泌尿系结核96例分析

目的提高泌尿系结核的诊断水平。方法回顾性分析96例泌尿系结核的临床表现及实验室、影像学检查,总结其诊断经验。结果及结论泌尿系结核临床表现越来越不典型,过度依赖临床表现、B超检查结果是误诊的首要原因。应综合病史、尿液分析、影像学检查,必要时行逆行插管、膀胱镜活检,方能提高对泌尿系结核的诊断。     

Equivalent and sufficient effects of leuprolide acetate and goserelin acetate to suppress serum testosterone levels in patients with prostate cancer

OBJECTIVE

To compare the effects of leuprolide acetate and goserelin acetate for suppressing serum testosterone levels in Japanese patients with prostate cancer, as several recent studies suggested that serum testosterone is not always suppressed below the upper limit of the castration range in patients using luteinizing hormone‐releasing hormone (LH‐RH) agonists, especially leuprolide acetate.

PATIENTS AND METHODS

In all, 232 patients with prostate cancer, whose serum testosterone levels were measured before and during treatment using a 1‐ or 3‐monthly formulation of leuprolide or goserelin, were enrolled in a retrospective study. The mean age of the patients was 69.8 years and the mean testosterone level before the LHRH treatment was 4.54 ng/mL. The patients had their testosterone levels assessed a mean (range) of 5.4 (1–35) times during the LHRH treatment. A castrate serum testosterone level was defined as ≤0.5 ng/mL.

RESULTS

The mean maximum testosterone level during 1‐monthly leuprolide (40 patients), 3‐monthly leuprolide (68), 1‐monthly goserelin (50), or 3‐monthly goserelin (74) treatment was 0.22, 0.20, 0.19 and 0.20 ng/mL, respectively (not significant). Four patients, including two treated with 1‐monthly leuprolide, one with 3‐monthly leuprolide and one with 3‐monthly goserelin, had serum testosterone above the castrate level, with a maximum of 0.5–0.65 ng/mL. Three of these patients had elevated testosterone only once or twice during the follow‐up, and the remaining patient had serum testosterone fluctuating at 0.4–0.6 ng/mL throughout the follow‐up.

CONCLUSIONS

One‐ and 3‐monthly formulations of leuprolide and goserelin have equivalent and sufficient effects to suppress serum testosterone levels in men with prostate cancer. There were testosterone levels just outside the castrate range in a few patients during treatment.     

Brain neuroprotection by scavenging blood glutamate

Excess glutamate in brain fluids characterizes acute brain insults such as traumatic brain injury and stroke. Its removal could prevent the glutamate excitotoxicity that causes long-lasting neurological deficits. As blood glutamate scavenging has been demonstrated to increase the efflux of excess glutamate from brain into blood, we tested the prediction that oxaloacetate-mediated blood glutamate scavenging causes neuroprotection in a pathological situation such as closed head injury (CHI), in which there is a well established deleterious increase of glutamate in brain fluids. We observed highly significant improvements of the neurological status of rats submitted to CHI following an intravenous treatment with 1 mmol oxaloacetate/100 g rat weight which decreases blood glutamate levels by 40%. No detectable therapeutic effect was obtained when rats were treated IV with 1 mmol oxaloacetate together with 1 mmol glutamate/100 g rat. The treatment with 0.005 mmol/100 g rat oxaloacetate was no more effective than saline but when it was combined with the intravenous administration of 0.14 nmol/100 g of recombinant glutamate-oxaloacetate transaminase, recovery was almost complete. Oxaloacetate provided neuroprotection when administered before CHI or at 60 min post CHI but not at 120 min post CHI. Since neurological recovery from CHI was highly correlated with the decrease of blood glutamate levels (r=0.89, P=0.001), we conclude that blood glutamate scavenging affords brain neuroprotection Blood glutamate scavenging may open now new therapeutic options.     

Amperometric measures of age-related changes in glutamate regulation in the cortex of rhesus monkeys

l-glutamate (glutamate) is the principal excitatory neurotransmitter of the central nervous system and is involved in altered neural function during aging and in neurodegenerative diseases. Relatively little is known about the mechanisms of glutamate signaling in the primate brain, in part, because there is an absence of a method capable of rapidly measuring glutamate in either a non-clinical or a clinical setting. We have addressed this paucity of information by measuring extracellular glutamate at 1 Hz in the pre-motor and motor cortices of young, middle-aged, and aged monkeys using a minimally invasive amperometric recording method. In the motor cortex, mean resting glutamate levels were five times higher in the aged group compared to the young group while the pre-motor cortex showed an increasing trend in resting glutamate levels that was not statistically significant. In addition, we measured rapid, phasic glutamate release after local pressure-ejection of nanoliter volumes of either isotonic 70 mM potassium (to stimulate glutamate release) or 1 mM glutamate (to study glutamate uptake) into the pre-motor and motor cortex. In the pre-motor cortex, we measured reproducible glutamate uptake signals that had a significantly decreased (47%) rate of glutamate uptake in aged animals compared to young animals. However, following a 70 mM potassium delivery, we did not observe any consistent changes in evoked release between young versus aged animals. Using these non-clinical microelectrodes to measure glutamate signaling in the brain, our results support the hypothesis that the glutamatergic system undergoes reorganization with aging of the central nervous system.     

Impairment of several immune functions in anxious women

OBJECTIVE: Controversial results concerning immune function changes taking place in anxious subjects have been obtained. The aim of the present work was to study immune function in a group of anxious women. METHODS: Thirty-three anxious and 33 nonanxious age-matched women were included. Anxiety levels were determined by the Beck Anxiety Inventory. Peripheral blood samples were collected, and several leukocyte functions, as well as cytokine release, were studied. Plasma cortisol levels and total antioxidant capacity were also evaluated. RESULTS: The results showed diminished chemotaxis, phagocytosis, lymphoproliferation in response to phytohemagglutinin mitogen, natural killer activity, and interleukin-2 release, and augmented superoxide anion levels and tumor necrosis factor-alpha release in anxious women. Plasma cortisol was increased, while total antioxidant capacity was lowered in those subjects. CONCLUSIONS: The findings suggest impaired immune function and cytokine release in anxious women. This might be related to increased cortisol secretion, which would lead to oxidative stress reflected in lowered plasma total antioxidant capacity.     

Effects of graduated compression stockings with different pressure profiles on lower-limb venous structures and haemodynamics

INTRODUCTION: Graduated compression stockings (GCS) are one of the essential mechanical therapeutic approaches used in prevention and treatment of venous diseases. Pressure levels and gradient distribution are the two determined parameters influencing the performance of GCS products. However, the effects of GCS with different pressure profiles on venous function remain controversial in practical use. OBJECTIVE: To determine the physiological effects of GCS with different pressure levels and gradient distribution profiles on the venous function of the lower extremities. METHODS: At specific testing points along the long and short saphenous veins (LSV, SSV) and popliteal veins (PV) of the lower extremities, Doppler ultrasound techniques were used to examine venous cross-sectional areas (VA, cm(2)), the venous peak blood flow (PVpeak, cm/sec) and venous mean blood flow (PVmean, cm/sec) velocities in twelve female subjects wearing GCS with varying pressure profiles in a controlled laboratory environment. The Doppler examination was conducted three times during the 4-hour period (after wearing GCS for 1 minute, 70 minutes, and 170 minutes) in each subject. RESULTS: The pressure levels of GCS and duration of wear had statistically significant influences on the venous anatomy and venous haemodynamics. GCS with light, mild, moderate and strong pressures increased the popliteal PVpeak by 9.64%, 25.74%, 29.91% and 26.47%, respectively, and significantly decreased the VA. The GCS maintained these venous haemodynamics over time. No significant differences in blood flow were found between the mild, moderate and strong pressure GCS. CONCLUSION: The application of GCS with light and mild compression profiles appear to be effective in achieving a reduction in venous dilation and venous pooling, and improving venous return in the lower extremities. GCS with lighter pressures may be more suitable for subjects whose daily work requires long-term inactive standing or sitting, and GCS with mild pressure appear to be sufficient for most clinical applications.     

Transitioning Toward Evidence-Based Research in the Health Sciences for the XXI Century

This article discusses some of the misconceptions of evidence-based research in the health sciences. It proposes that since not all treatments in medicine and dentistry can be evidence-based, clinical applications of the evidence-based process should become a specialty. The case is particularly evident in dentistry. Therefore dentistry is taken in this article as a model for discussion. We propose that to approach dentistry from the viewpoint of the patient-oriented evidence that matters (POEM) is perfectly acceptable so far as we also engage in the process of research evaluation and appraisal in dentistry (READ). We distinguish between dentistry based on the evidence, and evidence-based dentistry. We argue that when invoking an evidence-based approach to dentistry or medicine, it is not sufficient to establish the ‘levels of evidence’, but rather that all evidence-based clinical intervention must undergo the stringent process of evidence-based research so that clinical practice guidelines be revised based on the best available evidence.     

学龄前儿童全血微量元素调查分析

目的 了解新乡地区学龄前儿童全血中微量元素的水平,为科学指导学龄前儿童的营养保健提供依据.方法 采用原子吸收分光光度法进行全血5种微量元素钙铁锌铜镁及铅元素检测,并对结果进行统计学分析.结果 本地区儿童最主要以缺锌(47.9%)为主,其次为钙(32.0%),铁(19.9%),而铜、镁基本正常.男女性别之间差异均无统计学意义(P>0.05),铅元素阳性率达4.15%,在各年龄段均有一定阳性率.结论 本地区学龄前儿童存在锌、钙、铁缺乏及血铅水平偏高现象,应重视监测,及早发现问题、及早治疗.     

Study of the long-term carcinogenicity potential of D-003, a mixture of high molecular weight sugarcane wax acids,in mice

D-003, a mixture of high aliphatic primary acids purified from sugar cane wax, has shown cholesterol-lowering, anti-platelet and antioxidant effects. Previous data demonstrated that D-003 was not toxic or carcinogenic when given orally to Sprague–Dawley rats up to 1500 mg/kg. This study investigated the potential long-term oral carcinogenicity of D-003 in a second rodent species. OF1 mice of both sexes were randomized into 4 groups treated for 18 months: a vehicle control group and three groups treated with D-003 at 50, 500 and 1500 mg/kg, respectively, orally gavaged 6 days per week. Mortality, clinical symptoms, weight gain, food consumption, organ weight, blood indicators and tumour incidence did not show significant differences between control and treated groups. D-003 did not increase the frequency of neoplastic or non-neoplastic lesions with respect to the controls. Lesions observed in the study were consistent with spontaneous lesions reported for this specie. It can be concluded that D-003 did not result toxic or carcinogenic when given orally to OF1 mice for 18 months and that the highest dose was a NOAEL, consistent with results of the oral carcinogenicity study of D-003 in rats.