药学监护在卫生保健中的作用与发展前景

随着社会文明程度的提高和科学知识的普及,人们的自我保健意识进一步加强,对健康的要求水平越来越高,已不再满足有药可用,而是要求提高治疗质量甚至生存质量;但同时,各种新药层出不穷,用药复杂性越来越高,因用药引起的问题也越来越多,     

妊娠相关性疟疾及其研究进展

恶性疟疾是对人类健康危害最为严重的传染病之一.生活在疟疾流行区的人随着年龄的增长和感染次数的增加会逐渐获得保护性免疫即临床免疫.然而,孕妇尤其是初孕妇女在妊娠过程中感染恶性疟原虫后往往呈现急性感染症状,甚至危及孕妇和胎儿的生命.妊娠相关性疟疾(pregnancy-associated malaria,PAM)主要是由于受恶性疟原虫感染的红细胞和单核细胞在胎盘绒毛问大量聚集引起的.大量的研究表明,黏附在子宫粘膜上的虫体表达一种具有特殊生物活性和抗原性的蛋白质(var2CSA).Var2CSA可特异性地与子宫粘膜上的硫酸软骨素A(Chondroitin sulfate A,CSA)结合.此外,由于var2CSA的序列相对保守,机体在感染几次以后较容易产生交叉免疫保护反应.对PAM的研究是疟疾领域内的重要内容,目前在很多领域(病原学、分子致病机理、免疫学等)已经取得重要进展.本篇综述概括了近年来在PAM研究方面的进展,包括虫体表达的主要膜蛋白质的功能、相关的人体受体以及免疫学方面等内容.     

HPLC法测定依托泊苷亚微乳中的药物含量

目的:采用高效液相色谱法测定依托泊苷亚微乳中依托泊苷的含量.方法:采用盐破乳,混合溶剂提取药物的方法,实现药物与亚微乳中油脂的分离,用甲醇定容后高效液相色谱法测定亚微乳中依托泊苷的含量.色谱条件:色谱柱:Inertsil ODS-3柱(250 mm×4.6 mm,5μm);流动相:乙腈-pH值4.0醋酸盐缓冲液(32∶68);流速:1.0 mL·min-1;柱温:30℃;检测波长:285 nm.结果:依托泊苷亚微乳中其他物质对依托泊昔的测定无干扰,在0.80～40.0 μg·mL-1范围内线性关系良好(r=0.999 9),平均回收率为98.9%,重复性和稳定性良好.结论:本法去除了亚微乳中的油脂,保护了色谱柱,适用于依托泊苷亚微乳的长期质量控制.     

济川煎合增液汤加减在老年便秘中的应用

近年来，笔者用济川煎合增液汤加减治疗老年便秘，取得了较好的临床效果。现报道如下。     

颈椎骨肿瘤的外科治疗分析

目的探讨颈椎骨肿瘤的临床特点和手术治疗效果。方法回顾1998年~2003年以来我院治疗的26例颈椎骨肿瘤临床资料,其中原发性骨肿瘤17例,转移性骨肿瘤9例。结果随访时间为9月~6年,平均2年半,除2例Frankel分级A级和没有神经功能障碍的2例E级外,其余22例均能提高1~2级。无手术并发症。结论颈椎骨肿瘤治疗应该个体化,手术治疗应根据肿瘤部位和分期决定手术方式。手术对于稳定颈椎,改善神经功能和生活质量有很大帮助。     

耳穴贴压治疗肠易激综合征54例

肠易激综合征指肠道本身无器质性病变而出现的肠道功能失调，以反复发作的腹痛、腹泻、便秘等为主症的一种综合征，为临床难治病症之一。笔者采用耳穴贴压王不留行籽治疗本病54例，并与西药治疗者46例对比。现将结果报告如下。     

Telmisartan but not Valsartan Inhibits TGF-β-mediated Accumulation of Extracelluar Matrix via Activation of PPARγ

Glomerulosclerosis, defined as phenotype transition of mesangial cell and deposition of extracelluar matrix, remains a chronic disease with excessive morbidity and mortality. The molecular mechanism underlying the suppression of mesangial cell activation is not fully understood. Since activation of peroxisome proliferators-activated receptor γ (PPARγ) has been proposed to decrease the effects of transforming growth factor-β (TGF-β) on glomerulosclerosis, we examined here whether and how telmisartan, an angiotensin Ⅱ type 1 receptor blocker with PPARγ-modulating activity, inhibited TGF-β-induced glomerulosclerosis in rat glomerular mesangial cells. Protein levels of PPARγ were detected by Western blot. Activation of PPARγ response element (PPRE) was analyzed by luciferase assays. Deposition of extracelluar matrix was tested by confocol laser scanning. The results showed that telmisartan, but not valsartan, another angiotensin Ⅱ type 1 receptor blocker, up-regulated PPARγ protein levels in a dose-dependent manner (P<0.05). Activation of PPRE, represented by luciferase activity, was also increased with higher concentration of telmisartan in a dose-dependent manner (P<0.05). Furthermore, telmisartan inhibited TGF-β-induced α-smooth muscle actin expression and collagen IV secretion in mesangial cells. GW9662, an inhibitor of PPAR-γ, blocked the inhibitory effects of telmisartan on TGF-β-induced glomerulosclerosis in mesangial cells. Our study indicates a benefit of telmisartan as a PPARγ agonist against TGF-β-induced mesangial cells activation in renal glomerulus. It may provide possibility that telmisartan works as a potential agent against diabetic nephropathy and hypertensive renal disease.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

噬菌体随机12肽库中VEGF模拟表位的筛选及初步鉴定

目的:从噬菌体随机12肽库中筛选能与抗血管内皮生长因子(VEGF)mAb阿瓦斯汀(Avastin)特异性结合的多肽.方法:用Avastin为靶分子,对噬菌体12肽库进行3轮生物淘洗,随机挑取80个克隆,ELISA法鉴定其亲和性,将亲和性高的阳性克隆进行DNA序列测定,推导与噬菌体外壳融合的12肽氨基酸序列.Fmoe固相法合成12肽,戊二醛交联12肽与血蓝蛋白(KLH),打点印迹(Dot blot)检测偶联物能否与Avastin结合.结果:ELISA显示,42个噬菌体克隆与Avastin有较强的亲和性,测序发现41个阳性克隆表达的融合12肽的序列一致,1个不同;化学合成的12肽能与Avastin特异性结合,12肽-KLH偶联物也能与Avastin特异性结合.结论:初步证明12肽模拟了VEGF部分表位.     

痿证独取阳明的临床运用

痿证独取阳明的临床运用李萌广西大学医务所（南宁５３０００４）《素问·痿论篇》曰：“治痿者独取阳明。阳明者，五脏六腑之海，主润宗筋，宗筋主束骨而利机关也。”笔者在临床中深受启发，运用于治疗脾胃虚弱为主兼肝肾虚损而发之瘫痪、腰腿酸痛等，均以调摄后天脾胃为...