Association of Epicardial Adipose Tissue With Progression of Coronary Artery Calcification Is More Pronounced in the Early Phase of Atherosclerosis: Results From the Heinz Nixdorf Recall Study

ObjectivesThis study sought to determine whether epicardial adipose tissue (EAT) volume predicts the progression of coronary artery calcification (CAC) score in the general population.BackgroundEAT predicts coronary events and is suggested to influence the development of atherosclerosis.MethodsWe included 3,367 subjects (mean age 59 ± 8 years; 47% male) from the population-based Heinz Nixdorf Recall study without known coronary artery disease at baseline. CAC was quantified from noncontrast cardiac electron beam computed tomography at baseline and after 5 years. EAT was defined as fat volume inside the pericardial sac and was quantified from axial computed tomography images. Association of EAT volume with CAC progression (log[CAC(follow-up) + 1] − log[CAC(baseline) + 1]) was depicted as percent progression of CAC + 1 per SD of EAT.ResultsSubjects with progression of CAC above the median had higher EAT volume than subjects with less CAC change (101.1 ± 47.1 ml vs. 84.4 ± 43.4 ml; p < 0.0001). In regression analysis, 6.3% (95% confidence interval [CI]: 2.3% to 10.4%; p = 0.0019) of progression of CAC + 1 was attributable to 1 SD of EAT, which persisted after adjustment for risk factors (6.1% [95% CI: 1.2% to 11.2%]; p = 0.014). For subjects with a CAC score of >0 to ≤100, progression of CAC + 1 by 20% (95% CI: 11% to 31%; p < 0.0001) was attributable to 1 SD of EAT. Effect sizes decreased with CAC at baseline, with no relevant link for subjects with a CAC score ≥400 (0.2% [95% CI: −3.5% to 4.2%]; p = 0.9). Likewise, subjects age <55 years at baseline showed the strongest association of EAT with CAC progression (20.6% [95% CI: 9.7% to 32.5%]; p < 0.0001). Interestingly, the effect of EAT on CAC progression was more pronounced in subjects with low body mass index (BMI), and decreased with degree of adiposity (BMI ≤25 kg/m²: 19.8% [95% CI: 9.2% to 31.4%]; p = 0.0001, BMI >40 kg/m²: 0.8% [95% CI: −26.7% to 38.9%]; p = 0.96).ConclusionsEAT is associated with the progression of CAC, especially in young subjects and subjects with low CAC score, suggesting that EAT may promote early atherosclerosis development.     

The Natural History of Left Ventricular Geometry in the Community: Clinical Correlates and Prognostic Significance of Change in LV Geometric Pattern

ObjectivesThis study sought to evaluate pattern and clinical correlates of change in left ventricular (LV) geometry over a 4-year period in the community; it also assessed whether the pattern of change in LV geometry over 4 years predicts incident cardiovascular disease (CVD), including myocardial infarction, heart failure, and cardiovascular death, during an additional subsequent follow-up period.BackgroundIt is unclear how LV geometric patterns change over time and whether changes in LV geometry have prognostic significance.MethodsThis study evaluated 4,492 observations (2,604 unique Framingham Heart Study participants attending consecutive examinations) to categorize LV geometry at baseline and after 4 years. Four groups were defined on the basis of the sex-specific distributions of left ventricular mass (LVM) and relative wall thickness (RWT) (normal: LVM and RWT <80th percentile; concentric remodeling: LVM <80th percentile but RWT ≥80th percentile; eccentric hypertrophy: LVM ≥80th percentile but RWT <80th percentile; and concentric hypertrophy: LVM and RWT ≥80th percentile).ResultsAt baseline, 2,874 of 4,492 observations (64%) had normal LVM and RWT. Participants with normal geometry or concentric remodeling progressed infrequently (4% to 8%) to eccentric or concentric hypertrophy. Change from eccentric to concentric hypertrophy was uncommon (8%). Among participants with concentric hypertrophy, 19% developed eccentric hypertrophy within the 4-year period. Among participants with abnormal LV geometry at baseline, a significant proportion (29% to 53%) reverted to normal geometry within 4 years. Higher blood pressure, greater body mass index (BMI), advancing age, and male sex were key correlates of developing an abnormal geometry. Development of an abnormal LV geometric pattern over 4 years was associated with increased CVD risk (140 events) during a subsequent median follow-up of 12 years (adjusted-hazards ratio: 1.59; 95% confidence interval: 1.04 to 2.43).ConclusionsThe longitudinal observations in the community suggest that dynamic changes in LV geometric pattern over time are common. Higher blood pressure and greater BMI are modifiable factors associated with the development of abnormal LV geometry, and such progression portends an adverse prognosis.     

漂浮体位下后内侧联合前外侧入路治疗胫骨平台双髁骨折疗效分析

目的 探讨漂浮体位下后内侧联合前外侧入路治疗累及后内侧髁胫骨平台双髁骨折的临床疗效。方法 收集累及后内侧髁的胫骨平台双髁骨折患者54例膝关节,均为单膝损伤,其中C1型13例,C2型17例,C3型24例。手术均采用漂浮体位下通过后内侧联合前外侧入路,术中探查半月板、韧带损伤情况并予以相应的修复,骨折予以复位、植骨支撑、钢板固定,术后制定康复方案,定期随访。结果 本组54例患者平均住院时间18.7±5.6 d,随访6～49个月,平均随访时间17.86±3.57月;愈合时间为7.45±1.34月。住院时间与性别和年龄均无关,但与AO分型有关;愈合时间和总有效率均与性别无关,但均与年龄和AO分型有关。术后无1例发生切口及深部感染、切口周围皮瓣坏死、关节不稳、骨筋膜室综合征和内、外翻畸形愈合等并发症。术后至取出内固定装置,无1例出现钢板螺钉松动和断裂、膝关节明显强直。根据Sanders膝关节功能评分标准,显效31例,有效17例,尚可5例,无效1例,总有效例数48例,总有效率为88.89%。结论 采用漂浮体位下后内侧联合前外侧入路可有效取得骨折的复位、固定牢靠,远期疗效满意。     

不同b值下弥散加权成像及表观弥散系数在老年肺部肿瘤的临床研究

目的分析不同b值下弥散加权成像(DWI)与表观弥散系数(ADC)用于老年肺部肿瘤良恶性鉴别诊断的价值。方法采用分层整群抽样回顾性分析的方法,抽取我院2015年7月至2018年12月接诊的肺部肿瘤患者100例为研究对象,全部患者均接受磁共振技术弥散加权成像,分析不同病变性质肿瘤的弥散加权成像表现,对比不同良恶性肿瘤在不同b值下弥散加权成像信号强度分布情况及其对应的ADC值,经受试者操作特征曲线(ROC曲线)计算不同b值下ADC值对应曲线面积。结果100例老年肺部肿瘤患者中,检出良性肿瘤、恶性肿瘤例数分别为51例、49例。不同b值恶性肿瘤低信号占比均低于良性肿瘤,高信号占比均高于良性肿瘤,差异有统计学意义(P<0.05);不同b值下,恶性肿瘤ADC值均低于良性肿瘤,差异有统计学意义(P<0.05);且随着b值的升高,全部肺部肿瘤患者ADC值均呈下降趋势,差异有统计学意义(P<0.05);不同b值下ADC值ROC曲线下对应面积分别为0.884、0.834、0.754,AUC>0.5可作为鉴别诊断肺部肿瘤良恶性的有效指标,且以b值为500s/mm2时所得到的ADC指曲线下面积最大,在ADC值取1.470时,可获得最高诊断效能。结论b值为500s/mm2下的弥散加权成像技术信号强度与表观弥散系数用于老年肺部肿瘤良恶性鉴别诊断有着较高价值,患者整体表观弥散系数值随b值的升高而减小。     

不同时间进行硬膜外镇痛对产妇产程时间的影响及母婴分娩结局分析

目的 探讨不同时间进行硬膜外镇痛对产程时间的影响和母婴分娩结局的影响。方法 选取我院收治的产妇165例为研究对象,选取的时间范围为2016年3月～2019年2月,按照产妇入院顺序分为活跃组、潜伏组和自然组,每组55例,活跃组产妇进行活跃期硬膜外镇痛,潜伏组产妇进行潜伏期硬膜外镇痛,自然组产妇进行自然分娩。观察三组产妇的产程时间、产妇的分娩状况以及不同时间点的视觉模拟评分(VAS),以及采用Apgar评分判断新生儿窒息情况。结果 潜伏组产妇的宫口扩张速度明显快于活跃组和自然组,潜伏期产妇的活跃期和第二产程明显短于活跃组和自然组,差异有统计学意义(P0.05);三组产妇的第三产程差异无统计学意义(P0.05)。活跃组和潜伏组产妇的缩宫素使用率分别为50.91%和45.45%,明显高于自然组18.18%,产妇器械助产率分别为25.45%和30.91%,明显高于自然组14.54%,差异有统计学意义(P0.05);活跃组和潜伏组产妇的剖宫产率分别为9.09%和7.27%,明显低于自然组21.82%,差异有统计学意义(P0.05);三组产妇的顺产率差异无统计学意义(P0.05);三组新生儿的窒息情况差异无统计学意义(P0.05)。分娩后10 min和40 min,自然组产妇的VAS评明显高于活跃组和潜伏组,差异有统计学意义(P0.05)。结论 在潜伏期对产妇进行硬膜外镇痛可以缩短产妇的活跃期和第二产程时间,加快宫口扩张,减轻产妇的疼痛,提高母婴结局。     

移动护士工作站在提高脑卒中偏瘫患者良肢位质量中的应用

目的探讨移动护士工作站在提高脑卒中偏瘫患者良肢位质量中的应用。方法 选取2018 年1～12 月期间在我院诊断治疗的脑卒中偏瘫患者80 例为研究对象,将前半年的40 例患者作为对照组,将后半年的40 例患者作为观察组,对照组给予常规康复护理措施及传统良肢位摆放宣教,观察组在常规康复护理的基础上实施移动护士工作站进行良肢位摆放宣教。比较两组的Fugl-Meyer 评分、ADL 评分、QOL-100 评分及CNS 评分,比较两组患者的良肢位质量应用效果。结果 两组的Fugl-Meyer 评分出院时与入院时比较,差异有统计学意义 （P＜0.05）;实施移动护士工作站后观察组与对照组ADL 评分、QOL-100 评分及CNS 评分比较,差异有统计学意义（P＜0.05）。结论 通过对行良肢位摆放的脑卒中偏瘫患者,采取移动护士工作站开展护理工作,能够有效改善患者的良肢位肢体质量,同时能够预防发生并发症,提升患者的生活质量,具备极为深远的社会意义,可以在临床中推广应用。     

不同材料固定义齿修复后牙连续缺损的效果及对口腔生物膜的影响

目的 研究不同材质义齿与修复材料对口腔生物膜的影响。方法 选择自2018年5月～2019年5月我院收治的120例2颗后牙连续缺损患者进行研究。将选取的120例牙体缺损患者平均分为三组,分别通过二氧化锆全瓷冠、钴铬合金烤瓷冠和银钯合金烤瓷冠进行修复。修复后三组患者均通过构建口腔生物膜体外模型对口腔生物膜形成情况进行分析;通过涂布等平板计数法对口腔生物膜平板菌落计数和口腔生物膜变形链球菌代谢产物进行分析。结果 三组患者口腔生物膜的形成、平板菌落计数和变形链球菌代谢产物的终pH值和ΔpH之间存在显著差异。其中二氧化锆组患者生物膜形成量较其他两组患者多,而平板菌落计数和变形链球菌代谢产物的pH值变化较小,三个指标的变化规律一致。结论 不同材质义齿与修复材料对口腔生物膜的影响不同。二氧化锆对患者口腔生物膜影响效果较其他两种材质与修复材料好,可进行临床推广。     

婴儿体位评估工具对新生儿重症监护室低出生体重早产儿临床结局的影响研究

目的 探讨婴儿体位评估工具对新生儿重症监护室（NICU）低出生体重早产儿（LBWP）临床结局的影响研究。方法 将我院2018 年3 月～2019 年3 月收治的80 例NICU LBWP 患儿设为观察组,在鸟巢体位支持下,使用婴儿体位评估工具（IPAT）来指导摆位,另选取2017 年1 月～2018 年1 月收治的80 例NICU LBWP 患儿设为对照组,给予鸟巢作为体位支持。比较两组患者临床相关指标（呼吸机使用时间、全肠内营养时间、胃管留置时间、住院时间）、早产儿合并症发生情况（败血症、视网膜病变、贫血、脑室周围白质软化、支气管肺发育不良、胆汁淤积症）及ALB、PA、P 等生化指标变化。结果 两组住院时间比较,差异无统计学意义（P＞0.05）,与对照组相比,观察组在呼吸机使用时间、全肠内营养时间、胃管留置时间显著缩短（t=12.609、26.975、10.509,P＜0.05）,观察组合并症总发生率（57.50%）明显低于对照组（95.00%）,差异有统计学意义（χ2=31.061,P＜0.05）,干预前两组ALB、PA、P 比较,差异无统计学意义（P＞0.05）,干预后观察组ALB、PA、P 均高于对照组,差异有统计学意义（t=2.667、4.391、8.655,P＜0.05）。结论 对NICU LBWP 患儿采用婴儿体位评估工具进行体位管理后,可显著缩短呼吸机使用时间、全肠内营养时间、胃管留置时间,还可改善患儿营养状况,减少合并症的发生,值得应用与推广。