Crystal Structure of 2-Debenzoyl, 2-Acetoxy Paclitaxel (Taxol®): Conformation of the Paclitaxel Side-Chain

Crystals of the C2-acetate analog of paclitaxel, grown from a mixture of isopropyl alcohol and methanol, belong to the space group P2_l with a = 9.058(3), b = 18.306(5), c = 15.043(1) , = 97.09(1)°, Z = 2, V = 2475.1(9)³, D _calc = 1.269 gcm^–3 and µ = 0.75 cm^–1. The structure was determined by direct methods and refined to R(F) = 0.054 and wR(F) = 0.057 for 605 variables and 3496 observed reflections. The paclitaxel side chain possesses a conformation similar to that observed in the crystal structure of docetaxel (Taxotere^®). A three dimensional network of hydrogen bonds is formed through solvent molecules and stabilizes the crystal lattice.     

P53 mutations may be related to tumor invasiveness of human hepatocellular-carcinoma in china

A combined polymerase chain reaction (PCR) with the enzyme HaeIII restriction analysis and DNA sequencing have been employed to study the mutations at codon 249 of p53 gene in two human hepatocellular carcinoma (HCC) cell lines and 28 surgical specimens of HCC. 14 of the 28 HCC samples (50%) had p53 point mutations at codon 249. All of point mutations at codon 249 in 10 cases sequenced are AGG to AGT transversion. p53 gene mutated more frequently in invasive HCCs than that in non-invasive HCCs. This suggested that the codon 249 was a mutational hotspot of p53 gene in human HCCs in China, and p53 mutations may be related to tumor invasiveness of human HCC.     

Anaesthetic management of a patient with a descending thoracic aortic aneurysm and severe bilateral bullous pulmonary parenchymal disease

The anaesthetic management of the surgical repair of a descending aortic aneurysm in a patient with large, bilateral, pulmonary bullae is described. Anaesthesia for descending aortic surgery normally involves unilateral, positive-pressure ventilation, an option which poses some risk of barotrauma in the presence of bilateral bullae. Patients with bullous disease commonly have severe lung disease and thorough preoperative assessment and preparation are necessary. Intraoperatively, bilateral rupture of the bullae could be catastrophic and preparations should be made for this possibility. In order to diminish this risk, a surgical technique including preemptive collapse of the bulla by minithoracotomy and tube drainage, with use of a bronchial blocker to the affected part of the lung may be used. If rupture occurs, then high frequency jet ventilation may be effective. Use of a double lumen endobronchial tube may be advantageous for patients with either unilateral and bilateral bullae. Anaesthesia for patients with bullae should avoid positive-pressure ventilation and nitrous oxide in order to limit the risk of barotrauma from a ball valve mechanism. In this case, the risk of barotrauma was reduced by performing an inhalational induction of anaesthesia and limiting peak inflation pressures during thoracotomy. It was elected to use positivepressure ventilation through a double lumen endobronchial tube following chest incision. A high frequency jet ventilator was available but not employed. Anaesthetic management was complicated by the presence of pleural adhesions, surgical approach directly through a bulla, and the requirement for one lung ventilation. The de i’aone descendante aecouverte cnez un pattent porde grosses bulles bilatérales d’emphysème est discutée, esthésie habituelle pour une chirurgie de l’aorte descendante site une ventilation mécanique unilatérale et constitue ainsi sque additionnel pour le porteur de bulles emphysémas bilatérales. Ces patients ont ordinairement des affections onaires graves et l’évaluation et la préparation préopéraprennent une importance spéciale. Pendant l’intervention, pture de bulles bilatérales peut être catastrophique et il se préparer à cette éventualité. Pour minimiser ce risque, technique chirurgicale qui inclut le collapsus préventif de lle par minithoracotomie et drainage, avec installation d’un ieur bronchique sur la partie atteinte du poumon. Si une re survient, le passage à la ventilation par jet à haute tence peut être salutaire. Le tube endobronchique à double ère peut présenter des avantages aussi bien dans les cas ulles unilatérales que bilatérales. Chez ces patients, il vaut x s’abstenir de ventiler avec une pression positive et du xyde d’azote afin de limiter le risque de barotraumisme soupape. Dans ce cas-ci, on a réussi à limiter le risque arotraumatisme en réalisant une induction par inhalation réduisant la pression d’inflation de pointe pendant la cotomie. Après l’incision thoracique, on a choisi d’utiliser tilation mécanique avec un tube endobronchique à double ère. Un ventilateur à jet à haute fréquence était prêt mais as été utilisé. La gestion de l’anesthésie a été compliquée par dhérences pleurales, par la rencontre d’une bulle d’emphysà l’incision et par l’obligation de ventiler un seul poumon.     

The effect of surgical glove powder on proliferation of human skin fibroblast and monocyte/macrophage

The effect of surgical glove powders (Biosorb, Keoflo, and CaCO3) and Hydrocote (powder-free lubricating agent, Biogel) was examined on human skin fibroblasts and monocyte/macrophage cell lines (U937 and HL-60). Glove powders (0.1-100 micrograms/ml) in the presence of 10% fetal bovine serum (FBS) had no significant effect on the rate of 3H-thymidine uptake and proliferation of these cells after 48 h and 7 days of exposure, respectively. However, they inhibited HL-60 growth after 10 days, and Biosorb and CaCO3 inhibited U937 after 10-21 days of exposure compared with control. In the presence of low serum (0.5%), Biosorb, but not Keoflo, CaCO3, and Hydrocote, inhibited HL-60 cells after the third day of exposure (p < 0.05), whereas they were without any effect on U937 cells. Further incubation resulted in a significant decrease in cell density in all treatments, as well as controls, because of cell death. In the presence of 2% serum, glove powder-treated HL-60 significantly increased in cell numbers during the first 3 days, and the cells became stationary thereafter, whereas Keoflo and CaCO3-stimulated U937 reached a maximal by 9 days of treatment. Coculturing of fibroblasts directly with macrophages (0.4-5 x 10(5) cells per dish) or incubation with macrophage culture-conditioned media (CCM) stimulated quiescent fibroblast growth equal to that induced by 10% and 0.5% serum, respectively (p < 0.05). However, incubation of fibroblasts with glove powder-treated HL-60 CCM (except CaCO3) inhibited (p < 0.05) and CCM from Biosorb-treated U937 stimulated (p < 0.05) fibroblast proliferation. The CCM from glove powder-treated HL-60 and U937 did not have any significant effect on the rate of 3H-thymidine incorporation into fibroblasts compared with controls. The present observations suggest that glove powder action on fibroblast and macrophage growth in vitro depends on both the serum concentration of the culture medium and the length of exposure. The results imply that glove powders may have an adverse effect in vivo by directly influencing the biologic activity of macrophages, as well as other cell types, leading to alterations in the early phases of wound healing.     

Preliminary evaluation of pelvic vascular bed isolation chemotherapy in the treatment of advanced cervical carcinoma

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公费医疗门诊项目实行“按人头付费”的效果评价

1998年,上海市普陀区医疗保险办公室改革公费医疗支付方式,对门诊项目实行按人头付费。本文就改革实施一年来公费医疗费用发生情况作一分析,对按人头付费方式实施效果进行评估,得出以下结论:该支付方式较为有效地降低了医疗费用的增长幅度,减少了浪费;对促进医院加强内部管理,转变经营策略,重视医疗成本控制,提高卫生资源的利用效率起到了积极的作用。同时提出,要注意纠正个别医疗机构控制费用方法简单化的偏差,要考虑人群年龄结构因素对医疗费用的影响,适当调整付费标准,以避免医疗机构在承担费用支出方面出现畸轻畸重的问题。     

树立市场经济法律意识繁荣社会主义卫生事业

市场经济是法制经济,社会主义市场经济体制的建立和完善,离不开社会主义市场经济法制体系的建立与完善。在实现两个转变的过程中,加强法制建设,树立和强化法律意识,对推进卫生改革,促进卫生发展具有十分重要的意义。     

血吸虫病与原发性肝癌关系的队列研究

为探讨日本血吸虫病与原发性肝癌的关系, 对大丰市455 人进行了12年的前瞻性观察。血吸虫病组表抗携带率为14.21% , 比非血吸虫病组的9.56% 高; 肝癌20岁以上截缩标化人年死亡率, 血吸虫病组为283.82/10 万, 非血吸虫病组为38.66/10万, RRM H为5.72,SMR分别为3.76 和0.65,P< 0.01;前者组内男女肝癌死亡率比RRM H 为1.51, P> 0.05,后者组内RRM H 为3.98,P< 0.01。用叉生法分析血吸虫病和表抗携带两因素的作用,则肝癌20岁以上截缩标化人年死亡率,血吸虫病和表抗携带双阴者为21.16/10万, 血吸虫病单阳者为118.47/10 万,表抗携带单阳者为232.33/10 万,血吸虫病和表抗携带双阳者为1228.75/10 万; 后三者与前者相比, RRM H 分别为3.99, 8.47, 34.57, P均< 0.01; 血吸虫病和表抗携带对肝癌联合作用指数S为3.2,Poisson 回归乘法模型拟合良好。结果提示两者与肝癌分别有密切联系,且有明显的相乘作用     

铅作业危害状况调查

目的探讨铅对作业工人健康的影响。方法对热处理,镀锌车间的铅作业工人进行健康检查,测试血铅浓度,同时测定两车间空气中的铅烟浓度。另设行政勤杂人员作为对照组。结果铅作业工人神衰,口内金属味,疲乏,心律不齐等症状明显高于对照组,两组人员的血铅浓度有显著性差异。１９９４～１９９７年度车间空气中铅浓度比较高,铅吸收患者主要集中在１９９４～１９９５年度。结论车间空气中铅浓度越高,对作业工人的铅危害程度越严重。     

上海市徐汇区性病流行特征及其分析

的探讨徐汇区性病流行特征及其趋势。方法对徐汇区１９８９～１９９７年的性病报告资料进行分析。结果１９８９～１９９７年,徐汇区的性病流行呈现高速、持续和中速增长三个时期,１９８９～１９９１年平均增长７５．６３％;１９９２～１９９４年平均增长２１．６６％;１９９５～１９９７年平均递增５０．１８％。淋病为优势病种;１９９５年以前２０～３９岁为高发年龄段,１９９５年以后,２０～４４岁为高发年龄段;文化层次较低者发病数较多;工人和经商者发病率较高;新生儿和儿童淋病明显增多;梅毒的发病数在逐年增加,呈现出高速增长态势。结论性病防治工作的重点是加强性病防治机构建设,实行匿名就诊,加强对高危人群监测和重点行业人群的宣传教育。