Gated myocardial perfusion single photon emission computed tomography in the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial, Veterans Administration Cooperative study no. 424

Background  Stress gated myocardial perfusion single photon emission computed tomography (gSPECT) is increasingly used before and after intercurrent therapeutic intervention and is the basis for ongoing evaluation in the Department of Veterans Affairs clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial. Methods and Results  The COURAGE trial is a North American multicenter randomized clinical trial that enrolled 2287 patients to aggressive medical therapy vs percutaneous coronary intervention plus aggressive medical therapy. Three COURAGE nuclear substudies have been designed. The goals of substudy 0 are to examine the diagnostic accuracy of the extent and severity of inducible ischemia at baseline in COURAGE patients compared with patient symptoms and quantitative coronary angiography and to explore the relationship between inducible ischemia and the benefit from revascularization when added to medical therapy. Substudy 1 will correlate the extent and severity of provocative ischemia with the frequency, quality, and instability of recurrent symptoms in postcatheterization patients. Substudy 2 (n _ 300) will examine the usefulness of sequential gSPECT monitoring 6 to 18 months after therapeutic intervention. Together, these nuclear substudies will evaluate the role of gSPECT to determine the effectiveness of aggressive risk-factor modifications, lifestyle interventions, and anti-ischemic medical therapies with or without revascularization in reducing patients’ ischemic burdens. Conclusions  The unfolding of evidence on the application of gSPECT in trials such as COURAGE defines a new era for nuclear cardiology. We hope the evidence that emerges from the COURAGE trial will further establish the role of nuclear imaging in the evidence-based management of patients with stable coronary disease. The COURAGE trial was supported by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development in collaboration with the Canadian Institutes of Health Research. Unrestricted research grants were obtained from Merck & Co; Pfizer Pharmaceuticals; Bristol-Myers Squibb Medical Imaging; Astellas Pharma; Kos Pharmaceuticals; Data Scope; Astra Zeneca Pharmaceuticals; Astra-Zeneca-Canada; Schering-Plough Coorporation, Ltd; Sanofi-Aventis, Inc; First Horizon; and GE Healthcare. All industrial funding for this trial was directed through the Department of Veterans Affairs. Additional funding for this substudy was provided by grants to the Department of Veterans Affairs and Canadian Institutes of Health Research from Astellas Pharma and Bristol-Myers-Squibb Medical Imaging.     

抗结核药物不良反应293例临床分析

[背景]观察抗结核药物的不良反应.[病例报告]对293例应用抗结核药物后出现不良反应的患者资料进行分析,抗结核药物常见不良反应的有肝脏损害、胃肠道反应、听力障碍及关节痛等.[讨论]应依据患者的具体情况,选择不同的抗结核药物进行联合应用.     

发作性睡病伴发的幻觉症——随访22年一例

患者十六岁开始有逐渐加重的睡眠发作,伴有轻度不典型猝倒。14岁后出现入睡前幻觉,主要为鲜明生动的听幻觉,偶有幻视、幻嗅。幻觉严重时继发关系妄想和被害妄想,失去自知力。22年随访结果:患者精神状态良好,仍有轻度睡眠发作及入睡前幻觉,不影响日常工作和生活。对诊疗作了评价。     

继发性唇裂鼻畸形硅胶植入整复术

本文介绍一种使继发性唇裂鼻畸形获得较好外形的新手术方法。术式包括切除偏曲的鼻中隔软骨,并将一片硅胶植入于中央作为鼻小柱支柱,从而矫正歪斜的鼻小柱和抬高鼻尖,使两侧鼻孔形态对称一致,用本法为11例单侧唇裂畸形较重者进行了整复,随访4个月至4年半。绝大多数(10/11)取得满意效果,未见有严重感染和变形等并发症。     

Therapeutic effect of Shenfu Injection on secondary aplastic anemia of tumor patients after chemotherapy

Objective: To explore the effect of Shenfu Injection, SFI) on the secondary aplastic anemia (AA) of tumor patients after chemotherapy (CT).Methods: The 15 cases of SFI treated group, 10 cases of control group, 25 cases of SFI + granulocyte-macrophage colony stimulating factor (GMCSF) treated group and the group of 23 GM-CSF-treated tumor cases of secondary AA after CT were compared, with their increasing rate and the rebound speed of neutrophil, platelet, bone marrow nucleated RBC, granulocyte, and megakaryocyte all being investigated.Results: The increasing rate and rebound speed of granulocyte, platelet, and the increasing rate of bone marrow nucleated RBC, granulocyte, megakaryocyte were obviously higher than those of the control, and the clinical manifestations were also obviously improved. The increasing rate of platelet, bone marrow nucleated RBC, megakaryocyte of the SFI + GM-CSF group were higher than those of the group which used GM-CSF alone, while the increasing rate of granulocyte in blood and bone marrow in both groups was similar.Conclusion: Significant efficacy was shown in SFI for the treatment of secondary AA of tumor patients after CT.     

浅析中专护生文化休克的护理策略

文化休克(culture shock),又译为文化震撼或文化震惊,是指生活在某一种文化环境中的人初次进入到另一种文化环境,如到了不同的民族、社会群体中或地区甚至国家时所产生的思想混乱与心理上精神紧张综合征。新入校中专护生,由于文化环境的改变,往往会出现孤独、焦虑、无助等文化休克的种种表现,这些现象若不能及时得到解决,将不利于他们的全面健康状态的成长与发展。众所周知,WHO明确规定,健康不但是没有疾病和身体缺陷,还要有完整的生理、心理状态和良好的社会适应能力。因此,新入校中专护生这一特殊群体所产生的文化休克现象应引起学校有…     

MANAGEMENT OF UNCONTROLLED GLAUCOMA WITH THE MOLTENO SYSTEM

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

Expression of the calcium receptor CaR in the parathyroid of secondary hyperparathyroidism patients

The effects of calcium on parathyroid hormone (PTH) has further discovered in recent years. It has been known that calcium ion concentration in the extracellular fluid is a major determinant of PTH secretion. The relationship between serum intact PTH (iPTH) and calcium ion levels is described by a sigmoidal curve. The calcium concentration that produces half-maximal change in PTH release (the midpoint between maximal and minimal     

沸石分子筛材料中次级孔的研究——Ⅱ.Y型沸石晶内次级孔对扩散的影响

以含有次级孔的沸石的晶内扩散为研究对象,对来源于同一NaY母体的一组改性Y型沸石,进行了孔结构分析和正戊烷的扩散系数的测定。得到了具不同次级孔量的Y型沸石晶内扩散性能变化的规律。并采用随机游动方法对实际的Y型沸石晶内扩散进行模拟,得到了与实验测定一致的结果,从而可以对有次级孔的Y型沸石的晶内扩散做定量的估计。     

负载型丝光沸石催化剂的催化性能研究

运用二元碱氮置换吸附红外光谱法、分子筛孔径分布测定技术、XPS技术,考察了丝光沸石表面酸性与孔结构的相互关系、钯在丝光沸石上分布情况和价态及其与沸石的相互作用。结果表明,随着丝光沸石脱铝程度的增加,表面出现大量不规整晶格,存在较多的次级孔道。强质子酸中心主要分布在它的“外表面”。钯在其表面富集,并与“外表面”上的质子酸中心协同作用,促进了轻质烷烃异构化反应。