从“肺常不足”论呼吸道病毒易感性

呼吸道病毒感染的易感机制不外病原因素和宿主因素两端,儿童之所以较成人易感,与小儿体质特点,特别是小儿"肺常不足"生理病理特点相关,掌握二者关系,对于指导小儿肺系的疾病预防治疗具有重要的意义。     

王力宁教授诊疗小儿肺系疾病经验介绍

介绍王力宁教授采用诊察小儿下眼睑瘀黑征和体质辨识相结合的方法诊疗小儿肺系疾病的临床经验,丰富了中医儿科望诊在临床中的应用。     

王力宁教授关于小儿体质与用药特点的学术经验总结

王力宁教授认为小儿的疾病和治疗与体质密切相关,掌握小儿不同体质的发病特点有利于临床的辨证论治。强调临证时应重视小儿体质的辨识,做到辨病、辨证与辨体质相结合。体质可分可调,临床上针对不同体质类型的患儿应因质施养,因质施治。附案例1则,以资验证。     

从少阳胆论治小儿发热

目的探讨小儿发热的病机及其与少阳胆的关系。方法结合实例,分析小儿体质的特点及其发病机制与少阳胆的关系,辨证施治。结果与结论小儿脏腑娇嫩,形气未充,胆气怯弱,但禀春生之气,生机蓬勃,邪气侵犯常杀阳升之气,故易伤少阳;少阳即是阳气初生之意,其阳气虽不至盛,但寓轻清冲和之气,禀清阳上升之性。小儿体质及发病与少阳胆之生理病理极其相似,故小儿发热从少阳胆论治,疗效确切。     

体质学在中医儿科临床中的应用研究

小儿体质学说在我国中医中已有了较为久远的应用历史,其中的经典共性学说包括:五藏有余不足、纯阳和稚阴稚阳等都较为全面地说明了小儿体质所存在的可塑性、多变性和不足性;而其个性学说又与共性学说存在较大的区别,所以,在中医临床治疗过程中,形成对小儿体质个性和共性的认识,是整个治疗过程得以顺利实施的关键,更能够从总体上把握中医儿科临床疾病的发展变化和小儿易感疾病的主要类型,对中医儿科临床疾病的预防、科学用药和辨证施治等都具有重要的指导意义。     

中医学对小儿体质的研究初探

针对小儿体质的形成、特点,运用中医学对小儿体质的保健及用药特点进行了总结。指出积极改善小儿体质,可减少相关疾病的发生,有利于未病先防。随着中医小儿体质学说的深入研究,以调整体质和恢复健康为中心的体质治疗学将得到充分发展,为现代小儿临床疑难病证的治疗提供新的途径。     

药物性肺损伤的研究现状

药物性肺损伤是药物在呼吸系统，包括肺、支气管、肺血管及胸膜等出现的药物不良反应的总称。其发病率逐年升高，且药物种类不断增多。因具有病变多样性、个体差异性以及诊断困难性的临床特点，易延误最佳诊治时期。药物性肺损伤的发病机制的认知有限，可分为细胞毒性和过敏反应。药物性肺损伤的临床类型复杂多变，包括气道疾病、肺泡与间质疾病、肺血管疾病、胸膜疾病及全身表现等。药物性肺损伤重在预防，临床医生需熟悉药物的副作用并进行用药监测。及时发现、早期诊断、立即停药是治疗的关键。本文着重介绍药物性肺损伤的临床特点、发病机制、常见的临床类型以及预防与治疗，旨在为医护人员早期识别药物性肺损伤提供参考，提高安全意识，以减少药物性肺损伤的发生。     

利用圆形分布对我院肺源性心脏病入院高峰进行分析

肺源性心脏病(简称肺心病)是对老年人危害较大的疾病，具有反复发作、迁延时间较长的特点。为此我们对其发病时间作一个统计，以便病人及家属掌握易发病时间，对该病采取积极预防措施，减少发病及减轻症状，提高生活质量，同时也让医院管理部门及临床工作者做到心中有数，合理安排技术力量，减少工作中的盲目性。     

小儿体质特点与小儿肾病关系的探讨

探讨小儿“三有余，四不足”及“小儿稚阳未充，稚阴未长”等体质特点与小儿肾病的发生、发展、病理变化和治疗的相关性。正确认识小儿体质的特点及其与小儿肾病的证的关系，以期利用小儿体质特点指导本病的诊断、治疗及复发和并发证的预防。     

小儿常见变态反应性皮肤疾病的中医临床体质类型研究

目的研究小儿常见变态反应性皮肤疾病(过敏性)的中医临床体质类型及相关规律。方法按照小儿临床体质的分类标准对纳入临床观察的湿疹、荨麻疹、丘疹性荨麻疹共354例样本进行临床体质分类研究。结果患湿疹和荨麻疹的小儿分别有肺热阳盛质、痰湿腻滞质、阴虚燥红质、气虚倦怠质、阳虚迟冷质5类临床体质,丘疹性荨麻疹有肺热阳盛质、痰湿腻滞质、阴虚燥红质、气虚倦怠质4种临床体质类型。3种疾病小儿的中医临床体质类型均以肺热阳盛质、湿热腻滞质、阴虚燥红质、气虚倦怠质、阳虚迟冷质所占研究总数的比例分布由高到低呈递减趋势;3种疾病小儿临床体质类型的排序均有相同规律。结论该项研究结果将有助于掌握小儿常见变态反应性皮肤疾病的发生、变化与预后转归的临床规律,对研究制定异病同质同治、辨质论食调养的综合方案、以达"已病防变"有重要价值。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.