感染模型家兔体内莫西沙星的药动学

目的 :研究莫西沙星在感染家兔模型中的药物动力学。方法 :8只家兔经埴入高尔夫练习球并用肺炎链球菌感染 3d后 ,用多剂量口服莫西沙星治疗 ,第 5天进行药动学试验。用高效液相色谱法测定血药浓度。结果 :莫西沙星在家兔体内属线性药物并符合二房室模型 ;达峰时间为 (1.2± 0 .6)h ,峰浓度为 (13 .2± 4 .0 ) μg·ml-1,曲线下面积为 (86.5± 2 1.1) μg·ml-1·h ,消除半衰期为 (13 .0± 6.2 )h。 4只家兔高尔夫练习球内的莫西沙星血清峰浓度 ,在为 3 .6± 2 .1μg·ml-12 4h内的平均曲线下面积为 (65 .4± 2 1.1) μg·ml-1·h。结论 :获得的莫西沙星在家兔模型中的药动学参数 ,对今后莫西沙星的药效学研究有很大的帮助。

羟考酮对左旋氧氟沙星在人体内药物动力学的影响

目的 :研究羟考酮对左旋氧氟沙星 (L VFX)在人体内药物动力学的影响。方法 :8名健康志愿者 ,单用 L VFX或合用羟考酮 ,用 HPL C法测定血药浓度。结果 :单用 L VFX5 0 0 m g后的药物动力学参数分别为 :tmax(1.5 6 2± 1.0 5 0 ) h,cmax(6 .6 419± 0 .15 86 0 )︼g/ ml,AU C(47.6 5± 11.2 9) h·︼g/ m l,T1 /2 (β) (7.0 34± 0 .941) h;合用羟考酮时 ,L VFX的药物动力学参数分别为 :tmax(1.12 5± 0 .6 41) h,cmax(7.6 5 2± 2 .5 94)︼g/ m l,AU C(48.74± 10 .5 8) h·︼g/ m l,T1 /2 (β) (6 .2 75± 0 .5 88) h。两者除T1 /2 ka和 cmax外 ,无显著性差异。结论 :羟考酮对 L VFX在人体内药物动力学参数无影响。

高剂量美罗培南在肺炎囊性纤维化病人体内的药物动力学

目的 :研究美罗培南在肺炎囊性纤维化病人体内的药物动力学。 方法 :6例成年肺炎囊性纤维化住院病人 ,静脉滴注给予美罗培南 2 g q8h,用 HPLC法测定血药浓度。采用 3 P87程序统计矩方法求算药代动力学参数。结果 :美罗培南的体内过程符合二室开放模型 ,其药物动力学参数分别为 :tm ax=(0 .5 742± 0 .0 2 0 7) h,cm ax=(14 1.7± 40 .48) μg/ml,AUC=(14 8.7± 2 3 .42 ) μg·h· ml-1 ,t1 /2β=(1.168± 0 .2 78) h,与常规剂量一致。 结论 :肺炎囊性纤维化病人应用高剂量美罗培南时 。

Cardiac adipose tissue and its relationship to diabetes mellitus and cardiovascular disease

Type-2 diabetes mellitus(T2DM) plays a central role in the development of cardiovascular disease(CVD). However, its relationship to epicardial adipose tissue(EAT) and pericardial adipose tissue(PAT) in particular is important in the pathophysiology of coronary artery disease. Owing to its close proximity to the heart and coronary vasculature, EAT exerts a direct metabolic impact by secreting proinflammatory adipokines and free fatty acids, which promote CVD locally. In this review, we have discussed the relationship between T2 DM and cardiac fat deposits, particularly EAT and PAT, which together exert a big impact on the cardiovascular health.

Clostridium paraputrificum septicemia and liver abscess

We report the first case of a healthy 23-year-old female who underwent an interventional radiology-guided embolization of a hepatic adenoma, which resulted in a gas forming hepatic liver abscess and septicemia by Clostridium paraputrificum. A retrospective review of Clostridial liver abscesses was performed using a Pub Med literature search, and we found 57 clostridial hepatic abscess cases. The two most commonly reported clostridial species are C. perfringens and C. septicum(64.9% and 17.5% respectively). C. perfringens cases carried a mortality of 67.6% with median survival of 11 h, and 70.2% of the C. perfringens cases experienced hemolysis. All C. septicum cases were found to have underlying liver malignancy at the time of the presentation with a mortality of only 30%. The remaining cases were caused by various Clostridium species, and this cohort's clinical course was significantly milder when compared to the above C. perfringens and C. septicum cohorts.

Obesity paradox in patients undergoing coronary intervention:A review

There is strong relationship between obesity and cardiovascular disease including coronary artery disease(CAD). However, the literature has shown better outcomes in higher obese patients who undergo percutaneous cardiovascular interventions for CAD, a phenomenon known as the obesity paradox(OX). In this review, we performed extensive search for OX in patients undergoing percutaneous coronary intervention. We also discussed possible mechanism OX and disparities in different race and sex.

Review of heart transplantation from hepatitis C-positive donors

Significant scarcity of a donor pool exists for heart transplantation(HT)as the prevalence of patients with end-stage refractory heart failure is increasing exceptionally.With the discovery of effective direct-acting antiviral and favorable short-term outcomes following HT,the hearts from hepatitis C virus(HCV)patient are being utilized to increase the donor pool.Short-term outcomes with regards to graft function,coronary artery vasculopathy,and kidney and liver disease is comparable in HCV-negative recipients undergoing HT from HCVpositive donors compared to HCV-negative donors.A significant high incidence of donor-derived HCV transmission was observed with great success of achieving sustained viral response with the use of direct-acting antivirals.By accepting HCV-positive organs,the donor pool has expanded with younger donors,a shorter waitlist time,and a reduction in waitlist mortality.However,the longterm outcomes and impact of specific HCV genotypes remains to be seen.We reviewed the current literature on HT from HCV-positive donors.

Risk of New-Onset Atrial Fibrillation in Elderly Patients with the Overlap Syndrome: A Retrospective Cohort Study

Background Co-existence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is referred to as overlap syndrome. Overlap patients have greater degree of hypoxia and pulmonary hypertension than patients with OSA or COPD alone. Studies showed that elderly patients with OSA alone do not have increased risk of atrial fibrillation (AF) but it is not known if overlap patients have higher risk of AF. Objective To determine whether elderly patients with overlap syndrome have an increased risk of AF. Methods In this single center, community-based retrospective cohort analysis, data were collected on 2,873 patients > 65 years of age without AF, presenting in the year 2006. Patients were divided into OSA group (n = 60), COPD group (n = 416), overlap syndrome group (n = 28) and group with no OSA or COPD(n = 2369). The primary endpoint was incidence of new-onset AF over the following two years. Logistic regression was performed to adjust for heart failure (HF), coronary artery disease, hypertension (HTN), cerebrovascular disease, cardiac valve disorders, diabetes mellitus, hyperlipidemia, chronic kidney disease (CKD) and obesity. Results The incidence of AF was 10% in COPD group, 6% in OSA group and 21% in overlap syndrome group (P < 0.05). After adjusting for age, sex, HF, CKD, and HTN, patientswith overlap syndrome demonstrated a significant association with new-onset AF (OR = 3.66, P = 0.007). HF, CKD and HTNwere also significantly associated with new-onset AF (P < 0.05). Conclusion Among elderly patients, the presence of overlap syndrome is associatedwith a marked increase in risk of new-onset AF as compared to the presence of OSA or COPDalone.

脓毒症性脑病的MRI表现

A 48 year old woman, status post renal transplantation six years earlier, died after a two week illness characterised by fever, recurrent seizures, and coma. Widespread abnormalities were seen on neuroimaging. A diagnosis of septic encephalopathy was established on postmortem. We describe the magnetic resonance imaging findings of bilateral basal ganglia, thalamic, cerebellar, brainstem, and cerebral abnormalities in this patient, which correlate with the pathophysiology of septic encephalopathy.

与宫颈细胞学中非典型腺细胞相关的发育异常

OBJECTIVES: To estimate the rates of and identify risk factors for disease in women with atypical glandular cells of undetermined significance (AGUS). METHODS: From 1998-2001, 477 Pap tests at Hartford Hospital were classified as AGUS and met the inclusion criteria of this study. Findings were evaluated for 2 years from the initial test. Disease was defined as histology results with a finding of high-grade squamous intraepithelial lesion or greater. RESULTS: Disease was diagnosed in 9%of the women, including malignancy in 3%. Women with malignant-appearing AGUS Pap tests had a higher rate of disease (29%) than women with benign-appearing (5%, P <.01) and unspecified AGUS Pap tests (13%, P <.03). Malignancies were associated with all subclassifications of AGUS Pap tests. Women aged less than 35 years were more likely to have disease than women aged 35 years or older (P <.02). Most women aged younger than 35 years had a squamous abnormality, whereas women aged 35 years or older had a greater diversity of squamous and glandular lesions and accounted for all cases of endometrial cancer, adenocarcinoma in situ, and cervical adenocarcinoma. Women with persistent AGUS Pap tests had a 31%rate of disease. The rate of disease among women with AGUS Pap tests collected by liquid-based cytology was 11%, compared with 6%among samples collected by the conventional method. CONCLUSION: These data suggest that women with atypical glandular cells are at substantial risk for dysplasia and malignancy. The rate of disease varies with the method of Pap test collection, age, presence of persistent AGUS Pap tests, and AGUS subclassification.

前列腺素E_1在逆行灌注24h肺保存中的作用

以往的研究证明由左心房逆行灌注冲洗肺,在短期肺保存中获得良好效果。但此法是否适用于长时间的肺保存,至今尚无资料。也有资料表明:由于肺静脉端较低的血管阻力,常规用于顺行肺灌注—肺保存中的血管扩张素一前列腺素E_1可能不必用于逆行灌注—肺保存。本研究旨在估价逆行灌注和前列腺素E_1(PGE_1)在24h肺保存中的作用。实验狗分为两组,University of Wisconsin保存液(UW液)作为冲洗和保存液。在A组(n=7),250μg PGE_1在进行灌注之前注入供体的肺动脉,另外250μg混合在UW液中。B组为对照组,不用PGE_1。在4℃下保存22～25h后,作同种异体左肺移植。在肺移植之前和之后的10—,30—,60—,120—min测试血流动力学指标、血气分析、呼吸道阻力和肺顺应性。结果表明,经120 min的在体再灌注后,氧和二氧化碳分压(kPa)分别为85.52±3.20和4.93±0.40(A组);79.80±3.87和4.93±0.40(B组)。血流动力学指标(kPa,A组对B组):肺动脉压2.67±0.13对3.73±0.27(P<0.05);右房压0.53±0.13对1.07±0.13(P<0.05);肺血管阻力(dyne·s·cm^(-5))1109±51对1525±133(P<0.05)。气道阻力(kPa/L·s)2.16±0.10对2.35±0.10(P=NS);肺顺应性(CC╱cm)30±1对26±1(P<0.05)。在B组,经2h的再灌注后,气道阻力显著高于实验前的基值(19±1)(P<0.05)。电子显微镜观察表明:除组织间隙水肿外,Ⅰ型肺上皮细胞、毛细血管内皮和微细支气管上皮均现正常。Ⅱ型肺上皮细胞的板层小体内容物减少或消失。上述改变在两组间无明显差别。结论:用UW液逆灌保存犬肺24h是可行的。PGE_1有助于减小肺血管阻力、气道阻力和改善肺顺应性。

Drug and herbal/dietary supplements-induced liver injury:A tertiary care center experience

BACKGROUND Drug-induced liver injury(DILI)and herbal/dietary supplements(HDS)related liver injury present unique diagnostic challenges.Collaboration between the clinician and the pathologist is required for an accurate diagnosis and management.AIM To report our experience on the clinical-pathological findings of hepatic injury caused by drugs/HDS.METHODS A retrospective review of clinically proven cases of DILI/HDS who presented to our institution from January 1,2013 to December 31,2017 was performed.Slides were reviewed for histopathological patterns of injury and correlated with the causative agent.Out of 600 patients presenting with unexplained rise in liver enzymes undergoing biopsy,107 were suspected to have DILI/HDS.Of these,53 had a directly linked exposure to drug/herbal supplements.Fifteen patients were excluded for concurrent known liver disease.Thirty-eight patients with clinically proven DILI/HDS were finally included.RESULTS Thirty-eight cases of DILI/HDS with a male:female of 1:1.5 and mean age of 51±3 years were identified.DILI was identified in 84.2%cases while HDS injury in 15.8%.Acute hepatitis(42.1%)was the most common pattern of injury while granulomatous hepatitis(2.6%)was the least common.We found one case of acute-cholestasis due to rivaroxaban and two cases of cholestatic-hepatitis due to rizatriptan and trimethobenzamide-hydrochloride that,to the best of our knowledge,have not been previously reported.One case of steatohepatitis due to trimethoprim-sulfamethoxazole and three unusual cases of cholestatic-hepatitis with bile duct injury and steatosis due to dronedarone,C4-Extreme and hydroxycut,were also seen.Of our cohort,81.6%of the patients fared well with discontinuation of drug and 18.4%underwent transplant;of which 42.9%were deceased.CONCLUSION We describe the clinical findings,histopathological patterns of injury and clinical outcomes caused by drugs.In particular,we report a few previously unreported/rarely observed clinical and histopathological patterns of hepatic injury.

The Impact of Enteric Contrast on Radiologist Confidence in Intravenously Enhanced MDCT of the Abdomen and Pelvis: A Randomized Controlled Trial

After Institutional Review Board approval, 109 patients ≥ 18 years old undergoing intravenously enhanced Computed Tomography (CT) of the abdomen and pelvis were prospectively enrolled and randomized into two arms. Patients with a history of inflammatory bowel disease, Crohn disease and ulcerative colitis were excluded. The control arm received routine enteric contrast and intravenous contrast. The experimental arm did not receive oral contrast, but received the standard dose of intravenous (IV) contrast. One of four experienced body radiologists reviewed the studies and rated his/her confidence on a scale of 1 (no confidence) to 10 (all confident findings have been made). Confidence levels were compared between groups. The 109 subjects were distributed 54 (49.5%) in the control arm and 55 (50.5%) in the experimental arm. The average confidence level in the control arm was 8.7 ± 0.9 versus 8.4 ± 1.1 in the experimental arm, which is not statistically significant (p value = 0.09). Among radiologists, the average confidence levels ranged from 6 - 10 in the control arm and 7 - 10 in the experimental arm. No examinations were repeated for technical considerations in either group. No studies were repeated in the experimental group in order to administer oral contrast. When each radiologist was compared to the others, there were no differences in confidence level between pairs in the control arm;however, there were statistically significant differences in confidence level among three pairs of radiologists for the experimental arm. There was no statistically significant difference in radiologist confidence level between intravenously enhanced abdomen and pelvis CTs with enteric contrast and without enteric contrast.

Prevalence of Malaria Infection and ABO Human Blood Group in Dar-es-Salaam, Tanzania

The main objective of this study was to determine the relationship between occurrence of malaria infection with that of human blood group in Dar-es-Salaam Tanzania. The study was based on data collected randomly from the patients who were screened for malaria of all age groups for a period of three months at Mission Mikocheni Hospital. During this time period, a total of 430 blood samples were collected. From the study findings, it is clear that more than 50% of the patients tested were positive for malaria. Further analysis revealed that about 50% of malaria positive patients were type “O” blood group.

ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients. Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4.5%. Fifteen patients ( 4.8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. Conclusion Although the difficulties and risk factors were increased, the results of redo CABG were still good.

THE EFFECT OF PROSTAGLANDIN E1 ON PULMONARY BLOOD FLOW AFTER RETROGRADE FLUSH AND COLD STORAGE OF LUNGS

ReSllm6 Objectif Nos studes Precedentes out montrd une panne fonCtion de la greffe pulmonaire traitde Prdalablementper perfusion forcde retrograde et un stockage d froid inns ~. L' etude Prdsente a pour but de determiner l' effet de ~ surlefiot mngUin du poumon trait4 Prdalablement per perfusion retrograde forcde et un stockage d froid. met~. 12poumons donneurs canins out ate trait4s per perfusion r4tFograde de solution UW. Chez 6 animaux du grouch A, 250ng furent injectes dans l' artrdre pulmonaire avant l...

CARIDIAC TRANSPLANTATION IN PATIENTS OVER 60 YEARS OLD

ffeSUm6 Objectif Pour dvaluer la limite d' age de transplantation cordiaque en sc agent sur l' analyse des rdsultats dlong tease des ma lades Othe. at~ L' etude s' est faite mr 161 oas de transPlantation cardiaque de l' octobre 1984 an~bre 1996 a l' H6Pital Hartford. De a divisd ies malndes en deux grouch: grouch senile (n = 35 ) aunt l' age moyen 63, 5f 2, 7(60 -- 68) et grouch t&moin (n = 126 ) avec l' age mopn 47, 6 1 11, 3. ho cardiopethies en cause pour la transplantation cardiaque des deux poupe de ma...

缺乏针对有宫颈细胞学非典型腺细胞妇女的实践指导方针

OBJECTIVE: We sought to estimate the rates and types of evaluation in women with atypical glandular cells of undetermined significance (AGC-US) on cervical cytology and to assess these findings on the basis of published management guidelines. METHODS: The rates of histologic sampling, comprehensive initial evaluations, and secondary evaluations were assessed in 477 women with an AGC-US Pap test from 1998 to 2001. A comprehensive evaluation was defined as a colposcopy and an endocervical curettage with or without a cervical biopsy. For women aged 35 or older, a comprehensive evaluation also included an endometrial biopsy. A secondary evaluation consisted of a diagnostic cone biopsy. RESULTS: Sixty-four percent of women with an AGC-US Pap test had histologic sampling; 36%were followed by repeat Pap test only. Thirty-six percent of women with an AGC-US Pap test had a comprehensive evaluation. Women with an AGC-US Pap test that was subclassified as malignant-appearing had higher rates of histologic and comprehensive evaluations than women with a benign-appearing or unspecified AGC-US Pap test (P < .01). Twenty-eight percent of women aged 35 or older had comprehensive evaluations compared with 57%of women younger than the age of 35 (P < .01). Secondary evaluations were performed in 8%of women with persistent AGC-US Pap tests and 2%of women with malignant-appearing AGC-US Pap tests after negative initial histologic evaluations. Twelve of the 42 cases of disease (29%) were diagnosed more than 1 year from the initial AGC-US Pap test. CONCLUSION: On the basis of accepted management guidelines, these data suggest that women with AGC-US Pap tests are under-managed in both their initial and secondary evaluations.

他汀类药物治疗与癌症的患病危险汇总分析

背景：随机对照试验证实，他汀类降胆固醇药物能够预防心脏事件的发生。近来的回顾性分析提示，他汀类药物还可预防癌症。 目的：观测他汀类药物治疗对癌症发生和癌症死亡的影响，分析他汀类药物对不同类型癌症的作用，探讨他汀亲脂性或其来源的作用。 数据来源：使用特定的检索词对2005年7月以前的MEDLINE、EMBASE、CLINAHL、Web of Science、CANCERLIT和Cochrane系统综述数据库进行系统文献检索。审查心脏病和癌症摘要，对论文参考文献亦进行人工审查。 研究选择：在筛查的8943篇（n=86936）文献中，27篇符合入选标准。27篇论文共报道了26项他汀类药物随机对照试验。这些研究至少平均随访1年，每项研究至少入选100例患者。研究提供了癌症发生（n=20项研究）或癌症死亡（n=22项研究）数据。 资料提取：3位研究者使用标准的资料提取工具独立地提取所有资料。应用随机效应模型（DerSimonian和Laird法），加权均值报告为优势比（odds ratios，ORs）和95％可信区间（confidence intervals，CIs）。应用Q统计评估统计学异质性。 资料综合：汇总分析共包括6662例癌症和2407例癌症死亡。结果显示，他汀类药物并未降低癌症的发生（OR，1．02；95％CI，0．97～1．07）或癌症死亡（OR，1．01；95％CI，0．93～1．09），也未见任何类型癌症的减少。无论是亲水性他汀或亲脂性他汀、天然他汀或人工合成他汀都没有影响癌症的发生。 结论：在随机对照试验中，他汀类药物对癌症发生和癌症死亡的危险呈中性效应。我们发现，癌症类型不受他汀类药物使用与否的影响，不同他汀类药物亚型（亲水或亲脂性、天然或人工合成）对癌症的危险亦无影响。

腕管综合征主要症状体征敏感性与特异性的比较

目的 比较腕管综合征 (carpaltunnelsyndrome ,CTS)主要症状、体征的敏感性与特异性。方法 对 10 1例 ( 162只手 )进行症状严重程度与功能状况的询问 ,感觉、运动功能的检查 ;其中 62只手在术后 6周再次测定。结果 162只患手中 15 8只具有典型症状 ( 98% )。Phalen征、前臂正中神经加压征、Semmes Weinstein单丝纤维测试阳性率分别为 98%、96%、82 %。 87%的患手出现肌力下降 ,拇短展肌肌力测定 (定量法 )结果显示 ,与徒手法相比 ,不同性别间、术前与术后的差异均具非常显著意义 (P <0 .0 1)。结论 典型症状、Phalen征、前臂正中神经加压征、拇短展肌肌力变化的敏感性与特异性最高 ,拇短展肌肌力定量法测定是判断腕管综合征严重程度、评定疗效的一个良好的客观指标。