全麻诱导时丙泊酚滴定给药与传统给药对患者血流动力学的影响

 目的：比较丙泊酚全麻诱导时滴定给药和传统给药对患者血流动力学的影响,以探求更安全、合理的麻醉诱导方案。方法：60例美国麻醉医师学会（American Society of Anesthesiology,ASA）分级Ⅰ~Ⅱ级、拟气管插管全麻下行择期手术的患者,随机分成2组,每组30例。Ⅰ组为传统给药组,按丙泊酚传统量2 mg·kg^-1以250 mg·min^-1的速度静脉泵注;Ⅱ组为滴定给药组,丙泊酚以1 mg·kg^-1·min^-1的速度静脉泵注,滴定至患者镇静警觉（OAA/S）评分1分,改为1  mg·kg^-1·h^-1维持。2组均在泵注丙泊酚的同时,给予芬太尼4 μg·kg^-1以注射泵注入。传统组给丙泊酚后1 min、滴定组入睡后给予顺阿曲库铵2  mg·kg^-1静推,4 min后行气管插管。记录诱导插管期间各个时点的收缩压（SBP）、舒张压（DBP）、平均血压（MBP）、心率（HR）和脉搏氧饱和度（SpO₂）。记录血压下降超过30%的例数。术后第2 d询问患者对插管过程是否有记忆。结果：2组均在一次试插即完成气管插管,术后随访均对插管过程无记忆。Ⅱ组SBP和MBP在给药后1 min、3 min及DBP在给药后1 min下降幅度均较Ⅰ组小（P<0.01）。Ⅱ组血压下降超过30％的例数较Ⅰ组少（P<0.01）。结论：和传统的给药方法相比,全麻诱导时丙泊酚滴定给药既能满足气管插管所需要的麻醉深度,又能避免血流动力学的剧烈波动。     

两种不同能量的阈值下微脉冲光凝治疗急性中心性浆液性脉络膜视网膜病变疗效分析

目的 评估并比较50％滴定能量(TP)的577 nm阈值下微脉冲光凝(SMLP)与25％TP的577 nm SMLP治疗急性中心性浆液性脉络膜视网膜病变(CsC)的短期疗效.方法 前瞻性非随机对照研究.纳入2014年12月至2016年6月在中山大学中山眼科中心就诊且符合入选标准的单眼急性CSC患者94例(94眼),给予50％的TP-SMLP治疗(50％TP-SMLP组)或者25％的TP-SMLP治疗(25％TP-SMLP组).治疗前及治疗后1个月均行最佳矫正视力(BCVA)和频域光学相干断层扫描检查(SD-OCT).通过t检验或秩和检验评估BCVA(LogMAR)及黄斑中心凹厚度(CMT)的改变及2组之间的差异,卡方检验比较2组治疗后视网膜下积液(SRF)完全吸收率.结果 50％TP-SMLP组共纳入55例患者(男性82％),治疗前BCVA为(0.34±0.25)LogMAR,治疗后1个月为(0.12±0.21)LogMAR(t=8.557,P＜ 0.001);治疗前CMT为(461±168)μm,治疗后1个月为(227 ±82) μm(t=10.332,P＜0.001).25％TP-SMLP组共纳入39例患者(男性92％),治疗前BCVA为(0.35±0.25)LogMAR,治疗后1个月为(0.24±0.22) LogMAR(t=3.759,P=0.001);治疗前CMT为(471±170)μm,治疗后1个月为(298±97)μm(t=6.610,P＜0.001).组间比较显示在治疗1个月后,50％TP-SMLP组在提高BCVA(t=2.850,P=0.005)及降低CMT(Z=-3.787,P＜0.001)方面均显著好于25 ％TP-SMLP组.治疗后1个月50％TP-SMLP组及25％TP-SMLP组的SRF完全吸收率分别为71％与26％(x2=18.738,P＜0.001).结论 50％TP-SMLP与25％TP-SMLP治疗急性CSC后1个月均可显著改善患者的BCVA、CMT,促进SRF吸收,且50％ TP-SMLP的疗效更好.     

非水滴定法测定黄杨宁片中生物碱的含量

首次用非水溶液滴定法测定黄杨宁片中生物碱的含量,本法灵敏度高,结果准确,操作简便、快捷,测得回收率为９７．３９％,ＲＳＤ为２．１８％。     

Hydroxyl content of solution-precipitated calcium phosphates

Summary A method is described for determination of the titratable hydroxide ion in calcium phosphate precipitates. The procedure requires accurate analysis of the other titratable species in the crystal lattice but is unaffected by the presence of other lattice constituents or impurities. The method was applied to precipitates that had been previously analyzed by solution thermodynamic techniques, and the results were consistent with the earlier observations. The hydroxide content of the precipitates increased with crystal maturity and with increasing pH of the precipitation medium. The hydroxide content of the amorphous phase and the immediate post-amorphous-crystalline transformation phase was shown to be nearly zero. After 3 to 4 days' maturation, the hydroxide content of precipitates prepared at pH values of 7, 8, and 9 was shown to increase to approximately 23, 40, 56% of that required for pure hydroxyapatite.     

The kinetic study of the inhibition of human cholinesterases by demeton-S-methyl shows that cholinesterase-based titration methods are not suitable for this organophosphate

The organophosphorus insecticide, demeton-S-methyl (DSM), is considered as a good surrogate of the highly toxic nerve agent VX for skin absorption studies due to similar physico-chemical properties and in vitro percutaneous penetration profile. But, when skin distribution was estimated by measuring inhibition of cholinesterase activity, the results were poorly reproducible. The various grades of commercial DSM solutions were suspected to be the origin of the discrepancies. This hypothesis was tested by measuring inhibition of human acetyl- and butyrylcholinesterase by two commercial DSM solutions. The inhibition rate was independent on the enzyme concentration confirming pseudo-first order conditions. But complete inhibition of butyrylcholinesterase activity was achieved only when the DSM concentration was at least 1500-fold higher than the enzyme concentration. Besides, complete inhibition of acetylcholinesterase was never achieved. Mass spectrometry analysis of the inhibited butyrylcholinesterase adducts identified monomethoxyphosphorylated-serine, the aged product of inhibition by DSM or a derivative with a modified leaving group. Neither spontaneous reactivation nor aging of the dimethoxyphosphorylated-serine could account for the inhibition kinetics observed, suggesting an overly complicated kinetic scheme not compatible with the requirement of a titration experiment. In conclusion, cholinesterase-based analytical methods should be avoided for DSM titration in skin penetration studies.     

Titration of Igs contained in an intravenous IgM-enriched preparation against selected pathogens involved in sepsis

The goal of our work was to titer the IgG, IgM and IgA in Pentaglobin® (a preparation enriched in IgM), targeting specific surface antigens of Gram-positive and Gram-negative bacteria as well as a C. albicans strain. Lipopolysaccharides from Gram-negative bacteria, peptidoglycan and lipoteichoic acid from the other microorganisms were extracted and used in several ELISA assays in order to determine the titration of immunoglobulins in Pentaglobin® directed towards the aforementioned surface antigens. Our results showed an overall immunoglobulin titer of at least 10³ in Pentaglobin® with some exceptions for the IgA titers and for some immunoglobulin titers against E. faecalis, K. pneumoniae and P. aeruginosa. According to these results, Pentaglobin® can be considered as a potential adjuvant for antimicrobial therapy.     

抗结核药物加肠内营养治疗重症结核性肠梗阻病人

目的:探讨无手术指征的重症结核性肠梗阻病人的治疗方法。方法:对28例重症结核性肠梗阻病人在充分抗结核治疗的基础上,早期开始以"复方氨基酸注射液+地塞米松磷酸钠注射液"为营养制剂的肠内营养(EN)联合肠外营养(PN)治疗。依据病人对EN的耐受程度调整鼻饲的速度和营养液的种类,逐渐过渡至TEN。结果:28例病人均采用此方法得以治愈,无中转手术病例。行氨基酸+地塞米松混合液滴定式EN序贯治疗平均鼻饲时间为(6±2)d。治疗后1~2 d病人腹痛、腹胀开始缓解,1~3 d开始排气、排便,恢复正常饮食平均时间为(14±6)d。结论:在充分抗结核治疗的基础上,采用复方氨基酸+地塞米松磷酸钠滴定式EN序贯治疗,对无手术指征的重症结核性肠梗阻病人疗效满意。     

应用最佳顺应性设定呼气末正压的临床研究

目的 以低流速法描记准静态压力-容积曲线(P-V曲线)选择最佳呼气末正压(PEEP)作为对照,观察滴定最佳顺应性方法选择最佳PEEP的临床实用性和安全性.方法 选取本院重症监护病房(ICU)2009年11月至2010年12月14例接受机械通气的急性呼吸窘迫综合征(ARDS)患者,分为两组,每组7例;分别使用低流速法描记准静态P-V曲线和滴定最佳顺应性的方法确定最佳PEEP,连续测量3次,比较各组所确定的最佳PEEP值和重复试验的一致性;观察试验前及试验后2、4、6h血流动力学参数、氧合指数(0I)、肺顺应性(C)以及血浆中细胞因子和肺表面活性蛋白D(SP-D)的变化.结果 ①两组性别、年龄、疾病严重程度等基础状态无明显差异.②准静态P-V曲线和滴定最佳顺应性方法确定的最佳PEEP值(cmH20,1 cm H2O=0.098 kPa)无明显差异(11.53±2.07比10.57±0.87,P＞0.05).但准静态P-V曲线描记的重复性差,3次描记的P-V曲线斜率呈逐渐下降趋势,每次确定的最佳PEEP值呈逐渐升高趋势,第3次与第1次描记比较差异有统计学意义(12.80±1.92比10.00±1.58,P＜0.05);而滴定最佳顺应性的方法重复性好,每次确定的最佳PEEP值无明显差异.③描记准静态P-V曲线后患者的心率(HR,次/min)、体温(℃)、白细胞介素-6(IL-6,ng/L)、肿瘤坏死因子-α(TNF-α,ng/L)、SP-D(μg/L)均呈逐渐升高趋势,平均动脉压(MAP,mm Hg,1 mm Hg=0.133 kPa)、连续心排血指数(CCI,L·min-1·m-2)、OI(mm Hg)及C(ml/cm H20)均呈下降趋势,均于试验后6h达峰值或谷值,与试验前比较差异有统计学意义(HR:117.34±8.53比93.71±5.38,体温:38.05±0.73比36.99±1.02,IL-6:144.84±23.89比94.73±5.91,TNF-α:151.46±46.00比89.86±13.13,SP-D:33.65±8.66比16.63±5.61,MAP:85.47±9.24比102.43±8.38,CCI:3.00±0.48比3.81±0.81,OI:62.00±21.45比103.40±37.27,C:32.10±2.92比49.57±7.18,均P＜0.05),提示准静态P-V曲线的描记会加重原有肺损伤;而滴定最佳顺应性试验前后患者HR、MAP、体温、CCI、OI、C、细胞因子及SP-D均无明显差异.结论 滴定最佳顺应性方法确定最佳PEEP重复性好,临床操作更简单、更安全,便于临床开展.     

A stimulus-control account of dysregulated drug intake

Drug self-administration typically occurs in a regular temporal pattern, with a consistent pause following each injection. We have proposed that this patterning results from differential reinforcement of post-injection pausing. In this view, even when every response produces an injection, some injections are not reinforcing because they occur when the level of drug effect is already maximal; consequently, drug reinforcement occurs on an intermittent schedule, and the interoceptive drug effect functions as a cue, indicating when another injection will be reinforcing. Previously, we emulated this situation with rats by using food reinforcement; each response was recorded as delivering a “virtual” injection, and a visual cue tracked the virtual drug level to indicate availability of reinforcement. This emulation schedule produced response patterns strikingly similar to actual drug self-administration. In the present study, the emulation schedule was modified to determine whether reinforcement of pausing is sufficient to produce these patterns, or whether a cue is necessary. Without a cue, response patterns were irregular and virtual drug intake was escalated. These results suggest that a failure of interoceptive cues to control pausing might contribute to the dysregulated drug intake that is associated with addiction.     

Diferencias de género en la titulación de fármacos de pacientes con insuficiencia cardiaca y fracción de eyección reducida del ensayo ETIFIC

Introduction and objectivesOptimal medical therapy decreases mortality and heart failure (HF) hospitalizations in HF patients with reduced left ventricular ejection fraction. Women have been underrepresented in clinical trials and not specifically evaluated. This study aimed to compare the safety and effectiveness of drug titration in women vs men.MethodsThis post hoc gender study of the ETIFIC multicenter randomized trial included hospitalized patients with new-onset HF with reduced ejection fraction and New York Heart Association II-III and no contraindications to beta-blockers. A structured 4-month titration process was implemented in HF clinics. The primary endpoint was the mean relative dose (% of target dose) of beta-blockers achieved by women vs men. Secondary endpoints included the mean relative doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists, adverse events, and other clinical outcomes at 6 months.ResultsA total of 320 patients were included, 83 (25.93%) women and 237 (74.06%) men (76 vs 213 analyzed). The mean ± standard deviation of the relative doses achieved by women vs men were as follows: beta-blockers 62.08% ± 30.72% vs 64.4% ± 32.77%, with a difference of ?2.32% (95%CI, ?10.58-5.94), P = .580; and mineralocorticoid receptor antagonists 79.85% ± 27.72% vs 67.29% ± 31.43%, P =.003. No other differences in drug dosage were found. Multivariate analysis showed nonsignificant differences. CV mortality was 1 (1.20%) vs 3 (1.26%), P = 1, and HF hospitalizations 0 (0.00%) vs 10 (4.22%), P = .125.ConclusionsIn a post hoc analysis from the HF-titration ETIFIC trial, we found nonsignificant gender differences in drug dosage, cardiovascular mortality, and HF hospitalizations.Trial registry number: NCT02546856.