海水浴体操对48例中青年高血压患者心脑血流动力学的影响

目的:探讨海水浴体疗操对中青年高血压病患者疗养后心脑血流动力学的影响。方法:48例来自不同部队的中青年高血压病疗养员采用本院设计的海水浴体疗操,3~4疗程,对比疗养前、后血压、心率、收缩压与心率乘积、左室功能与大脑中动脉的参数变化,并与对照组作比较。结果:海水浴体疗操组疗程结束后,与体疗前及对照组疗养后比:①血压、心率、收缩压与心率乘积呈非常显著改善(P<0.01);②左室功能、大脑中动脉血流各参数呈非常显著性提高(P<0.01)。结论:海水浴体疗操对于中青年高血压病患者可调整心率、降低血压,提高心脑血氧供应,是一种较理想的康复疗养方法。     

海水浴体疗对高血压患者左房收缩功能的康复作用

目的:应用超声心动图技术评价海水浴体疗运动对高血压患者左房收缩功能的康复作用。方法:160例高血压病人,按自愿分为海水浴组和对照组,根据左室质量指数(LVMI)高血压患者被分为左室正常构型和左室肥厚型。应用超声心动图技术分析被观察者疗养前、后的左房收缩功能各指标,并进行比较。结果:治疗前,与左室构型正常组比较,左室肥厚组的左房灌注分数(LAT)、左房射血分数(LAEF)、左房搏出量(LASV)、左房射血力、左房动能明显增加(P<0．05-<0．01);两组同型左房收缩功能各指标无明显差异(P>0．05)。经过4周的疗养后,海水浴组左房收缩功能各指标与疗养前及对照组比较,左室正常构型组的显著下降(P<0．05),左室肥厚型组的极显著下降(P<0．05-<0．01),而对照组于疗养前、后无明显差异(P>0．05)。结论:海水浴体疗运动是项综合性的全身有氧运动;能降低高血压病患者的心肌耗氧量,减轻心脏负荷,改善左房收缩功能。     

老年原发性高血压患者左心房/左心室容量比值的变化

目的本文旨在探讨老年原发性高血压患者左心房容量／左心室容量比值变化的临床意义。方法老年正常对照组32例。老年原发性高血压无室壁肥厚患者35例，老年原发性高血压患者伴室壁肥厚者33例。应用实时三维三平面显像方式测量左房、左室容量，对3组病人的左房容量，左房内径，左房容量指数和左心房容量／左心室容量比值进行分析。结果左房容量，左房内径，左房容量指数和左心房容量／左心室容量比值在高血压室壁肥厚组与对照组之间均存在极显著差异（P〈0．01），但左房内径在原发高血压无室壁肥厚组与对照组之间无显著差异（P〉0．05）。左房容量、左房容量指数在原发高血压无室壁肥厚组与对照组之间差异有显著性（P〈0．05），左心房容量／左心室容量比值在原发高血压无室壁肥厚组与对照组之间差异更为显著（P〈0．01）且变异性最小。结论左心房容量／左心室容量比值是一种新的参数，能够灵敏地反映老年原发性高血压患者舒张功能减低的血流动力学改变。     

老年陈旧性心肌梗死患者海水浴体疗的心率变异性分析

目的 :观察老年陈旧性心肌梗死 （OMI）患者海水浴前后的心率变异性 （HRV）。方法 :应用 2 4h动态心电图监测、分析 13例老年 OMI患者海水浴体疗前、4疗程结束后的 HRV时域指标 ;心脏超声获 LVEF值并设健康同龄对照组。结果 :1老年 OMI组海水浴前 HRV与 LVEF值均低于对照组 （P<0 .0 5或 P<0 .0 1） ;2老年 OMI组海水浴后 HRV与 LVEF值较对照组无明显差异 （P>0 .0 5 ）。 3老年 OMI组海水浴后 HRV与 L VEF值较海水浴前明显增高 ,差异非常显著 （P<0 .0 1）。结论 :海水浴体疗可使老年 OMI患者 HRV与 L VEF值增高 ,改善左室功能 ,可作为老年心血管疾病患者的一种康复途径     

海水浴体疗操对老年2型糖尿病患者的心脏康复作用

目的:探讨海水浴体疗操运动对老年2型糖尿病(DM)患者的心脏康复作用。方法:应用本院设计的海水浴体疗操1套,对疗养期间62例老年2型DM患者(DM组)进行4疗程运动治疗。使用超声心动图仪观察患者体疗前、后LAD、EF、FS、E/A指标变化,并与健康老人(对照组)对照;使用常规心电图描记并观察DM组体疗前后的心电图变化。结果:DM组体疗前各指标较对照组有显著差异(P<0.01,P<0.05);体疗后与前对比:LAD缩小,E/A、FS、EF值明显增高,有非常显著统计学意义(P<0.01)。体疗后心电图窦性心律增至66.1％,Petfv1异常率减至24.2％,ST-T异常率减至17.7％,P均<0.01。结论:海水浴体疗操运动对DM患者心脏康复有较好疗效。     

超声评价老年高血压、冠心病患者海水浴对左心室舒张充盈的影响

目的　研究海水浴体疗运动时对老年高血压、冠心病患者左心室舒张充盈功能影响。方法　受检者为病情稳定的疗养员共117例。其中老年高血压患者 47例 ,老年冠心病患者 70例 ,年龄 60～ 78岁。疗养期间接受海水浴体疗三至四疗程 (每日一次 ,每周一疗程 )。应用超声心动图 (UCG)对海水浴体疗开始前、全部疗程结束后的左心房收缩末内径 (L AD)、左心室早期充盈分数(FRF)、二尖瓣口舒张血流频谱 E峰与 A峰比值 (E/ A)等指标进行检测、计算 ,并对比和分析各参数变化。结果　海水浴体疗三至四疗程后 :老年高血压组 LAD由 3 3 .4± 2 .8mm减小至 3 0 .7± 1.4mm,FRF由 0 .5 5± 0 .0 7增高至 0 .63± 0 .0 5 ,E/ A由 0 .83±0 .0 6增大至 0 .98± 0 .0 8,海水浴前后变化非常显著 (P<0 .0 1) ,老年冠心病组 L AD由 3 3 .9± 0 .7mm减小为 3 2 .5± 1.0 mm海水浴前后变化显著 (P<0 .0 5 ) ,FRF由 0 .5 3± 0 .12增高至 0 .61± 0 .13 ,E/ A由 0 .83± 0 .16增大至 0 .92± 0 .11,海水浴前后变化非常显著 (P<0 .0 1)。结论　提示海水浴体疗具有改善老年心血管患者左心充盈及舒缓功能的良好功效     

海水浴体疗对老年2型糖尿病患者心率变异性的影响

目的：探讨海水浴体疗对老年2型糖尿病（T2DM）患者心脏自主神经功能的康复作用。方法：于海水浴前后对60例海水浴组和60例一般疗养组的T2DM患者进行24h动态心电图检测，并分析其心率变异性（HRV）时域指标，以心脏超声检测左室射血分数（LVEF），并与30例健康对照组的进行比较。结果：①疗养前：T2DM患者HRV和LVEF值均较健康组降低（P〈0.05～〈0.01），且T2DM合并无症状心肌缺血（DM＋SMI）组较单型性T2DM（DM）组的降低显著（P〈0.05～〈0.01）；②疗养后：与疗养前比海水浴DM组各值升高显著（P〈0．05），DM＋SMI组升高非常显著（P〈0.05～〈0.01）；而一般疗养组各值均无明显升高（P〉0．05）。结论：海水浴体疗对老年T2DM患者心脏自主神经功能有着积极康复作用。     

136例老年高血压病患者海水浴康复疗养前后的心电图变化

目的 老年高血压病患者应用海水浴体疗操康复疗养(简称康复治疗)前后的心电图变化。方法对136例患者康复治疗4疗程前后的心电图表现作分析。结果 治疗前后心率(HR)、P波最大时限(Pmax)、V1导联P波终末电势(Ptfv1)变化有统计学意义(P<0.01),窦律不齐、窦速、窦缓、偶发房性早搏(PAS)、肢导联低电压、ST-T改变的发生率由13.9％、4.4％、16.9％、5.1％、12.5％、28.7％降低为5.1％、o％、5.9％、o％、11.0％、10.3％,传导阻滞病例数无变化。结论 康复治疗4疗程后,可获得较好的心电生理效应,心电图出现明显好转。     

心电图半定量估测左房内径的价值

本研究通过对１１９名心脏病患者同步检查体在心电图及二维超声心动图，探讨Ｐ波时间及Ｐｔｆｖ１估测左房内径的价值及两者诊断左房扩大的敏感性与特异性。结果表明:Ｐ波时间≥１１０ｍｓ诊断左房扩大的敏感性为５６．９６％，特异性为５９．２６％，Ｐｔｆｖ１≥－３０ｍｓ·ｍｍ诊断左房扩大的敏感性为６９．２３％，特异性为８１．４８％。随着左房内径的增大，Ｐ波时间逐渐延长，Ｐｔｆｖ１逐渐增大。经分析在明采用Ｐ波时间诊断左房扩大不如Ｐｔｆｖ１可靠，Ｐｔｆｖ１不仅可以诊断左房扩大，而且可以半定量估测左房扩大的程度。     

康复疗养对老年陈旧性心肌梗塞患者P波离散度的影响

目的：探讨康复疗养对老年陈旧性心肌梗塞（OMI）患者P波离散度（Pd）的影响。方法：利用常规心电图观察并分析两组（常规疗养组、海水浴体疗组）各30例OMI患者，疗养1个月前、后的Pmax（P波最长时值）、Pd变化。结果：（1）同组疗养前＼后比较，两组Pmax、Pd均呈非常显著性差异（P〈0．01）；（2）两组间对比，疗养前Pmax、Pd无显著性差异（P〉0．05）、疗养后Pmax呈显著性差异（P〈0．05），Pd呈非常显著性差异（P〈0．01）。结论：（1）康复疗养能不同程度地缩短OMI者的P波离散度，有利患者心房电生理稳定；（2）海水浴体疗方法对Pd的改善优于常规疗养方法。     

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.     

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。     

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。     

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.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

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。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.