血清NO、IL-6及IL-8与急性高原病的关系研究

目的 :了解血清一氧化氮 (Nitricoxide ,NO)、白介素 - 6 (Interleuk - 6 ,IL - 6 )及白介素 - 8(Interleuk - 8,IL - 8)与急性高原病 (Acutehighaltitudediseaes ,AHAD)及NO与IL -6、IL - 8之间的关系。方法 :将 4 7例AHAD患者随机分为两组 ,一组为常规药物治疗组 (2 3例 ) ,另一组为NO治疗组 (2 4例 )。常规药物治疗组给予吸氧、氨茶碱、地塞米松、速尿等药物常规治疗 ,NO治疗组仅给予吸入由海拔 36 5 8m高度的空气平衡的 1 0 ppm的NO气体 ,每天2次 ,上午、下午各 1h ,并对两组AHAD患者治疗前后的血清NO(NO以其代谢终产物NO3-和NO2 - 表示 )、IL - 6及IL - 8含量进行观察比较。结果 :两组治疗后的血清IL - 6及IL - 8含量均显著低于治疗前 ,NO含量则均显著高于治疗前 (NO治疗组P <0 .0 0 1 ,常规药物治疗组P <0 .0 5～ 0 .0 1 )。且两组治疗后的血清NO、IL - 6及IL - 8含量亦具有显著性差异 (P <0 .0 5 )。结论 :血清NO、IL - 6及IL - 8与AHAD有着密切关系 ,NO能抑制AHAD患者IL -6及IL - 8的分泌 ,对患者的康复有着积极的作用     

人胃癌双功能抗体制备的研究

以不同技术路线制备Ｐ２１０／ＭＭＣ，Ｐ２１０／ＴＮＰ及Ｐ４０／ＣＤ３三种双功能抗体（ＢｓＡｂ）。在１１次细胞融合中，接种７４８４孔，获１５株二次杂交瘤，其中５株分泌ＢｓＡｂ。将亲本杂交瘤分别诱变为ＨＧＰＲＴ＾－及ＴＫ＾－，融合后以ＨＡＴ选择培养并辅以饲养细胞较易获得二次杂交瘤。证明两种抗原交互反应的桥联试验，特别是当二次杂交瘤分泌不同类别的Ｉｇ时，对于确证ＢｓＡｂ的存在有着重要意义。本文首次报告，     

Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma

RATIONALE: One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control. OBJECTIVES: To determine if the response to an inhaled corticosteroid or a leukotriene receptor antagonist is attenuated in individuals with asthma who smoke. METHODS: In a multicenter, placebo-controlled, double-blind, double-dummy, crossover trial, 44 nonsmokers and 39 light smokers with mild asthma were assigned randomly to treatment twice daily with inhaled beclomethasone and once daily with oral montelukast. MEASUREMENTS AND MAIN RESULTS: Primary outcome was change in prebronchodilator FEV(1) in smokers versus nonsmokers. Secondary outcomes included peak flow, PC(20) methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV(1), bronchodilator response, and sensitivity to methacholine at baseline, subjects with asthma who smoked had significantly more symptoms, worse quality of life, and lower daily peak flow than nonsmokers. Adherence to therapy did not differ significantly between smokers and nonsmokers, or between treatment arms. Beclomethasone significantly reduced sputum eosinophils and eosinophil cationic protein (ECP) in both smokers and nonsmokers, but increased FEV(1) (170 ml, p = 0.0003) only in nonsmokers. Montelukast significantly increased a.m. peak flow in smokers (12.6 L/min, p = 0.002), but not in nonsmokers. CONCLUSIONS: In subjects with mild asthma who smoke, the response to inhaled corticosteroids is attenuated, suggesting that adjustments to standard therapy may be required to attain asthma control. The greater improvement seen in some outcomes in smokers treated with montelukast suggests that leukotrienes may be important in this setting. Larger prospective studies are required to determine whether leukotriene modifiers can be recommended for managing asthma in patients who smoke.     

语言刺激的功能性MR成像在自闭症诊断中的潜在应用价值

目的对自闭症病人给予被动性语言刺激,评价采用功能性磁共振(MR)成像作为判断病人有无语言缺陷的客观指标的可行性。材料与方法本研究为前瞻性研究,研究方     

Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments

Objective

Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient‐level factors.

Methods

This was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect.

Results

In the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (–0.65 points in quality, 95% confidence interval [CI] = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07).

Conclusion

We found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.

     

Short-term outcomes of five heroin detoxification methods in the Australian NEPOD Project

This study included 380 participants in five heroin detoxification trials whose data were pooled to enable direct comparison of five detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD). Rapid detoxification achieved similar initial abstinence rates with either anaesthesia or sedation (average 59%), which were higher than was achieved by inpatient detoxification using clonidine plus other symptomatic medications (24%), which in turn was higher than outpatient detoxification using either buprenorphine (12%) or clonidine plus other symptomatic medications (4%). Older participants and those using more illicit drugs were more likely to achieve abstinence. Entry rates into ongoing postdetoxification treatment were as follows: buprenorphine outpatient (65%), sedation (63%), anaesthesia (42%), symptomatic outpatient (27%), and symptomatic inpatient (12%). Postdetoxification treatment with buprenorphine or methadone was preferred over naltrexone. Participants with more previous detoxification attempts were more likely to enter postdetoxification treatment. Given that outpatient detoxification was more effective with buprenorphine than with symptomatic medications and that rapid detoxification was more effective than the symptomatic inpatient method, the roles of the symptomatic methods should be reconsidered.     

Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia?

Objective To assess whether an inflatable obstetric belt, synchronised to apply uniform fundal pressure during a uterine contraction, reduces operative delivery rates when used in the second stage of labour.
Design Randomised controlled trial.
Methods Five hundred nulliparae with a singleton cephalic pregnancy at term and with an epidural in labour were recruited during the first stage and randomised at full dilatation. Standard care involved one hour passive second stage and one hour active pushing after which instrumental delivery was performed if delivery was not imminent. Those randomised to the belt group, in addition to standard care, had the inflatable obstetric belt for the whole second stage of labour.
Main outcome measure Mode of delivery.
Results One hundred and eleven of the 260 women in the belt group (42.7%) compared with 94 of the 240 in the control group (39.2%) had a spontaneous vertex delivery (   P = 0.423  ). The lift-out instrumental delivery rate was similar between the two groups: 108 belts (41.5%), compared with 101 controls (42.1%) (   P = 0.902  ), whereas rotational instrumental deliveries in the belt group were 26 belts (10%) compared with 36 controls (15%) (   P = 0.09  ). Fifteen women (5.8%) in the belt group and nine women (34%) in the control group had a caesarean section in the second stage (   P = 0.292  ). An intact perineum was more likely in the belt group (16.5% compared with 9–6%,   P = 0.022  ) as was a third degree tear (6.5% compared with 0.4%,   P = 0.001  ).
Conclusion The inflatable obstetric belt did not significantly reduce operative delivery rates when used in this clinical setting in the second stage of labour.     

肾小球白介素-10基因表达的检测及其在狼疮性肾炎分子诊断中的应用

目的：探讨狼疮性肾炎(LN)患者肾活检组织切片中肾小球IL-10 mRNA表达与临床病理的联系，及其在LN分子诊断中的意义。方法：对20例病理证实的Ⅳ型LN患者，运用激光微分离系统分离其肾活检组织切片中的肾小球，提取总RNA，用荧光定量PCR检测IL-10 mRNA的表达。结果：12例患者的肾小球中检测到IL-10 mRNA表达。肾小球IL-10 CT比值与尿IL-10水平、血IgG水平和肾小球CD68平均计数呈显著正相关，与血C3水平呈显著负相关。结论：应用激光微分离技术精确获取肾小球检测基因表达，发现肾小球IL-l0 mRNA表达与Ⅳ型LN患者的免疫损伤表现及肾小球病理改变特点显著关联。肾小球原位IL-10 mRNA表达的检测为判断LN患者病情，指导治疗提供了新的组织学分子标志。     

温阳利水强心颗粒剂治疗慢性充血性心力衰竭60例临床疗效观察

"温阳利水强心颗粒剂"系我所在真武汤基础上,结合云南著名中医学家吴佩衡先生运用附子的经验,采用现代制剂工艺研制而成.具有温阳利水、强心益肾、通脉宁心之功,治疗慢性充血性心力衰竭(阳虚型).将100例符合要求病例随机分为治疗组60例,西药对照组40例进行对比观察,结果治疗组总有效率96.67%.对照组总有效率95%,治疗组与对照组P＞0.05,无显著性差异.中医舌脉总改善率治疗组53.33%,对照组32.5%,P＜0.05,有显著差异,说明温阳利水强心颗粒剂突出中医定性指标及辨证论治特色,不仅心功能得到有效改善,中医宏观疗效指标也得到明显改善,提高病人生存质量,减少心衰发作次数,显示了中药复方多环节、多靶点的整体调节优势.