厄贝沙坦联合胺碘酮预防阵发性心房颤动复发

目的 观察厄贝沙坦联合胺碘酮预防阵发性心房颤动复发的疗效.方法 阵发性心房颤动病人100例,随机分为厄贝沙坦加胺碘酮组(Ⅰ组)与胺碘酮组(Ⅱ组),Ⅰ组给予厄贝沙坦150 mg/d加胺碘酮0.2 mg/d,Ⅱ组给予胺碘酮0.2 mg/d.随访1年,观察两组心房颤动复发率、左心房功能变化.结果 Ⅰ组心房颤动复发率显著低于Ⅱ组(P<0.05);两组左心房内径治疗前与治疗12个月后比较差异无统计学意义(P>0.05).结论 厄贝沙坦联合胺碘酮能有效预防心房颤动的复发,维持窦性心律,改善左房重构.     

胺碘酮联合厄贝沙坦治疗高血压病合并阵发性房颤的临床疗效观察

目的探讨胺碘酮联合厄贝沙坦治疗高血压病合并阵发性房颤的临床疗效。方法选取2012年2月—2013年3月收治的高血压病合并阵发性房颤患者92例,随机分为对照组和治疗组各46例。对照组给予苯磺酸氨氯地平及胺碘酮治疗,治疗组给予厄贝沙坦及胺碘酮治疗,随访12个月,观察两组治疗前后血压、房颤的复发次数、复发持续时间及左心房内径大小变化情况。结果两组治疗后血压均较治疗前明显降低(P0.05),两组治疗后降压疗效差异无统计学意义(P0.05),治疗组房颤复发次数明显低于对照组(P0.05);治疗组复发持续时间短于对照组(P0.05);治疗组治疗后左房内径比治疗前明显缩小(P0.05),对照组无明显变化,两组治疗后比较差异有统计学意义(P0.05)。结论胺碘酮联合厄贝沙坦治疗高血压病合并阵发性房颤患者能有效降低血压,并减少房颤复发次数以及缩短的持续时间,同时长期使用厄贝沙坦还可以抑制左房扩大。     

胺碘酮联合厄贝沙坦治疗老年CHF伴阵发性心房颤动的效果观察

目的探讨胺碘酮联合厄贝沙坦治疗老年慢性心力衰竭(CHF)伴阵发性心房颤动的临床效果。方法选取2013年6月—2015年6月我院收治的老年CHF伴阵发性心房颤病人80例作为研究对象,根据随机数字表法分为观察组和对照组,每组40例。在常规治疗的基础上对照组给予胺碘酮治疗,观察组给予胺碘酮联合厄贝沙坦治疗。治疗12个月后比较两组的窦性心律维持率、超声心动图指标、阵发性心房颤发作次数及心脑血管不良事件发生情况。结果治疗9个月、12个月后,观察组窦性心律维持率明显高于对照组(P0.05);治疗12个月后,观察组室间隔厚度(IVST)、左室舒张末期内径(LVDd)、左心室后壁厚度(LVPW)、左室重量指数(LVMI)、P波离散度(Pd)均明显低于对照组(P0.05);观察组阵发性心房颤动发作次数明显低于对照组(P0.05);两组心力衰竭再入院、脑卒中发生率比较差异均无统计学意义(P0.05)。结论胺碘酮联合厄贝沙坦能够明显降低老年CHF伴阵发性心房颤动病人的Pd,有效维持窦性心律。     

厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用。方法风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦+胺碘酮组(61例)。两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用。试验随访时间为18月。比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径。结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮+厄贝沙坦组,P<0.05。厄贝沙坦+胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异。结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发。     

厄贝沙坦和阿托伐他汀联合治疗慢性心功能不全患者阵发性心房纤颤

目的 观察厄贝沙坦和阿托伐他汀联合治疗慢性心功能不全患者阵发性心房颤动的临床疗效.方法 145例伴有阵发性房颤的慢性心功能不全患者随机分为胺碘酮组(Ⅰ组)、胺碘酮加厄贝沙坦组(Ⅱ组)、胺碘酮加阿托伐他汀组(Ⅲ组)、胺碘酮+厄贝沙坦加阿托伐他汀组(Ⅳ组),治疗并随访2年,比较4组治疗前后左心房内径、C反应蛋白(CRP)水平变化及窦性心律维持率.结果 治疗后,Ⅰ组和Ⅲ组左心房内径均大于Ⅱ组和Ⅳ组(P<0.05),而Ⅰ组和Ⅲ组间,Ⅱ组和Ⅳ组差异无统计学意义;Ⅰ组和Ⅱ组CRP水平高于Ⅲ组和Ⅳ组(P<0.05),Ⅰ组和Ⅱ组间、Ⅲ组和Ⅳ组间无统计学意义;Ⅰ组窦性心律维持率低于Ⅱ组、Ⅲ组和Ⅳ组(P<0.05).结论 厄贝沙坦和阿托汀他汀联合应用能减少慢性心力衰竭患者阵发性房颤的复发.厄贝沙坦能抑制左心房的扩大,而阿托伐他汀能有效降低血中CRP的水平.     

厄贝沙坦与胺碘酮联合对风湿性心脏病持续性心房颤动转复患者的窦性心律维持作用

目的 研究风湿性心脏病持续性心房颤动(房颤)应用厄贝沙坦联合胺碘酮的窦性心律(窦律)维持作用及复发的危险因素.方法 选择住院准备房颤复律且符合入选标准风湿性心脏病(风心病)瓣膜置换术后持续性房颤患者63例.随机分为对照组(31例)和试验组(32例).对照组给予胺碘酮,试验组用胺碘酮+厄贝沙坦.入选患者转复为窦律后即为试验起始时间,试验终点为转复后12个月.终点事件:症状或无症状房颤首次复发.结果 试验组窦律维持率显著高于对照组(68.7%与41.9%,P＜0.05).治疗12个月后,试验组左心房内径(LAD)显著小于对照组[(48.6±4.6)mm与(51.5±4.2)mm,P＜0.05].风心病持续性房颤复发与LAD(OR 1.242)和是否使用厄贝沙坦(OR 0.226)有关.结论 LAD是风心病持续性房颤复发的危险因素.厄贝沙坦联合胺碘酮在风心病持续性房颤复律后维持窦律的疗效优于单用胺碘酮,并能延缓左心房扩大,防止房颤复发.     

厄贝沙坦联合胺碘酮对风湿性心脏病人瓣膜置换术后维持窦律的作用

目的 评价厄贝沙坦和胺碘酮联用在风湿性心脏病持续性房颤患者复律后的窦律维持作用.方法 风湿性心脏病瓣膜置换术后持续性房颤患者116例随机分为胺碘酮组(55例)和厄贝沙坦 胺碘酮组(61例).两组均在治疗2周后行电复律术,转为窦性心律后继续分别服用.试验随访时间为18月.比较治疗后的窦性心律维持率和治疗前及治疗后6、12、18月左心房内径. 结果胺碘酮组左心房内径在治疗12月后显著大于胺碘酮 厄贝沙坦组,P＜0.05.厄贝沙坦 胺碘酮组窦律维持率高于胺碘酮组,在治疗12月时有显著差异. 结论厄贝沙坦联合胺碘酮在风湿性心脏病持续性房颤复律后维持窦性心律的疗效优于单用胺碘酮,并能延缓左房扩大,防止房颤复发.     

厄贝沙坦预防阵发性心房颤动复发作用的观察

目的探讨厄贝沙坦预防心房颤动复发的作用。方法将78例阵发性心房颤动患者随机分为口服胺碘酮组(甲组)和口服胺碘酮加厄贝沙坦组(乙组)各39例,观察窦性心律的维持情况。结果甲、乙两组随访时间分别为304.5±120.6天和272.7±107.4天,差异无显著性意义(P>0.05),窦性心律的维持率分别为56.41%和76.31%,差异有显著性意义(P<0.05)。结论厄贝沙坦可预防心房颤动的复发。     

厄贝沙坦联合胺碘酮治疗高血压病合并阵发性房颤的临床观察

目的探究对高血压病合并阵发性房颤患者实施厄贝沙坦联合胺碘酮治疗。方法随机将2016年1月至2017年9月我院96例高血压病合并阵发性房颤患者分为观察组(48例,应用厄贝沙坦联合胺碘酮治疗)、对照组(48例,应用胺碘酮及硝苯地平治疗)。均随访一年,对比两组患者的血压水平、房颤复发率、房颤复发第一次间隔时间、房颤发作频率、房颤持续时间、左心房内径大小。结果观察组治疗后舒张压[(82.23±0.42)mmHg]、收缩压[(126.42±0.29)mmHg]低于对照组[(86.78±2.95)mmHg、(132.30±2.36)mmHg],P0.05;观察组房颤复发率、房颤复发第一次间隔时间均少于对照组,且治疗后左心房内径小于对照组,P0.05。观察组治疗后房颤发作频率[(3.95±1.42)次/年]、房颤持续时间[(16.42±0.29)h]均少于对照组[(6.89±1.95)次/年、(26.30±2.36)h],P0.05。结论对高血压病合并阵发性房颤患者实施厄贝沙坦联合胺碘酮治疗十分可行,不仅可增强降压效果,还能减少房颤复发,缩小左心房内径。     

厄贝沙坦联合胺碘酮治疗非瓣膜病阵发性心房颤动疗效观察

将211例非瓣膜病阵发性房颤患者随机为胺碘酮治疗组(A组)105例和厄贝沙坦 胺碘酮治疗组(B组)106例,治疗随访3 a,研究的-级终点为房颤复发.比较两组治疗后的窦性心律维持率以及治疗前、治疗后12、24和36个月的左心房内径.结果治疗12个月后,A组左心房内径为(37.01±1.56)mm,明显大于B组的(35.32±1.62)mm,P<0.05.实验终点时,A组的窦性心律维持率为59.05%,明显低于B组的83.52%(P<0.05).认为厄贝沙坦联合胺碘酮治疗非瓣膜病阵发性房颤在维持窦性心律和抑制左心房扩大方面疗效较好.     

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.     

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.