问题解答:

一、何谓过早复极综合征?有何临床意义? 答:过早复极综合征(Early repolarization Syndrome)是心电图的一种正常变异。在健康人中占1～2.5％,在黑人中更多见。原因是在心室全部去极化结束之前,某些区域的心室肌提早复极,产生向前、下偏左的ST     

Hypothesis: Extra-hepatic acromegaly: a new paradigm?

Medical treatment of acromegaly with long-acting somatostatin analogs (LA-SMSA) and the GH receptor antagonist, pegvisomant (PEGV), has made it possible to achieve normal serum IGF1 concentrations in a majority of patients with acromegaly. These two compounds, however, impact the GH-IGF1 axis differently, which challenges the traditional biochemical assessment of the therapeutic response. We postulate that LA-SMSA in certain patients normalizes serum IGF1 levels in the presence of elevated GH actions in extra-hepatic tissues. This may result in persistent disease activity for which we propose the term extra-hepatic acromegaly. PEGV, on the other hand, blocks systemic GH actions, which are not necessarily reliably reflected by serum IGF1 levels, and this treatment causes a further elevation of serum GH levels. Medical treatment is therefore difficult to monitor with the traditional biomarkers. Moreover, the different modes of actions of LA-SMSA and PEGV make it attractive to use the two drugs in combination. We believe that it is time to challenge the existing concepts of treatment and monitoring of patients with acromegaly.     

心血管病:机遇

今后的 30年 ,我们要继续降低人群冠心病 (ＣＨＤ)的病死率、总罹患率和充血性心衰的罹患率 ,在与冠心病的斗争中 ,将面临严峻的挑战。冠心病人及有冠心病危险因子的人的临床治疗将会有所突破 ,基础研究亦会续有进步。它们将大有助于降低ＣＨＤ病死率及罹患率 ,大有助于ＣＨＤ预防。我们需要进一步强调ＣＨＤ的一级预防。向群众宣教 ,摄有益于健康的膳食 ,日常生活中安排有规律的体力活动 ,青年时代就要开始防止吸烟。在美国全国 ,心血管病的防治应力求一致。我们的专科培训规划中是否需要培训更多的心脏专家 ,列入机构的编制 ?此问题须妥善…     

Editorial: consensus guidelines: method or madness?

Consensus development methodologies are used to develop evidence-based guidelines and include the Delphi process, the nominal group technique, and the National Institutes of Health (NIH) consensus process. Attention to methodology improves the outcomes of the consensus process and better guidelines.     

Coronaryarterycalcificationinchronickidneydisease:Anupdate

Arterial calcification is a well-recognized complication of advanced atherosclerosis.Chronic kidney disease(CKD) is characterized by significantly more pronounced,dis-seminated and fast-progressing calcification of the vascular system,including the coronary arteries.New computed tomography-based imaging techniques al-low for the noninvasive assessment and monitoring of calcification in different vascular sites.Coronary artery calcification(CAC) develops early in the course of CKD and is tightly associated with mineral and bone disor-ders,which include but are not limited to secondary hyperparathyroidism.In this review,recent data on the pathogenesis of CAC development and progression are discussed,with a special emphasis on fibroblast growth factor 23 and its co-receptor,klotho.The prevalence,progression and prognostic significance of CAC are reviewed separately for patients with end-stage renal disease treated with dialysis,kidney transplant recipi-ents and patients with earlier stages of CKD.In the last section,therapeutic considerations are discussed,with special attention paid to the importance of treatment that addresses mineral and bone disorders of CKD.     

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糖尿病的发病率不断增加,糖尿病的急、慢性并发症严重威胁着人们的健康,影响着人们的生存质量。急性高血糖对机体的肾脏、心血管、神经系统等均产生不良影响。长期高血糖状态下,糖尿病慢性并发症的发生率显著增高。严格控制血糖使其达到理想水平是预防和减少糖尿病各种并发症的     

Telementoringineducationoflaparoscopicsurgeons:Anemergingtechnology

Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these ad-vanced procedures. We highlight in the review several key emerging technologies such as the telementor-ing and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.     

专家门诊:许樟荣

患者张某某,52岁,女,技术人员。糖尿病近10年,血糖控制长期不达标。曾每天用瑞格列奈8毫克,阿卡波糖150毫克,二甲双胍2550毫克,高血糖未得到控制。且服用阿卡波糖后腹胀难忍。目前用诺和.锐30(24单位),早晚各1次;二甲双胍1.0克,一日两次。治疗过程中无低血糖反应。无胸闷、憋气或活动后心前区不适,睡眠正常。有高血压病史10年,口服缬沙坦80毫克、拜新同30毫克,一日1次。     

沙门氏菌亚属Ⅰ菌型:3,19:eh:1,W分离鉴定

沙门氏菌是人和动物重要的肠道致病菌。1995年我们在饮食、服务行业从业人员健康体检时，从一份稀便中检出革兰氏阴性杆菌，其生化反应属Kauffmann沙门氏菌亚属Ⅰ．经鉴定为E4群中的卡拉巴尔沙门氏菌，抗原式为：3．19：eh：1，W现报告如下：材料与方法一、菌株来源95－1385菌株由滨州市饮食从业人员粪便中分得。二、培养基S．S琼脂、三精铁（TSTA）由山东省卫生防疫站供给。三、沙门氏菌诊断血清144株／套、57株／套．由成都、兰州生物制品研究所生产。四、菌株分离鉴定方法按肠道致病菌常现方法进行。结果与讨论附表95－1385菌株生化…     

Editorial: Exercise for NAFLD: does intensity matter?

Currently, there are no established means for the prevention or treatment of non-alcoholic steatohepatitis (NASH) despite our increasing understanding of nonalcoholic fatty liver disease (NAFLD) pathogenesis implicating insulin resistance (IR) as a key factor and highlighting the central role of lipotoxic liver injury in the development of NASH. Lifestyle interventions aiming at decreasing IR and preventing lipotoxicity, including weight loss, diet, and physical exercise, are in the frontline for NASH patient management. Physical activity may ameliorate IR, maintain weight loss, and improve liver histology in NASH patients. However, there are no recognized criteria for the optimal intensity, duration, or total volume of exercise needed to obtain these beneficial effects. In this issue of the American Journal of Gastroenterology, Kistler and colleagues show that vigorous, but not moderate exercise, nor total duration or volume of physical activity, is related to decreased odds of having NASH or advanced fibrosis. Prospective studies using the objective criteria of physical activity, addressing the role of concurrent weight loss, and assessing individual histological features are needed to further clarify the effects of exercise intensity on NAFLD histology.     

述评:心动过速性心肌病:一个独立的心血管疾病

快速性心律失常易与心脏扩大、心力衰竭并存,其常被认为继发于心力衰竭。但随着动物实验和临床研究的进展,此观点遇到了挑战。早在1913年,Gossage等首次报道1例房颤合并快速心室率的     

Editorial: drug-induced acute pancreatitis: uncommon or commonplace?

Many drugs have been implicated as causing acute pancreatitis (AP), mainly based on the recurrence of pancreatitis following rechallenge with a drug that the patient had been taking at the time of an initial episode of AP. However, estimates of the relative frequency with which drugs cause AP vary widely. This is largely because many patients may be taking a number of drugs, may have co-morbidities such as gallstone disease or hypertriglyceridemia, or may be consuming large amounts of alcohol, making it difficult to determine what actually is the primary cause of an episode of AP. Large, rigorously designed epidemdiological studies are needed to better define the frequency with which the drugs in general cause AP and the specific risk of pancreatitis associated with any individual drug.