通窍活血汤治疗脑梗死恢复期气虚血瘀证的疗效观察

目的:观察通窍活血汤在脑梗死恢复期气虚血瘀证治疗中的应用效果。方法:选取2015年6月~2017年10月我院收治的气虚血瘀证型脑梗死恢复期患者92例,随机分为对照组和观察组,各46例。对照组给予常规西医对症治疗,观察组在此基础上加用通窍活血汤治疗,两组均连续治疗2周。比较两组临床疗效。结果:观察组治疗总有效率明显高于对照组(P0.05);治疗前,两组NHISS、BI评分及血清HCY、hs-CRP、Fg水平比较无显著性差异(P0.05);治疗后,观察组NHISS评分及血清HCY、hs-CRP、Fg水平均明显低于对照组,BI评分高于对照组(P0.05);两组复发率比较无显著性差异(P0.05)。结论:通窍活血汤治疗脑梗死恢复期气虚血瘀证效果显著,能够有效改善患者临床症状及体征,促进神经功能恢复,提高患者生活质量。     

复元通络方联合西药治疗气虚血瘀型脑卒中恢复期患者的疗效观察

目的 观察气虚血瘀型脑卒中恢复期患者应用复元通络方联合西药治疗的疗效。方法 选取2020年1月至2022年1月我院收治的92例缺血性脑卒中（CIS）恢复期患者，采用随机数字法分为对照组和观察组各46例。对照组给予常规西药治疗，观察给予以常规西药+复元通络方治疗，均连续治疗4周。结果 观察组临床总有效率高于对照组，差异有统计学意义（P<0.05）。治疗后，观察组中医证候积分积分、神经功能缺损（NIHSS）评分及全血黏度（高切、低切）、血浆黏度较对照组低，观察组Fugl-Meyer运动功能评分（FMA）、Barthel指数（BI）评分高于对照组，差异有统计学意义（P<0.05）；两组未见严重不良反应。结论 在西药基础上，联合复元通络方治疗气虚血瘀型CIS恢复期患者可增强疗效，促进神经功能、运动功能恢复及血液循环，提高日常生活能力。     

化痰活血通络汤加减对缺血性中风恢复期痰瘀阻络证患者临床症状及神经功能的影响

目的:分析化痰活血通络汤加减对缺血性中风恢复期痰瘀阻络证患者临床症状及神经功能的影响。方法:选取我院收治的缺血性中风恢复期痰瘀阻络证患者68例,按抽签顺序分为对照组和观察组,每组34例。对照组实施常规西医和针灸治疗,观察组在对照组基础上加用化痰活血通络汤加减治疗。比较两组美国国立卫生研究院卒中量表(NIHSS)评分、中医证候评分及疗效。结果:治疗后,观察组NIHSS评分和中医证候评分较对照组明显改善,差异有统计学意义(P0.05);观察组治疗效果较对照组明显提高,差异有统计学意义(P0.05)。结论:给予缺血性中风恢复期痰瘀阻络证患者化痰活血通络汤加减治疗,可改善患者临床症状,恢复神经功能。     

益气活血方对气虚血瘀型冠心病同型半胱氨酸、超敏C反应蛋白水平的影响

目的:观察益气活血方对气虚血瘀型冠心病患者临床症状及血同型半胱氨酸(HCY)、超敏C反应蛋白(hsCRP)水平的影响,评估该药物的临床疗效,探讨益气活血方在冠状动脉粥样硬化性心脏病气虚血瘀型患者治疗方面上的价值。方法:将符合纳入标准的60例(气虚血瘀型)CHD患者随机分为对照组、试验组各30例。对照组予以西药常规治疗;试验组在对照组治疗基础上加用益气活血方。4周后对比2组患者用药前后临床症状及HCY、hs-CRP的变化情况,将所得数据进行统计学处理,并进行相关分析讨论。结果:经过4周治疗,试验组西医症状疗效有效率83.33%,对照组为56.67%;试验组中医症候疗效有效率86.67%,对照组为63.33%,差异均有统计学意义。治疗前后2组患者HCY、hs-CRP水平均较治疗前有所降低,试验组降低幅度优于对照组,差异有统计学意义。结论:益气活血方能够有效降低冠心病患者HCY、hs-CRP水平,改善气虚血瘀型冠心病患者的生活质量及治疗效果。     

盐酸多奈哌齐对急性缺血性脑卒中患者的疗效以及对血液流变学及超敏C反应蛋白的影响

目的探讨盐酸多奈哌齐治疗急性缺血性脑卒中的疗效及其对患者血液流变学指标及血清超敏C反应蛋白(hs-CRP)的影响。方法选取急性缺血性脑卒中患者760例,随机分成对照组与观察组,各380例。对照组患者接受急性缺血性脑卒中的常规基础治疗,观察组在此基础上,同时口服盐酸多奈哌齐治疗。比较两组临床疗效,治疗后血液流变指标改善情况,hs-CRP水平变化以及日常生活能力量表(ADL)、美国国立卫生研究院卒中量表(NHISS)、简易精神状态检查表(MMSE)评分等。结果观察组患者治疗总有效率为92.63%,明显高于对照组的76.05%,差异具有统计学意义(P0.01)。治疗后,观察组患者的全血黏度高切、全血黏度低切、血细胞比容、纤维蛋白原及血浆黏度明显低于对照组,差异具有统计学意义(P0.01)。治疗后,观察组患者的hs-CRP浓度明显低于对照组,差异具有统计学意义(P0.01)。治疗后,观察组患者的ADL与NHISS评分明显低于对照组,差异具有统计学意义(P0.01);观察组患者的MMSE评分明显高于对照组,差异具有统计学意义(P0.01)。结论盐酸多奈哌齐治疗急性缺血性脑卒中疗效确切,能够改善患者的血液流变学指标,减轻炎症反应,促进神经功能的恢复。     

小牛血清去蛋白注射液联合依达拉奉治疗缺血性脑卒中的临床效果分析

目的 探讨小牛血清去蛋白注射液联合依达拉奉治疗缺血性脑卒中的临床效果。方法 选取2019年3月～2020年12月在我院接受治疗的缺血性脑卒中患者120例,随机平均分为对照组和观察组各60例。比较两组患者治疗前后神经功能缺损情况与日常生活活动能力;比较两组患者治疗后的临床疗效。结果 治疗前,两组患者的神经功能缺损评分比较,差异无统计学意义(P0.05);治疗后,观察组神经功能缺损评分明显低于对照组,差异有统计学意义(P0.05)。治疗前,两组患者的ADL评分比较,差异无统计学意义(P0.05);治疗后,观察组ADL评分显著高于对照组,差异有统计学意义(P0.05)。观察组治疗总有效率为91.67,显著高于对照组的75.00%,差异有统计学意义(P0.05)。结论 小牛血清去蛋白注射液联合依达拉奉能有效改善缺血性脑卒中患者神经功能缺损和提高患者日常生活活动能力,临床疗效更佳。     

延续护理对缺血性脑卒中病人治疗依从性及生活质量的影响

[目的]探讨延续护理对缺血性脑卒中病人治疗依从性及生活质量的影响。[方法]选取收治的120例缺血性脑卒中病人作为研究对象,抽取60例作为对照组,另根据配对原则抽取60例作为观察组。对照组采取常规护理,观察组在对照组基础上采取延续护理。对比治疗依从性及护理前后病人认知评分、神经功能缺损评分、睡眠质量及生活质量评分。[结果]观察组治疗依从性高于对照组,差异有统计学意义(P0.05)。护理前两组认知评分、神经功能缺损评分、睡眠质量及生活质量评分比较差异无统计学意义(P0.05)。护理后观察组认知评分、生活质量评分优于对照组,神经功能缺损评分、睡眠质量评分低于对照组,差异有统计学意义(P0.05)。[结论]延续护理可有效提高脑卒中病人治疗依从性,保障其预后。     

化痰活血通络汤加减对缺血性中风恢复期痰瘀阻络证患者临床症状及神经功能的影响

[摘要] 目的 分析化痰活血通络汤加减对缺血性中风恢复期痰瘀阻络证患者临床症状及神经功能的影响。方法 选取我院收治的缺血性中风恢复期痰瘀阻络证患者68例,按抽签顺序分为两组,各34例。对照组实施常规西医和针灸治疗,观察组在对照组基础上加用化痰活血通络汤加减治疗。比较两组美国国立卫生研究院卒中量表（NIHSS）评分、中医证候评分及疗效。结果 治疗后,观察组NIHSS评分和中医证候评分较对照组明显改善,差异有统计学意义（P＜0.05）;观察组治疗效果较对照组明显提高,差异有统计学意义（P＜0.05）。结论 给予缺血性中风恢复期痰瘀阻络证患者化痰活血通络汤加减治疗,可改善患者临床症状,恢复神经功能。     

徵调音乐对气虚血瘀型缺血性脑卒中偏瘫患者运动功能的影响

目的:探讨徵调音乐对气虚血瘀型缺血性脑卒中偏瘫患者运动功能的影响。方法:90例气虚血瘀型缺血性脑卒中偏瘫患者按照随机数字表法分为徵调音乐组和常规对照组,每组各45例。常规对照组接受常规治疗与护理,徵调音乐组在对照组基础上聆听徵调音乐每次1 h,每天1次,1周5次,2组治疗时间为4周。治疗前后采用Fugl-Meyer测评量表(FMA)、中医症候分级量化评分标准和临床神经功能缺损程度评分标准对患者进行测评,判定徵调音乐的干预效果。结果:2组治疗后上、下肢Fugl-Meyer评分均提高(P0.05),且徵调音乐组下肢评分提高幅度大于对照组(P0.05)。2组治疗后神经功能缺损评分均下降(P0.05),且徵调音乐组神经功能缺损评分下降幅度大于对照组(P0.05)。2组治疗后中医证候疗效比较,徵调音乐组优于常规对照组(P0.05)。结论:徵调音乐干预可促进气虚血瘀型缺血性脑卒中偏瘫患者下肢运动功能康复,修复缺损的神经功能,改善中医证候,疗效优于常规治疗。     

复元通络汤治疗气虚血瘀证缺血性脑中风的临床疗效观察

目的探讨复元通络汤治疗气虚血瘀证缺血性脑中风的临床疗效。方法选择收治的1200例气虚血瘀证缺血性脑中风患者作为研究对象,采用随机数字表法分为对照组和观察组各600例。对照组采用西药治疗,观察组采用西药+复元通络汤治疗,两组均连续治疗8周。观察两组炎症指标水平及神经功能。结果治疗8周后,观察组白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平均低于对照组,观察组美国国立卫生研究院卒中量表(NIHSS)评分低于对照组,差异有统计学意义(P0.05)。结论复元通络汤联合西药治疗气虚血瘀证缺血性脑中风可使机体炎症反应得到降低,神经功能得到改善,疗效确切,值得推广。     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Activity of amikacin and ampicillin in succession and in combination

One strain each of Escherichia coli and Streptococcus faecalis were exposed to amikacin and ampicillin in combination as well as in succession. Exposure to ampicillin for 1 hr followed by amikacin for 3 or 4 hr had the greatest antibacterial activity when the antibiotics were applied in succession. The least effective exposures for both organisms were 1 hr to amikacin followed by 3 or 4 hr to ampicillin. Exposure to the antibiotics in combination each at 1 MIC had the overall greatest antibacterial activity. Simultaneous exposure to the antibiotic combination does not necessarily mean simultaneous activity of both ampicillin and amikacin on the E. coli. The cell wall autolytic activities produced by ampicillin are triggered within 10 min after physical contact with the bacteria. In contrast, amikacin requires at least 30 min after physical contact to manifest its activity on the ribosome. Although physical exposure to both antibiotics in the combination is simultaneous, the specific activity of each is in fact sequential, with ampicillin acting first. This explains the synergistic effect of the combination. It appears, therefore, that the synergistic or antagonistic affect of a drug combination is determined by the sequence and timing of the antibacterial manifestations of its components.     

纤维支气管镜在儿童咯血诊断与治疗中的应用

目的 评价纤维支气管镜术在儿童咯血病因诊断及治疗中的价值以及安全性.方法 应用用日本产Olympus BF 3c-40纤维支气管镜(最小外径3.6 mm)给58名咯血原因不明的患者行纤维支气管镜检查,并予镜下局部止血治疗.判断出血部位、观察病变情况和出血的原因、临床表现、其他辅助检查、治疗及转归等进行综合分析.结果 引起咯血的主要疾病为气管支气管、肺部的炎症24例(41.3%)、支气管内膜结核12例(20.7%)、支气管异物8例(13.7%)、特发性肺含铁血黄素沉着症7例(12.1%)、支气管扩张4例(6.9%)、心肺血管发育异常1例,原因不明2例.诊断阳性率为96.5%.镜下发现有活动性出血18例,镜下局部止血治疗后显效者10例,有效者8例,有效率为100%.术中并发短暂低氧血症(SaO2＜85%,＜20 s)15例,加大吸氧流量后均改善;术后发热3例均为低热,24 h后热退.结论 纤维支气管镜检查可明确出血部位及原因并可进行局部治疗,且安全的有效.     

Sites of in vivo extraction and interconversion of testosterone and androstenedione in dogs

The interconversion and extraction of testosterone and androstenedione across and within different tissues or areas have been studied by the constant infusion technique. The results were calculated using the (3)H/(14)C ratios and radioactive concentrations of testosterone and androstenedione obtained from afferent and efferent blood and tissues at equilibrium. In each tissue studied, the interconversion between testosterone and androstenedione inside the tissue was significantly higher than the corresponding interconversion across the tissue. The pulmonary contribution to the total interconversion between testosterone and androstenedione was far more important than that of any of the other tissues studied. The hepatic metabolic clearance rates of testosterone and androstenedione were not different from their metabolic clearance rates in the mesenteric area. The extraction of each of these compounds, although not negligible, was lower in the kidney and the femoral bed compared with the extraction in the liver and the mesenteric area. Finally, with the possible exception of the liver, testosterone and androstenedione were more completely metabolized when they originated from the cells than from afferent blood.The evaluation of these different tissue transfer constants provides more precise information concerning the relative importance of different sites in the metabolism of these interconverting hormones.     

Evaluation of aprotinin and tranexamic acid in different in vitro and in vivo models of fibrinolysis, coagulation and thrombus formation

BACKGROUND: The serine protease inhibitor aprotinin and plasminogen inhibitor tranexamic acid are used in coronary artery bypass graft (CABG) surgery to reduce bleeding. Clinicians may consider these agents as readily substitutable regarding their pharmacological profiles. OBJECTIVE: These agents were evaluated in assays of hemostasis to elucidate their underlying mechanism(s) of action. METHODS: In human plasma, effects on both clot fibrinolysis and coagulation were spectrophotometrically quantified in vitro. Rat-tail bleeding and arteriovenous shunt thrombus formation models were conducted in vivo. RESULTS: Fibrinolysis was inhibited by aprotinin (IC(50), 0.16 +/- 0.02 micromol L(-1)) and tranexamic acid (IC(50), 24.1 +/-1.1 micromol L(-1)). In vivo, aprotinin dose-dependently reduced rat-tail bleeding time (minimal effective dose, 3 mg kg(-1) bolus plus 6 mg kg(-1 )h(-1) infusion); tranexamic acid reduced bleeding time (minimal effective dose, 100 mg kg(-1) h(-1)). In vitro, coagulation time was doubled by aprotinin at 3.2 +/- 0.2 micromol L(-1), while tranexamic acid showed no effect at concentrations up to 3 mmol L(-1). Aprotinin inhibited thrombus formation in vivo in a dose-dependent manner (minimal effective dose, 3 mg kg(-1) bolus plus 6 mg kg(-1) h(-1) infusion). Conversely, tranexamic acid dose-dependently increased thrombus formation and thrombus weight (minimal effective dose, 100 mg kg(-1 )h(-1) infusion). CONCLUSIONS: These data show that aprotinin and tranexamic acid have differential effects on hemostasis and are not necessarily substitutable with respect to mechanism of action. Although both agents have been shown to reduce bleeding in patients undergoing CABG, their divergent effects on thrombus formation observed in vitro and in vivo should be critically evaluated clinically.     

Noradrenaline and Adrenaline in Blood and Urine in a Case of Phaeochromocytoma

A case of phaeochromocytoma is described in which X-ray investigation and pharmacodynamical tests with tetraethyl-ammonium and Regitin were non-informative. The diagnosis was established by the increased excretion of catechols with the urine (1010–2400 μg noradrenaline and 16–19 μg adrenaline per 24-hour period).

Estimation of catechols in samples of the blood and of the urine from the same period showed an average blood level of 3.6 μg/100 ml noradrenaline and a corresponding urinary output of 110 μg per hour.

The high systolic and diastolic blood pressure, the electrocardiographic changes, the increased basal metabolic rate, the response to the glucose tolerance test, sweating, eosinopenia and fatigue are explained as symptoms and signs of hypernoradrenalinemia.

Biological estimation of the catechols in the tumor, which weighed 40 g, showed 590 μg/g noradrenaline and 12 μg/g adrenaline.

After operation the blood pressure and the level of the urinary catechols returned to normal.     

Population pharmacokinetics and pharmacogenetics of alcohol in Chinese and Indians in Singapore

What is known and Objective:  Interindividual variability in alcohol pharmacokinetics is influenced by a number of factors, including polymorphisms in genes mediating alcohol pharmacology, ethnicity, sex and body size. Several studies have evaluated the population pharmacokinetics of alcohol from breath alcohol measures. None of these studies, however, have evaluated ethnicity and alcohol‐metabolizing enzyme genotypes as covariates in their population pharmacokinetic modelling. We aimed to develop a population pharmacokinetic model using clinical and genetic factors and to identify covariates that influenced interindividual variability in alcohol clearance and volume of distribution. Methods:  Hundred and eighty healthy subjects (90 Chinese and 90 Indians; 45 males and 45 females from each ethnic group) ingested a vodka–orange juice mixture to simulate social drinking. Subjects were genotyped for the ADH1B (Arg48His), ALDH2 (Glu504Lys) and CYP2E1 (c.‐1293G>C and c.‐1053C>T) polymorphisms. A base pharmacokinetic model was developed using the nonmem software (NONMEM Project Group, University of California, San Francisco, San Francisco, CA, USA) to determine the alcohol clearance and volume of distribution. The model was extended to include covariates that influenced the between‐subject variability. Results and Discussion:  Body weight and sex significantly influenced absorption rate and volume of distribution of alcohol. Body weight and ADH1B Arg48His polymorphism significantly influenced alcohol clearance. The Michaelis–Menten elimination rate (V_max) was decreased by 10% in homozygous ADH1B*1/*1 subjects. Ethnicity was not determined to be a significant covariate in the final population pharmacokinetic model. What is new and Conclusion:  Gender and body weight were covariates that contributed most to explaining the observed interindividual alcohol pharmacokinetic variability. Of the four SNPs examined in this study, only ADH1B Arg48His polymorphism had a significant, though modest, effect on the pharmacokinetics of alcohol.     

Safety and efficacy of linezolid in 16 infants and children in Japan

Linezolid, an oxazolidinone antibiotic, exhibits a broad spectrum of activity against Gram-positive bacteria. It has been licensed for adult use in Japan since 2006 for MRSA infections, and has also been used off-label for pediatric patients. At our university hospital, a total of 16 infants and children (including one non-Japanese Asian) were administered linezolid owing to infection with multidrug-resistant Gram-positive bacteria, after consent had been provided. All patients had severe underlying diseases or indications for surgery. Eighty-eight percent of the causal microorganisms were methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant coagulase-negative Staphylococcus and all were sensitive to linezolid. Linezolid was administered because the antecedent anti-MRSA medications were ineffective or contraindicated, or intravenous-to-oral switch therapy was requested owing to cardiac or orthopedic surgical-site infections. The median duration of administration was 13 days (range 3-31 days). The overall efficacy was 91 % (10/11) in those for whom efficacy could be evaluated. Only two patients (both teen-aged) encountered linezolid-related adverse effects (13 %, 2/16). One patient showed elevation of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]), requiring that administration be withdrawn, but enzyme levels returned to normal after the patient had been switched to vancomycin. The other patient showed transiently decreased platelet counts. Linezolid is considered generally safe and effective for children in Japan, especially for those who cannot use other anti-MRSA medications or those who require oral antibiotics for infections with multidrug-resistant Gram-positive bacteria.