动态心电图检出室性心律失常

室性心律失常 (简称ＶＡ)是老年常见心血管疾患。近年由于心电监护的广泛应用 ,ＶＡ的检出率明显提高 ,为ＶＡ的诊断、治疗和预后提供了重要依据。为探讨老年人ＶＡ的特点和意义 ,本文就动态心电图(ＤＣＧ)检出的 365例老年ＶＡ做一小结。1　资料和方法1 1　方法　使用日本福田ＳＣＭ - 2 4型盒式磁带记录器 ,电极导联安放于ＣＭ5位置。对每个受试者进行连续 2 4ｈ心电图磁带记录 ,然后经ＳＣＭ -2 4 0型复现装置进行回放分析。1 2　资料　收集 1 991～ 1 998年本院收治住院做ＤＣＧ检查的 62 5例 60岁以上老年患者资料 ,共检出ＶＡ 365例…     

急性心肌梗塞不典型心电图改变20例分析

急性心肌梗塞（ＡＭＩ）是目前中老年人的一种常见病、多发病，大多数患者心电图（ＥＣＧ）都有典型的图型改变，但确有不少患者ＡＭＩ发生后ＥＣＧ不出现典型改变．本组２０例，其中男１２例，女８例，平均年龄（５５ ±３．６）岁，现报道如下。１ＡＭＩ的不典型ＥＣＧ表现类型 ①Ｔ波高而失，当Ｔ波振幅在心前导联≥１１ｍｍ或Ⅱ、 Ⅲ， ａｖＦ≥５ｍｍ且Ｔ／Ｒ比值≥１时有诊断价值，就应考虑到前壁或下壁ＡＭＩ．这种Ｔ波高尖的变化亦称为ＡＭＩ的超急期改变，临床上则称之为ＡＭＩ前综合征的一种变化． ②出现Ｑ波：在 Ｖ１、Ｖ２导联…     

诊断心房肥大的新导联新标准

本文分析了１２０例头胸导联心电图（ＨＣＥＯＧ）及常规导联心电图（ＲＬＥＣＧ）的５４００种Ｐ波形态、振幅、时限。结合其中３０例心房肥大病人的Ｘ线心脏片及超声（彩色多普勒、Ｂ型、Ｍ型）检查，以临床心电图诊断心室肥大，室内传导阻滞的方法为参考，拟订出心房肥大（ＡＨ），房内传导阻滞（ＡＢ）的诊断标准。结果表面：５０例健康人两种导联心电图Ｐ波振幅、时限均值均在正常范围。但ＨＣＥＣＧ的Ｐ波振幅明显高于ＲＬＥＣＧ，且波形清晰易测；４０例异常心电图比较，ＲＬＥＣＧＰ波变化多反映在Ⅱ、Ⅲ，ａＶＦ三个导联上，可视范围小，而对照组的ＨＣＥＣＧＰ波变化多反映在与ＲＬＥＣＧ对应的ＨＬ３，ＨＯ，ＨＲ３，ＨＶ２－ＨＶ９，ＨＶ１－ＨＶ９Ｒ１９个导联上，可视范围广；３０例心房肥大病人分析，ＨＣＥＣＧ诊断阳性率高于ＲＬＥＣＧ。     

急性下壁心肌梗塞中心电图与梗死相关动脉关系探讨

研究急性下壁心肌梗塞中心电图与梗死相关动脉之间的关系,探讨ＥＣＧ变化预报ＩＲＡ的可靠指标。方法：急性下壁心梗病人４５例,根据冠脉造影为标准判定ＩＲＡ为右冠状动脉或左回旋动脉,比较两组间心电图差异。结果：ＲＣＡ组Ⅰ导联ＳＴ段下降１８例（５１．５％）,ａＶＬ导联下降１９例（５４．３％）,明显高于ＬＣＸ组（１例,１０％,Ｐ〈０．０５）;ＬＣＸ组Ｖ１导联ＳＴ下降７例（７０％）高于ＲＣＡ组２例（５．８％）,     

放线菌KS—5555产生的抑制VCAM—1表达的活性物质的研究

使用一个含有人ＶＣＡＭ－１基因启动子和荧光素酶编码基因的转染细胞株，从微生物代谢产物中筛选能够抑制由ＴＮＦ－α诱导的ＶＣＡＭ－１表达的活性物质。在筛选过程中，应用有机溶媒萃取、ＯＤＳ柱层析及ＨＰＬＣ等方法，从一株放线菌ＫＳ－５５５５的发酵液中分离到了ＫＳ－５５５５－Ｅ、Ｆ、Ｇ３种生物活性物质。它们对与人ＶＣＡＭ－１基因的启动子相连接的荧光素酶基因的表达显示出较强的抑制活性，其ＩＣ５０值分别为０．３２、０．１４、０．１９μｍｏｌ／Ｌ。经各种理化特性及ＵＶ、ＭＳ、ＨＰＬＣ等分析，确定化合物ＫＳ－５５５５－Ｅ、Ｆ、Ｇ分别与脂酰ＣｏＡ合成抑制剂ｔｒｉａｃｓｉｎＣ、Ｄ、Ａ的结构相同。     

高糖增强兔血管平滑肌细胞对内皮素-1的增殖反应性(英文)

观察高糖对内皮素－１（ＥＴ－１）促兔主动脉血管平滑肌细胞（ＶＳＭＣ）增殖的影响．方法： ＶＳＭＣ分别培养于含正常葡萄糖、高糖或高渗（５．５，２５，葡萄糖 ５．５＋甘露醇 １９．５ ｍｍｏｌ·Ｌ－１）的培养基中［３Ｈ］胸腺嘧啶掺入法检测ＤＮＡ合成速率，蛋白质印迹法检测磷酸化 ｐ４４／４２ ＭＡＰＫ的表达．结果：在 １０至 １０－８ｍｏｌ·Ｌ－１浓度范围内， ＥＴ－１以浓度依赖方式增加 ＶＳＭＣ的［３Ｈ］胸腺嘧啶掺入及磷酸化ｐ４４／４２ ＭＡＰＫ的表达，从 １０－１１到 １０－８ｍｏｌ·Ｌ－１，培养于高糖的 ＶＳＭＣ对相同浓度 ＥＴ－１的增殖反应性高于正常糖或高渗培养条件下的ＶＳＭＣ（Ｐ＜ ０．０５，或 Ｐ＜ ０．０１），而在后两种条件下，ＶＳＭＣ对ＥＴ－１的增殖反应无显著差别．同样，在高糖条件下，ＥＴ－１诱导的ＶＳＭＣ磷酸化ｐ４４／４２ＭＡＰＫ的表达较正常糖和高渗ＶＳＭＣ增加 ６０％－６５％结论：高糖增强ＶＳＭＣ对ＥＴ－１的增殖反应性，可能与磷酸化的 ｐ４４／４２ ＭＡＰＫ高表达有关     

糖尿病神经并发症的电生理研究

对１０５例糖尿病（ＤＭ）患者行体感诱发电位（ＳＥＰ）、感觉神经传导速度（ＳＣＶ）、运动神经传导速度（ＭＣＶ）和脑电图（ＥＥＧ）检查，并与４０例健康人对照，结果：ＤＭ患者中Ｎ＿９潜伏期延长或波幅下降者７５例，Ｐ＿１～Ｎ＿３各波潜伏期延长或波幅下降者８８例，反映周围神经为ＳＥＰ＿（Ｎ９）的异常率７１．４％明显高于ＳＣＶ和ＭＣＶ的异常率５６．２％、４３．８％（Ｐ＜０．０１），反映中枢神经系统电生理的ＳＥＰ＿（Ｐ＿１～Ｎ＿３）的异常率８３．８％明显高于ＥＥＧ２３．８％。提示ＳＥＰ是诊断ＤＭ周围和中枢神经病变亚临床期的一种有效方法。     

气相色谱法分离测定环孢菌素A中有机挥发性杂质

气相色谱法分离测定环孢菌素Ａ中有机挥发性杂质陈剑琴（华北制药厂质检处，石家庄０５００１５）ＱＵＡＮＴＩＴＡＴＩＶＥＡＮＡＬＹＳＩＳＯＦＯＲＧＡＮＩＣＶＯＬＡＴＩＬＥＩＭＰＵＲＩＴＩＥＳＩＮＣＹＣＬＯＳＰＯＲＩＮＡＢＹＧＡＳＣＨＲＯＭＡＴＯＧＲＡＰＨＹ...     

利培酮治疗老年痴呆的精神病性症状21例

目的：了解利培酮治疗老年痴呆的精神病性症状的疗效。方法：选取２１例符合ＣＣＭＤ－Ⅱ－诊断标准的老年性痴呆的住院患者。在治疗前、治疗后４周，采用简明智力量表（ＭＭＳＥ）及老年临床评定量表（ＳＣＡＧ）进行评定，将治疗前、治疗后４周的ＭＭＳＥ总分、ＳＣＡＧ各因子分分别进行ｔ检验。结果：利培酮治疗老年性痴呆精神性症状有如下特征：①利培酮用量小。②治疗后ＭＭＳＥ总分明显增加。③ＳＣＡＧ各项因子分明显改善。结     

三氧化二砷对慢性髓细胞性白血病VEGF表达的影响

目的 研究慢性髓细胞性白血病(ＣＭＬ)患者血管内皮生长因子(ＶＥＧＦ)的表达及三氧化二砷(Ａｓ２Ｏ３)对其表达的影响。方法 采用酶联免疫吸附法(ＥＬＩＳＡ)检测正常人和初治ＣＭＬ患者骨髓细胞及ＣＭＬ细胞系Ｋ５６２细胞培养上清液中ＶＥＧＦ的含量。结果ＣＭＬ患者(ｎ＝２０)骨髓细胞培养上清液ＶＥＧＦ浓度为 ６４９．１６ｐｇ/ｍｌ,明显高于正常对照组的 １５２．１６ｐｇ/ｍｌ(Ｐ＜０．００１),而 ５×１０－６ｍｏｌ/ＬＡｓ２Ｏ３可明显降低ＶＥＧＦ的表达水平(Ｐ＜０．０５);细胞系Ｋ５６２有ＶＥＧＦ的过高表达,Ｋ５６２经２．５×１０－６ｍｏｌ/Ｌ及５×１０－６ｍｏl/Ｌ浓度Ａｓ２Ｏ３处理７２小时后ＶＥＧＦ浓度分别下降６６．４%和 ７８．０%。结论 ＶＥＧＦ在 ＣＭＬ患者骨髓细胞存在高表达;Ａｓ２Ｏ３可能通过抑制 ＶＥＧＦ的表达而阻断血管形成。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.