美托洛尔改善舒张功能不良性心衰疗效及QT离散度的临床研究

目的:探究在舒张功能不良性心衰治疗中应用美托洛尔的疗效及QT离散度。方法:择取2015年5月~2018年7月我院收治的70例舒张功能不良性心衰患者,随机分成对照组和研究组,对照组35例行以常规治疗,研究组35例在常规治疗基础上加行美托洛尔治疗,对两组临床效果及QT离散度进行分析和对比。结果:治疗前两组舒张压、收缩压以及心率对比无显著差异,治疗后研究组舒张压、收缩压以及心率均明显低于对照组(P<0.05);治疗前两组QT离散度对比无显著差异,治疗后研究组QT离散度明显低于对照组(P<0.05)。结论:在舒张功能不良性心衰治疗中应用美托洛尔的疗效显著,可以缩小QT离散度,临床价值显著。

中医治疗收缩功能不良性胆囊结石36例

中医治疗收缩功能不良性胆囊结石３６例云南省红十字会医院（６５００２１）鲁翠英关键词中医治疗，胆囊结石，收缩功能不良性胆囊在胆囊结石治疗中，胆囊收缩功能好坏被列为排石三要素中的首要因素，故在筛选排石时大都不选择胆囊收缩功能不良者，笔者自１９８９年以来，...

美托洛尔改善舒张功能不良性心衰疗效及QT离散度的临床研究

以舒张功能不良性心衰患者作为研究对象分析,利用美托洛尔进行治疗的临床疗效。方法:于2019年1月至2020年6月收治58例患者为研究对象,根据入院顺序先后分组,各29例,对照组采用常规抗心衰治疗,观察组采用常规抗心衰+美托洛尔。两组治疗效果比较。结果:观察组总有效率高于对照组(P<0.05)。两组治疗后QT离散度均低于治疗前,且观察组低于对照组(P<0.05)。结论:对于舒张功能不良性心衰患者的治疗,在常规抗心衰治疗药物的基础上联合美托洛尔可获得良好疗效并降低QT离散度,具有显著临床应用价值,值得推广。

视网膜变性和功能不良性疾病动物模型的研究现状

随着医学分子生物学技术的发展 ,对各种视网膜变性和功能不良性疾病发病机制的研究及疾病治疗的探索有了进一步的深入 ,实验性活体基因治疗将是未来最有希望挽救视网膜感光细胞的治疗手段 ,因而建立相应的疾病动物模型 ,有着比以往更为重要的作用 ,从遗传学、转基因技术及诱导的动物模型三方面对视网膜变性性疾病的动物模型研究作一综述。

功能不良性滤过泡结膜下分离注射干扰素α-2b疗效观察

目的 评价针刺分离联合结膜下注射干扰素α-2b治疗青光眼小梁切除术后早期功能不良性滤过泡的有效性和安全性.方法 对23例（27只眼）小梁切除术后早期发生的功能不良性滤过泡行针刺分离联合干扰素α-2b结膜下注射,随访时间6个月以上,采用Van Buskirk裂隙灯显微镜分型法和Leung前节-OCT检查法相结合评估滤过泡治疗前后的形态和功能.结果 功能不良性滤过泡的发生时间为术后（51.04±23.09）d（19～89d）.治疗前患眼眼压为（22.77±8.65）mmHg（10～45mmHg））,随访终点眼压为（16.68±3.37）mmHg（7.70～21mmHg）,两者差异有统计学意义（P=0.002）.治疗的完全成功率为66.67%（18只眼）,条件成功率为25.93%为（7只眼）,总有效率为92.6%.治疗的主要并发症为滤过泡区结膜下出血（37%）和结膜破裂（22.22%）,治疗后无明显远期并发症.结论 针刺分离联合滤过区结膜下注射干扰素α-2b是治疗功能不良性滤过泡安全有效的方法,采用AS-OCT能客观、及时评估功能不良性滤过泡的形态和功能变化.

声带良性病变发病因素的分析研究

目的了解声带良性病变发病的危险因素，探讨该病的预防措施并进行康复指导。方法对2005年8月-2006年8月在我院门诊经喉镜检查诊断为功能不良性声带病变的168例患者厦同期喉部检查正常的153例患者进行性别、年龄、职业、用嗓情况分析对照。结果调查显示患者的职业、工作环境、饮酒、用声时间、嗓音误用5个因素是致声带良性疾病的危险因素。结论为患者提供嗓音保健知识。给予细致的康复指导及护理，可以更好地预防该病的发生。

PRESENT SITUATION OF STUDY AND VIEW ON FUNCTIONAL DYSPEPSIA TREATED WITH SPECIFIC ACUPOINTS IN ACUPUNCTURE

Acupuncture plays a dominant role in treating functional dyspepsia （FD）. By reviewing and e- valuating clinical ROT and fundamental research with high quality in the past 17 years, it is found that specific acupoints are the chief in the treatment of FD; additionally, there are differences between specific acupoints and non-specific acupoints in therapeutic effect, explaining that the specificity of meridian points plays an im- portant role in treatment. However, because of inadequate high-quality researches in clinics, the specificity of acupoints can＇t be proved until the researches of clinical effect and mechanism of therapeutic difference are intensified.

Functional dyspepsia:The role of visceral hypersensitivity in its pathogenesis

Functional, or non-ulcer, dyspepsia （FD） is one of the most common reasons for referral to gastroenterologists. It is associated with significant morbidity and impaired quality of life. Many authorities believe that functional dyspepsia and irritable bowel syndrome represent part of the spectrum of the same disease process. The pathophysiology of FD remains unclear but several theories have been proposed including visceral hypersensitivity, gastric motor dysfunction, Helicobacter pylori infection and psychosocial factors. In this review, we look at the evidence, to date, for the role of visceral hypersensitivity in the aetiology of FD.

Gender differences in ghrelin, nociception genes, psychological factors and quality of life in functional dyspepsia

AIM to evaluate gender differences in the aspect of ghrelin,nociception-related genes and psychological aspects and the quality of life(Qo L) in Korean functional dyspepsia(FD) patients.METHODS Total of 191 persons were prospectively enrolled between March 2013 and May 2016 in Seoul National Bundang Hospital,and classified into control and FD group based on ROME Ⅲ criteria. Questionnaire included assessment for dyspepsia symptoms,Qo L and anxiety or depression. Preproghrelin and nociception genes in the gastric mucosa and plasma acyl/des-acyl ghrelin were measured. RESULTS Lower level of plasma acyl ghrelin in FD patients compared to control was significant only in male(15.9 fmol/m L vs 10.4 fmol/m L,P = 0.017). Significantly higher m RNA expressions of nerve growth factor and transient receptor potential vanilloid receptor 1 were observed in male(P = 0.002 and P = 0.014,respectively) than in female. In contrast,female FD patients had a higher anxiety and depression score than male FD(P = 0.029),and anxiety score was correlated with epigastric pain only in female FD patients(female: Spearman rho = 0.420,P = 0.037). The impairment of overall Qo L was more prominent in female FD patients than male patients(5.4 ± 0.3 vs 6.5 ± 0.3,P = 0.020). CONCLUSION Gender differences of ghrelin and nociception-related genes in male and psychological factors in female underlie FD symptoms. More careful assessment of psychological or emotional status is required particularly for the female FD patients.

Novel mechanisms in functional dyspepsia

Functional dyspepsia （FD） is a highly prevalent but heterogeneous disorder in which multiple pathogenetic mechanisms are involved. Although there are many studies that have investigated various pathophysiologic mechanisms, the underlying casual pathways associated with FD remain obscure. The currently proposed pathophysiologic mechanisms associated with FD include genetic susceptibility, delayed as well as accelerated gastric emptying, visceral hypersensitivity to acid or mechanical distention, impaired gastric accommodation, abnormal fundic phasic contractions, abnormal antroduodenal motility, acute and chronic infections, and psychosocial comorbidity. A greater understanding of the abnormalities underlying FD may lead to improved management. The aim of this editorial is to provide a critical overview of current pathophysiologic concepts in functional dyspepsia.

Cholecystokinin hyperresponsiveness in functional dyspepsia

Functional dyspepsia （FD） is a common disorder of yet uncertain etiology. Dyspeptic symptoms are usually meal related and suggest an association to gastrointestinal （GI） sensorimotor dysfunction. Cholecystokinin （CCK） is an established brain-gut peptide that plays an important regulatory role in gastrointestinal function. It inhibits gastric motility and emptying via a capsaicin sensitive vagal pathway. The effects on emptying are via its action on the proximal stomach and pylorus. CCK is also involved in the regulation of food intake. It is released in the gut in response to a meal and acts via vagal afferents to induce satiety. Furthermore CCK has also been shown to be involved in the pathogenesis of panic disorder, anxiety and pain. Other neurotransmitters such as serotonin and noradrenaline may be implicated with CCK in the coordination of GI activity. In addition, intravenous administration of CCK has been observed to reproduce the symptoms in FD and this effect can be blocked both by atropine and Ioxiglumide （CCK-A antagonist）. It is possible that an altered response to CCK may be responsible for the commonly observed gastric sensorimotor dysfunction, which may then be associated with the genesis of dyspeptic symptoms.

Role of cholecystokinin and central serotonergic receptors in functional dyspepsia

Symptoms of functional dyspepsia are characterized by upper abdominal discomfort or pain, early satiety, postprandial fullness, bloating, nausea and vomiting. It is a chronic disorder, with symptoms more than 3 mo per year, and no evidence of organic diseases. Dysfunctional motility, altered visceral sensation, and psychosocial factors have all been identified as major pathophysiological mechanisms. It is believed that these pathophysiological mechanisms interact to produce the observed symptoms. Dyspepsia has been categorized into three subgroups based on dominant symptoms. Dysmotility-like dyspepsia describes a subgroup of patients whose symptom complex is usually related to a gastric sensorimotor dysfunction. The brain-gut peptide cholecystokinin （CCK） and serotonin （5-HT） share certain physiological effects. Both have been shown to decrease gastric emptying and affect satiety. Furthermore the CCK induced anorexia depended on serotonergic functions probably acting via central pathways. We believe that abnormalities of central serotonergic receptors functioning together with a hyper responsiveness to CCK or their interactions may be responsible for the genesis of symptoms in functional dyspepsia （FD）.

Functional dyspepsia:Are psychosocial factors of relevance?

The pathogenesis of Functional Dyspepsia （FD） remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intdnsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to vadation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited.

Central serotonergic and noradrenergic receptors in functional dyspepsia

Functional dyspepsia is a symptom complex characterised by upper abdominal discomfort or pain, early satiety, motor abnormalities, abdominal bloating and nausea in the absence of organic disease. The central nervous system plays an important role in the conducting and processing of visceral signals. Alterations in brain processing of pain, perception and affective responses may be key factors in the pathogenesis of functional dyspepsia. Central serotonergic and noradrenergic receptor systems are involved in the processing of motor, sensory and secretory activities of the gastrointestinal tract. Visceral hypersensitivity is currently regarded as the mechanism responsible for both motor alterations and abdominal pain in functional dyspepsia. Some studies suggest that there are alterations in central serotonergic and noradrenergic systems which may partially explain some of the symptoms of functional dyspepsia. Alterations in the autonomic nervous system may be implicated in the motor abnormalities and increases in visceral sensitivity in these patients. Noradrenaline is the main neurotransmitter in the sympathetic nervous system and again alterations in the functioning of this system may lead to changes in motor function. Functional dyspepsia causes considerable burden on the patient and society. The pathophysiology of functional dyspepsia is not fully understood but alterations in central processing by the serotonergic and noradrenergic systems may provide plausible explanations for at least some of the symptoms and offer possible treatment targets for the future.

Relationship between antral distension and postprandial symptoms in functional dyspepsia

AIM: To investigate in patients with functional dyspepsia (FD) after an every-day meal whether (1) gastrointestinal (GI) and extra-GI symptoms had any relation with the degree of antral volume, (2) the onset of postprandial symptoms was associated with, and may predict, delayed gastric emptying. METHODS: In 94 symptomatic FD patients, antral volume variations and gastric emptying were assessed with ultrasonography after a 1050 kcal meal. Symptoms were evaluated with a standardized questionnaire. The association of GI and extra-GI symptoms with antral volumes and gastric emptying were estimated with logistic regression analysis. RESULTS: Forty percent of patients did not report any symptoms after a meal. Compared to the healthy controls, the antrum was more distended in patients throughout the entire observation period and 37 (39.4%) patients had delayed gastric emptying. Only postprandial drowsiness was associated with antral volume variations (AOR = 1.42; P < 0.001) and with delayed gastric emptying (AOR = 3.59; P < 0.03). CONCLUSION: In FD patients, GI symptoms are neither associated with antral distension nor with gastric emptying. Drowsiness is associated with antral distension and delayed gastric emptying. The onset of drowsiness is preceded by an increment of antral distension and the duration of the symptom appears to be related to the persistence of antral distension.

Role of Helicobacter pylori in functional dyspepsia

The aetiology of dyspepsia is unknown in the majority of patients. Helicobacter pylori （H pylon） is the cause in a subset of patients. A non invasive test to assess the presence of H pylori is recommended in the management of patients under the age of 50 presenting tO a family practitioner with dyspepsia. A urea breath test or a stool antigen test are the most reliable non invasive tests. Eradication of H pylori will reduce the risk to the patient with dyspepsia of developing a peptic ulcer, reduce the complication rate if prescribed nonsteroid anti-inflammatory drugs and later reduce the risk of gastric cancer. The recommended treatment for non ulcer dyspepsia associated with a H pylon infection should be a 10-d course of treatment with a PPI and two antibiotics. Treatment efficacy should be assessed four weeks after completing treatment with a urea breath test or a stool antigen test.

Drug treatment of functional dyspepsia

Symptomatic improvement of patients with functional dyspepsia after drug therapy is often incomplete and obtained in not more than 60% of patients. This is likely because functional dyspepsia is a heterogeneous disease. Although great advance has been achieved with the consensus definitions of the Rome I and II criteria, there are still some aspects about the definition of functional dyspepsia that require clarification. The Rome criteria explicitly recognise that epigastric pain or discomfort must be the predominant complaint in patients labelled as suffering from functional dyspepsia. However, this strict definition can create problems in the daily primary care clinical practice, where the patient with functional dyspepsia presents with multiple symptoms. Before starting drug therapy it is recommended to provide the patient with an explanation of the disease process and reassurance. A thorough physical examination and judicious use of laboratory data and endoscopy are also indicated. In general, the approach to treat patients with functional dyspepsia based on their main symptom is practical and effective. Generally, patients should be treated with acid suppressive therapy using proton-pump inhibitors if the predominant symptoms are epigastric pain or gastroesophageal reflux symptoms. Although the role of Helicobacter pylori （H pylon） in functional dyspepsia continues to be a matter of debate, recent data indicate that there is modest but clear benefit of eradication of H pylori in patients with functional dyspepsia. In addition, H pylori is a gastric carcinogen and if found it should be eliminated. Although there are no specific diets for patients with FD, it may be helpful to guide the patients on healthy exercise and eating habits.

Functional dyspepsia and irritable bowel syndrome,are they different entities and does it matter?

A high prevalence of overlap between functional dyspepsia and irritable bowel syndrome has been consistently and universally reported. Recent studies demonstrating shared common pathophysiological disturbances including delayed gastric emptying and visceral hypersensitivity involving more than one region, suggest that these patients have a generalised rather than regional, disorder of the gut. Furthermore, a study of the natural history of dyspepsia suggests that with time, a substantial proportion will evolve into IBS. The recognition of IBS in dyspeptic patients has potentially profound therapeutic importance. It could help to reduce the risk of unnecessary cholecystectomy in IBS patients. The ability to appreciate the extent of involvement could allow us to address the disturbances more comprehensively, and thereby achieve greater patient satisfaction with their treatment.