钙拮抗剂—治疗原发性高血压的新概念

在临床研究和高血压治疗中,钙拮抗剂已得到了更多的注意。在高血压病人中,钙拮抗剂具更强大的扩血管活性,因而促进了对它的研究。细胞内钙离子浓度对于增加血管平滑肌细胞张力是一决定因素。就调节平滑肌张力的所有神经激素和离子影响而言,游离钙为一焦点。尽管关于血管平滑肌细胞中膜受体和离子泵是如何影响慢通道钙流入的确切机理尚不完全清楚,但在原发性高血压的鼠及病人脂肪组织中观察到细胞内钙离子浓度增加。最近Erne等使用细胞内埋藏萤     

盐酸川芎嗪肺靶向微球的研究

用乳化法制备盐酸川芎嗪明肢微球,优化了工艺。对微球的外观、粒径与其分布、含量、体外释药、稳定性及体内分布等进行研究。结果表明平均粒径为12.65μm,粒径范围5.0～24.9μm占总数的87.5%,球内含药量平均为16.49%±0.49%(n=3),冰箱或室温放置稳定,体外释药符合一级动力学规律,释药t_1/2比原药延长约5倍。小鼠静注微球后20 min,在肺内的相对分布百分率明显高于其它组织与血液,与溶液对照组相比,提高近6倍。     

Presentation,management,and outcome of newly diagnosed glioblastoma in elderly patients

OBJECT: Optimum management for elderly patients with newly diagnosed glioblastoma(GBM) in the temozolomide(TMZ) era is not well defined.The object of this study was to clarify outcomes in this population.METHODS: The authors retrospectively reviewed 105 consecutive cases involving elderly patients(age ≥ 65 years) with newly diagnosed GBM who were treated at the Mayo Clinic between 2003 and 2008.RESULTS: The patients’ median age was 74 years(range 66-87 years),and the median Karnofsky Performance Status(KPS) score was 80(range 40-90).Half of the patients underwent biopsy and half underwent resection.Patients with deep-seated lesions(19 patients [18%]) or multifocal lesions(34 patients [32%]) were more likely to have biopsy than resection(p = 0.0001 and 0.0009,respectively).New persistent neurological deficits developed in 7 patients(6.7%).Postoperative hemorrhage occurred in 6 patients(5.7%),all of whom underwent biopsy.Complete follow-up data regarding adjuvant treatment was available in 84 patients.Forty-one(49%) were treated with chemotherapy(mostly TMZ) and radiation therapy(RT),and 23(27%) with RT alone.Nineteen(23%) received only palliative care after surgery(more common with biopsy,p = 0.03).Chemotherapy complications occurred in 28.6%(Grade 3 or 4 hematological complications in 11.9%).The median values for progression-free survival(PFS) and overall survival(OS) were 3.5 and 5.5 months.In a multivariate analysis,younger age(p = 0.03,risk ratio [RR] 0.34,95% CI 0.13-0.89),single lesion(p = 0.02,RR 0.51,95% CI 0.30-0.89),resection(p = 0.04,RR 0.54,95% CI 0.31-0.94),and adjuvant treatment(p = 0.0001,RR 0.24,95% CI 0.11-0.49) were associated with better OS.Only adjuvant treatment was significantly associated with prolonged PFS(p = 0.0007,RR 0.27,95% CI 0.13-0.57).With combined therapy with resection,RT,and chemotherapy,the median PFS and OS were 8 and 12.5 months,respectively.CONCLUSIONS: The prognosis for GBM worsens with increasing age in elderly patients.With important risks,resection and adjuvant treatment are associated with prolonged survival.Although selection bias cannot be excluded in this retrospective study,advanced age alone should not necessarily preclude optimal resection followed by adjuvant radiochemotherapy.     

A retrospective review of chronic anal fistulae treated by anal fistulae plug

Objective The aim of this study was to analyse the efficacy of the anal fistulae plug (Cook Surgisis® AFP?) for the management of complex anal fistulae. Method A review of patients with anal fistulae treated using Cook Surgisis® AFP? between October 2005 and 2007 was undertaken. Patient’s demographics, fistulae aetiology and success rates were recorded. Results Thirty‐three patients underwent 49 plug insertions. The median age was 44.4 years; 18 females. The fistulae aetiology was cryptoglandular in 61% and Crohn’s disease in 39%. The median follow up 221.5 days (range 44–684). Twenty‐one patients had previous failed surgery. Twenty‐eight patients had draining setons in situ at time of plug placement. The overall success rate was 8/32 patients (25%). Two of the 22 Crohn’s fistulae healed (9.1%) and 9/26(34.6%) cryptoglandular fistulae healed. The reasons for failure were sepsis in 87% and plug dislodgement in 13%. Significant predictor factors for improved outcome were African‐Americans patients (P = 0.009), and presence of seton (P = 0.05). Conclusions Anal fistulae plug was associated with a lower success rate than previously reported. Septic complications were the main reason for failure.