左氧氟沙星静脉／口服序贯治疗老年社区获得性下呼吸道感染

目的 观察左氧氟沙星静脉／口服序贯治疗老年下呼吸道感染的疗效和安全性。方法 100例老年下呼吸道感染患者分成两组，分别予左氧氟沙星500mg／d静脉／口服序贯治疗或全程静脉治疗。结果 序贯治疗有效率84％，菌清除率69．2％。全程静脉治疗有效率86％，菌清除率72．7％。两组不良反应均轻微。结论 左氧氟沙星静脉／口服序贯治疗老年社区获得性下呼吸道感染有效，安全。     

莫西沙星序贯治疗老年急性下呼吸道感染的疗效观察

目的观察莫西沙星序贯治疗老年急性下呼吸道感染的疗效。方法选取60例老年中重度急性下呼吸道感染的老年患者,随机分组后,分别给予莫西沙星序贯治疗、莫西沙星静脉治疗及头孢呋辛序贯治疗,比较其临床疗效、细菌清除率及不良反应。结果莫西沙星序贯治疗组与莫西沙星静脉治疗组相比,总有效率（85％与90％）、治愈率（75％与75％）及细菌清除率（88．23％与87．5％）无显著差异（P〉0．05）,但显著优于头孢呋辛序贯治疗组（65％、50％和68．8％,P〈0．05）。3组不良反应发生率均较低,无显著性差异（P〉0．05）。结论莫西沙星序贯治疗临床抗感染疗效确切,不良反应轻微,是治疗老年人急性下呼吸道感染较为理想的治疗方法。     

青霉烷砜／氨苄青霉素与头孢呋肟序贯疗法对老年呼吸道感染的临床研究

目的本总结青霉烷砜／氨苄青霉素(优立新)与头孢呋肟序贯疗法对老年人急性呼吸道感染治疗的临床疗效。方法对31例呼吸道感染患静脉注射青霉烷砜／氨苄青霉素继服舒他西林(优立新组)；同时对52例患静脉注射头孢呋肟继服头孢呋肟酯(头孢呋肟组)．两组疗效进行比较。结果优立新组：痊愈12例(39％)．显效12例(39％)．总有效率78％；头孢呋肟组：痊愈24例(46％)．显效15例(29％)，总有效率75％；两组在疗程中均无肝、肾、血象等方面的不良反应。结论两种序贯治疗对老年急性呼吸道感染均有较好的疗效．无明显差异。安全性高，使用方便。     

阿奇霉素序贯疗法联合孟鲁司特治疗儿童支原体肺炎的疗效分析

目的探讨阿奇霉素序贯疗法联合孟鲁司特治疗儿童支原体肺炎的疗效。方法将60例支原体肺炎患儿随机分为两组,对照组30例予以阿奇霉素静脉滴注并序贯口服治疗,治疗组30例在静脉滴注并序贯口服阿奇霉素基础上加用孟鲁司特口服,对比两组患者总有效率,观察临床症状、体征消失时间,不良反应。结果治疗组体征消失时间均短于对照组;住院时间也显著短于对照组(P0.05);治疗组总有效率为96.7%,对照组的总有效率为86.7%,显著高于对照组(P0.05);治疗组在治疗过程中未发现与孟鲁司特相关的不良反应。结论阿奇霉素序贯疗法联合孟鲁司特可有效改善支原体肺炎患儿临床症状,缩短病程,提高儿童肺炎支原体肺炎的防治水平。     

序贯疗法治疗社区获得性肺炎的临床观察

目的探讨头孢菌素与左氧氟沙星序贯治疗在社区获得性肺炎患者中的合理应用。方法将符合入选条件的129例患者随机分为两组。序贯疗法组67例，静滴头孢噻肟钠与乳酸左氧氟沙星3d后改用口服头孢克洛胶囊和盐酸左氧氟沙星片7d，总疗程10d；对照组62例，采用头孢噻肟钠与盐酸左氧氟沙星连续静脉滴注10d。对两组患者临床疗效、细菌清除率、药物不良反应及医疗费用进行分析评价。结果贯序疗法组临床总有效率为88．06％，对照组为90．32％，两组总有效率间差异无统计学意义（P〉0.05）；贯序疗法组细菌清除率为92．71％，对照组为94．02％，差异无统计学意义（P〉0．05）；两组均未出现严重不良反应；住院总费用：序贯疗法组468．7元，对照组972．8元，差异有统计学意义（P〈0．05）。结论序贯疗法对治疗社区获得性肺炎安全有效，具有更加合理的效价比。     

头孢曲松-头孢克洛序贯疗法治疗儿童支气管肺炎的成本-效益分析

目的分析头孢曲松-头孢克洛序贯疗法治疗儿童支气管肺炎的临床疗效及疾病成本负担。方法选取2015年1月—2016年1月菏泽市牡丹人民医院收治的支气管肺炎患儿120例,采用随机数字表法分为对照组和试验组,每组60例。在常规治疗基础上,对照组患儿给予头孢曲松治疗7 d,试验组患儿给予头孢曲松治疗3 d后改用头孢克洛缓释片治疗4 d。比较两组患儿临床疗效,治疗前后白细胞计数、中性粒细胞分数、淋巴细胞分数及C反应蛋白水平,治疗成本(包括抗生素治疗费用、治疗总费用、住院天数),观察两组患儿治疗期间不良反应发生情况。结果两组患儿临床疗效比较,差异无统计学意义(P0.05)。两组患儿治疗前后白细胞计数、中性粒细胞分数、淋巴细胞分数及C反应蛋白水平比较,差异均无统计学意义(P0.05)。试验组患儿抗生素治疗费用、治疗总费用少于对照组,住院天数短于对照组(P0.05)。两组患儿治疗期间均未出现严重不良反应。结论头孢曲松-头孢克洛序贯疗法治疗儿童支气管肺炎的临床疗效与头孢曲松常规治疗相当,安全性相似,但头孢曲松-头孢克洛序贯疗法的成本-效益更优。     

头孢他美匹酯与头孢克肟随机对照治疗细菌性感染的临床研究

为评价头孢他美匹酯的安全性及临床疗效，用头孢他美匹酯（每１２小时２５０～５００ｍｇ）与头孢克肟（每１２小时２００ｍｇ，疗程均为７～１０天）随机对照治疗呼吸道与泌尿道感染９９例。试验组进入临床试验病例６１例，不良反应评价病例５５例，疗效评价５１例。对照组进入试验病例５８例，不良反应评价病例５４例，疗效评价４８例。结果头孢他美匹酯与头孢克肟两组的临床有效率分别为９４．１％（４８／５１例）与９１．７％（４４／４８例），细菌清除率分别为９５．３％与９５．１％，不良反应发生率分别为９．１％与７．４％，上述结果经统计学比较差异无显著性。表明头孢他美匹酯为治疗临床常见的呼吸道、泌尿道感染的安全、有效的抗菌药物。     

可乐必妥静滴液和片剂序贯法治疗呼吸道感染的安全性与有效性研究

目的评价可乐必妥（500mg）先静脉后口服序贯给药治疗呼吸道感染的疗效与安全性。方法采用前瞻性随机开放试验设计方法，对30例急性呼吸道感染患者采用可乐必妥500mg静脉滴注，每日1次，3—5天，继以可乐必妥500mg口服，每日1次，5—10天，总疗程8—15天。观察临床疗效和不良反应情况。结果临床总有效率为93．3％。其中临床症状和体征改善有效率为100％，胸片阴影改善好转率为90％，降低白细胞计数及中性粒细胞有效率为100％，细菌清除率100％。不良反应以胃肠道反应为多见，实验室检查异常发生率均系轻度改变，并呈一过性，无需处理。结论本研究结果显示，可乐必妥500mg静脉口服序贯给药用于治疗呼吸道感染可获良好疗效，使用安全、不良反应发生率低，且经济方便，病人依从性好。     

氟康唑序贯疗法治疗老年人肺部白色念珠菌感染的临床评价

目的　评价氟康唑静脉滴注后改口服的序贯疗法治疗老年人肺部白色念珠菌感染的疗效及不良反应。方法　用氟康唑序贯疗法治疗老年人肺部白色念珠菌感染 60例 ,第 1d 40 0mg静脉滴注 ,第 2d改为 2 0 0mg静脉滴注 ,每日 1次 ,连续用 7～ 10d后改口服 ,2 0 0mg/d ,每天 1次。疗程 3～ 4周。 结果　总有效率为 90 0 % ,白色念珠菌清除率为 85 0 % ,不良反应发生率为 8 3 %。结论　氟康唑序贯疗法疗效高 ,不良反应少 ,用药方便 ,尤适用于老年人     

头孢米诺钠治疗糖尿病合并社区获得性下呼吸道感染的临床分析

目的研究头孢米诺钠治疗糖尿病合并社区获得性下呼吸道感染的临床疗效。方法抽选在该院接受糖尿病合并社区获得性下呼吸道感染治疗的100例患者作为研究对象进行分析,将其分组观察,即观察组与对照组,各50例,对照组选择的治疗方法为常规头孢噻肟钠,而观察组则是选取头孢米诺钠进行治疗。对比两组的总有效率、不良反应发生率、空腹血糖、餐后2 h血糖以及细菌清除率。结果对照组的总有效率低于观察组、不良反应发生率、细菌清除率、空腹血糖、餐后2 h血糖低于观察组,差异有统计学意义(P0.05)。结论头孢米诺钠治疗糖尿病合并社区获得性下呼吸道感染具有极高的应用价值,效果理想,安全指数高,值得推广使用。     

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.