海绵共附生菌Streptomyces sp. LHW2432的次级代谢产物研究

目的 从海绵共附生菌Streptomyces sp. LHW2432的发酵产物中发现药用活性分子。方法 采用正向硅胶柱、ODS反向柱以及高效液相色谱分离技术,对LHW2432的发酵萃取物进行分离纯化;通过现代波谱技术和文献调研确定化合物结构;利用平板涂布法和微量稀释法,评价化合物对芽胞杆菌、耐甲氧西林金黄色葡萄球菌（MRSA）、耻垢分支杆菌、白色念珠菌和大肠杆菌的抑菌活性。结果 从LHW2432发酵物中共分离鉴定了5个化合物：descycloavandulyl-lavanduquinocin (1)、N-acetyltyramine (2)、phomapyrone C (3)、germicidin A (4) 和germicidin I (5)。化合物1对MRSA和耻垢分支杆菌的最小抑菌浓度（MIC）值分别为100和64 μg/ml。结论 从LHW2432菌中分离得到5个化合物,其中,化合物1是新天然产物,可作为神经保护活性三环咔唑类生物碱的合成前体,其对G⁺菌有微弱的抑制活性。     

Editorial Commentary: With Properly Indicated and Performed Surgery,We Can (Hopefully) Prevent Osteoarthritis in Patients With Hip Femoroacetabular Impingement

Surgical treatment of femoroacetabular impingement (FAI) syndrome has been proven to be tremendously successful, outperforming the best conservative care and physical therapy in several prospective multicenter randomized controlled trials. The durability of this operation over time is less commonly reported on. We do know that FAI is associated with the development of hip osteoarthritis, and this is well established. We also know that surgical FAI treatment results in good short-term return to function/sport and improvements in patient-reported outcomes. We do not yet know if we are able to alter the natural history of FAI and prevent or delay conversion to total hip arthroplasty in this population.     

国内外多学科诊疗模式研究进展分析

多学科诊疗已成为现代医学诊疗模式的发展趋势。通过文献综述发现,国外MDT体现了以患者为中心的理念,覆盖了患者咨询、首诊前准备、诊断治疗和后续跟进与支持4个阶段,MDT模式对于提高患者诊断准确率和生存率、慢性病护理和控制医疗费用等有重要作用。我国医疗机构也已纷纷开始探索MDT,但目前面临医疗资源有限、医务人员认识不足、主观能动性不够、配套政策缺乏等问题,建议完善国家支持政策和医院制度建设,构建评价体系,充分把握适应证,并促进MDT与信息化建设和全生命周期管理相结合。     

继续动机性访谈对糖尿病性白内障患者日间手术出院后复诊依从性的影响

  目的  继续动机性访谈糖尿病性白内障患者，以得出其在日间手术出院后的复诊依从性的影响因素，并分析其应用效果。  方法  随机选取2018年1月至2019年1月上海交通大学医学院附属仁济医院眼科的糖尿病性白内障日间手术患者共108例，随机分为观察组与对照组，所有研究对象均接受仁济医院的健康教育，出院后对患者每个月都进行一次观察，不间断地观察6个月。对照组患者回访包含患者身体状况、服药情况，并且根据回访结果进行指导，对观察组患者采用继续动机性访谈的访谈方法，了解影响其出院后的复诊依从性的因素，并分析其应用效果，制定针对性继续访谈方案，护理人员负责访谈工作和健康教育。对比两组被研究者的复诊依从性。  结果  观察组患者应该复查知晓率为77.77%（42/54），对照组患者对复查的知晓率为38.89%（21/54）；观察组患者出院1～6个月复查依从性为74.07%、77.80%、81.48%、81.50%、83.30%和85.19%，对照组患者出院1～6个月复查依从性为38.89%、44.40%、48.15%、50.00%、53.70%和57.41%；在出院后的不良反应总发生概率中，观察组患者为9.26%，而对照组却高达37.04%，组间对比差异有统计学意义（P < 0.05）。  结论  继续动机性访谈可明显提高糖尿病性白内障患者日间手术出院后复诊依从性，出院后延续性访谈工作确保患者居家延续护理质量，降低患者不良反应发生率，具有很高的临床推广应用价值。     

HPLC法测定黄麦合剂中金丝桃苷的含量

目的:建立黄麦合剂中金丝桃苷的HPLC测定方法。方法:色谱柱:Waters XBridge^TMC₁₈柱（250 mm×4.6 mm,5μm）,流动相:乙腈-0.1%磷酸溶液（15:85）,检测波长:360 nm,流速:1.0 ml·min^-1。结果:金丝桃苷浓度在8.42～134.72μg·ml^-1的范围内,峰面积与浓度呈良好的线性关系（r=0.999 9）。平均回收率为98.09%,RSD为2.79%（n=7）。结论:本法简便、准确、重复性好,可用于黄麦合剂中金丝桃苷的含量测定。     

恶性肿瘤手术患者全身麻醉的最小成本分析

目的:找寻具有最低成本且具较优麻醉效果的麻醉方式。方法:采用回顾性方法,将1699例美国麻醉医师协会(ASA)Ⅰ～Ⅱ级的恶性肿瘤手术患者按麻醉方式分为静吸复合组(BAL组)、全凭静脉麻醉组(TIVA组)和吸入麻醉组(INH组)。结果:在3组麻醉效果差异无统计学意义的前提下,BAL组、TIVA组、INH组的平均每小时麻醉费用分别为(419.34±121.22)元、(463.49±136.51)元、(325.81±99.36)元,INH组成本最低,与其他2组比较差异有统计学意义(P<0.05)。麻醉总费用(包含浪费药物费用)与麻醉时间、年龄呈正相关,与麻醉方式呈负相关,与体重未见正相关。结论:恶性肿瘤手术患者全身麻醉时,吸入麻醉成本最低。     

H1N1 in Pregnancy: A Tertiary Care Centre Experience

ObjectiveTo elucidate factors pertinent to the course and outcome of H1N1 infection in pregnancy.MethodsWe conducted a retrospective chart review of H1N1-affected pregnant patients at Mount Sinai Hospital in Toronto, Ontario. All women who tested positive for H1N1 from June 1, 2009, to December 5, 2009, were identified. Records were reviewed to determine pregnancy status. Information from clinic and hospital charts of pregnant patients was gathered using data collection forms previously approved by the Mount Sinai Hospital Research Ethics Board.ResultsOf 42 patients, 12 were inpatients and 30 were outpatients. Sixty percent of patients (25/42) presented in the third trimester, 33% (14/42) had comorbidities, and 69% were afebrile and therefore did not have a condition that met the United States Centers for Disease Control and Prevention’s definition of influenza-like illness. Antiviral agents were administered promptly in most patients, but delays resulted in one third of patients being treated more than 48 hours from the onset of symptoms. Seventyone percent (30/42) did not require hospitalization, and 58% of hospitalized patients (7/12) were admitted for reasons unrelated to H1N1. Although one quarter of hospitalized patients (3/12) had delivered at the time of discharge, no deliveries occurred because of H1N1. Most patients (91%) delivered at term. One half of the deliveries (51%) were by Caesarean section, but none of these were because of H1N1 infection. Most of the infants (88%) were appropriately grown, and none were admitted to the NICU because of H1N1.ConclusionInfection with H1N1 in pregnant women has the propensity to result in significant maternal and fetal morbidity and mortality, and requires vigilance in assessment and prompt treatment. In contrast to reports published to date, our cohort experienced a largely uncomplicated course of illness, with minimal fetal and maternal impact in most instances.     

104例儿童系统性红斑狼疮临床分析

目的探讨系统性红斑狼疮(SLE)患儿的临床特点。方法对2003年3月—2010年10月确诊的104例SLE患儿首次住院病史进行回顾性分析。结果 104例患儿中男17例、女87例。首发症状以面部皮疹(71.2%)、发热(62.5%)、关节肿痛(60.5%)、肢端红斑(49.0%)多见;其中38例累及肾脏的病理分型为局灶增生型(Ⅲ,26.3%)、弥漫增生型(Ⅳ,57.1%)、膜型(Ⅴ,18.4%)。男性患儿发病初期,皮疹、血尿、蛋白尿、浆膜腔积液、肺间质改变、受累器官数、危重症病例数、疾病活动性指数(SLEDAI积分)等与女性患儿的差异有统计学意义(P均<0.05)。结论儿童SLE多发于青春期,女性多见。男性患儿发病年龄较女性早,临床症状重,器官受累多,肾脏受累突出,病情进展快。     

依那西普治疗非全身型幼年特发性关节炎的近期疗效及安全性观察

目的观察依那西普治疗非全身型幼年特发性关节炎的疗效和安全性。方法对30例非全身型幼年特发性关节炎患儿皮下注射依那西普0.4 mg/(kg.次),每周2次,在治疗后1周、1个月及3个月采用ACRPedi 30/50/70评分进行疗效评估。结果治疗后1周、1月及3月时ACR Pedi 30达标率分别为16.70%、90.00%、96.67%,ACR Pedi 50达标率分别为3.30%、30.00%、66.70%,ACR Pedi 70达标率分别为0、0、16.70%(5),且无重大不良事件发生。结论依那西普治疗非全身型幼年特发性关节炎具有较好的近期疗效,在病程早期使用效果更显著,不良反应小且发生率低。