冠心病患者NT-proBNP水平与GRACE评分间的相关性分析

目的:探讨冠心病患者氮末端脑钠素原(NT-proBNP)水平与全球急性冠状动脉事件注册评分(GRACE)的相关性。方法 :以2011年6月至2013年6月在我院进行冠状动脉造影的冠心病患者116例为研究对象,按照冠心病的诊断标准分为稳定型冠心病组(SAP)78例和急性冠脉综合征组(ACS)38例,并以62例正常人为对照组(CON),测定各组外周血NT-pro BNP,同时进行GRACE评分,对比两者间的相关性。结果:SAP组和ACS的GRACE评分和NT-proBNP水平均高于正常组,且ACS组显著高于SAP组(P0.05)。GRACE评分的中危组和高危组的NT-pro BNP水平均显著高于低危组(P0.05)。冠心病患者GRACE评分与NT-proBNP水平间呈显著正相关(r=0.473,P0.01)。结论:NT-proBNP水平与冠心病GRACE评分之间呈正相关。     

急性冠脉综合征患者血清MMP-9水平的研究

目的探讨急性冠脉综合征(ACS)患者和正常人血清基质金属蛋白酶-9(MMP-9)水平,并评价血清MMP-9水平与冠脉病变程度的相关性。方法对ACS 40例,稳定型心绞痛(SAP)组40例(均接受冠脉造影检查确诊),正常对照组40例,抽取静脉血采用双抗体夹心ELISA测定血清MMP-9的水平,并记录患者冠脉病变支数及Gensini冠脉病变评分,分别与血清MMP-9水平做相关性分析。结果 ACS组血清MMP-9水平明显高于SAP组(P<0.01),SAP组血清MMP-9水平高于正常对照组(P<0.01),血清MMP-9水平与冠脉病变支数(r=0.64,P<0.05)和Gensini冠脉病变评分(r=0.78,P<0.01)均呈正相关,Gensini评分与血清MMP-9浓度的水平呈正相关(r=0.725,P=0.0000)。结论 ACS患者血清MMP-9水平明显增高,测定血清MMP-9水平有可能有助于ACS的诊断及冠脉狭窄程度的评价。     

非ST段抬高急性冠脉综合征患者血清超敏C反应蛋白水平与GRACE危险评分的相关性研究

目的检测非ST段抬高急性冠脉综合征患者外周血中超敏C反应蛋白（hs-CRP）水平,并探讨其与全球急性冠脉事件注册（GRACE）危险评分的相关性及其临床意义。方法经冠状动脉造影确诊的56例冠心病患者分为两组：非ST段抬高型急性冠脉综合征（NSTE-ACS）33例,稳定性心绞痛（SA）组23例;同时选择冠状动脉造影正常者20例作为对照组。采用免疫透射比浊法测定3组患者的血清hs-CRP水平,并对NSTE—ACS组患者进行GRACE危险评分。比较三组患者之间血清hs．CRP水平,并对血清hs．CRP水平与GRACE危险评分进行相关性分析。结果血清hs-CRP水平在NSTE-ACS组患者显著高于SA组和对照组。对于NSTE．ACS患者,血清hs—CRP水平与GRACE危险评分呈正相关,高危组患者的血清hs—CRP水平明显高于低危组,高血清hs-CRP水平NSTE-ACS患者的GRACE危险评分也高于低血清hs—CRP水平患者,差异均有统计学意义。结论对于NSTE-ACS患者,血清hs—CRP水平与GRACE危险评分具有良好的病情评估一致性。血清hs—CRP可为NSTE-ACS危险分层提供额外的评估指标。     

PAF表达与冠心病患者冠脉斑块形成及稳定性的关系

目的探讨冠心病患者血清中血小板活化因子(PAF)的水平变化与冠脉斑块性质的关系。方法选取我院确诊的冠心病患者140例,其中稳定性心绞痛患者60例(SAP组)、急性冠脉综合征80例(ACS组),收集时间2014年11月至2016年1月,选取同期健康人群60例作为对照组,检测三组血清PAF水平并进行比较,采用血管内超声技术检测各组CHD患者冠脉斑块的形成情况、斑块参数,并进行相关性分析。结果 ACS组患者的血清PAF水平显著高于对照组和SAP组(P0.05),SAP组患者的血清PAF水平高于对照组(P0.05);ACS组患者的脂质斑块检出率53.74%显著的高于SAP组患者的16.33 (P0.05),ACS组的斑块破裂检出率66.67%显著的高于SAP组的28.57%(P0.05);SAP组纤维斑块检出率52.04%显著的高于ACS组的19.73%(P0.005);ACS组和SAP组的钙化斑块、混合性斑块检出率差异无统计学意义(P0.05);ACS组患者的EEMA、PA、EI、PB、RI高于SAP组(P0.05),ACS组的LA显著低于SAP组(P0.05);冠心病患者血清PAF水平与EEMA、PA、EI、PB、RI参数呈显著的正相关关系(P0.05),与LA呈显著的负相关关系(P0.05)。结论冠心病患者的血清PAF与患者斑块形成及斑块稳定性有关。     

绝经后女性ACS患者雌二醇、C反应蛋白、脂蛋白a与GRACE评分的相关性研究

目的检测绝经后女性急性冠脉综合征(ACS)患者血浆雌二醇(E2)、C反应蛋白(CRP)、脂蛋白a[Lp(a)]的水平并探讨其与GRACE评分的相关性。方法选取绝经后女性经冠脉造影检查确诊为ACS的患者60例,并分为急性ST段抬高型心肌梗死(STEMI)组和非ST段抬高型急性冠脉综合征(NSTE-ACS)组,另选取经冠脉造影检查排除冠心病的绝经后女性60例为对照组。采集其年龄、绝经年龄、体表面积、体重指数等基本信息,并检测其E2、CRP、Lp(a),ACS组患者入院后24h内进行GRACE评分。结果 ACS组与对照组在年龄、绝经年龄、体表面积、体重指数等基线资料方面比较差异均无统计学意义(P0.05)。STEMI组较NSTE-ACS组及对照组血浆E2、CRP、Lp(a)水平升高,差异均有统计学意义(P0.05)。对ACS组内患者按照GRACE评分进行分组后,GRACE评分高危组(140分)患者E2、CRP水平显著高于中危组(109-140分)和低危组(109分)(P0.05)。GRACE评分高危组患者Lp(a)水平高于中危组和低危组但无统计学意义(P0.05)。Pearson直线相关分析表明,ACS组GRACE评分与E2、CRP呈正相关关系(r=0.712,P0.01;r=0.276,P0.05)。结论绝经后女性ACS患者血浆E2、CRP、Lp(a)水平升高,随着GRACE危险程度升高,血浆E2、CRP、Lp(a)水平升高,且E2、CRP水平与GRACE评分呈正相关,在绝经后女性ACS患者中联合应用可能对疾病早期风险评估及预后有重要的临床参考价值。     

FIB和D-二聚体联合GRACE评分与急性冠脉综合征的风险预测

目的探讨纤维蛋白原(FIB)、D-二聚体(D-D)联合GRACE评分对急性冠脉综合征(ACS)患者风险预测。方法分别检测90例ACS患者,23例健康体检者血浆FIB,D-D,GRACE评分及ACS患者冠状动脉病变支数,分析其相关性。结果 ACS患病组FIB,D-D和GRACE评分分别为2.77±0.79 g/L,1.67±2.13 mg/L,147.19±32.50.分,与对照组(2.77±0.13 g/L,0.21±0.08 mg/L,92.30±19.5分)比较显著增高,差异有统计学意义(t=6.256,6.465,10.317,P值均0.001);血浆D-D,FIB含量在不同的危险分层比较,差异有统计学意义(F=18.475,9.426,P值均0.001);相关性分析显示ACS患者血浆D-D(r=0.485,P0.000 1),FIB(r=0.357,P0.000 6)含量与GRACE评分呈正相关关系。结论ACS患者血浆的FIB,D-D和GRACE评分均升高,FIB和D-D可作为ACS的风险预测因子,D-D的预测价值优于FIB。     

血清LPE、LPC对急性冠脉综合征的早期诊断及预后评估价值

目的 探讨血清溶血磷脂酰乙醇胺(LPE)及溶血磷脂酰胆碱(LPC)在急性冠状动脉综合征(ACS)患者早期诊断及预后评估中的价值。方法 选取2021年1月至2022年6月在该院诊治的108例ACS患者作为ACS组,60例稳定型心绞痛(SAP)患者作为SAP组,另选取同期50例健康查体的健康人作为对照组。应用高效液相色谱-串联质谱法检测各组血清LPE、LPC水平。Pearson相关分析血清LPE,LPC水平与肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)的相关性。受试者工作特征(ROC)曲线分析血清LPE、LPC、cTnT对ACS的早期诊断价值。分析血清LPE、LPC水平与全球急性冠状动脉事件注册(GRACE)危险评分的关系。多因素Logistic回归分析影响ACS患者预后的因素。结果 相比于对照组和SAP组,ACS组血清高血压发生率、LPE、LPC、cTnT、CK-MB水平明显较高(均P<0.05)。ACS患者血清LPE、LPC水平与血清cTnT、CK-MB水平均呈正相关(r=0.612、0.568、0.408、0.426,均P<0.05)。GRACE危险评分高危组、中...     

急性冠脉综合征患者血清胎盘生长因子水平的研究

目的探讨急性冠脉综合征（ACS）患者和正常人血清胎盘生长因子（PLGF）水平,并评价血清PLGF水平与冠脉病变程度的相关性。方法选ACS组40例,稳定型心绞痛（SAP）组40例（均接受冠脉造影检查确诊）,正常对照组40例,抽取静脉血采用双抗体夹心ELISA测定血清PLGF的水平,同时记录患者冠脉病变支数及Gensini冠脉病变评分,分别与血清PLGF水平做相关性分析。结果 ACS组血清PLGF水平高于SAP组（36.80±25.18）ng/L vs.（18.40±4.60）ng/L,（P〈0.05）,SAP组血清PLGF水平高于正常对照组（18.40±4.60）ng/L vs.（10.09±3.22）ng/L（P〈0.05）,血清PLGF水平与冠脉病变支数（r=0.753,P〈0.05）和Gensini冠脉病变评分（r=0.735,P〈0.01）均呈正相关。结论 ACS患者血清PLGF水平明显增高,测定血清PLGF水平有可能有助于ACS的诊断及冠脉狭窄程度的评价。     

血浆vaspin浓度与急性冠脉综合征的相关性

目的探讨血浆腹腔脂肪型丝氨酸蛋白酶抑制剂(Vaspin)浓度与急性冠脉综合征的相关性。方法选择稳定型心绞痛患者共87例(SAP组),急性冠脉综合征患者共51例(ACS组),另外选择50例冠状动脉正常者为对照组。检测血清vaspin水平,Gensini积分方法评估冠脉病变程度并分析。结果 ACS组血清vaspin水平显著低于SAP组和对照组,ACS组Gensini积分显著高于SAP组和对照组,差异均有显著性(P0.05)。Spearman相关分析发现,各组血清vaspin水平与Gensini积分具有显著负相关关系(r=-0.762~-0.812;P0.001)。多支病变组血清vaspin水平显著低于单支病变组和2支病变组。结论血清vaspin水平可作为反映急性冠脉综合征患者冠脉病变的新的血清标记物。     

脂连素及胆红素与急性冠脉综合征的关系

目的探讨血清脂连素在急性冠脉综合征发生发展中的作用以及与传统心血管危险因素及胆红素水平的关系。方法将65例冠心病患者设为冠心病组,均行冠脉造影(CAG)检查,其中稳定型心绞痛(SAP)为26例,急性冠脉综合征(ACS)患者39例;对照组15例来自门诊健康查体者。所有患者均测定脂连素、胆红素浓度等指标。ACS组患者血清脂连素水平明显低于SAP组和对照组(均有P<0.01),SAP组与对照组相比较差异有显著性;ACS组患者血清总胆红素水平明显低于对照组,ACS组与SAP组相比较、SAP组与对照组相比较差异均具有统计学意义(P<0.05)。不同Gensini评分组,各组间脂连素的浓度及总胆红素的浓度差异均具有统计学意义(均有P<0.05)。Gensini评分与脂连素、总胆红素浓度有关,而与传统心血管危险因素无关(P>0.05)。低脂连素、总胆红素血症与ACS的发生、发展有一定关系,两者水平能较好地反映冠状动脉病变程度,具有良好的临床价值。     

Interview with George Szasz,CM, MD

Interprofessional working requires co-operation and mutual understanding among the groups concerned, yet there are many barriers that can prevent this from happening. This paper considers the role of professional codes of ethics in this context and addresses their potential for both enhancing and compromising interprofessional working. The manifest and latent functions of codes of ethics are explored, and their potential to foster professional distinctiveness and exclusivity is identified. Comparisons are drawn between a number of codes of professional ethics and areas of common ground identified. The usefulness of the codes in terms of their moral status and the practical support they afford health care practitioners is evaluated, with particular reference to the issue of ‘whistleblowing’, and recommendations are made for refinement of the codes in order to render them more relevant to contemporay practice. In particular, it is suggested that the client should be placed firmly at the centre of the duties imposed on the professional by codes of ethics. Finally, it is argued that the role of management is crucial in facilitating this process and achieving effective interprofessional working. With agreement on the basic values and moral principles of health care, managers can develop their role to become co-ordinators of multiprofessional teams, thus minimising professional rivalries and, through adherence to the recently re-discovered public service ethos, retain a central focus on patient need.     

Cardiotoxicity associated with the synthetic cannabinoid, K9, with laboratory confirmation

Synthetic cannabinoids have been popular recreational drugs of abuse for their psychoactive properties. Five of the many synthetic cannabinoids have been recently banned in the United States because of their unknown and potentially harmful adverse effects. Little is known about these substances. They are thought to have natural cannabinoid-like effects but have different chemical structures. Adverse effects related to synthetic cannabinoids are not well known. We provide clinical effects and patient outcome following K9 use. In addition, we briefly review synthetic cannabinoids. We present a 17-year-old adolescent boy with chest pain, tachycardia, and then bradycardia associated with smoking K9. Two synthetic cannabinoids, JWH-018 and JWH-073, were confirmed on laboratory analysis. In addition to the limited current data, we demonstrate harmful adverse effects related to toxicity of 2 synthetic cannabinoids. Further studies are needed.     

Psychological, sleep, lifestyle, and comorbid associations with headache

OBJECTIVE: To investigate the associations of headache occurrence, severity, and frequency with psychological, sleep, and lifestyle characteristics, and comorbid conditions. BACKGROUND: Whilst associations for individual headache types, particularly migraine, have been investigated, possible associations between headache of all types and general health characteristics have not been explored. METHODS: Cross-sectional postal survey in an adult general population sample registered at five general practices in North Staffordshire, UK. RESULTS: Headache occurrence was associated with anxiety (odds ratio 4.09, 95% confidence interval 3.0, 5.6) and sleep problems (moderate sleep problems OR 3.60, 95% CI 2.5, 5.0), and the strength of the associations increased with higher levels of anxiety and sleep problem. Whilst depression showed an association with headache, this was not seen in respondents with depression in the absence of anxiety. Headache occurrence was also associated with comorbid pain anywhere in the body (OR 2.12, 95% CI 1.7, 2.6), with the strongest associations being for the neck and upper body areas compared with other areas. There was no overall link with alcohol or caffeine consumption. Increasing severity and frequency of headache resulted in stronger associations, and there were strong associations between the occurrence, severity, and frequency of headache, and both sleep problems and psychological distress. CONCLUSION: Poor sleep and anxiety appear to make a substantial contribution to the impact of headache on sufferers' lives in the general population.     

In Vitro Studies with Netilmicin Compared with Amikacin, Gentamicin, and Tobramycin

Netilmicin, a new semisynthetic aminoglycoside derived by ethylation of the 1-N position of the deoxystreptamine ring of sisomicin, was tested in vitro with 4,070 strains of gram-negative bacilli isolated at the UCLA Medical Center during 1975 to 1976, using the agar dilution technique and an inoculum of approximately 10⁴ organisms. Results were compared with those simultaneously obtained for amikacin, gentamicin, and tobramycin. Using Mueller-Hinton medium, inhibitory concentrations in broth correlated with those obtained by the agar dilution method except for Pseudomonas aeruginosa, where a 2- to 16-fold difference in susceptibility was noted. For most clinically significant Enterobacteriaceae and P. aeruginosa, the activity of netilmicin in vitro was comparable or superior to that of gentamicin, tobramycin, and amikacin with respect to potency by weight and achievable blood levels. Against gentamicin-resistant strains (MIC > 16 μg/ml), the activity of netilmicin paralleled that of amikacin with the exception of Providencia stuartii, which was inhibited by amikacin but not by netilmicin.     

Pharmacokinetics of ethambutol under fasting conditions, with food, and with antacids

Ethambutol (EMB) is the most frequent "fourth drug" used for the empiric treatment of Mycobacterium tuberculosis and a frequently used drug for infections caused by Mycobacterium avium complex. The pharmacokinetics of EMB in serum were studied with 14 healthy males and females in a randomized, four-period crossover study. Subjects ingested single doses of EMB of 25 mg/kg of body weight under fasting conditions twice, with a high-fat meal, and with aluminum-magnesium antacid. Serum was collected for 48 h and assayed by gas chromatography-mass spectrometry. Data were analyzed by noncompartmental methods and by a two-compartment pharmacokinetic model with zero-order absorption and first-order elimination. Both fasting conditions produced similar results: a mean (+/- standard deviation) EMB maximum concentration of drug in serum (Cmax) of 4.5 +/- 1.0 micrograms/ml, time to maximum concentration of drug in serum (Tmax) of 2.5 +/- 0.9 h, and area under the concentration-time curve from 0 h to infinity (AUC0-infinity) of 28.9 +/- 4.7 micrograms.h/ml. In the presence of antacids, subjects had a mean Cmax of 3.3 +/- 0.5 micrograms/ml, Tmax of 2.9 +/- 1.2 h, and AUC0-infinity of 27.5 +/- 5.9 micrograms.h/ml. In the presence of the Food and Drug Administration high-fat meal, subjects had a mean Cmax of 3.8 +/- 0.8 micrograms/ml, Tmax of 3.2 +/- 1.3 h, and AUC0-infinity of 29.6 +/- 4.7 micrograms.h/ml. These reductions in Cmax, delays in Tmax, and modest reductions in AUC0-infinity can be avoided by giving EMB on an empty stomach whenever possible.