脑钠肽与D-二聚体在间质性肺疾病急性加重期中的预测价值

目的探究脑钠肽和D-二聚体对于间质性的急性肺部疾病加重期治疗效果的预测价值。方法选取自2013年12月至2014年12月于我院治疗间质性的肺部疾病的急性加重期病患42例,对42例病患进行脑钠肽和D-二聚体的常规检测,以检测的结果为依据,将42例病患分为干预组和对照组,实验组为22例,均为治疗成功的存活病例,对照组为20例,均为治疗失败死亡病例,比较实验组和对照组病患在入院初期的脑钠肽和D-二聚体的常规检测的数值,并进行分析。结果通过对实验组和对照组的比较,间质性的急性肺部疾病加重期治疗失败的对照组的脑钠肽和D-二聚体数值显著高于对照组,两组之间的比较差异明显,具有统计学意义(P0.05)。结论脑钠肽和D-二聚体数值能够有效预测病患的急性肺部疾病加重期,病患的脑钠肽和D-二聚体的检测数值应成为急性肺部疾病病患加重期的判断指标。     

急性肺栓塞患者血浆B型利钠肽、D-二聚体水平与病情的相关性分析

目的:探讨急性肺栓塞(APE)患者血浆B型利钠肽(BNP)、血清D-二聚体水平与病情的相关性。方法:选择2012年3月~2015年12月入院治疗的APE病例122例。根据右心功能和临床症状,患者被分为低危组(61例)、中危组(36例)和高危组(25例);所有患者出院后随访半年,根据存活状况分为存活组(105例)和死亡组(17例)。检测并比较各组血浆BNP和血清D-二聚体的水平,分析BNP、D-二聚体与病情严重程度的相关性。结果:与低危组比较,中危组、高危组血浆BNP[(133.28±74.92)ng/L比(273.89±179.29)ng/L比(834.80±509.09)ng/L]、血清D-二聚体[(761.80±333.65)ng/ml比(966.67±370.33)ng/ml比(1228.40±569.11)ng/ml]水平均显著升高,且高危组的显著高于中危组,P均=0.001。与存活组比较,死亡组血浆BNP[(257.33±27.11)ng/L比(696.47±64.92)ng/L]和血清D-二聚体水平[(818.57±64.92)ng/ml比(1513.25±48.14)ng/ml]均显著升高,P均=0.001。Pearson相关分析显示,血浆BNP、血清D-二聚体水平与病情严重程度呈显著正相关(r=0.69,0.41,P均0.01),且血浆BNP与血清D-二聚体水平也呈显著正相关(r=0.79,P=0.002)。结论:检测急性肺栓塞病例的血浆BNP及血清D-二聚体,有利于评估患者的病情严重程度和近期预后,并为个体化治疗提供依据。     

丹红注射液治疗慢性肺源性心脏病的临床观察

目的探讨丹红注射液在慢性肺心病急性加重期患者的疗效。方法对70例慢性肺心病急性加重期患者随机分为二组:对照组(34例)和治疗组(36例)。对照组给予常规西医综合治疗,治疗组在对照组基础上加用丹红注射液静脉滴注,10天后比较两组治疗前、治疗后的动脉血气分析、脑钠肽、D-二聚体水平。结果治疗组10天后动脉血气分析、脑钠肽、D-二聚体优于对照组(P<0.05)。结论丹红注射液能有效缓解慢性肺源性心脏病急性加重期病情,改善临床症状。     

血清NSE、BNP和D-二聚体水平在预测慢阻肺急性加重中的临床意义

目的研究慢性阻塞性肺疾病急性期(AECOPD)患者血清神经元特异性烯醇化酶(NSE)血清脑钠肽(BNP)和D-二聚体的水平及其临床意义。方法选取AECOPD患者87例、慢性阻塞性肺疾病稳定期87例、健康对照者50例,分别测定慢性阻塞性肺疾病患者急性加重期,稳定期及健康对照者血清NSE、BNP和D-二聚体水平。结果 AECOPD患者血清NSE、BNP和D-二聚体水平显著高于正常对照组(P0.05);AECOPD患者血清中的NSE、BNP和D-二聚体水平显著高于慢性阻塞性肺疾病稳定期(P0.05)。结论动态监测慢性阻塞性肺疾病患者血清NSE、BNP和D-二聚体水平对慢性阻塞性肺疾病的急性发作有较好的预测作用。     

脑钠肽对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的意义

目的探讨脑钠肽(Nt-pro-BNP)对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的意义。方法应用酶联免疫吸附法对比慢性阻塞性肺病急性发作期组、慢性肺源性心脏病代偿期组、慢性肺源性心脏病失代偿期组血清中血浆Nt-pro-BNP。结果慢性阻塞性肺病急性发作期组、慢性肺源性心脏病代偿期组、慢性肺源性心脏病失代偿期组血清中Nt-pro-BNP含量分别为185±21 pg/ml,1128±76 pg/ml,7893±248 pg/ml,组间比较,差异显著。结论脑钠肽对评估慢性阻塞性肺病和慢性肺源性心脏病严重程度的有重要意义。     

探讨急性心肌梗死患者血浆脑纳肽、D-二聚体的检测意义

目的分析急性心肌梗死患者血浆脑钠肽、D-二聚体检测方法及结果。方法随机选取我院2013年1月~2014年1月收治的急性心肌梗死患者45例作为观察组,同时选择同期在我院开展健康体检的正常人45名作为对照组,应用全定量金标法与酶联免疫法对两组患者血浆脑钠肽与D-二聚体开展检测。结果观察组患者血浆中的脑钠肽与D-二聚体的含量要明显高于对照组患者,差异有统计学意义(P0.05)。结论对急性心肌梗死患者开展血浆脑钠肽与D-二聚体的检测,对于患者疾病的诊治具有一定的参考价值。     

Analysis of the effect of low molecular heparin plus milrinone on acute exacerbation of chronic cor pulmonale

目的 分析低分子肝素联合米力农对慢性肺源性心脏病急性加重期患者的治疗疗效.方法 将60例慢性肺源性心脏病急性加重期的住院患者随机分为治疗组和对照组,每组各30例.对照组给予常规治疗,治疗组在常规治疗的基础上加用低分子肝素和米力农,疗程7天.观察两组患者的心衰症状、体征、心功能、肺动脉压、脑尿钠肽和D-二聚体水平的变化情况.结果 治疗组有效率达90.0％,对照组有效率为66.7％,两组比较差异有统计学意义(P＜0.05);治疗组肺动脉压、脑尿钠肽和D-二聚体水平降低程度均明显大于对照组,两组比较差异有统计学意义(P均＜0.05).结论 低分子肝素联合米力农治疗慢性肺源性心脏病急性加重期患者有效.     

D-二聚体在主动脉夹层鉴别诊断中的作用

目的:探讨血D-二聚体浓度对主动脉夹层(AD)的诊断价值。方法:以23例经心脏超声、CT或CT主动脉造影(CTA)确诊的主动脉夹层患者为AD组,同期住院的35例急性心肌梗死(AMI)患者为AMI对照组。所有患者入院时抽血检测D-二聚体(参考值<0.3mg/L)、C反应蛋白(CRP)(参考值0～10mg/L)和肌钙蛋白T(cTnT,参考值﹤0.1μg/L)水平。结果:与AMI对照组比较,AD组D-二聚体[(0.41±0.07)mg/L比(2.69±1.28)mg/L]、CRP[(20.36±8.71)mg/L比(45.91±16.45)mg/L]水平明显升高,cTnT[(2.40±1.10)ng/ml比(0.04±0.03)ng/ml]水平明显降低(P均<0.01)。结论:于胸痛病人联合检测血D-二聚体和肌钙蛋白T的浓度对鉴别急性主动脉夹层和急性心肌梗死有重要价值。     

NT-proBNP对评估COPD急性加重风险的意义

目的主要探讨检测血浆N端脑钠肽前体(NT-proBNP)对评估慢性阻塞性肺疾病(COPD)急性加重风险的意义。方法选取2012.1~2012.8在我院住院治疗的COPD患者63名,根据2011版GOLD策略综合评估分为COPD低危组22人(包含A组和B组)和COPD高危组23人(包含C组和D组),分别测定并比较2组NT-proBNP、肺功能、体重指数及并发症情况。结果 COPD低危组患者血浆NT-proBNP水平(245.7±166.2 pg/ml)明显低于COPD高危组患者(1326.7±198.8 pg/ml)(P0.05)。肺功能FEV1(perd%)与NT-proBNP(pg/ml)成负相关(r=-0.395,P=0.001)。而年龄、性别与体重指数则与NT-proBNP(pg/ml)无相关性(P0.05)。结论 NT-proBNP能较好反应COPD的急性加重风险。     

肺部疾病的老年患者血浆D-二聚体水平测定及临床意义

目的 探讨血浆D-二聚体水平在老年常见肺部疾病中的表达和临床意义.方法 对310例住院治疗的肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞及原发肺癌患者及转移性肺癌患者的血浆D-二聚体水平进行测定,分析比较血浆D-二聚体水平的差异性.结果 肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞及原发性肺癌及转移性肺癌组的血浆D-二聚体水平与对照组比较差异有统计学意义(P＜0.05).肺炎组血浆D-二聚体水平低于肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞、原发性肺癌及转移性肺癌组,差异有统计学意义(P＜0.05).肺结核、慢性阻塞性肺疾病急性加重、原发性肺癌及转移性肺癌组间血浆D-二聚体水平差异无统计学意义(P＞0.05).急性肺栓塞患者血浆D-二聚体水平升高,与肺结核、慢性阻塞性肺疾病急性加重、原发性肺癌及转移性肺癌组血浆D-二聚体水平差异有统计学意义(P＜0.05).结论 肺炎、肺结核、慢性阻塞性肺疾病急性加重、急性肺栓塞、原发性肺癌及转移性肺癌均可引起凝血机制的异常,导致血浆D-二聚体水平升高,在急性肺栓塞中最为明显.但血浆D-二聚体水平的升高不是诊断急性肺栓塞的特异性指标,也不是疾病严重程度的预测指标,其临床价值在于阴性排除结果.     

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.     

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。     

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。     

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.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

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。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.