FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

Circulatory and extracirculatory effects of angiotensin-converting enzyme inhibition.

The antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors cannot be fully explained by their actions on the circulating renin-angiotensin system (RAS). Agents such as captopril or enalapril maintain efficacy during long-term therapy even when plasma concentrations of converting enzyme or angiotensin II are not fully suppressed. Components of the entire RAS exist at several sites, thereby making it possible for drugs to produce effects at extracirculatory locations. An ACE inhibitor such as quinapril that has a comparatively short plasma concentration half-life binds strongly to plasma ACE as well as to ACE in key tissues including artery wall, heart, and kidney. The effects of ACE inhibition on the tissue RAS are of potential importance in fully explaining the blood pressure-lowering effects of these drugs. ACE inhibitors might also reduce blood pressure by blocking nonhemodynamic actions of angiotensin II. They affect vascular properties by increasing compliance of arteries and they act on baroreceptors and central regulatory mechanisms. Furthermore, ACE inhibitors affect other neuroendocrine systems, including aldosterone, kinins, and prostaglandins; attenuation of sympathetic activity can contribute further to their antihypertensive properties. Actions independent of circulating renin effects do not necessarily require plasma ACE inhibition throughout a 24-hour period. Sustained antihypertensive effects by drugs with short durations of plasma ACE inhibition give credibility to therapeutic targets beyond the circulating RAS.     

Comparison of a Chronotherapeutically Administered β Blocker vs. a Traditionally Administered β Blocker in Patients With Hypertension

Increasing systolic blood pressure and heart rate during the early morning results in increased myocardial oxygen demand. The use of β blockers during this period may decrease cardiac workload, particularly in β-blocker sensitive patients. The impact of a new chronotherapeutic β blocker was assessed in 44 hypertensive patients. Patients were randomized to delayed-release propranolol (INP) dosed at 10 p.m. or to traditionally dosed propranolol (ILA) dosed at 8 a.m. for 4 weeks, following which they were switched to the alternative formulation for 4 weeks. Thirty-four-hour ambulatory blood pressure monitoring and pharmacokinetic measurements were obtained. INP and ILA resulted in significant reductions in mean 24-hour blood pressure (−9.01-6.9 mm Hg and −10.41-7.7 mm Hg, respectively). The top 25% of responders to highdose propranolol (sensitive patients) were compared on each formulation. Mean trough reductions were −8.0/-6.7 mm Hg and −7.61-5.8 mm Hg, respectively. Mean blood pressure reductions in the β-blocker sensitive patients (n=11) between 6 a.m. and noon were −15.2/-11.9 mm Hg on INP and -8.0/-4.6 mm Hg on ILA. Heart rate reduction was −14.1 bpm and double product reduction was −3319 in the INP patients between 6 a.m. and 12 noon compared with −10.5 and −2209 in the ILA patients. This study suggests that INP and ILA are effective once-a-day β blockers, but the use of delayed-release propanolol results in a greater reduction in double product between 6 a.m. and noon in β-blocker sensitive patients than does traditionally dosed propranolol.     

肌病肾病代谢综合征治疗进展

肌病肾病代谢综合征是急性动脉阻塞致骨骼肌溶解的严重并发症。积极治疗原发病，及早补液扩容、碱化尿液、早期血液净化治疗是降低截肢率、病死率的关键。本文就肌病肾病代谢综合征治疗进展作一综述。     

单独肝尾状叶血管瘤切除术

肝尾状叶由于解剖位置特殊,位置深,难以显露,手术难度大,是肝脏外科领域手术操作的难点与研究热点.随着肝血流控制技术的发展、肝实质离断技术的提高,肝尾状叶肿瘤切除率明显提高[1].2006年4月至2008年10月,我科完成单独肝尾状叶血管瘤切除术9例,现将手术技巧与疗效报道如下.     

Vascular networks of the nucleus lentiformis

Summary The nucleus lentiformis vascular networks were studied in 30 brains by injecting the vascular system with gelatinous Indian ink. The nucleus lentiformis is divided into a medial part, the globus pallidus, and a lateral part, the putamen. These two parts differ completely from one another in their embryology, structure and functions. For these reasons, each part presents a specific vascular network. The putaminal network is dense and shows many similarities with the cerebral cortex vascular network; the pallidal one is simpler and less dense. These two vascular networks are located close to each other without overlapping. Their specificity may be in relation with the histological structure, with the morphogenetic evolution or with the functional activity of both nuclei to which they provide the vascularization.

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Les réseaux vascularies du noyau lenticulaire

Résumé L'étude des réseaux vasculaires du noyau lenticulaire (NL) est réalisée sur 30 cerveaux dont le système vasculaire a été injecté à l'encre de Chine gélosée. Le NL est constitué par deux parties, le putamen (néostriatum) et le globus pallidus (paléo-striatum), totalement différentes sur les plans morphologique, embryologique et fonctionnel. Chacune de ces parties possède un réseau vasculaire spécifique et caractéristique. Les deux réseaux se côtoient sans se chevaucher. Le réseau vasculaire putaminal est dense et présente de nombreuses similitudes avec le réseau vasculaire du cortex cérébral. Le réseau vasculaire pallidal se caractérise par sa simplicité et sa moindre densité. Leur spécificité peut être en rapport avec la structure histologique, l'évolution morphogénétique et avec l'activité fonctionnelle des noyaux dont ils assurent l'irrigation.

     

L1 knockout mice show dilated ventricles, vermis hypoplasia and impaired exploration patterns

L1 is a neural cell adhesion molecule mainly involved in axon guidance and neuronal migration during brain development. Mutations in the human L1 gene give rise to a complex clinical picture, with mental retardation, neurologic abnormalities and a variable degree of hydrocephalus. Recently, a transgenic mouse model with a targeted null mutation in the L1 gene was generated. These knockout (KO) mice show hypoplasia of the corticospinal tract. Here we have performed further studies of these KO mice including magnetic resonance imaging of the brain, neuropathological analysis and behavioral testing. The ventricular system was shown to be abnormal with dilatation of the lateral ventricles and the 4th ventricle, and an altered shape of the Sylvius aqueduct. Additionally, the cerebellar vermis of the KO mice is hypoplastic. Their exploratory behavior is characterized by stereotype peripheral circling reminiscent of that of rodents with induced cerebellar lesions.      

咪唑斯汀治疗慢性荨麻疹临床疗效评价及对血清IL-4水平的影响

目的：评价咪唑斯汀治疗慢性荨麻疹的疗效，探讨IL-4在慢性荨麻疹发病中的作用。方法：对32例慢性荨麻疹患用咪唑斯汀治疗，评价疗效，记录不良反应。同时用ELISA法检测慢性荨麻疹患治疗前后及正常人血清IL-4的水平。结果：治疗1、2wk后总有效率分别为62．5％、84．4％(P＜0．01)，不良反应3例。治疗前血清IL-4水平较正常人明显升高(P＜0．01)；治疗后IL-4水平下降(P＜0．01)，与正常人比较差异不甚明显(P＞0．05)。结论：咪唑斯汀是一种有效、安全的治疗慢性荨麻疹的药物，能降低慢性荨麻疹患血清IL-4的水平。     

青藏高原鼠疫耶尔森菌基因型分布

目的研究青藏高原鼠疫耶尔森菌（鼠疫菌）基因组型分布特征.方法对分离到的青藏高原鼠疫菌297株,根据已经证实的22个差异区段设计引物,每株鼠疫菌的每个基因差异区段都采用PCR技术进行验证.结果在喜马拉雅旱獭鼠疫自然疫源地中,鼠疫菌基因组型有9种,分别为1、5、6、7、8、10、11、新基因组型和Ype-ancestor型,其中以5、8和10型为主,3种基因组型合计所占比例为80.6%（204/253）,而且不同地区鼠疫菌基因组型的分布也不一致.青藏高原青海田鼠鼠疫疫源地鼠疫菌基因组型全部为14型.结论青藏高原鼠疫菌基因组型分布具有明显的地理特征.根据基因组型的分布状况推测出了鼠疫菌在青藏高原的传播路径.     

黄芩苷、丹参酮ⅡA、三七皂苷R1对过氧化氢所致大鼠海马神经元损伤的保护作用

目的:探讨黄芩苷、丹参酮ⅡA、三七皂苷R1对过氧化氢所致的大鼠海马神经元损伤的保护作用.方法:采用新生1d SD大鼠海马神经元原代培养,以H2O2(50μM)造成细胞损伤模型,将黄芩苷、丹参酮ⅡA、三七皂苷R1的高(20μg/ml)和低(0.2μg/ml)两个剂量加入到培养细胞液中.在4h时,检测细胞形态及释放出的LDH活性变化,观察到上述药物对海马神经元损伤的直接保护作用.结果:低剂量黄芩苷和三七皂苷R1与模型组比较,未见明显差异,三种组分高剂量和丹参酮ⅡA低剂量组与模型组比较,均有明显差异.结论:黄芩苷、丹参酮ⅡA、三七皂苷R1对过氧化氢所致的大鼠海马神经元损伤具有一定的保护作用.