两种微创治疗方案治疗老年患者胆总管结石的临床对照研究

目的比较腹腔镜胆囊切除联合胆总管探查术（LC联合LCBDE）与内镜乳头切开取石联合腹腔镜胆囊切除术（EST联合LC）治疗老年患者（≥65岁）胆总管结石的临床疗效。方法2005年7月～2010年12月,胆总管直径≥8mm且既往未接受乳头括约肌切开、胆囊切除或胆道手术的110例老年胆总管结石患者,LC联合LCBDE组47例,先行LC,确认胆总管后行LCBDE,结石取净后胆道镜检查胆道系统以确认有无结石残留;EST联合LC组63例,十二指肠镜确认十二指肠乳头,常规ERCP进一步明确诊断后行EST,取石后鼻胆管引流2—5d后行LC。对两组结石清除率、术后并发症、中转开腹率及单次治疗成功率等指标进行对比,并进行随访。结果2组结石清除率、术后并发症、中转开腹率差异无显著性（P〉0．05）,而单次治疗成功率Lc联合LCBDE组显著高于EST联合LC组[87．2％（41／47）vs．68．3％（43／63）,z。=5．372,P=0．020]。所有病例随访1—3年,平均2．1年,未出现腹痛、发热及黄疸等症状,B超未见结石复发。结论LC联合LCBDE和EST联合LC都是治疗老年患者胆总管结石安全有效的方法,而在减少治疗次数方面,LC联合LCBDE更有优势。     

青蒿化学成分及药理作用研究进展

青蒿为常用中药,主要含有倍半萜、二萜、黄酮、苯丙酸、香豆素、黄酮和挥发油等多种类型化学成分,具有抗疟疾、抗肿瘤、抑菌杀虫、解热抗炎、免疫调节等药理活性。显著的抗疟活性使青蒿较早就用于疟疾的治疗。对近年来有关青蒿的化学成分及药理活性进行综述,以期为其进一步的开发与合理利用提供参考。     

三种内固定方式治疗股骨远端Müller分型C2和C3型骨折的疗效比较

目的比较3种内固定方式治疗股骨远端Müller分型C2、C3型骨折的疗效。方法回顾性分析2013年2月至2017年2月期间宁波市第六医院创伤骨科收治的58例股骨远端Müller分型C2、C3型骨折患者资料。根据内固定方式不同分为3组:单切口锁定钢板组(A组)21例,男13例,女8例;年龄为(50.6±12.9)岁。双切口锁定钢板联合重建钢板组(B组)18例,男11例,女7例;年龄为(53.5±13.0)岁。单切口锁定钢板联合重建钢板组(C组)19例,男10例,女9例;年龄为(48.1±12.2)岁。比较3组患者的手术时间、术中出血量、术中C型臂透视次数、骨折愈合时间、术后并发症发生率、膝关节活动度及膝关节功能等。结果3组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。3组患者术中C型臂透视次数、随访时间及术后并发症发生率比较差异均无统计学意义(P>0.05)。但A组、C组患者的手术时间[(96.7±16.4)、(101.9±16.5)min]和术中出血量[(237.8±47.5)、(253.6±46.6)mL]显著少于B组患者[(114.9±20.1)min、(290.1±60.9)mL],差异均有统计学意义(P<0.05)。B组、C组患者的骨折愈合时间[(6.9±1.6)、(6.6±1.7)个月]显著短于A组患者[(8.4±1.9)个月],术后12个月膝关节活动度(91.7°±16.7°、90.9°±14.4°)显著大于A组患者(78.8°±14.4°),术后12个月膝关节功能恢复优良率[77.8%(14/18)、73.7%(14/19)]显著高于A组患者[57.1%(12/21)],差异均有统计学意义(P<0.05)。结论采用股骨远端前外侧切口外侧应用锁定钢板、前侧附加重建钢板固定治疗股骨远端Müller分型C2、C3型骨折,固定坚强、对周围软组织损伤相对较小,兼具单切口锁定钢板和双切口内外侧锁定钢板固定的优点,术后患者膝关节功能恢复良好。     

蛇床子素温敏型原位凝胶的研制及含量测定

目的：蛇床子素温敏型凝胶剂的研制,并建立其含量测定方法。方法建立用HPLC法测定制剂的含量及体外释药量。采用搅拌子法测定相变温度并测定其动态黏度,从而确定处方。用转篮法进行处方的体外释放实验。结果确定蛇床子素温敏型凝胶的最佳基质配比是质量分数为25%的泊洛沙姆407和质量分数为10%的泊洛沙姆188的组合。结论该制剂制备工艺简单,进入体内形成凝胶并且24 h累计释放药物约83%。含量测定方法操作简便、快速准确。     

缺陷药品侵权责任中的抗辩事由分析

目的:对缺陷药品侵权责任中的抗辩事由进行分析。方法:采用比较研究方法、文献研究方法对可能适用于缺陷药品侵权责任的抗辩事由进行分析,主要包括受害人过错、第三人过错、特殊敏感性、发展风险、未将药品投入流通、投入流通时致损缺陷尚不存在、不可抗力。结果与结论:药品侵权责任案件中,抗辩事由的适用具有一定的特殊性,如不可抗力不能适用;而受害人过错、第三人过错是损害发生的唯一原因时,可以构成免责事由;根据原因力的大小,特殊敏感性可减轻赔偿责任;传统产品责任法中的未将药品投入流通、投入流通时致损缺陷尚不存在、发展风险三大抗辩事由均可以构成免责事由。     

Design and controllable synthesis of ethylenediamine-grafted ion imprinted magnetic polymers for highly selective adsorption to perchlorate

A series of ethylenediamine-grafted ion imprinted magnetic polymers (Fe₃O₄@IIPs) were synthesized via ultrasonic assisted suspension polymerization with perchlorate (ClO₄⁻) as an ion imprinting template. They were characterized by XRD, EA, VSM, FTIR and XPS and applied as adsorbents for ClO₄⁻ removal from aqueous solutions. The effects of the usage amount of crosslinking agent divinylbenzene (DVB) used for preparation on the structure and the adsorptive performance of Fe₃O₄@IIPs were investigated. The results show that the Fe₃O₄@IIPs have an average size of 200–800 nm, which increases with the increase of the amount of DVB from 0 to 2 g during the preparation process. The saturation magnetization intensities are at 35.6–42.8 emu g⁻¹, which decrease with the increase of the usage amount of DVB. The addition of DVB is beneficial to the formation and stability of the ion imprinted cavity of Fe₃O₄@IIPs. The effects of the solution pH value, initial concentration of ClO₄⁻, and adsorption time on the adsorption properties of ClO₄⁻ in aqueous solutions were investigated. The results show that the adsorption capability is affected significantly by solution pH value and reaches the maximum adsorption capacity at pH 3.0. The best adsorption capacity and selectivity of Fe₃O₄@IIPs to ClO₄⁻ can be obtained when the usage amount of DVB is at 0.5 g for synthesis. The adsorption mechanisms might include both ion exchange and electrostatic interaction. The isothermal adsorption curves mainly obey the Langmuir model with the theoretical maximum adsorption capacities (q_m,c) at 76.92–111.1 mg g⁻¹ and the experimental maximum adsorption capacities (q_m,e) at 75.7–108.9 mg g⁻¹, respectively, which are much higher than those of the non-ion imprinted material (Fe₃O₄@NIP, q_m,NIP: q_m,c at 60.61 mg g⁻¹ and q_m,e at 59.0 mg g⁻¹). The adsorption kinetic studies show that the adsorption processes reach equilibrium within 10 min and the kinetic data are well fitted to the pseudo-second-order model. There is almost no interference by the coexisting anions for the selective adsorption of ClO₄⁻, with a imprinting factor (α) at 1.8, and selectivity factor (β) larger than 5.9 for several kinds of common co-existing anions, respectively. The Fe₃O₄@IIPs are ideal candidates for removal of ClO₄⁻ from aqueous solution.

A series of ethylenediamine-grafted ion imprinted magnetic polymers (Fe₃O₄@IIPs) were synthesized via ultrasonic assisted suspension polymerization with perchlorate (ClO₄⁻) as an ion imprinting template.     

输尿管软镜取石术治疗经皮肾镜术残留肾结石12例报告

目的:评估输尿管软镜取石术治疗经皮肾镜取石术(PCNL)残留肾结石的效果。方法:利用输尿管软镜治疗PCNL残留肾结石12例,男8例,女4例;平均年龄42.6岁。左侧5例,右侧3例。KUB测量结石直径为0.7~2.6cm,平均1.4cm。经留置输尿管扩张鞘或沿导丝直接置入输尿管软镜抵达肾盂,寻及结石后以200μm光纤、10 W功率钬激光碎石。观察其手术时间、结石清除率、并发症等疗效指标。结果:本组12例均顺利完成输尿管软镜碎石,手术时间68~116min,平均92min;结石清除率为83.3%(10/12)。1例结石残留患者另作穿刺通道行二期PCNL后结石完全清除;1例术后行ESWL仍有少量结石残留,随访观察。均无严重出血及输尿管穿孔等并发症。结论:输尿管软镜取石术治疗PCNL后残留肾石安全、有效。     

环状RNA-42398通过调控TGF-β1/Smads信号通路抑制肝星状细胞活化

目的:探讨小鼠环状RNA-42398(mmucirc42398)对肝星状细胞活化的影响及机制是否与调节TGF-β1/Smads信号通路有关。方法:小鼠肝星状细胞株JS1,分成正常对照组、空载体阴性对照组(vector组)和mmucirc42398过表达组(mmucirc42398组),体外构建mmucirc42398过表达载体,通过脂质体瞬时转染法转入JS1细胞,48 h后RT-qPCR检测mmucirc42398的表达变化,PCR产物经一代测序验证其环化位点,Western blot检测α-平滑肌肌动蛋白(α-SMA)、I型胶原(Col I)、转化生长因子β1(TGF-β1)、Smad2、Smad3、p-Smad2和p-Smad3蛋白表达。结果:与vector组相比,mmucirc42398组的mmucirc42398表达增加(P<0.01),PCR产物测序验证了其环化位点,提示mmucirc42398过表达质粒成功转入JS1细胞并高效表达;在JS1细胞中过表达mmucirc42398后,α-SMA和Col I蛋白表达显著降低(P<0.01),TGF-β1、Smad2和Smad3蛋白表达无显著变化(P>0.05),但p-Smad2和p-Smad3蛋白水平显著降低(P<0.01)。结论:mmucirc42398能抑制肝星状细胞的活化,其机制与调控TGF-β1/smads信号通路有关。