二巯基丙硫酸钠解救急性四次甲基二砜四胺中毒的疗效观察

我们分析总结了 1998年 3月至 2 0 0 0年 3月应用二巯基丙磺酸钠 (Ｎａ ＤＭＰＳ)解救急性四次甲基二砜四胺 (ＡＴＩ,毒鼠强 )中毒患者 39例的用法、用量及疗效 ,旨在探讨Ｎａ ＤＭＰＳ解救ＡＴＩ的基本方法 ,以供临床借鉴。1 临床资料 :所有患者均经气相色谱分析仪检测确诊为ＡＴＩ,中毒程度按邵孝[1] 主编的现代急诊医学进行判定。重度组 :男 8例 ,女 12例 ,年龄 18～ 78岁 ,均口服中毒 ,中毒至症状发作为数分钟至半小时 ,就诊时间多为发病后0 5～ 1ｈ内 ,1例约 2ｈ ,1例为 4ｈ ,1例中毒就诊时间不详。轻度组 19例为误食所致。男 15例 …     

呼吸系统疾病

呼吸系统疾病１９７硫酸镁治疗ＣＯＰＤ急性发作的疗效［英］／ＳｋｏｒｅｄｉｎＭＳ…∥ＡｒｃｈＩｎｔｅｒｎＭｅｄ．－１９９５，１５５（５）．－４９６～５００作者就硫酸镁治疗慢性阻塞性肺疾病（ＣＯＰＤ）急性发作的疗效进行了观察。患者７２例，年龄＞３５岁，男...     

转导人TIMP—2基因抑制癌浸润转移的实验研究

目的 外源性人ＴＩＭＰ－２基因在人ＬＡＫ细胞中的表达及其对胃癌浸润转移的抑制作用。方法 通过磷酸钙－ＤＮＡ共沉淀的方法将ＴＩＭＰ－２重组真核表达质粒ｐＬ（ＴＩＭＰ－２）ＳＮ转染兼性包装细胞ＰＡ３１７包装形成病毒颗粒。用病毒液感染人ＬＡＫ细胞,再以Ｎｏｒｔｈｅｒｎ杂交、ＳＤＳ－ＰＡＧＥ及反向酶谱试验进行表达及活性分析。用转基因ＬＡＫ细胞（ＬＡＫ／ＬＴ）２×１０＾６给胃癌转移模型腹腔内注射。结果 ＴＩ     

抗抑郁药治疗功能生消化不良的临床研究

目的 探讨精神、心理因素与功能性消化不良（ＦＤ）的关系及抗抑郁药对其的疗效。方法对２４例正常人和２４例ＦＤ患者进行汉密尔顿抑郁量表（ＨＡＭＤ）、汉密尔顿焦虑量表（ＨＡＭＡ）和症状自评量表（ＳＣＬ－９０）评分;用抗抑郁药、５－羟色胺再摄取剂（ＳＳＲＩ）帕罗西汀（赛乐特）和盐酸氟西汀（百优解）治疗ＦＤ患者,疗程均为８周,治疗后再行量表评分。结果 三种量表（ＨＡＭＤ、ＨＡＭＡ、ＳＣＬ－９０）评分对比,均     

卡托普利对NIDDM微白蛋白尿患者红细胞膜ATP酶活力和红细胞内离子水平的影响

测定２０例正常人及２０例ＮＩＤＤＭ伴微白蛋白尿患者红细胞膜ＡＴＰ酶活力和红细胞内Ｎａ＋、Ｋ＋、Ｃａ＋浓度。结果与正常组比较，ＮＩＤＤＭ微白蛋白尿患者Ｎａ＋－Ｋ＋－ＡＴＰ酶和Ｃａ＋＋－ＡＴＰ酶活力降低（Ｐ＜０．０５和Ｐ＜０．０１）；红细胞内Ｋ＋浓度降低（Ｐ＜０．０５），Ｎａ＋和Ｃａ＋＋浓度增高（Ｐ均＜０．０１）。给予ＮＩＤＤＭ微白蛋白尿患者卡托普利（１２．５ｍｇ，ｔｉｄ，×２周；２５ｍｇ，ｔｉｄ，×１４周）治疗１６周，红细胞Ｎａ＋－Ｋ＋－ＡＴＰ酶及Ｃａ＋＋－ＡＴＰ酶活力和红细胞内Ｎａ＋、Ｋ＋、Ｃａ＋＋浓度基本恢复正常，尿白蛋白排泄量减少。     

HLA—DR—DQ连锁基因单倍体与成人缓慢进展型和速发型1型 …

目的 探讨ＨＬＡ－ＤＲ－ＤＱ连锁基因单倍体与成人缓慢进展型１型糖尿病（ＳＰＩＤＤＭ）和速发型１型糖尿病（ＦＰＩＤＤＭ）的相关性。方法 利用ＰＣＲ／ＳＳＰ技术检测了５２例ＳＰＩＤＤＭ患者、３０例ＦＰＩＤＤＭ患者和１３０例正常人的ＨＬＡ－ＤＲ－ＤＱ连锁基因频率。结果 ①ＨＬＡ－ＤＱＡ１＊０３０１－ＤＱＢ１＊０２０１和ＤＱＡ１＊０５０１－ＤＱＢ１＊０２０１连锁基因单倍体与ＳＰＩＤＤＭ（Ｐｃ〈０．００１）     

老年急性心肌梗塞心率变异时域分析

目的分析急性心肌梗塞（ＡＭＩ）后老年患者心率变异（ＨＲＶ）时域指标，了解ＡＭＩ后ＨＲＶ变化。方法以多单位协作方式对１５７例ＡＭＩ后２周的老年患者行动态心电图检测ＨＲＶ时域法５项指标，并与健康老年组对比分析。数据经ＥｐｉＩｎｆｏ（６．０）统计软件处理。结果①ＡＭＩ患者的正常Ｒ－Ｒ间期标准差（ＳＤＮＮ）、平均值的标准差（ＳＤＡＮＮ）和标准差的平均值（ＳＤＮＮＩｎｄｅｘ）低于对照组（Ｐ＜０．０１），而相邻正常Ｒ－Ｒ间期差值的均方根（ＲＭＳＳＤ）和相邻正常Ｒ－Ｒ差值大于５０ｍｓ记数占总Ｒ－Ｒ间期数的百分比（ＰＮＮ５０）虽低于对照组，但无显著差异（Ｐ＞０．０５）。②ＡＭＩ后ＨＲＶ时域５项指标男、女性别间无显著性差异（Ｐ＞０．０５）。③ＳＤＮＮ、ＳＤＡＮＮ和ＳＤＮＮＩｎ－ｄｅｘ在心肌梗塞各部位间无显著差异（Ｐ＞０．０５），ＲＭＳＳＤ和ＰＮＮ５０前间壁低于下壁心肌梗塞（Ｐ＜０．０５）。结论老年人ＡＭＩ后ＨＲＶ降低。反映交感神经活性的ＳＤＮＮ、ＳＤＡＮＮ和ＳＤＮＮＩｎｄｅｘ和反映迷走神经活性的ＲＭＳＳＤ和ＰＮＮ５０２组指标变化不相同。     

系统性红斑狼疮患者血浆D-二聚体水平测定及其临床意义

目的 了解系统性红斑狼疮（ＳＬＥ）患者Ｄ－二聚体的水平测定及其临床价值。方法 用单克隆抗体乳胶凝集试验法测定５９例ＳＬＥ患者血浆Ｄ－二聚体水平。结果 （１）ＳＬＥ患者血浆Ｄ－二聚体水平较正常组显著增高（Ｐ〈０．００１）;（２）ＳＬＥ患者血浆Ｄ－二聚体水平与ＳＬＡＭ得分呈显著正相关（ｒ＝０．５５４,Ｐ〈０．００１）;（３）Ｄ－二聚体阳性组ＳＬＡＭ得分、发生血管炎、狼疮性肾炎均明显高于阴性组（Ｐ〈０．     

复方海蛇胶囊治疗老年及老年前期痴呆双盲研究

目的 观察复方海蛇胶囊（ＲＳＣ）治疗老年痴呆的临床疗效。方法 随机双盲法用药，共１０８例，治疗组５８例（单纯ＶＤ２２例、单纯ＡＤ３１例，ＡＤ±ＶＤ５例）；空白对照组５０例（ＶＤ２９例、ＡＤ１８例，ＶＤ合并ＡＤ３例），治疗组服ＲＤＣ，对照组服空白胶囊，均为每例每次６粒，每粒０．２８克，每日三次，疗程３个月。以ＭＭＳＥ、ＨＤＳ、ＷＭＳ评定疗效。结果 ①ＲＳＣ与对照组治后ＭＭＳＥ增值分别为２．８８０±１     

硫酸镁对慢性肺心病患者肺动脉高压的短期影响

临床上硫酸镁（ＭｇＳＯ４）对新生儿肺动脉高压（ＰＡＨ）的疗效已基本得到肯定［１］,但ＭｇＳＯ４能否降低慢性阻塞性肺疾病（ＣＯＰＤ）所致肺心病患者的ＰＡＨ,尚未见报道。我们用右心漂浮导管检测法观察静脉滴注ＭｇＳＯ４对慢性肺心病伴ＰＡＨ患者血流动力学及血气的短期影响,为临床治疗提供依据。对象　ＣＯＰＤ所致肺心病患者８例,男５例,女３例,年龄５３～７１岁,均符合第二次全国肺心病专业会议修定的诊断标准。无心衰或心衰已控制,右心导管检查证实患者在安静状态下的肺动脉平均压＞２０ｍｍＨｇ（１ｍｍＨｇ＝０１３…     

Aprotinin and Na2CaEDTA in experimental hemorrhagic pancreatitis in pigs

We have analyzed the effects of aprotinin and Na2CaEDTA on phospholipase A2 activity and on the outcome of experimental pancreatitis in pigs. Hemorrhagic pancreatitis was induced in 29 piglets by infusing Na-taurocholate and trypsin into the pancreatic duct with simultaneous intravenous injection of secretin. Twelve animals serving as controls had no specific treatment. Nine animals were treated with aprotinin and eight pigs with Na2CaEDTA. Ten of the control animals died within 24 h of the induction of pancreatitis, and two of them lived for a week. In the aprotinin group three piglets died within 24 h and two died during the next day; four animals lived for a week. In the Na2CaEDTA group five animals died within 24 h and one the next day; two animals lived for a week. In all the animals serum phospholipase A2 activity increased significantly (p less than 0.01), there being no differences between the groups. In those animals that lived for a week the phospholipase A2 activities decreased on the 2nd day. This decrease was seen in both treated groups. Aprotinin prolonged the survival time of the animals. This prolongation was statistically significant (p less than 0.05, chi-square test, logrank test). Na2CaEDTA did not improve the prognosis of the animals. Neither of the drugs given influenced the serum phospholipase A2 activities during the first hours of the disease.     

急性心肌梗死患者的直接经皮腔内冠状动脉成形术与溶栓治疗疗效比较

为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗     

Impact of infliximab therapeutic drug level monitoring on outcomes of patients with inflammatory bowel disease: A real-world experience from a Middle Eastern cohort

Background and study aimTherapeutic drug monitoring (TDM) through measurement of infliximab (IFX) trough levels and antibodies to infliximab (ATI) is performed to guide IFX intensification strategies and improve its efficacy. We conducted this study to explore the relationship between clinical and endoscopic/radiological remission and IFX and ATI levels in patients with inflammatory bowel disease (IBD) treated with IFX and to evaluate the appropriateness of treatment decision post TDM.Patients and methodsThis was a cross-sectional study of a cohort of adult patients with IBD. Serum IFX trough concentrations and ATI were measured.ResultsA total of 129 patients [104] with ulcerative colitis (UC) and 25 with Crohn’s disease (CD)] were included in this study, of whom 61.2% were men. The mean disease duration was 6.7 years, and 72% of patients with UC had extensive colitis. The mean serum IFX trough level was 4.1 µg/mL; the IFX trough levels were subtherapeutic in 75 patients (58%), therapeutic in 37 patients (29%), and supratherapeutic in 17 patients (13%). Positivity to ATI was found in 16 patients (12.4%). Only 43 patients (33.3%) underwent an appropriate change in therapy after TDM, patients with penetrating CD disease had low IFX levels and higher C-reactive protein levels at 12 months before TDM.ConclusionsPatients with IBD with therapeutic IFX levels tend to have increased endoscopic/radiological remission rates. However, an appropriate change in management based on TDM was absent in the majority of patients, potentially reflecting the need to have a dashboard to support and guide clinicians in decision-making.     

A multicenter prospective study on the treatment of chronic idiopathic thrombocytopenic purpura.

A multicenter prospective study on the treatment of chronic idiopathic thrombocytopenic purpura (ITP) was conducted by the Idiopathic Disorders of Hematopoietic Organs Research Committee (IDHORC), the Ministry of Health and Welfare of Japan. The aim of the study was to establish an improved therapeutic guide for chronic ITP. Of the 247 eligible patients 175 have been followed up to the present time, 16 patients have died, and 56 have been lost to follow-up. The median follow-up time was 55 months (range: 1 to 91 months). Of the 206 patients treated with corticosteroids, 13.1% achieved sustained complete remission. Splenectomy produced remissions in 52.5% of 72 patients evaluated 12 months after operation. Eighty-five patients were treated with immunosuppressive agents, but the response rates were low and the effect was transient in most cases. In the patients followed up without any specific treatment, the mean platelet counts showed slight improvement. Of the 16 patients who died during the observation period, only one died of bleeding; the remaining 15 died of causes unrelated to thrombocytopenia. It is noteworthy that five patients who were treated with corticosteroids or immunosuppressive agents died of infection.     

Dissection of mechanisms of Chinese medicinal formula Realgar-Indigo naturalis as an effective treatment for promyelocytic leukemia

To enhance therapeutic efficacy and reduce adverse effects, practitioners of traditional Chinese medicine (TCM) prescribe a combination of plant species/minerals, called formulae, based on clinical experience. Nearly 100,000 formulae have been recorded, but the working mechanisms of most remain unknown. In trying to address the possible beneficial effects of formulae with current biomedical approaches, we use Realgar-Indigo naturalis formula (RIF), which has been proven to be very effective in treating human acute promyelocytic leukemia (APL) as a model. The main components of RIF are realgar, Indigo naturalis, and Salvia miltiorrhiza, with tetraarsenic tetrasulfide (A), indirubin (I), and tanshinone IIA (T) as major active ingredients, respectively. Here, we report that the ATI combination yields synergy in the treatment of a murine APL model in vivo and in the induction of APL cell differentiation in vitro. ATI causes intensified ubiquitination/degradation of promyelocytic leukemia (PML)-retinoic acid receptor alpha (RARalpha) oncoprotein, stronger reprogramming of myeloid differentiation regulators, and enhanced G(1)/G(0) arrest in APL cells through hitting multiple targets compared with the effects of mono- or biagents. Furthermore, ATI intensifies the expression of Aquaglyceroporin 9 and facilitates the transportation of A into APL cells, which in turn enhances A-mediated PML-RARalpha degradation and therapeutic efficacy. Our data also indicate A as the principal component of the formula, whereas T and I serve as adjuvant ingredients. We therefore suggest that dissecting the mode of action of clinically effective formulae at the molecular, cellular, and organism levels may be a good strategy in exploring the value of traditional medicine.     

大剂量化疗自体外周血干细胞移植生物治疗序贯疗法对67例非霍奇金淋巴瘤的疗效观察

目的评价大剂量化疗、自体外周血干细胞移植、生物治疗序贯疗法对非霍奇金淋巴瘤的疗效。方法2003年6月至2007年3月在第三军医大学新桥医院对67例中、高度恶性非霍奇金淋巴瘤(NHL)患者采用大剂量化疗、自体外周血干细胞移植、白介素-2(IL-2)生物治疗序贯治疗,观察其治疗效果和相关并发症。结果67例患者中,41例完全缓解期患者(NHL-CR),经上述序贯治疗,36例持续CR(87.8%),5例复发(RE,12.2%),其中1例死亡(2.4%);26例部分缓解患者(NHL-PR),达CR15例(57.7%),RE11例(42.3%),其中死亡5例(19.2%)。结论该序贯疗法治疗非霍奇金淋巴瘤安全有效,治疗前达到CR患者疗效更好。     

Significance of low level infliximab in the absence of anti-infliximab antibodies

AIM:To evaluate the prevalence of double negative(DN)sera and the mechanisms responsible for DN status.METHODS:Sera of inflammatory bowel disease patients treated with infliximab(IFX)were tested for drug/antibodies to infliximab(ATI)trough levels and the proportion of DN results was compared between a commercially available double antigen ELISA(with labeled IFX as the detection antibody)and an antilambda ELISA(with anti-human lambda chain detection antibody).Repeat testing with lower than customary serum dilution(1:10)was performed.Patients with DN status were matched with IFX+/ATI-controls and were followed-up for subsequent development of nontransient ATI to investigate if DN status precedes ATI.RESULTS:Of 67 sera obtained at time of loss of response,only 6/67(9%)were DN by anti-lambda ELISA compared to 27/67(40%)with double antigen ELISA(P0.001,Fisher’s Exact test).Of the latter27 sera,22%were also DN by anti-lambda ELISA,whereas 44%were actually IFX positive(IFX+ATI-),30%were ATI positive(IFX-ATI+)and 4%were double positive(IFX+ATI+).Re-testing using a 1:10 dilution converted most DN results into IFX+and/or ATI+status.Patients with DN status had shorter survival free of non-transient ATI compared with matched controls(log rank test,P0.001).In 9/30(30%)of these patients,non transient ATI occurred before and after the event at which the DN serum was obtained,supporting the view that a DN result may represent aparticular time-point along the two curves of ATI titer rise and infliximab drug level decline.CONCLUSION:DN status may result from false negative detection of IFX or ATI by double antigen ELISA,suggesting a transitional state of low-level immunogenicity,rather than non-immunological clearance.     

Utility of serum TNF-a,infliximab trough level,and antibody titers in inflammatory bowel disease

AIM:To assess tumor necrosis factor-a(TNF-a),infliximab(IFX)concentrations,and antibodies against IFX molecules in patients with inflammatory bowel disease(IBD)who develop loss of response,side effects,or allergic reaction during anti TNF-a therapy.METHODS:Blood samples of 36 patients with response loss,side effects,or hypersensitivity to IFX therapy(Group?Ⅰ)and 31 patients in complete clinical remission(GroupⅡ)selected as a control group were collected to measure trough serum TNF-a level,IFX,and anti-IFX antibody(ATI)concentration.We examined the correlation between loss of response,the development of side effects or hypersensitivity,and serum TNF-a,IFX trough levels,and ATI concentrations.RESULTS:The serum TNF-a level was shown to be correlated with the presence of ATI;ATI positivity was significantly correlated with low trough levels of IFX.ATIs were detected in 25%of IBD patients with loss of response,side effects,or hypersensitivity,however no association was revealed between these patients and antibody positivity or lower serum IFX levels.Previous use of IFX correlated with the development of ATI,although concomitant immunosuppression did not have any impact on them.CONCLUSION:On the basis of the present study,we suggest that the simultaneous measurement of serum TNF-a level,serum anti TNF-a concentration,and antibodies against anti TNF-a may further help to optimize the therapy in critical situations.     

Cholinergic-adrenergic antagonism in the induction of tachyarrhythmia by electrical stimulation in isolated rat atria

Atrial tachyarrhythmias (AT) are the most common cardiac rhythm disturbance. In the present study, we analyzed the cholinergic-adrenergic interaction in the in vitro induction of cholinergic-dependent tachyarrhythmia by high-frequency electric stimulation. Tachyarrhythmia was evoked in isolated rat right atria by trains of electric stimuli. Atrial response was expressed as the tachyarrhythmia induction index (ATI, i.e. the fraction of applied trains that resulted in arrhythmia induction). ATI was reversibly increased by 0.6 microM carbachol (CCh), which also decreased atrial spontaneous rate (ASR). In contrast, 10 nM isoproterenol (ISO), 100 microM tyramine and the phosphodiesterase inhibitor isobutyl-methylxanthine (IBMX, 100 microM) increased ASR and decreased ATI. Amiodarone (AMI, 10 microM) reduced ATI in the presence and absence of CCh. Further CCh addition restored ATI in atria treated with either IBMX or AMI, but not when both compounds were present. Increase in ATI by CCh in atria pretreated with IBMX plus ISO was significantly attenuated by 3 mM NaF. The antagonism between cholinergic muscarinic and beta-adrenergic receptor stimulation (the former facilitating and the latter inhibiting tachyarrhythmia installation) possibly involves regulation of the phosphorylation status of adenosine cyclic 3'-5'-monophosphate (cAMP)-dependent protein kinase substrates. Additionally, cAMP-independent, AMI-sensitive mechanism stimulated by CCh (possibly muscarinic-dependent K(+) current activation) seems to contribute to AT facilitation.     

英夫利西单抗谷浓度及抗体水平监测在维持治疗强直性脊柱炎患者中的临床应用

目的:探讨AS患者英夫利西单抗(IFX)谷浓度(TLs)与疗效的关系,了解抗IFX抗体(ATI)产生情况。方法:连续纳入2017年1月至2018年12月苏北人民医院接受IFX治疗的AS患者38例。在第8次应用IFX前空腹抽取检测血清IFX-TLs和ATI水平,在第1次、第6次、第8次应用IFX前进行AS病情活动度评分(ASDAS),采用单因素方差分析、秩和检验、χ^2检验、Logistic回归分析进行统计学分析。从而进行疗效评价。结果:①38例AS患者,其中6例(16%)出现了ATI。这6例患者第8次IFX给药(38周)时出现病情反弹。②以第8次IFX治疗相比第6次IFX治疗的ASDAS是否上升进行分组,绘制受试者工作曲线(ROC)曲线,计算出IFX-TLs维持在0.635μg/ml以上时,患者病情不易反跳。③Logistic回归分析结果显示IFX-TLs与BMI相关[OR(95%CI)=1.536(1.023,2.308),P=0.039],与合并用药相关[OR(95%CI)=0.218(0.06,0.797),P=0.021]。结论:ATI的产生以及IFX-TLs变化与IFX失应答密切相关,应定期监测,调整治疗方案。