双氢青蒿素哌喹复方片治疗缅甸恶性疟的临床观察

目的观察双氢青蒿素哌喹复方片对缅甸无并发症恶性疟的疗效。方法 2007-2008年,分别在缅甸佤邦和克钦邦两个区,选择6～60岁无并发症、原虫无性体密度为500～200 000个/μl的单纯恶性疟病例,使用双氢青蒿素哌喹复方片治疗,成人总剂量8片(每片含双氢青蒿素40 mg,磷酸哌喹320 mg),儿童剂量按年龄递减,疗程3 d。观察患者的退热时间、原虫转阴时间、无性体清除情况和不良反应等。结果共完成治疗134例患者,平均退热时间为(25.5±2.8)h,平均原虫转阴时间为(39.5±7.8)h,无性体7 d清除率100%,治后28 d有4例复燃;16例在服药后出现中枢神经系统及胃肠道反应,如头痛、恶心、呕吐和腹泻等轻微症状,停药后即自行消失。结论双氢青蒿素哌喹复方片在缅甸治疗无并发症恶性疟效果良好。     

驻西非维和二级医院采用两种药物治疗恶性疟66例临床研究

目的 比较研究双氢青蒿素哌喹片和复方磷酸萘酚喹片治疗恶性疟的疗效及不良反应.方法 采用随机分组将联合国驻西非利比里亚维和中国二级医院收治的66例轻型恶性疟患者分为双氢青蒿素哌喹片治疗组和复方磷酸萘酚喹片治疗组,各33例,分别采用双氢青蒿素哌喹片及复方磷酸萘酚喹片进行抗疟治疗,比较两组患者的疗效(包括治愈率、复燃率、平均原虫转阴时间和平均退热时间)及药物不良反应.结果 双氢青蒿素哌喹片治疗组和复方磷酸萘酚喹片治疗组患者的平均原虫转阴时间分别为(45.2±17.7)h和(48.3±19.1)h,平均退热时间分别为(25.5±8.7)h及(27 9±7 8)h,两组比较无统计学差异(P＞0.05);两组的治愈率均为97％,无统计学差异(P＞0.05);两组复燃率均为3％,亦无统计学差异(P＞0.05).两组患者不良反应发生率比较,复方磷酸萘酚喹片治疗组(21.2％)高于双氢青蒿素哌喹片治疗组(12.1％)(P＜0.05),但不良反应均较轻微,停药后均自行缓解.结论 双氢青蒿素哌喹片和复方磷酸萘酚喹片治疗恶性疟治愈率高,复燃率低,无严重不良反应,均可作为治疗轻型恶性疟的一线药物.     

双氢青蒿素与磷酸萘酚喹伍用治疗恶性疟的疗效观察

目的　观察双氢青蒿素与磷酸萘酚喹配伍使用治疗恶性疟的疗效。　方法　以显微镜血检单纯恶性疟原虫阳性患者为观察对象 ,药物为双氢青蒿素 1 60mg加磷酸萘酚喹 40 0mg(成人量 ) ,一次顿服 ,服药后按时测量体温和血检原虫 ,随访 2 8d ,观察治疗效果。　结果　收治 37例恶性疟患者 ,有 1例复燃 ,治愈率为 97.3 %。平均退热时间为(1 5 .8± 8.7)h ,2 4h平均原虫下降率为 96 .7%± 2 6 .5 % ,原虫无性体转阴时间平均为 (2 7.6± 1 3 .2 )h ,药后无明显不良反应。　结论　双氢青蒿素与磷酸萘酚喹配伍使用治疗恶性疟具有良好的效果     

磷酸咯萘啶与磺胺多辛、伯喹伍用在抗氯喹地区治疗恶性疟的观察

将磷酸咯萘啶1.2g与磺胺多辛1.0g.伯喹45mg伍用,在抗氯喹恶性疟流行区治疗恶性疟48例,治疗后平均退热时间32±16h,平均原虫无性体转阴时间59±20.8h.服药后48h疟原虫无性体下降率为88～100％,即时疗效与单用磷酸咯萘啶1.2g对照组相似.伍用组一个月内复燃率2.5％,服药后配子体转阴时间1～12d,并能减少配子体出现,根治效果和对配子体的作用优于单用组。三药伍用后毒副反应无明显增加,是治疗抗氯喹恶性疟的较好方案.     

双氢青蒿素与咯萘啶联用治疗恶性疟的初步研究

为提高治疗抗药性恶性疟的治愈率和消除配子体,作者选择了口服双氢青蒿素咯萘啶组合联用。于 １９９６ 年秋,在海南省对氯喹及哌喹的抗性率分别为８０％ 和７０％ 的恶性疟流行区,进行治疗恶性疟的初步观察。双氢青蒿素总剂量２００ｍ ｇ,咯萘啶８００ｍ ｇ,均等分２ 剂,间隔１２－ ２４ｈ服第二剂。共治恶性疟 １０ 例,平均退热时间为２３１±１２７ｈ;无性体原虫平均转阴时间为 ３４４±１００ｈ;药后追踪观察２８ｄ,其中７ 例追踪 ４０ｄ,均未见原虫复燃。治前查见配子体低密度的１ 例,高密度的２ 例,分别于药后ｄ３,ｄ１４ 及 ｄ２０转阴。结果表明,本治疗方案疗程短、治愈率高、可消除配子体,很有前景     

几种新抗疟药联合应用治疗海南省恶性疟的效果观察

1985～1987年6～10月连续3年在海南省三亚市和乐东县抗氯喹恶性疟流行区用喹哌750mg 硝喹25mg联合用药治疗33例恶性疟患者,其平均退热时数为39h;原虫无性体平均转阴为49h。服药后28d的复燃率在不同地区为0～47％。 用咯萘啶600mg 硝喹25mg治疗11例;咯萘啶800mg 硝喹40mg治疗43例;咯萘啶800mg 硝喹80mg治疗31例,其退热时数为31～35h,原虫无性体平均转阴为46～53h,服药后28d的复燃率在13～18％之间,与对照组单服咯萘啶1200mg治疗42例的平均退热时数33h,平均原虫无性体转阴时数48h和28d复燃率12％无显著性差别。各组服药前后曾抽样进行了血、尿常规、肝功能等检查,结果都在正常范围之内,证明联合用药是安全的。     

双氢青蒿素-磷酸哌喹和蒿甲醚-本芴醇两种复方对海南岛无并发症恶性疟的疗效观察

目的 观察双氢青蒿素-磷酸哌喹和蒿甲醚-本芴醇两种复方抗疟药对海南岛无并发症恶性疟的治疗效果。 方法 2005-2006年在海南省5县（市）恶性疟流行区,选择1～60岁无并发症单纯恶性疟病例107例（原虫无性体密度为1 000～200 000个/μl）,病例随机分为2组,A组55例, 口服双氢青蒿素-磷酸哌喹治疗（成人总剂量8片,1次/d,疗程为3 d,首日4片）, B组52例,口服蒿甲醚-本芴醇治疗（成人总剂量24片,2次/d,早晚各服4片,疗程为3 d）。 按照WHO体内法观察标准进行治疗、观察和随访。 结果 A组55例,全部完成治疗、观察和28 d随访,平均退热时间为(22.35±13.26） h,平均原虫转阴时间为（34.99±12.28） h;B组52例中有51例完成治疗、观察和28 d随访, 平均退热时间为（20.99±11.38） h,平均原虫转阴时间为（36.45±12.60） h,两组间差异均无统计学意义（P>0.05）。28 d随访两组病例均未出现复燃。个别病例在服药后出现中枢神经系统及胃肠道反应, 如头痛、恶心、呕吐等,症状较轻,停药后即自行消失。未出现严重的不良反应。 结论 双氢青蒿素-磷酸哌喹和蒿甲醚-本芴醇两复方治疗海南岛无并发症恶性疟效果好,控制症状快,治愈率高。     

咯萘啶针剂与防疟2号片及伯喹联用治疗恶性疟疾的效果

在海南岛的抗药性恶性疟流行区,用咯萘啶针剂160mg 肌注,同时口服防疟2号片4片(含磺胺多辛1000mg 和乙胺嘧啶70mg)的一次法,治疗恶性疟31例,平均退热时间为37.7±21.2h,平均原虫无性体转阴时间为48.6±15.2h,28d 内无复燃,但原虫配子体携带率高达61.5%。为杀灭配子体,另20例恶性疟于治疗时加服伯喹2d,总量45mg,临床疗效与一次法相似,不同的是治后未见配子体。两药或三药联用,均未见明显毒副反应。     

缅甸拉咱市恶性疟原虫对6种抗疟药的敏感性体外测定

目的了解中缅边境缅甸拉咱市恶性疟药物抗性现状,为中国第六轮全球基金疟疾项目制定防治策略提供依据。方法在缅甸拉咱市城区建立研究站,镜检发热病人和/或疑似疟疾病例,筛查疟疾患者。选择城区及郊区4村的单纯恶性疟现症患者,用WHO推荐的体外微量试验测定恶性疟原虫对6种抗疟药的敏感性。结果体外微量测定43例,成功27例,测得恶性疟原虫对氯喹、哌喹、咯萘啶、青蒿琥酯、双氢青蒿素和双氢青蒿素/哌喹的抗性率分别为100%、0、25.9%、22.2%、7.4%和0,半数抑制浓度(IC50)分别为298.0、49.4、22.3、24.3、11.8和5.6/44.8nmol/L。结论缅甸拉咱市流行株恶性疟原虫对氯喹100%抗性,对咯萘啶、青蒿琥酯和双氢青蒿素具有一定程度抗性,对氯喹、咯萘啶和青蒿琥酯抗性呈逐渐增强趋势,对哌喹和双氢青蒿素/哌喹敏感。     

青蒿琥酯伍用伯喹治疗抗药性恶性疟疗效观察

青蒿琥酯600mg与伯喹90mg伍用,治疗抗药性恶性疟43例,退热时间26.9±19.5h,原虫无性体转阴时间33.8±10.4h,28d复燃率6.5％,对配子体形成和清除有明显效果,副反应少,但疗程长,对G-6-PD缺陷者不宜。与Fansimef相比,在退热速度、对配子体作用、副反应方面优于后者。     

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     

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.     

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.