胰十二指肠切除术后腹腔引流的意义

胰十二指肠切除术是治疗胰腺及十二指肠壶腹周围疾病的重要手术方式。胰十二指肠切除术后进行腹腔引流是防止并发症、促进患者快速康复的主要方法,在国内外已经实践多年。但随着加速康复外科理念的兴起,术后腹腔引流的安全性和有效性争议不断。本文就胰十二指肠切除术后是否需要放置腹腔引流管、如何放置腹腔引流管以及何时拔除腹腔引流管的争议...     

Factors That Affect Blood Pressure Variability: A Community-Based Study in Ohasama,Japan

Factors that affect blood pressure (BP) variability, ie, standard deviation (SD) and variation coefficient (VC: SD/average ambulatory BP) of ambulatory BP, were examined in a community-based sample in northeastern Japan. Screening and ambulatory BPs were measured in 823 subjects ≥20 years of age, and the effects of age and BP on the SD and the VC were examined. In bivariate regression analysis, the SD of ambulatory BP was positively correlated with age and the ambulatory BP. The VC was also correlated with age. Both the SD and the VC were strongly correlated with the magnitude of the nocturnal decline in BP. Ambulatory BP was positively correlated with age and negatively correlated with heart rate and the SD of heart rate. Multivariate analysis demonstrated that the nocturnal decline in BP showed the strongest association with the SD and the VC of 24-h BP. However, age and BP were still independently and positively associated with the SD and the VC of ambulatory BP. Furthermore, pulse pressure and BMI were independently and positively associated with the SD and the VC of ambulatory BP. Since the SD and the VC of 24-h ambulatory BP were determined mainly by the nocturnal decline in BP, this variable appears to be an index of the circadian variation in BP and not an index of short-term BP variability. Pulse pressure, an index of arterial stiffness, was a relatively strong predictor of the SD and the VC of BP. In addition, the SD of heart rate, an index of baroreflex function, decreased with increasing age. Findings suggest that the increase in BP variability in hypertensive and elderly subjects may be explained, in part, by a disturbance of baroreflex function associated with an increase in arterial stiffness due to aging and hypertension.     

Contribución al estudio epidemiológico de las dermatofitosis en el área este de Valladolid

—We perform an epidemiological study of patients diagnosed of dermatophytosis confirmed by culture, which were observed in our Unit of Mycology at the Hospital Clínico Universitario in Valladolid for the period extended between January 2000 and May 2001. Data are analysed in relationship to different variables such as age, sex, time of occurrence, lesion localization or identified etiologic agent. We report 40 patients with positive dermatophyte culture. Fourteen were diagnosed as Tinea corporis, 10 Tinea pedis, 9 Tinea unguium, 6 Tinea cruris, 2 Tinea capitis, 2 Tinea manuum and 1 Tinea barbae. The most frequent isolated species was Trichophyton mentagrophytes (37%) followed by T. rubrum (32%), Microsporum canis (17%), T. tonsurans (8%), M. gypseum (3%) and M. audouinii (3%).M. canis predominated in Tinea corporis and accounted for two cases of Tinea capitis. In Tinea unguium, T. mentagrophytes and T. rubrum were mostly isolated. T. rubrum predominated in Tinea pedis.We present our results, which basically agree with those from other studies, in order to contribute to the epidemiological mapping of superficial mycoses in Spain.     

器官系统整合课程在临床医学专业本科生中的教学效果分析

目的:探讨器官系统整合课程在临床医学专业本科生中的教学效果。方法:采用回顾性队列方法,以2011至2016级上海交通大学医学院临床医学专业本科生284人为研究对象。其中观察组2014至2016级本科生147人采取基础医学课程实施器官系统整合模式教学,对照组2011至2013级本科生137人采取以学科为中心的传统模式教学...     

万古霉素类药物在患儿中的应用分析与合理性评价

目的:了解万古霉素类药物在患儿中的应用情况。方法:回顾性调查某院2005～2006年368例患儿应用万古霉素类药物的病史记录,就患儿基本情况、微生物学检查、用药方案和发生不良反应等信息判断万古霉素类药物的应用是否合理。结果:有17例患儿(占4.6%)发生药品不良反应;240例患儿(占65.2%)的用药合理或基本合理。结论:患儿应用万古霉素类药物应受到更为严格的管理。     

Membrane transport of nucleobases: Interaction with inhibitors

• 1.1. The kinetic properties and the mechanism of nucleobase transport and transport inhibition are briefly reviewed.
• 2.2. Many purine derivatives even when bearing large substituents on N⁹ and C⁶ are inhibitors of nucleobase transport, some are also substrates.
• 3.3. Papaverine and other benzyl-isoquinolines are efficient inhibitors of facilitated transport of nucleobases.
• 4.4. Papaverine is a noncompetitive inhibitor of nucleobase transport in human erythrocytes.
• 5.5. Reduction of the aromatic isoquinoline to the tetrahydro form causes loss of inhibitory activity whereas replacement of methoxy groups by ethoxy groups leads to increased activity.
• 6.6. Papaverine also inhibits sodium dependent active nucleobase transport in pig kidney cells.
• 7.7. The nucleoside transport inhibitors dipyridamole and dilazep have no effect on facilitated diffusion transport of nucleobases, but inhibit in micromolar concentrations active sodium dependent nucleobase transport in pig kidney cells.

     

Irreversible suppression of alcohol drinking in cyanamide-treated rats after sustained delivery of the 5-HT2 antagonist amperozide

The purpose of this study was to evaluate the long-term effect of sustained treatment with amperozide, which has been shown to attenuate the volitional drinking of ethyl alcohol in the rat without side effects. Preference for alcohol first was induced pharmacologically in Sprague-Dawley rats by the inhibitor of aldehyde dehydrogenase, cyanamide, administered in a dose of 10 mg/kg twice daily for 3 days. Then following a standard preference test, each rat was offered water and its maximally preferred concentration of alcohol which ranged from 7% to 15%. Following a 4-day pre-drug test, saline control vehicle or amperozide was administered for 7 days by an osmotic minipump implanted in the intrascapular space. A single dose of 208 μg/kg/h (i.e., 5.0 mg/kg/day) was selected on the basis of a prior dose response study of amperozide. During the interval of sustained release of amperozide, the consumption of alcohol declined significantly in terms of both absolute g/kg intake and proportion of alcohol to water. When the preference of the rats was retested at 4, 30, 70, 110, and 140 day intervals after the pump had exhausted amperozide, the absolute g/kg consumption of alcohol continued to decline significantly. Unlike other drugs, amperozide did not produce any side effects, particularly on the intake of food or water or on body weight, which suggests a pharmacological specificity of its action. Because amperozide acts centrally on 5-HT₂ receptors as well as on dopaminergic synapses in the limbic system, it is envisaged that the drug exerts a unique effect on reward systems in the brain by affecting their receptor reuptake mechanisms, release of the respective transmitters, or other processes potentially involved in the abnormal imbibition of alcohol. Finally, because the effect of amperozide on alcohol drinking is progressive and irreversible, it thus may serve as a pharmacological adjunct to current therapy used in the clinical treatment of the disease of alcoholism.