三阶梯技术在筛查妊娠期妇女宫颈病变的临床应用

目的探讨三阶梯技术在诊断孕妇宫颈病变的临床价值和安全性。方法采用队列研究方法,选择2008年1月1日至2011年12月31日在密云县妇幼保健院产科门诊初次检查的孕10—32周、1年内未进行过宫颈液基薄层细胞学检查（TCT）的6649例孕妇,先行TCT筛查,对TCT结果异常者在知情同意后进行阴道镜检查和阴道镜指引下宫颈多点活检。结果①TCT筛查6649例孕妇,其中TCT结果异常154倒,发生率为2．32％;②114例孕妇的阴遭镜图像满意度为93．86％（107／114）,阴道镜拟诊慢性宫颈炎12例、鳞状上皮低度病变（LSIL）67例、鳞状上皮高度病变（HSIL）35例;③114例孕妇全部进行了宫颈活检,病理结果为宫颈炎及宫颈湿疣共48例,宫颈上皮内瘤样病变（CIN）136例、CINⅡ18例、CINⅢ10例、宫颈癌早浸2例;④与宫颈活检病理结果比较,阴道镜检查拟诊炎症和LSIL79例,其中71例与宫颈活检病理结果相同,符合率为89．87％（71／79）,79例拟诊炎症和LSIL患者中,无鳞状细胞癌（SCC）病例。拟诊为HSIL的35例孕妇中,20例活检病理结果为CINⅡ或CINⅢ,2例为早浸,符合率为57．14％（20／35）;⑤未发生与阴道镜检查和宫颈活检相关的不良事件。结论对1年内未进行宫颈细胞学筛查的孕妇进行TCT检查是必要的,对TCT结果异常者应进行阴道镜检查,阴道镜检查拟诊宫颈炎或LSIL可以随诊;对阴道镜检查下拟诊高级别宫颈病变的孕妇,应行阴道镜下宫颈活检以明确病理学诊断。     

正交试验法优选金铃子颗粒提取工艺

摘 要 目的：：优选金铃子颗粒的提取工艺。 方法: 用正交试验法考察加水量、煎煮时间、煎煮次数等因素对提取工艺的影响,以干浸膏得率和延胡索乙素含量为考察指标,烘干法测定干浸膏得率,高效液相色谱法测定延胡索乙素含量。 结果: 加10倍量水,煎煮1 h,煎煮 3 次为最佳提取工艺。 结论: 优选的工艺合理可行、重复性良好、提取效率高,适合于工业化生产。     

Effects of cardiac contractility modulation by non-excitatory electrical stimulation on exercise capacity and quality of life: An individual patient's data meta-analysis of randomized controlled trials

Background

Although cardiac contractility modulation (CCM) has emerged as a promising device treatment for heart failure (HF), the effect of CCM on functional capacity and quality of life has not been the subject of an individual patient data meta-analysis to determine its effect on measures of functional capacity and life quality. This meta-analysis is aimed at systematically reviewing the latest available randomized evidence on the effectiveness of CCM on functional capacity and quality of life indexes in patients with HF.

Methods

The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched in May 2013 to identify eligible randomized controlled trials comparing CCM with sham treatment or usual care. Primary outcomes of interest were peak oxygen consumption, 6-minute walk test distance and quality of life measured by Minnesota Living With Heart Failure Questionnaire. There was no sufficient information to address safety. Mean difference and 95% confidence intervals (C.I.s) were calculated for continuous data using a fixed-effects model.

Results

Three studies enrolling 641 participants were identified and included. Pooled analysis showed that, compared to control, CCM significantly improved peak oxygen consumption (mean difference + 0.71, 95% C.I. 0.20 to 1.21 mL/kg/min, p = 0.006), 6-minute walk test distance (mean difference + 13.92, 95% C.I. − 0.08 to 27.91 m, p = 0.05) and quality of life measured by Minnesota Living With Heart Failure Questionnaire (mean difference − 7.17, 95% C.I. − 10.38 to − 3.96, p < 0.0001).

Conclusions

Meta-analysis of individual patient data from randomized trials suggests that CCM has significant if somewhat modest benefits in improving measures of functional capacity and quality of life.     

非诺贝特片仿制药与原研药溶出度一致性评价研究

目的 建立非诺贝特片溶出度曲线测定方法,评价国内10家仿制药产品与原研药品溶出曲线的相似性。方法 用含0.025 mol·L^-1 SDS的pH 1.0盐酸溶液、pH 4.0缓冲液、pH 6.8缓冲液和水溶液4种溶出介质,分别考察非诺贝特片仿制药与原研片的溶出状况,并通过计算相似因子（f₂）评价溶出曲线的相似性。结果 国内仅1家企业产品与原研片在4种溶出介质中的溶出曲线均相似,其余企业产品与原研片相比溶出行为均不一致。结论 该方法适用于非诺贝特片的溶出曲线测定,可为非诺贝特片质量一致性评价提供参考。     

Management of venous thromboembolism in cancer patients and the role of the new oral anticoagulants

Patients with cancer are at high risk for venous thromboembolism (VTE). Most clinical guidelines agree that low-molecular-weight heparins (LMWHs) are the preferred anticoagulants for the prevention and treatment of VTE in cancer patients. However, LMWHs require daily injections, weight-adjustment of dose, and can be associated with heparin-induced thrombocytopenia; all of which are important considerations in managing cancer-associated VTE. Comparatively, the new oral anticoagulants offer a more attractive option because of their oral administration, fixed-dose, and lack of routine laboratory monitoring. The results of phase III trials support the efficacy and safety of the new oral anticoagulants in the management of VTE. However, generalizing these findings to cancer patients with VTE is difficult since very few cancer patients were included. In this comprehensive review, we provide an overview of the current treatment of VTE, explore anticoagulant thromboprophylaxis in ambulatory cancer patients, and summarize existing evidence on the efficacy and safety of the new oral anticoagulants for the management of VTE in both non-cancer and cancer populations.     

江苏部分地区慢性乙型肝炎病毒感染者天然耐药的调查

目的 通过连续监测江苏部分地区乙型肝炎病毒（HBV）感染者发生天然耐药基因变异的频度及耐药位点的分布特点,为合理选择抗病毒治疗的药物提供依据.方法 回顾性分析2004～2010年未服用核苷类似物抗病毒药物的352例慢性乙型肝炎（CHB）患者临床资料.应用焦磷酸测序技术及双脱氧链终止法基因测序的方法进行耐药基因的检测.结果 352例CHB患者中,345例基因测序成功,7例测序失败.8例有耐药基因突变,天然耐药突变检出率为2.32％.主要耐药位点为rtV173L、rtL180M、rtA181T、rtM204V、rtV207L、rtS213T、rtV214I、rtN236T.2004～2006年间145例CHB患者均未检测出耐药突变,2007、2008、2009及2010年耐药突变的检出率分别为2.63％、3.92％、4.69％和4％.多因素Logistic回归分析显示耐药突变的发生与感染者年龄相关.结论 江苏部分地区CHB患者有天然耐药基因突变,耐药突变检出率为2.32％.2004～2010年耐药突变检出率呈上升趋势.年龄超过30岁是耐药突变发生的相关因素.     

在线成像结合红外光谱技术对头孢克肟反应结晶过程的工艺优化

头孢克肟的粒度分布、结晶度及杂质含量是影响其加工性能、颜色 ( 白度 )、贮存时间和生物毒性的关键质量指标, 在实际生产过程中发现这些关键指标较难控制。本研究应用了先进在线过程分析技术对头孢克肟的反应结晶过程进行了测量和 分析,包括：傅里叶变换衰减全反射红外光谱仪 (ATR-FTIR) 准确测量结晶过程浓度,并辅助解释反应结晶过程转晶机理,在 线成像系统测量结晶过程颗粒的形貌和粒形变化,在线浊度仪测量成核时刻。实验考察了反应结晶过程的反应温度、养晶时刻、 养晶时间、加料速率、搅拌速率等工艺条件对头孢克肟粒度分布、白度、结晶度和杂质含量的影响,探寻反应结晶过程晶型转 变的规律。结果表明,头孢克肟结晶为聚结生长方式,养晶时刻是影响其聚集体粒度分布及白度的关键因素,养晶时间与滴酸 速率是影响结晶度的关键因素。实验优化得到了头孢克肟反应结晶的最佳操作工艺并可为其工业化提供重要参考,利用该工艺 得到了粒度分布均匀、结晶度高、杂质含量低和白度好的产品。     

A Digital Approach to Retrofitting a Post and Core Restoration to an Existing Crown

One problem that may arise in full‐coverage restorations is clinical crown fracture. Fracture of an endodontically treated and crowned tooth in the esthetic zone may be embarrassing to both the patient and clinician. If a completely sound margin and at least 2 mm of coronal structure remain, a fractured tooth may possibly be retreated by a repair. Several methods have been introduced to reproduce the original contour of the tooth for retrofitting an existing crown. If an existing crown is used as a template, excessive core material may remain over the margin, as loading the proper amount of core material is difficult, and making vent holes on the existing crown is not feasible. This article presents a repair technique to reuse an existing crown with computer‐aided design and computer‐aided manufacturing (CAD/CAM) technology. By using a milled poly(methylmethacrylate) matrix, the mentioned limitations are eliminated, and the original contour of the tooth can be effectively restored with minimal intervention. As an existing crown is reused, the issues of additional time and cost for repreparation, reimpression, and new crown are eliminated.     

施源器材料对192Ir后装源水中吸收剂量的影响

目的 应用3D打印支架联合人造金刚石探头测量施源器材料对高剂量率后装¹⁹²Ir源水中吸收剂量的影响。方法 将金刚石探头与塑料插植针分别固定在3D打印支架上,金刚石探头的中心轴与塑料插植针的中心轴在一个平面内相互垂直。采用模拟源尺测量实测驻留位置为248 mm,该驻留位置与逐点测量的最大响应位置吻合。测量材料有304不锈钢、聚亚苯基砜树脂（PPSU）材料、有机玻璃（PMMA）材料和3D打印聚乳酸（PLA）材质。测量水中不同厚度或不同填充率的材料对吸收剂量的衰减。结果 304不锈钢和PPSU材料厚度与相对剂量的线性拟合公式分别为y=-0.029 7x+1.000 3,y=-0.002 3x+1.010 2;拟合优度R²分别为0.925 3和0.722 2。10 mm以内PMMA材料对剂量的影响均<1.5%。3D打印材料填充率（%）与相对剂量的线性拟合公式为y=-0.000 4x+1.024 6,拟合优度R²为0.854 5。结论 施源器材料,尤其是高密度材料（如304不锈钢）和新型技术材料（如3D打印PLA）,对¹⁹²Ir后装源的吸收剂量影响需引起施源器开发人员和临床应用者的足够重视。