神经内镜下经鼻蝶治疗伴甲介型蝶窦垂体腺瘤

目的探讨伴甲介型蝶窦的垂体腺瘤手术治疗方法。方法回顾性分析12例甲介型蝶窦垂体腺瘤病人的临床资料。术前行CT多平面重建,术中应用神经内镜经鼻蝶入路结合磨钻暴露鞍底,切除垂体腺瘤。结果未使用定位设备的情况下,术中均能顺利暴露鞍底,切除肿瘤。术后MRJ复查示肿瘤全切除10例,次全切除2例,无严重并发症发生。随访6—12个月,病人恢复良好。结论经鼻蝶人路手术治疗甲介型蝶窦的垂体腺瘤,通过术前详细的影像学检查、术中神经内镜结合磨钻的使用,均能准确辨认及暴露鞍底、切除肿瘤,是一种创伤小、治疗效果良好的微侵袭神经外科手术方法。     

Role of IL‐17 and TGF‐β in peritoneal adhesion formation after surgical trauma

Peritoneal adhesions are fibrous tissues formed after surgery. Both cytokines and transforming growth factors (TGFs) are involved in this process. The objective of this study was to investigate the cross talk between these entities. Peritoneal drainage fluid after surgery from patients and rodent models was examined by enzyme‐linked immunosorbent assay and fluorescence‐activated cell sorter. Data showed that the concentrations of interferon (IFN)‐γ and interleukin (IL)‐17 reached their peaks 6–12 hours after surgery, whereas TGF‐β1 concentrations showed two postoperative peak time points at 2 and 72–96 hours. By neutralizing IFN‐γ, IL‐17 6–12 hours, and TGF‐β1 72–96 hours after surgery, the degree of adhesion reduced significantly. However, neutralizing TGF‐β1 2 hours after surgery did not affect adhesion formation. Furthermore, in vitro studies showed that compared with the fibroblasts that were directly stimulated with TGF‐β1, the prestimulation of IL‐17 promoted plasminogen activator inhibitor‐1 production while inhibiting tissue‐type plasminogen activator production. Moreover, additional stimulation with IFN‐γ enhanced this effect. Together, these data indicate that IL‐17 may promote adhesion formation by increasing the reaction of fibroblasts against TGF‐β1. Blocking IL‐17 might have a therapeutic potential in preventing adhesion formation after surgery.     

全结直肠切除回肠贮袋肛管手缝吻合术在溃疡性结肠炎治疗中的临床价值

目的 评价全结直肠切除回肠贮袋肛管手缝吻合术（HIPAA）治疗溃疡性结肠炎的临床价值.方法 回顾性分析1989年1月至2013年12月天津医科大学总医院收治的191例溃疡性结肠炎患者的临床资料,采用开腹和腹腔镜辅助手术行HIPAA.末次手术后3个月和12个月进行问卷调查,依据24h和夜间排便次数、Bristol粪便分类表和Kirwan分级评价贮袋肛门功能.依据克利夫兰生命质量表评价生命质量;依据贮袋炎活动指数诊断贮袋炎.随访时间截至2014年4月.独立样本比较采用t检验,多组比较采用方差分析,两两比较采用LSD-t检验,计数资料比较采用x2检验.结果 191例患者中有180例行开腹手术,11例行腹腔镜手术.175例行二期手术,9例行一期手术,7例行三期手术.181例采用J型贮袋,9例采用H型贮袋,1例采用W型贮袋.患者无围手术期死亡,术后早期8例患者腹腔感染,7例切口感染,应用抗生素后治愈.术后1～2周发生贮袋吻合口出血4例,吻合口漏4例,给予止血处理后治愈.6例患者术后出现高位肠梗阻,经对应处理后缓解.8例患者发生贮袋炎,经饮食调节或抗生素治疗后缓解.2例患者发生性功能障碍.所有患者获得随访,随访时间1～25年.术后贮袋肛门功能不断改善,术后3个月24 h和夜间排便次数、Bristol粪便分类和Kirwan分级分别为（6.5±2.8）次,（2.9±1.5）次,Ⅳ类86例、Ⅴ类89例、Ⅵ类16例,Ⅰ级160例、Ⅱ级19例、Ⅲ级12例;术后12个月分别为（3.7±1.4）次,（1.3±0.5）次,Ⅳ类107例、Ⅴ类76例、Ⅵ类8例,Ⅰ级177、Ⅱ级8例、Ⅲ级6例,两者比较,差异有统计学意义（=12.36,3.98,x2=7.76,29.27,P＜0.05）.克利夫兰生命质量表评分：术前为（0.37±0.19）分,术后3个月为（0.67±0.16）分,术后12个月为（0.82±0.13）分,3者比较,差异有统计学意义（F=6.011,P＜0.05）.术后3个月与术前和术后12个月比较,差异有统计学意义（t=16.69,10.06,P＜0.05）;术后12?     

肾移植患者他克莫司血药浓度与肝肾毒性分析

目的分析我院肾移植患者他克莫司血药浓度的控制情况,探讨他克莫司血药浓度与肝肾功能之间的关系,以期为临床的合理用药提供依据。方法收集我院2011年11月至2013年4月96例肾移植患者他克莫司血药浓度的数据,及血药浓度测定当天的生化检测结果。根据他克莫司血药浓度（A）测定结果,将其分为4组（I组,A≤6 ng/mL;II组,6〈A≤10 ng/mL;III组,10〈A≤15 ng/mL;IV组,A〉15 ng/mL）,对4组中的各项生化指标及不良反应比例进行统计分析。结果红细胞（P=0.57）,血红蛋白（P=0.60）,血小板（P=0.12）,总胆红素（P=0.58）,谷氨酰基转移酶（P=0.46）,天门冬氨酸氨基转移酶（P=0.98）和丙氨酸氨基转移酶（P=0.40）在4组之间没有统计学意义;而白细胞（P=0.007）,碱性磷酸酶（P=0.004）和血尿素氮（P=0.007）在4组之间差异有统计学意义。当患者的他克莫司血药浓度维持在6-15 ng/mL 时,其肾小球滤过率估计值（estimated glo-merular filtration rate,eGFR）（70.2 mL/min）要明显高于≤6 ng/mL（58.2 mL/min）和〉15 ng/mL （66.2 mL/min）。同时,感染及中重度贫血的风险也较低,但他克莫司血药浓度与肝功能异常比例之间未发现显著的相关性。结论他克莫司血药浓度维持在6-15 ng/mL有利于患者肾功能的维持,同时能够降低感染和中重度贫血的风险,这一结果将有利于他克莫司的临床使用。     

In vivo evidence of methamphetamine induced attenuation of brain tissue oxygenation as measured by EPR oximetry

Abuse of methamphetamine (METH) is a major and significant societal problem in the US, as a number of studies have suggested that METH is associated with increased cerebrovascular events, hemorrhage or vasospasm. Although cellular and molecular mechanisms involved in METH-induced toxicity are not completely understood, changes in brain O₂ may play an important role and contribute to METH-induced neurotoxicity including dopaminergic receptor degradation. Given that O₂ is the terminal electron acceptor for many enzymes that are important in brain function, the impact of METH on brain tissue pO₂in vivo remains largely uncharacterized. This study investigated striatal tissue pO₂ changes in male C57BL/6 mice (16–20 g) following METH administration using EPR oximetry, a highly sensitive modality to measure pO₂in vivo, in situ and in real time. We demonstrate that 20 min after a single injection of METH (8 mg/kg i.v.), the striatal pO₂ was reduced to 81% of the pretreatment level and exposure to METH for 3 consecutive days further attenuated striatal pO₂ to 64%. More importantly, pO₂ did not recover fully to control levels even 24 h after administration of a single dose of METH and continual exposure to METH exacerbates the condition. We also show a reduction in cerebral blood flow associated with a decreased brain pO₂ indicating an ischemic condition. Our findings suggests that administration of METH can attenuate brain tissue pO₂, which may lead to hypoxic insult, thus a risk factor for METH-induced brain injury and the development of stroke in young adults.     

Three new diphenylpropanes from Celastrus hindsii

Three new diphenylpropanes, Hindsiipropane A–C (1–3), together with one known arylpropyl quinone Griffithane D (4), were isolated from Celastrus hindsii. Their structures were established by 1D and 2D nuclear magnetic resonance spectroscopic analysis, and mass spectroscopy. Compound 4 was firstly obtained in this genus. All the isolated compounds were evaluated in vitro for cytotoxicity against four human tumor cell lines (A549, HCT116, MDA-MB-231, BEL7404) by the MTT assay.     

热熔挤出技术制备穿心莲提取物固体分散体

目的:采用热熔挤出技术(HME)制备穿心莲提取物的固体分散体,并对其进行体外评价。方法:以穿心莲内酯和脱水穿心莲内酯含量为指标,采用单因素试验,分别对亲水性载体种类、穿心莲提取物与载体用量比例进行筛选,确定最优穿心莲提取物热熔挤出固体分散体的制备方法,并对形成的固体分散体进行体外溶出度试验和差式扫描量热分析、电镜扫描、X-射线衍射等物相鉴别。结果:穿心莲提取物热熔挤出固体分散体的最优制备工艺为:以Soluplus为载体,穿心莲提取物∶Soluplus=1∶2(m/m)混合,热熔挤出区段升温程序为130→135→140→130℃,螺杆转速为27 r/min,加料速度为15 g/min。物相鉴别试验显示穿心莲提取物在热熔挤出分散体中以无定形态分散。结论:HME能使穿心莲提取物以无定形状态分散,提高穿心莲提取物的溶解度。     

分散式静脉用药调配中心的实践与创新简

目的保障临床用药安全、有效。方法比较分散式静脉用药调配中心（PIVAS）与传统集中模式PIVAS的异同及优缺点,总结分散式PIVAS的优势。结果与结论建立以科室为单位的分散式PIVAS,解决了集中模式的PIVAS工作时间安排、人员配备、运输通道的矛盾,降低了用药风险,保证了临床用药及时与安全。     

右旋佐匹克隆的合成新方法

目的制备右旋佐匹克隆。方法以2,3-吡嗪二酸酐和2-氨基-5-氯吡啶为起始原料,经酯化、环合、不对称还原、成酯和精制反应得到右旋佐匹克隆。结果与结论目标化合物的结构经1H-NMR谱确证。新合成方法操作简便、收率高,适合工业化生产。产品光学纯度大于99.9%,化学纯度大于99.5%。     

2-(4-三氟甲基苯基)-4-乙基-呋喃-3-酰胺衍生物的设计、合成及其抗肿瘤活性研究

目的 设计、合成新型抗肿瘤的2-（4-三氟甲基苯基）-4-乙基-呋喃-3-酰胺衍生物.方法 以对三氟甲基苯甲醛和丙二酸二乙酯为起始原料,经缩合、环合、酰氯化及胺解等4步反应,合成系列目标化合物.结果 设计合成了15个目标化合物,并对其进行了4种肿瘤细胞A549、QGY、HeLa和SW480的活性测试.结论 显示出较好的抗肿瘤活性,化合物5b显示出最优的高效、广谱抗肿瘤活性,值得深入研究.