肺螨病的病理观察

本文报道螨类接种豚鼠气管引起的肺部病变,并对5种常见螨类的致病性进行比较。发现螨类接种后6天豚鼠肺部已形成典型的结节性病灶。结节圆锥形淡黄色,直径1～5mm之间。镜下表现为细支气管炎和细支气管周围炎,肺实质内有明显的异物肉芽肿形成,炎症在螨类接种豚鼠20天时,肺部嗜酸粒细胞浸润不明显,但30或40天时则出现明显的嗜酸细胞浸润,细支气管周围小动脉受到损害,部分小动脉内可见到螨体残骸。5种常见螨炎接种于5组豚鼠可引起大致相同的病变。从而证明豚鼠可作为动物模型以供肺螨病的研究,同时也证明5种常见贮藏螨具有相同的致病性。     

Interaction of glucagon with artificial lipid bilayer membranes

The enhancement of fluorescence emission from the tryptophan residue of glucagon, the quenching of that emission with acrylamide and with 5-doxyl and 16-doxyl stearic acid, circular dichroism spectra, the release of 6-carboxytluorescein, and polarized infrared attenuated total reflection (IR-ATR) spectra were used to study the interaction of glucagon with intact lipid vesicles and flat bilayers. Dimyristoylphosphatidylcholine bound the peptide only below the main transition temperature, thus confirming earlier results of Epand et al. (1977). However, the peptide is also bound by vesicles of unsaturated lipids above their transition temperature, suggesting an influence of lipid area on the binding process. Circular dichroism showed that binding to such vesicles also increases the helix content of glucagon. The IR-ATR study and a comparison with dynorphin-A-(I-13)-tridecapeptide revealed profound differences in orientation of the two peptides. The dichroic ratios and the derived order parameters indicated an isotropic orientation of the helical segments of glucagon, but did not exclude a principal orientation of the molecules lying flat on the nienibrane surface. In contrast, the axis of the dynorphin helix is clearly oriented normal to the interface. The two peptides also differ in their rates of 6-carboxyfluorescein release, suggesting a deeper penetration of the primary amphiphilic helix of dynorphin A-(I-13) than of the secondary amphiphilic helix of glucagon.     

The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams

Abstract Background: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. Aims: The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment. Methods: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow-up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. Results: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two-thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. Conclusions: The study demonstrates that for one-year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378–385.)     

膀胱前间隙炎性假瘤临床病理观察及文献复习

目的 探讨膀胱前间隙炎性假瘤的临床病理特征及发病因素，以提高对本病的认识。方法 复习3例膀胱前间隙炎性假瘤的临床特征、组织病理学、免疫表型及相关文献。结果 3例患者均为女性，均为输卵管结扎术后1～2年发现膀胱前间隙炎性假瘤，CT及B超提示膀胱前壁肿块，但膀胱黏膜光滑。术中发现肿块位于膀胱前间隙并累及膀胱前壁。病理检查：眼观为灰白色质韧的结节状肿块，镜下见炎性假瘤的病理特征及不同程度炎症背景，有组织疏松区、黏液样区、部分区域梭形细胞和纤维母细胞排列杂乱，细胞较大，光镜检查时易误诊为肉瘤，但缺乏核异型。3例均成功行肿块连同部分膀胱壁切除术，随访3～5年无复发。结论 膀胱前间隙炎性假瘤形态上需与软组织肉瘤、结节性筋膜炎、术后梭形细胞结节、间质性膀胱炎等疾病相鉴别，既往输卵管结扎术和感染可能是其重要的致病因素。     

Adaptive group sequential design for phase II clinical trials: A Bayesian decision theoretic approach

Bayesian decision theoretic approaches (BDTAs) have been widely studied in the literature as tools for designing and conducting phase II clinical trials. However, full Bayesian approaches that consider multiple endpoints are lacking. Since the monitoring of toxicity is a major goal of phase II trials, we propose an adaptive group sequential design using a BDTA, which characterizes efficacy and toxicity as correlated bivariate binary endpoints. We allow trade‐off between the two endpoints. Interim evaluations are conducted group sequentially, but the number of interim looks and the size of each group are chosen adaptively based on current observations. We utilize a loss function consisting of two components: the loss associated with accruing, treating, and monitoring patients, and the loss associated with making incorrect decisions. The performance of our Bayesian modeling, and the operating characteristics of decision rules under a wide range of loss function parameters are evaluated using seven scenarios in a simulation study. Our method is illustrated in the context of a single‐arm phase II trial of bevacizumab, gemcitabine, and oxaliplatin in patients with metastatic pancreatic adenocarcinoma. Copyright © 2009 John Wiley & Sons, Ltd.     

局部PUVA治疗儿童白癜风疗效及安全性观察

目的:观察局部光化学疗法(Psoralen plus UVA,PUVA)治疗儿童白癜风的临床疗效及安全性.方法:采用小型UVA灯(电压220V,电流0.34A,功率25.4w,主波峰长36 5nm,辐照度为1 070uw/cm2)治疗56例白癜风患儿,30次为一个疗程,共观察3个疗程.结果:第一疗程、第二疗程及第三疗程结束后临床显效率分别达39.29%、48.21%和5 5.36%,未发现明显不良反应,其中病程短、局限性及面颈部白癜风患儿疗效佳.结论:局部PUVA治疗儿童白癜风安全、有效、不良反应小,小型UVA灯具有疗效好、治疗方便的优点.     

Analysis of 23 cases of pulmonary cryptococcosis

Pulmonary cryptococcosis (PC) is a subacute or chronic pulmonary fungitis caused hy Cryptococcus neoformans.Because of no specific clinical symptoms or manifestaions in chest radiographs, misdiagnosis is common. Between January 1980 and january 2004, 23 eases of PC were diagnosed by pathological examinations in our hospital and the clinical data were retospectively analyzed to inprove the diagnosis of PC.     

17例无绳胶囊内镜检查临床分析

目的通过对无绳胶囊内镜检查情况分析，评价胶囊内镜检查在临床上应用的效果。方法对17例疑小肠疾病或不能耐受胃镜检查的病人或体检者行胶囊内镜检查，并对其结果进行分析。结果所有病人检查无不适感，15例完成小肠检查，2例胶囊分别滞留于食管、胃。7例不明原因胃肠道出血中5例完成小肠检查。均发现了小肠病变。结论胶囊内镜检查是一种无痛苦、无创、安全的上消化道检查，是小肠疾病尤其是不明原因胃肠道出血诊断的首选方法。     

Risk groups for clinical complications of norovirus infections: an outbreak investigation

Norovirus infections have been described as self-limiting diseases of short duration. An investigation of a norovirus outbreak in a university hospital provided evidence for severe clinical features in patients with several underlying diseases. Clinical outcomes of norovirus infection were defined. Risk-factor analysis targeting underlying diseases and medication was performed using multivariate analyses. In five outbreak wards, 84 patients and 60 nurses were infected (an overall attack rate of 32% in patients, and 76% in nurses). The causative agent was the new variant Grimsby virus. Severe clinical features, including acute renal failure, arrhythmia and signs of acute graft organ rejection in renal transplant patients, were observed in seven (8.3%) patients. In multivariate analyses, cardiovascular disease (OR 17.1, 95% CI 2.17-403) and renal transplant (OR 13.0, 95% CI 1.63-281) were risk-factors for a potassium decrease of >20%. Age >65 years (OR 11.6, 95% CI 1.89-224) was a risk-factor for diarrhoea lasting >2 days. Immunosuppression (OR 5.7, 95% CI 1.78-20.1) was a risk-factor for a creatinine increase of >10%. Norovirus infections in patients with underlying conditions such as cardiovascular disease, renal transplant and immunosuppressive therapy may lead to severe consequences typified by decreased potassium levels, increased levels of C-reactive protein and creatine phosphokinase. In the elderly, norovirus infection may lead to an increased duration of diarrhoea. Therefore patients at risk should be hospitalised early and monitored frequently. Strict preventional measures should be implemented as early as possible to minimise the risk of nosocomial outbreaks.     

针刺对海洛因依赖的脱毒疗效及其防复吸潜力的临床研究

目的 比较针刺、针刺加阿片、阿片加丁丙诺啡及阿片加韩氏戒毒仪4种方法的脱毒疗效及其对脱毒末期稽延性戒断症状和心理渴求的影响。方法 应用戒断症状量表观察脱毒疗效，应用视觉类比量表(VAS)研究心理渴求程度。结果 针刺改善海洛困依赖者戒断症状的优势主要表现在治疗的第6天以后，改善渴求心理的优势表现在第8天以后，且无明显副作用。结论 针刺具有防复吸潜力。可作为解决稽延性戒断症状和消除心理依赖的治疗方法。