Clinical evaluation of plasma free phenytoin measurement and factors influencing its protein binding

The relationship between free phenytoin concentrations and clinical responses, and the factors influencing protein binding of phenytoin were investigated. A total of 119 plasma samples from 70 patients treated orally with phenytoin were analysed. The mean free phenytoin concentration was significantly higher in the patients who received phenytoin monotherapy and were classified as having a complete response (1.25 +/- 1.09 microg/ml) than that in the partial response group (0.59 +/- 0.07 microg/ml), whereas the mean total concentrations were not significantly different between the two groups. Samples were divided into three groups based on the free fraction of phenytoin, i.e. low, <5%; medium, 5%-10%; high, > 10%. The mean age (55.3 +/- 10.9 years) was significantly higher in the high group than in the low (42.7 +/- 21.2 years) and medium (42.8 +/- 16.0 years) groups. The mean creatinine clearance (CLcr) (55.3 +/- 10.9 ml/min) and serum albumin concentration (3.30 +/- 1.25 g/dl) were significantly lower in the high group than the low (88.3 +/- 29.0 ml/min and 4.08 +/- 0.50 g/dl, respectively) and medium (95.0 +/- 32.8 ml/min and 3.95 +/- 0.92 g/dl, respectively) groups. These results suggest that the free phenytoin concentration, rather than the total concentration, is more useful for monitoring antiepileptic effects in patients receiving phenytoin monotherapy. It was also found that the free phenytoin fraction was significantly influenced by aging, CLcr and serum albumin levels.     

扶正化瘀胶囊配合肝病治疗仪治疗慢性肝炎肝纤维化30例

目的评价扶正化瘀胶囊联合肝病治疗仪治疗慢性肝炎肝纤维化的临床疗效。方法 60例确诊为慢性肝炎肝纤维化患者分成两组,对照组给予单纯的扶正化瘀胶囊治疗,联合组采取扶正化瘀胶囊联合肝病治疗仪治疗方案,观察治疗前后肝功能指标变化情况。结果联合组ALB、T-Bi L、PTA等肝功指标改善效果优于对照组,HA、LN等肝纤维化指标下降幅度大于对照组(P0.05),对比差异均具有统计学意义。联合组有效率为90.0%,显著高于对照组的76.7%(χ~2=13.452,P0.05)。结论扶正化瘀胶囊联合肝病治疗仪能够进一步改善慢性肝炎肝纤维化治疗效果,协同作用强,适合临床推广。     

从"肾虚毒损"治疗慢性肾炎蛋白尿血尿

毒损肾络与肾虚纠结不解是蛋白尿、血尿长期不消的罪魁祸首，提出了从“肾虚毒损”治疗慢性肾炎蛋白尿血尿的论点。在治疗上除了补肾益肾外，还要注意涤除火热、瘀血和湿浊所化之毒邪。在清除毒邪上，则创新性地提出了使用解毒药、攻毒药、排毒药的治疗思路，为临床辨治慢性肾炎又辟蹊径。     

氨茶碱针与二羟丙茶碱针治疗支气管哮喘疗效比较

目的观察氨茶碱针与二羟丙茶碱针对照治疗支气管哮喘的效果。方法对100例中老年哮喘患者分别使用氨茶碱针与二羟丙茶碱针治疗1h后疗效及3d后疗效、不良反应进行了观察、比较和统计。结果氨茶碱针对哮喘患者的显效时间比二羟丙茶碱针快,不良反应前者比后者多。结论氨茶碱针治疗支气管哮喘优于二羟丙茶碱针,但不良反应较多。临床应用应权衡利弊。     

治疗性经内镜逆行胰胆管造影术102例分析

目的探讨治疗性经内镜逆行胰胆管造影术（ERCP）在胆胰疾病中的应用价值。方法对102例经ERCP治疗的病例进行回顾性分析,其中EST58例、EPBD24例、ENBD34例,ERBD7例。结果治疗性ERCP成功率97／102（95．1％）,其中胆石症61例（62．9％）,胆总管下端良性狭窄13例（13．4％）,胆胰肿瘤10例（10．3％,）胰腺炎5例（5．2％）,化脓性胆管炎3例（3．1％）,胆蛔2例（2．1％）,胰管结石1例（1％）,硬化性胆管炎1例（1％）、胆道畸形1例（1％）,并发症发生率9／97（9．3％）。结论对于胆胰疾病治疗性ERCP是一种有效的微创治疗手段,能替代部分传统外科手术。     

如何看待绝经激素治疗的争议

绝经激素治疗(menopausal hormone treatment,MHT)对缓解围绝经期症状、治疗泌尿生殖道症状、防治骨质疏松,提高和改善更年期和绝经后妇女的生活质量起到了非常积极和重要的作用。但MHT的安全性,尤其MHT与恶性肿瘤(乳腺癌、子宫内膜癌和卵巢癌)以及心血管疾病(冠心病、静脉血栓、中风)的风险也一直是人们关注和争论的焦点。肿瘤与心血管疾病的发病原因是多因素的,个体有其自身危险因素,激素治疗可能在其发生过程中有一定影响。个体化的MHT治疗方案,包括选择好用药的时机("潜力治疗窗")、采用天然雌激素与孕激素、最低有效剂量,定期复查,可以不增加、甚至减少肿瘤与心血管疾病的发病风险。     

Design of Biodegradable Hydrogel for the Local and Sustained Delivery of Angiogenic Plasmid DNA

Purpose To attain the effective local and sustained delivery of plasmid DNA (pDNA) encoding for a growth factor. Methods We hypothesized that controlling the degradation rate of biomaterials encapsulating pDNA via concurrent physical dissociation of the cross-linked structure and hydrolytic chain breakage of polymers would allow one to significantly broaden the range of pDNA release rate. This hypothesis was examined using ionically cross-linked polysaccharide hydrogels which were previously designed to rapidly degrade via engineering of ionic cross-linking junction and partial oxidation of polysaccharide chains. Results The hydrogel degradation rates were varied over the broad range, and pDNA release correlated with the gel degradation rate. Degradable hydrogels were used for the local and sustained delivery of a pDNA encoding for vascular endothelial growth factor (VEGF) in the ischemic hindlimbs of mice, and local pDNA release significantly improved the recovery of blood perfusion as compared with a bolus injection of VEGFencoding pDNA. Conclusion This strategy to control the hydrogel degradation rate may be useful in regulating the delivery of a broad array of macromolecular drugs, and subsequently improve their therapeutic efficacy.     

The republic of therapy: Triage and sovereignty in West Africa's time of AIDS

Commonalities abound varied health challenges confronting Pakistan and India. Some of these warrant joint collaborative solutions. This study presents existing health collaborations by mapping out active connections between the countries, through a literature review and clinical and public health professionals’ interviews. It reveals that a diversity of practices exist beyond the usual notions of ‘collaboration’ usually depicted in the literature. Outcomes from such initiatives included enhanced learning and exchanges of information and research across various communities and contexts. In various adoptions of the term, contextualisation within and between countries and amongst particular communities is cited as important. Travel and mobility restriction emerged as one key issue that hampers and discourages collaborations. Key lessons conveyed by the participants included an enabling environment, missing on both sides of the border. Opportunities and recommendations are presented to address the obstacles that discourage cross-border dialogue and to enhance collaborations between the two countries.     

腹腔镜治疗肾盂输尿管狭窄临床疗效观察

目的观察腹腔镜治疗肾盂输尿管狭窄的临床疗效以及并发症发生率,为临床防治提供一定的理论基础。方法对100例肾盂输尿管狭窄的患者进行回顾性分析,其中腹腔镜治疗(治疗组)及常规开腹手术(对照组),各50例,比较2组治疗疗效以及并发症的发生率。结果与对照组比较,治疗组收缩压(SBP)、舒张压(DBP)、平均动脉压、心率(HR)明显升高(P<0.05),动脉血氧饱和度(SpO2)明显下降(P<0.05),但均在正常范围之内;电解质紊乱、感染、肝、肾功能不全和心律失常的发生率、手术时间、术中出血量和住院天数均明显减少(P<0.05)。结论腹腔镜辅助肾盂输尿管狭窄手术具有切口小,损伤少,术后恢复快的优势,但腹腔镜手术对呼吸循环影响较大,术中应规范操作,术后应加强护理。     

眶周注射曲安奈德治疗Graves眼病的临床研究

目的评价长效糖皮质激素曲安奈德治疗Graves眼病的临床效果。方法用曲安奈德40 mg行患眼眶周注射,每3周1次,4次为1个疗程,治疗前和疗程结束后3个月观察记录症状、体征情况。结果治疗117例256眼,治疗后眼球突出回退率为81.3%(208/256);睑裂高度回缩率为82.4%(211/256);73只视力下降眼中,61只眼(83.6%)视力改善;61例斜视和复视者,13例(21.3%)消失,33例(54.1%)得到改善,15例(24.6%)无明显变化;83眼(32.4%)畏光流泪、眼胀眼痛等症状消失,156眼(60.9%)改善;73眼(28.5%)结膜充血水肿、眼睑水肿等体征消失,144眼(56.3%)改善。结论眶周注射曲安奈德对Graves眼病的眼征具有明显改善或消除作用,不良反应小,安全性高。