Propagations- und Progressionsfaktoren der Arteriosklerose

Zusammenfassung Ausgehend von generalisierenden Theorien zur Arteriosklerose wird ein umfassendes faktorenanalytisches Modell vorgestellt, welches das bislang bekannte klinische Risikospektrum zur koronaren Herzkrankheit als auch zur Arteriosklerose neben dem morphologischen Befund berücksichtigt. Es werden sogenannte Ausbreitungs- und Bündelungsmuster unterschieden, die in einer spezifischen Struktur mit den klinischen Risiken bündeln. Der Anteil der noch unbekannten Einflu\faktoren lÄ\t sich einerseits quantitativ abschÄtzen, andererseits qualitativ derart strukturieren, da\ z.B. Hinweise für die hohe ZeitabhÄngigkeit und die mit dem Alter zunehmende ProgressivitÄt herausgestellt werden konnten.

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Factors in the progression and propagation of arteriosclerosisResults of an interdisciplinary study

Summary Starting from generalized theories of the arteriosclerosis, a comprehensive model of factor analysis is presented which considers the clinical risk spectrum of coronary heart disease as presently known. Arteriosclerosis and morphological findings are also included in the analysis. A differentiation is made between progressive ramification and multiple variable patterns, which combine the clinical risks in a specific structure. Fractions of unknown influencing factors could be estimated quantitatively and qualitatively in such a manner that suggestions concerning the huge dependency of time and the progressive increase with age could be determined.

Herr Dipl.-Ing. H. Pasternak hat freundlicherweise die Anfertigung der Photos besorgt.     

体外循环瓣膜置换术时IL-6、IL-8、IL-10水平的变化

目的:观察体外循环心内直视手术中及术后促炎因子白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和抗炎因子白细胞介素-10(IL-10)水平的变化。方法:随机选择12例择期行瓣膜置换术、心功能II~IV级的风湿性心脏病患者,分别于下列9个时点采取混合静脉血7mL:麻醉诱导前、诱导后30min、主A阻断后30min、主A开放后10min、主A开放后30min、体外循环(CPB)后30min、CPB后8h、术后24h、术后72h。以3000r／min转速离心10min后留取上清液,酶联免疫吸附反应(ELISA)技术测定细胞因子IL-6、IL-8及IL-10水平。术中输入晶胶体液及血管活性药物维持血流动力学稳定。结果:自主A开放后30min-术后72hIL-6、IL-8水平显著升高,抗炎因子IL-10水平自主A阻断后30min-术后72h也升高。各参数的峰值都位于CPB结束后30min。结论:体外循环瓣膜置换术可使血中IL-6、IL-8和IL-10水平产生明显变化,这些变化于CPB后30min达到高峰,并持续至术后数日。     

自体血液回输对成人心脏瓣膜置换术患者血液携氧功能的影响

目的 探讨自体血回输对体外循环下心瓣膜置换术患者血液携氧功能的影响。方法抽选河南省胸科医院心外科2014年4月—2016 年1月收治的90例首次接受心脏手术的心脏瓣膜病患者作为研究对象,随机分为观察组和对照组。观察组45例采用自体血液回收技术;对照组45例不采用自体血液回收技术,直接使用库血。检测并比较两组术前(T₁)、术毕(T₂)、术后24 h(T₃)、术后第7天(T₄)的动脉血液携氧功能指标,包括RBC、Hb、红细胞比容(Hct)、氧合指数、红细胞内2,3-二磷酸甘油酸浓度(2,3-DPG) 、红细胞变形指数(RCD)。结果 观察组与对照组在T₂时点的RBC分别为(3.59±0.37)×10¹²/L和(3.64±0.44)×10¹²/L,Hb分别为(101.26±19.54)g/L和(102.38±20.05)g/L,Hct分别为(0.35±0.12)和(0.34±0.13),较组内T₁降低,差异均有统计学意义(P值均＜0.05);但T₃和T₄与组内T₁时点比较,差异均无统计学意义(P值均>0.05),且组间各时点比较差异均无统计学意义(P值均>0.05)。观察组在T₁~T₄的氧合指数分别为(415.14±51.24)、(348.33±39.45)、(317.59±33.36)和(377.16±45.44) mmHg(1 mmHg=0.133 kPa),对照组则分别为(418.16±52.18)、(344.44±42.20)、(320.65±35.11)和(375.24±43.94) mmHg,组间各时点比较差异均无统计学意义(P值均>0.05),但组内术后各时点与术前比较差异均有统计学意义(P值均＜0.01)。两组间及组内术前术后红细胞2,3-DPG比较差异均无统计学意义(P值均>0.05)。两组RCD术后较术前的有明显增高(P值均＜0.01),而组间比较差异均无统计学意义(P值均>0.05)。结论 应用自体血液回输对成人心脏瓣膜置换术中血液携氧功能无明显损伤,可减少库血的使用,具有较高的临床意义。     

Koronararteriensklerose und Risikospektrum zur koronaren Herzkrankheit

Zusammenfassung An einem grö\eren pathoanatomischen Untersuchungsgut wird die Relevanz der klinischen Risikokriterien zur koronaren Herzkrankheit in Bezug auf die Koronararteriensklerose (Atherom, Fibröse; 5 Teststellen) geprüft. Als Methode wird die VARIMAX-rotierte Faktorenanalyse verwendet. Die hierbei errechneten Faktoren werden als Bündelungsmuster interpretiert, welche jeweils unterschiedliche Beziehungen zu den Risikokriterien, zur koronaren Herzkrankheit und zum morphologischen GefÄ\befund der Koronararterien aufweisen. Die Bedeutung der bekannten Risiken für den GefÄ\befund wird abgeschÄtzt und die DignitÄt der klinischen Einflu\kriterien diskutiert. Es scheint, da\ trotz der methodischen EinschrÄnkungen zusÄtzliche morphologische Argumente zur ErklÄrung des Herzinfarktes gefordert werden müssen, welche nicht die epikardialen Aufzweigungen des KoronargefÄ\systemes betreffen.

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Coronary arteriosclerosis and risk factors in coronary heart disease

Summary A large number of cases were tested for the relevance of clinical risk factors in coronary heart disease with regard to coronary arteriosclerosis (atheroma, fibrosis; five different locations). The method applied was VARI-MAX-rotated factor analysis. The resulting factors were interpreted as the multiple variable structures which are in different relationships to the risk criterion, coronary heart disease, and morphological vascular diagnosis of the coronary arteries. The importance of the known risk of the vascular diagnosis was estimated and the reterance of the clinically influencing criterion was discussed. It appears that in spite of limited methodology additional morphological criteria are required in order to be able to explain heart infarction which does not involve the epicardial branches of the coronary vascular system.

Wir danken Frl. I. Fischer für die ausgezeichnete technische Assistenz. Herr Dipl.-Ing. H. Pasternak hat freundlicherweise die Anfertigung der Fotos besorgt.     

Dopplersonographie der extracraniellen hirnversorgenden und der peripheren Arterien bei Arterioskleroserisikofaktoren und bei KHE

Summary Doppler examination of the neck and limbs of 160 patients with a predisposition to arterial vascular disease in the presence of hypertension, hyperlipoproteinaemia, cigarette smoking and diabetes mellitus, 66% of whom had a combination of two or more of these risk factors, showed in 48 cases single or combined lesions in the arteries of the neck. One patient had unilateral stenosis of the common carotid artery; 20 patients showed unilateral and seven bilateral stenosis of the internal cartid artery; nine patients had unilateral and two patients bilateral stenosis of the external cartid artery; 28 patients showed unilateral flow reduction in the vertebral artery. There was a combined lesion of two or three vessels of the neck in 12 patients. Stenotic peripheral arteries at different levels of the leg with an ankle pressure index decrease of up to 22.5% were detected in 54 patients. These peripheral arterial diseases were associated with stenotic carotid arteries in 28%. Peripheral vascular lesions were present in 40% of patients with stenotic carotid arteries. Of the 160 patients studied 67 had proven coronary heart disease; 22% of these showed stenotic carotid arteries and 29% showed stenotic peripheral arteries. Combined lesions of the coronary, carotid and peripheral arteries were found in 13%.

     

Predictive role of hs-C-reactive protein in patients with antiphospholipid syndrome

High-sensitive C-reactive protein (hs-CRP) is a marker of inflammation which has been shown in several prospective studies to independently predict myocardial infarction, stroke and peripheral artery disease. Patients with antiphospholipid antibodies (aPL) are at increased risk of recurrent thromboembolic events, but the possibility of predicting this risk seems rather limited. Similarities were recently found between aPL and CRP in the pathology of thrombosis. The current study investigated the predictive role of hs-CRP in a cohort of patients with neurological manifestations. A follow-up investigation was done in a cohort of 55 aPL-positive patients with acute manifestations of neurological disease. hs-CRP levels were measured in all patients at enrollment and were compared to the patients' condition after a median period of 32 months. Lupus anticoagulants were detected according to the Standardization of Lupus Anticoagulants (SSC) of the ISTH. Anticardiolipin tests were performed by a beta2-glycoprotein I-dependent enzyme-linked immunsorbent assay (Pharmacia ELISA). hs-CRP was measured by latex-enhanced turbidometry (dimension RXL, Dade Behring). Cerebral infarctions and transient ischemic attacks were the most frequent cerebral events. In patients with aPL, elevated levels of hs-CRP were closely associated with an increased rate of recurrent or residual symptoms (OR, 12.5; 95% CI, 3.72-41.94) and were not related to other risk factors, except smoking (p<0.05). The rate at which a given patient's condition deteriorated was also related to the level of hs-CRP. In patients with antiphospholipid syndrome (APS), elevated levels of hs-CRP may identify a group of patients which is at high risk of recurrent or residual neurological symptoms and which may benefit from more careful follow-up and from antithrombotic therapy.     

右胸骨旁微创小切口体外循环停跳下二尖瓣置换术20例

目的 探讨右胸骨旁微创小切口体外循环停跳下二尖瓣置换术治疗二尖瓣病变的可行性,评价其临床应用价值。方法 回顾性分析2016年9月—2017年5月蚌埠医学院第一附属医院心脏外科采用右胸骨旁微创小切口体外循环停跳下行二尖瓣置换术20例患者的临床资料,其中男6例、女14例,年龄39~72(55±3.8)岁。均通过右胸骨旁第四肋间6~10 cm横切口进胸,股动脉插管、右房房腔管引流建立体外循环,经胸直视下阻断升主动脉,心脏停跳后经左房入路行二尖瓣置换。结果 无围术期死亡,体外循环时间118～205(150.3±37.2)min,主动脉阻断时间98～189(133.5±27.4)min,术后机械通气时间(11.1±10.4)h,ICU停留时间(1.3±0.5)d,住院时间(7.3±1.7)d。患者术后平均随访(2.1±1.7)月,瓣膜位置均良好、启闭功能正常,无瓣周漏发生及严重心脑血管并发症出现。结论 作为向全胸腔镜下二尖瓣置换过渡的一种微创术式,右胸骨旁微创小切口体外循环停跳下二尖瓣置换术安全、可靠,早期临床效果确切。     

The role of vagal function in the risk for cardiovascular disease and mortality

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The understanding of the risk factors for CVD may yield important insights into the prevention, etiology, course, and treatment of this major public health concern. We review the evidence for the role of vagal function in the risk for cardiovascular disease and mortality. Using a broad range of indicators of vagal function including resting heart rate, heart rate recovery, heart rate variability, and baroreflex sensitivity we show that decreased vagal function is associated with an increased risk for morbidity and mortality. These effects are independent of traditional risk factors. Moreover, we show that decreased vagal function is associated with both traditional and emerging risk factors as well as modifiable and non-modifiable risk factors. Most importantly, we provide evidence to support the notion that decreased vagal function precedes the development of a number of risk factors and that modification of risk profiles in the direction of lower risk is associated with increased vagal function. We close with a brief overview of the neural concomitants of vagal function and suggest that a model of neurovisceral integration may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors, on cardiovascular disease.     

Alcohol and cardiovascular health

The substantial medical risks of heavy alcohol drinking as well as the probable existence of a less harmful or safe drinking limit have been evident for centuries. Modern epidemiology studies suggest lowered risk of morbidity and mortality among lighter drinkers. Thus, defining “heavy” drinking as ≥ 3 standard drinks per day, the alcohol-mortality relationship is a J-curve with risk highest for heavy drinkers, lowest for light drinkers and intermediate for abstainers. A number of non-cardiovascular and cardiovascular problems contribute to the increased mortality risk of heavier drinkers. The lower risk of light drinkers is due mostly to lower risk of the most common cardiovascular condition, coronary heart disease (CHD). These disparate relationships of alcoholic drinking to various cardiovascular and non-cardiovascular conditions constitute a modern concept of alcohol and health. Increased cardiovascular risks of heavy drinking include: (1) alcoholic cardiomyopathy, (2) systemic hypertension (high blood pressure), (3) heart rhythm disturbances, and (4) hemorrhagic stroke. Lighter drinking is not clearly related to increased risk of any cardiovascular condition and, in observational studies, is related to lower risk of CHD, ischemic stroke, and diabetes mellitus. A protective hypothesis for CHD is supported by evidence for plausible biological mechanisms attributable to ethyl alcohol. International comparisons and some prospective study data suggest that wine is more protective against CHD than liquor or beer. Possible non-alcohol beneficial components in wine (especially red) support possible extra protection by wine, but a healthier pattern of drinking or more favorable risk traits in wine drinkers may be involved.     

全膝关节置换治疗类风湿性膝关节炎的早期急性并发症

文题释义：全膝关节置换：是通过手术将人工关节假体置入患者膝关节部位,以替代原有的病损关节,达到缓解疼痛、恢复下肢力线及改善患者生活质量的目的,对治疗类风湿性膝关节炎、膝关节退行性病变等膝关节疾病具有显著疗效。 类风湿性关节炎：是一种病因未明的慢性、以炎性滑膜炎为主的系统性疾病。其特征是手、足小关节的多关节、对称性、侵袭性关节炎症,经常伴有关节外器官受累及血清类风湿因子阳性,可以导致关节畸形及功能丧失。晚期累及膝关节的类风湿性关节炎可行全膝关节置换术可显著改善患者生活质量。 背景：类风湿性关节炎患者行全膝关节置换的数量不断增加,但是目前尚无研究报道类风湿性关节炎患者行全膝关节置换后早期并发症的发生情况及相关危险因素。 目的：探讨类风湿性关节炎患者行初次全膝关节置换后早期急性并发症的发生情况及危险因素。 方法：回顾性分析2013年9月至2019年5月于青岛大学附属医院因类风湿性关节炎行初次全膝关节置换的300例患者(337膝)的资料,其中男62例,女238例,平均(65.61±8.40)岁。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。收集并记录患者基本信息、并存疾病、术前检查、手术信息、住院其他信息及随访资料,分析患者并发症发生的相关危险因素,并利用受试者工作特征曲线计算相关资料对类风湿性关节炎患者术后30 d内并发症的预测价值。 结果与结论：①共9例患者在术后30 d内出现急性并发症,发生率为3.33%;②多因素Logistic回归分析结果显示,并发症组患者手术时间、年龄、病程和术前合并脑血管疾病是类风湿性关节炎患者全膝关节置换后30 d内并发症发生的独立危险因素;③并发症组患者手术时间大于无并发症组(OR=1.023,95%CI：1.001-1.045,P=0.037),年龄大于无并发症组(OR=1.163,95%CI：1.025-1.319,P=0.019),病程大于无并发症组(OR=1.110,95%CI：1.031-1.195,P=0.006),术前合并脑血管疾病比例大于无并发症组(OR=31.736,95%CI：4.053-248.517,P=0.001);④受试者工作特征曲线表明,年龄、病程及手术时间预测类风湿性关节炎患者全膝关节置换后30 d内并发症的曲线下面积分别为0.693,0.865,0.685。 ORCID: 0000-0003-2279-2742(沈瑞) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Risk factors and prognoses of invasive Candida infection in surgical critical ill patients with perforated peptic ulcer

BackgroundThe risk of invasive Candida infection (ICI) is high in patients with perforated peptic ulcer (PPU) who received laparotomy or laparoscopic surgery, but the risk factors and predictors of morbidity outcomes remain uncertain. This study aims to identify the risk factors of ICI in surgical critically ill PPU patients and to evaluate the impact on patient's outcomes.MethodsThis is a single-center, retrospective study, with a total of 170 surgical critically ill PPU patients. Thirty-seven patients were ICI present and 133 were ICI absent subjects. The differences in pulmonary complications according to invasive candidiasis were determined by the Mann–Whitney U test. Evaluation of predictors contributing to ICI and 90-day mortality was conducted by using multivariate logistic regression analysis.ResultsCandida albicans was the primary pathogen of ICI (74.29%). The infected patients had higher incidence of bacteremia (p < 0.001), longer intensive care unit (p < 0.001) and hospital (p < 0.001) stay, longer ventilator duration (p < 0.001) and increased hospital mortality (p = 0.02). In the multivariate analysis, serum lactate level measured at hospital admission was independently associated with the occurrence of ICI (p = 0.03). Liver cirrhosis (p = 0.03) and Sequential Organ Failure Assessment (SOFA) score (p = 0.007) were independently associated with the 90-day mortality.ConclusionsBlood lactate level measured at hospital admission could be a predictor of ICI and the surgical critically ill PPU patients with liver cirrhosis and higher SOFA score are associated with poor outcomes.