Antiplatelet Therapy and Coronary Artery Bypass Grafting: Analysis of Current Evidence With a Focus on Acute Coronary Syndrome

This review was undertaken to summarize and discuss the current evidence around antiplatelet therapy and coronary artery bypass grafting (CABG). Aspirin (ASA) monotherapy remains the standard of care among patients before and after CABG. The role of more intense antiplatelet therapy—specifically, P2Y12 inhibitors—in improving clinical outcomes and graft patency is becoming increasingly apparent. As such, we provide an overview of a variety of antiplatelet regimens. The review discusses the evidence around preoperative management of antiplatelet therapies, with a particular focus on timing of cessation. It also evaluates the current literature to elucidate the best antiplatelet therapy regimen after CABG, focusing on acute coronary syndrome (ACS). Whenever possible, data are presented from randomized controlled trials (RCTs) and meta-analyses. Although guidelines recommend use of dual antiplatelet therapy (DAPT) after CABG for patients with ACS, available evidence is limited to small RCTs, and meta-analyses are of substudies of larger RCTs. There is also considerable heterogeneity in patient population of these studies; a significant number of patients underwent off-pump CABG (OPCAB) in trials that demonstrate graft-patency benefit with DAPT. With this limited evidence, DAPT remains underused in the CABG population, even among patients presenting after ACS.     

临床抗青光眼药物的新进展

青光眼是致盲的主要原因之一，构成视神经的神经节细胞轴突受到多种因素的损伤，其机制尚未完全明了。青光眼最重要的危险因素是眼压升高。由于青光眼的视神经损伤尚不能直接治疗，根据目前提供的唯一已知可治疗的危险因素，可以降低升高的眼压，而眼压与房水流出通道的功能息息相关。这些方面的药物均可以影响青光眼的进展。随着医疗技术的发展以及对青光眼发病机制认识的加深，新型抗青光眼药物也应运而生，为眼科医师提供新的选择。本文将对国内外新型抗青光眼药物从机制、药理特点及临床疗效等方面进行综述。     

外周血miR-150-5p、SOCS1 mRNA对类风湿关节炎“病”“证”诊断意义的初步探讨＊

目的 探讨类风湿关节炎患者外周血miR-150-5p、细胞因子信号抑制因子1（suppressor of cytokine signaling 1，SOCS1）mRNA的表达及对类风湿关节炎（Rheumatoid Arthritis，RA）疾病诊断、中医证型判断的意义。方法 纳入符合诊断标准的RA患者57例及健康对照组19例，根据《22个专业95个病种中医诊疗方案》有关RA的中医证候诊断标准，判断RA的中医证型。qPCR检测RA患者及健康对照组miR-150-5p、SOCS1mRNA的相对表达水平，同时检测血常规、肝功能、肾功能等常规指标。双荧光素酶分析方法判断两者是否存在靶向关系。统计分析miR-150-5p、SOCS1 mRNA对RA疾病的诊断意义及其与中医证型的相关性。结果 RA患者外周血miR-150-5p的相对表达水平下调，低于正常人群（t = -19.019，P < 0.05）；其表达水平随疾病活动度升高，有下降趋势；患者外周血SOCS1 mRNA的相对表达水平上调，低于正常人群（t = 5.333，P < 0.05）；其表达水平随疾病活动度升高，有上升趋势。MiR-150-5p与SOCS1 mRNA有靶向结合关系（P < 0.05）。通过AUC曲线比较，miR-150-5p的相对表达水平区分RA的敏感性及特异性分别为98.1%、92.1%（AUC = 0.972，P < 0.05）；SOCS1 mRNA的相对表达水平无法区分RA（AUC = 0.472，P > 0.05）。RA患者中miR-150-5p的相对表达水平低于3.06，RA患者风湿痹阻证、寒湿痹阻证的相对风险分别为8.33、250.00（P < 0.05）。结论 miR-150-5p、SOCS1 mRNA在RA患者中有差异性表达，且有靶向结合关系。miR-150-5p可能是RA的疾病诊断及中医风湿痹阻证、寒湿痹阻证证型诊断的潜在生物标志物。     

Helicobacter pylori induces epithelial-mesenchymal transition in gastric carcinogenesis via the AKT/GSK3β signaling pathway

Helicobacter pylori (H. pylori) is a main risk factor for gastric cancer (GC). Epithelial-mesenchymal transition (EMT) is involved in the development and progression of H. pylori-associated GC. However, the exact molecular mechanism of this process remains unclear. The AKT/GSK3β signaling pathway has been demonstrated to promote EMT in several types of cancer. The present study investigated whether H. pylori infection induced EMT, and promoted the development and metastasis of cancer in the normal gastric mucosa, and whether this process was dependent on AKT activation. The expression levels of the EMT-associated proteins, including E-cadherin and N-cadherin, were determined in 165 gastric mucosal samples of different disease stages by immunohistochemical analysis. The expression levels of E-cadherin, N-cadherin, AKT, phosphorylated (p-)AKT (Ser473), GSK3β and p-GSK3β (Ser9) were further determined in H. pylori-infected Mongolian gerbil gastric tissues and cells co-cultured with H. pylori by immunohistochemical analysis and western blotting. The results indicated that the expression levels of the epithelial marker E-cadherin were decreased, whereas the expression levels of the mesenchymal marker N-cadherin were increased during gastric carcinogenesis. Their expression levels were associated with H. pylori infection. Furthermore, H. pylori infection resulted in downregulation of E-cadherin expression and upregulation of N-cadherin expression in Mongolian gerbils and GES-1 cells. In addition, an investigation of the associated mechanism of action revealed that p-AKT (Ser473) and p-GSK3β (Ser9) were activated in GES-1 cells following co-culture with H. pylori. Furthermore, following pretreatment of the cells with the AKT inhibitor VIII, the expression levels of E-cadherin, N-cadherin, p-AKT and p-GSK3β did not show significant differences between GES-1 cells that were co-cultured with or without H. pylori. The levels of p-AKT and p-GSK3β were increased in H. pylori-infected Mongolian gerbils. In conclusion, the present study demonstrated that H. pylori infection activated AKT and resulted in the phosphorylation and inactivation of GSK3β, which in turn promoted early stage EMT. These effects were AKT-dependent. This mechanism may serve as a prerequisite for GC development.     

miR-21对视网膜母细胞瘤细胞增殖的影响及作用机制

目的　探讨MicroRNA-21（miR-21）对视网膜母细胞瘤(RB)细胞增殖的影响及作用机制。方法　采用Real-time PCR技术检测miR-21在正常视网膜组织和确诊RB组织中的表达情况；然后在转染的基础上运用MTT检查RB细胞存活率、流式细胞仪检测细胞凋亡率。Western blot法检测与细胞凋亡相关蛋白PDCD4、Bax、Bcl-2的表达。结果　与正常视网膜组织miR-21表达 （0.703±0.071）相比，RB组织miR-21为高表达（2.214±0.162），差异有统计学意义（P<0.01）。在Weri-Rb-1细胞中，与NC组(2.245±0.213)相比，miR-21抑制剂转染后明显降低了miR-21的表达水平，miR-21 inhibitor组为0.683±0.075,差异有统计学意义 （P<0.01）。两组细胞转染后24 h、48 h、72 h、96 h，MTT测定法检测细胞活力结果显示:两组24 h的A值比较，差异无统计学意义 （P>0.05），miR-21 inhibitor 组在 48 h、72 h、 96 h的A值均低于 NC 组，差异均有统计学意义 （均为P<0.01）。流式细胞术检测结果显示:NC组凋亡细胞在总细胞中百分比为（3.045±0.301）%和（4.832±0.493）%，miR-21 inhibitor组凋亡细胞在总细胞中百分比为（2.593±0.257）%和（40.167±4.014）%，miR-21 inhibitor组Weri-Rb-1细胞的凋亡率明显高于miR-21 NC组(P<0.01)。Western blot检测结果显示:NC组PDCD4表达（0.192±0.045）相比miR-21 inhibitor组（0.683±0.091）表达明显减少，NC组Bax的蛋白表达水平（0.143±0.036）相比miR-21 inhibitor组（1.192±0.054）也明显减少，差异均有统计学意义（P<0.01)，NC组Bcl-2蛋白表达（0.864±0.038）相比miR-21 inhibitor组（0.257±0.026）明显增多，差异有统计学意义（P<0.05)。结论　miR-21是RB的促癌基因，miR-21抑制剂可以通过降低miR-21表达抑制肿瘤细胞的增殖、促进细胞凋亡，这一过程与PDCD4、Bax、Bcl-2等凋亡相关蛋白有关。     

基于虚实辨证的补泻平衡手法治疗膝骨关节炎临床研究

目的观察补泻平衡手法治疗膝骨关节炎的疗效及对患者临床症状、体征的影响。方法采用随机数字表法将220例单膝骨关节炎患者分为治疗组和对照组各110例。治疗组予补泻平衡手法,对照组予常规推拿手法,均每次20 min,每日2次,1周为1个疗程,连续治疗2个疗程。观察2组治疗前后及治疗后3、6个月全身临床症状、体征及中医证候评分,比较2组临床疗效及不良反应。结果与本组治疗前比较,2组治疗后全身临床症状、体征评分明显降低(P<0.05),治疗组中医证候评分明显降低(P<0.05);2组治疗后比较,治疗组全身临床症状、体征改善程度优于对照组(P<0.05);与本组治疗后比较,2组治疗后3、6个月全身临床症状、体征评分升高。治疗组治疗后3、6个月中医证候评分升高,仍低于治疗前(P<0.05)。治疗组总有效率为91.8%(101/110),对照组为78.2%(86/110),2组比较差异有统计学意义(P<0.05)。2组均未见不良反应。结论补泻平衡手法与常规推拿手法治疗膝骨关节炎均有效,前者疗效优于后者,且中远期疗效更佳。     

肛直肠抑制反射时门静脉血中P物质变化

目的探讨肛直肠抑制反射（RAIR）时门静脉血中P物质（SP）的变化规律及外源性内脏神经对其变化的影响。方法将实验大白鼠分为7组，其中6组先按去与不去直肠肛管外源性内脏神经支配而分为不去神经和去神经两大组，每组中又按Foley导管上气囊置入直肠腔中的位置分为2、4、6cm组；同时再设1个对照组，将Foley导管置入直肠腔中，但不注水扩张球囊。检测并比较在直肠腔内刺激后，各组门静脉血中的SP值及变化情况。结果去神经组中2、4cm组与不去神经组之间及对照组之间，门静脉血中SP值变化比较，P〉0．05，差异无统计学意义。不去神经组中的6cm组与对照组及去神经组中2cm和4cm组之间SP值比较，P〈0．01，差异有统计学意义；去神经组和不去神经组中的6cm组之间SP值比较，P〈0．01，差异有统计学意义。结论直肠腔内上部的刺激不引出RAIR可能与该部位的刺激使内括约肌兴奋性递质（SP）的释放有关；外源性内脏神经对RAIR中门静脉血的SP变化有调控作用。     

腹腔镜下盆腔腹膜移植阴道成型术的探讨

目的 探讨腹腔镜下盆腔腹膜移植阴道成型术在妇科临床中的应用。方法使用特制的腹膜推进器行腹腔镜下盆腔腹膜移植阴道成型术。结果 术后成型的阴道上皮化良好，阴道无塌陷，性生活满意。结论 该术式损伤小、效果好、术后恢复快，是目前较理想的阴道成型方法。     

饮食控制及运动疗法对糖耐量降低人群干预效果分析

目的观察饮食控制及运动疗法对糖耐量降低人群血糖控制的影响。方法对门诊病例中符合1997年美国糖尿病协会诊断标准的60例糖耐量降低患者随机分为3组，分别采取饮食控制（饮食组）、运动疗法（运动组）及饮食控制＋运动疗法（饮食＋运动组）进行干预，8周后检测，对干预前后自身及各组间对照分析效果。结果3组干预后空腹血糖（FPG）和餐后2小时血糖（2hPG）均较干预前显著下降（P值分别〈0．05和0．01）。饮食＋运动组的总有效率显著优于饮食组和运动组（P值分别〈0．05和0．01），后两组间的差异无统计学意义（P〉0．05）。结论饮食控制与运动疗法有助于控制糖耐量降低人群的空腹及餐后血糖，有可能延缓其向糖尿病发展。     

慢传输型便秘的病因研究进展

慢传输型便秘是一种临床很常见的疾病,其症状十分顽固,但目前它的病因尚不清,所以给临床治疗带来很大困难。现就慢传输型便秘的多种发病原因,尤其是结肠蠕动方面的研究进展加以探讨,希望能给临床工作者带来一些帮助。