N末端B型钠尿肽前体对高龄急性冠状动脉综合征患者预后评估的价值

目的探讨血浆N末端B型钠尿肽前体(NT-proBNP)对高龄急性冠状动脉综合征(ACS)患者病情及预后评估的价值。方法回顾性选择2011年1月～2016年1月中国医学科学院阜外医院因ACS住院治疗的高龄患者338例,根据NT-proBNP水平分为高水平组84例(NT-proBNP≥1228.7 ng/L)和低水平组(NT-proBNP1228.7 ng/L)254例。检测基线NT-proBNP水平,计算全球急性冠状动脉事件注册(GRACE)评分。观察出院后1年及长期随访期间主要不良心血管事件(MACE)发生情况。结果高水平组NT-proBNP、GRACE评分、GRACE评分高危比例明显高于低水平组,差异有统计学意义(P0.01)。Spearman相关性分析显示,NT-proBNP水平与高龄ACS患者GRACE评分呈正相关(r=0.341,P0.01)。ROC曲线分析显示,NT-proBNP能预测高龄ACS患者短期和长期MACE风险(P0.05,P0.01)。短期随访中发生MACE 24例(7.4%),长期随访中发生MACE 152例(49.2%)。Kaplan-Meier生存曲线显示,高水平组短期及长期随访MACE累积发生率明显高于低水平组,差异有统计学意义(P_(log rank)0.01)。多因素Cox回归分析显示,调整相关因素后,高水平NT-proBNP与高龄ACS患者短期及长期随访MACE发生风险独立相关(HR=2.841,95%CI:1.172～6.884,P=0.021;HR=1.653,95%CI:1.138～2.399,P=0.008)。结论高水平NT-proBNP是高龄ACS患者短期及长期MACE的独立预测因素。     

内源性促红细胞生成素对急性心肌梗死长期预后的预测价值

目的探讨初发急性ST抬高型心肌梗死(STEMI)患者,直接经皮冠状动脉介入治疗(PCI)后,入院时血清内源性促红细胞生成素(EPO)水平对长期预后的预测价值。方法入选2013年9月~2014年9月于郑州大学附属洛阳中心医院初发STEMI患者163例,随访时间(19.1±2.8)月,随访终点为发生主要不良心血管事件(MACE),包括:心力衰竭再住院、心肌梗死、卒中、心源性死亡。对MACE组和无MACE组临床随访资料进行统计分析。结果 MACE组肌酸激酶(CK)峰值显著高于无MACE组,血清EPO水平和梗死前心绞痛发生率显著低于无MACE组(P均0.05);Cox回归分析显示,血清EPO低于中位数(HR=3.504,95%CI:1.548~7.935,P=0.003)和CK峰值高于中位数(HR=7.456,95%CI:2.001~27.776,P=0.003)是MACE发生的独立危险因素;ROC曲线显示,以血清EPO切点界值17.6IU/L预测MACE,曲线下面积为0.816(95%CI:0.741~0.891,P0.001),预测价值优于CK峰值;LogRank检验显示血清EPO与无MACE生存率有显著统计学意义(χ2=6.095,P=0.014)。结论初发STEMI患者直接PCI术后,血清内源性EPO是MACE发生的独立危险因素,对患者长期预后有一定的预测价值。     

高龄急性ST段抬高型心肌梗死行直接经皮冠状动脉介入治疗患者的预后分析

目的探讨行直接经皮冠状动脉介入治疗(PPCI)的高龄急性ST段抬高型心肌梗死(STEMI)患者的病史特点及预后的影响因素。方法入选因STEMI就诊于大连医科大学附属第一医院并行PPCI的高龄(年龄≥75岁)患者共292例。收集患者的基线资料及住院期间的相关信息。一级研究终点为PPCI术后1年内的全因死亡;二级研究终点为PPCI术后1年内的主要不良心血管事件(MACE),包括死亡、再次血运重建、因心力衰竭再次入院治疗及新发卒中;安全终点为PPCI术后1年内开通闭塞冠状动脉策略的全球性研究(GUSTO)出血事件(包括轻微出血、中度出血及重度出血)。结果高龄STEMI患者PPCI术后1年内死亡37例(12.7%),发生MACE 125例(42.8%),发生GUSTO出血事件55例(18.8%)。Cox多因素回归分析显示:一级研究终点Killip心功能分级(HR 2.074,95%CI 1.377～3.125,P0.001)是患者死亡的独立危险因素,估算的肾小球滤过率(HR 0.978,95%CI 0.957～0.999,P=0.040)、血管紧张素转换酶抑制药/血管紧张素Ⅱ受体拮抗药(ACEI/ARB)(HR 0.333,95%CI 0.113～0.981,P=0.046)是独立保护因素;二级研究终点Killip心功能分级(HR 1.638,95%CI 1.339～2.004,P0.001)是患者发生MACE的独立危险因素,左心室射血分数(LVEF)(HR 0.943,95%CI 0.923～0.963,P0.001)、β阻滞药(HR0.610,95%CI 0.390～0.953,P=0.030)是独立保护因素。安全终点Killip心功能分级(HR 1.866,95%CI1.511～2.305,P0.001)是患者出血的独立危险因素,LVEF(HR 0.991,95%CI 0.983～0.999,P=0.022)、估算的肾小球滤过率(HR 0.610,95%CI 0.390～0.953,P=0.030)是独立保护因素。结论心功能与高龄STEMI患者行PPCI预后关系密切。Killip心功能分级是患者预后不良的独立危险因素,LVEF、ACEI/ARB、β阻滞药是患者术后1年内发生死亡、MACE或出血事件的独立保护因素。估算的肾小球滤过率是高龄STEMI患者PPCI术后1年内死亡的保护因素,也是死亡及出血事件的独立保护因素。     

急性冠状动脉综合征类型对老年患者介入治疗远期预后的影响

目的比较不同类型急性冠状动脉综合征(acute coronary syndrome, ACS)对60岁以上老年患者行经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的远期预后影响。方法连续纳入2013年1月至12月在中国医学科学院阜外医院行PCI治疗、年龄≥60岁的ACS患者,根据ACS类型分为ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI,n=540)组和非ST段抬高型急性冠状动脉综合征(non-ST-segment elevation acute coronary syndrome,NSTEACS,n=2314)组。术后随访2年,记录主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular events,MACCE,包括全因死亡、心源性死亡、心肌梗死、血运重建、脑卒中)。两组间进行倾向性评分匹配,并采用Cox回归方法比较MACCE的独立危险因素。根据年龄、性别、左心室射血分数(left ventricular ejection fraction,LVEF)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、是否三支病变等进行亚组分析。结果两组的基本特点、冠状动脉病变及介入治疗情况差异显著。与NSTEACS组相比,STEMI组患者1年、2年的全因死亡,MACCE风险显著升高(P0.001)。Kaplan-Meier生存分析显示,STEMI患者1年全因死亡风险高,而第二年死亡风险升高不明显,NSTEACS患者1年和2年全因死亡风险差异不显著。多因素Cox回归分析显示,STEMI是全因死亡(HR=2.68,95%CI:1.55-4.63,P0.001)、心源性死亡(HR=3.08,95%CI:1.52-6.25,P=0.002)的独立危险因素;而倾向性评分匹配后,两组的MACCE无显著差异,STEMI也不再是MACCE的预测因素;而年龄增加、LVEF40%是全因死亡和心源性死亡的独立危险因素。亚组分析结果显示:老年女性STEMI患者全因死亡风险显著高于男性患者(交互检验P值=0.023),而高龄、心功能减低、三支病变及肾功能减低的老年患者,ACS类型不影响全因死亡风险。结论 STEMI患者1年、2年全因死亡和MACCE风险高于NSTEACS患者。STEMI是全因死亡和MACCE的独立危险因素;倾向性评分匹配后,STEMI不再是全因死亡、心源性死亡和MACCE的独立危险因素。老年女性STEMI患者的全因死亡风险显著高于男性。高龄增加老年患者的死亡风险,但其作用与ACS类型无关。     

高Glasgow预后评分与急性冠脉综合征患者的全因死亡率和心血管死亡率独立相关

目的：探讨Glasgow预后评分（GPS）与急性冠脉综合征（ACS）患者不良临床预后的关系。方法：收集2016年6月至2018年6月海口市人民医院收治的ACS患者593例。本研究中，高GPS定义为GPS≥1。593例ACS患者分为2组：GPS=0组（424例，71.5%）和GPS≥1组（169例，28.5%）。不良预后为12个月的全因死亡和心血管死亡率、卒中、支架血栓形成和靶血管重建。使用逆处理概率加权（IPTW）分析来调整潜在的混杂协变量，并用Kaplan-Meier曲线表示事件发生率。结果：593例患者中位随访1.7年。GPS=0和GPS≥1的患者不良预后发生率分别为4%和8.9%。Kaplan-Meier曲线分析显示，GPS≥1组的不良预后和全因死亡率在1个月内显著高于GPS=0组（P均<0.001）。IPTW分析显示：高GPS与较高的不良预后发生率（HR:2.206；95%CI:1.085~4.486；P=0.029）、较高的全因死亡率（HR:5.963；95%CI:2.068~17.190；P<0.001）和较高的心血管死亡率（HR:6.122；95%CI:1.882~19.914；P=0.003）独立相关。结论：高GPS与ACS患者的全因死亡和心血管死亡率独立相关。GPS有助于预测ACS患者的死亡率。     

心电图异常对预测扩张型心肌病致慢性心力衰竭患者的预后意义

目的:评价12导联心电图对扩张型心肌病致慢性心力衰竭(心衰)患者预后的预测作用。方法:前瞻性、多中心随访787例扩张型心肌病致慢性心衰患者。通过门诊随诊或电话、信件随访慢性心衰患者的终点事件。用Cox风险比例回归分析确定全因死亡的独立预测因子,对QRS时限是否大于120 ms等心电图指标用Kaplan-Meier曲线进行生存分析(log-rank检验)。结果:随访过程中203例死亡。经Cox回归分析发现心房颤动与全因死亡有关[风险比(HR)=2.064;95%可信区间(CI):1.102~3.864,P0.05];非持续性室性心动过速与全因死亡有关[HR=3.887;95%CI:1.554~9.724,P0.05];QRS时限与全因死亡有关[HR=1.010;95%CI:1.002~1.018,P0.05]。Kaplan-Meier生存曲线分析显示,以QRS时限分层,不同水平的QRS时限其生存率之间的差异具有统计学意义(P0.05)。结论:对扩张型心肌病致慢性心衰患者生存率有影响的心电图指标是心房颤动、非持续性室性心动过速和QRS时限;不同水平QRS时限与生存率之间存在显著差异。     

平均血小板体积/血小板计数比值对冠心病PCI术后临床结局的影响

目的探讨血小板平均体积(MPV)/血小板计数(PC)比值与接受经皮冠状动脉介入治疗(PCI)的冠心病患者长期预后的关系。方法采用回顾性队列研究,选取2008年1月—2016年12月在新疆医科大学第一附属医院诊治的冠心病PCI术后患者的一般资料,包括入院血小板参数、生化数据、心血管疾病相关危险因素等资料。设定随访终点:全因死亡(ACM)、心血管死亡(CM)、出血事件、主要不良心血管事件(MACE),并进行电话随访。最终纳入6 046例患者,选取患者入院MPV/PC比值,利用ROC曲线评估患者MPV/PC值的最佳临床截点后进行分组,应用多因素Cox回归分析比较不同组别与远期预后的相关性。结果基线资料分析表明,与MPV/PC低值组相比,MPV/PC高值组全因死亡率(6.4%比4.5%,P=0.001)、心源性死亡率(5.6%比3.4%,P0.001)、MACE事件发生率(15.8%比11.5%,P0.001)显著升高。多因素Cox回归分析显示,与MPV/PC低值组相比,MPV/PC高值组全因死亡风险增加46.6%(HR=1.466,95%CI:1.159～1.852,P=0.001),心源性死亡增加64.7%(HR=1.647,95%CI:1.271～2.137,P0.001),MACE发生率增加31.8%(HR=1.318,95%CI:1.138～1.527,P0.001)。结论 MPV/PC比值升高显著增加PCI术后不良事件的发生率,其水平的升高是全因死亡及心源性死亡的独立危险因素。     

餐后低血压对高龄老年人远期预后的影响

目的研究餐后低血压(postprandial hypotension,PPH)对高龄老年人远期预后的影响。方法连续入选2011年5月1日～2012年10月30日解放军联勤保障部队第九二四医院干部病房住院的高龄PPH患者78例(PPH组),随机抽取高龄非PPH患者78例(对照组)。收集2组一般资料、颈动脉粥样硬化及斑块、心脏结构及功能等,进行7年随访,主要研究终点包括全因病死率、影响预后的心脑血管事件(包括急性心肌梗死、脑梗死和心源性猝死)发生率。采用Kaplan-Meier法、log-rank检验及Cox回归模型进行预后危险因素分析。结果 PPH组全因死亡、急性脑梗死比例明显高于对照组(51.3%vs 32.1%,P=0.015;35.9%vs 21.8%,P=0.017)。以全因死亡为结局,PPH组第1、3、5、7年累积生存率分别为96.2%、82.1%、62.8%、48.7%,对照组第1、3、5、7年累积生存率分别为100%、88.5%、74.4%、67.9%,2组生存时间比较,差异有统计学意义(P0.05)。以终点事件为结局,2组生存时间比较,差异无统计学意义(P0.05)。多因素Cox回归分析显示,升主动脉内径、室间隔厚度、LVEF以及早餐△收缩压是全因死亡的独立危险因素(RR=0.898,95%CI:0.828～0.974,P=0.010;RR=1.424,95%CI:1.109～1.829,P=0.006;RR=0.940,95%CI:0.905～0.977,P=0.002;RR=1.800,95%CI:1.306～2.482,P=0.000)。结论高龄PPH患者远期预后较非PPH患者差,全因病死率随着早餐后收缩压下降幅度的增加而增加。     

红细胞分布宽度对心脏再同步化治疗患者预后的风险评估作用

目的:探讨红细胞分布宽度(RDW)对接受心脏再同步化治疗(CRT)的心力衰竭(心衰)患者临床预后的影响及相关因素分析。方法:回顾性调查在本院行首次CRT植入术的264例心衰患者临床资料。定义随访终点为全因死亡(包括心脏移植)和心衰再住院。以CRT植入术后1年内全因死亡为因变量绘制受试者工作特征(ROC)曲线,根据敏感度和特异度之和最大值找到RDW的最佳界值(cut-off值)。以RDW的最佳界值将患者分为2组,对基线资料行相关性分析,对随访结果做Kaplan-Meier生存分析和Cox回归,并评价RDW对各临床终点事件的预测价值。结果:ROC曲线预测患者1年内全因死亡的RDW界值为13.75%(P=0.006,曲线下面积0.638,敏感度0.538,特异度0.747)。相关性分析显示,RDW与高敏C反应蛋白(hsCRP)、左房前后径(LAd)呈正相关(r=0.233,P0.01;r=0.289,P0.01)。RDW≥13.75%组纽约心脏病学会(NYHA)分级高于RDW13.75%组。Kaplan-Meier生存曲线显示,在全因死亡和心衰再住院方面RDW≥13.75%组均明显劣于RDW13.75%组(log-rank检验:P0.01;P=0.006)。单因素及多因素Cox回归在校正年龄和性别后,RDW≥13.75%(HR=2.078,95%CI:1.014~4.262,P=0.046)仍是CRT患者全因死亡的独立危险因素,但在心衰再住院方面无统计学意义(HR=1.386,95%CI:0.833~2.306,P=0.209);LAd(HR=1.038,95%CI:1.003~1.074,P=0.031)是心衰再住院的独立危险因素。结论:RDW与患者的心衰严重程度相关。RDW≥13.75%提示CRT患者远期死亡及心脏移植风险增加。     

原发性扩张型心肌病和酒精型心肌病患者临床与预后对比研究

目的:比较原发性扩张型心肌病(IDCM)和酒精型心肌病(ACM)患者的临床特点和预后。方法:回顾性分析464例患者的临床资料,其中IDCM患者165例(IDCM组),ACM患者299例(ACM组);分别对2组患者进行生存分析。结果:ACM组患者初次发病年龄较IDCM组低,且左室舒张末期内径(LVEDd)、右室内径(RV)、左房内径(LA)以及心功能分级Ⅲ、Ⅳ级的患者比例均大于IDCM组,此外,2组患者在性别、吸烟史、肌酐(Cr)、尿素氮(BUN)、氨基末端B型脑钠肽前体(NT-proBNP)水平、QRS波宽均存在显著差异(P0.05),但两组总生存率比较差异无统计学意义(log rankχ~20.001,P=0.994);单因素Cox回归分析结果表明:在IDCM组中,年龄、心功能分级、舒张压(DBP)、完全性右束支传导阻滞(CRBBB)、LVEDd、右房内径(RA)是IDCM的预后指标;在ACM组中,心功能分级、收缩压(SBP)、QRS波宽、心房颤动、LVEDd、RV、RA、左室射血分数(LVEF)、NT-proBNP水平是ACM的预后指标。多因素Cox回归分析结果表明:LVEDd(HR=1.034,95%CI:1.004～1.066,P=0.029)和CRBBB(HR=2.898,95%CI:1.201～6.995,P=0.018)为IDCM患者全因死亡的独立预测指标;心功能分级(HR=1.595,95%CI:1.110～2.290,P=0.011)、SBP(HR=0.980,95%CI:0.963～0.997,P=0.020)和QRS波宽(HR=1.014,95%CI:1.004～1.019,P=0.003)为ACM患者全因死亡的独立预测指标。结论:ACM的临床症状更明显,心脏扩大更显著;IDCM和ACM的长期预后相近,但独立预后因素不一致。     

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.     

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.