冠心病患者冠状动脉旁路移植术近期预后的影响因素分析

目的 分析影响冠心病患者冠状动脉旁路移植术(CABG)近期预后的相关因素,旨在为改善CABG术的效果提供一些依据。方法 收集2019年6月—12月在广东省人民医院心血管外科接受初次CABG手术的65例患者的临床资料,分别比较纳入患者的术前、术中及术后临床指标及手术效果,筛选出可能影响CABG术近期预后的相关因素。结果 纳入接受体外循环CABG术患者55例,非体外循环CABG术(OPCABG)患者10例。年龄高导致CABG术后非正常(死亡和自动出院)出院率增加(P＝0.024);OPCABG(P＝0.009)、正高职称医师主刀(P＝0.027)可减少术后住院时间;同期处理心脏瓣膜可能增加术后并发症的发生(P＝0.012);吸烟者术后心功能恢复较慢(P＝0.017)。体外循环时间与重症监护病房时间呈正相关(r＝0.621,P＜0.001)。65例患者中院内死亡1例,死亡率1.54%。结论 年龄、OPCABG、同期处理瓣膜、吸烟、正高职称医师主刀、术前高密度脂蛋白水平和体外循环时间是可能影响冠心病患者CABG近期预后的因素。     

Impaired participation of potassium channels and Na+/K+‐ATPase in vasodilatation due to reduced nitric oxide bioavailability in rats exposed to mercury

Mercury intoxication is a public health risk factor due to its hazardous effect to several organs, including the cardiovascular system. There is evidence of endothelial dysfunction after exposure to mercury, but the effects on endothelium‐dependent vasodilatation are still unknown. In the present study, we aimed to evaluate the chronic effects of high HgCl₂ doses on the mechanisms of vasodilatation. Wistar rats were injected with HgCl₂ (1st dose 10.86 μg/kg, and daily doses 0.014 μg/kg for 30 days i.m.), and saline was used as control. Mercury exposure reduced the acetylcholine‐induced vasodilatation in aortic rings, which was restored by incubation with antioxidant tiron. Inhibition of the NO synthase, Na⁺/K⁺‐ATPase and K⁺ channels indicates reduced participation of these factors. In the mercury group, there were an increased local anion superoxide and a reduced NO. The vasodilatation to exogenous NO was partially inhibited by co‐incubation with TEA plus tiron, suggesting that reduced NO bioavailability is the responsible to that decreased the participation of K⁺ channels. Moreover, there was an increased participation of the Na⁺/K⁺‐ATPase associated with an up‐regulation of its alpha‐1 subunit. In conclusion, reduced NO bioavailability plays a major role in the impaired participation of K⁺ channels and Na⁺/K⁺‐ATPase in the acetylcholine‐mediated relaxation, although sodium pump is up‐regulated probably as a compensatory mechanism.     

The influence of time attitudes on adolescent alcohol use behaviours: a 33-month prospective study in the United Kingdom

Time Perspective researchers are concerned with the way in which a combination of thoughts and feelings about the past, present and future influence behaviour. Time attitudes comprise a dimension of time perspective where the focus is narrowed to evaluative feelings about the three time periods. The present study included four waves of data gathered in the United Kingdom, and focused on time attitudes. Participants were adolescents in High schools who completed both the Adolescent and Adult Time Inventory-Time Attitudes Scale, at waves one to three (corresponding to High school years 1 to 3), and surveys of heavy episodic drinking (HED) and drunkenness at wave four (year 4 of High school). Four time attitudes profiles were identified (Positives, Negatives, Negative Futures, and Ambivalents), and the majority of adolescents (75.2%) transitioned between profiles at least once during the three waves of data collection. Fully adjusted analyses tentatively supported the relationship between having a positive time attitudes profile and reduced levels of HED, frequency of lifetime drunkenness, and age of first of drunkenness, with small to moderate effect sizes. Results suggested that the development and maintenance of a positive time attitudes profile might be protective against problematic drinking behaviour in adolescence. Consistent with related studies, it is clear that some time attitudes profiles are associated with less risky and healthier alcohol use behaviours than others, which has implications for possible intervention for problematic drinkers.     

山药饮片中外源性有害物质残留情况分析

目的：了解山药饮片中外源性有害物质的残留状况。方法：依据《中华人民共和国药典》和探索性研究方法对不同来源的山药饮片中的二氧化硫残留量、脱硫剂、重金属及有害元素、农药残留进行分析和评价。结果：168批样品中检出11批二氧化硫残留量超标,检出1批使用了脱硫剂;37批样品中检出2批汞元素超标;38批样品中检出5批含有国家禁用和限用农药残留（涕灭威砜、3-羟基克百威、甲拌磷砜、氟虫腈、杀虫脒）,检出15批含有植物生长调节剂残留。结论：山药饮片中外源性有害物质以二氧化硫和农药残留为主,需要进一步加强生产监管,建议完善现行质量标准对农药残留进行限量控制。     

Redefining the prognostic likelihood of chronic lymphocytic leukaemia patients with borderline percentage of immunoglobulin variable heavy chain region mutations

In chronic lymphocytic leukaemia (CLL), caution is warranted regarding the clinical implications of immunoglobulin variable heavy chain region (IGHV) rearrangements with a ‘borderline’ (BL) percentage of mutations (i.e. 97–97·9% IGHV identity). We analysed the IGHV mutational status in 759 untreated CLL patients (cohort 1). BL-CLL (n = 36, 5%) showed a time to first treatment (TFT) similar to that of M-CLL (n = 338) and significantly longer than that of UM-CLL (n = 385), despite the enrichment in subset #2 cases. In fact, CLLs belonging to subset #2 (n = 15/759, 2%) were significantly more frequent among BL-CLLs (n = 5/36, 14%), with a brief TFT. TFT of BL-CLL remained comparable to that of M-CLL also considering the 327 CLL patients evaluated at diagnosis. These findings were then validated in an independent cohort 2 of 759 newly diagnosed CLL patients (BL-CLL: n = 11, 1·4%) and in all newly diagnosed patients from cohorts 1 and 2 (n = 1 086, 84% stage A; BL-CLL: n = 47, 4·3%). BL-CLL at diagnosis showed a biological profile comparable to that of M-CLL with a low frequency of unfavourable prognostic markers, except for a significant enrichment in subset #2. Our data suggest that the prognosis of BL-CLL is good and similar to that of M-CLL, with the exception of subset #2 cases.     

术后早期血糖异常对食管癌根治术患者短期预后的预测价值

目的 分析食管癌根治术后早期血糖异常对术后短期预后的评估价值。方法 回顾性研究复旦大学附属中山医院2015年4月至2017年9月的308例食管癌根治术患者的住院病例,收集人口学特征、术前已知的夹杂症、术前空腹血糖、术后早期血糖值及术后住院期间的短期临床不良事件等数据。308例中1例术后早期发生低血糖（3.8 mmol/L）,未单独成组。307例患者按术后早期血糖分为正常血糖组（n=215）和高血糖组（n=92）。另以术前的空腹血糖为基础血糖,分为术后血糖升高较多组（≥ 4 mmol/L,n=52）及血糖升高较少组（<4 mmol/L,n=255）。结果 采用分层χ²检验进行术后早期高血糖与各术后临床不良事件的风险评估,差异无统计学意义。多元Logistics回归处理混杂因素后发现,血糖波动大是术后不良事件总发生率的危险因素（P=0.003,OR=2.641,95% CI：1.402~4.976）,血糖波动大亦是病死率的危险因素（P=0.012,OR=7.539,95% CI：11.534~36.713）。结论 术后早期血糖较术前空腹血糖波动较大可以预测食管癌根治术后短期预后不良。     

石墨炉原子吸收分光光度法测定一次性使用无菌注射器中重金属镉含量的不确定度评定

本文通过对石墨炉原子吸收分光光度法测定一次性使用无菌注射器中重金属镉含量的不确定度进行分析,找出影响该方法的不确定度主要因素,并进行评定.给出合成标准不确定度和扩展不确定度.     

Detection of unique neutrophil non-muscle myosin heavy chain-A localization by immunofluorescence analysis in MYH9 disorder presented with macrothrombocytopenia without leukocyte inclusions and deafness

MYH9 disorders are autosomal-dominant macrothrombocytopenias with leukocyte inclusions caused by mutations in the MYH9 gene, which encodes the non-muscle myosin heavy chain-A (NMMHCA). We report a patient with an MYH9 disorder who presented with macrothrombocytopenia without leukocyte inclusions and severe bilateral sensory deafness. Conventional May-Grunwald-Giemsa staining failed to detect granulocyte cytoplasmic inclusions, whereas immunofluorescence analysis clearly demonstrated abnormal neutrophil NMMHCA localization. Genetic analyses revealed a novel heterozygous 18 base deletion in MYH9, leading to a six-amino acid in-frame deletion (N76_S81del) in NMMHCA. These results further support the usefulness of immunofluorescence analysis in differential diagnosis of MYH9 disorders.     

建立疟疾近期复发动物模型的研究 Ⅱ.食蟹猴疟原虫特殊的环状体原虫血症的持续现象

作者在食蟹猴疟原虫(引自越南)-斯氏按蚊系统的猴疟模型上,利用抗疟药的持效作用,观察到一种特殊的环状体原虫血症,此系红外期裂殖子从肝脏持续释放至血循环中的表现,已获结果显示,环状体原虫血症最长的达53d。经本文研究,此种环状体原虫血症持续现象得到进一步证实。环状体原虫密度随时间的变化,符合Verhulst模型,可用灰色微分方程作数学描述。结果提示,迟缓释放的红外期裂殖子可能为近期复发之源。     

肌球蛋白重链基因Arg663Cys和Arg663His突变基因型与家族性肥厚型心肌病表型关系研究

目的：研究中国人家族性肥厚型心肌病相关致病基因，揭示致病基因型与临床表型的关系。方法；在60例门诊肥厚型心肌病患者及60例正常对照中进行β－肌球蛋白重链（β－MHC）基因突变扫描，聚合酶链反应扩增其功能区外显子基因片断，测序检测突变，对阳性结果者进行家系调查，限制性片断长度多态性分析其他家系成员。结果：在一患者及其家系中发现位于β－MHC基因第18号外显子的663密码子位置发生C→T转换，使精氨酸变为半胱氨酸，该突变以前未见报道，在另两个患者及其家系中同样在663密码子位置发生C→A转换，使精氨酸变为组氨酸，3个家系基因型类似但临床表型不同。前者表现为进行性心力衰竭，心房颤动，外显率100％，而后者临床表现则相对轻微，呈不完全外显，另外57例患者和60例正常对照未发现异常。结论：β－MHC同一位置基因突变表现为不同的临床表型，提示即使是在同一种族（中国人群）中肥厚型心肌病亦存在异质性遗传特点。