左氧氟沙星联合阿莫西林克拉维酸钾治疗耐多药肺结核疗效观察

目的 观察左氧氟沙星联合阿莫西林克拉维酸钾对耐多药肺结核的临床疗效.方法 将110例耐多药肺结核患者随机分为对照组和治疗组,每组各55例,疗程均为12个月.对照组采用左氧氟沙星（V）、吡嗪酰胺（Z）、盐酸乙胺丁醇（E）、对氨基水杨酸异烟肼（D）、利福喷丁（L）方案治疗;治疗组在对照组用药基础上加用阿莫西林克拉维酸钾治疗.结果 疗程结束时治疗组的痰菌转阴率、病灶吸收率及空洞闭合率均明显高于对照组（P＜0.01）.结论 左氧氟沙星联合阿莫西林钠克拉维酸钾治疗耐多药肺结核疗效显著,能有效促进病灶吸收、痰茵阴转及空洞闭合.     

克拉维酸钾配伍阿莫西林治疗对老年肺结核外周血自然杀伤细胞表面受体及肺组织中B、T淋巴细胞衰减子表达的影响

目的探究克拉维酸钾联合阿莫西林治疗老年肺结核患者外周血自然杀伤细胞(NK)细胞表面受体和肺组织中B、T淋巴细胞衰减子(BTLA)表达的影响。方法选取老年肺结核患者120例,随机分成研究组和对照组,各60例,对照组采用左氧氟沙星治疗,研究组采用克拉维酸钾配伍阿莫西林并结合左氧氟沙星进行治疗,比较治疗前与治疗后3个月、6个月两组痰菌阴转率、肺部病灶吸收、空洞闭合率情况;并对两组治疗前与治疗后3个月、6个月NK细胞表面受体表达率、肺组织中BTLA表达情况及不良反应发生率进行比较。结果治疗前,两组各指标比较无统计学差异(P0.05);治疗后3个月,研究组痰菌阴转率、肺部病灶吸收有效率显著高于对照组(P0.05),治疗后6个月两组痰菌阴转率、肺部病灶吸收有效率比较差异无统计学意义(P0.05);两组治疗后3个月和6个月空洞闭合率、NK细胞表面受体表达率、肺组织中BTLA表达情况均较治疗前显著降低(P0.05),且研究组相比于对照组更低(P0.05);治疗期间两组不良反应发生情况比较差异无统计学意义(P0.05)。结论应用克拉维酸钾配伍阿莫西林治疗对老年肺结核疗效确切,不良反应发生较少,对于老年肺结核外周血NK细胞表面受体及肺组织中BTLA表达有显著调节作用。     

阿莫西林克拉维酸钾治疗老年肺结核的近期临床观察

目的分析老年肺结核患者采用阿莫西林克拉维酸钾分散片(4∶1)的个体化方案抗结核治疗的近期临床效果。方法以2012年1月至2013年6月收治的80例老年肺结核患者为研究对象,采用H(D)LE(左氧氟沙星)阿莫西林克拉维酸钾方案治疗9个月,另外选择80例老年肺结核接受2HLEZ(左氧氟沙星)/7HLE抗结核治疗作为对照组,观察半年痰菌阴转率和主要不良反应发生率。结果治疗组肝功能异常率5%(4/80),明显低于对照组37.5%(30/80),(P0.05);治疗组半年内痰菌阴转率90%(54/60),对照组为91.7%(55/60),(P0.05),两组近期疗效相当。结论对老年肺结核患者采用含阿莫西林克拉维酸钾分散片的联合治疗方案,近期疗效确切,药物不良反应少,病人耐受性好。     

利奈唑胺联合方案治疗耐多药结核病效果及不良反应研究

目的探讨含利奈唑胺联合方案治疗对耐多药结核病患者痰菌阴转率、病灶吸收情况、空洞变化情况及不良反应的影响。方法收集2012年1月—2017年12月于我院治疗的60例耐多药结核病患者临床资料,根据治疗方案将患者分为对照组与研究组。对照组治疗方案为左氧氟沙星、阿米卡星、吡嗪酰胺、丙硫异烟胺及对氨基水杨酸。研究组治疗方案为在对照组治疗方案基础上给予利奈唑胺治疗。比较2组患者痰菌阴转率、病灶吸收情况、空洞变化情况及不良反应。结果治疗6个月,研究组痰菌阴转率与病灶吸收有效率均大于对照组(P均<0.05),空洞变化有效率及不良反应发生率与对照组无显著差异(P均> 0.05)。结论含利奈唑胺联合方案治疗可提高耐多药结核病患者痰菌阴转率和病灶吸收有效率,但易发生血小板减少,贫血等不良反应,须定期进行血常规检查。空洞变化有效率及不良反应与对照组相同。     

左氧氟沙星及卷曲霉素方案治疗耐多药肺结核疗效分析

目的评价含左氧氟沙星和卷曲霉素联合化疗方案在耐多药肺结核(MDR-PTB)治疗中的疗效。方法将216例MDR-TB患者分为治疗组109例和对照组107例。化疗方案:治疗组以左氧氟沙星和卷曲霉素为主,联合利福喷汀、异烟肼、对氨基水杨酸钠、吡嗪酰胺;对照组用链霉素、乙胺丁醇,联合用药同治疗组,疗程均为21个月。结果189例患者完成化疗疗程,治疗组94例,痰菌阴转率85.1%;对照组95例,痰菌阴转率57.8%,痰菌阴转率治疗组明显高于对照组(P<0.01)。治疗组病灶显效率51%,空洞闭合率63.3%,治疗组优于对照组(P<0.01);治疗组的药物不良反应率为31%,对照组为35%,两组比较差异无显著性(P>0.05)。结论左氧氟沙星和卷曲霉素的方案治疗MDR-TB,痰菌阴转和病变吸收好转较优,药物不良反应低,值得在临床上推广应用。     

耐药肺结核80例治疗研究

目的观察和分析含莫西沙星方案治疗耐药肺结核的疗效。方法 2004年7月～2009年12月收治资料完整的80例耐药肺结核病例,分为治疗组40例,对照组40例。治疗组应用含莫西沙星联合抗结核化学药物,对照组应用含左氧氟沙星的抗结核化学药物。两组其他抗结核药物组成相同,疗程1年。结果两组病例疗程结束时,痰结核菌转阴率治疗组95.0%,明显高于对照组77.5%（P〈0.05）。治疗组病灶吸收和空洞闭合率分别为87.5%和60.6%;对照组病灶吸收率和空洞闭合率分别为70.0%和42.6%（P〈0.05）。结论在痰菌阴转、病灶吸收、空洞闭合方面含莫西沙星方案均明显优于含左氧氟沙星方案。     

益气养阴法辅助治疗耐多药肺结核的临床研究

目的观察益气养阴法辅助治疗耐多药肺结核的临床疗效及对T淋巴细胞亚群的影响。方法将58例耐多药肺结核患者随机分为治疗组30例,对照组28例,两组均采用3DThLAZ/15DThL化疗方案、治疗组同时服用抗痨汤30例。观察两组治疗后肺部病灶吸收、痰菌阴转、症状改善、免疫功能变化情况。结果治疗组与对照组3个月时痰菌阴转率分别为46.7%和21.4%,18个月时为56.7%和50.0%有显著差异（P〈0.05）;X线病灶吸收率及空洞缩小,闭合率,均有明显差异（P〈0.05）。结论益气养阴法能提高痰菌阴转率,有助于病灶吸收空洞闭合,减少不良反应的发生,可作为耐多药肺结核化疗的辅助治疗。     

卷曲霉素联合左氧氟沙星治疗复治涂阳肺结核的疗效分析

目的观察卷曲霉素联合左氧氟沙星治疗复治涂阳肺结核的临床疗效。方法按照随机数字表法将84例复治涂阳肺结核患者分为对照组和治疗组,各42例。对照组：采用3SEL2Pa Z/9EL2Pa治疗;治疗组：在对照组治疗基础上加用卷曲霉素联合左氧氟沙星治疗。观察两组痰结核菌阴转和X线胸片病灶吸收及空洞变化、不良反应情况。结果治疗2个月后,治疗组痰结核菌阴转率为85.71%（36/42）,明显高于对照组69.05%（29/42）（P〈0.05）;治疗组X线胸片病灶吸收率和空洞闭合率分别为73.81%（31/42）、61.90%（26/42）,与对照组64.29%（27/42）、40.48%（17/42）比较,P均〈0.05。此外,两组不良反应发生率比较,P〈0.05。结论复治涂阳肺结核患者采用卷曲霉素联合左氧氟沙星治疗,可促进患者痰菌转阴,加速病灶吸收和空洞闭合,且发生不良反应少。     

氧氟沙星联合丁胺卡那霉素治疗耐多药肺结核的疗效分析

目的观察氧氟沙星联合丁胺卡那霉素在治疗耐多药肺结核治疗中的作用。方法将耐多药肺结核患者71例随机分为2组:治疗组(38例)采用卡那霉素联合利福平、结核清及吡嗪酰胺、乙胺丁醇,疗程18个月。结果患者完成化疗疗程时;治疗组痰菌阴转率89.5%,优于对照组54.5%,(P<0.01);治疗组病灶吸收率94.7%,优于对照组57.5%,治疗组空洞闭合率71.9%,也优于对照组35.3%,(P<0.05)。结论氧氟沙星联合丁胺卡那霉素治疗耐多药肺结核痰阴转高,病变吸收好,药物不良反应低,值得在临床上推广应用。     

利福喷丁联合左氧氟沙星治疗初治菌阳肺结核近期疗效观察

目的 探讨利福喷丁联合左氧氟沙星治疗方案对初治菌阳肺结核的疗效.方法 将本院收治的96例初治菌阳肺结核患者随机分为对照组和治疗组各48例,分别给予2HRZE/4HRE和2HL2ZV/4HL2V治疗方案,在治疗2月、6月末比较两组患者痰菌阴转率、病灶吸收和空洞愈合情况.结果 治疗2月、6月末,治疗组痰菌阴转率为91.67%和100%、病灶吸收好转率为54.17%和77.08%、空洞愈合率为32.35%和55.88%;对照组明菌阴转率为72.92%和89.58%、病灶吸收好转率为37.50%和54.17%、空洞愈合率为12.5%和31.25%.两组之间以上指标比较,差异有统计学意义（P＜0.05）.结论 利福喷丁联合左氧氟沙星方案治疗初治菌阳肺结核疗效满意.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.