Evaluación multimodal de la degeneración estructural de válvulas percutáneas en el seguimiento a largo plazo

Introduction and objectivesWe assessed the long-term hemodynamic performance of transcatheter heart valve (THV) by paired transthoracic echocardiography (TTE), and the incidence, characteristics and factors associated with THV structural valve degeneration (SVD).MethodsA total of 212 patients who underwent transcatheter aortic valve replacement and had a potential follow-up > 5 years with at least 1 TTE ≥ 1-year postprocedure were included. All patients had a TTE at 1 to 5 years and 36 had another one at 6 to 10 years. SVD was defined as subclinical (increase > 10 mmHg in mean transvalvular gradient +  decrease > 0.3 cm² in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase > 20 mmHg in mean transvalvular gradient + decrease > 0.6 cm² in valve area and/or new-onset moderate-to-severe aortic regurgitation). Fifteen patients had a transesophageal echocardiography at the time of SVD diagnosis, and 85 an opportunistic computed tomography examination at 1 (0.5-2) years.ResultsTransvalvular mean gradient increased and valve area decreased over time (P < .01). At 8 years of follow-up, SVD occurred in 30.2% of patients (clinically relevant: 9.3%). Transesophageal echocardiography revealed thickened and reduced-mobility leaflets in 80% and 73% of SVD cases, respectively. No baseline or procedural factors were associated with SVD. THV underexpansion (3.5%) or eccentricity (8.2%) had no impact on valve hemodynamics/SVD at follow-up.ConclusionsA gradual THV hemodynamic deterioration occurred throughout a 10-year period, leading to SVD in ～30% of patients (clinically relevant in < 10%). Leaflet morphology/mobility were frequently impaired in SVD cases, but THV geometry did not influence valve hemodynamics or SVD.     

正常人大脑皮层言语分区结构性不对称研究

目的采用结构性磁共振成像技术,对正常人群大脑皮层言语相关区域的结构性不对称进行研究。材料与方法对60例健康志愿者行高分辨三维T1结构性MRI扫描,选择以下5个脑区作为感兴趣区(ROI):额下回岛盖部、额下回三角部、颞横回、颞平面及岛叶,应用Freesurfer软件进行表面的重建及皮层厚度、皮层表面面积和皮层体积等解剖学结构的测量。比较每个ROI的两侧解剖学测量值和偏侧化指数(LI),并进行相关分析。结果颞横回皮层厚度呈右侧化不对称,岛叶皮层厚度呈左侧化不对称,额下回岛盖部、颞横回、颞平面及岛叶皮层表面面积与皮层体积均呈左侧化不对称;所有ROI的皮层厚度与皮层表面面积均无明显相关;皮层厚度的不对称与皮层体积的不对称无明显相关,皮层表面面积的不对称与皮层体积的不对称均呈明显的正相关。结论言语相关脑区皮层结构主要表现为左侧化的不对称,皮层厚度和皮层表面面积是相互独立的,皮层体积的不对称主要由皮层表面面积的不对称决定。     

医改前后陕西省农村家庭灾难性卫生支出及其影响因素研究

目的:分析新医改前后农村家庭灾难性卫生支出的变化,探讨发生灾难性卫生支出的影响因素。方法:利用陕西省第4次和第5次卫生服务调查数据,以灾难性卫生支出发生率、平均差距和相对差距为测量指标,采用Logistic回归模型分析发生灾难性卫生支出的影响因素。结果:与2008年相比,2013年灾难性卫生支出发生率和平均差距均有下降,相对差距略有上升。当灾难性卫生支出界定标准为40%时,灾难性卫生支出发生率从19.43%降为17.29%,平均差距从3.14%降为2.93%,相对差距则从17.15%上升为17.55%。家庭灾难性卫生支出发生与家庭成员是否患有慢性病、是否有住院利用、是否有65岁及以上老人等因素显著相关。结论:建议加强农村老年居民的慢性病防治工作,同时进一步提高新农合保障水平。     

聚乙烯亚胺非病毒基因载体结构修饰研究进展

聚乙烯亚胺（PEI）作为最经典的非病毒基因载体之一,由于其高转染效率,在基因递送领域受到极大的关注,但其毒性限制了聚乙烯亚胺的应用。本文综述了对聚乙烯亚胺进行不同的结构修饰,如多糖修饰、PEG修饰和低分子聚乙烯亚胺衍生物等,以实现在不显著降低转染效率的前提下减少细胞毒性。     

The relationships between asthma control,daytime sleepiness,and quality of life among children with asthma: a path analysis

ObjectivesWe aimed to examine the relationships between asthma control, daytime sleepiness, and asthma-specific health-related quality of life (HRQOL) among children with asthma. Path analyses were conducted to test if daytime sleepiness can mediate the effect of asthma control status on asthma-specific HRQOL.Methods160 dyads (pairs) of asthmatic children and their parents were collected for analyses. The Asthma Control and Communication Instrument (ACCI) was used to categorize adequate and poor asthma control status. The Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure children’s daytime sleepiness, including sleep in school, awake in school, sleep in evening, and sleep during transport. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale was used to measure asthma-specific HRQOL.ResultsPoorly controlled asthma was associated with daytime sleepiness and impaired asthma-specific HRQOL. Asthma control status was directly associated with asthma-specific HRQOL (P < .05), whereas sleep in school and sleep in evening domains of daytime sleepiness significantly mediated the relationship between poor asthma control and impaired HRQOL (P < .01).ConclusionsAsthma control status was associated with pediatric asthma-specific HRQOL, and the association was significantly mediated by daytime sleepiness. Healthcare providers need to address pediatric sleep needs related to poor asthma control to reduce the negative impact on HRQOL.     

人体寄生虫学教学改革

随着高校学生的扩招和寄生虫学课时数的减少,近年来,授课教师在人体寄生虫学教学中,就如何保证教学质量,从提高教师素质,优化教学内容,开展多媒体教学,充分利用网络资源,充分调动学生学习的积极性,改革新的实验教学模式和考试方式等方面进行了改革,取得了良好的教学效果.     

Abnormal subcortical components of the corticostriatal system in young adults with DLI: A combined structural MRI and DTI study

Developmental Language Impairment (DLI) is a neurodevelopmental disorder affecting 12% to 14% of the school-age children in the United States. While substantial studies have shown a wide range of linguistic and non-linguistic difficulty in individuals with DLI, very little is known about the neuroanatomical mechanisms underlying this disorder. In the current study, we examined the subcortical components of the corticostriatal system in young adults with DLI, including the caudate nucleus, the putamen, the nucleus accumbens, the globus pallidus, and the thalamus. Additionally, the four cerebral lobes and the hippocampus were also comprised for an exploratory analysis. We used conventional magnetic resonance imaging (MRI) to measure regional brain volumes, as well as diffusion tensor imaging (DTI) to assess water diffusion anisotropy as quantified by fractional anisotropy (FA). Two groups of participants, one with DLI (n=12) and the other without (n=12), were recruited from a prior behavioral study, and all were matched on age, gender, and handedness. Volumetric analyses revealed region-specific abnormalities in individuals with DLI, showing pathological enlargement bilaterally in the putamen and the nucleus accumbens, and unilaterally in the right globus pallidus after the intracranial volumes were controlled. Regarding the DTI findings, the DLI group showed decreased FA values in the globus pallidus and the thalamus but these significant differences disappeared after controlling for the whole-brain FA value, indicating that microstructural abnormality is diffuse and affects other regions of the brain. Taken together, these results suggest region-specific corticostriatal abnormalities in DLI at the macrostructural level, but corticostriatal abnormalities at the microstructural level may be a part of a diffuse pattern of brain development. Future work is suggested to investigate the relationship between corticostriatal connectivity and individual differences in language development.