肾上腺素联合4-苯丙酸甲酯盐酸盐改善心跳骤停动物复苏早期生存率的研究

目的 观察心肺复苏时联合应用肾上腺素和短效β1肾上腺素能受体阻滞剂--4-苯丙酸甲酯盐酸盐（Esmolol）对复苏早期生存率影响.方法 36只清洁级家兔随机,建立心肺复苏模型.并分为三组,A组：手术对照组,仅行麻醉、手术、气管插管,但不致颤;B组：单纯肾上腺素组,在复苏时使用标准剂量肾上腺素（10 μg/kg）;C组：肾上腺素＋Esmolol组,在复苏时使用肾上腺素（10 μg/kg）联合Esmolol（200 μg/kg）.记录电除颤次数、生存时间,并在致颤前15 mim,复苏后30 min、60 min、120 min、180 min及240 min采血检测心肌损伤标志物BNP和cTnT.结果 与A组比较,B、C组复苏成功后BNP、cTnT水平均明显增高（P〈0.05,P〈0.01）,其中B组升高幅度大于C组（P〈0.01）.C组电除颤次数小于B组（P〈0.05）,C组生存率显著大于B组（P〈0.05）.结论 在复苏时使用肾上腺素联合Esmolol在心肺复苏后早期对复苏后心脏有保护作用,可提高实验动物生存率.     

心肺脑复苏的前沿动态

近年循证医学证据推动着心肺脑复苏理念和方式的科学发展.国内外对心脏骤停（CA）实施的心肺脑复苏术（CPCR）进行了大量的研究和探索.2010年美国心脏协会心肺复苏和心血管急救指南（2010.AHA.CPR和ECC指南）,提出了CA首先进行胸外心脏按压和尽早电击除颤是研究的主要进展,并将之前的清理气道、人工呼吸放在次要位置.临床实践证明,在基础生命支持早期的10 min,人工呼吸环节可省略.当患者CA发生时：①即刻启动急救系统;②尽早CPR;③快速电击除颤;④有效的高级生命支持;⑤综合心肺脑监护、治疗（急救五环生存链）.心搏骤停10min内采取的主要是CPR技术,10min后应该实施综合的CPCR技术.本文对CPCR研究中的前沿问题进行分析和论述.     

米伐西醇对家兔心肺复苏后心功能影响的实验研究

目的 明确选择性α2-肾上腺素能受体激动剂米伐西醇对心肺复苏（CPR）后血流动力学和B型利钠肽（BNP）及肌钙蛋白T（cTnT）的影响,寻求防治复苏后心功能不全的有效方法.方法 18只清洁级家兔随机均分为三组,A组：生理盐水空白对照组;B组：米伐西醇组（50 μg/kg）;C组：肾上腺素组（30 μg/kg）.建立家兔心肺复苏模型,胸外按压1 min后经右房导管分别注入上述药物.按压5min后行电除颤.持续监测血流动力学指标及左室内压变化至自主循环恢复（ROSC）后240min.分别于基础,ROSC后30、60、120、180、240min时间点检测血BNP、cTnT含量.结果 ①复苏后,B组左室舒张末压（LVEDP）显著低于A组（P〈0.05）、C组（P〈0.01）,左室内压上升和下降最大速率（peak±dp/dt）,各时间段值明显高于A组（P〈0.05）、C组（P 〈0.01）;②复苏后,B组BNP、cTnT浓度明显低于A组（P〈0.05）、C组（P〈0.01）.结论 米伐西醇可改善室颤复苏后家兔血流动力学指标,降低BNP、cTnT的浓度,对复苏后心脏有保护作用.     

苄星青霉素联合头孢曲松钠治疗MSM早期梅毒疗效观察

目的:观察苄星青霉素联合头孢曲松钠治疗男男性行为人群(MSM)早期梅毒的临床疗效及血清学变化.方法:93例因男男性行为史而感染梅毒的早期梅毒患者,随机分成苄星青霉素联合头孢曲松钠治疗组(A组,46例)和苄星青霉素单一治疗组(B组,47例).结果:A组有效随访例数为42例;B组有效随访44例.1周内皮损消退率A组为89.3%(25/28),B组为64.3%(18/28).6个月TRUST阴转率,A组为57.1%(24/42),B组为25.0%(11/44),两组差异有统计学意义(χ2=10.237,P=0.003).12个月TRUST阴转率A组为92.9%(39/42),B组为66.7%(28/42),二组有统计学差异(χ2=8.924,P=0.006);18个月TRUST阴转率A组为97.6%(41/42),B组为88.1%(37/42),两组无统计学差异(χ2=2.872,P=0.090).血清固定率A组为2.4%(1/42),B组为11.9%(5/42).结论:苄星青霉素联合头孢曲松钠治疗MSM人群早期梅毒效果较单一使用苄星青霉素显著,表现在皮损消退时间快、梅毒血清阴转时间缩短,血清固定率降低.     

白芍总苷治疗寻常性银屑病的临床疗效观察

目的:观察白芍总苷治疗寻常性银屑病的疗效及不良反应.方法:采用随机对照临床试验.90例符合纳入标准的患者随机分为3组.治疗组30例及对照组60例,分别使用白芍总苷1.8 g/d加5%松馏油软膏(A组)、5%松馏油软膏加海棠合剂(B组)及单用5%松馏油软膏(C组).疗程均为6周.治疗前、后检查3组患者的血、尿、粪常规及肝、肾功能,同时观察患者的不良反应.结果:A组有效率为83.3%,B组及C组分别为86.7%、46.7%.A组和B组有效率差异无统计学意义(P > 0.05);而A、B组分别与C组比较有效率差异均有统计学意义(P < 0.05).3组的不良反应均较少.结论:白芍总苷联合5%松馏油软膏治疗寻常性银屑病疗效明显,且不良反应少,安全性高.     

亚低温疗法对复苏后家兔心肌保护作用的实验研究

目的 明确亚低温疗法对复苏后家兔心功能不全的影响.方法 通过体外致颤法建立家兔心肺复苏模型,20只健康家兔随机分为常温复苏组(A 组,n=10)与亚低温复苏组(B组,n=10).常温复苏组在常温状态下行标准心肺复苏,整个实验过程中家兔体温维持在正常体温38.3℃～39.2℃;亚低温复苏组在常温下行标准心肺复苏至自主循环恢复(ROSC)后快速诱导亚低温,亚低温诱导采用从家兔耳缘静脉以1.0 ml/(kg·min)速度泵入4.0℃生理盐水,同时配合体表降温方法,约10～15 min 后降至目标温度32℃～34℃.动态观察左室舒张末压(LVEDP)、左室内压上升和下降最大速率(±dp/dt max)以及血清心型脂肪酸结合蛋白(H-FABP)浓度变化.结果 ①与致颤前相比,两组LVEDP值在复苏后各时间点均有不同程度升高,±dp/dt max值均有不同程度降低(均P<0.01),但B组LVEDP升高幅度及±dp/dt max下降幅度均小于A组(均P <0.05);②与致颤前比较,两组血清H-FABP值在复苏后各时间点明显上升(均P <0.01),但B组H-FABP值升高幅度明显小于A组(均P<0.05).结论 亚低温治疗能够减轻复苏后心肌损伤,改善家兔复苏后心功能不全,具有复苏后心肌保护作用.     

雌二醇对黑素细胞Wnt5A、ROR2及β-catenin表达的影响

目的:明确雌二醇对体外培养的黑素细胞非经典Wnt5A/ROR2通路中Wnt5A、ROR2及β-catenin表达的影响.方法:将体外黑素细胞随机分为2组(n=6):DMEM培养液组(A组)和50 nM雌二醇组(B组).孵育6h后采用Western blotting检测Wnt5A、ROR2及α-catenin的表达.结果:与A组相比,B组Wnt5A及ROR2的表达均明显上调(P＜0.05),而α-catenin的表达无显著性差异(P＞0.05).结论:雌二醇诱导黄褐斑形成可能与激活非经典Wnt5A/ROR2通路有关.     

不同剂量氮(艹卓)斯汀及联合西咪替丁治疗慢性荨麻疹疗效观察

目的:对比不同剂量氮(艹卓)斯汀及联合西咪替丁治疗慢性荨麻疹的疗效及不良反应.方法:采用随机人组开放观察同样疗程不同剂量氮(艹卓)斯汀(A、B两组)及联合西咪替丁(B c组)治疗慢性荨麻疹的疗效及不良反应.A组患者采用氮(艹卓)斯汀4mg/d治疗:B组患者采用氮(艹卓)斯汀2 mg/d治疗;B C组患者采用氮(艹卓)斯汀2 mg/d联合西咪替丁400 mg/d治疗.3组胄者均在28 d时观察疗效及不良反应.结果:A组显效27例(81.8%),良效4例(12.1%),微效2例(6.1%);B组显效21例(61.8%),良效6例(17.6%).微效7例(2.06%);B C组显效26例(78.8%),良效3例(9.1%),微效4例(12.1%).A组出现口干1例,困倦2例;B组出现口干3例,头昏、困倦1例;B C组出现困倦3例,口干1例.均不影响疗效.结论:A组及B C组患者的疗效相似,且高于B组,差异有统计学意义(P<0.05).     

5%咪喹莫特乳膏治疗复发性尖锐湿疣临床观察

目的:观察5%咪喹莫特乳膏治疗复发性尖锐湿疣的疗效和复发率.方法:将120例患者随机分成A、B两组,A组仅用CO2激光去除全部皮损,B组去除全部皮损后外用5%咪喹莫特乳膏.记录疣体的复发情况,评价治疗的有效率.结果:治疗组(B组)的治愈率60%,复发率40%;对照组(A组)治愈率25%,复发率75%.B组复发率低于A组(P＜0.05),且B组有效率明显高于A组(P＜0.05).结论:5%咪喹莫特乳膏治疗复发性尖锐湿疣能明显降低复发率,提高治愈率.     

重组人促红素对家兔心肺复苏后早期心脏功能影响的实验研究

目的通过观察心肺复苏后家兔血流动力学和心肌细胞凋亡的改变,探讨重组人促红素（rhEPO）对复苏后心功能的影响及可能机制。方法采用休外致颤法建立家兔心肺复苏模型,18只家兔随机分为3组：手术对照组（A组）：仅麻醉、手术、气管插管,但不致颤;肾上腺素组（B组）：复苏时使用标准剂量肾上腺素（30μg／kg）;肾上腺素＋rhEPO组（C组）：在B组基础上,自主循环恢复（ROSC）后给予rhEPO（5000IU／kg）。动态记录室颤前,ROSC即刻、15min、30min、60min和120min的左室舒张末压（LVEDP）、左室内压上升和下降最大速率（peak±dp／dt）,实验后处死家兔,观察各组心肌凋亡及凋亡诱导因子（AIF）表达,同时观察心肌趟微结构。结果①与A组比较,B、C两组复苏成功后LVEDP明显增高（P〈0．05或P〈0．01）,复苏后60min,两组LVEDP呈下降趋势,C组虽较B组明碌,但直到120min时差异有显著性（P=0．003）;②与A组比较,B、C曲组复苏成功后peak±dp／dt均呈下降趋势（P〈0．05或P〈0．01）,但复苏后60min,C组出现回升,且持续副120min时,差异显著（P=0．009）;③电镜观察显示B、C两组均见心肌细胞肿胀,线粒体及肌丝等超微结构损伤,尤以B组显著。结论rhEPO可改善复苏后心功能障碍,对复苏后心脏有保护作用,其机制可能与降低AIF表达,抑制细胞捌亡有关。     

Off-label use of biologic agents in the treatment of dermatosis, part 2: etanercept, efalizumab, alefacept, rituximab, daclizumab, basiliximab, omalizumab, and cetuximab

In recent years, a series of new drugs have been developed through the application of molecular biology. These drugs act by blocking specific molecules of the immune system and have been developed to act on specific targets that play an important role in the pathophysiology of the diseases in which their therapeutic use has now been approved. Over time, experience has been accumulated in the use of these drugs in the treatment of skin diseases for which they have not been approved but in which the pathophysiology suggests that they could also be effective. The use of these drugs is increasing in difficult-to-treat cases of skin diseases for which the drugs are not approved. The second part of this review of off-label use of biologic agents in dermatology considers the use of etanercept, efalizumab, alefacept, rituximab, basiliximab, omalizumab, and cetuximab.     

Treatment of Paracoccidioidomycosis, Candidiasis, Chromomycosis, Lobomycosis, and Mycetoma with Ketoconazole

ABSTRACT: The authors present the use of ketoconazole in 27 cases of paracoccidioidomycosis, eight of mycetoma, seven of chromomycosis. four of systemic candidiasis and one of lobomycosis. The drug was administered orally in a dosage of 200 to 400 mg per day within a period of up to 90 days. The results of the treatment for paracoccidioidomycosis were of cicatrization of the cutaneous lesions in three to four weeks in 24 patients and in two, from six to seven weeks. Out of 27 patients, 14 presented pulmonary lesions. The evolution within a 90-day period showed radiological cure in one case, improvement in seven, and unaltered picture in five patients. In one there was no further control. In the three out of four cases of candidiasis there was clinical and mycological cure and in one case marked improvement. In seven cases of chromomycosis there was marked improvement in two moderate in four, and slight in one case. There was slight improvement in one case of lobomycosis, and in eight cases of mycetoma moderate improvement in three, slight in three and none in two, but the mycological examinations wore still positive. The drug tolerance was excellent.     

Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up

Vitiligo is an acquired pigmentary disorder of unknown etiology that is clinically characterized by the development of white macules related to the selective loss of melanocytes. The prevalence of the disease is around 1% in the United States and in Europe, but ranges from less than 0.1% to greater than 8% worldwide. A recorded predominance of women may reflect their greater willingness to express concern about cosmetically relevant issues. Half of all patients develop the disease before 20 years of age. Onset at an advanced age occurs but is unusual, and should raise concerns about associated diseases, such as thyroid dysfunction, rheumatoid arthritis, diabetes mellitus, and alopecia areata. Generalized vitiligo is the most common clinical presentation and often involves the face and acral regions. The course of the disease is unpredictable and the response to treatment varies. Depigmentation may be the source of severe psychological distress, diminished quality of life, and increased risk of psychiatric morbidity. Part I of this two-part series describes the clinical presentation, histopathologic findings, and various hypotheses for the pathogenesis of vitiligo based on past and current research.     

Association of auxotypes of Neisseria gonorrhoeae and susceptibility to penicillin G, spectinomycin, tetracycline, cefaclor, cefoxitin, and moxalactam

Isolates of Neisseria gonorrhoeae from 304 patients attending a venereal disease clinic were examined by a plate dilution method for their susceptibility to six antibiotics: penicillin G, spectinomycin, tetracycline, cefaclor, cefoxitin, and moxalactam. The isolates were also characterized by gonococcal auxotyping. The most frequent auxotypes were Nonrequiring, 58%; Pro-, 14%; Pro- Arg (Orn*) Ura-, 14%; Arg- Hyx- Ura-, 6%; and a miscellaneous group consisting of 8% of the isolates. If the entire group of isolates were examined, moxalactam was the most active of the antibiotics; 94% of the isolates were inhibited by less than or equal to 0.25 microgram/ml. The Pro- Arg (Orn*) Ura- isolates were relatively resistant to penicillin G and cefoxitin. The Arg- Hyx- Ura- group of isolates was the most susceptible of the auxotypes to all of the antibiotics except spectinomycin. The uncommon auxotype Arg (Orn*) Ura- has a requirement for arginine that is satisfied by citrulline but not by ornithine. The results of the present study indicate that the nutritional requirements of gonococci may be associated with their response to certain antibiotics.