阻塞性睡眠呼吸暂停与缓慢性心律失常的关系

Objective To analyze the relations between obstructive sleep apnea and bradyarrhythmia.Methods From 1999 to 2005,203 patients who came from Bering Tongren Hospital and Fuwai Hospital were found to have sleep apnea in an ambulatory study. A Hoher electrecardiogram was recorded for 24 hours within 2 weeks after patients were diagnosed as obstructive sleep apnem Results Nocturnal episodes of bradyarrhythmia were identified in 12(5.9%)of 203 patients.Body mass index and respiratory disturbance index in patients with bradyarrhythmia(n=12)were higher than those in patientswithour bradyarrhymia(n=191)(34±5 735.24±6 and 63±15 vs.25±5,respectively,both P<0.01).There was a significant difference in end-apneic oxygen saturation in apnea/hypopnea episodes with and without bradyarrhythmia(63%±15% vs.75%±11%,P<0.05).A linear relation between end-apneic oxygen saturation and number of sinus arrests and heart blocks was not found.Conclusions Patients with apnea-associated bradyarrhythmia have higher body mflgB index and higher respiratory disturbance index than patients without bradyarrhythmi&Bradyarrhythmia occurres independently from decrease in oxygen saturation.     

Presynaptic α2-adrenoceptor-mediated modulation of norepinephrine release from vascular adrenergic neurons in reduced renal mass salt hypertensive rats

The present study was designed to investigate the presynaptic alpha 2-adrenoceptor function to inhibit norepinephrine (NE) release in blood vessels of reduced renal mass salt hypertensive rats (Na-loaded HT). Isolated perfused mesenteric vasculatures were prepared from Na-loaded HT and normotensive control rats (NT-control), and the NE release and vascular responsiveness were examined. Periarterial nerve stimulation caused a significantly greater release of NE and pressor responses in Na-loaded HT than in NT-control. Yohimbine, a potent alpha 2-adrenoceptor antagonist, demonstrated the facilitatory effects on NE release during nerve stimulation. The effects were significantly attenuated in Na-loaded HT compared with NT-control. These results demonstrate that vascular sympathetic nervous activity might be enhanced in Na-loaded HT. Furthermore, the increased NE release from vascular adrenergic neurons in Na-loaded HT could partially depend on impaired presynaptic alpha 2-adrenoceptor-mediated modulation, which might contribute to the pathogenesis and maintenance of this form of salt-dependent hypertension.     

Mass Screening for Neuroblastoma and Estimation of Costs

ABSTRACT. On the basis of epidemiological data and medical costs for patients with neuroblastoma, we have calculated the cost of mass screening for neuroblastoma with high performance liquid chromatography (HPLC) compared to the cost when it is not performed. If the sensitivity of the mass screening is 80 % and 22 000 infants are screened annually the cost will be 27809000 yen ($191800). If mass screening is not performed, the cost will be 28 446 000 yen ($196 200). The difference in cost (637 000 yen or $4 400) is fairly small. If the sensitivity is 75 % and 16 500 infants are screened, the difference is also small (174000 yen or $1 200). Therefore, mass screening with the HPLC method will not be an undue financial burden. But re-screening at an older age will be done with less financially favorable results, considering that the sensitivity may not be as high as that of the first screening and that mothers are somewhat reluctant about re-screening. The balance of the cost of mass screening by qualitative methods may also be less favorable, since the detection rate is low.     

Prevalence of and risk factors for nocturia: Analysis of a health screening program

BACKGROUND: We examined the prevalence of and risk factors for nocturia in Kurashiki city and the surrounding area, a rural area in Japan. MATERIALS AND METHODS: We collected data on 6517 individuals (4568 men and 1949 women) who participated in a multiphasic health screening. We analyzed the relationships between nocturia assessed by a questionnaire (voiding twice or more during night) and other variables including age, hypertension, cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes mellitus (DM), chronic renal failure, benign prostatic hyperplasia (BPH), smoking habit and alcohol intake. RESULTS: Overall, 1856 individuals (28.5%) answered that they arose to urinate at least twice during the night. This rate increased with age from 16.5% in individuals younger than 50 to 60.0% in those older than 69. Logistic regression analysis revealed that cohorts of subjects 50-59, 60-69, and 70 years old or over had, respectively, 1.75, 3.35, and 6.21 times the prevalence of nocturia of the 49 years or younger cohort. Hypertension (odds ratio [OR] 1.64) and DM (OR 1.70) were other independent positive risk factors for nocturia. On the other hand, current smokers who smoked 20 or more cigarettes per day were less likely to have nocturia than non-smokers (OR 0.72). In male individuals, BPH was another independent positive risk factor (OR 1.35). Gender was not associated with nocturia. CONCLUSIONS: Although population bias is an important limitation to this study, nocturia is associated with various factors suggesting that multiple approaches are needed to the treatment of patients with nocturia.     

老年2型糖尿病患者胰岛素抵抗相关指标的检测和意义

目的:探讨老年2型糖尿病胰岛素抵抗(IR)及其相关性,为老年2型糖尿病的合理防治提供临床依据。方法:选择120例老年2型糖尿病患者,按胰岛素敏感指数(HOMA)胰岛素抵抗(HOMA-IR)50百分位点将患者分为两组:胰岛素相对敏感组(HOMA-IR<3.56)和胰岛素相对抵抗组(HOMA-IR≥3.56),比较体重指数(BMI)、腰/臀比(WHR)、血压、血生化学检查等指标。用年龄>40岁,<60岁的2型糖尿病患者做对照组。结果:两组老年患者在年龄、性别、舒张压、空腹血糖、胆固醇、高密度脂蛋白、糖化血红蛋白、HOMA胰岛β细胞功能方面无差异;但BMI、WHR、收缩压、甘油三脂、空腹胰岛素、HOMA-IR差异具有显著性。多线性回归分析后,只有腰/臀比、收缩压、甘油三脂、HOMA-IR存在统计学差异。老年患者与对照组相比,IR发生率明显增加,且两者腰/臀比、收缩压、甘油三脂方面也差异显著。结论:IR与老年2型糖尿病密切相关,是临床防治糖尿病的重要靶点。     

D4S1647、D6S2414基因座在中国汉族、蒙古族、藏族的遗传多态性

目的 调查D4S1647、D6S2414基因座在中国汉族、蒙古族、藏族群体中的遗传分布规律。方法 采集308份血及唾液标本应用PCR技术，扩增产物用非变性聚丙酰胺凝胶电泳分离，银染显色分析。结果 两位点各群体基因型频率分布均符合Hardy-Weinberg平衡，每一位点等位基因频率分布在各群体间无显著差异；通过对10个汉族家系的遗传模式分析，证实了两位点等位基因传递遵循孟德尔遗传规律。结论 D4S1647、D6S2414基因座在中国汉族，蒙古族，藏族群体均具有高度遗传多态性。     

四逆汤煎煮过程中乌头类生物碱的溶出和水解平衡

目的 研究四逆汤中乌头类生物碱的溶出平衡和水解平衡。方法 利用电喷雾质谱分析，比较了制附子、四逆汤、四逆汤药渣和含有3种双酯型生物碱的混合对照品体系中的乌头碱类二萜生物碱。结果 在煎煮过程中双酯型生物碱溶解并发生水解反应，而脂类生物碱则难溶于水。乌头碱、中乌头碱、次乌头碱水溶性相近，但是次乌头碱在水中的热稳定性更高，C19二萜骨架上C3取代基(—OH或—H)的变化影响生物碱的稳定性。结论四逆汤中的乌头碱类生物碱的种类及含量由其溶解性和化学稳定性共同决定。     

The influence of partial gastrectomy on biochemical parameters of bone metabolism and bone density

Summary Since it has been suggested that gastric resections are followed by changes in bone metabolism, the aim of our study was to determine the biochemical parameters of bone metabolism and radial and lumbar bone density in 15 male ulcus patients treated by partial gastrectomy (Billroth II). Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography was statistically significantly lower (P < 0.04) in the patient group, whereas the peripheral bone mass of the distal part of the nondominant forearm measured by single-photon absorptiometry showed no statistically significant difference. In addition, a marked increase in alkaline phosphatase (P < 0.002) and urinary excretion of hydroxyproline (P < 0.003) was found in the gastrectomy group, whereas the 25-hydroxy-vitamin D levels were found to be significantly decreased (P < 0.04). Osteocalcin, a biochemical marker for osteoblast activity, and the carboxy-terminal propeptide of type I procollagen (PICP), a marker of collagen formation, were slightly but not significantly higher in gastrectomy-treated patients. The serum parathyroid hormone levels were similar in both groups. As none of the patients had any radiologic evidence of osteopenia, the changes in biochemical parameters of bone metabolism and bone mass in patients who had undergone partial gastrectomy could be a marker of latent bone loss.Abbreviations DPA/SPA dual/single-photon absorptiometry - BMD bone mineral density - QCT quantitative computed tomography - PICP carboxy-terminal propeptide of type I procollagen - 250HD₃ 25-hydroxy-vitamin D - iPTH parathyroid hormone - OC osteocalcin - BMC bone mineral content