早期股骨头缺血坏死介入治疗的探讨（附15例报告）

目的：探索早期股骨头缺血性坏死的介入治疗方法及效果。方法：采用seldinger穿刺方法超选择插管至患侧旋股内,外动脉,注入治疗药物（溶栓,扩血管,改善微循环等）。介入前后分别血管造影,以观察血管数及近期疗效。结果：介入治疗后患髋股头颈区血管数较治疗前增多（P＜0．001）,髋关节疼痛缓解,功能改善。结论：对早期股骨头缺血性坏死实施介入治疗,能够改善患髋的血液循环,减轻临床症状,改善关节功能,是一种微创安全有效的新方法,对远期疗效和治疗机理尚有待进一步观察和研究。     

普罗布考治疗高胆固醇血症的近期临床疗效观察

目的：评价普罗布考片（Probucol)应用于高胆固醇血症患者的有效性和安全性。方法：80例高胆固醇血症患者入选本研究（其中33例患者同时有高甘油三酯血症）,连续服用普罗布考片4周,每天2次,每次500mg,用药后4周测定血清总胆固醇（TC）,高密度脂蛋白（HDL－C）,甘油三酯（TG）及低密度脂蛋白（LDL－C）,结果：服用普罗布考片4周后,患者TC下降25．3％（P＜0．001）,LDL－C下降30．8％（P＜0．001）,HDL－C下降13．2％（P＜0．05）。伴有高甘油三酯血症患者的TG下降7．4％（P＞0．05）,在本研究中,除有2例患者因为腹泻而退出研究,没有发现其他严重的副作用,结论：普罗布考片可以安全,有效的降低高胆固醇患者的TC,LDL－C和HDL－C。     

雷尼替丁与复方丹参联合治疗急性胰腺炎35例疗效分析

目的：观察雷尼替丁与复方丹参联合治疗急性胰腺炎的疗效。方法：对确诊急性胰腺炎65例随机分成治疗组35例,对照组30例,分别用常规治疗,常规治疗加雷尼替丁与复方丹参静滴,连用4－7天,评价其疗效。结果：治疗组与对照组显效率分别为85.71%、43.3%,两组差异显著,P＜0.05。结论：两药联合应用不仅可减轻本病的炎症病变,且可改善心肌细胞营养状况。     

日本血吸虫成虫67kDa分子抗原的纯化及其对血吸虫病的诊断和疗效考核

目的 为检测日本血吸虫成虫67kDa分子抗原(SjAWA67)对血吸虫病的诊断及疗效考核价值。方法 通过SDS-PAGE和电渗方法,从日本血吸虫成虫抗原中分离纯化出67kDa分子抗原,并用该抗原包被酶标反应板微孔,进行ELISA检测。结果 SjAWA67的纯度已达到电泳纯和免疫纯,对急、慢性血吸虫病患血清的捡出率分别为100％和95％,与正常人血清、肝吸虫病和肺吸虫病患血清均未出现明显的交叉反应,44例血吸虫病患治疗后3、6和12个月后的阴转率分别达45．5％、75．0％和90,9％。结论 SjAWA67分子抗原具有较好的疗效考核价值和现场应用前景。     

日本血吸虫多价DNA疫苗pBK-Sj26(Sj32)-Sj23免疫效果的观察

为了观察血吸虫病多价DNA疫苗的保护力,将小鼠分成5组空白对照组、空质粒对照组、单价抗原DNA疫苗pBK-CMV-Sj23组、多价抗原DNA疫苗pBK-CMV-Sj26-Sj23和pBK-CMV-Sj32-Sj23组.大量提取各组质粒DNA后,各组于0、3、5周在BALB/c小鼠股四头肌注射相应质粒DNA,9周用血吸虫尾蚴攻击感染,15周剖杀小鼠计算减虫率及减卵率.结果显示与对照组比较,实验组小鼠减虫率及减卵率有极显著性差异(P<0.01);与单价pBK-CMV-Sj23组比较,多价DNA疫苗组的减虫率及减卵率有显著性差异.提示血吸虫多价DNA疫苗诱导小鼠对血吸虫的保护力优于单价DNA疫苗.     

A European consensus statement on the use of four-factor prothrombin complex concentrate for cardiac and non-cardiac surgical patients

Modern four-factor prothrombin complex concentrate was designed originally for rapid targeted replacement of the coagulation factors II, VII, IX and X. Dosing strategies for the approved indication of vitamin K antagonist-related bleeding vary greatly. They include INR and bodyweight-related protocols as well as fixed dose regimens. Particularly in the massively bleeding trauma and cardiac surgery patient, four-factor prothrombin complex concentrate is used increasingly for haemostatic resuscitation. Members of the Transfusion and Haemostasis Subcommittee of the European Association of Cardiothoracic Anaesthesiology performed a systematic literature review on four-factor prothrombin complex concentrate. The available evidence has been summarised for dosing, efficacy, drug safety and monitoring strategies in different scenarios. Whereas there is evidence for the efficacy of four-factor prothrombin concentrate for a variety of bleeding scenarios, convincing safety data are clearly missing. In the massively bleeding patient with coagulopathy, our group recommends the administration of an initial bolus of 25 IU.kg^-1. This applies for: the acute reversal of vitamin K antagonist therapy; haemostatic resuscitation, particularly in trauma; and the reversal of direct oral anticoagulants when no specific antidote is available. In patients with a high risk for thromboembolic complications, e.g. cardiac surgery, the administration of an initial half-dose bolus (12.5 IU.kg^-1) should be considered. A second bolus may be indicated if coagulopathy and microvascular bleeding persists and other reasons for bleeding are largely ruled out. Tissue-factor-activated, factor VII-dependent and heparin insensitive point-of-care tests may be used for peri-operative monitoring and guiding of prothrombin complex concentrate therapy.     

The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety

Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a ‘high-risk’ medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg^-1, calculated using the patient’s ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg^-1.h^-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.     

中药配伍减毒增效的现代研究及思考

中药配伍是中医药临床应用的精华之一,合理配伍是保障中药临床用药有效性和安全性的重要措施。配伍后减毒增效机制的研究是诠释中药配伍合理性的关键内容。中药配伍机制研究正处于从体外到体内、成分到靶标、单一技术到多学科融合研究技术的转变历程,因此提出以“体外成分、体内过程、直接靶标”研究为基础,“中药配伍药理机制研究”为目的,从不同角度和不同层面探索中药配伍后作用机制的研究策略。     

青黛表面改性对口腔溃疡双层膜质量与药效的影响

目的 采用溶剂浇铸法制备口腔溃疡双层膜剂,研究青黛表面改性前后对膜剂质量与药效的影响。方法 通过单因素实验设计和响应面优化法优选膜剂最佳处方,并对膜剂表面形貌、黏附时间、抗拉强度、含量测定以及体外药物释放等性能进行评估。进一步采用化学灼烧法建立大鼠口腔溃疡模型,考察膜剂对溃疡组织肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-1β（interleukin-1β,IL-1β）、IL-6以及口腔溃疡组织形态的影响。结果 空白隔离层确定为25 mg/mL的乙基纤维素乙醇溶液,载药膜最佳处方为63 mg/mL PVA17-88、55 mg/mL PVP K30、3.0 mg/mL明胶与0.047 mL/mL甘油。青黛表面改性后,双层膜剂比未改性双层膜剂具有更加光滑均一的外观、更高的含量均匀性和有效成分靛蓝释放率。药效学结果表明,与模型组相比,阳性组与青黛改性膜剂组显著降低了溃疡组织TNF-α、IL-1β、IL-6的含量（P＜0.05）,并减少了炎症细胞的浸润,溃疡组织愈合程度较高。结论 青黛改性之后的口腔溃疡双层膜剂具有更好的质量与更佳的疗效,具有较好的应用前景。     

Washed microbiota transplantation stopped the deterioration of amyotrophic lateral sclerosis: The first case report and narrative review

Amyotrophic lateral sclerosis (ALS) is known as a progressive paralysis disorder characterized by degeneration of upper and lower motor neurons, and has an average survival time of three to five years. Growing evidence has suggested a bidirectional link between gut microbiota and neurodegeneration. Here we aimed to report one female case with ALS, who benefited from washed microbiota transplantation (WMT), an improved fecal microbiota transplantation (FMT), through a transendoscopic enteral tube during a 12-month follow-up. Notedly, the accidental scalp trauma the patient suffered later was treated with prescribed antibiotics that caused ALS deterioration. The subsequent rescue WMTs successfully stopped the progression of the disease with a quick improvement. The plateaus and reversals occurred during the whole course of WMT. The stool and blood samples from the first WMT to the last were collected for dynamic microbial and metabolomic analysis. We observed the microbial and metabolomic changing trend consistent with the disease status. This case report for the first time shows the direct clinical evidence on using WMT for treating ALS, indicating that WMT may be the novel treatment strategy for controlling this so-called incurable disease.