大孔树脂吸附法富集野菊花总黄酮的工艺研究

目的研究大孔树脂吸附法富集野菊花总黄酮的工艺条件及参数。方法以野菊花总黄酮为考察指标,考察大孔树脂富集野菊花总黄酮的最佳工艺条件。结果野菊花提取液(50mg生药/mL)5mL上大孔树脂柱(150mm×10mm),吸附30min后,先用100mL蒸馏水洗脱除去杂质,然后用70%乙醇100mL洗脱,洗脱速度为2mg/mL,洗脱剂用量为9倍量树脂,树脂可重复使用3次,采用此条件为最佳工艺。结论AB-8型大孔树脂在所确定的工艺条件下,可较好的吸附分离野菊花总黄酮。其70%乙醇洗脱物中总黄酮质量分数达4.34%以上,总黄酮收率为84.47%以上。采用此法可以较好的富集野菊花中的有效成分。     

Blood loss and replacement in total hip arthroplasty: a multicenter study. The Preoperative Autologous Blood Donation Study Group

To determine blood loss, the number of transfusions, and the hemoglobin levels achieved in patients via transfusion in the course of total hip arthroplasty, 324 patient records from 1987 through 1989 were reviewed at three university and three community hospitals. Calculated blood loss was 3.2 +/- 1.3 units in primary procedures and 4.0 +/- 2.1 units in revision procedures (mean +/- SD). Of 777 red cell units transfused, 455 (59%) were autologous units. Transfused patients received 2.0 +/- 1.8 units for primary procedures and 2.9 +/- 2.3 units for revision procedures (mean +/- SD). The maximum number of units given to 95 percent of the transfused patients was 4 for primary procedures and 6 for revision procedures. The mean postoperative hemoglobin level after all transfusions was 103 to 110 g per L, regardless of patient age group of physical status, autologous donor status, or hospital. No difference in length of hospital stay was observed for patients less than 65 years old with hemoglobin concentrations of 80 to 139 g per L at discharge.     

急性冠状动脉综合征置入支架患者使用替罗非班和阿司匹林时泮托拉唑对消化道保护作用的评价

目的:急性冠状动脉综合征(ACS)置入支架患者使用盐酸替罗非班、阿司匹林、氯吡格雷、低分子肝素(四联)时,评价泮托拉唑对消化道的保护作用.方法:选择ACS置入支架治疗的患者266例,随机分入观察组134例,对照组132例,所有患者均服用阿司匹林、氯吡格雷、低分子肝素和盐酸替罗非班.观察组患者静脉注射泮托拉唑40 mg/d 4～5天,之后改为泮托拉唑片剂40 mg/次,2次/天,服用30天.观察两组间30天全因死亡、再次心肌梗死、再次经皮冠状动脉介入治疗(PCI)、再次住院、颅内出血和消化道出血状况.结果:观察组134例患者30天内全因死亡5例、再次心肌梗死4例、再次PCI4例和再次住院8例;对照组132例患者分别为8例、6例、5例和13例,两组相比差异均无统计学意义(P>0.05);两组均无颅内出血发生.观察组消化道大出血0和总消化道出血事件3例,对照组分别为5例和15例,两组比较观察组消化道大出血和总消化道出血事件少于对照组(P<0.05),差异均有统计学意义.结论:ACS置入支架治疗的患者,盐酸替罗非班治疗是安全有效的,未见颅内出血发生.静脉注射和口服泮托拉唑并不增加30天全因死亡、再次心肌梗死、再次PCI和再次住院发生,同时可以减少30天内消化道出血发生率特别是消化道大出血事件的发生,具有良好的消化道保护作用和安全性.     

Breast Surgery Outcomes as Quality Measures According to the NSQIP Database

Background

The National Surgical Quality Improvement Program (NSQIP) is a risk-adjusted database designed to benchmark quality initiatives. NSQIP captures uniform morbidity variables for all operations and calculates expected morbidity probabilities. Given the frequent need for reoperation following breast-conserving surgery (BCS) and mastectomy, we hypothesized that NSQIP may inaccurately reflect surgical morbidity after breast cancer operations.

Methods

Using the 2008 NSQIP database, we identified 24,447 breast surgery patients. We calculated the observed versus expected (O/E) morbidity ratios, compared them to other general surgery procedures, and analyzed the O/E morbidity ratios among benign and malignant breast diagnoses.

Results

The NSQIP database shows that breast surgery has an O/E morbidity ratio of 3.11, which is higher than other general surgery procedures. Additionally, breast operations for malignancy have higher O/E morbidity ratios (3.22) than those performed for benign disease (2.59). Analysis of malignant patients by CPT code revealed that BCS patients had an O/E morbidity ratio of 7.75 and attributed 89?% of morbidity to reoperation, whereas mastectomy patients had an O/E morbidity ratio of only 1.7. Elimination of the reoperation variable from morbidity calculations in breast surgery reduces the O/E morbidity ratio to less than expected in all breast procedures.

Discussion

Breast surgery has a higher O/E morbidity ratio than other general surgery procedures. Reoperations are expected in BCS for positive margins and in mastectomy for completion ALND. Breast surgeons should advocate for benchmarking by surgical site-specific metrics, because current NSQIP criteria may negatively affect the quality assessment of high-volume breast centers.     

Iotrol versus metrizamide in lumbar myelography: a double-blind study

In a prospective, randomized, double-blind study, 49 patients underwent lumbar myelography using iotrol (24 patients) or metrizamide (25 patients). The diagnostic imaging adequacy of iotrol was comparable with that of metrizamide. After iotrol myelography, adverse reactions were fewer, less severe, and of shorter duration than were those following metrizamide myelography. Thirteen of 24 patients (54%) receiving iotrol reported some adverse reactions compared with 24 of 25 patients (96%) receiving metrizamide. Five moderate and one severe adverse reaction occurred in the group receiving iotrol. Fourteen moderate and eight severe adverse reactions occurred in the group receiving metrizamide. Thirty-eight patients underwent electroencephalography both before and after myelography (19 iotrol and 19 metrizamide). None of the EEGs obtained after iotrol myelography changed from baseline, while seven of the EEGs obtained after metrizamide myelography showed changes from baseline. Iotrol was judged superior to metrizamide as a contrast medium in this patient population.     

The diagnostic dilemma of congenital unstable hemoglobinopathies

Unstable hemoglobin variants represent a rare etiology of congenital hemolytic anemia. Without a high index of suspicion, plus proper laboratory testing and interpretation, the correct diagnosis can be elusive. We report on five children who were initially thought to have other congenital disorders such as hereditary spherocytosis or thalassemia, before β‐globin gene sequencing led to the definitive diagnosis. Recognizing the variable clinical presentation and laboratory data reported will aid clinicians in diagnosis of unstable hemoglobins variants in children with atypical forms of hemolytic anemia, particularly those with low pulse oximetry values or whose hemoglobin electrophoresis suggest β‐thalassemia trait. Pediatr Blood Cancer. 2010;55:1393–1395. © 2010 Wiley‐Liss, Inc.     

早产儿瘦素质量浓度与早期静脉营养及生长发育相关性探讨

目的探讨瘦素质量浓度与早期静脉营养及生长发育的关系。方法新疆医科大学第一 附属医院新生儿科于2005 01—2006 02，将收治的86例早产适于胎龄儿用随机数字表法分为观察组(早期微量喂养同时辅助胃肠外营养组)45 例和对照组(单纯早期微量喂养组)47例，分别测定脐血及第7天血清瘦素质量浓度，同时监测营养状况和生长发育指标，并作对比分析。结果 (1)观察组与对照组脐血瘦素质量浓度分别为(4.6±3.7)ng/mL、(4.8±2.2)ng/mL，生后第7天两组瘦素质量浓度分别为(4.3±2.2)ng/mL、(3.1 ±1.7)ng/mL。对照组第7天血清瘦素质量浓度明显低于脐血(P<0.05)，而观察组其差异无统计学意义(P>0.05)。(2)脐血瘦素质量浓度与出生体 重、胎龄成正相关(r=0.56、r=0.67)。(3)观察组第7天热卡及蛋白质摄入量、血清瘦素质量浓度、皮褶厚度变化值与对照组相比，差异有统计 学意义(P<0.05)。结论对早产儿应尽早喂养，同时需要胃肠外营养作为肠内营养的补充。瘦素可作为新生儿营养效果判定的实验室指标之一。     

Effects of dopaminergic medications on psychosis and motor function in dementia with Lewy bodies

Dopaminergic treatment in dementia with Lewy bodies (DLB) requires balancing risk of worsened psychosis and potential motor benefit. We assessed the effects of increased dopaminergic medication on psychosis and motor function in DLB. We studied 19 subjects fulfilling probable DLB Consensus criteria before and after increased dopaminergic medications. Standard clinical measures included: Thought Disorder score from the Unified Parkinson's disease Rating Scale (UPDRS) Part I, total motor score (UPDRS Part III), and Hoehn–Yahr (H&Y) stage. Motor benefit defined as >10% improvement over baseline UPDRS Part III score, occurred in only one‐third of subjects. In this group, worsened hallucinations or psychosis developed in one‐third. Considering motor benefit without exacerbation of psychosis as our aim, only 4 DLB subjects (22%) achieved this goal. Our results suggest that dopaminergic medications have limited benefit in DLB because of the low likelihood of motor improvement and the risk of psychosis exacerbation. © 2008 Movement Disorder Society