螺内酯在慢性充血性心力衰竭治疗中的应用

1临床资料2003-01/2004-12,我院慢性充血性心力衰竭(心衰)住院患者238例中,使用螺内酯者185(男127,女58)例,使用率为77.7%(185/238),年龄32~96(平均61.2)岁.     

转移性黑色素瘤的姑息性放疔

目的：根据恶性黑色素瘤的放射生物学特性，设计了短疗程的放射治疗，以评价其在转移性患者中的姑息疗效。方法：21例(27个部位)转移性恶性黑色素瘤接受姑息性放疗，照射部位包括骨转移15个，淋巴结和皮下转移7个，脑转移5个。结合黑色素瘤生物特点和患者一般情况而制定时间-剂量模式，主要包括30Gy／10次／2周(10例，占37％)和20Gy／5次／1．5周(8例，占30％)。结果：总的姑息有效率为89％(24／27)，其中，骨和软组织转移的有效率为90％(20／22)，脑转移有效率为80％(4／5)。有效患者的中位缓解持续时间为60d，占剩余生存时问的67％。结论：短程放射治疗作为姑息治疗的手段，可以在大多数晚期转移性黑色素瘤患者中达到有效的减症作用。在高于常规分割剂量的基础上，可以视正常组织耐受性而适当降低分次剂量。总剂量的生物效应需达到相当于常规分割36Gy以获得较满意的姑息疗效。     

The dignity in advanced dementia (diadem) study: Developing an integrated geriatric palliative homecare program

Background: The prevalence of dementia is rising globally. Many patients suffer from the burdensome complications of advanced dementia as they are still poorly addressed. Aims: To describe the development of an interdisciplinary palliative homecare program for patients with advanced dementia and to develop a workflow that delineates the seamless continuation of care between the hospital and community with the homecare program. Design: Palliative care needs of patients and caregivers were established through a qualitative review of the literature. Appraisal tools were chosen based on their validity and feasibility in the homecare setting. Gaps in the healthcare system were identified and addressed as part of the integration of care between the hospital and the community. Setting/participants: Patients at Functional Assessment Staging (FAST) 7 with pneumonia, albumin level <35?g/L and/or enteral feeding were enrolled from a tertiary care hospital into the homecare program. Results: Patients’ symptom burden and quality of life were assessed. Caregivers were engaged in the planning of patients’ care. With the homecare program, patients and caregivers received support at home. Two physicians, seven nurses, and three social work professionals were educated about advanced dementia palliative care and medical information was communicated between different healthcare sites. Preliminary analysis of 306 patients revealed the presence of pain and neuropsychiatric behaviors. Impact of caregiving was mild to moderately severe. Conclusion: Advanced dementia is under-recognized as a terminal illness requiring specialized palliative intervention. Integrating a homecare palliative program into advanced dementia care is the first step towards palliating suffering at the end-of-life.     

A retrospective cohort study of stroke onset: implications for characterizing short term effects from ambient air pollution

Background

Androgens are crucial for normal testicular descent. Studies show that some pesticides have estrogenic or antiandrogenic effects, and that female workers exposed to pesticides have increased risk of having a boy with cryptorchidism. The main objective of the present study was to investigate whether pregnant women exposed to pesticides due to their work in horticulture experience excess risk of having sons with cryptorchidism.

Methods

We conducted a cohort study of pregnant women working in horticulture using four cohorts including one cohort established with data from the departments of occupational medicine in Jutland and Funen and three existing mother-child cohorts (n = 1,468). A reference group was established from the entire Danish population of boys born in the period of 1986-2007 (n = 783,817). Nationwide Danish health registers provided information on birth outcome, cryptorchidism diagnosis and orchiopexy. The level of occupational exposure to pesticides was assessed by expert judgment blinded towards outcome status. Risk of cryptorchidism among exposed horticulture workers compared to the background population and to unexposed horticulture workers was assessed by Cox regression models.

Results

Pesticide exposed women employed in horticulture had a hazard ratio (HR) of having cryptorchid sons of 1.39 (95% CI 0.84; 2.31) and a HR of orchiopexy of 1.34 (0.72; 2.49) compared to the background population. Analysis divided into separate cohorts revealed a significantly increased risk of cryptorchidism in cohort 2: HR 2.58 (1.07;6.20) and increased risk of orchiopexy in cohort 4: HR 2.76 (1.03;7.35), but no significant associations in the other cohorts. Compared to unexposed women working in horticulture, pesticide exposed women had a risk of having sons with cryptorchidism of 1.34 (0.30; 5.96) and of orchiopexy of 1.93 (0.24;15.4).

Conclusions

The data are compatible with a slightly increased risk of cryptorchidism in sons of women exposed to pesticides by working in horticulture.     

[6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C→T polymorphism of methylenetetrahydrofolate reductase

Background and purpose:

5,10-Methylenetetrahydrofolate reductase (MTHFR) is responsible for the synthesis of 5-methyltetrahydrofolate (5-MTHF). The 677C→T mutation of MTHFR reduces the activity of this enzyme. The aim of this study was, first, to compare pharmacokinetic parameters of [6S]-5-MTHF and folic acid (FA) in women with the homozygous (TT) and wild-type (CC) 677C→T mutation, and second, to explore genotype differences. The metabolism of [6S]-5-MTHF and FA was evaluated by measuring plasma folate derivatives.

Experimental approach:

Healthy females (TT, n= 16; CC, n= 8) received a single oral dose of FA (400 µg) and [6S]-5-MTHF (416 µg) in a randomized crossover design. Plasma folate was measured up to 8 h after supplementation. Concentration-time-profile [area under the curve of the plasma folate concentration vs. time (AUC)], maximum concentration (C_max) and time-to-reach-maximum (t_max) were calculated.

Key results:

AUC and C_max were significantly higher, and t_max significantly shorter for [6S]-5-MTHF compared with FA in both genotypes. A significant difference between the genotypes was observed for t_max after FA only (P < 0.05). Plasma folate consisted essentially of 5-MTHF irrespective of the folate form given. Unmetabolized FA in plasma occurs regularly following FA supplementation, but rarely with [6S]-5-MTHF.

Conclusions and implications:

These data suggest that [6S]-5-MTHF increases plasma folate more effectively than FA irrespective of the 677C→T mutation of the MTHFR. This natural form of folate could be an alternative to FA supplementation or fortification.     

表皮生长因子含量表达与骨折愈合的关系

目的:观察骨折后表皮生长因子含量表达的变化,分析表皮生长因子浓度变化与骨折愈合之间的关系。方法:实验于2003-10在山东大学齐鲁医院动物实验室完成。选用成年雄性家兔30只,以随机数字表法分成骨折固定组、骨折组、创伤组,各10只。骨折固定组制作左第一跖骨骨折模型,然后用管型石膏将左下肢固定;骨折组造模后不给予任何固定;创伤组仅用止血钳在家兔左大腿的中部钳夹1次。在造模前、造模后24,48,96h,2,4周,分别采静脉血,采用放射免疫分析法对家兔血清表皮生长因子浓度进行测定,进行组间、组内对照,观察骨折对家兔血清表皮生长因子浓度变化的影响。并通过X射线检测骨折愈合的情况,对家兔血清表皮生长因子浓度升高是否影响骨折愈合的速度进行评估。结果:所有30只实验动物均纳入实验动物数量分析,无脱失。①骨折固定组与骨折组骨折后24h血清表皮生长因子浓度开始升高[(45.98±3.36),(43.64±3.11)μg/L];到48h达到高峰[(51.02±3.11),(49.31±2.94)μg/L];96h已开始下降[(47.18±5.08),(45.41±4.73)μg/L];2～4周可维持较正常稍高水平[(43.50±3.78),(39.15±4.20)μg/L];4周时接近正常值[(42.26±3.14),(37.64±3.93)μg/L]。②骨折后24,48,96h骨折固定组、骨折组与创伤组家兔血清表皮生长因子浓度差异均有显著性意义(P<0.05);此间骨折固定组和骨折组差异无显著性意义(P>0.05)。③X射线检查结果,4周时骨折固定组愈合5例;骨折组愈合2例。6周时骨折固定组愈合8例;骨折组愈合5例。结论:骨折可导致家兔血清表皮生长因子浓度的升高,高表皮生长因子浓度可能有利于骨折的愈合。     

小鼠胚胎背主动脉发育过程中内皮和平滑肌标志物表达时相及其变化

目的:观察小鼠胚胎发育过程中背主动脉胎肝激酶1、α-平滑肌肌动蛋白的表达时相,初步探讨背主动脉内皮和平滑肌细胞的形成及其可能起源。方法:实验于2006-01/2007-01在解放军沈阳军区总医院全军心血管病研究所心内科完成。①实验材料:昆明种小白鼠50只,体质量20～22g,其中雌鼠30只。②实验方法:将雌鼠分别放入公鼠笼内过夜、交配,从怀孕第8.5天开始获取胚胎,在雌鼠怀孕第8.5～18.5天,每一时间点取10个小鼠胚胎。③实验评估:对胎鼠组织切片分别行苏木精-伊红染色,观察背主动脉形态学变化;免疫组织化学染色法观察内皮细胞标志物胎肝激酶1、CD31、Ⅷ因子相关抗原,α-平滑肌肌动蛋白表达变化及其相互关系。结果:①胚胎8.5～9.5d胎鼠背主动脉由单层细胞构成,呈胎肝激酶1、CD31阳性,α-平滑肌肌动蛋白、Ⅷ因子相关抗原阴性。②胚胎10.5d胎鼠背主动脉仍为单层细胞,但胎肝激酶1、CD31、Ⅷ因子相关抗原、α-平滑肌肌动蛋白均呈阳性。③胚胎11.5d背主动脉管壁发育为多层,内层细胞呈胎肝激酶1阳性、α-平滑肌肌动蛋白阴性,外层细胞呈胎肝激酶1阴性而α-平滑肌肌动蛋白阳性,血管与周围间充质无明显分界,背主动脉管壁周围可见散在α-平滑肌肌动蛋白阳性细胞。④11.5d之后,背主动脉管壁平滑肌细胞数量增多且由不规则型转变为纺锤型,内层内皮细胞继续呈胎肝激酶1阳性、α-平滑肌肌动蛋白阴性,外层平滑肌细胞胎肝激酶1阴性、α-平滑肌肌动蛋白阳性,血管与周围间充质分界清楚,背主动脉血管周围无散在α-平滑肌肌动蛋白阳性细胞。结论:胚胎背主动脉的平滑肌细胞可能最早起源于胎肝激酶1、CD31阳性细胞,后期可能来源于周围间充质细胞的募集分化。     

Lifetime direct healthcare costs of treating colorectal cancer: a systematic review

The European Journal of Health Economics - Colorectal cancer is a global public health issue and imposes a significant economic burden on populations and healthcare systems. This paper...