莲子心生物碱的研究——Ⅳ.莲心碱的全合成

本文报导了莲心碱(Ⅰ)全合成的研究。(1)合成了1-(3′-溴-4′-苄氧基)苄基-2-甲基-6,7-二甲氧基-1,2,3,4-四氢异喹啉(Ⅷ)和1-(4′-苄氧基)苄基-2-甲基-6-甲氧基7-羟基-1,2,3,4-四氢异喹啉(XV).(2)1-(3′-溴-4′-苄氧基)苄基-6,7-二甲氧基-1,2,3,4-四氢异喹啉(Ⅵ)和1-(4′-苄氧基)苄基-6-甲氧基-7-乙酰氧基-1,2,3,4-四氢异喹啉(ⅩⅢ)借d-和1-DPT-酒石酸各自拆分为其对映体。D-(-)-Ⅵ和L-(+)-Ⅵ以甲酸和甲醛甲基化分别生成D-(-)-Ⅷ和L-(+)-Ⅷ。D-(+)-;ⅩⅢ和L-(-)-ⅩⅢ经N-甲基化后再进行水解卽得D-(-)-ⅩⅤ和L-(+)+ⅩⅤ。(3)D-(-)-Ⅷ和D-(-)-ⅩⅤ在吡啶中有铜粉和碳酸钾存在下进行Ullmann反应,反应物经氧化鋁柱层析可分得一油状物,此油状物经盐酸水解得黄色无定形固体,后者与过氯酸生成过氯酸盐结晶,其理化性质均与天然莲心碱过氯酸盐相同。(±)-Ⅷ和(±)-ⅩⅤ在相似的条件下缩合则生成(±)-莲心碱。     

延胡索对缺血再灌注损伤大鼠局灶性脑梗死的作用

目的：探讨延胡索对局灶性脑梗死的作用。方法：总共有30只Sprague-Dawley(SD)大鼠被用来研究。局灶性脑梗死动物模型的建立是将两侧的颈总动脉和右侧的中大脑动脉的血流阻断90min后,再经24h的灌注,然后评估它们的神经状态,大鼠被牺牲取脑,并作成切片用2,3,5-triphenyl-tetrazolium chloride染色。以神经的状态和脑梗死面积的变化作为指标来评估延胡索对脑梗死的作用。另外,24只SD大鼠腹腔注射延胡索,经24h后从心脏采血测量血液的变化。结果：延胡索100mg/kg腹腔注射能够改善大鼠神经缺损的症状和减少脑梗死的面积以及能增加全血中红血球的数目和提高血比容（hematocrit)。结论：延胡索在缺血再灌流损伤大鼠能改善神经状态和减少脑梗死面积。     

Clinicopathological significance of intestinal and diffuse types of gastric carcinoma in Taiwan Chinese

The present study sought to evaluate the clinicopathological features of our gastric cancer patients in terms of a modified Lauren's histological classification and compared the results with those from studies from Japan and Western countries. A total of 536 consecutive patients with gastric cancer were treated surgically between December 1987 and December 1993. A clinicopathological analysis was only performed for intestinal types (IT) and diffuse types (DT) of gastric cancer because patients falling into the ‘other’ category were too small to produce meaningful data. Of 536 cases of gastric cancer, 268 (50%) were IT, 231 (43.1%) were DT and 37 (6.9%) were of the other type. The overall IT:DT ratio was 1.2. Gastric cancer patients with IT (in contrast to DT) were characterized by older age, male dominance, smaller tumours, the tumour often being located in the lower and upper third of the stomach and less peritoneal metastasis. In both sexes, the peak incidence of gastric cancer patients was in the age group 65–74 years. Men had higher proportions of IT carcinoma than women. The IT:DT ratio for men and women was 1.4 and 0.4, respectively. Although the increased ratio of IT:DT paralleled the advance of age in both sexes, the transitional age (the age at which the IT:DT ratio exceeds 1.0) in male patients (age group 51–64 years) was earlier than for female patients (age group 65–74 years). Patients with IT gastric cancer had a significantly better survival rate than those with DT. However, the type of carcinoma (IT or DT) was not an independent predictor of survival. These data indicate that gastric cancer in Taiwan Chinese has different biological behaviour in terms of IT and DT. The clinicopathological features in IT and DT carcinoma are similar to studies from Japan and from Western countries.     

番石榴叶中一个新的番石榴二醛二聚体

目的：研究番石榴叶中潜在的生物活性次生代谢产物，进一步评价民族药的性质。方法：利用硅胶柱层析和凝胶柱层析分离纯化得到化合物1，借助光谱学手段鉴定其结构。结果：分离得到一个新的番石榴二醛二聚体。结论：番石榴二醛二聚体是一个新的杂萜，由两分子番石榴二醛通过醚键形成结构对称的二聚体。     

Ventricular Tachycardia in a Patient with Primary Hyperparathyroidism

We present a case of primary hyperparathyroidism with hypercalcemia in a patient who had spontaneous attacks of ventricular tachycardia. Right ventricular burst pacing reproducibly induced ventricular tachycardia in the electrophysiological laboratory after intravenous administration of calcium-gluconate, and verapamil could terminate the tachycardia. After resection of the parathyroid adenoma, the calcium level was restored to normal, and ventricular tachycardia did not occur again during the follow-up period,     

Differentiating the Ligament of Marshall from the Pulmonary Vein Musculature Potentials in Patients with Paroxysmal Atrial Fibrillation: Electrophysiological Characteristics and Results of Radiofrequency Ablation

TAI, C.-T., et al. : Differentiating the Ligament of Marshall from the Pulmonary Vein Musculature Potentials in Patients with Paroxysmal Atrial Fibrillation: Electrophysiological Characteristics and Results of Radiofrequency Ablation. It was reported that paroxysmal atrial fibrillation (PAF) can be initiated by ectopic atrial beats originating from the pulmonary vein (PV) or left atrial tract (LAT) within the ligament of Marshall (LOM). The aim of this study was to differentiate the LAT from the PV potentials, and to investigate the results of radiofrequency ablation guided by these potentials. Ten patients (  age 60 ± 12 years  ) with PAF who had a recording of double potentials (DPs) in or around the left PV were included. Group I had five patients with the second deflection of DPs (D2) due to activation of the LAT, and Group II had five patients with D2 due to activation of the PV musculature. There were no significant difference in the isoelectric interval between DPs, the activation time, and amplitude of D2 between Groups I and II. During distal coronary sinus (CS) pacing, the CS ostium (CSO) to D2 interval was shorter compared with that during sinus rhythm in Group I (  39 ± 19 vs 71 ± 25 ms, P = 0.04  ), but was longer in Group II (  96 ± 16 vs 44 ± 19 ms, P = 0.04  ). During ectopic activation, three patients in Group I, but no Group II patients, had transformation of recorded DPs into triple potentials. Radiofrequency ablation guided by the earliest activation of the LAT potential was performed with transient suppression of PAF, but ablation guided by the earliest activation of the PV potentials had a high success rate in eliminating PAF. In conclusion, differentiating the LAT from the PV potentials for initiation of PAF is feasible by an electrophysiological approach, and may be important for radiofrequency ablation of PAF.     

Correlation between white blood cell count and metabolic syndrome in adolescence

BACKGROUND: Metabolic syndrome (MetS) is associated with increased risk for diabetes and coronary heart disease. Data suggest that MetS starts even in children. Thus, it is important to understand the role of MetS and the risks related to it. Furthermore, white blood cell count (WBCC) is available in routine examination and it has been proved to be related to risks of MetS. METHODS: A total of 1657 subjects aged 14-19 years were enrolled, with normal WBCC (< or =10 x 10(9) cells/L). The subjects were divided into four quartiles according to WBCC (WBCC1-4, from the lowest to highest WBCC) in both genders. RESULTS: The female subjects had significantly lower systolic blood pressure, fasting plasma glucose (FPG), triglyceride (TG), body mass index (BMI) and higher high-density lipoprotein-cholesterol (HDL-C) than the male subjects. When comparing the risks of the quartiles of WBCC, WBCC4 had significant higher BMI than WBCC1 and WBCC2 in both genders; and lower HDL-C than WBCC3 in male subjects. On multiple regression WBCC was positively related with BMI and TG and negatively related to HDL-C in male subjects. In female subjects only BMI was positively correlated with WBCC. Subjects with MetS did not have significant higher WBCC than those without MetS. CONCLUSIONS: In adolescents with normal WBCC, BMI is significantly related to the levels of WBCC and is the earliest component of MetS to be noted in adolescents. Elevated TG and decreased HDL-C could also be important markers for future risk factors only in male subjects.     

Effects of acupuncture on post-cesarean section pain

Background Post-operation pain is a very subjective phenomenon. The aim of this study was to find out the effects of acupuncture or electro-acupuncture on post-cesarean pain. Methods Sixty women, who had had spinal anesthesia during cesarean section at the Department of Obstetrics of China Medical University Hospital, were randomly assigned to the control group, the acupuncture group, and the electro-acupuncture group. After the operation, we applied subjects with acupuncture or electro-acupuncture on the bilateral acupuncture point, San Yin Jiao （Sp6）, and the patient controlled analgesia （PCA）. The first time of requesting morphine, the frequency of PCA demands in 24 hours, and the doses of PCA used were recorded double blindly. In addition, monitoring the subjects＇ vital signs, the opioid-related side effects, and the pain scores was done. Results The results showed that the acupuncture group and the electro-acupuncture group could delay the time of requesting morphine up to 10-11 minutes when compared with the control group. The total dose of PCA used within the first 24 hours was 30%-35% less in the acupuncture group and the electro-acupuncture group when compared with the control group, which was indicated in statistical significance. However, there was no significant difference between the acupuncture group and the electro-acupuncture group. The electro-acupuncture group＇s and the acupuncture group＇s pain scores were lower than the control group＇s within the first 2 hours. Both were statistically significant. However, two hours later, there were no significant differences of the visual analogue scale （VAS） scores between either of the treatment groups and the control group. Finally, the incidence of opioid-related side effects, such as dizziness, was less in the acupuncture group and electro-acupuncture group than in the control group. Conclusions This study shows that the application of acupuncture and electro-acupuncture could definitely delay the time of requesting pain relief medication after cesarean section and decrease the PCA doses used within the first 24 hours.