Effect of surgical castration on risk factors for arteriosclerosis of patients with prostate cancer

Objective To analyze the effect of castration on risk factors for arteriosclerosis of patients with prostate cancerMethods Thirty patients with primary regional prostate adenocarcinoma limited to the prostate theca were selected in this study.Serum levels of testosterone (T), free testosterone (FT), dehydroepiandrosterone (DHEA), sex hormone-binding globulin (SHBG), prostatic specific antigen (PSA), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), apoprotein α(1) (APOα(1)) and apoprotein β (APOβ), insulin, plasma fibrinopeptide A (FPA), plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were determined just prior to, 1 week and 1, 4 and 8 months after castration.Results T, FT and PSA decreased significantly 1 week after castration (21.12±15.11 ng/ml vs 383.9±62.6 ng/ml, P<0.001; 4.08±3.29 pmol/L vs 34.11±11.59 pmol/L, P<0.001; 14.34±7.77 ng/ml vs 23.51±6.57 ng/ml, P=0.001, respectively) and continued to decrease until reaching their lowest levels 8 months after castration.DHEA and SHBG did not undergo any changes.TG, fasting insulin and glucose, 2-hour insulin and glucose levels were significantly elevated 1 month after castration (1.84±0.61 mmol/L vs 1.30±0.40 mmol/L, P<0.05; 18.16±5.57 mU/L vs 9.47±3.81 mU/L, P<0.05; 4.77±0.66 mmol/L vs 3.92±0.34 mmol/L, P<0.05; 65.52±14.78 mU/L vs 36.94±17.12 mU/L, P<0.01; 6.98±0.79 mmol/L vs 6.01±0.23 mmol/L, P=0.001, respectively).TC, LDL-C, FPA and PAI-1 levels were elevated 4 months after castration (6.56±0.99 mmol/L vs 5.29±0.75 mmol/L, P<0.01; 4.09±0.86 mmol/L vs 3.04±0.15 mmol/L, P<0.01; 3.39±1.67 nmol/L vs 1.48±0.50 nmol/L, P<0.01; 27.02±5.98 ng/ml vs 21.78±3.16 ng/ml, P<0.05, respectively), continuing to increase after that point.Insulin sensitive index (ISI) decreased significantly 1 month after surgery (-4.42±0.36 vs -3.50±0.39, P<0.001), and continued to decrease from that point forward.HDL-C, APOα(1), APOβ and fibrinogen remained at pre-operative levels.There was a negative linear correlation between FT and TG, TC, LDL-C, PAI-1, FPA, fasting insulin and glucose, 2-hour insulin and glucose (r=-0.311, -0.384, -0.385, -0.339, -0.353, -0.381, -0.303, -0.460 and -0.395, respectively; P<0.05).A similar phenomenon occurred with T (r=-0.308, -0.309, -0.356, -0.320, -0.430, -0.453, -0.435, -0.483 and -0.512, respectively; P<0.05).T and FT were positively associated with ISI (r=0.555 and 0.501; P<0.001).Conclusions At 8 months follow-up of the study subjects, we found that lower androgen levels have adverse effects on lipid metabolism, coagulative function and insulin sensitivity, related to arteriosclerosis in men.     

Estrogen receptor gene polymorphisms and bone mineral density in Chinese postmenopausal women

Objective To investigate the relationships between the polymorphisms of estrogen receptor (ER) gene, bone mineral density (BMD) and bone biochemical markers in Chinese postmenopausal women. Methods BMD of lumbar spine and femoral neck were measured using dual-energy X-ray absorptiometry （DEXA）in 186 Chinese postmenopausal women. The PvuⅡ and XbaⅠ polymorphisms of the ER gene were detected using polymerase chain reaction (PCR). Bone biochemical markers, serum alkaline phosphatase, osteocalcin and pyridinoline were measured by ELISA. Results The femoral neck(FN) BMD (Z score) was higher in pp compared to Pp (-0.01±0.12 vs. -0.35±0.09, P<0.05) while lumbar spine BMD (Z score) was higher in XX type compared to Xx and xx genotypes (0.01±0.45 vs -1.53±0.17, -1.29±0.10, P<0.001 and 0.001, respectively). Women without Px haplotype (n=79) had a higher BMD Z-score for the lumbar spine (-1.03±0.14 vs -1.45±0.11, P<0.05) and femoral neck (-0.01±0.11 vs -0.31±0.09, P<0.05) than those who had it (n=107). Conclusions The present study suggested that the pp and XX genotypes of ER gene might play a certain role in maintaining FN and lumbar spine BMD. ER genotypes without Px haplotype might be favorable to bone mass, while those with it might exert some harmful effect on bone mineral density.     

β2-AR多态性对哮喘支气管舒张反应曲线的影响

目的探讨β2肾上腺素受体编码区16,27位点基因突变对哮喘支气管舒张反应的影响.方法通过测序确定22名哮喘患者的基因突变类型,以FEV1为指标,观测吸入400 μg沙丁胺醇后7 h支气管舒张反应性曲线,进一步分析基因突变对支气管舒张反应的影响.结果22例基因型分别为16位点(Arg/Arg 8例;Arg/Gly 8例;Gly/Gly 6例);27位点(Gln/Gln 17例;Gln/Glu 3例;Glu/Glu 2例).22例哮喘的基础FEV1无显著性差异,但16位点3种基因型(A组Arg/Arg,B组Arg/Gly及C组Gly/Gly)对吸入400 μg沙丁胺醇后支气管舒张反应性曲线的影响差异较大△FEV1峰值%分别为(19.2±1.3),(12.6±0.9)及(12.1±0.9),A∶B P<0.001;A∶C P<0.001;出现时间为15,60及60 min;起始斜率为4.40±0.19,1.11±0.05及0.98±0.04,A∶B P<0.05;A∶C P<0.05;曲线下面积4.22±0.18,2.52±0.11及2.27±0.10,A∶B P<0.001;A∶C P<0.001.而27位点各基因型对吸入沙丁胺醇后支气管舒张反应性曲线的影响无显著差异.结论β2肾上腺素受体16位点多态性是影响哮喘吸入沙丁胺醇后支气管舒张反应性的重要原因之一.     

Improvement of cardiac function after transplantation of autologous bone marrow mesenchymal stem cells in patients with acute myocardial infarction

Background The infarct size determines the long-term prognosis of patients with acute myocardial infarction (AMI). There is a growing interest in repairing scar area by transplanting bone marrow stem cells. However, effectiveness of intracoronary injection of bone marrow mesenchymal stem cells (BMSCs) in patients with AMI still remains unclear.Methods Sixty-nine patients with AMI after percutaneous coronary intervention (PCI) were randomly divided into intracoronary injection of BMSCs (n=34) and saline (control group, n=35) groups. Serial single positron emission computer tomography (SPECT), cardiac echo and cardiac electromechanical mapping were done at the designed time intervals until six months after transplantation of BMSCs or injection of saline. Results The proportion with functional defect decreased significantly in the BMSCs patients after three months ［(13±5)%］ compared with that pre-transplantation ［(32±11)%］ and the control group ［(28±10)%］ at three month follow-up (P&lt;0.05, respectively). Wall movement velocity over the infracted region increased significantly in the BMSCs group ［(4.2±2.5) cm/s vs (2.2±1.3) cm/s, P&lt;0.05］, but not in the control group ［(2.2±1.5) cm/s vs (2.7±1.7) cm/s, P&gt;0.05］. Left ventricular ejection fraction (LVEF) three months after transplantation in BMSCs group increased significantly compared with that pre-implantation and with that of the control group at three months post-injection ［(67±11)% vs (49±9)% and (53±8)%, P&lt;0.05 respectively］. SPECT scan results showed that perfusion defect was improved significantly in BMSCs group at three-month follow-up compared with that in the control group ［(134±66)cm2 vs (185±87)cm2, P&lt;0.01］. At the same time, left ventricular end-diastolic volume ［(136±31) ml vs (162±27) ml, P&lt;0.05］ and end-systolic volume ［(63±20) ml vs (88±19) ml, P&lt;0.05］ decreased synchronously. The ratio of end-systolic pressure to end-systolic volume ［Psyst/ESV, (2.84±1.30) mmHg/ml vs (1.72±1.23) mmHg/ml, P&lt;0.05］ increased significantly. Cardiac electromechnical mapping demonstrated significant improvement at three months after implantation of BMSCs compared with that pre-injection in both cardiac mechanical capability as left line local shorting ［LLS, (11.29±1.64)% vs (7.32±1.86)%, P&lt;0.05］ and electrical property as left ventricular endocardial unipolar voltage ［UV, (10.38±1.12) mV vs (7.61±1.09) mV, P&lt;0.01］; perfusion defect decreased from (36.2±6.2) % to (20.3±5.31)% (P&lt;0.01). Twenty-four-hour electrocardiographic monitoring demonstrated no arrhythmias occurred at three-months follow-up.Conclusions The transplantation of BMSCs might improve the cardiac function and it is safe and feasible with no deaths or malignant arrhythmias.     

益气活血胶囊抗心肌梗塞后早期左室重构的临床观察

[目的]观察益气活血胶囊抗心肌梗塞后早期左室重构的效应.[方法]将90例急性心肌梗塞(AMI)病人随机分为益气活血胶囊组和安慰剂组,每组各45例,在给予溶栓治疗和/或常规治疗基础上分别给予益气活血胶囊或安慰剂治疗.治疗后1周、8周分别检测两组间的室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室舒张末内径(LVDd)、局部室壁运动记分和左室射血分数(LVFF).[结果]安慰剂组AMI后8周的IVS、LVPW及LVDd较AMI后1周时明显增加,而益气活血胶囊组则未见明显增加,两组间比较差异具有显著性意义(P<0.05);安慰剂组局部室壁运动记分增加,而益气活血胶囊组无明显改变,两组间比较具有显著性差异(P<0.05);安慰剂组LVEF下降,益气活血胶囊组则增加,差异具有显著性意义(P<0.05).[结论]中药复方制剂益气活血胶囊可抑制AMI后舒张末内径的扩大,减轻室间隔及非梗塞区的代偿性肥厚,改善心室局部运动障碍和整体左室功能,具有一定的抗心室重构作用.     

舒张性心力衰竭兔Ca2+调控蛋白相关基因表达的变化

目的探讨舒张性心力衰竭(DHF)时Ca2+调控蛋白相关基因表达的变化,以阐明DHF发生的分子机制.方法建立DHF兔模型,并设假手术为对照组,分别测定2组兔心肌细胞内Ca2+含量和肌浆网(SR)Ca2+-ATPase(钙泵)活性,并以定量RT-PCR和Westernblot技术检测Ca2+调控蛋白相关基因的转录和蛋白质表达水平.结果(1)DHF兔心肌细胞内Ca2+含量(μg/ml)显著高于对照组(1728±545vs633±168,P＜0.01);(2)DHF兔SR钙泵活性,细胞膜L型Ca2+通道和SR钙泵mRNA水平(μmol*mg-1*h-1)明显低于对照组(10.5±2.8vs21.1±5.7;0.75±0.11vs1.20±0.33;0.76±0.12vs1.24±0.38,P＜0.05～0.01);(3)DHF兔细胞膜L型Ca2+通道mRNA水平与左室舒张末压中度负相关(r=-0.74,P＜0.05),SR钙泵mRNA水平与左室舒张末压和左室松弛时间常数中度负相关(r分别为-0.81、-0.64,P＜0.05～0.01);DHF兔兰尼碱受体mRNA水平与左室松弛时间常数负相关(r=-0.71,P＜0.05);(4)DHF兔SR钙泵的蛋白质表达明显低于对照组(0.75±0.06vs1.02±0.09,P＜0.05).结论细胞膜L型Ca2+通道和SR钙泵mRNA和蛋白质表达减低是导致心肌细胞内Ca2+超负荷及DHF发生的重要因素.     

疾病现象邻位排列教学法对临床见习生语流质量影响的研究

目的创建适用于临床工作入门阶段医学生的疾病现象邻位排列教学法,验证该教学法对四年级临床见习学生语流质量的影响.方法将接受内科学课堂教学和临床见习的四年级学生322人随机按班级分成实验组(n=172)和对照组(N=150).实验组接受疾病现象邻位排列教学法,课后和平时应用疾病现象邻位排列教学法进行自我临床思维训练.对照组接受传统的疾病现象概率排列或随机排列教学法,课后和平时应用传统学习方法进行自我临床思维训练.在临床见习时,通过提问并记录学生回答问题时语言的流利程度(停顿次数)、语言所表述的内容的准确完整率和回答问题内容的逻辑性(逻辑倒错率),来考察两种教学方法对学生语流质量的影响.结果实验组学生回答问题时平均停顿次数(0.68±0.22 vs 0.87±0.16,P<0.001)和平均停顿时间(2.70±0.12 vs 3.30±0.21,P<0.05)显著少于对照组,回答内容的准确完整率(0.94±0.23 vs 0.71±0.41,P<0.001)明显高于对照组,语言的逻辑倒错率(1.82±0.46vs 3.11±0.53,P<0.001)显著低于对照组.结论疾病现象邻位排列教学法能明显提高四年级临床见习学生的语流质量.     

2型糖尿病合并冠心病患者PAI—1基因4G／5G多态性研究

目的探讨2型糖尿病患者血浆纤溶酶原激活物抑制因子-1(PAI-1)基因启动区4G/5G多态性及与并发冠心病的关系.方法118名2型糖尿病患者,按有无冠心病分为两组.未合并冠心病组80例,合并冠心病组38例.应用PCR扩增PAI-1基因启动区片段,γ32P末端标记2个序列特异性寡核苷酸(ASO)进行点杂交,比较基因型在两组糖尿病人群中的分布及与血浆PAI-1活性的关系.结果(1)合并冠心病的2型糖尿病患者较未合并冠心病组4G基因型的频率升高,但未达统计学意义(P>0.05);(2)两组的血浆PAI-1活性差异明显(10.32±2.65vs8.87±3.24)kU/L,P<0.05;(3)两组的血TG水平差异明显(1.99±1.04vs1.56±0.72)mmol/L,P<0.05;(4)两组的空腹胰岛素水平差异明显(14.6±5.8vs11.2±4.3)kU/L,P<0.05;(5)在4G/4G基因型患者中血浆PAI-1活性与TG明显相关(r=0.57,P<0.05).结论PAI-1活性升高及PAI-     

实验性高胆固醇血症兔离体主动脉功能变化的研究

目的探讨高胆固醇血症对血管功能的影响。方法20只新西兰雄性兔随机分为2组正常饮食组(normal cholesterol,NC)10只及高胆固醇饮食组(hypercholesterol,HC)10只。4周后取出每只兔的降主动脉,5mm宽动脉环放置于含有25mlKreb液的组织－器官水浴系统中。分别测量游离血管对乙酰胆碱（10-10～10-5mol/L)的舒张反应及对去甲肾上腺素（10-10～10-5mol/L）的收缩反应。结果2组兔血胆固醇有显著差异,其中NC组（30.1±11.2）mg/dl,HC组（987.3±110.0)mg/dl(P<0.01);HC组血管对乙酰胆碱舒张反应与NC组比较明显减弱,HC组最大为（58.50±6.17）％,NC组最大为(103.2±6.9)％(P<0.01）;HC组血管对去甲肾上腺素反应增强,最大收缩力HC组为(4.15±0.56)g,NC组为(2.9±0.3)g(P<0.05）。2组动脉病理学检查无动脉硬化的改变。结论高胆固醇血症降低血管内皮依赖性舒张反应,增加血管对去甲肾上腺素的收缩反应。高胆固醇血症时血管内皮功能改变早于动脉粥样硬化的结构改变。     

左旋精氨酸对大鼠心脏移植模型移植物血管病变的抑制作用

目的研究左旋精氨酸对心脏移植物血管病变的抑制作用及其机制.方法采用大鼠异位心脏移植模型.对照组26只,移植后不用左旋精氨酸;实验组21只,移植后按每天800mg/kg将左旋精氨酸加入饮水中.于移植后2个月和3个月检测各组的心脏移植物血管病变评分和血浆一氧化氮含量.结果移植后2个月,实验组的移植物存活率为90.5%,显著高于对照组的61.5%(P<0.05).移植后2个月和3个月,实验组血浆一氧化氮均显著高于对照组,分别为(105.37±10.66)μmol/L vs (68.54±6.83)μmol/L(P<0.05),和(104.53±12.31)μmol/L vs (66.32±10.54)μmol/L(P<0.05);而对照组心脏移植物血管病变评分显著高于实验组,分别为2.4±0.7 vs 1.1±0.6(P<0.05),和3.0±0.8 vs 1.6±0.9(P<0.05).实验组心脏移植物的冠状动脉内膜病变轻微,内皮和内弹力层基本保持完整,平滑肌细胞增殖不明显.结论补充左旋精氨酸可改善心脏移植物血管病变,其机制与一氧化氮合成增加有关.一氧化氮具有保护内皮功能,抑制平滑肌细胞增殖的作用.     

胎盘生长因子恢复急性心肌梗死大鼠心功能及其机制

目的：探讨胎盘生长因子（PlGF）及其受体（VEGFR1）在急性心肌梗死后心功能恢复中的作用。 方法：采用结扎Wistar大鼠左冠状动脉前降支的方法建立急性心肌梗死模型。建模型成功后随机将30只Wistar大鼠分为对照组、PlGF组、抗VEGFR1抗体组,于心肌梗死区分别注射生理盐水、PlGF、鼠抗VEGFR1抗体。术后2周观测各组大鼠心功能,然后经股静脉注射2 ml 15% 氯化钠溶液处死大鼠,制作心脏病理切片评估左心室结构,免疫组织化学法检测冯·维勒布兰德因子（vWF）和α平滑肌肌动蛋白（α-SMA）,分析心肌梗死区域的新生血管,以及TUNEL法检测心肌梗死区心肌细胞凋亡情况。 结果：PlGF组大鼠心肌血流动力学指标每搏输出量、收缩压/舒张压、左心室峰压、左心室发展峰压、左心室舒张末压明显优于对照组（均P<0.01）;PlGF组大鼠左心室直径、心室梗死交界区室壁厚度均小于对照组（均P<0.01）,抗VEGFR1抗体组与对照组的心脏几何学参数基本一致;PlGF组大鼠新生血管和动脉密度均高于对照组（P<0.01）,抗VEGFR1抗体组的动脉密度略低于对照组,差异无统计学意义（P>0.05）;PlGF组大鼠心肌细胞凋亡率明显低于对照组（P<0.01）。 结论：急性心肌梗死大鼠心肌局部注射PlGF可显著改善心功能恢复并抑制左心室扩张, 促进血管再生并降低心肌细胞凋亡。PlGF治疗有望作为急性心肌梗死患者综合治疗中的一个辅助性手段。     

心衰大鼠心肌SR Ca2+泵活性和Ca2+释放通道密度的变化及培哚普利干预的影响

目的　探讨ACEI干预慢性心衰对心肌肌浆网(SR)Ca     

清醒犬慢性充血性心力衰竭模型的血流动力学特征

目的:评价犬心肌梗死后快速起搏法建立的类似人类慢性充血性心力衰竭模型的血流动力学特征。方法：5只健康雄性比格犬在全身麻醉下接受开胸手术,安置测压、测距装置和心脏起搏导线后结扎冠状动脉左前降支,6周后以220～260次/min行右心室起搏诱导犬充血性心力衰竭。术前进行多普勒超声心动图检测,起搏前及起搏4周后分别观测和记录多普勒超声心动图和血流动力学数据。结果：手术前和起搏前LVEDD,LVEF和FS的变化均无统计学意义（P＞0.05）。与起搏前比较,起搏4周后LVEDD和LVEDP明显增高（P＜0.05）,起搏后和起搏前LVEDD分别为(44.71±3.35) mm和(38.01±1.54) mm,LVEDP分别为(25.63±1.86) mmHg和(10.58±1.23) mmHg（P＜0.05）,起搏后LVEF,FS,LV dp/dt max较起搏前显著降低（P＜0.01）。结论：比格犬心肌梗死后快速起搏制备的心力衰竭模型的左心室结构和血流动力学变化特点与人类心力衰竭相似。     

替格瑞洛辅助急诊PCI治疗STEMI对患者心室重构影响情况分析

目的 探讨ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)行急诊经皮冠脉介入术(percutaneous coronary intervention,PCI)患者加用替格瑞洛治疗的临床效果及对患者心室重构的影响.方法 选取我院急诊PCI手术治疗的STEMI患者120例(2014年1月至2016年8月)进行回顾性分析,患者均急诊PCI手术,根据治疗药物分为两组,60例患者术前及术后均给予替格瑞洛(替格瑞洛组)、60例患者术前及术后均给予氯吡格雷(氯吡格雷组),对比两组患者术后心室重构指标、心电图等指标.结果 术后12周,替格瑞洛组LVEDd (49.1±5.4)mm、LVESD (40.6±4.6)mm、LVMI(112.8±11.0) g/m2、LVMW(140.7 ±18.5)g低于氯吡格雷组患者LVEDd(53.1±4.6) mm、LVESD (43.9±4.7) mm、LVMI(118.2 ±9.4)g/m2、LVMW(153.0±21.3) g(t =4.638、t=3.887、t=2.891、t =2.198,P均＜0.05),两组患者的LVEF值差异无统计学意义(t=1.064,P ＞0.05);术后12周,替格瑞洛组Tp-e(114.2±12.7) ms、Tp-e/QTc(0.20±0.05)低于氯吡格雷组患者Tp-e(120.6±13.9)ms、Tp-e/QTc (0.25±0.07)(t=2.633、t=4.502,P ＜0.05);替格瑞洛组的不良心血管事件发生率6.67％与氯吡格雷组的13.33％比较,差异无统计学意义(x2=1.481,P＞0.05).讨论 STEMI行PCI患者加用替格瑞洛治疗能有效减轻心室重构,改善心电图指标.     

心衰大鼠心肌SR Ca2+释放通道数量及其mRNA表达的变化及培哚普利干预的影响

目的　探讨慢性心衰心肌肌浆网 (SR)Ca2 + 释放通道 (RyR2 )数量及其mRNA表达的变化及ACEI干预的影响及意义。方法　通过结扎大鼠左冠脉建立慢性心衰模型 ,以培哚普利进行干预 ,对照观察血流动力学、[3 H]-ryanodine与左室心肌RyR2 最大结合量 (Bmax)和Kd 值、RyR2 mRNA表达水平。结果　与对照组 (C组 )相比 ,心衰组 (F组 )LVEDP显著升高 (P <0 .0 1) ,+dp/dtmax、-dp/dtmax显著降低 (P <0 .0 1) ,培哚普利组 (P组 )LVEDP显著低于F组 (P <0 .0 1) ,+dp/dtmax、-dp/dtmax显著高于F组 (P<0 .0 1)。F组 [3 H]-ryanodine与RyR2 最大结合量Bmax显著低于C组 (P <0 .0 1) ,P组显著高于F组 (P <0 .0 1) ,三组Kd 值无显著差异 (P >0 .0 5 ) ;F组RyR2 mRNA表达水平显著低于C组 (P <0 .0 1) ,P组显著高于F组 (P <0 .0 1)。结论　慢性心衰心肌SRCa2 + 释放通道数量及其mRNA表达水平降低 ,培哚普利长期干预慢性心衰 ,能够增加RyR2 基因表达 ,增加RyR2 数量 ,可能与其改善心肌收缩功能有关     

心脏震波对猪心肌梗死后早期侧枝循环重建及左心功能的影响

［摘要］ 目的　观察心脏震波治疗（cardiac shock wave therapy,CSWT）对猪急性心肌梗死后的心肌局部侧枝循环血管及心脏整体功能有无影响,对比不同震波方案疗效差异,为优化CSWT方法学提供进一步科学依据．方法　选取本地小型猪25只,3～5月龄,体重26～32 kg．实验猪随机分为3组:震波组,假震波组及及手术组．震波组按震波治疗方案不同随机分为3个亚组．通过选择性冠状动脉造影评价心肌侧枝循环分级;通过左心室造影检测不同治疗期间及不同处理组间左心室整体心功能,心腔室容积变化差异,综合评价CSWT对心肌梗死后心室重塑的影响．结果　通过选择性血管造影评价侧枝循环Rentrop分级,震波组与假震波组比较差异有统计学意义［（2.05±0.11）vs（0.98±0.09）,P＝0.03］;假震波组心肌侧枝循环指数与假手术组间相比未见显著差异性［（0.98±0.09）vs（0.86±0.03）,P＞0.05］,各震波治疗亚组间分析也显示不同治疗亚组间侧枝循环分级有一定差别,且延长治疗组侧枝循环建立明显优于标准治疗组及扩大范围组．左心室形态学指标（左室收缩末容积及舒张末容积、左室整体射血分数）的变化结果显示心肌梗死组动物（震波组及假震波组）左室收缩末容积（LVESV）和舒张末容积（LVEDV）较心肌梗死前基础值及非梗死组明显增加,左室射血分数（LVEF）降低,但与假震波组相比,CSWT明显改善了震波组的LVESV、LVEDV及LVEF．结论　梗死后早期实施CSWT能明显促进局部心肌微循环结构的重建,及明显改善心肌梗死后左心室整体心功能,且延长震波疗程的方案可获得更明显益处．因此,认为及早有效的进行CSWT可在一定程度上延缓心肌梗死后左心室重塑由可逆阶段向不可逆阶段发展．     

沙库巴曲缬沙坦钠治疗急性心肌梗死后心力衰竭效果观察

目的 观察沙库巴曲缬沙坦钠治疗急性心肌梗死后心力衰竭的效果,使其更好改善预后。 方法 纳入急性心肌梗死伴有心力衰竭且经皮冠状动脉介入治疗患者86例,据临床治疗方法不同分为对照组（贝那普利）和观察组（沙库巴曲缬沙坦钠）,每组43例。比较2组术后3个月心脏超声指标［左心室收缩末期容积（left ventricular end-systolic volume,LVESV）、左心室舒张末期容积（left ventricular end-diastolic volume,LVEDD）、左心室射血分数（left ventricular ejection fraction LVEF）、每搏输出量（stroke volume,SV）］、血清学炎症因子变化［超敏C反应蛋白［（high sensitivity C-reactive protein,hs-CRP）和白细胞介素6（interleukin-6,IL-6）］、N末端B型利钠肽原（N-terminalpro-B-type natriuretic peptide,NT-proBNP）、6 min步行实验、不良反应发生率、预后及转归等。 结果 治疗后,2组LVESV、LVEDD低于治疗前,LVEF、SV高于治疗前,观察组LVESV、LVEDD低于对照组,LVEF、SV高于对照组,差异有统计学意义（P＜0.05）。2组hs-CRP、IL-6、NT-proBNP水平低于治疗前,观察组hs-CRP、IL-6、NT-proBNP水平低于对照组,差异有统计学意义（P＜0.05）。2组低血压、高钾血症、肾功能不全不良反应发生率差异无统计学意义（P＞0.05）。2组再发心肌梗死、室性心动过速/频发室性期前收缩、心源性猝死差异无统计学意义（P＞0.05）;观察组心力衰竭再住院率低于对照组,6 min步行实验长于对照组,差异有统计学意义（P＜0.05）。 结论 与贝那普利相比,沙库巴曲缬沙坦可改善心肌梗死后心力衰竭左心室心功能、左心室重塑,增强其活动耐量,降低心力衰竭再住院率,但并不增加不良反应及不良心血管事件发生率。     

腹腔镜阑尾切除术与开腹阑尾切除术的对比研究

 目的 比较腹腔镜阑尾切除术(laparoscopic appendectomy, LA)与开腹阑尾切除术(open appendectomy, OA)治疗阑尾炎的疗效和安全性。方法 回顾性分析复旦大学附属金山医院2013年1月至2016年10月收治行阑尾切除术患者862例,其中LA组335例,OA组527例。对比分析两组手术时间、出血量、住院时间、住院费用、切口感染、肠梗阻、腹腔脓肿等情况。结果 LA组患者中,325例在腹腔镜下切除阑尾,中转开腹10例(3.0%)。LA组较OA组出血量少［(16.6±13.2) mL vs. (24.7±18.3) mL,P<0.001］,切口感染率低(0.9% vs. 4.9%,P<0.001),术后中-重度疼痛发生率低(4.5% vs.11.6%,P<0.001),平均住院时间短［(4.4±1.9) 天 vs. (5.1±2.5) 天,P<0.001］,住院综合费用高［ (7 806±1 406)元 vs.(4 871±1 308)元,P<0.001］,手术时间长［(41.4±8.1) min vs.(38.8±11.7) min,P<0.001］。两组腹腔脓肿、肠梗阻及再次手术发生率差异无统计学意义。 LA组患者并发症总发生率9.55%,低于OA组的14.42% (P=0.035)。对于超重或肥胖患者(BMI≥24),LA组较OA组有明显微创优势,而且手术时间缩短［(45.2±7.7) min vs.(49.0±7.6)min,P=0.004］,住院费用不增加［(7 951±1 485)元vs.(7 717±1 705)元,P=0.396)］。结论 LA与OA同样安全可靠,在减少切口感染、术后疼痛等并发症方面较OA有明显优势,但费用较高,手术时间稍长。对于超重或肥胖患者LA可作为阑尾切除手术首选。     

苯并[α］芘及丁基羟基茴香醚对大鼠学习记忆能力影响研究

目的 探究苯并［α］芘（B［α］P）对海马学习记忆能力的毒性作用及丁基羟基茴香醚（BHA）对此的保护作用。方法 90只雄性SD大鼠随机分为空白对照组、溶剂对照组、B［α］P处理组〔（2 mg/（kg·d）〕、BHA处理组〔50 mg/（kg·d）〕和B［α］P+BHA联合处理组。按分组及大鼠体质量给予相应剂量灌胃处理(空白对照组、溶剂对照组用等量生理盐水、花生油处理),1次/d,持续90 d。暴露90 d后采用Morris水迷宫测试大鼠学习记忆能力;处死大鼠,剥离脑组织,检测海马组织丙二醛（MDA）含量,超氧化物歧化酶（SOD）、ATP酶活性及海马突触体内Ca2+浓度。结果 Morris水迷宫行为学测试结果显示,与其他组相比,B［α］P组逃避潜伏期增加,跨平台次数减少,差异均有统计学意义（P<0.05）;海马中MDA〔（2.46±0.39） nmol/mg prot.〕含量及Ca2+浓度〔(146.3±16.68) nmol/L〕升高,而SOD〔（76.1±11.42） nmol/mg prot.〕和ATP酶活性降低（P均<0.05）。B［α］P+BHA联合处理组较B［α］P组各指标改善（P均<0.05）,且与溶剂对照组比较,差异无统计学意义。结论 B［α］P引起的神经行为毒性作用可能与海马ATP酶活性降低及Ca2+浓度增加等氧化损伤有关,而BHA可防止此类损伤。     

不同起搏模式对缓慢性心律失常患者心脏重构及远期预后影响的随访观察

目的 评价单腔起搏(VVI)和双腔起搏(DDD)对缓慢性心律失常患者心脏重构及远期预后的影响.方法 回顾性分析1991年1月至2003年1月植入永久性起搏器的患者的随访资料,评价VVI和DDD两种不同起搏方式患者左心系统重构与瓣膜反流、心脏功能、血栓与心房颤动事件发生率、病死率等影响情况.结果 对DDD组患者57例和VVI组患者59例,长期随访(97±27)个月、(107±44)个月发现,DDD组患者左心房、左心室内径同术前比差异无统计学意义[(37±5)mm比(35±5)mm,P=0.07;(47±7) mm比 (47±5)mm,P=0.32],三尖瓣反流率显著增加(42.1%比10.5%,P<0.01);VVI组左心房[(45±12)mm比(39±12)mm,P<0.01]、左心室[(53±11) mm比( 50±9)mm,P=0.01)]舒张末期内径较术前明显增加且三尖瓣反流率(42.4% 比 16.9%,P<0.01)显著增加;DDD组[(57±7)%比(59%±9)%,P=0.11]和VVI组患者末次随访左心室射血分数[(53±10)%比(56±11)%,P=0.05]同术前比无明显变化;末次随访时DDD组和VVI组心房颤动发生率(5.4% 比 22.0%,P=0.14)、再住院率(26.3%比33.9%,P=0.08)和病死率(10.5%比11.9%,P=0.77)差异无统计学意义.结论 两种起搏模式均不能阻止心脏电重构与机械重构的发生.提示现有的房室顺序起搏模式基础上,有必要寻求更加生理性的起搏部位或最小化心室起搏、优化房室间期等方式提高患者的预后.

Abstract：

Objective To assess the effects of VVI (ventricular demand) and DDD (dual-chamber) pacing models on cardiac remodeling and the long-term clinical outcome of patients with symptomatic bradycardia.Methods All patients with DDD and VVI pacing models at our hospital from January 1991 to January 2003 were retrospectively analyzed.Results After a follow-up period of over 8 years in DDD and VVI groups (97±27, 107±44 months), left atrial diameter [(45±12) mm vs (39±12) mm, P<0.01] and left ventricular end-diastolic diameter[ (53±11) mm vs (50±9)mm, P=0.01] in 57 patients with VVI pacing model were markedly enlarged than those at pre-implantation. And tricuspid regurgitation increased (42.4% vs 16.9%, P<0.05). But in 59 patients with DDD pacing model, except for increased tricuspid regurgitation(42.1% vs 10.5%, P<0.01), left atrial diameter [(37±5) mm vs. (35±5)mm, P=0.07] and left ventricular end-diastolic diameter[(47±7)mm vs (47±5)mm, P=0.32] were not significantly different. Mitral regurgitation significantly increased only in the VVI group (P<0.01). The increases of left ventricular end-diastolic diameter (P=0.04), mitral valve (P=0.02) and tricuspid regurgitation (P<0.01) were much more pronounced in the VVI group than those in the DDD group. Left ventricular ejection fraction (LVEF) showed no difference with that at pre-implantation (P=0.11 in DDD group, P=0.05 in VVI group). But the LVEF value was lower (P=0.04) while the incidence of thrombolism was higher (P=0.03) in the VVI group than those in the DDD group at post-implantation. However, the incidence of atrial fibrillation (P=0.14), hospitalization (P=0.08) and survival (P=0.77) showed no significant difference between two groups.Conclusion DDD pacing offers more benefits over VVI pacing through improving cardiac functions and arresting left ventricular remodeling. However, neither groups showed any difference in decreasing mortality rate and hospitalization.Moreover, both pacing modes fail to reverse cardiac electrical and anatomical remodeling. It is imperative to explore more physiological pacing site and rational atrioventricular (AV) interval to improve the prognosis of patients.