灌肠合剂的药效学试验

目的:研究灌肠合剂抗炎、解热及促进大肠运动和直肠蠕动等作用。方法:灌肠合剂生药剂量为9.36g/kg(大剂量)和3.12g/kg(小剂量),相当于临床用药的6.9倍和2.3倍。阳性对照药为导便栓,阴性对照品为蒸馏水,其中抗炎试验未设阳性对照。结果:直肠给药,灌肠合剂对鸡蛋清致大鼠足跖肿胀有抑制作用,大剂量组与蒸馏水组比较有显著性差异(P<0.01);能抑制大肠杆菌内毒素致家兔体温升高,受试组与蒸馏水对照组比较有显著差异(P<0.05和P<0.01);能增强大鼠和家兔的大肠运动,给药后粪便排泄量增加,墨汁推进距离延长,受试组与蒸馏水对照组比较有显著差异(P<0.05和P<0.01)。结论:经直肠给药灌肠合剂有抗炎、解热、增强大肠运动和直肠蠕动作用。     

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目的探讨首次丙种球蛋白静脉注射(IVIG)无反应性川崎病(KD)的发生率及危险因素,及其再治疗方法的选择。方法总结2000—2004年北京45家医院KD患儿的临床资料,IVIG无反应性定义为首次IVIG治疗36h后体温仍超过38·5℃。结果1107例患儿纳入研究对象,1092例有急性期治疗资料,1052例(96·3%)接受IVIG治疗,135例对首次IVIG治疗无反应,发生率12·8%(135/1052)。Logistic回归分析发现血沉、GPT、WBC、发病至用IVIG的时间、血浆白蛋白及IVIG治疗剂量,是IVIG无反应性的独立危险因素(P<0·05)。对IVIG无反应者8例给第2剂2g/kg IVIG,5例热退;114例给1g/kg剂量IVIG治疗,35例(30·7%)热退;11例给400~600mg/kg IVIG,1例(9·1%)热退;2例给糖皮质激素,2例均热退。4种再治疗方法间比较,差异有统计学意义(P=0·015)。第2剂2g/kg IVIG治疗较其它再治疗所需进一步IVIG或激素治疗次数少,体温恢复快。结论约12·8%KD患儿对初次IVIG治疗无反应。血沉、WBC和GPT、血浆白蛋白、IVIG使用方法及起病至用IVIG的时间,是IVIG无反应的独立危险因素。对初次IVIG无反应患儿推荐使用第2剂2g/kgIVIG,对2次2g/kgIVIG治疗仍无效者可以选用糖皮质激素治疗。     

静脉丙种球蛋白无反应性川崎病的治疗及危险因素分析

目的探讨首次丙种球蛋白静脉注射(IVIG)无反应性川崎病(KD)的发生率及危险因素，及其再治疗方法的选择。 方法总结2000—2004年北京45家医院KD患儿的临床资料，IVIG无反应性定义为首次IVIG治疗36h后体温仍超过38.5℃。 结果1107例患儿纳入研究对象，1092例有急性期治疗资料，1052例(96.3%)接受IVIG治疗，135例对首次IVIG治疗无反应，发生率12.8%(135/1052)。Logistic回归分析发现血沉、GPT、WBC、发病至用IVIG的时间、血浆白蛋白及IVIG治疗剂量，是IVIG无反应性的独立危险因素(P<0.05)。对IVIG无反应者8例给第2剂2g/kg IVIG，5例热退；114例给1g/kg剂量IVIG治疗，35例(30.7%)热退；11例给400~600mg/kg IVIG，1例(9.1%)热退；2例给糖皮质激素，2例均热退。4种再治疗方法间比较，差异有统计学意义(P=0.015)。第2剂2g/kg IVIG治疗较其它再治疗所需进一步IVIG或激素治疗次数少，体温恢复快。 结论约12.8%KD患儿对初次IVIG治疗无反应。血沉、WBC和GPT、血浆白蛋白、IVIG使用方法及起病至用IVIG的时间，是IVIG无反应的独立危险因素。对初次IVIG无反应患儿推荐使用第2剂2g/kgIVIG，对2次2g/kg IVIG治疗仍无效者可以选用糖皮质激素治疗。     

CT Imaging Biomarkers Predict Clinical Outcomes After Pancreatic Cancer Surgery

This study aimed to determine whether changes in contrast-enhanced computed tomography (CT) parameters could predict postsurgery overall and progression-free survival (PFS) in pancreatic cancer patients. Seventy-nine patients with a final pathological diagnosis of pancreatic adenocarcinoma were included in this study from June 2008 to August 2012. Dynamic contrast-enhanced (DCE) CT of tumors was obtained before curative-intent surgery. Absolute enhancement change (AEC) and relative enhancement change (REC) were evaluated on DCE-CT. PFS and overall survival (OS) were compared based on CT enhancement patterns. The markers of fibrogenic alpha-smooth muscle antigen (α-SMA) and periostin in tumor specimens were evaluated by immunohistochemical staining. The χ² test was performed to determine whether CT enhancement patterns were associated with α-SMA-periostin expression levels (recorded as positive or negative). Lower REC (<0.9) was associated with shorter PFS (HR 0.51, 95% CI: 0.31–0.89) and OS (HR 0.44, 95% CI: 0.25–0.78). The α-SMA and periostin expression level were negatively correlated with REC (both P = 0). Among several CT enhancement parameters, REC was the best predictor of patient postsurgery survival. Low REC was associated with a short progression-free time and poor survival. The pathological studies suggested that REC might be a reflection of cancer fibrogenic potential.     

PI3K－Akt 信号通路在内皮祖细胞移植减轻大鼠缺血再灌注肾损伤中的作用

目的探讨磷脂酰肌醇－3－激酶－丝氨酸／苏氨酸激酶（ PI3K－Akt）信号通路在内皮祖细胞（ EPC）移植减轻大鼠缺血再灌注肾损伤中的作用。方法抽取大鼠外周血,采用密度梯度离心的方法分离、培养内皮组细胞。22只雄性SD大鼠随机分为正常对照组、缺血再灌注（ I／R）组、EPCs移植组3组,分别于术后第1 d收获所有大鼠肾脏标本和血标本。流式细胞仪及细胞免疫荧光鉴定 EPC 表面标志（ CD34／VEGFR－2）;测定血标本尿素氮和肌酐值;行western bolt检测各组大鼠p－AKT蛋白的表达情况。结果与正常对照组比较,其余各组血肌酐及尿素氮均升高,I／R组、EPC组肾脏p－Akt表达上调（ P ＜0．05）;与I／R组比较,EPC组的肌酐及尿素氮降低,p－Akt表达上调（ P ＜0．05）。结论 EPC移植可能通过激活PI3K－Akt信号通路减轻大鼠缺血再灌注肾损伤。     

上颌窦底黏膜增厚与牙槽骨高度及上颌窦解剖结构的关联性

目的 通过观测上颌后牙缺失患者的锥形束CT,研究上颌窦底黏膜增厚与缺牙区部分解剖结构的关系,为上颌窦底黏膜增厚患者的上颌窦提升术与缺失牙种植治疗提供临床参考。方法 收集2013年1月—2022年5月于天津医科大学附属口腔医院牙周科与广州医科大学附属口腔医院牙周科拍摄锥形束CT的患者资料,筛选出上颌单侧单颗后牙缺失的患者103例,通过CBCT三维重建,并以上颌窦底黏膜是否增厚（＞2 mm）作为分组标准,测量牙槽骨高度、宽度、上颌窦外侧壁血管至窦底距离、上颌窦外侧壁厚度,以同一患者自身两侧指标的差值为统计值,分析上颌窦底黏膜增厚是否对缺牙区部分解剖结构存在影响。结果 最终纳入上颌窦底黏膜增厚组56例,非上颌窦底黏膜增厚组47例。对其指标进行统计,其中两组患者的牙槽骨高度差值存在差异,上颌窦底黏膜增厚组大于非上颌窦底黏膜增厚组,差异有统计学意义（P＝0.0246）。两组间的牙槽骨宽度、上颌窦外侧壁厚度、上颌窦外侧壁血管至窦底距离的差值,差异无统计学意义（P＞0.05）。结论 持续存在的上颌窦底黏膜增厚可能与缺牙后牙槽骨高度的变化存在关联     

Pharacogenetic effects of dopamine transporter gene polymorphisms on response to chlorpromazine and clozapine and on extrapyramidal syndrome in schizophrenia

A number of studies have investigated the effectiveness of the dopamine transporter (SLC6A3) Gene as an antipsychotic target. However, the focus has mainly been on a 40-bp variable number of a tandem repeat (VNTR) in the 3′-region and results have been inconsistent. To fully evaluate SLC6A3 as a therapeutic antipshycotic target we investigated association of the gene with responses to chlorpromazine and clozapine and with chlorpromazine-induced extrapyramidal syndrome (EPS) in the Chinese schizophrenia population. Six polymorphisms across the whole region of this gene were analyzed, namely rs2652511 (T-844C) and rs2975226 (T-71A) in the 5′-regulatory region, rs2963238 (A1491C) in intron 1, a 30-bp VNTR in intron 8, rs27072 and the 40-bp VNTR in the 3′-region. We found that the polymorphic marker, rs2975226, showed significant association of allele and genotype frequencies with response to clozapine (allele-wise: adjusted p = 0.00404; genotype-wise: adjusted p = 0.024), and that patients with the T allele had a better response to the drug. The haplotype block constructed from the first three markers near the 5′-region showed significant association with response to clozapine (for haplotype T-T-A: p = 0.0085; for haplotype C-A-C: p = 0.0092). We did not identify any significant association of the six genetic variants or haplotypes with EPS after Bonferoni correction. Our findings suggest that the 5′-regulatory region of SLC6A3 plays an important role in response to clozapine and that its role in EPS needs to be replicated in a large-scale well designed study.     

结肠癌术后腹腔化疗和静脉化疗的疗效比较

目的评价结肠癌术后腹腔化疗的效果。方法对比分析1995年-2000年结肠癌术后腹腔化疗组和术后静脉化疗组的临床资料。结果术后腹腔化疗组的3、4、5年生存率显著高于术后静脉化疗组。结论术后腹腔化疗能比静脉化疗更显著改善结肠癌病人的预后。     

开展慢性病综合监测,掌握慢性病流行动态

1 开展慢性病综合监测势在必行 随着经济的发展，工业化速度增快，社会人口老龄化，人群中出生率、生育率的下降，传染病发生率和死亡率的下降，慢性非传染性疾病（NCD）逐渐成为危害人类健康的主要卫生问题。     

小儿左冠状动脉起源于肺动脉临床分析

目的:总结小儿左冠状动脉起源于肺动脉(ALCAPA)的临床特点,提高对ALCAPA的认识。方法:对2006年8月至2008年12月期间我院心脏中心门诊以"心内膜弹力纤维增生症"收治但最终诊断为ALCAPA的8例患者的临床特点、检查情况进行回顾性分析。结果:8例ALCAPA的患者女性7例,男性1例。发病年龄2～10个月,平均年龄5.3个月。8例患者均表现不同程度的气促、喘息、声哑、多汗及喂养困难等心力衰竭(心衰)症状。病初均于首诊医院误诊为心内膜弹力纤维增生症。患儿心电图、心脏超声及心脏增强CT均有较为特征性的改变。结论:小儿ALCAPA病例临床常易与心内膜弹力纤维增生症混淆。对于临床诊断心内膜弹力纤维增生症的患儿应注意其心电图表现。其中符合ALCAPA心电图特点的病例,反复探查其心脏彩超并进行心脏增强CT、心脏冠状动脉造影检查有助于ALCAPA的诊断。