筛查和诊断糖尿病的新观点

美国约有30％的糖尿病患者（约620万人）被漏诊。超过25％的新诊断糖尿病患者已经患有糖尿病视网膜病变或出现微量白蛋白尿，这意味着患者在2型糖尿病发病和确诊之间被“忽视”了7年。有时发现在糖尿病前期，即空腹血糖（FPG）略有偏高（IFG，空腹血糖受损）或口服葡萄糖耐量试验（OGTT）略有偏高，甚至已存在微血管和大血管并发症。     

青翘和老翘中连翘苷的含量测定

目的：测定青翘与老翘中连翘苷含量。方法：。双波和薄层扫描法。结果：表翘中连翘苷含量为０．０７６％;老翘中仅占０．０１２％,与报道的青翘中连翘酯苷含量高于老翘的实验结果相同,结论;本文结果与文献报道的就抗菌效价而言青翘优于老翘的结论吻合,目前市售药材青老翘混杂,有必要进行深入研究,确定合理的采收期。     

Computer analysis of optokinetic nystagmus in patients with spontaneous nystagmus of peripheral vestibular origin

The bias of slow phase velocity (SPV) of optokinetic nystagmus (OKN) caused by an acute labyrinthine lesion was examined in 8 patients using differnet optokinetic stimulus velocities. In all patients a directional preponderance of OKN-SPV was found corresponding to spontaneous nystagmus. This was due to enhancement of nystagmus SPV to the side of the lesion and depression of SPV in the opposite horizontal direction. The preponderance of OKN on the average increased with the intensity of spontaneous nystagmus and decreased along with recovery. These vestibularly induced differences in OKN-SPV range up to 70%. A differentiation is discussed between OKN preponderances caused by labyrinthine lesions and brain stem lesions.     

The effect of gait approach velocity on the broken escalator phenomenon

Walking onto a stationary surface previously experienced as moving generates an after-effect commonly known as the “broken escalator” after-effect (AE). This AE represents an inappropriate expression of the locomotor adaptation necessary to step onto the moving platform (or escalator). It is characterised by two main biomechanical components, an increased gait approach velocity (GAV) and a forward trunk overshoot on gait termination. We investigated whether the trunk overshoot and other biomechanical measures are the direct inertial consequence of the increased GAV or whether these are the result of an independent adaptive mechanism. Forty-eight healthy young adults walked onto a movable sled. They performed 5 trials with the sled stationary at their preferred walking velocity (BEFORE trials), 5 with the sled moving (MOVING or adaptation trials), and 5 with the sled stationary again (AFTER trials). For the AFTER trials, subjects were divided into four groups. One group was instructed to walk slowly (“slower”), another with cueing at the BEFORE pace (“metronome”). The third group walked without cueing at the BEFORE pace (“normal”), and the fourth, fast (“faster”). We measured trunk pitch angle, trunk linear horizontal displacement, left shank pitch angular velocity and surface EMG from lower leg and trunk muscles. In the AFTER trials, an AE was observed in these biomechanical measures for all gait speeds, but these were not strongly dependent on GAV. An AE was present even when GAV was not different from that of BEFORE trials. Therefore, we conclude that, although contributary, the trunk overshoot is not the direct consequence of the increased GAV. Instead, it appears to be generated by anticipatory motor activity “just in case” the sled moves, herewith termed a “pre-emptive” postural adjustment.     

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.     

Adenocarcinoma of the cardia: A 10-year regional review

Adenocarcinoma of the gastric cardia has the worst prognosis of all sites, and treatment is often palliative. This study has reviewed 736 patients with carcinoma of the cardia registered with the Birmingham Cancer Registry during 1960–1969. Fifty-eight percent of the patients presented with advanced disease. Radical resection was accomplished in 265 (36%). The age adjusted 5-year survival for all patients was 4.5% and 9.8% for those undergoing radical resection. In patients with advanced disease, palliative resection was associated with a longer survival than for those treated by intubation (p < 0.001) and this difference was maintained even in the presence of liver or peritoneal metastases. There was no difference in the 30-day mortality rates for those undergoing palliative resection or intubation and it is suggested that resection be undertaken whenever possible.

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Resumen El adenocarcinoma del cardias gástrico tiene pésimo pronóstico y su tratamiento frecuentemente es sólo paliativo. El présente estudio revisa 736 casos de carcinoma del cardias del Registre de Cáncer de Birmingham entre 1960 y 1969. Cincuenta y ocho por ciento de los pacientes presentaba enfermedad avanzada. La resección radical fue realizada en 265 (36%). La supervivencia a 5 años ajustada por edad para la totalidad de los casos fue de 4.5% y para los sometidos a resección fue de 9.8%. En los pacientes con enfermedad avanzada la resección paliativa apareció asociada con una más prolongada supervivencia que la simple intubación (p < 0.001) y esta diferencia se mantuvo aún en presencia de metástasis hepáticas o peritoneales. No hubo diferencia en las tasas de mortalidad a 30 días para aquellos sometidos a resección paliativa o a intubación; se sugiere que se emprenda la resección los casos en que sea factible.

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Résumé L'adénocarcinome du cardia est d'un pronostic particulièrement sévère car le traitement n'est souvent que palliatif. L'étude présentée par les auteurs concerne 736 cas de cancer du cardia opérés de 1960 à 1969. Cinquante-huit pour cent des malades présentaient des lésions avancées. Dans trente-six pour cent des cas il fut procédé à une résection (265 cas). Le taux de la survie à 5 ans fut au total de 4.5% atteignant 9.8% après résection radicale. Chez les malades qui présentaient des lésions avancées la survie fut plus longue après résection qu'après intubation (p<0.001) alors même qu'étaient présentes des métastases péritonéales ou hépatiques. La mortalité postopératoire (30 jours) de la résection ne fut pas supérieure à la mortalité consécutive à l'intubation. Ce fait suggère que la résection doit toujours être entreprise quand elle est possible.

     

Characteristics of electrically evoked 'auditory' brainstem responses elicited with the nucleus 22-electrode intracochlear implant

Electrically evoked auditory brainstem responses (EABRs) were measured in cochlear implant patients fitted with the Nucleus 22 electrode system. The typical response waveform consisted of a series of two to three peaks. The largest peak was similar in form to the wave V of acoustically evoked ABRs and was most prominent for stimulus intensities nearly equal to the patients' maximum comfortable (MC) behavioural stimulus level for the test electrode. The first identifiable wave V amplitude was observed at stimulus levels greater than the patients' psychophysical threshold. With increasing stimulus intensity, wave V amplitude increased rapidly to plateau at a level highly correlated with the patients' MC level at the EABR stimulus rate of 17/s. Wave V peak latency was generally shorter than normal ABRs (4.0 cf. 5.5 ms) and varied with electrode position: apical electrodes had shorter latencies than basal electrodes by approximately 0.4 ms. These results suggest that EABRs can be used as an objective estimate of a patient's electrode-specific MC level, once the correlation of EABR growth functions at 17/s to those at clinically employed rates of 250/s has been determined. EABRs may indicate differences in nerve action potential generation for apical and basal electrodes.     

A phase II trial of preoperative chemotherapy with epirubicin, cisplatin and capecitabine for patients with localised gastro-oesophageal junctional adenocarcinoma

Preoperative cisplatin/fluorouracil is used for the treatment of localised oesophageal carcinoma. This phase II study aimed to assess the efficacy and safety of administering preoperative epirubicin/cisplatin/capecitabine (ECX). Patients with stage II or III oesophageal/gastro-oesophageal junctional adenocarcinoma from one institution received 4 cycles of ECX (epirubicin 50 mg m⁻² day 1, cisplatin 60 mg m⁻² day 1, capecitabine 625 mg m⁻² b.i.d. daily) followed by surgery. The primary end point was the pathological complete response (pCR) rate based on a Simon two-stage design. Secondary end points included overall and progression-free survival (OS/PFS). Thirty-four patients were recruited: median age 60 years (range 41–81), 91% male, 97% PS 0/1, 80% T3, 68% N1. Thirty-one patients completed four ECX cycles. Grade 3/4 toxicities ⩾5% included neutropenia (62%), hand–foot syndrome (15%) and nausea/vomiting (9%). Thirteen out of 28 (46%) evaluable patients responded to chemotherapy by EUS (⩾30% reduction in maximal tumour thickness). Twenty-six out of 34 (76%) patients underwent resection (R0=73%, R1=27%). Post-operatively, two patients died within 60 days of surgery. The pCR rate was 5.9% (95% CI 0–14%) in the intent-to-treat population. According to the statistical design, this prompted early study termination. However, with a median follow-up of 34 months the median OS and 1- and 2-year survival rates were 17 months, 67 and 39% respectively. Median PFS was 13 months. Of the 14 relapsed patients, 10 presented with distant metastases. Preoperative ECX is feasible and well tolerated. Although associated with a low pCR rate, survival with ECX was comparable with published studies suggesting that pCR may not correlate with satisfactory outcome from preoperative chemotherapy for localised oesophageal adenocarcinoma.     

苦楝化学成份的研究

从苦楝(Melia azedarach L.)果中分得苦楝新醇(Ⅰ),苦楝醇(Ⅱ)、苦楝酮(Ⅲ)、苦楝二醇(Ⅳ)、香草醛(Ⅴ)和香草酸(Ⅵ)。根据波谱(IR,MS,¹HNMR,¹³CNMR)分析和理化常数测定,确定了它们的结构。其中苦楝新醇(Ⅰ)为新化合物,对菜青小虫有一定的拒食活性。     

骨髓间充质干细胞移植后脑梗死大鼠脑电图的变化

目的:对比观察骨髓间充质干细胞移植前后脑梗死大鼠脑电图的变化。方法:实验于2002-09/12在解放军第三军医大学中心实验室及西南医院神经内科肌电图室完成。①实验分组:选取清洁级健康成年Wistar大鼠15只,随机数字表法分为干细胞移植组、模型对照组、假手术组,5只/组。②实验方法:另取2只健康幼年Wistar大鼠用于骨髓间充质干细胞的提取,联合采用密度梯度离心及贴壁法分离培养大鼠骨髓间充质干细胞,选取生长良好的1～3代细胞用于移植实验。干细胞移植组、模型对照组大鼠建立大脑中动脉栓塞模型。假手术组仅分离颈总动脉、颈外动脉和颈内动脉,不予结扎和放置线栓。造模后1周,干细胞移植组、假手术组大鼠行细胞移植,在立体定向仪定位下于脑梗死区(壳核)直接注射骨髓间充质干细胞悬液5μL,细胞浓度1×104μL-1,移植坐标为前囟前1.0mm,右旁开3.0mm,硬膜下5.0mm。模型对照组大鼠于相同部位注射等量不含细胞的磷酸盐缓冲液。③实验评估:采用脑电图机分别于造模前、造模后1周(移植前)、细胞移植后4周对各组大鼠进行脑电图检测。结果:15只大鼠均进入结果分析。①造模前基本节律为8～11Hz、15～30μV的α波,间或少量θ波,双侧对称。②造模后1周,假手术组异常率为0;模型对照组20%(1/5)轻度异常,80%(4/5)中度异常;干细胞移植组20%(1/5)轻度异常,60%(3/5)中度异常,20%(1/5)重度异常。③细胞移植后4周,假手术组脑电图恢复正常;模型对照组随术后时间的延长慢波有所减少,但仍可见到δ波、棘波、棘慢波的发放,至细胞移植后4周60%(3/5)轻度异常,40%(2/5)中度异常;干细胞移植组术后局限性慢波逐渐减少,基本节律全部恢复为α波,不对称的情况明显好转,至细胞移植后4周60%(3/5)轻度异常,以病灶侧局限性θ波较多为主,另外40%(2/5)基本正常。结论:动物实验显示骨髓间充质干细胞移植对脑梗死大鼠的脑电图背景节律有改善作用,一定程度上促进了神经系统功能的恢复。