Intrathecal Ziconotide in the Treatment of Chronic Nonmalignant Pain: A Randomized,Double‐Blind,Placebo‐Controlled Clinical Trial

Objective. The safety and efficacy of intrathecal (IT) ziconotide was studied in a randomized, double‐blind, placebo‐controlled trial. Materials and Methods. Patients (169 ziconotide, 86 placebo) with severe chronic nonmalignant pain unresponsive to conventional therapy and a visual analog scale of pain intensity (VASPI score) ≥ 50 mm were treated over a 6‐day period in an inpatient hospital setting. Initial starting dose was 0.4 µg/hour and was titrated to analgesia or intolerance (maximum dose 7.0 µg/hour). The starting and maximum doses were reduced to 0.1 µg/hour and 2.4 µg/hour, respectively, due to adverse events (AEs). Results. The mean percent reduction in VASPI score from baseline was 31.2% and 6.0% for ziconotide‐ and placebo‐treated patients, respectively (p ≤ 0.001). During the initial titration phase, a significantly greater percentage of patients in the ziconotide group compared to the placebo group reported AEs, including abnormal gait, amblyopia, dizziness, nausea, nystagmus, pain, urinary retention, and vomiting. Conclusion. Ziconotide provided significant analgesia in patients for whom conventional therapy failed. However, there was a considerable incidence of ziconotide‐associated AEs due to the rapid titration and high doses administered.     

社区干预对老年慢性支气管炎独居患者生活质量的影响

目的提高社区老年慢性支气管炎独居患者的生活质量.方法将70例老年慢性支气管炎独居患者随机分为对照组和干预组各35例.干预组采取社区健康干预,如疾病防治知识讲解、自我保健训练及干预人员(志愿者)与患者结对提供帮助与督促等;对照组未采取社区健康干预.于6个月后采用生活质量(QOL)测评表进行评估.结果干预组日常生活能力、社会活动能力、抑郁心理状态、焦虑心理状态及QOL总分显著优于对照组(均P<0.01).结论通过充分利用社区卫生资源为老年慢性支气管炎独居患者进行疾病防治的健康教育,可提高其生活质量.     

Preservation of Bile Ductules Mitigates Bile Duct Loss

The finer branches of the biliary tree (FBBT) contain a regenerative compartment. We hypothesized that preservation of the FBBT together with its microvasculature will lead to recovery of biliary damage and prolonged preservation of bile ductules during the development of chronic liver allograft rejection. The interlobular bile ducts, portal bile ductules and extraportal biliary cells with and without microvessels were studied in sequential biopsies in five patients who fulfilled the Banff criteria of early chronic rejection (CR) (imminence group). Biopsies of CR patients (n = 12) served as controls. Biopsies were double immunostained with CD34 (microvessels) and cytokeratin 7 (biliary structures). Proliferation and proangiogenic activity were assessed with Ki67 and VEGF-A immunostaining. Severe damage of bile ducts in the imminence group did not progress to significant bile duct loss. This was associated with a high proliferative activity in all biliary structures and preservation of the microvascular compartment. VEGF-A expression was increased in all but the reperfusion biopsies. In conclusion, both regenerative activity of the FBBT and an intact microvascular compartment are associated with less damage of the biliary tree and could therefore be prerequisites for biliary regeneration.     

静脉毒瘾者84例HGV感染状况

目的调查庚型肝炎病毒（ＨＧＶ）在静脉毒瘾者中的感染状况。方法采用逆转录聚合酶链反应（ＲＴ－ＰＣＲ）检测８４例静脉毒瘾者血浆标本。ＨＧＶＲＮＡ经热变性法提取后逆转录为ｃＤＮＡ，在ＨＧＶ５′非编码区（５′ＮＣＲ）设计两对引物进行巢式扩增，产物为２３８ｂｐ，并经限制性内切酶ＨｐａⅡ鉴定扩增产物来自ＨＧＶ。结果８４例中有１５例为ＨＧＶＲＮＡ阳性，阳性率为１７．９％。ＨＧＶＲＮＡ阳性病例中１１例合并丙型肝炎病毒感染（１１／１５）。结论静脉毒瘾者是ＨＧＶ感染的高危人群；不洁注射是获得ＨＧＶ感染的重要途径。     

Distal Penile Gangrene in a Patient with Chronic Renal Failure

To date, only 10 cases of distal penile gangrene in patients with chronic renal failure have been reported. This rare condition is believed to result from progressive vascular calcification due to secondary hyperparathyroidism in patients with chronic renal failure. We report an additional case of distal penile gangrene in a 41-year-old man who presented with chronic renal disease and pulmonary tuberculosis. Since some authors have emphasized that aggressive surgical treatment in such cases has a significant mortality rate, we took a more conservative approach to treatment.     

Mass Protection Program of Perinatal Hepatitis B Virus Infection in Japan and Impact of an Optional Booster Vaccination on Its Efficacy

We assessed the efficacy of a government-sponsored mass protection program in Osaka, Japan, for perinatal HBV infection in infants born to HBeAg positive HBV carrier mothers. We also evaluated the impact of optional follow-up procedures in such infants, including an evaluation of anti-HBs response and a booster dose of HBV vaccine for poor responders. The results demonstrated that this mass protection program protected 94.4% of the infants from perinatal HBV infection in the Osaka area. However, the proportion of infants with an unprotective level of anti-HBs was higher in the standard group than in the follow-up group both at 1.0 and 1.5 years of age, which was also the case for HBV events. Furthermore, the present study showed that a booster dose of vaccine in poor responders was very effective in promoting an anti-HBs response. In conclusion, we recommend that a follow-up blood test to confirm a response of anti-HBs to HBV vaccine should be performed at 4–8 weeks after the third injection of HBV vaccine in infants born to HBeAg positive HBV carrier mothers. We also recommend that a booster injection of HBV vaccine should be immediately given to poor responding infants who otherwise are at a considerable risk of developing HBV infection in late infancy.     

丙型肝炎病毒H株包膜蛋白在昆虫细胞中的表达及意义

目的　获得丙型肝炎病毒 (HCV) H株包膜糖蛋白的重组杆状病毒 ,在昆虫细胞中稳定表达包膜糖蛋白 E1和 E2 ,并初步应用于丙型肝炎患者血清抗体的检测。方法　用 PCR方法自 HCV H株扩增出包膜蛋白 E基因 ,构建重组杆状病毒 ,并在昆虫细胞中稳定表达包膜糖蛋白 E1和 E2。免疫荧光及 Western blot方法鉴定表达产物。用表达的 E1和 E2蛋白与 35例丙型肝炎患者血清反应。结果　昆虫细胞中表达的 E蛋白呈现 3种分子大小 ,E1的相对分子量为 2 1× 10 3和 33× 10 3 ,E2的相对分子量为 6 0× 10 3。在 35份感染者血清中 ,有 4例 E1抗体阳性 ,其中 1例检出 E2抗体。在 9例 PCR检测 HCV RNA阳性而抗 HCV检测阴性的血清中 ,有 3例血清与表达的 E蛋白反应。结论　 HCV E蛋白基因可在昆虫细胞中稳定表达 ,表达的 E1和 E2蛋白可用于 HCV患者的血清学诊断     

外科手术患者1 820例术前几种传染病感染情况

目的了解内蒙古自治区医院各类需要外科手术治疗患者的乙型肝炎病毒（HBV）、艾滋病病毒（HIV）和梅毒的感染情况，以便合理地采取相应的措施，减少交叉感染的发生。方法采用ELISA法检测需手术患者血清中HBV抗原和抗体及HIV、苍白密螺旋体（TP）抗体。结果被检对象HBV感染阳性率为4．51％，TP阳性率为1．42％。结论应加强外科手术患者的术前传染病血清学检测，针对性地采取相应措施，以减少经手术传播的概率。     

电镜下的乙型肝炎表面抗原

本文对81例乙型肝炎病人的肝活检组织进行了电镜观察,发现HBsAg的阳性率达93.8％。电镜下,HBsAg细丝不仅有一般的管状细丝型,还有分枝管型和管泡型,而且CAH病人肝组织不易找到HBsAg丝(易见者仅9％),CPH,CLH则多数(79.5％)为易见及可见,二者有高度显著性差异(P<0.01)。