A novel nutritional index and adverse outcomes in ischemic stroke: Results from the third China National Stroke Registry

Background and aimsFew studies have applied the triglyceride, cholesterol, body weight index (TCBI) in acute ischemic stroke (AIS). We investigated the association between the TCBI and adverse clinical outcomes in patients with AIS.Methods and resultsBased on the Third China National Stroke Registry (CNSR-III) data from August 2015 to March 2018, we evaluated the nutritional status of patients with AIS using the TCBI. Patients were categorized according to quartile levels of the TCBI. The main outcomes were poor functional outcomes and recurrent stroke at 1-year and secondary outcomes were adverse outcomes at 3 and 6 months after stroke onset. Poor functional outcomes consisted of all-cause mortality and major disabilities. Multivariate analyses with logistic or Cox regression analysis and restricted cubic splines determined the association between the TCBI and adverse outcomes. We included 9708 patients. At the 1-year follow-up, 1323 patients (13.6%) had died or experienced major disability. The adjusted odds ratios/hazard ratios and 95% confidence intervals of the lowest quartile at 1-year were 1.47 (1.22–1.78) for poor functional outcomes, 1.46 (1.18–1.81) for major disability, and 1.34 (0.94–1.86) for all-cause mortality. Kaplan–Meier analysis demonstrated an inverse relationship between all-cause mortality and the TCBI (log-rank p < 0.05). An approximately L-shaped relationship between TCBI levels and poor functional outcomes and major disability was observed at 1-year.ConclusionThe novel TCBI was associated with short- and long-term adverse outcomes in AIS. Thus, it may be useful for predicting adverse outcomes in patients with AIS.     

Functional roles of cyclic guanosine 3′,5′-monophosphate analogue in cerebral vasodilation

• 1.1. Vasodilating effects of cyclic nucleotides in cerebral vasculature were examined using membrane permeable cyclic nucleotide analogues, 8-bromoguanosine 3′,5′-cyclic monophosphate (8-Br-cGMP) and 8-bromoadenosine 3′,5′-cyclic monophosphate (8-Br-cAMP).
• 2.2. In isolated canine basilar artery (CBA), 8-Br-cGMP but not 8-Br-cAMP, significantly inhibited Ca²⁺-induced and agonist [serotonin(5-HT), prostaglandin(PG)F_2α or endothelin]-induced contraction, in a concentration-dependent manner.
• 3.3. When Ca²⁺ was depleted from intracellular store sites by pretreatment with A23187, 8-Br-cGMP but not 8-Br-cAMP strongly attenuated contractions induced by Ca²⁺-influx.
• 4.4. Neither 8-Br-cGMP nor 8-Br-cAMP modified contraction induced by caffeine which elicits Ca²⁺ release from intracellular Ca²⁺ store.
• 5.5. 8-Br-cGMP lowered the high K⁺-induced sustained [Ca²⁺] elevation.
• 6.6. These results suggest that, at least in CBA, cGMP exerts its inhibitory effect on the contraction induced by influx of Ca²⁺, by reducing the level of [Ca²⁺]_i and reducing [Ca²⁺]_i sensitivity of the contractile machinery.

     

连花清瘟结合西医治疗新型冠状病毒肺炎患者的文献分析

目的:对连花清瘟结合西医治疗新型冠状病毒肺炎的现有证据进行文献检索和分析,为临床合理用药提供参考依据.方法:计算机检索PubMed、Embase、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普数据库和万方数据库,收集连花清瘟结合西医常规治疗新型冠状病毒肺炎的临床研究.筛选文献并按照相关的结局指标进行分类...     

铁死亡在器官缺血再灌注损伤中的作用机制研究进展

缺血再灌注损伤（IRI）是导致器官功能障碍和移植失败的重要因素之一,其机制复杂,迄今未完全阐明,且缺乏有效治疗手段。IRI过程中,多种细胞死亡方式被激活,如凋亡、焦亡、自噬、程序性坏死等。铁死亡作为一种新型程序性细胞死亡方式,以铁依赖性的活性氧（ROS）自由基和脂质过氧化物堆积为主要特征,已被证实在IRI中发挥重要作用,通过调节铁、糖、氨基酸和脂质代谢及信号通路,加剧器官IRI。阻止铁死亡过程在多个器官中被证实能有效降低IRI的破坏,但与其他程序性细胞死亡方式相比,铁死亡在IRI中的作用机制研究仍较少。IRI与ROS产生密切相关,ROS通过诱发脂质过氧化反应,损害细胞膜结构,与铁死亡存在紧密联系。本文结合细胞铁死亡过程中的铁代谢、脂质过氧化、抗氧化系统及其他多种调节因子的调控途径,探讨铁死亡在器官IRI中扮演的多重角色,以期为IRI相关实验及临床治疗提供参考。     

额面QRS-T夹角及Tp-e/QTc比值与冠状动脉慢血流现象的相关性研究

  目的  探讨心电图额面QRS-T夹角和Tp-e/QTc比值与冠状动脉慢血流现象（CSFP）的关系及预测价值。  方法  选取昆明医科大学第二附属医院2019年9月至2021年12月行冠脉造影术检查确诊为CSFP的患者73例为观察组,随机选取同期67例冠脉血流正常患者作为对照组。比较两组患者临床资料、心电图相关参数及实验室检查指标,采用多因素Logistic回归分析影响CSFP发生的危险因素,绘制受试者工作特征（ROC）曲线,评估额面QRS-T夹角及Tp-e/QTc比值对CSFP的预测作用。  结果  与对照组比较,额面QRS-T 夹角、Tp-e间期、Tp-e/QT比值、Tp-e/QTc比值、体重指数（BMI）、红细胞（RBC）、血红蛋白（Hb）、红细胞比容（HCT）、肌酐（Cr）均较高,差异有统计学意义（P < 0.05）。多因素Logistic回归分析结果显示,BMI（OR = 1.137,P = 0.014）、Cr（OR = 1.048,P = 0.004）额面QRS-T夹角（OR = 1.020,P = 0.003）、Tp-e/QTc 4分位（IQR）等级（OR = 1.960,P < 0.001）是影响CSFP的独立相关因素。ROC曲线分析显示,额面 QRS-T夹角对CSFP的最佳截断值为45.5度,曲线下面积为 0.706,灵敏度和特异度分别为 56.2%和80.1%;Tp-Te/QTc 比值的CSFP的最佳截断值为0.22,曲线下面积为 0.68,灵敏度和特异度分别为 66%和69%。  结论  额面 QRS-T夹角和Tp-e/QTc比值与CSFP存在相关性,对CSFP具有一定的预测价值。     

新型冠状病毒肺炎常态化背景下云南某心血管专科医院核酸检测经验总结

2019年以来,新型冠状病毒肺炎（COVID-19）在世界范围内流行爆发,新型冠状病毒（SARS-CoV-2）持续变异,不仅对国际社会造成了恐慌,还对我国境外输入防控造成了巨大压力。云南地处边陲,大规模核酸筛查已成为常态化疫情防控的重要内容。在此背景下如何结合自身实际情况让SARS-CoV-2核酸检测高质量高效率进行是心血管专科医院面临的重大问题,本文依据云南省阜外心血管病医院3万多人次的SARS-CoV-2核酸检测工作,从两方面进行经验总结,一是在大量的急危重症手术情况下,如何应用快速核酸检测技术及时准确的出具报告;二是面临常规大规模筛查时如何能在保证质量的基础上,尽可能的缩短报告时间。希望可以为急诊实验室管理提供可借鉴之处。     

Does Percutaneous Coronary Intervention on Off Days have an Effect on Long-term Prognosis in Patients with Coronary Artery Disease in China?

As generally known, many hospitals provide routine care on weekdays but only emergency or urgent care on holidays and weekends. Hospital staffing is numerically reduced on holidays and weekends, as well as the available expertise on duty. The onset of acute myocardial infarction (AMI) on off days was reported to be associated with higher short-term mortality[1,2]. A similar phenomenon was also observed in patients with emergent diseases who were admitted on weekends and in the nighttime, as well as those who received elective procedures on weekends[3-5].     

Fishing for health: Neighborhood variation in fish intake,fish quality and association with stroke risk among older adults in the Cardiovascular Health Study

Background and aimsFish consumption has been associated with better health outcomes. Dietary patterns may vary substantially by neighborhood of residence. However, it is unclear if the benefits of a healthy diet are equivalent in different communities. This study examines associations of fish consumption with stroke incidence and stroke risk factors, and whether these differ by neighborhood socioeconomic status (NSES).Methods and resultsWe studied 4007 participants in the Cardiovascular Health Study who were 65 years or older and recruited between 1989 and 1990 from 4 US communities. Outcomes included fish consumption type (bakes/broiled vs. fried) and frequency, stroke incidence, and stroke risk factors. Multilevel regressions models were used to estimate fish consumption associations with clinical outcomes. Lower NSES was associated with higher consumption of fried fish (aOR = 1.47, 95% CI: 1.10–1.98) and lower consumption of non-fried fish (0.64, 0.47–0.86). Frequent fried fish (11.9 vs. 9.2 person-years for at least once weekly vs. less than once a month, respectively) and less frequent non-fried fish (17.7 vs. 9.6 person-years for less than once a month vs. at least once weekly, respectively) were independently associated with an increased risk of stroke (p-values < 0.05). However, among those with similar levels of healthy fish consumption, residents with low NSES had less benefit on stroke risk reduction, compared with high NSES.ConclusionFish consumption type and frequency both impact stroke risk. Benefits of healthy fish consumption differ by neighborhood socioeconomic status.     

米氮平联合艾司西酞普兰治疗卒中后睡眠障碍的临床疗效评价

目的：观察米氮平联合艾司西酞普兰治疗卒中后睡眠障碍的临床效果。方法将符合卒中后睡眠障碍诊断的脑卒中患者70例随机分为两组,治疗组38例在常规药物治疗及康复训练的基础上加用米氮平联合艾司西酞普兰治疗,对照组32例单采用神经科常规药物治疗及康复训练,两组患者分别在入选时及病程2周进行匹兹堡睡眠质量指数量表（PSQI）评分。结果治疗前两组PSQI评分差异无统计学意义（P〉0.05）,治疗2周后治疗组与对照组比较差异有统计学意义（P〈0.05）。治疗组PSQI评分于治疗2周后显著改善（P〈0.05）。结论米氮平联合艾司西酞普兰治疗卒中后睡眠障碍具有显著临床疗效。