Urinary sodium excretion in patients with nephrotic syndrome, and its circadian variation

We analysed sodium excretion and its circadian variation in70 patients with nephrotic syndrome and 19 healthy controlsover 1–3 days, with a regimen of bed rest and constantsodium intake around the clock. We sampled urine and blood andtook their blood pressure every 3 h. We also scored 60 renalbiopsies for presence of interstitial fibrosis and tubular atrophy.Peripheral oedema was estimated in 37 patients. Fifty-nine patients excreted >10mmol sodium per 24 h, inequilibrium with dietary intake. In group A (n = 24), sodiumexcretion followed a normal circadian rhythm, with a daytimepeak. In group B (n = 35), 29 had reversed circadian rhythmwith a night-time peak, and 6 had no apparent rhythm. Nephroticsyndrome was more severe in group B than in A (serum albumin19.5 vs. 24.1 g/l, p<0.05; oedema 7.0 vs. 3.8 kg, p<0.01).Group B also had signs of more advanced renal disease (GFR 49vs. 99 ml/min; number of biopsies with tubulo-interstitial damage:20/28 vs. 4/23; p< 0.001). Reversed sodium rhythm was associatedwith reversed circadian rhythms for GFR, effective renal plasmaflow and urine flow, and blunting or reversal of the day-nightdifferences in blood pressure and plasma renin activity. Elevenpatients had urinary sodium excretion <1 mmol/24 h. Withrespect to severity of nephrosis, they resembled group B, butGFR and incidence of tubulointerstitial lesions were like groupA. Half of the patients with nephrotic syndrome had reversed circadianrhythm for sodium excretion. This nocturnal peak in natriuresis(and diuresis) may be due to re-entry of oedema fluid into thecirculation, with a subsequent increase in renal blood flowand GFR, and especially occurs in patients with structural tubulointerstitialdamage, where sodium reabsorption is incomplete.     

高血压病患者血清瘦素含量与胰岛素抵抗水平的相关性研究

目的：探讨高血压病患者血清瘦素水平与胰岛素抵抗的关系。方法：测定217例高血压病患者(男92例，女125例)的空腹血清瘦素含量、空腹血糖、胰岛素、收缩压、舒张压和体质量指数(BMI)，稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)。分析瘦素与其他各项参数的相关性。结果：以HOMA—IR的25％位点，作为判断胰岛素抵抗的切割点，把高血压病患者分为胰岛素抵抗组(IR)和胰岛素敏感组(IS)，血清瘦素浓度IR组显著高于IS组(P＜0．05)。血清瘦素浓度与HOMA—IR呈显著正相关(男性r＝0．407，P＜0．01；女性r＝0．254，P＜0．01)；校正年龄和BMI后，男性组两者仍呈显著正相关(r＝0．219，P＜0．05)，女性组两者无相关；逐步回归分析显示，男性组HOMA—IR为血清瘦素浓度的独立预测因素。结论：男性高血压病患者血清瘦素浓度与胰岛素抵抗直接相关，女性则无直接相关性。性别差异的机制有待进一步探讨。     

Traumatic or septic aortic regurgitation: diagnosis by oesophageal echocardiography

Severe aortic regurgitation was discovered in a young man 21 days after blunt chest trauma and after a prolonged febrile state with positive blood cultures. Using transoesophageal echocardiography (TEE), it was possible to make the differential diagnosis between traumatic rupture and endocarditis as the cause of valvular insufficiency. The use of TEE in the initial evaluation of severe thoracic trauma with an unclear clinical picture is recommended. This method is easy to use at the bedside and gives precise information on the aortic valve and the ascending aorta.     

低剂量阿司匹林在辅助生育技术中的应用

目的　探讨在进行体外受精 -胚胎移植 ( IVF-ET)或卵母细胞浆内单精子注射 ( ICSI)患者口服低剂量阿司匹林对治疗结果的影响。　方法　 IVF或 ICSI治疗的 3 2 4个 ET周期 ,分为是否服用阿司匹林两组 ,分别统计患者注射人绒毛膜促性腺激素 ( h CG)时子宫内膜厚度及 ET胚胎数 ,比较两组的胚胎种植率、临床妊娠率及流产率 ,并进行统计学处理。　结果　两组在注射 h CG日内膜平均厚度、ET中优质胚胎的比率及流产率均无显著性差异 ;未服用阿司匹林组的 ET胚胎数明显多于服用组 ( P<0 .0 1 ) ,而前者的种植率、临床妊娠率却明显低于后者 ( P<0 .0 1 )。　结论　低剂量阿司匹林在 IVF-ET或ICSI的辅助生殖治疗中能有效地提高胚胎种植率 ,增加患者的临床妊娠率     

Psychological well-being of informal caregivers of elderly people with dementia: Changes over time

Psychological well-being of caregivers of demented elderly people was investigated during two years of follow-up. Three groups of caregivers were distinguished: those providing care for two years after baseline; those whose care-recipient died within the first year after baseline, and those whose care-recipient was institutionalized within the first year. Compared to general population norms, all groups of caregivers showed a great amount of psychological distress, especially those whose elder suffering from dementia deceased within the first year after baseline. The course of psychological well-being of caregivers who continued to provide care during follow-up supported the wear-and-tear model: an overall deterioration of psychological well-being was found (measured by the GHQ-12, SCL-90-R and SWLS) as elders' functioning declined and caregiving at home continued. Specific increases were found on total amount of psychological distress, but also on the SCL-90-R subscales: Depression, Anxiety, Interpersonal Sensitivity and Paranoid Ideation and Difficulty with Cognitive Performance. No overall changes were found for caregivers whose demented care-recipient had died or was institutionalized in the first year after baseline. These data suggest that the high level of psychological distress and the deterioration in psychological well-being among informal caregivers of dementia patients is a reason to reconsider the merits of the current trend to have demented older people live on their own as long as possible. Additional support should be considered.     

COMPARISON OF NITROGLYCERINE, VERAPAMIL AND NIFEDIPINE IN THE MANAGEMENT OF ARTERIAL PRESSURE DURING CORONARY ARTERY SURGERY

The efficacy of nitroglycerine, verapamil and nifedipine incontrolling post-sternotomy hypertension was compared in fourgroups of 20 patients anaesthetized with fentanyl 100 µgkg^–1 undergoing elective coronary artery surgery. Vasodilatorswere started before surgery and adjusted to maintain systolicarterial pressure < 120% of pre-infusion values, the mean(±SEM) requirements being: nitroglycerine (group II)3.6±0.6 µg kg^–1 min^–1; verapamil groupIII) 31.1 ±2.6 µg kg^–1 min¹ nifedipine (groupIV) 1.7±0.2 µg kg^–1 min^–1 Systolicpressure decreased significantly by 5 min after starting infusionsin groups II and III. In the control group (I: no vasodilator)arterial pressure increased significantly following skin incisionand sternotomy. Pulmonary arterial and capillary wedge pressuresincreased significantly following sternotomy in groups I andIII. Heart rate increased after sternotomy in all groups, butonly reached significance in groups III and IV. There were nosignificant changes in cardiac index or vascular resistance,although the latter remained lower than pre-infusion valuesat all times in groups III and IV. The P-Q interval increasedsignificantly in group III. It is concluded that nifedipineis a suitable alternative to nitroglycerine for the controlof arterial pressure during coronary artery surgery, but verapamilis not recommended because of its negative inotropic effectand its depressant effect on A-V conduction.     

THE PHARMACOLOGICAL ROLE OF P-GLYCOPROTEIN IN THE INTESTINAL EPITHELIUM

P-glycoprotein, a membrane-associated transport protein, has recently been recognised as an important element of the intestinal epithelium. This paper summarises thein vivodata on the pharmacological role of intestinal P-glycoprotein. These data show that P-glycoprotein contributes to the elimination of many drugs by mediating their direct secretion from the blood into the intestinal lumen. In addition, there is also evidence that this protein can limit oral drug absorption. Hence, inhibition of intestinal P-glycoprotein, e.g. by a reversal agent like cyclosporin A, may be a promising strategy for improving the oral bioavailability of P-glycoprotein substrate drugs. Indeed, several preclinical and clinical studies have shown that coadministration of drugs with a reversal agent can substantially increase oral drug absorption.     

喉癌患者气管内插管致气道完全梗阻1例

患男，78岁，以“持续性声音嘶哑半年余，加重1w”入院。半年前，患自觉发声困难，声音嘶哑，渐出现咽部异物感，气喘，痰多不易咳出，呼吸费力，夜间尤甚，无吞咽困难。近1w来，患以上症状加重，平卧时呼吸困难尤甚。CT示：喉部肿瘤侵及声门下区，杓状软骨破坏。查体：T：36．4℃，P：77次／min，R：18次／min，     

缺氧叠加三氯化铁大鼠肺动脉高压模型肺血管内皮细胞的病理变化

目的 :观察大鼠缺氧叠加静注FeCl3 致肺动脉高压模型肺动脉内皮细胞的病理变化。方法 :常规病理组织学和透射电子显微镜及多功能显微镜观察肺动脉内皮细胞的变化。结果 :缺氧叠加静注FeCl3 2周、4周时肺动脉平滑肌肥厚 ,肺间质有大量炎细胞浸润 ,血小板聚集 ,微血栓形成 ,血管内皮剥脱 ,内膜下组织暴露 ,内膜下及弹力纤维变形 ,内皮细胞成片脱落为循环内皮细胞。结论 :缺氧叠加静注FeCl3 引起的肺动脉内皮细胞脱落 ,内膜下组织暴露 ,微血栓形成和平滑肌肥厚是肺动脉高压形成的病理学基础     

34例淋巴瘤骨髓浸润患者治疗与预后分析

目的 探讨淋巴瘤骨髓浸润患者的治疗与预后。方法 34例淋巴瘤骨髓浸润患者分为单纯化疗组、化疗+放疗组、大剂量化疗+自体干细胞移植组进行治疗,长期随访,分析其预后状况。结果 全组中位生存期为20个月;1年和3年生存率分别为76.47％和26.47％,最初疗效为完全缓解和部分缓解患者的1年和3年生存率均大于未缓解患者(P<0.05);大剂量化疗+自体干细胞移植组的3年生存率大于单纯化疗组和化疗+放疗组(P<0.05)。结论 淋巴瘤骨髓浸润患者的生存率与最初疗效有关;大剂量化疗+自体干细胞移植能提高其生存率,改善预后。