苦参生物碱的高效液相色谱法测定

报道了苦参中五种主要生物碱——槐果碱、苦参碱、槐定、氧化槐果碱和氧化苦参碱的高效液相色谱测定法。用氨基键合相柱,乙腈—磷酸水溶液(pH 2)—无水乙醇(80:8:10)为流动相,220nm为检测波长。方法简便易行,可在15 min内完成测定。     

在聚乙氧基辛基苯基醚存在下氯米帕明的电分析特性

在聚乙氧基辛基苯基醚存在下氯米帕明的电分析特性张正奇，陈展光，陈声宗，曾鸽鸣，杨植岗（湖南大学化学化工系，长沙４１００８２）氯米帕明（ｃｌｏｍｉｐｒａｍｉｎｅ，ＣＭＩ）能选择性地抑制中枢神经系统内５－ＨＴ的重吸收，可消除抑郁心境，恢复活力。本品使用安...     

Musashi1 regulates breast tumor cell proliferation and is a prognostic indicator of poor survival

Background  

Musashi1 (Msi1) is a conserved RNA-binding protein that regulates the Notch and Wnt pathways, and serves as a stem cell marker in the breast and other tissues. It is unknown how Msi1 relates to other breast cancer markers, whether it denotes tumor initiating cells (TICs), and how it affects gene expression and tumor cell survival in breast cancer cells.     

New Cochrane Systematic Reviews – Cochrane Oral Health Group

ENAMEL MATRIX DERIVATIVE (EMDOGAIN®) FOR PERIODONTAL TISSUE REGENERATION IN INTRABONY DEFECTS (Cochrane Review). In: THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSUE 4, 2005.Esposito M, Grusovin MG, Coulthard P, Worthington H

Background

Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth-supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG), and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development.

Objectives

The objectives were to test whether EMD is effective, and to compare EMD versus GTR and various BG procedures for the treatment of intrabony defects.

Search strategy

We searched the Cochrane OHG Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Several journals were hand searched. No language restrictions were applied. Authors of randomized controlled clinical trials (RCTs) who were identified, personal contacts, and the manufacturer were contacted to identify unpublished trials. The most recent search was May 2005.

Selection criteria

Selected studies were RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR, and various BG procedures with at least 1 year of follow-up. The outcome measures considered were tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, esthetics, and adverse events. The following time points were to be evaluated: 1, 5, and 10 years.

Data collection & analysis

Screening of eligible studies, assessment of the methodological quality of the trials, and data extraction were conducted in duplicate and independently by 2 authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed.

Main results

Ten trials were included out of 29 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including 8 trials showed that EMD-treated sites displayed statistically significant PAL improvements (mean difference 1.2 mm, 95% CI 0.7 to 1.7) and PPD reduction (0.8 mm, 95% CI 0.5 to 1.0) when compared to placebo or control treated sites, although a high degree of heterogeneity was found. Significantly more sites had less than 2 mm PAL gain in the control group, with RR 0.48 (95% CI 0.29 to 0.80). Approximately 6 patients needed to be treated (NNT) to have 1 patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 35%. No differences in tooth loss or esthetic appearance as judged by the patients were observed. When evaluating the only 2 trials at a low risk of bias in a sensitivity analysis, the effect size for PAL was 0.6 mm, which was less than 1.2 mm for the overall result. Comparing EMD with GTR (5 trials), GTR showed a statistically significant increase of REC (0.4 mm) and significantly more postoperative complications. No trials were found comparing EMD with BG.

Reviewers' conclusions

One year after its application, EMD significantly improved PAL levels (1.2 mm) and PPD reduction (0.8 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD.

Abstract

INTERVENTIONS FOR REPLACING MISSING TEETH: DENTAL IMPLANTS IN ZYGOMATIC BONE FOR THE REHABILITATION OF THE SEVERELY DEFICIENT EDENTULOUS MAXILLA (Cochrane Review). In: THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSUE 4, 2005.Esposito M, Worthington HV, Coulthard P

Background

Dental implants are used for replacing missing teeth. Placing dental implants is limited by the presence of adequate bone volume permitting their anchorage. Several bone-augmentation procedures have been developed to solve this problem. Zygomatic implants are long screw-shaped implants developed as a partial or complete alternative to bone augmentation procedures for the severely atrophic maxilla. One to 3 zygomatic implants can be inserted through the posterior alveolar crest and maxillary sinus to engage the body of the zygomatic bone. A couple of conventional dental implants are also needed in the frontal region of the maxilla to stabilize the prosthesis. The potential main advantages of zygomatic implants could be that in some situations bone grafting may not be needed and a fixed denture could be fitted sooner. Another specific indication for using zygomatic implants could be the need for maxillary reconstruction after maxillectomy in cancer patients.

Objectives

The objective was to test the hypothesis of no difference in outcomes between zygomatic implants with and without bone-augmenting procedures in comparison with conventional dental implants in augmented bone for severely resorbed maxillae.

Search strategy

We searched the Cochrane Oral Health Group's Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. We hand searched several dental journals. No language restrictions were applied. Personal contacts and all known zygomatic implant manufacturers were contacted to identify unpublished trials. The most recent search was May 2005.

Selection criteria

Studies selected were randomized controlled clinical trials (RCTs) that included patients with severely resorbed maxillae who could not be rehabilitated with conventional dental implants and were treated with zygomatic implants with and without bone grafts versus patients treated with conventional dental implants in conjunction with bone-augmentation procedures having a follow-up of at least 1 year. Outcome measures considered were prosthesis and implant failures, side effects, patient satisfaction, and cost-effectiveness.

Data collection & analysis

Screening of eligible studies, assessment of the methodological quality of trials, and data extraction were to be conducted in duplicate and independently by 2 authors. Results were to be expressed as random-effects models using weighted mean differences for continuous outcomes and risk ratio for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.

Main results

No RCTs or controlled clinical trials (CCTs) were identified.

Reviewers' conclusions

There is the need for RCTs in this area to assess whether zygomatic implants offer some advantages over alternative bone-augmentation techniques for treating atrophic maxillae.     

Low‐molecular‐weight heparin added to aspirin in the prevention of recurrent early‐onset pre‐eclampsia in women with inheritable thrombophilia: the FRUIT‐RCT

Summary. Background: Early‐onset hypertensive disorders (HD) of pregnancy and small‐for‐gestational age infants (SGA) are associated with placental vascular thrombosis, these often recur and are also associated with inheritable thrombophilia. Aspirin reduces the recurrence risk. Objectives: Adding low‐molecular‐weight heparin (LMWH) to aspirin at < 12 weeks gestation reduces the recurrence of HD in women with previous early‐onset HD (pre‐eclampsia, hemolysis, elevated liver enzymes and low platelets [HELLP] syndrome and eclampsia) and/or SGA, in the context of inheritable thrombophilia without antiphospholipid antibodies. Patients/methods: In a multicenter randomized control trial (RCT), 139 women included were < 12 weeks gestation. Inclusion criteria: previous delivery < 34 weeks gestation with HD and/or SGA; inheritable thrombophilia (protein C deficiency, protein S deficiency, activated protein C resistance, factor V Leiden heterozygosity and prothrombin gene G20210A mutation heterozygosity); and no antiphospholipid antibodies detected. Intervention: either daily LMWH (dalteparin, 5000 IU weight‐adjusted dosage) with aspirin 80 mg or aspirin 80 mg alone. Main outcome measures: Primary outcomes: recurrent HD onset (i) < 34 weeks gestation and (ii) irrespective of gestational age. Secondary outcomes: recurrent SGA, preterm birth, maternal/neonatal hospitalization, spontaneous abortion and individual HD. Analysis by intention‐to‐treat. Results: Low‐molecular‐weight heparin with aspirin reduced recurrent HD onset < 34 weeks gestation (risk difference [RD] 8.7%: confidence interval [CI] of RD 1.9–15.5%; P = 0.012; number needed to treat [NNT] 12). Recurrent HD irrespective of gestational age was not different between the arms. No women withdrew as a result of adverse effects. Trial Registration: http://www.isrctn.org ) (isrctn87325378). Conclusions: Adding LMWH to aspirin at < 12 weeks gestation reduces recurrent HD onset < 34 weeks gestation in women with inheritable thrombophilia and prior delivery for HD/SGA <34 weeks. However, close monitoring of the mother and fetus remains important throughout pregnancy.     

Mortality and cancer incidence in persons with Down's syndrome, their parents and siblings

A cohort study of 1425 persons with Down's syndrome (DS), and of their parents (447 mothers, 435 fathers) and siblings (1176), was set up to investigate death rates from various causes and cancer incidence patterns. In individuals with DS the all-cause death rate was six times that of the national population (SMR = 622: 95% CI 559–693), the excess being attributable to many different causes. These included: leukaemia (SMR = 1304: 95% CI 651–2334); diabetes mellitus (SMR = 982: 95% CI 267–2515); Alzheimer's disease (SMR = 22028: 95% CI 7137–51326); epilepsy (SMR = 1727: 95% CI 744–3403); and congenital anomalies (SMR = 4987: 95% CI 4175–5955). The overall survival showed marked improvements for successive birth cohorts, particularly at young ages. For mothers and fathers of persons with DS, all-cause death rates were 20% lower than national rates and there were no significant excesses from any specific cause. For siblings, all-cause death rates were similar to national rates; the only condition with a significantly raised mortality ratio was colo-rectal cancer (SMR = 793: 95% CI 216–2031), but this may well be a chance finding.     

CHRONIC SACRAL NEUROMODULATION IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS: RESULTS FROM A NATIONAL REGISTER

PURPOSE: The Italian Register was created in February 1997 to collect the national results of sacral neuromodulation. All Italian centers at which sacral neuromodulation is performed were invited to participate in our study. We present the results from retrospective and prospective registers. MATERIALS AND METHODS: A total of 196 patients underwent permanent implantation of sacral neuromodulation and were enrolled in the Italian register. There were 18 males and 75 females in the retrospective, and 28 males and 75 females in the prospective studies. Student's t test was used to compare paired values, and the Wilcoxon rank sum and nonparametric tests were used when necessary. RESULTS: Mean incontinent episodes daily plus or minus standard deviation for patients with detrusor instability went from 5.4 +/- 3.9 to 1.1 +/- 1.6 (median 5 and 0, respectively) at 12-month followup (p <0.001). For idiopathic retention average residual volume decreased from 277 to 108 cc (median 287 and 80, respectively), and 50% of patients stopped catheterization and another 13% catheterized once daily at 1-year after implantation. With neurogenic voiding disturbances, the results fluctuated with time from a minimum of 33% to a maximum 66% of patients who did not catheterize at 6-month followup and 12 months after implantation, respectively. At 12-month followup, 50% of patients with hyperreflexia had less than 1 incontinent episode daily. The problem was completely solved in 66% of patients in the retention group. Of patients in the urge incontinent population 39% were completely dry and 23% had less than 1 incontinent episode daily. CONCLUSIONS: Sacral neuromodulation is effective therapy for treating lower urinary tract symptoms resistant to less invasive therapy.     

Reduction of immunosuppression for transplant-associated skin cancer: expert consensus survey

BACKGROUND: Reduction of immunosuppression is considered a reasonable adjuvant therapeutic strategy in solid-organ transplant recipients experiencing multiple or high-risk skin cancers. However, the literature provides no guidance about what threshold of cancer development would warrant initiation of reduction of immunosuppression. OBJECTIVES: To develop expert consensus guidelines for initiation of reduction of transplant-associated immunosuppression for solid-organ transplant recipients with severe skin cancer. METHODS: An expert consensus panel was convened by the International Transplant Skin Cancer Collaborative and Skin Care for Organ Transplant Patients Europe Reduction of Immunosuppression Task Force. Thirteen hypothetical patient scenarios with graduated morbidity and mortality risks were presented and mean and mode expert opinions about appropriate level of reduction of systemic immunosuppression (mild, moderate, severe) were generated. RESULTS: Mild reduction of transplant-associated immunosuppression was considered warranted once multiple skin cancers per year developed or with individual high-risk skin cancers. Moderate reduction was considered appropriate when patients experienced > 25 skin cancers per year or for skin cancers with a 10% 3-year risk of mortality. Severe reduction was considered warranted only for life-threatening skin cancers. CONCLUSIONS: Reduction of immunosuppression is considered a reasonable adjuvant management strategy for transplant recipients with numerous or life-threatening skin cancers. Proposed guidelines are presented for the graduated reduction of immunosuppression coincident with the increasing skin cancer risks.