益心汤联合阿托伐他汀对冠心病患者血脂水平的影响及安全性分析

目的：分析益心汤联合阿托伐他汀对冠心病患者血脂水平的影响及安全性。方法：选择2019年2月~2021年2月收治的120例冠心病患者为研究对象,按随机数字表法分为对照组和观察组,各60例。对照组给予阿托伐他汀等常规治疗,观察组在对照组基础上给予益心汤,两组均连续治疗2周。对比两组治疗后临床疗效,治疗期间心血管不良事件发生情况、不良反应以及治疗前后血脂水平。结果：治疗后观察组总有效率（95.00%）较对照组（80.00%）高;治疗期间观察组不良反应总发生率（13.33%）较对照组（46.67%）低;治疗期间观察组心肌梗死发生率、心绞痛发生率、心律失常发生率、心源性死亡发生率均低于对照组（P＜0.05）;治疗后两组血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平均较治疗前降低,且观察组低于对照组,两组血清高密度脂蛋白胆固醇水平较治疗前升高,且观察组高于对照组（P＜0.05）。结论：益心汤联合阿托伐他汀可有效改善冠心病患者临床症状,调节血脂水平,减少不良反应发生,疗效显著,安全性较高。     

血脂 第9讲 常用降脂药物及其疗效评价

目前在临床上常用的降脂药物有许多，归纳起来大体上可分为五大类。     

他汀类药的非调脂作用

新型调血脂药他汀类即羟甲基戊二酰辅酶A抑制剂(HMG-COA还原酶抑制剂)主要包括洛伐他汀、辛伐他汀、普伐他汀、氟伐他汀等，临床广泛用于治疗多种类型的高脂血症，还可减少高脂血症病人发生心脏病的危险，其降血脂作用机制是竞争抑制胆固醇生物合成途径中的限速酶-HAG-COA还原酶，可减少肝脏的胆固醇生物合成，明显降低LDL水平，进而改善血清脂质。目前新的实验研究和临床流行病学调查结果显示，     

中国卫生技术评估与循证准入管理探索

目的探索从卫生部层面采用卫生技术评估的高质量证据,对影响广、费用高、风险大、有争议的卫生技术实行准入管理的可行性.方法借鉴国外卫生技术评估与循证管理实践的经验,在国内建立了四家卫生技术评估和循证医学相关机构,推动和开展卫生技术评估工作.以"脐带血造血干细胞库"、"人类辅助生殖技术"、"人类精子库"等技术的管理问题为切入点,领导开展技术评估,以高质量证据制定卫生部的准入管理办法和条例.结果开展多项有关医疗设备、临床医疗技术、预防与疾病控制的筛查技术等方面研究与评估;制定了多个单项技术评估与循证准入管理办法:<脐带血造血干细胞库管理办法>、<人类辅助生殖技术管理办法>、<人类精子库管理办法>等,指导各地机构和人员认证,规范管理.结论在我国建立卫生技术评估与循证准入管理制度已有一定基础,还需不断改进与完善,逐步形成行之有效的卫生技术准入管理运行机制.     

Multi-Modality Safety Assessment of Blood-Brain Barrier Opening Using Focused Ultrasound and Definity Microbubbles: A Short-Term Study

As a potentially viable method of brain drug delivery, the safety profile of blood-brain barrier (BBB) opening using focused ultrasound (FUS) and ultrasound contrast agents (UCA) needs to be established. In this study, we provide a short-term (30-min or 5-h survival) histological assessment of murine brains undergoing FUS-induced BBB opening. Forty-nine mice were intravenously injected with Definity microbubbles (0.05 μL/kg) and sonicated under the following parameters: frequency of 1.525 MHz, pulse length of 20 ms, pulse repetition frequency of 10 Hz, peak rarefactional acoustic pressures of 0.15–0.98 MPa and two 30-s sonication intervals with an intermittent 30-s delay. The BBB opening threshold was found to be 0.15–0.3 MPa based on fluorescence and magnetic resonance imaging of systemically injected tracers. Analysis of three histological measures in hematoxylin and eosin–stained sections revealed the safest acoustic pressure to be within the range of 0.3–0.46 MPa in all examined time periods post sonication. Across different pressure amplitudes, only the samples 30 min post opening showed significant difference (p < 0.05) in the average number of distinct damaged sites, microvacuolated sites, dark neurons and sites with extravasated erythrocytes. Enhanced fluorescence around severed microvessels was also noted and found to be associated with the largest tissue effects, whereas mildly diffuse BBB opening with uniform fluorescence in the parenchyma was associated with no or mild tissue injury. Region-specific areas of the sonicated brain (thalamus, hippocampal fissure, dentate gyrus and CA3 area of hippocampus) exhibited variation in fluorescence intensity based on the position, orientation and size of affected vessels. The results of this short-term histological analysis demonstrated the feasibility of a safe FUS-UCA–induced BBB opening under a specific set of sonication parameters and provided new insights on the mechanism of BBB opening. (E-mail: ek2191@columbia.edu)     

临终医疗的卫生技术评估系列研究Ⅰ.围脑死亡期医疗服务的现状及费用分析

目的　了解我国围脑死亡期医疗服务现状 ,分析其治疗效果和费用特点。　方法　采用回顾性系列病例研究方法 ,对 1 999年 6月～ 2 0 0 0年 1 2月、2 0 0 1年 1 1月～ 2 0 0 2年 6月间四川大学华西医院外科ICU 940例患者的治疗情况和部分直接医疗成本进行调查分析 ,数据统计与分析使用SPSS 1 0 .0软件。　结果　以病人出现深昏迷、瞳孔对光反射消失和无自主呼吸中的任二种 ,且持续时间超过 1h为围脑死亡期的纳入标准 ,共纳入病例 1 1 5例 ,死亡率高达 99.1 0 % ,人均医疗费 2 5 1 5 .9元 /天。影响费用的主要因素是院内感染 (P =0 .0 0 7)和围脑死亡期持续时间 (P <0 .0 5 )。且随着围脑死亡期持续时间延长 ,患者死亡率迅速增加 ,80 %的病人在符合纳入标准后 72h内死亡。　结论　国内围脑死亡期医疗服务仍主要采用全力抢救模式 ,资源浪费严重。应积极促进脑死亡立法 ,呼吁理性的临终医疗。     

A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.