儿童慢性轻度哮喘治疗的临床研究

目的　探讨 3～ 8岁儿童慢性轻度哮喘的早期干预治疗方法。方法　将 12 0例 3～ 8岁慢性轻度哮喘患儿随机均分为治疗组 1、2和对照组。治疗组 1:3～ 5岁患儿口服孟鲁司特 (顺尔宁 ) 4 .0mg/d ,5～ 8岁服5 .0mg/d ,疗程 3～ 6个月 ;治疗组 2 :予口服盐酸西替利嗪 2 .5～ 5 .0mg/d ,疗程 3～ 6个月 ;对照组 :口服安慰剂。均于每日睡前服用。结果　与治疗组 2及对照组相比 ,治疗组 1的日间及夜间症状出现率、急性加重发生率、月均 β 受体激动剂使用率、峰值呼气流速 (PEF)变化、嗜酸性粒细胞计数 (EC)下降率的差异有显著性 (P <0 .0 1) ,而住院率、药物不良反应率的差异无显著性 (P >0 .0 5 )。治疗组 2与对照组EC值的差异有显著性 (P <0 .0 1) ,其余指标的差异均无显著性 (P值均 >0 .0 5 )。结论　白三烯受体拮抗剂孟鲁司特单独用于慢性轻型哮喘儿童的早期干预治疗具有疗效好、不良反应小及患儿依从性高的特点     

COPD患者营养状况与生活质量的关系

观察５６例男性慢性阻塞性肺病（ＣＯＰＤ）患者的体检营养指标，并分析其与生活质量的关系，实测体重占理想体重的百分比和生活质量测评表中的日常生活能力，社会活动情况，抑郁心理障碍等项评分有显著相关性（Ｐ〈０．０５），上臂中点肌肉臂围与日常生活能力和社会活动情况的评分的相关也有统计学意义（Ｐ〈０．０５）。提示改善ＣＯＰＤ患者的营养状况对提高生活质量有重要意义。     

慢性肾功能不全时测定左心室收缩时间间期的意义

本文报道了36例慢性肾功能不全患者的左心室收缩时间间期测定结果,并探讨其临床意义。作者认为,该项检查在慢性肾功能不全患者中有实际应用的价值;有关PEP/LVET比值和多种病理因素的相关分析表明,尿毒症晚期心肌病变确非单一因素引起。     

Brain-derived neurotrophic factor in cerebrospinal fluid of patients with chronic daily headache: relationship with nerve growth factor and glutamate levels

Little has been done to investigate the biochemical basis of chronic daily headache (CDH). Our group has recently demonstrated an increase in the cerebrospinal fluid (CSF) levels of nerve growth factor (NGF) in CDH patients, supporting the involvement of this growth factor in the abnormal processing of head pain in this pathological condition. Other members of the neurotrophin family, especially brain-derived neurotrophic factor (BDNF), have been hypothesized as being involved in the development of chronic head pain in patients affected by CDH, but so far no data are available on this subject. BDNF, NGF and glutamate levels were determined in the CSF of 25 patients affected by CDH with a previous history of migraine. These levels were compared with those of a group of 20 control subjects, for whom the CSF examination and other instrumental investigations excluded diseases of the central and peripheral nervous systems. Significantly higher levels of BDNF, NGF and glutamate were found in CDH patients compared with control subjects (p<0.0001, p<0.0002 and p<0.001, respectively). A significant positive correlation emerged between CSF values of BDNF and those of NGF (r=0.61, p<0.001) and glutamate (r=0.44, p<0.025) in CDH patients. No significant differences were detected in BDNF, NGF and glutamate levels between CDH patients with analgesic overuse and those without. These results support the involvement of BDNF in CDH through the potentiation of glutamatergic transmission involved in the processing of head pain. The significant correlation between BDNF and NGF levels suggests that NGF-mediated up-regulation of BDNF in central sites involved in long-term sensitization plays a key role in persistent head pain in CDH patients. Correspondence to P. Sarchielli     

CT扫描在内窥镜鼻窦手术中的应用价值

目的 探讨鼻窦CT扫描在内窥镜鼻窦手术中的应用价值。方法 回顾性对80例慢性鼻窦炎患者鼻窦CT扫描与手术中所见进行分析总结。结果 冠状位CT扫描鼻窦病变发现率高，辅以水平CT扫描，鼻窦精细结构、病变范围和程度能够清楚地显示，符合术中所见。结论 鼻窦CT扫描能精确显示鼻窦结构及病变，能正确指导鼻窦内窥镜手术。     

Association between chronic hepatitis B virus infection and diabetes among Asian Americans and Pacific Islanders

BACKGROUND: Asians have a higher prevalence of both diabetes (diabetes mellitus) and chronic hepatitis B virus infection compared to Caucasians. The aim of this study was to investigate whether hepatitis B virus infection was associated with diabetes mellitus among Asian Americans and Pacific Islanders. METHODS: We reviewed the electronic medical records of 411 Asian and 424 Pacific Islanders seen at our medical centre over a 5-year period. Diabetes mellitus was defined by the presence of two or more random blood glucose levels > or =200mg/dL, an ICD-9 diagnostic code of diabetes mellitus, or use of medications for diabetes mellitus. Hepatitis B virus infection was defined by a positive HBsAg test. RESULTS: Diabetes mellitus was diagnosed in 223 of the 835 subjects (26.7%), whereas hepatitis B virus infection was diagnosed in 56 (13.8%) of the 407 subjects tested for HBsAg. Overall, the prevalence of diabetes mellitus was significantly higher in patients with hepatitis B virus than in those without hepatitis B virus (58.9% vs. 33.3%, P<0.001), and this remained significant after adjustment for potential confounding variables (OR=3.17; 95% CI, 1.58-6.35). When Asians and Pacific Islanders were analysed separately, the prevalence of diabetes mellitus in patients with hepatitis B virus was significantly higher than in those without hepatitis B virus among Asians (65.0% vs. 27.5%, P<0.001) but not in Pacific Islanders (43.8% vs. 37.1%, P=0.60). Among the 390 subjects who were tested for both hepatitis B virus and hepatitis C virus, the prevalence of diabetes mellitus was 29.4% in uninfected subjects, 44.4% in patients with hepatitis B virus monoinfection, 47.2% in patients with hepatitis C virus monoinfection and 85.0% in patients with hepatitis B virus and hepatitis C virus coinfection (P<0.001). CONCLUSIONS: Hepatitis B virus infection is strongly associated with diabetes mellitus among Asian Americans, but not in Pacific Islanders, whereas hepatitis C virus infection was associated with diabetes mellitus in both ethnic groups.     

Direct evidence for the link between monoaminergic descending pathways and motor activity:: II. A study with microdialysis probes implanted in the ventral horn of the spinal cord

In order to define precisely the relation between descending monoaminergic systems and the motor system, we measured in the ventral horn of spinal cord of adult rats the variations of extracellular concentrations of 5-HT, 5-HIAA, DA and MHPG. Measurements were performed during rest, endurance running on a treadmill, and a post-exercise period, with microdialysis probes implanted permanently for 45 days. We found a slight decrease in both 5-HT and 5-HIAA during locomotion with a more marked decrease during the post-exercise period compared to the mean of rest values. In contrast, the concentration of DA and MHPG increased slightly during the exercise and decreased thereafter. These results, when compared with those of a previous study, which measured monoamines in the spinal cord white matter [C. Gerin, D. Bécquet, A. Privat, Direct evidence for the link between monoaminergic descending pathways and motor activity: I. A study with microdialysis probes implanted in the ventral funiculus of the spinal cord, Brain Res. 704 (1995) 191–201], highlight the complex regulation of the release of monoamines that occurs in the ventral horn.     

鳞癌相关抗原的检测及临床意义

本文对７７例肺癌，４８例食管鳞癌和１４例良性疾病病人进行了鳞癌相关抗原（ＳｑｕａｍｏｕｓＣｅｌｌＣａｒｉｎｏｍａＡｎｔｉｇｅｎ，ＳＣＣ—Ａｇ）测定，肺鳞癌（４５例）阳性率为６８．８％（＞１．５ｎｇ／ｍｌ）；腺癌（１８例）阳性率１６．６％；小细胞癌（８例）阳性率１２．５％；大细胞癌（６例）阳性率１６．７％。食管鳞癌阳性率３１．３％。１４例良性疾病均阴性。治疗前ＳＣＣ—Ａｇ浓度与肿瘤分期呈对应关系，肺鳞癌Ⅰ期阳性率为２２．２％；Ⅱ期为６４．２％；Ⅲ期８２．３％；Ⅳ期则１００％。食管鳞癌Ⅰ～Ⅱ期阳性率为１３．４％；Ⅲ～Ⅳ期阳性率为４８％。在行肿瘤根治切除的病人，其ＳＣＣ—Ａｇ在术后７２小时内转阴，而行非根治手术的病人，其ＳＣＣ—Ａｇ仍为阳性。治疗后无转移和复发的鳞癌病人，其ＳＣＣ—Ａｇ持续阴性，该抗原在治疗后由阴性再次上升为阳性，临床均证实为复发。     

High resolution nuclear magnetic resonance imaging of the spinal cord in experimental demyelinating disease

Summary Chronic recurrent experimental allergic encephalomyelitis was induced in a strain 13 guinea pig by inoculation of isologous spinal cord homogenate. The spinal cord was obtained after perfusion with 4% paraformaldehyde and examined with nuclear magnetic resonance (NMR) imaging. Proton NMR spin echo images (repetition time: 3 s; echo times: 20 and 60 ms) were obtained from intact, isolated spinal cord in a 4.7 Tesla, 50 mm bore magnet. The slice thickness of the images was 380 m and the inplane resolution was 40×40 m. The images showed superficial areas of low signal intensity in the lateroventral regions of the white matter, in some instances with a seam of higher signal intensity. Neuropathologically, these abnormalities corresponded exactly to areas of demyelination. Control images did not show these abnormalities. The present high resolution imaging allowed a correlation between demyelination and abnormal NMR signals in a small laboratory animal with an inflammatory demyelinating disease.Supported by the Belgian Foundation of Medical Scientific Research (FGWO, grant 3.0096.86 and grant 3.0019.86), by the Institute for the promotion of Scientific Research in Industry and Agriculture (IWONL) and by the Scientic Research Planning Office of the Belgian Government (DPWB), contract no. 87/92-120     

Circulating 1,25-Dihydroxycholecalciferol After Intravenous Injections of l{alpha}-Hydroxycholecalciferol in Patients on Regular Haemodialysis

The formation of 1.25-dihydroxycholecalciferol (1.25-(OH)₂D₃after single intravenous injections of 1-hydroxycholecalciferol(1-OHD₃) was examined in four patients with chronic renal failureon regular haemodialysis. Following 1–3µg 1-OHD₃administered at weekly intervals, 1.25-(OH)₂D₃ appeared in thecirculation within 1 h, and peak concentrations were reachedbetween 2 h and 5 h. By 8 h serum 1.25-(OH)₂D₃ concentrationshad started declining and by 44 h they had returned to baselineafter 1µg 1-OHD₃ but they were still above basal after2 and 3 µg by an average of 30 pmol/l. One week afterinjections, concentrations were back to basal in all patientsstudied. The serum 1,25-(OH)₂D₃ dose response to injected la-OHDwas linear, indicating ample capacity of the liver 25-hydroxylaseto further hydroxylate 1-OHD. However, examination of the individualresponses revealed lower increments in serum 1.25-(OH)₃ concentrationsin the patients with the highest basal serum 25-hydroxyvitaminD concen trations. Intravenous 1-OHD₃ may be useful in the furtherstudy of the interactions between 1.25-(OH)₂₃ calcium and PTHin chronic renal failure, as well as of the hepatic metabolismof vitamin D.