急性心肌梗死溶栓治疗后ST段恢复时间对室壁运动及左室收缩功能的影响

目的观察急性心肌梗死(AMI)溶栓治疗后ST段恢复时间对预测室壁运动的临床意义。方法将心内科及急诊监护病房收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的120例AMI患者,根据溶栓后心电图的ST段达稳定下移50%的时间,分为30min内(n=34)、60min(n=49)、90min(n=37),分别测定3组的梗死血管室壁运动幅度及射血分数。结果抬高的ST段稳定下移50%所需要的时间不同,梗死相关室壁运动幅度存在差异(P<0.05),且随需要的时间延长,梗死相关室壁运动幅度及左室前壁收缩功能有下降趋势(P<0.05)。结论抬高的ST段恢复时间越短,梗死相关的室壁运动及左室前壁的收缩功能改善越明显。     

87例急性心肌梗死患者的心电图改变与预后

目的：探讨急性心肌梗死（AMI）心电图改变与预后的关系。方法：回顾分析87例未溶栓的AMI病人的临床资料。结果：（1）总病死率18．39％；（2）心律失常：单纯窦速及室上性早搏无1例死亡，频发室早死亡率37．5％，Ⅲ度房室传导阻滞（A-VB)死亡率50％，并发束传导阻滞死亡率43．75％，除左前分支阻滞死亡率为16．7％外，其他束支阻滞死亡率均在50％以上；（3）梗死部位：（1）下壁AMI，胸导ST段下移≥2mm，死亡率60％；（2）前壁AMI，ⅡⅢaVF导联ST段下移≥2mm死亡率33．33％；（4）梗死范围；（1）病理性Q波导联数＞5个的，死亡率31．2％；（2）心电图异常项目数；并发1项心电异常死亡率10．53％，5项异常死亡率75％。结论：AMI并有心电图异常项目，病理性Q波导联数愈多，死亡率愈高；伴有梗死灶对应导联ST段下移幅度大，双支及三支阻滞，三度A－VB，频发室性早搏，及Ron T现象死亡率高。这些可以作为近期预后不良的判断指标。     

急性心肌梗塞早期溶栓后心电图ST段改变与预后

目的:探索急性心肌梗塞(AMI)早期溶栓治疗后,心电图抬高的ST段回降的幅度对临床预后的影响。方法: 描记88例AMI早期患者溶栓治疗后1 h、2 h、3 h、1 d、3 d等时段的心电图,根据有、无早期(溶栓后2 h)ST段的恢复分为三组:A组,ST段基本恢复至等电线,即回降的幅度≥90％;B组,ST段回降的幅度在50％～90％之间; C组,ST段回降的幅度不到50％。比较三组心肌酶、左心功能及住院病死率。结果:血清肌酸激酶(CK)峰值、左室射血分数(LVEF)及病死率,A组与B组、C组相比较有显著差异(P<0．05,或<0．01):A组CK峰值低、LVEF 高、预后好;C组则相反。结论:AMI早期溶栓后的心电图ST段变化,有助于对临床预后的评估。     

急性心肌梗死时心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义

目的　探讨急性心肌梗死时 (AMI)心电图ST段抬高恢复时间对预测溶栓治疗后心室壁运动的临床意义。方法　将监护病房 (CCU)收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的 36 0例AMI患者 ,根据溶栓后心电图ST段抬高达到稳定性下移 5 0 %的时间 ,分成A组 (时间在 30min内 ,n =92 )、B组(6 0min内 ,n =12 6 )及C组 (90min ,n =14 2 ) ,分别测定 3组的梗死血管室壁运动的幅度。结果　ST段抬高达到稳定性下移 5 0 %所需要的时间不同 ,梗死相关心室壁运动幅度存在差异 [急性前壁心肌梗死 (AAMI)相关室间隔运动幅度A、B、C 3组分别为 (8 15± 1 6 2 )、(7 84± 1 4 3)及 (6 5 6± 2 15 )mm ,P <0 0 5 ;急性下壁心肌梗死 (AI MI)相关左室后壁运动幅度 3组分别为 (8 78± 1 92 )、(7 32± 1 5 4 )及 (6 15± 2 0 5 )mm ,P <0 0 5 ,且随需要的时间延长 ,梗死相关的心室壁运动幅度有下降的趋势。结论　抬高的ST段恢复时间越短 ,梗死相关的心室壁运动改善越明显     

抬高的ST段恢复时间对预测溶栓治疗后室壁运动的临床意义

目的 :探讨抬高的ST段恢复时间对预测溶栓治疗后室壁运动的临床意义。方法 :将冠心病监护病房收治并接受静脉尿激酶溶栓治疗且符合梗死相关血管再通标准的 180例AMI患者 ,根据溶栓后心电图抬高的ST段达到稳定下移 5 0 %的时间 ,分成A组 (时间在 30min内 ,n =4 6 )、B组 (6 0min内 ,n =6 3)及C组 (90min内 ,n =71) ,分别测定 3组的梗死血管室壁运动幅度。结果 :抬高的ST段达到稳定下移 5 0 %所需的时间不同 ,梗死相关室壁运动幅度存在差异〔急性前壁心肌梗死相关室间隔运动幅度A、B、C 3组分别为 (8.15± 1.6 2 )、(7.84± 1.4 3)及 (6 .5 6± 2 .15 )mm ,P <0 .0 5 ;急性下壁心肌梗死相关左室后壁运动幅度 3组分别为 (8.78±1.92 )、(7.32± 1.5 4 )及 (6 .15± 2 .0 5 )mm ,P <0 .0 5〕 ,且随需要的时间延长 ,梗死相关的室壁运动幅度有下降的趋势。结论 :抬高的ST段恢复时间越短 ,梗死相关的室壁运动改善越明显     

急性心肌梗死后左心功能及室壁运动恢复与ST段的变化关系

目的探讨急性心肌梗死(AMI)患者接受直接经皮冠状动脉腔内成形术(PTCA)治疗后左室收缩功能及梗死区室壁运动恢复与心电图抬高ST下降幅度的关系。方法接受直接PTCA的AMI患者共34例,比较PTCA前及术后1h12导联心电图抬高ST段的总和,按ST段下降幅度分为两组A组ST段下降≥50％;B组ST段下降＜50％。所有患者于发病第(7±2)d行小剂量多巴酚丁胺超声心动图负荷试验并于发病第1、2、3个月行超声心动图检查。结果AMI发病急性期基础状态和负荷状态及发病后第1、2、3个月左室射血分数(LVEF)A组均明显大于B组(63.4vs56.7;68.9vs60.5;60.1vs53.1;61.4vs53.1;60.9vs52.3;P均<0.05)。基础状态和多巴酚丁胺负荷状态下总室壁运动积分指数(GWMSI)和梗死区室壁运动积分指数(IWMSI)A组均明显小于B组。AMI发病第1、2、3个月GWMSIA组均明显小于B组(1.21vs1.38,P=0.042;1.17vs1.38,P=0.015;1.18vs1.30,P=0.035)。发病第1、2个月IWMST两组间无统计学差异。发病第3个月IWMSTA组明显小于B组(2.16vs2.47,P=0.048)。结论急性心肌梗死直接PTCA后心电图ST段下降幅度≥50％组在AMI急性期和恢复期左室收缩功能及梗死区室壁运动的恢复均明显优于ST段下降幅度<50％组。     

急性心肌梗死再灌注后心电图ST段抬高的意义

目的：探讨急性心肌梗死（AMI）患者接受经皮冠状动脉腔内成形术（PTCA）治疗心电图ST段持续高与临床预后的关系。方法：AMI患者共30例,比较PTCA前及术后1h12导联心电图抬高ST的总和,按ST段下降幅度分为两组,A组：AT段下降≥50％,B组：ST段下降＜50％。行小剂量多巴酚丁胺负荷超声心动图检查并随访复查超声心动图。结果：AMI发病早期基础状态和负荷状态及发病后第1、2、3个月左室射血分数（LVEF）A组均明显大于B组。多巴酚丁胺负荷状态下主动脉峰值血流加速度、每搏输出量及每搏指数A组明显大于B组。基于状态和负荷状态下总室壁运动积分指数（GWMSI）和梗死区室壁运动积分指数（IWMSI）A组均明显小于B组,AMI发病后1、2、3个月GWMSI A组均明显小于B组。发病第1、2个月IWMSI两组间差异无统计学意义。发病第3个月IWMSI A组明显小于B组。AMI直接PTCA后心电图ST段持续抬高的患者左室收缩功能及收缩储备功能以及梗死区室壁运动的恢复明显低于ST段迅速下降者。     

不同ST段恢复时间与左室收缩功能的关系

目的　探讨急性心肌梗死抬高的ST段恢复时间对预测溶栓治疗后左室收缩功能的临床意义。方法　将 92例AMI患者根据溶栓后心电图抬高的ST段达到稳定下移 5 0 %的时间 ,分成A组 (时间在 3 0分钟内 ) ,B组 (时间在 60分钟内 )和C组 (时间在 90分钟内 )。比较不同组间 3 0天的左室收缩功能。结果　溶栓后心电图抬高的ST段达到稳定下移 5 0 %的时间不同 ,各组 3 0天左室收缩功能存在差异 ,其LVEF( % )分别为A组 65 4± 1 1 2、B组 5 7 6± 1 0 3、C组 49 9± 1 0 1 ,ST段恢复时间越短 ,左室收缩功能恢复越好 (P <0 0 5 ) ,并随梗死部位不同而有所变化 ,前壁MIST段恢复时间与左室收缩功能恢复关系更密切 (P <0 0 1 ) ,下壁MI随ST段恢复时间延长 ,左室收缩功能有下降趋势 ,但无显著性差异 (P >0 0 5 )。结论　用心电图监测溶栓后ST段的变化 ,是预测左室收缩功能的良好指标 ,尤其对前壁MI有更好的预测性。     

急性心肌梗死患者急诊经皮冠状动脉内介入治疗后ST段下降幅度的临床意义

目的观察经皮冠状动脉内介入治疗(PCI)达TIMI血流3级的急性心肌梗死(AMI)患者,早期ST段下降幅度的临床意义。方法选择首次发生ST段抬高型急性心肌梗死(AMI)经急诊PCI治疗,且TIMI血流达3级的120例患者,男性76例,女性44例,平均年龄(55.6±11.4)岁,测量并比较PCI术前、术后2 h梗死相关导联ST段下降幅度,以∑ST段下降≥50%为A组,<50%为B组,应用超声心动图分别测量左心室射血分数(LVEF),观察可能影响ST段下降的常见因素及PCI术后2个月的心血管事件。结果急诊PCI的AMI患者早期ST段下降幅度≥50%者心脏功能改善明显,且心血管事件较低,未发现常见的临床因素对ST段下降有影响。结论AMI患者急诊PCI术后早期ST段下降的幅度是预测其预后的一项直观、简易、可靠的临床指标。     

急性心肌梗死者急诊PCI术后ST段下降幅度临床意义及其相关因素分析

目的观察经皮冠脉内介入（PCI）治疗达TIMI血流3级的急性心肌梗死（AMI）者的早期ST段下降幅度的临床意义及其影响因素。方法选择首次ST段抬高的AMI经急诊PCI且TIMI血流达3级的100例患者,测量并比较PCI术前、术后2h梗死相关导联ST段下降幅度,以∑ST段下降≥50％为A纽。〈50％为B纽,应用超声心动图分别测量左心室射血分数（LVEF）及PCI2个月后的心血管事件,观察可能影响ST段下降的常见因素。结果急诊PCI的AMI者早期ST段下降幅度≥50％者心脏功能改善明显,且心血管事件较低。未发现常见的临床因素对ST段下降有影响。结论AMI者急诊PCI术后早期ST段下降的幅度是预测其预后的一项直观、简易、可靠的临床指标．     

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.     

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。     

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     

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.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.