复方丹参滴丸与硝酸异山梨酯治疗冠心病稳定型心绞痛的疗效对比观察

目的探讨复方丹参滴丸治疗冠心病稳定型心绞痛的疗效。方法治疗组应用复方丹参滴丸，对照组应用硝酸异山梨酯，对比观察两组用药治疗后心绞痛缓解情况及心电图改善情况。结果治疗组显效率68．5％，对照组为51．9％，两组差异有统计学意义（P〈0．05）；心电图ST—T段复常治疗组总有效率64．8％，对照组总有效率53．8％，两组比较差异有显著统计学意义（P〈0．01），表明复方丹参滴丸的疗效优于硝酸异山梨酯。结论复方丹参滴丸是一种治疗稳定型心绞痛较为理想和安全的药物。     

葛根素注射剂治疗老年不稳定型心绞痛及其对血液流变学的影响

目的观察葛根素注射荆治疗老年不稳定型心绞痛的临床疗效度其对血液流变学的影响。方法68例不稳定型心绞痛老年病人，随机分为注射用葛根素治疗组（34例）和复方丹参注射液作为对照组（34例）。观察治疗前后心绞痛发作、心电图度血液流变学的变化。结果治疗组心绞痛疗效的总有效率91.18％，明显优于对照组76．47％（P〈0．05），两组心电图的改善率比较有统计学意义（P〈0．05）。结论葛根素注射剂是治疗老年不稳定型心绞痛的有效药物，并能明显改善高黏状态。     

舒冠滴丸治疗不稳定型心绞痛气虚寒凝血瘀痰阻证的临床研究

目的 研究舒冠滴丸治疗不稳定型心绞痛（UAP）的临床疗效。方法 将60例病人随机分为舒冠滴丸组（治疗组）30例和麝香保心丸组（对照组）30例，两组均以3周为1个疗程，观察两组治疗前后心绞痛疗效、硝酸甘油用量和停减情况、中医证候疗效和积分变化情况、心电图疗效及不良反应。结果 两组治疗后心绞痛疗效、发作次数、持续时间和硝酸甘油用量、停减率均较治疗前明显改善（P〈0．01），但治疗组疗效优于对照组（P〈0.05或P〈0.01）；治疗组中医证候总有效率为90，00％，明显优于对照组的66.67％（P〈0．05）；两组治疗后中医证候总积分、心电图∑-ST、N—ST、N-T均较治疗前明显减少（P〈0．01），且治疗组优于对照组（P〈0.05或P〈0．01）。结论 舒冠滴丸能改善不稳定型心绞痛病人的症状及心电图，疗效显著，且无不良反应。     

益气活血汤治疗冠心病心绞痛临床观察

目的观察益气活血汤治疗冠心病心绞痛的疗效。方法将80例冠心病心绞痛病人随机分为两组，对照组采用常规治疗，治疗组加用益气活血汤，疗程均为30d，分别对治疗前后临床症状积分、心电图等变化进行观察。结果治疗组，临床疗效总有效率为95．0％，心电图疗效总有效率为82．5％均优于对照组的87．5％与55.0％（P〈0．05或P〈0．01）。治疗组临床症状积分也优于对照组（P〈0．01）。结论益气活血汤能增加心肌抗缺氧能力，增加冠状动脉血流量，改善心肌缺血、缺氧，是治疗冠心病心绞痛的安全、有效良方。     

中西医结合治疗老年不稳定型心绞痛疗效观察

目的观察黄芪注射液联合银杏叶提取物注射液治疗不稳定型心绞痛的临床疗效。方法将80例不稳定型心绞痛气虚血淤证患者随机分为对照组和观察组（各40例）。对照组予西医常规治疗,如扩张心血管、抗血小板聚集、抗心肌缺血、稳定动脉粥样硬化斑块、调脂等治疗。观察组在此基础上加静滴黄芪注射液合银杏叶提取物注射液,每日1次,两组疗程均为2周。观察两组临床疗效、心电图改善及血脂变化情况。结果观察组和对照组缓解心绞痛的总有效率分别为92．5％和67．5％,心电图总有效率分别为87．5％和55．0％,两组比较差异均有统计学意义（P〈0．05）。观察组治疗后血脂多项指标均有改善,与对照组相比差异有统计学意义（P〈0．05或P〈0．01）。结论中西医结合治疗在改善心绞痛症状、心电图以及调脂方面,有满意疗效。     

康心胶囊治疗冠心病稳定型心绞痛的临床研究

目的观察康心胶囊治疗冠心痛稳定型心绞痛的有效性和安全性。方法采用随机分组对照试验方法，观察康心胶囊治疗冠心痛稳定型心绞痛（48例）病人的疗效，井与复方丹参片对照组（48例）比较疗效。结果治疗组与对照组改善心绞痛症状的总有效率分别为91．7％和70．8％。减少冠心痛心绞痛发作次数的总有效率分别为93．8％和68．8％；心电图的总有效率分别为68．8％和47．9％。两组总有效率比较均有统计学意义（P〈0．05），平板运动试验显示总运动时间、最大代谢当量明显增加。峰运动ST段平均下移明显下降。两组比较均有统计学意义（P〈0．05）。结论康心胶囊疗效明显优于复方丹参片，两者都未发现明显的不良反应和毒副反应。     

心通胶囊治疗不稳定型心绞痛的临床观察

目的观察心通胶囊治疗冠心病不稳定型心绞痛的临床疗效。方法将确诊为冠心病不稳定型心绞痛的患者60例随机分为治疗组和对照组各30例。治疗组口服心通胶囊治疗。对照组口服复方丹参片治疗。结果治疗组心绞痛疗效总有效率为90.00％,心电图疗效总有效率为86．67％,对照纽心绞痛疗效总有效率为73．33％,心电图疗效总有效率为60．00％。两组比较有统计学意义（P〈0．05）。结论心通胶囊治疗冠心病不稳定型心绞痛疗效优于复方丹参片。     

新通注射液治疗冠心病心绞痛的临床观察

目的观察新通注射液治疗冠心病心绞痛的临床疗效。方法108例冠心病患者，双盲随机分为新通治疗组（73例）和对照组（35例），以新通注射液12ml加入5％葡萄糖液500ml静滴治疗为治疗组，以复方丹参针12ml加入5％葡萄糖液250ml静滴治疗为治疗组（有糖尿病者改用生理盐水稀释）。平均每日1次，连续治疗2周，观察前后心绞痛症状、心电图的变化。结果心绞痛症状疗效：治疗组总有效率94．4％，对照组总有效率80．0％，两组比较差异有非常显著性（P〈0．01）；心电图疗效：治疗组总有效率69．9％，对照组总有效率37．1％，两组比较差异有非常显著性（P〈0．01）。结论新通注射液治疗冠心病心绞痛安全有效。     

鹿红方治疗充血性心力衰竭合并心绞痛的临床研究

目的观察鹿红方（复方鹿红强心扩脉颗粒）治疗充血性心力衰竭合并心绞痛的临床疗效。方法将50例充血性心力衰竭合并心绞痛的病人随机分为两组，其中鹿红方治疗组（治疗组）27例和培哚普利（雅施达）对照组（对照组）23例。结果治疗组心功能疗效总有效率为33．33％。心绞痛症状疗效总有效率为62．96％，中医心绞痛证候疗效总有效率为44．44％，中医心力衰竭证候疗效总有效率为48．15％，与对照组比较均有统计学意义（19〈0．05）。治疗组心电图疗效总有效率33．33％，心绞痛疾病疗效总有效率25．93％。与对照组比较无统计学意义（P〉0．05）。两组病人治疗前后心肌耗氧量及体重改变无明显差异（P〉0．05）。结论鹿红方治疗充血性心力衰竭合并心绞痛。可以缓解心力衰竭、心绞痛中西医各项症状，在一定程度上可以改善病人的生活质量。     

疏血通注射液治疗不稳定型心绞痛疗效观察

目的观察疏血通注射液在治疗不稳定型心绞痛中的疗效。方法采用回顾性分析的方法将94例不稳定型心绞痛患者随机分为观察组（47例）对照组（47例）。比较观察两组治疗效果及不良反应的发生情况。结果（1）观察组心绞痛控制的有效率93．6％，明显高于对照组66％，P〈0．01。（2）观察组心电图变化总有效率91％，明显高于对照组72％，P〈0.01。（3）对照组发生心肌梗死4．3％，高于观察组0．7％。（4）两组均无严重不良反应。结论疏血通注射液治疗不稳定型心绞痛可以减少发作，心电图缺血性ST—T改善明显，发生心肌梗死几率减少，安全性好，疗效满意，值得临床广泛推广使用。     

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.