LC-MS快速检测降糖类中成药中14种非法添加化学药物

目的 建立一种降糖类中成药中非法添加的14种化学成分（伏格列波糖、阿卡波糖、维达列汀、氯磺丙脲、醋磺己脲、西他列汀、妥拉磺脲、达格列净、那格列奈、莫格他唑、卡格列净、曲格列酮、GW501516、环格列酮）的LC-MS检测方法。方法 样品经甲醇超声提取后，采用资生堂CAPCELL-PAK C₁₈（4.6 mm×150 mm，5 μm）色谱柱分离，以甲醇-0.01 mol·L^-1乙酸铵溶液为流动相进行梯度洗脱，流速0.5 mL·min^-1。采用离子阱质谱（ion trap mass spectrometry，ITMS）作为检测器，电喷雾离子源（ESI），正负离子扫描方式，以一级全扫描模式和二级全扫描模式检测14种降糖类药物。通过比较供试品和对照品的色谱图及质谱图，对供试品中非法添加的化学药物进行定性分析。结果 14种化合物色谱峰分离良好，最低检出限为0.05~3.5 mg·kg^-1。30批样品中，3批检出卡格列净，1批检出那格列奈。结论 该方法灵敏度高，专属性强，操作简单高效，可用于降糖类中成药中非法添加的14种化学药物的快速检测。     

Profiling of the pattern of the human TRB/IGH–CDR3 repertoire in primary biliary cholangitis patients

IntroductionPrimary biliary cholangitis (PBC) is characterized by lymphocyte cell-induced immune destruction of cholangiole. However, the immunological characteristics of peripheral blood cells in PBC patients remain unknown. This study was designed to reveal the differences in the immunological characteristics between PBC patients and healthy adults.MethodsWe performed high-throughput sequencing to determine the TRB–CDR3 and IGH–CDR3 repertoires of T and B cells in 19 healthy controls and 29 PBC patients. Different immunological characteristics, such as distinctive complementarity determining region 3 (TRB–CDR3) lengths, usage bias of V and J segments, and random nucleotide addition were identified in PBC and healthy control (HC) groups.ResultsThe diversity of TRB–CDR3 was significantly lower in the PBC group compared with the HC group. CDR3 and the N addition length distribution were significantly changed compared with the HC group. It appeared that the PBC group had more short N additions and the HC group had more long N additions in the TRB–CDR3 repertoire. The results also revealed a set of PBC-associated clonotypes compared with the HC group.ConclusionThis study suggested that PBC is a complex autoimmune disease process with evidence of different TRB–CDR3 rearrangements compared with healthy adults that share IGH–CDR3 peptides with some autoimmune diseases. This new insight may contribute to a better understanding of the immune functions of PBC patients and benefit efficient applications of PBC diagnosis and treatments.     

桂枝汤加减治疗营卫不和型慢性瘾疹的临床疗效

目的:观察桂枝汤加减治疗营卫不和型慢性瘾疹的临床疗效。方法:将我院门诊2017年10月-2019年10月收治的48例营卫不和型慢性瘾疹患者,按随机数表法分成对照组(24例)与实验组(24例)。对照组实施常规西药治疗,实验组实施桂枝汤合地骨皮、白鲜皮加减治疗。对照两组治疗前后症状积分、临床疗效及并发症发生率。结果:两组治疗前症状积分相比无显著差异(P>0.05)。治疗后,两组症状积分均有所下降,实验组低于对照组;实验组临床总有效率为91.67%(22/24)高于对照组的66.67%(16/24);实验组并发症发生率0(0/24)低于对照组的16.67%(4/24),差异具有统计学意义(P<0.05)。结论:在营卫不和型慢性瘾疹治疗中,采取桂枝汤加减治疗,可明显降低症状积分,提高临床治疗效果,减少并发症,效果理想。     

反向添加疗法联合醋酸亮丙瑞林在子宫内膜异位症病灶切除术后的应用效果及对机体Th1/Th2漂移现象的影响

目的探讨反向添加疗法联合醋酸亮丙瑞林在子宫内膜异位症(EM)病灶切除术后的应用效果及对机体Th1/Th2漂移现象的影响。方法选取2016年6月至2018年1月本院收治的96例EM患者作为研究对象,采用随机抽签法将其分为对照组(46例)与观察组(50例)。两组均接受腹腔镜下EM病灶切除手术,术后,对照组给予皮下注射醋酸亮丙瑞林治疗,观察组给予反向添加疗法联合醋酸亮丙瑞林治疗。比较两组的治疗效果。结果治疗后,两组的血清LH、AMH和腰椎BMD水平均明显下降,但观察组高于对照组(P<0.05)。治疗后,两组的血清IFN-γ水平及IFN-γ/IL-4均升高,IL-4水平均降低,观察组优于对照组(P<0.05)。随访18个月,观察组复发率明显低于对照组(P<0.05)。结论反向添加疗法联合醋酸亮丙瑞林应用于EM病灶切除术后,可有效纠正机体生殖激素表达,减少骨量丢失,促进患者卵巢功能恢复,纠正Th1/Th2漂移现象,预防疾病复发。     

佛山120急救调度模式下的院内反应时间状况分析及策略

目的对佛山120急救调度模式下的院内反应时间进行分析，提出缩短院内反应时间的策略。方法使用SPSS统计软件对2011年11～12月8点至18点我院急诊科确认并接受的由通讯指挥中心发出的院前急救指令进行随机抽查，对其院内反应时间【A组（急诊医师组）、B组（急诊护士组）、C组（担架员组）和D组（救护车司机组）】进行分析。结果2011年11～12月8点至18点，对佛山市中医院急诊科调度护士接收到的526例院前急救指令进行随机抽查并进行统计。A组院内反应时间（51．58±16．63）S，B组院内反应时间（51．09±16．47）s，C组院内反应时间（59．40±17．06）s．D组院内反应时间（59．30±17．12）s。A、B、C和D组院内反应时间比较，差异有统计学意义（P〈0．05）。A组和B组较C组和D组的院内反应时间较短，A组和B组间无统计学意义（P〉0．0083），C组和D组间无统计学意义（P〉0．05）．A组和B组与C组和D组间的差异有统计学意义（P〈0．05）。我院急诊科综合院内平均反应时间（59．69±16．78）s．2min内出车率100％。比广州市120急救网络医院的院内反应时间短，差异有统计学意义（P〈0．05）。结论因地制宜，制定相关策略缩短院内反应时间。     

基于UPLC-Q-TOF-MSn的化妆品中40种性激素非法添加分析方法及筛查数据库的建立

目的 建立基于UPLC-Q-TOF-MSⁿ的化妆品中40种性激素非法添加分析方法及筛查数据库。方法 色谱柱为Agilent SB-C₁₈(2.1 mm×50 mm，1.8 μm)，正离子模式以0.1%甲酸水溶液-乙腈为流动相，负离子模式以水-乙腈为流动相，梯度洗脱，流速0.2 mL·min^-1，柱温35 ℃；采用电喷雾电离源(ESI)，采集模式为Scan MS及Targeted MS/MS，将40种性激素的精确质量数、保留时间、二级质谱图导入PCDL软件建立筛查数据库。结果 采用所建立的数据库方法快速筛查100批化妆品，1批育发类产品检出少量黄体酮。结论 本研究所建立的40种性激素分析方法和筛查数据库具有简便、快速、灵敏和准确的特点，适合化妆品中非法添加性激素的高通量筛查和准确定性。     

Complications and operative spine fusion construct length in Parkinson’s disease: A nationwide population-based analysis

There remains a dearth of information regarding the surgical complications following multilevel spine surgery in Parkinson’s disease (PD) patients. This retrospective cohort study was performed to address this issue on a nationwide level using the Nationwide Inpatient Sample from 2001 to 2012. More than 25 postoperative variables were analyzed to assess the impact of fusion construct length on each variable. Subsequently, the same analysis was performed on admissions without PD. 4301 PD patients with spine fusion were identified, of whom 934 (21.7%) underwent fusion of at least three levels; the remaining 3367 underwent fusion of 1–2 levels. Patients with 3+ level fusions were more likely to suffer paraplegia (P = .001; OR = 3.0; 95%CI = 1.5–6.1), hematoma/seroma (P = .009; OR = 1.9; 95%CI = 1.2–3.2), IVC filter placement (P = .018; OR = 2.1; 95%CI = 1.1–3.9), RBC transfusion (P < .001; OR = 3.2; 95%CI = 2.7–3.8), PE (P = .027; OR = 4.5; 95%CI = 1.2–16.9), postoperative shock (P = .023; OR = 7.3; 95%CI = 1.3–39.6), ARDS (P < .001; OR = 4.1; 95%CI = 2.7–6.3), VTE (P = .006; OR = 2.6; 95%CI = 1.3–5.4), acute posthemorrhagic anemia (P < .001; OR = 2.0; 95%CI = 1.7–2.4), device-related complications (P < .001; OR = 3.1; 95%CI = 2.3–4.2), and in-hospital mortality (P = .005; OR = 3.4; 95%CI = 1.5–7.4). 3+ level fusions were also more likely to have LOS > 1 week (P < .001; OR = 2.1; 95%CI = 1.8–2.5), and a nonroutine discharge (P = .005; OR = 1.9; 95%CI = 1.4–2.4). 692,173 non-PD patients with spine fusion were identified; 123,964 (17.9%) underwent 3+ level fusion. Differences between 3+ versus 1–2 level fusions were similar to those in PD patient, but unlike PD patients, postoperative infection was significant while in-hospital mortality, PE and VTE were not. Fusion of at least three levels increased morbidity, mortality, and adverse discharge disposition compared with 1–2 level fusions. Nearly 80% of all spine fusions performed in the United States are fewer than three levels. These findings are worth considering during operative decision-making in both PD and non-PD patients.     

中成药中非法添加物N-苄基他达拉非的结构确证

目的 鉴定中成药中一种新型他达拉非类似物。方法 采用HPLC-DAD初筛和制备液相色谱仪对中成药中非法添加物进行分离和纯化，采用高分辨质谱确定其精确分子量和结构碎片，结合碳谱和氢谱，最终确定该添加物的结构。结果 该添加物为N-苄基他达拉非。结论 N-苄基他达拉非的化学结构已有文献报道，但作为一种非法的中成药添加物首次被检出。     

急诊室小儿心搏呼吸骤停流行病学调查及初步复苏效果评估

目的 调查儿科急诊室内小儿心搏呼吸骤停情况,分析影响心肺复苏效果的因素,并对复苏效果做初步评估.方法 采用标准的院内Utstein格式(the in-hospital Utstein style)前瞻性收集数据,填写调查表,内容包括:心搏呼吸骤停的原因、影响心肺复苏效果的因素及复苏效果.用自主循环恢复(return of spontaneous circulation,ROSC)评估初步复苏效果.结果 2008年7月1日至2010年2月28日,北京儿童医院急诊室全部就诊患者(29 d至18岁)182 380例,心搏呼吸骤停237例(0.13％).实施心肺复苏169例,其中ROSC 88例(52.1％).性别和年龄对ROSC的影响差异无统计学意义.原发病和初始节律对ROSC的影响有显著性意义.有无院前转运的ROSC分别为64.1％和44.8％；CPR时间≤10 min、10 ～ 30 min及＞30 min的ROSC分别为67.5％、61.4％和30.5％,差异均具有统计学意义.多元逐步Logistic回归分析显示,初始节律和CPR持续时间对ROSC有明显影响.结论 急诊室内小儿心肺复苏的ROSC为52.1％.初始节律和CPR持续时间对ROSC有明显影响.     

Quantifying the importance of active antimicrobial therapy among patients with Gram-negative bloodstream infections: Cefepime as a representative agent

The quantitative importance of active antimicrobial treatment relative to other modifiable and non-modifiable risk factors for mortality has not been well defined in the literature. Here we quantify the impact of active antimicrobial treatment on mortality relative to other disease modifiers in patients with Gram-negative bloodstream infection (GNBSI). Patients with at least one positive blood culture who were treated with ≥24 h of cefepime for GNBSI were included in the study. To examine in-hospital survival, a full primary model and a base model with the least significant covariate from the primary model were established. Relative importance of covariates was calculated using percentages of difference in log-likelihood values when each covariate was iteratively added to the base model. A total of 154 unique patients with GNBSI were included. The primary model included active cefepime therapy (P?=?0.004), normalised days to positive culture (P?=?0.091), intensive care unit (ICU) at time of treatment (P?=?0.001), modified Acute Physiology and Chronic Health Evaluation (APACHE) II score on day zero (P?=?0.025), history of leukaemia (P?=?0.008) and prior immunosuppressive therapy (P?=?0.088). Active antimicrobial therapy displayed a relative importance of 32.2%, which was second to ICU residence at the time of culture. Amongst all covariates in the model, active antimicrobial therapy was the only modifiable variable and contributed significantly to in-hospital survival in acutely ill patients with GNBSI.