依达拉奉注射液联合丁苯酞治疗急性脑梗死的疗效观察

目的 观察依达拉奉联合丁苯酞治疗急性脑梗死的临床疗效。方法 选取200例在宝鸡市人民医院就诊的急性脑梗死患者,随机分为观察组100例,给予依达拉奉注射液联合丁苯酞治疗,对照组100例,仅给予丁苯酞治疗。对两组患者的临床疗效、NDS评分、MoCA评分、ADL评分及血清C-反应蛋白（hs-CRP）水平及不良反应进行比较。结果 观察组总有效率（92%）显著高于对照组（79%）,差异具有统计学意义（P<0.05）。治疗后两组患者神经功能缺损均有所下降,认知功能均有所改善,但观察组神经功能缺损下降显著低于对照组,认知功能改善优于对照组,观察组ADL评分显著高于对照组,hs-CRP水平显著低于对照组,差异具有统计学意义（P<0.05）。所有患者治疗过程中无明显不良反应。结论 依达拉奉注射液联合丁苯酞对急性脑梗死疗效显著,安全性好,值得临床推广。     

天丹通络片联合丁苯酞治疗急性脑梗死的临床研究

目的 探讨天丹通络片联合丁苯酞氯化钠注射液治疗急性脑梗死的临床疗效。方法 选取2020年8月—2022年5月首都医科大学附属北京友谊医院平谷医院收治的86例急性脑梗死患者，按随机数字表法将所有患者分为对照组和治疗组，每组各43例。对照组静脉滴注丁苯酞氯化钠注射液，100 mL/次，2次/d。治疗组患者在对照组治疗基础上口服天丹通络片，5片/次，3次/d。两组疗程均为14 d。观察两组的临床疗效，比较治疗前后两组美国国立卫生研究院卒中量表（NIHSS）评分、血小板参数[血小板分布宽度（PDW）、平均血小板体积（MPV）]，凝血指标[纤维蛋白原（FIB）、D-二聚体（D-D）]，外周血血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）及血清同型半胱氨酸（HCY）、超敏C反应蛋白（hs-CRP）水平。结果 治疗后，治疗组总有效率是95.35%，较对照组的81.40%显著提高（P＜0.05）。治疗后，两组NIHSS评分均显著降低（P＜0.05）；治疗后，治疗组NIHSS评分显著低于对照组（P＜0.05）。治疗后，两组PDW、MPV和血浆FIB、D-D水平均显著降低（P＜0.05）；且治疗后，治疗组PDW、MPV和血浆FIB、D-D水平均显著低于对照组（P＜0.05）。治疗后，两组外周血PLR、NLR和血清Hcy、hs-CRP水平均显著下降（P＜0.05）；且治疗后，治疗组外周血PLR、NLR和血清Hcy、hs-CRP水平均显著低于对照组（P＜0.05）。结论 天丹通络片联合丁苯酞氯化钠注射液治疗急性脑梗死的整体效果确切，可减轻患者神经功能缺损、促进侧支循环建立，并能进一步改善血液高凝状态及下调外周血PLR、NLR和血清HCY、hs-CRP水平。     

丁苯酞对急性脑梗死患者NT-proBNP水平和血清炎症因子的影响

目的探讨分析丁苯酞对急性脑梗死患者NT-proBNP水平和血清炎症因子的影响。方法选择2014年3月-2016年5月在衡水市第五人民医院神经内科接受治疗的118例急性脑梗死患者,随机分为对照组60例和观察组58例。对照组给予常规药物治疗,观察组在对照组的基础上给予丁苯酞注射液治疗。观察治疗前及治疗7、14 d后两组患者的血浆N末端B型脑钠肽前体（NT-proBNP）水平、美国国立卫生研究院卒中量表（NIHSS）和血清炎症因子包括超敏C反应蛋白（hypersensitiveC-reactive protein,hs-CRP）、白细胞介素-6（interleukin-6,IL-6）及肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）,以及不良反应发生情况。结果治疗前,两组患者的血浆NT-proBNP水平、NIHSS评分以及血清炎症因子水平比较差异无统计学意义。治疗7、14 d后,两组NT-proBNP水平、NIHSS评分均明显降低,与治疗前比较差异显著（P<0.05）;治疗7、14 d后,观察组的NT-proBNP水平显著低于对照组（P<0.05）;治疗14 d后,观察组的NIHSS评分显著低于对照组,比较差异具有统计学意义（P<0.05）。治疗前,两组的hs-CRP、IL-6、TNF-α比较差异无统计学意义;治疗7、14 d后,两组的hs-CRP、IL-6、TNF-α水平均明显降低,与治疗前比较差异显著（P<0.05）;且观察组的以上3个血清炎症因子水平均显著低于对照组,两组比较差异具有统计学意义（P<0.05）。结论丁苯酞可有效抑制急性脑梗死患者的血浆NT-proBNP水平及血清炎症因子水平,改善患者神经功能预后。     

珍龙醒脑胶囊联合丁苯酞治疗急性脑梗死的临床研究

目的 探讨珍龙醒脑胶囊联合丁苯酞治疗急性脑梗死的临床疗效。方法 选取2018年10月—2020年12月河南科技大学第二附属医院治疗的86例急性脑梗死患者,根据随机数字法将所有患者分为对照组和治疗组,每组各43例。对照组静脉滴注丁苯酞氯化钠注射液,100 mL/次,2次/d。治疗组在对照组治疗基础上口服珍龙醒脑胶囊,2粒/次,2次/d。两组用药治疗14 d。观察两组的临床疗效和症状缓解时间,比较两组神经功能缺损程度（NIHSS）评分、同型半胱氨酸（Hcy）、N末端前脑钠肽（NT-proBNP）、D-二聚体（D-D）、超敏C反应蛋白（hs-CRP）的变化情况。结果 治疗后,治疗组总有效率是97.67%,显著高于对照组的79.07%（P＜0.05）。治疗后,治疗组出现眩晕、头痛、中枢性面瘫、肢体无力缓解时间均短于对照组（P＜0.05）。治疗后,两组NIHSS评分均较治疗前显著降低（P＜0.05）;治疗后,治疗组患者NIHSS评分低于对照组（P＜0.05）。治疗后,两组血清因子Hcy、NT-proBNP、D-D、hs-CRP水平均显著降低（P＜0.05）;治疗后,治疗组血清因子水平低于对照组（P＜0.05）。治疗组不良反应发生率是6.98%,显著低于对照组的16.28%（P＜0.05）。结论 珍龙醒脑胶囊联合丁苯酞治疗急性脑梗死具有较好的临床疗效,可明显改善患者症状,有效改善患者神经功能缺损程度,并能降低机体炎性反应,且安全有效。     

丁苯酞对老年急性脑梗死的疗效及对血清尿酸、C反应蛋白和血液流变学的影响

目的 研究丁苯酞对老年急性脑梗死的疗效及对血清尿酸、C反应蛋白和血液流变学的影响。方法 选择2015年1月-2015年12月在西安市第一医院进行诊治的老年急性脑梗死患者86例，随机分为两组，对照组采用常规急性脑梗死对症治疗，观察组加用丁苯酞胶囊。观察两组的美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数和疗效，检测并比较治疗前后两组患者血清尿酸、C反应蛋白、血小板聚集率和血黏稠度。结果 观察组的有效率为90.70%，明显高于对照组的72.09%（P<0.05）；治疗后两组的NIHSS评分、血清尿酸和C反应蛋白水平、血小板聚集率和血黏稠度均明显降低，Barthel指数明显升高（P<0.05），且观察组的变化较对照组更为明显（P<0.05）。结论 丁苯酞对老年急性脑梗死患者的疗效显著，能降低患者的血清尿酸、C反应蛋白水平和神经功能缺损程度，改善其血液流变学状态和生活自理活动能力，具有脑保护作用。     

丁苯酞联合前列地尔治疗缺血性脑卒中的临床疗效及对hs-CRP的影响

目的 探讨丁苯酞联合前列地尔治疗缺血性脑卒中的临床疗效及对超敏C反应蛋白（hs-CRP）的影响。方法 收集2014年1月—2016年3月河南科技大学第一附属医院收治的85例缺血性脑卒中患者,随机分为对照组（43例）和观察组（42例）。两组患者均接受常规治疗,对照组在常规治疗基础上给予注射用前列地尔10 μg静脉推注,1次/d。观察组在对照组的基础上加用丁苯酞胶囊0.2 g/次,3次/d,顿服。两组患者均连续治疗14 d。观察比较两组治疗前后的神经功能缺损评分（NIHSS）、日常生活自理能力量表（ADL）、hs-CRP、凝血功能指标的变化,以及临床疗效。结果 治疗14 d后,两组的NIHSS、ADL评分、hs-CRP水平均有明显改善,同组治疗前后比较差异有统计学意义（P<0.05）。观察组的NIHSS评分显著低于对照组,ADL评分明显高于对照组,且hs-CRP水平明显低于对照组,组间比较差异有统计学意义（P<0.05）。治疗前,两组的凝血功能指标比较差异无统计学意义。治疗14 d后,两组的凝血酶原时间（PT）、D-二聚体（DD）及纤维蛋白酶原（FIB）均较治疗前有明显改善,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组的PT显著高于对照组,DD和FIB明显低于对照组,组间比较差异有统计学意义（P<0.05）。此外,观察组患者的临床治疗有效率（90.5%）显著高于对照组（72.1%）,差异具有统计学意义（P<0.05）。结论 相较于前列地尔单一用药,联合丁苯酞治疗能更好改善缺血性脑卒中患者的神经功能、日常生活能力及凝血功能,抑制hs-CRP水平,临床疗效显著。     

超早期使用丁苯酞注射液对急性脑梗死患者神经功能及侧支循环建立的影响

目的 探讨超早期使用丁苯酞注射液对急性脑梗死患者神经功能及侧支循环建立的影响。方法 选取2014年7月—2017年7月漯河市第二人民医院诊治的急性脑梗死患者86例作为研究对象,按照入院先后顺序分为对照组（42例）和观察组（44例）。对照组给予阿替普酶静脉溶栓治疗,观察组在阿替普酶静脉溶栓前后给予丁苯酞注射液100 mL静脉滴注,2次/d,两次间隔时间为7 h,治疗14 d。比较两组患者治疗前和治疗14 d的临床有效率、侧支循环血流速度,比较两组患者治疗前、治疗1 h、治疗7 d和治疗14 d的美国国立卫生院神经功能缺损评分（NIHSS）和日常生活能力（ADL）评分。结果 观察组的临床有效率为90.91%,对照组的临床有效率为78.57%,观察组显著高于对照组（P<0.05）。两组患者NIHSS评分在治疗1 h、治疗7 d和治疗14 d均显著低于治疗前（P<0.05）,且观察组在治疗1 h、治疗7 d和治疗14 d均显著低于对照组（P<0.05）。两组患者ADL评分在治疗1 h、治疗7 d和治疗14 d均显著高于治疗前（P<0.05）,且观察组在治疗1h、治疗7 d和治疗14 d均显著高于对照组（P<0.05）。两组患者治疗后大脑中动脉（MCA）流速显著加快,大脑前动脉（ACA）和大脑后动脉（PCA）流速显著减慢（P<0.05）;且治疗后观察组MCA流速与对照组相比较快（P<0.05）,观察组ACA和PCA流速与对照组相比较慢（P<0.05）。结论 超早期使用丁苯酞注射液治疗急性脑梗死可显著改善患者的神经功能、提高生活能力,改善侧支循环血流速度,取得较好的临床疗效。     

注射用丹参多酚酸对急性缺血性脑卒中患者超敏C反应蛋白、CD62P水平及短期预后的影响

目的 探讨注射用丹参多酚酸对急性缺血性脑卒中患者血清中超敏C反应蛋白（hs-CRP）、CD62P水平及短期预后的影响。方法 选取2017年7月—2020年12月保定市第一中心医院收治的符合入组标准的急性缺血性脑卒中患者200例为研究对象,采用随机数字表法分为试验组100例和对照组100例。对照组按照指南给予标准化治疗,试验组在对照组治疗的基础上静脉滴注注射用丹参多酚酸（0.13 g加入0.9%的氯化钠注射液250 mL）,每天1次,两组均持续治疗14 d,观察两组治疗前、后血清中hs-CRP以及CD62P水平的变化以及美国国立卫生研究院脑卒中量表（NIHSS）评分的变化。结果 对照组2例脱落、共98例完成研究,试验组全部完成研究。治疗后,两组NIHSS评分均明显降低,同组治疗前后比较差异具有统计学意义（P＜0.05）,且试验组NIHSS评分明显低于对照组（P＜0.05）;治疗后,两组患者血清中hs-CRP、CD62P的水平均明显降低,同组治疗前后比较差异具有统计学意义（P＜0.05）,且试验组血清中hs-CRP、CD62P的水平显著低于对照组（P＜0.05）。结论 注射用丹参多酚酸可降低炎症因子（hs-CRP、CD62P）的水平,改善患者的生活质量,促进患者神经功能的恢复,有利于急性缺血性脑卒中患者的短期预后,且安全性较高,具有一定的临床应用价值。     

丁苯酞软胶囊治疗进展性卒中的系统评价

目的 系统评价丁苯酞软胶囊治疗进展性卒中的疗效和安全性。方法 检索Cochrane图书馆、万方、CNKI等数据库收集关于丁苯酞治疗进展性卒中的随机对照试验（randomized controlled trials，RCTs），时间截至2018年12月，根据明确的纳入与排除标准筛选相关研究，采用RevMan 5.3软件进行统计分析。结果 共纳入26个RCTs（2 519例患者），meta分析结果示，与对照组比较，丁苯酞治疗进展性卒中疗效更好（RR=1.23，95%CI 1.17~1.29，P<0.000 01）；丁苯酞治疗进展性卒中在神经功能缺损评分（The National Institutes of Health Stroke Scale，NIHSS）（MD=-3.01，95%CI -3.49~-2.52，P<0.000 01）、卒中评分量表（Chinese Stroke Scale，CSS）评分（MD=-3.39，95%CI -4.70~-2.08，P<0.000 01）及日常生活活动能力评分量表（Barthel Index，BI）评分（MD=9.84，95%CI 6.06~13.62，P<0.000 01）改善方面均优于对照组，差异有统计学意义。2组在不良反应方面差异无统计学意义（RR=1.27，95%CI 0.50~3.18，P=0.61）。结论 丁苯酞软胶囊能有效改善进展性卒中患者的神经功能，且不增加不良反应。     

2017—2019年天津市滨海新区汉沽中医医院Ⅰ类切口围手术期预防用抗菌药物的合理性分析

目的 探究丁苯酞软胶囊联合依达拉奉治疗神经功能障碍的临床疗效。方法 选择2017年1月—2019年1月于西安大兴医院神经内科接受治疗的98例神经功能障碍的患者为研究对象,按照随机数字表法将患者均分为对照组和观察组,每组各49例。对照组患者静滴依达拉奉注射液,应用剂量为30 mg/次,2次/d。观察组在对照组基础上口服丁苯酞软胶囊,2粒/次,3次/d。两组患者治疗2周。观察两组患者的临床疗效,同时比较两组治疗前后的美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数及简易智能精神状态量表（MMSE）评分。结果 治疗后,观察组治疗总有效率为93.88%,对照组的治疗总有效率为83.67%,两组对比差异存在统计学意义（P<0.05）。经治疗1周及2周后,两组患者NIHSS量表评分较治疗前显著下降（P<0.05）,且观察组患者NIHSS评分显著均低于对照组（P<0.05）。治疗后,两组患者Barthel指数和MMSE量表评分均显著提升（P<0.05）,且观察组患者Barthel指数及MMSE评分均显著高于对照组（P<0.05）。结论 丁苯酞联合依达拉奉对于神经功能障碍有较好的治疗效果,能显著改善患者的神经功能和生活质量,且不良反应的发生率较低,值得进行临床推广。     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Synthesis and anti-nociceptive and anti-inflammatory effects of gaultherin and its analogs

The synthesis of gaultherin (1) and its analogs was carried out to provide 11 glycosides under phase-transfer catalytic conditions. The activities of all synthesized compounds were evaluated by nitric oxide production inhibitory assay in vitro. Methyl 2-O-(4-O-β-d-galactopyranosyl)-β-d-glucopyranosylbenzoate (5f) showed significantly anti-nociceptive and anti-inflammatory effects by the evaluation in vivo. Structure–activity relationships within these compounds were discussed.     

Modelling and simulation of variability and uncertainty in toxicokinetics and pharmacokinetics

Two important methodological issues within the framework of the variability and uncertainty analysis of toxicokinetic and pharmacokinetic systems are discussed: (i) modelling and simulation of the existing physiologic variability in a population; and (ii) modelling and simulation of variability and uncertainty when there is insufficient or not well defined (e.g. small sample, semiquantitative, qualitative and vague) information available. Physiologically based pharmacokinetic models are especially suited for separating and characterising the physiologic variability from the overall variability and uncertainty in the system. Monte Carlo sampling should draw from multivariate distributions, which reflect all levels of existing dependencies in the intact organism. The population characteristics should be taken into account. A fuzzy simulation approach is proposed to model variability and uncertainty when there is semiquantitative, qualitative and vague information about the model parameters and their statistical distributions cannot be defined reliably.     

成骨细胞的功能与损伤和骨质疏松的防治

骨质疏松是一种全身性骨骼疾病,导致骨折风险增加。成人的骨量通过破骨细胞的骨吸收和成骨细胞的骨形成作用来维持动态平衡,治疗骨质疏松症的理想策略是抑制破骨细胞的骨吸收和/或增强成骨细胞的骨形成功能。目前针对保护成骨细胞及增强其功能的骨质疏松疗法相对较少。因此,本文针对成骨细胞相关功能蛋白、各种细胞损伤机制（内质网应激、氧化应激、机械过载、微小RNA和长链非编码RNA的影响等）及骨质疏松的治疗与预防作一综述,以期为针对增强成骨细胞功能的骨质疏松治疗策略提供新思路。     

益生菌与肿瘤防治

益生菌广泛存在于自然界中,通过维持宿主体内菌群平衡、影响肠屏障功能和调节免疫应答等作用,提高宿主健康水平,被公认为"肠道健康卫士".一些益生菌可以增强机体的免疫功能,抑制致癌物质,影响肿瘤细胞的基因表达,对肿瘤具有拮抗作用.大量研究表明,益生菌在未来的肿瘤防治中有很好的应用和发展前景.     

Self-stimulation and amphetamine: Tolerance to d and l isomers and cross tolerance to cocaine and methylphenidate

The effects of the d and l isomers of amphetamine on self-stimulation responding were tested following acute and chronic administration. Tolerance and post-drug depression of responding occurred in tests with both isomers, indicating no role for p-hydroxynorephedrine (PHN) which is one of the metabolites of d-amphetamine. In the second experiment, d-amphetamine, methylphenidate and cocaine all produced quantitatively and qualitatively similar effects on self-stimulation responding following acute administration. Following chronic administration of d-amphetamine, animals showed tolerance to all three drugs, indicating cross-tolerance among them. These data are consistent with an hypothesis that tolerance and post-drug depression following chronic amphetamine treatment are the result of decreases in postsynaptic receptor sensitivity, which would lead to a decreased effectiveness of all three drugs, regardless of their pre-synaptic mechanisms.     

Acamprosate and naltrexone treatment effects on ethanol and sucrose seeking and intake in ethanol-dependent and nondependent rats

Rationale  Two pharmacotherapies are approved for treating alcohol craving (acamprosate and naltrexone), but both have shown mixed findings in animals and humans. Objectives  The present experiments utilized a “reinforcer blocking” approach (i.e., rats were able to consume ethanol during treatment) to better understand the efficacy of these treatments for ethanol seeking and drinking using ethanol-dependent and nondependent rats. Materials and methods  In “nondependent” experiments, drugs (acamprosate 50, 100, and 200 mg/kg; naltrexone 0.1, 0.3, and 1.0 mg/kg) were administered over 3-week periods prior to operant sessions with a low response requirement to gain access to reinforcers for 20 min. For “dependent” experiments, rats were made dependent in vapor/inhalation chambers. Results  Acamprosate and naltrexone had similar effects on intake in nondependent and dependent rats; neither drug was selective for ethanol over sucrose drinking. In nondependent animals, naltrexone was more efficacious at more doses than acamprosate, and acamprosate’s effects were limited to a dose that also had adverse effects on body weight. Both pharmacotherapies showed more selectivity when examining reinforcer seeking. In nondependent rats, acamprosate and naltrexone had response-attenuating effects in ethanol, but not sucrose, groups. In dependent animals, acamprosate had selective effects limited to a decrease in sucrose seeking. Naltrexone, however, selectively decreased ethanol-seeking in nondependent rats. Conclusions  The naltrexone-induced decreases in seeking suggested a change in incentive motivation which was selective for ethanol in nondependent rats. The “nondependent” paradigm may model early stages of “problem drinking” in humans, and the findings suggest that naltrexone could be a good intervention for this level of alcohol abuse and relapse prevention.     

Antiinfective and encrustation-inhibiting materials--myth and facts

Catheters, urethral and ureteral stents and other urological implants are frequently affected by encrustration and infection due to their permanent contact with urine. Indwelling urinary catheters provide a haven for microorganisms and thus require extensive monitoring. Several surface modification techniques have been proposed to improve the performance of devices including the immobilization of biomolecules, the incorporation of hydrophilic grafts to reduce protein adsorption, the creation of hydrophobic surfaces, the creation of microdomains to regulate cellular and protein adhesion, new polymers and antimicrobial coatings. Physico-chemical explanation to elucidate the mechanism of such encrustation or infection inhibiting materials is still not available. Our series of experiments showed a marked decrease of silver-activity in biological fluids which corresponds with the controversial clinical results obtained with silver coated urinary catheters. Rifampicin/minocycline coated catheters had very low activity against Gram-negative rods, enterococci and Candida spp., the main causing organisms of urinary catheter infection. Surface engineered materials and antimicrobial drug delivery systems will be the next generation of sophisticated urinary catheters and stents, if both efficacy as well as efficiency has been proved clinically.     

Alprazolam and lorazepam single and multiple-dose effects on psychomotor skills and sleep

Summary The effects of alprazolam 0.5 mg and lorazepam 2 mg on cognitive and psychomotor skills were assessed in twelve normal volunteer subjects in a randomised, double-blind, crossover design. Single and multiple dose effects were monitored using a battery of tests comprising critical flicker fusion threshold (CFFT), choice reaction time (CRT), simulated car tracking, and subjective ratings of perceived sedation (LARS) and of sleep behaviour (LSEQ). Compared with placebo baseline scores, treatment with lorazepam 2 mg (both single and multiple doses) resulted in a widespread impairment of CRT, tracking accuracy, and CFFT. Single doses of alprazolam 0.5 mg reduced CFFT with respect to the placebo baseline. Single and multiple dose treatment with both drugs resulted in subjective reports of sedation, a reduction of sleep onset latency, and improved sleep quality. Only lorazepam 2 mg significantly disrupted the integrity of behaviour on waking from sleep. These results suggest important pharmacodynamic differences between the two drugs in the doses used.