裙带菜多糖对人外周血单个核细胞的免疫活性作用

目的 观察裙带菜多糖对人外周血单个核细胞(PBMC)增殖、淋巴细胞亚群的影响,探讨其免疫调节机制.方法 采用逐步分离法对裙带菜多糖进行分离与纯化.Ficoll密度梯度离心法分离PBMC,随机分为观察组和对照组,观察组分别加入0.5、5、20、100、500 μg/mL裙带菜多糖,对照组仅加入PBS.采用MTT法分析裙带菜多糖对人PBMC体外增殖作用的影响;用流式细胞术检测淋巴细胞亚群的变化.结果 观察组各浓度PBMC增殖活性明显高于对照组(P均＜0.01),且随着浓度的增加增殖反应明显增强.观察组CD8+及CD16+ CD56+细胞比例较对照组明显增加,并呈浓度依赖性(P均＜0.01).结论 裙带菜多糖可通过刺激人PBMC增殖促进CD8+、NK细胞增殖,从而发挥细胞免疫调节作用.     

Worldwide Experience with the Robotic Navigation System in Catheter Ablation of Atrial Fibrillation: Methodology, Efficacy and Safety

Worldwide Survey on Robotic AF Ablation . Introduction: The Hansen Robotic system has been utilized in ablation procedures for atrial fibrillation (AF). However, because of the lack of tactile feedback and the rigidity of the robotic sheath, this approach could result in higher risk of complications. This worldwide survey reports a multicenter experience on the methodology, efficacy, and safety of the Hansen system in AF ablations. Methods and Results: A questionnaire addressing questions on patient's demographics, procedural parameters, ablation success rate and safety information was sent to all centers where more than 50 robotic AF ablation cases have been performed. From June 2007 to December 2009, 1,728 procedures were performed at 12 centers utilizing the Hansen robotic navigation technology. The overall complication rate was 4.7% and the success rate was 67.1% after 18 ± 4 months of follow‐up. In 5 low volume centers there appeared to be a learning curve of about 50 cases (complication rate 11.2% for the first 50 cases vs 3.7% for the 51–100 cases; P = 0.044) and a trend showing a decrease of complication rate with increasing case volume. However, in the remaining 7 centers no learning curve was present and the complication rate was stable over time (3.7% for the first 50 cases vs 3.6% for the 51st case thereafter; P = 0.942). Conclusion: The Hansen robotic system can be used for AF ablation safely. In low volume centers, there appeared to be a learning curve of the first 50 cases after which the complication rate decreased. With a higher case volume, the success rate increased. (J Cardiovasc Electrophysiol, Vol. 23, pp. 820‐826, August 2012)     

Safety and Effectiveness of Transvenous Lead Extraction in Octogenarians

Transvenous Lead Extraction . Introduction: As the population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase in Western countries. The safety and effectiveness of lead extraction in elderly patients has not been well evaluated. We report the safety and effectiveness of transvenous lead extraction in octogenarians. Methods and Results: From January 2005 to January 2011, we reviewed data from consecutive patients ≥ 80 years referred to our institutions for transvenous lead extraction because of cardiac device infection or lead malfunction. Clinical characteristics, procedural features, and periprocedural major and minor complications were compared between octogenarians and younger patients. Out of 849 patients undergoing lead extraction in the participating institutions during the study period, 150 (18%) patients were octogenarians (mean age 84 years; range 80–96; 64% males). A significantly higher percentage of octogenarians presented with chronic renal failure (55% vs 26%; P < 0.001), history of malignancy (22% vs 6%; P < 0.001), and chronic obstructive pulmonary disease (46% vs 19%; P < 0.001). Complete lead extraction rates were similar in the 2 age groups (97% in octogenarians vs 96% in patients <80 years; P = 0.39). Periprocedural death occurred in 2 (1.3%) patients ≥80 years and in 5 (0.72%) patients <80 years (P = 0.45 for comparison). No differences in terms of other periprocedural major and minor complications were found between the 2 age groups. Conclusion: Despite presenting with a significantly higher rate of comorbidities, transvenous lead extraction can be performed safely and successfully in octogenarians. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1103‐1108, October 2012)     

Management of bleeding disorders in adults

Development of FVIII inhibitors is currently the most severe and challenging complication of haemophilia A treatment and represents a very large economic burden for a chronic disease. As a result, clinical research is making major efforts to optimize the therapeutic approaches for this condition. In this section we will review some important aspects of the management of haemophilia in adults, including an overview of bleeding in women with von Willebrand disease, an analysis of FVIII consumption in patients with severe haemophilia A, an update of the ongoing RES.I.ST study, long-term prophylaxis and experience from the Pro.Will study, current evidence relating to economic aspects of the treatment of haemophilic patients with inhibitors (based on the PROFIT study), and an overview of musculoskeletal complications in adults with severe bleeding disorders.     

粪肠球菌主要毒力因子研究进展

粪肠球菌为条件性致病菌,是许多国家医院内感染的主要病原菌,也是一种新的人畜共患病病原体。粪肠球菌感染和致死主要是由其毒力因子引起的,本文概述了粪肠球菌主要毒力因子尤其是溶血素的研究进展,为粪肠球菌致病机制的研究奠定基础。     

Comparison of the Truview PCD™ and the GlideScope® video laryngoscopes with direct laryngoscopy in pediatric patients: a randomized trial

Introduction

The GlideScope^® video laryngoscope has a 60° angled blade and the blade of the Truview PCD? video laryngoscope has an optical lens that provides a 46° refraction of the viewing angle. Despite successful results using the GlideScope in adults, few studies have been published regarding its use in pediatric patients. We therefore tested our joint primary hypothesis that the GlideScope and the Truview PCD video laryngoscopes provide superior visualization to direct laryngoscopy and are non-inferior regarding time to intubation.

Methods

One hundred thirty-four patients (neonate to ten years of age, American Society of Anesthesiologists physical status I-III) scheduled for general surgical procedures were randomized to tracheal intubation using the Truview PCD or GlideScope video laryngoscope or direct laryngoscopy (Macintosh blade). The laryngoscopic view was scored using the Cormack-Lehane scale. Time to intubation (defined as the time from the moment the device entered the patient’s mouth until end-tidal CO₂ was detected) and the number of attempts were recorded.

Results

The Cormack-Lehane views attained using the GlideScope (P > 0.99) and Truview PCD (P = 0.18) were not superior to the views attained with direct laryngoscopy. Furthermore, the view attained using the GlideScope was significantly worse than that attained using direct laryngoscopy (P < 0.001). Fewer patients showed Cormack-Lehane grade I views with the GlideScope than with the Truview PCD (14% vs 82%, respectively; 95% confidence interval [CI] ?91% to ?46%). The observed median [Q1, Q3] times to intubation were: 39 [31, 59] sec, 44 [28, 62] sec, and 23 [21, 28] sec with the GlideScope, Truview PCD, and direct laryngoscopy, respectively, with median differences of 14 sec (95% CI 7 to 26, GlideScope – direct laryngoscopy) and 17 sec (95% CI 6 to 28, Truview PCD – direct laryngoscopy).

Conclusion

The Cormack-Lehane views attained using the GlideScope and the Truview PCD video laryngoscopes were not superior to views attained using direct laryngoscopy. Visualization with the GlideScope was significantly worse than with direct laryngoscopy. Use of the GlideScope and Truview PCD systems should be restricted to patients with specific indications.     

生物黏附性三七总皂苷-白及多糖-海藻酸钠复合微球的制备及表征

目的利用白及多糖(BSP)的生物黏附性,与海藻酸钠(SA)混合作为复合载体,以具有缓释特性的三七总皂苷(PNS)分散体作为包封药物,制备具有生物黏附性的PNS-BSP-SA复合微球。方法采用离子交联法制备微球,通过单因素试验和正交设计考察并优化处方工艺。通过扫描电镜(SEM)、粒径分布、差示扫描量热法(DSC)分析、溶胀性能测定、体外黏附性能评价、体外释放研究对微球进行表征。结果 PNS-BSP-SA复合微球圆整度较好,表面粗糙不平有褶皱,粒径分布较窄,PNS原料药以无定形状态均匀分散于微球中。最佳处方工艺制备的微球工艺稳定,重现性较好,与直接加入PNS原料药制备的微球相比,PNS分散体微球的载药量、包封率和得率均明显增加,分别为10.34%、51.25%、82.21%,而PNS原料药微球的载药量、包封率、得率分别为4.04%、12.16%、61.35%。BSP的加入增加了SA微球的溶胀性能,明显增加了其在大鼠胃部的滞留率。PNS-BSP-SA复合微球中人参皂苷Rg1的释放较PNS原料药缓慢。结论 BSP增加了微球的生物黏附性,将PNS制备为分散体,提高了微球的载药量、包封率和得率,并使微球具有一定的缓释性能。     

吡贝地尔缓释片释放度检测方法学研究

目的建立测定吡贝地尔缓释片体外释放度的方法。方法采用溶出度浆法的装置进行体外释放实验,以0.1 mol/L盐酸溶液1 000 m L释放介质,转速为50 r/min,温度为(37±0.5)℃,含量检测方法为高效液相色谱法(HPLC)。结果吡贝地尔在6.87~89.34μg/m L(r=1.000)范围内呈良好的线性关系;平均回收率为100.72%(RSD=0.6%),3批产品在2、4 h和8 h的平均累积释药量分别为32.7%、52.7%和80.0%,符合2010年版《中国药典》缓释制剂的指导原则。结论溶出度浆法检测准确、可靠、灵敏,可用于吡贝地尔缓释片释放度的测定。