低温含氧血和乌司他丁混合灌注对心脏瓣膜置换术患者的肺保护作用

将40例二尖瓣病变行瓣膜置换手术患者随机分为观察组和对照组各20例,观察组经肺动脉持续灌注低温含氧血混合乌司他丁。两组体外循环后肿瘤坏死因子α（TNF-α）、白介素6（IL-6）和IL-8水平明显升高．24h时仍高于术前,但观察组各指标在各时间点上升幅度均低于对照组,机械辅助通气时间亦显著低于对照组。认为持续肺动脉灌注低温含氧血混合乌司他丁能减轻体外循环术后肺损伤。     

异丙酚对体外循环肺损伤作用的临床观察

目的探讨异丙酚对体外循环肺损伤的作用。方法选择拟行心瓣膜置换术的患者30例,随机分为两组,每组各15例。异丙酚组麻醉维持持续输注异丙酚(8mg·kg-1.h-1),对照组麻醉维持用芬太尼和咪唑安定。体外循环(CPB)开始前、主动脉开放后5min及CPB结束时取左右心房血液,光学显微镜下检测中性粒细胞数;同时取适量动脉血,测定细胞因子IL-6、IL-8、IL-10和TNF-α浓度。测定两组围术期肺动态顺应性和氧合指数。结果两组转流前左、右心房PMN无显著差异,CPB后两组中性粒细胞计数比CPB前显著升高(p<0.01),对照组主动脉开放后5min及CPB后左心房中性粒细胞计数显著低于右心房(P<0.01或P<0.05),而异丙酚组左心房高于右心房(P<0.05)。CPB后两组IL-6,IL-8,TNF-α进行性增高(P<0.05或0.01),异丙酚组与对照组相比明显减少IL-6,IL-8,TNF-α,有统计学意义(P<0.05或0.01)。IL-10在对照组和异丙酚组均进行性增高,两组比较无统计学意义(P>0.05)。两组患者CPB后肺顺应性及氧合指数显著降低(P<0.05或0.01),CPB后1h最低,6h后有所改善,异丙酚组在各时间点肺顺应性及氧合指数均显著高于对照组(P<0.05或0.01)。结论异丙酚对体外循环肺损伤有保护作用。     

乌司他丁联合前列地尔对体外循环冠状动脉旁路移植术患者术后肺损伤的影响研究

目的观察乌司他丁联合前列地尔对体外循环冠状动脉旁路移植术患者术后肺损伤的影响。方法选取2013—2016年在佛山市第一人民医院行体外循环冠状动脉旁路移植术的患者164例,随机分为对照组(n=41)、前列地尔组(n=41)、乌司他丁组(n=41)和联合用药组(n=41)。对照组患者不做任何处理,前列地尔组患者麻醉诱导后经静脉微泵恒速泵入前列地尔,乌司他丁组患者麻醉诱导后经静脉微泵恒速泵入乌司他丁,联合用药组患者同时使用前列地尔和乌司他丁。比较4组患者硫酸鱼精蛋白用药前(T1)和硫酸鱼精蛋白用药后1 h(T2)血清炎性细胞因子水平[白介素6(IL-6)、白介素8(IL-8)、白介素10(IL-10)、肿瘤坏死因子α(TNF-α)、中性粒细胞黏附分子CD11b/CD18]和肺功能指标[动脉血氧分压(Pa O2)、肺泡-动脉氧分压差(A-a DO2)、呼吸指数(RI)和氧合指数(OI)]。结果 T1时4组患者血清IL-6、IL-8、IL-10、TNF-α及CD11b/CD18水平比较,差异无统计学意义(P0.05);T2时前列地尔组、乌司他丁组及联合用药组患者血清IL-6、IL-8、IL-10、TNF-α及CD11b/CD18水平低于对照组,联合用药组患者血清IL-6、IL-8、IL-10、TNF-α及CD11b/CD18水平低于前列地尔组和乌司他丁组(P0.05)。T1时4组患者Pa O2、A-a DO2、RI、OI比较,差异无统计学意义(P0.05);T2时前列地尔组、乌司他丁组、联合用药组患者Pa O2、OI高于对照组,而A-a DO2和RI低于对照组(P0.05)。结论乌司他丁联合前列地尔可有效减轻体外循环冠状动脉旁路移植术患者的炎性反应,改善患者肺功能。     

乌司他丁对食管癌根治术患者肺损伤的保护作用及机制

目的探讨乌司他丁对行食管癌根治术患者肺损伤的保护作用及机制。方法拟行食管癌根治术患者50例,ASAⅠ～Ⅱ级;将患者随机分为观察组和对照组各25例,均行食管癌根治术,麻醉诱导后观察组将乌司他丁10 000 U/kg溶于100 ml生理盐水中缓慢静推,对照组予等量生理盐水。分别于麻醉诱导后（T1）、单肺通气45 min（T2）、90 min（T3）及术后2 h（T4）采集外周静脉血,测定血清TNF-α、IL-6、IL-8和IL-10水平。结果两组T2时点TNF-α、IL-6、IL-8和IL-10水平均明显升高（P均〈0.05）,且随时间延长逐渐升高;与对照组相比,观察组T3、T4时点TNF-α、IL-6、IL-8水平显著降低,IL-10水平明显升高,P均〈0.05。结论乌司他丁对食管癌根治术患者肺损伤有一定保护作用,其机制可能与减轻全身炎性反应有关。     

乌司他丁对心脏瓣膜置换术患者CPB中血浆TNF-α、IL-8、IL-10水平的影响

目的观察乌司他丁对体外循环（CPB）患者血浆中TNF-α、IL-8、IL-10水平的影响。方法选取心脏瓣膜置换手术患者50例,随机分为对照组和实验组,各25例。实验组在麻醉诱导后开始恒速静注乌司他丁6000U／kg（30min内输完）,然后以1000U／（kg·h）的速度持续静滴至手术结束;对照组不给予乌司他丁。分别于麻醉诱导前（T1）、CPB开始后1h（T2）及CPB停止后1（T3）、24（T4）h抽取动脉血,用ELISA法检测血浆TNF-α、IL-8、IL-10水平。结果T2-T4时两组血浆TNF-α、IL-8和IL-10水平与CPB前比较,P均〈0．05;T2-T4时实验组血浆TNF-α和IL-8水平明显低于对照组（P〈0．05）,IL-10水平明显高于对照组（P〈0．05）。结论乌司他丁能抑制CPB过程中TNF-α和IL-8释放,促进IL-10的释放,有效降低由CPB引发的炎症反应。     

乌司他丁对老年心脏瓣膜置换病人全身炎症反应的影响

目的 探讨乌司他丁在体外循环期间人工机械瓣置换手术中对老年患者全身炎症反应的影响.方法 将20例老年单纯二尖瓣人工机械瓣置换病人随机分为对照组和实验组.实验组在麻醉诱导后开始恒速静脉输注乌司他丁6 000 U/kg(30 min内输完),然后以1 000 U·kg-1·h-1的速率持续静脉输注至手术结束;对照组则不使用乌司他丁.分别于麻醉诱导前(T1)、体外循环开始后1 h(T2)、体外循环停止后1 h(T3)、体外循环停止后24 h(T4)抽取动脉血,测定血浆肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-10(IL-10)浓度.结果 两组病人血浆TNF-α、IL-6和IL-10的浓度,在T2～T4各时点与体外循环前比较均明显增加(P＜0.05);T2～T4时点实验组血浆TNF-α和IL-6浓度明显低于对照组(P＜0.01), IL-10浓度明显高于对照组(P＜0.05).结论 乌司他丁能抑制体外循环过程中促炎细胞因子TNF-α和IL-6的释放,促进抗炎细胞因子IL-10的释放,从而减轻体外循环引起的全身炎症反应.     

乌司他丁对急性百草枯中毒肺损伤患者血清炎性因子水平的影响

目的探讨乌司他丁对急性百草枯中毒肺损伤患者血清炎性因子TNF-α与IL-6的影响。方法将35例急性百革枯中毒肺损伤患者随机分为乌司他丁组18例及对照组17例。两组均予洗胃、导泻、保护胃黏膜、血液灌流联合血液透析等常规治疗,乌司他丁组在此基础上静注乌司他丁,250kU／次,2次／d,连用5d。治疗前后采用双抗体夹心ELISA法检测两组血清TNF—α与IL-6水平并行肺损伤评分。结果两组治疗前血清TNF-α和IL-6水平均明显高于正常;治疗后血清TNF-α和IL-6水平及肺损伤评分均明显低于治疗前,且鸟司他丁组改善程度明显优于对照组（P均〈0．05）。结论乌司他丁用于急性百草枯中毒肺损伤患者能显著抑制炎性因子TNF-α和IL-6表达,减轻肺损伤。     

氨溴索、乌司他丁对体外循环心脏手术患者肺功能的保护作用及机制

目的观察氨溴索、乌司他丁对体外循环（CPB）心脏手术患者肺功能的保护作用,并探讨其机制。方法40例CPB下行瓣膜置换手术患者,随机分为氨溴索组（A组）、乌司他丁组（U组）、联合组（AU组）和对照组（C组）,每组10例。A组麻醉诱导后静脉滴注氨溴索0.5 mg/kg,U组在CPB过程中予1万U/kg乌司他丁,AU组联合应用上述两种药物;C组均未应用氨溴索及乌司他丁。分别在CPB前（T1）、CPB停止（T2）、CPB结束后2 h（T3）、CPB结束后4 h（T4）及CPB结束后18 h（T5）采集桡动脉血,测定血清白介素-6（IL-6）、白介素-8（IL-8）、白介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）,并通过血气分析计算呼吸指数（RI）和肺氧合指数（OI）。结果四组患者CPB后RI和OI较CPB前均有不同程度升高（P均〈0.05）;CPB后各时点A、U、AU组患者RI、OI均明显低于C组,AU组RI、OI明显低于其他3组（P均〈0.05）。四组患者血清中IL-6、IL-8、IL-10、TNF-α水平在T2开始升高并很快达到峰值,后逐渐下降,IL-6、IL-8和TNF-α直到术后18 h仍未降至术前水平（P均〈0.05）。与C组相比,CPB结束后各时点U组、AU组患者血清中IL-6、IL-8、IL-10、TNF-α水平明显减低（P均〈0.05）,AU组降低更加明显（P均〈0.05）。结论氨溴索、乌司他丁均可对CPB心脏瓣膜置换手术患者围术期肺功能起到保护作用。乌司他丁的肺保护作用与其抑制炎症因子的释放有关,从而减轻肺功能损伤,保护并改善术后肺功能。     

乌司他丁对体外循环心脏瓣膜置换术患者围术期IL-6和TNF—α的影响

目的探讨乌司他丁对体外循环（CPB）心脏瓣膜置换术患者围术期炎性反应的影响。方法将50例择期CPB下行心脏瓣膜置换术患者随机分为乌司他丁组和对照组各25例,两组麻醉及手术方法相同,术中乌司他丁组予乌司他丁1．2×10^4U／kg静滴,对照组予等量生理盐水;分别于麻醉诱导前（T1）、CPB开始后1h（T2）及CPB停止后1h（T3）、24h（T4）四个时点抽取动脉血,用ELISA法测定血清IL-6和TNF-α水平。结果两组T2～T4时点血清IL-6和TNF-α均显著高于T1,乌司他丁组T2-T4时点血清IL-6和TNF-α水平均明显低于对照组（P均〈0.05）。结论乌司他丁能减轻CPB心脏瓣膜置换术患者围术期全身炎症反应,有望减轻心、肺缺血再灌注损伤。     

乌司他丁减少放化疗后肺癌根治术患者肺损伤效应的临床研究

目的探讨乌司他丁对放化疗后肺癌患者肺损伤保护效果。方法选取45例放化疗后肺癌患者为研究对象,分为治疗组、对照组,治疗组行乌司他丁预注射,对照组给予生理盐水;对手术前后患者血气分析及各项炎性因子进行测定比较。结果与T0相比较,治疗组IL-6、IL-10、TNF-α浓度均升高;与对照组比较,治疗组IL-6、TNF-α浓度在各时刻均降低,上述差异均有统计学意义(P均0.05)。结论乌司他丁对放化疗后肺癌患者肺损伤保护效果好,炎性反应因子能有效抑制,手术前后呼吸、血液动力学指标稳定,同时预防术后肺缺血再灌注损伤及肺动脉高压。     

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.