硬膜外复合全麻对气管拔管应激反应的影响

目的：探讨硬膜外麻醉复合全身麻醉方法对气管拔管应激反应的预防作用。方法：22例气管插管全麻下手术患，随机分为对照组和硬膜外组，每组各11例。两组麻醉前用药、麻醉诱导和维持方法相同，硬膜外组气管拔管期间复合应用硬膜外麻醉。分别在麻醉前、拔管前、拔管后1min、2min、5min、10min各采集动脉血标本．测定血浆儿茶酚胺等浓度．并做血气分析，计录各时点的血流动力学参数。结果：两组气管拔管期间血浆儿茶酚胺等浓度均明显增高，两组比较对照组高于硬膜外组。结论：气管拔管期间复合硬膜外麻醉能减轻气管拔管引起的应激反应。     

HPLC法测定感冒清热颗粒中欧前胡素含量

目的建立HPLC法测定感冒清热颗粒中欧前胡素含量的方法,同时对6家不同企业生产的产品进行质量比对。方法采用HPLC法欧前胡素含量测定条件：色谱柱：Diamonsil（R）C18（250 mm×4.6 mm,5μm）,流动相：乙腈-水（49.5∶50.5）,检测波长：300 nm,流速：1.0 ml·min-1。,柱温：35℃;葛根素含量测定方法参照《中国药典》。结果欧前胡素线性范围为0.2955～11.82μg·ml-1（r=0.9999）,平均回收率为99.47%,RSD为0.69%（n=6）;不同企业生产的产品质量有差异,葛根素的含量以每袋计为12.20～24.00 mg。结论 HPLC测定欧前胡素的方法简便,准确,重复性好,可有效控制该制剂的质量。     

Molecular imaging of small animals with fluorescent proteins: from projection to multimodality

Fluorescent proteins (FPs) have been widely adopted in cell research for protein trafficking and reporter gene expression studies, as well as to study other biological processes. However, biological tissue has high light scattering and high absorption coefficients of visible light; hence, using FPs in small animal imaging remains a challenge, especially when the FPs are located deep in the tissue. In small animals, fluorescence molecular imaging could potentially address this difficulty. We constructed fluorescence molecular imaging systems that have two modes: a planner mode (projection imaging) and a multimodality mode (fluorescence molecular tomography and micro-CT). The planner mode can provide projection images of a fluorophore in the whole body of a small animal, whereas three-dimensional information can be offered by multimodality mode. The planner imaging system works in the reflection mode and is designed to provide fast imaging. The multimodality imaging system is designed to allow quantification and three-dimensional localization of fluorophores. A nude mouse with a tumour targeted with a far-red FP, which is appropriate for in vivo imaging, was adopted to validate the two systems. The results indicate that the planner imaging system is probably suitable for high throughput molecular imaging, whereas the multimodality imaging system is fit for quantitative research.     

肾小管疾病的诊断思路

肾小管疾病起病隐匿,临床表现及早期尿液检查常无特异性改变,如不及时治疗,一旦出现肾功能受累,多进展至晚期,病损呈不可逆性改变.与小球疾病相比,其误、漏诊率极高.本文重点介绍肾小管疾病,强调详细询问病史、重视肾小管功能系列的实验室检查以及低钾性肾小管疾病的诊断思路.     

ALK-rearranged squamous cell lung cancer: a case report

ALK rearrangement is a very rare subset of squamous cell cancer of lung and the efficacy of crizotinib treatment for these patients is lack of data. Here we report a case with squamous cell cancer of lung that harbored the ALK rearrangement was given crizotinib in the second-line therapy. A 55-year-old female patient was diagnosed with squamous cell carcinoma of lung by bronchoscopy biopsy with stage IV. The patient was given two cycles of chemotherapy and the response was progressive disease. After failure to chemotherapy, genotype testing showed wild-type EGFR/KRAS and ALK rearrangement positive. The patient was administered with crizotinib and had a partial response, and the progression-free survival was 6 months. The side effects were tolerable.     

皮质下缺血性脑血管病患者额叶白质病变对认知领域的损害研究

目的探讨皮质下缺血性血管病(SIVD)患者的额叶的白质病变(WML)累及的认知功能域。方法将50例SIVD患者,根据额叶WML评分的严重程度,分为严重WML组(视觉评分3分)27例和轻度WML组(视觉评分≤3分)23例。另以7例无SIVD的人群作为对照。对所有受试者进行全套的认知心理学测查并对结果进行对比分析。结果 3组间一般资料的差异无统计学意义。与轻度WML组和对照组相比,严重WML组的非额叶白质评分、额叶腔隙灶数目明显增多(均P=0.000);与轻度WML组相比,严重WML组的蒙特利尔认知评估量表评分明显降低(P=0.047);且执行功能相关的认知评分明显降低(P=0.006),在调整了额叶的腔隙灶数量后,该差异仍有统计学意义(P=0.038)。多元回归分析发现,对注意执行Z分显著影响的因素为额叶WML评分(P=0.000)。结论在SIVD患者中,额叶的WML主要累及执行功能。     

姜黄素激活Nrf2抗氧化系统缓解百草枯诱导的胰岛素抵抗

目的：观察姜黄素是否具有改善百草枯（ paraquat,PQ）所致氧化应激诱导的胰岛素抵抗作用并探讨其改善胰岛素抵抗的效应机理。方法将实验小鼠随机分成对照组（ Control组）,百草枯组（ PQ组）以及PQ加姜黄素组（ Cur组）。 PQ和Cur组连续腹腔注射百草枯7天造模成功后。 Cur组继续Cur灌胃干预。7天后,取胰岛素敏感组织肌肉,用蛋白免疫印迹方法（ Western blot,WB）检测蛋白水平和磷酸化变化,并检测脂质过氧化指标MDA。结果在PQ诱导的小鼠胰岛素抵抗模型中,姜黄素可改善小鼠葡萄糖耐量并对抗 PQ 所致的胰岛素信号蛋白 PKB－Ser473磷酸化损害;姜黄素还可明显降低肌肉MDA水平,激活小鼠Nrf2系统,促进Nrf2核转位和NQO－1的表达,同时能增强IкBα的水平,缓解氧化应激及炎症反应。结论姜黄素通过增强内源性Nrf2系统功能和胰岛素信号水平,对抗PQ诱导的氧化应激,是其缓解胰岛素抵抗的重要机理。     

临床药理学的教学实践与思考

目的为提高临床药理学的教学效果提供参考。方法结合教学实践,总结提高临床药理学教学质量的方法和途径。结果与结论不断提高教师的素养,突出临床药理学的临床特点,灵活运用多种教学方法和教学手段,建立循证思维和理念,可提高临床药理学的教学质量,有利于医药复合型高素质人才的培养。     

鸦胆子油乳注射液及配置后静脉输液的室温稳定性研究

目的 考察说明书中贮存条件要求冷藏,且须临用前即配即用的鸦胆子油乳注射液的原液和稀释后的静脉输液在室温(25 ℃)下的稳定性,为该药品的临床管理与使用提供依据。方法 模拟临床给药剂量和给药时间,考察性状、pH、渗透压、颗粒细度和油酸含量在室温下放置不同时间点的变化。结果 在室温下,鸦胆子油乳注射液原液放置72 h质量稳定,配置后静脉输液(30 mL∶250 mL 0.9%生理盐水)在24 h内各项理化指标均无明显变化。结论 鸦胆子油乳注射液在医院内部的短时间药物配送无需严格实施冷链管理;配置后静脉输液室温放置24 h稳定,无需“即配即用”。     

复方夏天无片治疗老年骨质疏松性桡骨远端骨折的疗效观察

复方夏天无片具有祛风逐湿、舒筋通络、行血止痛等功效,临床广泛应用于风湿性关节炎、腰椎间盘突出症、骨关节炎等的治疗,但未见对骨折治疗的有关报道。该文观察复方夏天无片治疗老年骨质疏松性桡骨远端骨折的疗效,通过选取2011年1月—2014年6月在我院就诊骨质疏松性桡骨远端骨折患者180例,随机数字表法将患者分为观察组和对照组,每组各90例。对照组予以手法复位,石膏外固定后,予以钙尔奇D,观察组在对照组的基础上加复方夏天无片治疗。观察2组治疗后的疗效,腕关节功能和并发症发生率。结果显示观察组的优良率为95.56%,明显高于对照组的77.78%,差异有统计学意义(χ²=4.712,P<0.05)。观察组的并发症发生率明显低于对照组(P<0.05)。结果说明复方夏天无片能够提高老年骨质疏松性桡骨远端骨折的疗效,减少并发症的发生率, 减轻患者的痛苦,对提高生命质量具有重要作用。