肾素-血管紧张素系统在儿童膀胱尿道功能障碍中的作用研究进展

膀胱尿道功能障碍临床表现各异,部分患者治疗效果不佳(尤其是神经源性膀胱患者),后期可引起各种严重的并发症,甚至可引起致死性肾功能衰竭。肾素-血管紧张素系统(renin-angiotensin system,RAS)尤其是局部RAS在炎症及器官重塑等方面的作用已被证实,相关研究表明,RAS抑制剂(包括ACEI和ARBs)和新近发现的拮抗轴ACE2-Ang(1-7)-Mas轴具有改善下尿路功能和组织保护等功能。本文主要就ACE-AngⅡ-AT1轴和ACE2-Ang(1-7)-Mas轴在膀胱尿道功能障碍及其相关并发症的作用进行综述,探讨泌尿系统局部RAS作为儿童膀胱尿道功能障碍及其相关并发症药物治疗新靶点的可行性。     

Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review

Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.     

六味能消胶囊联合脂必泰胶囊治疗高脂血症的临床研究

目的探讨六味能消胶囊联合脂必泰胶囊治疗高脂血症的临床效果。方法选取2017年5月—2018年10月东营市东营区人民医院收治的64例高脂血症患者,随机分为对照组和治疗组,每组各32例。对照组口服脂必泰胶囊,1粒/次,2次/d。治疗组在对照组治疗基础上口服六味能消胶囊,1粒/次,3次/d。两组均连续治疗8周。观察两组的临床疗效,比较两组治疗前后血脂指标、血流变学指标、血小板参数及血清学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别是75.0%、96.9%,两组比较差异具有统计学意义(P0.05)。治疗后,两组总胆固醇(TC)、非-HDL-C、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前显著降低,而高密度脂蛋白胆固醇(HDL-C)显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组TC、非-HDL-C、TG、LDL-C水平低于对照组,而HDL-C高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血浆黏度(PV)、红细胞比容(HCT)、聚集指数(RCAI)、平均血小板体积(MPV)、血小板最大聚集率(MAR)均显著降低,而变形指数(RDI)值均显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,PV、HCT、RCAI、MPV、MAR值均显著低于对照组,而RDI值高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清C反应蛋白(CRP)、内皮素(ET)水平较治疗前均显著降低,而一氧化氮(NO)水平显著增高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组CRP、ET水平低于对照组,而NO水平高于对照组,两组比较差异有统计学意义(P0.05)。结论六味能消胶囊联合脂必泰胶囊治疗高脂血症具有较好的临床疗效,综合调脂作用显著,可明显纠正患者体内血流变学异常,改善血小板功能及微炎症状态,保护血管内皮功能,具有一定的临床推广应用价值。     

Myeloproliferative neoplasms

The myeloproliferative neoplasms (MPN) are a group of clonal myeloid proliferations characterised by varying combinations of increased circulating red cells, granulocytes and platelets caused by excess proliferation of haemopoietic precursors in bone marrow with retained cellular maturation. These disorders typically pursue an indolent course requiring management of the consequences of the increased circulating elements (predominantly effects of thrombosis of haemorrhage in different body organs). Patients have complex symptoms, including fatigue, which are not yet fully explained. The MPN carry varying risks of progression to an acute phase characterised by increasing bone marrow and circulating blasts cells, and/or to fibrosis characterised by falling peripheral cell counts and increasing splenomegaly. Megakaryocyte morphology in BMT samples provides essential clues for diagnosis and subtyping in MPN; high quality and consistent reticulin staining for accurate assessment is also key.     

急性心肌梗死后并发心房颤动患者RDW、ET及NT-proBNP水平变化及其与预后的关系

目的探讨急性心肌梗死后并发心房颤动患者红细胞分布宽度(RDW)、内皮素(ET)及N末端B型脑钠肽前体(NT-proBNP)水平变化及其与预后的关系。方法回顾性分析2016年3月至2018年3月本院收治的106例急性心肌梗死患者[依据患者是否并发心房颤动分为并发组(n=40)及未并发组(n=66)]的临床资料,比较两组临床资料、RDW、ET、NT-proBNP水平及预后情况,分析急性心肌梗死后并发心房颤动及其预后与RDW、ET及NT-proBNP水平的关系。结果并发组TC、左心房内径较未并发组明显扩大,左心室射血分数较未并发组明显降低,并发组RDW、ET及NT-proBNP、不良心血管事件发生率较未并发组明显升高,差异有统计学意义(P <0. 05);未发生心血管事件组LDLC、RDW、ET及NTproBNP较发生心血管事件组明显降低,差异有统计学意义(P <0. 05); RDW、ET及NT-proBNP是急性心肌梗死患者不良心血管事件发生的影响因子(OR=2.591、2.220、1.657,95%CI=1.311～5.153、1.132～4.350、1.058～2.027,P<0.05);急性心肌梗死患者左心房内径与RDW、ET及NT-proBNP呈明显正相关(P<0.05),左心室射血分数与RDW、ET及NTproBNP呈明显负相关(P<0.05)。结论急性心肌梗死后并发心房颤动及其不良预后发生与RDW、ET及NT-proBNP水平升高密切相关,三者在评估急性心肌梗死患者心房颤动及预后中有一定临床意义。     

祛浊胶囊联合阿托伐他汀钙治疗高脂血症的临床研究

目的探讨祛浊胶囊联合阿托伐他汀钙治疗高脂血症的临床疗效。方法选取2015年7月—2017年7月在石家庄市第三医院治疗的高脂血症患者108例,随机分为对照组(54例)和治疗组(54例)。对照组口服阿托伐他汀钙片,20 mg/次,1次/d。治疗组在对照组基础上口服祛浊胶囊,3 g/次,3次/d。两组患者均治疗4周。观察两组患者临床疗效,比较治疗前后两组患者血脂水平、血清一氧化氮(NO)和内皮素(ET)水平。结果治疗后,对照组和治疗组临床有效率分别为81.48%和96.30%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者三酰甘油(TG)、胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)显著降低,高密度脂蛋白胆固醇(HDL-C)显著升高,同组比较差异具有统计学意义(P0.05);且治疗组患者的血脂水平明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血清NO水平显著升高,ET水平显著降低,同组比较差异具有统计学意义(P0.05);且治疗组患者NO和ET水平明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论祛浊胶囊联合阿托伐他汀钙治疗高脂血症效果显著,可有效降低机体血脂水平,改善机体血管内皮功能。     

Efficient differentiation of vascular endothelial cells from dermal-derived mesenchymal stem cells induced by endothelial cell lines conditioned medium

Objective

To directionally-differentiate dermis-derived mesenchymal stem cells (DMSCs) into vascular endothelial cells (VECs) in vitro, providing an experimental basis for studies on the pathogenesis and treatment of vascular diseases.