60岁以上老人动态肺功能随年龄增长的变化规律及机制.方法: 用日本PM-81型胸描仪对60岁以上老人动态肺功能的各项指标进行测量和分析.结果: 60岁以上老人动态肺功能各项指标均随年龄增加而降低,差异有高度显著性(P<0.01).结论: 60岁以上老人动态肺功能随年龄的增加而降低.其机制主要是呼吸中枢的功能降低,肺和胸廓的弹性阻力、呼吸道的非弹性阻力增加所致.     

Resetting of the arterial baroreflex increases orthostatic sympathetic activation and prevents postural hypotension in rabbits

Since humans are under ceaseless orthostatic stress, the mechanism to maintain arterial pressure (AP) under orthostatic stress against gravitational fluid shift is of great importance. We hypothesized that (1) orthostatic stress resets the arterial baroreflex control of sympathetic nerve activity (SNA) to a higher SNA, and (2) resetting of the arterial baroreflex contributes to preventing postural hypotension. Renal SNA and AP were recorded in eight anaesthetized, vagotomized and aortic-denervated rabbits. Isolated intracarotid sinus pressure (CSP) was increased stepwise from 40 to 160 mmHg with increments of 20 mmHg (60 s for each CSP level) while the animal was placed supine and at 60 deg upright tilt. Upright tilt shifted the CSP–SNA relationship (the baroreflex neural arc) to a higher SNA, shifted the SNA–AP relationship (the baroreflex peripheral arc) to a lower AP, and consequently moved the operating point to marked high SNA while maintaining AP. A simulation study suggests that resetting in the neural arc would double the orthostatic activation of SNA and increase the operating AP in upright tilt by 10 mmHg, compared with the absence of resetting. In addition, upright tilt did not change the CSP–AP relationship (the baroreflex total arc). A simulation study suggests that although a downward shift of the peripheral arc could shift the total arc downward, resetting in the neural arc would compensate this fall and prevent the total arc from shifting downward to a lower AP. In conclusion, upright tilt increases SNA by resetting the baroreflex neural arc. This resetting may compensate for the reduced pressor responses to SNA in the peripheral cardiovascular system and contribute to preventing postural hypotension.     

Goldenhar 综合征家系的临床表型和遗传学分析

目的分析1组Goldenhar综合征家系的临床表现及遗传学特征。方法我们随访到1组4代33人的Goldenhar综合征家系，对目前存活的29人进行了临床表型和遗传学的初步分析。结果家系内有Goldenhaar综合征患者5人．临床表现具高度多样性，累及眼、耳、脊柱、颜面、口腔等多个器官和系统的发育不良，在遗传方式上属于常染色体显性遗传。从细胞遗传学水平对家系中成员进行染色体检查，未发现核型异常。结论该Goldenhar综合征家系属常染色体显性遗传，染色体检查未发现核型异常。     

额叶内侧面损伤的临床特点及救治

目的 总结17例额叶内侧面损伤的临床特点及救治经验。方法 对我科1999年7月至2003年4月收治的额叶内侧面损伤患者进行回顾性分析。结果 手术治疗1例，恢复良好，保守治疗16例，其中恢复良好12例，中残2例，死亡2例，全组死亡率11．77％。结论 额叶内侧面损伤一般意识障碍较轻，但易直接发生枕骨大孔疝，严密观察病情及动态CT检查，颅内压监测，不拘泥传统手术指征，及时抓住手术时机，可有效降低致残率及死亡率。     

由Valiolamine制备伏格列波糖

Valiolamine和1,3-二羟基丙酮在Pd/C作用下催化氢化得到伏格列波糖,收率75%.