胆总管取石术后并发胰腺炎患病率及不同药物预防效果的调查分析

目的探讨胆总管取石术后并发胰腺炎的几率及不同药物预防效果。方法选取2013年1月至2015年1月江苏省宜兴市人民医院择期内镜下逆行胰胆管造影(ERCP)取石术患者150例作为研究对象,随机分为吲哚美辛组、生长抑素组、对照组,各50例。吲哚美辛组直肠内给予吲哚美辛栓100 mg,生长抑素组给予生长抑素3 mg+9%氯化钠注射液50 m L持续泵入,4~6 m L/h,持续12~24 h,对照组直肠内给予安慰剂,三组均于术后立即给药。记录术后4 h、24h、48 h血清淀粉酶、C反应蛋白(CRP),发放视觉模拟评分(VAS)评估患者疼痛程度,记录术后48 h高淀粉酶、PEF发生率,对比住院时间。结果吲哚美辛组、生长抑素组术后4h、24 h、48 h血清淀粉酶、CRP、VAS显著低于对照组(P0.05),吲哚美辛组、生长抑素组PEP、高血清淀粉酶发生率显著低于对照组(P0.05);吲哚美辛组、生长抑素组住院时间短于对照组(P0.05),但吲哚美辛组、生长抑素组上述指标组间对比无明显差异(P0.05)。结论吲哚美辛组、生长抑素均可用于预防ERCP术后PEP、高血清淀粉酶,效果大致相同。     

吲哚美辛在预防ERCP术后胰腺炎中作用的研究

目的观察直肠应用吲哚美辛对ERCP术后胰腺炎（PEP）及高淀粉酶血症的预防作用。方法将行ERCP检查的168例患者随机分为两组,吲哚美辛组在ERCP术前30 min直肠内给予吲哚美辛栓剂100 mg,对照组在ERCP术前30 min直肠内给予安慰剂栓。ERCP术后观察患者有无腹痛,并于术后12 h做血清及尿淀粉酶测定。结果吲哚美辛组PEP发生率（6.0%）与安慰剂组PEP发生率（10.6%）无显著差异（P=0.28）,但是吲哚美辛组ERCP术后高淀粉酶血症的发生率（18.1%）显著低于安慰剂组（37.6%,P=0.005）。结论直肠应用吲哚美辛可以预防ERCP术后高淀粉酶血症的发生。     

吲哚美辛及鼻胆管引流预防内镜下逆行胰胆管造影术后胰腺炎及高淀粉酶血症效果观察

目的探讨预防性吲哚美辛直肠给药及术后鼻胆管引流术(ENBD)对内镜下逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉血症的预防作用及安全性。方法行ERCP诊治的患者152例,随机分为吲哚美辛组(n=49)、ENBD组(n=50)和安慰剂组(n=53)。观察各组术后2、6、24 h血清淀粉酶水平,对比PEP、高淀粉酶血症的发生率及预后。结果吲哚美辛组与ENBD组的PEP及高淀粉酶血症的发生率低于安慰剂组(P均<0.05)。血清淀粉酶变化,吲哚美辛组和ENBD组术后2、6 h较安慰剂组低(P均<0.05);但术后24 h血清淀粉酶水平组间比较差异无统计学意义(P均>0.05)。吲哚美辛组和ENBD组胰腺炎患者腹部症状体征消失时间及平均住院时间较安慰剂组明显缩短(P均<0.05)。结论吲哚美辛、ENBD均可有效预防ERCP术后PEP及高淀粉酶血症的发生,同时吲哚美辛干预方法更为经济。     

吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎和高淀粉酶血症的效果

目的探讨预防性使用吲哚美辛治疗经内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的效果及安全性。方法按既定标准入选接受ERCP诊治患者243例,随机分为吲哚美辛组(81例)、奥曲肽组(78例)和安慰剂组(84例),观察记录各组患者术前、术后3、24 h的血清淀粉酶水平,并评估患者ERCP术后胰腺炎和高淀粉酶血症的发生率。结果三组患者ERCP术前的血清淀粉酶均在正常范围内。吲哚美辛组〔(99.12±44.58)U/L〕和奥曲肽组〔(100.27±43.31)U/L〕患者ERCP术后24 h血清淀粉酶水平均低于对照组〔(195.45±89.67)U/L〕(均P<0.05),但吲哚美辛组和奥曲肽组比较,二者无明显差异。三组患者ERCP术后胰腺炎发生率,吲哚美辛组(4.94%)和奥曲肽组(5.13%)均低于安慰剂组(15.48%)(均P<0.05),但吲哚美辛组与奥曲肽组相比无明显差异。ERCP术后高淀粉酶血症发生率,吲哚美辛组(2.47%)、奥曲肽组(1.28%)均低于安慰剂组(13.61%),差异有或接近显著性意义,而吲哚美辛组和奥曲肽组之间无明显差异。结论 ERCP术前经直肠给予吲哚美辛可有效降低老年ERCP术后PEP和高淀粉酶血症的发生率,并且效果与奥曲肽相比无明显差异,但具有较好的性价比,安全性高。     

吲哚美辛对经内镜逆行胰胆管造影术后胰腺炎患者血小板微粒水平的影响

观察经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)术前使用吲哚美辛栓剂100 mg对ERCP术后胰腺炎（post-ERCP pancreatitis,PEP）患者的血小板微粒（platelet microparticles,PMPs）水平的影响。采用随机数字表法,将2019年6月—2020年10月在安徽医科大学第一附属医院行ERCP的191例患者分为吲哚美辛组（n=96）与对照组（n=95）,吲哚美辛组ERCP术前吲哚美辛栓剂100 mg纳肛,对照组采用等质量安慰剂纳肛。采用流式细胞仪检测术前、术后3 h与术后24 h的血液标本的PMPs水平,同时检测患者术前、术后3 h、术后24 h血液标本中白细胞介素-1(IL-1)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平。吲哚美辛组PEP发生率为5.21％（5/96）,对照组PEP发生率为13.68％（13/95）,差异有统计学意义（P=0.044）。吲哚美辛组术前PMPs水平（1 910.01个/μL)略低于对照组(2 351.87个/μL,P＞0.05）;吲哚美辛组术后3 h和24 h的PMPs水平(1 671.47个/μL,862.74个/μL）明显低于对照组同时间点PMPs水平(2 443.75个/μL,2 536.76个/μL,P均＜0.05）。患者血浆中IL-1、IL-6和TNF-α水平出现相同趋势的改变。吲哚美辛降低PEP的发生率,可能与减少PMPs形成有关。     

吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎和高淀粉酶血症的临床研究

目的 探讨吲哚美辛对ERCP术后胰腺炎和高淀粉酶血症的预防作用.方法 将拟施行ERCP手术的600例患者随机表法分为吲哚美辛组、奥曲肽组和安慰剂对照组,每组200例,观察其术前、术后24 h血清淀粉酶水平,并评估ERCP术后胰腺炎和高淀粉酶血症发生率及预后.结果 3组患者ERCP术前血清淀粉酶均为正常值.ERCP术后24h血清淀粉酶水平,吲哚美辛组[(101.3±77.7)U/L]低于奥曲肽组[(176.6±138.3)U/L]及对照组[(227.2±264.9) U/L],差异均有统计学意义(P=0.040,P=0.048);奥曲肽组低于对照组,但差异没有显著意义(P＞0.05).ERCP术后胰腺炎发生率,吲哚美辛组(2.5％)低于对照组(9.5％),差异有显著性意义(P=0.003);奥曲肽组(4.5％)低于对照组,但无统计学差异(P=0.05).ERCP术后高淀粉酶血症发生率,吲哚美辛组(5.5％)低于对照组(13.5％),差异有显著性意义(P=0.006);奥曲肽组(10.0％)低于对照组,但差异没有统计学意义(P＞0.05).结论 ERCP术前应用吲哚美辛可有效降低胰腺炎和高淀粉酶血症的发生率.     

不同剂量吲哚美辛栓对减少内镜下逆行胰胆管造影术后胰胆炎的价值

[目的]探讨内镜下逆行胰胆管造影术(encoscopic retrograde cholangio-pancreatography,ERCP)前应用不同剂量吲哚美辛栓对减少ERCP后胰腺炎(PEP)的临床价值。[方法]纳入确诊为胆总管结石的269例患者,并随机分成A组(90例)、B组(90例)、C组(89例)。A组常规基础治疗+ERCP前30min、100mg吲哚美辛栓塞肛,B组常规基础治疗+ERCP前30min、50mg吲哚美辛栓塞肛,C组常规基础治疗+ERCP前30min安慰剂维生素C100mg塞肛,观察各组出现的新症状、体征(腹痛、腹胀、恶心呕吐、发热、腹部压痛及反跳痛)或原有症状加重情况,比较各组ERCP后3h、12h、24h、48h血清淀粉酶,判断PEP、高淀粉酶血症发生率。[结果]A组、B组、C组ERCP后新出现的症状、体征或原有症状加重的发生率分别为6.7%、10.0%、21.1%,A组、B组明显低于C组(P0.05);A组、B组、C组PEP发生率为2.2%、3.3%、16.9%;高淀粉酶血症发生率为13.3%、18.9%、31.5%,A组、B组明显低于C组(P0.05);A组、B组ERCP后3h、12h、24h、48h血清淀粉酶均低于C组,差异有统计学意义(P0.05)。A组ERCP后血清淀粉酶及新出现的症状、体征或原有症状加重的发生率,高淀粉酶血症、PEP发生率均低于B组,但2组比较差异无统计学意义(P0.05)。[结论]ERCP前30min吲哚美辛栓塞肛可以减少PEP的发生率,100mg与50mg吲哚美辛栓塞肛对降低PEP的疗效相当。故可应用小剂量(50mg)吲哚美辛栓肛栓。     

胰管支架联合吲哚美辛栓对困难胆管插管术后胰腺炎的预防作用分析

目的探索胰管支架联合吲哚美辛栓直肠给药对内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)困难插管术后胰腺炎(post-ERCP pancreatitis, PEP)的预防作用。方法 2019年1月—2021年12月在南京医科大学附属杭州医院行ERCP治疗的胆道疾病患者术前30 min予吲哚美辛栓100 mg纳肛, 将术中发生困难胆管插管的患者(n=204)纳入本研究。根据随机数字数表将患者分为两组, 联合组术中置入胰管支架(n=104), 吲哚美辛组不置入支架(n=100)。比较两组术后高淀粉酶血症及PEP的发生率。结果联合组术后高淀粉酶血症[21.2%(22/104)比34.0%(34/100), χ2=4.22, P=0.040]及PEP发生率[14.4%(15/104)比32.0%(32/100), χ2=8.88, P=0.003]均明显低于吲哚美辛组, 但两组重症PEP发生率之间差异无统计学意义[1.0%(1/104)比1.0%(1/100), χ2=0.001, P=0.978]。结论与单用吲哚...     

吲哚美辛对内镜下逆行性胰胆管造影术后胰腺炎的预防

目的 探讨吲哚美辛对内镜下逆行性胰胆管造影术后胰腺炎(PEP)的预防作用.方法 从需行内镜下十二指肠乳头括约肌切开术(EST)的患者中选择年龄18～75岁,未合并有心、肺、肝、肾疾病及凝血功能障碍等手术高危因素,未合并恶性疾病,无非甾体类抗炎(NSAIDs)药物禁忌证,术前影像学及血清学证实未合并胰腺炎者.采用前瞻性随机对照病例研究方法分为吲哚美辛组和对照组.吲哚美辛组患者术后0.5h使用吲哚美辛100 mg肛塞,对照组给予安慰剂.以术后出现持续性的胰腺炎相关临床症状伴有术后24h血清淀粉酶值超过正常上限3倍、需住院1d以上者诊断为PEP.并对诊断PEP的患者于术后72 h进行APACHEⅡ评分.结果 2004年至2010年共入选348例患者,其中吲哚美辛组182例,对照组166例.吲哚美辛组术后发生PEP 6例(3.3％),对照组14例(8.4％),两组差异具有统计学意义(P＜0.05).吲哚美辛组发生PEP者的APACHEⅡ评分为4.3±1.3,对照组为7.4±1.7,两组差异具有统计学意义(P＜0.05).但两组高胰淀粉酶血症的发生率无统计学差异(9.3％比10.8％,P＞0.05).结论 内镜下乳头括约肌切开取石术后使用吲哚美辛肛栓预防术后胰腺炎是有效的,同时可以降低胰腺炎的严重程度.     

吲哚美辛预防国人经内镜逆行胰胆管造影术后胰腺炎及高淀粉酶血症效果的Meta分析

近年来,ERCP已成为临床诊断和治疗胆胰疾病的重要手段[1],但研究显示ERCP术后胰腺炎（PEP）发生率仍高达30％以上[2]。国外大规模随机对照试验证明预防性应用吲哚美辛可降低PEP的发生率[3],但国内部分研究结果却与之相反H0。为了明确吲哚美辛预防国人PEP和高淀粉酶血症的确切效果,我们对针对我国大陆地区国人的相关研究进行了Meta分析,现总结报道如下。     

Strikes, flooding, rats, and leptospirosis in Marseille, France

Objectives

The aim of this study was to examine the mechanisms by which weather conditions, the incidence of Leptospira in reservoir populations, and various socio-ecological factors are driving the emergence of leptospirosis in Marseille, France.

Methods

Over the last 30 years our laboratory has surveyed all human cases of leptospirosis in Marseille using clinical, epidemiological, serological, and molecular tools. Data for the weather conditions in Marseille were collected from the official meteorological station, and garbage management strikes were monitored through the local press. Rats were trapped in alleys near to where the patients may have acquired leptospirosis.

Results

Three new cases of autochthonous leptospirosis are reported. The global tendency for rainfall showed a slight increase over the period under analysis. The index case of leptospirosis occurred after a heavy rainfall with flooding. Over the last 10 years Marseille has undergone 82 days of garbage management strikes. Leptospira DNA was detected in two of 11 rats.

Conclusions

The emergence of leptospirosis has become a public health problem in Marseille, and is associated with a combination of heavy rainfall and garbage collection strikes in which garbage is left on the street and thereby contributes to the expansion of the rat population on the surface.     

Changes in Hypertension Prevalence,Awareness, Treatment,and Control in High-, Middle-, and Low-Income Countries: An Update

The aim of this paper was to critically evaluate recent publications on hypertension treatment and control in regions by income. Prevalence of hypertension is increasing worldwide, most prominently in low-income countries. Awareness, treatment, and control are most successful in North America while remaining a challenge in middle- and low-income countries. Easy access to medical care and aggressive use of pharmacotherapy are the key strategies which have proved to be successful in reducing the burden of hypertension on the population level.     

Sigma-receptors in endocrine organs: identification, characterization, and autoradiographic localization in rat pituitary, adrenal, testis, and ovary

We have used a variety of selective radioligands to identify and localize sigma- and phencyclidine (PCP)-binding sites in rat endocrine organs. [3H]Haloperidol-labeled sigma-receptors were identified in membrane homogenates of rat pituitary, adrenal, testis, and ovary which had kinetic and pharmacological characteristics similar to those of the well characterized sigma-receptors in rat cerebellum. The highest density of sigma-receptors was present in the ovary, with progressively lower densities present in the testis, pituitary, adrenal, and cerebellum, respectively. In autoradiographic studies, sigma-receptors [labeled with d-3-(3-hydroxyphenyl)N-(1-propyl-2,3-[3H]piperidine or [3H]1,3-di-(2-tolyl)guanidine] were discretely localized within the endocrine tissues. In the pituitary, the highest density of sigma-receptors was found in the anterior lobe. In the adrenal, sigma-receptors were localized primarily in the cortex. In the testis, sigma-receptors were present in highest concentrations in the ductuli efferentes and ductus epididymis; lower densities of binding sites were present in the seminiferous tubules, and no binding was seen in the interstitial tissue. In the ovary, sigma-receptors were localized in high density in the maturing follicles, and lower densities were present in resting follicles. After hypophysectomy, there were relative increases in the densities of sigma receptors in the remaining tissue in the adrenal gland and testis. In contrast, hypophysectomy resulted in a marked depletion of sigma-binding sites in the ovary. The data from hypophysectomized rats indicate that the highest densities of sigma-receptors in the ovary are localized to (LH-dependent) maturing follicles, while sigma-binding sites in adrenal and testis are localized to cells that are not dependent on trophic maintenance by the pituitary. In contrast, high affinity PCP receptors were not detected in pituitary, adrenal, testis, or ovary either by homogenate binding studies with 3,4-[3H]N-[1-(2-thienyl)cyclohexyl]piperidine or in vitro autoradiography using 3,4-[3H]N-[1-(2-thienyl)cyclohexyl]piperidine and d-[3H]5-methyl-10,11-dihydro-5H-dibenzo-[a,d] + cyclohepten-5,10-imine. In summary, the data suggest that the reported endocrine effects of PCP and the prototypic sigma-receptor agonist N-allylnormetazocine are probably mediated either through direct action on sigma-receptors in the pituitary and/or target endocrine organs or by actions on sigma- and/or PCP receptors in brain.     

Rickettsia, Ehrlichia, Anaplasma, and Bartonella in ticks and fleas from dogs and cats in Bangkok

Flea and tick specimens (5-10 fleas or ticks) on dogs and cats from various sites in Bangkok were tested by polymerase chain reaction and DNA sequencing to detect DNA of bacteria Rickettsia (gltA and 17?kDa genes), Anaplasmataceae (16S rRNA gene), and Bartonella (pap31 and its genes). We confirmed that Rickettsia sp. related to Rickettsia felis was detected in 66 of 98 (67.4%) flea specimens from dogs, whereas 8 Bartonella henselae and 2 Bartonella clarridgeiae were detected in 10 of 54 (18.5%) flea specimens from cats. Further, this work provides the first evidence of 10 Ehrlichia canis (3.3%), 7 Anaplasma platys (2.3%), and 2 Wolbachia spp. (0.66%) in 304 Rhipicephalus sanguineus tick specimens in Thailand.     

Heterogeneity in expression and subcellular localization of claudins 2, 3, 4, and 5 in the rat liver, pancreas, and gut

BACKGROUND & AIMS: Paracellular transport varies widely among epithelia of the gastrointestinal tract. We determined whether members of the claudin family of tight junction proteins are differentially expressed consistent with a potential role in creating these variable properties. METHODS: Rabbit polyclonal antibodies were produced against peptides from claudins 2 through 5. The distribution of individual claudins was detected by immunoblotting, and their cell type and subcellular localization were determined by immunofluorescence on cryosections of rat liver, pancreas, stomach, and small and large intestine. RESULTS: All antibodies detected single bands of the expected size on immunoblots and were monospecific based on peptide competition studies. Immunoblotting detected strong differences among tissues in the expression level of each claudin. Immunolocalization confirmed these differences and revealed striking variations in expression patterns. In the liver, claudin 2 shows a lobular gradient increasing from periportal to pericentral hepatocytes, claudin 3 is uniformly expressed, claudin 4 is absent, and claudin 5 is only expressed in endothelial junctions. In the pancreas, claudin 2 is only detected in junctions of the duct epithelia, claudin 5 only in junctions of acinar cells, whereas claudin 3 and 4 are in both. Among differences in the gut are a crypt-to-villus decrease in claudin 2, a highly restricted expression of claudin 4 to colonic surface cells, and the finding that some claudins can be junctional, lateral, or show a gradient in junctional vs. lateral localization along the crypt-to-villus surface axis. CONCLUSIONS: Claudins have very different expression patterns among and within gastrointestinal tissues. We propose these patterns underlie differences in paracellular permeability properties, such as electrical resistance and ion selectivity that would complement known differences in transcellular transport.     

Strategy use, recall, and recall organization in young, middle-aged, and elderly adults

The application and transfer of free recall study strategies were examined for young, middle-aged, and elderly adults. Subjects were either instructed to use clustering and imagery, instructed to use their own study strategies, or given standard free recall instructions. Subjects at all age levels showed high initial use of categorization and low initial use of imagery. Subject-reported imagery increased after training, but categorization was the only strategy associated with higher recall levels. Training produced increases in recall clustering that were apparent only on a transfer list. The results provided evidence that adult age differences in memory occur even when middle-aged and elderly adults show evidence of categorization in recall.     

Strategy use,recall, and recall organization in young,middle-aged,and elderly adults

Abstract

The application and transfer of free recall study strategies were examined for young, middle-aged, and elderly adults. Subjects were either instructed to use clustering and imagery, instructed to use their own study strategies, or given standard free recall instructions. Subjects at all age levels showed high initial use of categorization and low initial use of imagery. Subject-reported imagery increased after training, but categorization was the only strategy associated with higher recall levels. Training produced increases in recall clustering that were apparent only on a transfer list. The results provided evidence that adult age differences in memory occur even when middle-aged and elderly adults show evidence of categorization in recall.