Elevation of the tumor marker CA125 in right heart failure

Carbohydrate antigen 125, known as a marker for ovarian cancer, has been reported to be elevated in heart failure caused by left ventricular dysfunction. A case of elevated carbohydrate antigen 125 in isolated right heart failure due to atrial septal defect with preserved left ventricular function is reported.     

Expression of cancer antigen 125 by peritoneal mesothelial cells is not influenced by duration of peritoneal dialysis.

OBJECTIVE: To investigate the presence of cancer antigen 125 (CA125) on mesothelial cells in the effluent of peritoneal dialysis (PD) patients and to analyze the effect of duration of PD on the number of mesothelial cells in peritoneal effluent, the number of CA125-positive cells, and dialysate CA125 concentration. DESIGN: A cross-sectional study in which long-dwell peritoneal effluents were investigated for mesothelial cells and CA125. SETTING: A university hospital population of chronic PD patients. PATIENTS: 33 stable PD patients who were free of peritonitis during the investigation and during the 4 weeks prior to the study. METHODS: Examination of cytospin preparations of peritoneal effluent stained with May-Grünwald Giemsa, and also with an immunocytochemical double-staining method consisting of anticalretinin (pan-mesothelial cell marker) and OC125. RESULTS: A close relationship was present between the numbers of mesothelial cells counted with the two staining methods (r= 0.998, p < 0.001). On average, 92% of mesothelial cells were positive for CA125, ranging between 75% and 100% in 80% of the patients. Correlations were found between the effluent CA125 concentration and the total number of mesothelial cells (r = 0.64, p < 0.001), and also the number of CA125-positive cells (r = 0.66, p < 0.001). A negative effect of time was seen on the effluent CA125 concentration, the total number of mesothelial cells, and the number of CA125-positive mesothelial cells. However, no effect of time was present on the percentage CA125-positive cells. CONCLUSIONS: On average, 92% of mesothelial cells in peritoneal effluent are positive for CA125. This figure is not dependent on the duration of PD. Long-term PD is associated with low dialysate CA125 concentrations, a low number of mesothelial cells, and a low number of CA125-positive mesothelial cells in effluent. These results support the hypothesis that dialysate CA125 can be used as a marker of mesothelial cell mass in stable PD patients.     

阿托伐他汀对高血压大鼠心肌重塑和心力衰竭的作用

目的探讨免疫因素在长期高血压所伴随的心脏靶器官损害-左室肥厚向充血性心力衰竭（CHF）的转变机制中的作用。方法采用升主动脉缩窄的方式复制大鼠高血压心力衰竭模型，随机分为他汀组和手术对照组，前者术后12周予阿托伐他汀（0．4mg．kg-1．d-1）灌胃治疗，对照组予生理盐水灌胃。于术后12和20周测定明胶酶（MMP-9）、CRP、IL-1β、IL-4、IL-10、TNF-α和心肌胶原含量及左心室湿重、平均动脉压、左心室舒张末压、左心室内压最大上升速率、左心室内压最大下降速率等。观察阿托伐他汀对各种炎症介质表达的干预作用以及对心室重塑的影响。结果①20周时他汀组较对照组左心室舒张末压均显著降低（P〈0．05），平均动脉压、左心室内压最大上升和下降速率则显著增加，有显著性差异（P〈0．01）；②他汀组MMP-9、CRP、TNF-α均较对照组明显降低，而IL-4、IL-10较对照组升高，心肌胶原含量减少，与心功能呈负相关。结论阿托伐他汀可一定程度抑制炎性反应，延缓心衰的进展和心室重塑。     

一组单抗鉴别浆膜转移腺癌细胞与反应性间皮细胞的意义

目的 为提高浆膜转移腺癌细胞的诊断率,探讨一组正反互补单克隆抗体鉴别浆膜转移腺癌细胞与反应性间皮细胞的意义。方法 用低分子量细胞角蛋白（CK^LMW)、癌胚抗原（CEA）及间皮细胞（MC）3种标记物,对50份浆膜腔积液及14份腹腔冲洗液内的细胞进行免疫细胞化学标记。结果 3组细胞与CK^LMW、CEA及MC的表达率分别为：腺癌细胞（95.83%,70.83%,16.67%;可疑癌细胞100%,50.00%,不表达;反应性间皮细胞33.33%,33.33%,66.66%;细胞病理学最初分类的4例可疑癌细胞和2例反应性间皮细胞应归属于腺癌细胞。CK^LMW、CEA及MC3种抗体的敏感度、特异度及可用度分别为96.30%,80.00%,77.10%;70.37%,90.00%,61.60%;90.00%,85.20%,75.30%。结论 免疫细胞化学CK^LMW、CEA及MC联合应用在鉴别浆膜转移腺癌细胞与反应性间皮细胞时,是一项具有重要价值的辅助手段。     

血清CA125测定对卵巢高、低级别浆液性癌鉴别诊断价值的回顾性研究

目的探讨血清糖类抗原125(CA125)测定对卵巢浆液性上皮良恶性肿瘤间及高、低级别浆液性癌间鉴别诊断的价值。方法回顾性研究128例卵巢肿瘤患者的病例资料。比较高级别、低级别浆液性上皮性卵巢癌患者与浆液性囊腺瘤患者各组间术前血CA125值。结果高级别、低级别浆液性上皮性卵巢癌患者术前血CA125值均高于浆液性囊腺瘤患者(P=0.002、P=0.003)。高级别与低级别浆液性上皮性卵巢癌患者之间术前血CA125值相比差异无统计学意义(P=0.426)。结论血清CA125测定对卵巢良恶性肿瘤的鉴别具有意义,但对高级别和低级别浆液性上皮性卵巢癌的区分没有作用,需寻找更好的血清学指标来鉴别二者。     

老年女性慢性心力衰竭患者血清N末端-B型钠尿肽前体及糖类抗原125水平的变化

目的观察老年女性慢性心力衰竭(CHF)患者N末端-B型钠尿肽前体(NT-pro BNP)、糖类抗原125(CA125)水平变化及意义。方法选取50例老年女性慢性心力衰竭患者作为观察组,另选择50名同期进行健康体检的老年女性作为对照组。按照纽约心功能分级分级标准心功能分Ⅱ级、Ⅲ级和Ⅳ级,检测两组血清中NT-pro BNP和CA125的水平。结果观察组血清NT-pro BNP水平为[1490.50(459.28,3263.25)]ng/L,明显高于对照组[94.07(43.71,191.43)]ng/L,两者比较差异有统计学意义(P<0.01);观察组血清CA125水平为[106.80(55.24,225.75)]μg/L,明显高于对照组[14.84(7.79,19.06)]μg/L,两者比较有统计学意义(P<0.01)。结论血清NT-pro BNP和CA125水平的升高对诊断老年女性慢性心力衰竭具有一定的意义。     

超声二维斑点追踪成像技术评估慢性心力衰竭患者左心室内心肌收缩不同步性

目的探讨超声二维斑点追踪技术(2D-STI)评价慢性心力衰竭(CHF)患者左心室内心肌收缩不同步性的临床应用价值。方法采集80例CHF患者及20例正常成人左心室短轴切面的动态二维图像及心尖四腔切面的动态三维全容积图像。依据NYHA分级法将病例组分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组。应用2D-STI技术分析左心室16节段的时间-应变曲线,测量左心室不同步参数,即Tcsbfirst-SD、Tcsmfirst-SD、Tcsafirst-SD、Trsbfirst-SD、Trsmfirst-SD、Trsafirst-SD。应用三维超声心动图技术测量左心室射血分数(LVEF)。采集受试者经胸心电图及血浆NT-pro BNP值。结果病例组Ⅱ组、Ⅲ组、Ⅳ组患者的Tcsbfirst-SD、Tcsmfirst-SD、Tcsafirst-SD均高于对照组(P<0.05),Ⅰ组患者与对照组的差别无统计学意义(P>0.05)。病例组各组患者的Trsmfirst-SD、Trsafirst-SD均高于对照组(P<0.05)。病例组Ⅲ组、Ⅳ组患者的Trsbfirst-SD高于对照组(P<0.05),Ⅰ组、Ⅱ组患者与对照组的差别无统计学意义(P>0.05)。以上不同步参数均与左心室射血分数有显著的负相关性(均P<0.001);均与NT-pro BNP有显著的正相关性(均P<0.001)。结论利用2D-STI技术检测的Tfirst-SD不同步参数可用来评价不同级别CHF患者左心室内心肌收缩的不同步性。     

Elevation of plasma atrial natriuretic peptide in rats with chronic heart failure by SCH 39370, a neutral metalloendopeptidase inhibitor

Hormonal, renal and blood pressure effects of SCH 39370, a selective inhibitor of neutral metalloendopeptidase (endopeptidase 24.11, NEP), were studied in a chronic, congestive heart failure (CHF) model produced by coronary artery ligation in the rat. Sham-operated control rats and rats with CHF were treated either with vehicle or SCH 39370, 30 mg/kg s.c. b.i.d. for 2.5 days. Plasma levels of atrial natriuretic peptide (ANP) and urinary excretion of cyclic GMP (cGMP) were clearly raised in rats with CHF as compared with controls during vehicle treatment. SCH 39370 caused a further increase in plasma ANP in CHF rats but not in control rats. Urinary excretion of immunoreactive ANP and cGMP increased during SCH 39370 treatment both in CHF rats and in controls. SCH 39370 treatment resulted in an initial increase in urine volume in rats with CHF whereas urine sodium excretion did not change significantly. No changes in renal function due to SCH 39370 treatment were seen in control rats. Systolic blood pressure, plasma renin activity and urine excretion of catecholamine metabolites (4-hydroxy-3-methoxyphenyl acetic acid and metanephrines) did not change during SCH 39370 treatment either in controls or in CHF rats. We conclude that the NEP-inhibitory compound SCH 39370 is capable of increasing plasma ANP concentration and urinary excretion of cGMP in rats with chronic CHF. In this severe heart failure model, the possible beneficial effects of additional ANP increments may be blunted, however. NEP inhibitors offer a novel approach to study the significance of ANP elevation in chronic CHF.     

Hypocalcemia may not be essential for the development of secondary hyperparathyroidism in chronic renal failure.

Hypocalcemia is the main factor responsible for the genesis of secondary hyperparathyroidism in chronic renal disease. Studies with parathyroid cells obtained from uremic patients indicate that there is a shift in the set point for calcium-regulated hormone (parathyroid hormone [PTH] secretion. Studies were performed in dogs to further clarify this new potential mechanism. Hypocalcemia was prevented in uremic dogs by the administration of a high calcium diet. Initially, ionized calcium was 4.79 +/- 0.09 mg/dl and gradually increased up to 5.30 +/- 0.05 mg/dl. Despite a moderate increase in ionized calcium, immunoreactive PTH (iPTH) increased from 64 +/- 7.7 to 118 +/- 21 pg/ml. Serum 1,25(OH)2D3 decreased from 25.4 +/- 3.8 to 12.2 +/- 3.6 pg/ml. Further studies were performed in two other groups of dogs. One group received 150-200 ng and the second group 75-100 ng of 1,25(OH)2D3 twice daily. The levels of 1,25(OH)2D3 increased from 32.8 +/- 3.5 to a maximum of 69.6 +/- 4.4 pg/ml. In the second group the levels of serum 1,25(OH)2D3 after nephrectomy remained normal during the study. Amino-terminal iPTH did not increase in either of the two groups treated with 1,25(OH)2D3. In summary, the dogs at no time developed hypocalcemia; however, there was an 84% increase in iPTH levels, suggesting that hypocalcemia, per se, may not be the only factor responsible for the genesis of secondary hyperparathyroidism.     

Study of carbohydrate material isolated from ultrafiltrates in patients with chronic renal failure

We have isolated substances of molecular weight ranging between 350 and 2,000 daltons from ultrafiltrates of 3 patients treated by maintenance haemodialysis for chronic renal failure. Such substances might have a role in the genesis of uraemic toxicity. We have chiefly studied their carbohydrate content. Material was fractionated according to a procedure previously used to urine in healthy controls. Consecutive ion exchange, charcoal Celite and paper chromatography lead to the isolation and purification of oligosaccharides, glycopeptides, glucuronoconjugates and peptides. The different classes of carbohydrate material present in dialysis fluids from uraemic patients are close to those formed in normal urines. All the oligosaccharides in renal failure urine had have identified in normal urine. In a previous studies we have demonstrated that the levels of glucuronoconjugates are higher in the blood of uraemic patients. The glucuronoconjugates and their aglycones could have a toxic effect but a great part of them is removed by hemodialysis.     

慢性心力衰竭患者血清肿瘤相关糖类抗原125和脑钠肽联合测定及其意义

目的探讨慢性心力衰竭（以下简称心衰）患者血清肿瘤相关糖类抗原125（CA125）和脑钠肽（BNP）水平变化及其意义。方法按AHA心衰指南标准随机入选113例慢性心衰患者,按照NYHA心功能分级将其分为两组,A组：NYHA 2级55例,B组：NYHA 3～4级58例。CA125和BNP的测定：采用化学发光技术分别测定所有患者入院第2天CA125和BNP水平。对B组患者出院前复测CA125和BNP水平。结果 NYHA 3～4级组与NYHA 2级组比较,CA125和BNP水平显著升高（〔95±86）U/ml vs（20±26）U/ml（,1052±959）pg/ml vs（317±513）pg/ml,P〈0.01〕,经标准心衰治疗后CA125和BNP水平明显下降（〔95±86）U/ml vs（30±21）U/ml（,1052±959）pg/ml vs（351±213）pg/ml,P〈0.01〕。结论和BNP一样,CA125也是诊断和评价慢性心衰的一个良好指标。     

血清CA125浓度改变对慢性心力衰竭患者临床诊治的价值

目的探讨慢性心力衰竭(CHF)患者血清中CA125浓度的改变与心力衰竭程度的关系和影响其浓度的相关因素,正确评价其临床意义。方法血清CA125测定:抽取2ml空腹时的静脉血,分离血清进行免疫放射分析法测定浓度。123例患者按照纽约心脏病学会心功能分级标准,分为Ⅱ、Ⅲ、Ⅳ级组。设对照组20例。按有无心源性胸水而分为有胸水组和无胸水组,并对治疗前后的CA125浓度作对比。结果CHF患者CA125血清浓度明显高于对照组(P<0.01),而且浓度的升高与心力衰竭的程度呈正相关。心源性胸水患者明显高于无心源性胸水患者。治疗后CA125的血清浓度随心衰好转而显著下降。结论CHF患者的CA125水平与左室射血分数(LVEF)值呈负相关,与心衰程度呈正相关;有心源性胸水者的CA125水平明显高于无心源性胸水者;CHF治疗后CA125水平显著下降。     

机械通气在海洛因中毒呼吸衰竭中的应用

目的探讨机械通气(MV)在海洛因中毒致呼吸衰竭中的应用以及病情监测、管道护理等问题.方法对意识不清、呼吸微弱且不规则或深昏迷、无自主呼吸者立即行MV,根据血气分析结果调整呼吸机参数.结果MV辅助治疗后患者发绀迅速缓解,5例于4～6h内呼吸平衡,17例在24～48h内神志转清,行MV 2～5d自主呼吸恢复,血气分析正常,顺利脱机,1例患者因就诊时间太长,呼吸衰竭死亡.结论快速建立MV,加强呼吸道护理可避免并发症发生.     

机械通气在海洛因中毒呼吸衰竭中的应用

目的：探讨机械通气（MV）在海洛因中毒致呼吸衰竭中的应用以及病情监测、管道护理等问题。方法：对意识不清、呼吸微弱且不规则或深昏迷、无自主呼吸者立即行MV，根据血气分析结果调整呼吸机参数。结果：MV辅助治疗后患者发绀迅速缓解，5例于4～6h内呼吸平衡，17例在24～48h内神志转清，行MV 2～5d自主呼吸恢复，血气分析正常，顺利脱机，1例患者因就诊时间太长，呼吸衰竭死亡。结论：快速建立MV，加强呼吸道护理可避免并发症发生。     

慢性心力衰竭患者Th17细胞的检测及意义

目的:探讨慢性心力衰竭(CHF)患者外周血Th17细胞水平及意义.方法:采用流式细胞分析法检测66例CHF患者(CHF组)和23例正常对照者(对照组)外周血Th17细胞比例.结果:CHF患者外周血Th17/cD4+T细胞比例[(2.4±1.6)%]显著高于对照组[(0.4±0.3)%].Th17/CD4+T比例在缺血性心脏病者与非缺血性心脏病者间差异无统计学意义,但心功能NYHA分级Ⅲ～Ⅳ级者[(3.3±1.1)%]比例明显高于Ⅰ～Ⅱ级者[(1.7±0.9)%].结论:CHF患者外周血外周血Th17细胞比例增加,且与心功能有一定关系.Th17细胞可能参与了心力衰竭的发生发展.     

机械通气在海洛因中毒呼吸衰竭中的应用

目的:探讨机械通气(MV)在海洛因中毒致呼吸衰竭中的应用以及病情监测、管道护理等问题。方法:对意识不清、呼吸微弱且不规则或深昏迷、无自主呼吸者立即行MV,根据血气分析结果调整呼吸机参数。结果:MV辅助治疗后患者发绀迅速缓解,5例于4~6h内呼吸平衡,17例在24~48h内神志转清,行MV2~5d自主呼吸恢复,血气分析正常,顺利脱机,1例患者因就诊时间太长,呼吸衰竭死亡。结论:快速建立MV,加强呼吸道护理可避免并发症发生。     

Reduction in induced pain by ultrasound may be caused by altered expression of spinal neuronal nitric oxide synthase-producing neurons

OBJECTIVE: To examine the peripheral influence of therapeutic ultrasound (US) on central spinal nociceptive modulation. DESIGN: Controlled, experimental animal trial. SETTING: Neuroscience laboratory of a medical university in Taiwan. ANIMALS: Ten male Wistar rats weighing 250 to 300 g. INTERVENTION: To induce inflammatory arthritis, the rats were injected intracapsularly with complete Freund's adjuvant (CFA) into the right tibiotarsal joint. Eighteen hours later, at the inflammatory phase of arthritis, US or sham-operated treatment was applied to the arthritic limb. MAIN OUTCOME MEASURES: The numbers and distributional proportions of immunoreactive spinal neuronal nitric oxide synthase-like (nNOS-LI) neurons were assessed. RESULTS: The nNOS-LI neurons were abundant bilaterally in the L1 and L2 regions of the spinal cord areas after CFA-induced arthritis with sham-operated treatment. US treatment significantly suppressed this increase in the numbers of nNOS-LI neurons bilaterally in the superficial laminae (laminae I-II, P < .001), nucleus proprius (laminae III-IV, P < .01), deep laminae (laminae V-VI, P < .001), and ventral horn (laminae VII-X, P < .001) of the spinal cord. When expressed as a percentage of the total labeled cells, the proportions of nNOS-LI neurons showed significant differences in laminae III-IV (P < .001) and laminae V-VI (P < .01) between sham-treated rats and those treated with US. CONCLUSIONS: US treatment may modulate the CFA insult-induced increase in total and regional nNOS-LI neurons. I propose that the peripheral influences of US on central modulation of the spinal nociceptive processing system is important and may reflect the neuroplasticity of the spinal cord in response to peripheral input.     

Tei指数评价卡维地洛治疗慢性心衰效果研究

目的：用Tei指数及其他心功能指标评价卡维地洛治疗慢性心衰的效果。方法：63例慢性心衰患者（NYHAⅡ～Ⅲ级）随机分为2组,一组为常规治疗组,用常规抗心衰的方法治疗;另一组为卡维地洛治疗组,在常规治疗方法的基础上加用卡维地洛。所有的病人至少随访6个月,用超声心动图分别检查左室射血分数（LVEF）、Tei指数、左室舒张末期内径（LVIDd）、室间隔舒张末期厚度（IVSd）、左室后壁舒张末期厚度（LVPWd）以及左室的等容收缩期（ICT）、等容舒张期（IRT）、射血时间（ET）。结果：治疗后常规治疗组和卡维地洛治疗组的LVIDd、ICT、IRT和Tei指数均较治疗前显著减低,IVSd、LVPWd、LVEF和ET均显著增加。治疗6个月后,卡维地洛治疗组的LVEF和ET显著高于常规治疗组（P〈0.05,P〈0.01）,卡维地洛治疗组的Tei指数和ICT显著低于常规治疗组（P〈0.01,P〈0.05）。结论：在常规治疗方法的基础上加用卡维地洛治疗慢性心衰效果好于仅用常规的方法治疗。Tei指数较LVEF和NYHA分级法评价心功能更为敏感。