阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化失代偿期的临床体会

目的对阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化失代偿期的临床疗效和药物安全性进行观察和探讨。方法将102例乙型肝炎肝硬化失代偿期患者随机分成两组：每组各51例。对两组都进行常规护肝及抗纤维化对症治疗,观察组在常规的基础上对其进行阿德福韦酯10mg/d和拉米夫定100mg/d的联合治疗,对照组在常规的基础上对其进行阿德福韦酯10mg/d的治疗,并对两组患者治疗后的各项疗效指标进行比较和观察。结果治疗48周时观察组的各项指标在改善程度上都比对照组组高,两组数据差异具有统计学意义（P〈0.05）。结论阿德福韦酯联合拉米夫定治疗乙型肝炎肝硬化失代偿期疗效显著,是理想的抗乙肝病毒药物,两种药物的联合使用可以增加抗毒效果,对患者预后能明显改善。     

乙型肝炎失代偿期肝硬化的抗病毒与中药灌肠联合治疗

目的观察抗病毒与中药灌肠联合治疗乙型肝炎失代偿期肝硬化患者的疗效,以寻求更佳的治疗方案,改善患者生活质量。方法60例乙型肝炎失代偿期肝硬化患者随机分为A、B、C3组。A组应用拉米夫定或阿德福韦酯并辨证施治,给予中药灌肠疗法,每日2次,疗程1个月。B组给予拉米夫定或阿德福韦酯。C组给予复方益肝灵、复方氨基酸、门冬酸钾镁、还原型谷胱甘肽等保肝支持疗法,酌情给予利尿剂、预防感染等对症治疗。观察肝功能、凝血功能、HBVDNA定量、HBV表面标志物及Child-Pugh评分、临床结局和药物不良反应。结果治疗后3组就上述指标进行比较,A组较B、C组疗效好,差异有显著性;只有A组发生2例HBeAg／HBeAb血清学转换;A组和B组临床结局好转率均为100％,3组均无药物不良反应发生。结论抗病毒与中药灌肠联合治疗乙型肝炎失代偿期肝硬化有协同作用,安全有效,可明显改善肝功能,提高生活质量,明显优于单独抗病毒和仅保肝对症治疗。     

核苷（酸）类似物对失代偿性乙型肝炎肝硬化长期预后的影响

目的评价核苷（酸）类似物对失代偿性乙型肝炎肝硬化患者长期预后的影响。方法选取53例失代偿性乙型肝炎肝硬化患者,在常规护肝、对症治疗的同时,每天口服拉米夫定（100mg/d）、阿德福韦酯（10mg／d）或恩替卡韦（0．5mg／d）。另选取同时期仅行常规护肝、对症治疗的41例失代偿性乙型肝炎肝硬化患者为对照组。发生肝癌、肝移植、死亡或拒绝继续治疗者停止随访。随访结束时分析比较2组治疗前后血清肝功能指标和Child—Push分级的变化及临床结局。结果治疗组ALT、AST、球蛋白（Glb）和TBil均较治疗前下降,Alb及胆碱酯酶（CHE）较治疗前升高,43例（81．1％）患者的Child-Pugh分级下降。对照组治疗前后ALT、AST、Glb和TBil变化差异无统计学意义,但CHE较治疗前明显降低,差异有统计学意义（t=5．225,P〈0．01）。2组Child-Pugh分级变化差异有统计学意义（x^2=52.16,P〈0．01）,治疗组明显好于对照组。治疗组与对照组发生肝癌比例分别为0．0％和19．5％,差异有统计学意义（x^2=23．07,P〈0．01）,但在病死率及需要接受肝移植的比例方面2组的差异不明显。结论核苷（酸）类似物长期治疗失代偿性乙型肝炎肝硬化可以改善患者肝功能状况,改善患者的预后,并有可能降低肝癌的发生机会。     

拉米夫定和(或)阿德福韦酯治疗失代偿期乙型肝炎肝硬化3年疗效观察

目的 观察拉米夫定和(或)阿德福韦酯治疗失代偿期乙型肝炎肝硬化3年疗效.方法 收集乙型肝炎肝硬化失代偿期患者68例,分为抗病毒治疗组和对照组,观察入组患者的临床症状、体征、生化指标、HBV DNA和Child-Pugh分级等变化情况.结果 随访治疗中,治疗组6个月后ALT、ALB和HBV DNA水平均较对照组有明显改善,12个月后TBil和Child-Pugh评分较对照组有明显改善,差异具有统计学意义(P<0.05);治疗组和对照组36个月生存率分别为62.5%和36.1%,差异具有统计学意义(P< 0.05);36个月后治疗组和对照组肝细胞癌发生率分别为3.1%和8.3%,差异无统计学意义.结论 拉米夫定和(或)阿德福韦酯治疗失代偿期乙型肝炎肝硬化,能够改善患者肝功能,延缓疾病进展,提高生存率.     

阿德福韦酯联合苦参素胶囊治疗乙型肝炎肝硬化疗效观察

目的 观察阿德福韦酯联合苦参素胶囊治疗乙型肝炎肝硬化疗效以及对患者HBV DNA载量的影响.方法 260例乙型肝炎肝硬化患者随机分为治疗组和对照组.治疗组140例给予阿德福韦酯10 mg/次,1次/d,苦参素胶囊每次0.3 g,3次/d口服;对照组120例给予苦参素胶囊每次0.3 g,3次/d 口服.两组疗程均为48周.每12周检测1次患者肝功能、乙型肝炎病毒血清学标志物及HBV DNA载量.结果 治疗组用药48周后HBV DNA低于检测下限的比率及ALT复常率显著优于对照组.结论 阿德福韦酯联合苦参素胶囊治疗乙型肝炎肝硬化疗效较好,建议长期服用.     

阿德福韦酯治疗失败的乙型肝炎肝硬化患者联合恩替卡韦优化治疗的疗效分析

抗病毒治疗是HBV相关肝病的治疗关键已成为医学界的共识。阿德福韦酯（adefovir dipivoxil,ADV）因相对廉价、耐药率低等特点,在我国广泛应用于慢性乙型肝炎及乙型肝炎肝硬化初始抗病毒治疗及核苷（酸）类似物（如拉米夫定、替比夫定和恩替卡韦等）治疗失败后的优化治疗[1-2].对于活动性乙型肝炎肝硬化患者来说,由于肝功能储备较差,抗病毒治疗更显必要及紧迫。     

乙型肝炎肝硬化并脾亢脾部分栓塞术后阿德福韦酯疗效分析

目的观察乙型肝炎肝硬化并脾功能亢进患者行脾部分栓塞术后阿德福韦酯疗效。方法41例乙型肝炎肝硬化并脾功能亢进患者行脾部分栓塞术治疗后,21例口服阿德福韦酯10mg／d,疗程1年,对照组20例常规护肝、降酶等对症治疗。观察两组患者肝功能、血清肝纤维化指标、HBVDNA、HBeAg／抗．HBe血清学变化、Child-Pugh分级比较和不良反应。结果治疗组ALT、AST、TBil、ALB各项指标优于对照组,血清肝纤维化HA、PC-Ⅲ、Ⅳ—C各项优于对照组,治疗组HBVDNA转阴11例,对照组转阴1例,差异有统计学意义（Χ^2=8．5,P〈0．05）。治疗组发生HBeAg／抗．HBe血清转换者4例,对照组1例,差异有统计学意义（Χ^2=3．2,P〈0．05）。治疗组Child．Pugh分级为A级者9例,B级10例,C级2例;对照组A级6例,B级7例,C级7例,差异有统计学意义（Χ^2=5．9,P〈0．05）。阿德福韦酯治疗组未发现相关的肾功能损害和其他不良反应。结论乙型肝炎肝硬化并脾功能亢进患者行脾部分栓塞术治疗,脾功能亢进可获得明显改善,但不能阻止乙型肝炎肝硬化病情进展,脾栓塞术后采用阿德福韦酯是较理想的长期抗病毒药物。     

核苷（酸）类药物初始治疗乙型肝炎肝硬化患者的临床疗效比较

目的分析不同核苷（酸）类似物初始治疗乙型肝炎肝硬化的临床疗效。 方法选取2010年8月至2013年8月于河北医科大学第三医院感染科诊断为乙型肝炎肝硬化的患者共218例,随机分为拉米夫定联合阿德福韦酯治疗组（LA组）、替比夫定联合阿德福韦酯组（TA组）、恩替卡韦单药治疗组（EN组）和对照组。分别给予不同抗病毒治疗,持续48周后检测患者相关肝功能以及肝硬化指标并进行综合评价。 结果经48周的治疗,四组患者的肝功能均有一定程度改善,抗病毒治疗的患者优于对照组,而LA和TA两组联合治疗方式优于EN组单药治疗,差异均有统计学意义（F = 9.775、10.148,P = 0.012、0.008）;四组患者的病毒复制均有所降低,抗病毒治疗的患者优于对照组,而LA组和TA组两组联合治疗方式优于EN组单药治疗,差异均具有统计学意义（F = 11.275、12.198、15.645,P = 0.037、0.016、0.003）;四组患者的肝硬化程度亦有所降低,抗病毒治疗的患者优于对照组,而LA组和TA组两组联合治疗方式优于EN组单药治疗,差异均具有统计学意义（F = 13.534、11.009、12.756,P = 0.015、0.022、0.019）。 结论使用不同核苷（酸）类似物进行抗病毒治疗后,乙型肝炎肝硬化患者的肝功能以及肝硬化程度有明显改善,且联合用药优于单药治疗。     

恩替卡韦单药与拉米夫定及阿德福韦酯联合治疗慢性乙型肝炎初治患者疗效的Meta分析

目的比较恩替卡韦单药与拉米夫定及阿德福韦酯联合治疗慢性乙型肝炎初治患者的疗效及安全性。方法检索2014年9月之前在Pub Med、Web of Knowledge和中国全文期刊数据库(CNKI)等数据库公开发表的有关恩替卡韦单用及拉米夫定联合阿德福韦酯治疗慢性乙型肝炎初治患者的临床研究,提取数据资料,运用Rev Man 5.0软件进行Meta分析。结果共入选9个研究(包括710患者);各时点(12周/3月、24周/6月、48周/12月及96周/24月)两组的HBV DNA低于检测下限的比率、丙氨酸氨基转移酶复常率、病毒学突破率及耐药基因突变率、药物不良反应发生率差异均无统计学意义,治疗48周/12月、96周/24月联合组的HBe Ag血清学转换率均高于单药组(RR=0.55,95%CI:0.31~0.99,P=0.05;RR=0.37,95%CI:0.22~0.63,P=0.0002)。结论恩替卡韦单药与拉米夫定及阿德福韦酯联合治疗慢性乙型肝炎初治患者的疗效相似,且均有良好的安全性,但拉米夫定及阿德福韦酯联合治疗方案可使慢性乙型肝炎初治患者更快实现HBe Ag的血清学转换,获得更高的HBe Ag血清学转换率。     

YMDD变异与ALT、HBeAg及HBV DNA的相关性分析

目的 研究乙型肝炎病毒P基因突变在乙型肝炎患者治疗中的临床意义,为其诊断和治疗提供依据.方法 选择接受拉米夫定治疗的慢性乙型肝炎(CHB)患者,进行血清YMDD检测且出现病毒学反弹的68例CHB患者为研究对象,将治疗前HBV DNA载量、ALT水平、免疫标志物和变异后HBV DNA载量、ALT的情况分别进行比较分析.结果 68例患者中,YMDD变异者42例,其中YIDD变异者30例,YVDD变异者8例,YIDD和YVDD混合变异者4例,YMDD变异的检出率为61.8%.YMDD变异组治疗前的ALT水平显著低于YMDD野生组(P＜ 0.05);YMDD变异组与YMDD野生组治疗前的HBV DNA水平差异无统计学意义(P＞ 0.05);YMDD变异组与YMDD野生组治疗前HBeAg阳性率比较差异具有统计学意义(P＜ 0.05);YIDD变异组患者治疗后的HBV DNA水平显著低于治疗前(P＜ 0.05),YVDD变异组患者治疗后的HBV DNA水平与治疗前比较差异无统计学意义(P＞ 0.05),YIDD变异组与YVDD变异组治疗后的HBV DNA水平差异无统计学意义(P＞ 0.05);YMDD变异组的患者治疗后与治疗前ALT水平差异无统计学意义(P＞ 0.05).结论 CHB患者接受拉米夫定治疗期间应定期监测肝功能和HBV DNA水平以及时发现是否存在YMDD变异,采取补救措施,提高疗效.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

目的 评价脊髓胶质细胞在小鼠骨癌痛形成中的作用.方法 健康雄性C3H/He小鼠40只,周龄8～10周,体重18～22 g,随机分为4组(n=10):假手术组(S组)、骨癌痛组(B组)、PBS组(P组)和米诺环素组(M组).S组跟骨骨髓腔内注射PBS 10 μl;余3组跟骨骨髓腔内注射含2×105个骨纤维肉瘤细胞的PBS 10 μl制备骨癌痛模型,于造模前即刻开始PBS组鞘内注射PBS 5μl,M组鞘内注射米诺环素(用PBS溶解为0.2 mmol/L)5μl,1次/d,连续11 d.于造模前1 d、造模后即刻、3、5、7、9、11 d时测定机械痛阈;于造模后3、7、9、11 d机械痛阈测定结束后测定冷痛阈.痛阈测定结束后处死小鼠,取脊髓组织,测定神经胶质纤维酸性蛋白(GFAP)和CD11b的表达水平.结果 与S组比较,B组和P组造模后3-11 d时、M组造模后3、5 d时机械痛阈升高,B组、P组和M组造模后7～11 d时冷痛阈升高,脊髓CD11b和GFAP表达上调(P<0.05).与B组比较,M组造模后3-11 d时机械痛阈降低,造模后7-11 d时冷痛阈降低,脊髓CD11b和GFAP表达下调(P<0.05).结论 脊髓胶质细胞(星形胶质细胞和小胶质细胞)的激活参与了小鼠骨癌痛的形成.     

脊髓胶质细胞在大鼠炎性痛形成中的作用

目的 评价脊髓胶质细胞在大鼠炎性痛形成中的作用.方法 清洁Ⅱ级成年雄性SD大鼠,体重180～220 g,取蛛网膜下腔置管成功的大鼠65只,随机分为5组(n=13),生理盐水组(NS组):右后肢踝关节外侧皮下注射NS 50μl;炎性痛组(IP组):采用右后肢踝关节外侧皮下注射完全弗氏佐剂50μl的方法制备炎性痛模型;氟代柠檬酸组(FC组):经蛛网膜下腔导管注射FC 1 nmol/10 μl,15 min后右后肢踝关节外侧皮下注射NS 50 μl;NS+IP组:经蛛网膜下腔导管注射NS 10 μl,15 min后制备炎性痛模型;FC+IP组:经蛛网膜下腔导管注射FC 1 nmol/10 μ,15 min后制备炎性痛模型.于模型制备前2 d(T_0)、皮下注射药物前(T_1)和注射药物后2、4、6、8、10、12、24、26 h(T_(2～9))时测定机械缩足阈值(MWT)和热缩足潜伏期(TWL).皮下注射药物后8 h时采用免疫组化法测定脊髓背角星形胶质细胞标记物(GFAP)和小胶质细胞标记物(OX-42)的表达水平.结果 与NS组比较,IP组和NS+IP组T_(3～9)时MWT和TWL降低,FC+IP组T_(3～9)时MWT降低,T_(8,9)时TWL降低,IP组、NS+EP组和FC+EP组脊髓GFAP和OX-42的表达水平均上调(P<0.05);与IP组比较,FC组T_(3～9)时MWT和TWL升高,FC+IP组T_(3～7)时MWT和TWL升高,2组脊髓GFAP和OX-42的表达水平均下调(P<0.05或0.01).结论 脊髓胶质细胞的活化参与了大鼠炎性痛的形成.     

脊柱侧凸顶椎区椎间盘纤维环中多聚蛋白多糖的表达及意义

目的：探讨脊柱侧凸患者顶椎区椎间盘纤维环中多聚蛋白多糖的表达及其意义。方法：采集2003年7月至2004年9月间行前路松解或矫形手术的40例脊柱侧凸患者侧凸顶椎区椎间盘组织。青少年特发性脊柱侧凸患者（adolescent idiopathic scoliosis，AIS）25例，胸椎椎间盘11例，腰椎椎间盘14例；先天性脊柱侧凸患者（congenital scoliosis，CS）15例，胸椎椎间盘6例，腰椎椎间盘9例。利用RT—PCR扩增多聚蛋白多糖（Aguecan），琼脂糖凝胶电泳，在UVP（紫外光测定法）成像系统进行扫描．GelWork图像分析系统中进行灰度测定半定量分析。分别计算AIS组和CS组凹侧、凸侧纤维环中Aggrecan含量，并对CS组和AIS组胸椎和腰椎以及椎间盘的凹侧和凸侧进行比较。结果：AIS组和CS组椎间盘凹侧纤维环中Aggrecan含量低于凸侧．差异有显著性（P〈0．01），胸椎椎间盘纤维环中Aggrecan的含量低于腰椎，但无统计学差异。AIS组Aggrecan的含量和CS组相应部位Aggrecan的含量无明显差别。结论：AIS椎间盘纤维环凹凸侧存在Aggrecan代谢差异．并且可能是脊柱侧凸所致的继发改变．但也可能是脊柱侧凸发生、发展中的重要因素。     

沈阳男性髋部骨折多于女性原因探讨

为找出沈阳地区髋部骨折发生男性多于女性的原因，探索该病在不发达国家或地区的流行特点，我们再次通过查阅病例记录，对沈阳市１９９４年５０岁以上人口的部分髋部骨折病发生的原因进行了较详细的调查分析。共调查分析２６６髋部骨折病例，其中男１６３例，女１０３例。损伤原因记为单纯摔倒（滑倒或绊倒）、骑自行车摔倒、自行车撞倒、机动车事故和高位跌下（滚楼梯或从较高位置掉下）。结果表明：男女在髋部骨折伤因构成上有差别（Ｐ＝０．００４）。女性髋部骨折的大多数（７０％）是由单纯摔倒引起，而在男性则不足一半（４９％），即男性髋部骨折的一半以上不是由于单纯摔倒而是由各种意外事故造成的（Ｐ＝０．０００８）。在各种意外事故中，男性骑自行车摔倒引起骨折的频率（２８％）明显高于女性（１０％）。除了骑自行车摔倒外，男性由自行车撞倒和高位跌下引起骨折的频率稍高于女性，但无太大差别。机动车事故造成骨折的频率男女基本一致。此结果在一定的程度上说明，１９９４年沈阳５０岁以上的男性髋部骨折发病率高是由于男性发生的各种意外事故多，尤其是骑自行车引起的事故造成的。     

标准化患者在评估麻醉临床型研究生术前访视能力中的应用

目的 在现有的研究生培训体系中,术前访视能力缺少有效的评估方法。本研究拟评价标准化患者(standardized patients, SP)情景模拟在术前访视能力评估中的可行性和有效性。方法 将SP情景模拟整合到多站式考核的术前访视考核站点中,对我院第二、第三年麻醉临床型研究生进行考核。考核过程中由SP和2名现场考官分别对考生进行评分,评分方法采用一个核查表评估术前访视的内容,采用一个量表评估病史采集技巧、交流技巧及人文素养的能力,同时由现场考官对SP的表现进行打分。考核结束后,另一名考官通过回顾视频对考生和SP的表现进行打分。SP与考官打分采用Pearson相关性分析。结果 在量表评估中,病史采集技巧评分(r=0.701,P<0.001)、交流技巧评分(r=0.752,P<0.001)和人文素养评分(r=0.595,P<0.001)在SP与考官之间均存在良好的相关性。在核查表评估中,SP评分与考官评分也具有良好的相关性(r=0.718,P<0.001)。结论 标准化患者情景模拟能够为麻醉临床型研究生术前访视过程中非技术技能的考核提供一种直观可靠的方法。     

Evaluation of Role of Arterialization of Venous Flaps in Abdomen in Rats

Introduction  Reconstruction forms the primary tenet in plastic surgery. Venous flaps are a known option but the survival is limited. Arterialization of venous flap can enhance its survival. While various techniques of arterialization of venous flaps are described, there are very few studies comparing them. Material and methods  The current study was conducted among 34 rats weighing 160 to 200 grams. The rats were divided into four groups. Group I—islanded epigastric flap was raised with superficial caudal epigastric vessels as pedicle. Group II—arterialized flow through venous flap was raised with superficial caudal epigastric vein (SCEV) as afferent and lateral thoracic vein as drainage vein. Side-to-side anastomosis was done between femoral artery and vein, lateral to the origin of superficial caudal epigastric artery. Group III—after raising the flap, as in group II, femoral vein was ligated proximal to superficial caudal epigastric vessels. Group IV—an arterialized flow through venous flap was raised with superficial caudal epigastric vein as afferent and lateral thoracic vein as drainage vein. End-to-side anastomosis was done between femoral artery and superficial caudal epigastric vein. Animals that died before completion of the study were excluded. The color changes of flaps were noted. Flap survival was expressed as a percentage of the total flap surface area. The patency of anastomosis was seen on postoperative day 5. Results  There was no total flap failure. On statical analysis, the flap survival area on day 5 between Group I and Group IV was not significant ( p value 0.431). The survival area in Group I (78.85 ± 10.54%) was comparable to Group IV (65.71 ± 20.70%). Group II and III had poor results as compared with Group I. In four rats, thrombosis of arteriovenous anastomosis was noted with flap survival area of 30 to 33%. Conclusion  It was noted that epigastric venous flaps with end-to-side anastomosis between femoral artery and superficial caudal epigastric vein (group IV) have survival area comparable to islanded flaps.     

Effect of dantrolene in an in vivo and in vitro model of myocardial reperfusion injury

BACKGROUND: In skeletal muscle, dantrolene reduces free cytosolic calcium by inhibiting calcium release from the sarcoplasmic reticulum. A similar effect in ischemic-reperfused heart cells would protect myocardial tissue against reperfusion injury. We tested the hypothesis that dantrolene infusion during reperfusion protects the heart against reperfusion injury. METHODS: Isovolumetric beating rat hearts were subjected to 30 min of ischemia followed by 60 min of reperfusion. Left ventricular (LV) developed pressure (LVDP) and creatine kinase release (CKR) were determined as indices of myocardial performance and cellular injury, respectively. In the treatment groups, dantrolene (25 (DAN25) or 100 (DAN100) micromol l(-1)) was infused during the first 15 min of reperfusion; control hearts received the respective concentration of the vehicle (mannitol (CON25, CON100), each group n=7). To investigate the effects of dantrolene on reperfusion injury in vivo, 18 chloralose-anesthetized rabbits were subjected to 30 min occlusion and 180 min reperfusion of a major coronary artery. LV pressure (LVP), cardiac output (CO), and infarct size were determined. During the last 5 min of ischemia, nine rabbits received 10 mg kg(-1) dantrolene intravenously (DAN). Another nine rabbits received the vehicle (dimethylsulfoxide) and served as controls (CON). RESULTS: In isolated rat hearts, there was no recovery of LVDP in any group. Total CKR during 1 h of reperfusion was 845+/-76 (CON100) and 550+/-81 U g(-1) dry mass (DAN100, P<0.05). In rabbits in vivo, hemodynamic baseline values were similar between groups (CON vs. DAN: LVP, 99+/-6 (mean+/-SEM) vs. 91+/-6mm Hg, P=0.29; CO, 252+/-26 vs. 275+/-23 ml min(-1), P= 0.53). During coronary artery occlusion, LVP and CO were reduced in both groups (CON: LVP, 89+/-3%; CO, 90+/-5% of baseline values) and LVP did not recover to baseline values during reperfusion (51+/-5% (CON) vs. 67+/-7% (DAN) of baseline, P=0.10). Infarct size was 41+/-4% of the area at risk in controls and 37+/-6% in dantrolene treated hearts (P=0.59). CONCLUSIONS: Dantrolene reduced CKR, indicating an attenuation of lethal cellular reperfusion injury in isolated rat hearts. However, in the rabbit in vivo, there was no effect on the extent of reperfusion injury after regional myocardial ischemia.     

脊髓背角卡配因在大鼠足底炎性痛形成中的作用

目的 探讨脊髓背角卡配因在大鼠足底炎性痛形成中的作用.方法 雄性SD大鼠48只,6周龄,体重160～200 g,采用随机数字表法,将其随机分为3组:正常对照组(C组,n=8)、PBS组(n=16)和酵母多糖诱发足底炎性痛组(Z组,n=24).Z组于大鼠左侧后足足底皮下注射酵母多糖1.25 mg,制备酵母多糖诱发足底炎性痛模型,PBS组给予等容量PBS 100μl.分别于给药前(T0)、给药后30 min(T1)、1 h(T2)、2 h(T3)、4 h(T4)、8 h(T5)、24 h(T6)和48 h(T7)时测定左侧后足机械刺激缩足阈值(MWT)、热缩足反应潜伏期(PWTL)和左侧后足足底最大厚度.PBS组于T4时处死8只大鼠,Z组分别于T4、T6和T7时各处死8只大鼠,取左侧脊髓L4～6节段,采用Western blot法测定脊髓背角spectrin αⅡ降解产物、IκBα、环氧化酶-2(COX-2)的表达和NF-κB活性.结果 与C组比较,Z组MWT降低,PWTL缩短,足底最大厚度增厚,脊髓背角spectrin αⅡ降解产物和COX-2的表达上调,IκBα表达下调,NF-κB活性升高(P＜0.05或0.01),PBS组上述指标差异无统计学意义(P＞0.05).结论 脊髓背角卡配因活化参与了大鼠足底炎性痛的形成,其机制与激活NF-κB,上调COX-2表达有关.     

Trends in the prevalence of Helicobacter pylori in symptomatic children in the era of eradication

Purpose

Helicobacter pylori infection is common in Asia and is associated with dyspepsia, peptic ulcer, and gastric cancer. Eradication of the organism remains an important goal. Here, we looked at the trends in the prevalence of H pylori in symptomatic children over an 8-year period to assess the impact of an aggressive eradication program.

Method

A retrospective review was carried out between 1997 and 2004. All children with a history of dyspepsia or acute gastrointestinal bleeding were included and underwent gastroscopy. Three antral biopsies were taken during endoscopy and sent for histological analysis. Positivity of H pylori was treated aggressively with quadruple therapy under protocol. The demographic data, the histological findings, and the H pylori status were recorded.

Results

There were a total of 159 patients (71 males, 88 females) who underwent gastroscopy in this period. One hundred nineteen patients showed histological evidence of gastritis, and the positive rate of H pylori was 25.6%. The overall prevalence has not decreased (33.3% in 1997, 27.7% in 2004). Increasing age, however, was associated significantly with the higher risk of H pylori infection.

Conclusion

H pylori has a high prevalence in Chinese children with increasing age. Eradication efforts seem to be unsuccessful in the reduction of prevalence. We hypothesize that this may be owing to cross-infection at meal times from sharing chopsticks.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.