宣肺豁痰法治疗哮喘（冷哮证）的临床研究

目的：探讨宣肺豁痰法治疗冷哮证的临床效果及其改善肺功能的机制。方法：将125例冷哮证患者随机分为实验组和对照组，实验组（宣肺豁痰法，74例）采用三拗汤和华盖散加减治疗，对照组（51例）采用小青龙汤治疗。用药治疗7天后停药，比较两组拜药后的症状、体征、改善时间及疗效。结果：实验组在哮喘主要症状和体征（除咳嗽外）的控制率明显优于对照组，且这种差异在磋疗的早期即已体现并持续至治疗结束；实验组的起效日寸间明显短于对照组；治疗后随着两组患者临床症状的改善，气道高反应的状态多数得以纠正，治疗后丽组PEF均有显著增加，差异有显著性（P〈0．05），与对照组相比较，实验组在缓解气道痉挛、改善大气道∥能方面有明显优势。治疗后EOS绝对计数及百分比明显下降，实验组下降更显著（P〈0．05）。结论：宣肺豁痰法治疗冷哮证在扩张小气道、缓解其痉挛、消除痰栓、减轻其陶塞等方面较对照组有明显优势。     

甲亢性周期性瘫痪心电图、心肌酶变化及临床特点分析

目的分析甲亢性周期性瘫痪患者心电图、心肌酶变化及临床特点。方法回顾性分析1997年1月~2009年5月间甲亢合并周期性瘫痪（TPP）患者31例,分析其临床发病特点及心电图、心肌酶在发病前后的变化特点。结果 TPP心电图异常18例,其中窦性心动过缓占35.2%,表现为T波低平,ST段下降,P-R间期延长,可见U波。窦性心动过速占12.9%,2例出现传导阻滞。发病时血清钾均低于正常。7例出现心肌酶升高。结论及时发现心电图变化,及早补钾纠正心律失常,早期积极治疗甲亢是治疗TPP的关键。     

改良混合痔切除术的临床研究

为探讨改良混合痔切除术的临床疗效，本研究将40例重度混合痔患者随机分为两组，一组予改良混合痔切除术（治疗组）治疗，一组予传统外剥内扎术（对照组）治疗，对比分析两组患者疗效、术后并发症、创面愈合时间、药比、住院费用、住院时问及患者满意度。结果显示，两组疗效、创面愈合时间、药比及肛门狭窄和尿潴留方面差异均无统计学意义，P〉0．05；但在住院费用、住院时间、患者满意度及后遗皮赘、肛缘水肿、创面出血、术区疼痛方面差异有均统计学意义，P〈0．05，且治疗组优于对照组。结果表明，改良混合痔切除术治疗重度混合痔疗效确切，术后并发症少，不影响肛门功能和外观，患者满意度高，值得临床推广。     

Variation in European harbour seal immune response genes and susceptibility to phocine distemper virus (PDV)

Phocine distemper virus (PDV) has caused two mass mortalities of European harbour seals (Phoca vitulina) in recent decades. Levels of mortality varied considerably among European populations in both the 1988 and 2002 epidemics, with higher mortality in continental European populations in comparison to UK populations. High levels of genetic differentiation at neutral makers among seal populations allow for the possibility that there could be potential genetic differences at functional loci that may account for some of the variation in mortality. Recent genome sequencing of carnivore species and development of genomic tools have now made it possible to explore the possible contribution of variation in candidate genes from harbour seals in relation to the differential mortality patterns. We assessed variation in eight genes (CD46, IFNG, IL4, IL8, IL10, RARa, SLAM and TLR2) encoding key proteins involved in host cellular interactions with Morbilliviruses and the relationship of variants to disease status. This work constitutes the first genetic association study for Morbillivirus disease susceptibility in a non-model organism, and for a natural mortality event. We found no variation in harbour seals from across Europe in the protein coding domains of the viral receptors SLAM and CD46, but SNPs were present in SLAM intron 2. SNPs were also present in IL8 p2 and RARa exon 1. There was no significant association of SLAM or RARa polymorphisms with disease status implying no role of these genes in determining resistance to PDV induced mortality, that could be detected with the available samples and the small number of polymorphisms indentified. However there was significant differentiation of allele frequencies among populations. PDV and other morbilliviruses are important models for wildlife epidemiology, host switches and viral evolution. Despite a negative result in this case, full sequencing of pinniped and other ‘non-model’ carnivore genomes will help in refining understanding the role of host genetics in disease susceptibility for these viruses.     

Impact of a Standardized Titration Protocol with Carvedilol in Heart Failure: Safety,Tolerability, and Efficacy—A Report from the GESICA Registry

Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA) studied whether a standardized protocol for the initiation and titration of the β-blocker carvedilol in a multicenter, open-label program would optimize β-blocker use in heart failure (HF) patients. The program included: (1) the carvedilol initiation and titration period, and (2) long-term follow-up at 6 and 12 months. Of 1299 patients in the registry, 504 were excluded due to current therapy; of the remaining 795 eligible patients, 293 were excluded due to contraindications. Of the included patients with follow-up data (n = 316), 93.3% tolerated carvedilol initiation and 47.7% of the patients reached the target dose of 50 mg/day for a mean dose of 39 mg/day. Rates were comparable in the elderly (n = 83), of which 53% achieved a target dose for a mean dose of 43.08 mg/day. This protocol improved therapy rates and achieved target doses quickly (average of 4 visits). Concomitant medications did not have to be adjusted and there were low withdrawal rates (10%) and hospital admissions (7.2%) for HF. Patients were able to maintain carvedilol therapy at 6 and 12 months. These results indicate that a standardized titration protocol, as used in GESICA, for the initiation and titration of β-blockers is well tolerated and may improve β-blocker use in carefully selected heart failure patients.The study authors are members of the GESICA Steering Committee and Subcommittees     

Multiple Concealed Accessory Pathways Associate with Antegrade Triple AV Nodal Pathways and Catheter Ablation

This article describes a 54-year-old man with incessant supraven-tricular tachycardia refractory to antiarrhythmic drugs. Multiple concealed accessory pathways associated with antegrade triple AV nodal pathways were documented by a series of successful catheter ablations and detailed electrophysiological studies. After the left-wall accessory pathways were abolished with two courses of multiple low energy shocks, another two accessory pathways, one near the os of coronary sinus and the other near the site of the His bundle, were documented by programmed premature ventricular stimulation. This was followed by a third course of shocks to the os of coronary sinus for ablating posteroseptal AP and a fourth course of shock to proximal His bundle for control of SVT with a septal accessory pathway as a retrograde limb and AV nodal pathways as an antegrade limb. Without medications, the patient has remained asymptomatic even during moderate physical activity over a follow-up period of 36 months. His ECG showed sinus rhythm with persistence of right bundle branch block.     

儿童先天性心脏病室间隔缺损致病因素分析

目的 :对儿童先天性室间隔缺损因素进行分析。方法 :报告 2 5 8例先天性室间隔缺损儿童 ,男性 14 4例 ,女性 114例 ,年龄 1～ 14岁。同时对 2 5 8例儿童的父母进行调查 ,调查对象为患先天性室间隔缺损儿童 ,儿童的父亲、母亲孕前和孕期多方面因素 ,将引起室间隔缺损的可能原因进行分析。结果 :发现家族中有遗传史 ,父母亲饮酒史 ,母孕期有感冒病史 ,母孕期服用抗病毒药物 ,父母孕期使用黄体酮及母孕期接触X射线 ,有较高先天性室间隔缺损的发病率。同时对患先天性室间隔缺损儿童血型分析 ,表明A型儿童和AB型儿童患先天性室间隔缺损频率较高 (分别为 4 2 2 5 %和 11 2 4 % )比值比(OR)分别为 1 6 3和 2 2 1。与对照组比较差异有显著性 (即A型 χ2 =7.0 2 ,P <0 0 0 1,AB型 χ2 =5 71,P <0 .0 5 )。A O ,AB O抗原患者组与对照组比较 ,OR分别为 1 72和 2 6 2 ,χ2 值分别为 6 72和 7 5 1均差异有显著性 (P <0 .0 0 1) ,而O型则相反患先天性室间隔缺损的机率相对减少。结论 :先天性室间隔缺损与家族遗传史、血型及父母孕期饮酒、服药等多方面因素有关。     

Association of Long-Term Diet Quality with Hippocampal Volume: Longitudinal Cohort Study

BACKGROUND

Diet quality is associated with brain aging outcomes. However, few studies have explored in humans the brain structures potentially affected by long-term diet quality. We examined whether cumulative average of the Alternative Healthy Eating Index 2010 (AHEI-2010) score during adult life (an 11-year exposure period) is associated with hippocampal volume.