老年社区获得性肺炎66例疗效观察

目的 观察莫西沙星治疗老年社区获得性肺炎（CAP）的疗效和安全性.方法 将66例老年CAP患者分成治疗组和对照组各33例,治疗组用莫西沙星400 mg静脉滴注,每日1次;对照组用左氧氟沙星400 mg静脉滴注,每日1次;疗程7～14天.结果 治疗组有效率占93.94%.对照组有效率占81.81%;细菌清除率分别为88.46%和80.00%,不良反应发生率分别为12.12 %和18.18%.结论 莫西沙星抗菌谱广,抗菌活性强,副作用小,治疗老年CAP安全有效.     

莫西沙星与左氧氟沙星治疗社区获得性肺炎的临床研究

目的探讨莫西沙星和左氧氟沙星治疗社区获得性肺炎的疗效。方法选择社区获得性肺炎患者120例,随机分成莫西沙星组60例和左氧氟沙星组60例,分别给予治疗7 d,运用药物经济学的成本-效果分析方法进行评价。结果莫西沙星组和左氧氟沙星组治疗有效率分别为98.33%和71.67%,细菌清除率分别为91.67和65.57%,不良反应发生率分别为8.33%和13.33%,成本-效果比分别为21.87%和10.26%。结论莫西沙星组的治疗有效率和细菌清除率明显优于左氧氟沙星组（P〈0.01）,莫西沙星治疗社区获得性肺炎在临床治疗中是优选方案。     

拜复乐治疗42例慢性阻塞性肺疾病的疗效观察

目的评价拜复乐（盐酸莫西沙星）治疗慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）感染发作期的临床疗效和用药安全性。方法应用拜复乐（盐酸莫西沙星）400mg口服，每天1次，疗程10—14天，观察拜复乐治疗效果、细菌清除率和不良反应。结果42例患者治疗总有效率95．24％，细菌清除率92．3％，不良反应发生率4．76％。结论拜复乐治疗慢性阻塞性肺疾病感染发作期具有良好的临床细菌学疗效和安全性。     

莫西沙星序贯治疗老年人社区获得性肺炎的临床研究

目的探讨莫西沙星序贯治疗老年社区获得性肺炎的临床疗效，安全性和治疗费用。方法70例老年社区获得性肺炎患者先给予莫西沙星注射液400mg／250ml静脉滴注，每天1次，治疗5～7d。临床症状改善后，随机分成序贯组和对照组。序贯组35例换予莫西沙星片剂400mg口服，每天1次。对照组35例继续使用莫西沙星注射液400mg／250ml静脉滴注，每天1次。两组总疗程14d。观察治疗效果，药物的不良反应和治疗费用。结果两组的治愈率无明显差异（P〉0．05），分别为91．43％和94．29％。序贯组的治疗费用、不良反应均明显低于对照组（P〈0．01或P〈0．05）。结论莫西沙星序贯治疗老年社区获得性肺炎疗效确切，不良反应少，并可节省医疗费用。     

口服莫西沙星治疗急性气管-支气管炎临床分析

目的研究口服莫西沙星治疗急性气管-支气管炎的临床疗效与安全性。方法164例急性气管一支气管炎患者随机分为莫西沙星治疗组和青霉素对照组,疗程均为5d,治疗前后行痰培养检查。结果治疗组与对照组临床有效率、细菌清除率分别为98．78％、100％和91．46％、96．15％,两组临床有效率差异有统计学意义（P〈0．05）,但细菌清除率差异无统计学意义（P〉0．05）。结论口服莫西沙星治疗急性气管-支气管炎效果好,可作为急性气管-支气管炎抗菌治疗优选方案。     

含莫西沙星三联疗法在老年幽门螺杆菌感染补救治疗中的疗效观察

目的观察含莫西沙星的三联疗法治疗老年初治失败的幽门螺杆菌（Hpylori）感染的临床疗效及不良反应。方法将94例经标准三联疗法治疗失败的Hpylori感染老年患者随机分成A组和B组,每组47例。A组给予口服雷贝拉唑20mg（2次／d）＋阿莫西林1g（2次／d）＋莫西沙星400mg（1次／d）;B组给予口服雷贝拉唑20mg（2次,d）＋枸橼酸铋钾300mg（4次／d）＋呋喃唑酮100mg（2次／d）＋阿莫两林ig（2次／d）。两组均治疗7d,治疗结束后4W进行”C尿素呼气检测试验。结果A、B两组的根除率（ITT）分别为91．5％和72．3％（P〈0．05）;不良反应发生率分别为8．5％和27．6％（P〈0．05）。结论莫西沙星三联疗法治疗仞治失败的老年幽门螺杆菌感染是一种有效,安全的治疗方案。     

含莫西沙星三联疗法和含左氧氟沙星三联疗法作为幽门螺杆菌感染二线治疗的比较

目的 观察含莫西沙星三联疗法和含左氧氟沙星三联疗法治疗初治失败的幽门螺杆菌（Hp）感染的临床疗效和不良反应,并比较它们的根除率.方法 将132例经标准三联疗法治疗失败的Hp感染患者随机分为A组和B组,二组均为66例.A组给予口服莫西沙星（400mg/次,1次/d）＋阿莫西林（1g/次,2次/d）＋泮托拉唑（40mg/次,2次/d）;B组给口服予左氧氟沙星（500mg/次,1次/d）＋阿莫西林（1g/次,2次/d）＋泮托拉唑（40mg/次,2次/d）.两组均治疗10d,停服质子泵及抗生素4周后行14 C-BUT或者13C-BUT试验检测Hp感染是否根治.结果 按意向治疗分析（ITT）A组和B组的Hp根除率分别为83.33％和68.18％,有显著性差异（P =0.042）;按符合方案分析（PP）A组和B组的Hp根除率分别为88.71％和72.58％,有显著性差异（P =0.023）.两组的不良反应率分别为9.1％和10.6％,无显著差异（P=0.770）.结论 含莫西沙星的三联疗法治疗初治失败的Hp感染优于含左氧氟沙星的三联疗法,是一种安全而有效的Hp根除二线方案.     

莫西沙星治疗老年社区获得性肺炎中的疗效

目的评估莫西沙星治疗老年社区获得性肺炎的有效性及其安全性。方法将2008年1月至2009年3月在我科住院的老年社区获得性肺炎分治疗组和对照组,其中治疗组随机抽取40例患者,对照组随机抽取20例患者。治疗组给予莫西沙星400 mg静脉滴注qd;对照组给予左氧氟沙星300 mg静脉滴注qd,疗程为2周。观察临床疗效及其不良反应。结果治疗组有效率87.50%,细菌清除率为82.75%,不良反应12.50%。结论莫西沙星在老年社区获得性肺炎中有效率高,不良反应少。     

莫西沙星治疗急性下呼吸道感染的临床观察

目的对60例急性下呼吸道感染患者随机分为莫西沙星组（30例）和左氧氟沙星组（30例）进行治疗。观察临床指标、细菌学、临床疗效及安全性。结果莫西沙星组总有效率为96．7％（29／30）,细菌清除率为96％;左氧氟沙星组总有效率为86．7％（26／30）,细菌清除率为80％,莫西沙星组总有效率优于左氧氟沙星组（P〈0．05）,两组细菌清除率差异无统计学意义（P〉0．05）。结论莫西沙星是耐药产生低且安全性好的氟喹诺酮类药物。     

莫西沙星治疗AECOPD 306例临床疗效观察

目的观察莫西沙星静脉注射治疗慢性阻塞性肺疾病急性加重临床疗效。方法对606例慢性阻塞性肺疾病急性加重患者，分为莫西沙星注射液400mg／d一次静脉注射的观察组和头孢曲松粉针剂2g加入5％葡萄糖注射液250ml静脉滴注1次／天，联合阿奇霉素注射液500mg静脉滴注1次／天的对照组，疗程14天后进行治疗前后两组间的比较。结果观察组与对照组临床有效率分别为90．4％和81．5％，经统计学处理差异无显著性；不良反应发生率观察组和对照组分别为9．5％和26．3％，二者有显著差异。结论莫西沙星静脉滴注治疗慢性阻塞性肺疾病急性加重具有疗效高，不良反应少，且给药方便特点。     

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.