口服莫沙必利治疗功能性消化不良的随机对照试验

目的　观察新型促胃肠动力药莫沙必利 (胃 5 HT4受体促进剂 )对功能性消化不良 (FD)的随机对照试验。方法　FD患者 42例 ,随机分为试验组 (2 1例 ,服枸橼酸莫沙必利片 )和对照组 (2 1例 ,服吗叮啉片 )。采用GCP标准 ,双盲法观察 ,在实验开始前、服药第 1 4、2 8天记录症状变化及副作用发生情况。随机抽取部分患者于实验开始前和结束时做99MTc胃排空试验。结果　莫沙必利对FD症状的疗效与吗叮啉组相当 (P >0 .0 5 )。99MTc胃排空测定发现莫沙必利组治疗后的半排时间 (45 .0 5± 1 2 .2 1 )min缩短 ,1 2 0min残留率 (2 9.73%± 8.5 1 % )减少 (P <0 .0 5 ) ,两组病例未发现毒副反应。结论　莫沙必利对于FD疗效良好 ,对胃排空延迟有良好疗效 ,安全度高。     

关于建立非隶属关系附属医院的实践与思考

本文从医学人才培养的高度,论述高校与附属医院建立非隶属关系的附属医院的过程、体会和思考,指出目前存在的问题和解决途径.对进一步深化临床教育教学改革具有重要意义.     

Strabismus after retinal detachment surgery: etiology, diagnosis, and treatment

Between 5% and 25% of patients may experience persistent diplopia after surgery for retinal detachment. The complexity of the presentation poses a distinct challenge to both the retinal and the strabismus surgeon. Careful evaluation to determine factors contributing to the strabismus and assessment of fusional capabilities are essential before treatment. A combination of the appropriate surgical approach with nonsurgical adjuncts such as prisms or botulinum toxin is often successful in relieving symptoms.     

An assessment of a urinary biomarker for total human environmental exposure to benzo[a]pyrene

Urinary banzo[a]pyrene (BaP) metabolite levels were compared to human environmental exposure to BaP through inhalation and dietary ingestion to assess the predictive validity of the exposure biomarker. These measurements were made for 14 adult volunteers over 14 consecutive days, once during summer/fall, again during winter periods. Based on personal air monitoring, median potential inhalation doses of 11.0 and 2.3 ng/day were estimated for the winter and summer/fall studies, respectively. A median potential ingested dose of 176 ng/day, estimated from duplicate plate sampling, exceeded inhalation by 6-and 122-fold for the winter and summer/fall studies, respectively. Total urinary BaP metabolites were measured using a published reverse metabolism (BaP) method of analysis. Median rates of urinary BaP metabolite elimination for the winter and summer/fall studies were 121 and 129 ng/day, respectively. The changes in inhaled and ingested potential doses were regressed on the change in urinary metabolite elimination from week 1 to week 2 to test the predictive validity of the biomarker measurement. The regression was statistically significant (r = 0.620, p = 0.015, n = 25) when body weight was included and two extreme values were removed. Consistent with the exposure measurements showing diet as the dominant route of exposure, most of the variation in urinary metabolite elimination was explained by the ingested dose. It is concluded that the measurement of urinary BaP by reverse metabolism is qualitative and of marginal predictive validity as an exposure biomarker due to the method's low recoveries and the large unexplained variance.     

Differentiation of prostatic carcinoma and benign prostatic hyperplasia: correlation between dynamic Gd-DTPA-enhanced MR imaging and histopathology

One of the major factors limiting the staging accuracy of conventional magnetic resonance imaging (MRI) for prostatic carcinoma, is the similarity in signal intensity between tumor and coexisting benign prostatic hyperplasia (BPH). As neovascularity is an independent indicator of pathological state, dynamic contrast-enhanced MRI may yield additional information. This study correlates the histopathological findings from 12 radical prostatectomy patients on a region-by-region basis, with pharmacokinetic modeling of dynamic contrast-enhanced (0.2 mmol dimeglumine gadopentetate/kg), fast multiplanar spoilt gradient-recalled echo images, using a two-compartment simplex minimization technique. Quantitative analysis demonstrated differences in the amplitude of the initial contrast upslope and contrast exchange rate between tumor and fibromuscular BPH (P<0.03 and P<0.03, respectively) and for the contrast exchange rate between tumor and fibroglandular BPH (P<0.04), providing improved delineation of intraprostatic tumor extent compared with conventional imaging techniques.     

Identification of urinary metabolites of isoprene in rats and comparison with mouse urinary metabolites.

Isoprene, a major commodity chemical used in production of polyisoprene elastomers, has been shown to be carcinogenic in rodents. Similar to findings for the structurally related compound butadiene, mice are more susceptible than rats to isoprene-induced toxicity and carcinogenicity. Although differences in uptake, and disposition of isoprene in rats and mice have been described, its in vivo biotransformation products have not been characterized in either species. The purpose of these studies was to identify the urinary metabolites of isoprene in Fischer 344 rats and compare these metabolites with those formed in male B6C3F1 mice. After i.p. administration of 64 mg [14C]isoprene/kg to rats and mice, isoprene was excreted unchanged in breath ( approximately 50%) or as urinary metabolites ( approximately 32%). In rats isoprene was primarily excreted in urine as 2-hydroxy-2-methyl-3-butenoic acid (53%), 2-methyl-3-buten-1,2-diol (23%), and the C-1 glucuronide conjugate of 2-methyl-3-buten-1,2-diol (13%). These metabolites are consistent with preferential oxidation of isoprene's methyl-substituted vinyl group. No oxidation of the unsubstituted vinyl group was observed. In addition to the isoprene metabolites found in rat urine, mouse urine contained numerous other isoprene metabolites with a larger percentage (25%) of total urinary radioactivity associated with an unidentified, polar fraction than in the rat (7%). Unlike butadiene, there was no evidence that glutathione conjugation played a significant role in the metabolism of isoprene in rats. Because of the unidentified metabolites in mouse urine, involvement of glutathione in the metabolism of isoprene in mice cannot be delineated.