卡维地洛对充血性心力衰竭神经激素及心功能的影响

为了解卡维地洛对充血性心力衰竭患者神经激素及心功能的影响 ,将 35例充血性心力衰竭病人双盲随机分为卡维地洛组、安慰剂组 ,两组病人基础临床特征相似。于治疗前、后检测血浆中去甲肾上腺素 (NE)、血管紧张素Ⅱ (AngⅡ )浓度、血浆肾素活性 (PRA) ,左心室射血分数 (LVEF)及左心室腔径变化 ,15例健康人为正常对照组。结果显示 :心衰患者血浆中NE、AngⅡ、PRA均较正常对照组升高 (P <0 .0 1) ,卡维地洛组与安慰剂组相比血浆NE、PRA、AngⅡ水平下降 (P <0 .0 1) ,LVEF升高 (P <0 .0 1) ,左室舒张末径 (LVDd)、左室收缩末径(LVDs)均缩短 (P <0 .0 1)、左室收缩末容量 (ESV)减小 (P <0 .0 1)。提示卡维地洛能阻断神经激素对充血性心力衰竭的不良影响 ,改善患者左心功能 ,长期使用可使扩大的左心室腔径缩小。     

血栓抽吸治疗急性ST抬高型心肌梗死神经内分泌变化的临床研究

目的 探讨应用血栓抽吸装置GuardWire PlusTM行血栓抽吸治疗急性ST抬高型心肌梗死(STEMI)神经内分泌变化及其临床价值.方法 将2004年9月至2006年9月在我院行急诊PCI的72例急性STEMI患者分为两组,A组(38例):血栓抽吸后支架植入组;B组(34例):直接PCI组.于手术当天、术后第1、2、3、5日分别测定外周血中内皮素(ET)、血浆肾素活性(PRA)、醛固酮(ALD)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)、肾上腺素(E)水平.术后1周与3个月测定左室射血分数(LVEF),评价心功能.结果 两组病例均成功地置入支架,术前两组患者的神经内分泌因子水平无显著差异(P＞0.05),ET、PRA、AngⅡ、ALD、E等神经内分泌因子于术后第1、2日A组下降较B组明显(P＜0.05),两组间NE下降无明显差异(P＞0.05).术后3个月A组的LVEF明显高于B组(P＜0.05).结论 血栓抽吸治疗急性STEMI较直接PCI能够明显改善恶化的神经内分泌变化,对心功能可能有潜在的保护作用.     

卡维地洛和美托洛尔治疗急性心肌梗死伴心功能不全对比研究

目的　比较卡维地洛和美托洛尔治疗急性心肌梗死 (AMI)伴心功能不全患者的疗效和安全性。方法　 82例AMI伴左心室收缩功能减退患者以 2 :1随机分为卡维地洛组 (5 4例 )和美托洛尔组(2 8例 )。测定治疗前后临床心功能分级、血压、心率、左心室功能及肾功能和血糖、血脂水平。结果　治疗后 ,卡维地洛组的收缩压、舒张压和心率分别从 (12 6± 2 2 )mmHg ,(77± 10 )mmHg和 (75± 10 )次 min下降至 (12 2± 16 )mmHg(P <0 .0 1) ,(74± 9)mmHg(P <0 .0 5 )和 (6 9± 6 )次 min(P <0 .0 1)。美托洛尔组的心率从 (79± 7)次 min下降至 (71± 7)次 min(P <0 .0 1) ,但收缩压 [(12 9± 17)mmHg和 (12 9± 13)mmHg]和舒张压 [(79± 8)mmHg和 (77± 10 )mmHg]无显著变化。卡维地洛和美托洛尔治疗后 ,NYHA心功能分级分别从 2 .7和 2 .8改善为 2 .0 (P =0 .0 0 1)和 2 .2 (P <0 .0 0 1)。两组左心室射血分数增高 (从 0 .4 4± 0 .0 9和 0 .4 5± 0 .0 7增加至 0 .5 2± 0 .0 9和 0 .5 1± 0 .0 8,P均 <0 .0 5 ) ,收缩末期容量降低 (从 5 9± 2 8ml和 5 4± 2 1ml降低至 5 3± 2 2ml和 4 9± 15 ,P均 <0 .0 5 )。卡维地洛组的血糖、总胆固醇 (TC)和低密度脂蛋白胆固醇 (LDL C)从 7.5mmol L ,4 .6mmol L和 3.0mmol L     

依那普利联合卡维地洛治疗无症状性心力衰竭的研究

目的 :观察依那普利联合卡维地洛对无症状心力衰竭患者心室重塑和心功能进展的影响。方法 :4 7例未经治疗的无症状性心力衰竭患者 ,随机分为治疗组 (依那普利 卡维地洛 )和对照组 (安慰剂 )治疗 12个月 ,治疗前后分别进行心功能 (NYHA)分级评估 ,并应用超声心动图测量左室射血分数 (LVEF)、左室收缩末期容积 (LVESV)和左室舒张末期容积 (LVEDV)。结果 :治疗组有 95 8%的患者心功能仍为Ⅰ级 ,对照组只有 6 8 2 %的患者心功能为Ⅰ级 (P <0 0 5 ) ;LVEF治疗组从 37 7%上升到 4 8 5 % (P <0 0 5 ) ,而对照组从 38 3%下降至 33 4 % (P <0 0 5 ) ,治疗组与对照组相比有显著性差异 (P <0 0 1) ;治疗组LVESV、LVEDV较治疗前明显下降 (P <0 0 5 ) ,对照组LVESV、LVEDV继续恶化 ,但与治疗前相比无显著性差异 (P >0 0 5 )。结论 :依那普利与卡维地洛联合治疗能抑制无症状心衰患者的心室重塑 ,提高左室射血分数 ,延缓无症状心衰的进展 ,降低心衰住院率。     

卡维地洛与美托洛尔治疗慢性心力衰竭的长期疗效观察

目的对比第三代β受体阻滞剂卡维地洛(carvediol)与第二代β受体阻滞剂美托洛尔(metoprolol)对慢性充血性心力衰竭(CHF)的长期临床疗效,为临床治疗的药物选择提供依据。方法81例患者随机分为卡维地洛组(n=43)和美托洛尔组(n=38),治疗6个月,监测治疗前后心率(HR)、血压(BP)、左心室内径(LVEDD、LVESD)、射血分数(LVEF)的变化。结果美托洛尔组心率的减慢明显优于卡维地洛组(P<0.01),卡维地洛组收缩压和舒张压的下降比美托洛尔组明显(P<0.05),卡维地洛组LVEF、LVEDD与LVESD的改善优于美托洛尔组(P<0.05)。结论美托洛尔有更明显的减慢性率的作用,卡维地洛有更好的降压、增加心肌收缩力,改善心功能作用,还表现出更强的逆转心肌重构作用。     

卡维地洛对心力衰竭患者的抗氧化作用

 目的探讨卡维地洛治疗充血性心力衰竭(CHF)的临床疗效及抗氧化作用.方法将35例充血性心力衰竭患者双盲随机分为卡维地洛组和安慰组,两组患者基础临床特征相似,于治疗前后检测血浆中谷光甘肽(GSH)、超氧化物歧化酶(SOD)及丙二醛(MDA)浓度,左室射血分数(LVEF)及左室腔径变化,15例健康人为对照组.结果CHF患者MDA浓度较对照组上升(P＜0.01),GSH、SOD浓度较对照组下降(P＜0.01),卡维地洛组与安慰组相比MDA浓度下降(P＜0.05),GSH、SOD水平上升(P＜0.01);LVEF升高(P＜0.01),左室舒张末期径(LVDd)和左室收缩末期径(LVDs)均缩短(P＜0.01),左室收缩末期容量(ESV)减小(P＜0.01).结论卡维地洛具有抗脂质过氧化物作用,改善CHF患者左心功能,长期使用可使扩大的心室缩小.     

高血压病患者血浆肾上腺髓质素前体肽段水平及其与部分调节肽的相互关系

目的:探讨高血压病患者肾上腺髓质素N端20肽(PAMP)水平,及其与内皮素(ET)、血管紧张素Ⅱ(AⅡ)、去甲肾上腺素(NE)和肾上腺素(E)的相互关系.方法;用放免法测定血浆PAMP、ET和AⅡ的含量,用高效液相法测定血浆NE和E的浓度.结果:高血压病患者血浆PAMP、ET、AⅡ、NE和E含量均高于对照组(P<0．01);与平均动脉压(MAP)均呈正相关(P<0．05~0．001);PAMP与ET、AⅡ,NE、E亦呈正相关(P<0．05~0.01);经血管紧张素转化酶抑制剂(ACEI)治疗后,其MAP、PAMP、ETAⅡ、TVE、E均下降(P均<0．01).结论:PAMP是一种新的舒血管肽,高血压病患者其血浆浓度升高,可拮抗缩血管物质的生物学效应,对维持机体内环境稳定起重要作用,     

卡维地洛与螺内酯联合应用治疗72例充血性心力衰竭的临床评价

目的 观察卡维地洛与螺内酯联合应用治疗72例充血性心力衰竭的临床效果.方法 选取治疗的慢性充血性心力衰竭患者72例为研究对象,将其随机分为对照组(常规治疗组)34例和实验组(卡维地洛与螺内酯组)38例,药物治疗20周,然后对比两组治疗前后心率、步行距离改变情况及超声检测左心室舒张末期容积(LVEDD)、左心室收缩末期容积(LVESD)和左心室射血分数(LVEF).结果 两组治疗后与治疗前比,实验组治疗后与对照组治疗后比均P＜0.05,存在统计学差异.结论 在慢性充血性心力衰竭常规治疗基础上加用卡维地洛与螺内酯联合治疗,不仅能改善心功能,且长期使用更安全.     

卡维地洛与美托洛尔对充血性心力衰竭的疗效和二者的成本─效果分析

目的:观察卡维地洛与美托洛尔治疗充血性心力衰竭(CHF)的远期疗效及二者的成本─效果分析.方法:选择CHF患者114例,随机分3组.A组为对照组,予以血管扩张剂、利尿剂、地高辛、血管紧张素转换酶抑制荆等常规治疗;B组为卡维地洛组,在上述常规治疗的基础上给予卡维地洛.C组在常规治疗基础上给予美托洛尔,随访6个月.用药前后分别观察左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、心衰症状等指标变化情况.结果:6个月后B组和C组LVEDD、LVESD缩小,LVEF明显提高,心衰症状明显好转.但卡维地洛组LVEF改善优于美托洛尔组:卡维地洛组的成本─效果分析低于美托洛尔组.结论:美托洛尔、卡维地洛均可逆转心室重塑,改善心脏功能.卡维地洛疗效略优于美托洛尔.     

经急诊PCI治疗的急性心肌梗死患者血浆N氨基末端脑钠肽前体水平变化的临床意义

目的探讨血浆N氨基末端脑钠肽前体(NT-proBNP)在行急诊经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者的临床意义。方法荧光免疫法检测72例行急诊PCI治疗的AMI患者入院时血浆NT-proBNP和肌钙蛋白I(cTnI)浓度及入院第7天血浆NT-proBNP浓度,经超声心动图测定入院1周时左心室射血分数(LVEF)及左心室舒张末期内径(LVEDD)。随访观察发病3月内是否发生心衰、再梗死、梗死后心绞痛、心血管死亡等心血管事件,比较心血管事件组与无心血管事件组之间相关指标的差别。分析两组入院时血浆NT-proBNP和cTnI及入院第七天血浆NT-proBNP和LVEF、LVEDD的相关性。结果 45例患者未发生心血管事件,27例患者发生心血管事件,且两组患者入院时血浆NT-proBNP均与cTnI呈正相关,入院第7天血浆NT-proBNP浓度较入院时明显降低(P<0.05),入院第7天血浆NT-proBNP与LVEDD呈正相关、与LVEF呈负相关。结论血浆NT-proBNP浓度是反映左心室功能不良的更敏感和特异的指标,可以反映心肌坏死程度并预测AMI患者近期预后。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.