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无症状性2型糖尿病患者,其脑利钠肽与心脏舒张功能不全相关,而尿白蛋白排泄率与左心室质量相关

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中华高血压杂志 2010年第7期18卷 647-647页

作者：张玲玉叶鹏 magnusson m Jovinge S Shahgaldi K

该研究评估无症状性2型糖尿病患者的左心室收缩功能不全(l eft vent ricular systolic dysfunction , LVSD)和左心室舒张功能不全(lef t ve nt ricular dias2 tolic dysf unction , L VDD)的发生情况,并检验是否患者的脑利钠肽和尿白... 详细信息

该研究评估无症状性2型糖尿病患者的左心室收缩功能不全(l eft vent ricular systolic dysfunction , LVSD)和左心室舒张功能不全(lef t ve nt ricular dias2 tolic dysf unction , L VDD)的发生情况,并检验是否患者的脑利钠肽和尿白蛋白排泄率( urina ry albumin ex2 cret io n rat e , UAER)与L VSD、LVDD以及左心室质量(lef t vent ricula r ma ss , L Vm)相关。方法:对153 例不同年龄的无症状性2型糖尿病患者,应用超声心动图检查确定是否患者有LVSD、L VDD ,同时测量他们的LVm ,并将上述指标的测定值与脑利钠钛和 UAR作相关分析。结[第一段]

关键词：尿白蛋白排泄率糖尿病患者脑利钠肽无症状性左心室质量

以多种证据建立的白云鄂博稀土矿床成矿矿物的生成顺序

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地质找矿论丛 1991年第4期6卷 1-17页

作者：赵景德 mitsunobu Tatsumoto J.A.minkin J.m.Back E.H.mcKee 任英忱李永明美国地质调查所冶金工业部天津地质研究院

通过野外和室内的研究认为白云鄂博稀土矿床是后生热液交代成因的矿床。热液活动始于1200ma,终于400ma。473～400ma为成矿高峰期。导致矿床形成的断裂和热液活动是经历了三次区域变质和两次板块俯冲作用的产物。

关键词：稀土矿矿床成矿矿物生成顺序

对上呼吸道感染者行扁桃体切除术:基于的证据

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世界核心医学期刊文摘（儿科学分册） 2005年第5期1卷 17-18页

作者： Van Staaij B. K. Van Den Akker E. H. Van Der Heijden G. J. m. G. 贺莉 University medical Center Utrecht Julius Ctr. Hlth. Sci. Prim. Care Location Stratenum 6.131 Universiteitsweg 100 3584 CG Utrecht Netherlan ds

Background: Despite high rates of (adeno)tonsillectomy for upper respiratory i nfections in western countries, the medical literature offers the physician litt le support in deciding which child might benefit from the operation. methods: A literature search was performed to identify randomised trials and non-randomise d controlled studies into the efficacy of tonsillectomy with or without adenoide ctomy in children under 18 years. For the outcomes sore throat episodes, sore th roat associated school absence, and upper respiratory infections, pooled estimat es of the incidence rate ratios and rate differences with 95%confidence interva ls were calculated, assuming a Poisson distribution. Results: Six randomised tri als and seven non-randomised controlled studies on the efficacy of adenotonsill ectomy in children were evaluated. For sore throat episodes data for 2483 person -years were available. The pooled risk difference was-1.2 episodes per person -year (95%CI-1.3 to-1.1). For sore throat associated school absence 1669 p erson-years were analysed. The pooled risk difference was-2.8 days per person -year (95%CI-3.9 to-1.6). For upper respiratory infections 1596 person-ye ars were available. The pooled risk difference was-0.5 episodes per person-ye ar (95%CI-0.7 to-0.3). Conclusions: All available randomised trials and non -randomised controlled studies into the efficacy of (adeno)-tonsillectomy had important limitations. The frequency of sore throat episodes and upper respirato ry infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore t hroat episodes, days of sore throat associated school absence, and upper respira tory infections compared to watchful waiting.

关键词：扁桃体切除术呼吸道感染者非随机对照试验内科医师率比随机试验西方国家 Poisson 检索文献

延迟多久才算过迟:初产妇的第二产程延长对母体及新生儿结局是否有影响

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世界核心医学期刊文摘（妇产科学分册） 2005年第2期1卷 20-20页

作者： Hopkins L.m. Caughey A.B. 朱晓明

The purpose of this study was to exami ne maternal and neonatal outcomes in relation to len gthening intervals of the second stage of *** is a retro spective cohort study of15,759nulliparous,term,cephalic,singleton births at the University of California,San Francisco,between *** second stage of labor was di vided into 1-hour *** and neonatal ou tcomes were compared with the use of chi -squared and Student t tests,and a probability value of≤.05was used to indicate statistical *** confounders were controlled for withmultivariate logistic *** rates of cesarean delivery,operative vaginal delive ry,and perineal trauma were associated with the second stag e beyond the first *** multivariate analysis,the>4-hour interval group had higher rates of cesarean delivery(odds ratio,5.65;P m-nionitis(odds ratio,1.79;P minute Apgar score ofme,a prolonged second stage is associate d with increased mater-nal morbidity and operative delivery rates.

关键词：新生儿结局第二产程延长初产妇会阴损伤阴道助产绒毛膜羊膜炎单胎妊娠头先露会阴裂伤手术分娩

聚乙二醇脂质体阿霉素与托泊替康治疗复发难治性卵巢上皮癌患者的长期生存优势比较:3期随机研究

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世界核心医学期刊文摘（妇产科学分册） 2005年第2期1卷 42-42页

作者： Gordon A.N. Tonda m. Rackoff W. 张剑萍

Provide long -term follow -up data fo r women treated in a randomized multicenter study of pegylated liposomal dox-orubicin compared with topotecan.P atients with epithelial ovarian cancer that recurred after o r failed to respond to firstline platinum -based chemotherapy were randomized to receive pegylated liposomal doxoru bicin 50mg /m 2 every28days(n =239)or topotecan 1.5mg /m 2 per day for 5days every 21days(n =235).Patients were stratified prospectively based on response to i nitial platinum -based chemotherapy as well as the presence or absence of bulky *** patients had been previously treated with platinum and taxanes(74%in the pegylated liposomal doxorubicin group and 72%in the topotecan group).Survival data are mature:87%of patients have died(n =413).There was an 18%reduction in the ris k of death for patients treated with pegy lated liposomal doxoru-bicin(median survival 62.7weeks for pegylated liposomal doxorubicin and 59.7weeks for topotecan -treated pa-tients;HR =1.216;95%confidence in terval(CI )1.000-1.478;P =0.050).The hazard ratio for all randomized subjects(includes those randomized,but never treated;n =481)was 1.23(median survival 63.6weeks for pegylated liposomal doxorubicin and 57.0weeks for topotecan -treated patients;95%CI 1.01-1.50;P =0.038).For patients with platinum -sensitive dis-ease,there was a 30%reduction in the risk of death for the pegylated liposomal doxorubicin -t reated group(median survival 107.9weeks for pegylated l iposomal doxorubicin and 70.1weeks for topotecan -treate d patients;HR =1.432;95%CI 1.066-1.923;P =0.017).In pa-tients with platinum -refractory di sease,survival was similar between treatment groups.L ong -term follow -up demonstrates that treatmentwith pegylated liposomal dox-orubicin significantly prolongs su rvival compared with topotecan in patients with recurren t and refractory epithelial ovarian *** survival benefi t is pronounced in pa-tients with platinumsensitive dise ase.

关键词：卵巢上皮癌托泊替康生存优势随机研究中位生存时间铂类药物铂类化疗药物肿瘤复发紫杉烷类研究机构

压力支持通气和双相气道正压通气通过肺血流重新分布从而提高氧合

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麻醉与镇痛 2012年第1期8卷 67-77页

作者： Alysson R. Carvalho, PhD Peter m. Spieth, mD Paolo Pelosi, mD, PhD Alessandro Beda, PhD Agnaldo J. Lopes, mD, DSc Boriana Neykova, mD Axel R. Heller, mD, PhD Thea Koch, mD, PhD marcelo Gama de Abreu, mD, mSc, PhD, DEAA 王琦（翻译） Clinic of Anesthesiology and Intensive Care medicine University Clinic Carl Gustav Carus Dresden Germany University Augusto motta Rio de Janeiro Brazil Department of Ambient Health and Safety University of Insubria Varese Italy Institute of Radiology University Clinic Carl Gustav Carus Technical University Dresden Dresden Germany

背景机械通气时保留自主呼吸（spontaneousbreathing，SB）可改善气体交换，主要是因为这种通气方式可使萎陷的肺复张。在保留SB的机械通气中，常选择压力支持通气（pressuresupportventilation，PSV）和双相气道正压通气（biphasicposi... 详细信息

背景机械通气时保留自主呼吸（spontaneousbreathing，SB）可改善气体交换，主要是因为这种通气方式可使萎陷的肺复张。在保留SB的机械通气中，常选择压力支持通气（pressuresupportventilation，PSV）和双相气道正压通气（biphasicpositiveairwaypressure，BIPAP）。但医师对这些辅助性机械通气方式改善肺功能的机制却不甚了解。我们评价了采用PSV和BIPAP改善氧合的机制。方法5头猪（25-29．3kg）于仰卧位行机械通气，并通过清除肺表面活性物质诱发其发生急性肺损伤（acutelung砸jury，Au）。状态稳定后，给予BIPAP通气，初期较低持续气道正压设置为5cmH2O，随后逐渐增加持续气道正压至维持潮气量在6-8ml／kg。减浅麻醉深度，当SB≥每分通气量的20％时，随机进行1小时的PSV或BIPAP＋SB通气。于呼气末行全胸螺旋式计算机体层扫描，并记录肺功能参数。静脉给予荧光微球体来记录肺血流（pulmonarybloodflow，PBF），并利用空间聚类分析来评估每种通气方式对PBF重新分布的影响。结果Au损伤肺功能并加大了下肺萎陷或不张组织的面积（P〈0．05）。和对照组比较，PSV和BIPAP＋SB的通气模式提高了氧合并减少了静脉血掺杂（P〈0．05）。尽管如此，我们观察到自主呼吸时下肺的不张肺组织或通气不良组织明显增加，而可正常通气的肺组织减少。观察到6例中有5例行PSV或sB＋BIPAP通气时PBF由下至上重新分布，肺通气也较好。结论在ALI模型中采用PSV或BIPAP＋SB行机械通气可改善氧合，减少静脉血掺杂的原因为PBF由下至上的重新分布，而不是因为下肺复张。

关键词：双相气道正压通气压力支持通气肺血流氧合 BIPAP通气保留自主呼吸持续气道正压肺功能参数

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与年龄相关的人心房电生理和电解剖变化

世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 43-43页

作者： Kistler P.m. Sanders P. Fynn S.P. 苏显明

Objectives The purpose of this study was to characterize the pattern of atrial remodeling seen with human aging. Background Atrial fibrillation (AF) occurs in 3%to 4%of the population over 65 years of age. It is associated with thromboe mbolic complications, worsening heart failure, and increased mortality, yet the electrical and structural remodeling that occurs with human aging remains unknow n. methods Thirteen patients (66.4 ±1.7 years) ≥60 years (group A), 13 patient s (50 ±2.1 years) age 31 to 59 years(group B), and 15 patients(24.7 ±1.0 years ) ≤30 years(group C) underwent conventional electrophysiologic studies and elec troanatomic mapping. We measured atrial refractoriness(ERP) at the distal corona ry sinus(CS); low and high lateral right atrium (LRA) and the high septal right atrium at 600, 500, and 400 ms; maximum corrected sinus node recovery time (CSNR T); P-wave duration(PWD); conduction time(CT) along the CS and LRA; and discret e double potentials(DP) along the crista. Results Aging was associated with an i ncrease in atrial ERP, prolonged CT along the CS, increased PWD and CSNRT. There was no significant change in dispersion of refractoriness or rate adaptation. E lectroanatomic mapping revealed diffuse areas of low voltage with regional condu ction slowing. Both techniques demonstrated a greater number of DPs and fraction ated signals along the crista terminalis with aging. Conclusions Aging is associ ated with regional conduction slowing, anatomically determined conduction delay at the crista, and structural changes that include areas of low voltage. In addi tion, impairment of sinus node function and an increase in atrial ERP occurred w ith aging. This electrical and structural remodeling may explain the increased p ropensity to AF with aging.

关键词：电生理窦房结恢复时间标测不应期窦房结功能房间隔离散度冠状窦传导时间压区

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侵犯至眶外的眶炎性假瘤

世界核心医学期刊文摘（眼科学分册） 2005年第3期1卷 34-34页

作者： mahr m.A. Salomao D.R. Garrity J.A. 秦雪娇 Department of Ophthalmology And the Div. of Anatomic Pathol ogy Mayo Clinic Rochester MN United States Dr

Purpose To summarize the clinical profile and response to treatment of 4 biops y-proven cases of inflammatory orbital pseudotumor extending beyond the orbit. Design Retrospective observational case series. methods Four patients’charts we re retrospectively reviewed. There were three men with extraorbital extension (t wo intracranial; one maxillary antrum) and one woman with intracranial disease t hat extended into the orbit. The men were 40, 41, and 60 years old; the woman wa s 73 years old. Results Two men with orbital myositis and mild discom fort, init ially treated with corticosteroids, had asymptomatic intracranial disease 9 and 12 months after initial presentation. A third man had extension into the maxilla ry antrumafter initial symptoms of painless diplopia. The woman had intraorbital disease with minimal discomfort (dacryoadenitis and myositis) 5 years after pre senting with intracranial disease in the meckel cave that subsequently became bi lateral. Histopathologic examination in all cases showed nonspecific inflammatio n without evidence of vasculitis or granulomas. Conclusions Unlike typical cases of nonspecific orbital inflammation, two of these four cases did not have pain as a prominent feature. Neuroimaging was essential in diagnosing asymptomatic ex traorbital disease. Surgery has a prominent role in confirming this diagnosis, p rimarily by helping to rule out other diseases, such as those with granulomatous inflammation or vasculitis. Additional therapy was usually not required postope ratively.

关键词：炎性假瘤眶内病变颅内病变炎性肉芽肿泪腺炎眶部病理学检查初次就诊无症状性血管炎

促进前庭功能康复的初级护理对慢性眩晕的作用

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世界核心医学期刊文摘（神经病学分册） 2005年第3期1卷 3-3页

作者： Yardley L Donovan-Hall m. Smith H.E. 黄卫东 School of Psychology University of Southampton Highfield So uthampton SO17 1BK United Kingdom Dr.

Background: Dizziness is a very common symptom and is usually managed in prima ry care. Vestibular rehabilitation for dizziness is a simple treatment that may be suitable for prim.ry care delivery, but its effectiveness has not yet been de termined. Objective: To evaluate the effectiveness of nurse delivered vestibula r rehabilitation in prim.ry care for patients with chronic dizziness. Design: Si ngle blind randomized, controlled trial. Setting: 20 general practices in south ern England. Patients: 170 adult patients with chronic dizziness who were random ly assigned to vestibular rehabilitation (n = 83) or usual medical care (n = 87) . Intervention: Each patient received one 30 to 40 minute appointment with a p rim.ry care nurse. The nurse taught the patient exercises to be carried out dail y at home, with the support of a treatment booklet. measurements: Prim.ry outcom e measures were baseline, 3 month, and 6 month assessment of self reported sp ontaneous and provoked symptoms of dizziness, dizzi ness related quality of li fe, and objective measurement of postural stability with eyes open and eyes clos ed. Results:At 3 months, improvement on all prim.ry outcome measures in the vest ibular rehabilitation group was significantly greater than in the usual medical care group; this improvement was maintained at 6 months. Of 83 treated patients, 56 (67%) reported clinically significant improvement compared with 33 of 87 (3 8%) usual care patients (relative risk, 1.78 [95%CI, 1.31 to 2.42]). Limitat io ns: Psychological elements of the therapy may have contributed to outcomes, and the treatment may be effective only for well motivated patients. Conclusions: V estibular rehabilitation delivered by nurses in general practice improves sympto ms, postural stability, and dizziness related handicap in patients with chronic dizziness.

关键词：前庭功能功能康复训练医学护理患者治疗效果眩晕患者单盲综合医院生活质量诱发性临床症状