膈肌电活动对慢性阻塞性肺疾病急性加重期插管患者成功撤机的预测价值

目的 探究膈肌电活动对慢性阻塞性肺疾病急性加重期(AECOPD)插管患者撤机的预测价值.方法 选择2013年5月至2015年5月在哈尔滨医科大学附属第一医院行机械通气治疗并考虑撤机的AECOPD插管患者55例作为研究对象,根据患者是否撤机成功将55例AECOPD患者分为撤机成功组与撤机失败组2组.符合撤机条件后,分别对2组患者行自主呼吸试验(SBT) 30 min,分别监测、记录并比较行SBT后0、10及30 min时2组患者膈肌电活动(Edi)、口腔闭合压(P0.1)及呼吸浅快指数(f/Vt),并监测比较2组患者PaCO2、PaO2、MAP及HR等一般情况.结果 55例患者中,撤机成功者35例,占63.6％,撤机失败者20例,占36.4％,2组患者的年龄、PaO2、MAP等一般情况差异均无统计学意义(t=0.078、1.669、1.150,P＞0.05);与撤机失败组相比,撤机成功组患者的PaCO2均明显偏低,差异有统计学意义(t=2.454,P=0.017);行SBT后10 min及30 min时2组患者Edi均显著高于SBT后0 min时相应组别患者的Edi,差异有统计学意义(P＜0.05);行SBT 30 min时,与撤机失败组相比,撤机成功组患者Edi明显偏低,差异有统计学意义(t=3.505,P=0.001);行SBT后10 min及30 min时撤机失败组患者f/Vt较撤机成功组患者高,差异有统计学意义(t=2.624、2.170,P值均＜0.05);与撤机失败组相比,撤机成功组患者P0.1无明显差异,且差异无统计学意义(P＞0.05).结论 Edi对AECOPD插管患者撤机具有较好的预测价值.     

评价膈肌功能指导慢性阻塞性肺疾病患者撤机的可行性研究

目的 探讨神经机械耦联指数(NMC)和神经通气耦联指数(NVC)对慢性阻塞性肺疾病(COPD)患者撤机的指导价值.方法 以2008年12月至2009年12月入住东南大学附属中大医院重症医学科行机械通气超过24 h,且考虑撤机的COPD患者为研究对象.根据患者撤机成功与否分为撤机成功组与撤机失败组.具备撤机条件后行自主呼吸试验(SBT)30 min,监测SBT0、5、30 min时膈肌电活动(Edi)、NMC、NVC、NVC × NMC、呼吸浅快指数(f/Vt)及口腔闭合压(P0.1).结果 16例患者纳入本研究,其中撤机成功组6例,撤机失败组10例.(1)Edi对撤机失败的预测价值:SBT30 min时,撤机失败组Edi明显高于撤机成功组,其预测撤机失败的接受者操作特征(ROC)曲线下面积(AUC)为0.817(P＜0.05).(2)NVC、NMC对撤机的判断:SBT 5、30 min时撤机成功组NVC、NMC均高于撤机失败组.SBT 30 min时,NVC预测撤机失败的AUC为0.850(P＜0.05),NMC预测撤机失败的AUC为0.800(P＞0.05).(3)NVC×NMC对撤机失败的预测:SBT 30 min时预测撤机失败的AUC为0.850(P＜0.05),以NVC×NMC＜39 em H2O·ml·μV-2(1 em H2O=0.098 kPa)为临界值时,其灵敏度为100.0%,特异度为83.3%.(4)f/Vt、f/Vt×P0.1对撤机的预测:SBT 时,f/Vt、f/Vt×P0.1均不能预测撤机失败.结论 Edi、NVC、NVC×NMC对COPD患者撤机具有良好的预测价值.

Abstract：

Objective To evaluate the predictive performance of neuro-mechanical coupling (NMC) and neuro-ventilatory coupling (NVC) in the weaning outcome in patients with chronic obstructive pulmonary disease (COPD). Methods Sixteen patients were enrolled when the criteria for their first spontaneous breathing trial (SBT) was met. A 30-minute SBT was attempted, with the measurement of electrical activity of the diaphragm (Edi) , NMC, NVC, NVC ×NMC, index of rapid shallow breathing (f/Vt) , airway occlusion pressure (P0.1) and f/Vt ×P0.1 at 0, 5 and 30 min. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. Results Successful weaning(S group) was observed in 6 patients while weaning failure(F group) in 10 patients. (1)The predictive capacity of Edi: at 30 min of SBT, Edi showed higher values in the F group (P ＜ 0. 05), the area under the ROC curves(AUC) was 0. 817(P ＜0. 05). (2) The predictive capacity of NVC and NMC:at 5, 30 min of SBT, NVC and NMC showed higher values in the S group (P ＜0. 05); at 30 min of SBT NVC presented the largest AUC than any other time of SBT (0. 822, P ＜ 0. 05), while the AUC of NMC was 0. 800 (P ＞ 0. 05). (3) The predictive capacity of NVC × NMC: at 30 min of SBT, the AUC of NVC × NMC was larger than NVC (0. 864, P ＜ 0. 05) , showing greater sensitivity (100. 0%) and specificity (83. 3%) .(4) The predictive capacity of f/Vt and P0.1: f/Vt and f/Vt × P0.1 presented poor predictive performance in the failed patients. Conclusions Edi, NVC and NVC × NMC were good predictor for the weaning outcome in patients with COPD.     

序贯健肌操联合床旁B超监测膈肌预测老年慢性阻塞性肺疾病急性加重期患者机械通气撤机的临床观察

目的 探讨序贯健肌操联合床旁B超监测膈肌预测老年慢性阻塞性肺疾病(慢阻肺)急性加重期患者机械通气撤机情况的效果.方法 60例老年慢阻肺急性加重期患者,所有患者接受序贯健肌操联合床旁B超监测膈肌,观察分析其机械通气撤机成功率及撤机指标〔膈肌电活动(Edi)、口腔闭合压(P0.1)及呼吸浅快指数(f/Vt)〕情况.结果 6...     

自主呼吸试验前后下腔静脉变异度对呼吸衰竭合并心功能不全患者撤机失败的预测价值

目的评价自主呼吸试验(SBT)前后下腔静脉变异度(△DIVC)对呼吸衰竭合并心功能不全患者机械通气后撤机失败的预测价值。方法选取2016年11月至2018年2月在徐州市中心医院ICU进行机械通气的呼吸衰竭合并心功能不全患者120例。患者30 min SBT成功后拔管,48 h内不需要再次气管插管和无创呼吸机辅助为撤机成功组(n=62);30 min SBT失败或者SBT成功后拔管,但48 h内需要再次插管或无创呼吸机辅助为撤机失败组(n=58)。分别在SBT前和30 min后记录并比较2组患者的临床特征及△DIVC。采用SPSS 17.0软件统计分析。根据数据类型,组间比较采用独立样本t检验、Mann-Whitney U检验或χ~2检验。采用多因素logistic回归法分析影响撤机失败的独立危险因素。利用受试者工作特征(ROC)曲线评估△DIVC对撤机失败的预测价值。结果 2组患者在慢性呼吸疾病、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、第1次插管到拔管的持续时间和血红蛋白水平方面比较差异有统计学意义(P0.05)。与撤机成功组比较,撤机失败组患者在SBT前及30 min后二氧化碳分压和N端脑钠肽前体显著升高,左室射血分数(LVEF)显著降低,差异有统计学意义(P0.05);在SBT后30 min,撤机失败组患者△DIVC较撤机成功组显著升高,差异亦有统计学意义(P0.05)。多变量logistic回归分析显示,LVEF(OR=1.204,95%CI 1.133～1.381;P=0.015)和SBT后30 min的△DIVC(OR=1.450,95%CI 1.102～2.026;P=0.009)是患者撤机失败的独立危险因素。SBT后30 min的△DIVC预测患者撤机失败的ROC曲线下面积为0.905,最佳截断点0.27,灵敏度为82.4%,特异度为94.4%。LVEF预测患者撤机失败的曲线下面积为0.806,最佳截断点为42.0%,灵敏度为54.5%,特异度为86.8%。结论 SBT 30 min后的△DIVC对于呼吸衰竭合并心功能不全患者撤机失败具有较高的预测价值。     

机械通气时间对机械通气撤机患者膈肌功能的影响分析

目的 探讨机械通气时间对机械通气患者膈肌功能的影响.方法 以2008年12月至2009年12月入住东南大学附属中大医院ICU行机械通气超过24 h,且准备撤机的患者为研究对象,根据机械通气时间分为机械通气≤3d组(A组)及机械通气＞3d组(B组).行自主呼吸实验(SBT)30 min,监测SBT 0、5及30 min时膈肌电位(Edi)、神经肌肉强度指数(NMS)、神经机械耦连指数(NMC)及神经通气耦连指数(NVC)等膈肌功能指标.结果 44例患者纳入研究,A组患者25例(56.8％),B组患者19例(43.2％).①SBT 0 min时A、B两组患者间Edi、NMS、NMC及NVC差异均无统计学意义.②SBT 5 min时B组患者Edi和NMS显著高于A组.③SBT 30 min时B组患者Edi显著高于A组[(23±11)μV比(15±8)μV,P＜0.05];与A组患者NMS相比,B组患者NMS显著增高[(598±309)μV· cpm比(363±224)μV·cpm](P＜0.05),而B组患者NVC则明显低于A组.结论 SBT 30 min时机械通气＞3 d的患者膈肌收缩能力、耐力均下降;提示机械通气时间增加可能是导致膈肌功能下降的重要原因.     

膈肌超声对重症患者机械通气撤机的预测价值

目的:评价膈肌超声对机械通气(MV)患者撤机结果的预测价值。方法:选取行MV时间 48h的重症患者41例,在符合撤机条件后使用T管进行自主呼吸试验(SBT),于SBT 30min时使用床旁超声测量患者右侧躯体的膈肌移动度(DE)和膈肌厚度,并计算膈肌增厚率(DTF),根据撤机成败与否将患者分为撤机成功组(26例)和撤机失败组(15例)。采用受试者工作特征(ROC)曲线评价膈肌功能超声指标对撤机的指导价值。结果:撤机成功组患者DE及DTF高于撤机失败组(均P 0. 05)。分别选取1. 08 cm和30%作为DE和DTF的截断值,其预测撤机成功的敏感度分别为80. 77%和65. 38%,特异度分别为80. 00%和60. 00%,ROC曲线下面积分别为0. 751(95%CI:0. 571～0. 932)和0. 668(95%CI:0. 484～0. 852)。结论:膈肌功能超声监测可作为重症医学科MV患者撤机能力的预测指标,对撤机具有较好的指导价值。     

浅快呼吸指数指导缺血性脑卒中患者撤机的临床观察

目的探讨浅快呼吸指数(RSBI)指导缺血性脑卒中患者撤机的临床价值。方法前瞻性研究,入选在重症医学科进行有创机械通气24 h 40例缺血性脑卒中患者,根据撤机结果将患者分为成功组26例,失败组14例。应用低水平压力支持通气法进行自主呼吸实验(SBT),40例患者均通过了1 h的自主呼吸实验,记录SBT前和SBT1h、SBT1.5h及SBT2h的RSBI,同时记录年龄、性别、APACHEⅡ评分、撤机前30 min的血气分析。结果成功组和失败组年龄、性别、GCS评分、APACHEⅡ评分无明显差异(P0.05),失败组合并冠心病比例较成功组明显升高(P0.05)。以RSBI≤105 bpm/L为标准预测撤机成功的灵敏度和特异度分别为:SBT前93.8%、10.6%,SBT1 h 100%、40.24%、SBT1.5 h 98.2%、38.7%SBT2 h 96.3%、38.2%。结论SBT1 h的RSBI预测缺血性脑卒中患者撤机成功的准确率高。动态观察RSBI对缺血性脑卒中患者成功撤机有一定的预测价值。     

浅快呼吸指数对机械通气脑梗死患者撤机成功率的预测价值

目的研究浅快呼吸指数(RSBI)对机械通气脑梗死患者撤机成功率的预测价值。方法采用程序化撤机策略对机械通气>24h且符合筛查试验标准的急性脑梗死患者34例,根据撤机成功与否分为成功组23例,失败组11例。应用低水平压力支持通气法进行自主呼吸试验(SBT)。SBT前和开始3min时测定呼吸频率、潮气量、心率和血氧饱和度等指标。对通过3min SBT的患者继续完成120min SBT,持续监测上述指标,每15min记录1次,血气分析分别于30、60、120min采取。结果失败组合并冠心病比例、SBT后15、30、60、90、120min的RSBI较成功组明显升高(P<0.05)。SBT前和SBT后3、15、30、60、90、120min的RSBI与撤机结果的ROC曲线下面积分别为0.581、0.745、0.658、0.838、0.925、0.889、0.881,提示SBT 60min时的RSBI预测撤机的准确性最高。SBT 60min时,以RSBI≤60次/(min·L)为标准,RSBI预测撤机成功的敏感性为100%,特异性为81.81%,准确性为84.12%。结论动态观察RSBI对机械通气脑梗死患者撤机成功率有一定的预测价值。     

评价膈肌功能指导慢性阻塞性肺疾病患者撤机的可行性研究

Objective To evaluate the predictive performance of neuro-mechanical coupling (NMC) and neuro-ventilatory coupling (NVC) in the weaning outcome in patients with chronic obstructive pulmonary disease (COPD). Methods Sixteen patients were enrolled when the criteria for their first spontaneous breathing trial (SBT) was met. A 30-minute SBT was attempted, with the measurement of electrical activity of the diaphragm (Edi) , NMC, NVC, NVC ×NMC, index of rapid shallow breathing (f/Vt) , airway occlusion pressure (P0.1) and f/Vt ×P0.1 at 0, 5 and 30 min. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. Results Successful weaning(S group) was observed in 6 patients while weaning failure(F group) in 10 patients. (1)The predictive capacity of Edi: at 30 min of SBT, Edi showed higher values in the F group (P ＜ 0. 05), the area under the ROC curves(AUC) was 0. 817(P ＜0. 05). (2) The predictive capacity of NVC and NMC:at 5, 30 min of SBT, NVC and NMC showed higher values in the S group (P ＜0. 05); at 30 min of SBT NVC presented the largest AUC than any other time of SBT (0. 822, P ＜ 0. 05), while the AUC of NMC was 0. 800 (P ＞ 0. 05). (3) The predictive capacity of NVC × NMC: at 30 min of SBT, the AUC of NVC × NMC was larger than NVC (0. 864, P ＜ 0. 05) , showing greater sensitivity (100. 0%) and specificity (83. 3%) .(4) The predictive capacity of f/Vt and P0.1: f/Vt and f/Vt × P0.1 presented poor predictive performance in the failed patients. Conclusions Edi, NVC and NVC × NMC were good predictor for the weaning outcome in patients with COPD.     

气道闭合压（P0.1）、用力呼吸指数(CORE)、综合脱机指数(IWI)对ICU患者脱机能力的预测价值

目的 探讨气道闭合压（P0.1）、用力呼吸指数(CORE)、综合脱机指数(IWI)对重症监护病房（ICU）患者脱机能力的预测价值。方法 选取2014年9月—2017年9月我院入住ICU接受机械通气治疗的患者96例作为研究对象,采取撤机筛查实验,对符合条件者采取30 min自主呼吸实验（SBT）,观察患者撤机成功率,对比撤机成功与失败患者年龄、性别、机械通气时间等一般情况与SBT前的P0.1、CORE、IWI水平,以Logistic回归分析探究ICU机械通气患者撤机成功率的影响因素,Spearman相关性分析探讨P0.1、CORE、IWI与ICU患者撤机成功率的相关性,并以受试者操作特征曲线（ROC）分析P0.1、CORE、IWI对ICU患者撤机成功率的预测价值。结果 本组96例ICU患者中撤机成功73例,撤机成功率为76.04%（73/96）;撤机失败23例,撤机失败率为23.96%（23/96）;撤机成功组与撤机失败组年龄、性别、机械通气时间对比,差异无统计学意义（P＞0.05）,撤机成功组SBT前的CORE、IWI高于撤机失败组,P0.1低于撤机失败组,差异有统计学意义（P＜0.05）;Logistic回归分析显示,P0.1、CORE、IWI均为ICU机械通气患者撤机成功率的重要影响因素（P＜0.05）;Spearman相关性分析显示,CORE、IWI与ICU机械通气患者撤机成功率有明显正相关关系（r1=0.789、P1=0.003,r2=0.837、P2=0.001）,P0.1与ICU机械通气患者撤机成功率有明显负相关关系（r=﹣0.757、P=0.004）;ROC曲线分析显示,联合应用P0.1、CORE、IWI对ICU机械通气患者撤机成功率预测的敏感性及准确性高于单一参数（P＜0.05）。结论 P0.1、CORE、IWI与ICU机械通气患者撤机成功率具有密切关系,可将其用于患者撤机评估中,且联合应用三种参数可提高对患者撤机成功率的预测准确性,减少误判情况,有效指导临床治疗,改善患者预后。     

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。