三七片DNA条形码分子鉴定及方法学考察

目的为研究DNA条形码技术在中成药鉴定中的应用,以三七片为研究对象,对方法的适用性、专属性与精密度进行考察。方法收集15批次市售三七片样品,考察三七片DNA提取条件,并对"中药材DNA条形码分子鉴定法指导原则"中PCR扩增、序列获得、结果判定等方法适用性进行确认;收集三七、人参、西洋参,制作三七片及其掺伪品,考察方法的专属性和重现性。结果三七片取样量100 mg,56℃水浴8 h所获得DNA的质量浓度平均值为60.7 ng/μL,PCR扩增、序列获得和结果判定均可获成功;三七、人参和西洋参的ITS2序列长度均为230bp,三七与人参、三七与西洋参的序列间均存在7个稳定的SNP位点,自制三七片和掺伪三七片均可成功获得ITS2序列,不同比例三七与人参、三七与西洋参的测序峰图在SNP位点处呈现相应峰高比的SNP套峰具备专属性;重复性、中间精密度和重现性考察符合《中国药典》2015年版(通则9101)相关要求。结论 ITS2序列作为DNA条形码能够稳定、准确鉴定三七片的原料药材,具备良好的专属性和精密度,三七片DNA条形码分子鉴定法将为保障三七片临床用药安全提供新的技术手段,并对《中国药典》其他收载单方制剂的鉴定提供参考。     

Indwelling Urinary Catheter for Total Joint Arthroplasty Using Epidural Anesthesia

BackgroundThe objective of this study was to evaluate if not placing an indwelling urinary catheter leads to a higher potential for adverse genitourinary (GU) issues after total joint arthroplasty (TJA) under epidural anesthesia.MethodsThree hundred thirty-five consecutive patients who underwent primary TJA using epidural anesthesia were retrospectively reviewed. The initial 103 patients received a preoperative urinary catheter, which was maintained until the morning of postoperative day 1. The subsequent 232 patients did not receive a preoperative urinary catheter. Demographics, medical complications, GU complications, and length of stay were compared between groups.ResultsCompared between catheter and noncatheter groups, there were no differences in demographics including age, gender, or laterality of surgery. There was a difference in type of surgery (total knee arthroplasty vs total hip arthroplasty) (P = .008). There was no difference in American Society of Anesthesiologists score, but with a difference in body mass index (P = .01). There were no differences in GU complications among patients with benign prostatic hyperplasia or prostate cancer. However, among patients with a history of prostate disorders (benign prostatic hyperplasia or prostate cancer), urinary tract infection rate was higher in catheter group (P = .023). Postoperative GU complications were associated with increased median age in years and increased average length of stay in days.ConclusionPatients undergoing TJA under epidural anesthesia demonstrate no increased risk of postoperative urological complications without the placement of preoperative indwelling urinary catheter. The routine use of preoperative catheters can be reconsidered for this mode of anesthesia.Level of EvidenceLevel II, retrospective comparative study.     

The Effectiveness of Tranexamic Acid at Reducing Blood Loss and Transfusion Requirement for Women Undergoing Myomectomy: A Systematic Review and Meta-analysis

BackgroundThe surgical removal of fibroids can be associated with excessive blood loss requiring transfusion.ObjectiveThis review sought to determine the effectiveness of tranexamic acid (TA) in reducing perioperative blood loss in women undergoing myomectomy.MethodsElectronic bibliographic databases were searched from inception until June 3, 2017. The review included RCTs of women of reproductive age with uterine fibroids who were undergoing myomectomy and who received TA or a comparator. Two independent reviewers extracted relevant data, and meta-analysis was performed.ResultsThree studies included women undergoing abdominal myomectomy. TA significantly reduced intraoperative blood loss by a mean difference of 213.1 mL (95% CI ?242.4 to ?183.7) and postoperative blood loss by a mean difference of 56.3 mL (95% CI ?67.8 to ?44.8) compared with control arms. However, no significant differences were seen in blood transfusion requirement (relative risk 0.58; 95% CI 0.33–1.00). In one study for women undergoing hysteroscopic myomectomy, TA was not associated with improved outcomes in transfusion requirement and resulted in reduced postoperative hemoglobin levels compared with oxytocin.ConclusionAmong women undergoing abdominal myomectomy, TA is effective at reducing perioperative blood loss compared with no treatment or placebo. For women undergoing hysteroscopic myomectomy, TA compared with oxytocin is not associated with improved outcomes in transfusion requirement and resulted in reduced postoperative hemoglobin levels.     

三七HPLC指纹图谱及5种成分测定

目的 建立三七HPLC指纹图谱,并测定5种成分的含有量.方法 三七70%甲醇提取物的分析采用Waters XBridge C18色谱柱(4.6 mm×250 mm,5μm);流动相乙腈-水,梯度洗脱;体积流量1.5 mL/min;柱温25℃;检测波长203 nm.结果 15批样品指纹图谱中有5个共有峰,相似度均大于0.99.三七皂苷R1、人参皂苷Rg1、人参皂苷Re、人参皂苷Rb1和人参皂苷Rd分别在0.000 76~0.567 64(r=0.9999)、0.002 69~2.017 43 (r=0.9998)、0.000 38~0.283 82 (r=1.000 0)、0.002 83~2.12483 (r=0.999 8)、0.000 78~0.582 98 mg/mL (r=0.999 8)范围内线性关系良好,平均加样回收率分别为101.78%、97.22%、102.14%、98.96%、101.73%,RSD分别为1.58%、1.31%、2.17%、1.55%、1.80%.结论 该方法简便、快速、准确,可用于三七的质量控制.     

Incidence,distribution and clinical relevance of microbial contamination of preservation solution in deceased kidney transplant recipients: a retrospective cohort study from China

ObjectivesTo determine whether microbial contamination of preservation solution (PS) in kidney transplantation is associated with donor-derived infections (DDIs).MethodsWe retrospectively analysed data from 1077 deceased kidney transplant recipients of 560 donors. In all, 1002 PS samples were collected for microbiological assessment to establish the incidence and distribution of contamination. Comparisons between patients with contaminated PS and those with sterile PS were performed to assess the impact of microbial contaminations in perfusate on probable donor-derived infections (p-DDIs), and potential risk factors for p-DDIs were examined.ResultsThe contamination rate of PS was 77.8% (402/517). Bacterial species accounted for 85.6% (887/1036) of the total 1036 isolated microorganisms and 26.5% (275/1002) of the recipients' PS were contaminated by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.). Enterococcus predominated the microbiological pattern. The incidence of infection was significantly higher in patients with microbial contamination than in patients with sterile PS (13.8% (107/776) versus 7.1% (16/226), p 0.006). The prevalence of p-DDIs was significantly higher in patients with ESKAPE contamination than in patients with other bacterial contamination in PS (7.2% (18/251) versus 1.0% (4/405), p 0.000). Univariate analysis indicated that ESKAPE contamination increased the risk of p-DDIs (p 0.001, OR 3.610, 95% CI 1.678–7.764). Multivariate analysis determined ESKAPE contamination as the only independent risk factor associated with p-DDIs (OR 3.418, 95% CI 1.580–7.393).ConclusionsThe high rate of microbial contaminations in PS is unusual and probably due to poor surgical procedures. Patients whose PS are contaminated by ESKAPE pathogens could have a significantly increased risk of p-DDIs at early post-transplantation.     

三七叶的化学成分及其抗氧化活性研究

目的研究三七Panax notoginseng叶乙醇提取物的化学成分及抗氧化活性(ABTS和DPPH)。方法利用硅藻土、硅胶、MCI柱色谱、凝胶柱色谱、中压制备液相色谱和制备液相等色谱技术进行分离纯化,并应用质谱、核磁共振等波谱技术鉴定化合物结构。初步考察了这些化合物的抗氧化能力。结果从三七叶95%乙醇提取物的氯仿、丙酮-乙醇(4∶1)和丙酮-乙醇(1∶1)3个洗脱部位中分离鉴定了15个化合物,分别为falcarinol(1)、γ-tocopherol(2)、(5S)-3α-acetyl-2,3,5-trimethyl-7α-hydroxy-5-(4,8,12-trimethyltridecanyl)-1,3α,5,6,7,7α-hexahydro-4-oxainden-1-one(3)、picrionoside B(4)、linarionoside A(5)、viburnolide A(6)、槲皮素(7)、lilyn(8)、茵芋苷(9)、阿彼斯基姆素(10)、daphnin methylether(11)、20(S)-人参皂苷Rh2(12)、人参皂苷F2(13)、20(R)-人参皂苷Rh2(14)、异人参皂苷Rh3(15)。结论化合物3、6、9~11为首次从人参属植物中分离得到,化合物2、4为首次从该植物中分离得到。化合物2、4、7、8具有较强的抗氧化活性。     

陈霖主任治疗慢性胃炎的临床经验

介绍陈霖主任治疗慢性胃炎的临床经验。陈主任认为慢性胃炎属本虚标实,脾胃气虚、气机郁滞、胃失和降为最基本的病机,治疗上以枳术麦芽汤为基础方再结合辨证论治,处方用药崇尚寒热并用,主张在发作期遵循“甚者独行”的治疗原则,在缓解期遵循“间者并行”的治疗原则,临床疗效显著。