胃微小腺癌的组织发生研究

从２１０５例胃癌癌旁组织中找出微小腺癌３１例（〈０．１ｃｍ），观察其组织发生的特征，发现胃腺癌的发生有８种形式：①腺颈部干细胞癌变；②表面上皮癌变；③腺上皮癌变；④肠化生上皮癌变；⑤微腺囊癌变；⑥溃疡边缘上皮癌变；⑦扁平腺瘤癌变；⑧贲门交界处柱状上皮癌变。     

磷酸铝凝胶剂的研制

以微粒沉降速度、粒度分布、粘度大小等为指标，利用正交试验法筛选出磷酸铝凝胶剂的最佳处方。结果表明，磷酸铝凝胶剂的沉降容积比可达９３．１％，其粒度均小于１０μｍ，而且沉降速度较小。     

胃癌增殖活性的研究—Ki—67单克隆抗体标记与核分裂计数对比观察

作者用Ki—67单克隆抗体对30例胃癌标本做了免疫组化标记观察,并与核分裂计数作了对比研究.结果发现Ki—67标记阳性率在6.3%～81.3%之间(平均33.04±21.94),Ki—67标记阳性率与核分裂计数之间呈显著正相关(r=0.686,P<0.01),未发现Ki—67标记阳性率在有无淋巴结转移、胃壁侵犯深度、不同分化程度和生长方式之间存在差异( P >0.05).     

Innervation of the monotreme gastrointestinal tract: A study of peptide and catecholamine distribution

The distribution of neurons and endocrine cells containing various peptides or catecholamines was examined in the digestive tracts of the echidna (Tachyglossus aculeatus) and the platypus (Ornithorhynchus anatinus). Comparisons were made with published studies in other species in order to obtain a broader view of the phylogenetic distribution and possible functions of gut peptides and catecholamines. Further comparisons between the echidna and platypus were made in light of their different dietary features and gut histology. The distribution of neurons and axons containing catecholamines or various peptides resembled that in other species (such as the frequent appearance of axons containing substance P and vasoactive intestinal peptide in the intestinal mucosa, and axons containing substance P or enkephalins in the circular muscle). In both species, the stomach histologically resembles the esophagus, being aglandular and lined with stratified squamous epithelium. Innervation of these two organs was similar but not identical, with a greater array of peptides found in the gastric muscle. The intestinal mucosa was densely innervated in both species. The platypus small intestine is unusual in having a thick and deeply folded mucosa (but no villi), in which the superficial epithelium is absent or incomplete at many sites; many axons travel close to these luminal surfaces. Many (putative noradrenergic) axons associated with blood vessels contained neuropeptide Y, but there was no evidence for intrinsic catecholamine-containing neurons. Somatostatin and cholecystokinin were present in some endocrine cells, but unlike many mammals, absent in neuronal tissue. These studies have shown that there are many strong similarities between monotremes and other mammals in the distribution and array of peptides found within nervous and endocrine tissues of the digestive tract. However, numerous small differences of the echidna and platypus innervation may be correlated with their different digestive structures. © 1993 Wiley-Liss, Inc.     

Advancing Nursing Practice with a Unit-based Clinical Expert

Objective: To explore patterns in the practice of nursing and patient outcomes.
Design: Qualitative field research.
Population, Sample, Setting: Populations were critical care nurses and critically ill adult patients in the 10-bed medical critical care unit of a 900-bed teaching hospital. A convenience-purposive sample of 27 nurses and 31 patients was studied in 1985.
Methods: Six months of participant observation, unstructured interviews, and the constant comparison method of grounded theory.
Findings: Markedly different patterns were found in expert and nonexpert practice. The substantive theory of conversion helped explain how the majority of nonexpert nurses advanced their practice. The metaphor of catalyzed conversion captures how a unit-based expert nurse serves as a catalyst to advance the practice of nonexperts. Presence, defined as the way of being within a given clinical context, differentiated nurses.
Conclusions: (a) Expert and nonexpert practices are substantively different, (b) Expert and nonexpert practice results in different patient outcomes, (c) Conversion helps explain changes in nonexpert practice.
Clinical Implications: A unit-based expert nurse can increase patient-focused care.     

Similarities between the relaxations induced by vasoactive intestinal peptide and by stimulation of the non-adrenergic non-cholinergic neurons in the rat stomach

Summary The characteristics of the non-adrenergic, noncholinergic inhibitory response of the rat stomach fundus to transmural nerve stimulation were compared with the relaxation induced by vasoactive intestinal polypeptide (VIP). Treatment with -chymotrypsin (5 U/ml) or VIP antiserum (1:200) significantly reduced the relaxation induced by transmural nerve stimulation at 30 Hz, indicating that the possible transmitter in the non-adrenergic, non-cholinergic nerves is a peptide and may be VIP or a closely related peptide. VIP was able to relax, fully and dose-dependently, the stomach fundus that had previously been constricted by treatment with 10^–6 M serotonin, and the IC₅₀ value for VIP was 2.4 × 10^–9 M. VIP elevated levels of cyclic AMP in a dose-dependent manner and the EC₅₀ value was 2.8 × 10^–9 M in the presence of 10^–6 M atropine and 10^–6 M guanethidine. The stomach fundus was relaxed by transmural nerve stimulation (30 Hz, 50 mA) and transmural nerve stimulation also caused production of cyclic AMP in the rat stomach in the presence of atropine and guanethidine. The basal level of cyclic AMP in the stomach was 8.7 ± 0.26 pmole/mg protein. When transmural nerve stimulation was applied for 5 min, the contraction of the stomach, induced by 10^–6 M serotonin, was inhibited by 54% in the presence of atropine and guanethidine and the level of cyclic AMP was increased to 13.0 ± 0.73 pmol/mg protein. Apamin inhibited the transmural nerve stimulation-induced relaxation and shifted the dose-response curve for VIP to the right. These results suggest that one of the putative neurotransmitter from non-adrenergic, non-cholinergic nerves in the rat stomach is VIP and that VIP-induced relaxation may be mediated by the production of cyclic AMP and by the opening of apamin-sensitive K⁺-channels.Send offprint requests to K. Kamata at the above address     

于阴阳与基因调控关系辨治胃黏膜上皮内瘤变

胃黏膜上皮内瘤变是胃癌前病变,具有发展为胃癌的危险。阳主动,阴主静,文章基于阴阳理论,衷中参西,微观辨证与宏观辨证结合,以阴阳消长失调和基因调控紊乱的关系为出发点,认为胃黏膜上皮内瘤变发生时胃黏膜细胞凋亡周期紊乱和细胞异常增殖分化是阴阳消长失衡在细胞基因调控水平上的体现,进而探讨胃黏膜上皮内瘤变的病因病机以及辨证论治过程,为中医药治疗胃黏膜上皮内瘤变提供更多的理论依据,丰富治疗该病的临床手段。     

行气活血补肾壮骨方在双膦酸盐药物休假期患者的临床观察

摘要：目的：观察益气活血补肾壮骨方在骨质疏松症(气滞血瘀型)患者双膦酸盐药物休假期的临床疗效和不良反应等。方法：将本院2019年12月—2021年7月就诊120例气滞血瘀型骨质疏松症双膦酸盐药物休假期患者按照随机数字表均分为两组。对照组予钙片、阿法骨化醇胶囊、金天格治疗,研究组予钙片、阿法骨化醇胶囊加用益气活血补肾壮骨方治疗。治疗6个月后,比较两组患者骨代谢、细胞因子、骨密度、 健康调查简表(SF-36评分)、脆性骨折发生率、骨折风险评估、中医证候积分、疗效和不良反应等。结果：治疗前两组各项指标比较差异无统计学意义(p>0.05)。治疗后研究组骨代谢低于对照组（BGP25.69±4.07vs26.37±4.16ng/mL、PINP35.79±7.38vs37.02±8.12ng/mL、CTX0.85±0.14vs1.26±0.21mmol/L、TRACP8.93±1.26vs13.06±2.59u/L）,细胞因子(IL-1:26.36±3.07vs23.75±2.93pg/mL、IL-6:82.71±6.25vs78.62±9.08pg/mL、TNF-α5.03±1.02vs3.81±1.09ng/L)高于对照组,差异有统计学意义（p<0.05）。研究组SF-36评分(87.46±8.32vs70.62±6.59)、西医有效率(86%vs80%)、中医症候积分(23.46±5.32vs21.62±4.59)、中医疗效有效率(84%vs76%)高于对照组,左股骨颈BMD(0.68±0.05vs0.70±0.06g/cm2),脆性骨折发生率(2%vs8%)、骨折风险评估(1.49±0.32vs2.63±0.47)低于对照组,但差异无统计学意义(p>0.05)。结论：益气活血补肾壮骨方联合钙片、阿法骨化醇胶囊可改善双膦酸盐药物假期患者(气滞血瘀型)骨代谢水平,抑制骨吸收和炎性因子水平、促进骨形成、提高骨密度,降低脆性骨折发生率和骨折风险,提高中医症候积分、生活质量,从而提高疗效,疗效水平与金天格相当。     

益气养阴活血法治疗冠心病心律失常有效性和安全性的Meta分析*

[摘要]目的 系统评价益气养阴活血法治疗冠心病心律失常的有效性及安全性。方法 检索中国知网数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、中国学术期刊数据库（万方）、Cochrane图书馆、Web of Science和PubMed中有关益气养阴活血法治疗冠心病心律失常的临床随机对照试验研究,提取纳入研究的相关数据并进行方法学质量评价。应用RevMan5.3软件进行Meta分析。结果 共纳入26个研究。Meta分析结果显示,益气养阴活血法治疗组在临床总有效率[OR=3.47,95%CI（2.68, 4.48）,P<0.00001]、24h心律失常事件数[WMD=-204.82,95%CI（-228.78, -180.86）,P<0.00001]、中医症候疗效[OR=3.08,95%CI（2.04,4.66）,P<0.00001]、心电图疗效[OR=2.50,95%CI（1.63,3.83）,P<0.0001]、血液流变学指标：全血高切黏度[WMD=-1.02,95%CI（-1.18,-0.85）,P < 0.00001]、全血低切黏度值[WMD=-1.66,95%CI（-2.00,-1.33）,P< 0.00001]、血浆比黏度[WMD=-0.42,95%CI（-0.50,-0.35）,P < 0.00001]、纤维蛋白原[SMD=-1.67,95%CI（-2.06,-1.28）,P <0.00001]及安全性[OR=0.41,95%CI（0.27,0.61）,P<0.001]方面均优于常规西医治疗组。结论 益气养阴活血法治疗冠心病心律失常具有更好的有效性及安全性。由于目前纳入文献数量及质量的限制,期望今后有更多高质量的随机对照试验支持。     

心阻抗容积图的传统理论及其局限性

本文就心阻抗容积图的传统理论及其局限性展开讨论。由于传统理论模型与人体胸部结构差异太大，使这一方法存在很多问题。而实践中关于心输出量（ＣＯ）的计算，误差较大，可靠性差。