Subclinical Pulmonary Congestion and Abnormal Hemodynamics in Heart Failure With Preserved Ejection Fraction

ObjectivesThe authors hypothesized that quantitative computed tomography (QCT) imaging would reveal subclinical increases in lung congestion in patients with heart failure and preserved ejection fraction (HFpEF) and that this would be related to pulmonary vascular hemodynamic abnormalities.BackgroundGross evidence of lung congestion on physical examination, laboratory tests, and radiography is typically absent among compensated ambulatory patients with HFpEF. However, pulmonary gas transfer abnormalities are commonly observed and associated with poor outcomes.MethodsPatients referred for invasive hemodynamic exercise testing who had undergone chest computed tomography imaging within 1 month were identified (N = 137). A novel artificial intelligence QCT algorithm was used to measure pulmonary fluid content.ResultsCompared with control subjects with noncardiac dyspnea, patients with HFpEF displayed increased mean lung density (–758 HU [–793, –709 HU] vs –787 HU [–828, –747 HU]; P = 0.002) and a higher ratio of extravascular lung water to total lung volume (EVLWV/TLV) (1.25 [0.80, 1.76] vs 0.66 [0.01, 1.03]; P < 0.0001) by QCT imaging, indicating greater lung congestion. EVLWV/TLV was directly correlated with pulmonary vascular pressures at rest, with stronger correlations observed during exercise. Patients with increasing tertiles of EVLWV/TLV demonstrated higher mean pulmonary artery pressures at rest (34 ± 11 mm Hg vs 39 ± 14 mm Hg vs 45 ± 17 mm Hg; P = 0.0003) and during exercise (55 ± 17 mm Hg vs 59 ± 17 mm Hg vs 69 ± 22 mm Hg; P = 0.0003).ConclusionsQCT imaging identifies subclinical lung congestion in HFpEF that is not clinically apparent but is related to abnormalities in pulmonary vascular hemodynamics. These data provide new insight into the long-term effects of altered hemodynamics on pulmonary structure and function in HFpEF.     

Higher mass meningococcal group C-tetanus toxoid vaccines conjugated with carbodiimide correlate with greater immunogenicity

To examine the link between meningococcal C (MenC) vaccine size and immunogenic response, a panel of MenC glycoconjugate vaccines were prepared differing in chain length, molar mass and hydrodynamic volume. The preparations consisted of different lengths of MenC polysaccharide (PS) covalently linked to monomeric purified tetanus toxoid (TT) carrier protein using the coupling reagent ethylcarbodiimide hydrochloride (EDC). Size exclusion chromatography with multi-angle light scattering (SEC-MALS) and viscometry analysis confirmed that the panel of MenC-TT conjugates spanned masses of 191,500 to 2,348,000 g/mol, and hydrodynamic radii ranging from 12.1 to 47.9 nm. The two largest conjugates were elliptical in shape, whereas the two smallest conjugates were more spherical. The larger conjugates appeared to fit a model described by multiple TTs with cross-linked PS, typical of lattice-like networks described previously for TT conjugates, while the smaller conjugates were found to fit a monomeric or dimeric TT configuration. The effect of vaccine conjugate size on immune responses was determined using a two-dose murine immunization. The two larger panel vaccine conjugates produced higher anti-MenC IgG1 and IgG2b titres after the second dose. Larger vaccine conjugate size also stimulated greater T-cell proliferative responses in an in vitro recall assay, although cytokines indicative of a T-helper response were not measurable. In conclusion, larger MenC-TT conjugates up to 2,348,000 g/mol produced by EDC chemistry correlate with greater humoral and cellular murine immune responses. These observations suggest that conjugate size can be an important modulator of immune response.     

Effect of group reminiscence therapy on depression and perceived meaning of life of veterans diagnosed with dementia at veteran homes

ABSTRACT

Most senior veterans who live in veteran homes in Taiwan have few interpersonal relationships. Aging is often accompanied by solitude and illness, which causes senior veterans to doubt the meaning of life and to lose confidence in the value of life. This study tested the effectiveness of a group reminiscence therapy protocol on the depression and meaning of life among elderly institutionalized veterans. A quasi-experimental design was applied. A convenience sample of older adults was drawn from two veteran homes in southern Taiwan. Participants were assigned to intervention or control groups based on the veterans' homes they attended. The participants in the intervention group carried out group reminiscence therapy for 8 weeks in addition to their daily activities. The participants in the comparison group maintained their daily activities. Both groups were evaluated using the GDS-SF and MLS scale including two aspects of depression mood and meaning of life in weeks 1 and 8. The overall life satisfaction increased significantly over time for the intervention group compared to the comparison group from week 1 to week 8. The group reminiscence therapy programs showed promising effects in improving the depression and meaning of life of older veterans living in veteran homes.     

优质护理干预对肺结核患者用药依从性的作用

目的对优质护理干预对肺结核患者用药依从性的作用进行观察。方法选择本院收治的120例肺结核患者作为本次研究的纳入对象,选取时间段为2017年1月-2018年1月,随机将这些患者划分为两组,甲组60例,乙组60例,采用常规护理方式护理甲组患者,在此基础上,应用优质护理干预的方式护理乙组患者,对两组患者的治疗依从性进行分析和比较。结果在经过精心的护理之后,甲组中23例完全依从,23例部分依从,14例不依从,总依从率达到了76.7%,乙组中37例完全依从,21例部分依从,2例不依从,总依从率达到了96.7%。乙组在总依从率方面相对于甲组而言更高(P <0.05)。结论采用优质护理干预的方式护理肺结核患者具有很好的效果,能够使患者的用药依从性得以显著提升,从而进一步保障患者的治疗效果。     

滋肾清肝方治疗阴虚火旺型女性更年期失眠症临床研究

目的:观察滋肾清肝方治疗阴虚火旺型女性更年期失眠症的临床疗效。方法:将阴虚火旺型女性更年期失眠患者130例随机分为观察组和对照组,每组65例;观察组给予滋肾清肝方加减治疗,对照组给予阿普唑仑治疗,4周为1个疗程,共治疗2个疗程;观察2组患者临床疗效、睡眠质量、雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)水平及不良反应发生情况。结果:治疗后,2组睡眠质量、入睡时间、睡眠效率、睡眠时间、睡眠障碍、催眠药物、日间功能障碍评分及总分均较治疗前降低(P<0.05);且观察组各项评分均低于对照组(P<0.05)。停药4周后,对照组睡眠质量、入睡时间、睡眠时间、催眠药物评分及总分较治疗后升高(P<0.05);而观察组各项评分及总分较治疗后无明显差异(P>0.05);观察组各项评分及总分均低于对照组(P<0.05)。总有效率观察组为92.31%,对照组为81.53%,2组比较,差异无统计学意义(P>0.05)。治疗后,观察组患者E2水平高于治疗前(P<0.05),FSH、LH水平低于治疗前(P<0.05);对照组E2、FSH、LH治疗前后无明显差异(P>0.05)。治疗后观察组E2、FSH、LH水平较对照组明显改善,差异有统计学意义(P<0.05)。治疗期间观察组未见明显不良反应,对照组不良反应发生率为9.23%,2组比较,差异有统计学意义(P<0.05)。结论:滋肾清肝方治疗阴虚火旺型女性更年期失眠患者,可明显提高睡眠质量,改善内分泌激素水平,且长期疗效较好,不良反应少,安全有效。     

射血分数保留性心力衰竭合并糖尿病的研究进展

心力衰竭是一种心脏结构或功能异常所致的临床综合征,据推测目前中国心血管病患者人数为2.9亿,其中心力衰竭占据450万。依据左心室射血分数,心力衰竭又分为射血分数降低性心力衰竭(HFrEF)和射血分数保留性心力衰竭(HFpEF)。近年来,HFpEF的发病率明显较HFrEF增加且已成为研究的热点。高血压、糖尿病和冠心病是常见能导致心力衰竭的基础疾病,其中糖尿病是最常见合并症之一。在美国,糖尿病在HFpEF中的患病率约为45%,但人们对这一人群的特征和结果了解甚少,在中国更是这样。现总结几项HFpEF治疗临床试验的数据,这些数据都表明糖尿病与HFpEF的发病率和长期死亡率增加有关,并讨论了HFpEF和糖尿病中的几种常见病理机制,包括钠潴留、代谢紊乱、骨骼肌功能受损和潜在的治疗靶点。随着对合并HFpEF和糖尿病的理解的增加,希望能为临床医生更好地提供有效的治疗方法。