闭合性颅脑损伤伴降钙素原升高患者内毒素及血培养检测的临床意义

目的:通过对闭合性颅脑损伤伴有降钙素原(PCT)升高患者内毒素及血培养检测指标的结果进行分析,探讨此类"非感染性"创伤患者伴PCT升高的原因。方法:将闭合性颅脑损伤60例患者根据有无肠功能障碍分为实验组及对照组,各30例。检测患者入院即刻、入院后24、48、72、96 h血PCT、内毒素水平及血培养结果。结果:实验组血PCT及内毒素水平明显高于对照组,实验组血培养阳性率高于对照组,且均为革兰阴性菌。结论:闭合性颅脑损伤患者PCT升高的原因可能是由肠功能障碍所致的肠源性感染。     

丙氨酰谷氨酰胺在重度颅脑损伤治疗中的应用分析

目的观察丙氨酰谷氨酰胺辅治重度颅脑损伤的临床效果。方法治疗组在常规治疗基础上加用丙氨酰谷氨酰胺注射液20g/d,治疗10d,观察患者GCS评分、APACHE-II评分等判定临床治疗效果,并进行统计分析。结果治疗组治愈率和总有效率均明显优于对照组。结论丙氨酰谷氨酰胺辅治重度颅脑损伤效果良好。     

丙氨酰谷氨酰胺肠外营养改善轻症急性胰腺炎患者蛋白水平的效果观察

目的观察丙氨酰谷氨酰胺肠外营养对轻症急性胰腺炎患者蛋白水平的改善情况。方法选取2014年6月~2015年4月本院收治的轻症急性胰腺炎患者42例,将其按随机数字表法分为观察组与对照组,各21例。观察组肠外营养液中添加丙氨酰谷氨酰胺,对照组常规营养液中未添加丙氨酰谷氨酰胺。两组患者均给予禁食水、胃肠减压、抗炎、抑酸、保肝、抑制胰酶等对症治疗。分别于入院当日及行肠外营养后第5天测患者血前白蛋白、白蛋白、总蛋白。结果与入院当日相比,行肠外营养第5天,两组患者的血中前白蛋白、白蛋白、总蛋白水平均升高,差异有统计学意义(P0.05);在第5天时,观察组上述蛋白水平显著高于对照组,差异有统计学意义(P0.05)。结论丙氨酰谷氨酰胺促进轻症急性胰腺炎患者的蛋白合成,效果确切,具有推广意义。     

危重病人肠外营养补充谷氨酰胺二肽维持小肠功能作用

长期行全肠外营养(TPN)的重症监护病人常伴有肠粘膜萎缩而继发肠吸收不良。目前研究已证实对肠粘膜上皮起特殊营养作用的谷氨酰胺,在维持应激有关情况时的小肠结构和功能上起着重要作用。本文旨在研究长期行TPN的危重病人,补充丙氨酰-谷氨酰胺对小肠功能的影响。 12例重症监护病人(男7,女5)随机归于试验组及对照组,每组6人。两组患者所接受     

全肠外营养加丙氨酰谷氨酰胺治疗重症肺炎并肠道功能衰竭患者的疗效

目的：探讨全肠外营养（TPN）加丙氨酰谷氨酰胺治疗重症肺炎并肠道功能衰竭患者的疗效。方法：将96例重症肺炎并肠道功能衰竭患者依照随机数字表法分为对照组和治疗组，每组48例。对照组采用抗生素、机械通气等基础治疗，并给予TPN治疗；治疗组在TPN治疗中应用丙氨酰谷氨酰胺（20g/次，1次/d），2组均治疗4周。比较治疗前、后2组存活患者营养指标、细胞免疫功能指标、对肠道功能衰竭的疗效及药物不良反应。结果：治疗后，2组存活患者肱三头肌皮褶厚度、上臂肌围、白蛋白和血红蛋白、CD3+、CD4+和CD4+/CD8+升高，且治疗组更高（P均<0.05）；CD8+降低，且治疗组更低（P<0.05）；对肠道功能衰竭的疗效，治疗组的总有效率高于对照组（P均＜0.05）；2组用药不良反应比较，差异无统计学意义（P>0.05）。结论：在TPN治疗重症肺炎并肠道功能衰竭中，增加丙氨酰谷氨酰胺能改善营养状况，提高机体免疫功能。     

国产生长抑素联合丙氨酰谷氨酰胺对急性胰腺炎患者肠道功能的影响

[目的]观察国产生长抑素联合丙氨酰谷氨酰胺对急性胰腺炎患者肠道功能的影响。[方法]选取2014年9月~2016年9月我院急性胰腺炎患者98例,随机分为对照组和观察组,各49例。对照组在常规治疗基础上给予国产生长抑素,观察组在对照组基础上加用丙氨酰谷氨酰胺。治疗2周后,记录两组患者腹痛持续时间、血淀粉酶恢复正常时间、住院时间、肠功能评分等临床指标;比较两组患者治疗前后体重指数(BMI),白蛋白(ALB),前白蛋白(PA),血红蛋白(HB)等营养指标;比较两组患者治疗前后血浆二胺氧化酶(DAO)、C反应蛋白(CPR)、肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)等肠黏膜功能及免疫指标。[结果]治疗2周后,观察组腹痛持续时间、血淀粉酶恢复正常时间低于对照组(P0.05);观察组肠功能优于对照组(P0.05);观察组白蛋白较对照组升高(P0.05);观察组DAO,CRP,TNF-α,IL-1,IL-6均低于治疗前,治疗均有效(P0.05);两组治疗后比较,观察组DAO,CRP,TNF-α,IL-1,IL-6均低于对照组(P0.05)。[结论]国产生长抑素联合丙氨酰谷氨酰胺可缓解急性胰腺炎患者临床症状,减轻炎症反应,保护肠道功能。     

乌司他丁联合丙氨酰谷氨酰胺对重症急性胰腺炎患者细胞因子的影响

目的:观察蛋白酶抑制剂乌司他丁联合丙氨酰谷氨酰胺对重症急性胰腺炎(SAP)患者血清细胞因子的影响.方法:64例SAP患者随机分为治疗组(乌司他丁联合丙氨酰谷氨酰胺治疗)及对照组(乌司他丁治疗)各32例,对照组加用乌司他丁1×105U溶于50g/L葡萄糖溶液250mL中静滴,8h1次,治疗组在对照组治疗的基础上每天加用丙氨酰谷氨酰胺0.4g/kg.结果:治疗组第7、10天TNF-α(ng/L)、和内毒素(ng/L)水平明显低于对照组(7d:38.83±14.71vs51.92±18.29;0.46±0.13vs0.71±0.19;10d:31.49±12.65vs48.36±15.43;0.22±0.07vs0.43±0.15;均P<0.05),IL-6在第7天时明显低于对照组(117.68±14.87vs163.43±19.76,P<0.05),IL-18两组各时间点差异无统计学意义.结论:蛋白酶抑制剂乌司他丁联合生长抑素能抑制SAP患者TNF-α、IL-6的表达和合成,减少肠道内毒素易位,有利于提高SAP患者的救治成功率.     

微生态制剂联合肠内营养治疗肝性脑病的临床研究

[目的]观察微生态制剂联合肠内营养治疗对肝性脑病患者血清内毒素、肿瘤坏死因子α(TNF-α)、白细胞介素18(IL-18)、血氨水平及全身营养状态的影响。[方法]选取60例肝性脑病患者,随机分为3组,在常规保肝利尿等基础上,3组分别予口服培菲康加肠内营养、单纯口服培菲康、单纯静脉营养,疗程均为2周。分别检测治疗前和治疗后第7天、第14天血清内毒素、TNF-α、IL-18、血氨及白蛋白的水平。[结果]与治疗前相比,培菲康联合肠内营养治疗能明显下调血清内毒素、TNF-α、IL-18及血氨的水平,明显升高血浆白蛋白的水平,与单用培菲康及单用静脉营养治疗相比差异有统计学意义(P0.05)。[结论]微生态制剂联合肠内营养治疗能有效清除血氨、降低内毒素血症、保护肠黏膜屏障及改善机体的营养状态,是临床治疗肝性脑病的一条安全而高效的途径。     

含谷氨酰胺肠内营养及奥曲肽对老年重症急性胰腺炎患者肠黏膜屏障的影响

目的探讨给予老年重症急性胰腺炎(SAP)患者含谷氨酰胺肠内营养及奥曲肽治疗对肠黏膜屏障的影响。方法选取94例老年SAP患者,通过单盲法分为对照组和实验组,每组各47例。对照组在常规肠内营养基础上,联合奥曲肽治疗,在对照组基础上,加用含谷氨酰胺肠内营养治疗。对比两组临床疗效、胃肠功能恢复情况、肠道菌群数目、肠黏膜屏障指标、血清炎症因子水平。结果实验组治疗效果明显优于对照组,差异有统计学意义(P0.05);实验组腹痛腹胀消失时间、肠鸣音恢复时间、首次排气时间、住院时间均明显短于对照组,差异均有统计学意义(P0.05);治疗后,两组乳酸杆菌、双歧杆菌均较治疗前明显升高,大肠杆菌、肠球菌均较治疗前明显降低,且实验组改善明显优于对照组,差异有统计学意义(均P0.05);治疗后,两组肠黏膜屏障指标[内毒素、血浆二胺氧化酶(DAO)、D-乳酸]、血清炎症因子水平[C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6]均较治疗前明显降低,且实验组明显低于对照组,差异均有统计学意义(均P0.05)。结论给予老年SAP患者含谷氨酰胺肠内营养及奥曲肽治疗可提高临床疗效,促进胃肠道恢复,改善肠黏膜屏障功能,调节菌群平衡,减轻炎症反应。     

添加谷氨酰胺的肠外营养在ICU重症颅脑损伤患者中的应用效果

目的探讨添加谷氨酰胺的肠外营养在ICU重症颅脑损伤患者中的应用效果。方法选取2012年1月—2014年1月我院ICU收治的重型颅脑损伤患者78例,将患者随机分为观察组和对照组,各39例。两组患者均给予常规对症支持治疗,在此基础上,对照组患者给予中心静脉肠外营养支持治疗,观察组患者给予添加谷氨酰胺的肠外营养支持治疗。观察两组患者治疗前后干体质量、饮食摄入评分、胃肠道状况评分、功能状态评分、中臂肌肉周径、中臂肌皮褶厚度、体质指数、血清清蛋白、载铁蛋白及营养不良-炎症评分(MIS)。结果治疗前两组患者干体质量、饮食摄入评分、胃肠道状况评分、功能状态评分、中臂肌肉周径、中臂肌皮褶厚度、体质指数、血清清蛋白、载铁蛋白及MIS比较,差异均无统计学意义(P0.05)。治疗后观察组患者干体质量、中臂肌肉周径、中臂肌皮褶厚度、体质指数、血清清蛋白、载铁蛋白、MIS均高于对照组(P0.05);两组患者饮食摄入评分、胃肠道状况评分及功能状态评分比较,差异无统计学意义(P0.05)。结论将添加谷氨酰胺的肠外营养应用于ICU重症颅脑损伤患者具有良好的效果,能有效改善患者的营养状况,其可作为ICU重症颅脑损伤患者的营养供给方式。     

Effects of nutritional support combined with insulin therapy on serum proteins,inflammatory factors,pentraxin-3, and serum amylase levels in patients with diabetic ketoacidosis complicated with acute pancreatitis

To explore the effects of nutritional support combined with insulin therapy on serum protein, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), pentraxin-3 (PTX-3), and serum amylase (AMS) levels in patients with diabetic ketoacidosis complicated with acute pancreatitis.A total of 64 patients with diabetic ketoacidosis complicated with acute pancreatitis admitted to our hospital from January 2018 to February 2019 were enrolled in this prospective study. They were divided into the study group and the control group according to the random number table method, with 32 patients in each group. Patients in the study group were given nutritional support combined with insulin therapy, and patients in the control group were given insulin therapy.There were no significant differences in general data including age, gender, body mass index, course and type of diabetes, acute physiology and chronic health evaluation II, RANSON, CT grades between the 2 groups before treatment (all P > .05). After 7 days of treatment, the clinical efficacy of the study group was significantly higher than that of the control group (study group vs control group, 94.44% vs 75.00%, P < .05). After 7 days of treatment, the levels of prealbumin and albumin in the study group were significantly higher than those in the control group (P < .05). After 7 days of treatment, the levels of PCT, CRP, TNF-α, PTX-3, and AMS in the 2 groups were significantly lower than those before treatment (P < .05), and the levels of PCT, CRP, TNF-α, PTX-3, and AMS in the study group were significantly lower than those in the control group. After 7 days of treatment, the levels of IgG, IgM, and IgA in the 2 groups were significantly higher than those before treatment, and the levels of IgG, IgM, and IgA in the study group were significantly higher than those in the control group (P < .05).Nutritional support combined with insulin is obviously effective in the treatment of diabetic ketoacidosis complicated with acute pancreatitis, which can improve serum protein levels, reduce inflammatory response, improve immune function, and is worthy of clinical application.     

经内镜逆行胰胆管造影与超声、多排螺旋CT、磁共振胰胆管造影对梗阻性黄疸诊断价值的比较

目的比较内镜下逆行胰胆管造影(ERCP)与超声、多排螺旋CT(MSCT)及磁共振胰胆管造影(MRCP)对梗阻性黄疸的部位及病因诊断的准确率。方法 128例患者行超声、MSCT及ERCP检查,其中35例患者行MRCP检查。结果在梗阻部位的诊断上,四种方法对肝内胆管和胰头部的诊断准确率差异无统计学意义;ERCP对肝外胆管梗阻的诊断准确率与MRCP差异无统计学意义,但显著高于超声和MSCT;在病因诊断上,对于胆系结石、胆管炎和胰头癌的诊断准确率,四种方法差异无统计学意义;MRCP、ERCP和MSCT对于胆管癌诊断准确率均优于超声;此外,ERCP在诊断乳头部肿瘤、十二指肠乳头旁憩室时优于超声和MSCT。结论 ERCP对梗阻性黄疸的部位(尤其是肝外胆管和十二指肠乳头部)及病因(胆管癌、十二指肠乳头部肿瘤)的诊断具有重要价值。     

Gardner's syndrome associated with periampullary carcinoma,duodenal and gastric adenomatosis

A 48-year-old man with Gardner's syndrome, who had abdominoperineal resection for rectal carcinoma in 1962, was found to have an ulcerating growth of the duodenum, and pancreaticoduodenectomy was performed in 1979. Histologic examination by complete step-serial sectioning disclosed a well-differentiated adenocarcinoma with adenomatous remnants, a large adenoma with focal carcinoma, 256 adenomas of the duodenum, and 91 adenomas of the gastric antrum. The world medical literature was reviewed, and 29 cases of periampullary carcinoma and 12 cases of gastric carcinoma complicating familial polyposis coli or Gardner's syndrome were analyzed.     

Atrial natriuretic peptide, plasma renin activity, plasma volume, systemic vascular resistance and cardiac output in patients with cirrhosis

The present study aimed to assess relationships between plasma levels of atrial natriuretic peptide (ANP) and plasma volume, systemic vascular resistances, cardiac output and plasma renin activity in patients with cirrhosis. Thirty patients were included: eight with no history of liver disease were used as controls; 22 patients had biopsy-proven alcoholic cirrhosis without ascites (n = 11) and with ascites (n = 11). Mean ANP plasma level was significantly higher in both groups of cirrhotic patients than in controls (P less than 0.05). In the control group, ANP and plasma renin activity were inversely correlated (P less than 0.05) but no correlation was found in cirrhotic patients. In the group of patients with ascites, ANP plasma levels were inversely correlated to plasma volume (P less than 0.05) and to cardiac output (P less than 0.01) and directly correlated to systemic vascular resistances (P less than 0.01). Using multiple regression analysis, ANP remained correlated only with systemic vascular resistances (P less than 0.05). These results suggest that cirrhotic patients have high plasma levels of ANP whether or not they have ascites. In the light of current knowledge of ANP actions, the relationships between ANP plasma levels and plasma volume, cardiac output, and systemic vascular resistances are paradoxical in cirrhotic patients with ascites. ANP does not seem to play a critical role in the pathogenesis of sodium and water retention observed in these patients.     

Nitroglycerin rebound associated with vascular, rather than platelet, hypersensitivity

OBJECTIVES

The purpose of this study was to determine whether acute withdrawal of nitroglycerin (NTG) during hemodynamic tolerance is associated with platelet hypersensitivity.

BACKGROUND

Nitroglycerin is an effective antianginal medication but its use is limited by the development of tolerance and rebound. We have previously demonstrated a sustained inhibition of platelet function during continued use of NTG, but whether cessation of NTG is associated with an increase in platelet function that may contribute to rebound is unknown.

METHODS

Normal porcine aortic media were exposed to flowing arterial blood from pigs (n = 8) treated continuously with NTG patches (Nitrodur 0.8 mg/h) for 48 h. Platelet function, blood pressure and the responses to angiotensin II infusion were evaluated before, during and after NTG treatment.

RESULTS

Mean arterial pressure fell by 15% after 3 h of treatment compared with control, returned to baseline by 48 h and increased significantly 2 h after drug removal. Autologous ⁵¹Cr-labelled platelet deposition on the aortic media was reduced by 30% after 48 h of continuous NTG administration compared with baseline (p = 0.02) and remained decreased 2 h after cessation of NTG therapy. Platelet aggregation to thrombin decreased in parallel to the decrease in platelet deposition. Blood pressure increase after intravenous injection of 10 μg of angiotensin II was blunted during treatment with NTG but increased significantly 2 h after cessation of nitrate therapy when compared with baseline.

CONCLUSIONS

Supersensitivity of the vessel wall to vasoconstrictors such as angiotensin 11, but not platelet hyperactivity, may contribute to the rebound phenomenon after acute nitrate withdrawal.     

Coexistence of Sjögren syndrome in patients with synovitis,acne, pustulosis,hyperostosis, and osteitis syndrome: A retrospective observational study

To identify the prevalence and clinical characteristics of Sjögren syndrome (SS) in a Chinese single-center cohort of synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome.Patients diagnosed with SS were screened out from a cohort of 164 cases of SAHPO syndrome. Information regarding the patients’ gender, age at onset, clinical features, laboratory tests, bone scintigraphy, and treatment was reviewed.Five patients were screened out. The prevalence of SS in SAPHO patients was 3.05% The mean onset age of SS was 48.0 ± 12.0 years old and no apparent time order in the occurrence of SAPHO and SS was observed. Compared with the general SAPHO cohort, the 5 SS patients exhibited no significant difference in the SAPHO related clinical features or inflammatory markers, except for a higher prevalence of peripheral joints and bones involvement in bone scintigraphy. Objective evidence of dryness and positive salivary gland biopsy were found in all the patients. However, the positive rates of SSA and SSB antibody were only 20%. Anti-inflammatory treatment for SS was recorded in 3 patients (ESSDAI score: 3 in 2 patients; 12 in 1 patient) with extra-glandular manifestations, severe complications or poor response to the basic treatment.The prevalence of SS is higher in the SAPHO cohort than in the general Chinese population. Objective tests or biopsy might be more indicative than the antibody detection for SS diagnosis. Anti-inflammatory treatment should be prescribed in consideration of both the severity of SS and the demand for disease activity control of SAPHO.     

Slow release oxprenolol in angina pectoris: Study comparing oxprenolol,once daily,with propranolol,four times daily

Oxprenolol and propranolol are noncardioselective beta adrenoreceptor blocking agents known to be equally effective in the management of patients with angina pectoris. Both are usually prescribed four times daily. Slow release formulation of oxprenolol administered once daily has been shown to maintain therapeutic effects for 24 hours. In a double-blind crossover study in 23 patients with stable angina pectoris, the effects of 160 mg slow release oxprenolol, administered once daily for 1 month, were compared with those of 40 mg of propranolol given four times daily for a similar period. No adverse effects occurred when patients were switched between treatment schedules. The average number of anginal attacks experienced were 11/month during oxprenolol therapy and 8/ month during propranolol therapy (difference not significant). The resting values for heart rate were higher 7 $\text{1}\text{2}$ and 24 hours after oxprenolol than they were 4 and 12 hours after propranolol (p < 0.01). The treadmill walking time to the onset of angina and to the development of moderate angina 24 hours after oxprenolol was less than that observed 7 $\text{1}\text{2}$ hours after the drug or 4 and 12 hours after propranolol (p < 0.01). In contrast, the values for walking time to the onset of angina and to the development of moderate angina at 4 and 12 hours after propranolol were similar. This decreased exercise tolerance 24 hours after oxprenolol was associated with a lesser degree of beta adrenoreceptor blockade than that present after propranolol as documented by higher levels of heart rate (p < 0.05), systolic blood pressure (p < 0.05) and rate-pressure product (p < 0.05) during exercise after oxprenolol therapy.It is concluded that in the doses used, slow release oxprenolol administered once daily does not exert as consistent a beneficial effect on exercise tolerance throughout the dosing schedule as does propranolol given four times daily.     

成年女性I型戈谢病一例并文献复习

目的: 报道一例幼年发病合并骨损伤的中国成年女性I型戈谢病患者的临床表现及致病基因突变,为儿科、血液科、遗传代谢和内分泌科等相关科室的临床医学工作者提供可以借鉴的戈谢病诊疗思路。方法: 对患者的病史、临床症状、体征、影像学、骨髓细胞学、葡萄糖脑苷脂酶学检测结果进行分析；采用PCR-直接测序方法,对患者的父亲、母亲、姐姐、妹妹和儿子的外周血白细胞葡萄糖脑苷脂酶(GBA)基因进行突变检测；并结合文献讨论戈谢病的发病机制、主要症状、鉴别诊断以及治疗方法。结果: 患者,女,31岁,出生时脾脏显著肿大(4岁时脾脏已切除),无神经系统症状,智力和运动正常。入院前1年右侧大腿骨折,就诊时发现肝脏显著肿大,贫血,血丙种球蛋白增高,骨损伤症状(全身骨代谢增高,骨密度降低、溶骨性骨破坏和病理性骨折),骨髓穿刺涂片找到戈谢细胞。外周血白细胞β-葡糖苷酶活性降低(4.75 nmol/h/mg Pr,正常值5.43～14.35 nmol/h/mg Pr),符合I型戈谢病特征。GBA基因检测结果为c.1448T>C (L444P)纯合子突变。 结论: I型戈谢病患者典型表现以脾肿大和血小板减少为主,尤其是我国的戈谢病患者,发病较早,病情较重,GBA基因突变以 L444P纯合子突变为主。该病例提示临床上对脾脏明显肿大或伴有肝脏肿大的儿童或成年人在诊断时应考虑溶酶体贮积病的可能性,特别是合并有骨损伤的患者,其患戈谢病的可能性更大。通过外周血白细胞GBA活性测定以及GBA基因突变检测可尽早实现确诊,及时开始酶替代法等特异性治疗,可减少或延缓相关并发症的发生。     

Diels–Alder Cycloaddition with CO,CO2, SO2, or N2 Extrusion: A Powerful Tool for Material Chemistry

Phenyl, naphthyl, polyarylphenyl, coronene, and other aromatic and polyaromatic moieties primarily influence the final materials’ properties. One of the synthetic tools used to implement (hetero)aromatic moieties into final structures is Diels–Alder cycloaddition (DAC), typically combined with Scholl dehydrocondensation. Substituted 2-pyranones, 1,1-dioxothiophenes, and, especially, 1,3-cyclopentadienones are valuable substrates for [4 + 2] cycloaddition, leading to multisubstituted derivatives of benzene, naphthalene, and other aromatics. Cycloadditions of dienes can be carried out with extrusion of carbon dioxide, carbon oxide, or sulphur dioxide. When pyranones, dioxothiophenes, or cyclopentadienones and DA cycloaddition are aided with acetylenes including masked ones, conjugated or isolated diynes, or polyynes and arynes, aromatic systems are obtained. This review covers the development and the current state of knowledge regarding thermal DA cycloaddition of dienes mentioned above and dienophiles leading to (hetero)aromatics via CO, CO₂, or SO₂ extrusion. Particular attention was paid to the role that introduced aromatic moieties play in designing molecular structures with expected properties. Undoubtedly, the DAC variants described in this review, combined with other modern synthetic tools, constitute a convenient and efficient way of obtaining functionalized nanomaterials, continually showing the potential to impact materials sciences and new technologies in the nearest future.