颈部血管彩超对缺血性脑血管病患者颈部动脉血管病变的诊断价值

目的 探讨颈部血管彩超对缺血性脑血管病患者颈部动脉血管病变的诊断价值.方法 51例经头部CT或MRI及临床确诊的缺血性脑血管病患者,均进行了多层螺旋CT血管成像(CTA)和颈部血管超声(CVUS)检查,以CTA为对照,评价颈部血管彩超的诊断价值.结果 CTA和CVUS发现颈动脉狭窄及闭塞分别为20例、17例,椎动脉狭窄或发育异常分别为29例、15例.结论 对于颈动脉狭窄的评价,颈部血管彩超和CTA具有很好的一致性,但颈部血管彩超对椎动脉病变的评价不足,联合使用CVUS和CTA可以更全面地评价缺血性脑血管病患者的颈部动脉病变.     

颈部血管彩超检查在缺血性脑血管病患者中应用的临床价值分析

目的：研究分析颈部血管彩超检查在缺血性脑血管病患者中应用的临床价值。方法80例缺血性脑血管病患者，均进行多层螺旋CT血管成像检查和颈部血管彩超检查，观察对比两种方法检查的结果。结果多层螺旋CT血管成像检查方法检查出患者颈动脉狭窄及闭塞37例，椎动脉狭窄及发育异常23例，腔隙性脑梗死13例，动脉粥样硬化性斑块有15例；颈部血管彩超检查方法检查出患者颈动脉狭窄及闭塞49例，椎动脉狭窄及发育异常39例，腔隙性脑梗死28例，动脉粥样硬化性斑块26例，两种结果相比较差异具有统计学意义(P<0.05)。结论颈部血管彩超检查方法检查出的结果比多层螺旋CT血管成像检查的结果更加详细，在缺血性脑血管病的检查中发挥了重要作用，值得临床的推广和运用。     

颈部血管彩超对缺血性脑血管病颈部动脉血管病变的诊断价值

目的探讨颈部血管彩超对缺血性脑血管病颈部动脉血管病变的诊断价值。方法选取2010年11月至2011年11月期间本院收治缺血性脑血管颈部动脉血管病变患者89例设为观察组，选取同期在本院进行健康检查的健康人120例设为对照组。全部给予颈部血管彩超检查，回顾性比较分析两组患者的颈部血管彩超检查结果资料。结果观察组单纯内-中膜增厚29例，内-中膜增厚伴粥样硬化52例，管腔轻度狭窄2例，管腔中、重度狭窄3例，异常率96．63％；对照组单纯内-中膜增厚5例，内-中膜增厚伴粥样硬化3例，管腔轻度狭窄0例，管腔中、重度狭窄0例，异常率6．67％。两组在异常率上比较差异具有显著性（x2=24．13，P〈0．05）。观察组病变位置在颈动脉分又处49例，颈内动脉起始段19例，颈外动脉起始段10例，颈总动脉8例；对照组病变位置在颈动脉分叉处4例，颈内动脉起始段2例，颈外动脉起始段1例，颈总动脉1例。两组间在病变位置上差异没有显著性。结论颈部血管彩超在缺血性脑血管病颈部动脉血管病变上具有比较确切的临床诊断价值，病变高发部位是颈动脉分叉部。     

腔隙性脑梗死在颈部大动脉及眼底血管的改变

目的：探讨腔隙性脑梗死在颈部大动脉及眼底小血管的改变。方法：选取2009年9月～2010年5月神经内科收治的经头颅磁共振检查诊断符合腔隙性脑梗死（腔梗）患者64例,正常24例,均行颈动脉超声及直接检眼镜检查,两组进行对比分析。结果：64例腔梗组患者中颈动脉超声检查异常者54例,其中多发斑块形成26例,占总病例的40.6%,24例正常组患者中颈动脉超声检查异常18例,其中多发斑块形成2例,占正常组的8.3%,两组间比较差异有统计学意义（P=0.012）。64例腔梗组患者中眼底检查异常60例,其中眼底血管Ⅱ级改变36例,占总病例的56.3%,24例正常组患者中眼底检查异常6例,其中眼底血管Ⅱ级改变2例,占正常组的8.3%,两组间比较差异有统计学意义（P〈0.01）。结论：颈动脉多发斑块形成、眼底血管Ⅱ级改变与腔隙性脑梗死的发生密切相关。     

CTA和颈部血管彩超在脑梗死患者颈动脉狭窄检测中的临床价值

目的对CTA和颈部血管彩超在对脑梗死患者颈动脉狭窄进行检测的临床价值进行评价分析。方法随机抽取在2010年4月至2011年4月间我院收治的经CT或者是MRI证实为脑梗死患者48例,对其分别展开CTA、颈部血管彩超、数字减影血管造影检查,对患者的动脉狭窄检出率以及斑块检测情况进行观察,并将结果进行统计。结果将统计发现,DSA、CTA、以及CTA与彩超联合对动脉狭窄的检出率之间差异不具有显著的统计学意义(P>0.05),但三种检测方法的检出率均较彩超高,且(P<0.05)。结论采用CTA与彩超联合对动脉狭窄进行检测具有准确、无创等特点,值得临床应用。     

TCD检测脑梗死患者颅内脑动脉狭窄148例分析

目的 了解脑梗死患者颅内脑动脉狭窄或闭塞情况及其临床意义。方法对2005年1-7月在我院神经内科住院治疗的148例脑梗死患者进行TCD检测，将患者分为大面积脑梗死组（〉3cm^3）20例，小面积脑梗死组（≤3cm^3）68例，腔隙性脑梗死组（〈1．5cm^3）60例。分别在颈部、颞窗、眼窗、枕窗检测，并对所测动脉进行鉴别分析。结果大面积脑梗死组和小面积脑梗死组血管狭窄率均显著高于腔隙性脑梗死组，且大面积脑梗死组颅内动脉狭窄情况显著重于小面积脑梗死组，均具有显著的统计学意义。结论颅内脑动脉硬化狭窄程度与患者病变严重程度呈正相关；TCD技术对于早期发现患者的颅内脑动脉狭窄及其二级预防具有极其重要的价值。     

血流动力学与腔隙性脑梗死80例的分析

目的依据神经影像学资料分析血流动力学与腔隙性脑梗死患者发病的相关性。方法对80例腔隙性脑梗死患者进行头颅MRI、CT、MRA和PWI检查。结果单发腔隙性脑梗死2例,多发腔隙性脑梗死78例。MRA显示颈内动脉(ICA)重度狭窄或闭塞22例,轻、中度狭窄16例。中动脉(MCA)重度狭窄或闭塞8例,轻、中度狭窄4例。ICA或MCA粥样硬化17例,正常血管8例。PWI显示ICA-MCA供血区内血流灌注异常42例。结论腔隙性脑梗死可能由大动脉狭窄或闭塞所造成的远端小动脉血流灌注减低和微栓子所致。     

16排螺旋CT颈部动脉成像对颈部动脉血管病变筛查的应用及探讨

目的探讨16排螺旋CT颈部动脉血管成像(CTA)对颈部动脉血管狭窄和闭塞筛查的临床应用。方法 28例临床资料完整的疑有颈部血管病变患者,行颈部CTA检查,图像行容积再现(VR)。最大密度投影(MIP)、多平面重组(MPR)、曲面重组(CPR)后处理,了解颈部动脉血管的正常形态走行、狭窄及闭塞情况,对颈部动脉病变进行初步筛查。结果 28例患者中2例颈部血管未见明显异常,13例单侧或双侧椎动脉狭窄畸形,10例颈部动脉硬化,2例动脉管腔软斑块形成,1例右侧颈内动脉闭塞。结论 16排螺旋CT颈部血管CTA可准确获得患者颈部血管的有效信息,对头颈部不适的患者进行初筛及病因诊断,指导临床医师选择治疗方案及评价疗效,有广泛的临床应用前景。     

经颅多普勒超声联合颈部血管彩超对缺血性脑卒中的诊断价值研究

目的 研究经颅多普勒超声联合颈部血管彩超对缺血性脑卒中的诊断价值。方法 101例疑似缺血性脑卒中患者,均进行经颅多普勒超声、颈部血管彩超诊断。比较经颅多普勒超声、颈部血管彩超单独检查与联合检查对缺血性脑卒中的检出率,分析经颅多普勒超声与颈部血管彩超的影像学表现。结果 经颅多普勒超声联合颈部血管彩超对缺血性脑卒中的检出率99.01%与经颅多普勒超声单独检测的91.09%和颈部血管彩超单独检测的93.07%比较,差异有统计学意义(P<0.05);经颅多普勒超声单独检测对缺血性脑卒中的检出率与颈部血管彩超单独检测比较,差异无统计学意义(P>0.05)。经颅多普勒超声影像学显示：患者存在颅内外动脉狭窄138处,其中检出大脑中动脉狭窄38处,前动脉狭窄12处,大脑后动脉狭窄28处,颈内动脉终末段狭窄8处,基底动脉狭窄22处,椎动脉狭窄30处。其中轻度狭窄67处、中度狭窄38处、重度狭窄21处、完全闭塞12处。颈部血管彩超影像学显示：患者存在颅外动脉狭窄146处,其中检出大脑中动脉狭窄40处,前动脉狭窄14处,大脑后动脉狭窄29处,颈内动脉终末段狭窄9处,基底动脉狭窄23处,椎动脉狭窄...     

缺血性脑血管病患者多层螺旋CT血管造影情况分析

目的根据螺旋CT血管造影(CTA)情况,探讨缺血性脑血管病患者颅内外血管粥样硬化斑块的性质、成分和动脉管腔狭窄程度与缺血性脑血管病的关系。方法选择缺血性脑血管病患者45例,经头颈部螺旋CT血管造影(CTA),分析脑动脉管腔狭窄程度及动脉粥样斑块的性质、成分。结果 45例患者中,CTA检出各种斑块(钙化斑、软斑、混合斑)33例(73.3%),22例(48.8%)有动脉狭窄,血管闭塞5例。颅外动脉狭窄最常见的部位是颈内动脉起始部,颅内动脉狭窄最常见的部位是大脑中动脉M1段。结论缺血性脑血管病患者的颅内外动脉斑块发生率均较高,动脉粥样硬化致血管狭窄前循环发生率高于后循环,Ⅲ、Ⅳ级狭窄动脉相应供血区域大多出现缺血病灶,头颈动脉多层CTA可以准确评价颅内外动脉的病变情况,对脑卒中的二级预防具有重要指导意义。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.