大鼠BPDE-DNA加合物生成及其高效液相色谱测定

目的研究苯并（a）芘（BaP）诱导大鼠产生（7R，8S）-二羟基-（9S，10R）-环氧-7，8，9，10-四氢苯并（a）芘（BPDE）-DNA加合物的生成。建立以血液为样品的检测染毒大鼠BPDE-DNA加合物的高效液相色谱法。方法选用清洁级SD大鼠，一次性腹腔注射苯并（a）芘二甲基亚砜溶液（以1％羧甲基纤维素钠为助溶剂）100mg／kg，5h后取股静脉血。提取抗凝全血中的DNA，采用琼脂糖凝胶电泳确认DNA的提取效果。将提取的DNA在0．1nmol／L HCl、90℃恒温水浴箱中酸水解4h，乙酸乙酯提取酸水解产物——四醇-苯并（a）芘，高效液相色谱法检测，最后用高效液相色谱-质谱法确认。结果BaP染毒组与溶剂对照组和阴性对照组比较，高效液相色谱检测有新的色谱峰产生，质谱确定其相对分子质量与四醇-苯并（a）芘一致。结论本实验的染毒方法能使大鼠产生BPDE-DNA加合物；建立的高效液相色谱法可以血液为样品检测BPDE-DNA加合物。     

高效液相色谱法测定人血清中胺碘酮的浓度

【目的】采用高效液相色谱法建立和改良测定人血清中胺碘酮的方法学。【方法】色谱柱：shim—packvp—ODS柱（150mm×4．6mm,5μm）。流动相为甲醇：乙腈：乙酸铵缓冲液=45：45：10（v／v／v）,流速1．0ml／min,检测波长242nln。最低检出限为0．125μg／ml。【结果】纯甲醇色谱峰出现在进样后1．809 min,AD标准品色谱峰出现在进样后10．421 min。以峰面积与标准浓度做回归,得回归方程Y=2．67049×10^-6 X-0．1619,r=0．962（n=10）。线性范围为：0．125—4 μg/ml。日内变异系数为2．1％～5．1％,日间变异系数为3．2％-7．9％。【结论】此法是较为简便可行的检测血清胺碘酮浓度的方法。     

骨宁颗粒质量标准研究

【目的】建立骨宁颗粒质量标准。【方法】采用薄层色谱法对骨宁颗粒中白芍、葛根、威灵仙进行定性鉴别,并用高效液相色谱法对芍药苷的含量进行测定。色谱柱填充剂：十八烷基硅烷健合硅胶;流动相：乙腈-0．1％磷酸溶液（14：86,v／v）;流速：1．0ml／min;检测波长：230nm;柱温：30℃。【结果】薄层色谱分离清晰,阴性无干扰;芍药苷在0．4028—2．016μg范围内与峰面积有良好线性关系,r=0．9996,芍药苷的平均回收率为99．15％,RSD％=0．90％（n=6）。【结论】该方法专属性强,灵敏度高,重复性好,可用于骨宁颗粒的质量控制。     

RP—HPLC法测定粉针剂中两头尖皂苷D的含量

【目的】建立测定注射用粉针剂中两头尖皂苷D含量的反相高效液相色谱法。【方法】采用Hypersil ODS色谱柱（4．6mm×200mm,5μm）,流动相甲醇-水（80：20）,流速1．0ml／min,检测波长206nm。【结果】两头尖皂苷D进样量在2．4—12．0μg范围内线性关系良好。平均回收率为99．34％,RSD为1．41％。【结论】本法简便快速准确,可作为注射用ASD的质量控制方法。     

凝胶色谱净化-高效液相色谱法测定油炸面制品中苯并（a）芘

目的建立油炸面制品中苯并（a）芘的测定方法。方法样品经石油醚（沸程30℃～60℃）浸提油脂,乙酸乙酯＋环己烷（1：1）溶解,凝胶色谱（GPC）净化,溶剂转换浓缩后采用高效液相色谱法C18柱分离,以乙腈：水（95：5）作为流动相,流速1．0ml／min,检测器激发波长290nm、发射波长430nm进行检测,外标法定量。结果苯并（a）芘标准曲线在0．10—10．0μg／L范围内呈线性关系,r=0．999,回收率为90．0％-93．7％,相对标准偏差（RSD）均小于4％,方法检出限0．1μg／kg。结论该测定方法具有前处理简单、快速、准确、灵敏度高等优点,可适用于油炸面制品样品苯并（a）芘的测定。     

HPLC法测定妇康宝口服液中芍药苷的含量

【目的】建立HPLC法测定妇康宝口服液中芍药苷的含量。【方法】采用C18色谱柱（250mm×4．6mm,5μm）,甲醇-0．05％磷酸二氢钾溶液（26：74）为流动相,检测波长243nm,流速1．0ml／min,柱温为30℃。【结果】芍药苷在0．04～0．4μg范围内具有良好的线性关系（r=0．9998）,平均回收率为99．38％,RSD为1．96％（n=6）。【结论】该方法简便、快速、准确,可作为妇康宝口服液的质量控制方法。     

紫外分光光度法测定注射用甘氨双唑钠的含量

【目的】采用紫外分光光度法测定注射用甘氨双唑钠的含量。【方法】采用紫外分光光度法在319nm处测定甘氨双唑钠的含量，8h内考察其稳定性。【结果】甘氨双唑钠在5．5～27．5μg／ml浓度范围内与吸收度呈良好线性关系（r=0．9999），在8h内稳定性良好，平均回收率为100．4％，RSD为1．93％（n=9）。【结论】用紫外分光光度法测定注射用甘氨双唑钠的含量操作简便，结果准确。     

高效液相色谱法测定不同产地续断药材中木通皂苷D的含量

【目的】考察不同来源续断药材中木通皂苷D的含量,为评价续断药材质量提供参考。【方法】采用反相高效液相色谱法测定续断药材中木通皂苷D的含量,色谱柱KromasilC18柱（250mm×4．6mm,5μm）,流动相为乙腈-水梯度洗脱,检测波长212nm,流速为1．0ml／min。【结果】在实验条件下木通皂苷D分离效果良好,0．036～3．695μg范围内其线性关系良好（r=0．9999）;平均加样回收率为104．87％,RSD为1．85％。【结论】该方法准确、可靠,为续断药材的质量评价提供研究基础。     

RP-HPLC法测定开心散中人参皂苷Rg1和Re的含量

【目的】建立高效液相色谱法（RP-HPLC）测定开心散中有效成分人参皂苷Rg1和Re含量的方法。【方法】采用Eclipse XDB-C18色谱柱（4．6×250mm，5μm），美国Agilent公司；流动相：乙腈-0．05％磷酸水（19：81）；流速：1．0ml／min；柱温：25℃；检测波长：203nm。【结果】人参皂苷Rg1在0．0011～0．0176mg呈良好线性关系（r=0．9999，n=5），平均回收率为96．07％，RSD为0．77％（n=3）；人参皂苷Re在0．0005～0．0080mg呈良好线性关系（r=0．9999，n=5），平均回收率为98．98％，RSD为1．46％（n=3）。【结论】用本法测定开心散中人参皂苷含量，操作简便，结果准确，且可同时对人参皂苷Rg1及Re进行测定。此法可作为开心散有效部位的质量控制方法之一。     

反相高效液相色谱法测定人尿拉米夫定浓度

目的建立测定人体口服阿米洛利尿液中含量的方法。方法采用RP-HPLC法,色谱条件为GeminiC18柱（250mm×4．6mm,5μm）;流动相0．02mol／L磷酸盐缓冲液-甲醇（90：10）;流速1．0ml／min;检测波长274nm;柱温30℃。结果拉米夫定在0．0067mg／ml-0．0733mg／ml浓度范围内线性关系良好（r=0．9997）,加样回收率分别为96．00％、94．00％、97．67％,RSD为1．91％（n=5）。结论该方法能灵敏、准确的测定尿液中拉米夫定的含量。     

Serologic evidence of Chlamydia trachomatis infection and risk of preterm birth.

OBJECTIVE: To determine whether serologic evidence of Chlamydia trachomatis during pregnancy is a risk factor for preterm delivery (before 37 weeks' gestation). DESIGN: Chart review. SETTING: Antenatal clinics associated with a teaching hospital. PATIENTS: A group of 103 unselected consecutive patients presenting for routine prenatal care. OUTCOME MEASURES: Pregnancy outcome and C. trachomatis serologic status. RESULTS: A total of 21 women (20%) were found to be seropositive for IgG antibodies to C. trachomatis. They were similar to the seronegative women with respect to maternal age, parity, history of preterm birth, obstetric or medical problems, smoking status, history of drug abuse, educational status and psychosocial stressors. The seropositive women were significantly more likely than the seronegative women to have a preterm birth (24% [5/21] v. 7% [6/82]i p = 0.029, odds ratio 3.96, 95% confidence interval 1.08 to 14.57), an infant with a lower mean gestational age at birth (262 [standard deviation (SD) 19] days v. 273 [SD 15] days; p = 0.0052) and an infant with a lower mean birth weight (3125 [SD 692] g v. 3473 [SD 696] g; p = 0.0434). The positive predictive value of a seropositive result for preterm birth was 31% (5/16); the negative predictive value of a seronegative result for preterm birth was 8% (6/76). CONCLUSION: Women with serologic evidence of C. trachomatis may be at risk for preterm birth. Further study is required to determine whether serologic testing for C. trachomatis should be a routine part of prenatal care.     

A comparison of buprenorphine treatment in clinic and primary care settings: a randomised trial

OBJECTIVE: To compare outcomes, costs and incremental cost-effectiveness of heroin detoxification performed in a specialist clinic and in general practice. DESIGN AND SETTING: Randomised controlled trial set in a specialist outpatient drug treatment centre and six office-based general practices in inner city Sydney, Australia. PARTICIPANTS: 115 people seeking treatment for heroin dependence, of whom 97 (84%) were reinterviewed at Day 8, and 78 (68%) at Day 91. INTERVENTIONS: Participants were randomly allocated to primary care or a specialist clinic, and received buprenorphine for 5 days for detoxification, then were offered either maintenance therapy with methadone or buprenorphine, relapse prevention with naltrexone, or counselling alone. MAIN OUTCOME MEASURES: Completion of detoxification, engagement in post-detoxification treatment, and heroin use assessed at Days 8 and 91. Costs relevant to providing treatment, including staff time, medication use and diagnostic procedures, with abstinence from heroin use on Day 8 as the primary outcome measure. RESULTS: There were no significant differences in the proportions completing detoxification (40/56 [71%] primary care v 46/59 [78%] clinic), participating in postwithdrawal treatment (28/56 [50%] primary care v 36/59 [61%] clinic), reporting no opiate use during the withdrawal period (13/56 [23%] primary care v 13/59 [22%] clinic), and in duration of postwithdrawal treatment by survival analysis. Most participants in both groups entered postwithdrawal buprenorphine maintenance. On an intention-to-treat basis, self-reported heroin use in the month before the Day 91 interview was significantly lower than at baseline (27 days/month at baseline, 14 days/month at Day 91; P < 0.001) and did not differ between groups. Buprenorphine detoxification in primary care was estimated to be $24 more expensive per patient than treatment at the clinic. The incremental cost-effectiveness ratio reveals that, in this context, it costs $20 to achieve a 1% improvement in outcome in primary care. CONCLUSIONS: Buprenorphine-assisted detoxification from heroin in specialist clinic and primary care settings had similar efficacy and cost-effectiveness. Buprenorphine treatment can be initiated safely in primary care settings by trained GPs.     

Determinants of hospital admission among HIV-positive people in British Columbia

BACKGROUND: This study was initiated to evaluate the demographic and clinical determinants of admission to hospital among HIV-positive men and women receiving antiretroviral therapy in British Columbia. METHODS: The analysis was restricted to participants enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and March 1997 who had completed an annual participant survey, had a viral load determination and had signed a consent form allowing electronic access to their inpatient hospital records. A record linkage was conducted with the BC Ministry of Health to obtain all records of hospital admissions from April 1991 to March 1997. Statistical analyses were carried out using parametric and nonparametric methods and multivariate logistic analyses. RESULTS: The study sample comprised 947 participants (859 men, 88 women). Of these, 165 (17%) were admitted to hospital during the study period from May 1, 1996, to Mar. 31, 1997. The median number of admissions was 1 (interquartile range [IQR] 1-2 admissions), and the median length of stay per admission was 3 days (IQR 1-8 days). Admission to hospital was associated with being unemployed (82% of those admitted v. 58% of those not admitted), being an injection drug user (24% v. 17%), reporting a fair or poor health status (46% v. 29%) and having a physician experienced in the management of HIV/AIDS (31% v. 24%). Examination of clinical determinants demonstrated that hospital admission was associated with a previous admission (72% v. 46%), a high viral load (median 74,000 v. 14,000 HIV-1 RNA copies/mL), a low CD4 count (median 0.16 v. 0.27 x 10(9)/L) and an AIDS diagnosis (44% v. 24%). Multivariate logistic regression analysis revealed that being admitted to hospital was independently associated with being unemployed (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.66-4.20), having been previously admitted to hospital (OR 2.30, 95% CI 1.53-3.46), having a high viral load at baseline (OR 1.45, 95% CI 1.16-1.80), being an injection drug user (OR 1.63, 95% CI 1.02-2.62) and having an experienced physician (OR 1.98, 95% CI 1.29-3.03). INTERPRETATION: Hospital admission among participants in this study was found to be associated with marginalization and poor health status.     

High bone turnover in Muslim women with vitamin D deficiency

OBJECTIVE: To measure bone turnover in Muslim women with vitamin D deficiency. DESIGN: A cross-sectional study of a random sample of Muslim women aged 20-65 years, evaluated over a 6-month period from November 1999 to April 2000. SETTING AND PARTICIPANTS: 146 women living in an urban community in south-western Sydney with adequate opportunities for sun exposure. MAIN OUTCOME MEASURES: Bone turnover as measured by urinary deoxypyridinoline (DPYD) excretion rates; and vitamin D status as determined by 25-hydroxyvitamin D (25OHD) levels, serum calcium levels and parathyroid hormone (PTH) concentrations. RESULTS: We analysed data on 119 Muslim women (mean [SEM] age, 46.6 [1.1] years) who met the inclusion criteria. There were 81 (68.1%) women with serum 25OHD levels < 30 nmol/L (defined as "severe" vitamin D deficiency). Fifty-five (46.2%) women had evidence of high bone turnover (urinary DPYD excretion > 6.5 nmol/mmol creatinine). The women with "severe" vitamin D deficiency had significantly higher serum PTH levels (7.3 [0.3] v 5.4 [0.5] pmol/L; P = 0.001) and higher urinary DPYD excretion (7.2 [0.3] v 5.4 [0.2] nmol/mmol creatinine; P = 0.003) than women with serum 25OHD levels > or= 30 nmol/L. No significant differences were seen in their ages, menopausal status or serum calcium and phosphate measurements. The risk of developing high bone turnover was significantly greater in the women with "severe" vitamin D deficiency (relative risk = 5.52; 95% CI, 2-14.8; chi(2 )= 12.95; P = 0.0003). CONCLUSION: High bone turnover occurs in Muslim women with vitamin D deficiency.     

参血胶囊中人参皂苷Rb1、Re、Rg1含量的测定

[目的]建立高效液相色谱法测定参血胶囊中人参皂苷Rb1、Re、Rg1含量测定方法。[方法]采用HP1100高效液相色谱仪(包括G1314A可变波长紫外检测器,HP化学工作站,G1322A真空脱气机,HP1100四元泵),ZORBAX SB-C18柱(4.6mm×250mm,5μm)。人参皂苷Rb1流动相:乙腈-水(30∶70);人参皂苷Re、Rg1流动相:乙腈-水(20∶80)。紫外检测波长:203nm,流速:1.0ml/min,进样量10μl。[结果]人参皂苷Rb1在0.752μg～9.4μg范围内呈现良好的线性关系,平均回收率为101.2%(n=6)。人参皂苷Rg1在0.408μg～3.4μg范围内呈现良好的线性关系,平均回收率为99.2%(n=6)人参皂苷Re在0.576μg～3.6μg范围内呈现良好的线性关系,平均回收率为99.7%(n=6)。人参皂苷Rb1、Rg1和Re日内精密度(n=6)RSD分别为0.92%、0.60%及0.78%;人参皂苷Rb1、Rg1和Re日间精密度(n=5)RSD分别为1.20%、0.96%及1.27%。[结论]该法简便、准确、具有专属性,可用于测定参血胶囊中人参皂苷Rb1、Re、Rg1的含量。     

Autologous versus allogeneic transfusion: patients'' perceptions and experiences

BACKGROUND: Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion. METHODS: To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases. RESULTS: A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery). INTERPRETATION: Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate.     

Outcome of critically ill patients undergoing interhospital transfer

OBJECTIVE: To quantify the morbidity and mortality associated with acute interhospital transfer of critically ill patients requiring intensive care (ICU) services. DESIGN: Three-year (1 July 1996-30 June 1999) retrospective case-control study based on review of patients' medical records. SETTING: Metropolitan hospitals in Melbourne, Victoria. PARTICIPANTS: 73 (of 75) consecutive, critically ill patients from one metropolitan teaching hospital who were transferred to other hospitals because ICU services were not available. OUTCOME MEASURES: Primary endpoints included inhospital mortality and length of stay in ICU and hospital. Secondary endpoints included time from study entry to ICU admission and the change in predicted mortality risk after resuscitation and transfer to ICU (inter- or intrahospital transfer). RESULTS: The Transfer Group experienced a significant delay in admission to ICU (5.0 [4.0-6.0] v 3.0 [2.0-5.5] hours; P=0.001), and a longer stay in ICU (48 [33-111] v 44 [25-78] hours; P=0.04), and hospital (10 [3-14] v 6 [3-13] days; P=0.02). Hospital mortality in the Transfer Group (24.7%) was not statistically different from that in the Control Group (17.8%; P= 0.41; OR, 1.5; 95% CI, 0.68-3.4). CONCLUSION: Acute interhospital transfer is associated with a delay in ICU admission and a longer stay in ICU and hospital, but no statistically significant difference in mortality. A study of over 300 patient transfers would be required to clarify the morbidity and mortality risk of acute interhospital transfer.     

Ovarian cancer: patterns of care in Victoria during 1993-1995

OBJECTIVE: To describe the management of and outcomes in patients with newly diagnosed ovarian cancer during 1993, 1994 and 1995 in Victoria. DESIGN AND SETTING: Retrospective cohort study conducted by surveying doctors involved in managing incident ovarian cancer cases identified from the population-based Victorian Cancer Registry. The survey was conducted in 1997 and the cohort was followed up until the end of 1999 to obtain at least four years of follow-up data on all patients. PATIENTS: All women with invasive epithelial ovarian cancer diagnosed during 1993, 1994 and 1995. MAIN OUTCOME MEASURES: Reported management in terms of staging, treatment and survival. RESULTS: Management details were obtained for 84.5% (562/665) of eligible patients. Median age at diagnosis was 66 years (range, 22-98 years). Surgery was the primary therapy in 77.2% of women (434/562). Only one in three women had adequate surgery, which was less likely to be performed by general gynaecologists and general surgeons than gynaecological oncologists (21.3% [35/164] v 13.3% [8/60] v 52% [105/202]). After surgery 78.6% of women (341/434) received chemotherapy, usually with platinum-based regimens. The overall five-year relative survival was 46% for women treated surgically; poor survival was related to increasing age, later tumour stage, presence of ascites, residual disease > 2 cm and poorer histological differentiation of the tumour. CONCLUSIONS: For optimal care a preoperative carcinoma antigen (CA)-125 assay, chest x-ray and pelvic ultrasound should be performed, and early referral to a multi-disciplinary unit for definitive surgery is advised. Every effort should be made to adequately stage or debulk the tumour. Women with high-risk early-stage and advanced disease should be considered for platinum-based chemotherapy.     

Stress debriefing after childbirth: a randomised controlled trial

OBJECTIVE: To test whether critical incident stress debriefing after childbirth reduces the incidence of postnatal psychological disorders. DESIGN: Randomised single-blind controlled trial stratified for parity and delivery mode. SETTING: Two large maternity hospitals in Perth. PARTICIPANTS: 1745 women who delivered healthy term infants between April 1996 and December 1997 (875 allocated to intervention and 870 to control group). INTERVENTION: An individual, standardised debriefing session based on the principles of critical incident stress debriefing carried out within 72 hours of delivery. MAIN OUTCOME MEASURES: Diagnosis of stress disorders or depression in the 12 months postpartum, using structured psychological interview and criteria of the Diagnostic and statistical manual of mental disorders, 4th edition. RESULTS: Follow-up information was available for 1730 women (99.1%), 482 of whom underwent psychological interview. There were no significant differences between control and intervention groups in scores on Impact of Events or Edinburgh Postnatal Depression Scales at 2, 6 or 12 months postpartum, or in proportions of women who met diagnostic criteria for a stress disorder (intervention, 0.6% v control, 0.8%; P = 0.58) or major or minor depression (intervention, 17.8% v control, 18.2%; relative risk [95% CI], 0.99 [0.87-1.11]) during the postpartum year. Nor were there differences in median time to onset of depression (intervention, 6 [interquartile range, 4-9] weeks v control, 4 [3-8] weeks; P = 0.84), or duration of depression (intervention, 24 [12-46] weeks v control, 22 [10-52] weeks; P = 0.98). CONCLUSIONS: There is a high prevalence of depression in women during the first year after childbirth. A session of midwife-led, critical incident stress debriefing was not effective in preventing postnatal psychological disorders, but had no adverse effects.