冠状动脉分叉病变主支支架治疗后分支发生缺血事件的研究

目的通过分析单支架"骑跨"术后分支发生缺血事件的冠状动脉分叉病变病例特点,以期获得分支发生缺血事件的影响因素。方法回顾性分析2012年2月~2014年8月在本院接受单支架"骑跨"术治疗后分支发生缺血事件的7例分叉病变患者,术后进行定量血管造影分析,分析分叉病变的特点并探讨分支发生缺血事件的影响因素。结果 7例患者术前分支血管平均参考血管直径为(2.19±0.33)mm,分支病变平均长度为(4.37±2.47)mm,分支血管开口平均病变狭窄程度为(40.09±18.43)%,主支支架术后分支狭窄程度绝对值平均增加(32.84±13.62)%,分支血管走行平均长度为(20.47±9.19)mm,分叉夹角平均为(36±14.63)°。其中,1例于术后1 h出现分支血管闭塞,行"裙裤"技术挽救分支,另外6例术后3~6个月内均出现不同程度的分支血管狭窄加重,并出现相应心肌缺血症状及临床证据,其中3例于分支血管植入支架。结论分支血管直径大、供血范围广、分支血管开口狭窄且术后狭窄明显加重、分叉夹角小的分叉病变,单支架"骑跨"术后分支将来发生分支缺血事件的可能性大。     

心电图缺血分级与急性心肌梗死靶血管定位及狭窄程度的关系

目的探讨心电图缺血分级与急性心肌梗死(AMI)靶血管定位及狭窄程度的关系。方法共纳入80例AMI患者,发病时间12 h,根据Birnbaum心电图缺血分级分为二级缺血组(50例)和三级缺血组(30例),采用冠脉CAG直径目视法比较靶血管定位及狭窄程度,CK-MB、cTnI和BNP水平,左室舒张末内径(LVEDd)和射血分数(LVEF);随访6个月,比较主要心脏不良事件(MACE)的发生率。结果三级缺血组CK-MB、cTnI和BNP的基线水平及升高幅度均大于二级缺血组,差异有统计学意义(P0.05)。组间LVEDd和LVEF值比较无统计学差异(P0.05)。三级缺血组左前降支、左主干和左主干分叉病变发生率较高,二级缺血组以回旋支和右冠及分支病变为主;三级缺血组平均靶病变数目和管腔狭窄程度显著高于二级缺血组,差异有统计学意义(P0.05)。三级缺血组MACE发生率上升,差异有统计学意义(P0.05)。结论心电图缺血分级可评估AMI靶血管定位及狭窄程度,有重要的临床应用价值。     

紫杉醇药物洗脱支架应用的临床观察

目的探讨应用紫杉醇药物洗脱支架对经皮冠状动脉介入治疗(PC I)后再狭窄率及远期预后的影响。方法163例冠心病患者随机分为药物支架组83例和对照组80例,分别接受TaxusTM支架和Express2普通金属裸支架治疗。术后6个月行冠状动脉造影,并随访(10.7±2.3)个月,观察主要不良心血管事件(MACE)、靶血管失败(TVF)及支架内血栓形成等心脏事件情况。结果术后6个月冠状动脉造影QCA分析示药物支架组靶血管支架内及节段内MLD分别为(2.19±0.32)mm和(2.07±0.30)mm,显著大于对照组的(1.86±0.35)mm和(1.79±0.32)mm;支架内及节段内直径狭窄分别为(11.69±9.03)%和(18.59±9.11)%,显著低于对照组的(32.14±8.87)%和(35.09±9.01)%;再狭窄率为4.0%,显著低于对照组的34.9%。随访期药物支架组间主要不良心脏事件和靶血管失败发生率分别为13.3%和9.6%,均显著低于对照组的26.3%和21.3%;而支架内血栓形成发生率2组间差异无统计学意义。结论应用紫杉醇药物洗脱支架可以减少PC I术后再狭窄的发生并改善预后,且较安全。     

经颅多普勒超声联合呼气末二氧化碳分压评估脑血管狭窄患者脑血管储备功能的临床意义

目的 探讨经颅多普勒超声(TCD)联合呼气末二氧化碳分压(PETCO2)评估脑血管狭窄患者脑血管储备(CVR)功能的临床意义.方法 对52例脑血管狭窄患者(分为单血管狭窄组22例和多血管狭窄组30例)和45例健康体检者(对照组)采用TCD联合PETCO2检测,通过吸入自身呼出二氧化碳诱导高碳酸血症,过度换气诱导低碳酸血症的方法测定CVR功能.结果 (1)单血管狭窄组患侧[(3.16±2.73)％/mm Hg,1 mm Hg =0.133 kPa]、多血管狭窄组病变较重侧[(2.41±1.25) ％/mm Hg]和对照组血管扩张储备[(3.75±1.77)％/mm Hg]比较差异有统计学意义(F=3.866,P＜0.05),其中多血管狭窄组病变较重侧的血管扩张储备明显低于对照组,差异有统计学意义(t=-2.657,P＜0.05).单血管狭窄组患侧[(3.13±1.38) ％/mm Hg]、多血管狭窄组病变较重侧[(2.01±1.89)％/mm Hg]和对照组血管整体储备[(3.51±0.92)％/mm Hg]比较差异有统计学意义(F=5.905,P＜ 0.05),其中多血管狭窄组病变较重侧血管整体储备明显低于对照组及单血管狭窄组患侧,差异有统计学意义(t=-3.468、2.582,P＜0.05).(2)单血管狭窄组、多血管狭窄组及对照组在平静呼吸、低碳酸血症、高碳酸血症时PETCO2比较差异均无统计学意义(F=0.398、0.967、1.186,P＞ 0.05).(3)血管病变程度与血管扩张储备、血管整体储备呈负相关(r=-0.433、-0.475,P＜ 0.05).结论 TCD联合PETCO2作为一种简单、方便、经济的手段可有效地用于CVR功能的评价与研究.脑血管病变患者由于血管狭窄、闭塞、血流受阻使CVR功能降低,狭窄程度越重,CVR功能越差.     

药物支架治疗冠状动脉分叉病变9个月随访研究

目的：探讨应用国产药物洗脱支架（DES）治疗分叉病变及主支及分支血管均植入药物支架（Stent／Stent）和主支血管植人药物支架、分支血管球囊扩张（Stent/PTCA）两种方法的临床疗效。方法：自2003年9月至2007年1月在我中心因心绞痛、陈旧性心肌梗死、无痛性心肌缺血行冠状动脉造影证实为自身冠状动脉分叉病变的患者242例，248处病变。分又病变的标准根据Lefevre的标准进行分类，主支血管及分支血管的直径均大于2．5mm。分叉病变的类型为前降支／对角支105例（42．3％）．左冠状动脉主干分又病变70例（28．2％），回旋支／钝缘支42例（16．9％）．右冠状动脉远端分叉病变31例（12．5％），处分叉病变中采用Crush技术28例，“T”型支架置入23例；Reverse T支架置入25例，改良“Y”型支架置入3例；对吻支架置入11例；“V”型支架置入1例和Culotte技术置入5例。其余152例（64．7％）使用cross over技术，共植入药物支架384枚，其中Firebird支架（上海微创公司）327枚，占84．5％。术前常规应用阿司匹林及波力维，术中应用普通肝素或低分子肝索抗凝。术后用药氯吡格雷75mg／d至少服用6个月，长期服用阿司匹林100mg／d。主要研究终点为术后及9个月内的MACE事件（心源性死亡、急性心肌梗死、支架内血栓形成、再次靶血管重建术）。结果：手术成功率为100％，住院期间无死亡，住院期间心脏事件发生率为0％，所有病例均完成了9个月的临床随访，随访期间死亡3例，其中心源性死亡2例，非ST段抬高心肌梗死3例，再发心绞痛13例，主要心脏不良事件7．4％。118例完成9个月的造影随访，随访率为44．5％，其中双药物支架组51例，主支支架组67例。11例发生了支架内再狭窄．其中双药物支架组5例，主支支架组6例，发生率分别为9．8％和9．0％，P〉0．05，总再狭?     

左主干末端病变选择性雷帕霉素洗脱支架术临床评价

目的评价雷帕霉素洗脱支架在左主干末端分叉病变中应用的安全性及疗效。方法分析40例植入该支架的左主干末端病变的患者临床资料、手术术式、手术操作技巧、手术前后影像学结果、住院期间严重不良心性事件(MACEs)、出院后随访以及术后8个月的造影结果等。结果(1)患者平均最小管腔内径由术前(0.81±0.48)mm增加到了术后(3.53±0.22)mm。(2)手术即刻成功率为100.0%,住院期间的心绞痛复发率、病死率及急诊再次血运重建率均为0,非致死性心肌梗死病死率为2.5%。(3)平均随访(8.43±3.24)个月,MACEs发生率为20.0%。(4)27例(67.5%)患者术后8个月复查冠状动脉造影,22例(81.5%)患者左主干原支架内未见明显狭窄,5例(18.5%)患者左主干相关部位出现新病变,晚期管腔丢失平均为(2.18±0.11)mm。(5)不同手术方式的患者造影随访再狭窄率差异无统计学意义。结论雷帕霉素洗脱支架在经选择的左主干末端分叉病变中的应用,近期内是安全、有效的。     

原发性高血压并发急性心肌梗死的临床特点

目的 探讨原发性高血压患者并发急性心肌梗死(AMI)后血压的变化、临床特点以及冠状动脉病变的特点.方法 选取175例AMI患者,按发病前有无原发性高血压分为高血压组(A组)和非高血压组(B组),比较两组发生AMI后血压水平的变化、临床特点以及冠状动脉造影结果.结果 A组患者无痛性心肌梗死发生率为23.76%,高于B组(10.81%),P＜0.05.AMI后血压下降发生率:A组为83.17%,B组为28.38%,差异有统计学意义(P＜0.05).收缩压下降值:A组为(32±14)mm Hg(1 mmHg=0.133 kPa),B组为(12±9)mm Hg,差异也有统计学意义(P＜0.05),舒张压下降值:A组为(11±5)mm Hg,B组为(9±5)mm Hg,差异无统计学意义(P＞0.05).心功能分级:心功能Ⅲ级及Ⅳ级在A组分别为22.77%、17.82%,B组分别为12.16%、9.46%,差异有统计学意义(P＜0.05).并发症发生率A组高于B组(P＜0.05).A组病变血管双支、三支及三支以上病变率均显著高于B组(P＜0.05),A组患者中有32例(31.68%)为分叉病变,B组,仅有10例(13.51%)为分叉病变,差异有统计学意义(P＜0.05),病变血管弯曲数在A组为(5.7±1.2)个,而在B组为(2.1±0.5)个,差异有统计学意义(P＜0.05).结论 原发性高血压患者发生AMI后血压下降发生率、严重程度、并发症发生率及病死率均高于无原发性高血压组患者,其冠状动脉病变严重,病变范围广,血管弯曲及分叉病变较多.     

Rotarex~?S在股腘动脉钙化性病变血管准备中的应用初期经验

目的探讨Rotarex? S在股腘动脉钙化性病变血管准备中的应用价值。方法回顾性分析大连医科大学附属第一医院2020年3月至2021年12月收治5例应用Rotarex? S结合药物球囊处理的股腘动脉钙化性狭窄患者的资料, 记录所有操作的技术成功率、技术相关并发症, 应用CT软件对比所有病例术前及术后靶病变区有效管腔面积, 记录所有患者术前及术后患肢缺血分级情况。结果 5例患者均成功完成了Rotarex? S对钙化病变的减容处理, 减容后接受药物球囊扩张治疗, 技术成功率100%, 无限流性夹层、血管穿孔及远端栓塞事件发生。术后靶病变区有效管腔面积提高9～15.1 mm2(中位数:13 mm2), 所有患肢缺血程度从术前的Rutherford 2～4级提升至Rutherford 1～2级。结论 Rotarex? S在股腘动脉短段钙化性病变减容处理上安全、有效。     

基于CTA图像的髂总动脉分叉角大小与分叉附近斑块形成的相关性研究

目的:基于CT血管造影(CT angiography,CTA)图像探讨髂总动脉分叉角大小与其附近斑块形成是否具有一定的相关性。方法:选择影像科行下肢动脉CTA检查或腹部CT增强扫描的159例患者作为研究对象,155例患者被纳入研究范围。在原始轴位CT图像基础上进行冠状位多平面重建,测量髂总动脉分叉角并诊断分叉附近有无斑块形成,记录有斑块及无斑块患者的右侧髂总动脉、左侧髂总动脉及双侧髂总动脉的分叉角度。采用SPSS 19.0进行统计学分析。结果:右侧髂总动脉无斑块者平均夹角[(13.78±6.08)°]小于有斑块者[(24.01±7.47)°],角度大小与斑块形成之间有相关性(P<0.05);左侧髂总动脉无斑块者平均夹角[(12.85±6.45)°]小于有斑块者[(27.65±10.81)°],角度大小与斑块形成之间有相关性(P<0.05);双侧髂总动脉均无斑块者平均夹角[(26.58±9.28)°]小于均有斑块者[(48.37±15.72)°],角度大小与斑块形成之间具有相关性(P<0.05)。无论有无斑块,受检者的左侧髂总动脉平均夹角与右侧无统计学差异(P>0.05)。结论:髂总动脉分叉角大小与分叉附近斑块形成具有一定相关性,角度越大斑块越易形成,而左侧与右侧髂总动脉分叉角大小无统计学差异。     

适度告知对冠脉严重狭窄病人心肌缺血事件的影响

目的　探讨适度告知对冠状动脉病变严重狭窄病人的心肌缺血事件的影响。　方法　将实施冠状动脉造影后示多支多处严重狭窄需进d一步治疗的 10 5例病人随机分为观察组 (5 3例 )和对照组 (5 2例 ) ,观察组只告知冠脉有病变 ,不告知具体病变血管支数和狭窄程度 ,对照组被告知冠状动脉造影真实结果 ,两组均将造影所示结果告知病人家属。观察并比较两组病人造影术后 4h焦虑值及 3d内心肌缺血发生情况。　结果　观察组焦虑值及心肌缺血事件发生率均低于对照组 (P <0 .0 1)。　结论　冠状动脉病变适度告知可减少多支多处严重狭窄病人冠状动脉造影后心肌缺血事件发生率     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.