盐酸胺碘酮包衣脉冲片在犬体内的药动学研究

目的：建立测定盐酸胺碘酮包衣脉冲片在家犬体内血药浓度的方法,研究其药动学特征。方法：将家犬随机均分成盐酸胺碘酮包衣脉冲片组和普通片组,每日灌服200mg,1周后交叉实验,采用高效液相色谱法测定给药后24h内盐酸胺碘酮在2组家犬体内的血药浓度,并计算比较2组的药动学参数。色谱柱为Agilent C18,流动相为2%三乙胺（用磷酸调pH值至4.8）-乙腈（30：70）,柱温为25℃,检测波长为242nm。结果：盐酸胺碘酮检测浓度的线性范围为5～200μg·mL-1（r=0.9999）,提取回收率为91.62%～95.82%,RSD为1.83%～3.68%;盐酸胺碘酮在包衣脉冲片组和普通片组家犬体内的药动学参数分别为：t1/2为（17±1.68）、（18±2.16）h,tlag为（4.42±0.3）、（0.2±0.05）h,AUC0～24h为（298.4±32.5）、（278.4±24.8）μg·h·mL-1,cmax为（23.56±2.12）、（24.89±1.56）μg·mL-1,其中tlag有明显差异（P〈0.01）,而t1/2、cmax、AUC0～24h等无明显差异（P〉0.05）。结论：盐酸胺碘酮包衣脉冲片具有缓释作用,体内实验满足脉冲释药时滞效果。     

Repeated light-dark phase shifts modulate voluntary ethanol intake in male and female high alcohol-drinking (HAD1) rats

BACKGROUND: Chronic disruption of sleep and other circadian biological rhythms, such as occurs in shift work or in frequent transmeridian travel, appears to represent a significant source of allostatic load, leading to the emergence of stress-related physical and psychological illness. Recent animal experiments have shown that these negative health effects may be effectively modeled by exposure to repeated phase shifts of the daily light-dark (LD) cycle. As chronobiological disturbances are thought to promote relapse in abstinent alcoholics, and may also be associated with increased risk of subsequent alcohol abuse in nonalcoholic populations, the present experiment was designed to examine the effects of repeated LD phase shifts on voluntary ethanol intake in rats. A selectively bred, high alcohol-drinking (HAD1) rat line was utilized to increase the likelihood of excessive alcoholic-like drinking. METHODS: Male and female rats of the selectively bred HAD1 rat line were maintained individually under a LD 12:12 cycle with both ethanol (10% v/v) and water available continuously. Animals in the experimental group were subjected to repeated 6-hour LD phase advances at 3 to 4 week intervals, while control rats were maintained under a stable LD cycle throughout the study. Contact-sensing drinkometers were used to monitor circadian lick patterns, and ethanol and water intakes were recorded weekly. RESULTS: Control males showed progressively increasing ethanol intake and ethanol preference over the course of the study, but males exposed to chronic LD phase shifts exhibited gradual decreases in ethanol drinking. In contrast, control females displayed decreasing ethanol intake and ethanol preference over the course of the experiment, while females exposed to experimental LD phase shifts exhibited a slight increase in ethanol drinking. CONCLUSIONS: Chronic circadian desynchrony induced by repeated LD phase shifts resulted in sex-specific modulation of voluntary ethanol intake, reducing ethanol intake in males while slightly increasing intake in females. While partially contrary to initial predictions, these results are consistent with extensive prior research showing that chronic stress may either increase or decrease ethanol intake, depending on strain, sex, stressor type, and experimental history. Thus, repeated LD phase shifts may provide a novel chronobiological model for the analysis of stress effects on alcohol intake.     

近视儿童调节滞后与隐斜状态及相关因素研究

目的 研究近视儿童近距注视下的调节滞后和隐斜量,分析近视儿童调节滞后与近隐斜的关系及相关因素.方法 受试者为250名近视儿童,等效球镜屈光力范围为-0.50～-5.25D.采用MEM动态检影法测量受试者右眼近距的调节滞后;分别采用Howell测量法(HT)和改良Thorington测量法(MTT)测量近隐斜;通过问卷调查受试者父母的屈光状态.各重复测量三次,取均值.结果 受试者近距调节滞后为(+0.97±0.43)D,近隐斜为(-0.94±4.55)△(外隐斜,HT)和(-1.71±4.85)△(外隐斜,MTT).伴近内隐斜者占28.0％(HT)和22.8％(MTT).伴近内隐斜者的调节滞后和内隐斜呈正相关(r=0.353,P=0.003,HT;r =0.461,P＜0.001,MTT);受试者调节滞后和近视程度呈负相关(r=-0.241,P＜0.001).23％近视者父母均为近视,其调节滞后显著大于其父母组儿童(F =4.90,P=0.009).结论 近视儿童在近距注视状态下调节滞后较高.近隐斜状态和遗传因素都可能影响近视儿童的调节滞后,调节滞后量与近视程度可能存在相互作用.临床上应将近距调节反应和隐斜测量纳入儿童的常规视功能检查项目.     

2014—2019年湖州市相邻两日温差对儿童支气管肺炎影响的时间序列研究

目的 了解湖州市儿童支气管肺炎的分布情况,探索相邻两日温差对儿童支气管肺炎的影响,为发现易感人群,并采取针对性措施提供指导。方法 采用DLNM模型(distributed lag non - linear model)去探究相邻两日温差对儿童支气管肺炎的非线性滞后效应。结果 研究时间段内,儿童支气管肺炎的总发病数为17 658人,相邻两日温差每增加一个四分位间距（IQR = 2.5℃)时,各人群在滞后前3 d效应均没有统计学意义,在滞后4～8 d则有统计学意义,且除了3岁以上人群的最大滞后天数为滞后第5 d外(RR = 1.128,95%CI:1.055～1.206),其余滞后效应的最大值均为滞后第6 d,其相对危险度分别为1.078(95%CI:1.037～1.212)、1.054(95%CI:1.006～1.105)、1.108(95%CI:1.054～1.165)、1.067(95%CI:1.023～1.112),表明相邻两日温差对儿童支气管肺炎有明显滞后效应,且女童和3岁以上儿童更易受相邻两日温差的影响。结论 相邻两日温差对儿童支气管肺炎影响有明显滞后效应,当相邻两日温差发生巨大变化时,应加强对女童和3岁以上儿童的防护措施。     

经坐骨小切迹髋臼后柱打钉入路的应用解剖与导向器研究

目的为经坐骨小切迹髋臼后柱打钉入路提供解剖依据。方法用66侧成人髋骨标本,男36侧,女30侧;CT扫描男、女各30例骨盆,图像用Mimics软件行三维重建。根据坐骨小切迹的形态进行分型。结果髋骨标本分型:男性")"型44.4%;"C"型30.6%;"『"型16.7%;"丿"型8.3%。女性")"型73.3%;"C"型占3.3%;"『"型占6.7%;"丿"型1%。Mimics三维重建分型:男性")"型56.7%;"C"型26.7%;"『"型13.3%"丿"型3.3%。女性")"型76.7%;;"C"型10.0%;"『"型6.7%;"丿"型6.7%。结论坐骨小切迹"C"型时,坐骨小切迹的下端影响打钉,要用骨刀切下坐骨小切迹下端,打入导针;如坐骨小切迹为"『"型时,打导针易打滑,需要在坐骨小切迹的进钉点做一个台阶。     

Cost-effectiveness of orthoptic screening in kindergarten: A decision-analytic model

purpose The purpose of this study was to analyze the cost-effectiveness of orthoptic screening for amblyopia in kindergarten. METHODS. A decision-analytic model was used. In this model all kindergarten children in Germany aged 3 years were examined by an orthoptist. Children with positive screening results were referred to an ophthalmologist for diagnosis. The number of newly diagnosed cases of amblyopia, amblyogenic non-obvious strabismus and amblyogenic refractive errors was used as the measure of effectiveness. Direct costs were measured form a third-party payer perspective. Data for model parameters were obtained from the literature and from own measurements in kindergartens. A base analysis was performed using median parameter values. The influence of uncertain parameters was tested in sensitivity analyses. RESULTS. According to the base analysis, the cost of one orthoptic screening test was 7.87 euro. One ophthalmologic examination cost 36.40 euro. The total cost of the screening program in all kindergartens was 3.1 million euro. A total of 4,261 new cases would be detected. The cost-effectiveness ratio was 727 euro per case detected. Sensitivity analysis showed considerable influence of the prevalence rate of target conditions and of the specificity of the orthopic examination on the cost-effectiveness ratio. CONCLUSIONS. This analysis provides information which is useful for discussion about the implementation of orthoptic screening and for planning a field study.     

低浓度阿托品控制近视眼进展适宜浓度与剂型的临床研究

目的探索阿托品用于控制近视眼进展的适宜浓度和剂型。 方法本研究为随机对照试验。2017年2月在北京同仁医院招募了受试者10名(20只眼),双眼的等效球镜度数在-0.5 D至-5.0 D间,虹膜均为棕色。其中,男性2名、女性8名,年龄24~26岁,平均年龄(24.8±0.79)岁。依次给予受试者0.005%、0.01%、0.025%及0.05%的低浓度阿托品滴眼,应用滴眼液与凝胶的眼别随机,双侧剂型不同。检查近视力、调节幅度及瞳孔大小,并通过问卷记录受试者的主观视觉症状。采用三因素重复测量方差分析检验实验结果。 结果0.005%、0.01%、0.025%及0.05%浓度的阿托品用药(包括滴眼液和凝胶),均引起了一定程度的瞳孔散大、调节幅度降低,且随着浓度升高程度增大。经三因素重复测量方差分析,0.005%、0.01%及0.025%的阿托品用药,对瞳孔大小、调节幅度及近视力影响的差异均无统计学意义(F＝1.70,4.38,0.92;P>0.05)、(F＝0.27,3.28,0.82;P>0.05)及(F＝0.14,0.29,0.57;P>0.05)。凝胶对瞳孔大小的影响大于滴眼液,差异有统计学意义(F＝7.51,P<0.05)。0.05%的阿托品用药后产生毒性反应,受试者的主观不适评分明显升高。0.005%、0.01%及0.025%的阿托品用药均无毒性反应,主观不适评分虽升高但可耐受。 结论0.025%阿托品用药可能是控制近视眼发展的适宜浓度;滴眼液与凝胶两种剂型的副作用均可耐受。     

不同的多焦点可调节人工晶状体视觉效果比较

目的研究Tetraflex可调节、ReSTOR＋3D及Tecnis多焦点3种人工晶状体植入后的视觉效果。方法双眼植入同一类型人工晶状体,有完整记录及问卷调查结果。而且随访时间3～6个月者38例（76眼）,按植入的人工晶状体类型分为3组。Tetraflex可调节人工晶状体组13例（26眼）,ReSTOR＋3D人工晶状体组14例（28眼）,Tecnis多焦点人工晶状体组11例（22眼）。结果高照度裸眼远视力：3组之间无明显差别（P〉0．05）。低照度裸眼远视力：Tetraflex及Tecnis明显优于ReSTOR＋3D（P〈0．05）。裸眼中间视力（以70em为准）：Tetraflex优于ReSTOR＋3D及Tecnis（P〈0．05）。裸眼近视力（以阅读距离30cm为准）：Tecnis优于ReSTOR＋3D及Tetraflex（P〈0．05）。夜间眩光及光晕：Tecnis及Tetraflex抱怨较少,ReSTOR＋3D较多（P〈0．05）。患者对阅读的满意度：Tecnis及ReSTOR＋3D抱怨较少,而Tetraflex则抱怨较多（P〈0．01）,主要是随着时间的推移,近视力有所下降。结论3种人工晶状体各有优缺点,但是作为老视眼矫正的选择,目前还没有一种能够真正满足每位患者需要的人工晶状体,因此只能根据不同患者的实际情况来选择合适的人工晶状体。     

Smoking cessation increases the resistance of low-density lipoprotein to oxidation

The effects of smoking cessation on the susceptibility to oxidation of low-density lipoprotein (LDL) was investigated in 14 men who quit smoking for 3 months. LDL was isolated and susceptibility of LDL to V-70 (4-methoxy-2,4-dimethylvalerinitrile)-mediated oxidation was assessed by measuring conjugated diene production at 234 nm, the lag phase being a measure of the resistance of LDL to oxidation. The mean duration of the lag phase became 1.9-fold longer after 3 months (P<0.001). The result suggests that the increase in resistance of LDL to oxidation contributes to the reduction of the risk of coronary heart disease by smoking cessation.     

Breakage of a Lag Screw of Cephalomedullary Nail: A Technique of Removal

A broken lag screw of the cephalomedullary nail is a rare condition. Removal of the retained lag screw from the femoral head is also very challenging. This article describes a surgical technique and the modified instrument that was available in the operating room for removing the broken implant by closed technique.