布地奈德／福莫特罗联合孟鲁司特钠治疗咳嗽变异型哮喘的疗效观察

目的观察布地奈德／福莫特罗（信必可）联合孟鲁司特钠（顺尔宁）治疗成人咳嗽变异型哮喘的疗效。方法89例患者随机分成3组,治疗组吸入布地奈德／福莫特罗及服用孟鲁司特钠。对照组2组分别吸入布地奈德／福莫特罗或服用孟鲁司特钠。结果3组治疗后的症状积分及肺功能较治疗前均有显著改善。且3组治疗后的症状积分及肺功能比较,治疗组优于布地奈德／福莫特罗组、孟鲁司特钠组;经统计学处理,差异有统计学意义（P〈0．05）。结论布地奈德／福莫特罗与孟鲁司特钠联合应用在治疗咳嗽变异性哮喘的疗效优于单用布地奈德／福莫特罗、孟鲁司特钠。     

白三烯受体拮抗剂孟鲁司特治疗咳嗽变异性哮喘52例疗效观察

目的 了解孟鲁司特对咳嗽变异性哮喘的疗效。方法 将97例咳嗽变异性哮喘患者随机分为治疗组和对照组，对照组采用常规方法，给予口服盐酸丙卡特罗（美普清）治疗，治疗组在常规治疗的基础上给予口服孟鲁司特，观察咳嗽症状缓解时间及随访3个月的复发率。结果 治疗组咳嗽症状缓解时间及复发率明显短于对于对照组（P〈0．01）。结论 孟鲁司特治疗咳嗽变异性哮喘及降低其复发率有较好的疗效。     

孟鲁司特钠联合特布他林治疗儿童咳嗽变异性哮喘伴肺炎支原体感染的研究

目的探讨孟鲁司特钠联合特布他林治疗儿童咳嗽变异性哮喘伴肺炎支原体感染的可行性。方法将98例儿童咳嗽变异性哮喘伴肺炎支原体感染的患儿随机分为观察组和对照组各49例。对照组给予特布他林治疗,观察组在对照组的基础上给予孟鲁司特钠治疗,疗程12周,比较两组临床疗效以及临床不适症状等。结果观察组显效35例,有效11例,无效3例,对照组显效25例,有效13例,无效11例。观察组疗效优于对照组(P0.01);且临床症状改善时间短于对照组(P0.01)。结论儿童咳嗽变异性哮喘伴肺炎支原体感染患儿采用孟鲁司特钠联合特布他林治疗,能有效改善临床症状及体征,疗效确切,安全性高,不良反应少,具有一定可行性。     

孟鲁司特钠联合布地奈德治疗支气管哮喘临床疗效观察

目的:观察孟鲁司特钠联合布地奈德治疗支气管哮喘的临床治疗效果。方法:选择院收治的70例支气管哮喘患儿,把70例患儿随机均分为两组,对照组患儿给予布地奈德治疗,观察组患儿给予孟鲁司特钠联合布地奈德治疗,对两组患儿的临床治疗效果进行对比。结果:对照组患儿显效10例,有效15例,无效10例,有效率为71.4%,观察组患儿显效22例,有效12例,无效1例,有效率为97.1%,两组患儿对比,差异有统计学意义(P<0.05)。结论:孟鲁司特钠联合布地奈德治疗支气管哮喘临床疗效明显,建议推广临床应用。     

孟鲁司特钠治疗咳嗽变异性哮喘患儿气管炎症的效果分析简

目的 探讨孟鲁司特钠对咳嗽变异性哮喘患儿气管炎症的治疗效果.方法 以我院咳嗽变异性哮喘患儿98例为研究对象,按照患者是否使用孟鲁司特钠,将患儿分为观察组（49例）和对照组（49例）,比较患儿在临床症状、肺功能和咳嗽变异性哮喘相关炎性因子水平之间的差异.结果 观察组患儿临床各指标水平优于对照组,其差异有统计学意义.结论孟鲁司特钠相较于传统长期吸入糖皮质治疗方法,对于小儿咳嗽变异性哮喘有更积极的治疗作用.     

孟鲁司特钠联合沙美特罗/氟替卡松治疗咳嗽变异性哮喘疗效分析

目的比较孟鲁司特钠联合沙美特罗/氟替卡松、沙美特罗/氟替卡松治疗咳嗽变异性哮喘的疗效。方法选择60名咳嗽变异性哮喘患者,随机分成两组：对照组：吸入沙美特罗/氟替卡松（50 ug/250 ug）早晚各1吸,治疗组：联合孟鲁司特钠10mg每晚口服。每组按需吸入沙丁胺醇气雾剂。观察两组病人的临床疗效、不良反应和复发率。结果治疗组临床疗效明显改善,与对照组相比有显著差异性（P〈0.05）。结论孟鲁司特钠联合沙美特罗/氟替卡松治疗咳嗽变异性哮喘疗效明显,值得推广。     

孟鲁司特联合小剂量吸入型糖皮质激素治疗咳嗽变异性哮喘32例疗效观察

将确诊的62例咳嗽变异性哮喘（CVA）患者随机分为观察组32例和对照组30例,两组每天均予吸入型糖皮质激素布地奈德200～400μg／d治疗,并于必要时加用β2激动剂沙丁胺醇气雾剂,每次200峭（2喷）;观察组另予孟鲁司特10mg／d,睡前一次口服。治疗8周观察疗效。结果两组咳嗽频率评分、夜间咳醒次数及β2激动剂使用次数均显著减少,肺功能指标MVV、FEV1、FEV1／FVC等参数及晨间和夜间的PEF均明显提高（P均〈0．01）,且观察组优于对照组,P〈0．01。认为孟鲁司特联合小剂量吸入型糖皮质激素较单用激素能更有效控制哮喘发作,可进一步改善肺功能。     

孟鲁司特钠治疗咳嗽变异性哮喘患儿气管炎症的效果分析

目的探讨孟鲁司特钠对咳嗽变异性哮喘患儿气管炎症的治疗效果。方法以我院咳嗽变异性哮喘患儿98例为研究对象,按照患者是否使用孟鲁司特钠,将患儿分为观察组(49例)和对照组(49例),比较患儿在临床症状、肺功能和咳嗽变异性哮喘相关炎性因子水平之间的差异。结果观察组患儿临床各指标水平优于对照组,其差异有统计学意义。结论孟鲁司特钠相较于传统长期吸入糖皮质治疗方法,对于小儿咳嗽变异性哮喘有更积极的治疗作用。     

布地奈德/福莫特罗干粉吸入剂治疗成人咳嗽变异性哮喘的临床研究

目的:评价联合应用布地奈德/福莫特罗粉吸入剂及孟鲁司特钠口服片剂,治疗成人咳嗽变异性哮喘的疗效。方法:咳嗽变异性哮喘患者42例,随机分为观察组22例(联合应用布地奈德/福莫特罗粉吸入剂及孟鲁司特钠口服片剂治疗),对照组20例(单用孟鲁司特钠口服片剂),连用4w。在治疗前、治疗2w、4w后分别记录患者的咳嗽症状积分及视觉模拟评分(VAS),比较2组的疗效。结果:两组治疗2w及4w后,咳嗽积分及VAS较治疗前均有下降,观察组下降明显,观察组在治疗2w后与对照组咳嗽积分比较P<0.05;4w后显著下降,两组比较P<0.001。结论:联合应用布地奈德/福莫特罗粉吸入剂及孟鲁司特钠口服片剂治疗成人咳嗽变异性哮喘比单用孟鲁司特钠疗效显著。     

孟鲁司特钠联合布地奈德治疗小儿咳嗽变异性哮喘的疗效分析

目的:探讨孟鲁司特钠联合布地奈德治疗小儿咳嗽变异性哮喘的临床效果,旨在提高治疗效果。方法:选择咳嗽变异性哮喘患儿102例为研究对象。根据治疗模式的不同分为联合治疗组和单纯治疗组,每组51例。联合治疗组给予孟鲁司特钠联合布地奈德治疗,单纯治疗组只给予布地奈德气雾剂吸入治疗,分析对比两组的治疗效果、临床状况和肺功能指标。结果:联合治疗组患者的显效率显著高于对照组,而无效率显著低于对照组,两组在治疗效果间的差异具有统计学意义(P<0.05)。联合治疗组的咳嗽缓解时间、咳嗽消失时间和治疗时间均显著短于对照组,差异均具有统计学意义(P<0.05)。联合治疗组的FEV1、PEF和FEV1/FVC均高于对照组(P<0.05)。结论:孟鲁司特联用布地奈德治疗小儿咳嗽变异性哮喘临床疗效确切,不良反应少,提高肺功能,提高治疗效果。     

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.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。