Association of the Platelet Glycoprotein Ⅰa C807T Gene Polymorphism With Risk of Myocardial Infarction in Chinese

Objectives To investigate the relationship of the GPIa C807T dimorphism to the risk of myocardial infarction (MI) in Chinese. Methods We did a case-control study including 100 patients and 110 controls with same race. An allele-specific polymerase chain reaction (PCR) was used for genotyping of C807T polymorphism. Results An apparent association was found between the T807 allele and MI among individuals younger than the mean age of 60 years (odds ratio,2.49; 95% confidence interval, 1.08 ～ 6.22 ). The T807 allele remained an independent risk factor for MI when age, sex, smoking, hypertension, diabetes, bodymass index, LDL-cholesterol and HDL-cholesterol were adjusted by logistic regression. Conclusions GPⅠa T807 appears to be an independent risk factor for MI.     

表皮生长因子对大鼠脑梗死后神经功能恢复的影响

目的 观察表皮生长因子（EGF）对大鼠脑梗死后神经功能恢复的影响。方法 采用肾血管性高血压大鼠制作一侧大脑中动脉皮层支闭塞（MCAO）模型。MCAO术后24 h，32只大鼠侧脑室注入10μl EGF（100μg/L），连续2d，共2μg（EGF组）；32只大鼠只注入不含EGF的等量溶液（对照组）。MCAO术后1、2、3和4w，行Bederson神经功能评分后，免疫印迹检测双侧大脑半球生长相关蛋白（GAP43）、突触囊泡蛋白（SYN）和胶质原纤维酸性蛋白（GFAP）的表达。结果 与同期对照组相比，EGF组大鼠在MCAO术后1、2w神经运动功能恢复更好，脑梗死灶同侧半球GAP43、SYN和GFAP有更早期和更高表达（P<0.05）。结论 GAP43、SYN和GFAP等蛋白的早期高峰表达可能与EGF引起的早期神经可塑性改善有关。     

用99Tcm-HL91评价鼠心肌缺血模型

目的 探讨乏氧心肌显像剂99Tcm-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)用于诊断实验性缺血心肌的价值.方法 建立大鼠心肌在体缺血再灌注模型,采用体外放射自显影法检测正常对照组(6只)、缺血再灌注组(8只)及无再灌注组(8只)鼠心肌对99Tcm-HL91的摄取.结果 对照组和无再灌注组心肌未见局灶性放射性浓聚,再灌注组心肌非坏死区有较高放射性浓聚,与正常心肌组织的摄取比值为1.634±0.354.结论 99Tcm-HL91表现出较强的亲乏氧组织特性,能较好区分存活和梗死心肌.     

Comparison of 180° and 360° acquisition for myocardial perfusion SPECT with compensation for attenuation, detector response, and scatter: Monte Carlo and mathematical observer results

BACKGROUND: The optimal projection data acquisition strategy for myocardial perfusion (MP) single photon emission computed tomography (SPECT) remains controversial. METHODS: We compared MP SPECT using 180 degrees and 360 degrees projection data obtained with the same acquisition time, reconstructed either with filtered back projection (FBP) or the iterative ordered-subsets expectation maximization (OS-EM) algorithm with various combinations of attenuation, detector response, and scatter compensation using mathematical observers and a myocardial defect detection task. We used Monte Carlo-simulated projection data from a population of 3-dimensional nurbs-based cardiac-torso (NCAT) phantoms with ranges of variability in patient anatomy, organ uptake, defect location, defect size, and noise level based on clinical data. Projection data from 180 degrees and 360 degrees acquisitions were generated by assuming the same acquisition time. After iterative or FBP reconstruction, standard postprocessing methods were applied. For each acquisition and reconstruction method, we optimized the number of iterations and cut-off frequency of the Butterworth filter using the Channelized Hotelling Observer methodology. The optimum set of parameters was that which gave the maximum area under the curve. RESULTS: For both acquisition protocols, OS-EM with compensations provided better performance than FBP or OS-EM without compensation. For FBP, the optimized 180 degrees acquisition provided a statistically significant increase in AUC as compared with optimized 360 degrees acquisition. For OS-EM, the AUCs for 180 degrees were slightly larger than for 360 degrees acquisitions when comparing images reconstructed with the same compensations. However, the differences were smaller and not statistically significant. CONCLUSION: With optimized reconstruction and filtering parameters, 180 degrees acquisition provided a statistically significant improvement over 360 degrees acquisition for FBP reconstruction. However, for OS-EM the differences were small and not statistically significant.     

IMA在急性冠状动脉综合征中的诊断意义

目的：探讨ACB法检测急性冠脉综合征患者血清中IMA水平及联合检测IMA、CK、CK-MB、cTnI、LDH水平的诊断价值。方法：将80例急性冠脉综合征患者分为3组，不稳定性心绞痛组27例，ST段抬高型心肌梗死组25例，非ST段抬高型心肌梗死组28例，另选150例健康体检者为正常对照组，抽血检测其缺血修饰白蛋白（IMA）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）、乳酸脱氢酶（LDH），对检测结果进行分析讨论。结果：急性冠状动脉综合征3组患者中IMA水平均明显高于正常对照组（P〈0．01），IMA水平以不稳定性心绞痛组最高。各种心肌酶对诊断急性冠状动脉综合征的敏感性分别为：IMA88％、CK22％、CK-MB20％、cTnI32％、LDH28％；CK、CK-MB、cTnI、LDH，四者联合检测敏感性为52％；五者联合检测敏感性可达92％。结论：IMA在早期诊断急性冠脉综合征中具有临床应用价值。ACB法检测IMA对急性冠脉综合征的诊断明显优于其他传统酶类，联合检测则大大提高了急性冠脉综合征的确诊率，减少漏诊和误诊的发生。     

外伤性脑梗死的CT诊断

目的总结外伤性脑梗死的CT特征,探讨其发生机制,揭示其对疾病预后的判定价值。方法回顾性分析40例外伤性脑梗死患者头颅CT表现及相关临床资料。结果轻微外伤引起的脑梗死多发于儿童,好发部位为基底节内囊区,预后较好;重症外伤引起的脑梗死好发于成人,发病部位多见于颅内血肿同侧,且大脑后动脉支配区域最为多见,预后较差。结论CT扫描对外伤性脑梗死的诊断及预后判定有重要价值。     

Abdominal aortic aneurysm repair and colonic infarction: a risk factor appraisal

OBJECTIVE: Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients. METHOD: Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6-year period. RESULTS: A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross-clamp time, intra-operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients. CONCLUSION: In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality.     

从肝论治急性心肌梗死后心功能障碍的临床研究

目的探讨从肝论治急性心肌梗死（AMI）后心功能障碍的临床疗效。方法68例AMI患者随机分为2组，对照组33例给予单纯西医常规治疗，治疗组35例在对照组治疗基础上，予中药方剂代替血管紧张素转换酶抑制剂（ACEI）和β-受体阻滞剂，每日1剂，水煎服。2组均以2个月为1疗程。应用超声心动图检测2组AMI后15d和1个疗程后的各项心功自岂指标。结果2组AMI后15d的各项心功能指标比较差异无统计学意义（P〉0．05）；1个疗程后，2组二尖瓣前叶振幅（DE）、左室每搏量（SV）、每分钟排血量（CO）、左室射血分数（LVEF）、左室短轴缩短率（FS）、二尖瓣前叶斜率（MVEF）和二尖瓣口多普勒舒张早期最大流速与舒张末期最大流速比率（E／A）均明显改善，平均左室周径缩短率（MVCF）速度加快，左室舒张期及收缩期内径、二尖瓣前叶E峰与室间隔左室面的距离（EPSS）缩小，2组心功能改善情况比较差异有统计学意义（P〈0．05），治疗组优于对照组。结论ACEI和β-受体阻滞剂与中药方剂均能改善AMI后心功能，中药从肝论治优于ACEI和β-受体阻滞剂。     

出血性脑梗死危险因素的Logistic回归分析

目的探讨出血性脑梗死的危险因素。方法根据专业知识确定与出血性脑梗死有关的因素,采用非条件Logistic回归确定危险因素。结果大面积梗死灶、使用抗凝剂或溶栓治疗、糖尿病史是出血性脑梗死的独立危险因素,与年龄、高血压史、高血脂关系不大。结论大面积脑梗死、使用抗凝剂或溶栓、糖尿病患者发生梗死后出血的几率增大,及时行影像学检查可以早期发现。