The relationships among monocyte subsets,miRNAs and inflammatory cytokines in patients with acute myocardial infarction

Background

Acute myocardial infarction (AMI) causes irreversible myocardial damage and release of inflammatory mediators, including cytokines, chemokines and miRNAs. We aimed to investigate changes in the levels of cytokines (IL-6, TNF-α and IL-10), miRNAs profiles (miR-146 and miR-155) and distribution of different monocyte subsets (CD14++CD16-, CD14++CD16+, CD14+CD16++) in the acute and post-healing phases of AMI.

探讨双重排粪造影对结肠功能性便秘的诊断价值

目的研究双重排粪造影方式应用在结肠功能性便秘诊断当中的效果。方法文章所选择的调查对象来自2017年10月-2018年12月,均为在此期间本院收治的60例经临床病理诊断确诊为结肠功能性便秘患者,分析双重排粪造影方式和排粪造影的符合性。结果采用双重排粪造影方式诊断结肠功能性便秘59例得到确诊,占98.33%,和排粪造影相比,差异有统计学意义(P<0.05)。结论通过双重排粪造影方式进行结肠功能性便秘诊断,可以有效的提升诊断的效率,对于具体症型的确认也具有重要意义。     

Gd-EOB-DTPA增强MRI评估功能性肝体积与肝功能Child-Pugh分级的相关性

目的：对比解剖性肝脏体积（ALV）和功能性肝脏体积（FLV）与肝功能Child-Pugh分级的相关性。方法：选择温州医科大学附属第二医院育英儿童医院2014年1月至2019年4月同时行增强CT和Gd-EOB-DTPA增强MRI扫描的肝硬化患者25例。对所有患者进行肝功能Child-Pugh评分，检测所有入组患者每个肝段的Gd-EOB-DTPA增强MRI平扫期和肝胆特异期的信号对比增强率（CER），以CT扫描的数据为基础利用MI-3DVS计算每个肝段的ALV和全肝的FLV。分析ALV和FLV与肝功能Child-Pugh分级的相关性。结果：肝功能Child-Pugh分级与ALV呈负相关（r=-0.792，P＜0.001），曲线拟合的决定系数（R2）=0.63；肝功能Child-Pugh分级与FLV亦呈负相关（r=-0.911，P＜0.001），曲线拟合的R2=0.80。FLV与肝功能Child-Pugh分级有更显著的负相关性。结论：结合Gd-EOB-DTPA增强MRI平扫期和肝胆特异期的信号CER和ALV计算所得的FLV较ALV能更好地反映肝脏的功能状态。     

The Relationship between Self-Efficacy,Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses

Abstract

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted r?=?0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted r?=?0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted r?=?0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest.     

重症心源性肺水肿伴休克患者的机械通气治疗

目的研究重症心源性肺水肿伴休克患者机械通气(MV)治疗时通气压力的选择对预后的影响。方法将符合标准的22例患者分为两组对照组9例,常规给予较低通气压力和加强药物治疗;治疗组13例,适当增加通气压力。观察血压、临床症状和动脉血气的变化。结果调整MV后30分钟时,治疗组收缩压迅速由(95±12)mmHg升至(130±15)mmHg(P<0.001),呼吸频率(RR)由(38±11)次/min降至(27±6)次/min(P<0.005),心率(HR)由(126±15)次/min降至(105±12)次/min(P<0.001);对照组上述指标变化不明显。2小时后治疗组的升压药用量减少(70±15)%,对照组则增加(20±5)%;同时在吸氧浓度不变的情况下,治疗组的PaO2由(81±12)mmHg升至(140±15)mmHg(P<0.001),明显高于对照组PaO2的改善。24~48小时内治疗组11例患者(85%)停用升压药,对照组2例(22%)停用。最终治疗组100%的患者好转出院,对照组为45%(P<0.05)。结论与低压力通气相比,适当增加MV通气压力不仅可迅速改善重症心源性水肺肿伴休克患者的低氧血症,也可迅速升高血压,改善心功能,降低病死率。     

冠心病合并其他器质性心脏病的外科治疗

目的分析冠心病合并其他器质性心脏病的临床特点,探讨一期外科治疗的方法和临床疗效。方法分析2004年4月至2006年4月冠心病合并其他器质性心脏病患者13例,其中风湿性心脏病联合瓣膜病1例,二尖瓣病变4例,二尖瓣退行性病变3例,主动脉瓣关闭不全3例,升主动脉瘤1例,继发孔房缺1例。因冠心病首诊入院5例,以其他器质性心脏病首诊入院8例。术前有心绞痛症状者8例,无心绞痛5例。体外循环下一期外科治疗。结果无死亡病例,13例均顺利出院。冠脉搭桥+瓣膜置换8例,冠脉搭桥+瓣膜成形3例,冠脉搭桥+Bentall+室壁瘤切除1例,冠脉搭桥+房缺修补1例。手术中搭桥1～3支,平均(1.92±0.73)支。术后1周,左心室舒张末内径(LVDD)为(51.77±2.64)mm,较术前[(58.92±3.81)mm]明显缩小(P<0.05)。随访3个月,心绞痛症状完全消失,心功能(NYHA)明显提高(P<0.05)。结论冠心病合并其他器质性心脏病临床症状无特异性,容易漏诊。虽然手术风险性和难度增加,但未得到血液重建,对患者更将是致命性的灾难,应争取一期手术。     

外科治疗56例心脏非黏液性肿瘤的临床分析

目的探讨心脏非黏液性肿瘤临床特点,总结外科治疗经验。方法对我院1996年10月至2005年3月进行外科治疗的56例心脏非黏液性肿瘤的临床资料进行回顾性分析,总结其临床表现、发生部位、肿瘤性质和外科治疗特点等。结果心脏非粘液性肿瘤占本院同期手术患者的0.14%,良性肿瘤28例,恶性肿瘤28例,其中继发性心脏肿瘤8例。良性肿瘤最常见的是生长在心室,共18例;恶性肿瘤最常见的生长部位是心房,共15例。外科治疗行急诊手术者12例。心包开窗引流术2例,探查术1例,术中肿瘤全部切除者26例,部分切除27例,术后住院期间死亡1例。结论心脏非黏液性肿瘤临床表现各异、病理类型多样、病变广泛,手术原则为尽可能切除肿瘤和保持心脏结构的完整性和功能。     

自体血预充技术对血液保护作用的研究

目的研究采用自体血预充技术对体外循环下心脏手术的血液保护作用。方法40例非急诊手术的首次接受体外循环下心脏冠脉搭桥的患者,依性别(男女比例)、年龄、体重、身高、体表面积(BSA)和射血分数(EF)进行配对后分为两组:自体血预充组(n=20)和经典预充组(n=20)。自体血预充组:用1250ml晶体液和8000IU肝素预充,体外循环开始前先采用自体血预充技术置换出大部分最初预充液,维持平均动脉压(MAP)在50mmHg以上。经典预充组:1250ml晶体液和8000IU肝素预充。心肌保护均采用Calafiore温血停跳液灌注。体外循环中保持温度35.0℃～35.5℃,流量2.5～2.8L·min-·1m-2。所有患者按标准手术步骤进行手术。手术结束前将体外循环系统中余血全部回输给患者。结果自体血预充组平均置换出(894±171)ml的最初预充液,患者体外循环中,手术结束时,术后6h、1d、2d的HCT水平均明显高于经典预充组(P<0.05)。自体血预充组围术期人均输血量明显低于经典预充组[(0.16±1.09)U/人和(0.97±2.18)U/人,P<0.05]。自体血预充组患者术后胸腔引流量较经典预充组明显减少(303±89ml和495±112ml,P<0.05)。结论自体血预充技术的应用能减少血液稀释,减少围术期输血量,保护血液。     

Impact of Transcatheter Occlusion of a Patent Ductus Arteriosus on Atrial Septal Defect Diameter in Children

Background. A persistent patent ductus arteriosus (PDA) may delay closure of a coexisting atrial septal defect (ASD) due to volume loading and enlargement of the left atrium. The purpose of this study was to investigate the natural history of ASD size in patients with a PDA following transcatheter PDA occlusion. Methods. All patients with an ASD and a PDA who underwent transcatheter PDA occlusion at Texas Children’s Hospital were identified. Patients with ASD diameter <3 mm, or additional cardiac defects were excluded. Eight patients (7 females) with small‐ to moderate‐sized ASDs and a PDA were identified. Patient demographics, echocardiographic data, and cardiac catheterization data were recorded. Data were analyzed by 1‐tailed t‐test. Results. Following PDA occlusion, ASD diameter decreased in 6 of 8 patients by a mean of 3.8 mm (±2.3 mm), including 2 that closed. The median duration of follow‐up was 689 days. One ASD remained unchanged and 1 increased in size. The mean maximum ASD diameter decreased from 6.4 mm (±2.2 mm) to 3.9 mm (±3.4 mm) (P = .03). Two patients underwent subsequent transcatheter ASD occlusion. Conclusion. Following transcatheter PDA occlusion, small‐ to moderate‐sized ASDs have significant probability to decrease in size, and possibly close. In infants and children, we recommend transcatheter PDA occlusion, and serial follow‐up of the size of the ASD. This will allow many small‐ to moderate‐sized ASDs to either close, or become smaller, obviating the need for future intervention.     

Bipolar disorders: treatment options and patient satisfaction

Functional recovery, the goal of treatment, has long been overlooked in the assessment of effectiveness of pharmacological treatments. However, with the recent shift in paradigm, from syndromal–symptomatic recovery to functional recovery, there appears to be a new interest in the definition and evaluation of functional recovery. Since functional recovery lags symptomatic recovery, sometimes by months or years, the attainment of functional recovery will be determined by both efficacy and long-term compliance. Quetiapine, due to its efficacy in both mania and depression, and effect on cognition may lead to improved functioning in patients with bipolar disorder.