和营宁血汤治疗慢性特发性血小板减少性紫癜

目的观察和营宁血汤治疗成人慢性特发性血小板减少性紫癜（Idiopathicthrombocytopenicpurpura,IIP）临床疗效。方法30例气阴两虚或阴虚内热证邢患者运用和营宁血汤结合中医辨证治疗30d,观察血小板、骨髓巨核细胞、血小板相关抗体PAIgG及中医症候积分变化情况。结果治疗前后血小板计数、骨髓巨核细胞、PAIgG及中医症候积分有明显差别,有效率73．3％,中医症候疗效有效率86．7％,近期与远期疗效相似。结论和营宁血汤为基础的辨证治疗是成人慢性rIP的有效治法。     

A rabbit model of human familial, nonsyndromic unicoronal suture synostosis II. Intracranial contents, intracranial volume, and intracranial pressure

This two-part study reviews data from a recently developed colony of New Zealand white rabbits with familial, nonsyndromic unilateral coronal suture synostosis, and this second part presents neuropathological findings and age-related changes in intracranial volume (ICV) and intracranial pressure (ICP) in 106 normal rabbits and 56 craniosynostotic rabbits from this colony. Brain morphology and anteroposterior length were described in 44 rabbit fetuses and perinates (27 normal; 17 synostosed). Middle meningeal artery patterns were qualitatively assessed from 2-D PCC MRI VENC scans and endocranial tracings from 15, 126-day-old rabbits (8 normal, 7 rabbits with unicoronal synostosis). Brain metabolism was evaluated by assessing 18F-FDG uptake with high-resolution PET scanning in 7, 25-day-old rabbits (3 normal, 4 with unicoronal or bicoronal synostosis). Intracranial contents and ICV were assessed using 3-D CT scanning of the skulls of 30 rabbits (20 normal,10 with unicoronal synostosis) at 42 and 126 days of age. Serial ICP data were collected from 66 rabbits (49 normal; 17 with unicoronal synostosis) at 25 and 42 days of age. ICP was assessed in the epidural space using a Codman NeuroMonitor microsensor transducer. Results revealed that cerebral cortex morphology was similar between normal and synostosed fetuses around the time of synostosis. Significantly (P<0.05) decreased A-P cerebral hemisphere growth rates and asymmetrical cortical remodeling were noted with increasing age in synostotic rabbits. In addition, rabbits with unicoronal suture synostosis exhibited asymmetrical middle meningeal artery patterns, decreased and asymmetrical brain metabolism, a “beaten-copper” intracranial appearance, significantly (P<0.05) decreased ICV, and significantly (P<0.01) elevated ICP compared with normal control rabbits. The advantages and disadvantages of these rabbits as a model for human familial, nonsyndromic unicoronal suture synostosis are discussed, especially in light of recent clinical neuropathological, ICV, and ICP findings recorded in human craniosynostotic studies.     

A method to determine the utility of the third diagnostic and the second follow-up sputum smear examinations to diagnose tuberculosis cases and failures.

SETTING: Forty-two laboratories in four countries. OBJECTIVE: To determine the number of sputum smear examinations required to identify one additional case of tuberculosis from a third serial diagnostic smear or one additional treatment failure from a second serial follow-up smear. MATERIAL AND METHODS: Country-specific prevalence of new cases and failures among 59 665 examinees were determined, as well as the incremental yield from serial smears. The reciprocal value of the product of the prevalence of cases or failures and the respective incremental yield from the last serial smear provided the number of slides that have to be examined to identify one additional case or failure. RESULTS: The expected prevalence of cases among suspects ranged from 5.4% to 32.8%; the incremental yield from a third serial smear ranged from 0.7% to 7.2%. Between 122.7 and 796.3 smears were required to identify one additional case with the third serial smear. The prevalence of failures among follow-up examinees ranged from 1.0% to 2.5%; the incremental yield from the second follow-up serial smear ranged from 4.5% to 26.9%. Between 164.8 and 2133.4 slides were required to identify one additional failure with the second serial smear. CONCLUSION: The utility of serial smears can be rationally determined by careful review of program data.     

Predictive value of tumor necrosis factor alpha (TNF-α) in preeclampsia

Objective: To assess the measurement of plasma tumor necrosis factor alpha (TNF-α) as a predictive test for the development of preeclampsia. Study Design: One-hundred and twenty pregnant women were included in this prospective longitudinal study. Maternal plasma TNF-α levels were measured in the first, second and third trimesters by immunosorbent assay (ELISA). Preeclamptic patients were determined prospectively. Preeclamptic and normotensive patients were compared to assess the predictive value of TNF-α in preeclampsia. Results: Ninety patients completed the study. Preeclampsia developed in 10 out of 90 patients (11.1%). Plasma TNF-α levels were higher in preeclamptic patients than normotensive women in the third trimester of pregnancy (P<0.05). No difference was found between groups in the first and second trimesters (P>0.05). With the use of the receiver operating characteristics (ROC) 10.13 pg/ml was found to be a cut-off value predictive for the development of preeclampsia in the third trimester, but cut-off values in the first and second trimesters could not be found. The specificity, sensitivity, positive and negative predictive values were 90, 78, 33 and 98%, respectively. Conclusion: This study shows that plasma TNF-α levels are not useful as a specific marker for prediction of preeclampsia in the first and second trimesters. But determination of TNF-α may be useful for the prediction in the early third trimester.     

Autonomic nervous system dysfunction and their relationship with disease severity in children with atopic asthma

The involvement of autonomic imbalance has been reported in the pathogenesis of allergic diseases. The aim of this study was to investigate the association between the clinical severity of childhood asthma with autonomic nervous system (ANS) dysfunction and to define whether the severity of asthma correlates with ANS activity. In this case-control study, we evaluated the ANS activity by testing heart rate variability (HRV) and sympathetic skin response (SRR) in 77 asthmatic children, age 7-12 yrs, who had no co-morbidity and compared them with 40 gender- and age-matched control subjects. According to the severity of their asthma, study subjects were further divided into three groups: I (mild asthmatics), II (moderate asthmatics), and III (severe asthmatics). Inter-group ANS scale scores differed significantly (p<0.01) between Groups I and III and between Groups II and III. Combined use of HRV and SSR provides a higher degree of sensitivity for assessing disease severity in cases of pediatric asthma.     

参脉注射液联合重组人脑钠利肽治疗顽固性心衰随机平行对照研究

[目的]观察参脉注射液联合重组人脑钠利肽治疗顽固性心衰疗效。[方法]使用随机平行对照方法,将30例住院患者按随机数字表随机分为两组,对照组15例,限盐、吸氧和休息、积极去除诱因(抗感染,纠正酸碱失衡和电解质紊乱等)、抗心衰治疗(包括充分利尿,扩张血管ACET或ARB,地高辛等)。rhBNP治疗:负荷剂量1.5μg/mL静脉推注后,以0.0075μg/(kg.min)持续静脉泵入维持24h,2次/周,2周为1疗程。治疗组15例,西药治疗同对照组,参脉注射液50mL+5%GS/NS200mL静滴,1次/d。观测临床症状、一般指标、左心室功能、血液生化、B型利钠肽。2周为1疗程,连续治疗1疗程,判定疗效。[结果]治疗组,显效9例,有效5例,无效1例,总有效率93.33%。对照组显效3例,有效6例,无效6例,总有效率60.00%,治疗组疗效优于对照组(P<0.05)。心功能、BNP指标均有改善(P<0.01,P<0.05),治疗组优于对照组(P<0.01)。[结论]参脉注射液联合重组人脑钠利肽治疗各种顽固性心功能不全,临床症状、血液动力学均有改善,副作用少,安全,值得推广应用。     

Patient delay in the diagnosis and treatment of tuberculosis in China: findings of case detection projects

Objective: 1) To assess patient delay among new smear-positive pulmonary tuberculosis (PTB) patients in accessing health services in seven FIDELIS (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) projects from 2003 to 2008 in China; 2) to compare treatment delay by province; and 3) to assess factors associated with delay.Method: Records of new smear-positive PTB patients were reviewed. Data sources were the consultation book, laboratory register, patient record, treatment card and the PWLAHS (people with limited access to health services) evaluation form. Data were collected using a standard questionnaire, cross-checked by staff from the sites and by the International Union Against Tuberculosis and Lung Disease (The Union) and analysed by The Union.Results: Of the 75 401 new smear-positive PTB patients included in the study, 63–89% were PWLAHS. The average gross domestic product of the project sites and at national level were respectively US$557 and US$998. The median patient delay was 93 days (range 68–128). Delays were longer among females, older patients, rural residents and PWLAHS. Delayed access to health services was significantly associated with a greater number of symptoms.Conclusion: Patient delay in accessing health care in China was lengthy; TB care and control needs to be improved.     

“同经相应异位取穴”针刺治疗软组织损伤50例疗效观察

目的：观察采用“同经相应异住取穴”的针刺方法对软组织损伤治疗的临床疗效。方法：根据损伤后疼痛部住辩明所属的经络,然后在远离患处的同名经相应处部位选穴进针治疗。结果：50例患者中,一次治愈者28例占56％;二次治愈者13例占26％;三次治愈者6例占12％;四次治愈者2例占4％;五次治愈者1例占2％。痊愈率占70％,基本治愈率占30％。结论：同经相应异位取穴法与同名经对应取穴法是一致的,是以经络为依据的,所谓“经络所通,主治所及”。且针数少,针感激发显著,疗效迅速。     

Simultaneous determination of moexipril hydrochloride and hydrochlorothiazide in tablets by derivative spectrophotometric and high-performance liquid chromatographic methods

Two new simple and selective assay methods have been presented for the binary mixtures of moexipril hydrochloride (MOEX) and hydrochlorothiazide (HCTZ) in pharmaceutical formulations. The first method depends on second-derivative ultraviolet spectrophotometry with zero-crossing measurements at 215 and 234 nm for MOEX and HCTZ, respectively. The assay was linear over the concentration ranges 1.0-11.0 microg ml(-1) for MOEX and 0.5-9.0 microg ml(-1) for HCTZ. The determination limits for MOEX and HCTZ were found to be 1.0 and 0.5 microg ml(-1), respectively; while the detection limits were 0.2 microg ml(-1) for MOEX and 0.1 microg ml(-1) for HCTZ. The second method was based on isocratic reversed-phase liquid chromatography by using a mobile phase acetonitrile-20 mM phosphate buffer (pH 4.0) (50:50, v/v). Lisinopril was used as an internal standard (IS) and the substances were detected at 212 nm. The linearity range for both drugs was 0.5-12.0 microg ml(-1). The determination and detection limits were found to be 0.100 and 0.010 microg ml(-1) for MOEX and 0.025 and 0.005 microg ml(-1) for HCTZ, respectively. The proposed methods were successfully applied to the determination of these drugs in synthetic mixtures and commercially available tablets with a high percentage recovery, good accuracy and precision.