Sensitization Following LVAD Implantation Using Leucodepleted Blood Is Not Due to HLA Antibodies

Implantation of left ventricular assist devices (LVAD) is associated with HLA antibody sensitization. The objective of this study was to determine the specificity of antibodies produced by LVAD recipients using a combination of ELISA, Luminex and microcytotoxicity assays. Fifty-one LVAD patients were studied, from 44 to 838 days post-implantation. No patient developed HLA antibodies, although 24 produced IgG antibodies detectable in both ELISA and Luminex assays. These antibodies manifest as positive reactions with class I and class II wells of the ELISA and also blank wells. In Luminex assays, they produce high MFI readings with the negative control beads. Antibodies were detected 18 to 228 days after implantation. This reactivity was found to be directed against bovine serum albumin (BSA), commonly used to block non-specific binding in ELISA and Luminex assays; absorption of sera with BSA-coated beads completely abrogated reactivity in all solid phase assays, but did not eliminate anti-HLA antibodies in control sera. Ten of the 24 patients have proceeded to transplantation, with a 1-year graft survival of 69%. In conclusion, it appears that implantation of LVADS disrupts immunoregulatory pathways leading to production of anti-albumin antibodies. These can be misinterpreted as anti-HLA antibodies in solid phase assays.     

伊贝沙坦与雷米普利对充血性心力衰竭疗效比较

目的比较伊贝沙坦与雷米普利对充血性心力衰竭(CHF)的临床疗效及安全性。方法72例CHF患者在常规治疗基础上随机分为2组。伊贝沙坦组(36例)口服伊贝沙坦150 mg.d-1;雷米普利组(36例)口服雷米普利2.5 mg.d-1。治疗前与治疗6 mo后分别用超声心动图测量左室射血分数(LVEF)、左室短轴缩短分数(LVFS)、每搏输出量(SV)、心排量(CO)、心脏指数(CI)评估心功能。结果治疗6 mo后,2组心功能较治疗前非常明显改善(P<0.01),2组之间比较差异无统计学意义(P>0.05)。结论伊贝沙坦与雷米普利治疗CHF均有效,且疗效相当。     

冠状动脉瘘的诊治及新进展

冠状动脉瘘是一种罕见的冠状动脉畸形,绝大多数属于先天性畸形,极少数可由后天因素引起。由于冠状动脉血流向有关心腔、血管异常分流,导致引流部位负荷加重、瘘远端心肌缺血而引起相应临床症状。目前,绝大多数冠状动脉瘘已能由超声心动图明确诊断并可经内科介入技术或外科手术治愈。     

骨外固定器行胫骨迁移治疗血栓闭塞性脉管炎的护理

目的总结利用骨外固定器行胫骨迁移治疗血栓闭塞性脉管炎的护理经验.方法对35例血栓闭塞性脉管炎37条患肢应用骨外固定器迁移胫骨治疗.术前积极处理患肢、有效的心理护理,术后严密观察,做好骨外固定器迁移胫骨的护理.结果 32例间歇性跛行距离增加;27例夜间静息痛均得到缓解;7例足趾缺血坏死中除3例术后患肢缺血加重截肢外,余4例患肢供血改善,坏死区域结痂愈合;总有效率91.9%.结论全面、准确地评估患者,完善术前准备及术后正确迁移指导可提高骨外固定器行胫骨迁移治疗血栓闭塞性脉管炎的有效性.     

国产COSTANT冠状动脉支架治疗重症冠心病的远期疗效观察

目的评价国产COSTANT冠脉支架治疗重症冠心病的安全性和远期疗效。方法回顾性分析2001-03～2003-08沈阳军区总医院和广州省人民医院2个心脏中心应用COSTANT冠脉支架治疗71例重症冠心病者即刻疗效和2年随访结果。结果共置入COSTANT支架86枚，其他支架58枚，手术成功率均为100％。院内主要不良心脏事件（MACE）共3例（其中死亡2例、1例支架内发生亚急性血栓）。69例失访6例（随访率91．3％），63例随访21～26个月中4例死亡，21例行冠脉造影复查（占30．4％），8例发生再狭窄（RS）（COSTANT支架4例，其他支架3例，1例COSTANT和其他支架均RS并死亡），5例出现新生病变。COSTANT支架RS率为7．9％（5／63）、MACE发生率12．7％（8／63）。结论2年的长期随访结果表明国产COSTANT冠状动脉支架可安全用于重症冠心病介入治疗，且长期疗效较好。     

百鹰汤治疗慢性乙型肝炎43例

目的：观察以“温阳益气、化湿清热”为法拟方的百鹰汤治疗慢性乙型肝炎的临床疗效。方法：43例慢性乙型肝炎采用百鹰汤治疗作为治疗组，另设30例随机对照组以五酯胶囊治疗。结果：治疗组患临床症状改善明显，其降酶疗效和HBeAg与HBV－DNA阴转率明显优于对照组（P＜0．05）。结论：百鹰汤能改善慢性乙型肝炎患临床症状，具有抗病毒及改善肝功能的作用。     

Content of HSP70 in rats with hereditary stress-induced arterial hypertension

Sensitivity of normotensive Wistar rats and NISAG rats (with hereditary arterial hypertension) to heat stress is compared at the organism and cell levels. High temperature sensitivity of NISAG rats correlates with a low content of the main heat shock protein HSP70. This relationship can serve as a biochemical marker of predisposition to arterial hypertension. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 124, No. 8, pp. 171–173, August, 1997     

Influence of the Compliance of the Pump Housing and Cannulas of a Paracorporeal Pneumatic Ventricular Assist Device on Transient Pressure Characteristics

Abstract: The dependence of transient pressure characteristics of a ventricular assist device (VAD) on the compliance of its housing and cannulas was investigated in a mock circulation. The peak rate of change of pressure ( dP/dt _max) values was greater in the cannulas than other compartments and was associated with valve closure-induced pressure oscillations. When cannula compliance was increased from 0.0057 to 0.0129 cm³/mm Hg, these values decreased by ˜20%, and outflow cannula pressure oscillation frequency decreased from 17.5 Hz by 35%. This trend was also apparent in the inflow. A VAD housing compliance increase from 0.0162 to 0.0483 cm³/mm Hg caused a dP/dt _max decrease of 30% in both the blood chamber and the outflow cannula. The effect of this change on the inflow was weaker implying that housing absorbs the energy associated with outflow deceleration more effectively than the inflow. These findings suggest that increasing VAD housing and cannulas compliance can improve hydrodynamic performance.     

Preventing heart disease: is treating the high risk sufficient?

Monte Carlo simulation was used to assess the effects of several intervention strategies on coronary heart disease mortality rates in a Finnish and a North American cohort. Lowering total serum cholesterol by 4%, smoking by 15%, and diastolic blood pressure by 3% for the whole cohort would be expected to reduce the incidence of non-fatal myocardial infarction by at least 13% and coronary heart disease deaths by at least 18%. Lowering serum cholesterol by 34%, diastolic blood pressure to 90 mmHg, and reducing smoking by 20% in the subset of the population with all three risk factors in the highest quartile would result in a 6-8% reduction in non-fatal myocardial infarction and a 2-9% reduction in deaths from coronary heart disease in these cohorts. These data demonstrate that in populations with a relatively high incidence of heart disease, treating the entire population will produce larger effects than focusing only on high-risk populations.     

心脏微循环血管的扫描电镜观察Ⅰ.心脏血管球

应用血管铸型、扫描电镜观察方法，研究了２例成人及１例儿童的左冠状动脉前降支中段心肌浅层及其周围的脂肪组织内的心脏血管球的三维构筑。根据形态特点，将心脏血管球分为圆球型、柱型、多角型、捆绑型、绒团型及鸭梨型，并对各型心脏血管球的形态结构特点进行了描述，且阐述了这些心脏血管球的临床意义。