安定－脑电地形图敏感试验在判别癫痫预后中的价值

对６０例癫痫发作停止３年以上的病人进行前瞻性安定－脑电地形图敏感试验。结果发现在停药或减量后的随访中复发的２０例病人注射安定后，脑电地形图上β功率增加的量平均为１０．１０％，未复发的４０例病人β功率增加的量则为１７．１２％，两者之间有显著差异（Ｐ＜０．０５）．未复发组与４０例正常对照组间脑电地形图β功率的改变则没有显著差异（Ｐ＞０．０５）．为此，我们认为安定－脑电地形图敏感试验在判别癫痫病人的预后中是有价值的．     

Baroreflex Sensitivity as a Cardiac and Arrhythmia Mortality Risk Stratifier

The last two decades have provided clear evidence for the tight and casual relation existing between arrhythmic mortality and the autonomic nervous system, particularly with imbalances characterized by decreases in vagal and/or increases in sympathetic activity. A series of compelling experimental results has represented the driving force for the clinical evaluation of the potential prognostic value of baroreflex sensitivity (BBS), a measure that can provide information on the capability to augment vagal activity. This article reviews the methodology more commonly used to quantify the clinical evaluation of this parameter, and then focuses on the key clinical studies highlighting those performed in postmyocardial infarction patients. Among them the most informative is ATRAMI, a multicenter prospective study involving almost 1300 patients. The main conclusion is that both heart rate variability and BRS are strong and independent risk factors for post-infarction mortality, thus demonstrating the clinical usefulness of autonomic markers.     

Baroreflex Sensitivity and Heart Rate Variability in Coronary Disease Compared to Dilated Cardiomyopathy

This study was designed to compare baroreceptor sensitivity and heart rate variability as measures of cardiac autonomic tone in patients with coronary disease (CAD, n = 49) and idiopathic dilated Cardiomyopathy (IDC, n = 130). Time domain heart rate variability, including SDNN, SDANN, and pNN50, was determined during 24-hour Holter ECG. Baroreflex sensitivity was analyzed nonivasively using the phenylephrine method. Baroreflex sensitivity and heart rate variability were comparable between patients with CAD versus IDC (baroreflex sensitivity: 6.1 ± 3 vs 6.9 ± 5 ms/mmHg; SDNN: 97 ± 40 vs 114 ± 41 ms; SDANN: 83 ± 33 vs 99 ± 41 ms; pNNSO: 3.9 ± 4 vs 9.6 ± 13 ms, P = NS for all comparisons). Likewise, a subgroup analysis of patients with a left ventricular ejection fraction (LVEF) ≤ 30% showed no significant difference in baroreceptor sensitivity and heart rate variability between IDC and CAD patients. Patients with CAD and an LVEF > 30% had a decreased heart rate variability but not a decreased baroreflex sensitivity compared to patients with IDC and LVEF > 30 % (baroreflex sensitivity: 6.4 ± 4 vs 8.3 ± 6 ms/mmHg, P = NS; SDNN: 98 ± 19 vs 128 ± 42 ms, P < 0.05; SDANN: 86 ± 21 vs 112 ± 43 ms, P < 0.05; pNN50: 4.2 ± 3 vs 12.3 ± 8 ms, P < 0.05). Patients with a markedly depressed LVEF show comparable alterations in cardiac autonomic tone whether they have CAD or IDC. Patients with CAD and preserved LV function, however, have a decreased heart rate variability compared to patients with IDC and preserved LV function. The prognostic significance of these findings will be determined prospectively in a large patient cohort at our institution.     

阿托伐他汀早期强化抗炎作用对急性心肌梗死患者压力和化学反射敏感性的影响

目的：研究在急性心肌梗死（AMI）早期，阿托伐他汀强化治疗的抗炎作用对患者压力反射敏感性（BRS）和化学反射敏感性（ChRS）的影响。方法：将71例AMI患者分配至常规组（阿托伐他汀20mg／d，n=36）和强化组（阿托伐他汀40mg／d．n=35）。分别在入院时、用药后7d及14d检测血清超敏c反应蛋白（hsCRP）水平、白细胞介素6（IL-6）、血脂水平、BRS值、ChRS值及所有不良反应。结果：7d及14d时，两组hsCRP、IL-6水平较入院时均有明显降低；7d及14d时，强化组较常规组的hsCRP、IL-6水平均有显著降低。两组治疗后的血脂水平有显著改善，两组间差异无显著性。7d及14d时强化组BRS值、ChRS值较入院时均有明显改善；常规组仅于治疗后14d时BRS值、ChRS值有显著改善；与常规组相比，强化组治疗后BRS值、ChRS值的差异有显著性。结论：阿托伐他汀早期强化干预显著降低炎症因子水平，能更早地明显改善AMI的BRS、ChRS值。[著者文摘]     

Arrhythmia Risk Prediction in Idiopathic Dilated Cardiomyopathy Based on Heart Rate Variability and Baroreflex Sensitivity

This study examined the relation between heart rate variability (HRV) and baroreflex sensitivity (BRS) and subsequent major arrhythmic events (MAE), defined as sustained VT, VF or sudden death, in 263 patients with idiopathic dilated cardiomyopathy (IDC) in sinus rhythm. The predefined measure of HRV was the standard deviation of all normal-to-normal RR intervals (SDNN) on baseline 24-hour ambulatory ECG. BRS was determined by the phenylephrine method. Over 52 ± 21 months of follow-up, MAE occurred in 38 patients (14%). SDNN at baseline 24-hour ambulatory ECG (106 ± 46 vs 109 ± 45, ns) and BRS (7.9 ± 5.5 vs 7.7 ± 5.3 ms/mmHg, ns) were both similar in patients with versus without MAE during follow-up. In contrast, left ventricular ejection fraction was significantly lower in patients with versus without MAE (24%± 7% vs 31%± 10%, P < 0.019. Conclusions: Neither HRV nor BRS predicted MAE in patients with IDC.     

Neural and Psychosocial Mechanisms of Pain Sensitivity in Fibromyalgia

Fibromyalgia is a chronic musculoskeletal pain disorder that affects an estimated 5 million adults in the US. The hallmark is burning, searing, tingling, shooting, stabbing, deep aching, or sharp pain. Fibromyalgia is generally considered to be a “central sensitivity syndrome” where central sensitization is regarded as the cause of pain in its own right. Nonetheless, the case continues to be made that all central and spatially distributed peripheral components of fibromyalgia pain would fade if the peripheral generators could be silenced. Although neural mechanisms are clearly important in pain sensitivity, cognitive and social mechanisms also need to be considered. The aim of this review is to examine four mechanisms responsible for heightened pain sensitivity in fibromyalgia: peripheral sensitization, central sensitization, cognitive-emotional sensitization, and interpersonal sensitization. The purpose of framing the review in terms of pain sensitivity in fibromyalgia is to highlight that different mechanisms of sensitization are appropriately regarded as intervening variables when it comes to understanding individual differences in the experience of pain. The paper concludes by considering the implications of the findings of the review for explanations of fibromyalgia pain by nurses working in multidisciplinary teams. The trend appears to be able to explain the cause of fibromyalgia pain in terms of sensitization per se. The recommended alternative is to explain fibromyalgia pain in terms of changes in pain sensitivity and the role of underlying neural and psychosocial mechanisms.     

基质金属蛋白酶在肺癌病情监测、诊断和预后评估中的应用

肺癌的早期诊断早期治疗对肺癌患者的预后改善有很大的帮助，而在肺癌手术后的患者以及施行放化疗的患者，及时监测其复发转移情况，对于治疗方案的选择、改善预后，都有重要的作用。目前尚无可早期诊断肺癌以及监测其病情变化的较敏感、较特异的指标应用于临床。经多年研究表明，一组基质降解酶类基质金属蛋白酶在这方面有一定的应用前景。     

Effects of Respiratory Training on Heart Rate Variability and Baroreflex Sensitivity in Individuals With Chronic Spinal Cord Injury

Objective

To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI).

Effects of Hydrophilic and Lipophilic β-Blockers on Heart Rate Variability and Baroreflex Sensitivity in Normal Subjects

To evaluate the effect of a hydrophilic and a lipophilic β- blocker on the autonomic nervous system, 20 normal subjects were studied under baseline conditions and 7 days after being randomly assigned to metoprolol (200 mg/day), nadolol (80 mg/day), and placebo. Under each condition, the time-domain parameters were analyzed by means of 24-hour ECG monitoring and the frequency-domain parameters by means of the autoregressive method using 10-minute ECGs during rest, controlled respiration, and after a head-up tilt test. The alpha index (the gain in the relationship between the RR period and systolic arterial pressure variability) was also calculated. Both nadolol and metoprolol significantly increased all of the time-domain parameters except the standard deviation of the RR intervals; they also modified the frequency-domain parameters. Both blunted the significant reduction in the high frequency (HF) component and alpha index during tilt. In normal subjects, hydrophilic and lipophilic β-blockers similarly modify the time- and frequency-domain parameters that are particularly evident when high sympathetic tone is present (during daytime and tilt). The value of the alpha index was increased by both β-blockers in the HF, but not in the low frequency band; this difference might be due to the fact that the former is a measure of the vagal component of the baroreflex control and the latter a measure of the sympathethic component. The effects of hydrophilic and lipophilic β-blockers on the time- and frequency-domain parameters of heart rate variability are similar.     

髓母细胞瘤PCNA和c-erbB-2表达与预后关系的研究

目的：探讨ＰＣＮＡ和ｃ－ｅｒｂＢ－２表达与髓母细胞病人预后的关系。方法：应用免疫组化（ＳＰ法）结合临床随访,检测ＰＣＮＡ和ｃ－ｅｒｂＢ－２在６２例中ＰＣＮＡ和ｃ－ｅｒｂＢ－２组织和１０例正常脑组织中的表达并分析其与病人预后的关系。结果：在６２例髓母细胞瘤组织中,ＰＣＮＡ表达明显增强,且表达水平不一,其中４５例ＰＣＮＡ表达阳性（增殖指数≥２５％）。４３例有ｃ－ｅｒｂＢ－２表达,其中２２例ｃ－ｅｒｂＢ     

Baroreflex sensitivity in the elderly: influence of age, breathing and spectral methods

Baroreflex sensitivity (BRS) has been proposed as a diagnostic parameter for neurological disorders and as a survival-prognosis parameter in diabetic and cardiac patients. Therefore reference values and the reproducibility of BRS were assessed, taking into account the possible influence of age, gender, test conditions and some analysis variants. Healthy subjects (n=191) were randomly selected from the 50-75-year-old general population (the Hoorn Study). Variations in blood pressure and heart rate were recorded non-invasively during three breathing modes: spontaneous (3 min), slow metronome (1 min; 6 breaths/min=0.1 Hz) and fast metronome (1 min; 15 breaths/min=0.25 Hz), all in a supine position. From these recordings, BRS was assessed as the transfer gain between changes in blood pressure and heart period, and as the alpha coefficient. BRS values ranged from 5.0 to 8.9 ms.mmHg(-1). Slow metronome breathing resulted in higher BRS values than fast breathing, while during spontaneous breathing BRS in the low-frequency band was lower than that in the high-frequency band (respiratory origin). BRS values decreased with lower coherence criteria. BRS-alpha was significantly higher than BRS-gain. While regression analysis showed no gender differences, BRS decreased with age. Therefore age-specific reference values were calculated. The reproducibility of BRS values was in general moderate, with reliability coefficients ranging from 43 to 81% and coefficients of variation ranging from 34 to 59%. In conclusion, this study shows age, breathing mode, frequency and coherence threshold to affect measures of BRS. Therefore these factors should be considered in clinical studies; appropriate reference values are given.     

Influence of ECG Sampling Frequency on Spectral Analysis of RR Intervals and Baroreflex Sensitivity Using the EUROBAVAR Data set

To evaluate the impact of different ECG sampling frequencies on parameters of spectral and baroreflex analysis. Spectral and baroreflex analyses were performed in the EUROBAVAR data set (46 recordings of 23 persons) using the original ECG sampling frequency of 500 Hz and – simulated – sampling frequencies of 200 and 100 Hz. For this analysis, the technique of trigonometric regressive spectral (TRS) analysis was used. In the standing position, there were no statistically significant differences in baroreflex sensitivity and frequency bands ranging from VLF to HF using 100 Hz instead of the original 500 Hz. Only the UHF band (>0.40 Hz) was significantly different. In the supine position, similar results could be described for 100 Hz, although there were slight, but significant (P < 0.05) changes in baroreflex sensitivity of around 1 ms/mmHg at the simulated 100 Hz. Using a simulated 200 Hz instead of a 500 Hz sampling frequency had no significant impact on the spectral and baroreflex parameters. The probability to demonstrate an impact of different ECG sampling frequencies was higher in people with pathologically decreased variability of RR intervals. In most of the cases, it is sufficient for spectral and baroreflex analysis by TRS to use data with an ECG sampling frequency of 100 Hz in comparison to 500 Hz. Only if there is a pathologically decreased variability of RR intervals in patients, spectral and baroreflex parameters could be significantly influenced by lower ECG sampling frequencies of up to 100 Hz, but only to a minor degree. Ziemssen T, Gasch J, Ruediger H. Influence of ECG sampling frequency on spectral analysis of RR intervals and baroreflex sensitivity using the EUROBAVAR data set.     

RR Variability and Baroreflex Sensitivity in Patients with Ventricular Tachycardia Associated with Normal Heart and Patients with Ischemic Heart Disease

Recent studies have suggested that disordered autonomic function, particularly the loss of protective vagal reflexes are associated with an increased incidence of arrhythmic deaths following myocardial infarction (MI). Heart rate variability (HRV) and baroreflex sensitivity (BRS) are measures of myocardial autonomic function and predict arrhythmic deaths post-Mi. Patients with ventricular tachycardia associated with a “normal heart” frequently have exercise-induced arrhythmia suggesting that the autonomic nervous system is important in the genesis of this form of ventricular tachycardia (VT). This study examines HRV and BRS in patients with VT associated with a “normal heart” and compares these values to patients post-Mi with and without evidence of arrhythmia. Twenty patients with VT associated with a “normal heart,” 16 patients with MI but without arrhythmia on follow-up, and 11 patients with MI and VT on follow-up were studied. HRV was measured from 24-hour Holter recordings and BRS was measured from plots of change in systolic blood pressure versus change in heart rate following an intravenous injection of 0.4–0.6 mg phenylephrine. HRV was significantly higher in the patients with VT associated with a normal heart (34.2 ± 10.8 msec) compared to the patients post-Mi, without (23.7 ± 6.7 msec) and with (14.8 ± 3.8 msec) arrhythmia (F = 9.2, P < 0.001) and these differences were unaffected by adjustment for age. Baroreflex sensitivity was also higher in patients with VT associated with a “normal heart” (10.1 ± 6.8 msec/mmHg) compared to patients post-Mi, without (6.1 ± 3.2 msec/mmHg) and with 3.2 ± 3.1 msec/mmHg) arrhythmia, (F = 7.2, P < 0.02), though statistical significance was lost after adjustment for age (F = 1.2, P = 0.3). We conclude that patients with VT associated with “normal hearts” have HRV and BRS that is higher than in patients post-MI. Alterations of autonomic tone are, therefore, unlikely to be important in VT associated with a “normal heart,” whereas these appear to be important in patients with arrhythmic events post-MI.     

The Prognostic Value of Coronary CT Angiography

Coronary CT angiography has gained increasingly widespread acceptance as a highly accurate method for the diagnosis of coronary artery disease. Beyond its usefulness as a diagnostic test to identify coronary artery stenoses in appropriately selected patients, multiple studies have consistently demonstrated that the extent and severity of coronary atherosclerosis visualized using coronary CT angiography conveys robust prognostic information. The majority of studies to date examining clinical outcomes following coronary CT angiography have documented coronary artery disease either as the presence of any coronary plaque or through the number of vessels with ≥50% (obstructive) stenosis. In the future, advanced, semi-quantitative measures of coronary atherosclerotic disease burden, plaque morphology, and composition may provide additional prognostic information. It is imperative that patients undergoing coronary CT angiography and their providers understand the prognostic information inherent to modern coronary CT angiography so that the maximal yield may be realized. Herein, we review the currently available prognostic studies of coronary CT angiography.     

术前炎症和营养预后指数在胃癌预后评估中的价值

【目的】探讨胃癌患者术前炎症和营养预后指数（PINI）水平与胃癌近期疗效的关系。【方法】选择2010年4～12月本科收治的胃癌患者36例,均于术前3d测定血清α1-酸性糖蛋白、C-反应蛋白、白蛋白和前白蛋白水平,并以此计算术前PINI值。术后随访2～6个月,分析术前PINI水平与患者病理分期、术后并发症、生活质量及复发转移的关系。【结果】术前PINI水平与病理TNM分期有关：Ⅳ期PINI水平明显高于Ⅰ、Ⅱ及Ⅲ期（P〈O．01）。术前PINI水平与患者术后并发症有关：发生并发症患者其PINI水平明显高于无并发症者（P〈0．05）。术前PINI水平与患者术后生存质量总体评估水平有关：生存质量“差”者,其PINI水平明显高于生存质量“好”及“一般”者（P〈0．05）。【结论】术前PINI可作为胃癌患者短期预后的评估指标之一。     

泼尼松反应在CCLG-ALL 2008方案中预后价值的探讨

目的:评估泼尼松反应在儿童急性淋巴细胞白血病(ALL)治疗体系中的预后价值。方法:对入组598例初治ALL患儿,予以泼尼松预治疗,根据结果分为泼尼松反应良好(PGR)组和泼尼松反应不良(PPR)组,行后续治疗并随访,分析比较临床特征及治疗效果。结果:与PGR组相比,PPR组患儿具有年龄较大,初诊白细胞数较高,T细胞表型相对多见,费城染色体阳性急性淋巴细胞白血病(Ph+ALL)相对多见的特点(P0.05);PPR组患儿2年和5年无事件生存率(EFS)相对于PGR组明显降低(P0.05),PPR组患儿累积无事件生存率的下降主要发生在2年内;PPR组复发率较高,且以早期复发为主(P0.05);PPR组患儿治疗第33天及12周的微小残留病(MRD)发生率较高(P0.05);高危组ALL患儿不论泼尼松反应是否良好,其无事件生存率,复发时间均无差别(P0.05);在COX回归分析中,PPR、BCR-ABL1及MLL的存在均为显著预后不利因素(P0.05)。结论:泼尼松反应在CCLG-ALL 2008方案中仍然具有重要预后价值,泼尼松反应不良的ALL患儿整体预后较差,而泼尼松反应对高危组ALL预后评价意义不大。