儿泻暖脐膏治疗婴幼儿急性腹泻的临床研究

为了观察中药治疗婴幼儿急性腹泻的临床效果，应用儿泻暖脐膏敷脐配合西药常规疗法（简称治疗Ⅰ组）治疗婴幼儿急性腹泻，并与十香暖脐膏敷脐配合西药常规疗法（简称治疗Ⅱ组）及西药常规疗法（简称对照组）对照。结果治疗Ⅰ组102例，治愈61例（59．8％），显效24例（23．5％），有效11例（10．8％），无效6例（5．9％），显效率83．3％，总有效率94．1％；治疗Ⅱ组54例，治愈25例（46．3％），显效15例（27．8％），有效11例（20．4％），无效3例（5．6％），显效率74．1％，总有效率94．4％；对照组55例，治愈22例（40．0％），显效12例（21．8％），有效9例（16．4％），无效12例（21．8％），显效率61．8％，总有效率78．2％。治疗Ⅰ组的治愈率、显效率和总有效率均高于对照组（P＜0．05或P＜0．01）；治疗Ⅱ组总有效率显著高于对照组（P＜0．05）。提示儿泻暖脐膏敷脐配合西药常规疗法能提高临床疗效。     

养胃定痛汤治疗小儿功能性消化不良疗效观察

目的：观察养胃定痛汤治疗小儿功能性消化不良（FD）的临床疗效。方法：自拟中药养胃定痛汤治疗小儿FD（治疗组）56例,并与用促胃动力药吗丁啉治疗（对照组）50例进行疗效对比。结果：临床疗效,治疗组总有效率为98．21％,对照组78．00％,两组比较差异有显著性意义（P＜0．01）。治疗级对消除腹胀、腹痛,纠正厌食症状的时间均明显短于对照组（P＜0．01）,其中以腹痛消失最明显。临床观察中未发现有明显的不良反应。结论：该方治疗小儿FD较单一胃动力药优越。     

葡萄糖酸锌口服联合山莨菪碱保留灌肠治疗小儿轮状病毒性肠炎疗效观察

目的：观察葡萄糖酸锌口服联合山莨菪碱保留灌肠治疗小儿轮状病毒性肠炎的疗效。方法将70例小儿轮状病毒肠炎患儿随机分为两组各35例,对照组采用常规治疗,观察组在此基础上加用葡萄糖酸锌及山莨菪碱,观察两组治疗效果及病毒转阴率、病程。结果观察组显效28例,有效5例,无效2例,总有效率为94．3％;对照组分别为21、9、5例及85．7％,两组总有效率比较,P＜0．05。观察组及对照组病毒转阴率分别为68．6％（24／35）、48．6％（17／35）,两组比较,P＜0．05。观察组及对照组病程分别为（3．48±0．75）、（5．24±0．93）d,两组比较, P＜0．01。结论葡萄糖酸锌联合山莨菪碱治疗小儿轮状病毒性肠炎疗效较好。     

消渴灵1号治疗2型糖尿病的临床研究

在西药治疗基础上加用中药消渴灵1号治疗2型糖尿病人100例（治疗组），同时与单独西药治疗的50例作为对照（对照组），治疗2个月，观察二种治疗方法对糖尿病人血糖，胰岛B细胞功能（胰岛素，C肽），血脂等指标的影响，结果二组治疗均能明显降低糖尿病人空腹，餐后2小时血糖水平（P＜0．01），但治疗组血糖下降幅度更大（P＜0．01），降低空腹，餐后血糖的总有效率治疗组分别为87％和90％，对照组分别为70％和84％，二组均能升高血浆胰岛素，C肽水平（P＜0．01），治疗组甘油三酯，低密度脂蛋白水平较治疗前下降，高密度脂蛋白水平上升，而对照组治疗后仅有低密度脂蛋白水平下降（P＜0．01），二组均未观察到明显的低血糖及其他副反应发生，结论：中药消渴灵1号结合西药治疗能有效控制血糖且安全性好。     

山麦健脾口服液治疗小儿厌食症64例

[目的]观察山麦健脾口服液治疗小儿厌食症的疗效。[方法]按中医辨证将人选病例分为脾虚肝旺型，脾虚湿困型和脾肺二虚型。随机分为2组，治疗组予山麦健脾口服液，1～3岁每次10ml／支，2次／d；3岁以上3次／d。对照组1～2岁予乳酶生0．1g，食母生0．3g，3次／d；〉2岁予食母生0．6g，多酶片1片，3次／d，同时每人每天加服葡萄糖酸锌液10ml／支。疗程均为2周。[结果]治疗组有效率87．5％，与对照组69．6％比较差异有统计学意义（P〈0．01）；中医辨证分型的疗效比较，治疗组均明显优于对照组（均P〈0．01）。[结论]山麦健脾口服液治疗小儿厌食症疗效肯定。     

儿泻暖脐膏治疗婴幼儿急性腹泻的临床研究

为了观察中药治疗婴幼儿急性腹泻的临床效果，应用儿泻暖脐膏敷脐配合西药常规疗法（简称治疗１组）治疗婴幼儿急性腹泻，并与十香暖脐膏敷脐配合西药常规疗法（简称治疗Ⅱ组）及西药常规疗法（简称对照组）对照。结果治疗Ｉ组１０２例，治愈６１例（５９．８％），显效２４例（２３．５％），有效１１例（１０．８％），无效６例（５．９％），显效率８３．３％，总有效率９４．１％；治疗Ⅱ组５４例，治愈２５例（４６．３％），显     

高钾摄入对家兔血管内皮损伤后的抗增生作用

目的：观察高钾摄入对血管内皮损伤后的抗增生功能，探讨其对再狭窄的预防作用。方法：高脂饲养家兔分为钾剂治疗组（3％KCl100ml/d）和对照组，经髂动脉球囊扩张术建立血管内皮损伤模型，另设正常饮食和非髂动脉球囊扩张术的空白对照组，观察术后脂质过氧状况、血小板聚集功能、血管条3H-TdR掺入量和血管病理形态学改变。结果：（1）对照组MDA和PRMA均较空白组和治疗组显著升高（术后7天P＜0．05，术后30天P＜0.01），而空白组与治疗组之间无明显差异（P＞0．05）；对照组和治疗组SOD在术后30天均较空白组下降（P＜0．05）。（2）对照组3H－TdR掺入量较空白组明显升高（术后7天P＜0．01，术后30天P＜0．05），治疗组3H．TdR掺入量则较对照组明显下降（术后7天P＜0．01，术后30天P＜0．05）。（3）对照组管腔面积较治疗组明显减小（术后30天P＜0．01），而新生内膜面积、新生内膜面积／中膜面积治疗组显著低于对照组（术后7天P＜0.05），术后30天（P＜0．01）。结论：钾具有抗内膜增殖、抗氧化、抗血小板聚集等作用，可有效地抑制血管内皮损伤后再狭窄的发生。     

饭后口服有机磷农药中毒两种洗胃方法效果的比较

目的：探讨饭后口服急性有机磷农药中毒（acute organic phosphorus poisoning,AOPP)适宜的洗胃方法。方法：42例饭后口服AOPP患随机分为两组，观察组22例，对照组20例。观察组立即给予剖腹洗胃，对照组立即给予插管洗胃。结果：观察组平均每人阿托品用量600mg，对照组平均每人阿托品用量893．6mg,对照组明显高于观察组（P＜0．05）。治愈率：观察组86．4％，对照组65％，两组间有显性差异（P＜0．05）。并发症发生率；观察组18．8％，对照组50％，两组间有显性差异（P＜0．05）。结论：饭后口服AOPP患剖腹洗有可提高治愈率，减少并发症发生率和死亡率。     

气压式肢体血液循环治疗仪配合中药足浴治疗周围神经病变360例护理

治疗组180例用气压式肢体血液循环治疗仪配合中药足浴；对照组180例用甲钴胺0．5mg／次，3次／d，口服。1月为1个疗程，1个疗程后观察结果。结果：治疗组总有效率95．6％高于对照组总有效率69．4％（P〈0．01）。2组比较治疗组治疗后神经传导速度明显加快（P〈0．01），与对照组治疗后比较有非常显著差异（P〈0。01）。结论治疗过程中严密观察和积极护理十分重要。     

中药外敷联合西比灵治疗椎-基底动脉供血不足疗效观察

目的：探讨中药外敷联合西比灵治疗椎－基底动脉供血不足的疗效。方法：随机将76例病人分为治疗组和西药对照组，两组均用西比灵胶囊口服，对照组加用刺五加注射液40mg静脉输注，每日1次，治疗组用中药外敷，每日2次，每次30min，治疗2周后观察疗效。结果：治疗组总有效率为97．8％，组总有效率为73．3％，两组比较有统计学意义（P＜0．01），治疗组治疗前后椎－基底动脉血流速度有明显改善（P＜0．01）。结论：中药外敷配合西比灵口服，能够改善椎－基底动脉供血，提高血流速度。     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.