光学相干断层扫描血管成像对玻璃体腔注射雷珠单抗治疗湿性年龄相关性黄斑变性的随访观察

目的 利用光学相干断层扫描血管成像(OCTA)观察雷珠单抗玻璃体腔注射3次+必要时(3+PRN)方案治疗湿性年龄相关性黄斑变性(AMD)的图像特征。方法 选取2016年9月至2017年5月经荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)检查确诊且未予治疗的湿性AMD患者8例8只眼,按照3+PRN治疗方案给予玻璃体腔注射雷珠单抗(0.5 mg/0.05 ml)治疗,采用OCTA 6 mm×6 mm范围模式扫描黄斑区视网膜,在患者治疗前,治疗后1、3、6个月进行规律的门诊随访,记录患者最小分辨角对数(logMAR)矫正视力、脉络膜新生血管(CNV)分型、CNV形态特征及变化、黄斑中心凹视网膜厚度(CRT)、黄斑区视网膜外层血流密度(ORVD)及脉络膜毛细血管层血流密度(CCVD)。结果 男性4例4只眼,女性4例4只眼,平均年龄(70.9±10.6)岁;3只眼为Ⅰ型CNV,5只眼为Ⅱ型CNV。治疗前,治疗后1、3、6个月最佳矫正视力(BCVA)分别为0.55(0.33,0.87)、0.35(0.24,0.84)、0.35(0.22,0.58)、0.26(0.10,0.58)logMAR,各组间差异均无统计学意义(P均>0.05);CRT分别为(271.88±91.95)、(204.00±45.78)、(196.00±31.14)、(219.25±71.32)μm,其中,治疗3个月与治疗前差异有统计学意义(t=2.211,P=0.044);ORVD分别为(41.38±2.77)%、(41.73±3.60)%、(42.53±1.95)%、(41.40±2.33)%,各组间差异均无统计学意义(P均>0.05);CCVD分别为(64.38±2.24)%、(64.96±1.39)%、(64.16±1.39)%、(64.63±1.86)%,各组间差异也均无统计学意义(P均>0.05)。相关性分析结果显示,BCVA与CRT(P=0.009, RR=0.457)和CCVD(P=0.001,RR=0.574)显著相关,与ORVD(P=0.093,RR=0.302)不相关。治疗前CNV形态特征,2只眼为团状,2只眼为线条样,2只眼为纠缠错乱状,1只眼为椭圆环形,1只眼为碎片样。治疗1个月,7只眼CNV形态趋于正常化,表现为CNV最大直径减小、断裂/破碎、周边毛细血管丢失、数量和密度下降、所在区域最大横截面积减小;1只眼CNV形态较前恶化,表现为CNV吻合成环、密度增加、最大血管直径增加。治疗3个月,7只眼CNV形态趋于正常化,1只眼较前无明显变化。治疗6个月,5只眼CNV趋于正常化,3只眼恶化。随访中未发现眼内感染或玻璃体内注射的其他并发症。结论 利用OCTA技术观察CNV特征能够评估湿性AMD患者接受雷珠单抗治疗的疗效,可为湿性AMD患者的治疗与随访提供指导。     

Analysis of Similarities and Differences between Coronavirus Disease 2019 and Severe Acute Respiratory Syndrome

Both coronavirus disease 2019 (COVID?19) and severe acute respiratory syndrome (SARS) are epidemic, contagious, sudden, and publicly harmful diseases. The whole?genome nucleotide identity of the pathogens causing the two diseases reached 79.5%. The mechanism and treatment of COVID?19 are still under investigation. Combining the experiences of SARS prevention and treatment in 2003, and the case data and literature of COVID?19, the similarities and differences between the two diseases in terms of causes, susceptible people, characteristics, dialectical mode, and treatment were analyzed. The two diseases are both plagues in terms of Chinese medicine. The cause of SARS was “heat poison,” and its pathogenesis was “heat poison, stasis, and qi and yin deficiency.” Therefore the treatment regimen was mainly to clear away heat, detoxicate, and expel evil. While the cause of COVID?19 was “wet poison,” and its pathogenesis was “wet, poison, heat, stasis, close, syncope, and yang collapse.” Hence the basic treatment strategy was to declare lung and remove dampness. Treatment of COVID?19 was clearing away evil qi as soon as possible, with the basic treatment regimen, which was declaring lung, removing dampness, and dispelling the evil. Combined with Traditional Chinese medicine’s (TCM’s) understanding and experience in SARS prevention and treatment, and Chinese clinical cured cases, we try to provide strategies for people all over the world to understand and respond to COVID?19, through the analysis and comparison. To improve COVID-19 prevention and treatment regimen and give full play to the advantages of TCM.     

呋塞米注射液在新生儿湿肺中的应用

目的观察呋塞米注射液在新生儿湿肺中的疗效。方法选取2018年1月—2019年12月医院新生儿科收治的新生儿湿肺70例,随机分为试验组35例和对照组35例,二组性别、胎龄、出生体质量、生产方式的差异无统计学意义(P>0.05),试验组在对照组常规治疗的同时加用静注呋塞米注射液0.5 mg/(kg·d),疗程3 d,比较两组平均住院时间、停氧时间、48小时内症状缓解例数。结果平均住院时间:试验组(5.00±1.31)d,对照组(6.06±1.75)d;总用氧时间:试验组(49.04±18.23)h,对照组(63.80±24.11)h;48 h内呼吸症状改善者:试验组24例(68.57%),对照组15例(42.86%),二组比较在平均住院时间、总用氧时间及48小时内症状缓解例数,差异均有统计学意义(P<0.05)。结论呋塞米注射液治疗新生儿湿肺在平均住院时间、总用氧时间和48小时内呼吸症状缓解优于对照组,有一定的疗效。     

Influence of granulation temperature on particle size distribution of granules in twin-screw granulation (TSG)

This study investigated an influence of granulation temperature during twin-screw granulation (TSG) on particle size distributions (PSDs). The influence of the granulation temperature on granule size distributions varied, depending on the liquid to solid (L/S) ratio, the kind of binders, the method of binder addition, and the filler material. The PSD of granules was broad and bimodal at a barrel temperature of 30?°C. Granules size distributions became narrow and second height decreased at high barrel temperature. While the L/S ratio had an effect on the sharpness of granule size distributions, this effect was minor compared to the granulation temperature. Granule size distributions were influenced by binder addition methods. When the binder was added as solution, PSD became broad. In formulations using lactose as filler, PSD became broad and bimodal at 90?°C. Much lactose was dissolved in granulation solution at high temperature, because the solubility of lactose rises significantly with the solution temperature leading to higher effective L/S ratio in the granulator. Hence, granulation was proceeded and large granules were formed. From these results, the granulation temperature is one of important parameters to obtain mono-modal PSD in TSG.     

氟苯尼考纳米结晶的制备及其药剂学性质的考察

目的 增加氟苯尼考(FF) 的水溶性，制备氟苯尼考纳米结晶(FF-NC) 并对其药剂学性质进行体外评价。方法 采 用微型化介质研磨法，以西林瓶为研磨室，氧化锆珠子为研磨介质，磁力搅拌器为动力装置制备FF-NC，以粒径和多分散系数 (PDI) 为指标，正交试验得到的优化处方及工艺参数，进一步放大处方，采用喷雾干燥法固化FF-NC，以差式扫描量热分析，X 射线衍射分析，傅里叶红外光谱分析对所得纳米结晶进行表征，并考察其饱和溶解度及体外累积溶出度。结果 正交试验最优 处方制备得到的FF-NC，其粒径为(189.6±3.44)nm，PDI 为(0.192±0.021)；等比例放大研磨固化，复溶后FF-NC 粒径与喷雾干燥 前基本相同；X 射线衍射图谱和差式扫描量热分析结果均表明氟苯尼考制备成纳米结晶后呈无定型状态；饱和溶解度试验及体 外溶出结果表明制备的FF-NC 的饱和溶解度和体外累积溶出度明显高于FF 原粉。结论 微型化介质研磨法为FF-NC 制备工艺 的筛选提供了简单有效的途径，为放大化制备提供了依据，制备得到的FF-NC 速释、高效，值得进一步研究。     

重点肋骨内固定联合机械通气治疗连枷胸伴创伤性湿肺临床疗效

目的分析重点肋骨内固定联合机械通气治疗连枷胸伴创伤性湿肺的临床效果。 方法选取2014年1月至2015年10月江苏省新沂市人民医院胸心外科收治的连枷胸伴创伤性湿肺患者50例作为研究对象，其中男性35例，女性15例；年龄20~68岁，平均(43.40±2.40)岁。所有患者行重点肋骨内固定术并联合机械通气治疗，术后对比患者治疗前后动脉血气指标变化情况，并详细评估患者治疗前后疼痛和呼吸改善情况。 结果术后患者心率(P)、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)等体征指标及二氧化碳分压(PaCO₂)、动脉血氧分压(PaO₂)、酸碱度(PH)等动脉血气指标均优于术前(P<0.05)；术后所有患者经CT三维成像复查无二次撕裂或移动松脱并发症发生，内固定均牢固。术后疼痛评分及呼吸困难均明显改善。 结论重点肋骨内固定术联合机械通气治疗可改善患者的呼吸循环状况，加速促进患者的康复，值得临床推广使用。     

Influence of processing methods on physico-mechanical properties of Ibuprofen/HPC-SSL formulation

Abstract

The objective of the present study was to investigate the influence of processing methods on the physical and mechanical properties of formulations containing Ibuprofen and HPC-SSL. The powder blends, containing Ibuprofen and HPC-SSL in ratio of 9:0.5, were processed using melt granulation (MG) by hot melt extrusion (HME) and wet granulation (WG) by high shear mixer. Formulated granules and powder blends were compressed into round flat faced tablets using Riva Piccola tablet press. Differential scanning calorimetry (DSC) and X-ray powder diffraction (XRPD) studies proved that granulation process did not significantly alter the crystallinity of Ibuprofen, however, particle density and flow properties were significantly improved. Scanning electron microscopy (SEM) and particle size analysis corroborate with the findings that the flow characteristics of granules from MG were relatively superior to other formulations. Formulations were investigated for out-of-die compaction behaviour using Heckel, Kawakita, and CTC profile analysis. Detailed examination revealed that all three formulations differed in particle size due to the granulation, thus conferring to different compaction behaviour. In WG and MG, granulation offered an increase in particle size resulting in high compressibility along with deformation at low compression pressure. This results into low yield pressure, low yield strength, and higher densification, as compared with dry blend. The current work provides an insight into factors affecting physical and mechanical properties tablets, which can facilitate the rational selection of suitable change in processing method instead of changing excipients.