强化降脂治疗预防卒中试验的设计和进展

他汀类药物对于心血管疾病的预防已得到许多大样本临床试验证实,这些临床试验进一步提示,他汀类药物治疗能降低心血管疾病患者的卒中发生率,但对于无心血管疾病的患者,他汀类药物治疗对卒中的二级预防有何作用,仍缺乏确切的临床证据.因此,强化降脂治疗预防卒中（stroke prevention by aggressive reduction in cholesterol levels,SPARCL）试验研究的人群为既往有卒中或短暂性脑缺血发作（TIA）、同时无心血管疾病的患者,评价应用阿托伐他汀强化降脂治疗对心脑血管疾病的预防作用.     

他汀类药物在缺血性卒中防治中的作用

目前,他汀类药物是防治心脑血管病的最重要药物之一.近年来,大量临床研究和汇总分析证实,他汀类药物能有效降低缺血性卒中的发生和复发风险.文章就他汀类药物在缺血性卒中的一级预防、急性期治疗和二级预防中的应用进行了综述.     

所有缺血性卒中患者都应该使用大剂量他汀类药物吗?

他汀类药物治疗已成为缺血性卒中预防的标准方法,而且正在成为急性缺血性卒中的治疗选择.他汀类药物独立于胆固醇之外的多效性作用是将其用于缺血性卒中治疗的主要依据,这些多效性作用可能具有神经保护作用,进而改善患者的神经功能转归.同时,鉴于有研究显示他汀类药物的治疗作用存在剂量依赖性,因此主张采用大剂量他汀治疗.但是,围绕是否应将大剂量他汀类药物应用于不同机制的缺血性卒中患者仍然存在争论.     

缺血性卒中的早期他汀类药物治疗

在急性缺血性卒中发病后早期应用他汀类药物可改善患者的功能预后并降低院内病死率.文章对他汀类药物治疗缺血性卒中的临床前和临床试验进行了综述.     

脑出血患者应该中断他汀类药物治疗吗？

他汀类药物预防缺血性卒中的疗效已得到肯定,但其是否会增高脑出血风险尚无定论.对于那些长期接受他汀类药物治疗的患者,在罹患脑出血后应继续抑或中断他汀类药物治疗仍然着存在争论.文章就此进行了讨论.     

从指南看卒中患者血脂调控的目标值

大量研究已证实脂质代谢障碍是缺血性卒中的独立危险因素。他汀类药物可以通过调脂及调脂以外的多种机制，显著降低发生缺血性卒中的风险。2006年发表的积极降低胆固醇预防卒中复发研究（SPARCL）是目前惟一一项专门针对卒中患者二级预防的研究，结果表明阿托伐他汀80mg／d能显著降低近期发生过卒中而无冠心病史患者的再发卒中风险。那么，在临床实践中如何对缺血性卒中患者进行降脂治疗呢？借鉴其他国内外指南及循证医学证据，刚刚发表的“他汀类药物预防缺血性卒中／短暂性脑缺血发作的专家建议”（简称“建议”）强调应对缺血性卒中患者进行危险分层管理。     

卒中或短暂性脑缺血发作后大剂量阿托伐他汀治疗

他汀类药物可降低血管性疾病风险增高患者的卒中发病率,但能否降低新近卒中和短暂性脑缺血发作(transient ischemic attack,TIA)后的卒中风险仍不确定。强化降低胆固醇水平预防卒中(Stroke Prevention by nggressive Reduction in Cholesterol Levels,SPARCL)研究对4 731例脑血管病患者随机分组后给予阿托伐他汀(80 mg/d)或安慰剂双盲治疗。纳入标准为6个     

他汀类药物在急性缺血性卒中治疗中的应用

既往研究已证实了他汀类药物在缺血性卒中一级和二级预防中的作用,但对缺血性卒中急性期是否需要使用他汀类药物治疗,以及他汀类药物预处理对缺血性卒中的影响尚不明确.文章综述了近年来在这方面较有代表性的研究,分析了他汀类药物在急性缺血性卒中治疗中的应用对预后的影响.     

他汀治疗预防卒中

他汀类药物广泛应用于降低冠状动脉疾病(coronary artery disease,CAD)患者的卒中风险,但在无CAD患者中的使用却不多.华盛顿大学医学院的Nassief等对最近降低卒中风险新证据的一些试验进行了回顾性的分析. 在CAD患者中,中等强度他汀类药物治疗与卒中风险降低有关,且出血性卒中并未增加.此外,在治疗新靶向(Treating to New Targets,TNT)试验中,与稳定型CAD患者的中度降脂相比,强化降脂使卒中风险进一步降低.已有证据表明,他汀类药物治疗也可降低无CAD但心血管病风险较高或伴有糖尿病的患者的卒中风险.     

缺血性脑血管病危险分层下的他汀类药物达标剂量

目的 探讨国人缺血性卒中/短暂性脑缺血发作(TIA)危险分层下的他汀类药物达标剂量.方法 纳入2007年1-12月在暨南大学附属第一医院神经内科102例患者,将起病<6个月的缺血性卒中/TIA患者使用不同剂量阿托伐他汀(10～80 mg/d)分为常规、强化和常规剂量非达标3组.观察12周内LDL-C达标率、卒中复发及其他血管事件,阿托伐他汀与LDL-C降幅的最效关系.结果 102例患者中,极高危患者达56%.常规和强化剂量达标组2～12周LDL-C达标率为77%～85%,显著高于常规剂量非达标组(10%～15%,P<0.001).3组99例随访12周内再发卒中/其他血管事件、安全性指标差异无统计学意义.2～12周阿托伐他汀10、20、40和80 mg/d的LDL-C降幅分别为32%～35%,46%～49%,51%～52%和印%～65%.结论 半数以上缺血性卒中/TIA患者需要强化他汀类药物治疗,临床应采用危险分层下的他汀类药物达标剂量.国人阿托伐他汀与LDL-C降幅的量效关系与国外研究结果基本一致.     

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.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

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。     

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。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

南通市老年人生命质量影响因素的因子分析

目的 了解南通市老年人的生命质量及其影响因素.方法 2010年7月应用欧洲五维健康量表(EQ-5D)对南通市994例＞60岁的老年人进行问卷调查,探索性因子分析生命质量的影响因素.结果 英国权重计算城市老年人生命质量指数得分均数(0.590±0.092)高于农村老年人(0.560±0.115),农村老年人得分高于养老院老年人(0.447 ±0.154).社会经济因素、闲暇生活方式、慢性病、睡眠食欲、婚姻家庭和社会支持是影响老年人生命质量的主要因子.结论 政府应完善养老保险和医疗保险制度,加强老年人慢性病的健康管理,促进居家养老服务体系建设.     

糖尿病肾病血液透析护理效果分析

目的探讨糖尿病肾病血液透析中不同护理模式的护理效果。方法选择该院2018年3月—2019年3月收治的糖尿病肾病患者72例。该次选取的病例均拟行血液透析治疗,按照随机数表将患者分为对照组(35例)和观察组(37例),其中对照组在患者血液透析期间行常规基础护理,观察组行优质护理干预,观察两种不同的护理模式对患者血液透析的影响。结果观察组患者因低血压等中断透析的发生率低于对照组,差异有统计学意义(P<0.05)。观察组透析期间并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者的生活质量SF-36评分均高于对照组患者,差异有统计学意义(P<0.05)。结论在糖尿病肾病患者透析期间行优质护理,有助于保障血液透析的顺利开展,同时降低各种并发症的风险,使得患者的生活质量有最基本的保障。