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。     

Measurement of subjective quality of life of elders

There are two aims in this article, to define subjective quality of life and to suggest a way to standardize its measurement to enable comparisons to be made across studies. One of the unresolved issues in gerontological research has concerned the definition and measurement of quality of life (Lawton, 1991). This article focuses on subjective well-being, one of the four components proposed by Lawton (1991). There seems to be a growing consensus that most scales of well-being have at least two concepts in common, positive and negative affect. To test this hypothesis, two well-being scales, the Philadelphia Geriatric Center Morale Scale (Lawton, 1975) and the Center for Epidemiological Studies-Depression Scale (Radloff, 1977), were subjected to confirmatory factor analyses, using data on 1717 participants in the Australian Longitudinal Study of Ageing aged between 70 and 103 years. Each scale was shown to contain factors of positive and negative affect. The article concludes with a suggestion that the measurement of quality of life in elders should include, at a minimum, scales of positive and negative affect as well as other measures relevant to the aspect of quality of life under consideration.     

Filterability of subpopulations of leukocytes: effect of pentoxifylline

Human leukocytes were separated by density into two fractions, one containing predominantly granulocytes (FI) and the other, lymphocytes and monocytes (FII). The filterability of these fractions and their mixture was determined from the pressure measured during constant flow through 5-microns Nuclepore filters. The pressure-time curve of FI indicates the behavior of a relatively homogeneous cell population. The FII pressure-time curve can be analyzed to distinguish the effect of the more numerous and more filterable lymphocytes from that of the sparser but less filterable monocytes. Pressure generated by mixed leukocytes, which had been treated with 1 and 10 mmol/L of pentoxifylline (PTX) or its metabolite I, was substantially less than untreated control; at 10 mmol/L, the pressure was reduced to about 50% of control. PTX appears to affect the filterability of monocytes and polymorphonuclear leukocytes but not lymphocytes. Scanning electron microscopy showed an inhibition of protopod formation in the treated granulocytes. The degree of cell adhesion to the filter, as measured by the number of cells remaining on the outflow side of the filter, was similar in all groups (FI and FII, treated and untreated). The results indicate that the variations in filterability between the leukocyte subpopulations and the improvement by PTX treatment reflect differences in the cells' ability to deform under the test conditions.     

Mechanisms of action of antiresorptive therapies of postmenopausal osteoporosis

In the treatment of osteoporosis, the aim of the antiresorptive therapy is to restore bone density by decreasing bone remodeling. The process of bone remodeling plays a role in plasma calcium homeostasis and serves to modify bone architecture in order to meet changing mechanical needs, to maintain osteocyte viability, and to repair microdamage in bone matrix. Estrogen deficiency results in a number of detrimental effects on bone, including suppression of osteocyte survival as well as impairment of osteoblast response to mechanical stimuli and repair of ageing bone. In this review, effects of available antiresorptive therapies on endocrine regulations of bone metabolism in postmenopausal osteoporosis are compared. The aim of antiresorptive treatment is to ensure adequate bone remodeling, reparation of microdamage of bone, and increased bone strength. Ideally, this effect should be maintained long-term. Several agents are approved for the treatment of osteoporosis. Calcitonin transiently inhibits osteoclast activity without decreasing osteoblast collagen synthesis. Aminobisphosphonates decrease bone remodeling by decreasing osteoclast activity and by inducing osteoclast apoptosis. This allows more time for secondary mineralization to proceed to completion in the existing bone tissue mass, so increasing the mechanical resistance of bone to loading. Estrogens and raloxifene (a selective estrogen receptor modulator that acts as an estrogen agonist in bone) suppress bone remodeling to the premenopausal range, maintaining the function of osteoblasts and osteocytes. In the placebo-controlled osteoporosis treatment trials, all the above treatments reduced the risk of fractures. Raloxifene therapy was also associated with a favorable or neutral effect in the cardiovascular system, and a reduced incidence of breast cancer. Selection of appropriate drug for treatment of postmenopausal osteoporosis should take into account the long-term effect of the antiresorptive agent on bone. Moreover, the effects on other tissues ++should also be considered, and this encompasses both safety concerns, as well as the potentially beneficial effects on other tissues. Further investigation is needed to evaluate the different modes of action of these agents, and their long-term effects on bone and other tissues.     

Mechanism of induction and termination of ventricular fibrillation--significance of dispersion of ventricular repolarization

It has been known for many years that ventricular fibrillation may be induced and terminated by electrical field stimuli. Recent experimental studies have shown that both fibrillation and defibrillation have a common electrophysiologic mechanism that is based on the interaction between the electrical field stimulus and ventricular repolarization. Ventricular fibrillation will be induced if the field stimulus is applied with the area of vulnerability, this area of vulnerability is defined two dimensionally by the shock coupling interval and shock strength, and is modified by the configuration of the shock. A field shock that is applied within the area of vulnerability causes heterogeneity of ventricular repolarization immediately after the shock (postshock dispersion), thereby enabling the development of circuit movements and reentry, and resulting in ventricular fibrillation. High energy shocks, however, that are applied above the area of vulnerability (i.e., above the upper limit of vulnerability) will not induce ventricular fibrillation due to homogeneous prolongation of repolarization and a resulting small postshock dispersion. In analogy, ventricular fibrillation will continue after unsuccessful low-energy defibrillation shocks due to high postshock dispersion, whereas a high-energy shock will synchronize ventricular repolarization, thereby causing small postshock dispersion and termination of ventricular fibrillation. This paper describes the relation between fibrillation, defibrillation and ventricular repolarization based on experimental findings. A possible clinical application of these findings is that the upper limit of vulnerability may be used as a surrogate for the defibrillation threshold. Thus, defibrillation threshold testing may not be necessary during future implantations of automatic cardioverter defibrillators.     

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。     

不同机种对飞行人员血压影响的调查研究

目的 分析不同机种对飞行人员血压的影响，为我军飞行人员高血压的有效防控提供依据。 方法 选取2018年度多个飞行人员疗养中心采集的飞行人员体检资料，分析研究不同机种对飞行人员血压的影响。 结果 不同机种飞行人员正常高值血压和高血压的发生率存在显著差异；不同机种与收缩压、舒张压和脉压的相关系数（r）分别为r = 0.155（P < 0.01），r = 0.191（P < 0.01），r = 0.041（P = 0.172）；在<35岁年龄段，不同机种之间的收缩压和舒张压指标有显著差异（F = 6.91，11.193，P < 0.05），在35-45岁年龄段，不同机种之间的收缩压和脉压指标有显著差异（F = 8.98，8.464，P < 0.05），在≥45岁年龄段，不同机种之间的收缩压、舒张压和脉压指标均无显著差异（F = 0.52，0.147，0.874，P > 0.05）。 结论 不同机种与飞行人员收缩压和舒张压之间存在相关关系，不同年龄段，不同机种对飞行人员收缩压、舒张压和脉压的影响不同，在飞行人员高血压的个体化防治中应当考虑到不同机种对其影响的差异性。     

Inhibition of intimal thickening of the carotid artery of rabbits and of outgrowth of explants of aorta by probucol.

The effect of administration of probucol in preventing intimal thickening of rabbit carotid artery after balloon catheter injury and the mechanism of action of the drug were studied. Groups of 6 male New Zealand-White rabbits were given normal diet (Group I), high cholesterol diet (Group II) or high cholesterol diet plus probucol (Group III) for 4 weeks. Balloon catheter injury was made in week 2 and animals were killed in week 4. No significant differences in the total cholesterol levels in Groups II and III were found in week 4. The medians of areas of the intimal layer in cross-sections of the carotid arteries of Groups I, II and III were 0.237, 0.475 and 0.309 mm2, respectively. Thus high-cholesterol diet increased the thickness of the intimal layer and probucol reduced its effect. There were no significant differences in the areas of the medial layers in these 3 groups. For the examination of the mechanism of the effect of probucol, rabbits were given chow containing 0.5% cholesterol with and without 0.5% probucol (7 rabbits each) and then the numbers of explants from their aortas showing outgrowth were compared. The plasma total cholesterol levels of these two groups were the same. The probucol concentrations in the plasma and aorta of the former group were 18.6 +/- 13.2 micrograms/ml and 7.3 +/- 5.4 micrograms/g wet tissue, respectively. The number of explants showing outgrowth on day 14 was suppressed by 34% in the probucol-treated group.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Evaluation of the prevalence of helminthiasis among the population of the Republic of Tajikistan

Helminthological examinations of 2629 persons of different ages have shown that the prevalence rate of soil-transmitted helminths averages 54.24% of the examinees. There isa high rate of helminthiasis in the examined dwellers from two districts (Vanch and Faizobod) in the foothill and mountain zones (78.23% and 67.5%, respectively) and its low rate in the Murgab district in the high-altitude area. The non-observance of personal hygiene and sanitary standards and the use of water from open contamination-unprotected water sources contribute to intensive invasion of the population with helminthes.     

Method of study of epidemiology of diabetic angiopathies]

The authors present a method of a perspective study of the epidemiology of diabetic angiopathies with the use of standardized methods of examination of the cardiovascular system, including the assessment of microangiopathies and also glycemia and lipid metabolism indices in accordance with the WHO recommendations. This method can be used by endocrinologists, therapeutists and physicians of other specialties in studying the factors influencing the development of vascular affections in patients with diabetes mellitus.     

Histomorphological aspects of TNM-classification of carcinoma of the lung

This prospective study evaluates the histopathological findings on 613 patients undergoing curative resection of a bronchus carcinoma and operated on between January 1982 and September 1984. The WHO rules for tumor classification and grading, and the 1979 pTN classification rules of the UICC were followed. Taking into account the biological properties of the tumors and the patient survival times, the prognostic value of histopathological data is discussed. Apart from the clear general dependence of the average survival time on the tumor cell type, it was found that tumor volume is of greater prognostic value with respect to patient survival than tumor diameter.     

Operative therapy of cancer of the head of the pancreas--determination of surgical status

Therapy of ductal pancreatic carcinoma still remains a hardly resolved problem. In spite of the development of highly sensitive diagnostic methods 85 to 90% of the patients do not undergo therapy until they have already reached an incurable tumor stage. 5 years survival rate between 4 and 8% after potentially curative resections are rather depressing numbers. To patients with stages I and II duodenopancreatectomy as performed as subtotal pancreatectomy promises better mean survival and 5 years survival rates than bypass procedures only. When the tumor, however, infiltrates adjacent organs, resection might be limited to few selected cases. Substantial progress in the therapy of pancreatic carcinoma can be only expected from better understanding of the biological nature of the tumor, from earlier diagnosis and more precise selection of the patients as to the appropriate therapeutical alternatives.     

Dietary habits of the aged--frequency of intake of foods of high nutritive value

The high rate of malnutrition in the elderly suggests the need for increased availability of high nutrient density foods such as fruits, vegetables, milk, and whole grain products. An analysis of nutritional habits of 100 persons 75+ years showed that 75% had insufficient intake of whole grain products, 50% an insufficient intake of milk and dairy products, and 25% an insufficient intake of fruits and vegetables. Food intake was shown to be largely independent of such factors as sex, age, or life situation. Only for milk and dairy products could a better supply be shown for institutionalized persons than for independent-living persons. The results of the study emphasize the need for better nutritional information and education of the elderly regarding the importance of high nutrient density foods.     

38例主动脉窦瘤破裂的外科治疗

目的 :通过研究 38例主动脉窦瘤破裂治疗经过 ,总结主动脉窦瘤破裂外科治疗经验。方法 :1987年 1月至 2 0 0 1年 9月 ,对 38例主动脉窦瘤破裂病人行手术治疗 ,及时准确闭合主动脉窦瘤及矫正合并的心脏畸形。对于合并主动脉瓣关闭不全病例 ,轻度不予处理 ,中度行成形术 ,重度行主动脉瓣置换术。结果 :早期死亡 1例 ,死亡率为 2 6 %。术后随访 2个月～ 14年 ,随访者心脏功能恢复到Ⅰ～Ⅱ级 (NYHA)。结论 :主动脉窦瘤破裂一经诊断 ,应及早手术 ,同时矫正合并的心脏畸形 ,可获得满意的近期和远期效果。     

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。     

南疆地区不同类型黑热病流行状况调查

南疆地区不同类型黑热病流行状况调查显示,荒漠型黑热病流行区人群利什曼素阳性率为68.24%（101/148）,砾漠型流行区为20.97%（39/186）。解剖白蛉1 475只,其中吴氏白蛉1 271只,占86.17%;长管白蛉193只,占13.08%;亚历山大白蛉11只,占0.75%。在3只吴氏白蛉和1只亚历山大白蛉体内共检出4株自然感染的前鞭毛体。荒漠型和砾漠型流行区分别检出1名黑热病患者。南疆地区黑热病流行基本状况和媒介白蛉的种类及分布未发生明显变化。     

Validation of scores of use of inhalation devices: valoration of errors

Objective:

To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices.

Methods:

This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria.

Results:

The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p &lt; 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p &lt; 0.01) and an MDI (49%/51% and 54%/46%; p &lt; 0.05).

Conclusions:

The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.     

A comparison of methods of pathogen inactivation of FFP

Introduction Current methods for pathogen inactivation of plasma involve four major processes using solvent–detergent (SD), methylene blue (MB), amotosalen and riboflavin as additives. Three of these methods involve the use of visible or ultraviolet light. Methods A comparison of the four methods was made using publications in Medline, Pubmed, Embase and Biosis to obtain data on the logistics of use, the quality of the plasma proteins and the effectiveness of pathogen inactivation. Results Three of the methods, MB, amotosalen and riboflavin, are designed for use in a blood bank; the SD method is generally applied at a centralized manufacturing centre and involves large plasma pools. All methods result in a reduction in protein values with the per cent retention of FVIII activity in the range of 67–78% and fibrinogen of 65–84%. Protein S and alpha₂‐antiplasmin are lower following solvent–detergent treatment. Alterations in fibrinogen structure have been reported with methylene blue. Discussion Three of the methods are designed for small volume use in a blood bank. All four methods have some effect on the coagulant proteins; however, the final concentrations are within regulated limits. While there is variability in the effectiveness against pathogens, direct comparison is difficult because of the methodologies used. Nonetheless, all are effective in inactivating HIV and other lipid‐enveloped pathogens. Clinical studies on the effectiveness of these products are surprisingly sparse, and no randomized clinical trials have yet been performed with amotosalen or riboflavin plasmas.     

Models of Structure of the Envelope of Influenza Virus

Possible models of the structure of the influenza virus envelope are considered in terms of the known chemical composition. Models incorporating lipid in the form of a bimolecular leaflet are shown to be unlikely on geometrical grounds. A model having "inverted toadstool" protein units separated by spherical lipid micelles is favored, and is capable of explaining the appearance of the virus in the electron microscope and differences between normal and incomplete (von Magnus) forms of the virus.