α-硫辛酸联合甲钴胺及前列地尔治疗糖尿病周围神经病变的疗效观察

目的评价α-硫辛酸联合甲钴胺及前列地尔治疗糖尿病周围神经病变（DPN）的疗效。方法将32例患者随机分为两组：治疗组予α-硫辛酸、甲钴胺及前列地尔,对照组予甲钴胺及前列地尔,治疗2周。观察两组临床疗效及神经传导速度（NCV）。结果治疗组总有效率达87．5％,明显高于对照组的50％（P〈0．05）;两组患者的神经病变主觉症状问卷（TSS）评分明显改善（P〈0．05）;治疗组NCV较对照组有显著提高（P〈0．01）。结论临床使用旷硫辛酸联合甲钴胺及前列地尔治疗DPN安全有效。     

α-硫辛酸联合甲钴胺治疗糖尿病周围神经病变的疗效观察及与血浆同型半胱氨酸、超敏C反应蛋白的相关性分析

目的 观察α-硫辛酸联合甲钴胺治疗糖尿病神经病变(DPN)的疗效及与血浆同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)的相关性.方法 将160例2型糖尿病合并DPN患者随机分为对照组和联合治疗组,每组各80例.单用甲钴胺组(对照组):给予甲钴胺500 μg,静脉推注,每日1次.硫辛酸联合甲钴胺治疗组(联合治疗组):在对照组的基础上加用α-硫辛酸0.6加入生理盐水250ml,静脉滴注,每日1次,两组疗程均为14天.观察两组患者治疗前后临床症状的改善情况,同时监测其神经传导速度与血浆Hcy、hs-CRP水平在治疗前后的变化.结果 硫辛酸联合甲钴胺治疗组的临床症状改善情况明显优于单用甲钴胺治疗组,其TSS评分比较差异有统计学意义(P＜0.05),神经传导速度亦明显增加(P＜0.05);两组患者治疗后血浆Hcy及hs-CRP水平均明显降低,差异有统计学意义(P＜0.05);但联合治疗组血浆hs-CRP较对照组降低更明显,具有统计学意义(P ＜0.05);Hcy水平低于对照组,但差异无统计学意义(P＞0.05).结论 α-硫辛酸联合甲钴胺可显著改善DPN患者的临床症状,疗效优于单独使用甲钴胺,其作用机制可能与硫辛酸抗炎症损伤、抗氧化应激及保护血管内皮作用有关.     

α-硫辛酸联合甲钴胺、依帕司他治疗糖尿病周围神经病变的临床研究

将DPN 76例患者随机分成两组。A组:α-硫辛酸联合甲钴胺、依帕司他,B组:甲钴胺联合依帕司他,连续治疗三周。比较两组治疗前后症状、体征和神经传导速度。结果两组患者的神经症状和体征及神经传导功能都得到明显改善,其应用α-硫辛酸联合甲钴胺、依帕司他治疗组可以更加明显改善DPN患者症状及体征,更明显增加神经病变组织的传导速度,疗效显著。结论运用α-硫辛酸联合甲钴胺、依帕司他治疗糖尿病周围神经病变,可显著提高临床疗效,改善患者的生活质量。     

糖尿病周围神经病变采用α-硫辛酸联合甲钴胺治疗的效果探究

目的探讨糖尿病周围神经病变采用α-硫辛酸联合甲钴胺治疗的效果。方法该院100例2017年1月—2018年12月糖尿病周围神经病变患者。随机分组,甲钴胺治疗组对于糖尿病周围神经病变患者采取甲钴胺治疗,α-硫辛酸联合甲钴胺组则对于糖尿病周围神经病变患者采取α-硫辛酸+甲钴胺治疗。比较两组糖尿病周围神经病变疗效;疼痛感觉消失的时间、麻木消失的时间、烧灼感消失的时间;治疗前后患者正中神经传导的速度;不良反应发生率。结果α-硫辛酸联合甲钴胺组疗效比甲钴胺治疗组高(P0.05)。其中,甲钴胺治疗组治疗后显效16例,治疗后有效24例,治疗后无效10例,总有效率80.00%;α-硫辛酸联合甲钴胺组治疗后显效34例,治疗后有效16例,治疗后无效0例,总有效率100.00%。治疗前甲钴胺治疗组、α-硫辛酸联合甲钴胺组正中神经传导的速度相近(P0.05);治疗后α-硫辛酸联合甲钴胺组正中神经传导的速度变化幅度更大(P0.05)。α-硫辛酸联合甲钴胺组疼痛感觉消失的时间、麻木消失的时间、烧灼感消失的时间短于甲钴胺治疗组疼痛感觉消失的时间、麻木消失的时间、烧灼感消失的时间(P0.05)。α-硫辛酸联合甲钴胺组和甲钴胺治疗组不良反应发生率相似(P0.05)。结论α-硫辛酸+甲钴胺治疗糖尿病周围神经病变效果确切,可有效改善临床症状和神经传导速度,且无明显不良反应,安全性高。     

甲钴胺联合硫辛酸治疗糖尿病周围神经病变的临床疗效

目的观察甲钴胺联合硫辛酸治疗糖尿病周围神经病变(DPN)的临床疗效。方法选择广西壮族自治区桂东人民医院2015-01-10—2017-05-31收治的DPN患者260例,采用随机数字表法分为对照组和观察组,每组130例。在常规治疗基础上,对照组患者采用甲钴胺治疗,观察组患者采用甲钴胺联合硫辛酸治疗。比较两组患者临床疗效,治疗前后密歇根糖尿病神经病变计分法(MDNS)评分、糖化血红蛋白及空腹血糖。结果观察组患者总有效率为83.85%,高于对照组的48.46%(P<0.05)。治疗前两组患者MDNS评分比较,差异无统计学意义(P>0.05),治疗后观察组患者MDNS评分低于对照组(P<0.05)。两组患者治疗前后糖化血红蛋白、空腹血糖比较,差异无统计学意义(P>0.05)。结论甲钴胺联合硫辛酸治疗DPN的临床疗效确切,可有效改善患者临床症状。     

α-硫辛酸与甲钴胺联合治疗糖尿病周围神经病变的疗效及对氧化应激和炎症反应的影响分析

目的分析α-硫辛酸与甲钴胺治疗糖尿病周围神经病变的疗效及对氧化应激和炎症反应的影响。方法 2016年1月—2018年1月间将120例糖尿病周围神经病变患者平均分为对照组与研究组,对照组甲钴胺治疗,研究组联合甲钴胺与α-硫辛酸治疗,观察疗效。结果治疗后,研究组TSS评分、TCSS评分、血糖指标与氧化应激及炎症反应指标均优于对照组(P0.05)。结论糖尿病周围神经病变,α-硫辛酸与甲钴胺联合治疗,疗效满意。     

木丹颗粒联合甲钴胺、α-硫辛酸治疗糖尿病周围神经病变的疗效观察

目的观察木丹颗粒联合甲钴胺、α-硫辛酸治疗糖尿病周围神经病变(DNP)的临床疗效。方法将52例DNP患者随机分为观察组和对照组,在运动、饮食、糖尿病教育及血糖、血压、血脂得到有效控制基础治疗之上,观察组用木丹颗粒联合甲钴胺、α-硫辛酸治疗,对照组用甲钴胺、α-硫辛酸治疗,疗程2周。观察治疗前后的症状改善情况,测定优势侧神经传导速度。结果⑴组间有效、显效、无效率比较差异有统计意义(P<0.05),观察组疗效显著。⑵自身前后对照:两组神经传导速度均有改善,以观察组改善更显著。结论木丹颗粒联合甲钴胺、α-硫辛酸治疗糖尿病周围神经病变疗效确切,优于甲钴胺、α-硫辛酸方案。     

甲钴胺联合α-硫辛酸治疗糖尿病周围神经病变临床疗效观察

将84例DPN患者随机平分为A组接受甲钴胺治疗,B组接受甲钴胺+α-硫辛酸治疗。结果 B组患者治疗后DPN症状积分低于A组(P 0. 05);后腓总神经、正中神经的感觉传导速度、运动传导速度均高于A组(P 0. 05);总有效率(95. 24%)高于A组(76. 19%)(P 0. 05);两组均未见不良反应发生。结论甲钴胺联合α-硫辛酸治疗DPN临床疗效好。     

α-硫辛酸与甲钴胺联合治疗糖尿病周围神经病变68例疗效对比分析

目的观察α-硫辛酸与甲钴胺合用治疗糖尿病周围神经病变的疗效。方法将68例确诊为2型糖尿病合并周围神经病变的患者作为观察对象,并随机分组,治疗组和对照组各34例,在控制血糖和改善循环的基础上,治疗组给予α-硫辛酸和甲钴胺联合治疗,对照组给予甲钴胺治疗,疗程2周,对照两组治疗前后临床疗效和神经传导速度的变化。结果治疗组显效14例,有效18例,总有效率94.1%,对照组显效7例,有效11例,总有效率67.6%(P0.05)。治疗前后两组患者神经传导速度差异有统计学意义(P0.05)。结论α-硫辛酸联合甲钴胺治疗糖尿病周围神经病变较单用甲古胺疗效显著。     

甲钴胺联合硫辛酸治疗糖尿病周围神经病变的临床疗效

目的观察甲钴胺联合硫辛酸治疗糖尿病周围神经病变(DPN)的临床疗效。方法选择广西壮族自治区桂东人民医院2015-01-10—2017-05-31收治的DPN患者260例,采用随机数字表法分为对照组和观察组,每组130例。在常规治疗基础上,对照组患者采用甲钴胺治疗,观察组患者采用甲钴胺联合硫辛酸治疗。比较两组患者临床疗效,治疗前后密歇根糖尿病神经病变计分法(MDNS)评分、糖化血红蛋白及空腹血糖。结果观察组患者总有效率为83.85%,高于对照组的48.46%(P0.05)。治疗前两组患者MDNS评分比较,差异无统计学意义(P0.05),治疗后观察组患者MDNS评分低于对照组(P0.05)。两组患者治疗前后糖化血红蛋白、空腹血糖比较,差异无统计学意义(P0.05)。结论甲钴胺联合硫辛酸治疗DPN的临床疗效确切,可有效改善患者临床症状。     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.     

Dénervation rénale pour HTA réfractaire sans anesthésie générale : intérêt d’un protocole MEOPA Morphine. Expérience préliminaire

Renal denervation using the technique of radiofrequency is used only recently for the treatment of resistant hypertension. Normally, it is done under general anesthesia because the ablation point technique is painful. We suggest an alternative to general anesthesia comprising an association of morphin 0.1 mg/kg IV to MEOPA (gas combining oxygen and azot protoxyd) delivered through an oxygen mask. Our series includes 12 consecutive patients treated between October 2011 and June 2013, the first five patients (group 1) have received only an hydroxizin and morphin sedation. Every five have felt the ablation painful, in two cases bearable pain (EVA < 5), in three cases intense (EVA > 5) pain leading to increasing doses of morphin, (total dose of 0.25 mg/kg in two cases, 0.17 mg in one case). For the seven following patients, a protocol including hydroxyzin, morphin and MEOPA given through a mask has been set up. Only one patient has felt a mild pain (EVA 5) leading to an increasing dose of morphin (total dose 0.17 mg/kg). None of the six other patients has felt any pain during the procedure. The average dose of morphin is 0.17 mg/kg in group 1, 0.11 mg/kg in group 2. This is a preliminary study; if confirmed, it will allow a lot of hospitals without on-site possibilities of general anesthesia, to realize such procedures. Conclusion: regarding pain, the procedure of renal ablation was well tolerated for six among seven patients receiving the association MEOPA and IV morphin. In contrast, in the five patients treated only with IV morphin, we observed a less good tolerance to pain and the need to increase the doses of IV morphin.     

Scale‐up of TB and HIV programme collaborative activities in Zambia – a 10‐year review

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000–2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti‐retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV‐infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co‐trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale‐up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti‐retroviral (ARV) rollout with improved treatment outcomes among TB patients co‐infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA).     

C-MET在非小细胞肺癌对表皮生长因子受体酪氨酸激酶抑制剂耐药中的作用研究进展

以表皮生长因子受体(EGFR)为靶点的酪氨酸酶抑制剂(TKI)是近年来非小细胞肺癌(NSCLC)治疗的重大突破.但是随着临床的广泛应用,耐药成为新的难点.新近研究已发现对EGFRTKI的耐药产生主要涉及原癌基因C-MET的扩增突变.C-MET是原癌基因,是蛋白产物肝细胞生长因子/离散离子(HGF/SF)的受体,具有酪氨酸酶活性,C-MET基因扩增激活ErbB3-PI3K信号途径导致NSCLC对EGFR-TKI产生耐药,大量研究证实NSCLC患者对EGFR-TKI耐药约20％归因于C-MET基因扩增.     

Artificial intelligence in pancreaticobiliary endoscopy

Artificial intelligence (AI) applications in health care have exponentially increased in recent years, and a few of these are related to pancreatobiliary disorders. AI‐based methods were applied to extract information, in prognostication, to guide clinical treatment decisions and in pancreatobiliary endoscopy to characterize lesions. AI applications in endoscopy are expected to reduce inter‐operator variability, improve the accuracy of diagnosis, and assist in therapeutic decision‐making in real time. AI‐based literature must however be interpreted with caution given the limited external validation. A multidisciplinary approach combining clinical and imaging or endoscopy data will better utilize AI‐based technologies to further improve patient care.