重度阻塞性睡眠呼吸暂停低通气综合征围手术期持续正压通气治疗

目的　观察重度阻塞性睡眠呼吸暂停低通气综合征 (obstructivesleepapneahypopneasyndrome ,OSAHS)围手术期病情变化和持续正压通气治疗 (continuouspositiveairwaypressure,CPAP)的影响 ,探讨围手术期治疗的必要性。方法　 45例重度OSAHS患者均接受了完整保留悬雍垂的改良悬雍垂腭咽成形术。其中 2 4例不做围手术期CPAP治疗的作对照组 ,2 1例行围手术期CPAP治疗 :术前CPAP治疗 7d以上 ,于术后 1～ 3d夜应用自动调节治疗压力的CPAP(autotitratedCPAP ,AutoSet)进行治疗。治疗组患者术后第二夜在AutoSet治疗下同时做多导睡眠监测 (polysomnography,PSG)。对呼吸暂停低通气指数 (apneahyponeaindex ,AHI)、最低血氧饱和度 (lowestSaO2 ,LSaO2 )、血压以及睡眠结构等指标进行观察。结果　对照组 2 4例患者中有 6例于术后第二夜LSaO2 比术前下降 ,AHI升高 ,另外 1 8例患者LSaO2 升高 ,AHI下降。治疗组 2 1例患者CPAP治疗前AHI为 (61 1± 9 9)次 /h( x±s,以下同 ) ,LSaO2 为 65 0 %± 9 6 % ,手术前CPAP治疗后AHI为 (2 2± 1 4)次 /h ,LSaO2 为 94 5 %± 2 9% ,t检验P <0 0 0 1 ;手术前经CPAP治疗临床症状消失。术后患者均能良好耐受AutoSet治疗 ,术后第二夜应用AutoSet治疗时AHI为 (3 6± 1 8)次 /h     

Ⅰb-Ⅱb期手术治疗的宫颈腺癌卵巢转移及预后分析

目的　探讨Ⅰb—Ⅱb期手术治疗的宫颈腺癌卵巢转移的高危因素 ,并分析预后因素。方法　回顾性研究 32例Ⅰb—Ⅱb期手术治疗的宫颈腺癌的临床病理特点 ,应用 χ2 检验及logistic回归分析探讨 4例卵巢转移的高危因素 ;应用Kaplan -Meier法及Cox回归模型分析预后因素。结果　单因素分析提示卵巢转移的高危因素是临床分期和盆腔淋巴结转移 ,但多因素分析没有发现有统计学意义的危险因素。Cox回归提示肿瘤大小和盆腔淋巴结转移是独立预后因素。结论　对于有高危因素的宫颈腺癌 ,术中保留卵巢需要慎重。     

247例小儿急性肠套叠的诊治体会

目的 分析小儿肠套叠的临床特点、诊断及治疗。方法 总结247例小儿急性肠套叠的临床表现、治疗及效果。结果 244例均以阵发性哭闹（或腹痛）、呕吐、血便和腹部包块为主要症状，X线透视下行空气灌肠确诊和整复治疗，成功达210例（85．3％）。结论 小儿急性肠套叠早期诊断和治疗与预后相关。     

Identification of cytochrome p450 enzymes involved in the metabolism of 4'-methyl-alpha-pyrrolidinopropiophenone, a novel scheduled designer drug, in human liver microsomes.

4'-Methyl-alpha-pyrrolidinopropiophenone (MPPP) is a new drug of abuse. It is believed to have an abuse potential similar to that of amphetamines. Previous studies with Wistar rats had shown that MPPP was metabolized mainly by hydroxylation in position 4' followed by dehydrogenation to the corresponding carboxylic acid. The aim of the study presented here was to identify the human hepatic cytochrome p450 (p450) enzymes involved in the biotransformation of MPPP to 4'-hydroxymethyl-pyrrolidinopropiophenone. Baculovirus-infected insect cell microsomes and human liver microsomes were used for this purpose. Only CYP2C19 and CYP2D6 catalyzed this hydroxylation. The apparent Km and Vmax values for the latter were 9.8 +/- 2.5 microM and 13.6 +/- 0.7 pmol/min/pmol p450, respectively. CYP2C19 was not saturable over the tested substrate range (2-1000 microM) and interestingly showed a biphasic kinetic profile with apparent Km,1 and Vmax,1 values of 47.2 +/- 12.5 microM and 8.1 +/- 1.4 pmol/min/pmol p450, respectively. Experiments with pooled human liver microsomes also revealed biphasic nonsaturable kinetics with apparent Km,1 and Vmax,1 values of 57.0 +/- 20.9 microM and 199.7 +/- 59.7 pmol/min/mg of protein for the high affinity enzyme, respectively. Incubation of 2 microM MPPP with 3 microM of the CYP2D6-specific inhibitor quinidine resulted in significant (p < 0.01) turnover inhibition (11.8 +/- 1.6% of control). Based on kinetic data corrected for the relative activity factors, CYP2D6 is the enzyme mainly responsible for MPPP hydroxylation, confirmed by CYP2D6 inhibition studies.     

妊娠期血清铁、叶酸、维生素B_(12)的调查分析

目的:观察妊娠期女性血液中铁、叶酸及维生素B12的变化情况。方法:将200名妊娠期女性分成早、中、晚期及足月妊娠四组,分别测定其血清铁、叶酸及维生素B12的水平,与对照组妇女的血清铁、叶酸及维生素B12水平进行比较。结果:自中期妊娠开始,随着妊娠月份的增加,孕妇血清铁、叶酸、维生素B12水平明显下降,晚期妊娠为最低,足月妊娠期水平略有回升。结论:妊娠期孕妇体内铁、叶酸及维生素B12的消耗增加,应适当补充。     

The relationship between phalangeal bone density and vertebral deformities

Radiographic absorptiometry (RA) of the phalanges is a convenient and reliable technique for measuring bone mineral density (BMD). It needs only a radiograph of the hand, which can be sent for evaluation to a central facility, whereas other techniques require specialized equipment. We assessed the relationship between RA measurements and the presence of vertebral deformities in a population-based cohort of postmenopausal women, and to compare the results with simultaneously obtained BMD of the hip by dual-energy X-ray absorptiometry (DXA). A total of 389 women aged 55–84 (mean age 67.2 years, SD 8.7) were randomly selected from a large general practice. RA, DXA of the hip, and vertebral deformities in the lateral spine X-rays by vertebral morphometry were assessed. Thirty-eight women (9.8%) had severe (grade II) vertebral deformities, and their BMD at the phalanges and femoral neck was significantly lower than that of women without severe vertebral deformities. Odds ratios for the presence of severe vertebral deformities of 1.5 (95% CI: 1.1–2.1) for RA and 1.3 (95% CI: 0.9–1.9) for DXA, together with similar receiver operating characteristics curves, were found using age-adjusted logistic regression. Phalangeal BMD is related to vertebral deformities at least as closely as BMD of the femoral neck BMD. RA may therefore help to evaluate fracture risk, especially if no DXA equipment is available. Received: 21 July 1998 / Accepted: 1 July 1999     

针灸配合药物治疗周围性面瘫合并无症状性脑梗塞33例

目的 对33例周围性面瘫合并无症状性脑梗塞患者，观察针灸配合药物治疗的临床效果。方法 采用针刺加艾灸配合脉络宁静脉滴注等治疗。结果 5个疗程后，痊愈18例，显效11例，有效4例。总有效率为100％，愈显率为87．88％。结论 针灸配合药物治疗周围性面瘫合并无症状性脑梗塞效果显著。建议临床诊治周围性面瘫时，须防同时合并无症状性脑梗塞，以免漏诊而漏治。     

絮刺火罐疗法治疗颈椎病疗效观察141例

目的　观察絮刺火罐疗法治疗颈椎病的疗效。方法　将患者随机分为两组 ,一组运用传统的颈椎牵引法治疗 ,另一组运用絮刺火罐疗法治疗。结果　治疗 1星期时两组疗效没有明显差异 ( P>0 .0 5 ) ,治疗 2星期后絮刺火罐治疗组疗效优于传统牵引组 ( P<0 .0 5 )。结论　絮刺火罐疗法是治疗颈椎病的较好方法     

针灸配合推拿治疗支气管哮喘56例临床观察

目的　观察针灸配合推拿治疗支气管哮喘的疗效。方法　采用头皮针、体针、艾灸配合推拿治疗支气管哮喘 5 6例 ,并与西药常规治疗 30例对比。结果与结论　治疗组临床控制率为 6 0 .7% ,总有效率为 98.2 % ,西药组分别为 5 0 .0 %和 83.3% ,治疗组疗效优于西药组 (P<0 .0 5 )。治疗组治疗后肺活量、免疫球蛋白、CO2 结合力、血氧都有明显改善 (P<0 .0 1,P<0 .0 5 )     

穴位注射治疗周围性面神经麻痹及肌电图观察

目的　观察穴位注射治疗周围性面神经麻痹的疗效。方法　将 80例患者分为穴位注射组 5 0例和对照组 30例 ,穴位注射组采用维生素 B1 2 及维生素 B1 注射液穴位注射 ,对照组采用常规针刺 ,观察两组疗效及治疗前后面部肌电图变化。结果与结论　穴位注射组治愈率及愈显率明显高于对照组 (P<0 .0 5 ,P<0 .0 1) ,治疗后穴位注射组募集电位改善情况较对照组明显为优 (P<0 .0 5 ,P<0 .0 1)。