雷帕霉素洗脱支架治疗支架内再狭窄的临床及冠状动脉造影随访观察

目的评价雷帕霉素洗脱支架(商品名Cypher支架,强生公司产品)治疗支架内再狭窄的疗效及安全性。方法27例支架内再狭窄且有临床缺血症状的患者接受了Cypher支架治疗,其中23例患者的支架内再狭窄为弥漫、复杂病变,有5例同时置入了2个Cypher支架。术后对所有患者进行临床随访及冠状动脉造影复查。结果所有支架均成功置入,无残余狭窄或残余狭窄<10%,未见任何并发症。平均随访时间8.9±2.1(5～14)年,临床随访率96.3%,造影随访率92.6%。随访期间,无一例患者死亡。有1例支架近端边缘节段血管发生了再狭窄导致临床心绞痛复发,2例支架近端边缘节段有轻微的新生内膜增殖,但狭窄程度<25%,其余24例均无明显的晚期管腔丢失。本组支架内平均晚期管腔丢失(0.09±0.02)mm、支架远端边缘节段(0.10±0.03)mm、支架近端边缘节段(0.20±0.06)mm。靶血管血运重建率3.8%。结论Cypher支架治疗支架内再狭窄安全、可行,它能有效防止这类病变的新生内膜增殖和再次再狭窄。     

Human immunodeficiency virus type 1-infected women exhibit reduced interferon-gamma secretion after Chlamydia trachomatis stimulation of peripheral blood lymphocytes

Epidemiologic, animal, and in vitro models suggest an important role for interferon (IFN)-gamma in the clearance of Chlamydia trachomatis infection. IFN-gamma in the supernatants of in vitro-stimulated peripheral blood mononuclear cells (PBMC) from 22 human immunodeficiency virus type 1 (HIV-1)-infected and 73 uninfected women at high risk for C. trachomatis acute pelvic inflammatory disease (PID) was studied. PBMC were stimulated with C. trachomatis purified major outer membrane protein (MOMP) and whole elementary bodies (EBs) from the 4 predominant serovars (E, F, K, and L2) that circulate in Nairobi. PBMC IFN-gamma secretion after stimulation with C. trachomatis EBs was significantly decreased in HIV-1-infected women. Among HIV-1-infected women, CD4 T cell depletion was associated with lower IFN-gamma secretion from PBMC stimulated with either C. trachomatis MOMP or EB antigen. Decreased antigen-specific IFN-gamma production may enhance the susceptibility of HIV-1-infected women to C. trachomatis PID.     

既往心绞痛对急性心肌梗死患者冠状动脉侧支循环及左心室功能的影响

目的　探讨既往心绞痛对急性心肌梗死 (AMI)患者冠状动脉侧支循环及左心室功能的影响。方法　行选择性冠状动脉造影和左心室造影的 30 7例首次急性心肌梗死患者 ,分析既往心绞痛与肌酸激酶 (CK)峰值浓度、冠状动脉侧支循环和左心室功能等的关系。结果　① 30 7例患者中 ,有既往心绞痛者 192例 (A组 ) ,无既往心绞痛者 115例 (B组 )。②A组CK和CK MB峰值浓度均显著低于B组(P <0 0 5 )。③A组梗死相关动脉有良好侧支循环的比率显著高于B组 (P <0 0 5 )。④A组左心室射血分数 (LVEF)显著高于B组 (P <0 0 1) ,而室壁运动Cortina计分明显低于B组(P <0 0 1)。结论　既往心绞痛可能促进冠状动脉侧支循环的建立 ,对急性心肌梗死后的心脏功能起保护作用     

前列腺素E治疗病毒性肝炎的中文文献评价

1．资料与方法：以“前列腺素E(PGE)、前列地尔与病毒性肝炎”为检索词，计算机检索“中国生物医学文献数据库”，并手工检索全国会议论文汇编、中华传染病杂志、中华肝脏病杂志、临床肝胆病杂志、中国中西医结合杂志、中华内科杂志、中西医结合肝病杂志、中国药物杂志、中国新药杂志、中国临床药理学杂志以及所获文献的附属参考文献，检索年份为1979     

Expression of a novel apoptosis inhibitor-survivin in colorectal carcinoma

AIM: To investigate the role of survivin expression in the pathogenesis of colorectal carcinoma. METHODS: Immunohistochemistry S-P method and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) were used to detect the expression of survivin and apoptotic cell in situ in colorectal cancerous tissues, para-cancerous tissues and normal tissues of 48 cases of colorectal carcinoma. RESULTS: The survivin positive unit (PU) was higher in cancerous tissues (38.76±5.14) than in para-cancerous (25.17±7.26) or normal tissues (0.57±0.03) (P<0.05). The apoptosis index (AI) of para-cancerous tissues was (7.51±2.63%) higher than cancerous tissues (4.65±1.76%). The expression of survivin was associated with pathological grade, lymph node metastasis and Dukes stage of colorectal carcinoma. CONCLUSION: Survivin expression may play an important role in carcinogenesis of colorectal carcinoma and may be associated with malignant biological behaviors of colorectal carcinoma.     

Amino acid transporters: Emerging roles in drug delivery for tumor-targeting therapy

Amino acid transporters,which play a vital role in transporting amino acids for the biosynthesis of mammalian cells,are highly expressed in types of tumors.Increasing studies have shown the feasibility of amino acid transporters as a component of tumortargeting therapy.In this review,we focus on tumor-related amino acid transporters and their potential use in tumor-targeting therapy.Firstly,the expression characteristics of amino acid transporters in cancer and their relationship with tumor growth are reviewed.Secondly,the recognition requirements are discussed,focusing on the“acidbase”properties,conformational isomerism and structural analogues.Finally,recent developments in amino acid transporter-targeting drug delivery strategies are highlighted,including prodrugs and nanocarriers,with special attention to the latest findings of molecular mechanisms and targeting efficiency of transporter-mediated endocytosis.We aim to offer related clues that might lead to valuable tumor-targeting strategies by the utilization of amino acid transporters.     

临床药师参与治疗管理对门诊2型糖尿病合并高血压患者 血压控制的影响*

目的:探究临床药师参与治疗管理及对门诊Ⅱ型糖尿病合并高血压患者血压控制的作用。方法:纳入2017年6月至2018年6月500例心内科门诊Ⅱ型糖尿病合并高血压患者,随机分为对照组和药师干预组,各25例。对照组完成常规诊疗流程,每月电话咨询其药物使用情况;药师干预组现场记录患者一般情况,与医生讨论处方优化并决定是否执行,对患者进行用药指导。就诊后1个月内每2周随访1次,其后每4周随访1次,随访期间药师可根据情况与医生讨论是否调整降压方案并作出最终决定,患者根据药师建议或自己意愿回医院随诊,随访时间1年。主要终点事件为12个月后血压≤130/80 mmHg;次要终点事件为药物调整情况、药师建议采纳率、药物持有率(评估患者依从性)。结果:最终378例完成随访。对照组68名(36.4%)及干预组152名(79.6%)患者血压≤130/80 mmHg,P<0.01;干预组收缩压与舒张压降幅显著>对照组(P<0.01)。对照组药物调整35次,干预组调整129次,药师建议采纳率为85.18%。1年后,对照组药物持有率为0.22±0.04,干预组为0.77±0.11,P<0.01。结论:临床药师参与治疗管理有助于优化降压方案,提升用药依从性,提高了门诊Ⅱ型糖尿病合并高血压患者的血压控制达标率。     

血乳酸水平对重症手足口病患儿病情及预后评估的意义

目的:探讨早期血乳酸水平监测对重症手足口病患儿病情及预后评估的意义。方法:选取2012年1月至2013年12月湖南省儿童医院收治的重症手足口病住院患儿362例,按是否发生脑干脑炎分为危重症组68例和非危重症组294例,按不同预后分为死亡组25例和非死亡组337例。入院时检测血乳酸水平,观察脑干脑炎、肺水肿、肺出血和循环衰竭并发症发生情况,比较不同预后患儿血乳酸水平的差异并分析血乳酸水平对诊断各类并发症的影响。结果:危重症组患儿血乳酸水平为(3.97±3.77)mmol/L,非危重症组为(1.46±0.80)mmol/L,死亡组血乳酸水平为(5.67±4.10)mmol/L,非死亡组为(1.47±0.86)mmol/L,危重症组及死亡组均明显高于非危重症组及非死亡组(P<0.05)。以血乳酸3.2 mmol/L为界值,>3.2 mmol/L组脑干脑炎、肺水肿、循环衰竭、肺出血发生率和病死率较≤3.2 mmol/L组升高,差异有统计学意义(P<0.05)。血乳酸水平诊断肺出血、循环衰竭、预后是否死亡的ROC曲线下面积分别为0.81(0.70,0.92)、0.82(0.74,0.94)、0.85(0.74,0.96);血乳酸水平以3.2 mmol/L为界值时,最大约登指数为1.69,对预测发生肺水肿、肺出血、循环衰竭和死亡具有较高的敏感度和特异度。结论:血乳酸水平可反映重症手足口病患儿病情严重程度。入院血乳酸水平>3.2 mmol/L的重症手足口病患儿可能发生肺水肿、肺出血和循环衰竭等严重并发症,甚至死亡。     

静脉用药调配中心24小时全医嘱下临时医嘱的运行模式

目的：探讨24 h工作模式下我院静脉用药调配中心（PIVAS）临时医嘱的运行模式,为临床安全合理用药提供参考。方法：分析PIVAS临时医嘱的审核、提取、批次安排、摆药、贴签、配置及扫描交接的运行模式。结果：临时医嘱PIVAS集中调配后,日均调配人数减少66.67%,调配时间减少77.78%,调配耗材减少13.64%。结论：我院PIVAS 24 h接收并配制临时医嘱,提高了工作效率,满足了临床配置临时医嘱的需求,保证了静脉用药的安全性及合理性。