Prevalence of microalbuminuria and relationship to the risk of cardiovascular disease in the Japanese population

The prevalence of microalbuminuria and its relationship to cardiovascular disease risk factors were examined in subjects participating in an annual physical and laboratory examination program. The urinary albumin concentration and the urinary albumin/creatinine ratio were determined in morning urine specimens. A turbidimetric immunoassay was used for the measurement of urinary albumin. Of the 731 subjects, 41 (5.6%) who were weakly positive or positive on a routine dipstick test for protein were excluded from the final analysis of data. Microalbuminuria was present in 14.5% of the men, in 12.4% of the women, and in 13.2% of the entire subject population when defined as a urinary albumin concentration of 30-299 microgram/ml. The prevalence of microalbuminuria was significantly higher in subjects with a high normal blood pressure (15.0%) or hypertension (26.2%) as compared with normotensive subjects (6.5%). Subjects with impaired glucose tolerance (24.3%) or hyperglycemic subjects (50.0%) had a significantly higher prevalence of microalbuminuria than normoglycemic subjects (11.3%). The prevalence of microalbuminuria was significantly higher in subjects with left ventricular hypertrophy (47.1%) as compared with those with normal electrocardiograms (11.3%). A good correlation was observed between urinary albumin concentration and albumin/creatinine ratio, and both showed a significant positive correlation with age, systolic and diastolic blood pressures, and fasting plasma glucose, total serum protein, albumin, and triglyceride levels, but not with angiotensin-converting enzyme activity. Multiple regression analysis demonstrated that both the urinary albumin concentration and the albumin/creatinine ratio show a significant positive correlation with systolic blood pressure and fasting plasma glucose. The prevalence of microalbuminuria was about 13% in this Japanese cohort, and the systolic blood pressure and the fasting plasma glucose level were demonstrated as independent risk indicators for both urinary microalbumin level and urinary microalbumin/creatinine ratio.     

Anesthetic management for cesarean section in a pregnant woman with impending acute liver failure--a case report

Acute liver failure includes a constellation of clinical conditions resulting from rapid loss of hepatocyte function. The anesthesiologist may often be asked to anesthetize a patient with acute liver failure before the etiological entity of disease can be completely clarified. Most of the previous reports were concentrated in obstetric or hepatological periodicals. Reports about anesthesia for such patients are scanty. We present a case about a near term pregnant woman with a complication diagnosed as impending acute liver failure, who received total intravenous anesthesia for emergent cesarean section. Pros and cons of different anesthetic techniques for this condition are discussed.     

On the use of survival analysis techniques to estimate medical care costs.

Measurement of treatment costs is important in the evaluation of medical interventions. Accurate cost estimation is problematic, when cost records are incomplete. Methods from the survival analysis literature have been proposed for estimating costs using available data. In this article, we clarify assumptions necessary for validity of these techniques. We demonstrate how assumptions needed for valid survival analysis may be violated when these methods are applied to cost estimation. Our observations are confirmed through simulations and empirical data analysis. We conclude that survival analysis approaches are not generally appropriate for the analysis of medical costs and review several valid alternatives.     

Effect of dietary glutamate on chemotherapy-induced immunosuppression.

Chemotherapy causes severe host immune depression and consequently increases susceptibility to infection. Dietary glutamate (GLU) serves as a stable substrate for the formation of glutamine (GLN), which is an important fuel and metabolic precursor for the immune cells. The effect of addition of GLU to a GLN/GLU-free amino acid diet upon immune response was studied in rats recovering from chemotherapy. Animals were fed a 0, 4, or 8% GLU diet and received a single intraperitoneal injection of methotrexate (MTX, 20 mg/kg BW). Two in vivo immune tests, delayed-type hypersensitivity (DTH) and popliteal lymphoproliferation (PLP), were performed 3 and 7 d after MTX treatment. Food intake and body weight decreased significantly immediately after MTX treatment and gradually recovered after 8 d with no significant difference among treatment groups. In a 23-d feeding study, no significant difference was found in the DTH response, but the PLP response increased in a GLU dose related fashion (83 and 133% increases for the 4 and 8% GLU diets, respectively). In a 44-d feeding study, the DTH response increased 61 and 83%, while the PLP response increased 191 and 382% for the 4 and 8% GLU diets, respectively. Plasma GLN, GLU, or glutathione (GSH) levels were increased by dietary GLU, but only in the immediate postprandial state. In summary, dietary GLU improves immune status of rats recovering from MTX treatment. The immune-enhancing effect of dietary GLU was dose-dependent and more pronounced after a longer duration of dietary GLU intake.     

对医疗服务投诉案件的分析与思考

随着社会主义市场经济体制的建立与发展,人们的观念也在发生变化。病人到医院就医,不论何种原由引起不满意,就会找到有关部门投诉。北京协和医院收集了１９９７年４月～１９９８年１月,病人到院办公室投诉的案件,分析投诉案件的产生有关医院方面的原由有责任心不强,职能不到位;服务态度不好;医院管理脱节,科室各自为政。提出现阶段应加强几个方面的工作力度：制定医疗法规,保障医院发展;强化医院管理,建立健全规章制度与监督考核机制;注重软件建设,抓紧人才培养;深入持久地开展医德医风教育。     

氯酚在鲫鱼体内的分布、存在形式与生物富集研究

用气相色谱－电子捕获检测器法测定鱼组织中４种有代表性的氯酚（ＣＰｓ）及其共轭物。选取ＣＰｓ分别对鲫鱼在室温（２２±５）℃进行９６ｈ半静态染毒实验。实验发现：２４ｈ换一次水,能充分保证ＣＰｓ实验水的浓度恒定,鱼的存在并不影响实验水的浓度。实验水系统中,ＣＰｓ在鲫鱼（Ｃｒｕｉｃａｎｃａｒｐｓ）体内的分布和积累的研究结果表明,ＣＰｓ在鱼体内以游离ＣＰｓ及其共轭物２种形式存在。ＣＰｓ总量在各鱼组织间的分布顺序为：胆＞肝、肾＞肌肉,随着氯（Ｃｌ）原子数目的增多,ＣＰｓ共轭物所占比例亦增大,而ＰＣＰ共轭物所占比例则较ＴＣＰ有所下降。胆组织中ＣＰｓ共轭物由葡萄糖苷酸共轭物和硫酸酯共轭物２种形式组成,其中葡萄糖苷酸含量大于９３％。通过计算生物浓缩因子（ＢＣＦ）值来度量ＣＰｓ在鱼组织中的生物富集效果。由胆中游离氯酚和硫酸酯共轭物得到的ＢＣＦ值均与正辛醇／水体系的分配系数ＫＯＷ没有相关性;而通过葡萄糖苷酸共轭物和ＣＰｓ总量分别计算得到的ＢＣＦ值均与ＫＯＷ有较好的相关性,（ｒ＞０．９６）。鲫鱼鱼胆的ＢＣＦ,在２．０×１０３～６．３×１０３之间。     

健康寿命年——一个新的测量疾病负担的指标

介绍一种新的测量疾病负担的指标——健康寿命率（ＨｅａＬＹ）。我们用此指标对１９９０～１９９３年北京ＭＯＮＩＣＡ资料进行了重新估算和分析,并将其与几年前ＷＨＯ和世界银行提出的另一个测量疾病负担的指标ＤＡＬＹ进行了比较。     

内燃机车乘务员和轮轴工外周血淋巴细胞微核观察

本文作者对５１名内燃机车乘务员和车辆维修车间的３０名轮轴工外周血淋巴细胞微核进行了分析。结果表明,机车乘务员和轮轴工微核阳性检出率、微核细胞率和微核率均明显高于对照组（Ｐ＜０．０１）,而且随着作业工龄的延长,微核细胞率和微核率有接近显著（０．０５＜Ｐ＜０．０１）或显著（Ｐ＜０．０５）意义的增高。对两类作业工作人员微核增高的原因进行了讨论     

NO介导肺动脉高压及其调节

目的：研究NOS、O2-·和Ca2+在犬高动力型肺动脉高压形成中的意义,控讨O2-·、［Ca2+]i在L一精氨酸→NO通路上的调节作用。方法：6只高动力型肺动脉高压模型犬,检测肺组织NOS活性,丙二醛（MDA）含量及总钙含量。结果：与正常比较,肺高压时,肺组织NOS活性较正常明显降低（P＜0.01）,MDA、[Ca2+]i;含量明显升高（P＜0.05）,肺组织NOS与平均肺动脉压（MPAP）、肺血管阻力（PVR）、[Ca2+]i及MDA呈明显负相关。结论：NO作用减弱在肺高压形成中与限速酶NOS活性降低密切相关,O2·和[Ca2+];共同介导肺高压过程。     

介入化疗栓塞治疗32例宫颈癌合并出血的临床疗效分析

目的探讨介入化疗栓塞治疗宫颈癌合并出血的临床意义。方法对３２例宫颈癌合并出血的患者采用子宫动脉灌注５－氟尿嘧啶（５－Ｆｕ）、顺铂（ＰＤＤ）、丝裂霉素（ＭＭＣ）加碘油行子宫动脉化疗栓塞,再用明胶海绵栓塞止血。结果①盆腔动脉造影能清楚显示肿瘤血管及范围,明确出血部位,经化疗栓塞后全部病例得以止血。②介入治疗能够短时间内控制巨大肿瘤,但难以使肿瘤完全坏死。结论介入化疗栓塞能够取得满意的止血效果,是其他治疗手段不可比拟的。介入治疗能够提高宫颈癌的近期疗效,但单纯用介入治疗难以根治,必须配合手术治疗或放射治疗。