Ⅰ期双侧全髋关节置换治疗系统性红斑狼疮合并股骨头坏死的早中期疗效

目的分析Ⅰ期双侧全髋关节置换（THA）治疗系统性红斑狼疮（SLE）合并中晚期股骨头缺血性坏死（ANFH）的早中期疗效。方法中山大学附属第三医院骨科对17例SLE合并中晚期ANFH患者均行Ⅰ期双侧THA，按照ARCO分期分为ⅢB期7髋、ⅢC期12髋，Ⅳ期15髋，结合患者年龄与骨质条件选择股骨假体不同的固定方式。采用Harris评分结合SF-36评分方法进行疗效比较与随访，平均随访时间28个月。结果术后2例切口延迟愈合，1例假体脱位，1例大腿痛10月，1例急性肾衰，均经治疗后好转。6例经彩超发现无症状下肢深静脉血栓，无肺栓塞、假体深部感染发生，无肾上腺皮质危象表现，随访期间髋关节疼痛及活动度明显改善，无假体松动。Harris髋关节功能评分（平均91．6分）与术前（平均42．6分）相比差异有统计学意义（P〈0．01），SF-36评分（平均84．5分）与术前（平均51．4分）相比差异有统计学意义（P〈0．01）；不同ARCO分期病例术后Harris评分差异无统计学意义（P〉0．05）；不同假体固定方式术后Harris髋关节功能评分、SF-36评分均差异无统计学意义（P〉0．05）。结论Ⅰ期双侧人工髋关节置换术对SLE合并中晚期ANFH的早中期疗效良好，应严格掌握手术适应证和手术时机，加强围手术期处理，选择合适的假体固定方式。     

Long-term mortality in patients with myocardial infarction: impact of early treatment with captopril for 4 weeks

目的　中国心脏研究 Ⅰ (CCS 1)入选 150 0 0例急性心肌梗塞 (AMI) (发病 36小时内 )患者 ,随机口服卡托普利或安慰剂治疗 4周。结果卡托普利治疗组 4周病死率 (9 12 % )较安慰剂对照组 (9 74 % )轻微下降 (P =0 19) ,但对其远期病死率的影响尚不知晓。本研究目的是了解卡托普利早期治疗 4周 ,对远期病死率的影响。方法　选择急性期试验完成 2 0例以上的CCS 1单位进行随访 ,计划随访 80 0 0例 (MI)病人 ,实际随访 6 74 9例 ,随访率 84 4 %。结果　治疗组 (n =3391)与对照组 (n =3358)随访病人基本临床特征是可比的。平均年龄 6 3 6± 10 6岁 ;平均随访时间 2 3 4± 16 9个月 ;男性占 76 2 %。治疗组与对照组随访时心功能 (NYHA分级 )Ⅲ Ⅳ级者分别为 9 0 %与9 9% ;再梗塞发生率为 5 6 %与 6 0 % ;总心血管事件为 32 9与 34 3%。治疗组总病死率 (11 9% ;n =4 0 4 )明显低于对照组 (13 8% ;n =4 6 3) (P =0 0 3) ;心血管性死亡 (10 0 %vs 11 8% )明显减少 (P =0 0 2 ) ,其中心衰死亡(4 1%vs 5 5% )差异更显著 (P =0 0 1)。早期用卡托普利治疗 4周 ,远期可挽救生命 19/ 10 0 0人。随机前收缩压≥ 10 0mmHg者 ,治疗组远期病死率 (12 4 % )较对照组 (13 8% )明显减少 (P =0 0 4 ) ;基础心率≥     

Effects of benzodiazepine receptor ligands on the performance of an operant delayed matching to position task in rats: opposite effects of FG 7142 and lorazepam

The effects of a series of benzodiazepine (BZ) receptor ligands, ranging from a full agonist through to partial inverse agonists, were examined on short term working memory in the rat. The behavioural paradigm used was a discrete trial, operant delayed matching to position task, as originally described by Dunnett (1985), with delays of 0, 5, 15 and 30 s. The benzodiazepine receptor (BZR) full agonist lorazepam (0.25, 0.375 and 0.5 mg/kg) dose and delay dependently impaired matching accuracy. Lorazepam also increased the latency to respond and decreased the number of nose pokes made into the food tray during the delays. In contrast, the BZR partial agonist ZK 95 962 (1, 3, 10 mg/kg) did not affect matching accuracy, but did increase the speed of responding. The BZR antagonist ZK 93 426 (1.25, 5, 25 mg/kg) had no effects in this paradigm. The BZR weak partial inverse agonists Ro 15-4513 (0.1, 1 and 10 mg/kg) and ZK 90 886 (1, 3 and 10 mg/kg) did not affect accuracy of performance. However, both of these drugs increased the latency to respond and decreased nose poke responses. These motoric effects were particularly strong following 10 mg/kg Ro 15-4513. This shows that the effects of drugs on the accuracy of responding and on the speed of responding can be dissociated. The BZR partial inverse agonist FG 7142 had effects on matching accuracy that were dependent upon dose. The lowest dose of FG 7142 (1 mg/kg) significantly improved accuracy, whereas the highest dose (10 mg/kg) impaired accuracy. This impairment induced by FG 7142 (10 mg/kg) was accompanied by an increase in the latency to respond and a decrease in the number of nose pokes. Taken together, these results show that the accuracy of delayed matching performance can be modulated in opposite ways by the BZR full agonist lorazepam and a low dose of the BZR partial inverse agonist, FG 7142.     

米索前列醇用于足月妊娠引产的临床研究

目的探讨米索前列醇用于足月妊娠引产的临床应用价值。方法将２３６例符合引产指征的单胎、头位,尚未临产的孕妇随机分为米索前列醇引产组及催产素引产组。结果米索前列醇用于足月妊娠引产的有效率为９４．３％,显著高于催产素组７８．３％（Ｐ＜０．０１）;其临产发动时间及总产程分别为２．８１±０．４９ｈ和６．４０±２．３１ｈ,短于催产素的３．９８±０．２９ｈ及９．１２±２．５０ｈ（Ｐ＜０．０１）;剖宫产率为９．０４％;亦显著低于催产素组（１９．１４％）（Ｐ＜０．０１）;两组胎儿宫内窘迫发生率、新生儿体重及Ａｐｇａｒ评分、产后出血量均无显著差异（Ｐ＞０．０５）。结论米索前列醇用于足月妊娠引产疗效显著,安全、方便,而且有利于计划分娩,值得临床推广应用     

Ventricular fibrillation related to reversal of the neuromuscular blockade in a patient with long QT syndrome

The long QT syndrome (LQTS) is associated with syncopal attacks or even sudden death at a young age due to ventricular fibrillation. We report a patient with an undiagnosed LQTS who had an episode of cardiac arrest during the final part of general anesthesia, immediately after the drugs for reversal of the neuromuscular blockade were given. We suggest that the administration of glycopyrronium might have been the provoking factor in this patient.     

Preparing Older People to Cope after a Fall

Clinical experience and previous research show that older people at risk of falling can become anxious at the thought of being on the floor, therefore physiotherapists and occupational therapists may be reluctant to teach them how to get up.Old people's reactions to two different methods of teaching them this skill are compared (three groups, mean age 84 years). The conventional method requires people to be helped down to the floor and then to learn how to get on to their knees prior to getting up with the help of furniture. An alternative method, based on backward-chaining principles, does not require that people start from the floor and reduces the likelihood of them experiencing failure. The activity is broken down into small steps — the last step in the chain being taught first.It is concluded that:

1 The backward-chaining method of teaching elderly people how to get up from the floor is much less stressful to older people and to staff than the conventional method.

2 Older people are slightly more likely to learn successfully how to get up from the floor by the backward-chaining method which, even if they are not successful, provides them with functionally relevant exercise.

3 Older people who cannot learn to get up from the floor should be helped to develop alternative strategies for summoning help and for preventing the consequences of the long lie.

Plasma level monitoring of mitotane (o,p'-DDD) and its metabolite (o,p'-DDE) during long-term treatment of cushing's disease with low doses

Summary. Mitotane (o,p'-DDD) can be used for the treatment of various adrenocortical diseases such as Cushing's syndrome, but the usual doses of 6–8 g per day are often associated with severe adverse effects.This paper reports the results of much lower doses of o,p'-DDD (0.5–2 g per day) in two patients with Cushing's disease over periods of 8 and 5 years, respectively, under concomitant monitoring of the plasma levels of the parent drug and its major metabolite, o,p'-DDE.It became apparent that o,p'-DDD and o,p'-DDE have a strong tendency to accumulate in the body due to their high lipophilicity. As a consequence, changes in dose regimens had long lag times before they were reflected in plasma levels and once an increase or decrease had started one had to be careful not to cause overshoot.Steady state plasma levels of o,p'-DDD between 5–10 g/ml appeared sufficient to induce and to maintain remission of the disease, which was accompanied with normal cortisol levels in plasma and urine. DDD-levels below 5 g/ml for several weeks may lead to relapses, whereas DDD-levels over 10 g/ml gave rise to side effects. On the other hand, o,p'-DDE seemed inactive at levels up to 4 g/ml in plasma.     

小柴胡汤提取物灌胃给药的长期毒性实验研究

目的：观察小柴胡汤提取物长期连续灌胃给药对大鼠所产生的毒性反应。方法：小柴胡汤提取物2256，1128,100mg／kg灌胃给药和正常对照组作180天长期毒性试验，观察对大鼠的生长发育，血液学常规，血液生化指标和主要脏器病理形态的影响。结果：对大鼠生长发育，血液学常规，血液生化指标均在正常范围，主要脏器病理形态未出现毒性病变。结论：小柴胡汤提取物长期灌胃未发现毒性反应，长期服用安全。