Relation of percutaneous coronary intervention of complex lesions to clinical outcomes (from the NHLBI Dynamic Registry)

Advances in percutaneous coronary intervention (PCI) have reduced complications but expanded indications. We used the National Heart, Lung, and Blood Insitute Dynamic Registry to determine clinical outcomes up to 1 year after PCI in 2,839 patients with at least 1 treated complex lesion (defined as a lesion showing evidence of thrombus, calcification, bifurcation or ostial location, or chronic occlusion) and 1,790 patients with only simple lesions treated. Complex lesion interventions were associated (p <0.05) with more sustained major dissections, distal embolization, side branch occlusion, and persistent flow reduction. Patients with treated complex lesions had a lower procedural success rate (93.8% vs 97.3%, p <0.001) and increased in-hospital rates (p <0.001) of death (2.0% vs 0.6%), death/myocardial infarction [MI] (5.2% vs 2.4%), or death/MI/coronary artery bypass graft [CABG] surgery (6.5% vs 2.9%). After adjustment for potential confounders, patients treated for multiple complex lesions were more likely to experience the in-hospital combined end points of death/MI (odds ratio 3.22, 95% confidence interval 2.10 to 4.92), or death/MI/CABG (odds ratio 2.55, 95% confidence interval 1.71 to 3.80). At 1 year, patients with treated complex lesions were more likely (p <0.001) to die (6.2% vs 3.7%), suffer death/MI (11.7% vs 7.5%), or death/MI/CABG/repeat PCI (27.2% vs 23.4%). Patients treated for multiple complex lesions were approximately 50% more likely to die or to have major adverse events than with patients only treated for simple lesions. An increased in-hospital adverse clinical event rate was independently noted for thrombotic, bifurcation, and calcified lesions, and bifurcation lesions had worse long-term event rates.     

胡芦巴生制品降血脂功效研究

目的 对胡芦巴生、制品的降血脂功效进行研究。方法 通过喂养高脂高糖饲料,构建小鼠高血脂模型。将高血脂模型小鼠按TG、TC、体重分为模型组,阳性组,生品组,盐制品组,酒制品组,外加空白组。给予相应药物治疗21天后,对体重、血清中TC、TG、LDL-C、HDL-C、AST、ALT的水平进行测定,取肝脏称重,计算肝指数。结果 与空白组相比：模型组小鼠的体重显著升高（P<0.01）,与模型组相比,胡芦巴生、制品组小鼠的体重显著降低（P<0.05）;模型组小鼠的肝指数显著升高（P<0.01）,与模型组相比,胡芦巴生、制品组小鼠的肝指数显著降低（P<0.05）;模型组小鼠的TG、TC、LDL-C、HDL-C显著升高（P<0.01）,与模型组相比,胡芦巴生、酒制品组小鼠的TG、TC、LDL-C显著降低（P<0.05）,盐制品组TG、TC（P<0.01）、LDL-C（P<0.05）,对TG、TC的调节作用,盐制品组要优于生品组（P<0.05）;模型组小鼠的AST、ALT显著升高（P<0.01）,与模型组相比,胡芦巴生、盐制品组小鼠的AST、ALT显著降低（P<0.05）,酒制品组（P<0.01）。且酒制品组与生品组之间具有显著性差异（P<0.05）。结论 胡芦巴盐制后对高血脂模型中TG和TC的调节作用增强、酒制后对AST和ALT的调节作用增强,说明胡芦巴盐制后降血脂作用增强,酒制后肝保护的作用增强。     

地塞米松脂质体的制备及其对乳腺癌作用的体内外研究

目的制备地塞米松脂质体,探讨地塞米松对乳腺癌4T1细胞的生长抑制作用及对荷瘤鼠的抗肿瘤药效。方法采用薄膜分散–超声法,以粒径和多分散指数(PDI)为指标进行单因素实验考察了大豆磷脂(SPC)与甲氧基聚乙二醇磷脂(DSPE-mPEG2000)的质量比、SPC与地塞米松的质量比、超声时间对地塞米松脂质体粒径的影响从而筛选得到最佳处方和最佳工艺条件。采用MTT法比较地塞米松注射液和地塞米松脂质体对4T1细胞的作用。建立4T1 BAL B/c荷瘤小鼠模型,研究地塞米松脂质体对4T1荷瘤小鼠的体内抗肿瘤作用。结果当SPC与DSPE-mPEG2000质量比为5∶1、SPC与地塞米松质量比为50∶3、超声时间为20 min时制备得到的脂质体粒径最小,粒径分布最窄,室温放置15 d稳定,于生理介质中稳定。MTT测定结果显示地塞米松注射液和脂质体对4T1细胞生长抑制作用均较弱,但在4T1荷瘤鼠的体内实验中,在5mg/kg的给药剂量下,地塞米松脂质体的抑瘤率却高达78.9%,显著高于地塞米松注射液(33.4%,P<0.05)和8mg/kg紫杉醇注射液(55%,P<0.05)。结论制备的地塞米松脂质体放置于生理介质中均能稳定存在,能口服能静脉给药。地塞米松脂质体对4T1荷瘤小鼠肿瘤生长有较强的抑制作用,但体外对4T1细胞抑制抑制作用并不强,推测地塞米松脂质体是通过调节肿瘤微环境来抑制肿瘤生长。     

摆幅可调型足部康复机器人的生物力学特性分析

目的基于人机工程学和生物力学仿真技术,对人体肌肉进行生物学评价,研究摆幅可调型足部康复机器人的康复策略。方法在Any Body中建立人体和摆幅可调型足部康复机器人的人机耦合模型,并对耦合模型进行运动学仿真,将仿真结果与理论计算结果相比,验证耦合模型的可靠性;再利用Any Body中的参数研究机制对验证后的耦合模型进行生物力学仿真,以足部康复机器人的运动速度和摆幅为变量,分析在不同变量组合下的肌肉活动度和肌肉力。结果在康复运动中足部相关肌肉的拉伸性能得到有效训练,不同的运动速度和摆幅对肌肉的影响不同,并得出运动速度和摆幅调节的安全范围。结论实现了不同运动速度和摆幅下肌肉活动度和肌肉力的组合分析,研究结果对足部康复机器人的临床应用和被动康复模式下康复策略的制订具有一定指导意义。     

中药热奄包联合耳穴压豆及针刺对急性胃肠炎患者症状的影响

目的 探讨中药热奄包联合耳穴压豆及针刺对急性胃肠炎患者症状的影响.方法 选取2018年12月—2020年11月就诊于某院的86例急性胃肠炎患者,根据不同干预方法分为对照组与观察组各43例.对照组给予常规护理干预,观察组在对照组基础上实施中药热奄包联合耳穴压豆及针刺等中医护理干预.对比两组患者症状改善时间、视觉模拟评分法(VAS)疼痛评分与康复效果.结果 观察组腹泻、呕吐、腹痛症状改善时间为(16.68±4.22)h、(14.28±3.50)h、(21.39±5.63)h,短于对照组的(20.87±5.01)h、(19.97±5.77)h、(28.49±6.11)h;干预3 d后,观察组VAS疼痛评分(1.62±0.47)分,低于对照组的(2.28±0.49)分;干预3 d后,观察组康复总有效率97.67％,高于对照组的81.40％,有统计学差异(P<0.05).结论 中药热奄包联合耳穴压豆及针刺干预可促进急性胃肠炎患者腹泻、呕吐等症状的改善,减轻疼痛症状,增强其身心康复效果.     

大黄素-8-O-β-D-葡萄糖苷的体内外遗传毒性评价

目的:评价大黄素-8-O-β-D-葡萄糖苷(EG)的体内外遗传毒性,并比较体外细胞试验及大鼠体内实验评价结果的差异。方法:采用体外二维(2D)、三维(3D)细胞培养法分别构建2D、3D HepaRG细胞模型,造模成功后,分别将2D、3D HepaRG细胞分为空白对照组[0.5%二甲基亚砜(DMSO)]、丝裂霉素C组(阳性对照,0.1μg/mL)和EG低、中、高剂量组(10、50、200μg/mL),然后检测各组HepaRG细胞的微核形成率和尾DNA百分含量。将SD大鼠分为空白对照组(0.5%羧甲基纤维素钠)、甲磺酸乙酯组(阳性对照,200 mg/kg)和EG低、中、高剂量组(100、300、1 000 mg/kg),每组6只,连续灌胃给药15 d,每天1次;15 d后检测各组大鼠骨髓嗜多染红细胞、肝细胞的微核形成率及外周血淋巴细胞、肝细胞的尾DNA百分含量、尾距。结果:在体外2D HepaRG细胞模型中,与空白对照组比较,丝裂霉素C组HepaRG细胞的微核形成率和尾DNA百分含量均显著升高(P<0.01),EG各剂量组HepaRG细胞的微核形成率和尾DNA百分含量差异无统计学意义(P>0.05);在3D HepaRG细胞模型中,与空白对照组比较,丝裂霉素C组HepaRG细胞的微核形成率和尾DNA百分含量均显著升高(P<0.01或P<0.001),EG高剂量组HepaRG细胞的尾DNA百分含量显著升高(P<0.01)。在大鼠体内实验中,与空白对照组比较,甲磺酸乙酯组大鼠骨髓嗜多染红细胞、肝细胞的微核形成率和外周血淋巴细胞、肝细胞的尾DNA百分含量、尾距均显著升高(P<0.01),EG高剂量组大鼠外周血淋巴细胞尾DNA百分含量显著升高(P<0.01),EG各剂量组大鼠骨髓嗜多染红细胞、肝细胞的微核形成率和肝细胞尾DNA百分含量、尾距差异无统计学意义(P>0.05),但随剂量增加有升高趋势。结论:本研究结果提示在2D细胞模型中,EG未导致染色体断裂及DNA损伤,但3D细胞模型长期给药和体内重复给药结果均显示EG存在一定DNA损伤风险,故3D HepaRG细胞模型的评价结果更接近大鼠体内实验结果。     

植入式心律转复除颤器手术前后患者确定感、焦虑与性格乐观状态的研究

目的研究比较植入式心律转复除颤器(ICD)作为心源性猝死的一级预防(primary prevention,PP)和二级预防(secondary prevention,SP),在植入前、植入后1周以及植入后1个月对患者情绪的不同影响。方法选择15例患者应用植入式心律转复除颤器作为心源性猝死的PP,15例患者应用植入式心律转复除颤器作为心源性猝死的SP,应用描述性横断面调查法,利用Mishel-疾病不确定感量表(Mishel’s Uncertainty in Illness Scale,MUIS-C),特质状态焦虑量表(State-Trait Anxiety Inventory,STAI)和生活目标量表(the Life Orientation Test,LOT-R),通过晤谈行半结构访问。结果在植入式心律转复除颤器植入前,两组患者的MUIS-C分值都较高(PP=67.67±13.36;SP=70.27±6.80,P=0.507);LOT-R分值为PP=15.67±3.8,SP=16.47±3.6,P=0.557;STAI分值为PP=37.40±10.0,SP=37.73±13.6,P=0.940。在植入式心律转复除颤器植入后1个月,PP患者的MUIS-C分值明显低于SP患者(PP=62.33±4.17,SP=67.87±4.61,P=0.002)。结论利用植入式心律转复除颤器作为SP的患者护理时更应该引起护士的重视。     

维生素E微胶囊的制备工艺研究

目的:通过正交实验优化包合工艺参数,研究超声法制备维生素E油β-环糊精包合物的最佳工艺条件。方法:采用β-环糊精为壁材,运用包结络合法对维生素E进行微胶囊化。结果:得到超声法制备最佳工艺条件为:包合时间20 min、包合温度30℃、超声功率150 W、m(VE)∶m(β-CD)=1∶9。在优选的条件下包合得包合率为83.5%,产物收率达到71.3%。结论:在此条件下维生素E油β-环糊精包合物成功解决了维生素E易氧化、遇光和热不稳定的难题,提高了其稳定性。     

Extent and distribution of in-stent intimal hyperplasia and edge effect in a non-radiation stent population

Intimal hyperplasia within the body of the stent is the primary mechanism for in-stent restenosis; however, stent edge restenosis has been described after brachytherapy. Our current understanding about the magnitude of in vivo intimal hyperplasia and edge restenosis is limited to data obtained primarily from select, symptomatic patients requiring repeat angiography. The purpose of this study was to determine the extent and distribution of intimal hyperplasia both within the stent and along the stent edge in relatively nonselect, asymptomatic patients scheduled for 6-month intravascular ultrasound (IVUS) as part of a multicenter trial: Heparin Infusion Prior to Stenting. Planar IVUS measurements 1 mm apart were obtained throughout the stent and over a length of 10 mm proximal and distal to the stent at index and follow-up. Of the 179 patients enrolled, 140 returned for repeat angiography and IVUS at 6.4 +/- 1.9 months and had IVUS images adequate for analysis. Patients had 1.2 +/- 0.6 Palmaz-Schatz stents per vessel. There was a wide individual variation of intimal hyperplasia distribution within the stent and no mean predilection for any location. At 6 months, intimal hyperplasia occupied 29.3 +/- 16.2% of the stent volume on average. Lumen loss within 2 mm of the stent edge was due primarily to intimal proliferation. Beyond 2 mm, negative remodeling contributed more to lumen loss. Gender, age, vessel location, index plaque burden, hypercholesterolemia, diabetes, and tobacco did not predict luminal narrowing at the stent edges, but diabetes, unstable angina at presentation, and lesion length were predictive of in-stent intimal hyperplasia. In a non-radiation stent population, 29% of the stent volume is filled with intimal hyperplasia at 6 months. Lumen loss at the stent edge is due primarily to intimal proliferation.