4-羟基-2,2,6,6-四甲基哌啶对间歇低氧PMN导致的血管内皮细胞损伤的影响

目的 探讨间歇低氧(IH)模式下多形核中性粒细胞(PMN)对血管内皮细胞造成氧化应激损伤的机制,以及抗氧化剂4-羟基-2,2,6,6-四甲基哌啶(Tempol)对减轻该损伤的作用.方法 通过向低氧仓中循环充入氮气和压缩空气模拟阻塞性睡眠呼吸暂停(OSA)患者IH病理生理过程,制造IH大鼠模型.将大鼠随机分为IH组、常氧组、IH+ Tempol组、IH十生理盐水(NS)组.IH组最低氧浓度为5％,低氧频率均为30次/h,8 h/d,IH+ Tempol 组及IH+ NS组每天低氧开启前腹腔分别注射Tempol 1 mg/10 g及与Tempol同等体积的NS(已经大鼠体质量校正),常氧组内皮细胞不经过IH处理.大鼠低氧暴露6周后取血分离PMN,将PMN和大鼠动脉内皮细胞共培养后,收集上清液,用ELISA法测过氧化氢酶(CAT)、超氧化物歧化酶(SOD)和丙二醛(MDA)的浓度.结果 与常氧组比较,IH、IH+ NS及IH+ Tempol组CAT和SOD低,MDA高(P均＜0.05);与IH及IH+ NS组比较,IH+ Tempol 组CAT和SOD高(P＜0.05),MDA低(P均＜0.05).结论 IH环境来源的PMN会对血管内皮细胞造成氧化应激损伤,抗氧化剂Tempol能缓解PMN的氧化应激攻击作用而保护OSA患者血管内皮.     

不同频率间歇低氧下大鼠肝脏氧化应激损伤及Tempol的干预作用

目的 探讨不同频率间歇低氧(IH)对大鼠肝脏氧化应激损伤差异和Tempol的干预作用及可能机制.方法 应用慢性间歇低氧(CIH)大鼠模型,模拟OSAS周期性间歇低氧/再氧和病理生理过程.56只雄性Wistar大鼠随机分为不同频率IH组(IH1,IH2,IH3,IH4,频率依次为10、20、30、40次/h),30T组(...     

间歇低氧对大鼠交感神经兴奋性的影响及抗氧化剂的干预作用

目的 探究大鼠交感神经兴奋性在慢性间歇低氧(CIH)诱发高血压过程中的作用及交感神经兴奋性增强的机制与氧化应激的关系,观察抗氧化剂4-羟基-2,2,6,6-四甲基哌啶( Templ)对血压的干预作用.方法 48只雄性Wistar大鼠按随机数字表法分为6组,每组8只,分别为常氧对照组、间歇低氧空白对照组(低氧对照组)、Tempol预干预组(干预1组)、Tempol后干预组(干预2组)、生理盐水预对照组(对照1组)及后对照组(对照2组).除常氧对照组外均给予间歇低氧环境,其中干预1组和干预2组分别于实验前和实验后第28天给予10％ Tempol 100 mg·kg-1·d-1腹腔注射,对照1组和对照2组同时分别给予等量生理盐水腹腔注射.测定大鼠动脉收缩压、血清去甲肾上腺素、肾上腺素水平以及肾上腺组织匀浆中丙二醛水平.结果 6周后,低氧对照组收缩压与干预1组和干预2组相比,差异无统计学意义.干预1组收缩压[(114±6) mmHg,1 mm Hg=0.133 kPa]与常氧对照组和实验前相比无明显变化,其余各组大鼠收缩压均高于常氧对照组和实验前水平(F值为15.045,均P＜0.05).干预1组和干预2组收缩压[(128 ±6)mm Hg]均低于对照1组[( 138±10)mm Hg]和对照2组[(138±10)mm Hg,均P＜0.05],但干预2组高于干预1组(P＜0.01).常氧对照组收缩压水平与实验前比较差异无统计学意义.低氧对照组与对照1组和对照2组相比,血清去甲肾上腺素、肾上腺素及肾上腺匀浆中丙二醛水平均无统计学意义.干预1组和干预2组去甲肾上腺素、肾上腺素及丙二醛水平均低于对照1组和对照2组(P＜0.05),但干预2组各指标仍高于常氧对照组(P＜0.05)及干预1组(P＜0.05或P＜0.01).干预1组去甲肾上腺素、肾上腺素及丙二醛水平与常氧对照组比较无明显差异.结论 CIH可能导致交感神经活性增强,其途径可能为通过氧化应激产生活性氧,可能是CIH引起高血压的重要机制.抗氧化剂干预可能对防治OSAS合并症高血压发生起到一定作用.     

慢性间歇低氧对大鼠血压和交感神经兴奋性的影响

目的 通过观察不同程度慢性间歇低氧(chronic intermittent hypoxia,CIH)作用下大鼠血压与交感神经活性水平动态变化,探讨CIH对血压及交感神经活性的影响及血压与交感神经活性之间的相关性,并明确CIH诱发高血压发病的机制.方法 168只雄性6周龄Wistar大鼠,体重160 ～ 180 g,采用随机数字表法分为非暴露组(UD)、重度间歇低氧组(IH1)、中度间歇低氧组(IH2)、轻度间歇低氧组(IH3)、持续低氧组(CH)及对照组,分别给予不同程度和频率的低氧环境.UD组8只大鼠于实验前处死,其余各实验组每组32只大鼠,分别于2、4、6、8周时随机抽取8只处死,留取静脉血抗凝离心后- 80℃保存血浆,并于实验前、实验结束后分别测定动脉收缩压,实验结束后测定血浆中去甲肾上腺素(norepinephrine,NE).结果 各组大鼠实验前收缩压差异无统计学意义(F=0.008,P＞0.05),随着实验时间延长,各间歇低氧组大鼠收缩压逐渐升高,4周开始明显高于UD组、对照组及CH组(均P＜0.05)且血压水平与低氧程度正相关(F =9.844,P＜0.01),IH1组明显高于IH3组(P＜0.05),而对照组和CH组无明显改变.各间歇低氧组大鼠血浆NE随实验时间延长而逐渐升高,8周时明显高于UD组、SC组及CH组(均P＜0.05或P＜0.01),且NE水平与低氧程度正相关(F=11.537,P＜0.01),IH1组明显高于IH3组(P＜0.05),SC组和CH组大鼠血浆NE变化不显著.大鼠血浆NE与血压呈显著正相关(r=0.538,P＜0.01).结论 CIH作用可以引起大鼠血压增高和交感活性增强且存在明显的低氧程度依赖性和时间过程规律性,推测CIH引起大鼠血压增高可能与交感活性增强相关.     

不同频率间歇低氧大鼠心脏炎症状态及抗氧化干预的研究

目的 通过观察不同间歇低氧(intermittent hypoxia,IH)模式下和抗氧化干预后大鼠心肌组织炎症标志物白介素6(IL-6)、IL-8、肿瘤坏死因子α(TNF-α)和C反应蛋白(CRP)水平的变化,探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与心血管疾病的联系和影响机制,以及抗氧化剂4-羟基-2,2,6,6-四甲基哌啶(Tempol)的干预作用.方法 48只成年雄性Wistar大鼠采用随机排列表法分为6组,包括4个不同频率IH组(IH1组、IH2组、IH3组、IH4组)、1个持续常氧对照组(SC组)及1个Tempol干预组(IH3T组),每组8只大鼠.各组分别给予相应的低氧暴露,暴露6周后处死大鼠,立即分离心脏.采用酶联免疫吸附法测定心肌组织匀浆CRP、IL-6、IL-8及TNF-α水平.结果 ①所有IH组大鼠的心肌组织炎症标志物CRP、TNF-α、IL-8水平均高于SC组(P＜0.05).各IH组组间比较显示,低氧频率较高的IH3和IH4组的IL-6、CRP、TNF-α、IL-8水平高于低氧频率较低的IH1和IH2组(P＜0.05),提示随着低氧程度的加重,这4种炎症标志物水平也不断升高.②IH3T组的IL-6、IL-8、TNF-α及CRP水平仍然高于SC组(P＜0.05),但是与IH3组相比,其IL-8、TNF-α及CRP水平降低(P＜0.05).结论 ①慢性IH程度是影响大鼠心肌组织炎症标志物IL-6、IL-8、TNF-α及CRP水平的重要因素,其水平可随低氧程度的加重而升高,提示OSAHS可能是一个慢性炎症过程,炎症因子在OSAHS合并心血管疾病的发生发展中起着重要作用.②经Tempol干预后,IH大鼠心肌组织炎症标志物IL-6、IL-8、TNF-α及CRP水平有不同程度的下降,表明抗氧化干预能缓解IH所致氧化应激对大鼠心肌组织带来的损害,但并不能完全逆转这种损害.     

不同程度慢性间歇低氧诱发大鼠高血压发病过程中血管内皮功能改变的作用

目的 通过观察不同程度慢性间歇低氧(chronic intermittent hypoxia,CIH)诱发大鼠高血压过程血管活性物质水平动态变化,来探讨CIH诱发高血压发生过程中血管内皮功能改变的作用及在不同程度CIH之间差异性.方法 将168只Wistar大鼠随机分为零暴露组(UD)、不同程度间歇低氧组(重度:IH1...     

间歇低氧对大鼠胰岛素抵抗及骨骼肌细胞GLUT4、Akt2的影响

目的 检测不同间歇低氧暴露时间对骨骼肌葡萄糖转运蛋白(GLUT)4与蛋白激酶B(PKB/Akt)2表达的影响,探讨二者在间歇低氧导致胰岛素抵抗中的作用.方法 选取健康雄性Sprague-Dawley大鼠40只,按照随机数字表法分为5组:常氧对照组(NC组),间歇低氧2周组(IH2组),间歇低氧4周组(IH4组),间歇低氧6周组(IH6组),间歇低氧8周组(IH8组),每组8只.IH2组、IH4组、IH6组、IH8组每天给予8h间歇低氧暴露(9:00～17:00),NC组室内环境正常饲养.检测各组空腹血糖和空腹胰岛素水平,计算稳态模型评估-胰岛素抵抗指数(HOMA-IR).采用免疫组织化学法检测大鼠骨骼肌GLUT4及Akt2蛋白的表达,蛋白表达量用平均灰度值表示,并分析GLUT4与Akt2的相关性.结果 与NC组相比,IH2组、IH4组、IH6组、IH8组空腹血糖、HOMA-IR升高,骨骼肌GLUT4与Akt2灰度值升高,并且随间歇低氧暴露时间的延长而升高明显(F =87.67～288.63,P均＜0.05);与NC组相比,IH2组、IH4组、IH6组、IH8组空腹胰岛素升高,其中IH2组、IH4组、IH6组,随间歇低氧暴露时间的延长而升高明显,IH8组较IH6组下降(F=86.04,P＜0.01).Pearson相关分析显示GLUT4与Akt2的表达呈正相关(r=0.895,P ＜0.05).结论 随着间歇低氧暴露时间的延长胰岛素抵抗程度增加,GLUT4与Akt2蛋白表达水平下降,二者在间歇低氧导致胰岛素抵抗的过程中起协同作用.     

间歇低氧对大鼠肝脏GSK-3及mTOR表达的影响

目的 测定间歇低氧大鼠肝脏糖原合成酶激酶-3(GSK-3)及哺乳动物雷帕霉素靶蛋白(mTOR)的表达,观察间歇低氧对胰岛素信号转导通路的影响.方法 将24只健康雄性Sprague-Dawley大鼠按照随机数字表法分成间歇空气组(NC组)、间歇低氧4周组(IH4组)、间歇低氧8周组(IH8组),每组8只.于上午9:00至下午5:00将IH4组及IH8组暴露于间歇低氧舱内,NC组则给予间歇压缩空气.检测各组大鼠空腹血糖、空腹胰岛素(FINS),并以稳态模型评估-胰岛素敏感指数(HOMA-IS)及稳态模型评估-胰岛素抵抗指数(HOMA-IR)评价胰岛素抵抗;免疫组化法测定大鼠肝脏GSK-3及mTOR的表达,以平均灰度值评价二者的蛋白表达量.结果 与NC组相比,IH4组、IH8组HOMA-IS降低,空腹血糖、FINS、HOMA-IR升高,以IH8组更为显著(F值分别为62.52,100.37,68.90,8549,P均＜0.01);与NC组相比,IH4组、IH8组GSK-3及mTOR蛋白表达均升高,以IH8组更明显(F值分别为72.25,148.01,P均＜0.01).Pearson相关分析显示GSK-3、mTOR平均灰度值与HOMA-IS呈正相关(r =0.786,0.811,P均＜0.01),与HOMA-IR呈负相关(r=-0.882,-0.889,P均＜0.01).结论 间歇低氧暴露使大鼠肝脏GSK-3、mTOR表达增加,从而引起胰岛素抵抗.     

肿瘤坏死因子相关的凋亡诱导配体对2型糖尿病大鼠内皮依赖性血管舒张功能的影响

目的 观察TNF相关的凋亡诱导配体（TRAIL）对T2DM大鼠主动脉内皮依赖性血管舒张功能的影响及其可能的机制. 方法 选取4周龄雄性SD大鼠,分为正常对照组（NC,n=10）与模型组（n=40）,随机将模型组分为T2DM亚组（n=10）与TRAIL亚组（TRAIL,n=10）.TRAIL干预6周后,检测各组FPG及FIns水平,计算ISI.检测NC组与TRAIL亚组血清TRAIL水平.观察大鼠离体主动脉内皮依赖性血管舒张反应,并检测主动脉一氧化氮（NO）含量、内皮型一氧化氮合酶活性（eNOS）.结果 与NC组比较,T2DM亚组FPG、FIns水平升高（P＜0.01）,ISI降低（P＜0.01）,血清TRAIL水平降低（P＜0.01）;血管内皮功能失调,乙酰胆碱（Ach）引起的血管最大舒张率降低（P＜0.01）,血管中NO含量及eNOS阳性表达降低（P＜0.01或P＜0.01）.TRAIL亚组血管Ach的舒张反应改善（P＜0.01）;血管中NO含量增加且eNOS阳性表达上调（P＜0.05或P＜0.01）;FPG、FIns降低,ISI提高（P＜0.01）. 结论 TRAIL改善T2DM大鼠内皮依赖性血管舒张功能的同时,可促进具有血管保护作用的NO生成.     

17β-雌二醇和2-甲氧基雌二醇对慢性低氧性肺动脉高压大鼠体内内皮素-1/一氧化氮体系的影响

目的:探讨17β-雌二醇(E2)及2-甲氧基雌二醇(2ME)对慢性低氧性肺动脉高压大鼠体内内皮素-1(ET-1)/一氧化氮(NO)体系的影响。方法:雌性SD大鼠48只,按随机数字表法平均分为6组(各组n=8):假手术组、去势组、低氧组、去势+低氧组、去势+低氧+E2组、去势+低氧+2ME组。去势组行卵巢切除术;非去势组打开腹腔找到卵巢后不做处理直接还纳缝合。术后去势+低氧+E2组皮下注射E2[20μg/(kg·d)],去势+低氧+2ME组皮下注射2ME[240μg/(kg·d)],其他组皮下注射生理盐水(0.1 ml/d)。低氧组大鼠置于低氧箱内饲养,非低氧组大鼠呼吸正常空气。连续饲养8周以建立低氧性肺动脉高压模型。分别测定血清ET-1、NO水平、内皮型一氧化氮合酶(eNOS)活性及肺组织内皮素A受体(ET_AR)、内皮素B受体(ET_BR)、eNOS表达变化。结果:低氧组、去势+低氧组大鼠肺小动脉管壁增厚,管腔变窄明显,平均肺动脉压(mPAP)显著高于假手术组(P均0.01);E2和2ME干预组大鼠上述形态学及mPAP改变相对较轻。与假手术组相比,去势组和低氧组血清ET-1和肺组织ET_AR mRNA及蛋白水平均明显升高,ET_BR mRNA及蛋白水平明显下降(P均0.01);去势+低氧组以上指标变化更显著;E2和2ME干预后血清ET-1和肺组织ET_AR表达明显下降,但仍高于假手术组,同时ET_BR表达明显上升,但仍低于假手术组(P均0.01);且去势+低氧+2ME组血清ET-1水平低于去势+低氧+E2组(P0.05)。与假手术组相比,去势组肺组织eNOS蛋白水平明显下降(P0.01);低氧组血清NO水平及肺组织eNOS蛋白水平明显下降(P0.05或P0.01);去势+低氧组血清NO水平、eNOS活性及肺组织eNOS mRNA和蛋白水平均明显下降(P均0.01);去势+低氧+E2组和去势+低氧+2ME组上述指标较去势+低氧组均明显上升(P0.05或P0.01),但仍低于假手术组(P均0.05)。结论:E2及2ME均能显著降低血清ET-1水平,减少肺组织ET_AR表达,增加ET_BR的表达,升高血清NO水平、eNOS活性及肺组织eNOS表达,通过改善ET-1/NO体系平衡部分逆转肺动脉高压。     

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.     

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.     

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.     

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。     

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     

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。     

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。