选择性COX-2抑制剂NS-398的制备

目的制备选择性COX-2抑制剂NS-398。方法以2-氟硝基苯为起始原料,经4步反应化合成化合物NS-398。结果与结论用该方法可以在温和条件下合成出该药,最终产品纯度大于99%。     

Clinical application of neck acupoints in acupuncture

论述了颈部的局部解剖结构及常用穴位,以人迎穴为例,对针刺颈部穴位的刺法和注意事项进行阐述.     

超声波作用下NaBH4/ZrCl4还原9(E)-红霉素肟制备9(S)-红霉胺

9(S)-红霉胺是合成地红霉素和CP-544372的中间体，此化合物可在超声波的作用下利用NaBH4／ZrCl4于室温下还原9(E)-红霉素肟制得，收率为69％，其结构经IR、NMR和MS确证。该方法是制备9(S)-红霉胺的方便、有效的途径。     

药品降价和采购调控对我院抗感染药物利用的影响

目的 :探讨药品降价和采购调控对医院抗感染药物利用的影响。方法 :采用回顾性方法对5次降价期间我院抗感染药物的应用情况进行分析。结果 :抗感染药物销售额占药品总销售额的比例逐年下降 ,但抗感染药物总体限定日费用逐年上升 ,各类抗感染药物的用药频度和总体限定日费用呈不同的变化趋势。结论 :宏观的药品降价对抗感染药物的合理应用起到了积极的干预作用 ,但效果远未达到最佳 ;微观的采购调控手段正发挥着不可替代的作用。     

使用内窥镜辅助眼眶骨折手术的疗效

目的：探讨内窥镜辅助下眼眶骨折手术整复效果。

方法：回顾性分析2013-08/2016-08期间入我院就诊的眼眶骨折患者800例800眼,按照手术方式不同分为两组。其中354眼行鼻外径路手术,纳入对照组; 446眼行内窥镜辅助下眼眶骨折手术,纳入观察组。所有患者均完成术后6mo随访,观察患者术后临床疗效、复视分级、眼球凹陷改善情况,并评估患者术后随访对颜面部外形美观满意度。

结果：术后3mo观察组总有效率为92.8%,对照组为90.4%(P>0.05); 两组患者术前复视分级情况无差异(P>0.05),术后1mo观察组复视0级患者占70.9%,对照组占66.7%(P>0.05); 术后6mo观察组复视0级所占比例显著高于对照组(97.1% vs 76.0%,P<0.05)。术前组间眼球内陷深度比较无差异(P>0.05); 术后1mo眼球内陷深度≤1cm者：观察组占89.5%,对照组占85.9%(P>0.05); 术后6mo, 眼球内陷深度≤1cm,观察组97.3%明显高于对照组80.8%(P<0.05)。 术后6mo时观察组对颜面部外观满意度为97.8%,明显高于对照组94.6%(P<0.05)。

结论：内窥镜技术应用于眼眶骨折手术中可有效改善复视及眼球内陷情况,且长远疗效较好,术后恢复更符合现代人的审美要求。     

Outpatient initiation of the ketogenic diet in children with pharmacoresistant epilepsy: An effectiveness,safety and economic perspective

BackgroundChildren with pharmacoresistant epilepsy usually receive ketogenic diet (KD) as an inpatient, which makes it an expensive treatment.ObjectiveTo compare the effectiveness, safety, and costs of outpatient versus inpatient initiated KD.DesignRetrospective observational non-inferiority study.Patients/settingPatients (1–18 years of age) who started KD either inpatient or outpatient.Main outcome measuresEffectiveness was defined as ≥50% seizure reduction. Safety was measured by the numbers of emergency visits and complications. Economic impact was analyzed by calculating total costs of treatment.Statistical analysesNon-inferiority of outpatient initiation was tested using 95% confidence intervals of the differences in effectiveness and safety endpoints between groups with non-inferiority margins of 10%. Nonparametric bootstrap techniques were used to derive a 95% confidence interval for the mean difference in total costs between the groups.ResultsHundred and five patients started KD in the period 2001 to 2017: 43 inpatient and 62 outpatient. At three months, the KD was effective in 61% of outpatients versus 63% of inpatients. The KD was considered safe in 36% of the outpatients, as compared to 29% in the inpatients. Outpatient initiation was shown to be non-inferior to inpatient initiation in terms of safety. Total health care costs of outpatient initiation were € 2901, as compared to € 8195 of inpatient initiation per patient (mean difference € 5294, 95% CI; -€ 7653 to -€ 2935).ConclusionsOur study suggests that outpatient KD initiation is no worse than inpatient initiation in terms of effectiveness and safety, while carrying lower health care costs.     

What Can Proton Beam Therapy Achieve for Patients with Pectus Excavatum Requiring Left Breast,Axilla and Internal Mammary Nodal Radiotherapy?

AimsExposure of the heart to radiation increases the risk of ischaemic heart disease, proportionate to the mean heart dose (MHD). Radiotherapy techniques including proton beam therapy (PBT) can reduce MHD. The aims of this study were to quantify the MHD reduction achievable by PBT compared with volumetric modulated arc therapy in breath hold (VMAT-BH) in patients with pectus excavatum (PEx), to identify an anatomical metric from a computed tomography scan that might indicate which patients will achieve the greatest MHD reductions from PBT.Materials and methodsSixteen patients with PEx (Haller Index ≥2.7) were identified from radiotherapy planning computed tomography images. Left breast/chest wall, axilla (I–IV) and internal mammary node (IMN) volumes were delineated. VMAT and PBT plans were prepared, all satisfying target coverage constraints. Signed-rank comparisons of techniques were undertaken for the mean dose to the heart, ipsilateral lung and contralateral breast. Spearman's rho correlations were calculated for anatomical metrics against MHD reduction achieved by PBT.ResultsThe mean MHD for VMAT-BH plans was 4.1 Gy compared with 0.7 Gy for PBT plans. PBT reduced MHD by an average of 3.4 Gy (range 2.8–4.4 Gy) compared with VMAT-BH (P < 0.001). PBT significantly reduced the mean dose to the ipsilateral lung (4.7 Gy, P < 0.001) and contralateral breast (2.7 Gy, P < 0.001). The distance (mm) at the most inferomedial extent of IMN volume (IMN to heart distance) negatively correlated with MHD reduction achieved by PBT (Spearman's rho –0.88 (95% confidence interval –0.96 to –0.67, P < 0.001)).ConclusionFor patients with PEx requiring left-sided breast and IMN radiotherapy, a clinically significant MHD reduction is achievable using PBT, compared with the optimal photon technique (VMAT-BH). This is a patient group in whom PBT could have the greatest benefit.     

The Aldo-Keto Reductase Superfamily and its Role in Drug Metabolism and Detoxification

The aldo-keto reductase (AKR) superfamily comprises enzymes that catalyze redox transformations involved in biosynthesis, intermediary metabolism, and detoxification. Substrates of AKRs include glucose, steroids, glycosylation end-products, lipid peroxidation products, and environmental pollutants. These proteins adopt a (β /α )₈ barrel structural motif interrupted by a number of extraneous loops and helixes that vary between proteins and bring structural identity to individual families. The human AKR family differs from the rodent families. Due to their broad substrate specificity, AKRs play an important role in the phase II detoxification of a large number of pharmaceuticals, drugs, and xenobiotics.     

How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry

Yoga is increasingly used in clinical settings for a variety of mental and physical health issues, particularly stress-related illnesses and concerns, and has demonstrated promising efficacy. Yet the ways in which yoga reduces stress remain poorly understood. To examine the empirical evidence regarding the mechanisms through which yoga reduces stress, we conducted a systematic review of the literature, including any yoga intervention that measured stress as a primary dependent variable and tested a mechanism of the relationship with mediation. Our electronic database search yielded 926 abstracts, of which 71 were chosen for further inspection and 5 were selected for the final systematic review. These five studies examined three psychological mechanisms (positive affect, mindfulness and self-compassion) and four biological mechanisms (posterior hypothalamus, interleukin-6, C-reactive protein and cortisol). Positive affect, self-compassion, inhibition of the posterior hypothalamus and salivary cortisol were all shown to mediate the relationship between yoga and stress. It is striking that the literature describing potential mechanisms is growing rapidly, yet only seven mechanisms have been empirically examined; more research is necessary. Also, future research ought to include more rigorous methodology, including sufficient power, study randomisation and appropriate control groups.     

Risk conferred by tagged SNPs of AGT gene in causing susceptibility to essential hypertension

Introduction: AGT gene harbors several variants of which 21 are found to be in high linkage disequilibrium as per Hapmap database. Studies delineating the importance of these tagged SNPs are very limited and lacking from Indian population. In the present study, we evaluated the contribution of four tagged SNPs namely, g.6635G?>?A, g.6506G?>?A, g.12840G?>?A, and g.13828T?>?C at AGT locus along with the analyses of haplotype and epistatic interactions in causing susceptibility to essential hypertension (EHT).

Methods: About 215 hypertensives and 230 normotensives were genotyped for selected tagged SNPs using PCR-RFLP method.

Results: Significant association was obtained for g.6635G?>?A and g.6506G?>?A polymorphisms wherein GG homozygotes for both the markers were at risk for developing the condition. g.13828T?>?C polymorphism specially, female heterozygotes (TC) were found to be at increased risk for EHT. Haplotype GGGC was found to have a significant protective effect (p?=?0.0059). Markers g.6506G?>?A and g.12840G?>?A resulted in the creation of new enhancer sites thereby affecting splicing process.

Conclusion: The present report is the first one in the literature showing general- and gender-specific association of g.6506G?>?A and g.13828T?>?C polymorphisms, respectively, with EHT. However, further studies for replication of present observations are warranted from other populations and other parts of India.