恩替卡韦治疗合并肺结核的慢性HBV携带者效果观察

目的探讨肺结核合并慢性HBV携带患者抗结核治疗的同时应用恩替卡韦治疗的临床效果。方法收集2013年1月-2015年12月南安市医院收治的108例肺结核合并慢性HBV携带者,分为恩替卡韦组(n=58)和对照组(n=50)。恩替卡韦组在给予抗结核药物治疗前1个月至抗结核治疗全程均采用恩替卡韦进行干预,对照组单纯使用抗结核药物治疗,比较2组肝损伤及临床症状的发生率、肝功能异常出现时间及肝功能恢复的时间。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果恩替卡韦组与对照组肝功能异常发生率(29.31%vs 64.00%)、肝损伤临床症状发生率(17.24%vs 28.00%)比较,差异均有统计学意义(χ2值分别为8.475、5.534,P值均0.05);恩替卡韦组与对照组肝功能异常出现及恢复正常的时间分别为(25.1±10.2)d vs(20.1±8.9)d、(26.5±9.8)d vs(32.6±11.2)d,2组比较差异均有统计学意义(t值分别为2.675、3.778,P值均0.05)。结论恩替卡韦能明显降低肺结核合并慢性HBV携带者抗结核治疗所引起的肝损伤,延缓肝损伤出现时间,并能加快肝功能的恢复。     

前列地尔联合恩替卡韦治疗合并腹水的乙型肝炎肝衰竭效果观察

目的观察前列地尔联合恩替卡韦治疗乙型肝炎肝衰竭合并腹水患者的临床效果。方法选取2011年9月-2014年6月于中国人民解放军九七医院住院治疗的乙型肝炎肝衰竭合并腹水患者84例,随机分为治疗组(n=42)和对照组(n=42)。两组患者均予保肝、退黄、利尿、白蛋白营养支持等常规治疗,对照组加用恩替卡韦,治疗组加用前列地尔和恩替卡韦联合治疗。观察记录患者治疗前后的肝功能指标(TBil、ALT、AST)、PTA、HBV DNA载量、临床疗效及24 h尿量和腹水消退情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果 2组内治疗前后肝功能指标(TBil、ALT、AST)、PTA、HBV DNA水平比较差异均有统计学意义(P值均0.05);治疗组与对照组间治疗后TBil、ALT、AST、PTA比较差异均有统计学意义[TBil:(197.4±47.6)μmol/L vs(287.5±150.6)μmol/L,t=2.30,P0.05;ALT:(189.4±63.8)U/L vs(263.4±79.5)U/L,t=2.73,P0.05;AST:(138.7±87.5)U/L vs(250.8±90.4)U/L,t=3.43,P0.05;PTA:(63.5±17.0)%vs(45.5±15.1)%,t=2.60,P0.05]。治疗组患者临床疗效的显效率和总有效率显著高于对照组(显效率:40.48%vs 28.57%,χ2=4.32,P0.05;总有效率:85.71%vs66.67%,χ2=4.20,P0.05);治疗组患者腹水消退情况的显效率和总有效率显著高于对照组(显效率:47.62%vs 23.81%,χ2=13.20,P0.05;总有效率:88.10%vs 52.38%,χ2=12.81,P0.05)。结论前列地尔联合恩替卡韦治疗乙型肝炎肝衰竭临床效果好,可有效改善预后,安全性好,值得推广。     

恩替卡韦联合胸腺肽治疗HBeAg阳性慢性乙型肝炎患者的临床效果

目的研究HBe Ag阳性慢性乙型肝炎(CHB)患者应用恩替卡韦(ETV)联合胸腺肽治疗的临床疗效。方法纳入2012年3月-2015年3月于上海市第八人民医院传染病科就诊的HBe Ag阳性CHB患者108例,根据平行、单盲、随机对照原则分为对照组(54例)和观察组(54例)。两组均接受内科综合治疗,对照组单用ETV治疗,观察组应用ETV联合胸腺肽治疗。对比两组肝功能指标、病毒学指标、免疫指标及肝纤维化指标变化。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗48周后,观察组的肝功能指标(Alb/Glo、ALT、AST、TBil)与对照组比较差异均有统计学意义[(1.73±0.57)vs(1.50±0.51)、(42.58±14.32)U/L vs(54.26±18.78)U/L、(35.79±10.33)U/L vs(49.97±17.84)U/L、(18.89±6.02)μmol/L vs(25.24±9.06)μmol/L,t值分别为2.210、3.634、5.055、4.290,P值均0.05];治疗48周后,观察组的肝纤维化指标(层黏连蛋白、透明质酸、Ⅳ型胶原片段、Ⅲ型前胶原)与对照组比较差异均有统计学意义[(65.34±11.02)ng/ml vs(102.57±16.41)ng/ml、(91.68±11.53)ng/ml vs(151.23±16.71)ng/ml、(81.02±12.64)μg/ml vs(118.47±18.01)μg/ml、(70.44±13.06)μg/ml vs(91.57±17.16)μg/ml,t值分别为13.840、21.555、12.507、7.200,P值均0.001];治疗12、24及48周时,观察组HBe Ag阴转率分别为29.63%、46.30%、57.41%,显著高于对照组的12.96%、22.22%、25.93%(χ2值分别为4.475、6.948、11.009,P值均0.05);治疗48周后观察组的血清IL-4为(2.69±1.23)pg/ml,显著低于对照组的(4.38±1.44)pg/ml(t=6.558,P0.001),IFNγ水平为(1.82±0.89)pg/ml,显著高于对照组的(1.12±0.56)pg/ml(t=4.812,P0.001);观察组的不良反应率为3.70%,与对照组的1.85%比较,差异无统计学意义(χ2=0.343,P=0.558)。结论 HBe Ag阳性CHB患者应用恩替卡韦联合胸腺肽治疗能够促进肝功能康复,调节免疫功能,提高HBe Ag阴转率并抑制肝纤维化进程。     

恩替卡韦治疗肺结核合并乙型肝炎病毒携带者41例临床疗效分析

目的 观察抗结核的同时给予恩替卡韦抗病毒治疗对乙型肝炎病毒(HBV)携带者肺结核患者的临床疗效.方法 85例HBV携带者合并肺结核患者予2(HRZE)/4(HR)抗结核治疗,其中41例患者(治疗组)同时接受恩替卡韦抗病毒治疗,另44例患者作为对照组,治疗6个月后观察患者肝功能损害情况.结果 治疗结束时,治疗组肝功能指标[ALT(45.1±3.5)U/L,AST(40.1±5.5)U/L,TBIL(22.9±3.6) μmol/L]明显低于对照组[ALT(78.2±8.6) U/L,AST(70.1±9.3)U/L,TBIL(35.1±5.7) μmol/L],血清HBV DNA复制也明显受到抑制,治疗组HBV DNA为(3.5±0.5)log10 copies/ml,对照组为(6.2±2.4) log10 copies/ml.治疗组因肝功能损害停止抗结核治疗者1例(2.4％),对照组6例(13.6％).结论 抗结核治疗过程中给予恩替卡韦抗病毒治疗对防治肝炎发作有明显保护作用.     

长期恩替卡韦经治慢性乙型肝炎患者低病毒血症的相关影响因素

目的探讨长期接受恩替卡韦治疗的慢性乙型肝炎(CHB)患者仍维持低水平病毒复制的相关影响因素。方法选取2018年11月—2020年6月于徐州医科大学附属医院门诊接受恩替卡韦抗病毒治疗至少1年的CHB患者,根据至观察期结束患者HBV DNA载量分为低病毒血症(LLV)组和持续病毒学应答(SVR)组。观察患者人口学特征参数和实验室检测指标。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用多因素logistic回归分析长期恩替卡韦经治患者出现LLV的影响因素。结果共纳入560例CHB患者,其中LLV组204例,SVR组356例。两组患者比较,年龄(Z=-3.530,P<0.001)、性别(χ2=4.270,P=0.039)、是否存在肝硬化(χ2=53.879,P<0.001)、服药依从性(χ2=5.326,P=0.021)、HBeAg阳性率(χ2=90.681,P<0.001)、治疗前基线HBV DNA载量(Z=-8.337,P<0.001)、基线HBsAg定量(Z=-10.472,P<0.001)以及用药类型(χ2=7.558,P=0.006)差异均有统计学意义。多因素logistic回归分析显示,治疗前基线HBeAg状态(OR=3.381,95%CI:1.985~5.756,P<0.001)、HBV DNA载量(OR=1.223,95%CI:1.050~1.424,P=0.010)和HBsAg定量(OR=2.448,95%CI:1.743~3.438,P<0.001)是长期恩替卡韦抗病毒治疗出现LLV的危险因素。结论在临床实践中,基线高载量HBV DNA水平、高HBsAg定量和HBeAg阳性的CHB患者即使长期坚持服用恩替卡韦抗病毒治疗,也存在较高的LLV风险。因此,对于此类人群应予以重视,需动态监测HBsAg定量、HBV DNA载量、HBeAg状态。     

恩替卡韦治疗慢性乙型肝炎合并肝脂肪变的效果评价

目的探讨慢性乙型肝炎(CHB)合并肝脂肪变患者经恩替卡韦抗病毒治疗后的效果。方法纳入新疆巴州人民医院2014年6月-2015年6月就诊的HBe Ag阳性CHB患者164例,根据肝小叶内肝脂肪变的肝细胞数占总肝细胞数的比例将其分为3组:脂肪变肝细胞占比5%(对照组,89例),脂肪变肝细胞占比5%~30%(A组,43例),脂肪变肝细胞占比30%组(B组,32例)。患者均给予恩替卡韦治疗。检测患者治疗前和治疗后24、48周血清病毒学指标和肝功能指标变化。计量资料组间比较采用单因素方差分析,进一步两两比较采用Bonferroni法;计数资料组间比较采用χ~2检验。结果肝脂肪变不影响恩替卡韦治疗24周时的病毒学应答(P0.05),但恩替卡韦治疗48周时,B组HBe Ag阴转率(34.4%vs 60.2%)和HBV DNA阴转率(40.6%vs67.4%)均明显低于对照组,差异具有统计学意义(P值分别为0.012和0.008);恩替卡韦治疗24和48周时,A组、B组的ALT复常率明显低于对照组,差异均有统计学意义(A组:P值分别为0.013、0.001;B组:P值分别为0.001、0.001),而血清AST、ALP及GGT水平显著高于对照组,差异均有统计学意义(A组:P24值分别为0.001、0.031、0.001,P48值分别为0.001、0.021、0.001;B组:P24值分别为0.001、0.028、0.001;P48值分别为0.001、0.017、0.001)。结论肝脂肪变细胞占比30%与恩替卡韦治疗48周时病毒学应答降低相关,肝脂肪变会影响CHB患者恩替卡韦治疗24周和48周时的生化学应答。     

中医特色慢病管理在社区慢性乙型肝炎患者中的效果评价

目的观察中医特色慢病管理方案干预社区慢性乙型肝炎(CHB)患者的疗效。方法采用非随机病例对照的研究方法,选取2014年-2016年在广州天河社区就诊的84例CHB患者为研究对象,将其分成中医慢病管理组和对照组,每组42例。中医慢病管理组给予恩替卡韦片(0.5 mg,1次/d,口服)治疗和中医慢病管理;对照组给予恩替卡韦片治疗和常规疾病基础知识教育及服药指导。治疗48周后比较两组患者ALT复常率、HBeAg血清学转换率、HBV DNA阴转率、中医症状积分、生存质量积分等的差异。符合正态分布的计量资料组间比较采用两独立样本t检验,治疗前后的比较采用配对t检验;非正态分布的计量资料采用相对应的非参数检验方法进行分析。计数资料两组间比较采用χ~2检验或Fisher确切概率法。结果治疗48周后,中医慢病管理组的临床证候积分明显低于对照组(3.66±1.92 vs 6.42±2.48,t=5.563,P0.001),且生存质量总分明显高于对照组(550.75±54.24 vs 491.08±54.21,t=-4.888,P0.001)。中医慢病管理组的48周ALT复常率(80.00%vs 72.22%,χ~2=0.590,P=0.443)、HBV DNA阴转率(73.17%vs 68.42%,P0.05)、HBeAg血清学转换率(29.27%vs 18.42%,P0.05)均稍高于对照组,但差异均无统计学意义。结论中医特色慢病管理能够改善社区慢性乙型肝炎患者临床症状,提高患者生存质量,同时,对于提高患者抗病毒疗效有一定意义,值得在社区进一步推广应用。     

恩替卡韦单药治疗慢性乙型肝炎患者部分病毒学应答的影响因素

目的探讨恩替卡韦单药治疗慢性乙型肝炎(chronic hepatitis B,CHB)患者出现部分病毒学应答的影响因素。方法选取2016年1月至2017年12月于眉山市人民医院感染科门诊接受恩替卡韦连续抗病毒治疗至少1年的CHB初治患者为研究对象,采用单因素分析和多因素Logistic回归分析恩替卡韦单药治疗患者出现部分病毒学应答的影响因素。结果共纳入197例CHB患者,其中62例(31.5%)获得完全病毒学应答,135例(68.5%)获得部分病毒学应答。单因素分析提示,年龄(t=2.349,P=0.020)、HBe Ag状态(χ2=12.154,P 0.001)、治疗前HBV DNA水平(t=3.314,P=0.001)和错误的服药方式(χ2=61.167,P 0.001)在完全病毒学应答和部分病毒学应答患者间差异有统计学意义。多因素Logistic回归分析表明,HBe Ag状态(OR=2.117,95%CI:1.997～2.203,P=0.022)、治疗前HBV DNA水平(OR=6.147,95%CI:6.004～6.212,P=0.014)错误的服药方式(OR=37.541,95%CI:35.469～40.068,P=0.002)是恩替卡韦抗病毒治疗出现病毒学应答不佳的独立危险因素。结论在真实世界中,治疗前HBV DNA水平、HBe Ag状态和错误的服药方式均是恩替卡韦单药治疗CHB患者疗效欠佳的独立危险因素。     

恩替卡韦治疗慢性乙型肝炎的疗效观察

目的评价恩替卡韦治疗慢性乙型肝炎(CHB)患者96周的疗效。方法收集2011年7月-2014年7月在江苏省泰兴市人民医院门诊和住院的62例CHB患者,给予恩替卡韦0.5 mg/d抗病毒治疗96周。所有病例分为两组,HBe Ag阳性组患者43例,HBe Ag阴性组患者19例。其中HBV DNA106拷贝/ml患者38例,HBV DNA106拷贝/ml患者24例。比较两组治疗24、48及96周的疗效。计数资料组间比较采用χ2检验。结果在治疗24、48、96周时,HBe Ag阳性组患者HBV DNA阴转率分别为34.88%、65.12%、74.42%,明显低于HBe Ag阴性组的78.95%、89.47%、100%,差异均有统计学意义(P值分别为0.003、0.047、0.038)。两组患者的ALT复常率差异均无统计学意义(P值分别为0.102、0.779、0.638)。在38例HBV DNA载量106拷贝/ml和24例HBV DNA载量106拷贝/ml的两组中,治疗24、48、96周时,两组患者HBV DNA阴转率差异均有统计学意义(34.21%vs70.83%、57.89%vs 95.83%、76.32%vs 95.83%,P值分别为0.005、0.001、0.002);两组患者ALT复常率差异均无统计学意义(P值分别为0.940、0.150、0.280)。结论恩替卡韦治疗CHB有很好的抗病毒活性,在抑制病毒复制的同时能改善肝功能。     

恩替卡韦致外周血单个核细胞中线粒体DNA损伤的研究

目的 探讨长期服用恩替卡韦是否会导致慢性乙型肝炎(CHB)患者外周血单个核细胞(PBMCs)中线粒体损伤.方法 CHB患者52例,分为3组:(1)2年组:恩替卡韦单药治疗2年,共17例;(2)3年组:恩替卡韦单药治疗3年,共17例;(3)对照组:未经抗病毒治疗的首次发病的CHB患者18例.实时定量PCR检测各组患者外周血单个核细胞中线粒体DNA含量;酶联免疫吸附法检测血浆丙二醛、F2-isoprostanes含量;分光光度法检测血浆总抗氧化能力.满足方差齐性的数据,采用方差分析方法进行组间差异的比较;不满足方差齐性的数据,用秩转换的方差分析思想进行组间差异的比较.计数资料采用x2检验或Fisher's确切概率法进行组间差异的比较. 结果 3组间RQ值(线粒体DNA/核DNA)差异有统计学意义(F=5.233,P=0.009).3年组RQ值为0.5±0.3,低于对照组1.4±1.2,两组比较,差异有统计学意义(P=0.022);2年组RQ值0.4±0.2与对照组相比,P=0.004,差异有统计学意义.3组间F2-isoprostanes含量差异有统计学意义(F=6.266,P=0.004).3年组F2-isoprostanes为(1.2±0.5)ng/ml,显著低于对照组的(3.6±2.9) ng/ml和2年组的(2.4±1.3) ng/ml,P值分别为0.002,0.007.3组间血浆总抗氧化能力差异有统计学意义(F=4.326,P=0.019).3年组血浆总抗氧化能力为(2.6± 1.2) U/ml,显著低于对照组的(5.0±3.0) U/ml,差异有统计学意义(P=0.005),与2年组的血浆总抗氧化能力(3.2±1.6)U/ml相比,差异无统计学意义(P=0.227).血浆丙二醛3组间差异无统计学意义(P=0.749).结论 服用恩替卡韦治疗CHB达3年时总的效应是可能会导致外周血单个核细胞中线粒体DNA数量减少,但对线粒体功能的损伤在机体代偿范围内,不会损害线粒体功能.     

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.     

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.     

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.     

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。     

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     

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。     

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.