氟伐他汀防治缺血性心脏病心衰及其抗氧化应激作用的实验研究

目的:探讨羟甲基戊二酰辅酶A（HMG CoA）还原酶抑制剂氟伐他汀防治缺血性心脏病心衰疗效及其抗氧化应激作用。方法:雌性SD大鼠42只,急性心肌梗死（AMI）术后6h随机分为:①AMI对照组（n=24）;②氟伐他汀组（n=18）;③另设假手术组（n=10）。直接灌胃给药8周后行高频多普勒超声、血流动力学、心脏重塑指标、左心室α、βMHC的mRNA表达、心肌总抗氧化能力（TAOC）和丙二醛（MDA）测定。结果:与假手术组相比,AMI组左室舒张末期内径（LVEDd）、左室舒张末期容积（LVEDV）、E峰、E峰减速度、E/A、左室舒张末压（LVEDP）、左、右心室心肌肥厚指数、βMHCmRNA和MDA均显著增加,左室短轴缩短率（FS）、射血分数（EF）、αMHCmRNA和TAOC均显著降低。与AMI组相比,氟伐他汀组的LVEDd、LVEDV、E峰、E峰减速度、E/A、LVEDP和左、右心室心肌肥厚指数、βMHCmRNA及MDA均显著降低,FS、EF、αMHCmRNA和TAOC显著升高。结论:氟伐他汀能抑制心室重塑,预防缺血性心脏病心衰发生;抗氧化应激作用可能是其机制之一。     

氟伐他汀对心肌梗死后心力衰竭大鼠心肌单核细胞趋化蛋白-1表达的影响

目的:探讨羟甲基戊二酰辅酶A还原酶抑制剂氟伐他汀对急性心肌梗死(AMI)后心力衰竭(心衰)大鼠心肌单核细胞趋化蛋白-1(MCP-1)表达变化的影响。方法:雌性SD大鼠AMI术后6h随机分为:AMI对照组;氟伐他汀组;假手术组。直接灌胃给药8周后行高频多普勒超声、血流动力学、心脏重塑指标和左心室非梗死区心肌MCP-1mRNA表达的测定。结果:与假手术组比较,AMI组左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、E峰、E峰减速度、E/A、左心室舒张末压(LVEDP)、左心室、右心室心肌肥厚指数、左心室非梗死区胶原容积分数(CVF)和MCP-1mRNA表达均显著增加(P<0.01),左心室短轴速短率(FS)和射血分数(EF)均显著降低(P<0.01)。与AMI组比较,氟伐他汀组的LVEDD、LVEDV、E峰、E峰减速度、E/A、LVEDP和左心室、右心室心肌肥厚指数、CVF和MCP-1mRNA表达均显著降低(P<0.01),FS和EF显著升高(P<0.01)。结论:氟伐他汀能有效抑制心室重塑,延缓心衰进展,其机制可能部分通过下调心肌梗死后心衰大鼠心肌MCP-1的表达,抑制炎症反应。     

结缔组织生长因子在心力衰竭大鼠心肌中的表达及氟伐他汀的调节作用

目的观察结缔组织生长因子(CTGF)在心肌梗死后心力衰竭(心衰)大鼠心肌中的表达及氟伐他汀对其调节作用。方法制备大鼠心肌梗死模型术后6 h分为心肌梗死组24只、梗死后氟伐他汀治疗组18只、假手术组10只。给药8周后行超声、血流动力学、左、右心室相对重量(LVRW和RVRW)、左室非梗死区胶原容积分数(CVF)和CTGF mRNA及蛋白免疫印迹测定。结果与假手术组比较,心肌梗死组左室舒张末期内径(LVEDD)和容积(LVEDV)、E峰、E峰减速度、E/A、舒张末期压(LVEDP)、LVRW、RVRW、CVF、CTGF mRNA表达(分别为1．35±0．26和0．87±0．18)及蛋白质的产生(分别为1．21±0．23和0．49±0．15)增加(P＜0．01),左室短轴缩短率(FS)和射血分数(EF)降低(P＜0．01)。与心肌梗死组比较,氟伐他汀组的LVEDD、LVEDV、E峰、E峰减速度、E/A、LVEDP、LVRW、RVRW、CVF、CTGF mRNA表达(1．10±0．22)及蛋白质产生(0．73±0．24)降低(P＜0．05或0．01),FS和EF升高(P＜0．01)。结论CTGF参与了心肌梗死后心肌纤维化和心衰的进展,氟伐他汀抑制心肌梗死后心肌纤维化和心衰进展的机制部分与其下调CTGF表达有关。     

阿托伐他汀对慢性心力衰竭大鼠左室重构和功能的影响及可能的机制

目的探讨阿托伐他汀对异丙肾上腺素(ISO)诱导的慢性心力衰竭(CHF)大鼠左室重构和心功能的影响以及可能的机制。方法将ISO诱导的CHF大鼠随机分成ISO组与ISO 阿托伐他汀组,同时以正常大鼠为对照组。4周后行心动超声、血流动力学、血清细胞因子检查和心脏标本检测(左室质量／体质量)及RT-PCR 检测心肌基质金属蛋白酶-2(MMP-2)mRNA表达水平。结果 (1)与对照组比较,ISO组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室舒张末压(LVEDP)及左室压力最大下降速率(dp／dtmin)明显升高,左室收缩末压(LVESP)、左室压力最大上升速率(dp／dtmax)及左室短轴缩短率(FS)则明显降低(P<0．01);而ISO 阿托伐他汀组,LVESD、LVEDD、LVEDP、dp／dtmin和LVESP、dp／dtmax及FS值则介于对照组与ISO组之间,且与ISO组比较, LVESD、LVEDD、LVEDP及dp／dtmin明显降低,而LVESP、dp／dtmax及FS则明显升高(P<0．05);左室后壁厚度在 ISO组和ISO 阿托伐他汀组没有明显的不同(P>0．05)。(2)与对照组相比,ISO组和ISO 阿托伐他汀组左室质量／体质量(LVW／BW)明显增大(P<0．01);但与ISO组比较,ISO 阿托伐他汀组LVW／BW降低(P<0．05)。 ISO组MMP-2 mRNA表达水平较对照组明显升高(P<0．01),而ISO 阿托伐他汀组较ISO组降低(P<0．05)。 (3)ISO组大鼠血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平均比正常对照组显著升高(P<0．01); 与ISO组比较,ISO 阿托伐他汀组血清TNF-α和IL-α水平明显降低(P<0．05)。结论阿托伐他汀通过降低ISO诱导的CHF大鼠细胞因子水平,从而改善左室重构及心脏功能。     

普伐他汀对大鼠心肌梗死后心室重构和心功能的影响

目的探讨普伐他汀防治大鼠急性心肌梗死(AMI)后心室重构的作用。方法通过结扎冠状动脉前降支制成大鼠AMI模型,AMI后24h存活的24只大鼠随机分为AMI组12只,普伐他汀组12只;另设假手术组8只。术后24h普伐他汀组以普伐他汀20mg.kg-1.d-1直接灌胃给药,AMI及假手术组大鼠灌等量生理盐水,用药42d后,应用超声心动图测定心脏结构和功能,多导生理仪测定血流动力学参数,并用免疫组织化学法测定I、III型胶原表达及I/III型胶原比例。结果AMI组与假手术组比较,左室舒张末压〔LVEDP,分别为(25.00±2.52)(、3.71±1.95)mmHg〕、左室舒张末直径〔LVEDD,分别为(0.61±0.04)、(0.39±0.01)mm〕、左室及右室相对重量、I型胶原表达I、/III型胶原比例均显著增加(均为P<0.01);而左室压最大上升速率(dp/dtmax)和下降速率(dp/dtmin)、左室短轴缩短率(FS)、射血分数(EF)均显著下降(均为P<0.01)。普伐他汀使AMI组增加的LVEDP、LVEDD、左室及右室相对重量I、型胶原表达和I/III型胶原比例下降(P<0.05或0.01),使下降的dp/dtmax、dp/dtmin、EF、FS不同程度增加(P<0.05或0.01)。结论普伐他汀能缓解大鼠AMI后心室重构和改善心功能。他汀类药物可能有益于心力衰竭的治疗。     

氟伐他汀对急性心肌梗死家兔早期左室重构和心功能的影响

目的观察氟伐他汀对急性心肌梗死（AMI）家兔早期左室重构和心功能的影响。方法将梗死后24 h存活兔随机分成：AMI模型组（M组）、氟伐他汀组（F组）,另设假手术组（S组）。给药4周后,检测各组血流动力学变化,血脂、肌酐、肌酶、羟脯氨酸、基质金属蛋白酶2（MMP-2）水平。结果与假手术组比较,M组左室舒张末压（LVEDP）、左室重量（LVW）、左室重量指数（LVWI）、心肌羟脯氨酸、胶原蛋白、MMP-2含量均显著增加,左室收缩压（LVSP）、左室内压最大上升和下降速率（±dp/dtmax）均显著降低。与AMI模型组相比,氟伐他汀组LVEDP、LVW、LVWI、心肌羟脯氨酸和胶原蛋白、MMP-2含量均显著降低,LVSP、±dp/dtmax均显著增加。结论氟伐他汀具有改善AMI后心功能及早期左室重构的作用,减少心梗后心肌胶原和MMP-2合成的作用可能是其作用机制之一。     

瑞舒伐他汀对急性心肌梗死大鼠心肌重构的影响

目的探讨瑞舒伐他汀对急性心肌梗死(AMI)大鼠心肌重构的作用及机制。方法选择健康成年雄性SD大鼠,通过结扎冠状动脉左前降支建立AMI大鼠模型51只,按照随机数表法分成假手术组、模型组和瑞舒伐他汀组(他汀组),每组17只。他汀组大鼠灌胃给药瑞舒伐他汀钙片10 mg·kg-1·d-1,1次/d,另外两组大鼠给予等量的蒸馏水,连续给药6 w。采用彩色多普勒超声诊断仪检测心脏超声心动图,应用RT-PCR技术检测金属基质蛋白-2、9、10(MMP-2、-9、-10)、Perionstin蛋白及转化生长因子(TGF)-β1的含量。结果模型组和他汀组大鼠的左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD)均明显高于假手术组,左室射血分数(LVEF)显著低于假手术组(P0.05);与模型组相比,他汀组大鼠的LVEDD及LVESD明显下降,LVEF显著升高(P0.05)。与假手术组相比,其余两组大鼠心脏中MMP-2、-9、-10、Perionstin蛋白及TGF-β1 mRNA表达均明显升高(P0.05);其中他汀组大鼠心脏中MMP-2、-9、-10、Perionstin蛋白及TGF-β1 mRNA表达显著低于模型组(P0.05)。结论瑞舒伐他汀可以改善AMI大鼠心脏状态,通过调节MMP-2、-9、-10、Perionstin蛋白及TGF-β1 mRNA表达来调控其心肌重构,其作用机制可能与这些因素有关。     

木犀草素对心力衰竭大鼠心肌炎症反应和TLR4/MyD88/NF-κB信号通路的影响

目的观察木犀草素对心力衰竭大鼠心肌炎症反应和Toll样受体4/髓样分化因子88/核转录因子-κB(TLR4/MyD88/NF-κB)信号通路的影响,阐明木犀草素对心力衰竭的可能作用机制。方法将51只雄性SD大鼠采用随机数字表法分为假手术组(S组)、心力衰竭组(H组)和木犀草素治疗组(L组),各17只大鼠。采用开胸手术建立心力衰竭动物模型,L组大鼠给予50 mg/(kg·d)木犀草素(体积3 mL)灌胃。心脏超声测定左室射血分数(LVEF)、短轴缩短率(FS)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)。苏木精-伊红(HE)染色观察心脏组织形态学变化;Masson染色观察心肌组织胶原形成情况。采用双抗夹心酶联免疫吸附试验(ELISA)测定血清脑钠肽(BNP)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。采用蛋白免疫印迹法测定心肌组织IL-1β、IL-6、TNF-α、TLR4、MyD88、NF-κB p65蛋白表达水平。结果与S组比较,H组LVEF、FS降低(P<0.05),LVEDD、LVESD、LVEDV、LVESV增加(P<0.05);与H组比较,L组LVEF、FS升高(P<0.05),LVEDD、LVESD、LVEDV、LVESV降低(P<0.05)。HE染色:S组大鼠心肌组织正常;H组大鼠心肌坏死和炎症浸润严重;L组大鼠心肌坏死和炎症浸润明显减轻。Masson染色:与S组比较,H组胶原面积比增加(P<0.05);与H组比较,L组胶原面积比降低(P<0.05)。与S组比较,H组血清BNP、IL-1β、IL-6、TNF-α水平及心肌组织IL-1β、IL-6、TNF-α、TLR4、MyD88、NF-κB p65蛋白水平升高(P<0.05);与H组比较,L组血清BNP、IL-1β、IL-6、TNF-α水平及心肌组织IL-1β、IL-6、TNF-α、TLR4、MyD88、NF-κB p65蛋白水平降低(P<0.05)。结论木犀草素可抑制心力衰竭大鼠心肌炎症反应和TLR4/MyD88/NF-κB信号通路,发挥对心力衰竭的保护作用。     

瑞舒伐他汀对大鼠肥厚心肌组织PPARγ和NF-κB蛋白表达的影响

目的探讨瑞舒伐他汀对异丙肾上腺素(isoproterenol,Iso)诱导心肌肥厚大鼠心肌组织PPARγ和NF-κB表达的影响及其抑制心肌肥厚,改善心功能的机制。方法 40只雄性SD大鼠随机分为4组:正常对照组、模型组、瑞舒伐他汀组和卡托普利组,每组10只。除正常对照组外,各组背部皮下注射Iso建立心肌肥厚模型。模型制备成功后,瑞舒伐他汀组灌胃给予瑞舒伐他汀4 mg.kg-1.d-1,卡托普利组灌胃给予卡托普利50 mg.kg-1.d-1,其余两组灌胃给予等体积生理盐水。4 w末,分别测定各组大鼠左室收缩压(LVSP)、左室舒张末压(LVEDP)、左室压力上升及下降最大速率(±dp/dt max);测定大鼠体重(BW)、心脏重量(HW)及左心室重量(LVW),计算心脏重量指数(HWI)及左心室重量指数(LVWI);应用病理学方法观察心肌组织形态学改变;Western印迹法测定心肌组织PPARγ和NF-κB亚基p65蛋白表达。结果模型组大鼠LVEDP、HWI、LVWI明显高于正常对照组(P<0.01),LVSP和±dp/dt max明显降低(P<0.01);模型组PPARγ表达明显低于正常对照组(P<0.01),p65表达明显升高(P<0.01);瑞舒伐他汀组和卡托普利组PPARγ表达明显高于模型组(P<0.01),p65表达明显降低(P<0.01);瑞舒伐他汀组和卡托普利组比较,上述指标差异均无统计学意义(P>0.05)。结论瑞舒伐他汀抑制心肌肥厚,改善心功能,其机制与增加PPARγ表达,降低p65表达有关。     

瑞舒伐他汀对急性心肌梗死大鼠心肌重构的作用及其机制

目的探讨瑞舒伐他汀对急性心肌梗死(AMI)大鼠心肌重构的作用及其机制。方法选择健康成年雄性SD大鼠60只,通过结扎冠状动脉左前降支建立AMI大鼠模型51只,按照随机数表法分成假手术组、模型组和他汀组,每组各17只。他汀组大鼠灌胃给药瑞舒伐他汀钙片10 mg/(kg·d),1/日,另外两组大鼠给予等量的蒸馏水,连续给药6周。采用彩色多普勒超声诊断仪检测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD)。应用RT-PCR技术检测心肌组织基质金属蛋白酶-2/9/10(MMP2/9/10)、Perionstin蛋白及转化生长因子-β1(TGF-β1)m RNA表达情况。结果模型组和他汀组大鼠的LVEDD及LVESD均明显高于假手术组,LVEF显著低于假手术组,差异均具有统计学意义(P均0.05)。与模型组相比,他汀组大鼠的LVEDD及LVESD明显下降,LVEF显著升高,差异均具有统计学意义(P均0.05)。与假手术组相比,其余两组大鼠心肌组织中MMP-2/9/10、Perionstin蛋白及TGF-β1的m RNA表达均明显升高;其中他汀组大鼠心脏中MMP2/9/10、Perionstin蛋白及TGF-β1的m RNA表达显著低于模型组,且差异均具有统计学意义(P均0.05)。药物干预结束后,假手术组大鼠存活率为76.47%(13/17)明显高于模型组的41.18%(7/17)和他汀组的64.71%(11/17),同时他汀组的存活率显著高于模型组,且差异均具有统计学意义(P均0.05)。结论瑞舒伐他汀可改善AMI大鼠心脏功能,可能通过调节MMP2/9/10、Perionstin蛋白及TGF-β1的m RNA表达来调控其心肌重构。     

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.