Desvenlafaxine_succinate_hydrate_HNMR_15762_MedChemExpress
E.S401 E.S404 数显扳手说明书
7Dear Customers,Thank you for purchasing our digital torque screwdriver . This manual will help you to use the many features of your new digital torque screwdriver . Before operating the torque screwdriver , please read this manual completely, and keep it nearby for future reference MAIN FEATURES• Digital torque value readout • +/- 2 % or +/-3 % accuracy •CW and CCW operation• Peak hold and track mode selectable• Buzzer and LED indicator for the 9 pre-settable target torques • Engineering units (cN-m, in-lb, kg-cm) selectable • 250 data memory for recall and joint torque auditing • Auto Sleep after about 5 minutes idle• Both AAA and rechargeable batteries are compatible • Communication functions NAMES AND FUNCTIONS OF PART S A 1. Autolock bit holder 7. Buttons 2. Communication Port 8. Torque Value 3. LCD Display 9. Units4. LED Indicator 10. Peak / Track mode5. Anti-slip handle 11. Memory number6. Battery Cover12. Clear Button1112 E.S401E.S404Accuracy *1CW ±2% CCW ±3%Data memory size 250PC Connectivity *2Yes / USB Pre-setting No.9 sets Bright LED 2 LEDs / 1 Red+1 Green Operation Mode Peak Hold / Track Unit Selection cN-m, in-lb, kg-cm Head Type Autolock bit holderButton 5Battery*3AAA x 1Operating Tempe-rature -10°C ➜ 60°C Storage Temperature-20°C ➜ 70°C Humidity Up to 90% non-condensingDrop Test 1 m Vibration Test *410 G Environmental test *5Pass Electromagnetic compatibility test *6PassSPECIFICATIONSNote:*1: The accuracy of the readout is guaranteed from 20% to 100% of maximum range + /- 1 increment. The torque accuracy is a typical value. Calibration point is on the rubber grip. For keeping the accuracy, calibrate the screwdriver for a constant period time (1 year).*2: Use a special designed USB cable (accessory) to upload record data to PC. *3: Use one AAA batteries (Test condition: Toshiba carbon-zinc R6UG battery)*4: Horizontal and vertical test *5: Environmental test: a. Dry heat e. Impact (shock) b. Cold f. Vibration c. Damp heat g. Drop d. Change of temperature *6: Electromagnetic compatibility test: a. Electrostatic discharge immunity (ESD) b. Radiated susceptibility c. Radiated emissionDigital torque screwdriverBELGIQUE Stanley Black&Decker Belgium BVBA (FACOM)LUXEMBOURG Egide Walschaertstraat 16 2800 Mechelen Belgium T +32 (0)15 47 39 30************************DANMARK FACOM NordicFINLAND Flöjelbergsgatan 1c ISLAND SE-431 35 Mölndal, Sweden NORGE Box 94, SE-431 22 Mölndal, Sweden SVERIGE Tel. +45 7020 1510 Tel. +46 (0)31 68 60 60 Tel. +47 22 90 99 10 Tel. +358 (0)10 400 4333***********************DEUTSCHLAND STANLEY BLACK & DECKER Deutschland GmbH Black & Decker Str. 40 65510 Idstein Tel.: +49 (0) 6126 21 2922 / Fax +49 (0) 6126 21 21114************************** ESPAÑA FACOM HERRAMIENTAS, S.R.L.U. C/Luis 1°, n° 60 - Nave 95 - 2ª Pta Polígono Industrial de Vallecas - 28031 MADRID Tel: +34 91 778 21 13 / Fax: +34 91 778 27 53*************************** PORTUGAL FACOM S.A.S 6/8 rue Gustave Eiffel - BP 99 91423 MORANGIS CEDEX - France Tel: 01 64 54 45 45 / Fax: 01 69 09 60 93ITALIA SWK UTENSILERIE S.R.L. Sede Operativa : Via Volta 3 21020 MONVALLE (VA) - ITALIATel: 0332 790326 / Fax: 0332 790307LATIN FACOM S.L.A.AMERICA 9786 Premier Parkway Miramar, Florida 33025 USA Tel: +1 954 624 1110 / Fax: +1 954 624 1152NETHERLANDS Stanley Black&Decker Netherlands (FACOM) POSTBUS 83 6120 AB BORN NEDERLAND Tél************/Fax****************************************ASIA The Stanleyworks( Shanghai) Co., Ltd 8/F ,Lujiazui Fund Tower No.101, Zhulin Road PuDong District Shanghai, 20122,China Tel: 8621-6162 1858 / Fax: 8621-5080 5101SUISSE Stanley Works Europe Gmbh Ringstrasse 14 CH - 8600 DÜBENDORF Tel: 00 41 44 755 60 70 / Fax: 00 41 44 755 70 67ÖSTERREICH STANLEY BLACK & DECKER Austria GmbH Oberlaaerstrasse 248A-1230 Wien Tel.: +43 (0) 1 66116-0 Fax.: +43 (0) 1 66116-613************************ www.facom.atUNITED KINGDOM Stanley Black & Decker UK Limited EIRE 3 Europa Court Sheffi eld Business Park Sheffi eld, S9 1XE Tél. +44 1142 917266 Fax +44 1142 917131 ČESKÁ REP . Stanley Black & Decker SLOVAKIA Czech Republic s.r.o.Türkova 5b 149 00 Praha 4 - Chodov Tel.: +420 261 009 780 Fax. +420 261 009 784POLSKA Stanley Black & Decker Polska Sp. z o.o ul. Postepu 21D, 02-676 Warszawa Tel: +48 22 46 42 700Fax: +48 22 46 42 701FRANCE ET FACOM S.A.SINTERNATIONALE 6/8 rue Gustave Eiffel - BP 99 91423 MORANGIS CEDEX - France Tel: 01 64 54 45 45 Fax: 01 69 09 60 93 En France, pour tous renseignements techniques sur l’outillage à main, téléphonez au : 01 64 54 45 14NU-en ES401-E.S404_0615x .k g .c m m i n i. m a x .S P E C I F I C A T I O N SI S O 6789 M o d e l 2 C l a s s D S c r e w d r i v e r p r e c i s i o n : ± 2± 3A C C E S S O R I E Se r i e s N o E S (m m ) E P (N °) E D (N °) E X (N °) E TR+E .S 404 - K I T P l u g s K I T E .S 404 - U S BU S B c a b l eS P A R E :CONNECTING COMMUNICATION CABLE• Connect the accessory cable between the USB COM port of PC and screwdriver.UPLOADING RECORD DATA• Make sure the connection between PC and screwdriver is normal.• Change the screwdriver operation mode to “SendMode Recorded Value Review ” section) • Use PC to start the uploader program.• In uploader program, first select the correct COM port No. • Next, select the fi le path to save the uploaded data.• Finally, press “upload” button to transmit the torque records to PC.• The uploaded data is then shown on the column and saved in the *.csv fi le. MAINTENANCE AND STORAGE ATTENTION:One-year periodic recalibration is necessary to maintain accuracy. accuracy.2. Do not shake violently or drop screwdriver.3. Do not use this screwdriver as a hammer.4. Do not leave this screwdriver in any place exposed to excessive heat, humidity, or direct sunlight.5. Do not use this apparatus in water.(not waterproof)6. If the screwdriver gets wet, wipe it with a dry towel as soon as possible. The salt in seawater can be especially damaging.7. Do not use organic solvents, such as alcohol or paint thinner when cleaning the screwdriver.8. Keep this screwdriver away from magnets.9. Do not expose this screwdriver to dust or sand as this could cause serious damage.10. Do not apply excessive force to the LCD panel.11. Apply torque slowly and graspe the center of the handle. Do not apply load to the end of handle.12. When checking the accuracy or calibration, please use the bit head packed inside the blow mold case.BATTERY MAINTENANCE1. When the screwdriver isnot used for an extended period of time, remove the battery.2. Keep a spare battery on hand when going on a long trip or to cold areas.3. Sweat, oil and water can prevent a battery’s terminal from makingelectrical contact. To avoid this, wipe both terminals before loading a battery.4. Dispose of batteries in a designated disposal area. Do not throw batteries into a fi re.BEFORE USING THE SCREWDRIVERBATTERY INSTALLATION B • Remove the battery cover.• Insert one AAA batterie matching the -/+ polarities of the battery to the battery compartment.• Put on the battery cap and fasten it tightly according to the following fi gures.SCREWDRIVERscrewdriver.• screwdriver before using it. ATTENTION:If an external force is applied to the torque screwdriver during power-on/reset or wake up period, an initial torque offset will exist in the memory.ACTIVATION DURING SLEEP MODE• The screwdriver again.CAUTIONS:During communication period (Send appears), the sleep function is disabled. RESETTING THE SCREWDRIVER• If the screwdriver does not function normally, loosen the cap battery and tighten it to re-start.SET UP1 . Power On/Clear2 . Unit Selection/SettingAdjust torque value 4 . Pre-Setting No.STEP 1: PRE-SETTING NO.PEAK HOLD MODE RECORDED VALUE REVIEWCOMMUNICATIONPEAK HOLD MODE OPERATION...))...))Reach 90% of Target TorqueReach Target TorqueKEY LOCKLock on/off selection。
人凝血因子检验方法
人凝血因子检验方法引言人凝血因子是一组在血液凝固过程中起关键作用的蛋白质。
凝血因子检验是评估一个人的凝血功能是否正常的重要方法。
本文将介绍人凝血因子检验的方法，包括常用的实验室检测方法和新兴的分子诊断技术。
1. 凝血因子简介人体内共有13种已知的凝血因子，它们按照其参与凝血反应的顺序被编号为Ⅰ至ⅩⅢ。
这些凝血因子在正常情况下相互协作，形成一个复杂而精确的平衡系统，以维持正常的止血和溶栓过程。
2. 常用实验室检测方法2.1 凝血酶原时间（PT）PT是评估外源性凝血通路功能的指标。
该测试使用钠柠檬酸抗凝剂处理患者的血液样本，然后添加磷酸钙和组织因子来启动凝血反应。
通过计算患者样本中形成凝块所需时间来确定PT值。
2.2 部分凝血活酶时间（APTT）APTT是评估内源性凝血通路功能的指标。
该测试使用钠柠檬酸抗凝剂处理患者的血液样本，然后添加磷酸钙和活化的部分凝血活酶来启动凝血反应。
通过计算患者样本中形成凝块所需时间来确定APTT值。
2.3 血小板计数和出血时间除了凝血因子本身，血小板也是维持正常止血过程中不可或缺的组成部分。
进行完整的凝血功能检查时，还需要评估患者的血小板计数和出血时间。
3. 分子诊断技术近年来，随着分子生物学技术的不断发展，越来越多的新兴检测方法被应用于人凝血因子检验中。
3.1 多重PCR多重PCR（Polymerase Chain Reaction）是一种高效且灵敏的分子生物学技术，可以同时检测多个基因突变。
在人凝血因子检验中，多重PCR可以用于快速筛查常见突变引起的凝血因子缺陷。
3.2 基因测序基因测序是一种直接测定DNA序列的方法。
通过对凝血因子相关基因进行全序列测定，可以发现罕见突变或新的基因变异，为凝血功能异常的诊断提供更准确的依据。
3.3 基因芯片技术基因芯片技术是一种高通量的基因分析方法，可以同时检测上千个基因。
在人凝血因子检验中，基因芯片技术可以用于快速筛查多个凝血相关基因的变异。
临床麻醉学PPT课件
△1927 Ralph waters sodalime (钠石 灰)
1956 halothane (氟烷) 1972 enflurane (恩氟烷) 1981 isoflurane (异氟烷) 1990 sevoflurane (七氟烷) 1992 desflurane (地氟烷)
（2）Intravenous anesthesia (静脉麻醉)
△The latest local anesthetics include ropivacaine(罗哌卡
因)and levobupivacaine(左旋布比卡因)
△Anesthesiologist prof Rovenstine established the first pain clinic
1.To combine basic medical sciences with clinical medicine(基础与临床结合)
2.To combine theory with practice (理论与实践结合) Anesthesiologist on paper; craftsman of anesthesia 3.To learn, to investigate continuously; and to make
·1934 Lundy 和waters thiopental (硫喷妥钠)
·benzodiazepines ( 苯二氮卓类药 )
diazepam （地西泮） 1959 midazolam (咪达唑仑) 1976
·others:
sodium hydroxybutyrate , r-oH (羟丁酸钠)1960 ketamine (氯胺酮) 1970 etomidate (依托咪酯) 1972 △propofol (丙泊酚) 1983
迷迭香酸对过氧化氢处理下的皮肤黑色素瘤的抗氧化作用(原文翻译)
迷迭香酸（罗丹酚酸）对H2O2处理过的皮肤黑色素瘤细胞的抗氧化作用Sun Mi Yoo1 and Jeong Ran Kang2*1.韩国光州500-741号东冈大学美容系2.韩国首尔143-701号建国大学生物工程系2009.2.6收到 2009.4.17接收本学科旨在检测迷迭香酸对人工孵育的皮肤黑色素瘤细胞在ROS下的抗氧化作用。
通过XTT比色法，以细胞毒性和抗氧化作用来分析细胞粘附活性，DPPH自由基清除活性以及H2O2处理1-10h和未经处理的两种情况下乳酸脱氢酶的活性。
用20-110 μM 的H2O2处理皮肤黑色素瘤细胞5-7h后，细胞活性的降低呈剂量和时间依赖性。
通过XTT比色法测得H2O2的半抑制浓度（IC50 ）为90μM。
同时H2O2增强了LDH细胞的剂量依赖性。
用50-90μM的H2O2处理8h后测得LDH50为60 μM H2O2。
迷迭香酸能增强细胞活性和DPPH自由基清除活性，降低乳酸盐脱氢酶的活性。
细胞的H2O2处理证实了对人工孵育的皮肤黑色素瘤细胞的强抗氧化作用。
通过H2O2的处理，迷迭香酸能在细胞内能增强细胞活性和DPPH 自由基清除活性，降低乳酸盐脱氢酶的活性。
这被认为是迷迭香酸对ROS（ROS）如H2O2的抗氧化作用。
Key words：DPPH-radical scavenging, LDH, rosmarinic acid, XTT assay关键字：DPPH自由基清除活性，乳酸脱氢酶，迷迭香酸，XTT比色法据研究发现，ROS通过氧化应激对细胞的损伤和一些脑部疾病比如帕金森症或心脏疾病例如心肌梗塞之间有很大的关联[Difazio et al., 1992; Delanty and Dichter, 1998].尤其是研究人员认为ROS是皮肤老化的一个主要的因素后，一直试图从ROS方面研究衰老。
[Yokozawa et al., 1998].据研究表明，ROS的氧化应激会通过萎缩细胞引起各种疾病，例如超氧自由基、H2O2（H2O2）或羟基自由基的巯基蛋白反应中断酶的活性，破坏脱氧RMA（DNA）或RMA（RNA），诱导细胞膜脂质过氧化。
工程专业术语中英文对照
CDB工程专业术语中英文对照(二）添加时间：2013-4—24节流截止放空阀2011-08-10 16:50：46｜分类：English ｜标签：｜字号大中小订阅六、仪表及自动控制通用描述 COMMON DESCRIPTION设备名称Equipment Name 缩写ABB.分散控制系统Distributed Control System DCS安全仪表系统Safety Instrumentation System SIS紧急切断系统Emergency Shutdown system ESD火气系统Fire and Gas system F&G监视控制和数据采集系统Supervisory Control and DataAcquisitionSCADA可编程逻辑控制器Programmed Logic Controller PLC 远程终端单元Remote Terminal Unit RTU 站控系统Station Control System SCS 中央控制室Central Control Room CCR 操作间Operation room机柜间Equipment room/ Cabinet room大屏显示系统Large Screen Display system LSD 流量类仪表 FLOW INSTRUMENT设备名称Equipment Name孔板Orifice Plate文丘里流量计Venturi Flowmeter均速管流量计Averaging Pitot Tube阀式孔板节流装置Orifice Plate in quick change fitting涡轮流量计Turbine Flowmeter涡街流量计Vortex Flowmeter容积式流量计Positive Displacement Flowmeter 靶式流量计Target Flowmeter超声波流量计Ultrasonic FlowmeterV型流量计V-cone Flowmeter电磁流量计Electromagnetic Flowmeter楔型流量计Wedge Flowmeter转子流量计Rotameter整流器Straightening Vane温度类仪表 TEMPERATURE INSTRUMENT设备名称Equipment Name双金属温度计Bi—metallic temperature gauge 热电偶Thermocouple表面热电偶Surface Thermocouple热电阻Resistance Temperature Detector 温度变送器Temperature transmitter光学高温计Optical pyrometer温度计套管Thermowell压力类仪表 PRESSURE INSTRUMENT设备名称Equipment Name压力表Manometer /Pressure gauge弹簧管压力表Burdon-tube manometer隔膜压力表Diaphragm—seal manometer /Diaphragm—seal pressure gauge差压表Differential pressure gauge 压力变送器Pressure transmitter差压变送器Differential pressure transmitter液位类仪表 LEVEL INSTRUMENT设备名称Equipment Name玻板液位计Glass type level gauge磁浮子液位计Magnetic coupled indicator雷达液位变送器Radar level transmitter浮筒液位变送器Displacer level transmitter磁致伸缩液位变送器Magnetostrictive level transmitter液位开关Level switch阀门类 VALVE设备名称Equipment Name球阀Ball valve单座阀Globe valve套筒阀Sleeve valve蝶阀Butterfly valve偏心旋转阀Eccentric rotary valve截止阀Globe valve角阀Angle valve电磁阀Solenoid valve七、供配电设备名称Equipment Name变电所Substation高低压配电装置HV＆LV Switchgear柴油发电机Diesel Generator油浸式变压器Oil-immersed Power Transformer 干式变压器Dry-type Power Transformer有载调压开关On—load Tap Switch直流屏DC UPS微机综合自动化系统Integrated Substation Automation System应急电源Emergency Power Supply配电箱Lighting and Small Power Distribution Panel电缆桥架Cable Tray电缆沟Cable Trough架空电力线路Over—head Lines爆炸危险区域划分Hazardous Area Classification单线图Single Line Diagram电容补偿Capacitor Unit现场操作柱Local Control Station供配电系统Power Supply & Distribution System UPS:AC UPS八、给排水给水 Water Supply设备名称Equipment Name取水深井泵房Intake Structure高位水池Elevated Tank阀门井Valve Well生产、消防水泵房Water Supply Pump Room加药设备用房Dosage Room加药间Dosage Room预沉池Pre—sedimentation Tank穿孔旋流反应斜管沉淀池Reaction Sedimentation Tank 重力式无阀滤池Valveless Filter清水池Clear Water Pit循环水厂 Circulating Water Station循环水泵房Recirculating Pump House药剂间Chemical Room循环冷水池Cooling Water Tank循环热水提升池Lifting Tank冷却塔Cooling Tower污水 Sewage水泵棚Water Pump Shed污泥棚Sludge Shed风机棚Fan Shed化粪池Septic Tank污水处理综合用房Sewage Treatment House格栅池Bar Screen Tank曝气调节池Aeration Tank水解酸化池Acid hydrolysis Tank缺氧池Anoxia Tank好氧池Aerobic Tank生化池Biochemical Structure沉淀池Sedimentation Tank保险池Insurance Tank污泥浓缩池Concentration Tank检修污水池Overhaul Water Tank气浮池Floatation Tank隔油池Oil Separator事故水池Emergency Tank污泥焚烧系统Sludge Incineration System RO反渗透用房（Reverse Osmosis） RO House六、通信设备名称Equipment Name程控电话交换系统PABX System局域网及综合布线系统LAN ＆ Generic Cabling System防爆扩音/对讲系统Explosion-Proof Loud Speaking/Talk Back System工业电视监视系统CCTV System电力调度系统Power Line Carrier System周界防范系统Boundary Security System光通信系统Optical Fiber communication system 有线电视系统CATV System九、建筑设备名称Equipment Name工艺装置循环水泵房Recirculating Water Pump House污水处理综合用房Sewage Treatment House污泥脱水及鼓风机房Sludge dewatering and air blower room 生产、消防给水泵房Water supply pump room空氮站及10/0.4 KV变电所Air and nitrogen station and 10/0.4KV Transformer substation锅炉房Boiler room锅炉房10/0。
世界卫生组织儿童标准处方集
WHO Model Formulary for ChildrenBased on the Second Model List of Essential Medicines for Children 2009世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准目录WHO Library Cataloguing-in-Publication Data:WHO model formulary for children 2010.Based on the second model list of essential medicines for children 2009.1.Essential drugs.2.Formularies.3.Pharmaceutical preparations.4.Child.5.Drug utilization. I.World Health Organization.ISBN 978 92 4 159932 0 (NLM classification: QV 55)世界卫生组织实验室出版数据目录：世界卫生组织儿童标准处方集基于2009年儿童基本用药的第二个标准处方集1．基本药物 2.处方一览表 3.药品制备 4儿童 5.药物ISBN 978 92 4 159932 0 (美国国立医学图书馆分类：QV55)World Health Organization 2010All rights reserved. Publications of the World Health Organization can be obtained fromWHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: ******************). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the aboveaddress(fax:+41227914806;e-mail:*******************).世界卫生组织2010版权所有。
PhysicianAssistedSuicide
Physician-Assisted Suicide: For and AgainstAndrew D. Boyd, University of Texas Southwestern at DallasThe history of the debate for physician-assisted suicide has been long, even tracing back to the Greek and Roman times.1,2 The debate originally was centered around the Hippocratic oath and the condemnation of the practice. With the upsurge of Christianity, many physicians continued to condemn the practice. Within the last two centuries the public has spurned many discussions about Physician-assisted suicide and Euthanasia from many different historic perpectives1. Although this debate has been lengthy and many of the issues discussed over the centuries are repetitive, new ideas and concerns do emerge with the current debate.Many terms are used in the debate for Physician-assisted suicide, and in order to alleviate confusion through out the paper a few definitions will be given. Voluntary active euthanasia is the intentionally administering medication or other interventions to cause the patient's death at the patient's explicit request and with fully informed consent. Involuntary active euthanasia is the intentionally administering medications or other interventions to cause patient's death when patient was competent but without the patient's explicit request and/or fully informed consent. Nonvoluntary active euthanasia is the intentionally administering medication or other interventions to cause patient's death when patient was incompetent or not able to explicitly requesting it. Terminating life-sustaining treatments is withholding or withdrawing life-sustaining medical treatments from the patient to let him or her die. Palliative care or indirect euthanasia is administering narcotics or other medications to relieve pain with incidental consequence of causing sufficient respiratory depression to result in the patient's death. Physician-assisted suicide is a physician providing medication or other interventions to a patient with the understanding that the patient intends to use them to commit suicide 2. Although there are many terms, confusion can abound. However the discussion of physician-assisted suicide will be the focus of the paper, since most of the press and discussion has been about this subject3,4,5,8,12,13.A few public advocates have spoken for physician-assisted suicide. Besides Doctor Jack Kervokian with his "death machine", Dr. Timothy Quill shows the compassionate side of physician-assisted suicide. In the story of Diane, Dr. Quill tries to convince physicians to take seriously the request of a patient to die 3. Currently Oregon is only state that allows physician-assisted suicide. Many of the supporters say there is a right to choose when and where one dies. Quill does speak in favor of legalizing physician-assisted suicide 4. However he brings up ideas about dignified death. The argument of the right to die comes from the right to terminate life-sustaining treatment. The authors of this argument say there is no essential difference between physician-assisted suicide and termination of life-sustaining treatment, since refusal of life-sustaining treatment is an upheld legal right. The analogy is one of a person sitting on a beach waiting for the tide to come in to drown and then another person walking into the ocean to drown.5 Before the Supreme Court ruling in 1997, some argued that the right to terminate care would be expanded to physician-assisted suicide and therefore making it a right.5 However, the Supreme Court did not say physician-assisted suicide is a right. (See later discussion of ruling.) In response to the claim there is a right to die, there was detailed article published in the Hastings Center Report about the evolution of rights. According to the original liberal thinkers on rights,the right to commit suicide goes against the idea of a natural right. The philosophical arguments go to show there is no historical precedent for a right to be made dead, let alone requiring others to help. The essence of individual freedom is a sense of not belonging to someone else, not merely doing whatever you please. The current positing of rights to do whatever one pleases is a modern development and is seldom upheld in courts. 6 So the argument that there is a natural right to die is a stretch from interpretation of rights and currently has no basis in the U.S. Constitution.Although there may or may not be a right to die, there are other arguments for physician-assisted suicide. Quill showed how compassion can lead to the assisting of one's death.3 However at the same time Quill has discussed how a patient asking to die may not always be making a legitimate request. His idea is that this request should lead to a query about death and the options should be explored, instead of a simple yes or no answer. His example of a 55 year old women who requested to die was really a response to not wanting to undergo any more treatment for cancer and a desire to take a more symptom-related treatment path. Some patients are in a spiritual crisis, psychosocial problems, and even clinical depression. All of these requests for help, with proper discussion of options can lead to a more positive end of life experience. Physicians can feel sympathetic to a situation where there is nothing they can due to alleviate the pain of a patient. For many, simply side-stepping the question is unethical since the question can represent a cry for help.7 So the compassion for a patient who is in terminal pain can lead physicians to aid in physician-assisted suicide now even though it is illegal. Although there is know legal, medical,or philosophical historical precedent to allow physician-assisted suicide, physicians believe in physician-assisted suicide enough to knowingly break the law.Since the discussion of physician-assisted suicide surrounds feelings and uncertain situations, the discussion has turned somewhat from why to have physician-assisted suicide to how. A proposal has been published on the conditions of physician-assisted suicide.4 The first requirement is that the patient must have a condition that is incurable and associated with severe, unrelenting suffering and understand the prognosis. Second the physician must be sure the request is not made because of inadequate pain control. Third the patient must clearly and repeatedly request to die. Fourth the physician must be sure the patient's judgement is not distorted. Fifth, the physician-assisted suicide should be only carried out in a meaningful doctor patient relationship.A physician should not be forced to participate in any act that they deem unethical. Sixth, consultation with another experienced physician is required to ensure it is a sincere request. Seventh, all of the steps should be clearly documented.4 This policy takes reasonable sets to insure the procedure is not abused, but the chance of abuse is always present.To reduce the possibility abuse, the courts have recommended that the patient's judgment be evaluated by a psychiatrist.8 Using a psychiatrist as a gatekeeper to physician-assisted suicide brings up many other troubling points. In the field of psychiatry, the desire to commit suicide is considered a mental illness that can be treated. With this attitude how can a psychiatrist say someone is of sound mind with the desire to commit suicide? Usually the profession considers a suicide as an unsuccessful treatment of a disorder. National studies have showed that 90% of all suicides in the general population show some sort of psychiatric disorder.9 However these cases do not focus on the terminally ill. The studies of terminally ill patients who desire physician-assisted suicide and the prevalence of diagnosed depression can range from 13% to 77%.10,11,12Most of these studies have small numbers of patients desiring physician-assisted suicide so there needs to be further study along this line. Also these studies were in a society where physician-assisted suicide was not openly allowed. The desire for physician-assisted suicide might change if it was legal, thereby changing the sampling pool. Also there are no studies examining the likelihood of terminally ill, suicidal patients changing their minds about suicide after receiving psychotherapy.So there is a lack of information on desire for suicide in terminal patients.Besides the case of not knowing the true nature of the desires for suicide in terminally ill patients, determining the patient's capacity to make a decision could be difficult for a psychiatrist. How truthful will a patient be with a psychiatrist if one believes that they will not be allowed to terminate their life if the psychiatrist does not believe they are competent? Also, is depression a reason to hold back the decision for physician-assisted suicide? Many psychiatrists believe depression is a normal response to severe medical illness and not a sign of psychiatric illness.9 So, consulting a psychiatrist to determine competence may prevent abuses, but it leads to its own quandary, since psychiatrists may not want to perform this function.Although many issues about physician-assisted suicide remain, many studies have shown a strong support of it in medical physicians and in the general public in two published studies. In Oregon, 60 percent of physician believed that the physician-assisted suicide should be legal in some cases. 46 percent said they would prescribe a lethal dose. Moreover, 7 percent have admitted to complying with a request of a patient for a lethal dose, although this act was illegal at the time.13 In the Michigan study, the public and physicians were questioned. The proportion of respondants favoring the legalization was 56 percent of physicians and 66 percent of the public. This was compared to 37 percent of physicians and 26 percent of the public who favor an outright ban.14 The reasons for each individual choice can vary but there is a support for the legalization of physician-assisted suicide that in some way needs to be addressed. Also the fact the Dr. Kevokian has never been convicted may be another example the support for physician-assisted suicide in Michigan.Although some arguments for physician-assisted suicide are strong, many do have unresolved issues. Furthermore, the argument against physician-assisted suicide has many strong points. One of the most common arguments is the slippery slope. This argument is presented as a way to still allow the process to be illegal although there may be a moral authority in extreme cases.15 The presidential report of 1983 said "The Commission finds this limitation on individual self-determination [i.e., physician-assisted suicide] to be an acceptable cost of securing the general protection of human life afforded by the prohibition of direct killing."16 The report expressed a concern for the general protection of all life. The report did not think the limit few who would be helped with practices such as physician assisted suicide is worth the sacrifice to the general protection of human life. The fear is that the financial costs of treatment or pressures from the family will cause the decision of the patient to have physician-assisted suicide performed. The "slippery slope" claim is that the right to physician-assisted suicide will slowly spread to the disabled or mentally competent adults who are not terminally ill. The final extreme of the slippery slope argument is that it will finally reach a point of involuntary euthansia.15 Many cite the Dutch example of what will happen, however this discussion will be deferred to later. The arguments for the slippery slope normally do not distinguish a difference between euthanasia andphysician-assisted suicide, as noted by Mark Siegler. Society and legislators have all made a distinct difference between physician-assisted suicide and euthanasia. Also, the slippery slope argument ignores the current rights of real people in favor of the speculative harms that may be visited in future people.5Another major objection to physician-assisted suicide is the loss of trust of a doctor. What will a patient think if it is known that their physician actively aided in someone else's death. One maxim of medical care is "Cure sometimes, relieve often, comfort always."15 Many times a physician can not cure a disease and or relieve the symptoms. But how would a patient feel knowing that the doctor gave up on another patient especially if they were terminally ill and allowed the suicide to occur. The doctor-patient relationship is the foundation of all interactions and to have aided in death comes in the middle of it, would make more than a few patients uncomfortable. Also another maxim of a physician is to first do no harm; suicide can be seen as harm to a patient. The argument along these lines states that physician-assisted suicide distorts the healing purpose of medicine.17 This argument is valid and does cause many problems, however they must also be weighed against the needs of the particular patient, which each physician has to make.One issue that is difficult to resolve is the morality of physician-assisted suicide. Many physicians and patients have a moral dilemma with physician-assisted suicide. Another aspect involves the morality of the nurses who are involved with a possible action of physician-assisted suicide. If they object do they refer the patient to another nurse, or how do they voice their opinion against this action without involving the patient in the conflict between the physician and nurse?18 Besides the nurse there are many others who are involved as well. How do institutions make their policy clear enough ahead of time to alleviate any problems especially in the situation with terminally ill patients? What is the pharmacist's moral responsibility in this scenario? Do they ask the patient if the medication is for committing suicide? If they consciously object to physician-assisted suicide how do they perform their function? Do they not fill the prescription outright, or do they only fill the prescription to a level where the patient can not commit suicide? Another aspect of this is the responsibility of the doctor to provide further care. What happens if the suicide is botched somehow, or if other complications make the suicide impossible? There are many issues involved with the actual act and how it affects all of the people involved in the health care of the patient.19Another argument against physician-assisted suicide is that the physicians' professional societies, in particular the America Medical Association, has come out against the legalization of physician-assisted suicide.17 They have actively campaigned against the laws in Washington, California, and Oregon. The idea that the national organization stands against this measure is good for public policy support, however as previously mentioned many of the physicians polled in different studies responded positive to the legalization of the physician-assisted suicide. Some have claimed that the conservative leaders of organizations like the AMA are not necessarily representative of their constituents,20 though the AMA did recommend a more careful examination of the issue.17While there are many moral and practical decisions about the legalization of physician-assisted suicide, there is the example of the Netherlands. Although assisted suicide is still illegal in theNetherlands, the courts and government have come out with a set of guidelines that when followed ensure that a physician will not be prosecuted -- in essence decriminalizing the act. However, in the Netherlands there is not much of a distinction made between physician-assisted suicide and euthanasia since framers of the law did not want to discriminate against patients who could not effect their own death.21 There are four guidelines given to prevent a physician from being prosecuted. The first is the patient must be mentally competent adult. The second requirement must request euthanasia voluntarily and repeatedly and the physician needs to document the requests. The third requirement is the patient must be suffering intolerably, with no prospect of relief. The forth is the doctor must consult with another physician not involved with the case.In 1990 and 1995 the Dutch government commissioned surveys to see the true nature of euthanasia in the Netherlands. The surveys were headed by Professor Jan Remelink, the attorney general of the Dutch Supreme Court. The Remelink surveys have been tossed around between the two sides of the discussion of physician-assisted suicide, with both sides claiming that the surveys prove their points. Initially the 1990 survey showed that only 18 percent of all euthanasia was reported to the government with the proper documentation, the number has since risen to 41 percent in 1995.22 The rise in number could be contributed to the change in reporting procedures. There are many reasons why physicians still do not fill out the forms,23 so the reporting is not fully accurate. Some of the reasons mentioned for not filing the report are it is time consuming, burdensome and possibly incriminating.23 The example of the Netherlands is normally selected to show evidence of a slippery slope, but van der Maas, vader Wal, Haverkate, and rest of the authors themselves claim "our data provide no conclusive evidence in either direction" in regards to the slippery slope.22 Many observers disagree with them.21,24 The startling fact that many cite as evidence of a slippery slope is the reported 1030 deaths in 1990 and 948 deaths in 1995 where the ending of a life occurred without the request of the patient. Many of the doctors involved in these cases claimed that many of the patients expressed interest in the decision ahead of time and at the end they were in a position where the patient could not ask25. Still, there were a few reports of doctors ending the lives without the explicit request of a patient. The involuntary deaths is also not increasing, so some believe that the Dutch physicians continue to practice physician-assisted dying only reluctantly and under compelling circumstances.25 However others argue that the society is becoming more tolerant of physician-aided death and that any death with out explicit request is morally objectionable and any system that allows that is not justified and that the Netherlands is sliding down the slippery slope towards nonvoluntary active euthanasia.21,25While the Netherlands can provide insight into physician-assisted dying, a few differences need to be noted. First the only discussion in America is for physician-assisted suicide. Second the societies of the Netherlands and America are different and we each subscribe to different ideals. This does not mean that all of the evidence from the Netherlands is not important, we just needto realize that there is a limit to how far we project the results of the Netherlands onto American culture.While physician-assisted suicide is not legal in the U.S. except in Oregon, the Supreme Court ruled on the states' right to decide individually on the legality of physician-assisted suicide. The two cases were Vacco v. Quill and Washington v. Glucksberg, where the court upheld the rightfor the states to criminalize physician-assisted suicide.26,27 The Supreme Court reversed both decisions of the lower court's opinion claiming it was illegal to criminalize physician-assisted suicide; however the Supreme Court did not say there was a right to physician-assisted suicide. The Supreme Court did say in the concurring opinions that the patient had a right to palliative care. They did believe that when a physician gave pain medications to relieve the suffering of a patient such treatment would be permissible even if another consequence of that pain medication is a shortening of the patient's life. The Supreme Court did allow states to pass their own laws on the subject and allowed a discussion of the right to physician-assisted suicide in the public.26,27 In the case of Lee v. State of Oregon, the courts ruled that there was not enough protection for the terminally ill patient who may end up in a premature death who may actually want to live. This lack of protection came from the absence of a mental health professional consult when physician-assisted suicide is requested.8 So the courts do say there is a state interest in protecting patients who may want to live. While the states interest in protecting patients is one of the key legal arguments against physician-assisted suicide and making physician-assisted suicide illegal. So the courts have upheld the pillars of protecting the patient. However, in attempting to protect the patient the courts have incorporated the psychiatrist, which brings up the dilemmas of the psychiatry previously mentioned.Many physicians agree with the ruling that palliative care is very important and should not be restricted. 28, 29,30 However they also agree that the debate for physician-assisted suicide is not over. Some however disagree with the idea of a right to palliative care. They do not disagree with the idea of comforting patients at the end of their death, but they do think sedating someone to death is ethically problematic. The claim is that terminal sedation is equivalent to a slow euthanasia. If one sedates someone to a deep sleep and then withdraws food and water, does this ethically follow the guidelines of right to refuse medical treatment? The physician is putting the patient in a position where artificial support can be legally removed. Dr. Orentlicher claims the court rejected the idea that terminal sedation "is covert physician-assisted suicide." He also claims that in rejecting a right to physician-assisted suicide they embraced a direct form of euthanasia, which can be easily abused.31 While terminal sedation can be abused and at best there is still debate on the permissibility of terminally sedating a patient and withdrawing life support, the courts have upheld a right to palliative care, as long as the primary purpose of the sedation is to relieve pain and not hasten death.While the moral and ethical debate rages in the public and the courts, physicians have to deal with such situations every day. Looking back to the study of Oregon physicians, 4 percent of the physicians studied had given a lethal prescription to a patient and the patient had taken it, while 7 percent of physicians admitted to actually giving the medication.13 While this number may seem low, one must remember while the study was conducted it was illegal to write a lethal prescription. Attempts have been made at nationwide surveys of the practice of physician-assisted suicide, but not many of the surveys are returned and those that are cannot be factually verified. So the current prevalence of physician-assisted suicide is completely unknown. The practice, if it does occur, is not talked about openly, due to the legal ramifications. Additional research must determine the current actual practice of physicians.In the debate of physician-assisted suicide, there are many valid arguments on each side. This paper has only been able to touch on the surface of many of the arguments. Whichever path society does choose in regards to physician-assisted suicide, moral objections will need to be addressed. Either way, the public needs to be educated about the different legal options concerning the end-of-life care and the consequences of any changes in laws governing such care.I would like to express my appreciation to Anne C. Boyd, and Darby E. Grande for their help in research and editing the paper.Endnotes1. Emanuel E J, Euthanasia: historical, ethical, and empiric perspectives. Archives of Internal Medicine 1994;154:1890-1901.2. Nyman DJ, Eidelman LA, Sprung CL, Euthanasia. Critical Care Clinics Jan 1996;12:85-96.3. Quill TE, Death and Dignity: a case of individualized decision making. New England Journal of Medicine 1991;324:691-694.4. Quill TE, Cassel CK, Meier DE, Care of the hopelessly ill: Proposed Clinical Criteria for Physician-Assisted Suicide. New England Journal of Medicine 1992;327:1380-1384.5. Canick, SM Constitutional Aspects of Physician-Assisted Suicide After Lee v. Oregon. American Journal of Law and Medicine 1997;23:69-96.6. Kass LR, Is there a right to Die? Hastings Center Report Jan-Feb1993;34-43.7. Quill TE, Doctor, I want to Die, Will You Help Me? Journal of the American Medical Association 1993;270:870-873.8. Lee v. State of Oregon 891 F.Supp.1429.9. Zauble TS, Sullivan MD, Psychiatry and Physician-Assisted Suicide. Psychiatric Clinics of North America September1996;19:413-427.10. Chochinov HM, Wilson KG, Enns M, et al, Prevalnece of depression in the terminally ill: Effects of diagnostic criteria and symptom threshold judgments. American Journal of Psychiatry 1994;151:537-540.11. Chochinov HM, Wilson KG, Enns M, et al, Desire for Death in the terminally ill. American Journal of Psychiatry 1995;152:1185-1191.12. Bukberg j, Penman D, Holland JC: Depression in hospitalized cancer patients. Psychosomatic Medicine 1984;46:199-212.13. Lee MA, Nelson HD, Tilden VP, et al, Legalizing Assisted Suicide - views of Physicians in Oregon. New England Journal of Medicine 1996;334:310-315.14. Bachman JG, Alcser KH, Doukas DJ, et al, Attitudes of Michigan Physicians and the Public toward Legalizing Physician-Assisted Suicide and voluntary Euthanasia. New England Journal of Medicine 1996;334:303-309.15. Siegler M, Is there a Role for Physician-Assisted Suicide in Cancer? No. Important advances in oncology 1996;281-291.16. President's Commission on Ethical Problems in Medicine and Biomedical and Behavior Research. Deciding to Forgo Life-Sustaining Treatment. A Report on the Ethical and Legal Issue in treatment Decisions. Washington, DC: Government Printing Office, 1983.17. Council on Ethical and Judicial Affairs, American Medical Association. Decisions near the end of life. JAMA 1992;267:2229-2233.18. Haddad A, A woman with terminal bone cancer has asked her physician to help her end her life. He plans to lend assistance. If he asks you to make a lethal drug available to this patient What would you do? RN March 1997;17-20.19. Alpers A, Lo B, Physician-Assisted Suicide in Oregon: a bold experiment. Journal of the American Medical Association1995;274:483-487.20. McKhann CF, Is There a role for Physician-Assisted Suicide in Cancer? Yes. Important Advances in Oncology 1996;267-279.21. Hendin H, Rutenfrans C, Zylicz Z, Physician-Assisted Suicide and Euthanasia in the Netherlands. Journal of American Medical Association 1997;277:1720-1722.22. van der Maas PJ, van der Wal G, Haverkate I, et al Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. New England Journal of Medicine 1996;335:1699-1705.23. Van der Wal G, van der Mass PJ, Bosma JM, Evaluation of the notification procedures for physician-assisted death in the Netherlands. New England Journal of Medicine 1996;335:1706-1711.24. ten Have HAMJ, Velie JVM, Euthanasia in the Netherlands. Critical Care Clinics Jan 1996;12:97-108.25. Angell M, Euthanasia in the Netherlands-Good News or Bad? New England Journal of Medicine 1996;335:1676-1678.26. Vacco v. Quill, 117 S.Ct. 2293 (1997).27. Washington v. Glucksberg, 117 S.Ct. 2258 (1997).28. Paola FA, How Dead Is the federal Constitutional Right to Assisted Suicide? American Journal of Medicine 1998;104:565-568.29. Burt RA, The Supreme Court Speaks: not assisted suicide but a constitutional right to palliative care. New England Journal of Medicine 1997; 337:1234-1236.30. Quill TE, Meier D, Block SD, et al, The Debate over Physician-Assisted Suicide: Empirical Data and Convergent Views. Annalsof Internal Medicine 1998;128:552-558.31. Orentlicher D, The Supreme Court and Physician-Assisted Suicide: rejecting assisted suicide but embracing euthanasia. New England Journal of Medicine 1997;337:1236-1239.。
依诺肝素钠
Docket No. FDA-2003-P-0273
14, 2009). We have also reviewed the comments submitted by Amphastar Pharmaceuticals, Inc. (Amphastar) (dated May 13,2004, November 23,2004, July 18,2005, October 6, 2005, and October 7,2005), Hyman, Phelps & McNamara, P.C. (dated October 17,2003, and August 4,2004), Teva Pharaceuticals USA Inc. (dated August 20, 2004), and other commentApril
We have carefully reviewed your petition and the supplements submitted by you on behalf of Aventis and its successors in interest on February 12,2004 (Supplement No.1), September 26, 2005 (Supplement No.2), September 14,2006 (Supplement No.3), and June 29, 2007 (Supplement No.4), as well as the comments su October 13, 2004, March 17,2005, March 16,2006, August 25, 2006, March 2,2007, March 15,2007, and
EmboTrap设备使用说明书
Introduction EXCELLENT(NCT03685578)is a prospective, single-arm,multicenter,real-world international registry of mechanical thrombectomy(MT)for stroke with the EmboTrap device as first line treatment.The study entails thrombus anal-ysis of specimens collected with each MT pass.Aim of the Study T o compare rates of mRS0–2at90days and clot characteristics in subjects with and without first pass effect(FPE).Methods FPE was defined as mTICI2c/3after one pass and non-FPE as mTICI2c/3after>1pass as adjudicated by an independent core lab.Clot analysis was performed by inde-pendent central labs blinded to clinical data.mRS at90days was scored by investigators blinded to procedural data. Results Overall mTICI2c/3rates were63.7%(326/512).FPE was achieved in37.1%(190/512)and non-FPE in26.6% (136/512)subjects.90day mRS0–2or equal to pre-stroke was achieved in47.2%(75/159)with FPE and in42.1%(51/ 121)non-FPE patients.All-cause90-day mortality was19.1% (34/178)in subjects with FPE and26.4%(34/129)in subjects with non-FPE.Major thrombus components(mean%±SD) were as follows:RBC:FPE45.88±20.54,non-FPE39.08±18.23,and first pass mTICI<2c/340.96±18.84;Fibrin:FPE 24.72±13.82,non-FPE29.09±15.76first pass mTICI<2c/3 29.20±14.58.Conclusions The high rate of‘real-world’FPE observed in EXCELLENT was associated with improved clinical outcomes. Clots retrieved with FPE had higher RBC and lower fibrin content compared to non FPE and to first pass mTICI<2c/3 e.These preliminary findings await confirmation from analysis of the full dataset.Disclosure EXCELLENT is sponsored by Cerenovus.Dr.Jovin is a consultant for Neuravi,Codman Neurovascular,Stryker (PI DAWN;unpaid),Fundacio Ictus(PI REVASCAT;unpaid), and holds stock in Anaconda,Silk Road,and Blockade Medical.EP47*INVESTIGATION OF CURRENT AND NOVEL TREATMENT STRATEGIES FOR ICA AND MCA OCCLUSIONS IN AN IN-VITRO THROMBECTOMY MODEL1RG Nogueira,2J Thornton,3L Mullins,4S Fitzgerald.1Neurology,Grady Memorial Hospital and Emory University,Atlanta,GA,USA;2Radiology,Beaumont Hospital and Royal College of Surgeons Ireland,Dublin;3Perfuze Ltd;4Physiology,National University of Ireland Galway,Galway,Ireland10.1136/neurintsurg-2021-ESMINT.46Introduction Various mechanical thrombectomy devices and techniques including Stentrievers and Aspiration Catheters are used in the treatment of acute ischemic stroke.1Balloon Guide Catheters(BGC)are commonly used to achieve flow control.A new generation of‘Super-bore’088’’catheters are currently being tested clinically.23Objective/Aim We evaluated the in-vitro revascularization per-formance of current and novel thrombectomy approaches. Methods National University of Ireland Galway Research Ethics Committee approved the study.Clot analogues from human blood were used to create ICA(20mm)and MCA (10mm)occlusions in an In-vitro thrombectomy model. Thrombectomy setups tested were;ADAPT:Millipede088, SOFIA,SOFIA+BGC and Combination;Millipede088+Soli-itaire,SOFIA+BGC+Solitaire,SOFIA+Solitaire.10replicates of each test were performed.Endpoints were First Pass Effect (FPE),Second and Third-pass success and procedural-related distal emboli from50–1000m m.Results The Millipede088catheter achieved the highest rate of FPE in both ICA(60%)and MCA(100%)occlusions and had the lowest number of procedural-related emboli compared to all other device setups,followed by the Millipede088 +Solitaire technique.Of the currently used techniques,the use of a Solitaire in combination with a SOFIA lead to a higher rate of FPE in ICA occlusions(40%vs20%,SOFIA +BGC+Solitaire vs SOFIA+BGC),but a lower rate of FPE in MCA occlusions(50%vs60%,SOFIA+BGC+Solitaire vs SOFIA+BGC).Conclusions The novel0.088’’aspiration catheter achieves the best FPE rates in both ICA and MCA occlusions.In terms of existing techniques,ADAPT is more effective in the MCA, while the stentrievers provide a benefit in the ICA. REFERENCES1.Hafeez MU,Kan P,Srivatsan A,Moore S,Jafari M,DeLaGarza C,et pari-son of first-pass efficacy among four mechanical thrombectomy techniques:a sin-gle-center experience.World Neurosurgery2020;144:e533–e40.2.Gershon BS,Bageac DV,Shigematsu T,Majidi S,De Leacy R.Republished:firstclinical report of aspiration through a novel0.088-inch catheter positioned in the M1middle cerebral artery for ELVO thrombectomy.Journal of NeuroInterventional Surgery2021;13(4):e4–e.3.Nogueira RG,Mohammaden MH,Al-Bayati AR,Frankel MR,Haussen DC.Prelimi-nary experience with088large bore intracranial catheters during stroke thrombec-tomy.Interventional Neuroradiology2020:1591019920982219.Disclosure Seán Fitzgerald received research funding from Enterprise Ireland that is co-funded by Perfuze Ltd.Liam Mullins declares the following competing interest;Perfuze (stock options).John Thornton declares the following compet-ing interests;Perfuze(Physician Advisory Board,stock options);Consultancy fees:Microvention,Johnson and John-sons.Raul G.Nogueira declares the following competing interests:consulting fees for advisory roles with Anaconda, Biogen,Cerenovus,Genentech,Imperative Care,Medtronic, Phenox,Prolong Pharmaceuticals,Stryker Neurovascular and stock options for advisory roles with Astrocyte,Brainomix, Cerebrotech,Ceretrieve,Corindus Vascular Robotics,Vesalio, Viz-AI,and Perfuze.EP48*SAFETY AND EFFECTIVENESS OF MECHANICALTHROMBECTOMY FOR PRIMARY ISOLATED DISTALVESSEL OCCLUSIONS:A MONOCENTRIC RETROSPECTIVECOMPARATIVE STUDY1,2M Elhorany,3C Rosso,4E Shotar,3F Baronnet-Chauvet,4K Premat,4S Lenck,3S Crozier, 4C Corcy,5L Bottin,6O Yassin Mansour,7E-S Ali Tag El-din,7W Ahmed Fadel,4N Antoine Sourour,5S Alamowitch,3Y Samson,4F Clarençon.1Department of Neuroradiology.Pitié-Salpêtrière Hospital,Paris,France;2Department of Neurology.Faculty of Medicine,Tanta University,Tanta,Egypt;3AP-HP,Urgences Cérébro-Vasculaires,Hôpital Pitié-Salpêtrière, DMU Neuroscience,75013;4Department of Neuroradiology,Pitié-Salpêtrière Hospital; 5Department of Vascular Neurology,Saint-Antoine Hospital,Paris,France;6Department of Neurology,Faculty of Medicine,Alexandria University,Alexandria;7Department of Neurology,Faculty of Medicine,Tanta University,Tanta,Egypt10.1136/neurintsurg-2021-ESMINT.47Background Distal vessel occlusions represent about25–40% of acute ischemic stroke(AIS),either as primary occlusion or secondary occlusion complicating mechanical thrombectomy (MT)for large vessel occlusion.Objective Our aim was to evaluate safety and effectiveness of MT associated with the best medical treatment(BMT)in theJ NeuroIntervent Surg2021;13(Suppl2):A1–A29A19copyright. on December 24, 2023 by guest. Protected by / J NeuroIntervent Surg: first published as 10.1136/neurintsurg-2021-ESMINT.46 on 24 August 2021. Downloaded from。
西班牙语护肤品名
Vamos a ver... （先在这里啰嗦一下：斜体的是英语，加粗的才是西语，不要搞错了哦~~） 护肤: cuidado facial（skin care）洗面奶:Limpiador (con espuma/crema)（facial cleanser/face wash(Foaming,milky,cream,Gel)爽肤水: Loción purificante o loción clarificante（toner/astringent）紧肤水：Tónico Estimulante（firming lotion）柔肤水：Tónico Suavizante（toner/smoothing toner （facial mist/facial spray/complexion mist）护肤霜: crema/gel （moisturizers and creams）保湿：Hidratante（moisturizer）（姐妹们注意啦，看到这个词就可以确定是保湿类的东东咯~~）隔离霜，防晒：Protección solar facial o para cuerpo（sun screen/sun block）（这里又要啰嗦一下，在这里，人们没有化妆前要隔离的概念，所以不要白费力气跟她解释你要隔离，也不要太费力气去区分什么隔离还是防晒了，这里呢，主要区分的是晒后与晒前的东西不一样）美白：whitening(欧洲人都这么白了，当然不用美白啦，不过，貌似我有看到碧欧泉有美白产品在欧洲卖噢，等下次我去问来西语再补上啦~~)露：gel/Loción（lotion），霜：crema（cream）（关于这个呢，申明一下，其实吧，大家分什么露或者霜无非是因为肌肤油性与干性有别，其实买多了化妆品就会发现，简单来说，油性肌肤就用gel，干的呢就用crema，至于Loción呢，不用太在意，你要实在不放心，买的时候就问小姐是不是para piel más grasa的，一定不会有错啦~~）日霜：crema（day cream）(你要没特别说明是晚上用的，那店里给你的就是所谓的日霜了) 晚霜：Crema de noche（night cream）眼霜: gel o crema para ojos（eye gel）面膜: mascarilla（facial mask/masque）眼膜: mascarilla para ojos（eye mask）护唇用：(Bálsamo) protector para los labios（Lip care）口红护膜：Lip coat（没用过这么先进的东西，一定要买的话就甩英语吧……）磨砂膏: crema/máscara/gel exfoliante (facial scrub)去黑头: (deep) pore cleanser/striper pore refining紧致毛孔：anti-poros/tratamiento para reducer o mininizar los poros控油：anti-brillos/gel o trataminto para controlar los brillos(especial la zona T)(oil-control)去死皮: exfoliante (Exfoliating Scrub)润肤露（身体）: Bálsamo o Crema (hidratante) corporal (bodylotion/moisturizer)护手霜: crema de mano(hand lotion/moisturizer)沐浴露: gel de ducha(body wash)青春痘用品：tratimiento para los granos/anti-spot/ Anti-imperfecciones(Acne/Spot)（这个我有绝对发言权！在与痘痘抗争了这么多年，要是连这都不会说，那还不白活了啊，还有，有痘痘的姐妹们要是实在不会说，那就对着你脸上最大的痘痘指给小姐看吧！）賦活用：reactivar（Active）日晒后用品:cuidados para después del sol (After sun)使古铜色：Autobronceadores无酒精:sin Alcohol(Alcohol-free)无香精：sin perfumeAnti-（抗、防）抗老防皱：antienvejecimiento/anti-edad/ANTI-ARRUGAS(Anti-wrinkle)清洁用：limpiador/ purificante /clarificante(Clean-/Purify-)油性皮肤:piel grasa(Oily)混合性皮肤偏油:Piel mixta a grasa(Combination)干性皮肤:piel seca(Dry)敏感肌肤：Piel sensible中性皮肤:Piel normal mixta(Normal)精华液:serum(Essence)脸部用:para rostro o cara /facial(Facial)抗皱: anti-arrugas(Firm)泡沫：espuma（Foam）溫和的：Suavizante（Gentle）保湿用：Hidratante（Hydra)持久性: durar mucho tiempo/ de larga duración(Long lasting)乳，奶：leche(Milk)多元:multi(Mult)滋养: Nutrición(Nutritious)防干：Anti-sequedad去除、卸妝:desmaquillaje(Remover)溶解：Disolvente(Solvent)防水: ser resistente al agua(Waterproof)彩妆: Cosméticos (cosmetics)遮瑕膏: Corrector(para ocultar las imperfecciones) (concealer)修容餅：Shading powder(没用过这个玩意，也就不会说了……)粉底: base(para aplicar la base)（foundation (compact,stick)）粉底液：Base Líquida粉底霜：base cremosa粉饼: Polvos compactos(para fijar y matizar para ocultar los brillos de la piel)（pressed powder）散粉：Polvos sueltos ligero(para fijar y matizar para ocultar los brillos de la piel)（loose powder）闪粉：shimmering powder/glitter（这个也没买过……实在要的话，也不用问吧，一看就知道了吧……要不是polvo con brillos?）眉粉: polvo de cejas (brow powder)眉笔：Delineador（lápiz）de cejas(brow pencil)眼线液（眼线笔）：Delineador de ojos (liquido o lápiz)(liquid eye liner, eye liner)眼线膏：khol/Delineador de ojos cremoso眼影: sombras de ojos(eye shadow)睫毛膏: máscara de pastaña/Rimel（mascara）唇线笔:Delineador de labio/perfilador de labio（lip liner）口红:Lápiz labial（lip color/lipstick（笔状lip pencil，膏状lip lipstick，盒装lip color/lip gloss））唇彩: Brillo de labios（lip gloss/lip color）腮红: blush/Rubor/ colorete（blush）卸装水: Loción de desmaquillante (makeup remover)卸装乳: Leche desmaquilladora/ Leche limpiadora(makeup removing milk)卸妆凝胶：Gel Desmaquillante卸妆油：aceite desmaquillante(这个我不确定，因为没在这里看到过，我就类推咯……)眼唇卸妆液：Desmaquillante para Ojos y labios帖在身上的小亮片: las lentejuelas en el cuerpo(body art)美甲：Estética de uñas(manicure/pedicure)指甲油: laca de uñas/ esmalte (nail polish/color/enamel)去甲油：quitaesmalte(nail polish remover)护甲液：protector de uñas(Nail saver)亮油：brillo protector fijador指甲刷：cepillo de uñas夹趾器：separadoe de dedos洗发水: champú(shampoo)护发素: Acondicionado r(hair conditioner)锔油膏:conditioning hairdressing/hairdressing gel /treatment(不知和染发剂有什么区别……)摩丝: mousse/fijador con espuma para pelos（mousse）弹力素：agua de peinado发胶: gel Fijador (pelo) (hair gel)染发: coloración(hair color)冷烫水: perm/perming formula(这是什么……)卷发器: rollos de pelo（rollers/perm rollers）工具: instrumentos de cosmético（cosmetic applicators/accessories）粉刷: brocha de cosmético（cosmetic brush, face brush）粉扑: aplicador de polvo（powder puffs）海绵（卸妆海绵或者化妆海绵）：esponja(desmaquilladora o para maquillaje)（sponge puffs）（注：卸妆的呢就是那种洞洞大大的那种，化妆的呢就是那种扁扁圆圆的或者还有呢就是那种三角的啊，圆的啊，花型的啊等等）眉刷：Cepillo para cejas睫毛夹: Rizador de pestañas/ rezapestaña(lash curler)眼影刷: Pincel con esponjita/ Pincel alargado de cerdas cortas(eye shadow brush/shadow applicator)那种扁扁的刷子：brochas de arrastre口红刷:Pincel de labios（lip brush）胭脂扫: Brocha para rubor/Brocha gorda(blush brush)转笔刀: sacapuntas(doble filos) (pencil sharpener)电动剃毛器: electric shaver-for women(又没用过……不好意思了……)脱毛膏：depilatorio电动睫毛卷: electric lash curler描眉卡: brow template纸巾: pañuelo de papel（facial tissue）吸油纸: Láminas secantes (oil-Absorbing Sheets)化装棉: almohadilla de algodón（cotton pads）棉签: bastoncillo（Q-tips）睫毛刷：peine para pestañas修甲剪刀：tijera uñas角质剪（就是那种头头翘起来的那种剪刀啦）：Tijera pieles大指甲剪：Cortauña grande小指甲剪：Cortauña pequeño指皮推（金属）：Cortacutícula死皮剪（就是那种像钳子一样的）：Alicate pieles指甲钳（其实就是大一点的死皮剪啦）：Alicate uñas桔梗棒（就是用来去指甲缝里的污垢的）：Palito de naranjo大小矬子（就是表面最粗糙的那种）：Lima corindón(pequeño o grande)修形挫（就是稍微光一点的那种）：Lima decorada(recta o cuevada)抛光挫（就是最光的那种）：Lima pulidora(pule y abrilllanta)金属支架锉刀：Lima zafiro(acero)玻璃锉刀（通常都是两面）：Lima fibra de vidrio(doble cara)拔眉毛的镊子：Pinza para depilar cejas这里呢再补两个句子，很有用噢，是我自己去买东西的时候学会的：1，买粉底的时候可以和小姐说要和肤色接近的，因为这里的人都爱偏深一色号的，所以买的时候最好和小姐说清楚你的要求：Quiero que el tono de la base sea lo más parecido al color de mi piel.2，现在都很流行自然的妆容，那要怎么说呢？Quiero un efecto más natural.千万不能少了efecto啊，不然人家以为你要化妆品的成分是纯天然的呢，我就吃过亏哦，搞得很狼狈，鸡同鸭讲啊……。
急性间质性肾炎课件
AIN
七、治疗 1, 去出病因
首先停用有关药物、去除病因。 2, 支持疗法
如有急性肾衰竭, 存在透析指征时, 可考虑 行血液透析或腹膜透析治疗。 3, 肾上腺皮质激素的应用
六、诊断与鉴别诊断 （一）诊断
无统一的诊断标准。 *Baldwin(1968年）和Ooi（1975年）提出如有ARF、 伴有发热、皮疹或有嗜酸白细胞增多可诊断AIN。 *Laberke（1980年）首次提出急性过敏性间质性肾炎综合征的概念。
包括发热、皮疹、嗜酸细胞增多、血尿、肾功能下降、贫血等。
15
5
AIN
药物对肾脏组织损害的分类 1，药物阻塞性肾病：药物通过在肾小管释出结 晶、诱发肾结石或促进血凝块而后损害肾脏或堵 塞输尿管而致病。 析出结晶阻塞肾小管：磺胺、大量的氨甲蝶呤。 诱发肾石症：乙酰唑胺、维生素D.噻嗪类。 形成血块阻塞输尿管：氨基己酸、氨甲苯酸。 2，药物对肾小管和间质的直接损害：
菌星、悉能等。 （五）其它抗生素: Oxytetracycline、Doxycycline、Tetracycline、
Eryhromycin、Chloramphenicol、Vancomycin （六）非类固醇抗炎药
Indomethacin、Ibuprofen、piroxicam、Aspirin、氨基比林等。 （七）利尿药
*新型青霉素I等药物所致的AIN, 血循环中可 测到TBM抗体；
10
AIN
五、临床表现
（一）全身过敏反应:
1，药物热
文拉法辛+艾司西酞普兰治疗老年焦虑症的临床效果及不良反应分析
经验体会 Jingyantihui 《中外医学研究》第18卷 第36期（总第476期）2020年12月- 126 -①河池市复退军人医院 广西 河池 547000文拉法辛+艾司西酞普兰治疗老年焦虑症的临床效果及不良反应分析莫琳瑛①【摘要】 目的：观察老年焦虑症以文拉法辛配合艾司西酞普兰实施治疗对其临床效果及不良反应的影响。
方法：以2018年5月-2020年1月笔者所在医院接治的78例老年焦虑症患者为探究对象，按随机数字法分为常规组（n =39）和综合组（n =39），常规组接受单一用药（文拉法辛），综合组接受双向用药（文拉法辛+艾司西酞普兰），对比两组临床疗效及不良反应发生率等。
结果：综合组治疗总有效率高于常规组，综合组治疗后1、2、4周HAMA 评分均低于常规组，综合组不良反应发生率低于常规组，差异均有统计学意义（P <0.05）。
结论：老年焦虑症以文拉法辛配合艾司西酞普兰实施治疗效果显著，值得借鉴。
【关键词】 老年焦虑症 文拉法辛 艾司西酞普兰 临床效果 不良反应 doi：10.14033/ki.cfmr.2020.36.050文献标识码 B文章编号 1674-6805（2020）36-0126-02 Analysis of Clinical Effects and Adverse Reactions of Venlafaxine + Escitalopram in Treatment of Senile Anxiety Disorder/MO Linying. //Chinese and Foreign Medical Research, 2020, 18(36): 126-127 [Abstract] Objective: To analyze and observe the effect of Venlafaxine combined with Escitalopram on the clinical effect and adverse reaction rate of senile anxiety disorder. Method: A total of 78 elderly patients with anxiety disorder admitted to the author's hospital from May 2018 to January 2020 were studied, according to the random number method, they were divided into the regular group (n =39) and the comprehensive group (n =39), the regular group received single drug (Venlafaxine) and the comprehensive group received two-way drug (Venlafaxine + Escitalopram), the clinical efficacy and adverse reaction rate of the two groups were compared. Result: The total effective rate in the comprehensive group was higher than that of the regular group, the HAMA scores at 1, 2 and 4 weeks after treatment in the comprehensive group were all lower than those in the regular group, The incidence of adverse reactions in the comprehensive group was lower than that in the regular group, the difference was statistically significant (P <0.05). Conclusion: The effect of Venlafaxine combined with Escitalopram in treatment of senile anxiety disorder is remarkable and worthy of reference. [Key words] Senile anxiety disorder Venlafaxine Escitalopram Clinical effect Adverse reactions First-author ’s address: Hechi City Retired Military Hospital, Hechi 547000, China 焦虑症是当下临床多发性精神类病症，其是指人体长时间处于紧张、惧怕及焦虑等状态下，同时伴运动性不安等特征的一种焦虑效应。
B. Braun Midline Catheter 使用说明书
Information to nurse care services was delivered by a phar-macy intern and a public health nurse after each insertion and during changes in dressings.Medical criteria(indica-tions,complications,catheter operating times and removal reasons)and handling criteria(evaluation sheet by installers) were listed.Results Mean age was74±15years(G1)and70±17years (G2).There were seven successful insertions and three failures due to venous access difficulties in G1;there were eight inser-tions in G2.Midlines were placed by anaesthetist(94%of cases)for antibiotic therapy or nutrition.Median catheter use duration was7(2–24)days for G1 and15.5(1–65)days for G2.The reasons for withdrawal were:end of treatment(28.6%G1,37.5%G2),accidental withdrawal by the patient(28.6%G1,12.5%G2),thrombosis (14.3%G1),clogged catheter(12.5%G2),death(12.5%G2) and worsening of health(14.3%G1).Positive opinions were expressed regarding the length of the catheter(100%G1vs33%G2)and ease of installation (86%G1vs67%G2).Comments were made for G1(“rigid guide”)and for G2(“complexity of handling a peel-away sheath”);80%of installers who tested both devices preferred the Smartmidline.Conclusion and relevance The various clinical situations and small number of patients made the medical criteria not rele-vant to make a choice.The handling criteria and practicality of the Smartmidline,as evaluated by caregivers,led to its rec-ommendation.T o secure its use,a hygiene protocol has been implemented in the hospital.T o facilitate the interface between hospital and community carers,instructions for patients,doctors and pharmacists have to be reinforced.REFERENCES AND/OR ACKNOWLEDGEMENTSNo conflict of interest.Section3:Production and Compounding3PC-001COMPATIBILITY AND STABILITY ASSESSMENT OF A SODIUM GLYCEROPHOSPHATE FORMULATION MIXEDIN BAGS FOR NEONATAL TOTAL PARENTERALNUTRITION1A Isoardo*,1E Grande,1MM Ferrero,1M Viglione,2B Rolando,2R Fruttero,1C Fruttero. 1Ao S Croce E Carle,SC Farmacia Ospedaliera,Cuneo,Italy;2UniversitàDegli Studi Di Torino,Dipartimento Di Scienza E Tecnologia Del Farmaco,Torino,Italy10.1136/ejhpharm-2020-eahpconf.48Background and importance At the end of2018there was a shortage and withdrawal from the market of D-fructose-1,6-diphosphate(Esafosfina),a phosphate source for the extempo-raneous preparation of bags for neonatal total parenteral nutrition(TPN).Therefore,a solution of sodium glycerophos-phate(Natriumglycerophosphat-Ampulle Fresenius)was imported from abroad.This solution is different because it contains L-malic acid as an excipient.No stability data on Natriumglycerophosphat-Ampulle Fresenius in TPN bags were found in the literature.Aim and objectives T o test the compatibility and stability of Natriumglycerophosphat-Ampulle Fresenius in TPN bags we prepared.Material and methods Neonatal TPN formulations are custom-ised:therefore,we identified three test formulations,with varying concentrations of phosphate,calcium and magnesium (critical components),with and without lipids.T urbidity and pH controls were planned at appropriate time intervals(0, 24,48,72and96hours after preparation)and under differ-ent storage conditions(room temperature,refrigerated and at 37°C).These controls were performed either with lipid free or with all in one formulations(all components,including lip-ids,are mixed in the same bag).Results In lipid free formulations there was no formation of a precipitate at room temperature or under refrigerated condi-tions.The absorbance of the solutions at600nm(turbidity reading)remained below0.010,which means no evidence of precipitation.There was precipitate formation under storage condition at37°C(after72hours in test bags No1and No2 and after96hours in bag No3).The determining factors of the formation of this precipitate are alteration and degradation of the amino acids and the resulting pH reduction.In all in one formulations,we assessed stability with a microscope. Coalescence started in a bag48hours after preparation.Solu-tion pH ranged from5.5to6.5.Conclusion and relevance Sodium glycerophosphate(Natrium-glycerophosphat-Ampulle Fresenius)can be mixed with the usual components for neonatal TPN.In the test formulations there was no physical or chemical incompatibility.Lipid free formulations were stable for at least96hours.All in one for-mulations should be infused within24hours,especially if the amount of lipids is high.REFERENCES AND/OR ACKNOWLEDGEMENTSNo conflict of interest.3PC-002MICROBIOLOGICAL STABILITY TEST OF15%TOPICAL RESORCINOL FOR QUALITY CONTROL1J Cordero-Ramos,2M Delgado-Valverde,1V Merino-Bohórquez,1C Castillo-Martin*, 1FJ Falcón-Rodríguez,1M Cameán-Fernández.1Hospital Universitario Virgen Macarena, Hospital Pharmacy,Seville,Spain;2Hospital Universitario Virgen Macarena,Microbiology Department,Seville,Spain10.1136/ejhpharm-2020-eahpconf.49Background and importance Hidradenitis suppurativa(HS)is an inflammatory skin disease that causes painful boils and abscess formation,especially localised in intertriginous areas. Resorcinol is a phenol derivate,and in topical self-treatment decreases the size and pain of HS lesions.T opical15%resorcinol is prepared as a pharmaceutical compound and there are no data in the current literature on the microbiological stability of formulations of topical resorci-nol15%.The European Pharmacopoeia(EP)established acceptance criteria(chapter 5.1.4)for microbiological quality control of the compound.Previous to the microbiological quality assay,the EP also established the necessity of a suit-ability test of the method.Aim and objectives The objective of the study was to develop a microbiological growth assay to perform a microbiological stability test for quality control of this resorcinol formulation. Material and methods The composition of the formulation of topical resorcinol15%tested was:resorcinol15g,purified water15g,sodium metabisulfite0.1g and lanette base cream qs100g.T o determine the ability of microorganisms to grow in the formulation,several reference strains,according to the EP (chapters 2.6.12and 2.6.13)were selected:PseudomonasA22EJHP2020;27(Suppl1):A1–A232 on December 24, 2023 by guest. Protected by copyright./ Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2020-eahpconf.48 on 24 March 2020. Downloaded from。