利用主客体分子包结现象选择分离蛇床子有效成分的方法

利用1,1,6-四苯基-2,4-已二炔-1,6-二醇(I)的包结能力,可简单而迅速地从蛇床子中选择分离出有效成分欧前胡素(2)和花椒毒素(3),收率分别为0.054%(2)和0.002%(3)。本文用UV,IR,¹HNMR和¹³CNMR验证了2和3的化学结构,并用HPLC检验了2和3的纯度。X-射线衍射晶体结构分析表明主体分子I与组分2靠氢键形成包结物,它们的摩尔比为1:2,氢键长为2.8612A。包结物晶体属单斜晶系,空间群为已P₂₁/C,晶胞参数:a=15.468(5)A,b=8.595(3)A,c=18.663(7)A,β=93.64(5)°,Z=4和R=0.088。     

Risk of death from acute pancreatitis

Summary Conclusions The analysis of all the data available in 192 patients at 24 h from admission shows that only serum glucose above 250 mg/dL (13.88 mmol/L) and serum creatinine above 2 mg/dL (176.8 μmol/L) are prognostic factors of death (P<0.0001). When, however, pathological chest X-rays are also considered in a subset of 149 patients, these and serum creatinine are prognostic factors of death with odds ratios of 2.9 (95% CL 1.3–6.3) and 9.4 (95% CL 2.2–40.7), respectively (P<0.0001). Background In patients suffering from acute pancreatitis, neither Ranson scores nor Glasgow criteria evaluation at 24 h yield a sufficiently reliable prognosis of the risk of death from the first acute attack. Methods After excluding posttraumatic, postsurgical, and post-ERCP acute pancreatitis, we selected 192 consecutive patients admitted in the first instance to our center for a first attack, distinguishing between patients who died and patients who survived. We used Cox's model to analyze the prognostic weight of variables available within 24 h of admission (sex, age, alcohol intake, smoking habits, 17 biochemical tests, body mass index, chest X-rays, body temperature, and shock status). Results Seventeen (8.8%) patients died; mortality showed a decreasing trend over the period of years considered and was correlated, among other things, with necrotizing type of pancreatitis, idiopathic etiology, and shock status on admission.     

Diagnostic ultrasound of acute colonic diverticulitis by surgical residents

Background: Recent studies have documented the feasibility of ultrasonography (US) to diagnose acute colonic diverticulitis (ACD). This prospective observational trial determined the sonomorphology of ACD and evaluated the diagnostic accuracy of routine US performed on admission by surgeons in training. Methods: Fifty-seven consecutive patients with a confirmed episode of ACD were entered into this study, and the sonomorphology of the involved colon was assessed. US findings were compared to the results of the clinical evaluation and correlated to the clinicopathological outcome. Results: The sonomorphology of ACD was characterized by segmental inflammatory transformation of the colon averaging 9.9 ± 3.2 cm (range, 6–20) in length and visualized as target phenomena of a mean 3.5 ± 0.8 cm (range, 2.4–4.8) width. Targets were caused by hypoechogenic thickening of the colonic wall of an average 7.7 ± 2.6 mm (range, 4–18). In 40% of cases, a hyperechogenic halo representing peridiverticulitis (average width, 2.3 ± 0.6; range, 1.2–3 cm) was noted. Diverticula were seen in almost half of the cases. Of the 57 cases with confirmed ACD, the diagnosis was made by US in 48, for a global accuracy of 84.2%. US was false negative in nine patients, suggesting perforated appendicitis in five cases and acute appendicitis in one (the final diagnoses were perforated sigmoid diverticulitis in five cases and cecal diverticulitis in one case). In three patients, US was nondiagnostic. Conclusion: In the hands of sonographically trained surgeons, ultrasound is a useful modality to image acute colonic diverticulitis. US reveals diagnostic sonomorphology in most cases of ACD and therefore facilitates early confirmation of the diagnosis and assessment of severity. Received: 3 October 1996/Accepted: 9 May 1997     

TPA诱导的血小板聚集的研究

应用不同浓度ＴＰＡ诱发血小板聚集，观察２０名正常人血小板的聚集率。结果显示：ＴＰＡ从５ｎｇ／ｍｌ到１０ｎｇ／ｍｌ之间，随着浓度的增加，血小板聚集率逐渐增加，最佳浓度为１０ｎｇ／ｍｌ。当ＴＰＡ浓度〉１０ｍｇ／ｍｌ时，继续增加ＴＰＡ浓度，血小板聚集率将不再升高，且于２０ｍｇ／ｍｌ时出现明显的解聚现象。     

他汀类药物早期干预对急性冠脉综合征患者血脂、高敏C反应蛋白和纤维蛋白原的影响

目的 比较他汀类药物和阿司匹林联合用药与单用阿司匹林对急性冠脉综合征患者血脂、高敏C反应蛋白及纤维蛋白原的影响。方法 所有患者均在急性冠脉综合征发病后72h内开始接受药物治疗，他汀组(40例)应用他汀类药物加阿司匹林治疗8周，对照组(16例)单用阿司匹林治疗，观察两组总胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白和纤维蛋白原水平的变化。结果 治疗8周后，他汀组各指标显著降低，面对照组仅高敏C反应蛋白水平显著下降。他汀类药物降低高敏C反应蛋白、纤维蛋白原的程度与其降脂作用无关。结论 他汀类药物与阿司匹林联合用药降低高敏C反应蛋白和纤维蛋白原的作用可能优于单用阿司匹林，并与其抗炎作用有关。     

急性肾功能衰竭的治疗进展

目的：探讨急性肾功能衰竭的治疗。方法：复习有关急性肾功能衰竭的治疗文献，作一总结。结果：使用人工合成三肽序列（RGD）的多肽、生长因子、心房利钠因子和人工肾小管治疗急性肾功能衰竭都取得了较好的疗效。结论：这些新的治疗可望改善急性肾衰的预后和降低死亡率。     

Morphological changes in chest radiographs of patients with acute respiratory distress syndrome (ARDS)

Objective: To determine whether the quality of infiltrations in chest radiographs can accurately predict the histological extent of fibrotic change in patients with acute respiratory distress syndrome (ARDS). Design: Retrospective clinical investigation. Setting: Intensive care unit (ICU) of a university teaching hospital. Patients and methods: Of 47 patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS over a 5-year period, 23 patients underwent open lung biopsy at thoracotomy for treatment, mostly of pneumothorax. Chest films obtained by portable chest roentgenography preceding the operation were reviewed retrospectively and compared to the histomorphological results of the lung specimen. Results: Chest radiographs displayed mixed alveolar-reticular opacification in 60.2 %, alveolar patterns in 22.9 % and reticular opacities in 10.5 %. In 0.4 % there were no infiltrates, 6 % could not be evaluated because of insufficient quality. There was no relevant difference between the right and left lungs. Subdividing patients into two groups according to the histological results of either absent or mild (1) or severe (2) lung fibrosis, we found an alveolar haziness in 12.3 % in group 1 compared with 28.2 % in group 2, while reticular characteristics were identified in 13 % and 11 %, respectively. Conclusions: The most common opacity in chest radiographs of patients with severe ARDS treated with ECMO is mixed alveolar-reticular opacification. Severe lung fibrosis is not positively correlated with a reticular radiographic pattern. ECMO does not lead to specific radiological changes in conventional radiograms, contrary to clinical findings that treatment with ECMO might induce pleural or pulmonic haemorrhage, especially in the earlier days when systemic heparinization had to be used instead of the heparin-coated tube-surfacing. Received: 24 November 1997 Accepted: 20 July 1998     

急性心肌梗死再灌注期间的心电变化特征

目的　探讨急性心肌梗死 (AMI)再灌注期间的心电变化特征。方法　 46例经急诊冠状动脉造影明确为成功再灌注的AMI,其中 2 4例接受溶栓治疗和 2 2例接受直接经皮腔内冠状动脉成形 ,于发病的 6小时内以动态心电图技术持续2 4小时监测心电图变化 ,并与 1 5例无灌注者进行对比。结果　①再灌注发生后 ,相应导联ST段迅速下降 ,约 2小时达较低水平 ;同时 ,T波正向振幅进行性降低 ,距再灌注 0～ 2 2 (2 7± 4 5)小时呈现T波倒置并逐渐加深。②再灌注后的 1小时内 ,室性心律失常明显增加 ,6～ 8小时后显著减少。结论　AMI早期再灌注发生后呈现特征性心电变化 ,及时识别这些特征将有助于临床评估再灌注状态和危险度分层     

急性嗜碱粒细胞白血病及其超微结构

报告了一例急性嗜碱粒细胞白血病及其超微结构，观察了嗜碱早幼粒、中幼粒、晚幼粒及成熟嗜碱粒细胞。超微结构结果：骨髓嗜碱粒细胞的颗粒基质易水解，固定困难，它可能是嗜碱颗粒的特点，其他细胞的颗粒未见抽提现象。     

Early laparoscopic cholecystectomy for acute cholecystitis

Background: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial. Methods: One hundred ninety-four patients with acute cholecystitis were reviewed. The conversion rates for the various number of days of symptoms before surgery were analyzed. The conversion rate dramatically increased from 3.6% for those patients with 4 days of symptoms to 26% for those patients with 5 days of symptoms. The mean number of days of symptoms prior to surgery in those patients who underwent successful laparoscopic cholecystectomy was 4.1 as compared to 8.0 in those patients who required open cholecystectomy (p < 0.0001). Based on this data the patients were divided into two groups. Group 1 consisted of 109 patients who underwent laparoscopic cholecystectomy within 4 days of onset of symptoms and group 2 consisted of 85 patients who underwent laparoscopic cholecystectomy after more than 4 days following onset of symptoms. Results: The conversion rate from laparoscopic to open cholecystectomy was 15%. The conversion rate for group 1 was 1.8% as compared to 31.7% for group 2 (p < 0.0001). Indications for conversion were inability to identify the anatomy secondary to inflammatory adhesions (68%), cholecystoduodenal fistula (18%), and bleeding (14%). The major complication rate for group 1 was 2.7% as compared to 13% for group 2 (p= 0.007). The mortality rate for all patients with attempted laparoscopic cholecystectomy for acute cholecystitis was 1.5%. The average procedure time for group 1 was 100 ± 37 min vs 120 ± 55 min in group 2. The average number of postoperative hospital days in group 1 was 5.5 ± 2.7 days as compared to 10.8 ± 2.7 days in group 2. Conclusions: We advocate early laparoscopic cholecystectomy within 4 days of onset of symptoms to decrease major complications and conversion rates. This decreased conversion rate results in decreased length of procedure and hospital stay. Received: 28 March 1996/Accepted: 12 September 1996