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2010年类风湿关节炎分类标准——美国风湿病学会和欧洲抗风湿病联盟的联合倡议

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2010年类风湿关节炎分类标准——美国风湿病学会和欧洲抗风湿病联...

贵州省医学会风湿病学分会第四届学术年会

作者： daniel Aletaha Tuhina Neogi Alan J Silman Julia Funovits David T Felson Clifton O Bingham Ⅲ Neal S Birnbaum Gerd R Burmester Vivian p Bykerk Marc D Cohen Bernard Combe Karen H Costenbader Maxime Dougados paul Emery Gianfranco Ferraccioli Johanna MW Hazes Kathryn Hobbs Tom WJ Huizinga Arthur Kavanaugh Jonathan Kay Tore K Kvien Timothy Laing philip Mease Henri A Menard Larry W Moreland Raymond L Naden Theodore pincus Josef S Smolen Ewa Stanislawska-Biernat Deborah Symmons paul p Tak Katherine S Upchurch Jiri Vencovsky Frederick Wolfe Gillian Hawker 季兰岚邓雪蓉赵明田真张卓莉 Medical University of Vienna ViennaAustria Boston University School of Medicine BostonMassachusettsUSA

目的 :在早期类风湿关节炎(rheumatoid arthritis,RA)的诊断中,1987年美国风湿病学会(AmericanCollege of Rheumatology,ACR;旧称AmericanRheumatism Association,ARA)的诊断标准因为缺乏敏感度而受到质疑。本研究的目的是建立新的RA分类标准。方法 :由ACR和欧洲抗风湿病联盟(EuropeanLeague Against Rheumatism,EULAR)共同组成的工作小组,分三个阶段建立RA新的分类标准。研究的目标人群是初发的未分化关节炎患者,主要研究目的是寻找能够预测这些病人发展为RA的危险因素,并将RA疾病特点定义为持续性和/或侵蚀性关节炎。结果 :在新的分类标准中,确诊RA至少需要一个关节有明确的滑膜炎表现,除外其他可能导致滑膜炎症的疾病,同时以下四项评分的总分≥6分(最高10分):受累关节的数量和部位(0-5分)、血清学自身抗体异常(0-3分)、急性期反应物升高(0-1分)和症状持续时间(共分两级;0-1分)。结论 :既往诊断RA比较依赖骨破坏这一RA晚期表现,而新的分类标准着重于疾病早期表现而不是晚期特点,将疾病特点重新定义为持续性和/或侵蚀性滑膜炎。这一新标准的推出将再次强调了RA早期诊断的必要性以及早期有效治疗对于预防或减少不良后遗症的发生具有重要意义。

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宫颈原发性神经外胚层肿瘤1例报道

世界核心医学期刊文摘（妇产科学分册） 2006年第1期2卷 49-50页

作者： Snijders-Keilholz A. Ewing p. Seynaeve C. Burger C. W. 杨晓梅(译) 马超(校) A. Snijders-Keilholz Erasmus University Medical Center Daniel Den Hoed Cancer Center PO-Box 5201 3008 AE Rotterdam Netherlands 不详

Background. peripheral primitive neuroectodermal tumor (pNET) of the cervix uteri is extremely rare. Between 1987 and 2002, there have been eight cases described in the English literature. The treatment policies in these eight cases differed considerably, partly due to the rarity of the disease and to differing time periods of diagnosis and treatment. Case. At the end of 2002, a 21- year- old woman presented with a pNET of the cervix uteri at our institute, the Erasmus Medical Center. For the appropriate treatment in this case, we reviewed the literature and decided that the treatment should be different from the local surgical treatment followed by additional treatments as most of the earlier reports describe. Conclusion. In view of the current knowledge of pNET belonging to the family of Ewing’ s sarcoma, and the improvement of treatment outcome in these tumors due to dose-intensive neo-adjuvant chemotherapy, patients with pNET of the cervix should be treated in accordance to the protocol for bony Ewing’ s sarcoma with multimodality therapy by means of induction chemotherapy, surgery, and consolidation chemotherapy.

关键词：神经外胚层肿瘤原发性宫颈 Ewing肉瘤 Erasmus 治疗方法 pNET 文献记载治疗方案医疗中心

脑动静脉畸形的处理：美国心脏协会／美国卒中协会对医疗卫生专业人员发布的科学声明

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国际脑血管病杂志 2017年第8期25卷 684-708页

作者： Colin p. Derdeyn Gregory J. Zipfel Felipe C. Albuquerque daniel L. Cooke Edward Feldmann Jason p. Sheehan James C. Tomer 盖延廷王威简新革檀书斌李彦江彭方强刘旻谛宋冬雷不详冬雷脑科医生集团上海200040

背景本声明旨在复习目前脑动静脉畸形（brain arteriovenous malformations，bAVMs）的临床资料，为破裂或未破裂bAVMs的诊断和治疗提供建议。方法写作组通过面谈和电话会议的方式确定搜索关键词，讨论描述性文字和制定建议。作者通过pu... 详细信息

背景本声明旨在复习目前脑动静脉畸形（brain arteriovenous malformations，bAVMs）的临床资料，为破裂或未破裂bAVMs的诊断和治疗提供建议。方法写作组通过面谈和电话会议的方式确定搜索关键词，讨论描述性文字和制定建议。作者通过pubMed、Medline或Embase完成各自相关章节的文献检索，时间截止到2015年1月底。声明草稿由同行评议专家以及卒中委员会科学监督委员会和卒中委员会领导委员会进行预先审查。结果本科学声明的重点细分为流行病学、诊断、自然史、治疗方案（包括开颅手术、立体定向放射外科和栓塞治疗的作用）以及破裂和未破裂bAVMs的处理，并且确定了需要更多证据支持的领域。结论bAVMs是一种相对少见但非常重要的出血性卒中病因，尤其是在年轻成人中。本声明描述了目前关于破裂和未破裂bAVMs的自然史和治疗方法的知识现状，同时提供了处理建议以及对将来研究的提示。

关键词： AHA科学声明动静脉畸形脑出血诊断栓塞治疗颅内出血神经外科放射外科

penile prosthesis: patient satisfaction, use and preference for malleable vs inflatable

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World Journal of Clinical Urology 2014年第2期3卷 134-138页

作者： Ramón Rogel Bertó Jose daniel López-Acón Saturnino Luján Marco Domingo Guzmán Ordaz Jurado Francisco Delgado Oliva María Angeles Conca Baenas Francisco Boronat Tormo Urology Department University and Polytechnic Hospital La Fe46026 ValenciaSpain

AIM: To evaluate and compare long-term patient satisfaction and use after either malleable penile prosthesis(Mpp) or inflatable penile prosthesis(Ipp) implantation. METHODS: we present a retrospective unicenter study of 108 patients implanted with either 2 or 3-piece American Medical System^(TM)(AMS^(TM)) or Coloplast^(TM) inflatable penile prosthesis(AMS 700CX^(TM), AMS 700CXR^(TM), AMS Ambicor^(TM) or Coloplast TITAN^(TM)) or malleable(AMS Spectra^(TM) or Coloplast Genesis^(TM)) in our Centre between 1993 and 2011. We collected data from the medical record including follow-up, age and type of prosthesis. We used a four-question telephone surveydesigned ad hoc by urologist in our Department, with three multiple choice questions and a grading answer. After verbal consent was obtained, proposed questions concerned global satisfaction regarding to the procedure, quality of sexual intercourses graded from 0 to 10, frequency of sexual intercourse and about undergoing the same procedure again. SpSS^(TM) version 20.0 was used for the descriptive analysis of the data. RESULTS: Sixty seven(64%) patients underwent a Mpp and 41(36%) an Ipp. The mean age was 52.6 ± 3.6 years in the Mpp group and 57.2 ± 2.8 years in the Ipp group(p = 0.02). Total respond rate was 55.5%(60/108). Twenty six out of 33 Mpp patients(78.9%) and 19 of the 27 Ipp subjects(70.3%) were satisfied or very satisfied with the procedure. The quality of sexual intercourse was rated 7.13 ± 0.39 points in the Mpp group and 6.16 ± 0.47 points in the Ipp group. Frequency of sexual intercourse was 1 or more times per week in 15(46.9%) patients with Mpp and in 12(46.1%) of the Ipp patients. Twenty-eight(84.9%) patients who received a Mpp would undergo the procedure for the same device again as well as 24(88.9%) of the Ipp group. There were no statistical differences between groups regarding the four items in the ***: patients show high satisfaction rate and no statistical differences exist regarding to

关键词： penile prosthesis patient satisfaction Erectile dysfunction Medical survey

依据清创术后细菌培养结果确定开放骨折创面关闭时机

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中华骨科杂志 2011年第3期31卷 I0001-I0005页

作者： Christopher J. Lenarz, MD J. Tracy Watson, MD Berton R. Moed, MD Heidi Israel, phD, RN J. daniel Mullen MSpH, BA, BS James B. MacDonald, BS 叶伟胜(译) Investigation performed at the Department of Orthopaedic Surgery Division of Orthopaedic Traunutology Saint Louis University School of Medicine Saint Louis Missouri 天津医院创伤骨科 300211

背景：目前，对开放骨折创面缝合关闭的时机尚没有客观的标准。许多学者对于开放骨折创面缝合关闭最佳时机提出了各种各样的建议，但均依据主观评判的参数。本研究的目的是应用前瞻性方法，在四肢开放骨折清创和冲洗木后，依据创面细菌... 详细信息

背景：目前，对开放骨折创面缝合关闭的时机尚没有客观的标准。许多学者对于开放骨折创面缝合关闭最佳时机提出了各种各样的建议，但均依据主观评判的参数。本研究的目的是应用前瞻性方法，在四肢开放骨折清创和冲洗木后，依据创面细菌培养结果来指导创面的缝合关闭时机。方法：本组对422例急诊开放骨折患者，进行了创面清创冲洗、骨折固定和开放创面处理。清创术后创面采样进行厌氧菌和有氧菌培养。清创术后48h，患者再次手术。如果初次细菌培养结果为阳性，则再次进行冲洗和清创术，之后再次留取菌培样本。创面不关闭直到细菌培养结果为阴性为止，否则重复进行冲洗和清创术。结果：在422例开放骨折中，有346例获得了长期随访。全组创面深部感染率为4｜3％。GustiloⅡ型开放骨折创面深部感染率为4％，GustiloⅢ型开放骨折为5．7％。在GustiloⅢ型开放骨折中，依骨折类型不同，感染率出现变化，GustiloⅢA型开放骨折为1．8％，GustiloⅢB型开放骨折为10．6％，GustiloⅢC型开放骨折为20％。需要反复清创的骨折患者，伴有糖尿病患者以及体重指数增加的患者，感染率均出现上升。研究数据表明，开放骨折在菌培阳性条件下关闭创面（违反本研究原则）并未显著增加深部感染风险（p=0．0501）。结论：采用本文提出的标准处理方法，与历史对照方法相比，开放骨折深部感染率降到很低。但取得这样结果是以增加冲洗和清创术次数为代价。可信水平：治疗性研究Ⅳ级。关于证据等级的完整描述详见投稿须知。

关键词：四肢开放骨折创面关闭清创术后培养结果细菌 GustiloⅢC型骨折患者再次手术

Improving ITS sequence data for identification of plant pathogenic fungi

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Fungal Diversity 2014年第4期67卷 11-19页

作者： R.Henrik Nilsson Kevin D.Hyde Julia pawlowska Martin Ryberg Leho Tedersoo Anders Bjornsgard Aas Siti A.Alias Artur Alves Cajsa Lisa Anderson Alexandre Antonelli A.Elizabeth Arnold Barbara Bahnmann Mohammad Bahram Johan Bengtsson-palme Anna Berlin Sara Branco putarak Chomnunti Asha Dissanayake Rein Drenkhan Hanna Friberg Tobias Guldberg Froslev Bettina Halwachs Martin Hartmann Beatrice Henricot Ruvishika Jayawardena Ari Jumpponen Havard Kauserud Sonja Koskela Tomasz Kulik Kare Liimatainen Bjorn D.Lindahl daniel Lindner Jian-Kui Liu Sajeewa Maharachchikumbura Dimuthu Manamgoda Svante Martinsson Maria Alice Neves Tuula Niskanen Stephan Nylinder Olinto Liparini pereira Danilo Batista pinho Teresita M.porter Valentin Queloz Taavi Riit Marisol Sánchez-García Filipe de Sousa Emil Stefańczyk Mariusz Tadych Susumu Takamatsu Qing Tian Dhanushka Udayanga Martin Unterseher Zheng Wang Saowanee Wikee Jiye Yan Ellen Larsson Karl-Henrik Larsson Urmas Koljalg Kessy Abarenkov Department of Biological and Environmental Sciences University of GothenburgBox 46140530 GothenburgSweden Institute of Excellence in Fungal Research Mae Fah Luang UniversityChiang Rai 57100Thailand School of Science Mae Fah Luang UniversityChiang Rai 57100Thailand Department of plant Systematics and Geography Faculty of BiologyUniversity of WarsawAl.Ujazdowskie 400-478 WarsawPoland Department of Organismal Biology Uppsala UniversityNorbyvagen 18D75236 UppsalaSweden Institute of Ecology and Earth Sciences University of TartuLai 40Tartu 51005Estonia Microbial Evolution Research Group University of OsloBlindernveien 310371 OsloNorway Institute of Biological Sciences University of Malaya50603 Kuala LumpurMalaysia Department of Biology CESAMUniversity of Aveiro3810-193 AveiroPortugal School of plant Sciences The University of Arizona1140 E South Campus DriveForbes 303TucsonAZ 85721USA Laboratory of Environmental Microbiology Institute of Microbiology ASCRVídeňská108314220 Prague 4Czech Republic Department of Infectious Diseases Institute of BiomedicineSahlgrenska AcademyUniversity of GothenburgGuldhedsgatan 1041346 GoteborgSweden Department of Forest Mycology and plant pathology Swedish University of Agricultural SciencesBox 702675007 UppsalaSweden University of California at Berkeley 321 Koshland Hall University of CaliforniaBerkeleyCA 94720-3102USA Agriculture and Forestry Sciences Beijing 100097China Institute of Forestry and Rural Engineering Estonian University of Life SciencesKreutzwaldi551014 TartuEstonia Natural History Museum of Denmark Øster Voldgade 5-71350 København KDenmark Institute for Genomics and Bioinformatics Graz University of Technology8010 GrazAustria Core Facility Bioinformatics Austrian Centre of Industrial Biotechnology8010 GrazAustria Forest Soils and Biogeochemistry Swiss Federal Research Institute WSLZuercherstrasse 1118903 BirmensdorfSwitzerland Molecular Ecology Institute for Sustainability SciencesAgroscopeReckenholzstrasse 191

plant pathogenic fungi are a large and diverse assemblage of eukaryotes with substantial impacts on natural ecosystems and human *** taxa often have complex and poorly understood life cycles,lack observable,discriminatory morphological characters,and may not be amenable to in vitro *** a result,species identification is frequently ***(DNA sequence)data have emerged as crucial information for the taxonomic identification of plant pathogenic fungi,with the nuclear ribosomal internal transcribed spacer(ITS)region being the most popular ***,international nucleotide sequence databases are accumulating numerous sequences of compromised or low-resolution taxonomic annotations and substandard technical quality,making their use in the molecular identification of plant pathogenic fungi *** we report on a concerted effort to identify high-quality reference sequences for various plant pathogenic fungi and to re-annotate incorrectly or insufficiently annotated public ITS sequences from these fungal lineages.A third objective was to enrich the sequences with geographical and ecological *** results-a total of 31,954 changes-are incorporated in and made available through the UNITE database for molecular identification of fungi(http://***),including standalone FASTA files of sequence data for local BLAST searches,use in the next-generation sequencing analysis platforms QIIME and mothur,and related *** present initiative is just a beginning to cover the wide spectrum of plant pathogenic fungi,and we invite all researchers with pertinent expertise to join the annotation effort.

关键词： phytopathogenic fungi Molecular identification ITS Taxonomy Annotation

Fungal diversity notes 603–708: taxonomic and phylogenetic notes on genera and species

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Fungal Diversity 2017年第6期87卷 1-235页

作者： Kevin D.Hyde Chada Norphanphoun Vanessa p.Abreu Anna Bazzicalupo K.W.Thilini Chethana Marco Clericuzio Monika C.Dayarathne Asha J.Dissanayake Anusha H.Ekanayaka Mao-Qiang He Sinang Hongsanan Shi-Ke Huang Subashini C.Jayasiri Ruvishika S.Jayawardena Anuruddha Karunarathna Sirinapa Konta Ivana Kusan Hyun Lee Junfu Li Chuan-Gen Lin Ning-Guo Liu Yong-Zhong Lu Zong-Long Luo Ishara S.Manawasinghe Ausana Mapook Rekhani H.perera Rungtiwa phookamsak Chayanard phukhamsakda Igor Siedlecki Adriene Mayra Soares Danushka S.Tennakoon Qing Tian Saowaluck Tibpromma Dhanushka N.Wanasinghe Yuan-pin Xiao Jing Yang Xiang-Yu Zeng Faten A.Abdel-Aziz Wen-Jing Li Indunil C.Senanayake Qiu-Ju Shang Dinushani A.Daranagama Nimali Ide Silva Kasun M.Thambugala Mohamed A.Abdel-Wahab Ali H.Bahkali Mary L.Berbee Saranyaphat Boonmee D.Jayarama Bhat Timur S.Bulgakov Bart Buyck Erio Camporesi Rafael F.Castaneda-Ruiz putarak Chomnunti Minkwan Doilom Francesco Dovana Tatiana B.Gibertoni Margita Jadan Rajesh Jeewon E.B.Gareth Jones Ji-Chuan Kang Samantha C.Karunarathna Young Woon Lim Jian-Kui Liu Zuo-Yi Liu Helio Longoni plautz Jr Saisamorn Lumyong Sajeewa S.N.Maharachchikumbura Neven Matocec Eric H.C.McKenzie Armin Mesic daniel Miller Julia pawłowska Olinto L.pereira Itthayakorn promputtha Andrea I.Romero Leif Ryvarden Hong-Yan Su Satinee Suetrong Zdenko Tkalcec Alfredo Vizzini Ting-Chi Wen Komsit Wisitrassameewong Marta Wrzosek Jian-Chu Xu Qi Zhao Rui-Lin Zhao peter E.Mortimer Key Laboratory for plant Diversity and Biogeography of East Asia Kunming Institute of BotanyChinese Academy of ScienceKunming 650201YunnanPeople’s Republic of China Center of Excellence in Fungal Research Mae Fah Luang UniversityChiang Rai 57100Thailand School of Science Mae Fah Luang UniversityChiang Rai 57100Thailand World Agroforestry Centre East and Central AsiaKunming 650201YunnanPeople’s Republic of China Mushroom Research Foundation 128 M.3 Ban Pa Deng T.Pa PaeA.Mae TaengChiang Mai 50150Thailand A.M.B Circolo Micologico“Giovanni Carini”C.P.314BresciaItaly A.M.B.Gruppo Micologico Forlivese“Antonio Cicognani”Via Roma 18Forlı`Italy Centre of Mountain Ecosystem Studies Kunming Institute of BotanyChinese Academy of SciencesKunming 650201YunnanPeople’s Republic of China College of Agriculture and Biological Sciences Dali UniversityDali 671003YunnanPeople’s Republic of China College of Life Sciences University of Chinese Academy of SciencesHuairou DistrictBeijing 100408China Department of Biology Faculty of ScienceChiang Mai UniversityChiang Mai 50200Thailand Department of Botany University of British ColumbiaVancouverCanada Department of Botany and Microbiology College of ScienceKing Saud UniversityP.O.Box:2455Riyadh 1145Saudi Arabia Department of Botany and Microbiology Faculty of ScienceSohag UniversitySohag 82524Egypt Department of Crop Sciences College of Agricultural and Marine SciencesSultan Qaboos UniversityP.O.Box 34123 Al-KhodOman Department of Entomology and plant pathology Faculty of AgricultureChiang Mai UniversityChiang Mai 50200Thailand Department of Health Sciences Faculty of ScienceUniversity of MauritiusReduit 80837Mauritius Department of Molecular phylogenetics and Evolution Faculty of BiologyBiological and Chemical Research CentreUniversity of Warsaw_Zwirki i Wigury 10102-089 WarsawPoland Departamento de Micologia Centro de BiocienciasUniversidade Federal de PernambucoAv.da Engenharia s/nRecifePernambuco 50760-600Brazil Dipartimento

This is the sixth in a series of papers where we bring collaborating mycologists together to produce a set of notes of several taxa of *** this study we introduce a new family Fuscostagonosporaceae in *** also introduce the new ascomycete genera Acericola,Castellaniomyces,Dictyosporina and Longitudinalis and new species Acericola italica,Alternariaster trigonosporus,Amarenomyces dactylidis,Angustimassarina coryli,Astrocystis bambusicola,Castellaniomyces rosae,Chaetothyrina artocarpi,Chlamydotubeufia krabiensis,Colletotrichum lauri,Collodiscula chiangraiensis,Curvularia palmicola,Cytospora mali-sylvestris,Dictyocheirospora cheirospora,Dictyosporina ferruginea,Dothiora coronillae,Dothiora spartii,Dyfrolomyces phetchaburiensis,Epicoccum cedri,Epicoccum pruni,Fasciatispora calami,Fuscostagonospora cytisi,Grandibotrys hyalinus,Hermatomyces nabanheensis,Hongkongmyces thailandica,Hysterium rhizophorae,Jahnula guttulaspora,Kirschsteiniothelia rostrata,Koorchalomella salmonispora,Longitudinalis nabanheensis,Lophium zalerioides,Magnibotryascoma mali,Meliola clerodendri-infortunati,Microthyrium chinense,Neodidymelliopsis moricola,Neophaeocryptopus spartii,Nigrograna thymi,Ophiocordyceps cossidarum,Ophiocordyceps issidarum,Ophiosimulans plantaginis,Otidea pruinosa,Otidea stipitata,paucispora kunmingense,phaeoisaria microspora,pleurothecium floriforme,poaceascoma halophila,periconia aquatica,periconia submersa,phaeosphaeria acaciae,phaeopoacea muriformis,pseudopithomyces kunmingnensis,Ramgea ozimecii,Sardiniella celtidis,Seimatosporium italicum,Setoseptoria scirpi,Torula gaodangensis and Vamsapriya *** also provide an amended account of Rhytidhysteron to include apothecial ascomata and a J?*** type species of Ascotrichella hawksworthii(Xylariales genera incertae sedis),Biciliopsis leptogiicola(Sordariomycetes genera incertae sedis),Brooksia tropicalis(Micropeltidaceae),Bryochiton monascus(Teratosphaeriaceae),Bryomyces scapaniae(pseud

关键词： Ascomycota Basidiomycota Mucoromycota phylogeny Taxonomy

2-aminoethyl Dihydrogen phosphate as a Modulator of proliferative and Apoptotic Effects in Breast Cancer Cell Lines

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Journal of pharmacy and pharmacology 2021年第3期9卷 83-97页

作者： Manuela Garcia Laveli da Silva Laertty Garcia de Sousa Cabral Monique Gonçalves Alves Thais deOliveira Conceição Henrique Hesse Rosa Andrea Nogueira Laiso daniel da Conceição Rabelo Durvanei Augusto Maria Development and Innovation Laboratory Butantan InstituteSao PauloSP 05503-900Brazil Faculty of Medicine University of São PauloSao PauloSP 01246-000Brazil

Background: Breast cancer is a type of cancer that affects more women throughout the world, in developing anddeveloped countries. 2-AEH2p is a phospholipid analog of cellular membrane, which makes it different from existing molecules fortheir absorption, stability and display anti-inflammatory, anti-proliferative and pro-apoptotic properties. Methods: MCF-7 humanbreast adenocarcinoma cells were treated with 2-AEH2p. The viability and adhesion cells were evaluated by MTT assay. Cell cyclephases, apoptosis, markers and mitochondrial potential were assessed by flow cytometry. Morphological ultrastructural analyzeswere performed by laser confocal microscopy. Results: MCF-7 Tumor cells acquired round shapes, lost cytoplasmic expansions,formed clusters in suspension and decreased significantly viability. There were changes in the morphology, membrane fragmentationand loss of cytoplasmic projection. The obtained concentrations for IC50% were 37.2;25.8;1.8 mM for periods of 24, 48 and 72 h,respectively. Changes in the distribution of cell population phases of the cell cycle showed an increase in fragmented DNA and anincrease in the G2/M phase. The expression β-gal showed proliferative reduction induced by 2-AEH2p. Laser confocal microscopyshowed changes in the mitochondrial membrane and alteration in distribution. proliferative index of MCF-7 tumor cells treated with2-AEH2p decreased significantly when compared to fibroblast normal cells. The compound 2-AEH2p is a phospholipid withantiproliferative potential and apoptosis modulator.

关键词： Human Breast Adenocarcinoma MCF-7 2-AEH2p Antitumor Apoptosis Cell cycle Senescence

局部麻醉药浓度和剂量对持续锁骨下神经阻滞的影响：一项多中心、随机、单盲、对照研究

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麻醉与镇痛 2010年第1期6卷 60-66页

作者： Brian M. Ilfeld Linda T. Le Joanne Ramjohn Vanessa J. Loland Anupama N. Wadhwa J. C. Gerancher Elizabeth M. Renehan daniel I. Sessler Jonathan J. Shuster Douglas W. Theriaque Rosalita C. Maldonado Edward R. Mariano 周璐璐(译) 包睿(译) 邓小明(校) Department of Anesthesiology University of California San Diego San Diego California Department of Anesthesiology University of Florida Gainesville Florida Department of Anesthesiology University of Louisville Louisville Kentucky Department of Anesthesiology Wake Forest Medical Center Winston-Salem North Carolina Department of Anesthesiology University of Ottawa Ottawa Ontario Canada Department of Outcomes Research Cleveland Clinic Cleveland Ohio Department of Epidemiology and Health policy Research University of Florida Gainesville Florida General Clinical Research Center University of Florida Gainesville Florida 不详

背景目前尚不明确局部麻醉药浓度或药物总剂量是否是连续外周神经阻滞效果最主要的决定性因素。此前仅有一项关于胭窝坐骨神经阻滞的研究，该研究报道了使用高容量较低浓度罗哌卡因发生肢体感觉完全阻滞的概率远远高于低容量较高浓度罗... 详细信息

背景目前尚不明确局部麻醉药浓度或药物总剂量是否是连续外周神经阻滞效果最主要的决定性因素。此前仅有一项关于胭窝坐骨神经阻滞的研究，该研究报道了使用高容量较低浓度罗哌卡因发生肢体感觉完全阻滞的概率远远高于低容量较高浓度罗哌卡因，但上述现象是否仅限于腘窝处的坐骨神经，或者说是否因解剖部位变化而异尚不清楚。因此，本研究的检验假设定为：在连续锁骨下臂丛阻滞中，以不同的浓度和速率注射总量相等的罗哌卡因，可以产生相似的阻滞效果。方法选择拟行肘关节远端、中等疼痛骨科手术患者，经喙突入路放置锁骨下臂丛阻滞导管。患者经随机分组确定手术后第2天应用罗哌卡因神经周围镇痛的方法：浓度0．2％组（背景剂量8ml／h，单次追加量4ml）或0．4％组（背景剂量4ml／h，单次追加量2ml）。两组患者每小时持续注入罗哌卡因的总量均为16mg，每30分钟可能还有患者自控的追加剂量8mg。主要观察指标为自手术后次日早晨开始的24小时内患侧肢体完全无感觉的发生率，次要观察指标是镇痛效果和患者的满意度。结果给予0．4％罗哌卡因（n=27）的患者发生肢体无感觉的平均次数（标准差）为1．8（1．6）次，而给予0．2％罗哌卡因（n=23）的患者为0．6（0．9），评估差异为1．2次，95％可信区间0．5～1．9次（p=0．001）。手术后镇痛满意度（评分0—10分，10分为最高分）在0．2％罗哌卡因组得分的中位数（25％～75％百分位数）为10．0分（8．0～10．0），0．4％罗哌卡因组为7．0分（5．3～8．9）。镇痛效果两组相近。结论在连续锁骨下神经阻滞时，除了注射局麻药物总量之外，药物的浓度和容量是另两种影响神经周围镇痛辫果的因素。容量偏小而浓度略高的罗哌卡因产生肢体完全无感觉的概率较高，这一结果与此前关于连续胭窝坐骨神经阻滞的研究结果相反。局麻药浓度与容量之间的关系相当复杂，且随置管部位的不同而异。

关键词：坐骨神经阻滞麻醉药浓度背景剂量随机分组锁骨下低浓度罗哌卡因多中心手术后镇痛