克罗米芬的不同使用时机对体外受精助孕妊娠结局的影响

目的使用克罗米芬(CC)微刺激促排卵方案,在体外受精与胚胎移植(IVF-ET)患者中比较CC不同使用时机对妊娠结局的影响。方法回顾性分析河南省人民医院生殖医学中心2011年1月至2013年11月期间使用了CC微刺激促排卵方案新鲜取卵患者共456周期。按CC不同使用时机分为持续使用组(184周期)、后期使用组(203周期)、早期使用5d组(69周期),比较三组患者一般情况、促排卵情况及妊娠结局的差异。结果后期使用组人绒毛膜促性腺激素(HCG)日内膜厚度、获卵数、种植率及妊娠率均显著高于持续使用组及早期使用5d组(P0.05);三组之间HCG日雌二醇(E2)水平、黄体生成素(LH)水平及大于14mm以上卵泡数差异具统计学意义(P0.05)。年龄、不育年限、基础卵泡刺激素(FSH)、HCG日孕酮(P)水平、未获卵周期率及可移植胚胎数均无统计学差异。结论对于使用CC的微刺激促排卵患者,后期使用CC相对能获得较好的获卵情况及妊娠结局。     

枸橼酸局部抗凝在肝功能不全患者连续性肾脏替代治疗中的安全性评价

目的 评估枸橼酸局部抗凝(RCA)在肝功能不全患者连续性肾脏替代治疗(CRRT)中的安全性。方法 回顾性分析东部战区总医院(秦淮医疗区)重症医学科收治的56例行CRRT治疗的患者资料。患者分为肝功能正常组20例、肝功能轻中度异常组20例以及肝功能重度异常组16例,观察3组患者的滤器使用时间,监测各组的肝肾功能、凝血功能、酸碱及电解质、钙比值等相关指标。结果 3组间患者滤器使用时间比较,差异无统计学意义(P>0.05)。治疗后,肝功能轻中度异常组及肝功能重度异常组患者肌酐(Cr)较治疗前均降低,差异有统计学意义(P <0.05);3组间Na^+、总钙较治疗前的变化幅度比较,差异有统计学意义(P <0.05);余下指标比较,差异均无统计学意义(P均> 0.05)。肝功能轻中度异常组及肝功能重度异常组患者均出现少量枸橼酸盐蓄积的情况。结论 肝功能异常组(中度和重度)相比肝功能正常组滤器使用时间相当,未对酸碱及电解质等内环境指标产生严重影响,脏器功能、凝血状态治疗前后无差别。仅少数患者存在一定程度的枸橼酸盐蓄积,但未出现严重并发症,考虑安全性尚可。     

Identification of predictors of the ovarian response to clomiphene citrate in infertile women with polycystic ovary syndrome: a prospective cohort study

ObjectiveTo identify predictors of the ovarian response to clomiphene citrate (CC) in infertile patients with polycystic ovary syndrome (PCOS).MethodsWe performed a prospective cohort study of infertile patients with PCOS. The participants underwent assessments of their physical, endocrine, and metabolic characteristics, and treatment with CC at an initial dose of 50 mg/day and a maximum of 100 mg/day between days 3 and 7 of their menstrual cycles. Participants who ovulated were identified as responders and those who did not as non-responders.ResultsOf the 72 participants, 48 (66.7%) were identified as responders and 24 as non-responders. Sex hormone-binding globulin (SHBG) (odds ratio 1.022, 95% confidence interval: 1.000–1.045) was found to be associated with the ovarian response to CC using logistic multivariate regression analysis. Receiver operating characteristic analysis also showed that SHBG was a significant predictor of the response to CC (area under the curve 0.799).ConclusionWe have shown that SHBG is the best prognostic indicator of an ovulatory response to CC. However, larger prospective studies, in which more variables are assessed, are required to confirm this finding and to identify appropriate cut-off values.     

Prevention of citrate reactions during therapeutic plasma exchange by constant infusion of calcium gluconate with the return fluid

We have examined the effectiveness of intravenous calcium gluconate infusion in the prevention of citrate reactions during therapeutic plasma exchange. Over 2 years, 636 procedures were performed on 90 patients, mostly for treatment of neurological disorders. Return fluid consisted of 4–5% human serum albumin in 0.9% NaCl. Anticoagulant ACD-A was used at a starting ratio of 1:16. Whole blood flow rates were 70–80% ml/min. Treatments were divided into three groups for management of citrate reactions: Group A (360 treatments) were managed using simple measures only, including slowing the whole blood flow rate, altering the ACD:whole blood flow ratio, and oral calcium carbonate wafers; Group B (102 treatments) received small intravenous boluses of 10% calcium gluconate, up to 25 ml during the procedure; Group C (174 treatments) received constant infusion of calcium gluconate (10 ml/liter of return fluid) during the procedure. Citrate reactions occurred in 35.6% of Group A and 29.4% of Group B treatments (P = 0.3), but in only 8.6% of Group C treatments (P < 0.0001). Men with and without reactions were the same age (mean 63.3 vs. 61 years, P = 0.0823), but women with reactions were younger than women without reactions (mean 49.9 vs 57.9 years, P < 0.0001). Supplementation of the return fluid with calcium gluconate is an effective, convenient, and well-tolerated method for prevention of citrate toxicity during therapeutic plasma exchange procedures using albumin-based return fluid. © 1996 Wiley-Liss, Inc.     

枸橼酸氢钾钠在大负荷肾尿酸结石治疗中的应用(附6例报告并文献复习)

目的:探讨枸橼酸氢钾钠在大负荷肾尿酸结石治疗中的效果。方法:回顾性分析2018年1月至2020年7月天津医科大学第二医院以枸橼酸氢钾钠治疗的6例大负荷肾尿酸结石(长径>4cm)患者的临床资料。患者均为男性,平均年龄51.3(42～66)岁,平均结石长径6.0(4.1～7.6)cm,腹部X线片(KUB)阴性,平均CT值4...     

不同时机应用枸橼酸咖啡因对早产儿结局及神经发育影响的比较研究

目的探讨不同时机应用枸橼酸咖啡因对早产儿结局及神经发育的影响。方法选取2018年1月至6月于我院新生儿重症监护室住院治疗的胎龄小于32周、体重小于1500 g的早产儿共113例为研究对象,按开始使用枸橼酸咖啡因的日龄分为早期治疗组(日龄≤1 d,53例)和晚期治疗组(1 d<日龄≤10 d,60例),回顾性收集并比较两组患儿围生期的基本情况、治疗过程、临床结局,并针对神经发育情况随访至12月龄。结果早期治疗组患儿支气管肺发育不良、动脉导管未闭及脑室内出血/脑室周围白质软化的发生率低于晚期治疗组,差异均有统计学意义(均P<0.05)。早期治疗组纠正胎龄40周时新生儿神经行为测定评分高于晚期治疗组,差异有统计学意义(P<0.05)。早期治疗组纠正胎龄3月龄时智力发育指数高于晚期治疗组,纠正胎龄至12月龄时智力发育指数及运动发育指数均高于晚期治疗组,差异均有统计学意义(均P<0.05)。结论早期应用枸橼酸咖啡因可改善早产儿结局,改善神经系统预后。     

纠正EDTA依赖性假性血小板减少的方法学比较和分析

目的 对比枸橼酸钠法、阿米卡星法、硫酸镁法和预稀释法对EDTA依赖性假性血小板减少症(Ethylene Diamine Tetraacetic Acid Dependent Pseudothrombocytopenia,EDTA-PTCP)血小板检测的应用效果.方法 重新采集EDTA-PTCP患者的EDTA-K2、枸橼...     

枸地氯雷他定与依匹斯汀治疗慢性荨麻疹随机对照研究

目的 探讨枸地氯雷他定和依匹斯汀治疗慢性荨麻疹的疗效和安全性。 方法 随机、双盲、双模拟和对照研究。试验组服枸地氯雷他定胶囊每日1次,每次8.8 mg,对照组依匹斯汀胶囊每日1次,每次10 mg,均连续服用28 d。于用药后随访,观察疗效和不良反应。 结果 入选病例157例,可评价疗效和安全性病例142例。经28 d治疗后,枸地氯雷他定组有效率81.16％、依匹斯汀组有效率78.08％,两组比较差异无统计学意义（P > 0.05）。枸地氯雷他定组和对照组药物相关性不良反应发生率分别为13.89％和12.16％,两组比较差异无统计学意义（P > 0.05）。 结论 枸地氯雷他定治疗慢性荨麻疹安全有效。     

HPLC法测定枸橼酸西地那非阴道栓的含量

目的 建立枸橼酸西地那非阴道栓的含量测定方法,以控制其产品质量.方法 采用高效液相色谱测定法.C18色谱柱.流动相为:0.05mol·L-1磷酸三乙胺(0.7%三乙胺1000mL用磷酸调节pH3.0)甲醇-乙腈(52 ∶ 30∶18),检测波长290nm.结果 在10μg～60μg·mL-1范围内峰面积与西地那非浓度成良好的线形关系,加样回收率和RSD分别为99.0%和0.6%.结论 方法简便准确,可用于制剂的质量分析.     

Hydrogen sulfide is a novel prosecretory neuromodulator in the Guinea-pig and human colon

BACKGROUND & AIMS: Hydrogen sulfide (H(2)S) has been suggested as a novel gasomediator. We explored its unknown neuromodulatory role in human and guinea-pig colon. METHODS: We used immunohistochemistry to detect H(2)S-producing enzymes cystathionine gamma-lyase (CSE) and cystathionine beta-synthase (CBS) in enteric neurons, Ussing chambers to measure mucosal ion secretion, and neuroimaging with voltage- and Ca(++)-sensitive dyes to record H(2)S effects on guinea-pig and human enteric neurons. RESULTS: More than 90% of guinea-pig and human submucous and myenteric neurons were colabeled for CSE and CBS. Myenteric interstitial cells of Cajal were CSE-immunoreactive. The exogenous H(2)S donor NaHS (0.2-2.5 mmol/L) concentration-dependently increased chloride secretion in human and guinea-pig submucosa/mucosa preparations, but not in the colonic epithelial cell line T84. The secretory response was reduced significantly by tetrodotoxin (0.5 micromol/L), capsaicin desensitization (10 micromol/L), and the transient receptor potentials vanilloid receptor 1 antagonist capsazepine (10 micromol/L). The endogenous H(2)S donor L-cysteine also induced secretion that was diminished significantly by capsaicin desensitization, the CBS inhibitor amino-oxyacetic acid, and the CSE inhibitor propargylglycine. NaHS increased spike discharge in 23% of guinea-pig and 36% of human submucous neurons, but had no effect on Ca(++) mobilization in cultured guinea-pig enteric neurons. This excitatory response was reduced significantly by capsaicin desensitization and capsazepine, but not by glibenclamide (10 micromol/L). CONCLUSIONS: The presence of H(2)S-producing enzymes in human and guinea-pig enteric neurons, the excitatory action on enteric neurons, and the prosecretory effects of NaHS suggest H(2)S as a novel gut-signaling molecule. Its action mainly involves transient receptor potentials vanilloid receptor 1 receptors on extrinsic afferent terminals, which in turn activate enteric neurons.