耐药对肺结核病治疗效果的影响

目的评价耐药对地区肺结核病治疗效果的影响。方法对上海地区2004年2月—9月新登记敏感及耐药肺结核病人1年治疗转归进行分析和比较。结果在全市各区(县)结核病定点医院新登记1597例肺结核病病人中,805例培养阳性,其中731例经菌型鉴定为结核分枝杆菌的病人纳入分析。731例病人的总耐药率为18.7%,耐多药率为6.7%。敏感组治疗成功率达到93.0%,非MDR的耐药病人治疗成功率达到85%以上,MDR组治疗成功率为71.4%。经χ²检验,差别有统计学意义(χ²=83.9968,P<0.01)。在68例治疗不成功的病人中,耐药病人占38.2%;而在30例治疗失败的病人中,耐药病人占60%。复治敏感病人的治疗成功率(92.0%)与初治敏感病人(93.1%)相当,但是复治耐药病人的治疗成功率远低于初治耐药病人。结论(1)上海地区肺结核病病人治疗管理效果良好;(2)耐药是肺结核病治疗失败的重要因素,应加强和改进对耐药结核病的治疗措施;(3)耐药和敏感病人治疗效果存在较大差异,应分别评价。     

铜陵地区结核病耐药特征的初步探讨简

目的 了解铜陵地区结核病耐药特征,为治疗耐药结核病提供科学依据.方法对结核病患者的标本采用 BACT/ALERT 3D 系统进行分枝杆菌培养,阳性者进行菌种鉴定,并采用改良罗氏（L-J）培养基按绝对浓度法对9种药物进行敏感试验.结果培养显示结核分枝杆菌复合群 96株,耐药54例（56.3%）.单耐药 26例（27.1%）,耐多药（MDR）为9例 （9.4%）.对初治、复治患者比较,发现耐利福平、利福喷丁、异烟肼及MDR率差别有显著性（P＜0.05）.结论 我市结核病耐药率、耐多药率高;复治肺结核治疗困难.制定耐药结核病化疗方案时应注意乙胺丁醇、丙硫异烟胺、喹喏酮类药物的使用.     

424例可疑耐药结核病细菌学分析

目的研究耐药结核病（DR-TB）在不同类型可疑耐多药结核病人（MDR-TB）中的分布特点及其耐药谱分布情况。方法 2007年10月～2010年04月胜利油田发现的可疑耐多药结核病人为研究对象,通过痰涂片、培养、菌种鉴定和药物敏感试验诊断MDR-TB,按照可疑MDR-TB患者不同肺结核类型发生耐药和耐多药结核病情况进行统计分析。结果 406例临床分离菌株药物敏感试验,其中36.2%为MDR-TB,18.9%为其他DR-TB;147例MDR-TB病例中,初治占28.6%,复治70.1%,新患者1.3%。复治组中复治失败病例的MDR-TB发生率最高。结论复治组是MDR-TB发生的主要类别,但3个月末涂阳和初治失败患者也存在较高的MDR-TB发生率。     

我国耐药结核病的危险因素——2007年全国结核病耐药基线调查资料分析

目的 探索新登记、复治患者发生耐药、耐多药结核病的危险因素。 方法2007年4-12月中国进行了全国结核病耐药基线调查,调查覆盖全国31个省、自治区和直辖市,以省分层,采用多阶段整群抽样方法从全国结核病防治系统中随机抽取70个调查点,调查期间每个调查点纳入新登记涂阳新患者51例和复治患者17例。临床医师采用信息表收集患者的相关信息,通过当面询问患者填写治疗史信息,如有可能查阅患者医疗记录进行确认,治疗信息的准确性经另一位临床医师再次询问患者进行复核。采用比例法进行药敏试验,检测药物包括异烟肼、利福平、链霉素、乙胺丁醇、卡那霉素和氧氟沙星。 结果 多因素分析结果表明,对于新登记、治疗时间少于1个月(OR=1.6, 95% CI＝1.1～2.1)发生耐药结核病的风险较高;而女性（OR=1.4, 95% CI＝1.0～2.1）和进行过结核病药物治疗（OR=2.4, 95% CI＝1.5～3.7）是发生耐多药结核病的危险因素。对于复治患者,女性（OR=1.7,95% CI＝1.1～2.7）、既往有过2次及以上治疗且最近1次在结核病专科医院治疗（OR=4.0, 95% CI＝1.2～14.0）发生耐药结核病的风险较高;而女性（OR=2.3, 95% CI=1.5～3.6）、生活在实施DOTS较晚（2000年以后）的地区（OR=1.7, 95% CI＝1.2～2.4）、既往有过2次及以上治疗且最近1次在结核病专科医院外的其他医疗机构治疗（OR=3.3, 95% CI＝2.1～5.2）、既往有过2次及以上治疗且最近1次在结核病专科医院治疗（OR=13.0, 95% CI＝3.9～46.0）是产生耐多药结核病的危险因素。 结论 进行过结核病治疗的新登记产生耐药、耐多药结核病的风险较高;患者为女性、既往有过2次及以上的结核病治疗史是复治患者产生耐药、耐多药结核病的危险因素。     

124例复治涂阳肺结核的疗效分析

复治涂阳肺结核病人不仅是影响结核病流行的一个重要因素,而且会造成耐药菌株的传播,因此控制复治涂阳病人同样具有重要的意义。本文分析我市对卫X项目复治方案治疗失败病例,采用含氧氟沙星(OFLX)和丁胺卡那霉素(AMK)为基础的方案,对124例复治涂阳病人的疗效。     

立复欣治疗初治耐药肺结核病26例临床疗效对照观察

耐药结核菌感染的结核病,是临床治疗中的一大难题.近年来,随着复治耐多药结核病的增多,初治耐药肺结核病也有逐渐增多趋势.本文根据临床工作中观察到的52例初治耐药肺结核病人,分组以采用含立复欣化疗方案强化治疗对照观察,收到了良好的治疗效果.现分析总结如下:     

深圳市可疑耐多药病人中的耐药结核病及其耐药谱分布特点

目的 研究耐药结核病（DR-TB）在不同类型可疑耐多药结核病人（MDR-TB）中的分布特点及其耐药谱分布情况,为制定MDR-TB控制策略提供科学依据。 方法 2006年10月-2009年4月深圳市发现的可疑耐多药结核病人为研究对象,通过痰涂片、培养、菌种鉴定和药物敏感试验诊断MDR-TB,按照可疑MDR-TB患者不同肺结核类型发生耐药和耐多药结核病情况进行统计分析。结果406例临床分离菌株做药物敏感试验,其中36.2%为MDR-TB,18.9% 为其他DR-TB;82例初治可疑MDR-TB患者中,MDR-TB占45.1%;310例复治可疑MDR-TB患者中,MDR-TB占33.2%,以复治失败所占比例最高,为66.7%。147例MDR-TB病例中,初治占28.6%,复治70.1%,新患者1.3%。77例其他DR-TB病例中,初治占22.1%,复治77.9%。初治组2类病例均有较高的MDR-TB和DR-TB发生率;复治组中复治失败病例的MDR-TB发生率最高。MDR-TB中,初治组以耐HRS和HRES为多,复治组以HR和HRES为多;MDR-TB外的其他DR-TB患者中,各耐药谱的耐药频率以单耐药为主,其中耐H或R的频度最高。 结论 复治组是MDR-TB发生的主要类别,但3个月末涂阳和初治失败患者也存在较高的MDR-TB发生率(实际上此病例已属复治);初、复治组MDR-TB均有较严重的耐药程度,其他DR-TB为发生MDR-TB的高危人群。     

黑龙江省耐药监测项目中肺结核治疗失败的原因分析

目的分析耐药监测项目中肺结核治疗失败的主要影响因素,为黑龙江省结核病患者的治疗管理提供参考依据。方法对2004年黑龙江省按WHO/IUATLD《结核病耐药监测指南》发现的肺结核患者的指南耐药监测信息和短程督导化疗后的治疗转归信息进行整理分析。结（1）1995例菌阳肺结核中,初治1574例（78.9%）;复治421例（21.1%）。肺结核病患者的耐药情况差异有统计学意义(P)差异有统计学意义（P<0.001);(2)治疗失败患者的影响因素分析中,除复治是一个主要的影响因素外,初治病例中影响治疗失败的主要因素为居住地（P<0.05调整OR0.36,95%CI[0.17-0.76])、耐多药（MDR-TB)(P<0.05调整OR4.70,95%CI[1.76-12.51])和痰涂片载量（P<0.05调整OR5.52.95%CI[1.84-16.61]);(3)复治患者中影响治疗失败的主要因素为耐多药（P<0.05调整OR5.58,95%CI[1.44—21.69])以及复治的次数（P<0.05调整OR3.34,95%CI[1.31—8.5])。结论初复治患者间的耐药差异表明在选择治疗方案时应根据药敏试验选择敏感性药物;采用基于一线药的治疗方案在治疗耐药肺结核病方面存在不足,尤其是耐多药患者,确定一个病例耐药之后应根据其药敏结果尽快调整其治疗方案;同时应关注影响治疗失败的危险因素,采取相应措施,减少治疗失败和耐药的产生。     

388例患者结核分枝杆菌耐药情况分析

目的回顾性分析陕西省结核病防治院肺结核病人中结核分枝杆菌耐药状况并分析耐药形成原因。方法分析2008年分离培养388株结核分枝杆菌药物敏感试验结果,包括异烟肼（H）,利福平（R）,盐酸乙胺丁醇（E）,硫酸链霉素（S）。结果 388株结核分枝杆菌中,至少耐一种药物耐药率为64.43%,同时对4种药物耐药率为4.12%,耐多药率为10.31%。结论结核病人耐药情况比较严重,需要更严格执行结核病控制策略,防止耐药病人及耐药菌株的产生和传播。     

铜陵地区结核病耐药特征的初步探讨

目的了解铜陵地区结核病耐药特征,为治疗耐药结核病提供科学依据。方法对结核病患者的标本采用BACT/ALERT 3D系统进行分枝杆菌培养,阳性者进行菌种鉴定,并采用改良罗氏(L-J)培养基按绝对浓度法对9种药物进行敏感试验。结果培养显示结核分枝杆菌复合群96株,耐药54例(56.3%)。单耐药26例(27.1%),耐多药(MDR)为9例(9.4%)。对初治、复治患者比较,发现耐利福平、利福喷丁、异烟肼及MDR率差别有显著性(P0.05)。结论我市结核病耐药率、耐多药率高;复治肺结核治疗困难。制定耐药结核病化疗方案时应注意乙胺丁醇、丙硫异烟胺、喹喏酮类药物的使用。     

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.