左卡尼汀治疗老年慢性心力衰竭的疗效和安全性

目的 观察左卡尼汀治疗老年慢性心力衰竭的疗效及安全性.方法 老年慢性心力衰竭患者50例,随机均分为2组对照组和左卡尼汀组,两组均给予常规抗心衰治疗,左卡尼汀组同时给予5%GS250 ml加左卡尼汀3 g静脉滴注,1次/d,共15 d,然后口服左卡尼汀1 g/次,2次/d,共15 d.结果 加用左卡尼汀治疗慢性心功能衰竭总有效率为84.0%,显著优于对照组60.0%(P＜0.05),左室收缩功能较常规治疗组有明显改善(P＜0.05),未见明显不良反应.结论 左卡尼汀治疗老年慢性心力衰竭安全有效、无明显毒副作用.     

莫西沙星治疗老年社区获得性肺炎的疗效及其影响因素

目的探讨莫西沙星治疗老年社区获得性肺炎的疗效及影响因素。方法选取176例老年社区获得性肺炎患者,随机分为A组和B组各88例。A组采用莫西沙星进行治疗,B组采用左氧氟沙星进行治疗。对比两组治疗效果及细菌清除情况。A组中治疗有效的患者为有效组,治疗无效者为无效组,对比有效组和无效组各项临床资料,采用多因素Logistic回归分析分析影响莫西沙星治疗老年社区获得性肺炎临床疗效的影响因素。结果 A组痊愈率、总有效率均显著高于B组(均P0.05);A组检出致病菌50株,病原菌检出率为56.82%,B组检出致病菌57株,病原菌检出率为64.77%,两组差异无统计学意义(P0.05);A组流感嗜血杆菌的清除率、总清除率均显著高于B组(均P0.05)。无效组年龄、基础疾病1种比例、多叶肺炎比例、血红蛋白水平、白蛋白水平及血肌酐水平均显著高于有效组(均P0.05);多因素Logistic回归分析结果显示,年龄、基础疾病1种、多叶肺炎均是影响莫西沙星治疗老年社区获得性肺炎疗效的危险因素(均P0.05)。结论莫西沙星治疗老年社区获得性肺炎临床疗效和细菌清除率显著优于左氧氟沙星;年龄、合并多种基础疾病及多叶肺炎是影响莫西沙星治疗老年社区获得性肺炎疗效的危险因素。     

清热宣肺化痰法治疗老年社区获得性肺炎痰热壅肺证的临床疗效

目的观察清热宣肺化痰法治疗老年社区获得性肺炎(中医辩证为痰热壅肺证证候)的临床疗效。方法将100例老年社区获得性肺炎痰热壅肺证患者,随机分为治疗组与对照组,每组各50例。两组患者均给予使用抗感染、止咳、祛痰等基础治疗,治疗组在此基础上采取清热宣肺化痰法,运用复方清金化痰汤治疗,10d为1个疗程。治疗后观察比较两组患者治疗效果、中医症状改善情况,以及两组患者第3 d、第5 d、第9 d血白细胞总数正常率。结果治疗组患者疗效明显优于对照组(P0.05)、中医症状改善程度优于对照组(P0.05)。治疗组血白细胞恢复正常时间快于对照组,经统计学分析有差异(P0.05)。结论采取清热宣肺化痰法运用复方清金化痰汤治疗老年社区获得性肺炎疗效确切,在中医症状改善方面有明显优势,能够加快患者恢复,值得临床推广应用。     

左卡尼汀治疗老年2型糖尿病合并慢性心力衰竭患者的临床观察

目的 观察左卡尼汀治疗老年2型糖尿病合并慢性心力衰竭患者的疗效.方法 选择60例老年糖尿病合并慢性心力衰竭患者,随机分为左卡尼汀组及对照组各30例.两组均行常规抗心力衰竭治疗,左卡尼汀组患者在常规治疗基础上加用左卡尼汀2 g静脉泵入,一日两次,共15天,用药前以及开始用药后15天两组均检测左心室射血分数（LVEF）、左心室短径缩短率（LVFS）、心排出量（CO）、血浆氨基末端脑钠素前体（NT-pro-BNP）等指标,并分别对其治疗前后进行比较.结果 左卡尼汀能够增加心力衰竭患者的心肌收缩力及改善心功能,显著降低血NT-pro-BNP水平（P＜0.05）,两组比较差异有统计学意义（P＜0.05）,均未见明显不良反应,且血糖、三酰甘油（TG）、胆固醇（CHO）较治疗前明显下降.结论 左卡尼汀对治疗2型糖尿病合并慢性心力衰竭疗效较好,且无明显不良反应.     

左卡尼汀治疗老年慢性心力衰竭患者的疗效观察

目的观察左卡尼汀(L-carnitine,L-CN)治疗老年慢性心力衰竭(Chronic Heart Failure,CHF)患者的临床效果。方法选择CHF 120例,随机分为两组:对照组(60例)和L-CN组(60例),两组均给予常规抗心力衰竭治疗,L-CN组在常规抗心力衰竭基础上加用L-CN治疗。结果治疗2周后L-CN组患者NYHA心功能分级普遍提高1-2级,超声心动图LVEF、EDV、ESV有显著改善,与对照组相比差异有统计学意义(P0.05)。结论左旋卡尼汀可以辅助治疗CHF,改善心功能。     

抗胃食管反流治疗老年慢性阻塞性肺疾病急性加重的效果

目的观察抗胃食管反流治疗在老年慢性阻塞性肺疾病急性加重期(AECOPD)治疗中的临床效果。方法将78例无明显嗳气、胃灼热、反酸等胃食管反流症状的老年AECOPD患者随机分为抑酸组40例及常规治疗组38例,以上两组均采用常规治疗,包括持续低流量吸氧、抗感染、祛痰、支气管扩张剂解痉平喘、补液,维持水、电解质及酸碱平衡等,抑酸组加用静脉或口服的抑酸药物,维持1 w或以上,观察治疗第3天及第7天咳嗽咳痰气喘症状及肺部啰音体征情况,同时比较1 w后白细胞、中性粒细胞及C-反应蛋白变化。结果治疗第3天和第7天,抑酸组咳嗽咳痰、气喘症状及肺部啰音体征均较常规治疗组好转。治疗第7天后,抑酸组白细胞数、中性粒细胞数及中性百分比恢复正常率、C-反应蛋白及降钙素原水平均较常规治疗组显著下降(P0.05)。结论老年尤其是高龄患者大部分并不具有胃灼热、反酸等典型反流症状,在排除哮喘、鼻后滴漏综合征等常见原因所致的咳嗽后,对AECOPD患者应用质子泵抑制剂可明显减轻咳嗽咳痰气喘症状,降低应激反应,提高治疗疗效,使病情尽早得到有效控制。     

左卡尼汀对糖尿病合并心力衰竭老年患者的临床疗效

目的观察左卡尼汀对糖尿病合并心力衰竭老年患者的临床疗效。方法选择该院收治的50例糖尿病合并心力衰竭老年患者作为观察对象(2013年1月—2015年7月),随机将其分成两组,对照组采用常规治疗,实验组在对照组基础上加用左卡尼汀治疗,观察两组老年患者的治疗效果。结果对照组心功能改善率(60.00%)明显低于实验组(88.00%),且两组之间对比的血糖及血脂的变化情况差异有统计学意义(P0.05)。结论针对老年糖尿病合并心力衰竭患者采用左卡尼汀治疗的临床效果较为显著,能显著改善患者的心功能指标,控制患者的血糖水平。     

社区获得性肺炎左氧氟沙星序贯疗法的临床评价与成本效果分析

目的 探讨左氧氟沙星序贯疗法治疗社区获得性肺炎的疗效.方法 将社区获得性肺炎有效病例134例分为序贯治疗组(68例)和对照组(66例),序贯治疗组采用左氧氟沙星序贯疗法,对照组采用静脉滴注疗法.结果 2组治愈率比较无显著性差异(P＞0.05),序贯治疗组治疗费用、不良反应均明显低于对照组(P＜0.01或0.05).结论 左氧氟沙星序贯疗法治疗社区获得性肺炎疗效确切,可缩短住院时间,降低医疗费用,减少不良反应发生,使患者依从性提高,是治疗社区获得性肺炎的理想疗法.     

联合检测血清sTREM-1、IL-17、hs-CRP在肺炎中的诊断价值

目的研究可溶性髓系细胞触发受体(s TREM)-1、白细胞介素(IL)-17、超敏C反应蛋白(hs-CRP)在社区获得性肺炎中的诊断价值。方法 120例社区获得性肺炎患者为肺炎组、30例急性支气管炎患者为支气管炎组、30例健康志愿者为健康对照组,急性支气管炎患者、健康志愿者就诊时抽血检测血清s TREM-1、IL-17、hs-CRP的水平,肺炎组入院后第1、4、7天检测血清s TREM-1、IL-17、hs-CRP的水平。结果肺炎组与支气管炎组第1天血清s TREM-1、IL-17、hs-CRP水平均显著高于健康对照组(P0.05),肺炎组s TREM-1、IL-17、hs-CRP水平均显著高于支气管炎组(P0.05);肺炎组第4天、第7天血清s TREM-1、IL-17、hs-CRP与第1天相比较均有明显下降(P0.05);第7天血清s TREM-1、IL-17、hs-CRP分别与第4天比较有明显降低(P0.05);肺炎组入院第1天、第7天s TREM-1、hs-CRP下降幅度比IL-17显著大(P0.05);肺炎组s TREM-1、IL-17浓度与社区获得性肺炎评分(CURB)-65呈正相关(r=0.690,r=0.622,均P0.05)。而hs-CRP的水平与CURB-65评分无相关性(r=0.122,P0.05)。结论s TREM-1可望成为评价肺炎炎症程度的新生物学指标,联合检测血清s TREM-1、IL-17、hs-CRP的水平,对临床上预测肺炎患者病情严重程度有一定的参考价值。     

机械通气联合盐酸氨溴索对老年急性呼吸窘迫综合征患者氧合指标和炎性因子的影响

目的探讨机械通气与盐酸氨溴索联合治疗老年急性呼吸窘迫综合征(ARDS)的临床疗效。方法将2013年2月至2014年2月该院就诊的52例老年ARDS患者随机分为实验组和对照组,两组均采用抗炎、营养、脱水和吸痰等支持治疗,对照组仅采用机械通气治疗,实验组采用机械通气与盐酸氨溴索联合治疗。对比两组治疗前及治疗后1 w体内氧合指标及炎性因子浓度。结果两组患者经1 w治疗后,与治疗前相比,血清白细胞介素(IL)-10浓度、动脉血氧饱和度(Sa O2)、脉血氧分压(Pa O2)、氧合指数(Pa O2/Fi O2)均上升,血清IL-6和肿瘤坏死因子(TNF)-α浓度均降低(均P0.05);且实验组以上各指标较对照组改善更明显(均P0.05)。结论机械通气与盐酸氨溴索联合治疗ARDS可改善患者体内的氧合指标,调节细胞因子水平,增强患者抗炎能力,提高疗效。     

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.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.