犬自体肺组织瓣修补食管壁部分缺损的可行性

目的:分析犬自体肺组织瓣修补食管壁部分缺损的可行性。方法:实验于2003-01/2004-11在中国医科大学附属第二医院动物实验室完成。选用健康成年杂种犬20只,按随机数字表法分为2组,即支架组和无支架组,每组10只。20只实验犬经右胸第5肋间进胸,于胸内中段食管处胸内食管侧壁制成长4cm,环1/2~2/3周径全层缺损。于相应部位选择适当的肺组织,制成带蒂类舌状肺组织瓣。两组均将肺组织瓣覆盖并缝合固定于食管缺损处,支架组于食管缺损内衬自扩性记忆合金支架(管腔直径2.0cm、长6.0cm)并固定。术后抗炎及营养支持治疗。观察实验犬术后情况,并于术后2,4,6,8,10和12周定期处死实验犬行组织学观察。结果:无支架组实验犬存活7只,其中1只犬存活>24个月;支架组存活6只。①实验犬术后一般情况:存活犬于术后均能正常经口进食,早期有进食后呕吐,再吃下呕吐食物的现象,以支架组明显。②组织学观察结果:术后2周,无支架组均可见替代物表面有胶原及炎性渗出物,边缘见1~2层鳞状上皮细胞;支架组除有无支架组基本表现外,可见支架固定良好,光镜下见网架压迫处有较多中性粒细胞浸润。4~6周,两组均可见替代物表面有新生的3~5层复层鳞状上皮细胞;支架组见支架已基本陷入黏膜层内。8~10周,两组均可见管腔表面有6~8层新生复层鳞状上皮细胞;支架组网架边缘瘢痕组织增生,支架完全被包裹,炎症较重的局部有细胞爬行中断现象或新生细胞层数较薄,多为一两层。结论:应用自体肺组织瓣修补食管壁部分缺损是可行的,但支架组支架对食管修补处组织刺激大,炎性反应重,瘢痕重,因此如何选择合适的支撑物是今后替代节段性食管缺损面临的重要问题。     

Investigation of the mechanism of action of 2% fusidic acid lotion in the treatment of acne vulgaris

We describe the results of a single-centre, double-blind, vehicle-controlled, parallel group study on the quantitative effects of 2% fusidic acid lotion (Fucidin® lotion) in facial acne vulgaris. The trial was completed by 52 patients aged 15–25 years with mild to moderate acne who had been randomized to either Fucidin® Lotion (n= 25) or its base (n= 27). Primary outcome measures included colony counts of Propionibacterium acnes and microcoecaceae and measurements of skin surface lipid free tatty acids and sebum excretion rate. Clinical assessment was based on the acne grade, count of inflamed and non-inflamed lesions and evidence of a primary irritant dermatitis. There was a variable hut gradual reduction in lesion counts with the maximum improvement at 12 weeks for inflamed lesions, where the reduction was 19·9% for fusidic acid and 247% for the placebo. The non-inflamed lesions decreased by 10·8% in the fusidic acid group and increased by 15·9% in the placebo group; this difference was not statistically significant. Although the fusidic acid reduced the micrococcaceae count by 1 log cycle, inferring adequate compliance, there was no reduction in the counts of P. acnes, surface free fatty acids or sebum excretion rate. This study has failed to explain the mechanism of action of topical fusidic acid.     

Osteoporosis update

Introduction: Osteoporosis is a chronic disease that is estimated to affect more than 75 million people worldwide. The US Department of Health and Human Services projects that the disease will impact more than 10 million women by 2020 if efforts to prevent it are ineffective. This article provides an overview of the pathophysiology of osteoporosis, prevention measures, and an update of the US Food and Drug Administration–approved medications that are used in the treatment of this widespread disease. Methods: The current literature on the pathology, risks, and treatment of osteoporosis was reviewed. Studies providing the evidence for best practices are included in the following sections: prevention, diagnosis, and treatment of osteoporosis. Current national standards for diagnosis and treatment are highlighted. Results: Bisphosphonates continue to be the most popular and widely used pharmacologic treatment for osteoporosis. However, when bisphosphonates are contraindicated or cause side effects so serious that it is not possible for some women to use them, alternative pharmacologic treatments and forms of dosing are available. Discussion: When lifestyle and dietary modifications are insufficient to offset a diagnosis of osteoporosis, there are a variety of pharmaceutical options available that will provide safe and effective protection against fracture due to osteoporosis.     

Primary care management of major depression in patients aged ≥55 years:: outcome of a randomised clinical trial

Background

Late-life depression is associated with chronic illness, disability, and a poor prognosis. Primary care management may be in need of improvement.

Aim

To compare the effects of an intervention programme that aims to improve the identification, diagnosis, and treatment of depression in patients aged ≥55 years with the effects of usual care.

Design of study

Cluster randomised controlled trial.

Setting

General practices in the Netherlands.

Method

Trained GPs performed the intervention and their practice assistants conducted the screenings. Patients were screened with the 15-item Geriatric Depression Scale (GDS-15) and given a consultation with the GP who diagnosed depression with the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Antidepressant treatment was proposed. Primary outcomes were measured with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Trained independent research assistants performed independent evaluations in both arms.

Results

Eighteen practices (23 GPs) were allocated to the intervention and 16 practices (20 GPs) to usual care. From June 2000 to September 2002, 3937 patients were screened; 579 patients had a positive score on the GDS-15, 178 had major depression, of whom 145 participated in the trial. MÅDRS scores for the intervention group dropped from 21.66 at baseline to 9.23 at 6 months, and the usual care group from 20.94 at baseline to 11.45 at 6 months. MÅDRS scores decreased during the year in both arms. For the intervention group, these scores increased between 6 and 12 months.

Conclusion

The programme resulted in lower MÅDRS scores in the intervention group than in the usual care group, but only at the end of the intervention, at 6 months after baseline.     

硫酸锌对心肌慢反应电活动和哇巴因引起振荡后电位的影响

本文目的旨在观察硫酸锌对心肌慢反应电活动的影响,所得结果如下:(1) 0.1～0.3mmol硫酸锌能使高钾除极引起的豚鼠乳头肌慢反应动作电位APA和V_max降低,APD₅₀和APD₉₀)显著延长;(2) 0.1～0.3 mmol硫酸锌能抑制家兔离体窦房结细胞的自律性,使窦房结APA降低,APD₉₀延长,SP₀和SP₄减小;(3) 0.1 mmol硫酸锌可对抗0.4μmol哇巴因诱发的豚鼠心室肌振荡后电位,提高引起振荡后电位的哇巴因阈浓度。提示:锌抑制心肌慢反应电活动。     

楤木根皮中皂甙化学成分的研究

楤木根皮中的主要成分是皂甙。将总皂甙以柱层析分离,得到三个化合物(Ⅰ～Ⅲ),经光谱分析和化学方法证明,Ⅰ为楤木皂甙A(araloside A);Ⅱ为银莲花甙(narcissiflorine);Ⅲ是3-O-[β-D-吡喃葡萄糖-(1→2)-β-D-吡喃木糖-(1→)2)-α-L-阿拉伯糖]-齐墩果酸。Ⅲ为一新皂甙,命名为楤木皂甙D(araloside D)。     

清热中药对大鼠下丘脑组织AVP含量的影响

目的：清热中药大多具有一定的解热作用,为探讨其解热作用机理,我们选用典型的清热中药黄芩,银花,连翘组成清热方,从体温调节中枢神经介质方面来研究其解热作用机制。方法;选用Ｗｉｓｔａｒ大鼠,按体重随机分作３组,背部皮下注射酵母混悬液制造发热模型,给药组灌服清热方颗粒剂,模型组予等量饮用水,正常对照组不作处理,给药２ｈ后断头取脑,用放免方法检测大鼠下丘脑组织中ＡＶＰ含量。结果：模型组大鼠体温和下丘脑组织     

反相高效液相色谱法测定甲磺酸酚妥拉明片的含量

目的：建立了反向高效液相色谱法测定甲磺酸酚妥拉明的含量的方法。方法：采用Symmetry C18硅烷键和硅胶柱,甲醇－水－冰醋酸－三乙胺（10：10：1：0．1）作为流动相,检测波长为278nm,峰面积外标法测定。结果：平均回收率为100．2％（n=11),日内、日间差分别为0．7％和0．8％,在10－250μg范围内线性关系良好（r=0.9999),结论：该法简便、准确、结果满意。