晚期肝癌中西医综合个体化治疗研究

目的探索中西医综合个体化治疗晚期肝癌的临床疗效.方法根据每位病人的具体情况,用介入治疗、抗癌中药等"攻邪",用中医药辨证施治汤剂、药膳等"扶正".结果完全缓解(CR)、部分缓解(PR)、稳定(SD)和恶化(DP)分别为7.50%、35.00%、40.00%和17.50%,生存时间为20.83±16.42个月,1、3、5年生存率分别为63.75%、31.82%和22.22%.结论中西医综合个体化治疗晚期肝癌可取得较好的临床效果,显著延长病人的生命.     

中西医结合治疗青春期甲亢31例临床观察

目的　观察中成药“抑亢丸”辅助治疗青春期弥漫性甲状腺肿伴甲亢 (Graves病 )疗效。方法　对已接受西医系统抗甲亢治疗 3 0个月以上的 5 6位青春期Graves病患者随机分为观察组 (2 5例 )和治疗组 (3 1例 ) ,分别予以原抗甲亢药物 (ATD)方案治疗和在此基础上加用“抑亢丸”治疗 3个月 ,通过甲状腺功能 (FT3 、FT4)和甲状腺免疫标志物 (TPOAb、TMA、TGA)变化比较两组治疗效果。结果　 3个月后治疗组TPOAb、TGA、TMA较观察组显著下降 (P <0 .0 1,P <0 .0 5 ,P <0 .0 5 ) ,提示免疫功能改善。治疗组FT3 、FT4下降明显 (P <0 .0 1,P <0 .0 5 ) ,与免疫功能改善相平行 ,提示甲状腺功能明显恢复。结论　中药“抑亢丸”联合西医抗甲亢系统治疗青春期甲亢可改善甲状腺自身免疫功能 ,从而促进甲状腺功能恢复正常     

人工肝支持加中药治疗肝衰竭临床研究

目的:提高肝衰竭(HF)的临床疗效。方法:用新型膜材料制成血液透析滤过器,在常规药物治疗基础上,对治疗组HF病人进行血液透析(HDF),1周1～2次。配合特制中草药汤剂于HDF前后进行口服(或灌肠),对照组只用常规药物治疗。结果:治疗组26例,治愈14例,好转8例,治愈率53.8%,治愈好转率84.6％,1周2次HDF后TBil平均下降82.1μmol/L;对照组22例,同期治疗后,治愈2例,好转6例,治愈率9%,治愈好转率36.4%,1周后TBil平均下降10μmol/L。结论:人工肝支持加中药治疗HF,可提高HF的临床治愈好转率。     

循证医学与经验医学的区别

从4个方面论述了循证医学与经验医学的区别，主要是评价结果的指标不同，循证医学更重视以满意的终点指标为主要评价指标：其次是证据的来源不同，循证医学倡导的是慎重、准确而明智地应用目前所能获得的最佳证据，即RCT结果；此外，对研究方法的要求不同，循证医学强调的是采用RCT方法，对大样本病例进行系统观察和评价；最后是对样本量的要求不同，循证医学要求证据的获得是基于大样本、多中心、大规模的临床试验。循证医学从根本上克服经验医学模式下的无序医疗，向着有序医疗的目标迈进。     

Acute effects of the calcium antagonist, nifedipine, on blood pressure, pulse rate, and the renin-angiotensin-aldosterone system in patients with essential hypertension

Ten milligrams nifedipine was administered orally to young and old persons with or without hypertension, and the acute effects of nifedipine on the renin-angiotensin-aldosterone system were studied one half to 3 hours later. Nifedipine reduced blood pressure and increased pulse rate in young and old persons with or without hypertension. Simultaneously, nifedipine produced a significant increase of plasma renin activity in young persons with or without hypertension but failed to do so in old persons with or without hypertension. As a result, angiotensin I and II increased significantly in young persons but not in old persons. Hydralazine elevated aldosterone concentration by stimulating the renin-angiotensin system but nifedipine failed to do so despite its effect on the renin-angiotensin system in young individuals. Since calcium is required to secrete aldosterone, it is suggested that nifedipine blocked aldosterone secretion by the agent's calcium antagonizing action.     

Impact of radionuclide techniques on evaluation of patients with ischemic heart disease

Radiotracer studies of the heart have become clinically important in the last decade, especially for evaluation of patients with known or suspected ischemic heart disease. Radionuclide ventriculography provides quantitative measures of biventricular function and regional wall motion. Recent technical advances include the development of computer programs for analyzing diastolic function, parametric imaging methods such as "phase" analysis and methods for calculating absolute ventricular volumes. Thallium-201 scans provide maps of regional myocardial perfusion. Recent advances include development of computer programs to quantitate regional thallium-201 uptake and to calculate thallium-201 turnover rates and the development of tomographic imaging systems. Technetium-99m pyrophosphate localizes in irreversibly damaged myocardium and provides a method for diagnosing, localizing and sizing acute myocardial infarcts. Recent applications include tomographic imaging to improve image contrast and development of criteria to identify high risk patients after infarction. Two important trends affecting the application of all the radionuclide studies in clinical cardiologic practice are the increasing use of decision analysis for incorporating results of multiple tests into single diagnostic probability statements, and the use of diagnostic algorithms that include the radionuclide studies to optimize the cost effectiveness of evaluation of patients with ischemic heart disease.     

Protective effects of medical ozone combined with traditional Chinese medicine against chemically-induced hepatic injury in dogs

AIM： To investigate the protective effect of medical ozone （O3） combined with Traditional Chinese Medicine （TCM） Yigan Fuzheng Paidu Capsules （YC） against carbon tetrachloride （CCh）-induced hepatic injury in dogs. METHODS： Thirty healthy dogs were divided randomly into five groups （n = 6 in each group）, namely control, oleanolic acid tablet （OAT）, O3, YC and O3 ＋ YC, given either no particular pre-treatment, oral OAT, medical ozone rectal insulfflation every other day, oral YC, or oral YC plus medical ozone rectal insulfflation every other day, respectively, for 30 consecutive days. After pre-treatment, acute hepatic injury was induced in all dogs with a single-dose intraperitoneal injection of CCh. General condition and survival time were recorded. The biochemical and hematological indexes of alanine aminotransferase （ALT）, aspartate aminotransferase/ alanine aminotransferase （AST/ALT）, serum total bUirubin （TBIL）, prothrombin time （PT）, blood ammonia （AMMO）, and blood urea nitrogen （BUN） were measured after CCh injection. Hepatic pathological changes were also observed.RESULTS： Compared to the other four groups, the changes of group O3 ＋ YC dogs＇ general conditions （motoricity, mental state, eating, urination and defecation） could be better controlled. In group O3 ＋ YC the survival rates were higher （P 〈 0.05 vs group control）. AST/ALT values were kept within a normal level in group O3 ＋ YC. Hepatic histopathology showed that hepatic injury in group O3 ＋ YC was less serious than those in the other four groups.CONCLUSION： Medical ozone combined with TCM YC could exert a protective effect on acute liver injury induced by CCI4,     

Fenoldopam in critically ill patients with early renal dysfunction. A crossover study

Background: Acute kidney injury is a frequent problem among many critically ill patients, commonly in the context of multiple organ failure and decreased renal perfusion. Its presence conveys a poor prognosis. Currently, effective therapeutic interventions are limited and dopaminergic agonists have been suggested as an option to prevent further damage. Methods: We performed a randomized, double‐blinded, prospective crossover study in 17 patients admitted to our trauma intensive care unit (ICU) with evidence of impaired renal function. Patients were randomized to a 24‐h intravenous infusion of low‐dose fenoldopam or placebo. When the infusion of fenoldopam or placebo was completed, patients underwent a 24‐h “washout” period in which no study intervention was performed. This sequence was repeated in each patient with the opposite agent, so each patient served as his own control. Four‐hour creatinine collections were taken during the last 4 h of each infusion and washout periods to determine creatinine clearance changes during and after the administration of the study drug. Results: The creatinine clearance was higher with fenoldopam infusion than with placebo infusion (P= 0.045). The FENa was not significantly different. Conclusions: Our study showed that low‐dose Fenoldopam increases creatinine clearance in the critically ill with renal insufficiency. Fenoldopam may be a useful drug in ICU patients with early renal dysfunction.     

中药方剂治疗迈氏唇鞭毛虫感染1例

本文报道1例迈氏唇鞭毛虫感染者,并对其诊断和中医药治疗过程进行总结。     

Apolipoprotein B subspecies in chylomicrons isolated from a patient with chyluria

The diagnosis and the clinical course of a 17-year-old white male with chyluria are reported. Cloudy, milky urine appeared spontaneously, in the absence of edema or any signs or symptoms of parasitic infection. Pedal lymphangiography demonstrated the presence of a lymphatic renal fistula, and digital subtraction angiography showed aneurysmal dilatation of the aorta at the level of the renal arteries. This case provided an opportunity to ascertain which of the forms of apolipoprotein B were present in lymph chylomicrons. Apolipoprotein B is needed for chylomicron secretion. It exists in several forms--B-100, B-74, B-48, and B-26. After a meal consisting of fat, chylomicrons in which apolipoprotein B-48 was virtually the only apolipoprotein B present appeared in the urine, while apolipoprotein B-100 was the only apolipoprotein B present in the plasma very low-density lipoproteins. Chyluria disappeared two weeks after institution of a low-fat diet. This case illustrates an interesting, rare cause of chyluria. Because of the presence of chyluria, it was also demonstrated that chylomicrons in which apolipoprotein B-48 is virtually the only apolipoprotein B present are a physiologically normal product of the intestine.     

Reduction of S-T segment elevation with infusion of nitroprusside in patients with acute myocardial infarction

The effect of infusion of sodium nitroprusside on S-T segment elevation was evaluated in 12 patlents with acute anterior myocardial infarction. Precordial 35 lead S-T segment maps were obtained in each patient immediately before and 10 minutes after infusion of 53 μ/min (range 20 to 100 μg/min) of nitroprusside. The following measurements were made from each S-T map: ∑ST (total S-T elevation in all leads), NST (number of leads with S-T elevation greater than 1 mm) and $\text{ST}$ (average S-T elevation in leads with more than 1 mm elevation). After administration of nitroprusside, evidence of myocardial ischemic injury as assessed by S-T mapping decreased in association with reduction of the myocardial oxygen consumption index of pressure-time per minute. Group mean values diminished significantly for ∑ST (41.7 to 28.6 mm, P <0.001), NST (20.3 to 14.6, P <0.001) and $\text{ST}$ (1.6 to 1.2 mm, P <0.005). Pressure-time per minute decreased from 2,690 to 2,372 mm Hg-sec/min (P <0.001). Because there was no significant relation (P >0.05) between reductions in S-T elevation and lower indexes of myocardial oxygen consumption, it is suggested that nitroprusside may possess a separate action of augmenting regional blood flow to ischemic myocardium. Evaluation with the precordial S-T mapping technique suggested that intravenous administration of nitroprusside was associated with evidence of reduced ventricular ischemic injury in patients with acute myocardial infarction. This effect appears to be related to reduction of myocardial oxygen demand by the peripheral cardiac unloading mechanisms of nitroprusside as well as to a possible direct action of the drug in improving regional blood flow to ischemic heart muscle.