哇巴因抗体对肾血管性高血压大鼠的降压作用

目的:探讨哇巴因抗体的降压作用及内源性哇巴因与高血压发病的关系.方法:给"一肾一夹(1K1C)"、"两肾一夹+盐(2K1C-salt)"及"两肾一夹(2K1C)"肾血管性高血压大鼠随机静注哇巴因抗体、硝普钠、正常兔免疫球蛋白(IgG)及生理盐水,颈动脉插管观察注射后3 小时内大鼠血压的动态变化. 结果:哇巴因抗体对"一肾一夹"、"两肾一夹+盐"型高血压大鼠具有明显的降压作用,而对"两肾一夹"高血压鼠降压作用不明显.正常兔免疫球蛋白对各种高血压模型均无降压作用.结论:哇巴因抗体对"一肾一夹"、"两肾一夹+盐 "型高血压大鼠具有降压作用,间接证明了内源性哇巴因可能是高血压的发病因素之一.     

哇巴因抗体对肾血管性高血压大鼠的降压作用

目的：探讨哇巴因抗体的降压作用及内源性哇巴因与高血压发病的关系。方法：给”一肾一夹（１Ｋ１Ｃ）“”两肾一夹＋盐（２Ｋ１Ｃ－ｓａｌｔ）”肾血性高血压大鼠随机静注哇巴因抗体、硝普钠、正常兔免疫球蛋白（ＩｇＧ）及生理盐水,颈动脉插管观察注射生３小时内大鼠血压的动态变化。结果：哇巴因抗体对“一肾一夹”、“两肾一夹＋盐”型高血压大鼠具有明显的降压作用,而对“两肾一夹”高血压鼠降压作用不明显。正常免免疫球蛋白     

美托洛尔与非洛地平对老年高血压病人心率变异性的影响

目的　观察美托洛尔和非洛地平对老年高血压病人降压治疗后心率变异性的改变。方法　 10 0例年龄 6 0岁以上单纯收缩期高血压病人随机分为美托洛尔组和非洛地平组 ,用药前、后作动态血压和心率变异性检查。结果　美托洛尔组和非洛地平组的降压效果相似 ,两组的 2 4小时平均收缩压分别从 16 3± 13mm Hg、16 2± 15 m m Hg降至 148± 17mm Hg、15 0± 14mm Hg(P<0 .0 1) ,2 4小时平均舒张压分别从 81± 5 m m Hg、80± 4mm Hg降至 79± 4mm Hg、77± 4m m Hg(P<0 .0 5 )。然而两组的心率变异性改变却截然相反 ,2 4小时平均 R- R间期标准差美托洛尔组从 33± 3ms增至 34± 3ms(P<0 .0 5 ) ,非洛地平组则从 32± 4m s减少至 31± 4ms(P<0 .0 5 ) ;2 4小时相邻 R- R间期差大于 5 0 ms所占总心动次数的百分比 ,美托洛尔组从 11± 8(% )增至 14± 5 (% ) (P<0 .0 1) ,而非洛地平组则从 12± 8(% )降至 9± 6 (% ) ,但无统计学意义 (P>0 .0 5 )。结论　 β受体阻滞剂美托洛尔和钙通道阻滞剂非洛地平有相似的降压效果 ,对心率变异性的作用却不相同     

缬沙坦的降压和对左室肥厚的消退作用

本文以氨氯地平作对照 ,用 2 4 h动态血压监测 (2 4 h ABPM)和心脏超声来研究新型血管紧张素 (A )受体拮抗剂——缬沙坦对高血压左室肥厚患者的降压和左室肥厚消退作用。1　对象与方法1 .1 　 对象77例未经治疗或停用降压药 2周原发性高血压 (EH)伴左室肥厚患者 ,随机分为 2组 ,缬沙坦组 :3 9例 ,其中男 2 4例 ,女 1 5例 ;年龄 41～ 6 4(45 .3± 6 .1 )岁 ;收缩压 (SBP) (1 6 4± 1 6 ) mm Hg(1mm Hg =0 .1 3 3 k Pa) ,舒张压 (DBP) (1 0 3± 9)mm Hg;氨氯地平组 :3 8例 ,其中男 2 6例 ,女 1 2例 ,年龄 41～ 6 5 (48.0± 7.6 )岁 ,…     

老年男性原发性高血压患者动态血压及血压变异性与踝臂指数的关系探讨

目的评价老年男性原发性高血压患者动态血压及血压变异性(BPV)与踝臂指数(ABI)的关系。方法入选老年男性原发性高血压患者160例,按照ABI分为正常ABI组(ABI>0.90)104例和低ABI组(ABI≤0.90)56例,比较并分析其24 h动态血压参数和BPV参数。结果低ABI组较正常ABI组24 h平均脉压[(62.4±13.8)mm Hg比(53.0±13.0)mm Hg]、日间平均脉压[(67.3±17.0)mm Hg比(55.4±20.0)mm Hg]和夜间平均脉压[(63.0±16.0)mm Hg比(52.9±13.6)mm Hg]均高(P<0.01),同时夜间收缩压最大值[(146.5±17.4)mm Hg比(135.5±17.1)mm Hg]、夜间收缩压标准差[(12.4±4.0)mm Hg比(10.1±4.2)mm Hg]均大(P<0.05)。结论老年男性原发性高血压患者夜间收缩压最大值、夜间收缩压标准差、日间平均脉压、夜间平均脉压和24 h平均脉压升高可能是低ABI的危险因素。     

哇巴因与地高辛对大鼠心肌钠泵α亚单位基因表达影响的研究

目的　对比研究哇巴因与地高辛对大鼠心肌钠泵 (Na K ATP酶 )α亚单位基因表达的影响。方法　长期给予大鼠注射小剂量哇巴因 (2 0 μg·kg-1·d-1)与地高辛 (32 μg·kg-1·d-1) ,分别应用分子生物学RT PCR及免疫组织化学技术分析大鼠心肌钠泵α1、α2及α3亚单位mRNA及蛋白水平基因表达的改变。结果　长期给予大鼠注射小剂量哇巴因可使大鼠血压升高 ,而地高辛对大鼠血压无影响。无论是在mRNA水平还是在蛋白水平 ,哇巴因组大鼠心肌钠泵α1亚单位表达减弱 ,α3亚单位表达增强 ,而α2亚单位表达无改变 ;地高辛组大鼠心肌钠泵α3亚单位表达增强 ,而α1与α2亚单位表达无改变。结论　哇巴因在高血压发病中可能起着重要作用 ;哇巴因与地高辛可导致不同的钠泵基因表达改变     

国产坎地沙坦酯片治疗轻中度原发性高血压的疗效和安全性

目的评价坎地沙坦酯片治疗轻中度原发性高血压的疗效和安全性.方法随机、双盲、双模拟、阳性药物(氯沙坦)平行对照.61例轻、中度原发性高血压服用坎地沙坦酯片或氯沙坦片各1片,1次/d,必要时增加剂量1次.总疗程8周.结果氯沙坦组治疗前的血压为(146.2±11.6)/(100.3±3.3)mm Hg,治疗后的血压为(130.3±9.8)/(85.7±8.0)mm Hg,血压下降幅度为(16.0±11.8)/(14.6±6.8)mm Hg;坎地沙坦酯组治疗前的血压为(143.4±11.2)/(100.6±4.1)mm Hg,治疗后的血压为(130.4±11.2)/(86.3±8.0)mm Hg,血压下降幅度为(13.0±8.7)/(14.3±6.5) mm Hg.两组治疗后血压降低幅度均有统计学意义,主要降幅均在前2周.组间无差异.治疗前后心率无明显变化.坎地沙坦酯和氯沙坦降压显效率分别为60.7%和60.0%,总有效率分别为82.1%和76.7%,组间无差别.不良事件坎地沙坦酯和氯沙坦组为头晕各2例和1例,血生化等实验室指标无异常改变.结论国产坎地沙坦酯片治疗轻中度原发性高血压不良反应发生率很低,本文无1例出现咳嗽,耐受性良好,适用于长期治疗.     

哇巴因对大鼠心肌重构的作用

目的研究哇巴因对大鼠心肌重构的作用。方法雄性Sprague-Dawly(SD)大鼠22只随机分为哇巴因组(n=12)及对照组(n=10),经腹腔注射哇巴因[20μg/(kg·d)]和生理盐水[1mL/(kg·d)]8周构建动物模型。第6周,根据收缩压情况,将哇巴因组分为哇巴因敏感鼠(收缩压升高,n=10)和哇巴因抵抗鼠(收缩压没有明显升高,n=2)。电镜下观察3组心肌的超微结构变化,同时实时定量PCR检测其电压门控性K+通道4.2(Kv4.2)表达水平的变化;通过膜片钳方法研究哇巴因对大鼠心室肌细胞动作电位及瞬间外向钾电流(Ito)的影响。结果从第6周起,与对照组比较,10只哇巴因敏感鼠收缩压明显升高[(138.2±8.0)比(120.1±5.2)mmHg,P<0.01];2只哇巴因抵抗鼠收缩压无明显变化[(126.7±11.4)比(125.4±6.9)mmHg,P>0.05]。哇巴因敏感鼠电镜观察其左心室心尖部中层心肌组织可见线粒体肿胀等超微结构改变。哇巴因抵抗鼠心肌细胞超微结构较对照组差异无统计学意义。RT-PCR提示3组大鼠心肌Kv4.2表达差异无统计学意义。膜片钳结果提示哇巴因敏感鼠心室肌细胞动作电位时程延长,Ito密度下调,引起心肌电重构。结论哇巴因引起大鼠血压升高的同时引起心肌结构重构及电重构。     

G蛋白β_3亚单位基因C825T多态性影响缬沙坦的降压疗效

目的探讨G蛋白β3亚单位基因C825T多态性与缬沙坦的降压疗效的关系。方法采用聚合酶链反应限制片段长度多态性方法检测147例健康人(对照组)和321例高血压病患者(高血压组)的G蛋白β3亚单位C825T多态性,其中102例高血压病患者口服缬沙坦4周。结果高血压组G蛋白β3亚单位C825T多态性中基因型频率(CC28.7%、CT 52.0%、TT 19.3%)、等位基因频率(C 54.7%、T 45.3%)与对照组基因型频率(CC 27.2%、CT 46.9%、TT25.9%)、等位基因频率(C 50.7%、T 49.3%)比较无显著性差异;缬沙坦对CT[(18.29±11.17)mm Hg,1 mm Hg=0.133 kPa]、TT[(25.63±22.68)mm Hg]、CT+TT[(19.25±13.20)mm Hg]基因型患者降低收缩压的作用强于CC基因型[(11.33±9.15)mm Hg,P<0.05];对CT[(15.03±9.35)mm Hg]、CT+TT[(14.50±9.23)mm Hg]基因型患者降低舒张压的作用强于CC基因型[(8.81±5.60)mm Hg,P<0.05]。结论G蛋白β3亚单位基因C825T多态性与缬沙坦的降压疗效相关,而与原发性高血压无关。     

不同联合降压方案对高血压患者血压和脉搏波传导速度的影响

目的探讨不同药物的联合降压治疗方案对高血压患者血压和脉搏波传导速度(PWV)的影响。方法选择2008年1～9月在北京医院心内科门诊就诊的高血压患者66例,其中男性36例,女性30例,年龄50～75岁,平均(60.7±7.5)岁。将研究对象随机分为两组:一组患者采用氨氯地平+复方阿米洛利(A组)治疗,另一组患者采用氨氯地平+替米沙坦(B组)治疗。观察不同的联合降压方案对血压、心率、肱踝动脉PWV(baPWV)、血脂、血糖、肌酐和尿酸的影响。结果两种治疗方案均有良好的降压作用,A组平均收缩压和舒张压由(154.4±12.7)mm Hg和(89.1±7.4)mm Hg分别降至(127.7±11.2)mm Hg和(74.8±8.8)mm Hg(均为P<0.01);B组平均收缩压和舒张压由(155.0±12.9)mm Hg和(90.9±10.1)mm Hg分别降至(128.6±9.9)mm Hg和(77.7±9.0)mm Hg(均为P<0.01)。治疗前和治疗后及两组之间比较,治疗方案对baPWV、心率、血脂、血糖和肌酐无明显影响。B组治疗后尿酸水平由治疗前的(335.8±58.5)μmol/L上升到(361.4±51.3)μmol/L(P=0.017)。结论两种联合治疗方案均有良好的降压作用,对baPWV均无显著影响。     

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.