Methadone versus morphine as a first-line strong opioid for cancer pain: a randomized, double-blind study.

PURPOSE: To compare the effectiveness and side effects of methadone and morphine as first-line treatment with opioids for cancer pain. PATIENTS AND METHODS: Patients in international palliative care clinics with pain requiring initiation of strong opioids were randomly assigned to receive methadone (7.5 mg orally every 12 hours and 5 mg every 4 hours as needed) or morphine (15 mg sustained release every 12 hours and 5 mg every 4 hours as needed). The study duration was 4 weeks. RESULTS: A total of 103 patients were randomly assigned to treatment (49 in the methadone group and 54 in the morphine group). The groups had similar baseline scores for pain, sedation, nausea, confusion, and constipation. Patients receiving methadone had more opioid-related drop-outs (11 of 49; 22%) than those receiving morphine (three of 54; 6%; P =.019). The opioid escalation index at days 14 and 28 was similar between the two groups. More than three fourths of patients in each group reported a 20% or more reduction in pain intensity by day 8. The proportion of patients with a 20% or more improvement in pain at 4 weeks in the methadone group was 0.49 (95% CI, 0.34 to 0.64) and was similar in the morphine group (0.56; 95% CI, 0.41 to 0.70). The rates of patient-reported global benefit were nearly identical to the pain response rates and did not differ between the treatment groups. CONCLUSION: Methadone did not produce superior analgesic efficiency or overall tolerability at 4 weeks compared with morphine as a first-line strong opioid for the treatment of cancer pain.     

银环蛇毒素对白血病K562细胞株凋亡诱导作用的研究

目的 探讨银环蛇毒素及其若干组分在体外对白血病K562细胞株的凋亡诱导作用。方法 采用阳离子交换层析法分离纯化银环蛇粗毒，应用MTT法、荧光显微镜和流式细胞术等研究毒素对K562细胞株的凋亡作用。结果 除Ⅳ峰毒素外，银环蛇粗毒及分离的部分组分IV峰、Ⅶ峰和Ⅷ峰等毒素的荧光显微图末见特征性的凋亡小体，DNA含量分布组方图中的二倍体峰前末见Gl细胞群。结论 银环蛇毒对K562细胞具有杀伤作用，但并非是细胞凋亡作用，而是致细胞坏死，而粗毒中的某些组分可能具有促K562细胞凋亡作用。     

缝线法矫正乳头内陷

目的介绍一种中度以下乳头内陷的矫正方法。方法采用8字缝合法或荷包缝合法，使乳头、乳晕处基底部周围组织向乳头中底部靠拢，使乳头下撵托组织增加，并形成一定的疤痕组织衬托，使乳头突出。结果17例病人，15例达到Ⅰ期效果．2例(8字缝合法、荷包缝合法各1例)术后乳头内陷再度复发，采用切开法Ⅱ期矫正后痊愈。结论缝合法矫正乳头内陷，乳头、乳晕局部无切口，操作简单，损伤较小。     

唾液酸及其衍生物的应用前景

唾液酸(sialic acid, SA)是广泛存在于生物系统中的一类天然糖类化合物,是构成细胞表面复合糖质的成分,具有重要的生物活性;同时它还是某些毒素的受体和病原微生物的作用部位.近年来,以SA为先导化合物进行生物活性研究和新药开发成为一个新热点.     

鼻咽分泌物中β2微球蛋白测定的临床意义

To study its clinical significance, beta 2-microglobulin (beta 2-MG) in nasopharyngeal secretion was examined using radioimmunoassasy methods in 73 patients with nasopharyngeal carcinoma (NPC), 30 with chronic nasopharyngitis and 30 normal control subjects. In 31 NPC patients, the examination was repeated before and after radiotherapy. The average concentrations of beta 2-MG were 4.87 +/- 2.51 mg/L in NPC group, 1.05 +/- 0.64 mg/L in chronic nasopharygitis group, and 0.85 +/- 0.32 mg/L in the control. The beta 2-MG concentration was higher in the NPC patients than in both chronic pharyngitis patients and normal subjects (P < 0.01). The concentration was lowered down in NPC patients after radiotherapy, and remained high when the treatment failed to control the condition. It seems that beta 2-MG level in nasopharyngeal secretion is closely related to the prognosis and recurrence of nasopharyngeal carcinoma.     

肿瘤合并颈动脉切除术的探讨

肿瘤固着于颈动脉在临床实践中并非少见，如能将肿瘤与受累动脉一并切除，仍不无救治机会。通过体外或体内对患侧颈动脉压迫训练，促使大脑侧枝循环的建立，并采用脑血管造影或／和经颅多普勒血流检测仪（ＴＣＤ）检测证实合格后，可将肿瘤及受累段颈动脉作整块切除。本文报告１９８７～１９９５年间，我们按上述方法给７位患者施行本术，取得较好的效果，无手术死亡及脑血管并发症。     

胆红素对神经突触膜Na^＋,K^＋—ATP酶影响的实验研究

为了研究胆红素的神经毒性作用，对５９只出生２天的ＳＤ大白鼠分别予以腹腔注射不同剂量胆红素制造高胆红素血症动物模型，不连续密度梯度法分离提取脑神经元突触膜，测定Ｎａ＋，Ｋ＋－ＡＴＰ酶活力。结果：随着血清胆红素浓度的逐渐增加，脑组织中胆红素沉积量也逐渐增加，神经元突触膜Ｎａ＋，Ｋ＋－ＡＴＰ酶活力逐渐降低，Ｎａ＋，Ｋ＋－ＡＴＰ酶活力与脑组织中沉积的胆红素量呈负相关（ｒ＝－０．３４，Ｐ＜０．０１）。提示：胆红素对Ｎａ＋，Ｋ＋－ＡＴＰ酶具有抑制作用。     

热压处理后蛇胆的药理作用研究

本研究表明,热压处理后的蛇胆可减少由氨水所致的小鼠咳嗽次数,提高小鼠气管酚红排泌量,提示其具有止咳、化痰作用。     

中西医结合治疗慢性周围动脉闭塞性疾病

慢性周围动脉闭塞性疾病（PAO）治疗较为棘手。闭塞的血管不易再通，手术适应症范围小，且术后可能再度发生闭塞[1]。因此寻求适合的保守疗法非常重要。我院自1995年3月至1997年3月治疗PAO患者35例，其中23例用中药溶栓灵配合西药前列素E（PGE1）、天普乐欣（UK）治疗，与单纯用西药治疗的12例比较，疗效尚满意，现报道如下。1临床资料根据中国中西医结合研究会周围血管病专业委员会制定的诊断和分期标准[2]，收治35例PAO患者，包括血栓闭塞性脉管炎（TAO）19例，动脉硬化性闭塞（ASO）16例。随机分为两组：①溶栓灵结合PGEI、UK…