1-(α-萘甲基)-2甲基-6,7-二甲氧基-1,2,3,4-四氢异喹啉盐酸盐的HPLC手性拆分法及半制备

1-(α-Naphthylmethy)-2-methyl-6,7-dimethoxy-1,2,3,4-tetrahydroisoquinolinehydrochloride (code No, 86040)is a new kind of calcium antagonist. It has(+)and(一)enantiomers.Accordingly .the resolution and quantification of these two enantiomers have received agreat deal of attention,In this report the application of direct HPLC separation and semipreparation tothe determination of the enantiomeric composition of the new drug are described. All analysis andsemipreparation were performed with 25 cm×4. 6 mm i.d, 25 cm×8 mm i,d.and 30 cm×8 mmi.d. stainless steel column packed with a chiral β-cycledextrin bonded phase. Detection wavelengthwas 284 nm, The optimal composition of the mobile phase was EtOH─pH 4.0 phosphate buffer(35:65) at flow rate of 0. 3 ml·min^-1 for analysis and l.0 ml·min^-1 for semipreparation. Theseparation factor of the enantiomers was l.25. Purity of the semipreparation was 8l.4%,Quantityof semipreparation was 1 mg. This procedure was simple ,rapid and gave good resolution,The effectsof the composition of mobile phase, pH value, flow rate and column temperature on the resolution hadbeen sudied.     

Misclassification of primary liver cancer in the Life Span Study of atomic bomb survivors

Primary liver cancer is difficult to diagnose accurately at death, due to metastases from nearby organs and to concomitant diseases, such as chronic hepatitis and cirrhosis. Trends in diagnostic accuracy could affect radiation risk estimates for incident liver cancer by altering background rates or by impacting risk modification by sex and age. We quantified the potential impact of death-certificate inaccuracies on radiation risk estimates for liver cancer in the Life Span Study of atomic bomb survivors. True-positive and false-negative rates were obtained from a previous study that compared death-certificate causes of death with those based on pathological review, from 1958 to 1987. We assumed various scenarios for misclassification rates after 1987. We obtained estimated true positives and estimated false negatives by stratified sampling from binomial distributions with probabilities given by the true-positive and false-negative rates, respectively. Poisson regression methods were applied to highly stratified person-year tables of corrected case counts and accrued person years. During the study period (1958–2009), there were 1,885 cases of liver cancer, which included 383 death-certificate-only (DCO) cases; 1,283 cases with chronic liver disease as the underlying cause of death; and 150 DCO cases of pancreatic cancer among 105,444 study participants. Across the range of scenarios considered, radiation risk estimates based on corrected case counts were attenuated, on average, by 13–30%. Our results indicated that radiation risk estimates for liver cancer were potentially sensitive to death-certificate inaccuracies. Additional data are needed to inform misclassification rates in recent years.     

The views of adults with neurodegenerative diseases on end-of-life care: a metasynthesis

Objective: Improving end-of-life care for people with neurodegenerative diseases is seen as a clinical priority. In order to do this, it is important to take into account the views expressed by people with these conditions on their experiences of this care. The purpose of this review was to provide a thematic synthesis of the views of adults with neurodegenerative diseases on end-of-life care.

Methods: After a systematic search, 13 articles were included and thematic synthesis was used to collate and interpret findings.

Results: Four analytical themes were identified; (1) Importance of autonomy and control; (2) Informed decision-making and the role of healthcare professionals; (3) Contextual factors in decision-making; (4) The pitfalls of care.

Conclusion: Participants’ views were framed by the context of their lives and experience of their illness and these shaped their engagement with end-of-life care. Given the varying disease trajectories, care needs to be individualised and needs-based, implementing palliative care in a timely way to prevent crises and loss of autonomy.     

病情观察在临床护理工作中的作用-2例报告

1临床资料 患者，女，2006年4月20日因心悸、胸闷不适入院。心电图示：室性早搏，心率96次／min，拟诊“扩张型心肌病”。按照医嘱对其进行常规治疗，使用多巴胺20mg加入5％葡萄糖200ml溶液中以20滴／min静脉点滴。但用药过程中发现，患者心悸、胸闷症状没有好转反而加重，脉搏迅速增至136次／min，心音有力，同时伴出冷汗，面色苍白，烦躁等新的症状。立即报告主管医生，并进行密切观察，建议进行做辅助检查，排除其它疾病或用药的副作用。     

Influence of maternal and social factors as predictors of low birth weight in Italy

Background  

The purpose of this study is to provide insight into the determinants of low birth weight (LBW) in Italy.