雷公藤甲素大鼠在体肠吸收特性研究

目的 考察雷公藤甲素在大鼠肠道的吸收情况,为其安全合理应用提供生物药剂学依据。方法 采用大鼠在体肠灌流实验,利用超高效液相色谱 (UPLC) 法测定雷公藤甲素的量,分别研究吸收部位和药物浓度对雷公藤甲素吸收的影响。结果 4、8.3、20 μmol/L 雷公藤甲素灌流液在各肠段的有效渗透系数 (P_eff^*) 和 10 cm 肠段吸收百分比 (10 cm % ABS) 依次为十二指肠＞结肠＞空肠＞回肠,各肠段之间无显著性差异 (P＞0.05)。不同质量浓度 (4～20 μmol/L) 的雷公藤甲素在肠道内的吸收无显著性差异 (P＞0.05)。结论 雷公藤甲素在大鼠肠道内有较好的肠吸收,对肠段无明显的吸收部位选择性,一定范围内的药物浓度对雷公藤甲素的 P_eff^* 和 10 cm% ABS 无影响,初步判断其吸收机制为被动扩散。     

单向灌流法研究阿奇霉素泡囊的大鼠在体肠吸收

目的 研究阿奇霉素泡囊的大鼠在体肠吸收性质。方法 选择健康SD雄性大鼠6只,分为2组,运用单向灌流模型考察大鼠的十二指肠、空肠、回肠以及结肠在灌流速度为0.2 mL/min以及灌流时间为1 h条件下的药物吸收情况。采用HPLC法对药物的质量浓度进行检测,并计算其吸收速率常数（K_a）及有效渗透率（P_eff）。结果 阿奇霉素泡囊在十二指肠、空肠、回肠以及结肠的K_a和P_eff分别是阿奇霉素的2.41、2.35、2.54、2.95倍和2.34、1.47、2.20、1.40倍,差异均有统计学意义（P<0.05）。结论 阿奇霉素泡囊能明显改善药物在体肠吸收。     

实时直接分析-串联质谱法快速分析乳香中多种乳香酸

目的 应用实时直接分析-串联质谱法（DART-MS/MS）在未经前处理和色谱分离的情况下快速鉴别乳香中乳香酸类成分。方法 使用全扫描采集乳香的DART-MS特征图谱,并对乳香酸类成分进行二级质谱确证。结果 药材和提取液的负模式全扫描质谱图中可见11-羰基-β-乙酰乳香酸（m/z 511）、11-羰基-β-乳香酸（m/z 469）、α及β-乳香酸（m/z 455）、α及β-乙酰乳香酸（m/z 497）等成分的 [M－H]^? 离子,正模式质谱图中可见11-羰基-β-乙酰乳香酸（m/z 513）和11-羰基-β-乳香酸（m/z 471）的 [M＋H]^＋ 离子,提取液中的正离子m/z 513和m/z 471的CID二级图谱分别与11-羰基-β-乙酰乳香酸和11-羰基-β-乳香酸对照品的一致。结论 本法简便、专属性强,为药材、饮片的快速鉴别提供了新思路,具有实用价值。     

金莲花化学成分的HPLC-MS表征分析与鉴定

目的 探讨金莲花Trollius chinensis成分的化学表征,为完善其质量标准和鉴定特征提供科学依据。方法 采取HPLC-MS分析法。Hypersil ODS2（250 mm×4.6 mm,5 μm）色谱柱,流动相为乙腈-0.6%磷酸水,梯度洗脱,体积流量为1.2 mL/min,检测波长为345 nm,离子源为ESI(－)。结果 中药金莲花化学组分的保留时间、分子离子峰（m/z）和碎片信息表征明显,重要化学成分为荭草苷（m/z 446.7 [M－H]^?）、牡荆苷（m/z 430.8 [M－H]^?）和荭草素-2″-O-β-L-半乳糖苷（m/z 608.9 [M－H]^?）等。结论 金莲花化学成分的HPLC-MS表征可以作为其鉴定特征。     

液质联用技术鉴定预知子提取物中的主要化学成分

目的 建立分析鉴定预知子提取物中的主要化学成分的方法。方法 采用LC-ESI-MS负离子检测模式对预知子中的皂苷类成分进行分析,对其进行多级质谱裂解分析。以对照品及文献数据为对照,通过对各成分的MS²和MS³谱图的解析对各成分进行指认。结果 预知子中的17个皂苷类成分获得了良好的分离和鉴定。结论 本方法准确快速,适合预知子中主要化学成分的鉴定,可用于预知子原药材的质量控制。     

LC-MS法测定人血浆中人参三醇二琥珀酸酯钠含量的方法学研究

目的：建立测定人血浆中人参三醇二琥珀酸酯钠的液相色谱-质谱联用法。方法：色谱柱为Shimadzu VP-C₁₈柱（150 mm×2.0 mm,5 μm）; 乙腈-10 mmol/L乙酸铵水溶液（55∶45）为流动相,体积流量0.3 mL/min;柱温40 ℃;内标物吲达帕胺。质谱条件为电喷雾离子源（ESI）,选择负离子提取方式检测,人参三醇二琥珀酸酯钠和吲达帕胺的选择检测离子分别为m/z 675.5（[M-Na+H] ⁺）、m/z 364.1（[M+H] ⁺ ）。结果：人参三醇二琥珀酸酯钠线性范围为0.030 4～101.3 μg/mL,定量下限为0.030 4 μg/mL。准确度、精密度以及稳定性均符合有关要求。结论：本方法专属性强,灵敏度高,适用于人血浆中人参三醇二琥珀酸酯钠的药代动力学研究。     

基于准确相对分子质量和多级质谱技术的LC-MS方法鉴定麦冬醇提液中高异黄酮类成分

目的 建立一种基于准确相对分子质量和多级质谱技术相结合的LC-MS方法,对麦冬醇提液中的高异黄酮类成分进行鉴定。方法 色谱分离采用Alltima C₁₈色谱柱（250 mm×4.6 mm,5 μm）,Alltech保护柱,流动相组成为1 mmol/L乙酸铵水溶液-0.01%乙酸乙腈,梯度洗脱,体积流量为1.0 mL/min,检测波长为298 nm;质谱定性采用飞行时间质谱（TOF/MS）结合离子阱多级质谱（Trap/MSⁿ）,负离子模式扫描。结果 在麦冬醇提液中,采用TOF/MS筛查出11种成分的分子式,采用Trap/MSⁿ共鉴定出11种成分,并对各峰进行归属。结论 两种质谱联用能快速鉴定药材成分,为中药复方复杂体系分析提供了一种有效、可靠的分析模式。     

姜黄素磷脂复合物在大鼠体内的药代动力学评价

目的 通过对大鼠口服灌胃给药,评价姜黄素磷脂复合物在SD大鼠体内的药物代谢动力学性质。 方法 制备姜黄素磷脂复合物,以姜黄素作为对照,检测两者在水中的溶解度和体外累计溶出率;取SD大鼠12只,经口服灌胃给予姜黄素磷脂复合物或姜黄素混悬液后,不同时间点于大鼠眼底静脉丛取血,采用高效液相色谱法（HPLC）测定血浆中姜黄素的浓度。 结果 姜黄素磷脂复合物的溶解度、累计溶出率分别为0.150 g/L、68.04%,较姜黄素（0.057 g/L、50.68%）均有所增加。姜黄素磷脂复合物和姜黄素的药代动力学参数分别如下：C_max为（74.34±5.57） μg/L和（61.64±4.29） μg/L,T_max为（0.17±0） h和（0.25±0） h,AUC_0-t为（637.38±30.04） μg·h·L^-1和（172.41±31.66） μg·h·L^-1,AUC_0-∞为（857.80±223.69） μg·h·L^-1和（191.08±43.27） μg·h·L^-1。日内及日间精密度、回收率符合测定要求。 结论 姜黄素磷脂复合物混悬液与姜黄素相比吸收速度快,消除速率慢。     

LC-ESI-MSn法鉴定心悦胶囊中西洋参皂苷类成分

目的 建立LC-MS法确定心悦胶囊的主要组成成分。方法 采用LC-ESI-MS负离子检测模式对心悦胶囊中的皂苷类成分进行分析,通过与胶囊辅料提取物比较,筛选胶囊的主要成分,对其进行多级质谱裂解分析。以对照品及文献数据为对照,通过对各成分的MS²谱图和MS³谱图的解析对各成分进行指认。结果 从心悦胶囊中发现包括原人参二醇型、原人参三醇型和奥寇梯木醇型皂苷在内的18种人参皂苷类成分,采用对照品对其中的人参皂苷Re(ginsenoside Re,G-Re)、Rg₁(G-Rg₁)、拟人参皂苷F₁₁(pseudoginsenoside F₁₁,P-F₁₁)、人参皂苷Rg₂(G-Rg₂)、人参皂苷Rc(G-Rc)、Rb₂(G-Rb₂)、Rb₃(G-Rb₃)、Rd(G-Rd)、F₂(G-F₂)、20(S)-人参皂苷Rg₃［20(S)-G-Rg₃］等10个成分进行了结构确证。结论 所建立的LC-MSⁿ法可同时对奥寇悌隆型人参皂苷、原人参二醇型和原人参三醇型人参皂苷进行分析,方法灵敏、快速、简单,适用于心悦胶囊和西洋参皂苷类成分的分析和结构鉴定。     

THIEC改性三聚氰胺甲醛树脂泡沫的制备及其性能表征

以表面活性剂水溶液为液相介质、空气为气相介质,采用高速摄像机研究表面活性剂对二次雾化破裂性质的影响,重点阐述了破裂形变特征上的变化。研究结果表明:在形变特征方面,临界胶束浓度(CMC)对二次雾化袋状破裂形态有着重要影响,除了最大液滴直径形变率(d_f,m/d₀)基本不变,保持在1.64左右外,最大液环直径形变率(d_r,m/d₀)、最大轴向生长率(l_m/d₀)、最大径向生长率(h_m/d₀)和长宽比(l_m/h_m)等在表面活性剂质量分数小于CMC时均变化迅速,但在表面活性剂质量分数大于CMC后变化趋于平缓,d_r,m/d₀稳定在4.16左右,l_m/d₀稳定在6.36左右,l_m/h_m稳定在1.53左右。     

Dural metastasis of nasopharyngeal carcinoma: rare,but worth considering

Metastasis of nasopharyngeal carcinoma (NPC) to the dura, an extremely rare condition, can be symptomatically silent and mistaken for a benign entity radiographically. Missed diagnosis can lead to serious consequences or prove immediately fatal. We report a woman with dural metastasis of NPC that mimicked a meningioma on radiography. Craniectomy with tumour resection was performed due to rapid progression from the onset of symptoms to disability. The patient was still alive two years after surgery. This case emphasises the need to keep in mind the possibility of dural metastasis of NPC in patients with abnormal imaging features. This would not only avoid wrong and optimistic diagnosis, but also allow for appropriate treatment in a timely manner. To our knowledge, this is the first report of metastasis of NPC to the dura. We provide detailed information on the neoplastic lesion, which masqueraded as a benign entity and caused potentially fatal consequences.     

Electrocardiographic findings in pulmonary embolism

Pulmonary embolism (PE) poses a challenge to physicians, as it can be difficult to diagnose but results in significant mortality and morbidity in patients. Diagnosing PE requires an integrated approach using clinical findings, electrocardiography (ECG), blood investigations and imaging modalities. Abnormalities in ECG are common among patients with massive acute PE and can serve as a prognostic indicator. In this article, we describe the ECG presentations of two patients diagnosed with PE, and review the literature on the various types of ECG presentations and their role in predicting the prognosis of PE.     

Clinical characteristics,outcome and early induction deaths in patients with acute promyelocytic leukaemia: a five-year experience at a tertiary care centre

INTRODUCTION

Acute promyelocytic leukaemia (APL) is a distinct clinical and biological subtype of acute myeloid leukaemia. APL is notorious for causing early death during induction therapy, resulting in induction failure. The aim of our study was to report the clinical characteristics, outcome and early induction deaths with regard to patients with APL seen at our hospital.

METHODS

This was a retrospective study carried out at Aga Khan University Hospital, Karachi, Pakistan. Patients aged > 15 years diagnosed with APL within the period September 2007–September 2012 were included in the study.

RESULTS

Within the study period, 26 patients were diagnosed with APL based on morphology and the detection of t(15;17)(q24.1;q21.1) and promyelocytic leukaemia-retinoic acid receptor alpha (PML-RARA). The male to female ratio was 1:1. The median age of the patients was 41 (range 16–72) years. In all, there were 13 (50.0%) high-risk patients, and early induction death rate was 61.5%. Causes of early induction deaths (n = 16) included haemorrhage in 7 (43.8%) patients, differentiation (ATRA) syndrome in 7 (43.8%) and infection in 2 (12.5%). The survival rate among patients who survived the early period was 70% at 42 months. The relapse rate was 30%.

CONCLUSION

Early induction death rate was very high in patients with APL. The most common cause of early induction death in our study was haemorrhage. Outcome among patients with APL was found to be better among those who survived the initial period.     

Pedestrian injuries in children: who is most at risk?

INTRODUCTION

This study evaluates the demographics of paediatric pedestrian injuries with the aim of identifying the group of children who is most vulnerable and the risk factors for major trauma (MT).

METHODS

Data was extracted from the integrated trauma system of a regional paediatric referral hospital. All paediatric cases involving road traffic accidents from January 2011 to December 2013 were studied. Demographics, injury mechanism, treatment and outcome were evaluated. Patients were categorised as MT or non-MT (NMT) based on their Injury Severity Score, admission to the intensive care unit, type of surgery (e.g. life/limb-saving) and death. Data analysis was done using nonparametric tests and Fisher’s exact test.

RESULTS

A total of 261 children were admitted for pedestrian injuries during the study period. The median age was ten years (range 14 months–16 years) and the median weight was 42.4 (range 8.6–93.7) kg. Half (i.e. 50.2%) of the children were primary-schoolers. The majority of the accidents occurred on roads (i.e. 83.1%), between 12 pm and 6 pm (i.e. 52.8%). Among the 261 children, 177 (67.8%) were unaccompanied by an adult at the time of the accident; 17 (6.5%) children sustained MT, while 244 (93.5%) suffered NMT. MT patients were more likely to have lost consciousness (p < 0.001) and been flung (p = 0.001).

CONCLUSION

Most paediatric pedestrian injuries involved primary-schoolers walking home from school unaccompanied by adults. This information should inform future road safety campaigns. Being flung and loss of consciousness predicted MT in children who sustained pedestrian injuries.     

Cerebrovascular ischaemia after carbon monoxide intoxication

Carbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.     

Prevalence of dysglycaemic events among inpatients with diabetes mellitus: a Singaporean perspective

INTRODUCTION

As the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control.

METHODS

A retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia.

RESULTS

Among the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L).

CONCLUSION

Inpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.     

Prolonged hepatitis and jaundice: a rare complication of paediatric Epstein-Barr virus infection

We herein report the case of a 14-year-old girl with Epstein-Barr virus (EBV) infectious mononucleosis who developed prolonged hepatitis and jaundice. At presentation, she had tender hepatomegaly with a markedly deranged liver function test. Abdominal ultrasonography showed hepatomegaly and a thickened gallbladder wall. During the subsequent 11 weeks, her transaminases showed two further peaks, which corresponded with clinical deterioration. Her highest alanine transaminase level was 1,795 µ/L and total bilirubin level was 154 µmol/L. She recovered fully with conservative management. EBV-related liver involvement is typically mild and self-limiting. We believe that tender hepatomegaly and gallbladder thickening may be important predictors of significant liver involvement. Although multiple transaminase peaks may occur, we do not consider this an indication for antiviral or immunosuppressive therapy. In the absence of strong evidence supporting the use of any specific therapy, we recommend a conservative approach for an immunocompetent patient.     

The effects of the Trendelenburg position and the Valsalva manoeuvre on internal jugular vein diameter and placement in children

INTRODUCTION

We compared the effects of various surgical positions, with and without the Valsalva manoeuvre, on the diameter of the right internal jugular vein (RIJV).

METHODS

We recruited 100 American Society of Anesthesiologists physical status class I patients aged 2–12 years. The patients’ heart rate, blood pressure, peripheral oxygen saturation and end-tidal CO₂ pressure were monitored. Induction of anaesthesia was done using 1% propofol 10 mg/mL and fentanyl 2 µg/kg, while maintenance was achieved with 2% sevoflurane in a mixture of 50/50 oxygen and air (administered via a laryngeal mask airway). The RIJV diameter was measured using ultrasonography when the patient was in the supine position. Thereafter, it was measured when the patient was in the supine position + Valsalva, followed by the Trendelenburg, Trendelenburg + Valsalva, reverse Trendelenburg, and reverse Trendelenburg + Valsalva positions. A 15° depression or elevation was applied for the Trendelenburg position, and an airway pressure of 20 cmH₂O was applied in the Valsalva manoeuvre. During ultrasonography, the patient’s head was tilted 20° to the left.

RESULTS

When compared to the mean RIJV diameter in the supine position, the mean RIJV diameter was significantly greater in all positions (p < 0.001) except for the reverse Trendelenburg position. The greatest increase in diameter was observed in the Trendelenburg position with the Valsalva manoeuvre (p < 0.001).

CONCLUSION

In paediatric patients, the application of the Trendelenburg position with the Valsalva manoeuvre gave the greatest increase in RIJV diameter. The reverse Trendelenburg position had no significant effect on RIJV diameter.     

An audit of preoperative fasting compliance at a major tertiary referral hospital in Singapore

INTRODUCTION

To avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients’ knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting.

METHODS

Patients scheduled for ‘day surgery’ or ‘same day admission surgery’ under general or regional anaesthesia were surveyed over a four-week period. The patients were asked to answer an eighteen-point questionnaire on demographics, preoperative fasting and attitudes toward fasting.

RESULTS

A total of 130 patients were surveyed. 128 patients fasted before surgery, 111 patients knew that they needed to fast for at least six hours before surgery, and 121 patients believed that preoperative fasting was important, with 103 believing that preoperative fasting was necessary to avoid perioperative complications. However, patient understanding was poor, with only 44.6% of patients knowing the reason for fasting, and 10.8% of patients thinking that preoperative fasting did not include abstinence from beverages and sweets. When patients who did and did not know the reason for fasting were compared, we did not find any significant differences in age, gender or educational status.

CONCLUSION

Despite the patients’ poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance.     

Short-term result of arthroscopic synovial excision for dorsal wrist pain in hyperextension associated with synovial hypertrophy

INTRODUCTION

Arthroscopic excision of the hypertrophic dorsal synovium is performed on patients with dorsal wrist pain in hyperextension. Although dorsal wrist impingement has been described in cadaveric studies, to our knowledge, there is no published clinical data on its treatment with arthroscopic synovial excision. Herein, we present the results of arthroscopic management of this condition in our hospital.

METHOD

A total of 13 patients underwent arthroscopic excision of the hypertrophic dorsal impinging synovium. All patients presented with the cardinal symptom of dorsal-radial wrist pain in extreme extension. The diagnoses were made after excluding other causes and confirmed on wrist arthroscopy. Arthroscopy was offered after nonoperative measures failed. The mean postoperative follow-up period was 14 (range 6–31) months.

RESULTS

Mean pre-and postoperative quick Disabilities of the Arm, Shoulder and Hand scores were 49 (range 34–82) and 17 (range 0–48), respectively; paired t-test revealed a significant difference between the two (p < 0.001). Mean postoperative flexion-extension arc and radial-ulnar deviation arc were 120º and 46º, respectively. Postoperatively, one patient developed complex regional pain syndrome, with tethering of the dorsal branch of the ulnar nerve, which required surgical release, while another patient required revision arthroscopic excision of the impinging tissue. Both patients had good postoperative outcomes.

CONCLUSION

When treating patients with dorsal wrist pain, dorsal wrist impingement caused by synovial hypertrophy should be included in the differential diagnosis. Arthroscopic excision of the impinging synovium can achieve reliable pain relief with significant functional improvement in the short term, although further research on its long-term benefits is required.