反相高效液相色谱法同时检测肉汤培养基（CM129）中左氧氟沙星和阿奇霉素的药物浓度

目的：建立使用HPLC同时测定CM129培养基中左氧氟沙星和阿奇霉素的药物浓度的方法,为检测阿奇霉素促进左氧氟沙星透过生物膜实验提供检测方法。方法：色谱柱为Waters反相C18柱,流动相为甲醇-磷酸二氢钾缓冲液（29∶71,pH 2.53）,流速1.0 ml/min,检测波长210 nm,内标为西司他丁钠。结果：本法在10～160μg/ml范围内左氧氟沙星及阿奇霉素呈线性,相关系数r分别为0.999 9和0.999 9,平均回收率分别为99.83%和100.34%,RSD分别为1.08%和0.47%,在此范围内检测结果重复性良好。结论：该方法适合同时检测肉汤培养基中左氧氟沙星和阿奇霉素的药物浓度。     

A Warhead Substitution Study on the Coronavirus Main Protease Inhibitor Nirmatrelvir

The SARS-CoV-2 pandemic is currently causing an unprecedented global health emergency since its emergence in December 2019. In December 2021, the FDA granted emergency use authorization to nirmatrelvir, a SARS-CoV-2 main protease inhibitor, for treating infected patients. This peptidomimetic is designed with a nitrile warhead, which forms a covalent bond to the viral protease. Herein, we investigate nirmatrelvir analogs with different warheads and their inhibitory activities. In addition, antiviral activities against human alphacoronavirus 229E was also investigated along with a cell-based assay. We discovered that the hydroxymethylketone and ketobenzothiazole warheads were equipotent to the nitrile warhead, suggesting that these analogs can also be used for treating coronavirus infections.     

醋酸阿比特龙联合强的松治疗去势抵抗型前列腺癌的疗效分析

目的 分析去势抵抗型前列腺癌(castration resistant prostate cancer,CRPC)患者接受醋酸阿比特龙(abiraterone acetate,AA)联合强的松(prednisone,P)治疗的疗效及安全性,为后续治疗提供经验。方法 筛选2018年7月至2021年4月首都医科大学附属北京朝阳医院泌尿外科共计46例CRPC患者,选择使用AA+P治疗,最后共计37例患者纳入研究。分析37例患者的基本资料,参照前列腺特异抗原(prostate specific antigen,PSA)工作组2(PSA Working Group 2, PSAWG2)标准计算PSA缓解率,按照实体瘤的疗效评价(response evaluation criteria in solid tumors,RECIST)标准评估患者治疗期间的影像学结果,同时分析行多西他赛化疗、PSA闪烁现象以及基线PSA水平、肿瘤T分期、Gleason评分等指标对AA+P治疗的PSA缓解率的影响差异。结果 37例CRPC患者接受AA+P治疗,中位随访时间9.7个月。在接受AA+P初始,有5例患者发生了PSA闪烁现象,其PSA达峰再次下降至基线水平以下的中位时间为3.0(2.0,4.5)个月。37例患者PSA总体缓解率为59.5%,其中13例患者达到缓解后又发生了PSA复发,其中位复发时间为7.0个月。参照RECIST标准,37例CRPC患者中,有7例患者发生了影像学进展,而5例有明确的影像学缓解。6例达到PSA缓解后出现复发的患者将强的松转换为地塞米松,其中2例PSA再次缓解,PSA缓解率为33.3%。化疗失败后接受AA+P的患者PSA缓解低于未行化疗的患者(20.0% vs 65.6%,P=0.076)。此外,有PSA闪烁现象的PSA缓解率低于无此现象的患者(20.0% vs 65.6%,P=0.076)。醋酸阿比特龙的总体耐受性较好,药物不良反应少。结论 CRPC患者口服醋酸阿比特龙联合强的松疗效确切,安全性高,对于不愿意选择或不能耐受化疗的患者,有较高的PSA缓解率。PSA闪烁现象在AA治疗过程中并不少见,这部分患者达到PSA缓解的比例较低。PSA缓解后的中位复发时间为7.0个月,部分PSA进展患者用地塞米松替换强的松可重新达到PSA缓解,可恢复对阿比特龙治疗的敏感性。     

HELLP综合征期待治疗时间的探讨

目的：探讨妊娠＜34周的HELLP综合征患者终止妊娠时机。方法：选取51例＜34周产前HELLP 综合征患者为研究对象,根据诊断至终止妊娠时间分为期待≥48 h组（确诊后≥48 h终止妊娠）22例、期待＜48 h组（确诊后＜48 h终止妊娠）29例;每组再分为完全性和部分性2个亚组：完全性-期待≥48 h组9例,部分性-期待≥48 h组13例,完全性-期待＜48 h组21例,部分性-期待＜48 h组8例。比较各组一般情况、母儿情况、激素及血制品使用情况、疾病高峰期及恢复期主要实验室指标。结果：各组及亚组患者的一般情况、激素及血制品使用、产后住院时间、最低血小板恢复正常时间、产后出血情况、母体损害累计数、出院前疾病恢复期实验室指标,差异均无统计学意义。胎儿不良结局发生率,期待≥48 h组低于期待＜48 h组,部分性-期待≥48 h组低于部分性-期待＜48 h组（均P＜0.05）;而在完全性-期待≥48 h组和完全性-期待＜48 h组间相似（P＞0.05）。分娩前疾病高峰期,各组及亚组血红蛋白最低值、谷丙转氨酶（ALT）及谷草转氨酶（AST）最高值无明显差异。分娩前最低血小板值,期待＜48 h组低于期待≥48 h组,完全性-期待＜48 h组低于完全性-期待≥48 h组（均P＜0.05）;而部分性-期待＜48 h组和部分性-期待≥48 h组间比较差异无统计学意义（P＞0.05）。乳酸脱氢酶（LDH）最高值,期待＜48 h组高于期待≥48 h组,完全性-期待＜48 h组高于完全性-期待≥48 h组（均P＜0.05）;部分性-期待＜48 h组和部分性-期待≥48 h组间比较差异无统计学意义（P＞0.05）。结论：妊娠＜34周病情平稳的HELLP综合征患者尤其是部分性HELLP,密切监护母儿情况下,适当期待治疗超过48 h,能在一定程度上改善胎儿预后且不增加母体损伤风险。     

Methodology in Conventional Head and Neck Reconstruction Following Robotic Cancer Surgery: A Bridgehead Robotic Head and Neck Reconstruction

PurposeRobotic head and neck surgery is widespread nowadays. However, in the reconstruction field, the use of robotic operations is not. This article aimed to examine methodologies for conventional head and neck reconstruction after robotic tumor surgery in an effort to obtain further options for future reconstruction manipulations.Materials and MethodsA retrospective review of all patients who received head and neck robot surgery and conventional reconstructive surgery between October 2016 and September 2021.ResultsIn total, 53 cases were performed. 67.9% of the tumors were greater than 4 cm. Regarding defect size, 47.2% of the lesions were greater than 8 cm. In terms of TNM stage, stage 3 disease was recorded in 26.4% and stage 4 in 52.8%. To make a deep and narrow field wider, we changed the patient’s posture in pre-op field, additional dissection was done. We used radial forearm flap mostly (62.2%).ConclusionConventional head and neck reconstruction after robotic ENT cancer surgery is possible. One key step is to secure additional space in the deep and narrow space left after robotic surgery. For this, we opted for a radial forearm flap mostly. This can be performed as a bridgehead to perform robotic head and neck reconstruction.     

低强度脉冲式超声波机械力生物链内源性干细胞激活与功能修复的研究进展

近年来,以低强度脉冲式超声波(LIPUS)为代表的机械力治疗手段已被广泛用于康复医学、骨折修复、神经损伤修复、泌尿系统疾病等领域.目前研究表明,LIPUS可能通过激活内源性干细胞参与组织修复,但是机械力如何通过生物链的转化而激活干细胞的具体机制尚不明确,因此对机械力生物链传导过程的进一步探索有助于揭示LIPUS的作用机...     

β连环素和Ki-67表达在唾液腺腺样囊性癌和基底细胞腺癌鉴别诊断中的作用

目的 探讨β连环素(β-catenin)和Ki-67表达在唾液腺腺样囊性癌(ACC)和基底细胞腺癌(BCAC)鉴别诊断中的作用.方法 回顾性分析56例唾液腺ACC患者(A组)和32例BCAC患者(B组)的临床资料,比较两组组织病理学特征.通过免疫组化染色检测并比较两组β-catenin和Ki-67蛋白的表达.结果 A组...     

联合治疗方案与全身抗凝治疗脑静脉窦血栓形成

目的 比较脑静脉窦血栓形成的联合治疗方案与全身抗凝在临床应用中的有效性和安全性.方法 网顾性连续收集脑静脉窦血栓形成116例患者资料,根据治疗方式不同分为联合治疗组30例和全身抗凝组86例.其中联合治疗组在全身抗凝的基础上,接受改良溶栓方案介入治疗,即脑动脉及静脉窦造影明确诊断后行机械性破栓及吸栓术,于静脉窦内留置微导管行尿激酶微量泵点接触性溶栓.采用NIHSS评分对两组患者治疗前后神经功能缺损评分,应用改良Rankin量表(mRS)评价出院时情况.结果 联合治疗组30例,男9例;全身抗凝组86例,男23例.治疗前神经功能缺损:联合治疗组0～19分,全身抗凝组0～17分,差异无统计学意义(Z=-0.474,P=0.636);治疗后联合治疗组神经功能缺损程度减轻,出院时mRS评分较低,两组颅内出血发生率差异无统计学意义.结论 联合治疗较全身抗凝有利于神经功能恢复.两种治疗方法颅内出血发生率无明显差异.     

CADASIL的影像学改变

常染色体显性遗传性脑动脉病伴皮层下梗死和白质脑病（cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,CADASIL）是一种最常见的遗传性脑微小动脉肌病,由位于19号染色体的Notch3基因突变引起。病理改变特点是微小动脉的平滑肌细胞变性以及由此导致的脑缺血陛改变。在血管平滑肌细胞表面发现颗粒性嗜锇物质以及基因检查发现Notch3基因突变是诊断CADASIL的金标准。     

Extrahepatic collateral supply of hepatocellular carcinoma by the intercostal arteries

PURPOSE: To evaluate computed tomographic (CT) and angiographic findings of extrahepatic collateral supply of hepatocellular carcinoma (HCC) by the intercostal artery (ICA) and the efficacy of transcatheter arterial chemoembolization (TACE) in the ICA. MATERIALS AND METHODS: The CT and angiographic findings of 30 ICA collateral supplies of HCC in 19 patients were evaluated. TACE of the ICA collaterals was performed in 10 patients. The clinical outcomes and complications were evaluated. RESULTS: ICA collaterals were found at the first to 18th sessions of TACE of HCC. The CT findings were: large HCC (mean diameter, 10.3 cm), subcapsular location (94.7%), defect in iodized oil retention or progression of HCC at subcapsular region (31.6%), HCC abutting the abdominal wall in a broad area with or without abdominal wall invasion (63.2%), hypertrophied ICA (31.6%), and branching collateral vessels coursing from the abdominal wall to the HCC (26.3%). On angiograms, all ICA collaterals originated from the right side at levels of T8 (6.7%), T9 (30.0%), T10 (46.7%), or T11 (16.7%). Twelve sessions of TACE of the ICA collaterals were performed in 10 patients. Follow-up angiography was performed in six patients and showed persistent obliteration in one, recanalization in three, and progression in two. Complications were shoulder pain (n = 2), itching sensation (n = 1), erythema of skin (n = 1), and skin necrosis (n = 1). CONCLUSION: ICA collateral supply of HCC usually occurs in advanced HCC or after multiple sessions of TACE. When there are suggestive CT findings, ICA collaterals should be sought when TACE is performed in the management of HCC.