荧光偏振法测定去甲万古霉素血药浓度

目的建立用荧光偏振分析仪(TDx)测定去甲万古霉素血药浓度的方法。方法用万古霉素试剂盒以荧光偏振法测定不同血药浓度的去甲万古霉素样品。结果去甲万古霉素在0.5~60ug/ml的浓度范围内呈良好线性关系,线性回归方程为C(实际浓度)=C(测得浓度)×0.6435 0.2690,r=0.9998(n=10)。最低检测浓度为0.5ug/ml。相对回收率为91.6%~101.3%,日内RSD为1.9%~8.4%,日间RSD为4.0%~9.6%。结论本方法可以用于临床去甲万古霉素血药浓度的常规测定。     

联合使用甘露醇对万古霉素血药浓度的影响

目的研究联合使用甘露醇对使用万古霉素治疗的患者血药浓度的影响,为临床治疗提供参考依据。方法选取入住我院重症监护病房的74例脑出血合并MRSA肺炎患者,都使用万古霉素治疗。将其随机分为两组,使用甘露醇的为研究组,未使用甘露醇的为对照组。达到稳态浓度后抽取静脉血,测定万古霉素血药浓度,比较两组间差异有无统计学意义。结果研究组万古霉素的血药浓度谷值为(7.12±2.13)mg/L,对照组万古霉素的血药浓度谷值为(12.78±2.42)mg/L,研究组相比于对照组血药浓度较低,差异有统计学意义(P<0.05)。结论甘露醇能促进万古霉素在体内的清除和排泄,令血药浓度降低。     

高效液相色谱结合固相萃取测定人血中去甲万古霉素及在血药浓度监测中的应用

目的采用固相萃取技术结合反相高效液相色谱法建立测定血清去甲万古霉素浓度的方法.方法样品经PT-C18萃取小柱纯化后进样,色谱条件为Thim-pack CLC-ODS柱,流动相为甲醇-0.05 mol/L磷酸(30:70),检测波长为254nm.结果应用该法对临床使用去甲万古霉素患者血药浓度进行监测,其浓度范围在0.5～100 ug/ml之间呈线性关系,平均回收率为89.3%～92.7%,日内RSD为2.65%～3.57%,日间RSD为4.92%～6.59%.结论该方法简便、快速、准确,可用于去甲万古霉素的血药浓度测定和药动学研究.     

重症肺炎患儿万古霉素血药浓度监测结果分析

目的：通过分析30例重症肺炎患儿万古霉素血药浓度的监测结果,探讨万古霉素治疗药物监测的必要性、在重症肺炎患儿体内代谢的个体差异及影响因素。方法：采用高效液相色谱法测定30例重症肺炎患儿使用万古霉素后的血药浓度值,将浓度值、性别、年龄、身高、体重、生化指标等资料录入数据库,进行统计学分析。结果：30例患儿的万古霉素血药峰浓度和谷浓度在治疗窗范围内分别只占6．67％和16．67％,血药浓度普遍偏低;血药峰浓度和谷浓度与给药剂量无显著相关（r=0．185,P=0.328;r=0.147,P=0.438）;单位剂量血药浓度值与年龄、身高、体重及各项生化指标均无显著相关（P〉0.05）。结论：万古霉素在重症肺炎患儿体内的代谢个体差异显著,其影响因素复杂且不确定．应根据血药浓度监测结果制订和调整给药方案。     

FPIA和HPLC法在CsA血药浓度测定的比较分析

目的分别建立用荧光偏振免疫法（FPIA）和高效液相色谱法（HPLC）测定环孢素A血药浓度,并通过比较分析这两种方法的结果相关性,探讨血药浓度监测在临床药物治疗过程中的意义。方法采集在我院治疗的78例应用环孢素A的器官植患者血样,分别用FPIA和HPLC法测定血药浓度,测定结果用t检验的线性回归方法进行分析。结果用FPIA测定的78份环孢素A血药浓度为（142.26±50.64）ng/mL,HPLC法为（123.25±58.22）ng/mL,两种方法测定的结果相关系数r=0.948,P〈0.01,差异有统计学意义;FPIA测定的结果比HPLC法的平均高12.32%。结论环孢素A血药浓度在中高浓度时,FPIA和HPLC法具有良好的相关性,可应用于指导临床用药;但这两种方法有差异,FPIA测定的结果略高于HPLC法测定的结果,在临床应用中应值得注意。     

人血浆中头孢克洛高效液相色谱法与微生物法测定

目的:比较高效液相色谱法(HPLC)和微生物法测定头孢克洛血药浓度的差异。方法:10名健康受试者单剂量口服头孢克洛胶囊500mg,分别用HPLC法和微生物法测定血浆中药物浓度。结果:HPLC法线性范围为0.125~16mg·L-1,回收率为(93.34±5.94)%~(96.80±4.38)%,日内、日间相对偏差(RSD)分别为4.17%~6.36%和5.64%~9.09%;微生物法线性范围为0.125~16mg·L-1,回收率为(93.21±5.80)%~(95.62±4.23)%,日内、日间RSD分别为4.17%~6.03%和6.57%~8.70%;2种方法测定的受试者平均血药浓度和主要药动学参数差异无统计学意义。结论:2种方法精密度和回收率基本一致,均可用于头孢克洛血药浓度的测定。     

去甲万古霉素介入治疗慢性骨髓炎的实验研究

目的观察去甲万古霉素动脉灌注治疗慢性骨髓炎动物的疗效。方法将40只新西兰大白兔于右胫骨近端开骨窗,注入金黄色葡萄球菌及鱼肝油酸钠,骨蜡封闭骨窗,复制出慢性骨髓炎动物模型,随机分为2组,治疗组给予去甲万古霉素200 mg/kg动脉灌注,对照组予静脉推注,于用药后0.5、1、2、4、6、8和12 h采用微生物法测定血液、病灶周围软组织和病灶炎性骨段的去甲万古霉素浓度。结果治疗组炎性骨的去甲万古霉素浓度在用药后0.5、1和2 h明显高于对照组（P〈0.01）,在用药后4 h高于对照组（P〈0.05）;治疗组病灶周围软组织去甲万古霉素浓度在用药后0.5、1和2 h明显高于对照组（P〈0.01）,在用药后4、6 h高于对照组（P〈0.05）;血液中则相反,治疗组去甲万古霉素浓度在用药后0.5、1和2 h明显低于对照组（P〈0.01）,在用药后4 h低于对照组（P〈0.05）。结论术前4 h内经骨髓炎骨段供血动脉插管灌注去甲万古霉素,能保证慢性骨髓炎清除术术野有较高的抗生素浓度。     

血清胱抑素C测定在监测万古霉素致早期肾损害中的意义

目的探讨血清胱抑素C(CysC)测定在监测万古霉素致早期肾损害中的意义。方法既往无肾脏疾病、在广州医学院第一附属医院接受万古霉素治疗的患者60例,检测患者万古霉素血药浓度的同时检测CysC、血尿素氮(BUN)、血肌酐(Cre),分析其与血药浓度的相关性。结果 60例患者中CysC、BUN、Cre升高率分别为63.3%、47.5%和0;CysC与BUN或Cre对万古霉素所致肾损伤检测的阳性率差异有统计学意义(P<0.05);万古霉素浓度与CysC、BUN、Cre分别呈中度、低度相关以及不相关;万古霉素血药浓度<15mg/L与>15mg/L的患者,其CysC水平差异有统计学意义。结论 CysC是一项优于BUN和Cre的用于监测万古霉素所致早期肾损害的良好指标。     

HPLC法测定万古霉素和去甲万古霉素血清药物浓度

目的建立人血清中万古霉素和去甲万古霉素的HPLC测定方法 ,用于万古霉素和去甲万古霉素血药浓度临床监测。方法色谱柱为Shim-pack（150×4.6 mm,5μm）,流动相为甲醇∶磷酸二氢钾缓冲液（pH=3.2）=19∶81,检测波长为236 nm,流速1 ml/min,柱温为35℃,万古霉素和去甲万古霉素互为内标。结果万古霉素和去甲万古霉素的保留时间分别为4.835 min和4.020 min;标准曲线回归方程分别为Y=32.16624X-2.117683,r=0.9997（n=3）,Y=51.53402X-2.958621,r=0.9992（n=3）;线性范围均为2.5~100μg/ml;方法回收率〉95%,绝对回收率〉80%,日内和日间RSD〈6.2%。结论本测定方法快速、准确、简便,适用于万古霉素和去甲万古霉素的临床常规血药浓度的监测。     

高效液相色谱法测定人血清中万古霉素和去甲万古霉素浓度

目的建立人血清中万古霉素和去甲万古霉素浓度的高效液相色谱法（HPLC）测定方法。方法色谱柱为Hypersil BDS C18（250mm×4.6mm,5μm）柱;流动相为磷酸二氢钾缓冲液-甲醇（87∶13）,流速1ml/min;紫外检测波长236nm;以甲硝唑为内标,采用乙腈和硫酸锌沉淀蛋白后直接进样。结果万古霉素、去甲万古霉素血清浓度与峰面积线性关系良好,万古霉素回归方程为Y=0.0873X-0.0061,r=0.9999;去甲万古霉素回归方程为Y=0.1000X-0.0004,r=0.9997;线性范围1.0～50.0mg/L。日内相对标准编差（RSD）小于4.8%,日间RSD小于6.6%;万古霉素低、中、高浓度的平均方法回收率分别为102.41%,100.44%,104.69%,平均提取回收率分别为87.54%,89.86%,88.13%;去甲万古霉素低、中、高浓度的平均方法回收率分别为99.46%,98.88%,99.47%,平均提取回收率分别为78.13%,77.41%,76.45%。结论方法操作简便快速,回收率稳定,适于临床血药浓度测定及相关科研的应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.