急性冠脉综合征患者血清Sirtuin 1与冠脉病变相关

目的探讨急性冠脉综合征患者血清Sirtuin 1(SIRT1)水平与冠脉病变的相关性和影响冠脉病变的因素。方法分析81例中日友好医院心脏科急性冠脉综合征住院患者的临床数据,酶联免疫吸附测定法检测外周静脉血血清SIRT1水平,血运重建前进行SYNTAX评分评估冠脉病变程度。根据SYNTAX评分中位数将患者分为高SYNTAX评分(冠脉病变重度,n=38)和低SYNTAX评分(冠脉病变轻度,n=43)两组。建立多因素线性回归模型,统计分析影响急性冠脉综合征患者SYNTAX评分的因素。结果高SYNTAX评分组患者血清SIRT1水平[379.38(490.14)ng/L vs.242.95(173.85)ng/L,P<0.001]和冠心病家族史阳性率(42.11%vs.20.93%,P=0.039)显著高于低SYNTAX评分组患者,其余临床参数两组间差异无统计学意义。血清SIRT1水平与SYNTAX评分呈显著线性正相关(R=0.452,P<0.010)。多因素线性回归分析结果提示,血清SIRT1(ln处理后)、年龄和估计肾小球滤过率是急性冠脉综合征患者SYNTAX评分(ln处理后)的独立影响因素(Adjusted R2=0.330,P<0.001)。结论本研究首次探讨血清SIRT1和急性冠脉综合征患者冠脉病变程度的相关性,临床医生应注意识别高危患者,制订合理的血运重建策略,努力改善患者预后。     

Precise-DAPT评分与冠状动脉狭窄程度相关性研究

目的 探讨冠心病患者Precise-DAPT评分与冠状动脉狭窄程度的相关性.方法 选取接受冠状动脉介入治疗的539例冠心病患者作为研究对象,根据术前年龄、肌酐清除率、白细胞计数、血红蛋白水平和既往自发出血史计算Precise-DAPT评分,并依据术中造影结果计算Gensini评分及SYNTAX评分,分析Precise-DAPT评分与Gensini评分、SYNTAX评分的相关性.结果 二元Logistic回归分析显示,年龄(OR=1.189,95％CI为1.131～1.249,P＜0.001)、心率(OR=1.030,95％CI为1.006 ～1.055,P=0.015)、SYNTAX评分(OR=1.153,95％CI为1.089～1.220,P＜0.001)均为Precise-DAPT评分的独立影响因素;Pearson相关性分析显示,Precise-DAPT评分与Gensini评分(r=0.363,P＜0.001)、SYNTAX评分(r=0.501,P＜0.001)均呈正相关.结论 Precise-DAPT评分与冠状动脉狭窄程度呈正相关,出血风险较高的冠心病患者冠状动脉狭窄程度更加严重,在双联抗血小板治疗持续时间方面矛盾更突出,建议个性化治疗并密切随访.     

男性早发冠心病患者血浆高密度脂蛋白胆固醇、载脂蛋白B水平与SYNTAX评分的相关性分析

目的:探讨男性早发冠心病患者血浆高密度脂蛋白胆固醇、载脂蛋白B水平与SYNTAX评分(冠状动脉病变复杂程度)的相关性。方法:回顾性分析中山大学孙逸仙纪念医院2015年1月～2017年12月收治入院,年龄≤55岁的早发冠心病患者共155例,同期男性健康体检者共162例。依据SYNTAX评分结果分为低评分组(57例)、中评分组(47例)、高评分组(51例),收集各组入院时的一般资料、实验室相关检验结果,对比各组相关资料的差异及与SYNTAX评分的相关性。结果:男性早发冠心病患者血浆HDL-C水平低于对照组,ApoB水平高于对照组,差异均有统计学意义(P0.05);早发冠心病各亚组间比较,中评分组、高评分组HDL-C水平明显低于低评分组,中评分组、高评分组ApoB水平明显高于低评分组,差异均具有统计学意义(P0.05)。简单相关分析表明HDL-C与SYNTAX评分呈负相关、ApoB与SYNTAX评分呈正相关,相关系数分别为-0.241、0.399(P0.05)。多重线性回归分析表明,在校正了年龄、BMI、糖尿病史、高血压病史和吸烟史或TC、TG、LDL-C、non-HDL-C、ApoA1、ApoB/HDL-C后,HDL-C与SYNTAX评分呈负相关(P0.05),ApoB和SYNTAX评分仍呈正相关(P0.05)。结论:男性早发冠心病患者血浆HDL-C、ApoB水平与SYNTAX评分密切相关,低水平HDL-C与高水平ApoB可能在一定程度上反映冠状动脉病变的复杂程度。     

血清白介素15水平与冠心病冠状动脉病变严重程度的相关性研究

目的探讨血清白介素15(IL-15)与冠心病冠状动脉病变严重程度的相关性。方法选择2014~2015年收治的90例冠心病患者作为冠心病组,另选取30例健康受检者作为对照组,将冠心病组以Gensini评分分为轻度狭窄组30例、中度狭窄组30例、重度狭窄组30例。所有受检者进行问卷调查、查体、血清生化指标以及血清IL-15检查。采用Pearson相关分析法分析血清IL-15水平与冠心病冠状动脉病变严重程度的相关性。多元线性回归分析法分析Gensini评分的相关因素。结果冠心病组患者血清IL-15水平显著高于对照组(P0.05);重度狭窄组、中度狭窄组、轻度狭窄组患者血清IL-15水平逐渐降低,差异有统计学意义(P0.05)。IL-15水平与Gensini评分存在明显的正相关性(r=0.603,P=0.01),且在矫正BMI、年龄、血脂、C反应蛋白、高血压以及糖尿病等因素后仍然是独立的相关因素。结论血清IL-15水平与冠心病冠脉狭窄程度呈正相关,也是冠状动脉狭窄程度的独立相关因素。     

血清同型半胱氨酸水平与冠状动脉病变严重程度的相关性研究

目的对冠状动脉粥样硬化性心脏病(简称冠心病)患者同型半胱氨酸(Hcy)表达水平进行检测,并探索其与冠状动脉严重程度的相关性,为冠心病的临床诊断、预后评估提供客观依据。方法选取该院接诊冠心病患者124例,运用冠状动脉造影术对患者行SYNTAX评分分组,35例为低危组,38例为中危组,51例为高危组。另从同期心内科行冠状动脉造影术与经皮冠状动脉介入治疗术患者中选取非冠状动脉病变的患者60例作为对照组。对冠心病患者与对照组静脉血进行采集,处理后测定Hcy、超敏C反应蛋白(hs-CRP)、肌酐(Scr)、肌酸激酶(CK)等水平。结果冠心病各组Hcy测定结果高于对照组,差异有统计学意义(P0.05);根据SYNTAX分组,各组Hcy、hs-CRP、CK测定结果比较,均表现为低危组、中危组、高危组均明显高于对照组,高危组显著高于中危组、低危组,中危组显著高于低危组,差异均有统计学意义(P0.05);各组Scr测定结果比较,低危组、中危组、高危组均明显高于对照组,高危组、中危组均显著高于低危组,差异有统计学意义(P0.05);Spearman相关性分析发现,Hcy与SYNTAX评分呈正相关性(r=0.574,P0.05),hs-CRP与SYNTAX评分呈正相关性(r=0.581,P0.05),Scr、CK与SYNTAX评分无相关性(r=1.587、1.214,P0.05);经logistic回归分析显示,Hcy、hs-CRP均是冠心病的高危因素(P0.05);受试者工作特征曲线(ROC)的曲线下面积为0.655。结论 Hcy表达水平与冠状动脉严重程度呈明显的正相关,且为冠状动脉严重程度的独立危险因素,可用于冠状动脉严重程度的预测。     

糖化血红蛋白水平与冠状动脉病变的相关性

目的:观察糖化血红蛋白水平与冠状动脉病变的相关性。方法:选取2016年1月～2017年2月我院收治的106例冠心病患者为研究对象,均行冠脉造影检查和HbA1c检查。对患者的冠状动脉病变情况使用SYNTAX评分系统进行评价积分,依据评分结果分为低危组(1～22分,25例)、中危组(23～32分,34例)、高危组(≥33分,47例)三组;再按Hb A1c水平分为Hb A1c≤5.6%组(23例),HbA1c5.7%～6.4%组(31例),HbA1c≥6.5%组(52例);同时根据冠状动脉病变支数分为单支病变组(26例)、双支病变组(36例)、三支及左主干病变组(44例)。分析糖化血红蛋白水平与冠状动脉病变的相关性。结果:不同Hb A1c水平的SYNTAX评分分组情况比较具有显著性差异(P0.05);HbA1c水平随着SYNTAX评分的升高而升高,三组Hb A1c水平比较,组间差异显著(P0.05);HbA1c水平随着SYNTAX评分的升高而升高,三组HbA1c水平比较,组间差异显著(P0.05);Pearson相关分析可见,HbA1c水平与SYNTAX评分间相关系数为r=0.78,P0.05,Hb A1c与冠状动脉SYNTAX评分间有较强相关性。结论:糖化血红蛋白水平与冠状动脉病变呈正相关,冠状动脉病变严重程度随HbA1c水平升高而上升,因此高Hb A1c水平的患者应警惕冠状动脉病变风险。     

S100A8/A9与不稳定型心绞痛患者冠状动脉病变及短期预后相关性分析

目的探讨不稳定型心绞痛患者经皮冠状动脉介入术(percutaneous coronary intervention, PCI)前血清S100A8/A9蛋白水平与冠状动脉病变严重程度的相关性以及PCI后S100A8/A9蛋白水平变化与短期预后的相关性。方法行冠状动脉造影检查的不稳定型心绞痛患者99例,其中冠状动脉正常27例(对照组),冠状动脉病变72例(冠状动脉病变组,均行PCI),再根据Gensini评分将冠状动脉病变组分为轻中度病变(Gensini评分1～59分)组43例和重度病变组(Gensini评分≥60分)29例。记录患者临床资料,采用ELISA法检测血清S100A8/A9蛋白水平,采用Spearman相关法分析S100A8/A9蛋白水平与Gensini评分的相关性,采用多因素logistic回归分析冠状动脉病变严重程度的危险因素,应用Cox比例风险回归模型分析患者PCI前、后S100A8/A9蛋白水平变化与短期预后的关系。结果冠状动脉病变组PCI前血清S100A8/A9蛋白水平[628.80(359.90,1 045.00)μg/L]高于对照组[362.30(230.80,558.50)μg/L](P0.05);重度病变组PCI前血清S100A8/A9蛋白水平[813.50(577.10,1 645.00)μg/L]高于轻中度病变组[505.50(300.60,862.10)μg/L](P0.05)。冠状动脉病变组PCI前血清S100A8/A9蛋白水平与冠状动脉Gensini评分呈正相关(r=0.332,P=0.004)。PCI术前血清S100A8/A9蛋白水平升高是冠状动脉重度病变的独立危险因素(OR=1.091,95%CI:1.010～1.178,P=0.027)。冠状动脉病变患者PCI后S100A8/A9蛋白水平较术前每升高100个单位,发生短期主要心血管不良事件的风险提高5.8%(HR=1.058,95%CI:1.021～1.096,P=0.002)。结论不稳定型心绞痛冠状动脉病变患者PCI前S100A8/A9蛋白水平与冠状动脉病变严重程度相关,PCI前、后S100A8/A9蛋白变化水平与患者短期预后相关。     

冠心病患者同型半胱氨酸、血尿酸水平与冠脉病变的相关性北大核心CSCD

目的探讨血清同型半胱氨酸（Hcy）水平、血尿酸水平（UA）与冠状动脉病变严重程度的关系。方法回顾性分析2015年1月至2015年12月在北京安贞医院住院行冠状动脉造影检查者622例。根据造影结果,以任何冠脉狭窄／〉50％,作为冠心病的诊断标准,分为冠脉正常组和冠心病组,并根据SYNTAX评分,将冠心病组分为低危组（1～22分）、中危组（23～32分）及高危组（〉33分）。测定血清同型半胱氨酸水平、血尿酸水平、空腹血脂包括：总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）和低密度脂蛋白胆固醇（LDL—C）。比较各组患者血脂、血清同型半胱氨酸水平、血尿酸水平。以血清同型半胱氨≤15μmol／L为正常值,再将患者分为高Hcy组和正常组,比较两组SYNTAX评分,并进行相关性分析。血尿酸男性以〈416μmol／L为正常值,女性以〈357μmol／L为正常值,将UA和SYNTAX评分进行相关性分析。结果SYNTAX评分高危组、中危组与正常组比较TC、LDL—C显著增高,而正常组、低危组间差异无统计学意义（P〉0．05）。SYNTAX评分高危组、中危组与冠脉正常组比较,同型半胱氨酸水平显著增高。正常Hcy组与高Hcy组在年龄、性别、TC、TG、HDL-C、LDL—C的差异无统计学意义（P〉0．05）。高Hcy组患者的冠脉SYNTAX评分显著高于正常组（P〈0．05）。多元Logistic回归分析表明血Hcy水平与冠脉病变程度相关（P〈0．05）。SYNTAX评分高危组、中危组与同性别冠状动脉正常组比较,uA水平显著增高（P〈0．05）。多元Logistic回归分析表明血uA水平与冠状动脉病变程度相关（P〈0．05）。结论血Hcy水平、血uA水平是冠脉病变严重程度的危险因素,血Hcy水平及血UA水平较高的患者冠状动脉病变程度较重。     

冠心病患者血清游离脂肪酸、氧化脂蛋白(a)与冠状动脉病变程度的关系

目的分析冠心病(CAD)患者血清游离脂肪酸(NEFA)和氧化脂蛋白(a)[ox-Lp(a)]水平,探讨CAD患者该两种指标的关系,并评估其与冠状动脉病变狭窄程度的关系。方法选取急性冠状动脉综合征(ACS)患者56例、稳定性冠心病(SCAD)患者62例和健康对照者71例;测定血清NEFA和ox-Lp(a)水平,同时分析血脂水平、冠状动脉病变支数和Gensini积分。结果与健康人对照组相比,血清ox-Lp(a)(t=4.91,P0.01)和NEFA(t=7.77,P0.01)水平在CAD患者中均升高,且ACS患者ox-Lp(a)(t=2.84,P0.01)、NEFA(t=4.22,P0.01)水平高于SCAD患者。CAD患者中,冠状动脉多支病变组血清ox-Lp(a)(t=2.52,P=0.014)、NEFA(t=3.21,P0.01)水平高于单支病变组。CAD患者血清ox-Lp(a)(r=0.193,P0.05)和NEFA(r=0.322,P0.01)水平均与Gensini积分呈正相关。多元线性回归分析显示,冠状动脉病变支数和血清NEFA水平共同决定了Gensini积分34.6%的变化(β分别为0.497和0.225,P均0.01)。多因素Logistic回归分析显示,在校正了年龄、性别和其他血脂水平的影响后,血清高NEFA、ox-Lp(a)水平与ACS[ox-Lp(a),OR=1.159,95%CI=1.075~1.250,P0.01;NEFA,OR=1 118.185,95%CI=78.979~15 831.200,P0.01]、SCAD[ox-Lp(a),OR=1.082,95%CI=1.010~1.158,P0.05;NEFA,OR=65.007,95%CI=5.628~750.837,P0.01]的发生密切相关,且对ACS、SCAD的鉴别具有显著意义[ox-Lp(a),OR=1.072,95%CI=1.013~1.134,P0.05;NEFA,OR=17.201,95%CI=3.741~79.091,P0.01]。结论 CAD患者血清NEFA、ox-Lp(a)水平升高,且ACS患者NEFA、ox-Lp(a)水平高于SCAD患者;血清NEFA、ox-Lp(a)水平与冠状动脉病变狭窄程度密切相关。     

血清组织蛋白酶S、胱抑素C水平与冠状动脉粥样硬化病变严重程度相关性的研究——附107例报告

目的:探讨冠状动脉粥样硬化性心脏病(冠心病)患者血清组织蛋白酶S(cathepsin S,CatS)及胱抑素C水平与冠状动脉病变程度的关系.方法:对155例疑诊心绞痛患者进行冠状动脉造影(coronary angiography,CAG),根据GAG结果分为冠心病组(107例)及对照组(48例),测定所有入选者的空腹血清CatS、胱抑素C水平,采用Gensini积分对冠状动脉病变程度进行评价并分析它们之间的关系.结果:冠心病组血清CatS、胱抑素C水平较对照组高(P＜0.01),前者上升幅度更大,血清CatS水平与Gensini积分呈正相关(r=0.69,P＜0.01),Logistic回归分析剔除年龄、性别、收缩压、血清总胆固醇等因素后,此相关性仍存在(r=0.71,P＜0.01).结论:冠心痛患者的血清CatS、胱抑素C的水平增高,且CatS与冠状动脉粥样硬化病变程度密切相关,说明CatS及胱抑素C可能参与细胞外基质重塑的过程.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.