噻托溴铵治疗中重度支气管哮喘30例临床观察

目的:探讨噻托溴铵在中重度支气管哮喘治疗中的意义。方法:将60例中重度支气管哮喘患者随机分为观察组和对照组,两组患者均依据2009 GINA规范治疗3个月,其中观察组每天增加吸入一次噻托溴铵18μg。比较两组患者治疗前后性别、年龄、病程、哮喘控制测试(ACT)评分、血清免疫球蛋白E(IgE)、嗜酸细胞计数(EOS)、吸入支气管扩张剂后一秒钟用力呼气量(FEV1)、用力呼气中期流速(FEF25%~75%)值、用力呼气峰速(PEF)及每周急救药使用次数等指标变化并进行统计学分析。结果:①两组间患者性别、年龄、病程、治疗前各指标差异无统计学意义(P0.05)。②治疗后两组各指标与治疗前比较,差异有统计学意义(P0.01)。③治疗后,观察组的ACT评分、FEV1、PEF、FEF及每周急救药使用喷数与对照组比较,差异有统计学意义(P0.01)。治疗后观察组EOS、IgE与对照组比较,差异无统计学意义(P0.05)。结论:噻托溴铵治疗中重度支气管哮喘有效,且以扩张气道、改善症状和肺功能为主,其是否有非特异性抗炎作用还需进一步研究论证。     

室间隔偏曲的婴儿法洛四联症外科根治术前的左心室大小评价方法

目的:本研究旨在对比64排CT和二维经超声心动图,对外科手术治疗室间隔偏曲的婴儿法洛四联症前的左心室评价的准确性。方法:2012年12月至2013年11月期间,接受法洛四联症根治手术的50例婴儿中的12例,(其中男婴7例,女婴5例,月龄6~12个月,体质量7~9.9kg),12例患儿术前均接受了标准的二维经胸超声心动图和64排CT检查,超声心动图均发现室间隔偏曲同时测量左心室舒张末期内径,64排CT定量左心室容积。所有的12例患儿均接受了法洛四联症的根治术,术后效果良好。结果:二维经胸超声心动图测量左心室舒张末期内径均明显低于同龄患儿的平均水平,64排CT用来定量左心室容积容积指数均30mL/m2。二维经胸超声心动图的测量较64排CT明显低估了左心室的发育情况。最后12例患儿均行根治术,未行分期手术,术后均没有低心排排出量综合征(低心排)的表现,12例患儿均没有死亡,恢复良好。结论:64排CT较二维经胸超声心动图能够更准确地评价室间隔偏曲的法洛四联症婴儿的左心室大小,以利外科手术的选择。     

Correlation analysis between serum α-klotho level and the development of obesity-related glomerulopathy

Objective To detect the level of serum α-klotho in different obese people and to investigate the correlation between serum α-klotho and obesity-related glomerulopathy (ORG). Methods A total of 48 cases of ORG diagnosed by renal biopsy were enrolled in the study. Forty-eight gender-, age- and BMI- matched obese participants, and 48 obese chronic kidney disease (CKD) patients without ORG were included as controls. The clinical manifestations, laboratory examinations of all three groups were collected, and the level of serum α-klotho protein was measured by ELISA. Results The patients with ORG were characterized by decreased serum α-klotho concentration compared with obese patients group and obese CKD patients group [572.66(439.92, 690.58) pg/ml vs 635.85(559.52, 769.20) pg/ml and 690.30(516.15, 828.20) pg/ml, P＜0.01]. Multinomial multiple logistic regression analysis revealed that serum α-klotho (per 100 pg/ml increased) was independently associated with the prevalence of ORG, and the risk of ORG decreased by 35% in the obese participants (OR=0.652, 95% CI: 0.487-0.872) and 38% in CKD patients (OR=0.617, 95% CI: 0.453-0.832) respectively. Conclusions The level of serum α-klotho is significantly decreased in ORG and associated with the prevalence of ORG independently. Serum α-klotho may be a protective factor for ORG.     

IL-1β enhances vascular smooth muscle cell proliferation and migration via P2Y2 receptor-mediated RAGE expression and HMGB1 release

Vascular smooth muscle cells (VSMCs) are the major cell type in blood vessel walls, and their proliferation and migration play important roles in the development of atherosclerosis. Recently, it has been reported that IL-1β mediates the inflammatory response through the upregulation of the P2Y₂ receptor (P2Y₂R). Thus, we examined the role of P2Y₂R in IL-1β-mediated proliferation and migration of VSMCs and the underlying molecular mechanisms. VSMCs were pretreated with IL-1β for 24 h to upregulate P2Y₂R expression. The cells were then stimulated with UTP or ATP for the indicated times, and cell proliferation and migration and the related signaling pathways were examined. The equipotent P2Y₂R agonists ATP and UTP enhanced proliferation, RAGE expression and HMGB1 secretion in IL-1β-pretreated VSMCs. Additionally, pretreatment with IL-1β enhanced UTP-mediated VSMC migration and MMP-2 release, but these effects were not observed in the P2Y₂R-siRNA- or RAGE-siRNA-transfected VSMCs. Next, the signaling molecules involved in P2Y₂R-mediated cell proliferation and migration were determined. The ERK, AKT, PKC, Rac-1 and ROCK2 pathways were involved in UTP-induced cell proliferation and migration, MMP-2 and HMGB1 secretion and RAGE expression in the IL-1β-pretreated VSMCs. UTP induced the phosphorylation of ERK, AKT and PKC and the translocation of Rac-1 and ROCK2 from cytosol to membrane as well as stress fiber formation, which were markedly increased in the IL-1β-pretreated VSMCs but not in the P2Y₂R-siRNA-transfected VSMCs. These results demonstrate that pro-inflammatory cytokines associated with atherosclerosis, such as IL-1β, can accelerate the process of atherosclerosis through the upregulation of P2Y₂R.     

Left ventricular pseudoaneurysm complicating a ruptured isolated congenital diverticulum

We report a case of 41-year-old woman who presented with chest tightness and shortness of breath. Transthoracic echocardiogram (TTE) showed left ventricular (LV) pseudoaneurysm of the inferior wall with preserved LV systolic function. Coronary angiogram was normal. Surgical repair of the pseudoaneurysm with a pericardial patch was performed, and pathological results confirmed rupture of an isolated congenital LV diverticulum, as the most likely etiology.     

The relation between aortic arch branching types and the location of large vessel occlusion in cardioembolic stroke

Cardiac embolism is the leading etiology of ischemic strokes. There are arguments about the left–right propensity of cardioembolic strokes. This study aimed to reveal the relationship between the different aortic arch types and the location of large vessel occlusion (LVO) in cardioembolic stroke. We retrospectively identified all patients with acute ischemic stroke admitted to our comprehensive stroke center who had medium- to high-risk cardioembolic sources according to the TOAST classification. Only those with LVO and available images of the aortic arch were included. Patients were classified into 3 groups according to the aortic arch types: Type I (n = 44), Type II (n = 105), Type III (n = 36). The thrombus was divided into large thrombus or small thrombus based on the location of LVO. Overall, left-sided strokes (50.8%) were almost equal to right-sided (49.2%). There was a growing tendency for the percentage of left-sided infarcts with advancement of the aortic arch types either in the total cases or in the atrial fibrillation cases, with no statistical difference between the 3 aortic arch types. In type III aortic arch, left-sided strokes (69.0%) were twice than right-sided (31%) in large thrombus (P < 0.05), while right-sided strokes (85.7%) were more common than left-sided (14.3%) in small thrombus (P < 0.05). Conversely, in type Ⅰ and II aortic arches, left-sided strokes were more common than right-sided in small thrombus, while right-sided strokes were more common than left-sided in large thrombus (P < 0.05). The left–right propensity of cardioembolic stroke is related to the proximity of clot lodging in different aortic arch types.     

Interventions for prevention and treatment of tobacco smoking in school-aged children and adolescents: A systematic review and meta-analysis

ObjectivesTo determine the effectiveness of primary health care relevant interventions to prevent and treat tobacco smoking in school-aged children and adolescents.MethodsThis systematic review considered studies included in a prior review. We adapted and updated the search to April 2015. Titles, abstracts and full-text articles were reviewed in duplicate; data extraction and quality assessments were performed by one reviewer and verified by another. Meta-analyses and pre-specified sub-group analyses were performed when possible. PROSPERO #CRD42015019051.ResultsAfter screening 2118 records, we included nine randomized controlled trials. The mostly moderate quality evidence suggested targeted behavioral interventions can prevent smoking and assist with cessation. Meta-analysis showed intervention participants were 18% less likely to report having initiated smoking at the end of intervention relative to controls (Risk Ratio 0.82; 95% confidence interval 0.72, 0.94); the absolute effect is 1.92% for smoking initiation, Number Needed to Treat is 52 (95% confidence interval 33, 161). For cessation, meta-analysis showed intervention participants were 34% more likely to report having quit smoking at the end of intervention relative to controls (Risk Ratio 1.34; 95% confidence interval 1.05, 1.69); the absolute effect is 7.98% for cessation, Number Needed to Treat is 13 (95% confidence interval 6, 77). Treatment harms were not mentioned in the literature and no data were available to assess long-term effectiveness.ConclusionPrimary care relevant behavioral interventions improve smoking outcomes for children and youth. The evidence on key components is limited by heterogeneity in methodology and intervention strategy. Future trials should target tailored prevention or treatment approaches, establish uniform definition and measurement of smoking, isolate optimal intervention components, and include long-term follow-up.