晕得宁毒性的实验研究

晕得宁为复方中药制剂,济宁市第一人民医院耳科用于治疗美尼尔氏病疗效良好,我室对此方剂进行了毒理学研究。急性毒性实验表明,小鼠一次灌胃量达人用量的200倍(n=10),观察72小时,未见异常表现及死亡。亚急性毒性实验:实验组12只家兔(分成大、中、小剂量三组),连续给药三周,其观察指标包括体重、血常规、肝功(GPT)和肾功(BUN),与对照组(n=4)相比,均无异常(P>0.05);病理检查10兔正常,另2兔患有肺炎。其中1只病兔属大剂量组,于给药第20～21天出现腹泻并死亡,可能与方剂组成中半夏的毒性有关。作者认为晕得宁的毒性较小;鉴于半夏有毒,临床用药宜避免大剂量、长期应用。     

Sustained low-grade pro-inflammatory state in unmedicated, remitted women with major depressive disorder as evidenced by elevated serum levels of the acute phase proteins C-reactive protein and serum amyloid A.

BACKGROUND: Major depressive disorder (MDD) shows increased coronary artery disease (CAD) risk of unknown mechanism(s). MDD is more common in women than men; CAD diagnosis can be difficult in women. Elevations of the inflammatory markers C-reactive protein (CRP) and serum amyloid A (SAA) predict increased CAD risk in populations; few data on these markers exist in MDD, particularly in remitted patients. METHODS: We measured fasting am serum CRP (high sensitivity, CRP(hs)) and SAA in 18 unmedicated, remitted women with MDD (mean age 41 +/- (SD)12, body mass index (BMI) 25.2 +/- 4.1 kg/m(2)) and 18 BMI-matched healthy control subjects (age 36 +/- 10, BMI 25.3 +/- 3.8 kg/m(2)) on 2 separate occasions, > or = 6 days apart. RESULTS: Repeat SAA and CRP(hs) measurements strongly correlated across study days (SAA: r = .83, p < .001; CRP(hs): r = .94, p < .001). Both SAA (5.30 +/- 3.39 vs. 2.84 +/- 1.87 mg/L, p < .005) and CRP(hs) (3.23 +/- 3.17 vs. 1.12 +/- 1.45 mg/L; p < .01) were significantly elevated in MDD women versus controls. CONCLUSIONS: Elevated SAA and CRP(hs) in remitted, unmedicated women with MDD indicate a pro-inflammatory state unrelated to current depressive symptoms or pharmacotherapy. These findings suggest that inflammatory mechanisms may in part underlie findings of increased CAD risk in MDD.     

不同剂量普伐他汀治疗急性脑梗死的疗效和安全性研究

目的：探讨不同剂量普伐他汀在脑梗死急性期治疗的可行性、降脂疗效及安全性。方法：脑梗死急性期病人146例，随机分为3组，A组（50例）为对照组，B组（49例）每晚服普伐他汀10mg，C组（47例）每晚服普伐他汀20mg，观察30d。比较治疗前后血脂、神经功能缺损评分、生化指标等变化，并记录服药后不良反应。结果：各组总胆固醇（TC）、低密度脂蛋白（LDL-C）、超敏C-反应蛋白（hs-CRP）在治疗后都有所下降，C组下降最显著，B组次之，A组下降程度较小。A组TG治疗前后无明显变化，B组和C组TG治疗后有所下降，两组间无明显差别。脂蛋白（Lpa）在A组治疗后有下降，B组无明显变化，C组较前轻度升高。各组治疗前后神经功能缺损评分均有降低，但各组之间比较无明显差异（P〉0.05）。观察期间所有病人均能耐受普伐他汀，治疗前后肝、肾功能、肌酸激酶（CK）等无明显变化。结论：在脑梗死急性期应用普伐他汀（每日10～20mg）是安全可行的，且每日20mgTC、TG降低更显著，脑梗死急性期的病人应用普伐他汀后取得较好的降脂疗效，神经功能缺损评分的改善有待较长期观察。     

急性缺血性卒中大血管闭塞性质的判断与取栓方式和材料的选择

血管内机械取栓是治疗大血管闭塞性急性缺血性卒中的有效治疗方法。应结合病史、发
病形式及影像学检查等综合判断病变性质；依据病变性质并参考手术路径，个性化选择支架取栓、
抽吸取栓、球囊/支架血管成形术、动脉溶栓任一种或多种方法联合取栓；并依据手术方式选择手
术材料，以快速高效地完成手术。     

急性缺血性卒中患者发生院内消化道出血的危险因素分析

目的 分析急性缺血性卒中患者（acute ischemic stroke，AIS）住院期间消化道出血（gastrointestinal
bleeding，GIB）的发生率、发生时间及危险因素。
方法 本研究纳入首都医科大学附属北京天坛医院急性卒中院内并发症队列（inhospital medical
complication after acute stroke，iMCAS）研究中AIS患者。收集患者临床信息，根据住院期间是否发生
GIB分为GIB组和无GIB组，采用多因素Logistic回归模型，分析AIS患者发生GIB相关危险因素。
结果 共纳入1129例AIS患者，平均年龄58.7±12.5岁，女性230例（20.4%）。47例住院期间发生GIB，
发生率为4.2%，卒中发作至GIB确诊时间为5（3～13）d。合并肝硬化（OR 10.06，95%CI 2.44～41.38）、
高入院NIHSS评分（OR 1.13，95%CI 1.08～1.19）、高白细胞计数（OR 1.25，95%CI 1.13～1.38）、住院时
间长（OR 1.05，95%CI 1.01～1.10）是AIS患者发生消化道出血的独立危险因素。
结论 本单中心研究数据提示合并肝硬化、高入院NI HSS评分、高白细胞计数、住院时间长是AI S患
者住院期间发生GIB的独立危险因素。     

肠道T细胞淋巴瘤临床分析

本文总结报告了3例肠道T细胞淋巴瘤(intestinal T-cell lymphoma，ITCL)的诊治资料，并结合文献复习，发现IT—CL多见于中年男性，以腹痛、血便、发热、体质量下降为主要症状，治疗效果差，预后不良。病理改变以肠道溃疡形成为特点，溃疡形态呈多形性、多灶性、不规则，镜下瘤细胞明显异型、弥漫性浸润，中至大细胞多见。肿瘤细胞呈T细胞表型。ITCL临床少见，缺乏特异性临床表现，极易误诊。故临床医师应重视对ITCL临床病理特征、免疫表型和基因型的研究，注意识别，促其早期诊治。     

Clinical influence of vagotomy on postoperative acute phase response

BACKGROUND: Although there is increasing evidence suggesting that the vagus nerve functions as a connector between the nervous and immune systems in animals, little is known about the role of the vagus nerve in postoperative acute phase response in humans. MATERIALS AND METHODS: The extent of fever and acute phase protein response and the production of inflammatory cytokine during the early postoperative period were compared among the patients who had undergone total gastrectomy including truncal vagotomy (n = 13), those having distal gastrectomy with division of vagal branches (n = 14), and the patients with vagal nerve preserving gastrectomy (n = 12). RESULTS: There was no significant difference in serum levels of C-reactive protein, alpha-1-antirypsin, and interleukin-6 among the three groups. Also, postoperative maximum body temperature was similar. CONCLUSIONS: Vagotomy did not influence acute phase response after gastric cancer surgery. A multipathway mechanism for acute phase response including the induction of fever is suggested.