Myocardial Fibrosis and Inflammation by CMR Predict Cardiovascular Outcome in People Living With HIV

ObjectivesThe goal of this study was to examine prognostic relationships between cardiac imaging measures and cardiovascular outcome in people living with human immunodeficiency virus (HIV) (PLWH) on highly active antiretroviral therapy (HAART).BackgroundPLWH have a higher prevalence of cardiovascular disease and heart failure (HF) compared with the noninfected population. The pathophysiological drivers of myocardial dysfunction and worse cardiovascular outcome in HIV remain poorly understood.MethodsThis prospective observational longitudinal study included consecutive PLWH on long-term HAART undergoing cardiac magnetic resonance (CMR) examination for assessment of myocardial volumes and function, T1 and T2 mapping, perfusion, and scar. Time-to-event analysis was performed from the index CMR examination to the first single event per patient. The primary endpoint was an adjudicated adverse cardiovascular event (cardiovascular mortality, nonfatal acute coronary syndrome, an appropriate device discharge, or a documented HF hospitalization).ResultsA total of 156 participants (62% male; age [median, interquartile range]: 50 years [42 to 57 years]) were included. During a median follow-up of 13 months (9 to 19 months), 24 events were observed (4 HF deaths, 1 sudden cardiac death, 2 nonfatal acute myocardial infarction, 1 appropriate device discharge, and 16 HF hospitalizations). Patients with events had higher native T1 (median [interquartile range]: 1,149 ms [1,115 to 1,163 ms] vs. 1,110 ms [1,075 to 1,138 ms]); native T2 (40 ms [38 to 41 ms] vs. 37 ms [36 to 39 ms]); left ventricular (LV) mass index (65 g/m² [49 to 77 g/m²] vs. 57 g/m² [49 to 64 g/m²]), and N-terminal pro–B-type natriuretic peptide (109 pg/l [25 to 337 pg/l] vs. 48 pg/l [23 to 82 pg/l]) (all p < 0.05). In multivariable analyses, native T1 was independently predictive of adverse events (chi-square test, 15.9; p < 0.001; native T1 [10 ms] hazard ratio [95% confidence interval]: 1.20 [1.08 to 1.33]; p = 0.001), followed by a model that also included LV mass (chi-square test, 17.1; p < 0.001). Traditional cardiovascular risk scores were not predictive of the adverse events.ConclusionsOur findings reveal important prognostic associations of diffuse myocardial fibrosis and LV remodeling in PLWH. These results may support development of personalized approaches to screening and early intervention to reduce the burden of HF in PLWH (International T1 Multicenter Outcome Study; NCT03749343).     

疏肝化痰消癖散与乳块消片治疗肝郁气滞型乳腺增生症的疗效对比

目的：比较疏肝化痰消癖散[1]与乳块消片[2]治疗肝郁气滞型乳腺增生症的疗效。方法随机选取该院2012年9月—2014年10月收治的肝郁气滞型乳腺增生症[3]患者80例为研究对象,随机分为治疗组和对照组两组,治疗组采用疏肝化痰消癖散进行治疗,对照组采用乳块消片进行治疗。观察两组患者的病情好转情况,统计治愈率和总有效率。结果经过统计分析后,治疗组采用疏肝化痰消癖散进行治疗的总有效率为80%,对照组采用乳块消片进行治疗的总有效率为70%,治疗组总体有效率高于治疗组的10.0%。两组之间的差异有统计学意义(P＜0.05)。两组患者在治疗期间都没有发生严重不良反应,主要是轻微的消化道反应,患者可以忍受。结论治疗组的治愈率、总有效率均明显高于对照组(P＜0.05)。因此,疏肝化痰消癖散治疗乳腺增生的临床疗效明显,同时病情不易复发,不良反应小,适用于乳腺增生患者的临床治疗。     

肝动脉化疗栓塞联合索拉菲尼在多发性肝细胞癌治疗中的应用研究

目的 研究肝动脉化疗栓塞(TACE)联合索拉菲尼在多发性肝细胞癌(MHCC)治疗中的应用效果.方法 选取2010年12月至2012年11月于自贡市第四人民医院接受治疗的MHCC患者148例,依据随机数字表法按1∶1的比例分为A、B两组,两组一般资料差异无统计学意义(P＞0.05).A组行单纯TACE治疗,B组行TACE联合索拉菲尼治疗.观察两组治疗前后甲胎蛋白(AFP)、高尔基体蛋白73(GP73)、铁蛋白(FER)、E-钙粘连蛋白(EC)、内皮抑素(E)、癌胚抗原(CEA)、血管内皮生长因子(VEGF)等水平、缓解率、控制率、临床疗效及不良反应.结果 治疗后B组AFP、GP73、FER、EC、E、CEA和VEGF水平均低于A组,差异有统计学意义(P＜0.05).B组缓解率、控制率均高于A组,但差异无统计学意义(P＞0.05).B组中位生存时间、总生存时间均高于A组,差异无统计学意义(P＞0.05).B组脱发、腹泻、手足反应等不良反应发生率高于A组,差异有统计学意义(P＜0.05),两组不良反应经对症处理后均缓解.结论 TACE联合索拉菲尼治疗MHCC较单纯TACE更有优势.     

Administration of low doses of MK-801 during ethanol withdrawal in the developing rat pup attenuates alcohol's teratogenic effects

BACKGROUND: Alcohol exposure during development can produce severe and long-lasting central nervous system damage and consequent behavioral alterations. Recent evidence suggests that NMDA receptor-mediated excitotoxicity during periods of withdrawal may contribute to this damage. We have demonstrated that blocking the NMDA receptor with MK-801 during alcohol withdrawal can attenuate ethanol's adverse effects on behavioral development in the rat. This study examined the dose dependency of MK-801's ability to mitigate ethanol's teratogenic effects. METHODS: Neonatal rat pups were exposed to 6.0 g/kg of ethanol in a binge-like manner on postnatal day (PD) 6, a period of brain development equivalent to a portion of the human third trimester. Alcohol administration was accomplished with an artificial rearing procedure. Twenty-one hours after ethanol treatment, pups were injected intraperitoneally with one of four doses of MK-801 (0.05, 0.1, 0.5, or 1.0 mg/kg) or saline vehicle. An artificially reared control and a normally reared control group were included. On PD 18-19, activity level was monitored, and on PD 40-42, serial spatial discrimination reversal learning was assessed. RESULTS: Alcohol exposure on PD 6 produced significant increases in activity level and deficits in reversal learning. These alcohol-induced behavioral alterations were significantly attenuated in subjects treated with one of the three lower doses (0.05-0.5 mg/kg) of MK-801 during withdrawal. The performance of ethanol-exposed subjects treated with the high dose of MK-801 (1.0 mg/kg) did not differ from that of the Ethanol Only group. CONCLUSIONS: These data suggest that alterations in NMDA receptor activation during alcohol withdrawal contribute to the neuropathology and consequent behavioral alterations associated with developmental alcohol exposure. These data have important implications for pregnant women and newborns undergoing ethanol withdrawal.     

Costs and effects of new professional roles: Evidence from a literature review

One way in which governments are seeking to improve the efficiency of the health care sector is by redesigning health services to contain labour costs. The aim of this study was to investigate the impact of new professional roles on a wide range of health service outcomes and costs.A systematic literature review was performed by searching in different databases for evaluation papers of new professional roles (published 1985–2013). The PRISMA checklist was used to conduct and report the systematic literature review and the EPHPP-Quality Assessment Tool to assess the quality of the studies.Forty-one studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs) were selected for data extraction and analysis. The 25 SN studies evaluated most often quality of life (10 studies), clinical outcomes (8), and costs (8). Significant advantages were seen most frequently regarding health care utilization (in 3 of 3 studies), patient information (5 of 6), and patient satisfaction (4 of 6). The 16 ANP studies evaluated most often patient satisfaction (8), clinical outcomes (5), and costs (5). Significant advantages were seen most frequently regarding clinical outcomes (5 of 5), patient information (3 of 4), and patient satisfaction (5 of 8).Promoting new professional roles may help improve health care delivery and possibly contain costs. Exploring the optimal skill-mix deserves further attention from health care professionals, researchers and policy makers.     

糖尿病合并脑血管病病变的临床护理和处理分析

目的分析糖尿病合并脑血管病病变的临床护理和处理措施。方法 80例糖尿病合并脑血管病病变患者分为试验组与对照组,每组40例。对照组患者采用常规护理模式,试验组患者采用综合护理干预模式,对两组患者的护理效果进行分析对比。结果试验组患者护理效果明显优于对照组,差异有统计学意义(P<0.05)。结论对糖尿病合并脑血管病病变患者采用综合护理干预具有良好的临床疗效,能有效促进患者的病情缓解,值得在临床应用上推广。     

Response to Diazepam in Sons of Alcoholics

Alcohol exerts several of its actions via the chloride channel associated with the central GABA-benzodiazepine receptor complex. To explore a possible role for this receptor complex in risk for alcoholism, and to determine whether risk for alcoholism is associated with risk for benzodiazepine abuse, the authors administered intravenous diazepam to 18 sons of male alcoholics (SOAs) and 18 control subjects. Four logarithmically increasing doses of diazepam and matched volumes of placebo were given in randomized order on separate days about 1 week apart. SOAs were significantly more likely than controls to report euphoric responses to diazepam. At some diazepam doses, SOAs were more likely to report feeling "high" and "intoxicated." SOAs and controls did not differ in feeling "drugged." SOAs and controls may differ in expectations regarding the subjective effects of drugs and/or in the function of the central GABA-benzodiazepine receptor complex. These findings also add further evidence for increased pleasurable effects, and thus possibly increased risk for benzodiazepine abuse, in a subgroup of SOAs.     

Adverse drug reactions and debrisoquine/sparteine (P450IID6) polymorphism in patients with fibromyalgia

Summary Objective: To assess the frequency of adverse drug reaction in patients with fibromyalgia in relation to medications prescribed for this condition. To evaluate the potential role of the P450IID6 phenotype in the pathogenesis of these adverse drug reactions. Methods: Thirty-five patients with fibromyalgia were assessed using a structured questionnaire with demographic and clinical data and perceived adverse drug reactions. A sample of 60 patients with rheumatoid arthritis and 62 patients with localized back pain served as controls. The P450IID6 phenotype was determined for each of the fibromyalgia patients. Results: Overall, 141 patients had used NSAID and 79 (56%) of them reported adverse effects. Antidepressant drugs were used by 68 patients and 35 (51%) patients had adverse effects. Muscle relaxant drugs were used by 48 patients and 15 (31%) of them reported side effects. Analgesics were used by 122 patients and 22 (18%) had experienced adverse effects. Statistical differences in the frequency of adverse effects were found with antidepressant drugs in the fibromyalgia group, compared with rheumatoid arthritis (p=0.01) and back pain (p=0.02). Four of the 35 patients (11.4%) had a metabolic ratio (M.R.) greater than 0.30 (log M.R.=–0.52) indicative of the poor metabolizers (PM) phenotype. M.R. varied from 0.005 (log M.R.=–2.30) to 4.99 (log M.R.=0.70). Conclusions: The problem of adverse drug reactions in fibromyalgia patients does not appear to correlate with the PM phenotype of the P450IID6 oxidative enzyme. It also is unlikely that altered xenobiotic detoxification attributable to this PM phenotype would have a significant role in the development of fibromyalgia.     

经听觉统合训练改善听觉传导功能的孤独症谱系障碍患儿核心症状的变化分析

目的探究接受听觉统合训练(auditory integration training,AIT)后听觉传导功能障碍得到缓解的孤独症谱系障碍患儿核心症状的改善情况。方法将存在听觉诱发电位异常的ASD患儿分入AIT组(接受训练后恢复正常的组成试验组)、对照组A组(空白对照组)、对照B组(应用行为分析训练组),分别在各组入组时、入组1个月后、入组3个月后进行波特奇发育检核表、儿童孤独症评定量表(CARS)、孤独症治疗评定量表(ATEC)评估,以各因子分数的变化值评价核心症状改善水平。结果入组时试验组、对照A组及对照B组CARS[分别为(36.31±4.08)分,(36.33±3.76)分,(36.33±5.14)分]及ATEC语言[分别为(19.08±6.43)分,(16.40±6.42)分,(18.48±5.96)分]、社交[分别为(15.63±7.13)分,(16.05±7.57)分,(16.19±7.19)分]、感知[分别为(16.78±5.39)分,(16.92±6.75)分,(17.12±6.73)分]、自理[分别为(15.98±8.71)分、(17.93±8.22)分、(17.26±8.93)]评分均差异无统计学意义(均P>0.05)。入组1月、3月后,重复测量方差分析显示,试验组、对照B组、对照组A组CARS分值[1月:(33.96±3.79)分,(35.09±4.38)分,(34.30±3.98)分;3月:(32.95±3.15)分,(36.86±3.86)分,(33.95±3.90)分]的影响:时间主效应显著(F=22.308,P<0.01),组别主效应不显著(F=2.647,P>0.05),时间与组别存在交互作用(F=8.626,P<0.01);对ATEC语言[1月:(16.18±7.10)分,(18.62±6.63)分,(13.40±5.44)分;3月:(14.13±6.13)分,(18.40±6.35)分,(10.75±5.17)分]、社交[1月:(12.31±6.68)分,(17.76±6.82)分,(15.08±6.75)分;3月:(10.71±5.42)分,(16.31±6.30)分,(12.15±7.30)分]、感知觉[1月:(14.37±5.86)分,(17.43±7.22)分,(18.58±6.92)分;3月:(10.35±5.43)分,(16.44±7.05)分,(16.68±7.37)分]分量表分值的影响,时间主效应显著(F=35.534,40.729,40.401,均P<0.01),组别主效应亦显著(F=7.600,6.193,7.675,均P<0.01),时间与组别存在交互作用(F=7.602,3.355,7.649,均P<0.05),事后多重比较示:试验组与对照B组、对照A组与对照B组在干预后ATEC语言量表分值差异有统计学意义(I1-J1=-1.69,P1<0.05;I2-J2=-4.98,P2<0.01);试验组与对照A组在干预后ATEC社交量表分值差异有统计学意义(I-J=-4.54,P<0.01);试验组与对照A组、试验组与对照B组在干预后ATEC感知觉量表分值差异有统计学意义(I1-J1=-3.16,P1<0.05;I2-J2=-4.89,P2<0.01);对ATEC自理能力分量表分值影响的时间主效应显著(F=22.876,P<0.01),组别主效应亦显著(F=3.427,P<0.05),时间与组别无交互作用(F=1.885,P>0.05),事后多重比较示:试验组与对照A组在干预后ATEC自理能力量表分值差异有统计学意义(I-J=-4.46,P<0.05)。结论AIT训练后听觉传导功能恢复正常的ASD患儿的核心症状也能得到明显改善。