β受体阻滞剂比索洛尔对老年原发性高血压患者骨代谢的影响

目的观察β受体阻滞剂比索洛尔对老年原发性高血压患者骨质密度及骨折发生率的影响。方法选择老年男性原发性高血压患者150例,按是否服用β受体阻滞剂比索洛尔分为治疗组(85例,比索洛尔5 mg/d,连续服用3年)和对照组(65例)。分别比较两组血清钙、磷、碱性磷酸酶浓度;并分析骨密度及骨折发生率。结果治疗组血清钙、磷、碱性磷酸酶浓度与对照组比较,差异均无统计学意义(P>0.05);治疗组患者用药3年后骨折4例(4.7%),对照组患者3年后骨折7例(10.8%),治疗组较对照组骨折发生率虽有下降,但差异无统计学意义(P>0.05);与用药前骨密度比较,治疗组用药3年后骨密度明显增高[(1.04±0.11)g/cm~2vs(1.49±0.13)g/cm~2,P<0.05];与对照组3年后骨密度比较,治疗组用药3年后骨密度也明显增高[(1.06±0.12)g/cm~2vs(1.49±0.13)g/cm~3,P<0.05]。结论长期服用治疗剂量β受体阻滞剂比索洛尔的老年原发性高血压患者骨密度明显增高,骨折发生率下降,但血清钙代谢未受到影响。     

老年2型糖尿病合并糖尿病足患者骨密度的临床分析

目的 探讨老年2型糖尿病(T2DM)合并糖尿病足患者骨密度变化及其影响因素.方法 采用双能X线骨密度仪检测T2DM、T2DM合并糖尿病足患者及健康老年人腰椎(L2～4)和股骨(Neck)的骨密度,并对其与年龄、病程、体质指数(BMI)、糖化血红蛋白、血清胰岛素、血脂、尿微量白蛋白排泄率、骨钙素及性激素等指标的关系进行多元线性回归分析.结果 (1)老年T2DM组腰椎、股骨骨密度和骨质疏松患病率与同性别健康对照组比较(男性:腰椎(1.13±0.17)g/cm2和(1.15±0.18)g/cm2,股骨(0.87±0.13)g/cm2和(0.90±0.16)g/cm2,骨质疏松患病率36%和35%;女性:腰椎(0.96±0.15)g/cm2和(0.97±0.14)g/cm2,股骨(0.78±0.12)g/cm2和(0.82±0.15)g/cm2,骨质疏松患病率61%和62%],差异无统计学意义(P>0.05);(2)老年糖尿病足组男性腰椎骨密度(1.05±0.17)g/cm2、股骨(0.80±0.15)g/cm2;女性腰椎骨密度(0.89±0.11)g/cm2、股骨(0.72±0.13)g/cm2,均低于同性别T2DM组和健康对照组(P<0.01或P<0.05),骨质疏松患病率(男性54%,女性82%)均高于T2DM组和缝康对照组(P<0.05);(3)多元线性回归分析显示,影响老年男性糖尿病足患者骨密度的因素为年龄、BMI和空腹胰岛素水平,影响老年女性糖尿病足患者骨密度的因素为年龄、BMI和雌二醇水平.结论 老年T2DM患者骨密度和骨质疏松患病率与健康老年人相似,与老年T2DM患者和健康老年人比较,老年糖尿病足患者骨密度显著降低,骨质疏松患病率显著增高.     

血清睾酮水平与老年男性骨质疏松性髋部骨折的相关性

目的探究血清睾酮、雌二醇、碱性磷酸酶及骨密度与老年男性骨质疏松性髋部骨折的相关性。方法选取2015年9月1日至2018年11月30日4家三甲医院65～85岁男性髋部脆性骨折住院患者220例为试验组,选取同时期65～85岁无脆性骨折男性300例为对照组。检测两组受试者空腹血清睾酮、雌二醇、碱性磷酸酶水平,并进行腰椎、股骨颈、股骨大粗隆骨密度测定。结果试验组股骨大粗隆、股骨颈、腰椎骨密度低于对照组,差异有统计学意义[股骨大粗隆:(0. 834±1. 872) g/cm~2vs.(0. 892±0. 931) g/cm~2,P0. 01;股骨颈:(0. 677±2. 014) g/cm~2vs.(0. 728±3. 120) g/cm~2,P0. 01;腰椎:(0. 530±0. 034) g/cm~2vs.(0. 634±1. 592) g/cm~2,P0. 01]。试验组血清睾酮水平低于对照组,差异有统计学意义[7. 1 (4. 8,9. 1) nmol/L vs. 12. 3 (7. 9,16. 7) nmol/L,P0. 05];两组血清碱性磷酸酶、雌二醇水平差异无统计学意义(P0. 05)。Logistic回归分析校正三处骨密度值后发现,睾酮是脆性髋部骨折的危险因素(OR=2. 140,95%CI:1. 387～3. 302,P=0. 001)。结论血清睾酮水平降低可能是老年男性髋部骨折的危险因素之一,睾酮水平检测对老年男性骨质疏松性髋部骨折具有预测作用。     

老年髋部骨折患者肌肉减少症与骨密度的关系

目的探讨老年髋部骨折患者肌肉减少症(sarcopenia)及与骨密度下降的关系。方法 113例65岁的老年髋部骨折患者(骨折组)纳入本研究,男性67例,女性46例;同期非髋部骨折老年患者1 321例作为对照组,男性654例,女性667例。所有患者均用双能X线骨密度仪(DXA)检测全身身体组成成分(骨量、肌肉含量,脂肪含量)。肌肉减少症的诊断标准:骨骼肌重量指数(SMI)(肢体骨骼肌重量/身高平方,kg/m2)低于同人种健康成年人1个标准差为1级肌肉减少症(class 1),低于2个标准差为2级肌肉减少症(class 2)。根据以上标准将受试者分为肌量正常组:男性SMI7.01 kg/m2,女性SMI5.42 kg/m2;class 1组:男性SMI 6.09~7.01 kg/m2,女性SMI 4.80~5.42 kg/m2;class2组:男性SMI≤6.08 kg/m2,女性SMI≤4.79 kg/m2。分析不同组老年髋部骨折患者肌肉减少症的检出率。结果老年髋部骨折患者肌肉减少症检出率明显高于同性别类似年龄人群:骨折组男性肌肉减少症检出率(62.6%)与对照组男性肌肉减少症检出率(12.8%)比较差异有统计学意义(P0.001),骨折组女性肌肉减少症检出率(13.0%)与非骨折组女性肌肉减少症检出率(4.1%)比较差异有统计学意义(P0.001);老年女性髋部骨折患者中肌量正常者24例(52.1%),Class 1级者16例(34.7%),Class 2级者6例(13.0%);骨骼肌重量指数与股骨颈骨密度和全身骨密度呈正相关。老年男性髋部骨折患者中肌量正常者9例(13.4%),Class 1级者16例(23.8%),Class 2级者42例(62.6%),骨骼肌重量指数与BMI呈正相关,与年龄呈负相关。结论老年髋部骨折患者肌肉减少症检出率明显高于同龄非骨折者,男性肌少症检出率高于女性。老年女性髋部骨折患者的骨骼肌重量指数与股骨颈和全身骨密度呈正相关,老年男性髋部骨折患者骨骼肌重量指数则与骨密度无明显相关性。应关注骨折患者肌肉减少症的防治。     

老年髋部骨折患者的腰椎和股骨近端骨密度的比较

目的 通过比较老年髋部骨折患者的腰椎和股骨近端骨密度值,试图找出对于髋部骨折的更具有密切相关性的骨密度测定部位.方法 采用双能骨密度仪对102名65岁以上老年髋部骨折患者入院后2周内的脊柱和髋部两个部位骨密度测定,对组间和组内数据分别进行分散分析和t检验的统计学处理.结果髋部的骨密度无论在男性和女性组均比腰椎的骨密度要低,有非常显著差异(P<0.001).女性组的髋部及腰椎骨密度要比男性组为低,有非常显著差异(P<0.001).无论男性还是女性髋部骨折患者其腰椎的骨密度均无显著下降.结论 在老年髋部骨折患者测定股骨近端的骨密度值更能反映其实际骨质疏松情况.     

老年特发性膜性肾病患者的临床病理特点及其免疫系统功能的变化

目的:特发性膜性肾病(IMN)是老年肾病综合征常见病因.本文旨在分析阐明老年IMN临床病理特点及外周血淋巴细胞亚群的变化. 方法:根据年龄,选取两组IMN患者,共83例,其中老年组43例,年龄≥65岁;非老年组40例,年龄<50岁,流式细胞仪测定外周血T淋巴细胞亚群(CD3~+、CD4~+、CD8~+细胞)、B淋巴细胞(CD20~+细胞)和调节性T细胞(CD4~+CD25~+Foxp3~+Treg细胞),观察肾组织病理改变.40例健康志愿者作为对照. 结果:(1)老年组男性28例,女性15例,年龄65～78岁,平均(67.35±3.70)岁,非老年组男性26例,女性14例,年龄15～50岁,平均(38.08±7.91)岁,两组男女比例无明显差别,老年组患者高血压发生率升高(67.44%vs27.5%,P<0.01).(2)老年组和非老年组相比,24h尿蛋白定量无明显差别,但镜下血尿发生率老年组明显增加(55.81%vs 22.5%,P<0.01);老年组.肾小管功能受损明显,表现为尿NAG酶增高[(42.26±23.99)u/g·cr vs(29.80 ±16.53)u/g·cr,P<0.05],尿渗量降低[(522.62±138.02)mOsm/Kg·H_2O vs (642.0±136.81)mOsm/Kg·H_2O,P<0.01];老年组BUN和血清肌酐水平均较非老年组明显升高[(6.3±2.6)mmol/L vs(4.93±1.87)mmol/L,P<0.01],[(72.5±14.1)μmol/L vs (65.4±17.7)μmol/L,P<0.05].(3)老年组患者肾组织小管间质慢性化病变较非老年患者明显(P<0.01),球性硬化发生率高(P<0.05).(4)与正常对照相比,老年组和非老年组患者均存在外周血B淋巴细胞计数显著升高,T调节细胞计数显著降低,两组之间无明显筹别;非老年组外周血CD4~+、CD8~+细胞计数及CD4~+/CD8~+比值均较正常无照无显著筹别,老年组外剧血CD4~+细胞计数较正常对照组及非老年组均无明显差别,但CD8~+细胞计数较正常对照组及非老年组均明显下降[(328±106)cells/μl vs(464±200)cells/μl,P<0.01],[(328±106)cells/μl vs(430±200)cells/μl,P<0.01],CD4~+/CD8~+比值均明显升高(2.40±0.97 vs 1.52±0.48,P<0.01),(2.40±0.97 vs 1.81±0.89,P<0.01). 结论:老年IMN患者高血压,镜下血尿发生率升高,肾小管功能受损明显,肾小球硬化及肾小管间质慢性化病变严重,老年IMN患者治疗反应差,预后不佳可能与此有关.老年人IMN患者除与非老年患者同样表现出调节T细胞水平降低,B淋巴细胞水平上调外,CD8~+细胞水平下降,CD4~+、CD8~+比例失衡是老年人IMN患者免疫功能异常的特点.     

老年高血压患者动态血压变化的特点分析

目的 观察老年高血压患者24 h动态血压变化的特点.方法 入选的高血压患者按年龄分为老年组(年龄≥60岁)和中年对照组(年龄<60岁).观察两组患者在治疗状态下动态血压参数的变化情况,动态血压昼夜异常发生率及舒张压<60 mmHg的发生率.结果 平均舒张压老年组均低于中年组(P<0.05);全天、日间、夜间平均脉压老年组明显高于中年组(P<0.01);老年组24 h动态血压昼夜节律异常的发生率明显高于中年组(P<0.01);舒张压<60 mmHg的发生率老年组明显高于中年组(P<0.01).结论 老年高血压患者在治疗状态下有舒张压过低、脉压大及血压昼夜节律异常的特点.     

老年人生活方式及营养状况与骨密度的关联性

目的探讨生活方式、营养状况对老年人骨密度的影响。方法采用自行设计调查问卷对进行健康体检且自愿参加骨密度(BMD)检查的637例老年志愿者进行生活方式及膳食营养方面的调查,并借助超声骨密度测定仪对老年人受试者右侧跟骨的BMD进行测量。结果随着年龄的增加,老年男性和女性的BMD值均逐渐下降(P<0.01);常年吸烟、有饮酒习惯组的老年男性和女性BMD值分别低于无吸烟的男性和女性(P<0.01);常年参加体育锻炼的老年男性和女性BMD值分别高于偶尔及从不参加体育锻炼的男性和女性(P<0.01);坚持饮用奶制品、服用活性维生素D及钙剂的老年男性和女性BMD值分别高于不饮用奶制品的老年男性和女性(P<0.01)。结论老年人BMD与生活方式及膳食营养状况密切相关,养成良好的生活方式及膳食习惯对提高老年人骨健康极其重要。     

中年女性患者冠状动脉造影的临床特点分析

目的 分析中年女性冠心病临床危险因素、冠状动脉造影及介入治疗特点,评价冠心病发病、危险因素构成、冠状动脉造影及介入治疗方面年龄和性别的差异.方法 入选1998年1月1日至2006年12月30日9年间在我院临床疑诊冠心病、年龄40～79岁、行冠状动脉造影的住院患者5685例.根据年龄分为中年组(40～59岁)和老年组(60～79岁),根据性别分为女性组和男性组.以同龄男性及老年女性为对照,回顾性分析冠心病危险因素在中年女性的分布情况、冠心病的检出率、冠状动脉病变及介入治疗特点、肾动脉造影及介入治疗特点.结果 ①中年女性与同龄男性比较:血脂异常患病率女性(75.68%)显著低于男性(88.80%)(P<0.01);高血压患病率女性(59.42%)显著高于男性(50.66%)(P<0.01);糖尿病患病率女性(30.47%)与男性(33.42%)差异无统计学意义(P=0.98);陈旧心肌梗死患病率女性(11.48%)显著低于男性(42.50%)(P<0.01);脑卒中患病率女性(5.01%)与男性(4.77%)差异无统计学意义(P=0.82);肾功能下降患病率女性(1.71%)低于男性(2.87%)(P=0.07).冠状动脉造影冠心病检出率女性(36.64%)显著低于男性(69.10%)(P<0.001);在冠心病患者中,冠状动脉受累血管数量及严重程度中年女性组比男性轻(P<0.01);介入治疗比例(58.87%)低于男性(67.08%)(P<0.01).肾动脉狭窄检出率女性(8.62%)高于男性(4.97%)(P<0.05).②中年女性与老年女性比较:血脂异常、高血压、糖尿病、陈旧心梗、脑卒中、肾功能不全患病率,冠状动脉造影阳性率,冠状动脉病变受累血管数量及严重程度,冠状动脉介入治疗比例,肾动脉狭窄检出率均显著低于老年女性组(P<0.01).结论 在临床疑诊冠心病而行冠状动脉造影的患者中,中年女性血脂异常、陈旧心梗患病率、冠心病检出率、冠状动脉病变受累血管数量及严重程度、介入治疗比例显著低于同龄男性及老年女性.     

上海社区老年人生活方式与跟骨定量超声骨密度的相关性

目的探讨生活方式对上海社区老年人跟骨定量超声骨密度(quantitative ultrasound-bone mineral density,QUS-BMD)的影响。方法采用自行设计的调查问卷对上海社区自愿参加跟骨定量超声检查的14 814例老年人进行生活方式的调查,并使用跟骨定量超声仪对受试者右侧跟骨的骨密度(bone mineral density,BMD)进行测量。结果随着年龄的增加,老年男性和女性的BMD水平均逐渐下降(P均0.05);男性BMD水平高于女性(0.441 g/cm~2vs.0.377 g/cm~2,P均0.05);随着教育程度的提高,BMD水平逐渐升高(P均0.05);每天锻炼≥30 min者BMD水平明显高于不锻炼者或每天锻炼30 min者(0.415 g/cm~2vs.0.404 g/cm~2或0.409 g/cm~2,P均0.05);每天饮用乳制品≥250 m L者BMD水平明显高于不饮用乳制品或每天饮用250 m L者(0.418 g/cm~2vs.0.405 g/cm~2或0.405 g/cm~2,P均0.05);体质量指数(body mass index,BMI)低于21.77 kg/m~2组BMD水平明显低于BMI高于21.77 kg/m2的其他3组(0.396 g/cm~2vs.0.412 g/cm~2和0.411 g/cm~2、0.418 g/cm~2,P均0.05)。结论上海社区老年人跟骨定量超声骨密度与生活方式及膳食营养状况密切相关,教育程度、户外锻炼、饮用奶制品、BMI等因素为上海社区老年人QUS-BMD的保护性因素,而高龄、女性等因素是上海社区老年人QUS-BMD的不利因素,良好的生活方式和膳食习惯对老年人骨健康至关重要。     

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.     

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.