Coffee consumption,cigarette smoking and reporting of drowsiness in anxious patients treated with benzodiazepines or placebo

Data obtained from anxious outpatients treated with either chlordiazepoxide or diazepam (n= 533) or placebo (n= 285) were used to explore the impact of coffee/tea and cigarette consumption upon the frequency of reporting of drowsiness after 2 weeks of treatment. Strong evidence was provided that both cigarette smoking and coffee drinking afiect the frequency with which drowsiness is reported by patients receiving the two benzodiazepines. However, not only the magnitude but also the direction of the impact of coffee consumption upon drowsiness depends upon the level of cigarette smoking and vice versa. For patients smoking ≦ 1 pack of cigarettes/day, drowsiness is reported less frequently by heavy coffee users while for patients smoking > 1 pack of cigarettes/day, drowsiness is reported more frequently by heavy coffee users. Similarly, for patients drinking ≦ 2 cups of coflee/day, drowsiness occurs less frequently among heavier smokers while for patients drinking > 2 cups of coffee/day, drowsiness occurs more frequently among heavier smokers. These results are consistent with reports that particular substances contained in coffee and tea and in cigarette smoke stimulate the synthesis of hepatic enzymes which metabolize both the benzodiazepines here studied and the substances which have stimulated enzyme synthesis.     

莫沙必利联合阿嗪米特治疗胆汁反流性胃炎的临床疗效

【目的】探讨阿嗪米特联合胃肠动力药物莫沙必利对胆汁反流性胃炎患者的治疗效果。【方法】选择本院于2011年12月至2013年12月接诊的120例胆汁反流性胃炎患者的临床病例资料,将所有接诊患者按随机数字表分为对照组60例患者,采用碳酸铝镁联合莫沙必利治疗,观察组60例患者,采用阿嗪米特联合莫沙必利治疗,比较两组患者的治疗效果。【结果】治疗后,观察组患者的总有效率为86．67％,明显高于对照组患者66．67％,组间差异具有统计学意义（P＜0．05）;观察组患者的症状评分均较对照组患者治疗前明显改善,组间差异均具有明显统计学意义（P＜0．05）;观察组患者的胆汁反流次数和最长反流时间等均明显低于对照组患者,组间差异具有明显统计学意义（P＜0．05）。【结论】阿嗪米特与胃肠动力药物莫沙必利联合应用,可通过协同治疗作用,不但促进胆汁规律性地分泌,而且增加胃肠运动,促进食物消化能力,改善患者的临床不适症状,有利于患者病情改善和生活质量的提高,值得临床推广应用。     

参松养心胶囊联合慢心律片治疗室性早搏的疗效观察

【目的】观察参松养心胶囊联合慢心律片治疗室性早搏的临床疗效。【方法】将103例室性早搏患者随机分为三组：对照组35例，口服慢心律片150mg，每日3次；单药组33例，口服参松养心胶囊4粒，每日3次；两药联用组35例，同时服用慢心律片和参松养心胶囊，剂量同前，用药4周后观察心电图及24h动态心电图、临床症状及肝肾功能、血脂、血糖等指标的变化。【结果】两药联用组、单药组、对照组控制室性早搏的总有效率分别为91．4％，72．7％和68．6％；症状改善率分别为94．3％，75．8％和71．4％。两药联用组控制室早的总有效率及症状改善率均优于单药组及对照组（P〈0．05），单药组与对照组控制室早的总有效率及症状改善率均差异无显著性（P〉0．05）。【结论】参松养心胶囊联合慢心律片治疗室性早搏疗效优于两药单独使用。     

亚冬眠状态下全身热疗联合化疗治疗腹部晚期肿瘤

【目的】探讨亚冬眠状态下全身热疗联合化疗对腹部晚期肿瘤的有效加温时间及疗效、毒副作用。【方法】治疗组31例在给予加温前视情况加用镇静药物,酌情选用半量的人工冬眠Ⅰ、Ⅱ号或Ⅳ号合剂,及β受体阻滞剂,在用药30min后化疗与加温同步进行;对照组31例采用进行同步加热与化疗。两组直肠温度达到39．5℃后维持加温60～90min,最高温度不超过41．5℃,两组热化疗过程中使用热电偶监测鼓膜、加热区皮肤、直肠温度变化,同时进行全程心电监护。【结果】治疗组87．1％病人能够维持加温60～90min,其中66．1％超过90min;对照组维持加温时间60～90min者为66．1％,只有25．8％超过90min,两组比较差异有显著性（P〈0．001）;近期有效率治疗组77．4％,对照组51．6％,两组比较差异有显著性（P〈0．05）;治疗组心率增加低于对照组（P〈0．001）;两组病人均有皮肤反应,水疱发生,消化道反应与骨髓抑制均在Ⅱ级,无统计学意义。【结论】亚冬眠状态下实施全身亚高温热疗能增加维持加温时间,疗效优于非亚冬眠治疗;亚冬眠药物与β阻滞剂联用对心脏有保护作用,与化疗联合,毒副反应轻。     

地西泮、苯巴比妥联合表面麻醉对激光治疗早产儿视网膜病的镇痛效果

目的探讨地西泮、苯巴比妥联合表面麻醉对激光治疗早产儿视网膜病(ROP)的有效性和安全性。方法选择经双目间接检眼镜及Ret Cam Ⅱ眼底照相确诊的33例(66只眼)阈值期ROP患儿进行激光光凝术,术前30 min静脉注射苯巴比妥10mg·kg-1、术前5 min静脉注射地西泮0.4 mg.kg-1及结膜囊滴入5 g·L-1盐酸丙美卡因滴眼液。于术前、术中每隔15 min及术后15 min、30 min,分别对患儿进行CRIES疼痛评估,取最高分评估患儿在常规镇静联合表面麻醉下对激光手术的耐受程度。术前、术后检测其微量血糖评估患儿应激状态。结果激光手术持续时间为(34.4±10.1)min(17～53 min),激光点数为(1 228.7±542.7)点(290～2 350点);CRIES疼痛评分术中最高得分为(1.90±1.18)分,明显小于疼痛阈值(4分),其中29例全程得分<4分,占87.9%(29/33例),4例术中最高得分≥4分,经追加给药后手术均顺利完成;术后血糖[(6.3±1.2)mmol·L-1]显著高于术前[(5.4±1.7)mmol·L-1](t=3.987,P<0.05)。术中、术后并发症:术中均出现结膜下出血和角膜水肿,但不影响手术;仅6例在术中或术后出现短时呼吸暂停,经抚触、给氧或静脉滴注氨茶碱、或短期辅助通气等处理后较快缓解。结论地西泮、苯巴比妥联合表面麻醉进行激光治疗ROP,镇痛效果可靠、简便、安全,可在NICU内开展。     

苯二氮类药物对细胞免疫功能的影响

苯二氮类药物（安定）能促进小鼠胸腺细胞增殖,这种作用以安定5mg/kg腹腔注射,每天一次连续给药5d的作用最强。安定对小鼠脾脏细胞增殖、自然杀伤（NK）细胞毒活性、脾细胞初次抗体产生以及对体外培养胸腺细胞增殖等均无明显影响。安定对截肢应激所致小鼠胸腺、脾脏细胞免疫抑制有拮抗作用,并可有效地拮抗应激导致的小鼠胸腺重量减轻。     

肿瘤浸润淋巴细胞及重组白细胞介素2治疗原发性肝细胞癌

目的探讨联合应用肿瘤浸润性淋巴细胞（ｔｕｍｏｒｉｎｆｉｔｒａｔｉｎｇｌｙｍｐｈｏｃｙｔｅｓ,ＴＩＬ）和重组白细胞介素２（ｒＩＬ２）治疗对原发性肝细胞癌（ｐｒｉｍａｒｙｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉｎｏｍａ,ＰＨＣＣ）术后患者细胞免疫功能的影响和其临床疗效。方法对１６例ＰＨＣＣ术后患者进行了ＴＩＬ和ｒＩＬ２治疗,１２例从肝动脉插管输入,４例从门静脉插管输入。结果ＴＩＬ治疗后１６例患者外周血白细胞介素２（ＩＬ２）,Ｔ细胞亚群及比率均有不同程度上升;肿瘤坏死因子（ＴＮＦ）,白细胞介素６（ＩＬ６）多有不同程度下降。随访６～２４个月,１４例肝癌根治性切除术患者,肿瘤无复发迹象,１例肝癌根治切除术患者ＴＮＦ上升了８ＩＵ,该患者治疗８个月后死于肝功能衰竭;１例肝癌姑息性切除,残癌无水酒精注射病人,ＴＩＬ治疗１８个月后肿瘤直径扩大２ｃｍ。结论ＴＩＬ治疗对提高ＰＨＣＣ术后患者抗肿瘤细胞免疫功能,防止肿瘤复发,抑制残瘤生长,延长患者生存期具有一定作用。     

超生理剂量十一酸睾酮引起生精细胞凋亡的动态研究

目的：以生精细胞凋亡作为指标探讨超生理剂量十一酸睾酮（ＴＵ）抑制精子发生的机制。方法：正常生育史男性２０例肌内注射ＴＵ,应用瑞－吉染色和ＴＵＮＥＬ法对精液中脱落细胞进行凋亡率的动态检测。结果：用药后精子密度和生精细胞数较用药前显著下降（Ｐ＜０．０１）,精母细胞和精子细胞凋亡率则显著上升（Ｐ＜０．０１）。结论：ＴＵ具有显著的抑制精子发生的效应。其作用机制除通过抑制促性腺激素而导致睾丸内睾酮（Ｔ）浓度降低,继之使精子发生停滞外,还可能有促进生精细胞凋亡的作用。     

Hematin and Bilirubin Binding to Human Serum Albumin and Newborn Serum

ABSTRACT. In jaundiced newborn infants, hemolytic disease is considered a risk factor for kernicterus due to the suspected competition between bilirubin and other hemoglobin breakdown products for albumin binding. We have studied the effect of hematin on bilirubin-albumin binding using the peroxidase assay and a light-scattering technique for measuring unbound bilirubin. Our results show that hematin does not affect bilirubin-albumin binding. To determine if other albumin binding functions are affected by hematin, we used a microdialysis rate technique employing two ligands, diazepam and monoacetyldiaminodiphenyl sulfone (MADDS). Hematin does not utilize the diazepam binding function of albumin, but does decrease the albumin binding of MADDS. The results of this study indicate that the MADDS and bilirubin binding functions are not identical. The clinical usefulness of reserve albumin equivalent determination using MADDS is discussed.     

Long-lasting handling affects behavioural reactivity in adult rats of both sexes prenatally exposed to diazepam

Environmental stressors can substantially affect the adaptive response of rats to novelty in a sexually dimorphic manner. Gender-related differences are also observed in neurochemical and behavioural patterns of adult rats following prenatal exposure to diazepam (DZ). In the present study the behavioural reactivity to novelty is investigated in open field (OF) and in acoustic startle reflex (ASR) tests, in non handled (NH), short-lasting handled (SLH) and long-lasting handled (LLH) adult male and female rats prenatally exposed to DZ. A single daily s.c. injection of DZ (1.5 mg/kg) over gestation days 14-20 decreases GABA/BDZ receptor function in both sexes, as shown by the decreased electrographic hippocampal response to DZ and the increased response to picrotoxin, after intra-locus coeruleus injection of the two compounds. In OF NH DZ-exposed males display a lower total distance travelled (TDT), a higher rearing frequency (RF) and a greater number of transitions in the centre of the arena (CNT) compared to NH rats prenatally exposed to vehicle. Conversely, NH DZ-exposed females show slight changes in TDT and RF and a greater reduction in CNT and in the amount of time spent in the centre of the arena (CAT). These effects are associated with an increase in the peak amplitude of the ASR in both sexes. Short-lasting handling slightly influences DZ-evoked effects in animals of both sexes. In DZ-exposed males long-lasting handling attenuates the reduction in TDT and the enhancement in RF, prevents the increase in CNT and reduces the peak amplitude of ASR. In DZ-exposed females, long-lasting handling increases TDT and RF, induces a lower avoidance of the centre of the arena, and does not modify the peak amplitude of ASR, when compared to controls. These findings indicate that prenatal exposure to DZ differently affects behavioural reactivity in adult male and female rats, and suggest that a long-lasting handling is able to attenuate some behavioural deficits induced by prenatal DZ exposure.