高效液相色谱法测定人血清中酒石酸美托洛尔浓度

目的：建立测定人血清中酒石酸美托洛尔浓度的ＨＰＬＣ方法,为临床药理研究提供科学的分析技术。方法：血清样品萃取纯化后溶于流动相中,进样分析。测定使用Ｃ１８色谱柱,甲醇－水相（５０：５０,水相中含０．１６％戊烷磺酸钠和０．０１４％无水乙酸钠）为流动相,以纳多洛尔为内标,用荧光检测Ｅｘ＝２７７ｎｍ,Ｅｍ＝２９９ｎｍ。结果：本方法线性范围为１０～３００ｎｇ／ｍｌ,最低检测浓度为１ｎｇ／ｍｌ。平均回收率为（     

Treatment of onychomycosis by partial nail avulsion and topical miconazole

13 patients with distal subungual onychomycosis in a total of 48 dermatophyte-infected nails were treated with chemomechanical, partial nail avulsion followed by topical miconazole for 8 weeks. On examination, 6 months after cessation of therapy, 42% of the nails were cured by clinical and mycological criteria. The therapeutic response was related to the pretreatment extension of subungual hyperkeratosis. Periungual skin irritation was common during the initial avulsion period. Miconazole solution was well tolerated and this treatment modality proved to be a valuable alternative to other remedies for the treatment of onychomycosis limited to a few number of nails.     

Methodology of a randomized clinical trial of symptom management strategies in patients receiving chronic hemodialysis: The SMILE study

Despite the high prevalence of pain, sexual dysfunction, and depression in patients on chronic hemodialysis, these symptoms are often unrecognized and under-treated by renal providers. This report describes the rationale and methodology of the SMILE study (Symptom Management Involving End-Stage Renal Disease), a multi-center, randomized clinical trial comparing the effectiveness of two strategies for implementing treatment for these symptoms in patients receiving chronic hemodialysis. Approximately 250 patients from nine outpatient dialysis units will participate. Over a 2–12 month observational phase, participants complete monthly surveys characterizing their pain, sexual dysfunction, and depression. Following this observational period, subjects are randomized to one of two study arms to receive a 12-month intervention. In one study arm (feedback intervention), patients continue to complete the same three symptom surveys, and the presence and severity of the symptoms reported on these surveys is mailed to the patient's renal provider along with evidence-based algorithms outlining treatment options for these symptoms. Decisions on treatment are left at the discretion of the provider. Patients randomized to the other study arm (management intervention) also continue to complete the same monthly symptom surveys and are evaluated by a symptom management nurse trained in the management of these symptoms. This nurse then discusses the patient's symptoms with the renal provider, provides specific recommendations for treatment, and facilitates the implementation of treatment. The primary endpoints are changes in scores on pain, erectile dysfunction, and depression surveys. This report describes the rationale and methodology of this clinical trial.     

Pain Adversely Affects Outcomes to a Collaborative Care Intervention for Anxiety in Primary Care

BACKGROUND

Primary care patients with Panic Disorder (PD) and Generalized Anxiety Disorder (GAD) experience poorer than expected clinical outcomes, despite the availability of efficacious pharmacologic and non-pharmacologic treatments. A barrier to recovery from PD/GAD may be the co-occurrence of pain.

OBJECTIVE

To evaluate whether pain intensity interfered with treatment response for PD and/or GAD in primary care patients who had received collaborative care for anxiety disorders.

DESIGN

A secondary data analysis of a randomized, controlled effectiveness trial comparing a telephone-delivered collaborative care intervention for primary care patients with severe PD and/or GAD to their doctor’s “usual” care.

PARTICIPANTS

Patients had to have a diagnosis of PD and/or GAD and a severe level of anxiety symptoms. The 124 patients randomized at baseline to the collaborative care intervention were analyzed. Participants were divided into two pain intensity groups based on their response to the SF-36 Bodily Pain scale (none or mild pain vs. at least moderate pain).

MAIN MEASURES

Pain was assessed using the Bodily Pain scale of the SF-36. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HRS-A), Panic Disorder Severity Scale (PDSS) and Generalized Anxiety Disorder Severity Scale (GADSS). Measures were collected over 12 months.

KEY RESULTS

At baseline, patients with at least moderate pain were significantly more likely to endorse more anxiety symptoms on the HRS-A than patients with no pain or mild pain (P?<?.001). Among patients with severe anxiety symptoms, 65 % (80/124) endorsed experiencing at least moderate pain in the previous month. A significantly lesser number of patients achieved a 50 % improvement at 12 months on the HRS-A and GADSS if they had at least moderate pain as compared to patients with little or no pain (P?=?0.01 and P?=?0.04, respectively).

CONCLUSIONS

Coexisting pain was common in a sample of primary care patients with severe PD/GAD, and appeared to negatively affect response to anxiety treatment.