枢复宁在肺癌患者体内的药物动力学和生物利用度

９名接受顺铂化疗的原发性肺癌患者单次口服和静脉注射枢复宁８ｍｇ后，用反相高效液相色谱法测定血浆药物浓度。经用ＰＫＢＰ－Ｎ１程序在计算机上拟合计算表明，枢复宁在人体内表现为二房室模型。口服后主要药动学参数：Ｔ１／２Ｋａ＝０．４１±０．３０ｈ，Ｔ１／２α＝０．９±０．４３ｈ，Ｔ１／２β＝３．３±１．２ｈ，Ｃｍａｘ＝２８．６±９．５ｎｇ／ｍｌ，Ｔｍａｘ＝１．７±０．９ｈ，ＡＵＣ＝１５８±７３ｎｇ·ｈ／ｍｌ，绝对生物利用度为５５％。     

环丙沙星滴眼剂在家兔眼内组织分布及其药物动力学

环丙沙星（ｃｉｐｒｏｆｌｏｘａｃｉｎ，ＣＰＦＸ）滴眼液点入兔眼后，用ＨＰＬＣ法测定眼内各组织中药物浓度。结果在角膜、房水、虹膜－睫状体、晶体、玻璃体内峰浓度值分别为１９．４３μｇ／ｇ，１．５８μｇ／ｍｌ，１６．６８μｇ／ｇ，１．４２μｇ／ｇ和０．９６μｇ／ｍｌ；其半衰期分别为０．７６，０．６９，０．９２，０．６１和１．４０ｈ。结果表明ＣＰＦＸ能在眼内达到较高的抗菌浓度。     

老年人视网膜中央血管在前部视神经的解剖特征

目的：观察老年人前部视神经视网膜中央血管的解剖特征。 方法：通过组织连续切片和计算机影像分析，观察60~82岁老年人的18只眼球标本中无解剖变异的视网膜中央动脉(CRA)15条，视网膜中央静脉（CRV）23条在筛板前、筛板区及筛板后的管径变化。 结果：老年人筛板前、筛板区、筛板后CRA平均面积的均值分别为（12.70,17.40,18.00）×10^-3mm^2_;平均周长的均值分别为0.56，0.56，0.57mm，平均周长之间相比无显著差异。CRV平均面积的均值分别为（7.00，5.40，7.90）×10^-3mm²；平均周长的均值分别为0.44，0.38，0.41mm；CRV平均周长筛板前与筛板区相比，筛板区与筛板后相比均有显著差异。 结论：老年人CRA眼球内外管径一致；CRV在筛板区管径最小。 （中华眼底病杂志，1997，13：213-214）
     

A new and highly sensitive method for measuring 3-methoxytyramine using HPLC with electrochemical detection. Studies with drugs which alter dopamine metabolism in the brain

3-Methoxytyramine (3-MT) is a minor metabolite of dopamine which is suggested to reflect the turnover and utilization of dopamine. A novel, isocratic HPLC method has been developed which can be used to analyse 3-MT in homogenates of rat brain without the need for additional purification procedures. Furthermore, the coulometric electrochemical detection system is sensitive enough to measure 3 pg of 3-MT (equivalent to 0.6 ng/g tissue wet weight). 3-Methoxytyramine was measured in the striatum and n. accumbens after decapitation and rapid freezing, using 3-methoxy-4-hydroxybenzylamine as the internal standard. The effects of dopaminergic and other drugs on this metabolite were examined using this method. -Methyl-p-tyrosine (200 mg/kg i.v.) produced parallel linear decreases in dopamine and 3-MT in naive rats, but not those pretreated with tranylcypromine (5 mg/kg i.p.). Methamphetamine (0.3–10 mg/kg i.p.) and amphetamine (0.3–10 mg/kg i.p.) both dose-dependently increased 3-MT in naive and tranylcypromine-pretreated rats. In naive animals, 3-MT was not altered by intraperitoneal injection of the dopamine reuptake inhibitors, bupropion (10 mg/kg) and nomifensine (10 mg/kg) or by sibutramine HCl (3 mg/kg), amitriptyline (10 mg/kg), desipramine (10 mg/kg) and zimeldine (10 mg/kg). 3-Methoxy-tyramine was decreased by apomorphine (5 mg/kg i.p.) and also by large doses of the selective D₂ antagonist, BRL 34778 (5 mg/kg i.p.) or -DOPA (50 mg/kg i.p.). The selective D₁ antagonist, SCH 23390 (0.1 or 5 mg/kg i.p.) was without effect. In tranylcypromine-pretreated rats, 3-MT was dose-dependently reduced and increased by apomorphine (0.01–5 mg/kg i.p.) and BRL 34778 (0.1–5 mg/kg i.p.), respectively. The drug SCH 23390 (0.1–5 mg/kg i.p.) produced much smaller increases in 3-MT which were probably mediated through the striatonigral pathway. Overall, the data suggest that measurement of 3-MT, after inhibition of monoamine oxidase, is a useful index of the release and utilization of dopamine. However, after substantial and prolonged depletion of dopamine, levels of 3-MT in naive animals are a better index. Also, the formation of 3-MT in naive rats provides a sensitive method for distinguishing between dopamine releasing agents and reuptake inhibitors.     

激素敏感型肾病单个核细胞培养上清液对大鼠肾小球多阴离子及超微结构的影响

用刀豆蛋白Ａ刺激激素敏感型肾病单个核细胞，并将其培养上清液灌注于大鼠肾内。结合电镜观察，用图像分析仪及体视学方法分别对其肾组织胶体铁染色切片和电镜照片上的足突和滤过裂隙的平均宽度进行测定。结果表明：该病极期上清液灌注的鼠肾小球多阴离子明显减少，足突肿胀、融合，滤过裂隙变窄；而该病缓解组和正常对照组则为阴性。说明该病单个核细胞培养上清液可引起鼠肾小球微小病变型肾病综合征的病变，并揭示该变化可能是由其上清液中一种异常的Ｔ淋巴细胞因子所致。     

The Use of Performance Improvement Methods to Enhance Emergency Department Patient Satisfaction in the United States: A Critical Review of the Literature and Suggestions for Future Research

Objectives: The authors reviewed the evidence on performance improvement methods for increasing emergency department (ED) patient satisfaction to provide evidence-based suggestions for clinical practice.
Methods: Data sources consisted of searches through MEDLINE, CINAHL, PSYCHINFO, Cochrane Library, and Emergency Medicine Abstracts and a manual search of references. Articles were included if they reported a performance improvement intervention targeting patient satisfaction in the ED setting. Articles on studies not conducted in the United States or that failed to provide enough details to allow critical evaluation of the study were excluded. Two authors used structured evaluation criteria to independently review each retained study.
Results: Nineteen articles met all selection criteria. Three studies found varying levels of support for multicomponent interventions, predominantly focused on implementation of clinical practice guidelines for specific presenting complaints and process redesign. Sixteen studies evaluated single-component interventions, with the following having at least one supportive study: using alternating patient assignment to provider teams rather than "zone"-based assignment, enhancing provider communication and customer service skills, incorporating information delivery interventions (e.g., pamphlets, video) that target patient expectations, using preformatted charts, and establishing ED-based observation units for specific conditions such as asthma and chest pain.
Conclusions: There is modest evidence supporting a range of performance improvement interventions for improving ED patient satisfaction. Further work is needed before specific, evidence-based recommendations can be made regarding which process changes are most effective. Recommendations are made for improving the quality of performance improvement efforts in the ED setting.     

大鼠脑内儿茶酚胺类递质及其代谢物的同时提取及反向高效液相测定法

目的建立一种操作简便、高效的测定脑组织中去甲肾上腺素(NA)、肾上腺素(AD)、多巴胺(DA)、3,4二羟基苯乙酸(DOPAC)及高香草酸(HVA)的方法,为有关药物作用机理的研究提供实验手段.方法以有机溶剂提取,高效液相色谱--电化学检测器(HPLC-EC)测定大鼠纹状体、皮质、下丘脑NA、AD、DA、DOPAC及HVA的含量.结果测得NA、AD、DA、DOPAC及HVA的绝对回收率依次分别为:80.3%±12.4%,86.5%±14.3%,90.3%±12.1%,89.5%±17.2%、87.6%±[13].2%.线性范围0.2～20ng,批内与批间变异系数分别小于8%及10%.结论该方法具有简便、迅速、回收率较高的特点,便于实验室应用.     

计算机X线摄影适宜照射线量的探讨

目的以噪声的频率特性评价计算机X线摄影系统(computed radiography, CR)的适宜曝光量.方法在相同摄影条件下获得中速 CaWO4屏-Fuji片组合照片和CR照片,以此为基础,改变mAs,获得不同照射剂量下的CR影像,经相同的后处理条件输出它们的CR照片.用显微密度计依次对这些照片进行扫描,每张获得10万个密度值,作为离散随机信号来处理,用快速傅立叶变换计算威纳频谱(Wiener spectrum, WS),测试CR照片噪声的WS与中速CaWO4屏-Fuji片组合的照片噪声WS值相等的曝光量值.结果 (1)在照射剂量均为5.61μGy、照片密度均为1.0的情况下,在空间频率(ω)=0.1 LP/mm处,CR系统的WS值为 23.1×10 -6 mm2,屏-片系统的为20.1×10 -6 mm2;在ω=0.5 LP/mm处,CR系统的WS值为 9.73×10 -6 mm2,屏-片系统的为8.41×10 -6 mm2 .(2)当ω=0.1 LP/mm时,照射剂量为5.61μGy的CR照片的WS值分别是照射剂量为1.40、2.80、8.76、13.67、21.11μGy CR片的0.53、0.75、1.14、1.44、1.80倍;当空间频率为0.5 LP/mm时,照射剂量为5.61μGy的CR片的WS值分别是照射剂量为1.40、2.80、8.76、13.67、21.11μGy CR片的0.40、0.58、1.26、1.47、2.16倍.(3)在ω=0.5 LP/mm时,与照射剂量为5.61μGy的屏-片组合有相当的噪声水平的CR照片照射剂量大致为7.70 μGy左右.结论相同摄影条件下CR照片的噪声要比中速 CaWO4屏-Fuji片组合的大;随着照射量的增加CR系统总WS将减小,噪声下降;如想获得和屏-片相同噪声的影像,应适当增大CR系统的照射量.     

胸部螺旋CT最大密度投影重建的参数优化

目的探讨胸部螺旋CT最大密度投影(MIP)重建合理的扫描和重建参数。方法6例煤工的尸检离体肺脏制成充气固定肺标本,分别行不同参数组合的螺旋CT扫描,包括层厚1.5mm,2mm,4mm及8mm,重建间隔1mm,3mm,5mm;曝光量150mA,100mA;螺距1.5;滤过算法包括标准、锐利和平滑3种。每组图像均行MIP重建,重建厚度为12.5mm～13mm,比较不同参数MIP重建图像对支气管血管束的显示。结果a)曝光量对MIP重建图像的影响甚微,150mA、100mA两组剂量MIP无显著性差异(P>0.05);b)重建算法对MIP重建无显著影响。c)扫描层厚影响MIP图像,以薄层(1.5mm)扫描重建为最佳,1.5mm、2mm、4mm层厚MIP图像之间无显著性差异(P>0.05),8mm层厚与前4者MIP图像有显著性差异(P<0.01)。d)重建间隔影响MIP重建效果,8mm层厚扫描,1mm和5mm重建间隔重建图像MIP之间有显著性差异(P<0.05)。结论影响MIP重建的参数主要为扫描层厚和重建间隔,薄层扫描可获得理想的MIP图像,随层厚的增加,减小重建间隔有利于获得理想的MIP图像。建议以中等层厚(4mm)扫描,小重建间隔(1.5mm,2mm)行MIP重建。     

应用多层螺旋CT多方位重建技术诊断急性阑尾炎的价值

目的探讨多层螺旋CT多方位重建(MPVR)诊断急性阑尾炎的价值。方法2002年2月至2003年9月临床疑诊阑尾炎收治入院手术患者39例,术前均作了常规扫描和MPVR重建2种CT检查,术后31例确诊为阑尾炎,从阑尾充血、水肿至阑尾脓肿共分5级(正常阑尾为0级)。结果对照手术病理,MPVR重建诊断急性阑尾炎准确率872%,敏感度903%,特异度75%,阳性预测值933%,阴性预测值667%。常规CT检查诊断急性阑尾炎准确度385%,敏感度387%,特异度375%,阳性预测值706%,阴性预测值136%。28例确诊急性阑尾炎的MPVR重建片所示5种主要征象及出现频率如下阑尾肿大(管腔直径>6mm)(964%),阑尾结石(267%),回盲部肥厚(367%),阑尾周围炎(714%),脓肿(107%)。结论多层螺旋CTMPVR重建技术显著提高了CT对临床症状模棱两可、临床疑诊急性阑尾炎患者的术前诊断能力,并可减少重型阑尾炎病例的发生。