SII、NPAR与老年急性ST段抬高型心肌梗死患者短期预后的关系

目的 探讨全身免疫炎症指数(SII)、中性粒细胞计数与白蛋白比值(NPAR)与老年急性ST段抬高型心肌梗死(ASTEMI)患者短期预后的关系.方法 回顾性分析2017年1月至2020年1月我院老年病科和循环科收治的行经皮冠状动脉介入治疗(PCI)的152例老年ASTEMI患者的临床资料.随访6个月,根据患者PCI术后心血管不良事件(MACE)的发生情况,将其分为预后良好组(n=100)和预后不良组(n=52).比较两组患者的年龄、性别、体质量指数(BMI)、吸烟饮酒史、糖尿病史、高血压史、Killip分级等指标.绘制ROC曲线分析SII、NPAR对老年ASTEMI患者短期预后的预测价值;采用多因素Logistic回归分析影响老年ASTEMI患者不良预后的危险因素.结果 两组冠状动脉病变支数、发病至行PCI时间、Killip分级、入院GRACE评分、LVEF、中性粒细胞、淋巴细胞、白蛋白、CK-MB、TnI、SII和NPAR相比,差异有统计学意义(P＜0.05).Pearson相关性分析示,术前SII、NPAR分别与Killip分级、GRACE评分呈正相关(P＜0.05).ROC曲线示,SII、NPAR和两项联合检测预测老年ASTEMI患者预后的AUC分别为0.842、0.807、0.910.多因素Logistic回归分析示,冠状动脉病变支数、Killip分级、GRACE评分、LVEF、SII和NPAR是影响老年ASTEMI患者短期预后的独立危险因素(P＜0.05).结论 术前SII、NPAR升高与ASTEMI老年患者预后不良有关,联合检测SII、NPAR对评估ASTEMI老年患者短期预后有较高临床价值.     

血清HDAC1和BMP7对冠心病患者PCI术后发生不良心血管事件的预测价值评估

目的 探索血清组蛋白脱乙酰化酶1(HDAC1)和骨形态发生蛋白7(BMP7)对冠心病患者冠状动脉介入术(PCI)术后发生不良心血管事件的预测价值。方法 纳入2020年1月至2022年1月本院接收且均进行PCI术的冠心病患者90例为实验组。根据冠心病患者PCI术后6个月内心血管不良事件(MACE)发生情况进一步将其分为MACE组(28例)和非MACE组(62例)。选取同期健康体检者80例为对照组。采用酶联免疫吸附(ELISA)法检测血清HDAC1、BMP7水平;采用多因素Logistic回归分析MACE事件结局的影响因素;采用受试者工作曲线(ROC)来评价血清HDAC1、BMP7在冠心病预测中的临床意义。结果 相较于对照组,实验组患者血清HDAC1水平显著升高,BMP7水平显著降低,且差异具有统计学意义(P<0.05)。与对照组相比,非MACE和MACE组患者血清TC、LDL-C显著升高,且差异具有统计学意义(P<0.05);相较于非MACE组,MACE组患者血清HDAC1、TC、LDL-C水平显著升高,BMP7水平显著降低,且差异具有统计学意义(P<0.05)。多因素...     

血HMGB1、UA及MHR与老年冠心病PCI术不良心血管事件发生的关系

目的:探讨血高迁移率族蛋白B1(High-mobility group box-1,HMGB1)、尿酸(Uric acid,UA)及单核细胞/高密度脂蛋白(High-density lipoprotein cholesterol,HDL-C)比值(Monocyte to high-density lipoprotein cholesterol ratio,MHR)与老年冠心病(Coronary heart disease,CHD)经皮冠状动脉介入术(Percutaneous coronary intervention,PCI)不良心血管事件(Major adverse cardiovascular events,MACE)发生的关系.方法:采用回顾性分析法,选取2020年 9月至2022年 9月本院收治的200例行PCI术的老年CHD患者为CHD组,并纳入同期进行体检的健康者100例作为对照组.所有患者出院均接受6 m的随访调查,根据是否发生MACE,将CHD患者分为MACE组和非MACE组,采用受试者工作特征(Receiver operating characteristic,ROC)曲线分析血HMGB1、UA及MHR对老年冠心病PCI术MACE发生的预测价值.结果:CHD组血HMGB1、UA及MHR水平均高于对照组,MACE组血HMGB1、UA及MHR水平均高于非MACE组,且血HMGB1、UA及MHR三者联合ROC曲线下面积(Area under the curve,AUG)高于单独检测(P＜0.05).结论:血HMGB1、UA及MHR水平与老年CHD患者PCI术后MACE发生密切相关.     

血清TRPV6、MG53、Nesfatin-1与急性ST段抬高型心肌梗死患者预后的相关性研究

目的 探讨急性ST段抬高型心肌梗死(ASTEMI)患者血清瞬时受体电位香草酸6(TRPV6)、Mitsugumin53(MG53)、摄食抑制因子-1(Nesfatin-1)表达水平,分析其与患者临床预后的相关性.方法 选取2018年1月至2019年12月在我科接受经皮冠状动脉介入(PCI)治疗的140例ASTEMI患者...     

冠心病患者PCI术后血清IL-33、sST2、LP-PLA2水平及其与预后的关系

目的 分析冠心病(CHD)患者经皮冠状动脉介入术(PCI)术后血清白介素-33(IL-33)、可溶性生长刺激表达基因蛋白2(sST2)、脂蛋白相关磷脂酶A2(LP-PLA2)水平及其与预后的关系.方法 选取2017年1月至2020年1月我院收治的128例行PCI治疗的CHD患者为研究对象,作为观察组,根据冠状造影结果 分为单支病变组(n=48)、双支病变组(n=55)及多支病变组(n=25),并选取同期入院后未行PCI术治疗的CHD患者60例作为对照组,并随访术后6个月不良心血管事件(MACE)发生情况,根据MACE分为MACE组(n=25)和非MACE(n=103),检测血清IL-33、sST2、LP-PLA2水平,采用ROC曲线分析其水平对预后的评估价值.结果 观察组血清IL-33、sST2、LP-PLA2水平高于对照组(P<0.05);多支病变组血清IL-33、sST2、LP-PLA2水平高于单支病变组和双支病变组,双支病变组血清IL-33、sST2、LP-PLA2水平高于单支病变组(P<0.05);MACE组血清IL-33、sST2、LP-PLA2水平高于非MACE组(P<0.05);Logistic回归分析显示,血清IL-33、sST2、LP-PLA2水平是影响CHD患者PCI术后发生MACE的危险因素(P<0.05);ROC曲线分析显示,血清IL-33、sST2、LP-PLA2水平联合预测CHD预后的灵敏度及特异性均高于单独预测(P<0.05).结论 CHD患者PCI术后血清IL-33、sST2、LP-PLA2水平升高,可预测冠脉病变程度和预后,值得临床推广.     

焦虑抑郁状态对冠心病介入治疗患者预后的影响

目的探讨焦虑抑郁与冠心病介入治疗患者预后的关系。方法入选108例冠心病并行介入治疗病人,采用汉密尔顿抑郁量表及焦虑量表评估,将入选病人分为存在焦虑抑郁状态(A组)及对照组(B组)两组,观察6个月内有无心血管事件(MACE)的发生,将影响MACE事件的因素进行对比分析,焦虑抑郁状态等与MACE事件进行多因素相关性分析。结果存在焦虑抑郁状态(A组)31例(28.7%),对照组(B组)77例(71.3%)。A组发生MACE事件(29.0%)较B组发生MACE事件(15.6%)显著增加(P<0.01),多因素回归分析提示在6个月的随访中,焦虑抑郁状态、糖尿病、高血压、吸烟是MACE事件发生的独立预测因子(焦虑抑郁,OR=0.921,95%可信区间0.845～0.963,P=0.022)。结论冠心病介入治疗术后患者焦虑抑郁普遍存在,有可能增加了冠心病介入治疗术后患者MACE事件的发生。     

急性冠脉综合征PCI术前后中性粒细胞/淋巴细胞比值对近期预后的价值

目的 分析急性冠脉综合征(ACS)急诊冠脉介入术(PCI)前后患者中性粒细胞/淋巴细胞比值(NLR)变化对近期预后的预测价值.方法 选择于我院择期接受急诊PCI术治疗的72例ACS患者,术后均随访1年,统计主要心血管不良事件(MACE)发生率,测定有无MACE患者手术前后白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)、血小板计数(PLT)、NLR的变化,分析NLR对ACS患者PCI术后近期预后的预测价值.结果 ①AMI无MACE组术后WBC、NEUT、NLR均低于AMI并MACE组,LYM、PLT高于AMI并MACE组(P＜0.05);②UAP无MACE组术后WBC、NEUT、NLR均低于UAP并MACE组,LYM高于UAP并MACE组(P＜0.05);③术前、术后NLR预测PCI术后MACE灵敏度分别为74.0％、98.6％,特异性为45.3％、91.1％,术后NLR对ACI患者PCI术近期预后预测价值高.结论 NEUT上升、LYM降低对ACS患者PCI术后MACE事件的发生预测价值较高,较高的NLR水平提示ACS患者PCI术MACE发生风险较高.     

血小板参数检测在急性心肌梗死PCI术后不良事件中的预测价值

目的:血小板参数检测在经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)后心脏不良事件(Major adverse cardiac Events,MACE)预测价值.方法:以2018年10月至2020年1月收治的急性心肌梗死86例为对象,(随访(1年)分为MACE组、无MACE组).另选取同期健康体检86例(对照组).对比不同人群中血小板参数[血小板计数(platelet count,PLT)、平均血小板体积(Mean platelet volume,MPV)、血小板分布宽度(Platelet distribution width,PDW)、血小板压积(Hematocrit,PCT)]水平,分析发生MACE的相关因素.结果:观察组PLT、MPV、PDW值高于对照组,PCT值低于对照组(P<0.05).MACE组与无MACE组两组在年龄、高血压、PLT、PDW、MPV中比较存在差异(P<0.05);年龄、高血压、MPV升高是MACE发生的危险因素(P<0.05).结论:血小板参数中MPV升高可能与急性心肌梗死PCI术后不良事件发生有关,可作为评估预后的相关指标.     

冠状动脉造影微循环阻力指数对急性ST段抬高型心肌梗死患者急诊PCI术后预后的评估价值

目的 探究冠状动脉造影微循环阻力指数(coronary angiography-derived index of microcirculatory resistance, caIMR)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者行急诊经皮冠状动脉介入(percutaneous coronary intervention, PCI)术后发生主要心血管不良事件(major adverse cardiovascular events, MACE)的预测价值。方法 连续纳入2019年9月～2022年3月在徐州医科大学附属医院诊断为STEMI的患者541例。使用FlashAngio系统(苏州润迈德医疗科技有限公司)计算caIMR。按照住院或随访期间MACE发生与否将患者分为MACE组和非MACE组,MACE定义为全因死亡、心力衰竭再入院、非计划性血运重建。采用COX回归分析、受试者工作特征(receiver operating characteristics, ROC)曲线、Kaplan-Meier生存曲线探...     

氯吡格雷抵抗对急性心肌梗死合并糖尿病患者冠脉介入治疗预后的影响

目的：观察急性心肌梗死合并糖尿病且接受直接经皮冠脉介入治疗的患者氯吡格雷抵抗发生的情况及其对远期预后的影响。方法：连续入选2011年1月1日~2012年12月31日在我院接受直接经皮冠脉介入治疗,出院后随访>1年的急性心肌梗死合并糖尿病患者119例,所有患者均在服用氯吡格雷负荷量24 h后进行血栓弹力图检测,根据ADP诱导的血小板抑制率分为对照组(ADP抑制率≥50%,82例)和观察组(即氯吡格雷抵抗组,ADP抑制率<50%,37例)。记录患者的临床特点、生化指标、随访期间死亡和主要不良心血管事件(main adverse cardiac events,MACE)发生情况。结果：临床随访平均(783±241) d,氯吡格雷抵抗的发生率为31%。随访1年内总的MACE发生率为7.6%。氯吡格雷抵抗组1年内的MACE发生率明显高于对照组(16.2% vs.3.7%,P=0.025)。氯吡格雷抵抗和长期(1年以上)MACE发生无关(P=0.334);多因素Cox回归分析,氯吡格雷抵抗对患者的长期死亡率无明显影响。结论：接受直接经皮冠状动脉介入治疗的糖尿病合并急性心肌梗死患者存在明显的氯吡格雷抵抗现象。氯吡格雷抵抗会增加这些患者介入术后1年内发生主要心脏不良事件的风险,而对其1年以上的长期预后无显著影响。     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.