应用个体化营养方案对COPD患者病情影响的研究

目的　研究应用个体化营养方案对慢性阻塞性肺疾病 (COPD)患者进行营养治疗后的病情变化 ,评价个体化营养方案对病情的影响 ,阐明个体化营养方案的治疗价值。方法　选择 80例COPD患者 ,随机分为实验组与对照组 ,实验组应用个体化方案进行营养治疗 ,对照组采用普通膳食 ,观察营养状况、临床表现、病情急性发作次数、住院次数、治疗费用、并发症、呼吸衰竭发生率、死亡率、肺通气功能的变化。结果　实验组营养状况显著好于对照组P <0. 0 5 ,实验组病情急性发作次数、住院天数减少 ,治疗费用降低 ,与对照组比 ,差异显著P <0 . 0 5 ,实验组临床表现减轻 ,与对照组比差异显著P <0 . 0 5 ,实验组患者肺功能有所改善 ,差异显著P <0 . 0 5 ,实验组并发症、呼衰发生率、死亡率与对照组比显著降低P <0 . 0 5。结论　个体化营养方案简便易行、科学、经济 ,患者易接受 ,应用该个体化营养方案对COPD患者实施营养支持 ,营养效果明显 ,能确切改善患者病情。     

氨溴索对慢性阻塞性肺疾病大鼠模型肺的保护作用

①目的　探讨氨溴索对肿瘤坏死因子α(TNF α)在慢性阻塞性肺疾病 (COPD)大鼠模型肺内表达与分布的影响以及肺泡Ⅱ型上皮细胞超微结构的影响。②方法　实验大鼠随机分为 3组 :健康对照组 (n =8) ,COPD模型组 (n =1 2 ) ,氨溴索干预组 (n =1 2 )。采用熏吸香烟并气管内注入脂多糖法建立大鼠COPD模型 ,氨溴索干预组于COPD模型开始建立时腹腔注射氨溴索溶液 4 0mg/ (kg·d) ,连续 4 0d。观察各组气道炎症的病理特点、超微结构特点、血气指标、肺泡平均内衬间隔、平均肺泡数。应用原位杂交法检测TNF α基因表达的相对含量。③结果　所建COPD模型的病理以及病理生理学改变符合人类COPD的特点。氨溴索干预组肺泡平均内衬间隔、平均肺泡数、TNF α表达强度与健康对照组、COPD模型组比较差异有显著性 (F =3.2 4～ 1 1 .1 1 ,q =4 .74～ 36 .2 2 ,P <0 .0 1 ) ;动脉血氧分压、二氧化碳分压差异亦有显著性 (F =3.30、8.79,q =3.5 0～ 8.6 9,P <0 .0 5 )。 ④结论　长期应用氨溴索对COPD大鼠模型气道炎症有明显的抑制作用     

32P colloid radiosynovectomy in treatment of chronic haemophilic synovitis: Iran experience

Repeated intra-articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with (32)P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6-28). There were three repeat injections. According to Fernandez-pallazi and Cavilgia clinical classification (Table 1) [23], nine joints were Stage II and 46 were Stage III. In latest follow-up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment (P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy (P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using (32)P effectively reduces the intra-articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment.     

Malignancies following long-term azathioprine treatment in chronic liver disease

ABSTRACT— One hundred and fifty-four patients with histologically verified nonalcoholic chronic liver disease were randomized to azathioprine or prednisone treatment. After a median of 91 months observation time, the cause of death was assessed retrospectively. Autopsy was performed in 82% of 71 deaths. In the azathioprine group 33% (13/39) died from malignant neoplasia, and in the prednisone group (13%) (4/32) (p = 0.08). Considering a possible fatal outcome as a consequence of treatment, this finding urges caution in the long-term application of azathioprine at the usual dose level.     

慢性前列腺炎患者健康教育需求调查分析

目的了解慢性前列腺炎患者健康教育需求，并提出行之有效的健康教育方法和内容。方法对102例慢性前列腺炎患者采用问卷式调查方法进行调查。结果患者对用药指导、生活、饮食习惯内容需求强烈；与医护人员交谈、为病人提供科普手册这两种方式最受欢迎。结论护士在开展健康教育时，应根据病人健康需求提供个性化健康教育。以促进患者身心康复，提高其生活质量，同时增强了护士健康教育能力。     

Chronic orchialgia: Consider gabapentin or nortriptyline before considering surgery

OBJECTIVE: To establish if there is a role for gabapentin or nortriptyline in the treatment of chronic orchialgia. METHODS: Twenty-six consecutive patients with chronic orchialgia were seen in the chronic pain clinic by a multidisciplinary team. A pain questionnaire was completed prior to commencing either gabapentin or nortriptyline. They were reviewed at 3 months and a repeat questionnaire completed. A 50% improvement in pain was considered successful. RESULTS: Complete data was available for 19 patients. Overall, 61.5% of patients commenced on gabapentin and 66.6% of patients commenced on nortriptyline had a greater than 50% improvement in pain. Patients with post-vasectomy testicular pain were considered as a subgroup. None of these patients had a greater than 50% improvement in pain. However, 80% of patients in the subgroup with idiopathic chronic orchialgia had a greater than 50% improvement in pain. CONCLUSION: Although this is a small study, it appears that gabapentin and nortriptyline are effective in the treatment of idiopathic chronic orchialgia but not post-vasectomy pain.     

Chronic acid ingestion promotes renal stone formation in rats treated with vitamin D3

OBJECTIVE: Although hypercalciuria, a well-established adverse effect of vitamin D3, can be a risk factor of renal stone formation, the risk of nephrolithiasis has not been well defined. The consumption of a diet high in acid precursors is often cited as a risk factor for the development of calcium-based kidney stones. In the present study, we investigated the effect of chronic acid ingestion on kidney stone formation in rats treated with calcitriol (1-25[OH]2 D3). METHODS: Control rats (C-C), calcitriol-treated rats (C-V; three treatments of 0.5 microg of calcitriol per week) and acid-ingested (water containing 0.21 mol/L NH4Cl), calcitriol-treated (three treatments of 0.5 microg of calcitriol per week) rats (A-V) were fed in metabolic cages. After 1 month, urine, blood, kidney and bone samples were analyzed. RESULTS: The A-V rats exhibited elevated serum calcium concentrations, urinary calcium and phosphate excretion, urinary type I collagen cross-linked N-peptide (NTx)/creatinine values, mRNA expression of osteopontin in the kidney, and renal calcium contents as well as decreased bone mineral densities, compared with the C-C and C-V rats. Urinary citrate excretion was lower and NaDC-1 mRNA expression in the kidney was higher in the A-V rats than in the C-C and C-V rats. Calcium phosphate kidney stones were found in the A-V rats. CONCLUSIONS: The ingestion of NH4Cl, an acid precursor, promotes calcium phosphate kidney stone formation in calcitriol-treated rats. The chronic intake of a diet rich in acid precursors may be a risk factor for the development of kidney stones in subjects who are being treated with calcitriol.     

拉米夫定对慢性乙型肝炎的疗效及肝脏组织病理学改变

目的:从血清生化,病毒学,肝纤维化指标以及肝脏组织病理学改变的角度分析拉米夫定(LMD)治疗慢性乙型肝炎的疗效.方法:慢性乙型肝炎患者21例,给予口服LMD100 mg/d,连用1 a,动态观察服药0,24和48 wk肝功能、乙肝五项、HBV-DNA定量、血清肝纤维化指标透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原(PⅢP)和Ⅳ型胶原(ⅣC)的变化,通过肝组织穿刺活检,观察用药前后肝脏组织病理学的改变.结果:LMD治疗48 wk,可显著抑制HBV-DNA(copy/L)复制(6.13×109±4.03×105 vs 9.01×105±4.89×103,P＜0.01),使大多数患者肝功能(nkat/L,ALT:1697±907 vs550±503;AST:1787±717 vs 498±430)恢复正常(P＜0.01),显著降低血清肝纤维化指标水平(P＜0.01).减轻肝细胞坏死,汇管区炎细胞浸润及纤维化.结论:LMD是治疗慢性乙型肝炎的一种较为切实有效的措施.     

芪黄益气汤煎剂治疗慢性前列腺炎的研究

目的探讨芪黄益气汤煎剂治疗慢性前列腺炎(CP)临床疗效。方法CP患者84例分为芪黄组42例予芪黄益气汤煎剂治疗,清化组42例予清热化瘀煎剂治疗。观察2组CP患者的前列腺液卵磷脂小体、白细胞数、pH值及临床症状的改善情况。结果临床观察芪黄组疗效优于清化组,有显著性差异(P<0.01)。结论以具有益气功效的中药组成的芪黄益气汤煎剂是治疗CP的有效方剂。