万古霉素耐药屎肠球菌致术后颅内感染1例

1 病例摘要 患者,男,24岁,7个月前无明显诱因出现复视、视力下降,向右视物时明显.5个月前出现饮水呛咳,间歇性头痛,右侧肢体无力,半年体重增加10kg.     

ADA、CRP、IFN-γ联合检测对结核性胸膜炎的诊断价值

目的 探讨血清腺苷脱氨酶(ADA)活性、CRP含量和IFN-γ含量联合检测对结核性胸膜炎的诊断价值.方法 检测59例结核性胸膜炎患者(结核组)、20例恶性胸水患者(恶性胸水组)以及12例其他渗出性胸水患者(其他组)胸水和血清中的ADA活性、CRP含量以及IFN-γ含量,经统计学处理后,评价各项指标诊断结核性胸膜炎的灵敏度、特异度及临床诊断符合率.结果 结核组胸水中ADA活性、CRP含量、IFN-γ含量分别为(50.98±13.07)U/L、(142.90±51.42)mg/L、(139.46±70.43)ng/L,与恶性胸水组和其他组比较差异均有统计学意义,P＜0.05或＜0.1.ADA以45 U/L为临界值,诊断结核性胸膜炎的灵敏度为80.4%,特异度为96.9%,临床诊断符合率为86.4%;CRP以110 mg/L为临界值,诊断结核性胸膜炎的灵敏度为78.6%,特异度为81.2%,临床诊断符合率为79.5%;IFN-γ以100 ng/L为临界值,诊断结核性胸膜炎的灵敏度为83.9%,特异度为93.8%,临床诊断符合率为87.5%.三项指标联合检测,诊断结核性胸膜炎的灵敏度为94.5%,特异度为97.8%,临床诊断符合率为94.3%.结论 ADA活性、IFN-γ含量和CRP含量联合检测可极大地提高结核性胸膜炎的诊断效能.     

丹参注射液与异甘草酸镁抗肝纤维化的临床对比研究

Objective To observe the change of liver function and liver fibrosis indexes of the chronic hepatitis B patients that were treated by Danshen injection(DI) and magnesium isnglyeyrrhizinate(MI). Methods 80 chronic hepati-tis B patients based on the conventional treatment were randomly divided into D1 group(40 patients) and MI group(40 pa-tients). The two groups were used with DI and MI injection for 30 days respaetively and then,the levels of liver function and serum hepatic fibrosis(HA, LN, Ⅳ -C) were detected and compared before and after treatment. Results Treatment by DI and MI could both improve liver function significantly, the effect of Ml group was better than DI group(P < 0.05). Moreover, in improving serum hepatic fibrosis, the effect of DI group was better than MI group (P < 0.05). Conclusions The efficacy of the improvement to hepatic fibrosis DI is better than MI, while in improvement of liver function MI is superior to DI.     

Clinical and Urodynamic Follow-Up of Women with Established Urinary Dysfunction After Radical Hysterectomy

Summary: The aim of this study was to examine the symptomatic and urodynamic changes seen in women presenting with urinary dysfunction after radical hysterectomy and ascertain whether there is any significant improvement over time. Sixteen women with persistent urinary dysfunction after radical hysterectomy were assessed on 2 occasions by interview and urodynamic studies over an average time interval of 35 months. Urinary incontinence, decreased bladder sensation and voiding difficulty were common symptoms of urinary dysfunction after radical hysterectomy. The sign of stress incontinence was an unreliable indicator of urethral sphincter incompetence. The only symptom to show significant improvement was bladder sensation (p<0.02). No significant improvement was found in any urodynamic parameter during the interval in either women who had surgery alone or had surgery and radiotherapy. The persistent nature of urinary dysfunction after cervical cancer treatment highlights the importance of prevention and long-term follow-up.     

椎体内裂隙样变对椎体成形术治疗椎体压缩骨折疗效的影响

目的 研究经皮椎体成形术(PVP)治疗并存椎体内裂隙样变骨质疏松性椎体压缩骨折的疗效,并与单纯性(不合并椎体内裂隙样变)骨质疏松性椎体压缩骨折的疗效进行对比,以分析椎体内裂隙样变对疗效的影响.方法 回顾性分析PVP治疗95例患者、176节椎体骨质疏松性压缩骨折的临床及影像学资料.本组研究中除外多节段骨折、合并肿瘤病史、影像资料不全和术后随访不配合患者.入选43例分A、B两组,18例骨质疏松性椎体压缩骨折合并裂隙样变患者为A组,25例无椎体内裂隙样变患者为B组.比较两组间术前疼痛和功能障碍情况,分析两组术后1周局部疼痛缓解和功能改善情况;观察两组并发症情况.结果 A组与B组术后1周疼痛缓解及日常活动功能改善明显(P＜0.05);两组间术后1周疼痛缓解的程度和日常活动功能改善的程度差异无统计学意义(P＞0.05);两组间骨水泥外漏发生率相似(P＞0.05),但两组间骨水泥外漏类型分布有差异(P＜0.05).结论 PVP是治疗骨质疏松性椎体压缩骨折的有效方法;椎体内裂隙样变对PVP的止痛疗效、功能改善与骨水泥外漏发生率无明显影响,但对骨水泥的外漏类型有一定影响.     

胸锁乳突肌瓣在腮腺良性肿瘤手术中的应用

目的探讨腮腺良性肿瘤切除术同期行胸锁乳突肌瓣转移修复缺损区预防术后面部凹陷畸形及味觉出汗综合征的临床效果。方法42例腮腺良性肿瘤患者行腮腺肿瘤及部分腮腺或全叶切除术,其中18例同期行胸锁乳突肌瓣转移修复术,术后6-18个月观察面部凹陷畸形程度及味觉出汗综合征。结果常规手术组患者均有不同程度的面部凹陷畸形,味觉出汗综合征的发生率为54.2%,胸锁乳突肌瓣转移修复术组面部凹陷畸形均不明显,味觉出汗综合征的发生率为11.1%,两组间差异有统计学意义。结论胸锁乳突肌瓣转移修复术能明显改善腮腺肿瘤术后面部畸形,有效降低味觉出汗综合征发生率。     

Intestinal gaboxadol absorption via PAT1 (SLC36A1): modified absorption in vivo following co-administration of L-tryptophan

Background and purpose:

Gaboxadol has been in development for treatment of chronic pain and insomnia. The clinical use of gaboxadol has revealed that adverse effects seem related to peak serum concentrations. The aim of this study was to investigate the mechanism of intestinal absorption of gaboxadol in vitro and in vivo.

Experimental approach:

In vitro transport investigations were performed in Caco-2 cell monolayers. In vivo pharmacokinetic investigations were conducted in beagle dogs. Gaboxadol doses of 2.5 mg·kg⁻¹ were given either as an intravenous injection (1.0 mL·kg⁻¹) or as an oral solution (5.0 mL·kg⁻¹).

Key results:

Gaboxadol may be a substrate of the human proton-coupled amino acid transporter, hPAT1 and it inhibited the hPAT1-mediated L-[³H]proline uptake in Caco-2 cell monolayers with an inhibition constant K_i of 6.6 mmol·L⁻¹. The transepithelial transport of gaboxadol was polarized in the apical to basolateral direction, and was dependent on gaboxadol concentration and pH of the apical buffer solution. In beagle dogs, the absorption of gaboxadol was almost complete (absolute bioavailability, F_a, of 85.3%) and T_max was 0.46 h. Oral co-administration with 2.5–150 mg·kg⁻¹ of the PAT1 inhibitor, L-tryptophan, significantly decreased the absorption rate constant, k_a, and C_max, and increased T_max of gaboxadol, whereas the area under the curve and clearance of gaboxadol were constant.

Conclusions and implications:

The absorption of gaboxadol across the luminal membrane of the small intestinal enterocytes is probably mediated by PAT1. This knowledge is useful for reducing gaboxadol absorption rates in order to decrease peak plasma concentrations.