丹红注射液对慢性肺心病急性加重期的治疗作用

目的探讨合丹红注射液辅助治疗慢性肺心病急性加重期患者的效果。方法选择90例肺心病急性加重期患者,随机分为两组。对照组给予常规西医综合治疗,丹红组在常规治疗基础上加用丹红注射液静脉滴注,10d后观察两组血气分析指标、血液流变学、凝血功能以及血浆内皮素-1（ET—1）水平变化。结果与对照组比较,丹红组血气分析、血液流变学、凝血功能指标及血浆ET-1水平改善更明显。结论丹红注射液用于治疗慢性肺心病急性加重期可以降低血液黏稠度、改善血液高凝状态、降低ET-1分泌水平,有助于降低肺动脉压,改善肺通气,防止血栓形成。     

银杏达莫注射液治疗慢性肺心病急性加重期40例临床分析

目的观察银杏达莫注射液对慢性肺心病急性加重期的临床疗效。方法将80例慢性肺心病急性加重期患者随机分为治疗组（40例）和对照组（40例）。对照组予以常规治疗,治疗组在常规治疗基础上加用银杏达莫注射液,两组疗程均为10天,结果治疗组治疗慢性肺心病急性加重期10天后临床症状和体征明显好转,血液流变学明显改善,效果明显高于对照组（P〈0．05）。结论银杏达莫注射液可有效减轻慢性肺心病急性加重期患者的临床症状,缩短病程。     

疏血通注射液对慢性肺心病急性加重期患者血液流变学和呼吸功能的影响

目的 观察疏血通注射液治疗慢性肺心病急性加重期的临床疗效及对患者血液流变学和呼吸功能的影响.方法 将符合入选标准的慢性肺心病急性加重期患者120例随机分为治疗组与对照组,每组60例.对照组采用常规治疗包括低流量吸氧、抗感染、利尿、解痉、化痰、扩血管、强心、短期应用肾上腺皮质激素、降低肺动脉压及纠正水电解质紊乱等.治疗组在对照组治疗基础上加用疏血通注射液6 mL加入5％葡萄糖溶液或生理盐水250mL中静脉输注,每日1次,连续治疗14d.观察两组治疗前后血液流变学及动脉血氧分压(PaO2)及动脉二氧化碳分压( PaCO2)的变化.比较两组治疗后临床疗效.结果 治疗组临床疗效总有效率为88.3％,高于对照组的76.7％,差异有统计学意义(P＜0.05).治疗组治疗后血液流变学指标及PaO2、PaCO2较治疗前有明显改善(P＜0.05或P＜0.01),且改善程度优于对照组(P＜0.05或P＜0.01).结论 疏血通注射液具有降低慢性肺心病急性加重期患者血液黏稠性,改善微循环及血液流变性作用,从而改善呼吸衰竭、心力衰竭,有效改善患者的临床预后.     

疏血通联合辛伐他汀辅助治疗慢性肺心病急性发作46例疗效观察

目的 观察疏血通联合辛伐他汀治疗慢性肺心病急性发作期患者的临床疗效。方法将90例慢性肺心病急性发作期患者随机分为观察组46例和对照组44例，两组均予吸氧、抗感染、解除支气管痉挛、强心利尿等常规综合治疗，在此基础上观察组加用疏血通、辛伐他汀治疗，疗程均为10d。观察两组治疗前后临床表现、血液流变学指标、高敏-C反应蛋白（hsCRP）水平、血气分析、肺动脉压变化并据以判定临床疗效；测定凝血功能指标。结果观察组总有效率显著高于对照组，且各项凝血功能指标改善情况优于对照组（P〈0．05）。结论疏血通联合辛伐他汀辅助治疗慢性肺心病急性发作患者近期疗效确切，且可改善凝血功能。     

川芎嗪注射液对肺心病急性加重期患者血液流变学的影响

目的观察川芎嗪注射液对慢性肺心病急性加重期患者血液流变学的影响。方法将70例慢性肺心病急性加重期患者分成两组,对照组采用常规综合治疗,观察组在常规治疗的基础上加用川芎嗪2周,比较两组疗效和血液流变学的改善情况。结果观察组总有效率显著高于对照组;观察组红细胞压积、全血黏度、血浆黏度、血沉及纤维蛋白原水平显著降低,与对照组比较均有统计学差异（P均〈0.05）。结论川芎嗪能改善慢性肺心病急性加重期患者的血液流变学指标,纠正高凝状态,改善肺微循环,降低肺动脉高压,减少微血栓形成的可能性。     

血必净合生脉注射液治疗慢性肺心病急性发作

目的观察血必净配合生脉注射液治疗慢性肺心病急性加重期的临床疗效及作用机制.方法将58例慢性肺心病急性加重期病人随机分为治疗组和对照组,治疗组在西医综合治疗基础上加用血必净以及生脉注射液静脉输注;对照组仅采用西医综合治疗.结果治疗组总有效率为93.33%,明显优于对照组的71.43%（P〈0.05）.治疗组血氧分压（PaO2）、二氧化碳分压（PaCO2）改善明显优于对照组（P〈0.05）;血液流变学各项指标治疗后较治疗前改善明显（P〈0.05或P〈0.01）.结论血必净配合生脉注射液对于慢性肺心病急性加重期具有良好的治疗作用.     

苦碟子注射液对慢性肺心病急性加重期患者血液流变学的影响

目的 观察苦碟子注射液对老年慢性肺心病急性加重期患者血液流变学的影响. 方法 将72例慢性肺心病急性加重期患者随机分为2组,观察组在对照组常规治疗的基础上加用苦碟子注射液1个疗程,比较治疗前后2组疗效和血液流变学的差异. 结果 观察组总有效率显著高于对照组,差异有统计学意义(P<0.05),观察组红细胞压积、全血黏度(高切、低切)、血浆黏度及血沉的降低与对照组相比亦具有显著性差异(P<0.05). 结论 苦碟子注射液能改善老年慢性肺心病急性加重期患者血液流变学的各项指标,改善临床治疗效果.     

参麦注射液合真武汤治疗肺心病失代偿期49例

目的观察参麦注射液合真武汤治疗肺心病失代偿期的临床疗效。方法将96例病人随机分为两组。对照组47例应用西医常规治疗；治疗组49例在西医常规治疗的基础上，加用参麦注射液合真武汤。观察临床疗效、治疗前后血气分析指标、心功能参数、血液流变学等变化。结果总有效率治疗组为97．95％。对照组为87．22％，两组比较有统计学意义（P〈0．05）；两组治疗后血气分析PaO、PaCO2比较有统计学意义（P〈0．05）；治疗组治疗前后的心功能参数、血液流变学指标比较有统计学意义（P〈0．01或P〈0．05）；结论参麦注射液合真武汤治疗肺心病失代偿期（急性发作期）具有较好的临床疗效。     

血栓通对慢性肺心病急性发作期疗效观察

目的探讨注射用血栓通对慢性肺心病急性发作期患者临床疗效及血液流变学的影响。方法对2007年1月～2008年3月我院呼吸内科收治慢性肺心病急性发作患者66例,随机分对照组32例,治疗组34例。对照组予常规治疗,治疗组加注射用血栓通。两组均治疗2周。观察两组疗效、血气分析、血液流变学指标。结果注射用血栓通对肺心病急性发作期有较好的临床疗效,可改善肺心病急性期血液高凝、高黏滞状态。     

丹参酮ⅡA磺酸钠注射液治疗老年肺源性心脏病患者的临床观察

目的观察丹参酮ⅡA磺酸钠注射液对改善肺源性心脏病(肺心病)的临床疗效。方法选择肺心病急性加重期老年患者297例,分为观察组148例(丹参酮ⅡA磺酸钠注射液)和对照组149例,分析2组治疗前后临床表现、纤维蛋白原、D-二聚体、肺动脉收缩压、血气指标、血液流变学和动脉血气分析等指标。结果观察组临床疗效总有效率为94.59%,对照组为72.84%,差异有统计学意义(P<0.05);与治疗前比较,观察组治疗后纤维蛋白原、D-二聚体、肺动脉收缩压、心率、血液流变学指标明显降低,血氧饱和度明显升高,差异有统计学意义(P<0.05)。结论丹参酮ⅡA磺酸钠注射液在改善肺心病加重期血栓状态、降低肺动脉压、改善临床疗效上作用肯定。     

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。     

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。     

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     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.