奥美拉唑、替硝唑、克拉霉素短程三联疗法根除老年人幽门螺杆菌的疗效观察

目的观察奥美拉唑、替硝唑、克拉霉素短程三联疗法对老年人幽门螺杆菌（Ｈｐ）感染的根除效果及其副反应。方法将８７例伴有Ｈｐ感染的消化性溃疡或糜烂性胃窦炎老年患者随机分为两组，Ａ组４４例，给予奥美拉唑２０ｍｇ、替硝唑５００ｍｇ及克拉霉素２５０ｍｇ，每天２次口服，疗程７天（方案Ａ）；Ｂ组４３例，治疗同Ａ组，只是将克拉霉素改为５００ｍｇ（方案Ｂ）。活动期溃疡病患者继服奥美拉唑２０ｍｇ／ｄ，３周。疗程结束１个月后复查胃镜，检查Ｈｐ。结果Ａ组Ｈｐ根除率９０．９％、活动期溃疡愈合率１００．０％、糜烂性胃窦炎愈合率７９．３％、副反应发生率１３．６％，Ｂ组分别为８８．４％、９３．３％、８０．８％和２３．３％；两组比较差异无显著性。结论两种短程三联疗法对老年人Ｈｐ感染的根除均有良好疗效，而方案Ａ费用较低。     

比格犬胃窦黏膜组织学与超微结构的增龄变化特点

目的探讨比格犬胃窦黏膜组织学与超微结构的增龄变化特点。 方法选取健康比格犬(犬龄1.5～11.0岁,体重14～20 kg)19只。按年龄分组：≥1.5岁且≤6岁8只(中青年组),>6岁且≤9岁5只(低龄老年组),>9岁且≤11岁6只(高龄老年组)。光镜下观察对比各组犬胃窦黏膜上皮细胞形态学变化、胃窦黏膜炎症程度、肠上皮化生和异型增生情况、固有膜厚度及黏液腺体实质比的变化;透射电镜下观察对比各组犬胃窦黏膜上皮细胞形态、细胞间连接、幽门腺细胞黏原颗粒面积分数的变化。3组间胃黏膜炎症指数、胃窦黏膜固有膜厚度及黏液腺体实质比的比较采用单因素方差分析。 结果光镜观察结果：各组犬胃窦黏膜上皮细胞未见明显形态学变化;胃窦黏膜内均未见肠上皮化生、异型增生,且无炎症或炎症表现轻微,各组间炎症指数无明显差异(F＝0.023,P>0.05);中青年组、低龄老年组及高龄老年组胃窦黏膜固有膜厚度分别为(1016.7±203.2)、(727.5±64.3)、(931.7±92.4) μm,差异有统计学意义(F＝5.952,P<0.05),其中高龄老年组黏膜内结缔组织增生明显;3组黏液腺体实质比分别为(45.3±6.4)%、(33.9±2.4)%、(34.5±6.3)%,差异有统计学意义(F＝8.981,P<0.01)。透射电镜观察结果：各组胃窦黏膜上皮细胞超微结构及细胞间紧密连接均未见明显改变,但细胞间中间连接及缝隙连接随增龄逐渐疏松,并可见空泡样缝隙;中青年组、低龄老年组及高龄老年组幽门腺细胞内黏原颗粒面积分数分别为(50.3±10.0)%、(44.4±3.9)%、(18.6±5.6)%,差异有统计学意义(F＝15.501,P<0.01)。 结论健康比格犬胃窦黏膜组织学和超微结构随增龄出现了一系列退化现象。     

Senescent remodeling of the immune system and its contribution to the predisposition of the elderly to infections

Objective  To review the senescent remodeling of the immune system with aging and its relevance to the increased susceptibility of the elderly to infectious diseases, along with an outlook on emerging immunological biomarkers.

Data sources  The data selected were from PubMed with relevant published articles in English or French from 1995 to the present. Searches were made using the terms “immunosenescence” and “aging” paired with the following: “innate immunity”, “T-cell”, “B-cell”, “adaptive immunity” and “biomarkers”. Articles were reviewed for additional citations and some information was gathered from web searches.

Study selection  Articles on aging of both the innate and adaptive immunity were reviewed, with special attention to the remodeling effect on the ability of the immune system to fight infectious diseases. Articles related to biomarkers of immunosenescence were selected with the goal of identifying immunological biomarkers predisposing the elderly to infections.

Results  Innate immunity is generally thought to be relatively well preserved or enhanced during aging compared with adaptive immunity which manifests more profound alterations. However, evidence, particularly in the last decade, reveals that both limbs of the immune system undergo profound remodeling with aging. Reported data on adaptive immunity is consistent and changes are well established but conflicting results about innate immunity were reported between in vivo and in vitro studies, as well as between murine and human studies. Epidemiological data suggests increased predisposition of the elderly to infections, but no compelling scientific evidence has directly linked senescent immune remodeling to this increased susceptibility. Recently, growing interest in identifying immunological biomarkers and defining “immune risk phenotypes/profiles” (IRP) has been expressed. Identification of biomarkers is in its early days and few potential biomarkers have been identified, with the Swedish having defined one IRP based on the adaptive immune response.

Conclusions  Aging does not necessarily lead to an unavoidable decline in immune functions. Instead, a complex remodeling occurs. Despite the lack of compelling scientific evidence, senescent immune remodeling surely is a significant contributing factor to the increased risk and severity of infections in the elderly. Although, no immunological biomarker has been formally linked to the increased risk of infections in the elderly, biomarkers remain a promising tool to predict the likelihood of healthy aging, the level of immune competence, and mortality risk in the elderly. Hence, more research is required to define healthy aging and identify immunological biomarkers.

     

透明质酸钠治疗膝关节骨性关节炎60例分析

目的：观察透明质酸钠关节腔内注射治疗膝关节骨性关节炎的临床疗效。方法：应用透明质酸钠注射液对门诊确诊的60例膝关节骨性关节炎患者进行关节腔内注射治疗,并运用Bristol膝关节评分系统对治疗后患者膝关节疼痛和功能改善情况进行对比分析。结果：除2例无明显好转外,余58例治疗后关节疼痛和功能活动均得到明显改善。结论：透明质酸钠注射液对膝关节骨性关节炎具有较好疗效,无明显不良反应。     

经皮气管切开术在院前急救中的应用20例分析

目的:探讨经皮气管切开术(percutaneous tracheostomy,PT)的院前应用价值.方法:对我科在院前急救中采取PT建立人工气道的20例进行回顾性分析.结果:PT手术时间短,出血量少,并发症少,术后均安全转送病房.结论:PT值得在院前急救中推广应用.     

奥美拉唑不同途径、不同剂量给药抑制胃酸的效果

目的 :研究不同途径、不同剂量奥美拉唑抑制胃酸的效果 ,指导临床合理用药。方法 :将 10 0例内窥镜证实为活动期消化性溃疡病人分成A组 4 0例 ,静脉推注奥美拉唑 4 0mg ,bid ;B组 36例 ,口服奥美拉唑 2 0mg ,bid ;C组 2 4例 ,口服奥美拉唑 2 0mg ,qd。监测用药后d 3～ 5胃内 2 4hpH值变化 ,对A ,B 2组中各 10例 (为A2 ,B2 组 )测定了首次给药后的药物起效时间。结果 :A ,B组的抑酸效果相仿 (P >0 .0 5) ,胃内 pH值分别为 7.0 7±s0 .15和6 .9± 0 .6 ,与C组胃内 pH值 5.8± 1.4相比 ,差异有非常显著意义 (P <0 .0 1) ;A2 组起效时间为 (0 .7± 0 .6 )h ,B2 组为 (4.8± 1.0 )h ,差异有非常显著意义 (P <0 .0 1)。结论 :不同途径 3种剂量的奥美拉唑均有良好的抑酸效果 ,A ,B组更佳 ;静脉用药起效更迅速     

中药汤剂版Morisky8用药依从性量表在服用中药汤剂患者中的信效度检验

目的 验证中药汤剂版Morisky8用药依从性量表（MMAS-8）对服用中药汤剂患者的信效度。方法 以2021年8月至12月在复旦大学附属华东医院中医科就诊的门诊患者为研究对象,采用中药汤剂版MMAS-8进行用药依从性评估,依次通过项目分析、信度分析、效度分析及验证性因子分析对量表的信效度开展验证。结果 中药汤剂版MMAS-8各个条目临界比值均>3(P<0.01);各个条目得分与量表总分的相关性均>0.4(P<0.01);量表克朗巴哈系数（Cronbach’s α）为0.851,标准化Cronbach’s α为0.851,重测信度为0.780(P<0.01);巴特利特球形检验值为1 048.445(P<0.01),其取样适切性量数为0.844,校标关联度为0.613(P<0.01);量表共提取2个公共因子,可解释70.377%的总方差;结构模型参数卡方自由度比值、近似误差均方根、均方根残差、拟合优度指数、比较拟合指数、增值适配指数分别为2.789、0.024、0.009、0.957、0.967、0.967。结论 中药汤剂版MMAS-8具备可靠的...     

老年人肝功能异常病因分析及影像学诊断意义(附247例病例报告)

目的 探讨老年人肝功能异常病因及影像学诊断意义。方法 对247例60～95岁老年肝功能异常分别进行相关实验室检查和影像学检查．后包括B超，CT和MRI。结果 本组中肝脏本身疾病引起肝功能异常134例，肝外疾病引起105例，原因不明8例。其中72例是由影像学方法加以明确的。结论 选择合适的实验室和影像学检查对老年人肝功能异常的病因诊断有很大价值。     

奥美拉唑治疗老年人反流性食管炎

目的：观察奥美拉唑对我国老年人反流性食管炎的疗效。方法：老年人反流性食管炎４５例，男性４１例，女性４例，年龄７５±ｓ５ａ，单以奥美拉唑２０ｍｇ，ｐｏ，ｑｄ，治疗８ｗｋ。结果：治疗８ｗｋ临床全部有效，内镜检查的愈合率９３％，愈合者停药２ｍｏ，６ｍｏ，１２ｍｏ累积复发率分别为６０％，８２％，９１％；３９例复发者１５例需２０ｍｇ，ｑｄ，１９例需２ｄ服２０ｍｇ，５例需３ｄ服２０ｍｇ维持治疗，观察３～１２ｍｏ，症状缓解率分别为１００％，８９％，６０％。结论：奥美拉唑对我国老年人反流性食管炎的近期及维持治疗均有良好疗效，但停药后复发率高，需维持治疗，且维持剂量不宜过低