Optimized strategy of rotational atherectomy of underexpanded coronary stents in patients with acute coronary syndrome

BACKGROUND: Stent under-expansion is a main cause of acute coronary syndrome (ACS), which can lead to serious clinical outcomes. The rotational atherectomy of underexpanded coronary stents (academically called stent ablation, SA) by intravascular ultrasound (IVUS) may provide more visual reference in the intervention. We aim to analyze the procedural and long-term outcomes of the optimized strategy of SA in patients with ACS and to provide real-world data on this technique.     

Combining qSOFA criteria with initial lactate levels: Improved screening of septic patients for critical illness

ObjectiveTo determine if the addition of lactate to Quick Sequential Organ Failure Assessment (qSOFA) scoring improves emergency department (ED) screening of septic patients for critical illness.MethodsThis was a multicenter retrospective cohort study of consecutive adult patients admitted to the hospital from the ED with infectious disease-related illnesses. We recorded qSOFA criteria and initial lactate levels in the first 6 h of ED stay. Our primary outcome was a composite of hospital death, vasopressor use, and intensive care unit stay ≤72 h of presentation. Diagnostic test characteristics were determined for: 1) lactate levels ≥2 and ≥4; 2) qSOFA scores ≥1, ≥2, and =3; and 3) combinations of these.ResultsOf 3743 patients, 2584 had a lactate drawn ≤6 h of ED stay and 18% met the primary outcome. The qSOFA scores were ≥1, ≥2, and =3 in 59.2%, 22.0%, and 5.3% of patients, respectively, and 34.4% had a lactate level ≥2 and 7.9% had a lactate level ≥4. The combination of qSOFA ≥1 OR Lactate ≥2 had the highest sensitivity, 94.0% (95% CI: 91.3–95.9).ConclusionsThe combination of qSOFA ≥1 OR Lactate ≥2 provides substantially improved sensitivity for the screening of critical illness compared to isolated lactate and qSOFA thresholds.     

Mirizzi综合征31例临床分析

目的:探讨Mirizzi综合征的诊断及减少术中医源性胆管损伤的处理措施。方法:回顾分析我院31例Mirizzi综合征患者诊断、分型、手术方法等临床资料,并与同期3185例非Mirizzi综合征患者行胆囊切除术时医源性胆管损伤发生率进行比较。结果:31例Mirizzi综合征术前确诊9例,术中损伤胆管8例;3185例非Mirizzi综合征胆囊切除术中损伤胆管4例。结论:Mirizzi综合征已成为胆道外科手术中致胆管损伤的主要因素;ERCP、MRCP是诊断该病的主要检查方法;对术前确诊及高度怀疑此病的患者,主张开腹行胆囊切除、胆管修补或胆肠Roux-en-Y吻合术,这样会带来更多的安全性及获得正确的处理办法。     

腹股沟巨大复发疝无张力修补术式选择及决策

目的 :探讨腹股沟巨大及复发疝无张力修补术的术式选择及决策。方法 :选择 4 9例年龄 6 0岁以上年龄组 ,用疝环充填式无张力修补 38例 4 6例次 ,其中双侧疝 8例 ,复发疝 14例 ,11例巨大疝 ,疝内环口均大于5cm ,腹横筋膜缺损萎缩 ,内口边界不清 ,无明显内口界限 ,行单丝聚丙烯网片无张力修补 (Lichtenstein)。结果 :全组均痊愈 ,平均住院 14d ,最早 4d出院 ,2例发生术后尿潴留 ,6例病人行前列腺摘除 ,同时行疝修补 ,故出院延迟 ,随访 6～ 18月无复发。结论 :无张力疝修补作为腹股沟疝修补的金标准[1] ,具有操作简便省时 ,创伤小 ,复发率低 ,修补符合腹股沟管的正常生理要求及形态特点 ,尤其适应于后壁薄弱 ,缺损大 ,张力疝修补多次复发 ,并发症多的患者。故术式选择及术中决策在此类患者中显得十分重要 ,它直接影响患者术后的康复。     

Angiotensin IV possibly acts through PKMzeta in the hippocampus to regulate cognitive memory in rats

Ang IV is an endogenous peptide generated from the degradation of angiotensin II. Ang IV was found to enhance learning and memory in CNS. PKMzeta was identified to be a fragment of PKCzeta (protein kinase Czeta). Its continuous activation was demonstrated to be correlated with the formation of memory in the hippocampus. Therefore, we investigated whether PKMzeta participates in the effects of Ang IV on memory. We first examined the effect of Ang IV on non-spatial memory/cognition in modified object recognition test in rats. Our data showed that Ang IV could increase the exploration time on novel object. The co-administration of ZIP (PKMzeta inhibitor) with Ang IV significantly blocked the effect by Ang IV. The effects of Ang IV on hippocampal LTP at the CA1 region were also evaluated. Ang IV significantly increased the amplitude and slope of the EPSPs, which was consistent with other reports. Surprisingly, instead of potentiating LTP, Ang IV caused a failed maintenance of LTP. Moreover, there was no quantitative change in PKMzeta induced by Ang IV and/or ZIP after behavioral experiments. Taken together, our data re-confirmed the finding of the positive effect of Ang IV to enhance memory/cognition. The increased strength of EPSPs with Ang IV could also have certain functional relevance. Since the behavioral results suggested the involvement of PKMzeta, we hypothesized that the enhancement of memory/cognition by Ang IV may rely on an increase in PKMzeta activity. Overall, the present study provided important advances in our understanding of the action of Ang IV in the hippocampus.     

卡维地洛对兔心肌梗死后转化生长因子β1表达和心室重构的影响

目的探讨卡维地洛对兔心肌梗死后转化生长因子β1（TGF-β1）的表达和心室重构的影响。方法采用结扎冠状动脉左室支建立心肌梗死（MI）模型（假手术组开胸后在相应部位挂线不结扎）。术后24h将存活兔分为3组：假手术组、MI组、MI＋卡维地洛组。各组饲养4周后行血流动力学检查;测量体质量,左、右心室重量;采用苦味酸-酸性品红（VG）染色检测非梗死区的胶原容积分数（CVF）;采用免疫组化检测TGF-β1的表达情况。结果MI组与假手术组比较,左心室重量/体质量值（RVW/BW）、右心室重量/体质量（LVW/BW）、左室舒张末压（LV-EDP）、非梗死区CVF均显著升高（P〈0.05或P〈0.01）,TGF-β1的表达显著增强（P〈0.01）;MI＋卡维地洛组与MI组比较,RVW/BW、LVEDP、CVF均显著降低（P〈0.05或P〈0.01）,TGF-β1表达明显减弱（P〈0.05）。结论TGF-β1可能与心肌梗死后心室重构有关;卡维地洛能缓解心肌梗死后非梗死区的重构,其机制可能与减低TGF-β1的表达有关。     

三孔法腹腔镜胆囊切除术的临床应用

目的 探讨三孔法腹腔镜胆囊切除术的临床应用价值。方法 回顾性分析了我院345例结石性胆囊炎和胆囊息肉病人应用三孔法完成腹腔镜胆囊切除术的临床资料。结果 345例病人中，339例用三孔法顺利完成了手术，3例改为四孔法，3例中转开腹。全部病例末发生严重外发症。结论 应用三孔法行腹腔镜胆囊切除是安全可行的。     

游离阔筋膜张肌穿支皮瓣修复手足部软组织缺损

目的总结游离阔筋膜张肌穿支皮瓣修复手足部软组织缺损的临床应用效果。方法2004年1月至2008年12月,应用游离阔筋膜张肌穿支皮瓣修复6例手和足部软组织缺损。结果除1例术后发生表浅感染经换药愈合外,6例皮瓣全部成活,术后顺利。术后随访22～52个月(平均30个月),无明显的供区功能障碍,疗效满意。结论游离阔筋膜张肌穿支皮瓣具有血供丰富,血管解剖恒定,以及皮瓣较薄的优点,适宜修复手和足背部软组织缺损。     

三孔法腹腔镜胆囊切除术的应用

目的:探讨三孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床应用价值。方法:回顾分析我院为345例结石性胆囊炎和(或)胆囊息肉患者行三孔法LC的临床资料。结果:345例患者中,339例用三孔法顺利完成手术,3例改行四孔法LC,3例中转开腹。均无严重并发症发生。结论:三孔法LC安全可行。