超声心动图诊断左心室射血分数减低的左冠状动脉异常起源于肺动脉的效果分析

目的探讨左心室射血分数（LVEF）减低的左冠状动脉异常起源于肺动脉（ALCAPA）的超声心动图特点及手术效果。 方法选取2008年10月至2018年9月首都医科大学附属北京儿童医院ALCAPA患者28例，根据LVEF分为LVEF减低组（LVEF＜50%）19例和LVEF正常组（LVEF≥50%）9例，比较2组患者超声心动图表现，应用两独立样本t检验比较2组患者间超声参数的差异。手术患者（17例）分别于术后1 d、1个月、6个月、1年进行超声心动图随访，应用配对t检验与术前超声参数进行对比。 结果LVEF减低组患者LVEF为30%~48%，平均年龄5.4个月；LVEF正常组LVEF为60%~73%，平均年龄2.5岁。LVEF减低组与LVEF正常组相比，左心室舒张末期内径大［（131.95±24.24）mm/m² vs（85.67±20.26）mm/m²］，右冠状动脉内径小［（3.06±0.51）mm vs（4.01±0.62）mm］，差异具有统计学意义（t=-4.465、4.075，P均＜0.001），易形成室壁瘤。LVEF减低组中10例行手术治疗，7例超声心动图随访至术后1年；与术前相比，术后1 d开始左心室舒张末期内径逐渐回缩［（109.98±16.06）mm/m²、（99.49±12.02）mm/m²、（89.48±10.90）mm/m²、（80.03±8.09）mm/m² vs（123.26±12.40）mm/m²］，差异具有统计学意义（t=-2.668、-7.519、-5.413、-6.526，P=0.004、0.001、0.012、0.007），LVEF术后1个月开始恢复，术后6个月达正常水平［（45.50±9.57）%、（66.25±10.34）%、（67.25±4.50）% vs（38.83±7.05）%］，差异具有统计学意义（t=3.162、3.683、5.869，P=0.025、0.014、0.002）。 结论LVEF减低的ALCAPA患儿年龄小、心脏病变重，超声心动图可以准确作出诊断，但需要与心内膜弹力纤维增生症、扩张型心肌病相鉴别。ALCAPA手术治疗远期效果较好，超声心动图在术后随访中有重要作用。     

Shenling Baizhu Powder (参苓白术散) Ameliorates Pi (Spleen)-Deficiency-Induced Functional Diarrhea in Rats

Objective To explore the mechanism of Pi(Spleen)-deficiency-induced functional diarrhea(FD)model rats treated by Shenling Baizhu Powder(参苓白术散,SBP).Methods Thirty male Sprague-Dawley rats were randomly divided into 5 groups including control,model,low-,medium-,and high-dose SBP groups(SBPLDG,SBPMDG,SBPHDG),6 rats in each group,respectively.Pi-deficiency-induced FD rats model was developed through Radix et Rhizoma Rhei gavage for 7 days.After modeling,the rats were treated with 3 doses of SBP[0.93,1.86,and 3.72 g/(kg·d)],and the rats in the control and model groups were given pure water for 7 days.The diarrhea index was calculated.On the 7th and 14th days,the traveled distance of rat was measured by the open field test.Serum D-xylose content was determined by the phloroglucinol method and interleukin(IL)-10 and IL-17 levels were measured using an enzyme-linked immunosorbent assay kit.The content of Treg cells was determined by flow cytometry.Results Compared with the control group,the diarrhea index and IL-17 level in the model group were significantly higher and the total exercise distance and D-xylose content significantly decreased(P>0.05).The expression of IL-10 in the SBPHDG group was significantly up-regulated,and serum D-xylose level and Treg cells increased significantly compared with the model group(P>0.05).Conclusion High-dose SBP exhibited ameliorating effects against Pi-deficiency induced FD,which might be attributed to its modulations on intestinal absorption function as well as adaptive immunity in mesenteric lymph nodes of rat.     

Patient-derived non-small cell lung cancer xenograft mirrors complex tumor heterogeneity

Objective:Patient-derived xenograft(PDX)models have shown great promise in preclinical and translational applications,but their consistency with primary tumors in phenotypic,genetic,and pharmacodynamic heterogeneity has not been well-studied.This study aimed to establish a PDX repository for non-small cell lung cancer(NSCLC)and to further elucidate whether it could preserve the heterogeneity within and between tumors in patients.Methods:A total of 75 surgically resected NSCLC specimens were implanted into immunodeficient NOD/SCID mice.Based on the successful establishment of the NSCLC PDX model,we compared the expressions of vimentin,Ki67,EGFR,and PD-L1 proteins between cancer tissues and PDX models using hematoxylin and eosin staining and immunohistochemical staining.In addition,we detected whole gene expression profiling between primary tumors and PDX generations.We also performed whole exome sequencing(WES)analysis in 17 first generation xenografts to further assess whether PDXs retained the patient heterogeneities.Finally,paclitaxel,cisplatin,doxorubicin,atezolizumab,afatininb,and AZD4547 were used to evaluate the responses of PDX models to the standard-of-care agents.Results:A large collection of serially transplantable PDX models for NSCLC were successfully developed.The histology and pathological immunohistochemistry of PDX xenografts were consistent with the patients’tumor samples.WES and RNA-seq further confirmed that PDX accurately replicated the molecular heterogeneities of primary tumors.Similar to clinical patients,PDX models responded differentially to the standard-of-care treatment,including chemo-,targeted-and immuno-therapeutics.Conclusions:Our established PDX models of NSCLC faithfully reproduced the molecular,histopathological,and therapeutic characteristics,as well as the corresponding tumor heterogeneities,which provides a clinically relevant platform for drug screening,biomarker discovery,and translational research.     

~(60)Co-γ射线辐照对黄精中微生物及多糖的影响

目的研究~(60)Co-γ射线辐照对黄精中微生物数量及多糖含有量的影响。方法参照2015年版《中国药典》方法,检测需氧菌总数(TAMC)、霉菌和酵母菌总数(TYMC)、耐热菌数、大肠埃希菌;采用硫酸蒽酮比色法,检测波长582 nm,于辐照后0、1、3、6月进行相应检测。结果黄精经0.5～6.0 kGy ~(60)Co-γ射线辐照后,微生物数量显著减少,并随着辐照剂量增加而更明显;多糖含有量显著降低,也随着辐照剂量增加而更明显。结论 3.0～6.0 kGy ~(60)Co-γ射线辐照能有效杀灭黄精中微生物,但也可能使多糖含有量降低。     

斑点追踪分层应变技术评价蒽环类药物化疗患者早期心肌毒性

目的 本研究采用二维斑点追踪显像技术（2D-STI）评价使用蒽环类化疗药物患者左室收缩功能及左室收缩同步性，探讨2D-STI在评价蒽环类药物化疗早期心肌毒性中的应用价值。方法 选取我院诊断为乳腺癌的女性患者40例，所有患者均接受表柔比星化疗。分别在化疗前（T0）、第一周期及第二周期化疗后（T1、T2）进行二维超声心动图检查，用EchoPAC软件分析蒽环类药物化疗患者左室心肌内膜、心肌外膜、整体纵向应变（EndoGLS、EpiGLS、GLS）、环向应变（EndoGCS、EpiGCS、GCS）及左室整体径向应变（GRS）；获取纵向、环向及径向整体达峰时间标准差（Tssl-SD、Tssc-SD，Tssr-SD）及纵向、环向及径向达峰时间最大差值（Tssl-Dif、Tssc-Dif、Tssr-Dif），获取纵向、环向及径向延迟指数（LSDI、CSDI、RSDI）。结果 与T0周期相比，GLS、endoGLS及endoGCS在T2周期化疗后的变化有统计学意义（p2均＜0.05）；与T0周期相比，患者Tssl-SD及LSDI 在T2周期化疗后的变化有统计学意义（p2均＜0.05）。结论 2D-STI技术获取的分层应变参数及同步性参数可以准确分析蒽环类药物化疗患者早期心肌收缩功能的损伤及室壁运动协调性的损伤，能够敏感发现蒽环类药物化疗后的早期心肌毒性表现。     

股内侧肌悬吊髌骨单锚钉双束解剖重建内侧髌股韧带

[目的]介绍股内侧肌悬吊髌骨单锚钉双束解剖重建内侧髌股韧带(MPFL)治疗复发性髌骨脱位的技术方法。[方法]2013年1月～2016年6月收治的复发性髌骨脱位患者19例。手术以股骨内上髁、收肌结节与腓肠肌结节之间的凹陷作为MPFL股骨止点,建立直径6 mm、深40 mm骨隧道;髌骨内缘中点做髌骨侧止点,沿髌骨长轴建立约1 cm的骨槽,在中点平行于髌骨关节面打入1枚带双线4.5 mm锚钉,将移植物固定于骨槽并与周围软组织缝合。移植物近侧游离端穿过股内侧肌斜束肌腱,形成"悬吊"结构并自股骨侧切口下穿出,远侧游离端在深筋膜隧道自近端移植物同一位置穿出,远近端缝合为一股端,于骨道内口用可吸收界面螺钉固定。[结果]术后随访12～48个月。未发生感染、膝关节功能障碍、复发等相关并发症。末次随访时膝关节功能Lysholm、IKDC、Kujala和Tegner评分均较术前显著增加,差异有统计学意义(P0.05);末次随访时CA、Q角、PTA、PLSR均较术前显著减小,差异有统计学意义(P0.05)。[结论]股内侧肌悬吊髌骨拴桩双束解剖重建内侧髌股韧带切口小、复发率低,可恢复髌股轨迹的动力和静力稳定性,临床疗效满意。     

左心室舒张功能减低是青年高血压病患者罹患脑梗死的独立预测因素——一项回顾性调查研究

目的探讨左心室舒张功能减低与青年高血压病患者急性脑梗死的相关性。方法收集2014年10月~2018年2月宝鸡市第二中医医院神经内科收治的青年急性脑梗死同时患有高血压病的患者92例(观察组),同时选取同期患有高血压病的青年体检患者98例(对照组)。对两组患者都进行心脏彩色多普勒检查,观察患者的左心室舒张功能,并分析左心室舒张功能减低与急性脑梗死的关系。结果 190例青年高血压病患者中,左心室舒张功能正常者18例,占9. 47%,左心室舒张功能减低者172例,占90. 53%,其中127例为左心室舒张功能减低1级,占66. 84%(127/190),55例为左心室舒张功能2级,占28. 95%(55/190),8例为左心室舒张功能3级,占4. 21%(8/190)。观察组患者IVRT、Ea/Aa及A’值分别为(114. 97±10. 16)、(0. 79±0. 11)和(5. 21±1. 03),对照组分别为(72. 86±8. 75)、(1. 3±0. 25)和(5. 02±0. 82),差异有统计学意义(P 0. 05)。观察组患者左心室舒张功能减低IVRT、Ea/Aa及A’值和急性脑梗死发生之间有相关关系(r=0. 53,r=0. 61,r=-0. 59)。结论青年左心室舒张功能减低与高血压病有关,左室舒张功能减低可能是青年高血压病患者罹患急性脑梗死的独立预测因素。     

介入联合胫骨横向搬移治疗下肢缺血性疾病

[目的]比较介入治疗联合胫骨横向搬移与单纯介入手术治疗下肢缺血性疾病,包括血栓闭塞性脉管炎(TAO)、动脉硬化闭塞症(TSO)的临床效果。[方法]回顾性分析本院2015年4月～2017年4月收治的42例42肢下肢缺血性疾病患者,其中,介入-骨搬移组22例,应用介入治疗解决近端血管阻塞问题后采用胫骨横向搬移治疗;单纯介入组20例采用单纯介入治疗。采用视觉模拟疼痛评分(VAS)和生活质量综合评估(SF36)评价临床效果,测量第1足趾皮温、并行下肢血管CTA检查。[结果]两组患者均顺利手术,术中无严重并发症。两组术后随访时间12～23个月。虽然入院时、术后1个月两组间VAS评分、第1足趾皮温和SF36评分的差异无统计学意义(P0.05),但术后3、12个月时,介入-骨搬移组VAS评分显著低于单纯介入组,介入-骨搬移组第1足趾皮温显著高于单纯介入组,介入-骨搬移组SF36评分和生理机能(PF)、生理职能(RP)、躯体疼痛(BP)、健康状况(GH)亚评分显著优于单纯介入组,差异均有统计学意义(P0.05)。下肢动脉CTA显示介入-骨搬移组于术后3个月可见明显侧枝血管网形成,显著优于单纯介入组。[结论]介入治疗联合胫骨横向搬移可以重建下肢缺血性疾病患者远端肢体侧枝循环,远期疗效优于单纯介入治疗,可以更好地改善患者症状,提高生活质量。