富砷饮水对居民精经系统的影响

为了解饮水型慢性砷中毒中神经系统的影响，对长期饮用高砷水并具有砷性皮肤损害的砷中毒患57名和饮用非高砷水的健康人57名进行对照（1：1配比）研究，结果发现：砷中毒患末稍感觉异常以痛觉，温度觉，压觉减退最为明显，与其对照对比有显性差异（P＜0．05），植物神经功能损害以少汗，无汗及指甲异常（弧影消失，指甲变暗）最为明显，与其对照组比有显性差异（P＜0．05），结果提示，砷中毒患伴有不同程度的神经系统损害。     

地方性砷中毒对患者血压和心电图的影响

目的探讨地方性砷中毒对患者血压和心电图的影响。方法选择本地区确诊的269例地方性砷中毒患者作为观察组,再选择非地砷病区健康人群200名作为对照组,检测并比较分析两组受试者血压以及心电图变化情况。结果观察组患者检出血压异常141例(52.42%)、对照组受试者检出血压次以上73例(26.50%),两组比较差异具有统计学意义(P0.05),其中观察组检出收缩压异常率显著高于对照组(P0.05),而两组受试者检出舒张压异常率无显著差异(P0.05);观察组中检出心电图异常患者185例(68.77%),对照组心电图异常检出73例(36.50%),两组比较差异具有统计学意义(P0.05);观察组检出窦性心律失常、ST-T改变以及早搏的检出率显著高于对照组(P0.05);不同砷中毒分度患者心电图检出率具有显著差异(P0.05),病情越严重,心电图异常检出率越高。结论地方性砷中毒可引起患者血压的升高,且以收缩压升高为主,同时可引起患者心电图异常,主要包括窦性心律失常、ST-T改变以及早搏,且砷中毒患者病情越严重,心电图异常检出率越高。     

有机硒对地方性砷中毒心电图改变的治疗作用

观察了有机硒对地方性砷中毒心电图改变的治疗效果,硒治疗组有效率为８６．３８％,无变化１３．６４％,无加重,与饮用低砷水对照组比较差异显（Ｐ〈０．０５）;心电图正常患在观察期间硒治疗组１例出现异常对照组则为３例,上述结果显示,单独饮用低砷水的干预效果是有限的,同时采用药物治疗是不可缺少的措施,硒制剂可能是理想的药物之一。对自由基损伤作为慢性砷中毒致病机理进行了探讨。     

慢性心力衰竭病人心脏运动同步性与心电图的关系

目的观察窦性心律慢性心力衰竭病人左右心室间、左室室内收缩同步性差异，分析窦性心律慢性心力衰竭病人心电图与左室功能的变化。探讨心脏运动不同步与左室收缩功能、心电图的关系。方法选择33例慢性心力衰竭病人为观察组，NYHA分级Ⅲ级～Ⅳ级，对照组24例，为同期无器质性心脏病、心力衰竭病人。首先进行心电图检查，获得QRS间期、P-R间期。再选行心脏超声心动图检查，获得左室射血分数、左室舒张末径、主动脉射血前时间、肺动脉射血前时间、间隔-后壁运动延迟时间。结果两组间心电图参数QRS间期、P-R间期差异有统计学意义（P〈0．05），左室射血分数、左室舒张末径、主动脉射血前时间、间隔-后壁运动延迟时间、室间延迟时间有统计学意义（P〈0．05）。慢性心力衰竭病人心脏运动不同步与左室收缩功能减低有明显关系（P〈0.05），与心电图QRS间期无明显关系（P〉0．05）。观察组78。79％的病人存在室间、室内收缩不同步，其与无室间、室内收缩不同步病人比较，左室射血分数有统计学意义（P〈0．05），心电图差异无统计学意义（P〉0．05）。结论慢性心力衰竭病人的心电图、超声心动图参数存在着明显差异。     

砷中毒大鼠体内各脏器、组织中砷的分布

目的 研究砷中毒大鼠体内各脏器组织中砷的分布，为地方性砷中毒的治疗提供科学依据。方法 用亚砷酸钠（NaAsO2）诱导出大鼠亚急性砷中毒模型，采用超热中子活化法测定大鼠的肝、肺、肾、脾、心、脑、卵巢、睾丸、肌肉9种脏器组织中A5的含量。结果 中毒组大鼠各脏器组织中砷的含量均极显著高于正常对照组（P〈0．01或P〈0．001）。且砷在各脏器中的浓度并非均匀分布。在中毒组脏器组织中的浓度遵循脾〉肺〉肝〉肾〉卵巢〉心脏〉脑〉肌肉〉睾丸。结论 砷在脾、肺、肝、肾等脏器中大量的蓄积，可能导致这些器官细胞的损伤。     

甘肃省合作市地方性砷中毒流行病学调查

目的了解甘肃省合作市饮水高砷水源的分布和地方性砷中毒（地砷病）的流行情况，为进一步开展防治工作提供科学依据。方法对全市不同类型的饮水水源进行采样检测，同时进行地方性砷中毒病情调查。结果合作市的砷超标水样分布在4个乡19个自然村，呈点状分布，覆盖范围约700km^2，受威胁人群约1万人。在调查的987人中，检出地砷病可疑病例61例．检出率6．18％；高砷水源区人群尿砷平均值为0．0834mg／L，低砷水源区人群尿砷均值为0．0396mg／L，二者间差异有统计学意义（P〈0．05）。结论甘肃省合作市部分地区饮水含砷量超标．并存在地方性砷中毒的流行。     

燃煤型砷中毒患者血清中9种物质放免测定及临床意义

目的 了解燃煤型砷中毒患者血清中9种物质水平，并探讨其临床意义。方法 应用放免测定法（RIA）对患者血清叶酸、VB12、胆酸（CG）、白细胞介素素-2（IL-2）、肿瘤坏死因子（TNF）、透明质酸（HA）、Ⅳ型胶原（Ⅳ-C）、转化生长因子-α（TGFα）、皮质醇进行测定和分析。结果 砷中毒组与对照组比较，叶酸、VB12、IL-2、TNF明显下降（P〈0．01），CG、HA、Ⅳ-C、TGFα明显升高（P〈0．01）；皮质醇整体与对照组比较，差异无显著意义（P〉0．05）；分层分析，重度组与对照组比较，差异有显著意义（P〈0．01）。结论 用放免方法检测燃煤型砷中毒患者血清中上述9中物质，可以了解砷对机体的损害程度和范围，对砷中毒的临床治疗具有重要的指导作用。     

水砷暴露致人群心电图改变的研究

目的 研究不同水砷含量暴露与人群心电图改变的关系,探讨砷对心血管系统的影响.方法 2008-2013年,根据饮水型地方性砷中毒的历史监测资料,在山西省和内蒙古自治区选择15个村作为调查点,选择年龄≥20岁、饮水≥10年的当地常住居民作为调查对象,按照饮水砷含量分为对照组(＜0.01 mg/L)、低水砷组(0.01～＜0.05 mg/L)、中水砷组(0.05～＜0.10 mg/L)以及高水砷组(≥0.10 mg/L).采集调查对象家中的饮用水,应用氢化物原子荧光法检测水砷,并描记12导联心电图,比较不同水砷暴露人群的心电图改变.结果 共对1 341人进行心电图检查,异常率为11.56％(155/1 341),其中,对照组、低、中、高水砷组分别为5.7％(9/158)、12.85％(59/459)、12.02％(28/233)、12.02％(59/491).对照组的心电图异常率均低于低、中、高水砷组(x2值分别为6.141、4.391、5.090,P均＜0.05).心电图改变以心律失常和ST-T改变为主.对照组的各种心律失常异常率[0(0/158)]均低于低、中、高水砷组[4.58％(21/459)、3.86％(9/233)、3.46％(17/491);x2值分别为7.483、6.247、5.618,P均＜0.05].4组人群右心室扩大、心肌缺血心电图异常率组间比较差异均有统计学意义(x2值分别为9.525、9.848,P均＜0.05).结论 饮水型砷中毒病区居民心电图异常改变以心律失常和ST-T改变为主.水砷含量≥0.01 mg/L即可明显引起心电图异常率的增加,饮水砷对心脏组织有一定的影响.     

强化SOD刺梨汁对燃煤污染型砷中毒患者的排砷解毒作用及抗氧化能力的影响

目的观察强化SOD刺梨汁对燃煤污染型砷中毒患者的排砷作用和对患者体内抗氧化能力的影响。方法分别给予砷中毒患者口服强化SOD刺梨汁、刺梨汁治疗4周，每周收集1次晨尿测定尿砷，同时检测治疗前后患者超氧化物歧化酶（SOD）活性、巯基（-SH）及丙二醛（MDA）水平。结果强化SOD刺梨汁组在服用1周后尿总砷（2148μmol／L）较治疗前（2．02μmol／L）明址升高（t=2．189，P〈0．05），服用3、4周后尿总砷（1．59、1．6μmol／L）较治疗前明显降低（t值分别为-2．496、2．238，P〈0．05）；与治疗前（1．89μmol／L）相比，刺梨汁组在服用1周后尿砷（2．09μmol／L）有增高趋势，但差异无统计学意义（P〉0．05），在服用3、4周后尿砷（1．36、1.31μmol／L）较治疗前明显降低（t值分别为-2．578、2．755，P〈0．05或〈0．01）；两组在同一疗程的排砷效果差异无统计学意义。强化SOD刺梨汁治疗后患者的SOD活力较治疗前升高，一SH增加，MDA水平降低，差异均有统计学意义（t值分别为3．869、2．042、3．039，P〈0．05或〈0．01）；刺梨汁治疗后患者的SOD活力较治疗前明显提高（t=2．276，P〈0．05），但-SH、MDA水平在治疗前后差异不明显；与刺梨汁治疗组比较，强化SOD刺梨汁组患者的SOD、-SH均明显提高（t值分别为2．531、2．572，P〈0．05），MDA水平明显降低（t=2．405，P〈0．05）。结论强化SOD刺梨汁、刺梨汁对燃煤型砷中毒患者均有一定的排砷解毒作用；强化SOD刺梨汁可提高患者机体抗氧化能力．拮抗砷中毒自由基脂质过氧化的损害作用。强化SOD刺梨汁对燃煤型砷中毒患者的排砷解毒和拮抗脂质过氧化损害作用优于单纯刺梨汁。     

地方性砷中毒对机体氧化应激远期影响的研究

目的探讨地方性砷中毒对机体氧化应激反应的远期影响,为砷中毒病区居民的预防和治疗提供科学依据。方法采用整群抽样和典型调查相结合的方法进行现场调查,改水5年后的砷中毒病区调查者分为轻、中、重度病例组和内对照组,非病区调查者为外对照组。对调查者的氧化应激指标即超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）进行测定和分析,用SPSS13.0 for windows软件对数据进行统计分析处理。结果本次调查了5个组共252人,所选择的病区村5年前已实施改水,水砷含量符合国家标准（≤0.05 mg/L）,各组尿砷含量无显著差异（H=2.698,P〉0.05）。各组SOD活力差异显著（F=52.42,P〈0.01）,外对照组明显高于其他组（P〈0.05或P〈0.01）,内对照组高于病例组（P〈0.01）,各病例组间无显著差异（P〉0.05）;各组GSH-Px活力无显著差异（H=4.209,P〉0.05）;各组MDA含量差异显著（F=3.36,P〈0.05）,外对照组明显低于其他组（P〈0.05或P〈0.01）,其他组间比较无差异（P〉0.05）。结论地方性砷中毒患者饮用低砷水5年后砷对机体的氧化应激反应影响仍然存在,砷中毒病区在加大除砷改水力度的同时,应加强居民身体状况的监测。     

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.     

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.     

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.     

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。     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.