冠状病毒感染对心血管系统的损伤及可能机制

冠状病毒(coronavirus,CoVs)感染主要累及肺部,但对心血管系统损伤作用也不容忽视。CoVs感染引起的心脏损伤并非罕见,其发生与病情的严重程度密切相关。本文首先从CoVs引起心血管损伤的证据入手,进一步探讨了CoVs对心肌的直接损伤,以及肾素血管紧张素(RAS)系统激活和细胞因子风暴与炎症反应对心血管损伤的可能作用机制。相关心血管损伤的可能机制包括,(1)病毒直接作用:CoVs在心肌细胞复制,损伤心肌;(2)RAS系统激活:感染CoVs后,心脏血管紧张素转化酶2(angiotensin-converting enzyme 2,ACE2)的表达下调,激活RAS系统,使得血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)收缩血管功能增强,Ang1-7保护心脏效应减弱;(3)诱发细胞因子风暴:循环细胞因子和全身炎症反应引起心脏损伤;(4)其他:包括低氧血症和儿茶酚胺心脏毒性。本文就相关内容作一综述,为后续的详尽机制和治疗策略研究提供思路。     

Application of metagenomic next-generation sequencing for suspected infected pancreatic necrosis

BackgroundMetagenomic next-generation sequencing (mNGS) is increasingly used for the clinical diagnosis of infectious diseases, but there is a paucity of data regarding the application of mNGS in the early diagnosis of infected pancreatic necrosis (IPN).ObjectiveTo investigate the clinical application value of mNGS in the pathogenic diagnosis of IPN.MethodsForty-two patients with suspected IPN were prospectively and consecutively enrolled from August 2019 to August 2021. Blood samples were collected for mNGS and microbial culture simultaneously during fever (T ≥ 38.5 °C). For patients who had indications of surgical interventions, peri-pancreatic specimens were collected for mNGS and microbial culture simultaneously during the first surgical intervention to confirm IPN. The clinical performance of mNGS and microbial culture were compared.ResultsA total of 21 patients (50.0%) were confirmed to have IPN during hospitalization. The sensitivity of blood mNGS was significantly higher than blood culture (95.2% vs. 23.8%, P < 0.001) in diagnosing IPN. The negative predictive value of blood mNGS was 90.0%. The turnaround time of mNGS was significantly shorter than that of microbial culture [(37.70 ± 1.44) vs. (115.23 ± 8.79) h, P < 0.01] and the average costs of mNGS accounted for 1.7% of the average total cost of hospitalization. The survival analysis demonstrates that the positive blood mNGS result was not associated with increased mortality (P = 0.119).ConclusionsWith more valuable diagnostic performance and shorter turnaround time, clinical mNGS represents a potential step forward in the early diagnosis of IPN.     

Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases

IntroductionRates of aneurysm occlusion with the pipeline embolization device (PED) has varied widely in the literature from 55.7% to 93.3% at 6 months, which may reflect a difference in technique including sizing and number of devices used.Methods140 cases at our institution were retrospectively reviewed, and aneurysms treated with a single PED vs. multiple were compared.ResultsComplete aneurysm occlusion was achieved in 86.9% at 6 months, 91.8% at 1 year, and 97.6% at longest follow-up. Retreatment with an additional device was required in 7 (5.1%). Major and minor complication rate within 30 days was 1.4% and 5.0%, and at greater than 30 days was 0.8% and 3.1%.Patients treated with multiple PEDs had significantly higher rates of aneurysm occlusion at 6 months (92.9% vs. 75.6%, p = 0.017) and 12 months (98.4% vs. 81.1%, p = 0.014), with no difference in complications. The two groups were similar aside from a higher number of ophthalmic and paraophthalmic aneurysms treated with multiple PEDs (23.4% vs. 6.5%, p = 0.004; and 35.1% vs. 17.4%, p = 0.020), and more posterior communicating artery and recurrent aneurysms treated with a single PED (28.3% vs. 3.2%, p = 0.001; 23.9% vs. 8.5%, p = 0.031). The use of multiple PEDs was found to be an independent predictor of aneurysm occlusion in a multivariate analysis (p = 0.015).ConclusionsThe use of multiple PEDs for intracranial aneurysms leads to significantly higher occlusion rates without added morbidity. This benefit is particularly appropriate for ophthalmic segment aneurysms, while more distal segments with eloquent perforating branches should be managed with caution.     

复合带瓣人工血管替换升主动脉和主动脉瓣(24例报告)

报告２４例升主动脉瘤伴主动脉瓣关闭不全行升主动脉和主动脉瓣替换及冠状动脉开口移植术（Ｂｅｎｔａｌ术２２例，底盘法２例）。１３例伴有升主动脉夹层分离，对其中８例ＤｅＢａｋｅｙＩ型者，以Ｔｅｆｌｏｎ毡条内外加固主动脉切端后吻合。１３例用人工血管周围间隙与右心耳吻合以控制升主动脉吻合之外的出血。３例以人工血管片环包主动脉吻合口控制局部广泛渗血及出血。２例术毕不能脱离体外循环死亡，手术死亡率８３％。随访平均２１８个月，２例死于蛛网膜下腔出血，１例右股动脉栓塞经手术治愈；其余病人康复良好，心功能（ＮＹＨＡ）Ｉ～ＩＩ级。     

The Effect of Second-Trimester Antibiotic Therapy on the Rate of Preterm Birth

ObjectiveAs many as 50% of spontaneous preterm births are infection-related, with Mycoplasma species being the most common microbial isolates from the amniotic cavity. The goal of our study was to evaluate the effect of macrolides, a specific group of antibiotics known to be effective against Mycoplasma species, on the rate of preterm births.MethodsWe performed a systematic review of the literature and a meta-analysis. We searched PubMed, Medline (1965–March 2006), Embase, and the Cochrane Library, using the key words “pregnancy,” “macrolides,” “erythromycin,” “azithromycin,” and “clarithromycin.” The research was limited to randomized controlled trials and to human females. Studies included for analysis were of women in the second trimester of pregnancy who received either macrolides or placebo (or no treatment) in order to prevent preterm delivery with at least 95% of patient follow-up. We excluded studies involving women with preterm premature rupture of membranes or regular uterine contractions. Meta-analysis of the retrieved data was performed using RevMan 4.2.8 (Cochrane Collaboration) with dichotomous analyses and delivery prior to 37 weeks’ gestation as the primary outcome. The analysis was subsequently repeated using the same methodology for clindamycin and metronidazole administered during the second trimester.ResultsOf the 61 articles yielded by our search, three original papers, investigating a total of 1807 women, examined macrolide utilization and met our criteria. Women included in our analysis were all considered to be at higher risk for preterm delivery (vaginal fetal fibronectin positivity, urogenital Mycoplasma infection, prior preterm delivery, and/or pregestational maternal weight < 50 kg). Compared with placebo, macrolides were associated with a lower rate of preterm births (odds ratio [OR] 0.72; 95% confidence intervals [CI] 0.56–0.93), as was clindamycin (OR 0.68; 95% CI 0.49–0.95). On the other hand, metronidazole (OR 1.10; 95% CI 0.95–1.29) was not linked with significant changes in the rate of preterm births. A higher rate of preterm delivery was found when mid-trimester metronidazole was the only antibiotic administered (OR 1.31; 95% CI 1.08–1.58).ConclusionMacrolides and clindamycin, given during the second trimester of pregnancy, are associated with a lower rate of preterm delivery, whereas second-trimester metronidazole used alone is linked with a greater risk of preterm delivery in a high-risk population. Use of metronidazole, a common treatment for bacterial vaginosis and Trichomonas vaginalis, should be avoided during the second trimester of pregnancy in this population.     

心肌炎的免疫学作用机制

病毒感染引起的心肌炎临床最为常见,其中半数以上由柯萨奇B组病毒所致。然而,迄今为止,其发病机制尚未完全明了,病毒感染对心肌细胞的直接损伤作用及病毒介导的免疫损伤作用是目前认为最有可能的机制,因此,了解心肌炎的免疫学机制具有重要的理论和实践意义。     

从二尖瓣瓣环三维形态的研究探讨合理的瓣环成形术

观察１５个固定心脏标本、１２个非固定心脏标本二尖瓣瓣环三维形态，运用动态三维超声心动图重建了１１名健康成年人的二尖瓣瓣环。发现二尖瓣瓣环为非平面的“马鞍”形，在心动周期中二尖瓣瓣环始终保持着程度不同的“马鞍”形。结果认为用硬质人工二尖瓣瓣环作瓣环成形术后的某些并发症，可能与改变了二尖瓣瓣环的天然三维形态有关。     

肥厚型心肌病预后评估的研究进展

肥厚型心肌病是最常见的遗传性心脏病,其临床表现及预后极富多样性。该病患者的不良转归主要有:猝死、心力衰竭以及心房颤动所致的栓塞事件等。现就影响肥厚型心肌病预后的因素作一综述。     

Assessment of global and regional left ventricular twist and displacement in anterior myocardial infarction using 2-dimensional strain imaging

The recent development of 2-dimensional strain (2D strain) imaging can provide a powerful alternative for assessing left ventricular (LV) torsion. This study was conducted to evaluate the global and regional left ventricular twist by 2D strain in patients with anterior wall myocardial infarction (AMI). A total of 55 AMI patients were divided into two groups according to their ejection fraction (EF) values (group A: LVEF ⩾ 50%; group B: LVEF < 50%), and 35 normal people served as the control group. Using 2-dimensional strain software, global and regional LV rotation and displacement were obtained at two planes. Compared with the control group, patients of group A showed reduced peak LV twist of the anterior and anterior-septal wall (9.26±1.89 vs 10.74±2.67; 9.71±1.71 vs 11.36±2.29, both P < 0.05), but the radial displacement and global twist were maintained (P > 0.05). Differently, regional and global LV twist and radial displacement in patients of group B deceased significantly, especially in the anterior and anterior-septal wall, as compared with patients in the control or group A (both P < 0.05). Moreover, a strong correlation was noted between peak twist and radial displacement; the twist-displacement loop was markedly distorted in patients of group B. This study demonstrated that 2D strain has a potential ability for quantification of left ventricular global and segment twist and radial displacement in patients with coronary artery disease.