男性急性冠状动脉综合征血清睾酮与sICAM-1水平相关

目的 观察不同类型男性冠心病患者血清睾酮、游离睾酮与可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)水平改变及互相间相关关系,进一步探讨睾酮与sICAM-1在男性急性冠状动脉综合征(acute coronary syndrome,ACS)发病中的作用.方法 冠心病患者分为急性心肌梗死(acute myocardial infarction,AMI)组、不稳定型心绞痛(unstable angina pectoris,UA)组、稳定型心绞痛(stable angina pectoris,SA)组,每组30例患者,另设健康对照组30例,比较各组间血清睾酮、游离睾酮与sICAM-1水平差异并分析其相关性.结果 AMI组和UA组血清游离睾酮与sICAM-1水平与对照组差异有统计学意义(P＜0.01),ACS患者血清游离睾酮与sICAM-1水平之间呈负相关(P＜0.01).结论 血清游离睾酮与sICAM-1水平改变与ACS的发生有关,它们可作为评价冠状动脉粥样硬化斑块稳定性与病变严重程度的一个参考指标,并为临床预防和治疗ACS开辟了新的途径.     

BNP对老年不稳定型心绞痛患者近期预后的预测价值

目的探讨B型利钠肽(BNP)对老年不稳定型心绞痛(unstable angina,UA)患者6月内主要不良心血管事件的预测价值。方法选择≥70岁UA患者120例,测定BNP水平,按BNP80 pg/ml和BNP≤80 pg/ml分为2组。随访6月,观察终点记录主要不良心血管事件,包括再发心绞痛、非致死性心肌梗死或心力衰竭、恶性心律失常(室性心动过速、室颤)、心源性死亡。结果 BNP80 pg/ml组患者主要不良心血管事件发生率明显高于BNP≤80 pg/ml组患者(39.6%比22.2%),差异有统计学意义(P0.01)。Logistic多因素分析显示,BNP独立预测UA患者6月主要不良心血管事件,OR值为1.871,95%CI为1.394~2.511。结论 BNP对老年UA患者近期预后有独立的预测价值,可作为危险分层的重要指标,指导临床的治疗决策。     

不稳定型心绞痛患者外周血M-CSF水平及与预后关系的研究

目的探讨不稳定型心绞痛患者（UAP）外周血M—CSF水平及与预后的关系。方法选择不稳定型心绞痛患者（UAP）86例和稳定型心绞痛患者（SAP）22例为研究对象。选择健康体检者（N）20名为健康对照组。患者入院24h内或健康体检者接受体检当时采集血标本分装2个试管，离心、冻存待测。采用酶联免疫吸附实验方法测定外周血M—CSF水平。按TIMI危险评分将UAP患者分为高、中、低3组，组间比较M—CSF水平差异。随访UAP患者近期（30d、90d）心血管不良事件发生情况，根据M—CSF四分位和中位值水平分组，比较不良事件发生率。采用SPSS13．0统计软件对结果进行统计分析。结果①不稳定型心绞痛患者外周血M—CSF水平[（472．63±48．27）pg／ml]显著高于稳定型心绞痛患者[（325．25±43．61）pg／ml]（P〈0．01）；②在TIMI危险积分的高、中、低积分组中，不稳定型心绞痛患者M—CSF水平依次降低，分别为（557．62±59．47）pg／ml、（438．53±48．54）pg／ml和（215．73±38．26）pg／ml；③高M—CSF组的不稳定型心绞痛患者近期心脏不良事件发生率（30d26．1％，90d34．78％）明显升高（P〈0．01）。结论①外周血M—CSF水平可反映不稳定型心绞痛患者的病情危险程度。②不稳定型心绞痛患者近期心血管不良事件的发生与外周血M—CSF水平高有关。     

高敏C-反应蛋白与白介素-6在急性冠状动脉综合征意义

目的 探讨急性冠状动脉综合征(acute coronary symptom,ACS)病人血清高敏C反应蛋白(high sensitivity-C reactive protein,hs-CRP)和白介素-6(interleukin-6,IL-6)浓度的变化及临床意义.方法 ACS组ACS病人60例,稳定型心绞痛(stable angina pectoris,SAP)组病人40例,对照组为40名健康人,检测血清IL-6、hs-CRP水平.结果 ACS组血清IL-6、hs-CRP水平明显高于SAP组和对照组(P＜0.01);ACS组中,急性心肌梗死病人又高于不稳定型心绞痛病人(P＜0.05);SAP组与对照组差异无统计学意义(P＜0.05);血清IL-6和hs-CRP水平呈正相关(r=0.5942,P＜0.01).结论 ACS病人血清IL-6和hs-CRP升高,其水平变化反映ACS的严重程度.     

冠心病患者ET-1水平变化及与预后关系的分析

目的 探讨冠心病患者血清内皮素-1(ET-1)水平变化及与预后的关系.方法 随机选取2005年7月至2006年11月在南华大学附属第二医院住院确诊的冠心病(CHD)患者120例(试验组)及健康体检者31名(对照组).CHD患者中,稳定型心绞痛(SAP)、不稳定型心绞痛(UAP)、ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)各30例.所有入选对象于入院后24 h内采血样本,健康体检者于体检当时采血样本,分离、冷藏血清,用ELISA方法测定ET-1浓度.随访研究对象,了解CHD患者近期急性心血管事件发生率.结果 ①STEMI组、NSTEMI组、UAP组和SAP组血清ET-1水平分别为(28.67±4.09)ng/L、(16.69±1.68)ng/L、(14.33±2.39)ng/L、(6.04±1.01)ng/L,均较正常对照组血清ET-1水平(3.35±1.02)ng/L显著升高(P＜0.01);STEMI组分别与NSTEMI组、UAP组、SAP组比较血清ET-1水平,SAP组分别与NSTEMI组、UAP组比较血清ET-1水平,差异均有统计学意义(P＜0.01),但是,UAP组和NSTEMI两组组间比较血清ET-1水平差异无统计学意义(P＞0.05).②实验对象血清ET-1高水平组(22.53%)较低水平组(8.66%)近期心血管急性事件发生率增高.结论 血清ET-1水平高低可反映冠心病患者病情严重性和近期急性心血管事件发生的可能性.     

hs-CRP、BNP及D-二聚体与ACS近期不良心血管事件的关系

目的:探讨急性冠状动脉综合征(ACS)患者血清中高敏C反应蛋白(hs-CRP)、脑利钠肽(BNP)、D-二聚体的水平与近期不良心血管事件的关系,为临床诊治提供依据。方法:选择冠心病患者376例,均行冠状动脉造影检查,其中稳定型心绞痛(SAP)120例,不稳定型心绞痛(UAP)152例,非ST段抬高性心肌梗死(NSTEMI)30例及ST段抬高性心肌梗死(STEMI)74例。采用双抗夹心免疫荧光法检测BNP浓度;采用免疫比浊法测定hs-CRP、D-二聚体。出院后90d以电话、复查等手段随访本人或亲属,询问并记录不良心血管事件。结果:UAP、NSTEMI和STEMI外周血hs-CRP、BNP和D-二聚体水平依次升高,差异有统计学意义。同时3组不良心血管事件发生率UAP组最低(4.61%),NSTEMI组次之(16.67%),STEMI组最高(24.32%),其中UAP组和NSTEMI组、UAP组和STEMI组进行比较,差异有统计学意义;STEMI组不良事件发生率较NSTEMI组高,但差异无统计学意义。高血压病、hs-CRP、BNP、D-二聚体、LDL是ACS患者近期不良心血管事件的高危影响因素。结论:外周血hs-CRP、BNP、D-二聚体是反映ACS患者近期心血管事件的有效指标。     

血浆纤维蛋白原对不稳定型心绞痛危险分层的价值

目的 :探讨血浆纤维蛋白原 (Fib)水平对不稳定型心绞痛 (UA)危险分层的临床价值。方法 :测定10 9例UA患者血浆Fib并与 35例稳定型心绞痛 (SA)患者相对照 ,据血浆Fib >4 .0 0 g/L和Fib <4 .0 0 g/L将UA患者分为Fib升高组 (5 8例 )和Fib正常组 (5 1例 ) ,观察住院期间心血管事件 (包括顽固性心绞痛、急性心肌梗死和心源性死亡 )发生率。结果 :10 9例UA患者血浆Fib较SA患者明显升高 [(4.89± 1.6 2 )∶ (3.85± 0 .74 )g/L ,P <0 .0 1],UA患者中血浆Fib升高组心血管事件发生率明显高于Fib正常组 (41.4 %∶ 5 .9% ,P <0 .0 1)。结论 :血浆Fib水平能预测UA患者住院期间心血管事件 ,可作为UA患者危险分层的一项血浆学指标     

脑钠肽与早发心绞痛患者近期预后的相关性

目的:探讨血浆脑钠肽(BNP)浓度对早发心绞痛患者近期心血管事件的预测价值。方法:检测110例早发心绞痛患者入院时的血浆BNP浓度,稳定型心绞痛(SAP)50例,不稳定型心绞痛(UAP)60例;26例健康体检者作为对照组。心绞痛患者按常规方法进行药物治疗和冠状动脉介入治疗,记录住院和随访平均6个月期间的心血管事件(心血管死亡、心力衰竭、再发心绞痛、心肌梗死);检测所有对象的BNP。结果:心绞痛组中UAP、SAP者与对照组血浆BNP浓度分别为(94.88±35.92)、(40.19±23.05)与(35.85±14.96)ng/L。UAP者平均BNP浓度高于SAP者和对照组(均P<0.01),SAP者与对照组BNP比较差异无统计学意义。UAP者心力衰竭、再发心绞痛、心肌梗死复合心血管事件发生率高于SAP者(20%∶6%,P<0.05)。SAP者、UAP者中发生心血管事件者BNP均高于未发生心血管事件者,分别为P<0.05、P<0.01。结论:血浆BNP浓度可以预测早发心绞痛患者近期心血管事件。     

可溶性CD40L对不稳定型心绞痛近期预后的影响

目的探讨sCD40L对不稳定型心绞痛（UA）近期预后的影响。方法采用酶联免疫吸附法对uA患者49例、稳定型心绞痛（SA）患者20例及对照组20例入院时血浆sCD40L水平进行检测,并对UA患者住院期间及出院后30d的急性不良心血管事件进行随访。结果①UA组患者入院时血浆sCD40L水平[（9．39±1．89）ng／ml]显著高于SA组[（5．92±2．06）ng／ml]（P〈0．01）和正常对照组[（4．91±1．97）ng／ml]（P〈0．01）,SA组略高于对照组,但差异无统计学意义。②UA患者中血浆sCD40L增高组住院期间和出院后30d急性不良心血管事件发生率显著高于血浆sCD40L正常组（P〈0．01）。结论UA患者血浆sCD40L显著增高。sCD40L可以作为冠心病易损斑块的血清学标记物,其水平对uA的近期预后有很好的预测价值。     

丹红注射液治疗不稳定型心绞痛的研究进展

<正>不稳定型心绞痛(unstable angina pectoris,UAP)是介于稳定型心绞痛与急性心肌梗死之间的一组临床综合征,发病率高,病情变化快,具有进行性恶化趋势,极易恶化为急性心肌     

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。     

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。     

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.     

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.