雷帕霉素与紫杉醇洗脱支架置入治疗冠状动脉病变的有效性

背景：药物洗脱支架置入治疗冠状动脉病变具有良好的临床效果,但不同支架的治疗效果可能存在一定差异。 目的：比较不同支架置入治疗冠状动脉病变的临床效果。 方法：纳入278例冠状动脉病变患者,均接受冠状动脉支架置入治疗,其中91例置入雷帕霉素洗脱支架,92例置入紫杉醇洗脱支架,95例置入裸金属支架。支架置入后随访12个月,记录死亡和心肌梗死等不良心脏事件发生情况,以及冠状动脉再狭窄发生情况及材料宿主反应。 结果与结论：雷帕霉素洗脱支架组与紫杉醇洗脱支架组冠状动脉再狭窄率、急性心肌梗死发生率、冠状动脉旁路移植或再次经皮冠状动脉介入治疗率均低于裸金属支架组(P < 0.05),雷帕霉素洗脱支架组与紫杉醇洗脱支架组上述指标比较差异均无显著性意义(P > 0.05)。3组死亡率比较差异无显著性意义(P > 0.05)。3组均未发生支架移位、脱落、断裂、置入位置不良及白细胞增多和血小板减少、溶血等情况。表明两种药物洗脱支架的治疗效果相当,均优于裸金属支架。  中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

冠状动脉支架置入24 h血清内脏脂肪素变化

背景：冠状动脉支架置入会造成血管损伤和管壁重构,从而引起血管支架内的再狭窄。研究发现内脏脂肪素与炎性反应相关,在急性心肌梗死斑块破裂处表达增高。目的：观察经皮冠状动脉支架置入后早期对冠状动脉粥样硬化性心脏病患者血清内脏脂肪素水平的影响。方法：选取发病12 h内并行急诊冠状动脉支架置入的急性心肌梗死患者30例,同期选取行冠状动脉支架置入的不稳定性心绞痛和稳定性心绞痛患者各30例;同时选择一组仅行冠状动脉造影无需支架置入治疗患者30例,另选未接受任何处理的健康患者30例作为正常对照组。结果与结论：酶联免疫吸附法检测结果显示,急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组置入前及置入后30 min,置入后6,12,24 h各时点脂肪素的浓度持续升高,且均高于正常对照组(P < 0.05)。结果证实,冠脉支架置入后24 h内患者血清脏脂肪素水平持续升高。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

可降解与不可降解药物涂层支架及裸金属支架置入治疗急性心肌梗死

背景:大量随机对照临床试验显示药物涂层支架较金属裸支架的支架再狭窄率低,但药物涂层支架并不降低主要心血管事件和死亡发生率,而且长期随访的临床注册研究显示其可能会增加支架晚期血栓事件。目的:评价可降解、不可降解药物涂层支架及裸金属支架置入治疗心肌梗死后患者心血管狭窄的发生率及不良反应。方法:回顾性分析236例急性心肌梗死患者的临床资料,其中79例采用生物可降解雷帕霉素洗脱支架置入治疗,83例采用不可降解雷帕霉素洗脱支架置入治疗,74例采用金属裸支架置入治疗。对比3组支架置入12个月内晚期管腔丢失和支架再狭窄,以及24个月时的主要不良心脏反应。结果与结论:置入12个月时,裸支架组支架内晚期管腔丢失多于可降解和不可降降解雷帕霉素洗脱支架组(P0.05),3组间支架再狭窄率比较差异无显著性意义(P0.05)。置入24个月时,3组死亡、心因性死亡、再发心肌梗死、靶血管血运重建、靶病变血运重建、主要不良心脏事件发生率及支架内血栓形成事件比较差异无显著性意义。3种支架在直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死中的长期疗效和安全性有待进一步随访。     

可降解涂层雷帕霉素洗脱支架在冠状动脉狭窄病变处理中的安全性

背景：临床可以采用冠状动脉支架置入治疗各种冠状动脉狭窄病变,术中可以选择药物洗脱性支架和裸金属支架等不同的支架类型,但不同厂家生产的支架在治疗效果和安全性等方面可能存在一定的差异。目的：探讨不同厂家可降解涂层雷帕霉素洗脱支架在冠状动脉狭窄病变处理中的安全性。方法：纳入冠状动脉狭窄病变患者196例,其中男116例,女80例,年龄37-81岁,均分为两组治疗,分别置入微创公司生产的Firebird可降解涂层雷帕霉素洗脱支架与乐普公司生产的Partner可降解涂层雷帕霉素洗脱支架。治疗后随访12个月,对比两组的再狭窄率、急性心肌梗死发生率、冠状动脉旁路移植或再次经皮冠状动脉介入治疗率及死亡率。结果与结论：随访12个月,两组再狭窄率、急性心肌梗死发生率、冠状动脉旁路移植或再次经皮冠状动脉介入治疗率及死亡率比较差异均无显著性意义(P > 0.05)。经随访,两组均未发生与支架材料相关的不良反应。表明在治疗冠状动脉狭窄病变的过程中,置入不同品牌的可降解涂层雷帕霉素洗脱支架均可获得良好的效果,无不良反应发生,具有一定的安全性。中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

肝素缓释支架置入联合心肌钻孔对急性心肌梗死猪心肌细胞再生的影响

背景:课题组前期发明了一种新的心肌再血管化的方法,即肝素缓释支架置入联合心肌钻孔,可明显改善心肌灌注。目的:观察肝素缓释支架置入联合心肌钻孔在猪急性心肌梗死后心肌细胞再生中的作用。方法:通过结扎冠状动脉前降支制作猪急性心肌梗死模型,随机分为模型对照组、支架置入组,6只/组。支架置入组于心肌梗死区采用自制高速钻孔器由心外膜打2个直径为3.5mm透壁孔道,每个孔道内置入1枚肝素缓释支架。置入后静脉注射BrdU用以标记DNA复制。观察治疗前后基质细胞衍生因子1mRNA表达及心肌灌注、新生心肌、心功能等变化。结果与结论:与模型对照组比较,置入6周后支架置入组基质细胞衍生因子1的表达明显增强(P0.001),灌注质量缺损百分率的差值明显降低(P0.001),左室射血分数明显提高(P0.05),新生心肌明显增加(P0.001),缺血区存活心肌明显增多(P0.001)。证实心肌钻孔与肝素缓释支架置入可以通过提高基质细胞衍生因子1表达和增加缺血区灌注,增强心肌梗死区损伤心肌细胞的修复,改善心功能。     

糖尿病患者冠状动脉药物洗脱支架内晚期丢失及非靶病变进展的影响因素

背景：已有研究认为,冠心病合并2型糖尿病患者冠状动脉粥样硬化斑块进展和冠状动脉支架内再狭窄发生风险增加。  目的：探讨2型糖尿病患者支架内再狭窄和非靶病变进展情况及其影响因素。 方法：纳入399例冠心病接受冠状动脉支架置入患者,根据是否合并糖尿病将患者分为糖尿病组(n=179)和非糖尿病组(n=220),收集一般资料、冠状动脉造影及支架置入相关参数;将糖尿病组根据是否发生支架内再狭窄分为再狭窄组(n=66)和无再狭窄组(n=113),根据有无非靶病变快速进展分为非靶病变进展组(n=48)和非靶病变无进展组(n=131),检测支架置入3,120,210,360 d的血低密度脂蛋白胆固醇、糖化血红蛋白、血浆纤维蛋白原和超敏C-反应蛋白水平。 结果与结论：与非糖尿病组比较,糖尿病组冠状动脉支架长度更长(P=0.018),支架直径更小(P=0.002),支架置入后即刻和造影随访的最小管腔直径更小(P=0.001,P=0),支架置入后即刻和造影随访的冠状动脉狭窄程度更严重(P=0.038,P=0.004),造影随访晚期管腔丢失和再狭窄发生比例更多(P=0,P=0.097)。在糖尿病患者的亚组分析中,再狭窄者的血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平较无再狭窄者更高;非靶病变进展者的血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平较非靶病变未进展者更高。表明糖尿病患者发生支架内再狭窄和非靶病变进展的比例较高,同时血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白等生化指标可辅助预测再狭窄和非靶病变进展的发生。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

国产雷帕霉素药物涂层支架置入ST抬高型心肌梗死患者的近期预后

背景：冠状动脉药物涂层支架置入治疗是急性ST段抬高型心肌梗死的最佳治疗方法,但由于老年患者合并危险因素较多,死亡率随着年龄的增加而增高。 目的：观察不同年龄ST段抬高型心肌梗死患者置入国产雷帕霉素药物涂层支架的临床特征及住院期间预后特点。 方法：回顾性分析307例因初发ST段抬高型心肌梗死接受急诊冠状动脉国产雷帕霉素药物涂层支架置入治疗患者的临床资料,根据年龄分为3组,非老年组(< 65岁,n=175)、普通老年组(65-74岁,n=83)、高龄组(≥75岁,n=49),比较3组住院期间的临床特征、病死率及联合心血管事件发生情况。 结果与结论：与非老年组相比,普通老年组、高龄组女性比例较高(P < 0.05),吸烟者较少(P < 0.05),既往高血压病史比例增加(P < 0.05),血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平降低(P < 0.05)。随着年龄的增长,血清肌酐水平逐渐升高,恶性心律失常发生率与住院期间心源性死亡发生率逐渐增加。与非老年组、普通老年组比较,高龄组心功能Killip分级≥Ⅱ级比例、3支或左主干病变比例较高(P < 0.05),成功再灌注率下降(P < 0.05),急性充血性心力衰竭、联合心血管事件的发生率较高(P < 0.05)。多因素Logistic回归分析显示,年龄是患者住院期间病死率的独立危险因素(P < 0.01)。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

国产与进口氯吡格雷对冠状动脉支架置入后影响的等效性比较：1 798例总结

背景：有研究显示国产氯吡格雷与进口氯吡格雷在冠状动脉支架置入后的应用中具有相似的疗效及安全性,但国内尚缺少二者对冠状动脉支架置入后疗效及安全性的前瞻性大规模、大样本临床对比研究。 目的：探讨等剂量国产和进口氯吡格雷对冠状动脉支架置入后的疗效及安全性是否相同。 方法：前瞻性入选1 798例接受冠状动脉支架置入治疗的冠状动脉粥样硬化性心脏病患者,分为国产氯吡格雷组(n=1 104)及进口氯吡格雷组(n=694),在冠状动脉支架置入前给予300 mg负荷剂量,序贯75 mg/d,随访3-28个月,观察对急性、亚急性、晚期、极晚期支架内血栓和心肌梗死、心源性死亡、脑卒中联合终点事件及出血等相关不良反应的影响。 结果与结论：两组支架内血栓、靶血管重建、心源性死亡、出血和大出血事件及联合终点事件发生率差异无显著性意义,两组无事件生存率差异无显著性意义。两组治疗后的白细胞计数、红细胞计数、血红蛋白、红细胞压积、血小板计数均低于治疗前(P < 0.05),且国产氯吡格雷组血红蛋白较进口氯吡格雷组下降明显(P < 0.05)。表明等剂量国产与进口氯吡格雷对经皮冠状动脉支架置入后的疗效及安全性相似。     

国产可降解雷帕霉素药物洗脱支架置入的疗效评价：与金属裸支架比较

背景：药物洗脱支架明显降低了再狭窄率,但永久聚合物涂层在抑制血管平滑肌细胞增生的同时,阻碍血管完全内皮化进程,促使再狭窄发生,且永久聚合物涂层可引发晚期血栓等并发症。 目的：观察冠心病合并糖尿患者置入国产可降解药物洗脱支架后的远期疗效和安全性,并与置入金属裸支架患者进行比较。 方法：实验组选择冠心病合并2型糖尿病患者136例,首次经皮冠状动脉成形治疗,置入国产可降解药物洗脱支架(EXCELTM),并以同期行金属裸支架置入治疗的冠心病合并2型糖尿病患者87例为对照组,随访12个月以上,记录主要不良心血管事件发生情况,并复查冠状动脉造影。 结果与结论：实验组129例,对照组83例完成(13.5±3.5)个月随访,实验组及对照组分别有8例及12例患者发生不良心血管事件,两组间差异有显著性意义(P=0.045),对照组靶血管血运重建及再发心绞痛多于实验组(P < 0.05)。两组患者随访冠状动脉造影的定量分析提示实验组最终丢失指数小于对照组(P < 0.05),再狭窄率低于对照组(P < 0.05)。说明对于冠心病合并糖尿病患者,应用国产可降解药物洗脱支架可降低不良心血管事件发生率,减少再狭窄,改善患者远期预后,安全性能良好。     

冠状动脉内药物洗脱支架置入通过困难不同锚定方法的对比

背景：边支球囊锚定和远端钢丝锚定是提高冠状动脉内支架通过到位率的有效办法,目前国内尚无比较上述两种锚定方法在提高支架通过成功率方面的研究。 目的：比较边支球囊锚定和远端钢丝锚定在提高冠状动脉介入治疗药物洗脱支架通过困难方面的临床效果。 方法：纳入87例冠状动脉介入治疗过程中药物洗脱支架通过困难病例,随机分2组治疗,其中46例采用边支球囊锚定方法提高支架通过到位率,41例采用远端钢丝锚定方法提高支架通过到位率。对比两组患者支架置入成功率,以及支架置入12个月内的支架材料生物相容性问题,包括主要不良心脏反应、再发心绞痛、支架再狭窄和晚期管腔丢失等。 结果与结论：远端钢丝锚定组药物洗脱支架置入成功率明显高于边支球囊锚定组(83%,61%,P < 0.05),两组患者药物洗脱支架置入过程中并发症及支架置入12个月内的主要不良心脏反应、再发心绞痛、支架再狭窄和晚期管腔丢失结果比较差异无显著性意义(P > 0.05)。说明远端钢丝球囊锚定方法在不影响支架材料生物相容性的情况下,更有利于提高冠状动脉支架通过率。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

石斛属民族药用植物的分类及生药学研究

中药石斛早在《神农本草经》中就被列为上品,其应用历史悠久,具有养阴生津、补肾益气、润喉护嗓、活血明目、抗癌防老等功效。本文对国内外石斛属民族药用植物的分类及生药学研究进行了综述。     

Study of Effect of Colchicine Exposure on Length of Chromosome During Mitosis

In routine karyotyping procedure from lymphocyte culture (blood culture) cells are exposed to colchicine to arrest cell division at metaphase to visualise chromosomes. Routinely duration of exposure to colchicine varies from 1 to 2 hours. To get better quality of chromosomes both the concentration and period of exposure to colchicine can be altered.While standardization of departmental Genetic/Research laboratory trial different period of exposure time of colchicine was done to get longer chromosomes with splitted chromosomes.It was observed it was marked that by shortening the exposure period of colchicine longer and better quality of chromosomes can be obtained whereas longer exposure period of colchicine gives condensed chromosomes.     

新生儿气质行为361例临床观察

目的探讨影响新生儿气质的危害因素和进行早期干预指导.方法通过本院出生的新生儿按新生儿气质临床分型进行临床观察.结果观察总数361例,温顺型227例,占总人数63%,难弄型29例,占总人数8%,预热缓慢型52例,占总人数14%,混合型53例,占总人数15%.结论新生儿行为是新生儿与成人交流的一种方式,不同行为形成不同的气质,对可能形成危害新生儿的不利因素和后果进行早期干预,减少新生儿的危害.     

Timing of onset of afferent responses and of use of kinesthetic information for control of movement in normal and cerebellar-impaired subjects

A coordinated triggering task requiring use of kinesthetic information was employed to assess the timing of use of kinesthetic information in normal subjects and patients with cerebellar dysfunction. Passive movements of varying velocity were imposed in the flexor direction about the metacarpophalangeal joint of the right index finger. Subjects attempted to depress a switch with their left thumb when the index finger moved, past a specified angle that was learned during a training session. The velocities ranged from 10°/s to 88°/s in 2°/s increments. After 200 trials, subjects were then instructed instead to react as quickly as possible (reaction-time task) to the onset of movement for an additional 200 trials. For the same movements, the timing of onset of responses of muscle spindle afferents and cutaneous mechanoreceptors was determined by recording the responses of these afferents using microneurography. For slow velocities, patients were able to perform similarly to normals but at faster velocities patients triggered too late compared with normals. Patients required more time to use kinesthetic information than did normal subjects. An estimate of kinesthetic processing was not longer in patients. The chief explanation for the prolonged time required to use kinesthetic information in patients was that their reaction times were prolonged by 93 ms. In addition, the movement time was also prolonged, but this accounted for only 23 ms. Impaired motor performance in tasks requiring the use of kinesthetic information in cerebellar patients can be explained largely by their prolonged reaction times. Muscle spindle afferents responded on average much sooner than cutaneous mechanoreceptors. Because of the limited time available to perfomr the kinesthetic triggering task, the role for cutaneous mechanoreceptors, to provide singals for on-line coordination of movement appears limited compared with muscle spindle afferents.     

A test of the validity of the method of constant stimuli as an index of heartbeat detection

A heartbeat detection task, based on the method of constant stimuli (MCS), requires participants to judge which of a series of tones presented at different delays following a heartbeat are coincident with the heartbeat. Two experiments were conducted to test the validity of the MCS in assessing individual differences in the ability to detect heartbeat sensations. The first experiment found the MCS to be valid, in that about one-third of subjects met the criterion for classification as heartbeat detectors when the tones were presented with respect to their actual heartbeats, but only one subject met the criterion when the tones were presented with respect to previously recorded heartbeats. The second experiment manipulated the timing of the comparison intervals (i.e., R + 100–600 ms rather than R + 0–500 ms) to examine the validity of the median R-wave to tone interval as an index of temporal location of perceived heartbeats, and found it to be a valid index.     

Influence of layer V of area 18 of the cat visual cortex on responses of cells in layer V of area 17 to stimuli of high velocity

Focal blockade of restricted regions in layer V of area 18 was used to assess the contribution of this region to the responses to high-velocity stimuli of cells in retinotopically matched, layer V in area 17. In 40% of cases, blockade within area 18 revealed responses of area 17 cells to high-velocity stimuli to which they previously showed only poor responses. Stimulus specificity of the cells in area 17 was otherwise unaltered. All effects were reversible and repeatable. We suggest that a component of the output of layer V from area 18 normally suppresses the responses of retinotopically matched cells within area 17 to stimuli of high velocity, thereby enhancing the specificity of those cells to stimuli of low velocity     

Overview of biological effects of addition of DNA molecules to cells

Injected DNA proceeds with certain probabilities through the following steps: degradation by serum nucleases, adsorption to cells, uptake into cells, ligation to other DNA, mutation, expression of unintegrated DNA, integration, expression of integrated DNA, and activation of or inactivation of cellular genes. The maximal probability per DNA molecule of each of these steps is estimated based on experimental results in cell culture with transfection of DNA and with infection by retroviruses. A maximum cumulative probability of having a harmful effect is calculated to be less than 10(-16) to 10(-19) per DNA molecule from a cell without activated proto-oncogenes or active viral oncogenes. The most frequent harmful effects considered are inactivation of a tumor suppressor gene and activation of a proto-oncogene. Such inactivation and activation in a cell that could give rise to cancer would increase the age-standardized incidence of cancer by a small amount. The amount of increase would differ among individuals depending upon their genotypes and their environments. Thus, the magnitude of the increase will depend upon the frequency of more sensitive individuals. The probability of an increased incidence of cancer as a possible effect of the vaccination should be compared to the number of DNA molecules to be injected per person and to the protective effects of a successful HBV vaccine.     

Organization of the efferent projections of the pedunculopontine tegmental nucleus of the midbrain of the dog pallidum

Studies of the pedunculopontinopallidal projections of the dog brain based on the retrograde axonal transport of horseradish peroxidase demonstrated that the compact zone (PPNc) and the lateral area of the diffuse zone (PPNd) of the pedunculopontine tegmental nucleus (PPN) of the midbrain project to the globus pallidus, entopeduncular nucleus, and ventral pallidum. The medial area of the PPNd, adjacent to the chiasm of the upper cerebellar peduncles and seen in other animals as the mesencephalic extrapyramidal area (MEA), projects only to the globus pallidus. In dogs, this area of the tegmentum is not a major source of projections to the striopallidum, such that it is inappropriate to regard it as a separate structure, comment being restricted to the topical organization of PPNd projections to the pallidum. Projection fibers to pallidal structures arise from both cholinergic and non-cholinergic PPN neurons. __________ Translated from Morfologiya, Vol. 127, No. 2, pp. 19–23, March–April, 2005.     

149例围产儿死亡原因分析

目的通过对我院2005～2009年间围产儿死亡原因和死亡构成比的分析,为制定有效的干预措施提供科学依据,从而提高围产保健质量,进一步降低围产儿死亡率。方法对我院2005～2009年围产儿死亡原因进行回顾性分析。结果 5年间我院住院分娩围产儿数18 581例,围产儿死亡数149例,围产儿死亡率平均为8.26‰,呈逐年下降的趋势。其中,本市户籍围产儿死亡占死亡率的8.75%,非本市户籍占91.25%。导致围产儿死亡的主要原因有胎儿因素、出生缺陷、脐带胎盘因素、母体因素、原因不明及其他。结论加强对围产儿保健者的培训,28周前发现畸形、预防早产、治疗妊娠合并症、加强监护有助于减少围产儿死亡的发生。     

Unidirectional Movement of Flares of Cells of Myxococcus xanthus

Amongst other modes, Myxococcal cells move in swarms that are flares or columns of cells. It has been argued that this is a strategy allowing a large enough number of them to encounter food bacteria. Then, the combined large amount of extracellular lytic enzymes from the mass of cells can provide adequate nutrient resources from the food bacteria for all the myxococci of the swarm. However, how they move as a coherent column has not been adequately explained.

Here based on the idea that a rare cell can experience a special mutation such that it moves only unidirectionally, a proposal to account for this aspect of Myxococcus cell movement is suggested. Although wild type individual organisms of this species engage in forward and back movements, a mutant cell that moves unidirectionally can bias the movement of associated wild type cells and lead to the formation of a column of cells, headed by such a unique mutated cell. The non-mutated cells follow along it is suggested because of the S-motility (or social motility) system. This may link them to this single unidirectionally moving mutant cell to give a coherent movement to the column. This proposed type of mutation back mutates to wild type and the column no longer functions as such and only wild-type cells are present.