Ranitidine bismuth citrate, tetracycline, clarithromycin twice-a-day triple therapy for clarithromycin susceptible Helicobacter pylori infection

BACKGROUND: Although many combination therapies have been proposed, there is still interest in identifying simple, inexpensive, effective protocols that have high rates of success. AIM: To investigate the role of the new soluble form of bismuth, ranitidine bismuth citrate, in twice-a-day therapy for Helicobacter pylori infection. METHODS: Patients with histologically and culture proven H. pylori infection received ranitidine bismuth citrate 400 mg, tetracycline HCl 500 mg, and clarithromycin 500 mg, each b.d. for 14 days, followed by 300 mg ranitidine once a day for 4 additional weeks. Outcome was assessed 4 or more weeks after the end of antimicrobial therapy by repeat endoscopy with histology and culture (49 patients) or urea breath testing (14 patients). RESULTS: Sixty-three patients completed the therapy, 59 men and four women (average age 56.7 years; range 31-75 years). All patients had clarithromycin-susceptible strains prior to therapy. H. pylori infection was cured in 94% (95% CI: 85-98%). There was a therapy failure in one patient who took the medicine for only 1 day and stopped because of side-effects. Three of the isolates from treatment failures were available post-failure; two were clarithromycin-resistant and one was susceptible. Side-effects were severe in two patients (3%) and moderate in three (primarily diarrhoea). CONCLUSIONS: Twice-a-day ranitidine bismuth citrate, tetracycline, clarithromycin triple therapy was well tolerated and effective for the treatment of H. pylori infection in patients with clarithromycin-susceptible H. pylori.     

A comparison between the effect of cholecystokinin octapeptide and apomorphine on ingestion of intraorally administered sucrose in male rats

The involvement of dopamine receptors in the inhibitory effect of Cholecystokinin octapeptide on ingestive behaviour was investigated. Male rats were infused intraorally with a 1 M solution of sucrose and the amount ingested after treatment with the dopamine receptor agonist apomorphine was compared with that after treatment with Cholecystokinin octapeptide. The test allows a distinction between the consummatory aspects of ingestive behaviour, i.e. responses used to ingest food, from the appetitive aspects, i.e. responses used to obtain food, because it ignores the latter aspects. Comparisons were also made between the effects of apomorphine and Cholecystokinin octapeptide on pellet intake, a test in which the rat has to display appetitive ingestive behaviour. Injection of apomorphine (400 μg) increased the concentration of plasma apomorphine within 0.3 min and the concentration of dopamine in the cerebrospinal fluid within 1 min of injection and induced behavioural stereotypes within 10 min in food-deprived male rats. Plasma apomorphine and cerebrospinal fluid dopamine levels had decreased by 30 min and the behavioural stereotypies had decreased by 40 min after the injection. Injection of apomorphine also inhibited the consumption of food pellets and the ingestion of sucrose. Inhibition of pellet and sucrose ingestion paralleled the effect of apomorphine on Stereotypie behaviour. Thus, injection of a dopamine receptor agonist is followed by alterations in plasma levels of the agonist, cerebrospinal fluid dopamine levels and in Stereotypie and ingestive behaviour which occur in parallel, in an inverted U-shaped manner and with a temporal delay between each event. These results show a close correlation between dopamine receptor stimulation and inhibition of ingestive behaviour. However, reversal of the inhibitory effect of apomorphine on ingestive behaviour required pretreatment with a lower dose of a dopamine receptor antagonist (cis-flupentixol) (0.1 mg) than reversal of Stereotypie behaviour (0.8 mg). The effect of dopamine receptor stimulation on consummatory ingestive behaviour is thus relatively weak and not secondary to the induction of Stereotypic behaviour. Treatment with a high dose of cis-flupentixol (0.8 mg) caused a prolonged period of immobility but had no effect on the ingestion of sucrose. Dopamine receptor blockade, therefore, interferes with appetitive, but not consummatory ingestive behaviour. Injection of Cholecystokinin octapeptide (5 μg) suppressed pellet and sucrose intake in a manner comparable to that of apomorphine, but induced no behavioural stereotypes and caused a gradual, rather than inverted U-shaped, increase in the concentration of dopamine in the cerebrospinal fluid that did not correlate with the effect on ingestive behaviour. Furthermore, while the inhibitory effect of apomorphine on the ingestion of sucrose was reversed by pretreatment with a low dose of cis-flupentixol (0.1 mg), the inhibitory effect of Cholecystokinin octapeptide was only partially reversed by cis-flupentixol and a higher dose (0.8 mg) was required. Blockade of cholecystokinin-A receptors, by treatment with L-364,718, but not cholecystokinin-B receptors, by treatment with L-365,260, blocked the inhibitory effect of Cholecystokinin octapeptide and, by itself, L-364,718 increased the amount of ingested sucrose. The inhibitory effect of Cholecystokinin octapeptide on consummatory ingestive behaviour, which is mediated by cholecystokinin-A receptors, is likely to involve mechanisms in addition to dopaminergic ones.     

Evidence that Release of Dopamine in the Brain is Involved in the Inhibitory Effect of Cholecystokinin Octapeptide on Ingestion of Intraorally Administered Sucrose in Male Rats

To study the possibility that release of dopamine in the brain mediates the inhibitory effect of Cholecystokinin octapeptide on ingestive behaviour, the effect of amphetamine on intake of pellets or an intraorally administered sucrose solution was compared with that of Cholecystokinin octapeptide. Additionally, comparisons were made between the effect of Cholecystokinin octapeptide and pargyline, a monoamine oxidase inhibitor, and α-methyl-ρ-tyrosine, a tyrosine hydroxylase inhibitor. While amphetamine dose-dependently inhibited pellet intake it failed to inhibit sucrose intake in doses which caused behavioural stereotypies (<800 μg). Cholecystokinin octapeptide (5 μg) inhibited ingestive behaviour in both tests. A very high dose of amphetamine (2 mg) was required to inhibit sucrose intake to a level comparable to that of Cholecystokinin octapeptide. Pargyline (5 to 25 mg) or α-methyl-p-tyrosine (25 to 100 mg) dose-dependently inhibited pellet intake but had only weak effects on the intake of sucrose. Pargyline increased the concentration of dopamine and 3-methoxytyramine in the dorsal striatum and decreased the concentration of 3,4-dihydroxyphenylacetic acid. α-Methyl-ρ-tyrosine decreased the concentration of dopamine and 3,4-dihydroxyphenylacetic acid, but not that of 3-methoxytyramine. Injection of amphetamine (2 mg), but not Cholecystokinin octapeptide, in rats pretreated with pargyline increased the concentration of 3-methoxytyramine in the dorsal striatum and this effect was blocked by pretreatment with α-methyl-ρ-tyrosine. Pretreatment with α-methyl-ρ-tyrosine partially reversed the inhibitory effect of Cholecystokinin octapeptide on sucrose ingestion, enhanced the effect of amphetamine but did not affect that of apomorphine, a dopamine agonist. The results support the possibility that the inhibitory effect of Cholecystokinin octapeptide on consummatory ingestive behaviour, in part, is mediated via release of dopamine in the brain.     

神阙穴敷贴对原发性骨质疏松症骨钙素的影响

目的　观察神阙穴贴补血益精透皮贴对原发性骨质疏松症骨钙素 (BGP)的影响。方法　选择原发性骨质疏松症患者130名 ,分神阙穴贴药组 (补血益精穴位透皮贴剂 )、西药组 (羟乙磷酸钠片 )、中药组 (补血益精药丸 )、空白对照组。结果和结论　穴位敷贴组能显著提高骨钙素 (7.69± 1.65 )。穴位敷贴组与中药组 (7.82± 0 .99)和西药对照组 (7.13± 0 .89)对原发性骨质疏松症的骨钙素调整作用基本一致 (P>0 .0 5 )。     

卡马西平对吗啡依赖大鼠戒断症状及ACTH的影响

目的 :观察卡马西平 (Carb)对吗啡依赖大鼠纳洛酮催促戒断症状的抑制作用及血清促肾上腺皮质激素(ACTH)水平的影响。方法 :剂量递增法皮下注射 (sc)盐酸吗啡 (Mor) ,建立大鼠吗啡依赖模型 ,腹腔注射 (ip)盐酸纳洛酮 1mg·kg- 1 催促 ,观察戒断反应并评分 ;免疫发光法测定血清ACTH水平。结果 :Carb 10 0mg·kg- 1 及 2 0 0mg·kg- 1 均可明显减轻大鼠戒断症状 (P <0 0 5 )。 10 0mg·kg- 1 剂量组的ACTH水平接近正常 ,低于Carb 2 0 0mg·kg- 1 组(P <0 0 5 )。结论 :适当剂量的卡马西平可有效控制吗啡依赖大鼠的戒断症状     

3年2436株临床分离革兰阴性杆菌对头孢吡肟耐药趋势观察

目的：调查我院1999－2001年间2436株革兰阴性杆菌分离株对第4代头孢菌素头孢吡肟的耐药状况，为临床合理用药提供依据。方法：用K－B法检测头孢吡肟对8种2436株临床分离菌的抑菌环，按1999年NCCLS判断标准得出耐药结果，并与其他3种第3代头孢菌素比较。结果：头孢吡 肟对ESBL阴性大肠杆菌和克雷伯菌属，肠杆菌属，枸橼酸杆菌属，变形杆菌，不动杆菌属，铜绿假单胞菌和嗜麦芽窄食单胞菌等临床主要分离革兰阴性杆菌耐药性变化不大，1999－2001年耐药率分别为20．6％，20．4％和28％，与第3代头孢菌素比较，头孢吡肟，头孢他啶，头孢噻肟，头孢曲松总的细菌耐药率分别为24．6％，26．3％，38．5％和37．0％。结论：头孢吡肟对临床分离的大部分革兰阴性杆菌具有良好的体外抗菌活性，尤其对易产Bush-I型头孢菌素的肠杆菌属的菌株及枸橼酸杆菌属的抗菌活性远优于其他第3代头孢菌素。     

Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II--Clinical aspects and recommendations

We reviewed the incidence, risk factors, and clinical features of thromboembolic and ischemic events associated with diagnostic cerebral angiography, endovascular treatment of aneurysms using coils or balloons, angioplasty and stent placement to treat extracranial carotid artery stenosis, and embolization of arteriovenous malformations using glue or other embolic agents. We performed a cumulative analysis to determine the frequency and characteristics of these events and a subset analysis (whenever possible) to determine the benefits of various strategies for complication avoidance. Of the 1,547 patients who underwent Guglielmi detachable coil treatment, thromboembolic events were observed for 127 (8.2%), consisting of asymptomatic events for 12 patients, transient ischemic attacks for 29, and strokes for 86. The outcomes for the 86 patients with strokes were categorized as full recovery for 15, good recovery for 27, partial recovery for 19, no recovery for 11, death for 12, and undetermined outcome for 2. Of the 834 patients who underwent carotid angioplasty and stent placement, thromboembolic events were observed for 73 (8.8%), consisting of transient ischemic attacks for 26 patients and strokes for 47. The outcomes for the patients with strokes were categorized as full recovery for 20, good recovery for 15, partial recovery for 6, no recovery for 2, and death for 4. High rates of thromboembolic events were also observed with balloon occlusion of aneurysms (11%) or parent arteries (19%) and carotid angioplasty alone (5.9%). Arteriovenous malformation embolization was associated with an ischemic event/procedure rate of 9.4%. High rates of thromboembolic and ischemic complications, with subsequent morbidity and death, are associated with most endovascular procedures. Further research and the formulation of standard preventive guidelines may help to reduce these risks and improve the overall success of these procedures.     

葡萄糖对豚鼠心室肌细胞跨膜离子电流的影响

目的观察葡萄糖对豚鼠心室肌细胞膜APD,IK1,IK,ICa-L的影响.方法采用全细胞膜片技术记录单个豚鼠心室肌细胞膜的动作电位时程和离子电流.比较0、10和20mmol·L-1葡萄糖对心室肌细胞跨膜离子电流的作用.结果(1)与10 mmol·L-1葡萄糖相比,0和20mmol·L-1均可使豚鼠心室肌细胞的APD缩短(P＜0.05);(2)在细胞外葡萄糖浓度为10 mmol·L-1时,内向整流钾电流IK1的电流密度最大,标准化I-V曲线显示0和20mmol·L-1葡萄糖均可抑制IK1,并使I-V曲线左移,其翻转电位从-72.4移至-64.6 mV;(3)与mmol·L-1葡萄糖相比,0和20mmol·L-1葡萄糖均可增加ICa-L的电流幅度和电流密度.当钳制电位为10 mV,细胞外葡萄糖浓度为0 mmol·L-1时,ICa-L的电流密度为(-8.03±0.82)pA/pF(n=8),而10mmol·L-1和20mmol·L-1葡萄糖分别使电流密度增加为(-5.45±0.67)pA/pF和(-6.50±0.56)pA/pF;(4)当钳制电压为 70mV,细胞外葡萄糖浓度为0、10和20 mmol·L-1时,IK的电流密度分别为(18.96±2.86)pA/pF,(8.66±1.87)pA/pF,(15.32±3.12)pA/pF.结论细胞外不同浓度的葡萄糖可使豚鼠心室肌细胞APD,IK1,IK,ICa-L发生改变.细胞外葡萄糖浓度为0和20mmol·L-1对细胞膜离子电流产生相似的影响.     

论温病证治之热、郁、瘀

温病之病机，多为热、郁、瘀。三者之间由热致郁、由郁致瘀，循序渐变，环环相联，极易形成热郁或热瘀；热与郁当区分无形郁热或有形郁结。治疗以清热、解郁、化瘀三法兼顾，卫气阶段主清热散郁并举；营血阶段重散热化瘀同治；治热防郁，治郁防瘀。郁与瘀当区分无形郁滞或有形郁结，治疗采取相应消散法。对于临床辨治颇具指导意义。     

Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location

OBJECTIVE: Intracranial aneurysm size is an important determinant of risk of rupture and outcome after rupture. Risk factors influencing aneurysm formation and growth are not well defined. In this study, we examined the association between known risk factors for cerebrovascular disease and size of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage. METHODS: We analyzed prospectively collected data from the placebo-treated group in a multicenter clinical trial conducted at 54 neurosurgical centers in North America. The presence, location, and size of intracranial aneurysms were determined by review of the admission angiograms. Pertinent information regarding the presence of various cerebrovascular risk factors was collected for each patient. Using logistic regression analysis, we identified independent determinants of aneurysm size from demographic, clinical, and angiographic characteristics of the participants. The impact of aneurysm size on 3-month mortality was analyzed after adjusting for potential confounding factors. RESULTS: For 298 patients admitted with subarachnoid hemorrhage, the ruptured aneurysms were graded as small (<13 mm) in 235 patients (79%) and large (> or =13 mm) in 63 patients (21%). In the logistic regression model, both smoking at any time (odds ratio, 2.2; 95% confidence interval, 1.1-4.5) and middle cerebral artery origin (odds ratio, 2.5; 95% confidence interval, 1.3-4.9) were independently associated with large aneurysms. Neither hypertension, diabetes mellitus, nor alcohol and illicit drug use were associated with large-sized aneurysms. After adjusting for initial Glasgow Coma Scale score and age in the logistic regression model, the presence of large-sized aneurysms was independently associated with 3-month mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.8). CONCLUSION: Cigarette smoking and middle cerebral artery origin seem to increase the risk for developing large aneurysms in patients predisposed to intracranial aneurysm formation. Further studies are required to investigate the mechanism underlying the association between cigarette smoking and intracranial aneurysm formation.