高血压患者血压昼夜节律消失与血液流变学的变化

目的观察高血压昼夜节律消失与血液流变学之间的关系。方法选择行24h动态血压检测的Ⅰ～Ⅱ级原发性高血压患者148例,男性83例,女性65例。根据夜间平均动脉压下降10%以上或以下的标准,将原发性高血压患者分为杓型患者组(85例)和非杓型组(63例)。空腹采静脉血,测定血液流变血各项指标。结果非杓型组的凝血因子Ⅰ(Fg)、红细胞压积(Hct)、全血黏滞度(ηb)、血浆黏滞度(ηp)、全血低切黏度(ηbI)、红细胞聚集指数(EAI)显著高于杓型组(P<0.01,P<0.05)。结论高血压昼夜节律消失与血液流变学异常呈正相关。     

高血压对血管内皮功能的影响

目的:探讨高血压的血管内皮功能变化。方法:应用高分辨率超声仪检测我院门诊及住院的高血压患者的肱动脉对反应性充血(血流介导的内皮依赖性血管扩张)的舒张反应.并与健康人进行对比。结果:基础血管内径:高血压组3.89±0.47 mm.健康组3.84±0.455 mm,P>0.05;反应性充血的肱动脉内径的变化百分率:高血压组为7.4±2.83%.健康组为12.40±3.79%.有非常显著差异.P<0.001;含服硝酸甘油后肱动脉内径的变化百分率:高血压组为14.20±2.90%.健康组为14.22±0.88%(P>0.05)。结论:高血压患者血管内皮功能受损。     

阻塞性睡眠呼吸暂停低通气综合征患者的血管内皮舒张功能

目的评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血管内皮功能。方法OSAHS患者30例(轻度组8例,中重度组22例)及对照组10例,分别用高分辨率超声检测基础状态、反应性充血时(内皮依赖性血管扩张)以及含服硝酸甘油后(非内皮依赖性血管扩张)的肱动脉内径,计算不同状态下肱动脉的扩张率以评估血管内皮功能。结果对照组、轻度和中重度OSAHS组患者反应性充血时肱动脉内径扩张率分别为(15.2±2.6)%、(14.3±3.2)%和(9.8±4.9)%,中重度OSAHS组患者血管内皮介导的舒张反应较对照组和轻度OSAHS组明显降低;含服硝酸甘油后肱动脉内径扩张率分别为(16.5±5.0)%、(15.7±4.1)%和(14.1±6.2)%,3组间无明显差别。结论中重度OSAHS患者存在血管内皮功能障碍,OSAHS本身可能是导致血管内皮损伤的重要因素。     

应用超声血管反应性充血法评价血管内皮功能

目的探讨应用超声血管反应性充血法评估血管内皮舒张功能的可行性和可靠性。方法 12名中青年健康体检者(健康对照组)和10例中青年心肌梗死患者(心肌梗死组)接受肱动脉超声检查,比较两组肱动脉反应性充血前后血管内径及血流量变化百分率。结果肱动脉基础内径及基础血流量两组间比较差异无统计学意义。反应性充血后血管内径变化百分率健康对照组显著高于心肌梗死组(13.6%±6.6%比7.2%±2.3%,P<0.05),反应性充血后血流量变化百分率健康对照组显著高于心肌梗死组(398.6%±150.4%比283.8%±146.3%,P<0.05)。结论肱动脉超声检查间接评价血管内皮功能,测定准确、操作简便、无创性、可重复检测且可提供动脉壁的解剖学图像。     

高频超声评价高血压患者血管内皮功能的研究

目的:探讨高血压对血管内皮功能的影响。方法:应用高频超声检测48例原发性高血压患者和45例血压正常的健康人在静息状态、反应性充血后以及舌下含服硝酸甘油后的肱动脉内径变化。结果:原发性高血压患者反应性充血引起肱动脉内径扩张显著低于血压正常的健康人(7.62%±5.10%)vs(14.53%±3.82%),P<0.01,舌下含服硝酸甘油引起肱动脉内径扩张差异无统计学意义(18.23%±3.20%)vs(18.87%±4.35%),P>0.05。结论:原发性高血压患者存在血管内皮依赖性舒张功能受损,高频超声可以是评价血管内皮功能的无创、简单、可靠的方法。     

高分辨力超声评价川崎病急性期肱动脉内皮功能及维生素C的作用

目的研究川崎病(KD)急性期肱动脉内皮依赖性血管舒张(EDD)功能及快速经静脉输注维生素C的作用。方法应用高分辨力超声分别测定KD急性期患者及对照组反应性充血介导的肱动脉内径百分变化率,并测定快速经静脉输注维生素C后反应性充血介导的肱动脉内径百分变化率。结果KD急性期组反应性充血介导肱动脉内径百分变化率明显低于对照组(P<0.01),其中并发冠状动脉扩张者与未并发冠状动脉扩张者间差异无统计学意义(P>0.05)。KD急性期患者快速经静脉输注维生素C后反应性充血介导肱动脉内径百分变化率较前明显增加(P<0.01)。结论KD急性期外周动脉内皮功能减低,经静脉快速输注大剂量维生素C可以改善KD急性期外周动脉内皮功能。     

氯沙坦对高血压患者心脏和血管内皮功能影响的相关性研究

目的　评价应用氯沙坦 12周治疗原发性高血压患者心脏结构和血管内皮功能改变的相互关系。方法　入选 46例高血压患者 ,其中 ,男 2 0例 ,女 2 6例 ,平均年龄52 2 9± 10 2 7岁。氯沙坦治疗 4～ 6周前后根据所达目标血压 (舒张压 <90mmHg ,调整降压药 ,未达标者加寿比山 2 5mg ,观察氯沙坦治疗前后血浆内皮素的变化及应用二维和多普勒超声检测心脏结构和肱动脉血管内皮功能。结果　收缩压、舒张压、血浆内皮素、左心室重量指数在治疗 12周后明显降低 (P <0 0 1) ,反应性充血引起肱动脉内径的增加在治疗 12周后显著增加 (P 0 0 5)。左心室重量指数的变化与反应性充血后肱动脉内径的变化无相关性 (β =-0 14 82 ,P >0 0 5) ,与收缩压变化 (β =0 443 ,P <0 0 0 1)、内皮素变化 (β =0 3 8,P <0 0 1)有显著相关性。 结论　氯沙坦对心血管系统的影响不仅与血压降低有关 ,同时与逆转左室肥厚、改善血管内皮功能有关。     

应用彩超检测高血压患者血管内皮功能的临床意义

目的探讨彩超检测对高血压患者血管内皮功能的临床意义。方法选取本院2013年12月~2014年12月收治的高血压患者77例为观察组,并在同年选取健康体检志愿者46例为对照组。对高血压组应用彩超检测,观察反应性充血前后的肱动脉内径的变化,并与对照组进行比较。结果检测结束后,高血压组的肱动脉内径基础值为(3.67±0.23),低于对照组的肱动脉内径基础值(4.81±0.43),差异有统计学意义(P0.05);高血压组反应性充血后的肱动脉内径扩张值为(9.86±1.42),显著低于对照组反应性充血后的肱动脉内径扩张值(12.95±1.78),差异有统计学意义(P0.05)。结论对于高血压患者而言,采用彩超检测血管内皮功能,能有效提高评价的准确性,并对高血压并发症进行有效的预防和治疗,具有较高的临床价值,值得在临床中广泛推广和应用。     

老年杓型与非杓型高血压患者踝臂指数变化的临床意义

目的探讨老年杓型与非杓型高血压患者踝臂指数(ankle brachial index,ABI)的异常情况及临床意义。方法选择老年原发性高血压患者79例进行24 h动态血压监测,分为非杓型组52例和杓型组27例。测定ABI、高敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、髓过氧化物酶(myeloperoxidase,MPO)水平和血管内皮功能。结果非杓型组ABI、肱动脉内皮依赖性舒张功能较杓型组明显降低,MPO、hs-CRP较杓型组明显升高,差异有统计学意义(P<0.05)。非杓型组患者ABI与hs-CRP和MPO呈负相关(r=-0.723,r=-0.71 9,P<0.01),与肱动脉内皮依赖性舒张功能呈正相关(r=0.91 7,P<0.01)。结论 ABI降低与斑块不稳定、炎性反应及血管内皮功能受损密切相关,对评价夜间老年高血压患者动脉结构、功能的损害程度、判断预后、指导合理治疗有重要的临床意义。     

超声评价扩张型心肌病患者肱动脉内皮舒张功能

目的应用高频超声评价扩张型心肌病(dilated cardiomyopathy,DCM)患者肱动脉内皮功能。方法应用高频超声测量32例DCM患者和40例健康对照者的基础状态时、反应性充血后、舌下含服硝酸甘油后的肱动脉内径,计算反应性充血和含服硝酸甘油后肱动脉内径变化的百分率。结果DCM患者反应性充血所致的肱动脉内径百分变化率[(4.0±3.5)%]明显低于正常人[(13.2±3.9)%,P<0.05],DCM患者含服硝酸甘油所致的肱动脉内径变化的百分率[(27.8±9.2)%]和健康对照者[(28.5±8.9)%,P>0.05]差别无显著统计学意义。结论DCM患者肱动脉内皮舒张功能受损。     

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.