延迟小骨窗开颅手术治疗硬膜外血肿96例

1临床资料1999-08/2004-08我科采用延迟小骨窗开颅手术治疗硬膜外血肿96(男75,女21)例,年龄13～18(平均35)岁.受伤原因车祸72例,坠落伤11例,打击伤13例.均于伤后72 h内就诊并经头颅CT确诊,表现头痛96例,呕吐21例,一侧肢体无力32例,偏身麻木23例,癫痫发作1例,原发昏迷92例,59例≤30 min,33例为30～120 min,头痛进行性加重36例.就诊时GCS记分10～12分15例,13～15分81例,运动性失语2例,混合性失语3例.CT示血肿位于额顶叶12例,额叶32例,颞叶5例,顶枕叶8例,颞顶后39例(1例合并对侧脑内血肿,5例合并额颞叶脑挫裂伤).血肿量30～80mL.入院后3～15 d内先给予脱水剂、激素、止血剂、抗生素、脑活性药物、镇痛剂等对症处理保守治疗.     

Hematoxylin and Safranin O Staining of Frozen Sections

Currently the hematoxylin and eosin staining procedure is the most popular among Mohs surgeons for histology. However, safranin O, a cheaper and relatively safer stain which is predominantly used for plant histology, should be considered as it offers similar or improved accuracy in the diagnosis of frozen sections of basal and squamous cell carcinomas.     

Experimental evaluation of ten clinically used arterial prostheses

The arterial grafts currently in use are classified into five basic categories; 10 different commercially available prostheses were chosen to represent these categories. The Vascutek and Bionit are made from knitted Dacron and have medium porosity, requiring preclotting by the surgeon. The DeBakey Soft Woven and Plasma TFE grafts are made from woven Dacron and have low porosity, not requiring preclotting under most circumstances. Also studied were woven and knitted grafts with leakage resistance referred to as impervious Dacron grafts: the Vascutek Gelseal, the Bard Albumin Coated DeBakey Vasculour II, the Microvel with Hemashield, and the albumin saturated, autoclaved DeBakey Soft Woven graft. Gore-Tex and Impra are expanded polytetrafluoroethylene grafts which do not require preclotting. For each type, five grafts 6 cm long and 8 mm in diameter were implanted in the descending thoracic aorta of healthy adult dogs for 16 weeks. The physical characteristics, biocompatibility, and healing patterns varied according to the structure and treatment of the grafts. Pretreatment with biomaterials during manufacture is quite effective in preventing transinterstices blood loss during implantation, but results in altered physical qualities, increased thrombogenicity and delayed healing in comparison to the effects of preclotting with autogenous blood at the time of implantation.     

The LIFESTYLE study: costs and effects of a structured lifestyle program in overweight and obese subfertile women to reduce the need for fertility treatment and improve reproductive outcome. A randomised controlled trial

Background

In the Netherlands, 30% of subfertile women are overweight or obese, and at present there is no agreement on fertility care for them. Data from observational and small intervention studies suggest that reduction of weight will increase the chances of conception, decrease pregnancy complications and improve perinatal outcome, but this has not been confirmed in randomised controlled trials. This study will assess the cost and effects of a six-months structured lifestyle program aiming at weight reduction followed by conventional fertility care (intervention group) as compared to conventional fertility care only (control group) in overweight and obese subfertile women. We hypothesize that the intervention will decrease the need for fertility treatment, diminish overweight-related pregnancy complications, and will improve perinatal outcome.

Methods/Design

Multicenter randomised controlled trial in subfertile women (age 18-39 year) with a body mass index between 29 and 40 kg/m². Exclusion criteria are azoospermia, use of donor semen, severe endometriosis, premature ovarian failure, endocrinopathies or pre-existent hypertensive disorders. In the intervention group the aim is a weight loss of at least 5% to10% in a six-month period, to be achieved by the combination of a diet, increase of physical activity and behavioural modification. After six months, in case no conception has been achieved, these patients will start fertility treatment according to the Dutch fertility guidelines. In the control group treatment will be started according to Dutch fertility guidelines, independently of the patient's weight.

Outcome measures and analysis

The primary outcome measure is a healthy singleton born after at least 37 weeks of gestation after vaginal delivery. Secondary outcome parameters including pregnancy outcome and complications, percentage of women needing fertility treatment, clinical and ongoing pregnancy rates, body weight, quality of life and costs. Data will be analysed according to the intention to treat principle, and cost-effectiveness analysis will be performed to compare the costs and health effects in the intervention and control group.

Discussion

The trial will provide evidence for costs and effects of a lifestyle intervention aiming at weight reduction in overweight and obese subfertile women and will offer guidance to clinicians for the treatment of these patients.

Trial registration

Dutch Trial Register NTR1530     

苯乙哌啶合成的改进

目的：改进苯乙哌啶的合成方法,使之更适合工业化生产。方法,以N,N－双（β-氯乙基）对甲苯磺酰胺为原料,利用液－液相转移催化方法制得1－对甲苯磺酰基－4－氰基哌啶,再经水解,酯化,缩合,成盐等步骤,合成了苯乙哌啶。结果：总收率可达51．8％,结论：此合成方法适合工业化生产。     

平痛新素丸的处方设计及制备

目的：为制备平痛新包衣微丸提供良好的底物，方法：以流动性指数为指标采用均匀设计优化平痛新素丸。结果：确定了制备平痛新素丸的最佳处方工艺。结论：淀粉量是影响产率的主要因素：转速是影响堆密度，脆碎度的主要因素；粘合剂用量是影响休止角和流动性的主要因素；滚动时间是影响喷流指数的主要因素。