氯喹严重不良反应的临床表现及处理

国家卫生健康委员会和国家中医药管理局发布的《新型冠状病毒肺炎诊疗方案(试行第六版)》指出,可试用磷酸氯喹进行抗病毒治疗。氯喹既往用于疟疾、肠外阿米巴病和类风湿关节炎等疾病的治疗,关于其不良反应已有较多报道。本文重点对氯喹相关严重不良反应以及急性中毒的临床表现和处理进行文献回顾,以期为临床安全使用氯喹提供借鉴和参考。     

Determination and pharmacokinetic study of p-hydroxyphenethyl anisate following intravenous and oral administration in rats by RP-HPLC method

In the present study, we developed a rapid and specific reversed-phase high-performance liquid chromatographic (RP-HPLC) method for the quantification of p-hydroxyphenethyl anisate (HPA), one of the main bioactive constituents of the roots and rhizomes ofNotopterygium incisumand N. franchetii, in rat plasma after an intravenous (20 mg/kg, i.v.) and an intragastrical (200 mg/kg,i.g.) administration to rats, respectively. The method involved a plasma clear-up step using liquid-liquid extraction by EtOAc, followed by RP-HPLC separation and detection. Separation of HPAwas performed on an analytical Diamonsil^TM ODS C₁₈ column with the mobile phase of MeOH–H₂O at ratios of 75:25 (v/v) for i.v. and 70:30 (v/v) for i.g. administration. The flow-rate was 1.0 mL/min, and UV detection was performed at 256 nm. The calibration curves were linear over the ranges of 0.05–5.0 μg/mL (r² = 0.9984) for i.v. and 0.5–10.0 μg/mL (r² = 0.9995) for i.g. administrationin rat plasma. The extraction recoveries were in the range of 82.01%–87.97%. The intra- and inter-day precisions were between 1.71% and 3.99%, with accuracies ranging from 91.22% to 110.5%. The absolute bioavailability of an orally administered HPA in rats was about 48.17%. The developed method was suitable for the determination and pharmacokinetic studyof HPA in rat plasma.     

低场磁共振成像对强直性脊柱炎的髋关节病变诊断价值

目的探讨低场磁共振成像(MRI)对强直性脊柱炎(AS)髋关节MRI表现,以提高AS的早期诊断。方法对52例AS髋关节的病例进行MRI横、冠状位扫描快速自旋回波(FSE)T2WI,作自旋回波(SE)T1WI,快速自旋回波(FSE-XL)T2WI+脂肪抑制,3D FW FGRE T1WI。男性40例,女性12例,年龄14~58岁,平均30.36岁。结果 52例共104个髋关节有不同程度异常MRI表现,其中累及双侧髋关节47例,单侧5例。MRI表现有:关节积液50例98个髋关节;骨髓水肿19例;关节软骨异常10例;关节面软骨下囊状骨破坏15例;骨质疏松25例;关节间隙狭窄3例;骨质增生和骨赘形成12例;附着点炎症10例。结论 MRI是显示AS的髋关节受累最有效的方法,可用于早期诊断和疾病活动期的评价,为临床治疗、预防提供客观依据。     

CD146 as a new marker for an increased chondroprogenitor cell sub‐population in the later stages of osteoarthritis

Cartilage‐derived mesenchymal stem cells (MSCs) have been isolated with different methods. In this study lateral and medial femoral condyles were respectively collected from patients with late‐stage osteoarthritis during the total knee arthroplasty. After digestion of the cartilage tissues with type II collagenase and analysis by fluorescence‐activated cell sorting (FACS) with CD146, a chondroprogenitor cell sub‐population were isolated and purified. The expression of other MSC‐associated markers in the CD146⁺ chondroprogenitors was analyzed by flow cytometry. Multi‐lineage differentiation capacity of CD146⁺ chondroprogenitors was compared with that of unsorted chondrocytes and adipose‐derived MSCs (ADMSCs). Higher percentage of CD146⁺ chondroprogenitors isolated from the medial femoral condyles was observed than that from the lateral. CD146⁺ chondroprogenitors expressed high levels of MSC‐specific surface antigens, and showed higher chondrogenesis capacity than ADMSCs and unsorted chondrocytes in a 3D cell pellet culture model. Thus CD146 might be a new cell surface marker for cartilage progenitor cell population in the late‐stage osteoarthritis. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:84–91, 2015.     

Lactulose enhances neuroplasticity to improve cognitive function in early hepatic encephalopathy

Lactulose is known to improve cognitive function in patients with early hepatic encephalopathy; however, the underlying mechanism remains poorly understood. In the present study, we investigated the behavioral and neurochemical effects of lactulose in a rat model of early hepatic encephalopathy induced by carbon tetrachloride. Immunohistochemistry showed that lactulose treatment promoted neurogenesis and increased the number of neurons and astrocytes in the hippocampus. Moreover, lactulose-treated rats showed shorter escape latencies than model rats in the Morris water maze, indicating that lactulose improved the cognitive impairments caused by hepatic encephalopathy. The present findings suggest that lactulose effectively improves cognitive function by enhancing neuroplasticity in a rat model of early hepatic encephalopathy.     

ICU 患者谵妄危险因素分析

目的：通过评分系统分析患者ICU谵妄发生的危险因素。方法对440例患者分别在入ICU即刻与出ICU时应用焦虑自评量表（ SAS）、抑郁自评量表（ SDS）及ICU谵妄筛查表（ ICDSC）进行评价,同时记录发生ICU综合征的各种可能危险因素及入ICU及出ICU时的急性生理与慢性健康评分（ APACHEⅡ）。分别对危险因素与出ICU时SAS、SDS及ICDSC评分的关系进行多元线性回归分析。结果患者转出ICU后,APACHE Ⅱ评分、SAS、SDS及ICDSC各项评分分别为（9．8±3．2）,（43．8±11.3）,（43．1±10．8）与（2．43±2．00）分,进入ICU时分别为（17．3±5．5）,（48．3±12．7）,（48．5±12.3）,（1．36±0．81）分,差异有统计学意义（t值分别为7．549,3．004,3．780,－3．329;P＜0．05）。逐步多元回归分析显示,SAS评分与住院天数、出院 APACHE Ⅱ评分、引流管数量相关（R2＝0．515,F ＝14.139,P＜0．001）;SDS评分与住院天数、引流管数量相关（R2＝0．444,F＝16．395,P＜0．001）;ICDSC评分与文化程度、住院天数、机械通气时间、出院APACHE Ⅱ评分相关（ R2＝0．803,F＝39．769,P ＜0.001）。结论 ICDSC诊断ICU谵妄的敏感性较高,可用于ICU谵妄的筛查。随着住ICU天数的增加,发生ICU谵妄的可能性增加。     

30例甲状腺微小癌的外科治疗体会

【摘要】 目的 总结甲状腺微小癌的外科治疗经验。方法 回顾性分析2010年5月至2014年5月收治30例甲状腺微小癌患者的临床资料。结果〓30例病例均行手术切除,其中24例(80.00%)术中冰冻切片证实,6例(20.00%)术后病理确诊。24例中,单侧甲状腺腺叶加峡部切除术加中央区颈淋巴结(VI)清扫术14例;双侧甲状腺全切7例;单侧腺叶、峡部切除术加同侧颈淋巴结清扫术3例。术后病理确诊的6例均采用一侧腺体大部切除。全组30例无手术死亡和术后并发症,随访未见肿瘤复发。结论〓单侧甲状腺腺叶及峡部切除是甲状腺微小癌手术治疗较理想的术式;有淋巴结转移者同时行功能性颈部淋巴结清扫术。     

薯蓣皂苷元对THP-1巨噬细胞ABCA1表达及胆固醇流出的影响

目的　探讨薯蓣皂苷元（Dgn）对巨噬细胞ATP结合盒转运体A1（ABCA1）表达及其介导胆固醇流出的影响。方法　用Dgn或结合ABCA1小干扰RNA（siRNA）处理THP-1源性巨噬细胞24　h后,Western　blot检测ABCA1蛋白水平,HPLC检测胞内总胆固醇（TC）、游离胆固醇（FC）及胆固醇酯（CE）含量,液体闪烁计数仪检测胞内胆固醇流出,油红O染色观察胞内脂滴情况。结果　Dgn呈浓度依赖性上调巨噬细胞ABCA1的表达,促进胞内胆固醇流出,降低胞内TC、FC和CE含量,抑制胞内脂质蓄积和泡沫细胞形成。而ABCA1　siRNA与Dgn共处理细胞后,明显抑制Dgn促胆固醇流出作用,胞内脂质蓄积和泡沫细胞形成明显加剧。结论　Dgn通过促进巨噬细胞ABCA1表达和胆固醇流出,抑制胞内脂质蓄积和泡沫细胞形成。