200例慢性肾脏疾病患者营养状况与病程进展的关系

目的探讨主观综合营养评估法（subjective global assessment of nutrition,SGA）评价慢性肾脏疾病（chronic kidney disease,CKD）2～4期患者营养状态并分析其与病程进展的关系。方法对200例CKD患者进行分组：①根据肾小球滤过率（estimated glomerular filtration rate,eG-FR）分为CKD2期组、3期组、4期组;②根据SGA评估分为营养正常组、轻一中度营养不良组和重度营养不良组;③根据病程进展分为进展1组、进展2组、进展3组。于随访第1天、第12个月、第24个月分别检测血红蛋白（hemoglobin,Hb）,白蛋白（albumin,Alb）,前白蛋白（prealbumin,PA）,血清钙（Ca）,血清磷（P）,分析CKD患者的营养状况与病程进展的关系。结果在随访第1天、第12个月、第24个月,CKD4期组与2期组Hb比较有显著性差异;4期组与3期组比较,差异有统计学意义（P〈0．05）,但2期组与3期组比较无统计学差异;CKD2期组第1天与12个月Hb比较差异有统计学意义（P〈O．05）。CKD4期组随访第1天、第12个月、第24个月PA比较,均有统计学差异（P〈0．05）。在第1天、12个月,营养正常组、轻一中度营养不良组、重度营养不良组Alb组间比较,差异有统计学意义;轻一中度营养不良组随访第1天、第12个月、第24个月比较,均有统计学差异（P〈0．05）。重度营养不良组随访第1天、第12个月、第24个月PA比较,均有统计学差异（P〈0．05）。CKD患者不同营养状况与病程进展发生率差异有统计学意义（P〈0．05）,且重度营养不良患者进展3组发生率为92．6％。结论Alb可作为营养状况的评价指标之一。CKD患者PA随着肾功能下降及病程的延长而升高。重度营养不良对CKD患者病程进展影响较大,SGA评估CKD患者的营养状态具有一定临床参考价值。     

Isothermal Microcalorimetry of Pressurized Systems I: A Rapid Method to Evaluate Pressurized Metered Dose Inhaler Formulations

Purpose

The techniques available to study formulation stability in pressurized metered dose inhalers (pMDIs) are limited, due to the challenging conditions of working with high pressure propellants. Isothermal microcalorimetry is a valuable tool used to screen and aid in formulation development of solid and solution drug formulations; however there are currently no available methods to evaluate pMDIs. In this paper, we have developed a method that allows measurement of such pressurized systems.

Methods

Samples were prepared by cold filling ampoules with propellant (HFA 134a) and drugs of interest. Ampoule caps were fitted with a specific O-ring, coated with paraffin and pre-conditioned prior to measurement. Samples were equilibrated at 25°C, placed in a Thermal Activity Monitor III (TAM III) system and measured isothermally at 25°C for a period of at least 24 h.

Results

Using well-defined procedures and ampoule preparation techniques we were able to safely contain the volatile propellant and acquire a stable measurement baseline. We were able to rapidly determine, within 6 h, the physical stability of amorphous and crystalline drug forms of beclomethasone dipropionate and formoterol fumarate dihydrate when formulated with HFA 134a.

Conclusions

Isothermal microcalorimetry in pressurized HFA propellant systems was shown to be a rapid screening tool to evaluate pMDI formulation physical stability. This method can potentially be applied to study pMDI formulation factors to expedite product development.     

经食道超声在缺血性卒中疾病中的应用

目的评估主动脉内膜厚度与腔隙性脑梗塞和非腔隙性脑梗塞的关系。方法选取59例缺血性卒中患者,使用食道超声心动图（TEE）这一技术检测梗塞面积的大小。结果主动脉弓内膜厚度与缺血性卒中的种类有关,腔隙性脑梗塞主动脉弓粥样硬化的发生率是46．7％,非腔隙性脑梗塞主动脉弓粥样硬化的发病率为88．6％。结论TEE检查可以清晰的看见主动脉弓内膜厚度及斑块形成情况,对于缺血性卒中病人的病因的诊断可能衍生出新的临床证据,并对未来治疗提供最佳治疗方案。     

Comparative Investigation of the Efficacy of Three Different Adsorbents against OTA-Induced Toxicity in Broiler Chickens

The aim of our study was to determine the efficacy of three different adsorbents, inorganic (modified zeolite), organic (esterified glucomannans) and mixed (inorganic and organic components, with the addition of enzymes), in protecting broilers from the toxic effects of ochratoxin A in feed. Broilers were fed diets containing 2 mg/kg of ochratoxin A (OTA) and supplemented with adsorbents at the recommended concentration of 2 g/kg for 21 days. The presence of OTA led to a notable reduction in body weight, lower weight gain, increased feed conversion and induced histopathological changes in the liver and kidneys. The presence of inorganic, organic and mixed adsorbents in contaminated feed only partially reduced the negative effects of OTA on the broiler performances. Broilers that were fed with adsorbent-supplemented feed reached higher body weight (17.96%, 19.09% and 13.59%), compared to the group that received only OTA. The presence of adsorbents partially alleviated the reduction in feed consumption (22.68%, 12.91% and 10.59%), and a similar effect was observed with feed conversion. The applied adsorbents have also reduced the intensity of histopathological changes caused by OTA; however, they were not able to prevent their onset. After the withdrawal of the toxin and adsorbents from the feed (21–42 days), all previously observed disturbances in broilers were reduced, but more remarkably in broilers fed with adsorbents.     

快速康复外科护理对胸腔镜肺段切除术患者术后恢复与护理满意度的影响分析

目的 探讨快速康复外科（FTS）护理对胸腔镜肺段切除术患者术后恢复的影响。方法于2016年1月—2017年1月,选取复旦大学附属华山医院胸外科拟行胸腔镜肺段切除手术的患者126例为研究对象。采用随机数表法分为观察组（n=63）和对照组（n=63）。对照组采用传统的胸外科围手术期护理,观察组患者在围手术期给予FTS护理,比较两组患者术后恢复指标、并发症发生率、术后7d的世界卫生组织生存质量测定简表（WHOQOL-BREF）评分以及出院时患者的护理满意度。结果 观察组术后胸腔引流管放置时间、首次排便时间、术后住院天数与并发症的总发生率显著低于对照组,差异具有统计学意义（P＜0.05）。观察组术后7d WHOQOL-BREF量表的生理、心理、社会关系领域评分及总分显著高于对照组,护理满意度显著优于对照组,差异具有统计学意义（P＜0.05）。结论 FTS护理在胸腔镜肺段切除术的围手术期中的应用效果令人满意,能显著促进术后康复,减少术后并发症的发生风险,提高术后生活质量与护理满意度,值得临床推广应用。     

Chemoembolization in hepatocellular carcinoma: multivariate analysis of survival prognostic factors after the first session

AIM: The aim of the study was to determine whether simple routine parameters evaluating the first session of transarterial chemoembolization (variation in alfa-fetoprotein concentration, tumor lipiodol uptake, and post-embolization syndrome) can predict survival of patients treated for hepatocellular carcinoma. METHODS: Seventy-two patients treated with transarterial chemoembolization and evaluated one month after the first sessions with CT scan were included. Transarterial chemoembolization session included hepatic arteriography, lipiodol and doxorubicin (50 mg) emulsion injection, followed by gelatin sponge embolization. The following variables were studied in univariate and multivariate analysis: 6 recorded at the first session (age, cirrhosis etiology, Child-Pugh class, tumor number, largest lesion size, and alpha-fetoprotein concentration), and 5 recorded after the first session (variation in alfa-fetoprotein concentration, tumor lipiodol uptake, post-embolization syndrome, mean interval between each session, and associated treatment). RESULTS: Mean follow-up was 22.7 months (4-106). Mean survival was 30.4 months (95% CI: 23. 3-37.5). Actuarial survival at 1, 2, 3 and 5 years was respectively 65.5%, 44%, 29.5%, and 18%. The only independent prognostic factors in multivariate analysis were the Child Pugh class and the mean interval between sessions (P<0.001 and<0.01 respectively). None of our criteria evaluating the first TACE session significantly influenced survival. CONCLUSION: The 3 parameters (variation in alpha-fetoprotein concentration, tumor lipiodol uptake and post-embolization syndrome) after the first transarterial chemoembolization did not predict survival. They could not be used to determine which patient could benefit from repeated transarterial chemoembolization sessions.     

Effects of diet composition on glucose tolerance and plasma lipids of non insulin-dependent diabetics

Summary The possible influence of qualitative dietary changes on carbohydrate tolerance and plasma lipid levels of non insulin-dependent diabetics was studied in 5 maturity-onset diabetics of normal weight who remained stabilized with 5 to 10 mg glibenclamide. Each patient was submitted to 4 isocaloric qualitatively different diets: standard, high carbohydrate, high fat, and high protein. Each diet was administered for 30 consecutive days in random order. Apart from assessing metabolic control, an oral glucose tolerance test (40 g/m² body surface area) was performed in the morning, at the end of each period. Blood was collected at 0, 60, 120, and 180 min after starting glucose ingestion, for blood glucose and plasma FFA determinations. Fasting total lipids, triglycerides, lipoalbumins, and α- and β-lipoproteins, and 24-h urinary urea were also investigated. The findings did not disclose any differences in carbohydrate tolerance after the various diets. The drop in FFA levels following an oral glucose load was greatest after the high protein diet. Fasting total lipids were lowest after the high fat and high protein diets. Triglycerides fell after the high fat diet. The remaining parameters showed less significant variations. Although no differences were observed in carbohydrate tolerance, the conclusion is that relative carbohydrate restriction together with sufficient protein supply might be most beneficial for non insulin-dependent diabetics.     

Can flow cytometry detect successful ticlopidine treatment in patients with VVI pacemakers?

An increased platelet activation status is present in patients with VVI pacemakers. With platelet activation, there is modulation of platelet surface molecule expression. In the current study, the expression of platelet surface markers in VVI patients before and after ticlopidine treatment and control subjects was investigated by means of flow cytometry. The study group consisted of 25 patients with VVI pacemaker, and 15 control subjects. CD42b, CD61, and CD62p expression were significantly increased in VVI patients compared with control subjects (CD42b p < 0.001, CD61 p< 0.005 and CD62p p < 0.001). In addition, after ticlopidine treatment, platelets showed a significant fall in expression of all these markers in VVI patients (CD42b p < 0.001, CD61 p < 0.005 and CD62p p< 0.001). Our data suggest an increase of the surface expression of all these markers on platelets and demonstrate the efficacy of ticlopidine in reducing them.     

血清TSGF、CA242、CA19-9对老年胰腺癌患者诊断作用的临床研究

目的 评价血清中肿瘤标志物恶性肿瘤相关物质(TSGF)、糖类抗原CA242和CAl9-9对老年胰腺癌患者的诊断作用。方法 采用生化比色法与酶免法分别检测200例健康人、52例胰腺炎及96例胰腺癌患者的TSGF、CA242和CAl9-9含量。结果 TSGF、CA242和CAl9-9阳性似然比依次为5．4、12．6和6．3，阴性似然比依次为0．10、0．19和0．17。单项肿瘤标志物对胰腺癌诊断：TSGF敏感性高达91．6％，CA242特异性高达93．5％。以3项均为阳性诊断胰腺癌：敏感性为77．1％，特异性和阳性预测值皆为100．0％。胰头癌TSGF与CA242水平显著高于胰体癌、胰尾癌及全胰癌，而CAl9-9的表达与其部位无相关性。TSGF、CA242与CAl9-9随着临床分期的进展而敏感性增加，Ⅰ期者TSGF的敏感性显著高于CA242与CAl9-9，因此TSGF可以作为胰腺癌早期筛选的肿瘤标志物。结论 应用TSGF、CA242和CAl9-9联合诊断胰腺癌可以提高特异性，其表达对胰腺癌的不同组织分型起到重要作用，3项标志物联合检测可助早期诊断胰腺癌。