静脉注射地尔硫对心功能的影响

目的评价静注地尔硫对心功能的影响，了解其临床安全性。方法１２３例病人分为两组：Ⅰ组室上性快速心律失常９０例，Ⅱ组不稳定心绞痛３３例。分别静脉注射地尔硫０３ｍｇ·ｋｇ－１·ｍｉｎ－１（Ⅰ组）和０２ｍｇ·ｋｇ－１·ｍｉｎ－１（Ⅱ组）。分别在给药前，后进行心电图、血压监测及观察临床表现。并对Ⅰ组３０例，Ⅱ组６例，心功能Ⅱ～Ⅲ级患者采用ＳｗａｎＧａｎｚ漂浮导管监测，给药前及给药后３０、１２０分钟血流动力学变化。结果两组给药后心室率下降最大效应时间为１５分钟。Ⅰ组临床心悸等症状缓解时间平均为１５分钟，Ⅱ组心绞痛缓解平均为２０分钟。心室率平均下降幅度：Ⅰ组为３４次／分（Ｐ＜０．０５），Ⅱ组为２６次／分（Ｐ＜０．０５）。血流动力学：除Ⅰ组心输出量平均增加０５６Ｌ／ｍｉｎ（Ｐ＜０．０５）外，其它参数指标Ｐ值均＞０．０５，无统计学意义。结论静注地尔硫０２～０．３ｍｇ·ｋｇ－１·５ｍｉｎ－１，能快速有效地控制心房颤动心室率，室上性快速心律失常及不稳定心绞痛，且不会引起或加重心功能障碍。     

静脉滴注地尔硫治疗难治性心绞痛的临床观察

目的 观察静脉滴注地尔硫治疗难治性心绞痛的临床疗效及安全性。方法１０例难治性心绞痛患者停用静脉点滴硝酸甘油及口服β－受体阻滞剂后,静点地尔硫４０～１５０μｇ／ｍｉｎ（２．４～９ ｍｇ／ｈ）持续４８ ｈ。结果与用药前４８小时相比,７例患者心绞痛发作显著改善,其中５例完全控制,２例明显改善。３例（３０％）无效,经联合应用静脉硝酸甘油后１例完全控制,２例明显改善。无严重低血压、缓慢心律失常及心功能恶化等不良反应发生;无急性心肌梗死、需要急诊介入治疗及死亡发生。８例患者在病情稳定后１周内行介入检查与治疗,其中５例接受ＰＴＣＡ及支架置入术,３例接受冠状动脉旁路移植术。结论静脉滴注地尔硫４０～１５０μｇ／ｍｉｎ（２．４～９ ｍｇ／ｈ）或者联合应用静脉硝酸甘油为难治性心绞痛提供了一种较为安全有效的药物治疗手段,值得临床进一步深入探讨。     

G—CSF配合大剂量CTX和VCR动员自体外周血干细胞的研究

本研究对１２例拟行ＡＰＢＳＣＴ的患者予ＶＣＲ１－２ｍｇ／ｍ２，体表面静注及ＣＴＸ７ｇ／＾２体表面积静滴，５－７天后予Ｇ－ＣＳＦ１００μｇ／ｍ＾２体表面积静注５－７天，白细胞升至３．０×１０＾９／Ｌ以上时，用ＣＳ３０００血细胞分离机单次收集单个核细胞ＭＮＣ〉２．８×１０＾８／ｋｇ，ＣＤ＾＋３４〉．６×１０＾６／ｋｇ，ＣＦＵ－ＧＭ〉３．９×１－０＾４／ｋｇ，ＡＰＢＳＣＴ后，全部患者于＋５天－＋１０天白     

静脉地尔硫Zhuo治疗老年人快速心室率房颤,房扑和室上速的？…

目的：观察静脉地尔硫Ｚｈｕｏ对老年人快速心室率的房颤、房扑及室上速的疗效与安全性、方法１５例患者（７例房颤、３例房扑，５例室上速）静脉注射地尔硫Ｚｈｕｏ１０－１５ｍｇ，有反应者继以１０－１５ｍｇ／ｈ浓度持续静点６－１２ｈ。结果用药后心室率比用药前基础心率减少〉２０％，转复为窦性心律或心室率〈１００次／ｍｉｎ为治疗有反应，本组１５例患者１２例（８０％）有反应；用药后心室率下降最大效应时间１１ｍｉｎ，     

心肌梗死前48小时内心绞痛发作对初次心肌梗死近期预后的影响

目的对心肌梗死前４８小时内有无心绞痛发作的老年患者的临床经过及近期预后的影响进行评价。方法２６３例患者均为首次急性心肌梗死未接受溶栓等再灌注治疗的病例。心肌梗死发病前４８小时内有心绞痛发作（ａｎｇｉｎａｐｅｃｔｏｒｉｓ，ＡＰ）组１２４例；对照组１３９例；２组基础临床情况类似。结果ＡＰ组临床经过及短期预后较好，血浆肌酸磷酸激酸（ＣＰＫ）值为２６４±３３０Ｕ／Ｌ，住院期间发生心力衰竭３２例（２５．８％），发生严重心律失常３２例（２５．８％），心源性死亡８例（６．８％）；对照组分别为３１４±３２５Ｕ／Ｌ、５６例（４０．３％）、６１例（４３．９％）、２１例（１６．５％）。两组比较，差异有显著性（Ｐ值＜０．０５或０．０１）。结论　心肌梗死发病前４８小时内心绞痛发作对老年人同样具有保护作用，其机理可能和心肌缺血预适应有关。     

地尔硫缓释剂对高血压合并冠心病患者动态血压及心电图的影响

目的观察地尔硫缓释剂对高血压合并冠心病患者疗效。方法２９例高血压合并冠心病患者口服地尔硫缓释剂９０ｍｇ，２／ｄ，用药４周，应用２４ｈ动态血压和动态心电图观察用药前后血压和缺血性ＳＴ段的变化。结果用药后２４ｈ收缩压（ＳＢＰ）从１４５±９降至１２７±１２ｍｍＨｇ，舒张压（ＤＢＰ）从１０６±１１降至８２±１５ｍｍＨｇ（Ｐ＜０．０５）；ＳＢＰ负荷由６４±９％降至３８±９％（Ｐ＜０．０１），ＤＢＰ负荷由５４±１４％降至２９±１０％（Ｐ＜０．０１）。心肌缺血发作频率从４．３±２．０降至２．３±１．０／２４ｈ，缺血总时间（ｍｉｎ／２４ｈ）从１６．９±３．９降至９．４±２．９，最大ＳＴ段下移由１．４±０．５ｍｍ降为０．８±０．３ｍｍ（Ｐ＜０．０１）。结论地尔硫缓释剂能显著改善高血压合并冠心病患者的心肌缺血和降低患者血压。     

86例双侧胸腔积液临床回顾分析

目的：探讨双侧胸腔积液病因及临床特点。方法；对８６例双侧胸腔积液进行回顾性分析，结果：（１）结核性４８例（５５．８％）肿瘤转移２８例（３２．５％）其他原因１０例（１１．７％）（２）血性胸水在恶性和结核性胸水中分别上占５７％（１６／２８）和３１％（１５／４８）（Ｐ〈０．０５），（３）胸水ＣＥＡ在恶性胸水和结核性胸水中阳性率分别为８０％（１６／２０）和２．５％（１／４０）（Ｐ〈０．０１），（４）胸水Ａ     

冠心病患者尿纤维蛋白肽A检测初步报告

应用高效液相色谱法检测１０例稳定型心绞痛（ＳＡ组）、１２例不稳定型心绞痛（ＵＡ组）、１２例急性心肌梗塞（ＡＭＩ组）患者、４２例正常人（对照组）的尿纤维蛋白肽Ａ（ＦＰＡ）水平，结果分别为：２８．１±１３．３、３９．６±１１．８、８８．２±２８．９、２５．４±１０．３ｎｇ／ｍｇＣｒ．ＡＭＩ组明显高于其它各组（Ｐ＜０．０１）ＵＡ组高于ＳＡ组（Ｐ＜０．０５）、对照组（Ｐ＜０．０１）．ＳＡ组与对照组的尿ＦＰＡ无显著差异．表明冠心病患者体内存在高凝状态．提示，尿ＦＰＡ的定量对冠心病类型的鉴别有一定价值，认为通过动态观察尿ＦＰＡ变化有助于判断病情．     

抗乙肝iRNA联合Ara-AMP及胸腺肽治疗慢性乙型肝炎远期疗效观察

慢性乙型肝炎（ＨＢｅＡｇ＾＋,ＨＢｅＡｇ＾＋,ＨＢＶ－ＤＮＡ＾＋）１３６例,随机分为３组,第１组４９例采用抗乙肘ｉＲＮＡ２ｍｇ隔日肌注,３个月,联合单磷酸阿糖腺苷（ＡｒＡ－ＡＭＰ）１０ｍｇ／ｋｇ主５天后５ｍｇ／ｋｇ２３天,胸腺肽１０ｍｇ每日肌注３０天。第２组４５例用胸腺肽９０天,剂量和其他联合用药同１组。第３组４２例为对照组。治疗结束（３个月）３个组ＡＬＴ复常率分别为９３．８％,９３．３％,４７。     

亚剂量吡喹酮对慢性血吸虫病患者循环抗原水平的影响

目的观察不同亚治疗剂量吡喹酮对慢性血吸虫病患者血清血吸虫肠相关趋阴极抗原（ＧＡＣＡ）水平的影响。方法ＫａｔｏＫａｔｚ法粪检确定１０８例慢性血吸虫病患者，随机分成４组，分别给予口服５ｍｇ／ｋｇ、１０ｍｇ／ｋｇ、２０ｍｇ／ｋｇ剂量吡喹酮和安慰剂。采用单克隆抗体酶联免疫吸附试验（ＭｃＡｂＤｏｔＥＬＩＳＡ）分别检测服药前、后２、８、２４和４８小时患者血清ＧＡＣＡ水平。服药前、后检出率变化采用χ２检验。结果３个实验组服药后２小时检测血清ＧＡＣＡ水平，平均较服药前上升３个滴度，后渐下降；至服药后４８小时，血清ＧＡＣＡ水平仍高于服药前１个滴度。血清ＧＡＣＡ检测敏感性，可由服药前的８２．７％提高到服药后２小时的１００．０％（Ｐ＜０．０５）。对照组４８小时观察期内，血清ＧＡＣＡ水平波动在１个滴度范围内，检测敏感性无明显变化（Ｐ＞０．０５）。结论口服不同亚治疗剂量吡喹酮均能有效升高慢性血吸虫病患者血清血吸虫ＧＡＣＡ水平，并显著提高血清ＧＡＣＡ检测敏感性。     

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。