Factors related to renal haemodynamics in young type-1 diabetes mellitus patients

The influence of metabolic control (HbA_1c), noradrenaline (NA) and insulin-like growth factors (IGF-I and IGF-II) on renal function and size was investigated in 11 insulin-dependent diabetes mellitus patients aged 11–17 years. Renal function was evaluated in terms of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal size was determined as renal parenchymal volume (RPV) by ultrasonography. The patients' HbA_1c values ranged from 8.2% to 12.9% (normal range 5.5–8.5%) and their GFR and ERPF were higher than normal. Their IGF-II values were higher, and NA and IGF-I levels were lower than those of healthy controls. Inverse correlations between NA and GFR (r=–0.66) and NA and ERPF (r=–0.63) were found. No correlation was found between serum IGF-I and renal functional parameters. The IGF-II values correlated with GFR and HbA_1c (r=0.63,r=0.70 respectively). There were linear correlations between RPV and GFR, RPV and ERPF, HbA_1c and GFR, and ERPF and RPV. Decreased NA concentrations and increased IGF-II values appear to be factors contributing to renal hyperfunction in these patients.     

Laboratory screening method for selection of healthy volunteers

The aim of laboratory screening in Phase I is to exclude subjects with subclinical illness, who might be at increased risk in the study, and who might also adversely influence interpretation of the results. A new method for laboratory screening, based on Bayesian probability theory, is proposed, which consists of: 1. Drawing up a list of diseases to be excluded. 2. Defining for each disease, the maximum acceptable risk that an included subject could be affected by it. 3. Identifying one test for each disease. 4. Using a contingency table to calculate the specificity of the test and integrating the estimated prevalence of the disease from epidemiological data. 5. Applying the percentage obtained by the calculation of specificity to the previously determined distribution of values in the volunteer population to identify the threshold value for inclusion. Use of this deductive method in screening volunteers for Phase I trials affords increased security of selection, while reducing the number of non-pertinent exclusions because of laboratory findings.     

Heterogeneous proteolytic specificity and activity of the house dust mite proteinase allergen Der p I

Background Exposure of the skin or respiratory tract to proteinases is frequently associated with allergic sensitization. This is of particular significance in the domestic indoor environment where the proteolytic activity of Der p I, the group I allergen of the house dust mite Dermatophagoides pteronyssinus, may influence the allergenicity of mites. Using class-specific proteinase inhibitors and active-site affinity chromatography, we have previously shown that Der p I exhibits a mixed cysteine-serine proteinase activity. Measurement of the amount of cleavage, however, did not determine whether the inhibitors used were targeting exactly the same proteolytic mechanism. Objective To resolve this issue, we have examined whether the cleavage specificity of the cysteine and serine proteinase activities of Der p I was the same. Methods HPLC and mass spectrometry were used to analyse and identify the products of a Der p I-digested peptide substrate and thus identify the peptide bonds cleaved. Results Der p I cleaves different peptide bonds, depending upon the class of proteolytic mechanism used. In the model peptide substrate insulin B chain, the cysteine and serine proteinase activities of Der p I showed preference for glutamic acid and arginine respectively in the P1 position. Conclusion These data suggest the existence of more than one mechanistic form of the allergen immunologically identified as Der p I. If proteolytic activity is indeed a function of allergenicity, this information may have important implications for the pathogenicity of Der p I and the ability of innate antiproteinase defences in the respiratory tract to prevent immune sensitization.     

The decay of house dust mite allergens, Der p I and Der p II, under natural conditions

Background: Fluctuations in the level of mite allergens in domestic house dust are the result of changes in the balance between synthesis, removal and decay. Purely physical forces as well as enzymatic degradation, mediated by house dust inhabiting microbes, may contribute to the decay of allergens in domestic dust. Knowledge about the speed of decay is essential for an understanding of the dynamics of allergen levels. Objective: The present study is a quantitative assessment of the speed of decay at nine combinations of temperature (15°C, 20°C and 25°C) and relative humidity (33%, 55% and 75%). Methods: Samples of mite infested material of an old rug were stored at these temperature/relative humidity-combinations for 6, 12 or 18 months, after the mites were killed by cither a freezing treatment or an acaricide (lindane). The microbes living in the rug presumably survive these treatments. Concentrations of Der p I and Der p II + Der f II. in extracts of the rug material, were measured by a radio immunoassay. Results: No significant changes in the levels of Der p I and Der p II +Der f II, could be detected even after 1¹/₂ year at a high temperature and humidity. Conclusion: These findings incidate that mite allergens can be extremely stable under normal domestic circumstances.     

第二产程产妇自由体位分娩效果的研究

目的 探讨产妇在第二产程中采取自由体位对分娩效果及舒适瘦的影响。方法 随机将152例初产妇分为观察组77例和对照组75例。观察组产妇在第二产程根据产妇的意愿采取半卧位、侧卧位、蹲位、坐位等自由体位，接生时采用半卧蹲坐位。对照组产妇采取床头抬高30°的截石位分娩。比较2组第二产程的长度及产后的舒适度。结果 观察组第二产程较对照组缩短（P〈0．01），产后双下肢酸痛、麻木不适较对照组显著减轻，舒适度增加。结论 第二产程自由体位可有效缩短产程并缓解分娩体位的不适。     

次侧切术治疗期肛裂前后肛门直肠压力对比分析

目的 :探讨次侧切开内括约肌治疗肛裂术前、术后肛门直肌压力的变化。方法 :采用自行设计的次侧方内括约肌切开加双缘结扎术治疗 期肛裂 6 0例 ,测定手术前后肛门直肠压力 ,并与 6 0例正常人肛压比较 ,评价新术式治疗 期肛裂的临床疗效及其对肛门功能的影响。结果 :显示术后患者肛管静息压显著降低 ,与术前比较有显著性差异 (P <0 .0 1) ,与正常人比较无显著性差异 (P>0 .0 5 ) ;肛管最大收缩压与术前及正常人比较无显著性差异 (P>0 .0 5 )。结论 :次侧方内括约肌切开加双缘结扎术能有效地解除内括约肌痉挛 ,从根本上消除高肛压 ,从而彻底治愈肛裂 ,而且不影响肛门功能。     

1 108例终末期肾脏疾病血液透析病人原发疾病构成及相关因素分析

目的 回顾性研究终末期肾脏疾病（end stage renal disease，ESRD）血液透析病人原发疾病构成及其相关因素。方法 收集ESRD血液透析病人1108例，分析其原发疾病构成、年龄、性别、透析治疗持续时间、转归、生存率和死亡原因。结果 301例病人透析时间超过3个月，其中43．9％仍在进行血液透析治疗，最长者已存活13年；13．0％病人已行肾脏移植；19．9％转至外院治疗；7．3％改为腹膜透析；1．3％因经济困难放弃治疗；14．6％病人死亡。ESRD维持性血液透析病人1年生存率为93．53％，3年生存率为68．92％。5年生存率62．51％。死亡原因为心血管事件占54．5％，脑血管意外占20．5％。结论 本组病人以中、老年为主，男性多见。ESRD血液透析病人主要原发疾病为慢性肾小球肾炎，主要死亡原因为心血管事件和脑血管意外。     

阻塞型睡眠呼吸暂停低通气综合征患者血管活性肠肽与睡眠质量的关系

为明确阻塞型睡眠呼吸暂停低通气综合征 (OSAHS)患者清醒及不同睡眠期血中血管活性肠肽 (VIP)质量浓度与睡眠质量之间的关系 ,以 1 2例OSAHS患者为研究对象 ,在桡动脉内留置导管监测血压 ,同步进行夜间多导睡眠仪连续记录 ,并分别于睡前清醒时、非快动眼 (NREM)睡眠期、快动眼 (REM )睡眠期及清晨从桡动脉留置的导管内抽取血标本 ,采用放免分析法检测VIP。结果 :1 )睡前清醒时及清晨血VIP质量浓度与总睡眠时间和记录时间之比(TST/TRT ,睡眠效率 )成正相关 (r =0 .5 91 ,P <0 .0 5 ) ,与醒觉时间和记录时间之比 (Arousal/TRT)成负相关 (r =-0 .5 86,P <0 .0 5 ) ;以睡前清醒时作基础值 ,NREM期血VIP质量浓度的变化与快波睡眠和总睡眠时间之比 (Ⅰ +Ⅱ /TST)成负相关 (r=-0 .65 6,P <0 .0 5 ) ,与快动眼睡眠时间和总睡眠时间之比 (REM/TST)成正相关 (r =0 .70 5 ,P <0 .0 1 ) ,REM期血VIP质量浓度的变化与REM/TST成正相关 (r=0 .60 9,P <0 .0 5 ) ;2 )OSAHS患者清醒与不同睡眠期血中VIP质量浓度与最长呼吸暂停时间和睡眠呼吸暂停指数 (AHI)成正相关 ,与血氧的有关指标无相关性。提示 :VIP可能参与OSAHS患者睡眠的调节     

CT引导下无水乙醇阻滞双侧腹腔神经丛治疗腹部癌性疼痛的评价

目的探讨CT引导下腹腔神经丛无水乙醇阻滞治疗腹部癌性疼痛的价值。方法对无法切除和无法有效止痛的12例晚期上腹部癌症病例，CT引导下以无水酒精10-15毫升实施双侧腹腔神经丛阻滞。评价其止痛效果、不良反应、生存质量等。结果疼痛完全缓解7例，部分缓解3例，患者仅口服或肌注曲马多即能止痛．有效率83.3％；6例完全或部分缓解持续3个月，1例持续4．3个月。全部病例精神状态、饮食和睡眠明显好转。结论CT引导下腹腔神经丛无水乙醇阻滞可较有效地解除上腹部顽固性的癌性疼痛。     

重组人表皮生长因子应用于肛裂手术的临床研究

目的：研究外源性表皮生长因子对于肛裂手术后的手术创面愈合情况的影响。方法：肛裂手术后，治疗组患者每日用重组人表皮生长因子敷于肛管创面，对照组患者采用常规的方式换药。比较两组患者术后伤口疼痛、出血情况，以及伤口肉芽生长愈合情况。结果：治疗组在减轻术后伤口疼痛、伤口水肿和出血等方面均显著优于对照组，其平均住院时间和伤口愈合时间也显著短于对照组。结论：外源性表皮生长因子有助于肛裂术后创面的快速修复，减轻患者的痛苦。