入院血糖水平与急诊冠状动脉介入治疗术后患者预后的相关性

目的探讨急性心肌梗死（AMI）患者血糖水平与经皮冠状动脉介入（PCI）干预后住院期间心脏不良事件的相关性。方法入选312例初发AMI患者于入院即刻测定静脉血糖,并于发病24h内行急诊PCI。根据入院即刻血糖水平分为高血糖组（血糖〉11mmol／L,44例）和血糖正常组（血糖≤11mmol／L,268例）;按是否合并糖尿病分为糖尿病组（81例）和非糖尿病组（231例）。随访患者住院期间病死率及术后180d心脏不良事件发生率。结果无论是否合并糖尿病,高血糖组住院期间病死率及PCI术后180d心脏不良事件发生率均明显高于血糖正常组（18．2％比3．0％,P〈0．001;25％比12．7％,P=0．047）,多因素分析显示入院即刻血糖为死亡及心脏不良事件的独立预测因素（OR5．15,95％CI 1．74～15．28,P=0．003及OR 2．84,95％CI 1．18～6．83,P=0．019）,而是否合并糖尿病对上述终点无明显影响。结论无论是否合并糖尿病,入院即刻高血糖是AMI患者PCI术后住院期间病死率和180d心脏不良事件的相对独立危险因素。     

急性心肌梗塞经桡动脉冠状动脉介入治疗远期疗效

目的：探讨急性心肌梗塞（AMI）后延迟经桡动脉冠状动脉腔内成形术及支架术治疗的远期疗效。方法：133例AMI患者被分为经皮冠状动脉介入治疗组（PCI组）和非PCI组,PCI组于发病后平均13d行PCI术。随访两组患者的心脏事件发生率。结果：随访期间,与非PCI组相比,PCI组患者主要不良心血管事件发生率明显降低（80％比27．3％,P〈0．05）,左室射血分数明显提高[（42±6．9）％比（57．4±3．5）％,P〈0．05]。结论：急性心肌梗塞后延迟冠状动脉介入治疗可减少患者的心脏事件发生。     

延迟PCI与直接PCI治疗急性心肌梗死的比较

目的　探讨经皮延迟冠脉介入 (PCI)与直接PCI在治疗急性心肌梗死 (AMI)疗效的差异。方法　 14 5例连续行PCI的AMI患者分为直接PCI组 (75例 )和延迟PCI组 (70例 ) ,分析两组患者一般临床特征及心血管事件的发生率。结果　住院期间两组患者各项心脏事件均无显著差异。平均随访 (12 1± 4 5 )个月时 ,直接PCI组患者在不稳定性心绞痛 (9 3%vs 32 9% ,P <0 0 1)、非致死性心衰 (4 0 %vs14 3% ,P <0 0 5 )、死亡 (0vs 7 1% ,P <0 0 5 )及复合终点事件 (12 %vs 4 0 % ,P <0 0 1)方面较延迟PCI组明显降低。但两组间在非致死性再次心肌梗死、缺血性靶血管重建及总的心脏性死亡率无显著差异。近期内LVEF值延迟PCI组较直接PCI组显著降低 (0 5 8± 0 14vs 0 6 3± 0 10 ,P <0 0 5 )。结论　与直接PCI相比 ,延迟PCI治疗AMI近期内同样安全有效 ,1年死亡率无显著降低 ,但不稳定性心绞痛、非致死性心衰、死亡及复合终点事件发生率增加。     

急性心肌梗死急诊介入治疗与静脉溶栓后急诊介入治疗的比较研究

目的　探讨联合应用尿激酶静脉溶栓与急诊介入疗法治疗急性心肌梗死 (AMI)的有效性和安全性。方法　 5 2例发病≤ 12h的首次AMI患者随机分为溶栓 +经皮冠状动脉介入治疗 (PCI)组 (2 6例 )和直接PCI组 (2 6例 ) ,对两组患者介入治疗前梗死相关血管 (IRA)通畅率、介入治疗成功率、出血并发症发生率、住院期间急性缺血事件发生率及出院前左心室功能 (LVEF)进行比较。结果　介入治疗前溶栓 +PCI组IRA通畅率 (6 1 5 %)显著高于直接PCI组 (19 2 %) (P <0 0 5 ) ,两组介入治疗成功率均为 10 0 %,其中TIMIⅢ级血流者分别为 96 2 %和 91 5 %(P >0 0 5 ) ;住院期间两组均无严重出血及急性缺血事件发生 ,出院前经超声心动图测得LVEF在溶栓 +PCI组为 (6 4 3± 5 6 ) %,明显高于直接PCI组 (5 4 8± 4 9) %(P <0 0 1)。结论　尿激酶静脉溶栓联合急诊介入疗法治疗AMI早期再通率高 ,更有利于保护左室功能 ,不增加出血并发症。     

高龄急性心肌梗死患者介入治疗的临床分析

目的：对比介入治疗与保守治疗高龄老年（≥75岁）急性心肌梗死（AMI）患者的近期及中期临床疗效。方法：回顾性分析62例高龄AMI患者住院期间的临床资料。分为冠脉介入（PCI）治疗组30例和保守治疗组32例，对比观察梗死后死亡率、心肌酶学、心功能、心室重构及心律失常情况．结果：统计分析显示：和保守治疗组比较，介入治疗组病死率，心绞痛发生率，夜间阵发性呼吸困难发生率，平均住院时间，左房扩大率，左室扩大率，室壁瘤形成率，室上性及室性心律失常发生率显著减少，左室射血分数明显增加，P均〈0．05。结论：介入治疗可有效地治疗高龄AMI患者，保护心室功能，减少合并症，降低死亡率。     

急性心肌梗死PCI术后非勺型心率与预后

目的探讨夜间非勺型心率与急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后发生不良心脏事件(MACE)的关系。方法根据24h动态心电监测结果将PCI术后的AMI患者分为夜间非勺型心率组(A组)及夜间勺型心率组(B组)。比较两组患者随访期间主要不良心脏事件(MACE)和再次住院率。结果 A组患者的MACE、心源性死亡、靶血管再次血运重建和再次住院率分别为27.4%、8.1%、14.5%、23.4%,均明显高于B组(p0.05),但两组的非致死性心肌梗死发生率无显著性差异(4.8%vs 1.2%,p=0.123)。结论夜间非勺型心率有助于早期识别AMI患者PCI术后发生心脏不良事件的高危人群。     

80岁以上急性心肌梗死患者的急诊冠状动脉介入治疗

目的　评价高龄 (≥ 80岁 )急性心肌梗死 (AMI)患者急诊冠状动脉介入治疗 (PCI)的安全性和近、中期疗效。方法　 1999年 9月至 2 0 0 3年 10月收治的行急诊PCI(<12h)的AMI患者中≥80岁的 2 1例 (高龄组 )和 <6 0岁的 37例 (年轻组 ) ,分析两组基础资料特征、即刻手术成功率和随访期间主要不良心血管事件 (复发性心绞痛、心肌梗死及猝死 )发生率的差异。结果　高龄组心力衰竭及多支病变比例高于年轻组 (分别为 71%vs 16 %和 81%vs35 % ,P均 <0 0 5 ) ,高龄组入院至梗死相关动脉开通时间长于年轻组 [(6 3 6± 17 0 )minvs (5 5 3± 13 0 )min ,P <0 0 5 ]。两组患者急诊PCI成功率均为 10 0 %。住院期间死亡高龄组 2例 ,年轻组 0例。随访 4个月至 4年 ,高龄组发生心绞痛 3例、心肌梗死 2例、猝死 0例 (共占 2 4 % ) ;年轻组发生心绞痛 3例、心肌梗死 0例、猝死 0例 (总计 8% ,P <0 0 5 )。结论　高龄AMI患者急诊PCI成功率高 ,入院至梗死相关动脉开通时间延长 ,围手术期死亡和近、中期主要不良心血管事件发生率较高。     

急性心肌梗死患者二尖瓣返流与心血管事件发生率的相关性

目的研究急性心肌梗死(AMI)患者合并二尖瓣返流(MR)与心力衰竭等严重并发症和死亡率的相关性。方法选取109例AMI患者,住院期间行超声心动检查观察二尖瓣返流情况,测定左心室射血分数(LVEF)、左室舒张末期内径、左房内径,并观察心力衰竭和主要心脏不良事件发生率、住院心源性病死率。结果MR的发生率为46.8%,左室舒张末期内径、左房内径均显著高于非MR组(P<0.01),LVEF显著低于非MR组(P<0.01)。心功能不全(Killip分级Ⅱ～Ⅲ级)、主要心脏不良事件发生率MR组显著高于非MR组(P<0.01)。全部心源性病死率MR组高于非MR组(P<0.05)。结论AMI后合并MR者,心功能差,心力衰竭和主要心脏不良事件发生率高,住院心源性病死率高。     

急性心肌梗死静脉溶栓后延迟经皮冠状动脉介入术的疗效观察

目的 :评价急性心肌梗死 (AMI)患者经静脉溶栓治疗后 1个月内行延迟经皮冠状动脉介入治疗 (PCI)术的疗效。方法 :16 2例AMI患者早期均经静脉溶栓治疗 ,其中 98例行延迟PCI术 (住院 10～18d执行 ) ,6 4例未行延迟PCI术。比较 2组患者住院期间心力衰竭、心肌梗死后心绞痛、再次心肌梗死、死亡等心血管事件的发生率。结果 :行延迟PCI术组患者与非PCI组患者比较 ,其 30d心力衰竭发生率 (1 98vs 8 /6 4 ,P =0 . 0 33)降低明显 ,联合心血管事件发生率 (3/ 98vs 9/ 6 4 ,P =0 . 0 38)显著降低。结论 :AMI患者在接受静脉溶栓治疗后 1个月内 ,进行延迟PCI术较非PCI术治疗的患者能更好地降低心血管事件发生率 ,改善预后。     

高龄急性心肌梗死患者相关因素分析

目的:探讨高龄急性心肌梗死(AMI)患者临床特点、治疗手段及影响预后的相关因素。方法:AMI患者共119例,分为高龄组(年龄>80岁)和非高龄组(<70岁),分析2组患者的性别、危险因素、梗死部位、临床经过、不同的治疗手段及并发症,比较住院期间不良心脏事件发生率。结果:高龄组患者AMI无症状者14例(22.9%),2个部位以上梗塞19例(31.1%),接受介入治疗2例(3.3%),并发症多,病死率16.3%,以上结果均与非高龄组有明显差异(P<0.01)。结论:高龄AMI患者危险因素多,发病时症状不典型、治疗时矛盾多、并发症多及病死率高。临床上应能因人而异,以平衡的原则选择合适治疗方案,密切观察病情变化,加强护理,及早发现并恰当处理并发症,力争降低病死率。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.