2型糖尿病与冠脉支架术后再狭窄的相关性研究

回顾性分析2012年6月~2014年6月我院成功进行冠脉支架植入并复查冠脉造影者70例冠心病临床资料。根据支架内再狭窄直径≥50%,将其分为再狭窄组和无再狭窄组,并研究冠状动脉粥样硬化性心脏病相关危险因子与支架内再狭窄的关系,研究2型糖尿病为支架内再狭窄的独立危险因素是否成立。70例共植入97枚支架,其中23例(31枚)发生支架内再狭窄,6个月再狭窄率为32.85%。无再狭窄组和再狭窄组男性分别占68.9%和69.8%(P0.05)。两组平均年龄(47.5±11.4岁)。高血压患病率(58.9%VS 65.6%),高血压分级、高血压年限、吸烟、入院总胆固醇(TC),低密度脂蛋白(LDL),在统计学上无显著差异。在冠心病的危险因素中,再狭窄组糖尿病患者19例占82.6%,无再狭窄组只有13例占27.6%(P0.05);再狭窄组的入院空腹、餐后血糖水平为7.10±1.56mmol/L、13.90±1.56mmol/L,明显高于无再狭窄组空腹、餐后血糖5.14±0.82mmol/L、7.2±1.26mmol/L(P0.05)。多因素logistic回归分析结果:糖尿病是再狭窄危险因素,多支血管病变可能增加支架内再狭窄的发生。2型糖尿病是支架内再狭窄最有力的预测因子。     

冠脉支架术后患者支架内再狭窄原因的回顾性研究

目的 通过对冠脉支架植入术后复查冠脉造影患者的回顾性分析,研究引起支架内再狭窄(ISR)的可能原因.方法 入选2009年～2010年所有复查造影的冠心病支架治疗患者73例,将其分成支架内再狭窄组及无再狭窄组,分析两组间可能导致支架内再狭窄的因素间差异.结果 73例患者共植入177枚支架,其中有22枚支架发生再狭窄(支架内再狭窄定义为随访时造影提示支架内管腔内径损失≥50%).分析两组基本临床资料特征及支架长度、直径,是否为药物涂层支架等因素;支架内再狭窄组及无再狭窄组在吸烟、2型糖尿病、支架长度、直径和药物/非药物支架方面有显著差异(P ＜0.05).Cox比例风险回归模型显示仅支架长度(P=0.009)、直径(P=0.029)和药物/非药物支架(P=0.026)为冠心病介入患者发生ISR的预测因子.结论 冠脉支架植入后发生再狭窄的主要原因为支架长度、直径及是否为药物支架.     

冠状动脉支架置入后:糖化血红蛋白与再狭窄的关系

背景:众多基础和临床研究表明,多种因素参与了冠状动脉支架内再狭窄的形成,支架内再狭窄除与支架本身有关,吸烟、糖尿病和不稳定心绞痛等更是触发再狭窄的重要预测因素.糖化血红蛋白为糖尿病疗效评定的监测指标以及微血管病变的生化标志.目的:分析冠状动脉支架置入后支架内再狭窄与糖化血红蛋白的关系.方法:将36例成功接受支架置入治疗的冠状动脉粥样硬化性心脏病患者,根据糖化血红蛋白和空腹血糖水平分为3组:糖化血红蛋白与空腹血糖均正常组(n=11)、糖化血红蛋白正常而空腹血糖升高组(n=15)、糖化血红蛋白与空腹血糖均升高组(n=10).支架置入后患者因胸痛再发或常规行冠脉造影随访,以原靶病变管腔直径狭窄≥50%为支架内再狭窄,对照分析糖化血红蛋白对冠状动脉再狭窄的影响.结果与结论:36例患者中,7例发生冠状动脉内再狭窄,占19%,其中糖化血红蛋白与空腹血糖均正常组中有1例发生再狭窄,糖化血红蛋白正常而空腹血糖升高组中2例发生再狭窄,糖化血红蛋白与空腹血糖均升高组中有4例发生再狭窄.糖化血红蛋白与空腹血糖均升高组中冠状动脉内再狭窄比率明显高于其他两组(P<0.05).回归分析显示糖化血红蛋白升高是冠状动脉支架置入后再狭窄的重要因素之一,测定糖化血红蛋白可进一步评估冠脉支架置入后再狭窄的风险.     

术前血清胆红素预测冠心病支架再狭窄价值

目的 探讨术前血清胆红素的水平与冠心病支架术后再狭窄的相关性.方法 纳入2013-2014年入住浙江大学医学院附属第二医院行冠脉造影接受支架植入治疗,并于术后6月到12月之间再次入院行冠脉造影复查的249例冠心病患者,根据支架内有无再狭窄分为支架内再狭窄组和无再狭窄组,通过比较两组患者术前血清胆红素的水平,分析其与冠心病支架内再狭窄的关系.结果 血清总胆红素(TBIL)冠心病支架内再狭窄组(9.93±3.871μmol/L)水平低于无再狭窄组(12.08±4.67) μmol/L,(P=0.000),血清直接胆红素(DBIL)冠心病支架内再狭窄组(3.17±1.60) μmoL/L水平低于无再狭窄组(3.89±1.83)μmol/L,(P =0.002),血清间接胆红素(IBIL)冠心病支架内再狭窄组(6.76±2.82)μmol/L水平低于无再狭窄组(8.17±3.39)μmol/L,(P =0.001);差异具有统计学意义(P＜0.05).Spearman相关回归分析,结果显示,TBIL、DBIL、IBIL与再狭窄呈负相关,(P＜0.05),血清胆红素越低,再狭窄发生率越高.结论 冠心病再狭窄患者血清TBIL、DBIL、IBIL偏低,再狭窄与血清TBIL、DBIL、IBIL相关性高.术前TBIL、DBIL、IBIL可作为冠心病支架内再狭窄的预测因素.     

糖尿病患者糖化血红蛋白控制水平与支架内再狭窄的相关性研究

选取我院心内科行冠脉支架置入术的128例冠心病合并糖尿病患者,根据患者糖化血红蛋白水平分为观察组60例和对照组68例。所有患者均术后随访半年,入院行冠脉造影检查,对比两组再狭窄率。观察组患者再狭窄率为11.7%,对照组再狭窄率为25%,两组比较差异有统计学意义(P0.01)。吸烟史、高血压史、糖尿病史、血脂水平、hs-CRP水平与再狭窄发生率存在明显相关性。糖化血红蛋白是支架内再狭窄的重要影响因素,检测其水平能评估冠状动脉支架术后发生再狭窄的风险,对预防冠脉支架植入后再狭窄有一定应用价值。     

影响冠心病患者PCI术后支架内再狭窄的独立危险因素及干预对策分析

目的研究冠心病患者经冠状动脉介入术后支架内再狭窄的危险因素及干预对策。方法采用回顾性研究的方法,选择2016年4月~2017年4月在我院成功接受PCI手术治疗的160冠心病例患者为研究对象,根据术后复查冠状动脉造影结果分为支架内狭窄组(38例)和非狭窄组(122例),通过单因素分析和多因素Logistic回归分析探讨经冠状动脉介入术后支架内再狭窄的危险因素,并提出干预对策。结果两组患者在吸烟、糖尿病、高血压、支架直径方面比较差异显著(P<0.05);多因素Logistic回归分析显示,吸烟、糖尿病、高血压是支架内再狭窄的独立危险因素,支架直径是支架内再狭窄的保护因素。结论吸烟、糖尿病、高血压是冠心病患者经冠状动脉介入术后支架内再狭窄的独立危险因素,支架直径是其保护因素。     

冠心病患者支架置入术后支架内再狭窄原因的临床探讨

目的 探究冠心病患者冠状动脉(冠脉)支架置入术后再狭窄的影响因素.方法 回顾性分析2010年2月至2012年2月期间复诊造影的70例冠心病冠脉支架置入患者中出现术后再狭窄与未发生再狭窄者的临床资料.结果 单因素分析显示,年龄、高血脂、左室射血分数、支架最小管腔开放直径、最大扩张压、Duke病变分型及支架靶血管对冠脉支架置入术后支架内再狭窄发生无明显影响(P均＞0.05).术后出现支架内再狭窄患者,其男性、高血压史、糖尿病史、吸烟史的发生率及纤维蛋白原水平[(381.02±25.36)vs(283.36±22.27)mg/dl]均高于未发生再狭窄患者(P均＜0.05),支架直径＜3.5 mm者比率高于未发生再狭窄患者(61.90％vs39.13％,P＜0.05).结论 引起冠脉支架置入术后支架内再狭窄的因素较为复杂,为预防再狭窄,应加强对危险因素的控制,以改善冠心病患者术后康复质量.     

脑梗死与颅内动脉粥样硬化性狭窄及危险因素的关系

目的:研究脑梗死与颅内动脉粥样硬化性狭窄及危险因素的关系.方法:对125例脑梗死患者(脑梗死组)及120例非脑梗死患者及正常体检者(对照组)进行经颅多普勒超声和血脂、血糖检查.结果:脑梗死组颅内动脉粥样硬化性狭窄检出率(38.4%)与对照组(10.8%)比较差异有显著性(P＜0.01).脑梗死组颅内动脉粥样硬化性狭窄的分布依次为大脑中动脉(70.8%)、大脑前动脉(31.3%)、椎基底动脉(18.8%)、颈内动脉末端(10.4%).有高血压、糖尿病、冠心病、卒中家族史的脑梗死患者容易发生颅内动脉狭窄,其OR值分别为2.56、3.46、4.12、5.20(均P＜0.05).脑梗死组高密度脂蛋白[(1.09±0.32)mmol/L]比对照组[(1.33±0.40)mmol/L]低(P＜0.05).结论:颅内动脉粥样硬化性狭窄与脑梗死发生有密切关系,颅内动脉粥样硬化性狭窄的危险因素有高血压、糖尿病、冠心病、卒中家族史,保护因素有高密度脂蛋白.     

冠心病冠脉支架术后患者发生再狭窄的危险因素分析

目的探讨冠心病冠脉支架术后患者发生再狭窄的危险因素。方法选择2012年9月至2013年9月成功进行冠状支架植入手术患者183例,根据随访结果将其分为再狭窄组46例和非再狭窄组117例,比较两组患者临床资料、生化指标以及病情特点等因素,采用单因素分析以及Logistic多因素回归分析。结果两组患者在脂蛋白a、总胆红素、术前狭窄程度、植入支架长度、植入支架直径、病变支数、糖尿病以及吸烟8个因素上,差异具有统计学意义(P0.05);Logistic多因素分析结果显示,脂蛋白a、植入支架直径、糖尿病、植入支架长度以及吸烟5个因素进入回归模型(P0.05),为影响冠心病冠脉支架术后患者发生再狭窄的独立危险因素。结论脂蛋白a、植入支架直径、糖尿病、植入支架长度以及吸烟是造成冠心病冠脉支架术后患者发生再狭窄的独立危险因素,提示冠脉支架手术需要仔细考虑植入支架的长度和直径,术后密切观察注意对患者血清生化指标的检测,戒烟、积极治疗糖尿病。     

血管内超声指导小血管病变支架置入的临床应用

目的　观察血管内超声指导小血管病变支架置入的临床疗效 ,评价其应用价值。方法　 10 2例冠脉造影确定的小血管病变患者 ,随机分为冠脉造影指导组 (冠脉造影组 )和血管内超声指导组 (超声组 ) ,血管内超声组在血管内超声指导下置入支架 ,冠脉造影组在单纯冠脉造影指导下置入支架 ,根据各自不同的判定标准 ,对支架置入达不到理想标准的再次行高压球囊扩张或加置支架。在支架置入前、置入后即刻和术后 6个月不同时间定量冠脉造影测定病变长度、直径或面积狭窄率、病变最小血管直径 (MLD)、参照血管直径 ,观察 6个月内的再狭窄率和不良心血管事件。结果　冠脉造影组 5 2例患者 4 9例成功置入支架 ,超声组 5 0例患者全部完成血管内超声检查 ,4 8例成功置入支架。超声组和冠脉造影组比较 :支架置入前 ,两组所选支架长度、内径大小有显著差异 ;支架置入后即刻 ,超声组和冠脉造影组病变MLD分别是 (2 .78± 0 .30 )mm、(2 .5 0± 0 .2 7)mm ,直径狭窄率分别是 (8± 3) %、(12± 5 ) % (P <0 .0 1) ;6个月随访时超声组和冠脉造影组再狭窄率分别是 2 5 %、4 6 % (P <0 .0 1) ,总不良心血管事件分别是 6例(12 % )和 17例 (32 .7% ) (P <0 .0 5 )。结论　血管内超声指导小血管病变支架置入能获得较好的临床效果 ,安     

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.     

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.     

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.