行为干预及生物反馈治疗对老年高血压患者降压疗效的影响

目的 研究应用行为干预治疗及生物反馈治疗对老年高血压患者降压药物的影响。方法 在应用降压药物的基础上,增加行为干预及生物馈治疗,观察综合性行为干预措施对降压疗效的影响。结果 增加行为干预及生物反馈治疗后,降压和情绪障碍矫正的效果比单用药物明显改善。结论 老年高血压患者给予综合性行为干预措施可增加降压药物的疗效。     

Preoperative tyrosine kinase inhibitors risks bowel anastomotic healing in patients with advanced primary and recurrent/metastatic gastrointestinal stromal tumors--- A rose has its thorns

BackgroundThe combination of tyrosine kinase inhibitors (TKIs) and surgery has created a paradigm shift for advanced primary and metastatic gastrointestinal stromal tumors (GISTs). However, the associated surgical morbidity rate is reportedly high, which we hypothesized is attributable to the adverse effects of the previous use of TKIs on bowel anastomosis healing.MethodsA total of 613 GIST patients with (n = 108) and without (n = 505) preoperative TKI treatment were enrolled. Propensity score matching compared the surgical morbidities and mortalities between the two cohorts. An animal model was used to elucidate the relevant mechanism.ResultsAfter propensity score matching, the incidence and severity of surgical complications were higher in patients with preoperative TKIs than in those without (34% vs 10%, p < 0.0001; grades 3–5, 16% vs 2%, p < 0.0001). Specifically, the incidence of bowel anastomosis leakage was increased in those with versus those without preoperative TKI (18% vs 6%, p = 0.032). A constellation of mucosal shedding, shortening of villus height and crypt depth, and disarrayed epithelial lining of the bowel was observed with preoperative TKI treatment. The animal model showed that bowel anastomosis healing was weakened by imatinib through the downregulation of Col1A1, Col3A1, and MMPs.ConclusionsImpaired bowel anastomosis healing was responsible for the extraordinarily high surgical morbidity rate of patients with GIST after TKI treatment. The mechanism involved altered tissue microarchitecture and dysregulated Col1A1, Col3A1, and MMP expressions.     

Biophysics-based statistical learning: Application to heart and brain interactions

Initiatives such as the UK Biobank provide joint cardiac and brain imaging information for thousands of individuals, representing a unique opportunity to study the relationship between heart and brain. Most of research on large multimodal databases has been focusing on studying the associations among the available measurements by means of univariate and multivariate association models. However, these approaches do not provide insights about the underlying mechanisms and are often hampered by the lack of prior knowledge on the physiological relationships between measurements. For instance, important indices of the cardiovascular function, such as cardiac contractility, cannot be measured in-vivo. While these non-observable parameters can be estimated by means of biophysical models, their personalisation is generally an ill-posed problem, often lacking critical data and only applied to small datasets. Therefore, to jointly study brain and heart, we propose an approach in which the parameter personalisation of a lumped cardiovascular model is constrained by the statistical relationships observed between model parameters and brain-volumetric indices extracted from imaging, i.e. ventricles or white matter hyperintensities volumes, and clinical information such as age or body surface area. We explored the plausibility of the learnt relationships by inferring the model parameters conditioned on the absence of part of the target clinical features, applying this framework in a cohort of more than 3 000 subjects and in a pathological subgroup of 59 subjects diagnosed with atrial fibrillation. Our results demonstrate the impact of such external features in the cardiovascular model personalisation by learning more informative parameter-space constraints. Moreover, physiologically plausible mechanisms are captured through these personalised models as well as significant differences associated to specific clinical conditions.     

miR-375在变应性鼻炎小鼠鼻黏膜上皮细胞凋亡中的调控作用

目的探讨miR-375在变应性鼻炎小鼠鼻黏膜上皮细胞凋亡和炎症反应中的调控作用。方法运用卵清蛋白(OVA)致敏的小鼠变应性鼻炎模型,使用实时定量PCR(qRT-PCR)、蛋白质印迹试验(Western Blot)、酶联免疫吸附试验(ELISA)、免疫组织化学检测鼻黏膜上皮细胞内miR-375、JAK2、细胞凋亡相关蛋白(JAK2蛋白,裂解的蛋白酶3(Cleaved caspase 3),聚[ADP-核糖]聚合酶裂解酶(Cleaved PARP),蛋白酶3(Caspase 3),聚[ADP-核糖]聚合酶(PARP),p-STAT3蛋白,STAT3蛋白和β肌动蛋白(β-actin))和血浆IL-6、TNF-α、IL-10的表达水平。结果miR-375在变应性鼻炎小鼠的鼻黏膜上皮细胞中表达降低,而JAK2表达增高;JAK2蛋白、p-STAT3蛋白和裂解的蛋白酶3均在OVA组表达增高;给OVA致敏的变应性鼻炎小鼠注射miR-375模拟物可以导致血清IL-6、TNF-α的分泌下降,而IL-10分泌增加,该作用可以被带有过表达JAK2的腺病毒感染后而减弱。结论miR-375/JAK2调控通路存在于变应性鼻炎鼻黏膜上皮细胞中,并通过JAK2/STAT3信号通路调控细胞的凋亡和炎症反应,miR-375在变应性鼻炎的病程中有保护性机制。     

凝血检验标本采集与处理过程中的质量控制分析

目的观察分析凝血检验标本采集与处理过程中的质量控制。方法选择凝血检验标本采集与处理强化质控措施实施后(2018年3月至2019年2月)和实施前(2017年3月至2018年2月)在本院行凝血检验的健康体检者各41例,分别作为观察组和对照组。收集两组待检查者的标本采集、处理过程记录,比较两组标本不合格发生率。结果观察组凝血检验标本不合格发生率(2.44%,1/41)显著低于对照组(19.51%,8/41),差异有统计学意义(P<0.05)。结论强化质控措施可有效提升凝血检验标本采集与处理过程规范性,降低不合格标本风险,有助于保障凝血检验准确性和有效性,临床应用价值较高。     

阿罗洛尔对慢性心力衰竭患者血清N端脑钠肽前体的影响

目的观察阿罗洛尔对慢性心力衰竭患者血清N端脑钠肽前体(NT-proBNP)水平的影响。方法将80例慢性心力衰竭患者随机分为阿罗洛尔组和常规治疗组。常规治疗组(n=40)应用血管紧张素转换酶抑制剂、利尿剂和洋地黄制剂,阿罗洛尔组(n=40)在此基础上加用阿罗洛尔(目标剂量10 mg,2次/d),疗程均为12周。在治疗前和12周末采静脉血检测两组患者的NT-proBNP水平。结果治疗后两组NT-proBNP水平均较治疗前明显下降(P<0.05)。治疗后阿罗洛尔组NT-proBNP水平显著低于常规治疗组(P<0.05)。结论阿罗洛尔能降低心力衰竭患者的NT-proBNP水平,并改善慢性心力衰竭患者的心功能。