力平脂治疗高脂血症的临床观察

报告对１５３例高脂血症患者以力平脂治疗１００例，潘特生治疗５３例。于服力平脂４和８周后分别检测有关指标，总胆固醇（ＴＣ）分别下降２０％、２３％；甘油三酯（ＴＧ）下降５５％、５９％；低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）下降２０％、２３％；高密度脂蛋白胆固醇（ＨＤＬＣ）升高２８％、３８％；ＴＣＨＤＬ－Ｃ／ＨＤＬ－Ｃ比值下降３１％。前后对比差异非常显著（Ｐ＜０．０１～０．００１）。其中１５例重度高ＴＧ血症（ＴＧ≥５．５ｍｍｏｌ／Ｌ），服力平脂８周后，ＴＧ值下降７．２±３．３ｍｍｏｌ／Ｌ下降率为７４．０％，显示其降ＴＧ尤为显著。服药前ＴＧ值越高，治疗后下降越显著。力平脂还可使载脂蛋白Ａ（ａｐｏ－Ａ１）升高，为１５％（４周）、１８％（８周）；ａｐｏ－Ａ１／ａｐｏ－Ｂ比值分别上升４６％、４８％；ａｐｏ－８分别下降１５％、１７％。力平脂组部分病例的ＡＬＴ轻度升高，但为可逆性，其余尚未发现明显副作用。     

比较不同剂量氟伐代和普伐他汀治疗原发性高胆固醇…

采用随机、双盲、平行对照方式，比较氟伐他汀４０－８０ｍｇ／ｄ，（Ａ组３３例）和普伐他汀２０－４０ｍｇ／ｄ（Ｂ组３５例）治疗原发性高胆固醇血症１２周后的疗效和安全性。结果：Ａ组服药１２周后，血清ＴＣ、ＬＤＬ－Ｃ、ＴＣ／ＨＤＬ－Ｃ水平与Ｏ周时比较分别降低１８．４％，２４．７％和１１．７％；Ｂ组分别降低２１．０％、３１．５％和２７．５％。Ａ组和Ｂ组服药１２周时降低ＴＣ的总有效率分别为７７．４％和８２％。     

The Role of Renin－Angiotensin Systemin

目的研究压力负荷产生的心肌肥厚过程中的肾素－血管紧张素系统（ＲＡＳ）作用。方法应用ｌｏｓａｒｔａｎ（Ｌｏｓ）及卡托普利（Ｃａｐ）研究心肌ＲＡＳ在压力超荷大鼠心肌肥厚中的作用。狭窄大鼠腹主动脉造成压力超荷（ＣｏＡ），术后第二天给予ＣｏＡ大鼠亚降压量Ｌｏｓ（３ｍｇ／ｋｇ·ｄ－１）与Ｃａｐ（３０ｍｇ／ｋｇ·ｄ－１）。结果不影响动脉血压，但左室重分别减少５８．３％及６２．５％，左室／体重比值显著低于ＣｏＡ组（４．１２±０．１７及３．９２±０．２３ｖｓ４．８６±０．１８，Ｐ＜０．０５），但左室重与假手术组比仍有差异。高血压肥厚２周大鼠，经亚降压量Ｌｏｓ及Ｃａｐ治疗２周后，左室重较治疗前分别减少６０％及６４％，蛋白质含量显著低于ＣｏＡ组（１０２．１±１４及９８．５±１５ｍｇｖｓ１４３．３±１９ｍｇ，Ｐ＜０．０５），但高于正常组。结论Ｌｏｓ与Ｃａｐ逆转肥厚的机制除降压外，阻断心肌ＲＡＳ活性起重要作用     

国产洛伐他汀对高脂血症患者血脂代谢的影响

目的：研究国产洛伐他汀对高脂血症患者血脂代谢的影响。方法：将１２０例患者随机分为洛伐他汀组（ｎ＝８０）及美降之组（ｎ＝４０），分别口服国产洛伐他汀及进口洛伐他汀（美降之），每次２０ｍｇ，每日２次，服用８周。观察用药４周及８周患者血清总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、（ＴＣ－ＨＤＬ－Ｃ）／ＨＤＬ－Ｃ、甘油三酯、载脂蛋白ＡⅠ（ＡｐｏＡⅠ）、载脂蛋白Ｂ１００（ＡｐｏＢ１００）及ＡｐｏＡⅠ／ＡｐｏＢ１００变化。结果：服用国产洛伐他汀４周及８周可分别使患者血清ＴＣ降低２３．０％及２７．３％，ＬＤＬ－Ｃ降低２７．９％及３４．１％，高甘油三酯血症患者甘油三酯水平降低２１．６％及２６．２％；ＨＤＬ－Ｃ升高９．１％及１０．１％，（ＴＣ－ＨＤＬ－Ｃ）／ＨＤＬ－Ｃ降低２９．６％及３７．１％。血清ＡｐｏＢ１００降低９．６％及１５．５％，ＡｐｏＡⅠ升高１８．９％及１４．５％，ＡｐｏＡⅠ／ＡｐｏＢ１００升高３９．９％及４４．９％。服药４周即有明显疗效。结论：国产洛伐他汀调血脂作用疗效肯定，与其相应进口产品美降之比较基本相同     

c—erbB—2及p53蛋白在原发性肝癌肝组织的表达

目的和方法 应用免疫组化ＬＳＡＢ（Ｌａｂｌｌｅｄｓｔｒａｐｔａｖｉｄｉｎ－ｂｉｏｔｉｎ）法对４５例人原发性肝癌（ＰＨＣ）及其癌周肝组织以及５例正常肝组织进行了ｃ－ｅｒｂＢ－２和突变型ｐ５３癌基因蛋白的表达研究。结果 ｃ－ｅｒｂＢ－２癌基因蛋白和ｐ５３蛋白在ＰＨＣ及其癌肝硬变非肝硬变组织中的阳性表达率分别为７１．１％，２１．４％，（６／２８），１１．７％（２／１７）和４６．７％，１４．３％（４／２８     

阿苯达唑糖片驱除肠道线虫的现场观察

蛲虫感染者顿服阿苯达唑糖片１００ｍｇ１３５例、２００ｍｇ，２ｄ分服３２１例，治后３ｗｋ复查肛周虫卵全部阴转。蛔虫、钩虫和鞭虫感染者分别服用该药３００ｍｇ和４００ｍｇ两个剂量组的虫卵阴转率依次为蛔虫９９．４％（４６６／４６９）和９９．８％（４８７／４８８）、钩虫９６．８％（９１／９４）和９４．３％（９９／１０５）及鞭虫５３．４％（２２８／４２７）和７６．３％（３７０／４８６）。排出蛲虫、蛔虫和钩虫成虫最多的依次为１９４条、８８条和５８８条。其排虫高峰时间依次为ｄ２－３、ｄ３－５和ｄ２－４，而鞭虫排虫较少，平均排出虫体仅４．３条。表明该药对蛲虫、蛔虫和钩虫的疗效均佳，而对鞭虫的效果较差。本品副反应轻微，不需特殊处理，味道甜，服用方便，易被患者接受。     

内源性一氧化氮对犬急性缺氧性肺动脉高压的影响

利用一氧化氮合成酶抑制剂——Ｎ￣Ｇ－硝基－Ｌ－精氨酸甲酯（Ｌ－ＮＡＭＥ）观察内源性一氧化氮对犬急性缺氧性肺血管收缩的影响。Ｌ－ＮＡＭＥ（１、５、１５ｍｇ／ｋｇ）可显著增加缺氧时肺动脉平均压（ｍＰＡＰ）和肺血管阻力（ＰＶＲ），其作用维持９０～１８０分钟。与用药前缺氧时比较，ｍＰＡＰ最大可分别升高１．１±０．２、１．５±０．３、１．６±０．４ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ），而ＰＶＲ最大可分别升高５８．４±１５．６、９９．３±２８．８、７８±４．０ｋＰａ·ｓ／Ｌ，Ｌ－ＮＡＭＥ１５ｍｇ／ｋｇ升ｍＰＡＰ的作用明显强于１ｍｇ／ｋｇ组。Ｌ－精氨酸（０．５ｇ／ｋｇ）可逆转Ｌ－ＮＡＭＥ（５ｍｇ／ｋｇ）增强缺氧性肺血管收缩的作用。此外，Ｌ－ＮＡＭＥ也可明显增加缺氧时股动脉平均压和全身血管阻力，同时减少心输出量，减慢心率，结果提示内源性一氧化氮可能具有抑制急性缺氧性肺血管收缩的作用。     

血脂康治疗高脂血症的临床观察

目的：观察血脂康治疗高脂血症的疗效及安全性。方法：１２１例高脂血症患者随机分成两组。第１组９１例，每例服血脂康胶囊４粒／天；第２组３０例，每例服绞股兰６片／天，疗程均为８周。结果：治疗８周后与治疗前相比，在血脂康组，血清高密度脂蛋白胆固醇水平升高１２．８％（Ｐ＜０．００１），血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯、（总胆固醇－高密度脂蛋白胆固醇）／高密度脂蛋白胆固醇〔（ＴＣ－ＨＤＬ－Ｃ）／ＨＤＬ－Ｃ〕的比值分别下降２３．７％、３０．３％、３１．２％及３１．６％（Ｐ均＜０．００１）。在绞股兰组，上述指标未见明显改变。在降低血清总胆固醇、低密度脂蛋白胆固醇、甘油三酯、（总胆固醇－高密度脂蛋白胆固醇）／高密度脂蛋白胆固醇的比值方面，血脂康明显优于绞股兰（Ｐ＜０．００１）。在升高血清高密度脂蛋白胆固醇上，血脂康虽优于绞股兰，但两组间未见有统计学意义的差异。血脂康组中原有慢性胃炎的１例服药后胃痛加重而退出治疗，其余均未见有临床意义的副作用。结论：血脂康是一种安全、有效而易于耐受的血脂调节药。     

血脂康和辛伐他汀对高胆固醇血症调脂作用的比较

目的研究血脂康对高胆固醇血症患者的调脂作用并与辛伐他汀比较。方法２８例高胆固醇血症患者随机分为两组，服药前及服药后４、８周测定血脂。结果（１）服药后４周ＴＣ分别降低了２０７％和２２５％（Ｐ值均＜０００１）；血脂康降低血清低密度脂蛋白胆固醇（ＬＤＬＣ）作用与辛伐他汀相似，ＬＤＬＣ水平分别降低了２８２％和３３％（Ｐ值均＜００１）；（２）血脂康明显降低１７４％的血清ＴＧ水平（Ｐ＜００５）；（３）服血脂康和辛伐他汀４周后，载脂蛋白（Ａｐｏ）Ａ１却分别增加了１２７％和１３６％（Ｐ值均＜００１）；ＡｐｏＢ水平均下降了８％左右（Ｐ＜００５）；分别使脂蛋白（ａ）［Ｌｐ（ａ）］水平降低了３１３％（Ｐ＜００１）和２７８％（Ｐ＜００５）；（４）除了治疗８周后Ｌｐ（ａ）水平进一步下降外，两种药物治疗８周后的调脂作用与４周比较无明显差异。结论血脂康能显著降低Ⅱａ和Ⅱｂ型高胆固醇血症患者血清ＴＣ和ＬＤＬＣ，其作用与辛伐他汀相等；血脂康降低ＴＧ作用优于辛伐他汀     

高碘对脱碘酶活性影响

用高碘水喂养昆明种雄性小鼠，观察到高碘水引起小鼠甲状腺相对重量增加２８．９％（Ｐ＜０．０５），甲状腺滤泡充盈扩张及上皮细胞扁平；血清Ｔ４增高３１．８％（Ｐ＜０．０１），ｒＴ３增高２９．３％（Ｐ＜０．０５），Ｔ３降低２７．３％（Ｐ＜０．０５）；肝５′－脱碘酶活性下降２６．５％（Ｐ＜０．０５）。提示高碘甲状腺肿动物血清Ｔ４增高原因是高碘抑制了分解Ｔ４的５′－脱碘酶，使Ｔ４向Ｔ３转化减少。     

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。     

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。     

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。     

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.