中医辨证治疗口服降糖西药控制不佳2型糖尿病患者46例临床观察

目的 初步评价中医辨证治疗口服降糖西药控制不佳2型糖尿病的临床疗效.方法 选择口服降糖药控制不佳的2型糖尿病患者138例,根据患者意愿及基线资料分为中医组、胰岛素组、联合组各46例,分别给予中医辨证治疗、胰岛素治疗、中医辨证+胰岛素治疗,治疗8周后检测空腹血糖(FPG)、餐后2小时血糖(2hPG)和糖化血红蛋白(HbAlc)水平,观察低血糖发生次数、治疗前后血脂指标及中医证候积分的变化,并进一步比较各组常见症状治疗前后出现的频数.结果 胰岛素组和联合组FPG、2hPG、HbAlc的降幅明显大于中医组(P＜0.05)；中医组和联合组低密度脂蛋白胆固醇(LDL-C)、中医证候积分及常见症状出现频次明显低于胰岛素组(P＜0.05)；联合组能明显降低日平均胰岛素剂量和低血糖事件的发生率,与胰岛素组比较差异有统计学意义(P＜0.05).结论 中医辨证治疗能明显改善口服降糖西药控制不佳2型糖尿病患者的血脂水平,在调节患者的症状方面具有积极作用,联合胰岛素治疗能在有效降糖的同时预防低血糖事件的发生.     

A life-threatening complication of parenteral nutrition: How to prevent cardiac tamponade?

Complications caused by incorrect central venous insertion are numerous. Cardiac tamponade is a rare, but well-documented complication that is often lethal. We present the case of a patient with cardiac tamponade caused by incorrect tip position and infusion of hyperosmolar fluids such as for parenteral nutrition.     

丹皮酚对PMDD肝气逆证模型大鼠焦虑样行为及其神经内分泌功能的影响＊

目的 观察丹皮酚对经前烦躁障碍症（Premenstrual Dysphoric Disorder，PMDD）肝气逆证模型大鼠行为学和孕酮（P）、四氢孕酮（ALLO）、海马脑区GABA_ARα4 mRNA和蛋白表达的影响、以探讨其作用机制。方法 将大鼠分为正常组（Control）、模型组（Model）、模型+丹皮酚低剂量组（Model+6.05）、模型+丹皮酚中剂量组（Model+12.11）、模型+丹皮酚高剂量组（Model+24.23）、模型+氟西汀组（Model+FLX），运用攻击行为测试（RIT）、旷场实验（OFT）、高架十字迷宫实验（EPM）等检测大鼠的焦虑样行为，ELISA检测血清及海马P、ALLO的含量，通过免疫荧光和PCR检测海马脑区GABA_ARα4的蛋白定位和mRNA的表达。结果 与正常组相比，模型组OFT的Center distance（中央区运动路程）、Center time（中央区停留时间）显著下降（P<0.05，P<0.001），相比模型组，氟西汀组OFT的Center time（中央区停留时间）显著上升（P<0.05）；与模型组相比，氟西汀组和丹皮酚中剂量组进入EPM开放臂次数和时间百分比明显上升（P<0.05，P<0.01，P<0.05，P<0.001）；与模型组相比，丹皮酚中剂量组血清中P、ALLO的含量显著增加（P<0.001，P<0.01），丹皮酚高剂量组血清中ALLO含量明显升高（P<0.05）；与模型组相比，丹皮酚中剂量组海马脑区中P含量显著升高（P<0.01）；各给药组海马脑区中ALLO含量明显增加（P<0.01、P<0.001、P<0.0001、P<0.001）；与正常组相比，模型组GABA_ARα4蛋白含量显著性降低（P<0.05），相比模型组，丹皮酚低剂量组和丹皮酚中剂量组显著性降低（P<0.05，P<0.05）；与正常组相比，模型组海马脑区内GABA_ARα4 mRNA表达显著性升高（P<0.01）。结论 丹皮酚可有效改善PMDD肝气逆证大鼠焦虑样行为，且中剂量用药可发挥更明显的疗效，其作用机制可能与纠正P、ALLO、GABA_ARα4 有关。     

Are all forms of feature binding disturbed in schizophrenia? Evidence from a central vs. peripheral distinction in working memory

In this study we investigated central and peripheral feature binding in a group of 24 high pre-morbid IQ patients with schizophrenia and 24 healthy controls. In particular, participants were asked to remember specific single (e.g., word, colour) or multiple features (e.g., coloured words) of experimental items with central (coloured word) vs. peripheral (a coloured frame) attributes in a working memory binding task. Performance of the patients was significantly inferior to that of controls, especially when required to remember the peripheral combination of multiple features. Results suggest that patients with schizophrenia may have difficulties in unitizing peripheral features in working memory.     

ENVIRONMENTAL AND BIOLOGICAL MONITORING OF EXPOSURE TO MANCOZEB,ETHYLENETHIOUREA, AND DIMETHOATE DURING INDUSTRIAL FORMULATION

The results of environmental (11 subjects) and biological (57 subjects) monitoring of exposure to mancozeb, ethylenethiourea (ETU), and dim ethoate are reported for employees of a firm producing commercial formulations containing these active ingredients. Urinary excretion \[GM(GSD) ] of ETU (mug/g creatinine) and alkylphosphates \[dimethylphosphate (DMP) + dimethylthiophosphate (DMTP) + dimethyldithiophosphate (DMDTP)] (nmol/g creatinine) was 65.3(4.8) and 419.2(2.1), respectively, for employees engaged in the formulation of a product containing 80% mancozeb (n= 9), 36.6(1.9) and 296.4(2.4) for those formulating a product containing 35% mancozeb (n = 9), 9.5(6.1) and 1022.4(3.0) for those engaged in plant maintenance and internal transport of materials (n = 6), 10.3(4.2) and 322.8(3.3) for those engaged in packaging the mancozeb formulations (n = 16), 4.4(3.3) and 2545.4(3.9) for those formulating a product containing 40% dimethoate (n = 11), and 3.0(2.7) and 871.7(3.3) for those bottling the same dimethoate formulation (n = 10). Air concentrations (mug/m3) ranged from 25.3 to 194.4 for dimethoate, from 0.2 to 1.3 for ETU, and from 139.9 to 949.0 for mancozeb. Urinary excretion of ETU and alkylphosphates showed a significant correlation with mancozeb (r2= .971), and ETU (r2= .858), and dimethoate (r2= .955) contamination of the hands. Potential dose estimates showed that the potential respiratory doses of mancozeb and dimethoate accounted, on the average, for 38% of the total potential dose. The potential respiratory dose of ETU was 7% of the total potential dose. Total estimated absorption did not exceed the accepted daily dose (ADI) for ETU and mancozeb, but the ADI for dimethoate was exceeded. Serum and erythrocyte cholinesterase activities in workers formulating dimethoate products were not significantly different before and after exposure.     

Pathological findings of Angiostrongylus vasorum infection in red foxes (Vulpes vulpes) from Central Italy,with the first report of a disseminated infection in this host species

In Europe, the red fox (Vulpes vulpes) is considered the reservoir of Angiostrongylus vasorum, nematode residing in the pulmonary arteries and right heart of dogs and many species of wild carnivores. Italy is considered one of the European countries where this nematode is actually spreading. Between May 2007 and November 2013, 62 foxes found dead in Central Italy were necropsied. Right heart and pulmonary arteries were opened and checked for the presence of adult parasites. Impression smears from sectioned lungs were examined for the presence of first-stage larvae, and samples of lungs were processed for histological examination. In order to detect eventual disseminated infections, samples of heart, pulmonary lymph nodes, liver, kidneys, and brain of foxes positive for A. vasorum at necropsy or lungs histological examination were processed for histological examination. An overall prevalence of 43.5 % was recorded. Light, mild, and severe lung lesions were detected in 33.3, 22.2, and 25.9 % of infected animals, respectively. Severe lesions were more frequent in animals younger than 12 months. In five infected foxes (18.5 %), no gross lesions were observed, while for three animals, angiostrongylosis was considered the cause of death. A case of disseminated angiostrongylosis was detected and another one was suspected. This is the firs report of disseminated angiostrongylosis in the fox.