磁共振波谱分析轻度认知功能损害患者海马区的变化

BACKGROUND: Mild cognitive impairment (MCI) represents early status of Alzheimer’s disease. Magnetic resonance spectroscopy (MRS) has been used in early diagnosis and identification as well as monitoring of Alzheimer’s disease. However, little data is available concerning relationship between cognitive impairment and changes of biochemical metabolites. OBJECTIVE: To investigate the relationship between cognitive impairment and changes of biochemical metabolites as well as volumes of hippocampal formation (HPF) in MCI patients, accordingly to evaluate the roles of MRS in the diagnosis and the state monitoring of MCI. DESIGN, TIME AND SETTING: Case-contrast observation. The study was performed at the Outpatient Department and ward of Department of Neurology, Lianyungang Hospital of Xuzhou Medical College between September 2006 and December 2008. PARTICIPANTS: A total of 20 MCI patients were selected and 20 elderly with normal cognition, matched in gender, age and education, were selected. METHODS: Before volumes of the left HPF were measured by MRS, mini-mentalstate examination (MMSE), the Montreal Cognitive Assessment (MoCA), activities of daily living (ADL), clinical dementia rating (CDR) and Wechsler memory scale (WMS) were used to examine each participant. In addition, the N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (mI)/Cr of HPF were obtained. Moreover, the correlations between the NAA/Cr, Cho/Cr, mI/Cr and the volume of HPF in MCI group were analyzed. MAIN OUTCOME MEASURES: Volume of HPF, NAA/Cr, Cho/Cr, and mI/Cr. RESULTS: Compared with control group, reduced NAA/Cr (P < 0.01), increased mI/Cr (P < 0.01) and reduced volume of HPF (P < 0.05) were found in the MCI subjects. No significant difference was observed in the Cho/Cr between two groups (P > 0.05). In the MCI group, the NAA/Cr remarkably correlated with MoCA, memory quotient, and volumes of left HPF (P < 0.01); Cho/Cr significantly correlated with memory quotient (P < 0.05); mI/Cr has remarkably negative correlation with MoCA and volumes of left HPF (P < 0.01), but positive correlation with memory quotient (P < 0.01). The volumes of left HPF also remarkably correlated with MoCA and memory quotient (P < 0.01). CONCLUSION: An increased mI/Cr ratio, a decreased left HPF volumes and NAA/Cr ratio were observed in the MCI patients. Significant correlations between biochemical metabolites of HPF, HPF volumes and MoCA as well as memory quotient were observed. MRS plays an important role in the diagnosis and state monitoring of MCI.     

黄芪甲苷和三七的主要有效成分配伍对小鼠脑缺血再灌注后脑组织能量代谢的影响

目的研究黄芪甲苷和三七的主要有效成分人参皂苷Rg1、人参皂苷Rb1、三七皂苷R1分别配伍对小鼠脑缺血再灌注损伤后脑组织能量代谢的影响。方法 C57BL/6小鼠随机分组,连续给药3 d,末次给药1 h后,结扎双侧颈总动脉造成脑缺血20 min,再灌注24 h。采用HPLC法测定脑组织ATP、ADP、AMP水平,计算能荷(EC)值;采用逆转录聚合酶链式反应(RT-PCR)法和Western-blotting法测定脑组织葡萄糖转运蛋白3(GLUT3)基因和蛋白表达。结果模型组脑组织ATP、ADP、AMP的量及EC值显著降低(P<0.01),GLUT3基因和蛋白表达显著增强(P<0.05)。黄芪甲苷、人参皂苷Rg1、人参皂苷Rb1、三七皂苷R1、黄芪甲苷+人参皂苷Rg1、黄芪甲苷+人参皂苷Rb1、黄芪甲苷+三七皂苷R1均可显著增加脑组织ATP、ADP、AMP的量,增强脑组织GLUT3基因和蛋白表达,黄芪甲苷+人参皂苷Rg1、黄芪甲苷+人参皂苷Rb1和黄芪甲苷+三七皂苷R1改善上述指标的作用强于其单个有效成分;除4个有效成分单用外,黄芪甲苷+人参皂苷Rg1、黄芪甲苷+人参皂苷Rb1和黄芪甲苷+三七皂苷R1可显著增加EC值;黄芪甲苷+人参皂苷Rg1、黄芪甲苷+人参皂苷Rb1和黄芪甲苷+三七皂苷R1配伍对改善脑组织能量代谢指标具有协同或相加作用。结论黄芪甲苷和三七的主要有效成分可改善脑缺血再灌注损伤后脑组织能量代谢,促进缺血脑组织对能量物质的利用,黄芪甲苷与人参皂苷Rg1、人参皂苷Rb1、三七皂苷R1配伍对改善脑缺血后脑组织能量代谢具有增效作用。     

响应面法优化熟大黄炮制工艺

目的以多成分综合评分结合响应面法筛选熟大黄的最佳炮制工艺。方法以没食子酸、大黄酚-8-O-β-D葡萄糖苷、芦荟大黄素、大黄酸、大黄素、大黄酚、大黄素甲醚7种成分的综合评分为指标,采用3因素3水平的Box-Behnken响应面试验设计,考察加酒量、闷润时间、蒸制时间因素对熟大黄炮制工艺的影响,筛选最佳炮制工艺参数。结果采用Design Expert 8.05软件对数据进行分析,建立7种成分含量的综合评分与考察因素多元二次回归方程数学模型,预测熟大黄最佳炮制条件为每100 g药材加酒量36.6 mL,闷润时间2.16 h,蒸制时间10.96 h。结合生产实际,将工艺修正为每100 g药材加酒量35 mL,闷润时间2 h,蒸制时间11 h。结论优选的炮制工艺能合理控制熟大黄炮制质量,为制定其饮片的质量标准和临床应用提供了依据。     

HPLC．DAD法测定银屑优化颗粒中芍药苷、甘草苷、落新妇苷、迷迭香酸和甘草酸

目的建立同时测定银屑优化颗粒中芍药苷、甘草苷、落新妇苷、迷迭香酸和甘草酸5种成分的HPLC-DAD测定方法。方法采用高效液相色谱波长切换法。Lichrospher C18色谱柱（250mm×4．6mm,5μm）;流动相为乙腈-0．1％磷酸溶液,梯度洗脱;检测波长在230、254、290nm切换;体积流量为1mL／min;柱温为30℃;进样体积10μL。结果5种成分的线性关系良好。芍药苷在69．12~691．20ng线性关系良好,平均加样回收率为97．45％,RSD值为1．54％;甘草苷在39．02~390．20ng线性关系良好,平均加样回收率为97．10％,RSD值为1．90％;落新妇苷在30．03~300．30ng线性关系良好,平均加样回收率为99．98％,RSD值为1．22％;迷迭香酸在7．82~78．20ng线性关系良好,平均加样回收率为100．83％,RSD值为1．36％;甘草酸在31．09～310．90ng线性关系良好,平均加样回收率为97．52％,RSD值为1．49％。结论本方法具有方法简便、快速、准确等特点,可同时测定银屑优化颗粒中5种活性成分。     

半夏泻心汤联合美沙拉嗪灌肠对溃疡性结肠炎患者血清炎症因子的影响

目的：观察半夏泻心汤联合美沙拉嗪灌肠对溃疡性结肠炎患者血清炎症因子的影响,优化临床治疗效果.方法：96例符合纳入标准的溃疡性结肠炎患者按随机数字表分为观察组48例和对照组48例,对照组仅给予美沙拉嗪保留灌肠,观察组在对照组的基础上口服半夏泻心汤,14天为1个疗程.观察治疗前后患者症状（腹泻、腹痛、浓血便）改善情况,结肠黏膜（充血水肿、溃疡、糜烂、出血、颗粒状改变）改善情况,测定血清炎症指标（CRP、TNF-α、IL-1）,评价两组临床疗效,所有患者均随访1年,统计复发率。结果：观察组治疗2周后腹泻、腹痛、脓血便的复常率明显高于对照组,差异具有统计学意义（P＜0.01）;观察组黏膜充血水肿、溃疡、糜烂、出血、颗粒状改变改善效果明显优于对照组,差异具有统计学意义（P＜0.05）;观察组和对照组治疗后血清炎症因子CRP、TNF-α、IL-1均较治疗前明显降低（P＜0.05）,观察组治疗后血清炎症因子CRP、TNF-α、IL-1明显低于对照组（P＜0.05）;观察组的临床总有效率为83.67％,对照组的临床总有效率为60.42％,两组临床疗效差异有统计学意义（P＜0.05）;观察组的1年复发率为14.58％,对照组为33.33％,两组比较有统计学意义（P＜0.05）.结论：半夏泻心汤联合美沙拉嗪灌肠治疗溃疡性结肠炎临床疗效确切,可协同增强抗炎效果,快速改善肠道黏膜炎症,缓解临床不适症状,值得临床推广使用。     

高渗盐水预防骨科外固定支架钉道感染的护理研究

目的通过比较高渗盐水清洁钉道与常规的酒精消毒胫骨骨折外固定支架钉道,探讨高渗盐水在预防钉道感染中的疗效。方法本研究纳入68例胫骨骨折行单边外固定架固定的患者,共272枚固定半螺纹固定钉。将患者分为高渗盐水组34例,136枚固定针,用10%高渗盐水清洁钉道;酒精组34例,136枚固定针,随访并记录钉道周围的情况并比较患者术后钉道感染情况并进行统计学分析。结果 2组的钉道感染率均较低,2组各级别的钉道感染率比较无统计学差异(P0.05)。结论 10%高渗盐水用于外固架术后预防钉道感染的护理感染率低,是骨科外固定架术后进行预防钉道感染护理良好选择。     

基于海恩法则的乳腺门诊手术室护理安全管理实效研究

目的探讨乳腺门诊手术室运用海恩法则进行安全管理的应用效果。方法选取2015年10月至12月240例乳腺门诊手术患者为对照组,实施常规围手术期护理;选取2016年10月至12月240例乳腺门诊手术患者为观察组,以海恩法则理论为指导,针对门诊手术室存在的护理安全隐患,采取护理安全管理措施,包括:构建乳腺门诊手术室护理标准操作程序、设计制作"杏仁医生App"、推行移动护理信息系统、建立电子化标本标签。结果观察组患者在不良事件的发生、护理质量、患者满意度方面明显优于对照组(P0.01或P0.05)。结论针对乳腺门诊手术室的运行模式及患者安全目标,运用海恩法则进行护理安全风险管理,能够降低乳腺门诊手术室安全不良事件的发生,提升专科护理质量,提高患者满意度。