延迟经皮冠状动脉腔内成形术对急性心肌梗死患者左室心功能的影响

目的　本研究评价延迟的经皮冠状动脉腔内成形术 (PTCA)所产生的梗死区再灌注血流对急性心肌梗死 (AMI)患者左心室功能恢复的影响。方法　 33例初次Q波型AMI患者 ,于发病 2～3周内分别进行PTCA治疗。全部病例梗塞相关血管均为完全或次全闭塞病变。经过左心室造影应用面积长轴法计算每例患者的左室射血分数 (LVEF) ,梗塞区室壁运动百分率 ,左心室舒张末容积指数 (EDVI)及Cortina室壁运动不良积分。PTCA 6个月后所有患者重复进行左心室造影及重复以上指标的测量。结果　在PTCA 6个月后 ,本组病例表现出左室局部及整体收缩功能明显改善 [LVEF(5 5 2± 10 1) %vs (4 9 2± 9 9) % ,P <0 0 1]。梗塞区收缩百分率 [(12 8± 5 2 ) %vs (11 5± 6 0 ) % ,P <0 0 5 ]。Cortina室壁运动不良积分下降 [(7 6± 3 2 )vs (9 2± 2 8) ,P <0 0 1]。而EDVI则无明显变化 ,说明左心室的扩张受到了限制。结论　提示Q波型急性心肌梗死接受延迟的PTCA再血管化治疗有益于患者左心功能的恢复。     

老年急性心肌梗死并发型糖尿病患者临床及冠脉造影的分析

目的 :了解老年急性心肌梗死 （AMI）患者有和无 型糖尿病时 ,其临床及冠状动脉病变的异同。方法 :对 2 7例老年 AMI并发 型糖尿病 （A组 ）患者和 34例 AMI无糖尿病的患者 （B组 ）行冠状动脉和左室造影 ,分别记录临床情况和造影结果。结果 :A组甘油三脂为 2 .0± 0 .5 m mol/L,B组为 1.5± 0 .4 mm ol/L;A组并发心衰及高血压病例数多于 B组 ,冠状动脉积分、冠状动脉狭窄部位数和室壁运动积分 A组均高于 B组 ;A、B两组 L VEF值分别为4 7%± 19%和 5 6 %± 13% （P<0 .0 5 ）。结论 :老年 AMI并发 型糖尿病患者临床和冠状动脉病变情况均重于老年AMI无糖尿病的患者。     

等长运动对正常人、冠心病患者左室心功能的影响

目的 :通过核素心血池显像测定静息状态和等长运动后正常人、冠心病患者左室心功能指标的变化 ,探讨等长运动对冠心病诊断的临床价值。方法 :45例正常人、10 0例冠心病患者常规核素平衡法门电路心血池显像测定左室心功能。在静息状态下采集后 ,保持探头和患者体位不变 ,双手握力 5～ 10 min并同时进行采集从而获得静息和握力运动状态下两组血流动力学指标和时间—放射性曲线。11例正常人和 10 0例冠心病患者行冠状动脉及左心室造影 ,两项检查间隔不超过两周。运用 SPSS9.0统计软件进行 t检验和直线相关分析。结果 :左室射血分数（L VEF）、高峰充盈率 （PFR）、左室舒张末期容积 （L VEDV ）、左室收缩末期容积 （L VESV ）和心率 （HR）在静息（Rest）状态下 ,对照组和冠心病组分别为 （5 2± 9） % vs（4 5± 9% ） ,P<0 .0 1;2 .7± 0 .8EDV/s vs2 .0± 0 .8EDV/s,P<0 .0 1;1.33± 0 .12 vs 1.2 8± 0 .11,P <0 .0 5 ;0 .6 3± 0 .10 vs 0 .0 7± 0 .0 8,P<0 .0 1;7.0± 10 m in- 1 vs 6 9± 9min- 1 ,P>0 .0 5。在等长握力运动 （Stress）状态下 ,对照组和冠心病组分别为 （5 6± 10 ） % vs（4 2± 10 ） % ,P<0 .0 1;3.1± 0 .8EDV/s vs 1.8± 0 .7EDV/s.P<0 .0 1;1.35± 0 .14vs 1.2 5± 0 .12 ,P<0 .0 1;0 .6 0± 0 .1     

急性前壁心肌梗死后梗死相关血管延迟开通对晚期左室重构的影响

目的　探讨急性前壁心肌梗死(AMI)后延迟经皮冠状动脉介入治疗(PCI)使梗死相关动脉(IRA)开通对AMI晚期左室重构的影响。方法　选择64例急性前壁、前间壁及广泛前壁Q波性AMI后病情稳定,发病2~14天,平均(9 .1±2 .3)天冠状动脉造影证实左前降支完全闭塞者,依据是否成功行PCI,分为成功PCI组和对照组,分别于急性期、术后2个月和6个月应用超声心动图随访左室大小、左室功能和室壁活动异常情况,并观察6个月期间心力衰竭事件的发生情况。结果　AMI后2个月两组左室射血分数、左室收缩末期容积指数、左室舒张末期容积指数和室壁活动异常积分与急性期相比差异无统计学意义,急性期和2个月时两组上述各指标之间差异也无统计学意义。6个月时两组左室射血分数和室壁活动异常积分与急性期和2个月相比差异无统计学意义,但对照组左室舒张末期容积指数和左室收缩末期容积指数较急性期明显增大(P<0 .01, P<0. 05 ),且与成功PCI组相比差异有统计学意义(P<0 .01, P<0 .05)。6个月随访期间心力衰竭事件发生率对照组为19%,成功PCI组为2%,但差异无统计学意义。结论　急性前壁AMI后IRA延迟开通能明显减少AMI后晚期的左室重构,而对AMI后早期左室重构的影响不大。延迟PCI可能有利于减少AMI后远期心力衰竭事件的发生。     

延迟经皮腔内冠状动脉成形术及支架植入术治疗急性心肌梗死的意义

目的：探讨延迟经皮腔内冠状动脉成形术（PTCA）及支架植入术对急性心肌梗死（AMI）患者左室功能和预后的影响。方法：选择AMI3周～3个月内的21例患者行PTCA及支架植入术,设同期住院的30例心肌梗死患者做对照组,观察两组患者出院后3个月、6个月的超声心动图检查、活动平板运动试验、动态心电图检查结果及半年内的死亡、再梗死、接受外科搭桥手术情况。结果：介入治疗组3个月后左室重构改善,6个月时左室功能及运动耐量较对照组明显提高（P＜0．01）,无死亡、再梗死和接受外科手术者;对照组再梗死、死亡及接受外科搭桥手术各1例。结论：延迟PTCA及支架植入术,能改善AMI患者的左室功能和预后,手术本身有较高的成功率。     

经皮冠状动脉介入治疗对心肌梗死患者心功能的影响

目的 :评价心肌梗死并左心功能不全患者经皮冠状动脉介入 （PCI）治疗对左心收缩功能和左心室重构的影响。方法 :急性心肌梗死 （AMI）患者 30例 ,陈旧性心肌梗死 （OMI） 2 2例 ,经 PTCA、支架术治疗 ,术后随访 3个月 ,超声心动图测定左室舒张末内径 （L VEd）、左心房内径 （L Ad）、左室舒张末容积 （L VEDV）、左室收缩末容积（L VESV）、左室射血分数 （L VEF）和左室短轴缩短率 （L VFS） ,比较治疗前后各参数的变化。结果 :PCI治疗后L VEd、L Ad、L VEDV、L VESV显著减少 （P<0 .0 1）、L VEF和 L VFS显著增高 （P<0 .0 1） ,尤以 AMI组明显 ,并且冠状动脉血运重建的时间越早 ,心功能恢复越好。结论 :心肌梗死并左心功能不全患者尽早 PCI治疗可明显改善左心室收缩功能 ,可部份阻抑左心室重构。     

超声心动图评价PTCA手术前后左心功能变化

目的 :评价经皮冠状动脉腔内成形术 （PTCA）术后的左心功能变化。方法 :用二维彩色多普勒超声心动图对5 8例行 PTCA的冠心病患者 PTCA手术前后的心功能进行检测。结果 :PTCA92例次 （管腔狭窄由 86 %± 14%降至 13%± 2 1%） ,术前心脏 B超提示 ,冠心病患者存在狭窄或梗塞相关的室壁节段运动异常 ,左室收缩、舒张功能明显下降。PTCA手术后 2～ 4周 ,左室收缩功能明显改善 ,EF值比术前明显增高 （P<0 .0 1） ,节段性室壁运动异常率降低 ,左室舒张功能指标较比术前明显改善。结论 :PTCA术后 2～ 4周 ,左室心脏功能明显改善 ,B超可作为评价手术疗效的指标。     

AMI患者PCI后心肌灌注水平对心功能及左室重构的影响

目的:探讨急性心肌梗死（AMI）患者经皮冠脉介入术（PCI）后TIMI血流III级时的心肌灌注水平及其对心功能与左室重构的影响。方法: 对36例AMI患者PCI后行经静脉心肌声学造影（MCE）和心脏二维超声检查。①利用心肌声学造影评分（MCS）及室壁运动评分(WMS)分析PCI后心肌灌注情况与室壁运动情况的关系;②根据声学造影积分指数（CSI）将患者分为A、B两组,比较两组的左室射血分数（LVEF）,评估心肌灌注水平对心功能的影响;③根据心脏二维超声结果,比较两组患者术后6个月时左室舒张末直径（LVEDD）及LVEF的变化,进一步评估心肌灌注水平对左室重构的影响。结果: PCI后梗死相关血管TIMI血流均达III级。共152节段与梗死相关血管的再灌注有关。①MCS为0分的18节段中,2个（11.1%）WMS为1~2分;MCS为0.5分的30节段中16个（53.3 %）WMS为1~2分;MCS为1分的104节段中,82个（78.8%）WMS为1~2分;统计学分析显示,PCI后心肌灌注水平与室壁运动呈正相关（P<0.05）。②心肌灌注好的A组LVEF显著大于B组［(52.1±3.4)%,(47.2±2.9)%,P<0.05］。③术后6个月A组的LVEF及LVEDD均无明显变化,B组的LVEF较前有所下降［(47.2±2.9)%,(43.8±4.4)%,P<0.05］,LVEDD较前有所增加［(50.2±2.9) mm,(56.3±3.1) mm,P<0.05］。结论: AMI患者PCI后心肌灌注水平与心功能及左室重构有一定相关性,良好的心肌灌注在一定程度上可以抑制左室重构。     

急性心肌梗死延迟冠脉介入对左心功能的影响

目的探讨急性心肌梗死患者延迟冠脉介入对心功能的影响。方法选择明确诊断急性前壁心肌梗死的患者,在心肌梗死10～30d内行冠状动脉造影术,造影显示前降支血管残余狭窄≥75%者,根据是否进行冠脉介入治疗分为A组和B组。所有患者在造影前及6个月随访时,分别做超声心动图检查,以心内膜运动和室壁增厚率的变化评价室壁运动。同时测量左室收缩末容积(LVESV)、舒张末容积(LVEDV)和左室射血分数(LVEF)结果PCI组血运重建后,随访时E/A比值及左室射血分数均升高(P<0.001;P<0.01),左室收缩末容积指数缩小(P<0.05),室壁运动积分指数降低(P<0.05),而药物治疗组随访时E/A比值及左室射血分数均降低(P<0.05),左室收缩末容积指数增加(P<0.05),室壁运动积分指数升高(P<0.05)。结论延迟介入治疗对有闭塞性血管病变患者的左心室结构和功能恢复有重要的作用。     

冠状动脉介入治疗对心肌梗死患者室壁瘤逆转和心功能的影响

目的 探讨不同时间段行经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)后左心室室壁瘤(LVA)形成的逆转效应及其对心功能的影响.方法 选择2001年1月至2004年7月我院收治的首次前壁AMI患者,经导管法左心室造影确定合并室壁瘤者共326例,根据AMI发病后行PCI的时间分为:发病≤3 h组、4～6 h组、7～12 h组和1周组(发病时间≥13 h且小于1周),4组患者于PCI后即行导管法左心室造影,测定心室容积、压力参数和室壁运动积分;PCI术后1周时行平衡法核素心室造影,测定反常室壁容积指数;6个月时重复上述检查,并随访3年,记录主要心脏事件(MACE)的发生率. 结果 PCI术后6个月随访,发病≤3 h组、4～6 h组、7～12 h组、1周组左心室舒张末期容积指数、左心室收缩末期容积指数、左心室室壁运动积分、左心室舒张末期压力均较行PCI时降低(均P<0.05),而左心室射血分数较前增高(P<0.05),其中发病≤3 h组变化最为显著.PCI术后6个月,发病≤3 h组反常室壁容积指数明显低于4～6 h组、7～12 h组、1周组,分别为:(12.1±2.1)%与(15.4±2.4)%、(16.5±2.5)%、(20.4±3.7)%,均P<0.05.住院期间及术后3年随访,≤3 h组、4～6 h组、7～12 h组3组MACE发病率低于1周组,3年随访时病死率均低于1周组(分别为2.8%、3.0%、3.1%与17.9%,均P<0.05). 结论 对AMI患者越早期开通梗死相关动脉,越能有效地抑制并逆转LVA的形成,提高左心室功能,改善患者的预后.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.