痰热清注射液配伍研究概况

痰热清注射液是由黄芩、熊胆粉、山羊角、金银花、连翘5 味药材单独提取以丙二醇为溶媒制成的一种常用于治疗呼吸系统疾病的中药制剂。近年来,随着痰热清注射液临床应用的不断增加,发现痰热清注射液与一些常用注射剂临床配伍使用时,出现浑浊、沉淀、变色等一系列药液体系不稳定的现象。本文将对痰热清注射液上市至今的配伍禁忌类文献进行总结,为其临床合理配伍提供参考。     

宫腔镜治疗剖宫产术后切口瘢痕处妊娠的临床体会

目的探讨官腔镜治疗剖宫产术后切口瘢痕处妊娠（CSP）的临床应用价值和效果。方法选取本院2009年1月～2013年6月收治的CSP患者80例．所有患者均在B超监测下行官腔镜清宫术和病灶切除术,且术前均联合应用米非司酮和甲氨蝶呤降低B—HCG再行手术。结果患者均顺利完成官腔镜手术,无一例中转开腹,有61例内生型患者,19例外生型患者。术后进行为期3个月的随访,所有患者B—HCG均于3-6周降至正常,且恢复正常的月经周期。结论在米非司酮和甲氨蝶呤预处理的基础上,联合B超监测,对CSP患者行官腔镜手术安全、有效。值得临床推广。     

颈椎桥形连接融合器进行双节段以上椎间融合的效果评价

背景：颈椎前路钢板置入内固定被认为是颈椎前路多节段椎间盘切除和融合的标准治疗,但是,颈前路植入钢板有着很多金属植入物相关并发症的风险。目的：分析和比较使用颈椎桥形连接融合器和Cage椎间融合器±颈椎前路钢板置入内固定进行颈椎前路2节段以上椎问融合的有效性。方法：纳入54例2节段以上颈椎间盘突出接受颈椎前路减压和融合治疗的患者,分别使用颈椎桥形连接融合器进行颈椎前路椎间融合（n=30）和Cage椎间融合器与颈椎前路钢板固定系统进行椎间融合（n=24）。使用日本骨科学会（JOA）量表系统评价临床结果,椎间融合后3,6个月依据X射线检查评价颈椎前凸角、椎体间高度和颈椎融合状态。结果与结论：对桥形连接融合器和Cage椎间融合器组的平均随访时间为6个月。两组患者均获得骨性融合,平均愈合时间为5．5个月。桥形连接融合器组平均JOA评分由治疗前（7．4±0．4）分,提高到治疗后3个月（14．3±0．5）分,治疗后6个月（14．5±0．8）分,Cage椎间融合器组平均JOA评分由治疗前（7．6±0．7）分,提高到治疗后3个月（13．9±±0．4）分,治疗后6个月（14．0±0．6）分,且有显著性差异。治疗后两组的颈椎前凸角和椎间隙高度均较治疗前有显著性改善。说明该植入体植入后能有效恢复颈椎的生理曲度,避免出现螺钉钢板固定并发症,疗效确切。     

The eyes wake up: Screening for benign paroxysmal positional vertigo with polysomnography

ObjectiveWhile positional nystagmus of benign paroxysmal positional vertigo (BPPV) has been shown to be detectable in electrooculography (EOG) tracings of polysomnography (PSG), the frequency of undiagnosed BPPV in patients referred for sleep-wake examination has never been investigated.MethodsProspective evaluation of positional nystagmus in 129 patients, referred to a neurological sleep laboratory for sleep-wake examination with PSG. Both in the evening and morning, patients had diagnostic positioning maneuvers under ongoing EOG-PSG registration, followed by visual inspection of EOG for positional nystagmus.ResultsIn 19 patients (14.7%), we found patterns of positional nystagmus, typically appearing few seconds after changes in head position. In 9 of these patients (47%), the nystagmus was also provoked by the positioning maneuvers. Nystagmus only occurred during wakefulness, not during sleep. In a patient with severe cupulolithiasis, we observed disappearance of nystagmus while entering N1 sleep stage. Nocturnal positional nystagmus was independently associated with positive positioning maneuvers.ConclusionsInspection of EOG-PSG demonstrated that positional nystagmus is common, occurring only when wake, and independently associated with positive positioning maneuvers.SignificanceBy routinely searching for positional nystagmus in PSG, sleep physicians may substantially contribute to the identification of patients with so-far undiagnosed BPPV.     

青少年和成年人嵌甲的病因分析及其改良手术方法探讨

目的:探讨青少年及成年人嵌甲的病因,并对应用彻底切除两侧甲生发层的甲襞成形术治疗嵌甲的有效性进行分析。方法:选择2015年1月-2016年12月笔者医院收治的顽固性嵌甲症患者68例,其中青少年组:36例,成年组:32例;部位:单足第一趾60例,双足第一趾8例;病程最短2个月,最长3年,平均4个月;复发次数最少1次,最多6次,平均3次。分析青少年及成年嵌甲发病原因,并对所有患者采用彻底切除两侧甲生发层的甲襞成形术进行治疗。结果:青少年嵌甲致病原因主要为穿不合适、过紧的鞋子,多汗;成年嵌甲致病原因主要为修剪趾甲不当、创伤性甲损伤。68例患者中,青少年组36例,术后伤口愈合时间(6±1.38)d,成年组32例,术后伤口愈合时间(8±1.68)d。青少年组随访3~24个月,平均19个月,优良率达97.2%,成年组随访2~22个月,平均17个月,优良率达93.8%。术后拇趾外露甲体宽度患侧为(16.36±0.17)mm,术前拇趾外露甲体宽度为(16.58±O.36)mm,术后趾甲形态满意。结论:青少年和成年嵌甲致病主要原因各不相同。彻底切除两侧生发层的甲襞成形术治疗嵌甲效果满意,可获得较好的美观外形。     

南北五味子提取物对大鼠体内环磷酰胺代谢的影响

目的:探讨南北五味子提取物分别对环磷酰胺(CTX)及其代谢产物羧基磷酰胺(CPM)、4-酮基环磷酰胺(4-Keto CTX)、脱氯乙基环磷酰胺(DC-CTX)血浆药动学及尿排泄的影响,从药物相互作用影响环磷酰胺代谢的角度阐明南北五味子的减毒作用机制。方法:采用UHPLC-MS/MS法同时测定大鼠血浆或尿液中CTX及其代谢产物的浓度。将SD大鼠随机分组分别给药分别取样,采集不同时间点血浆样品,绘制药-时曲线,并用DAS2.0软件一室模型拟合药动学参数,使用单因素方差分析法比较组间药动学参数的差异性;采集不同时间段尿液样本,计算待测成分的累积排泄量。结果:CTX单独给药组、合并南五味子提取物(制剂五酯胶囊,WZC,300 mg·kg^-1)给药组,以及合并北五味子醇提物(BWWZ,750 mg·kg^-1)给药组,不同待测物的AUC(μg·h^-1·mL^-1)分别为:CTX:411.818±82.10,483.492±174.49,683.92±91.70;DC-CTX:683.97±91.70,35.95±70.51,8.44±3.96;4-Keto CTX:87.27±38.81,25.78±10.03,17.18±37.2;CPM:99.74±16.18,110.21±57.99,104.90±16.23。Cmax(μg·mL^-1)分别为:CTX:233.41±32.10,255.021±45.90,249.27±17.52;DC-CTX:3.63±1.25,1.21±13.48,1.31±0.72;4-Keto CTX:5.24±1.04,5.34±2.41,2.84±0.81;CPM:25.88±5.26,27.53±8.11,22.42±4.75。48 h内的累积排泄量(μg)分别为:CTX:1 455.36,3 829.16,4 830.69;DC-CTX:2 136.21,921.18,468.87;4-Keto CTX:759.18,1 348.54,338.38;CPM:9 268.06,17 386.18,8 902.05。结论:WZC和BWWZ对CTX的代谢产物DC-CTX的药动学及尿液排泄均有显著影响,均可通过抑制CYP3A4活性使得侧链代谢毒性产物氯乙醛的生成明显降低;结合血浆、尿液中的实验结果可知在血浆中浓度较高的待测物在尿液中排泄也较多,使用WZC和BWWZ均可促进CTX原型和CPM的排泄。     

普鲁卡因静脉滴注联合复方福尔可定口服溶液治疗小婴儿百日咳的临床分析

目的 探讨普鲁卡因静脉滴注联合复方福尔可定口服溶液治疗小婴儿百日咳窒息的临床疗效.方法 选择48例年龄＜3个月的小婴儿百日咳患儿,随机分为治疗组和对照组.治疗组除常规治疗外给予普鲁卡因静脉滴注及口服复方福尔可定口服溶液,观察两组患儿用药2、3、5d时咳嗽及窒息控制情况.结果 治疗组用药后5d症状全部控制,无一例死亡,无一例出现副反应.而对照组有1例因窒息后出现惊厥、心跳停顿死亡,用药后5d仅13例症状全部控制,两组差异有统计学意义（P＜0.05）.结论 静脉滴注普鲁卡因联合复方福尔可定口服溶液治疗小婴儿百日咳痉挛性咳嗽致窒息效果较好,值得临床推广.     

Hydroxysafflor yellow A ameliorates lipopolysaccharide-induced acute lung injury in mice via modulating toll-like receptor 4 signaling pathways

Hydroxysafflor yellow A (HSYA) is a main bio-active compound important of a traditional Chinese medicine named Carthamus tinctorius L. and has been shown to possess various effects, especially anti-inflammatory benefits and potential protections against acute lung injury (ALI) in previous studies. Therefore, in this present study, we aimed to evaluating effects of HSYA on lipopolysaccharide (LPS)-induced ALI in mice. ALI was induced by intratracheal instillation of LPS into lung, and dexamethasone was used as a positive control. Results demonstrated that HSYA abated LPS-induced pathological change and attenuated lung vascular permeability and edema. HSYA down-regulated both the ability of myeloperoxidase (MPO) in lung tissues and levels of inflammatory mediators including tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6 and IFN(interferon)-β in serum. Moreover, HSYA prevented toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and TIR-domain-containing adapter-inducing interferon-β (TRIF) protein up-expressions. In addition, the activations of mitogen-activated protein kinases including p38, extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK) were blocked by HSYA. And also, the phosphorylations of interferon regulatory factor 3 (IRF3), translocation of nuclear factor kappa B (NF-κB)/p65 and inhibitory kappa B (IκB)-α were inhibited by HSYA. In conclusion, HSYA attenuated inflammatory response in ALI mice through inhibition of TLR 4-dependent signaling pathways.     

DPD functional tests in plasma,fresh saliva and dried saliva samples as predictors of 5-fluorouracil exposure and occurrence of drug-related severe toxicity

Objectiveto evaluate plasma and salivary uracil (U) to dihydrouracil (UH2) ratios as tools for predicting 5-fluorouracil systemic exposure and drug-related severe toxicity, and clinically validate the use of dried saliva spots (DSS) as an alternative sampling strategy for dihydropyrimidine dehydrogenase (DPD) deficiency assessment.MethodsPre-chemotherapy plasma, fresh saliva and DSS samples were obtained from gastrointestinal patients (N = 40) for measurement of endogenous U and UH2 concentrations by LC-MS/MS. A second plasma sample collected during 5FU infusion was used for 5FU area under the curve (AUC) determination by HPLC-DAD. Data on toxicity was reported according to CTCAE.Results15% of the patients developed severe 5FU-related toxicity, with neutropenia accounting for 67% of the cases. U, UH2 and [UH2,]/[U] were highly correlated between fresh and dried saliva samples (r_s = 0.960; r_s = 0.828; r_s = 0.910, respectively). 5FU AUC ranged from 11.3 to 37.31 mg h L⁻¹, with 46.2% of under-dosed and 10.3% over-dosed patients. The [UH2]/[U] ratios in plasma, fresh saliva and dried saliva samples were moderately correlated with 5FU AUC and adverse events grade, indicating a partial contribution of the variables to drug exposure (r = −0.412, r_s = −0.373, r_s = 0.377) and toxicity (r = −0.363, r_s = −0.523, r_s = 0.542). Metabolic ratios were lower in patients with severe toxicity (P < .01 salivary ratios, and P < .5 plasma ratios), and 5FU AUC were in average 47% higher in this group than in moderate toxicity. The diagnostic performance of [UH2]/[U] ratios in fresh saliva and DSS for the identification of patients with severe toxicity were comparable.ConclusionsThe [UH2]/[U] metabolic ratios in plasma, fresh saliva and DSS were significantly associated with 5FU systemic exposure and toxicity degree. This study also demonstrated the applicability of DSS as alternative sampling for evaluating DPD activity.