泰魄颗粒对慢传输型便秘治疗机制的研究

[目的]研究泰魄颗粒治疗慢传输型便秘的机制。[方法]①分别测定20例正常人和25例便秘患者长期服用刺激性泻下药餐前及餐后5、10、15、30min横-降导联肠电图。②用大黄浸液制造慢传输型便秘模型,观察泰魄颗粒对模型大鼠血浆血管活性肠肽(VIP)、P物质(SP)的影响。[结果]长期服用刺激性泻药患者肠电图波幅、频率较正常人下降,餐后肠电图不升反降,治疗后波幅和频率均升高(P0.05,0.01)。便秘模型大鼠SP和VIP水平,与正常对照组比较显著降低(P0.01)。经泰魄颗粒治疗10d后血浆SP水平与模型对照组比较差异有统计学意义(P0.01),VIP水平在低剂量组与模型对照组比较差异无统计学意义,高剂量组有统计学意义(P0.05)。[结论]泰魄颗粒能有效改善长期服用刺激性泻剂便秘患者的肠电图异常现象,增加肠道推进性运动;改善慢传输模型大鼠血浆SP、VIP水平,从而促进肠道运动和水分的分泌。泰魄颗粒对泻剂导致的慢传输型便秘具有治疗作用。     

理脾通滞汤治疗慢性功能性便秘52例

[目的]观察理脾通滞汤治疗慢性功能性便秘(CFC)的临床疗效.[方法]对52例CFC患者采用理脾通滞汤治疗,并与用麻仁软胶囊进行临床对照观察.[结果]治疗组总有效率94.23％,治愈率19.23％；对照组总有效率80.39％,治愈率11.76％.2组间临床疗效比较差异有统计学意义(P＜0.05).[结论]理脾通滞汤能改善患者肠道功能,对CFC有较好疗效.     

三九胃泰与奥美拉唑联合应用治疗功能性消化不良疗效及安全性

[目的]探究三九胃泰颗粒与奥美拉唑联用治疗功能性消化不良疗效和安全性。[方法]回顾性分析于我院就诊的功能性消化不良患者141例,根据治疗方法分为对照组47例、治疗组46例和联合用药组48例,对照组患者采用奥美拉唑与三九胃泰颗粒模拟剂治疗,治疗组采用奥美拉唑模拟剂和三九胃泰颗粒治疗,联合组采用奥美拉唑与三九胃泰颗粒治疗,观察比较三种方法治疗效果与不良反应发生情况。[结果]联合用药组总有效率为95.83%,显著高于治疗组和对照组的73.91%和72.34%;联合用药组的症状积分改善率为71.16%,显著高于治疗组(46.75%)和对照组(44.80%);治疗后,联合用药组患者的症状评分显著低于治疗组和对照组,以上差异均有统计学意义,P0.05;三组不良反应分别为4.17%、6.52%和8.50%,差异不具有统计学意义,P0.05。[结论]对于功能性消化不良患者,实施三九胃泰颗粒与奥美拉唑联合治疗,可改善患者临床症状,不良反应发生率较低,安全性较高,具有临床推广和应用价值。     

董氏“三其穴”在功能性肛门直肠痛中的治疗应用

[目的]观察董氏"三其穴"对功能性肛门直肠痛的治疗效果。[方法]选取临床中符合功能性肛门直肠痛的患者45例,随机均分为3组,每组15例,其中第1组采用基础治疗+物理疗法,第2组采用基础治疗+针刺疗法,第3组采用基础治疗+物理疗法+针刺疗法,治疗后分别观察3组的临床疗效,并对比3组疗效。[结果]3组治疗方法治疗功能性肛门直肠痛均有明显的疗效,其中第1组治愈率为26.7%,有效率为60.0%,第2组治愈率为40.0%,有效率为73.3%,第3组治愈率为53.3%,有效率为93.3%。[结论]在以心理疗法+提肛运动为基础治疗上,物理疗法和针刺疗法对功能性肛门直肠痛的治疗均有明显的疗效,且针刺疗法优于物理疗法,而将两法合用则能更加显著的提高疗效。     

粪菌移植治疗慢性功能性便秘的研究进展

慢性功能性便秘是一种常见的肠道疾病,研究表明慢性功能性便秘与肠道菌群紊乱存在一定相关性,且改善肠道菌群紊乱的微生态制剂对慢性功能性便秘具有一定的临床疗效。近年来,肠道微生态的治疗在慢性功能性便秘领域取得了一定的进展,尤其是粪菌移植治疗获得了良好的效果。该文对粪菌移植治疗慢性功能性便秘的研究进展进行综述。     

温经汤加减治疗中青年女性慢性功能性便秘40例疗效观察

[目的]观察温经汤加减治疗中青年女性血少阳虚型慢性功能性便秘的临床疗效。[方法]将80例慢性功能性便秘女性患者随机分为对照组(复方聚乙二醇电解质散组)和观察组(温经汤加减方组)各40例,对照组采用口服复方聚乙二醇电解质散(Ⅳ),2次/d治疗,观察组采用温经汤加减方,1剂/d口服,2组均连续治疗1个月。在治疗1周(T1)、治疗1个月(T2)、随访1个月(T3)3个时刻观察2组患者的临床症状,在治疗1个月时观察中医证候的改变情况。[结果]3个时刻2组的有效率分别为:对照组72.5%、87.5%、62.5%,观察组57.5%、90.0%、77.5%,2组疗效比较差异均有统计学意义(P<0.05)。治疗结束时,观察组的中医证候疗效有效率高于对照组,且差异有统计学意义(P<0.05)。[结论]温经汤加减治疗中青年女性血少阳虚型慢性功能性便秘疗效确切,值得进一步推广研究。     

小麦纤维素对功能性便秘儿童肛门直肠压力的影响

[目的]观察小麦纤维素对功能性便秘儿童肛门直肠压力的影响以及其临床疗效。[方法]选取我院2014年1月~2016年4月儿科治疗的功能性便秘患儿116例,患儿使用数字法随机分为对照组和观察组,每组58例。对照组使用枯草杆菌二联活菌颗粒,1.0g/次,2次/d;观察组在对照组基础上加用小麦纤维素颗粒,3.5g/次,2次/d。4周为一疗程。多通道胃肠功能监测仪直肠肛管测压。比较2组临床有效率。[结果]2组治疗前、后直肠静息压和肛管静息压变化比较差异无统计学意义。治疗后观察组肛管最大缩榨压、直肠最大容量感觉阈值、模拟排便时肛管压显著低于对照组(P0.05)。2组治疗前排便次数、排便不净感、排便困难、排便疼痛评分差异无统计学意义。治疗后上述指标均较治疗前显著减低(P0.05或P0.01),但观察组显著低于对照组(P0.05)。观察组临床治疗有效率为94.8%(55/58),显著高于对照组的82.8%(48/55)(P0.05)。[结论]小麦纤维素显著改善了功能性便秘患儿的肠道动力学异常,以及肠道对粪便刺激的感觉能力,临床疗效显著。     

养荣润肠舒合剂配合针刺疗法治疗老年功能性便秘的疗效观察

[目的]观察养荣润肠舒合剂配合针刺疗法对老年功能性便秘的临床疗效。[方法]将60例患者随机分成2组。治疗组30例采用养荣润肠舒合剂配合针刺治疗,对照组30例口服麻仁软胶囊,2组均以10d为1个疗程,连续治疗2个疗程,治疗后对结果进行对比评价。[结果]治疗组有效率93.3%,对照组有效率83.3%,2组比较差异有统计学意义(P0.05)。[结论]养荣润肠舒合剂配合针刺疗法在老年功能性便秘的临床治疗中疗效满意。     

全结肠黑变病的临床特征分析

[目的]探讨全结肠黑变病（MC）的临床特征。[方法]对近3年来诊断的90例全MC患者相关资料进行分析。[结果]90例中,便秘58例,45例长期或间断服用蒽醌类泻药,腹泻8例,并发结肠癌3例,结肠息肉28例,溃疡性结肠炎3例。[结论]全MC的发病与服用蒽醌类泻药及便秘有关,便秘及服泻药时间越长、服药量越大,其MC程度越重。全MC还可能与炎症性肠病及腹泻本身有关。该病是一种良性疾病,与结肠肿瘤的发生有一定关系,停用刺激性泻药,纠正习惯性便秘可以逆转病变。     

功能性便秘的生物反馈治疗

目的评价生物反馈方法治疗功能性便秘的疗效。方法对我院42例慢性功能性便秘患者进行生物反馈治疗,治疗前后进行临床评估、直肠和盆底肌电描记并进行对比分析。结果生物反馈治疗后患者临床症状改善,肌电图显示盆底肌和腹肌的矛盾运动消失,肛门外括约肌的收缩幅度有不同程度的增加,松弛幅度降低(P<0·05),总有效率为93%,改善伴随症状有效率70%,6个月随访复发率仅5·26%。结论生物反馈治疗功能性便秘有效。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。