综述：α-葡萄糖苷酶抑制剂可改善血糖控制，但对2型糖尿病重要预后的效果尚不确定

问题：α-葡萄糖苷酶抑制剂能够有效地改善2型糖尿病患者的血糖控制吗？[编者按]     

A rare intrahepatic portacaval tubular shunt in a patient with spastic paraparesis

Although there are numerous communications between the portal and systemic venous systems, intrahepatic portosystemic venous shunts are not frequently encountered in clinical practice. Here we report a patient who presented with spastic paraparesis, who was found to have chronic liver disease with tubular intrahepatic portacaval shunting.     

肺栓塞孕产妇死亡病例56例临床分析

[目的]探讨孕产妇发生肺栓塞的诱因、诊治和预防。[方法]回顾性分析湖南省2006年10月1日至2012年9月30日56例因肺栓塞引起的孕产妇死亡病例资料。[结果]因肺栓塞所致孕产妇死亡人数占孕产妇死亡总数的4．71％（56/1190）;发生在产前7例,产时2例,产后43例。另外,发生在宫腔镜下清宫术中2例,剖宫流产术中1例,早孕人流术后1例。其中24例发生在产后48 h内,占产后死亡总数的55．8％（24/43）;产时及产后死亡病例中剖宫产39例,阴道产6例;依据临床表现联合C T 诊断肺栓塞4例,尸检确诊1例,余均依据临床表现死后推断;在抢救措施方面,仅3例给予了抗凝治疗。[结论]重视孕妇肺栓塞高危因素的筛查,严格控制剖宫产指征,规范肺栓塞的诊断并掌握急救方法,重视深静脉血栓的预防和筛查,是预防和降低因肺栓塞所致孕产妇死亡的关键。     

攻毒扶正法对非酒精性脂肪性肝炎大鼠瘦素、胰岛素的影响

目的：观察攻毒扶正法对非酒精性脂肪性肝炎（NASH）大鼠瘦素（LEP）、胰岛素（INS）的影响。方法：用高脂饲料与四氯化碳（CCl4）制备NASH大鼠模型,分别用乙肝系列中成药（乙肝清热解毒颗粒、乙肝益气解郁颗粒、乙肝养阴活血颗粒）、辛伐他丁溶液进行灌胃。分为正常组,模型组,辛伐他丁组,清热解毒组,益气解郁组,养阴活血组,清热解毒合益气解郁组（简称清解合益气组）,清热解毒合养阴活血组（简称清解合养阴组）共8组,每组12只。用药4周后显微镜下观察NASH大鼠肝脏HE染色切片,并对肝组织病变程度评分。检测肝功能、血脂、LEP、INS情况。结果：模型组肝组织病变程度评分明显高于正常组（P〈0.01）,丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）升高,总胆固醇（TCh）升高明显（P〈0.01）,LEP、INS水平均升高（P〈0.05）。治疗组均可降低LEP水平,肝组织病变评分降低。中药组的ALT、AST、TC、LEP、INS含量有下降趋势（P〈0.05或〈0.01）;辛伐他丁组能降低ALT、INS含量,差异无显著性意义。结论：NASH大鼠体内有明显LEP、INS水平升高趋势。各治疗组均能降低大鼠体内LEP、INS水平。通过各类指标的检测,中药组改善作用更为明显。证明攻毒扶正法治疗NASH大鼠有切实的作用。     

脱中性粒细胞温血心脏停搏液连续灌注在心脏手术中心肌保护的研究

目的 :研究体外循环期间常温血脱中性粒细胞心脏停搏液微流量连续灌注对心脏瓣膜置换术中心肌的保护作用。方法 :临床随机选取体外循环时间在 60min以上的风湿性心脏瓣膜病人 2 0例 ,随机分为实验组和对照组 (每组 10例 ) ,分别检测不同时间点血浆心肌肌钙蛋白I(cTnI)水平和血浆MDA水平的变化。结果 :①两组病人在CPB前cTnI含量组间差异无显著性 ,而在主动脉阻断后及主动脉开放后各时间点差异显著 ,对照组cTnI值高于实验组 (P <0 .0 5 ) ;②两组病人在体外循环前及主动脉阻断 3 0min时MDA的含量组间差异无显著性 ,而在主动脉开放各时间点组间差异具有显著性 (P <0 .0 5 ) ,对照组高于实验组。结论 :实验研究证实 ,脱除心脏停搏液中的中性粒细胞后 ,可减轻中性粒细胞介导的心肌损伤 ,有利于心肌保护     

A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal

OBJECTIVE: This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal. STUDY DESIGN: Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS: A statistically significant difference between the time to onset of A200 (1.66 +/- 0.13 minutes) and B200 (2.51 +/- 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% +/- 3.00% and 88.57% +/- 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05). CONCLUSIONS: In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.     

The haemodynamic, renal excretory and hormonal changes induced by resting in the left lateral position in normal pregnant women during late gestation

Objective  To characterise the haemodynamic, renal-electrolyte and hormonal parameters in normal near-term pregnancy.
Design  Observational prospective case-series study.
Setting and population  Eleven women with normal pregnancies at 35–39 weeks gestation.
Methods  Following baseline laboratory assessments and placement of a right-atrial catheter, serial measurements were obtained for 2 hours in the supine position (SP) followed by a change to the (LLP) and subsequent observations for 2 hours.
Main outcome measures  Blood pressure (BP), central venous pressure (CVP), atrial natriuretic peptide (ANP), plasma renin activity (PRA), plasma aldosterone (ALDO), diuresis, creatinine clearance, sodium and potassium excretion.
Results  In the SP, the subjects' BP remained stable while their CVP decreased. In the LLP, the subjects' systolic and diastolic BP consistently decreased by about 15 mmHg and their CVP increased within the first 60 minutes. ANP levels doubled in the subjects while they rested in the LLP, whereas the subjects' PRA and ALDO levels decreased by half compared with when they rested in the SP. In the LLP, the subjects' creatinine clearance significantly increased by 12% and their sodium excretion and diuresis increased by 38% and 59% respectively.
Conclusion  Rest in the LLP induces systemic and intra-renal haemodynamic and hormonal changes that may play a central physiological role in the renal excretory response to restore excessive sodium/water retention in late pregnancy.     

温氧合血连灌与冷晶体液间灌心肌线粒体量化计分及形态改变的对比研究

目的：对温血连续灌注与冷晶体液间断灌注下心肌线粒体结构及量化计分进行了对比研究。方法：病人分两组（每组７例），主动脉阻断６０分钟后及再灌注２０分钟各取２ｍｍ直径心室壁肌肉置入４℃２．５％戊二醛液中固定２小时。在Ｈ６００型电镜下选择５个视野、每视野随机观察２０个线粒体。依受损程度分为０～４级（０级为正常结构，４级受损程度最重），将１００个线粒体按级得分总和除以１００即为该组得分数。结果：阻断６０分钟线粒体量化计分冷晶组为２．５１４３±０．２８６３，温血组计分为１．５４８６±０．０９１５（Ｐ＜０．００１）。再灌注２０分钟后冷晶组记分为３．０１４３±０．１７９２，温血组记分为１．６８２９±０．１５８１（Ｐ＜０．０１）。阻断６０分钟再灌２０分钟电镜下冷晶组线粒体嵴断裂、溶解、基质颗粒丢失明显、内外膜完整性消失；温血组线粒体嵴无断裂、外膜完整、基质颗粒略少。结论：电镜下线粒体超微结构及量化计分证明温血组心肌保护作用明显优于冷晶组。