泻肾法在治疗小儿支气管哮喘中的运用观察

目的探讨泻肾法治疗小儿支气管哮喘的临床应用。方法选择我院自2010年1月—2011年12月小儿科收治的128例支气管哮喘的患儿,通过大量的文献,结合现代疾病本身的特点,所有患儿均经过中医辨证的肾实证病例,按照患儿入院登记的时间先后顺序,将患儿分为观察组（64例）与对照组（64例）,观察组给予大泻肾汤（黄芩、茯苓、细辛、干姜、芍药及甘草）,2 d/次,连续服用7 d。对照组服用氨茶碱,在临证中根据患儿的临床症状酌情使用抗生素,连续服用7 d,观察两组的治疗效果、症状消失时间,随访观察症状有无复发情况。结果观察组与对照组的疾病临床有效率分别为89.06%（57/64）、81.25%（52/64）,在中医证候疗效方面比较92.19%（59/64）、79.69%（51/64）,观察组的显效率明显优于对照组（P〈0.05）。结论小儿支气管哮喘患者主要按照肾实证加以辨治,通过服用泻肾清热方剂治疗,取得了一定的临床治疗效果。     

Gastro-intestinal toxicity of chemotherapeutics in colorectal cancer:The role of inflammation

Chemotherapy-induced diarrhea(CID)is a common and often severe side effect experienced by colorectal cancer(CRC)patients during their treatment.As chemotherapy regimens evolve to include more efficacious agents,CID is increasingly becoming a major cause of dose limiting toxicity and merits further investigation.Inflammation is a key factor behind gastrointestinal(GI)toxicity of chemotherapy.Different chemotherapeutic agents activate a diverse range of pro-inflammatory pathways culminating in distinct histopathological changes in the small intestine and colonic mucosa.Here we review the current understanding of the mechanisms behind GI toxicity and the mucositis associated with systemic treatment of CRC.Insights into the inflammatory response activated during this process gained from various models of GI toxicity are discussed.The inflammatory processes contributing to the GI toxicity of chemotherapeutic agents are increasingly being recognised as having an important role in the development of anti-tumor immunity,thus conferring added benefit against tumor recurrence and improving patient survival.We review the basic mechanisms involved in the promotion of immunogenic cell death and its relevance in the treatment of colorectal cancer.Finally,the impact of CID on patient outcomes and therapeutic strategies to prevent or minimise the effect of GI toxicity and mucositis are discussed.     

Maximal calf circumference reflects calf muscle mass measured using magnetic resonance imaging

BackgroundCalf circumference (CC) has been used as a surrogate for calf muscle mass, which facilitates venous blood return to the heart through active skeletal muscle. However, the correlation between CC and calf muscle mass has not been extensively examined. This study aimed to examine the relationship between CC and calf muscle mass considering differences in sex and physique in elderly individuals.MethodsA total of 124 community-dwelling elderly individuals ≥60 years of age (61 men, mean [±SD] age 74.3 ± 5.7 years) were enrolled. Maximal CC was measured using a tape measure with the subject supine. The cross-sectional area of skeletal muscle tissues was measured using magnetic resonance imaging from the point of greatest calf circumference to 5 cm proximal and distal. Calf muscle mass was calculated by multiplying the area of each slice by slice thickness (5 mm).ResultsCC was strongly correlated with calf muscle mass in male and female subjects (male: r = 0.908, P < 0.001; female: r = 0.892, P < 0.001). Multiple regression analysis revealed that CC and body mass index (BMI) were independent associate factors of calf muscle mass. The following estimation formulae were derived: (male) calf muscle mass (cm³) = 47.82 × CC (cm)−12.50 × BMI (kg/m²) −732.80; (female) calf muscle mass (cm³) = 32.23 × CC (cm) −4.85 × BMI (kg/m²) −429.94.ConclusionsA strong correlation was found between CC and calf muscle mass according to magnetic resonance imaging. Sex differences and BMI should be considered for accurate estimation of calf muscle mass using CC.     

人用轮状病毒疫苗研究进展

轮状病毒（rotavirus，RV）是全球范围内导致婴幼儿腹泻的主要病原体之一。研究表明干净的水源和良好的卫生环境不能阻断RV传播，且目前尚无特异性治疗RV性腹泻的药物，使用RV疫苗是唯一有效的防控手段。此文对RV疫苗的使用现状、研发进展及面临的挑战做一综述。     

程序化健康教育对婴幼儿腹泻的作用

目的探讨程序化健康教育对婴幼儿腹泻的作用。方法将84例婴幼儿腹泻患儿随机分为试验组43例和对照组41例,对照组采用传统健康教育方法教育,试验组按整体护理程序对患儿及家属实施程序化健康教育。观察2组患儿家属对婴幼儿腹泻病相关知识和技能的知晓程度;2组患儿的住院时间、红臀发生情况。结果试验组患儿家属对婴幼儿腹泻病相关知识和技能的知晓程度明显优于对照组(P<0.05),且试验组患儿的平均住院时间、红臀的发生均少于对照组。结论采用程序化健康教育能明显提高患儿家属的健康知识水平,缩短患儿的平均住院时间,减少红臀发生。     

短期去乳糖奶粉喂养方法对新生儿腹泻的效果

目的：探讨短期去乳糖奶粉喂养方法对新生儿腹泻的效果。方法选取2013年3月—2014年2月腹泻患儿140例，按随机数字表法随机分为观察组和对照组各70例，观察组采用短期去乳糖奶粉喂养，对照组采用长期去乳糖奶粉喂养。比较两组患儿治疗效果、胃肠道症状、体质量增长与喂养耐受情况。结果观察组患儿痊愈51例，有效17例，无效2例；对照组痊愈47例，有效20例，无效3例，差异无统计学意义（Z＝0．758，P＝0．366）。观察组患儿平均体质量增长（34．30±7．35）g／（kg· d），平均摄入奶量（105．37±24．02）ml／（kg· d），优于对照组的（24．29±8．06）g／（kg· d），（97．21±21．66）ml／（kg· d），差异有统计学意义（t值分别为2．809，3．161；P＜0．05）。观察组排便次数、呕吐、腹胀、胃潴留发生例数均少于对照组，差异有统计学意义（P＜0．05）。结论腹泻新生儿采取短期去乳糖奶粉喂养方式既符合婴幼儿的生长发育特点，又可以维持其免疫功能的平衡，且经济实惠，值得在临床推广。     

Saccharic acid 1.4-lactone protects against CPT-11-induced mucosa damage in rats

Purpose To evaluate the ability of D-saccharic acid 1.4-lactone (SAL), a -glucuronidase inhibitor, to prevent irinotecan hydrochloride (CPT-11) from inducing mucosal damage as a cause of diarrhea in rats.Methods Wistar rats were divided into six groups of three animals each, administered 1.0 ml isotonic solution intraperitoneally once daily for up to three consecutive days, respectively for up to six days. The series were as follows: (1) On days 1–3: saline; (2). On days 1–3: 200 mg CPT-11/m²; (3) On days –3 to –1 relative to the first administration of CPT-11: 10 mg/ml SAL; on days 1–3: 200 mg CPT-11/m²; (4) On days –3 to +3 relative to the first administration of CPT-11: 10 mg/ml SAL, and on days 1–3: additional 200 mg CPT-11/m²; (5) On days 1–3: 200 mg CPT-11/m² (0.5 ml) + 10 mg/0.5 ml SAL; (6) On days –3 to –1 relative to the first administration of CPT-11: 3 mg/ml SAL, and on days 1–3: 200 mg CPT-11/m². Luminal mucosa damage of the small intestine was detected by histology 24 h after the last intraperitoneal application. Peptidase activities of the proximal jejunum were measured by using an in situ perfusion model.Results Following intraperitoneal CPT-11 treatment, using conventional histology of paraffin sections, we observed severe mucosal damage. This was reflected by a decrease of the villi/crypt ratio, an increase of apoptotic cells, as well as an increase of mitotic figures in the crypt region. There was a concomitant increased lymphatic infiltration in mucosa of CPT-11 treated rats. This damage pattern could be clearly reduced by co-treatment with the -glucuronidase inhibitor, SAL, independent of the treatment schedule. In contrast to our expectations based on previous reports, the intraperitoneal application of CPT-11 alone or in combination with SAL did not cause significant differences in luminal enzyme liberation in comparison with controls in the in situ perfusion assay.Conclusions The -glucuronidase inhibitor SAL is able to significantly reduce CPT-11-induced mucosal damage in the small intestine of rats. This observation might soon have a clinical impact for the treatment of patients with CPT-11.     

奥曲肽治疗别嘌呤醇所致严重腹泻1例

患者因服用别嘌呤醇所致引发多种严重的药物不良反应,皮疹等不良反应经H1受体拮抗剂、激素等处理后好转,但严重腹泻经常规用药治疗无法得以改善,予以使用奥曲肽注射液以药理作用治疗后即好转,提示奥曲肽可能适用于药物不良反应引起的难治性严重腹泻。