氨氯地平联合阿托伐他汀钙对高血压颈动脉内膜中层厚度的影响

目的研究苯磺酸左旋氨氯地平联合应用阿托伐他汀钙对高血压患者颈动脉内膜中层厚度(IMT)的影响。方法将原发性高血压患者168例,随机分为实验组(84例)和对照组(84例),对照组使用苯磺酸左旋氨氯地平2.5mg,1次/d,2周后,血压未降至140/90mmHg(1mmHg=0.133kPa)以下者,增加剂量至5mg(2.5mg/次,2次/d),实验组在对照组基础上,加用阿托伐他汀钙10mg,1次/晚,治疗12个月,比较两组IMT、血压、空服血糖及血脂水平。结果实验组治疗12个月后,颈动脉IMT、收缩压、舒张压、TG、TC、LDL-C均显著降低,治疗后的IMT(0.76±0.07)mm,与治疗前(0.95±0.07)mm及对照组治疗前后的(0.97±0.05)mm、(0.84±0.06)mm比较,差异均有统计学意义(P<0.05)。两组间血糖、心率比较差异无统计学意义。结论高血压患者苯磺酸左旋氨氯地平联合阿托伐他汀钙治疗能更好的延缓颈动脉IMT进展。     

原发性高血压患者循环中的心钠素

受试者有:A组43例原发性高血压(收缩压≥160mmHg和/或舒张压≥95mmHg),B组16例临界高血压,C组17例正常血压(≤140/90mmHg)。A组各例均无心力衰竭、肾功能衰竭或代谢疾病;试验前从未服用降压药物或者试验前至少2周降压药物已从体内清除;其中4例因高血压急症而入院。(A、B和C)三组的年龄(53±9、49±11和48±10岁)、性别(男性56.8％、50.0％和52.0％)和血清肌酐浓度(1.0±0.3、0.9±0.3和0.9±0.3mg/dl)均无显著差别。三组平均动脉压分别为127.0±18.2、109.6±3.7和94.1±7.1mmHg;血浆心钠素水平     

伊贝沙坦对原发性高血压患者血浆内皮素及循环内皮细胞的影响

目的观察血管紧张素Ⅱ受体拮抗剂伊贝沙坦治疗原发性高血压患者对血浆内皮素1(ET-1)及循环内皮细胞(CECs)的影响。方法入选50例1~2级原发性高血压患者,经2周安慰剂洗脱期后,给予伊贝沙坦150mg/d,治疗4周,如血压得到控制(收缩压<140mmHg和舒张压<90mmHg),继续原剂量治疗4周;如血压未得到控制[收缩压≥140mmHg和(或)舒张压≥90mmHg],将药物剂量加倍继续治疗4周,观察血浆ET-1、CECs及血压的变化。结果50例患者均完成试验,口服伊贝沙坦2周末血压明显下降[治疗前:(154.0±12.8/96.3±2.0)mmHgvs治疗后(130.4±10.8/84.5±9.5)mmHg,P<0.01],治疗2、4、6、8周末血压间无明显差异;与治疗前比较,治疗后血浆ET-1和CECs显著下降[ET-1:治疗前(37.5±9.5)vs治疗后(29.7±12.1)ng/L,P<0.01;CECs:治疗前(6.7±3.6)vs治疗后(4.4±2.8)106cells/L,P<0.01]。结论对于轻中度原发性高血压患者,伊贝沙坦有效降压的同时改善血管内皮功能。     

厄贝沙坦与科素亚治疗轻中度原发性高血压的疗交对比

目的评价厄贝沙坦治疗轻中度原发性高血压的疗效和不良反应.方法采用随机双盲法将50例轻中度原发性高血压患者分为厄贝沙坦组和科素亚组,分别接受厄贝沙坦150mg/d或科素亚50mg/d,4周后若舒张压≥90mmHg,接受厄贝沙坦300mg/d或科素亚100g/d.治疗前后测量坐位血压,记录所有不良反应.结果厄贝沙坦与科素亚均能有效降低血压,治疗总有效率分别为85.6%和82.6%(P＞0.05),两组降压程度无统计学意义(14.1±7.2mmHg对15.9±9.4mmHg,P＞0.05).厄贝沙坦组具有良好的耐受性.结论厄贝沙坦(150～300mg,每日一次)是治疗轻中度原发性高血压的安全有效药物.     

高血压病降压疗效和达标率的性别差异探讨

目的探讨高血压控制的性别差异。方法本文收集了近3年在我院就诊的高血压并进行正规降压治疗的患者,共376例,其中男203例,女173例,分析每位患者诊室血压值,以及24小时的变化血压值(24小时的平均测量值),以及一般资料。结果16.8%的女性患者和13.9%的男性患者的诊室血压值(<140/90mmHg)和动态血压值(<130/80mmHg)均得到控制。女性患者隐匿性高血压比率(诊室血压值<140/90 mm Hg和动态血压值≥130/80mmHg)比男性的要低。女性白大衣高血压比率(办公室血压值≥140/90mmHg和动态血压值<130/80mmHg)比男性的高。男性和女性的诊室血压达标率(<140/90mmHg)相似,但是女性的动态血压达标率比男性要高。结论女性动态血压的控制达标率高于男性,可能是由于女性患者更容易发生白大衣高血压之故。     

长期服用氨氯地平对老年高血压患者颈动脉内膜-中层厚度及血管内皮依赖性舒张功能的影响

目的探讨氨氯地平对老年高血压患者粥样硬化动脉形态及功能的影响。方法以彩色多普勒超声检测76例高血压患者颈动脉内膜中层厚度(IMT),并按照IMT的厚度将76例分为3组,分别为x+1s组(C组,20例,男13例,女7例)。治疗前A、B、C3组的颈动脉IMT值分别为(1.03±0.06)mm、(1.24±0.06)mm、(1.34±0.01)mm。连续服用氨氯地平36个月后检测颈动脉IMT和未受干预状态下、肱动脉反应性充血时以及含服硝酸甘油后颈动脉内径,与治疗前进行比较。结果使用氨氯地平或加用利尿剂8周后血压能控制在140/90mmHg以下且保持平稳。治疗36个月后,3组的颈动脉IMT分别为(0.93±0.05)mm、(1.07±0.13)mm、(1.18±0.26)mm,各组治疗前后比较,差异有统计学意义(均为P<0.01),A组IMT恢复达正常,B组IMT值接近正常。A、B、C3组治疗前肱动脉反应性充血时颈动脉内径的变化率分别为(6.81±2.13)%、(6.07±2.07)%、(5.84±1.19)%,治疗后分别为(24.65±6.92)%、(20.71±4.36)%、(13.82±3.65)%,各组治疗后均明显升高,差异有统计学意义(均为P<0.01),A组疗效优于B组(P<0.05)及C组(P<0.01),B组疗效优于C组(P<0.01),含服硝酸甘油后颈动脉内径在治疗前后无显著变化。结论钙拮抗剂氨     

原发性高血压患者动态脉压与靶器官损害的相关性研究

目的　探讨原发性高血压患者动态脉压(PP)与靶器官损害之间的关系。方法　对 181例原发性高血压患者(年龄>60岁)行动态血压监测,按动态脉压不同分为脉压<50mmHg组 (PP1)93例和脉压≥50mmHg组(PP2)88例。对所有患者均做超声心动图、颈动脉超声、冠状动 脉造影检查,比较不同组间的检查结果,并进行统计学分析。结果　脉压≥50mmHg组与脉压< 50mmHg组比较,颈动脉内膜厚度[(1.02±0.23)mm比(0.92±0.17)mm]、颈动脉斑块积分指数 [(9.28±2.07)比(4.36±1.57)]、颈动脉狭窄指数[(1.92±0.83)比(1.31±0.67)]、左心室舒张 末期内径[(5.02±0.44)cm比(4.67±0.41)cm]、冠状动脉狭窄指数[(1.85±0.64)比(1.26± 0.41)],差异均有显著性(P<0.001)。结论　原发性高血压患者靶器官损害程度与增大的脉压有 关,脉压是颈动脉内膜厚度与左心室肥厚的危险因素之一。     

老年高血压合并糖尿病患者血压血糖水平与颈动脉粥样硬化的相关性

该文探讨血压及血糖水平与原发性高血压合并糖尿病患者颈动脉粥样硬化的关系。方法:将>60岁且同时患有糖尿病和原发性高血压的患者670例,按照其收缩压及糖化血红蛋白(hemoglobin A1c,HbA1c)水平进行分组。将患者根据收缩压分为血压(<130mm Hg)严格控制组,血压(130～139mm Hg)一般控制组,血压(≥140mm Hg)未控制组;根据其HbA1c水平分为血糖严格控制组(HbA1c<6.5%),血糖一般控制组(HbA1c6.5%～7.5%),血糖未控制     

高血压诊断评估

1 高血压诊断的确立中国高血压防治指南2011版(以下简称新指南)规定:在未使用降压药物的情况下,非同日3次测量血压,收缩压≥140 mmHg和(或)舒张压≥90 mmHg,可诊断为高血压.患者既往有高血压史,目前正在使用降压药物,血压即使＜140/90mmHg,也诊断为高血压.     

新诊断2型糖尿病患者脉压与颈动脉内膜-中层厚度的关系

目的对新诊断2型糖尿病患者血压及脉压水平与颈动脉内膜-中层厚度(IMT)的关系进行分析,以期为2型糖尿病患者预防早期心脑血管疾病提供临床依据。方法对中国糖尿病并发症防治研究——CDCPSⅠ期及Ⅱ期研究中1567例新诊断2型糖尿病患者(年龄30～70岁,其中女性698例,40.9%)行B超检查测量颈动脉IMT,并通过对血压的测量,分析血压及不同脉压(PP)对颈动脉IMT的影响,同时分析内膜增厚组(IMT≥0.8 mm)与内膜正常组(IMT<0.8 mm)血压和PP水平有无差异结果(1)合并高血压组与不合并高血压组比较,颈动脉IMT显著增厚[高血压组(0.76±0.15)mm,非高血压组(0.74±0.14)mm,差异有统计学意义(P=0.0006)]。(2)直线相关分析发现,颈动脉IMT与年龄(r=0.19548)、BMI(r=0.07252)、LDL(r=0.06523)、SBP(r=0.11173)、DBP(r=0.05962)、PP(r=0.10592)显著正相关(均为P<0.05)。(3)以PP 50mm Hg为界限将患者分为两组,脉压≥50mm Hg组颈动脉IMT(0.77±0.14)mm较脉压<50mm Hg组(0.74±0.15)mm显著增厚(P=0.0006);即使在非高血压患者,脉压≥50mm Hg组的颈动脉IMT(0.75±0.14)mm较脉压<50 mm Hg组(0.73±0.14)mm也有增厚(P=0.046);在<60岁的患者脉压≥50 mm Hg组的颈动脉IMT(0.75±0.15)mm较脉压<50 mm Hg组(0.73±0.14)mm也有显著增厚(P=0.008)(4)颈动脉IMT≥0.8 mm组SBP、PP均较IMT<0.8 mm组显著升高(P值分别为0.001和0.002),而两组间DBPIMT增厚组(78 2±9.8)mm Hg,正常组(79.1±10.0)mm Hg]差异无统计学意义(P=0.075)。结论在新诊断的2型糖尿病患者,PP与颈动脉IMT的正相关性与SBP相近,而强于DBP。对于PP≥50mm Hg的患者要尽早行颈动脉超声检查测量颈动脉IMT以早期发现可能存在的亚临床动脉粥样硬化性疾病,尽早进行干预治疗。     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

Routine diagnosis of intestinal tuberculosis and Crohn’s disease in Southern India

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant pain on examination and involvement of≥3 intestinal segments were independently associated with CD with adjusted odds ratios of 10.1(95%CI:2.0-51.3)and 5.9(95%CI:1.7-20.6),respectively.CONCLUSION:Weight loss and mucosal nodularity were associated with ITB.Abdominal pain and excessive intestinal involvement were associated with CD.ITB and CD were equally common.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Second and third line treatment options for Helicobacter pylori eradication

Helicobacter pylori is a highly successful bacterium with a high global prevalence and the infection carries significant disease burden. It is also becoming increasingly difficult to eradicate and the main reason for this is growing primary antibiotic resistance rates in a world where antibiotics are frequently prescribed and readily available. Despite knowing much more about the bacterium since its discovery, such as its genomic makeup and pathogenesis, we have seen declining treatment success. Therefore, clinicians today must be prepared to face one, two or even multiple treatment failures, and should be equipped with sufficient knowledge to decide on the appropriate salvage therapy when this happens. This article discusses the factors contributing to treatment failure and reviews the second and thirdline treatment strategies that have been investigated. Established empiric second line treatment options include both bismuth based quadruple therapy and levofloxacin based triple therapy. Antibiotic testing is recommended prior to initiating third line treatment. In the event that antibiotic susceptibility testing is unavailable, third line treatment options include rifabutin, rifaximin and sitafloxacin based therapies.     

岳阳市城区小学生血吸虫病防治健康教育现状调查

目的 调查湖南省岳阳市城区小学生血吸虫病防治知识、行为现状及健康教育需求情况,为制定科学有效的小学生血吸虫病健康教育方案提供参考依据。方法 采用分层整群抽样方法,抽取岳阳市城区洞庭湖湖畔学校和中心城区学校各2所,每所再从五、六年级分别抽取2个班的学生,通过调查问卷了解小学生血吸虫病相关知识、预防行为及健康教育需求,并进行统计分析。结果 共调查湖畔小学353人、中心城区小学363人,两组学校小学生年龄、性别、年级构成差异无统计学意义（t=-0.494,χ²_性别=1.615,χ²_年级=2.152;P均>0.05）。学生血吸虫病防治知识总知晓率为42.60%（305/716）,其中,湖畔学校小学生血防知识知晓率（52.97%）高于中心城区（32.51%）,差异有统计学意义（χ²=30.661,P<0.05）;学生行为正确率为76.68%（549/716）,血防知识知晓组行为正确率（81.31%）高于不知晓组（71.24%）,差异有统计学意义（χ²=6.384,P<0.05）。学生血防知识主要来源于老师（47.49%）;91.90%的学生愿意了解更多的血防知识,最喜欢的血防知识学习方式是参加课外活动（50.42%）。结论 岳阳市城区小学生的血防知识知晓率及行为正确率偏低,对血吸虫病防治健康教育需求较高。建议针对学生开展形式多样的血防健康教育,以增强学生的血吸虫病防护意识,提高自我防护能力。