Effect of severity of asthma on quality of life

This study is aimed to evaluate the health related quality of life (HRQL) in asthmatics and the probable association between HRQL and disease severity and also other demographic factors by using a generic scale, SF-36 questionnaire. One-hundred and two asthmatics were enrolled. The scores of the 8 domains of SF-36 questionnaire were evaluated according to age, gender, status of education and compared with the severity of asthma. The mean age of 84 (83%) female and 18 (17%) male patients was 42.86 +/- 11.15. Fifty-two of them was well educated (51%) and 50 was poorly educated (49%). Atopy ratio was 81%. Mild intermittent, mild persistent and moderate-severe persistent groups were 27 (26%), 46 (45%) and 29 (29%) respectively. Female gender were worse in physical functioning (p= 0.000), physical role difficulties (p= 0.0049), vitality (p= 0.045) and social functioning (p= 0.025). Poorly educated group were worse in physical functioning (p= 0.001), physical role difficulties (p= 0.039), vitality (p= 0.045), emotional role difficulties (p= 0.046), general health (p= 0.030) and mental health (p= 0.044). Mental health was worse in the presence of atopy (p= .035). Physical functioning was better in mild intermittent group than moderate and severe persistent group (p= 0.024). General health was better in mild intermittent group than mild persistent group (p= 0.018), moderate and severe persistent group (p= 0.015). Vitality and emotional role difficulties was better in mild intermittent than mild persistent group (p= 0.042, p= 0.007). The HRQL scores and severity of asthma is well correlated like other objective parameters. So one of the primary goals in management of asthma should also improve QOL as well as functional parameters.     

犬Marshall韧带心肌细胞电生理特性的研究

目的　研究Marshall韧带(ligamentofMarshall, LOM)内心肌细胞的电生理特性。方法　组织块酶解法分离犬LOM内单个心肌细胞,在倒置显微镜下直接比较细胞形态;采用全细胞膜片钳技术记录心肌细胞动作电位的时程 (APD90,APD50 )和振幅 (APA),测量ICa,L、Ito、IK1、IK、INa等离子电流密度。结果　LOM内有两种不同形态的心肌细胞:一种为短矩形,另一种为长杆形,两者的长宽比分别为 2 .99±0. 95和 12. 05±2 .41,P<0. 01。两种形态细胞均表现为快反应动作电位,短矩形细胞的APA(mV)、APD50 (ms)和APD90 (ms)均小于长杆形细胞,分别为 80. 02±3 .68比 91 .72±7. 56、69 .62±6 .33比 83. 14±3 .66和 107. 55±4 .25比 144. 00±5 .15,P<0 .05。两种细胞的INa、ICa,L、Ito、IK1等离子的电流密度差异有统计学意义。结论　Marshall韧带中肌细胞呈现两种形态,并且在动作电位及许多离子电流密度上存在差异,两者的细胞电生理呈不均一性。     

肝纤维化大鼠肝窦内皮细胞整合素α6β1及粘着斑激酶表达的变化

目的研究正常及肝纤维化时大鼠肝窦内皮细胞(SEC)表面层粘连蛋白(LN)的整合素受体α 6 β 1及粘着斑激酶(FAK)的变化.方法用胶原酶原位灌注、Percoll不连续密度梯度离心法分离正常及四氯化碳(CCl4)实验性大鼠肝纤维化模型中的SEC,并进行体外培养.采用细胞-ELISA和免疫沉淀-蛋白质酪氨酸激酶活性测定的方法,分别观察SEC细胞表面整合素α 6 β 1表达及FAK活性的变化.结果正常大鼠SEC细胞表面几乎不表达整合素α6 β 1;在肝纤维化时SEC细胞表面α 6 β 1蛋白表达却明显增加(P＜0.05),且细胞中FAK活性明显增高(P＜0 05).结论在肝纤维化时SEC细胞表面整合素α 6 β 1的表达及FAK活性明显增高,可能在SEC的形态及功能改变中起重要作用.     

Evaluation of the prevalence of pathology of drug origin in a department of internal medicine

The authors report the results of a one year study carried out in the Department of Internal Medicine at Laennec Hospital. Out of a total of 1334 hospitalisation, 95 had drug side effects (7.1 p. 100) and 3.5 p. 100 of admissions were directly related to a iatrogenic complication. These complications were more common in women and elderly patients. Sixty-two drugs were implicated: antibiotics (32.6 p. 100), cardiovascular drugs (20 p. 100) including the diuretics (8.4 p. 100), antiinflammatory and antalgic drugs (16.8 p. 100), anticoagulants (8.4 p. 100), neuropsychiatric drugs (7.4 p. 100), oral hypoglycaemic agents (6.3 p. 100)..., 101 side effects were observed: gastro-intestinal (35.6 p. 100) dermato-anaphylactic (19.8 p. 100), cardiovascular (12.9 p. 100), endocrine or metabolic (11.8 p. 100), neuropsychiatric (10.9 p. 100), haematological (5.9 p. 100) and renal (4.2 p. 100). Iatrogenic complications were responsible for the admission to hospital of 47 patients and for 390 days of hospitalisation, costing approximately 380.000 FF.     

Investigation of relaxant effects of propofol on sheep sphincter of Oddi.

BACKGROUND/AIMS: Intravenous anesthetics are often used for conscious sedation in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincter of Oddi (SO) manometry. This study was designed to investigate the effects of propofol on sheep SO. METHODS: SO rings were mounted in a tissue bath and tested for changes in isometric tension in response to propofol (10(-8)-10(-4)M) in the presence or absence of L-NAME (3 x 10(-5)M), a non-specific inhibitor of nitric oxide (NO) synthase; indomethacin (10(-5)M), an inhibitor of cyclooxygenase; glibenclamide (10(-5)M), an inhibitor of ATP-sensitive potassium channels; tetraethylammonium (3 x 10(-4)M), inhibitors of calcium-activated potassium channels; 4-aminopyridine (10(-3)M), a voltage-dependent potassium channel blocker. Furthermore, we investigated the Ca(2+) antagonist feature of propofol in precontracted SO rings by CaCl(2). RESULTS: Carbachol (10(-9)-10(-5)M) induced concentration-dependent contraction responses in the SO rings. Propofol (10(-8)-10(-4)M) produced concentration-dependent relaxation on isolated SO rings precontracted by carbachol (10(-6)M). Preincubation of SO rings by L-NAME (3 x 10(-5)M), indomethacin (10(-5)M), glibenclamide (10(-5)M), and 4-aminopyridine (10(-3)M) did not produce a significant alteration on propofol-induced relaxation responses (p > 0.05), while preincubation by tetraethylammonium (3 x 10(-4)M) significantly decreased the propofol-induced relaxation responses (p < 0.05). Propofol (10(-8)-10(-4)M) induced concentration-dependently relaxations in precontracted isolated SO rings by CaCl(2). CONCLUSION: The results suggest that propofol induced concentration-dependent relaxations in precontracted isolated SO rings. These relaxations are independent from NO, cyclooxygenase metabolites, and opened ATP-sensitive and voltage-dependent potassium channels. Opened Ca(2+)-sensitive K(+) channels and inhibited L-type Ca(2+) channels existing in smooth muscle by propofol can contribute to these relaxations. Propofol can be beneficial as alternative drugs for obtaining selective relaxation during SO manometry after controlled clinical studies.     

Comparison of genome profiles for identification of distinct subgroups of diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) comprises molecularly distinct subgroups such as activated B-cell-like (ABC) and germinal center B-cell-like (GCB) DLBCLs. We previously reported that CD5(+) and CD5(-)CD10(+) DLBCL constitute clinically relevant subgroups. To determine whether these 2 subgroups are related to ABC and GCB DLBCLs, we analyzed the genomic imbalance of 99 cases (36 CD5(+), 19 CD5(-)CD10(+), and 44 CD5(-)CD10(-)) using array-based comparative genomic hybridization (CGH). Forty-six of these cases (22 CD5(+), 7 CD5(-)CD10(+), and 17 CD5(-)CD10(-)) were subsequently subjected to gene-expression profiling, resulting in their division into 28 ABC (19 CD5(+) and 9 CD5(-)CD10(-)) and 18 GCB (3 CD5(+), 7 CD5(-)CD10(+), and 8 CD5(-)CD10(-)) types. A comparison of genome profiles of distinct subgroups of DLBCL demonstrated that (1) ABC DLBCL is characterized by gain of 3q, 18q, and 19q and loss of 6q and 9p21, and GCB DLBCL is characterized by gain of 1q, 2p, 7q, and 12q; (2) the genomic imbalances characteristic of the CD5(+) and CD5(-)CD10(+) groups were similar to those of the ABC and GCB types, respectively. These findings suggest that CD5(+) and CD5(-)CD10(+) subgroups are included, respectively, in the ABC and GCB types. Finally, when searching for genomic imbalances that affect patients' prognosis, we found that 9p21 loss (p16(INK4a) locus) marks the most aggressive type of DLBCL.     

Significance of site of origin of premature ventricular contractions.

One hundred and sixty-five inpatients with premature ventricular contractions (PVC's) were clinically evaluated in regard to the presence (130 patients) or absence (35 patients) of organic heart disease. PVC's were classified based on QRS morphology (bundle branch block pattern) in Lead V₁ as being either left ventricular (66 patients), right ventricular (71 patients), or of both ventricles (28 patients). The incidence of organic heart disease was significantly greater in patients with left ventricualr PVC's 60 of 66 (91 per cent) and biventricular PVC's 25 of 28 (89 per cent) than in patients with right ventricular PVC's 45 of 71 (63 per cent) (p < 0.001). Of the 130 patients with organic heart disease, 60 (46 per cent) had left ventricular PVC's, 25 (19 per cent) had biventricular PVC's, and 45 (35 per cent) had right ventricular PVC's. of the 35 patients without organic heart disease, six (17 per cent) had left ventricualr PVC's, four (9 per cent) had biventricular PVC's, and 26 (74 per cent) had right ventricular PVC's.These data suggest the following conclusions regarding inpatients with PVC's: (1) Organic heart disease is frequent in patients with right ventricular PVC's and almost universally present in patients with left ventricular and biventricular PVC's. (2) Patients without organic heart disease primarily have PVC's of right ventricular origin. The mechanism of the latter association is unknown.     

Urgency of reassessment of role of obesity indices for metabolic risks

The definition of metabolic syndrome places emphasis on health care for persons at risk. However, whether an obesity index should be a mandatory component of the definition and whether obesity indices can identify metabolic risks satisfactorily require further exploration. Therefore, we investigated the effectiveness of various anthropometric obesity indices in identifying the clustering of 2 or more American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI)/International Diabetes Federation (IDF)-defined metabolic risk factors (hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol) for metabolic syndrome and those of other metabolic risk factors (high low-density lipoprotein cholesterol, hyperuricemia, high γ-glutamyltransferase, fatty liver) in 6141 men and 2137 women. The anthropometric indices were the following: (1) for both sexes—various levels of waist-to-height ratio (WHtR) including 0.5 and body mass index (BMI) of 23 and 25 kg/m²; (2) for men and women individually—waist circumference (W) 90/80 cm (AHA/NHLBI/IDF for ethnic groups), W 85/90 cm (Japan Society for the Study of Obesity), and combined W and BMI: W 85/90 cm and/or BMI 25 kg/m² (Japanese government). The results showed the following: (1) The optimal value for WHtR was 0.5 for AHA/NHLBI/IDF-defined risk factors and approximately 0.5 for other risk factors in both sexes. (2) The sensitivities of various proposed obesity indices for identifying clustering of defined and other risk factors varied between 74.4% (WHtR 0.5) and 36.3% (BMI 25) and between 80.5% (WHtR 0.5) and 43.7% (BMI 25) in men, and varied between 65.6% (WHtR 0.5) and 16.8% (W 90 cm) and between 82.3% (WHtR 0.5) and 28.2% (W 90 cm) in women. Because the sensitivities of many anthropometric indices were very low, a reassessment of the effectiveness of obesity indices in evaluating metabolic risks and especially their suitability as a single mandatory component of metabolic syndrome is urgently needed. However, WHtR 0.5 provides a very useful algorithm for screening persons at risk.     

脊柱结核术后未愈的影响因素分析

目的 探讨脊柱结核患者术后未愈的影响因素。方法 收集2012年1月至2016年12月成都市公共卫生临床医疗中心收治的312例脊柱结核患者作为研究对象,其中,经手术治疗未愈者24例,治愈者288例。收集研究对象性别、年龄、营养状况、发病至就诊间隔时间、手术入路、抗结核药物治疗方案、患者依从性、脊柱病变节段、是否并发其他部位结核、耐药情况、病灶清除情况、内固定稳定性、术前规范抗结核时间、全程随访情况、抗结核药物治疗效果评定等信息,分析导致患者术后未愈的影响因素。结果 未愈组不规范抗结核药物治疗者、脊柱病变>2个节段者、耐药结核病者、病灶清除不彻底者、全程未进行规律随访者、抗结核药物治疗效果评定为无效者、发病至就诊间隔时间>12个月者、行后路手术者分别占75.0%(18/24)、66.7%(16/24)、41.7%(10/24)、66.7%(16/24)、58.3%(14/24)、58.3%(14/24)、41.7%(10/24)、66.6%(16/24),均明显高于治愈组[分别占27.4%(79/288)、35.8%(103/288)、12.1%(35/288)、35.8%(103/288)、26.4%(76/288)、29.2%(84/288)、4.9%(14/288)、17.7%(51/288)],差异均有统计学意义(χ ²值分别为10.11、7.19、15.64、8.97、11.01、8.75、12.14、12.29,P值均＜0.05)。多因素logistic回归分析显示,不规范抗结核药物治疗[OR(95%CI)=3.15(1.03~9.64)]、脊柱病变>2个节段[OR(95%CI)=2.52(1.29~4.94)]、耐药结核病[OR(95%CI)=4.31(1.25~14.88)]、病灶清除不彻底[OR(95%CI)=4.90(1.39~17.27)]、全程未规律随访[OR(95%CI)=3.99(1.39~17.27)]、抗结核药物治疗效果评定为无效[OR(95%CI)=4.46(1.34~11.84)]、发病至就诊间隔时间>12个月[OR(95%CI)=12.30(2.20~68.80)]及行后路手术方式[OR(95%CI)=6.51(1.77~23.91)]是脊柱结核患者术后不愈的危险因素。 结论 脊柱结核诊治过程中要早期就诊,采用规范的抗结核药物方案治疗,避免适应性耐药,手术尽量选择前路手术方式,术中尽可能彻底清除病灶,术后注重全程随访,及时调整不合理抗结核药物方案。     

The role of nebulised budesonide in the treatment of exacerbations of COPD.

The present study was designed to evaluate the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids (SC) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease (ECOPD). Patients hospitalised with ECOPD (n = 159) were randomised into three groups. Group 1 received only standard bronchodilator treatment (SBDT), group 2 received SC (40 mg prednisolone) plus SBDT, and group 3 received NB (1,500 microg q.i.d.) plus SBDT. Improvement during 10-day hospitalisation was compared with exacerbation and rehospitalisation rates after discharge. While mean+/-sd age was 64.1+/-8.9 yrs (female/male = 0.1), mean forced expiratory volume in one second (FEV(1)) at admission was found to be 37.2+/-12.2% predicted. Arterial blood gases and spirograms recovered faster in groups 2 and 3. While improvements in arterial oxygen tension (P(a,O(2))) and forced vital capacity (FVC) in group 2, and improvements in P(a,O(2)), FVC and FEV(1) in group 3, became significant at 24-h control, the first significant improvement in group 1 appeared in arterial oxygen saturation at 72-h control. The mean improvement of P(a,O(2)) after 10 days was 1.20 and 1.06 kPa (9 and 8 mmHg) higher in group 2 and 3, respectively, than in group 1. Blood glucose exhibited an upward trend only in group 2. The study demonstrates that nebulised budesonide may be an effective and safe alternative to systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease.     

小剂量皮质类固醇吸入合并小剂量茶碱口服对支气管哮喘 …

目的 研究小剂量茶碱合并小剂量皮质类固醇对哮喘患者的疗产及对下丘脑－垂体－肾上腺轴的影响。方法 ４３例以轻、中度的哮喘患者随机分成两组。茶碱激素组（Ａ）组２１例：给予无水缓释放茶口服,每晚２００ｍｇ,加二丙酸倍氯米松（ＢＤＰ）每天３００μｇ吸入;单纯激素组（Ｂ）组２２例：仅给予ＢＤＰ每天６００μｇ吸入及每晚口服安慰剂,疗程１３周。结果 治疗前、后的症状计分、呼气峰流速值（ＰＥＦ）及其变异率（ＰＥＦ     

血清瘦素对慢性阻塞性肺疾病患者营养状态影响的初步研究

目的 探讨血清瘦素及肿瘤坏死因子α（ＴＮＦ－α）的慢性阻塞性肺疾病（ＣＯＰＤ）患者营养不良发生中的意义。方法 测定３１例ＣＯＰＤ患者（分为营养不良组１２例,非营养不良组１９例）及１１名正常人的血清瘦素、ＴＮＦ－α浓度、体重指数（ＢＭＩ）、理想体重百分比（ＮＷ％）、三头肌皮皱厚度（ＴＳＦ）、肩胛下皮皱厚度（ＳＳＦ）、上臂中部臂围（ＭＡＣ）,血清白蛋白（ＡＬＢ）、总淋巴细胞计数（ＬＹＭ）等指标。瘦素与     

热量限制对人二倍体成纤维细胞衰老相关基因表达的影响

目的观察热量限制对人二倍体成纤维细胞IMR-90衰老相关基因表达的影响。方法应用RT-PCR和Western blot的方法，对含低浓度（3．0mmol／L）、高浓度（22．5mmol／L）葡萄糖和正常对照组（含5．0mmol／L葡萄糖）培养条件下的IMR-90细胞衰老相关基因p16、p21和p53的mRNA和蛋白表达水平进行分析。结果与对照组和高糖培养条件下的早期和晚期细胞相比较，低浓度葡萄糖培养条件下的早期和晚期细胞p16和p21在mRNA水平均显著下降（P〈0．05）；低浓度葡萄糖组、对照组和高浓度葡萄糖培养组晚期细胞p16蛋白水平分别为4．2、7．4、9．7，比各自早期细胞表达（0．6、1．0、1．8）增加5～7倍；低浓度葡萄糖组，对照组和高浓度葡萄糖培养早期细胞和低糖培养晚期细胞p21蛋白水平差异无统计学意义，分别为1．1、1．0、1．3、0．9，但与对照组和高糖培养晚期细胞p21蛋白水平（3．1、4．2）相比较则降低3～4倍；各组培养条件下的早期和晚期细胞中p53表达差异均无统计学意义（P〉0．05）。结论各组晚期细胞比各自早期细胞p16基因表达增高；对照组和高糖培养条件下的晚期细胞比各自早期细胞p21基因表达增高；低浓度葡萄糖培养延缓IMR-90细胞衰老并伴有p16和p21基因表达下调；p53基因可能不是IMR-90细胞复制衰老主要调节因子。     

An audit of the treatment of cancer of the oesophagus.

The treatment of cancer of the oesophagus in The General Infirmary at Leeds between the years 1975 and 1988 was reviewed. All cases with histologically proved cancer of the oesophagus were included, data being obtained from case notes, theatre operation books, endoscopy records, pathology records, and the Yorkshire Cancer Registry. Three hundred and sixteen patients were identified. Demographic details, mode of presentation, preoperative investigations, surgical management, methods of palliation, and survival data were entered into a database. The male to female ratio was 3:2 and the median age at presentation was 69 years (range 35-96). Surgical exploration was carried out in 134 of 316 patients (42%). Resection of the tumour, whether curative or palliative, was possible in 106 of 134 patients (79%). Operative (30 day) mortality was 27%. In 22 of 134 patients (16%), only intubation of the tumour was possible, while six patients (5%) had a thoracotomy or laparotomy alone. Median survival of the 106 patients after surgical resection was 292 days (range 0-14.2 years) and seven of them (7%) were still alive five years later. Of the remaining 182 patients (58%) who were not operated upon, 36 patients (11%) had a radical course of radiotherapy with a median survival of 175 days (range 80-453) and 146 patients (46%) either had endoscopic intubation (n = 64) or received no specific treatment (n = 82) with a median survival of 106 days (1-725) and 91 days (1-358) respectively. None of the 182 patients who did not have surgical treatment was alive at five years.     

Modulation of energy-dependent quenching of excitons in antennae of higher plants

Energy-dependent exciton quenching, or q(E), protects the higher plant photosynthetic apparatus from photodamage. Initiation of q(E) involves protonation of violaxanthin deepoxidase and PsbS, a component of the photosystem II antenna complex, as a result of lumen acidification driven by photosynthetic electron transfer. It has become clear that the response of q(E) to linear electron flow, termed "q(E) sensitivity," must be modulated in response to fluctuating environmental conditions. Previously, three mechanisms have been proposed to account for q(E) modulation: (i) the sensitivity of q(E) to the lumen pH is altered; (ii) elevated cyclic electron flow around photosystem I increases proton translocation into the lumen; and (iii) lowering the conductivity of the thylakoid ATP synthase to protons (g(H+)) allows formation of a larger steady-state proton motive force (pmf). Kinetic analysis of the electrochromic shift of intrinsic thylakoid pigments, a linear indicator of transthylakoid electric field component, suggests that, when CO(2) alone was lowered from 350 ppm to 50 ppm CO(2), modulation of q(E) sensitivity could be explained solely by changes in conductivity. Lowering both CO(2) (to 50 ppm) and O(2) (to 1%) resulted in an additional increase in q(E) sensitivity that could not be explained by changes in conductivity or cyclic electron flow associated with photosystem I. Evidence is presented for a fourth mechanism, in which changes in q(E) sensitivity result from variable partitioning of proton motive force into the electric field and pH gradient components. The implications of this mechanism for the storage of proton motive force and the regulation of the light reactions are discussed.     

Clinical analysis of surgical treatment of portal hypertension

AIM: To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions. METHODS: The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization (PAD), 167 with portasystemic shunt (PSS), 62 with selective shunt (SS), 11 with combined portasystemic shunt and portaazygous devascularization (PSS+PAD), 9 with liver transplantation (LT), 3 with union operation for hepatic carcinoma and portal hypertension (HCC+PH). RESULTS: In the 167 patents treated with PSS, free portal pressure (FPP) was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation (P<0.01). After the operation, FPP in the former patients markedly decreased compared to the latter ones (P<0.01). The incidence rate of hemorrhage in patients treated with PAD, PSS, SS, PSS+PAD, and HCC+PH was 21.09% (54/256), 13.77 (23/167), 11.29 (7/62), 36.36% (4/11), and 100% (3/3), respectively. The incidence rate of hepatic encephalopathy was 3.91% (10/256), 9.58% (16/167), 4.84% (3/62), 9.09% (1/11), and 100% (3/3), respectively while the operative mortality was 5.49% (15/256), 4.22% (7/167), 4.84% (3/62), 9.09% (1/11), and 66.67% (2/3) respectively. The operative mortality of liver transplantation was 22.22% (2/9). CONCLUSION: Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.     

不同全身麻醉药物诱导对老年患者心功能的影响

目的探讨不同全身麻醉药物诱导对老年患者心功能的影响。方法选择非心脏手术美国麻醉医师协会分级为Ⅰ～Ⅱ级的老年患者75例,随机分为七氟醚组(S组)、丙泊酚组(P组)和咪达唑仑组(M组),每组各25例。3组患者分别在麻醉诱导前(T_0)、诱导插管前1 min(T_1)、插管后2 min(T_2)、插管后5 min(T_3)、插管后10 min(T_4)5个时间点,应用心输出量超声监测仪,监测患者的左心室输出量、每搏输出量、外周血管阻力、峰值速度、净射血时间百分比、心率情况。结果与T_0比较,S组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力均明显下降,差异有统计学意义(P<0.05);P组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力显著下降(P<0.01),左心室输出量、每搏输出量、峰值速度降低,净射血时间延长,差异有统计学意义(P<0.05)。与S组和M组比较,P组T_1、T_2、T_3、T_4时间点的平均动脉压、外周血管阻力明显下降,差异有统计学意义(P<0.05);与M组比较,S组T_1、T_2、T_3、T_4时间点的外周血管阻力明显下降,差异有统计学意义(P<0.05)。结论 3种全身麻醉药物均可对老年患者进行安全、有效地诱导;但丙泊酚对老年患者心功能影响最大,咪达唑仑最小。     

发热待查75例临床分析

目的探讨不明原因发热(FUO)的病因和临床特征。方法回顾性分析2005年1月～2012年1月在我科住院且符合FUO诊断标准的75例患者的临床资料,总结了病因、诊断方法和临床表现。结果 75例患者中,68例(90.7%)最终确诊,感染性疾病22例(32.4%),其中结核病9例(40.9%)、传染性单核细胞增多症5例(22.7%);结缔组织病29例(42.6%),其中成人Still病17例(58.6%)、系统性红斑狼疮6例(20.7%);恶性肿瘤10例(14.7%),其中淋巴瘤6例(60.0%);其他疾病7例(10.3%),其中组织细胞坏死性淋巴结炎4例(57.1%)。结论 FUO涉及的病因众多,发病机制复杂,感染性疾病、结缔组织病仍是发热待查的主要原因,肿瘤性疾病在发热待查中也占相当的比例,临床工作中要开阔思路,全面搜集资料,以利于明确诊断。     

Variation of the McKusick-Kaufman gene and studies of relationships with common forms of obesity

Obesity is a prominent feature of the Bardet-Biedl syndrome (BBS), one subset of which, BBS6, is due to mutations in the chaperonin-like gene termed the McKusick-Kaufman syndrome (MKKS) gene. We tested whether variation in MKKS contributes to common and probably polygenic forms of obesity by performing mutation analysis of the coding region in 60 Danish white men with juvenile-onset obesity. Five variants were identified, including two synonymous mutations (Pro(39)Pro and Ile(178)Ile) and three nonsynonymous variants (Ala(242)Ser, Arg(517)Cys, and Gly(532)Val). Furthermore, the rare Ala(242)Ser was identified in two families and showed partial cosegregation with obesity. The Pro(39)Pro, Ile(178)Ile, and Arg(517)Cys variants are in complete linkage disequilibrium and defined a prevalent haplotype. In a case-control study, the Arg(517)Cys polymorphism allele prevalence was 11.4% [95% confidence interval (CI), 9.7-13.0] among 744 men with juvenile-onset obesity and 9.3% (CI, 7.9-10.7) among 867 control subjects (P = 0.048). However, among middle-aged men the allelic prevalence was 9.7% (CI, 7.9-11.4) among 523 obese men and 12.2% (CI, 10.8-13.6) among 1051 lean men (P = 0.037). In conclusion, it is unlikely that MKKS variants play a major role in the pathogenesis of nonsyndromic obesity, although in rare cases the A242S allele may contribute to obesity.