Losartan 在健康人体中药效学和药代学的研究

目的：探讨Losartan在体内对肾素-血管紧张素系统的影响以及国人体内losartan代谢过程，为解释其降压机理及临床合理用药提供参考；方法：以健康受试者为研究对象，采用随机、双盲给予药物和安慰剂，观察受试者血压和体内肾素的变化，以及losartan及其代谢产物在体内代谢过程。结果：血压在用药后6h内下降幅度较大，而肾素活性在8h左右升高幅度最大。以及losartan在服药后3h，药物浓度达到高峰，而其代谢产物EXP3174在服药后8h血药浓度达高峰。血浆肾素活性和EXP3174的AUC0-24成正相关。结论：losartan的降低血压与其代谢产物EXP3174作用直接相关，在降压幅度最大时，肾素的活性也达到最高点。这可能与血管紧张素系统的自身调节有关。     

Exploring the need for an occupational health service for those working in primary care

A research nurse interviewed 55 practice staff in 11 generalpractices to ascertain their views about their needs for occupationalhealth care. In a second parallel study, a specialist in occupationalmedicine undertook an in-depth audit of occupational healthprovision in five other general practices with respect to theorganization, the health and safety process, the services andthe working environment. In the first study, the majority ofpractice staff reported the need for various aspects of occupationalhealth care, particularly stress at work. In the second study,general practitioners and practice managers possessed a basicawareness of occupational health matters such as Health andSafety legislation, but their limited knowledge was not translatedinto effective management. General practice staff did not knowwhere to obtain occupational health advice; most practices hadno policies or procedures in place to manage health and safety.Both studies illustrate the need for expert occupational healthadvice in primary care.     

硅胶膜防治烧伤瘢痕增生及挛缩

1986年1988年应用硅胶膜治疗各年龄、程度不等的烧伤增生及挛缩瘢痕40例显示早期应用疗效最佳。经两年随访,显效率70％(关节功能恢复正常、瘢痕平、软),有效率20％(关节功能和瘢痕外观明显改善),无效率10％(关节功能和瘢痕外观无改变)电镜发现:经治疗的瘢痕内有大量巨噬细胞,胞内有丰富的溶酶体释出溶酶体酶。本文对硅胶膜治疗作用机理,影响疗效的因素等作了讨论。     

Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial

Context  Implantable cardioverter defibrillator (ICD) therapy with backup ventricular pacing increases survival in patients with life-threatening ventricular arrhythmias. Most currently implanted ICD devices provide dual-chamber pacing therapy. The most common comorbid cause for mortality in this population is congestive heart failure. Objective  To determine the efficacy of dual-chamber pacing compared with backup ventricular pacing in patients with standard indications for ICD implantation but without indications for antibradycardia pacing. Design  The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial, a single-blind, parallel-group, randomized clinical trial. Setting and Participants  A total of 506 patients with indications for ICD therapy were enrolled between October 2000 and September 2002 at 37 US centers. All patients had a left ventricular ejection fraction (LVEF) of 40% or less, no indication for antibradycardia pacemaker therapy, and no persistent atrial arrhythmias. Interventions  All patients had an ICD with dual-chamber, rate-responsive pacing capability implanted. Patients were randomly assigned to have the ICDs programmed to ventricular backup pacing at 40/min (VVI-40; n = 256) or dual-chamber rate-responsive pacing at 70/min (DDDR-70; n = 250). Maximal tolerated medical therapy for left ventricular dysfunction, including angiotensin-converting enzyme inhibitors and -blockers, was prescribed to all patients. Main Outcome Measure  Composite end point of time to death or first hospitalization for congestive heart failure. Results  One-year survival free of the composite end point was 83.9% for patients treated with VVI-40 compared with 73.3% for patients treated with DDDR-70 (relative hazard, 1.61; 95% confidence interval [CI], 1.06-2.44). The components of the composite end point, mortality of 6.5% for VVI-40 vs 10.1% for DDDR-70 (relative hazard, 1.61; 95% CI, 0.84-3.09) and hospitalization for congestive heart failure of 13.3% for VVI-40 vs 22.6% for DDDR-70 (relative hazard, 1.54; 95% CI, 0.97-2.46), also trended in favor of VVI-40 programming. Conclusion  For patients with standard indications for ICD therapy, no indication for cardiac pacing, and an LVEF of 40% or less, dual-chamber pacing offers no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined end point of death or hospitalization for heart failure.