碳酸利多卡因在硬膜外麻醉中的药动学-药效学与硬膜外输注给药方案设计

人中的药物动力学及药效学进行研究。采用荧光们振免疫分析方法测定血清利多卡因浓度;结果：根据药动学－药效学研究结果,提出维持有效麻醉血药浓度为２．５～５．０μｇ/ｍｌ;利用药动学参数清除率,计算出硬膜外持续输注给药速率为２０～４０μｇ／ｍｉｎ．ｋｇ。应用先给予初始剂量,后根据病人情况,选择合适的给药速率实施硬膜外持续给药。对５１例病人采用硬膜外持续输注给药后的１４５份血药浓度进行监测,同时对所有病人在手术全过程中的麻醉效果、血压及心牵进行连续监测。结果表明,初始给药剂量为（３．７５±０．６２）ｍｇ/ｋｇ（２．１～６．２）ｍｇ／ｋｇ（ｎ＝５１）;硬膜外持续输注速率为（３５．９９±５．３０）μｇ／ｍｉｎ．ｋｇ;平均血药浓度为（３．３２±ｌ．５２）μｇ／ｍｌ（ｎ＝１４５）。手术过程中麻醉效果满意,病人的血压及心率正常。结论：采用先给予初始剂量．后持续硬膜外输注给药的方案,即可获得满意的麻醉效果,又克服了在硬膜外麻醉中,由于重复给药所引起的血药浓度的较大波动,这种血药浓度的波动,可能引起浓度过低的麻醉效果不够,或浓度过高的药物中毒。     

头低位(-20°)限制活动7d对兔庆大霉素药代动力学的影响

目的 探讨模拟失重条件下以血流量改变为生理基础的药代动力学变化。方法 选择庆大霉素作为模型药物,采用头低位（ － ２０°） 兔限制活动为模拟失重动物模型,观察模拟失重对兔庆大霉素药代动力学参数的影响。７ 只家兔在头低位７ ｄ 前后,分别静脉滴注了３ ｍｇ／ｋｇ 的庆大霉素,用 Ｔ Ｄｘ Ｆ Ｌｘ 测定了给药后４ ｈ 内的血药浓度。结果 庆大霉素的分布变慢,这表现在α值由头低位前的（０ ．１８３８ ±０ ．１０７６）ｍｉｎ － １ 降至头低位后的（０ ．０５９１ ±０ ．０３３４） ｍｉｎ － １ ,ｔ１／２α由（５ ．３０ ±３ ．５５） ｍｉｎ 延长为（１５ ．０４ ±７ ．４９）ｍｉｎ , Ｋ１２ 由（０ ．１０２５ ±０ ．０７２１） ｍｉｎ － １ 降至（０ ．０１８１ ±０ ．０１６１） ｍｉｎ１ ,都有显著性差异; Ｖ（ Ｃ） 、 Ｖ（ Ｄ） 也有升高的趋势。庆大霉素清除率在模拟失重后也有所增加, Ｃ Ｌ（ Ｓ） 从（２ ．２ ±０ ．５）ｍｌ·ｍｉｎ１·ｋｇ１ 升至（２ ．７ ±０ ．３）ｍｌ·ｍｉｎ１·ｋｇ１ 。结论 模拟失重可改变药代动力学过程。     

用反相高效液相色谱法同时测定血中地苷洛韦和阿苷洛韦的浓度

目的：为了满足地苷洛韦（脱氧无环鸟苷，ＤＣＶ）药代动力学研究和血药浓度监测的需要，建立了能够同时测定血中ＤＣＶ和阿苷洛韦（无环鸟苷，ＡＣＶ）的反相高效液相色谱（ＨＰＬＣ）分离测定方法。方法：血浆经离心式超滤器离心除蛋白后，取超滤液直接进行ＨＰＬＣ分析。色谱条件如下：ＳｐｈｅｒｉｓｏｒｂＣ１８分析柱；甲醇水（１５８５，体积比）作为流动相，流速０．７ｍｌ／ｍｉｎ；可编程紫外检测器，波长：ＤＣＶ３０５ｎｍ，ＡＣＶ２０５ｎｍ；外标法定量。结果：血中ＤＣＶ和ＡＣＶ的最低检出浓度分别是０．１４和０．０８μｇ／ｍｌ；在１．０～２０μｇ／ｍｌ浓度范围内，血中ＤＣＶ和ＡＣＶ测定的平均回收率分别是（９９．２±１０．４）％和（１０９．２±２．５）％，重复测定变异系数分别是２．７％～１０．７％和０．２％～４．０％。结论：建立了同时测定血中ＤＣＶ和ＡＣＶ浓度的ＨＰＬＣ分离测定方法。该法灵敏、快速、准确、复演性好。     

用高效液相色谱法同时测定血浆中苯妥英和卡马西平的浓度

建立了快速测定血浆或全血中苯妥英及卡马西平浓度的高效液相色谱（ＨＰＬＣ）法。样品经乙酸乙酯一步提取，用ＳｐｈｅｒｉｓｏｒｂＣ１８柱分析，流动相为甲醇一水一四氢呋喃（４５：５５：５，ｖ：ｖ：ｖ），二级管阵列检测器（ＤＡＤ）检测波长２１０±２ ｎｍ。本方法快速简便，有较好的精密度（ＲＳＤ苯妥英 １．９％～８．６％；卡马西平 ２．１％～ ７．８％）和较宽的线性范围（苯妥英 ０．４～ ４０．０ μｇ／ ｍｌ；卡马西平 ０．２～２０．０ μｇ／ ｍｌ），适合于临床血药浓度的监测和药代动力学的研究。     

依诺沙星对氨茶碱药代动力学的影响

目的：测定健康人单用氨茶碱及合用依诺沙星后的血清茶碱浓度，并进行药代动力学比较。方法：采用反相高效液相色谱法（RP－HPLC）测定8名健康人单用氨茶碱及合用依诺沙星后茶碱的稳态血药浓度，并对两种情况下茶碱的药代动力学参数进行对比研究。结果：联用依诺沙星后血清茶碱浓度普遍提高，最大血药浓度（Cmax)与单用氨茶碱相比有显性差异（P＜0．05），药时曲线下面积（AUC）显提高（P＜0．05），清除率（Cl)明显降低（P＜0．05），半衰期（T1／2）明显延长（P＜0．05）。结论：依诺沙星可使氨茶碱的血清浓度提高，药时曲线下面积（AUC）和半衰期（T1／2）增大，清除率（Cl)减小。     

头低位（—20℃）限制活动7d对兔庆大霉素药代动力学的影响

目的 探讨模拟失重条件下以血流量改变为经代动力学变化。方法 选择庆大霉素作为模型药物,采用头低位（－２０℃（兔限制活动为模拟失重动物模型,观察模拟失重对兔庆大霉素药代动力学参数的影响。７只家兔在头低位７ｄ前后,分别静脉滴注了３ｍｇ／ｋｇ的庆大霉素,用ＴＤｘＦＬｘ测定了给药后４ｈ内的血药浓度。结果 庆大霉素的分布变慢,这表现在α值由头低位前的（０．１８３８±０．１０７６）ｍｉｎ＾－１降至头低位后的（     

感染患者口服司帕沙星片的药代动力学

目的：测定司帕沙星在感染患体内的药物代谢动力学。方法：ＨＰＬＣ法测定１０例患单剂量口服司帕沙星２００ｍｇ后血清和尿中药物深度并计算药代动力学参数。结果：司帕沙星血清药物浓度－时间曲线符合一级吸收开放二室模型。药物吸收有较长延滞期,平均为（０．２５±０．１２）ｈ,吸收相Ｔ１／２平均（０．８８±０．１７）ｈ,消除相Ｔ１／２平均（１３．２２±２．７８）ｈ,达峰时间（３．９９±０。４０）ｈ,曲线下面积     

高原环境对阿莫西林药代参数的影响研究

目的探讨急进高原后大鼠体内阿莫西林药代动力学参数的变化。方法Wistar大鼠于平原地区和急进高原后灌胃给药,分别于给药前（0h）及给药后0．33、0．66、1、1．5、2、3、4、6、8、12、24h采血,采用LC—MS／MS方法测定血药浓度,并分别计算蛋白结合率和药代动力学参数。结果急进高原组血浆蛋白结合率（45．oo％）与平原组血浆蛋白结合率（36．31％）相比显著升高,药一时曲线下面积从（11616．40±1071．92）μg·L^-1·h增大到（47879．24±9417．18）μg·L^-1·h,急进高原后体内平均驻留时间延长,峰浓度增大,清除率降低。结论统计学分析结果显示急进高原后,阿莫西林在大鼠体内药代动力学参数发生显著变化,为进一步研究人体药代动力学提供实验基础和参考依据。     

盐酸格拉司琼片剂人体内药动学的研究

目的研究盐酸格拉司琼片剂的人体药代动力学。方法采用甲醇-0．05M醋酸钠缓冲液（70：30,pH=6．0,含0．25％三乙胺）为流动相,以HPLC法测定30名男性健康志愿者单剂量口服2mg受试片剂后的血药浓度。结果药-时数据经3p87程序处理,得到格拉斯琼的Cmax为10．6±4．0μg·L^-1;达峰时间tmax分别为1．37±10．2h;消除相半衰期t1／2ke为7．19±4．11h;AUC0→36h为79．9±51．1μL·h^-1;AUC0→∞为85．0±54．5μg·L^-1·h。结论本HPLC方法可快速测定药物血药浓度。操作简洁,分析快速准确。格拉司琼片剂药动学参数表明,血药浓度和药代动力学参数个体变异较大,建议临床使用此药时应根据病人的具体情况采用个性化用药方案,以达到最佳疗效。     

兔脾动脉插管和耳静脉穿刺灌注氟尿嘧啶门静脉检测的药代动力学研究

对比研究经脾动脉和耳静脉灌注氟尿嘧啶时经门静脉测定的药代动力学,以评价在肝恶性肿瘤的血管内介入治疗中,经脾动脉灌注化疗药的临床治疗价值。对脾动脉灌注组（IA组）和耳静脉灌注组（IV组）均行门静脉插管取样测定,采用高效液相色谱仪检测门静脉血中氟尿嘧啶,进行药代动力学对比分析。结果显示,IA组各血样的血药浓度均高于IV组,前者之血药峰值比后者高64％,前者曲线下面积比后者大42％,提示经脾动脉灌注化疗药,门静脉内可达较高血药浓度,有利于对由门静脉供血的肝恶性肿瘤外围部分的控制。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）