肺栓塞严重指数对急性肺栓塞预后的预测价值

目的:探讨肺栓塞严重指数(PESI)对急性肺栓塞(PE)的预测价值。方法:利用PESI对6家医院2005年01月～2009年12月期间住院PE患者30天内的预后转归进行回顾性分析。结果:共收集PE患者185例,30d死亡率为11.9%,Ⅰ级0%、Ⅱ级2.4%、Ⅲ级6.5%、Ⅳ级15%、Ⅴ级22.5%,随PESI危险级别上升而显著升高(P0.001)。PESI预测死亡率准确度显示敏感性及阴性预测值均高。结论:利用PESI对PE进行危险分层,可较准确地判断PE预后,进而指导临床早期干预,改善预后。     

红细胞分布宽度等因素对肺栓塞预后的评估价值

目的:探讨红细胞分布宽度(RDW)、一个月内手术史、院内发病等因素对肺栓塞严重程度的评估价值。方法:回顾性分析中山大学孙逸仙纪念医院2015年9月至2018年8月经肺动脉CT造影(CTPA)确诊为肺栓塞的61例患者的临床资料。根据病情严重程度将肺栓塞患者分为低危组和非低危组。比较两组RDW的水平差异、一个月内手术史、院内发病等情况,评价RDW等因素对肺栓塞患者预后评估价值。结果:非低危组肺栓塞患者的RDW水平较低危组明显升高(P0.05),非低危组患者一个月内手术史和院内发病的构成比明显高于低危组(P0.05)。结论:RDW、一个月内手术史、院内发病等因素可能有助于评估肺栓塞患者的预后。     

ABCD3-Ⅰ评分法对TIA患者脑梗死的预测价值

目的:探讨ABCD3-Ⅰ评分法对短暂性脑缺血发作(TIA)患者进展脑梗死的风险预测价值。方法:收集187例以TIA为首发症状的患者,并且按照ABCD3-Ⅰ评分法分为低危组、中危组和高危组,观察30 d和90 d脑梗死发生率,并采用Logistic回归分析TIA进展为脑梗死的危险因素。结果:30 d内脑梗死和90 d内脑梗死发生率高危组明显高于中危组和低危组,有显著性差异(P<0.01)。双重TIA发作(OR=7.364;95%CI:1.536³5.305)、同侧颈动脉狭窄≥50%(OR=6.562;95%CI:2.84135.305)、同侧颈动脉狭窄≥50%(OR=6.562;95%CI:2.841¹5.156)、磁共振DWI出现高信号(OR=6.215;95%CI:2.78315.156)、磁共振DWI出现高信号(OR=6.215;95%CI:2.783¹3.879)是TIA进展为脑梗死独立的危险因素。预测90 d脑梗死方面,ABCD3-Ⅰ的ROC曲线下面积明显大于ABCD2和ABCD3。结论:ABCD3-I评分法能很好预测TIA进展为脑梗死的风险,可作为常规应用于临床,指导TIA危险分层评价和治疗。     

室间隔心肌切除术与化学消融术治疗肥厚型梗阻性心肌病临床效果Meta分析

目的应用Meta分析的方法评价室间隔心肌切除术(SM)与化学消融术(ASA)治疗肥厚型梗阻性心肌病(HOCM)的临床效果。方法计算机检索PubMed,Embase,Cochrane图书馆,CNKI、CBM disc及VIP里的比较SM和ASA治疗HOCM的对照研究。文献检索时间从建库至2013年10月。根据The Newcastle-Ottawa Scale(NOS)量表评价纳入文献的质量并提取资料。对符合质量标准的对照研究采用Rev Man 5.2进行异质性检验及Meta分析。结果检出相关文献380篇,根据纳入标准最终入选10篇文献;共入选病例927例。SM组与ASA组在术后住院病死率(OR:0.90;95%CI:0.23³.47)、术后随访期病死率(OR:1.01;95%CI:0.603.47)、术后随访期病死率(OR:1.01;95%CI:0.60¹.70)上未见明显差异(分别P=0.88,P=0.97)。两组患者手术前后左心室流出道压差(LVOTG)的下降和NYHA分级的提高均有意义(P<0.05);与ASA组相比,SM组患者的LVOTG下降(SMD:-0.46;95%CI:-0.6 01.70)上未见明显差异(分别P=0.88,P=0.97)。两组患者手术前后左心室流出道压差(LVOTG)的下降和NYHA分级的提高均有意义(P<0.05);与ASA组相比,SM组患者的LVOTG下降(SMD:-0.46;95%CI:-0.6 0⁰.32)及术后NYHA分级提高(SMD:-0.40;95%CI:-0.620.32)及术后NYHA分级提高(SMD:-0.40;95%CI:-0.62^-0.17)均更为明显,差异有统计学意义(均P<0.01)。SM组在术后右束支传导阻滞(OR:0.08;95%CI:0.03-0.17)均更为明显,差异有统计学意义(均P<0.01)。SM组在术后右束支传导阻滞(OR:0.08;95%CI:0.03⁰.23;P<0.01)、完全性传导阻滞(OR:0.27;95%CI:0.110.23;P<0.01)、完全性传导阻滞(OR:0.27;95%CI:0.11⁰.70;P<0.01)、室性心律失常(OR:0.17;95%CI:0.040.70;P<0.01)、室性心律失常(OR:0.17;95%CI:0.04⁰.75;P=0.02)及安装永久性起搏器(OR:0.22;95%CI:0.130.75;P=0.02)及安装永久性起搏器(OR:0.22;95%CI:0.13⁰.38;P<0.01)的发生率上均较ASA组明显降低。两组患者在术后植入性除颤器的安装率(OR:0.73;95%CI:0.310.38;P<0.01)的发生率上均较ASA组明显降低。两组患者在术后植入性除颤器的安装率(OR:0.73;95%CI:0.31¹.71)上未见统计学差异(P=0.46)。结论 SM仍然是治疗药物难治性HOCM的金标准;ASA作为一种替代治疗,远期结果需要进一步的观察和随访。     

脓毒症患者发生应激性溃疡的危险因素及预后分析

目的 探讨脓毒症患者住院期间发生应激性溃疡(stress ulcer,SU)的危险因素及其对预后的影响。方法 回顾性选择2019年1月至2021年7月复旦大学附属中山医院急诊科重症监护室收治的脓毒症患者344例,根据有无发生SU分为溃疡组和未溃疡组。采用logistic回归模型评估脓毒症患者发生SU及28 d死亡的危险因素,采用ROC曲线评估相关指标对脓毒症患者28 d死亡的预测价值。结果 344例脓毒症患者中发生SU 80例,占23.3%。部分促炎细胞因子（IL-6、IL-8）在溃疡组显著升高(P<0.05)。APACHEⅡ评分是脓毒症患者发生SU的影响因素(OR=1.066, 95%CI 1.030～1.103,P<0.001);呼吸衰竭(OR=3.408, 95%CI 1.604～7.239, P<0.001)、尿素氮升高(OR=1.046, 95%CI 1.003～1.090, P<0.05)、休克(OR=2.427, 95%CI 1.145～5.144, P<0.05)是脓毒症患者发生SU的独立危险因素。溃疡组和未溃疡组28 d死亡率为26.3%...     

PARADIGM-HF试验及其重要的临床意义

ACEI/ARB+β受体阻滞剂+醛固酮拮抗剂已经成为临床射血分数降低心力衰竭(EFr HF)治疗的金标准。本文简述了PARADIGM-HF临床试验,结果显示:与依那普利组比较,LCZ696(ARNI)治疗组主要复合终点[HR 0.80(95%CI 0.73~0.87),P<0.001]、心血管死亡[HR 0.80(95%CI 0.71~0.89),P<0.001]、因心力衰竭住院[HR 0.79(95%CI 0.71~0.89),P<0.001]和全因死亡[HR 0.84(95%CI 0.76~0.93),P<0.001]均显著降低,而且安全性良好。PARADIGM-HF研究意义重大,有可能改变未来心力衰竭的治疗格局。     

2型糖尿病患者趾臂指数与颈动脉及下肢动脉内中膜厚度的相关性研究

目的分析2型糖尿病(T2DM)患者趾臂指数(TBI)与外周动脉内中膜厚度(IMT)的相关性及TBI降低的危险因素。方法选择该院内分泌科住院的T2DM患者292例作为研究对象,分析其TBI与颈、股、腘动脉IMT的相关性及TBI降低的危险因素。结果 TBI降低组(TBI<0.7)与TBI正常组(TBI≥0.7)比较,年龄,DM病程,收缩压(SBP),颈、股、腘动脉IMT,DN患病人数差异均有统计学意义(P<0.05);TBI与颈、股、腘动脉IMT均呈负相关(r=-0.331、-0.288、-0.350,P<0.001);TBI降低的危险因素为年龄(OR=1.060、P<0.001、95%CI:1.027~1.095)、DM病程(OR=1.073、P=0.001、95%CI:1.027~1.121)、SBP(OR=1.021、P=0.018、95%CI:1.004~1.039)和吸烟史(OR=2.406、P=0.008、95%CI:1.251~4.626)。结论 T2DM患者TBI与颈、股、腘动脉IMT均呈负相关,年龄、糖尿病病程、SBP和吸烟史是TBI降低的危险因素。     

新疆成年人基础代谢率和颈动脉斑块相关性研究

目的了解新疆成年人基础代谢率和颈动脉斑块的相关性,提高对动脉粥样硬化的预防。方法 2007年10月至2010年3月应用四阶段整群随机抽样法,抽取新疆维吾尔族、哈萨克族、汉族18岁以上人群13 896名。进行问卷、体检和血糖、血脂检测及颈动脉斑块超声检测,采用Schofield公式计算人群基础代谢率,Logistic回归分析该人群颈动脉斑块形成的主要危险因素。结果新疆汉族、维吾尔族和哈萨克族基础代谢率分别为(1 488.8±235.2)kcal/d、(1 536.7±237.8)kcal/d和(1 454.7±220.7)kcal/d;颈动脉斑块形成组人群和无颈动脉斑块形成组人群基础代谢率分别为(1 506.71±246.80)kcal/d和(1 481.14±236.14)kcal/d(P<0.001)。Logistic回归分析显示,性别(OR:0.693,95%CI:0.554⁰.867,P=0.001),年龄(OR:1.036,95%CI:1.0280.867,P=0.001),年龄(OR:1.036,95%CI:1.028¹.044,P<0.001),基础代谢率(OR:1.982,95%CI:1.1261.044,P<0.001),基础代谢率(OR:1.982,95%CI:1.126².451,P<0.001),体重指数(OR:0.974,95%CI:0.9512.451,P<0.001),体重指数(OR:0.974,95%CI:0.951⁰.998,P=0.037),收缩压(OR:1.010,95%CI:1.0060.998,P=0.037),收缩压(OR:1.010,95%CI:1.006¹.015,P<0.001),肾小球滤过率(OR:0.995,95%CI:0.9931.015,P<0.001),肾小球滤过率(OR:0.995,95%CI:0.993⁰.998,P<0.001),甘油三酯(OR:1.092,95%CI:1.0460.998,P<0.001),甘油三酯(OR:1.092,95%CI:1.046¹.142,P<0.001)和高密度脂蛋白胆固醇(OR:0.853,95%CI:0.7421.142,P<0.001)和高密度脂蛋白胆固醇(OR:0.853,95%CI:0.742⁰.979,P=0.024)是颈动脉斑块形成的独立影响因素。结论新疆维吾尔族、哈萨克族、汉族基础代谢率和颈动脉斑块形成密切相关,且高基础代谢率为颈动脉斑块形成的独立危险因素之一。     

红细胞分布宽度与老年反杓型高血压患者早期肾功能损伤的关系

目的:探讨红细胞分布宽度(red cell distribution width,RDW)与老年反杓型高血压患者早期肾功能损伤的关系。方法:选取2015年9月至2018年8月首都医科大学附属北京中医医院收治的老年反杓型高血压患者256例作为观察组,年龄匹配的老年非杓型高血压患者89例作为对照组。比较两组患者基线资料及其RDW、肌酐(Cr)、尿素氮、β2微球蛋白(β2-MG)、胱抑素C(CysC)、尿微量白蛋白(microalbuminuria,MAU)及肾小球滤过率(estimated glomerular filtration rate,e GFR),并进一步分析RDW与老年反杓型高血压患者β2-MG,MAU,CysC的关系。结果:观察组RDW,MAU,Cr,尿素氮,β2-MG,CysC高于对照组(P0.05),而e GFR低于对照组(P0.05);Pearson相关分析示对照组RDW值与β2-MG(r=0.212,P0.05),MAU(r=0.357,P0.05),CysC呈显著正相关(r=0.236,P0.05);多元线性Logistic回归分析示RDW(OR=1.91,95%CI1.06～3.19,P=0.03),β2-MG(OR=4.12,95%CI2.05～8.31,P0.001),MAU(OR=0.42,95%CI0.20～0.79,P=0.01)是老年反杓型高血压患者肾损伤的危险因素。结论:RDW是老年反杓型高血压患者早期肾损伤的影响因素,提示其可作为此类患者早期肾功能损伤的独立预测指标。     

红细胞分布宽度与危重症患者病死率的相关性研究

目的探讨危重症患者入重症监护室(intensive care unit,ICU)时红细胞分布宽度(red cell distribution width,RDW)与病死率的相关性。方法采用回顾性队列研究,纳入美国重症监护数据库Ⅱ版本2.6(Multiparameter Intelligent Monitoring in Intensive CareⅡversion 2.6,MIMIC-Ⅱv2.6)中单次入院且ICU住院时长> 24 h,同时有RDW检测记录的成年患者。根据RDW预测病死率的最佳cut-off值(14.55%)将研究对象分为低RDW组(RDW <14.55%)及高RDW组(RDW≥14.55%),比较两组的病死率,进一步使用单因素及多因素Logistic回归和Cox回归分析评估RDW与病死率的关系。结果本研究最终共有13 822例患者入组。高RDW组的医院病死率、ICU病死率、28 d病死率及1年病死率均高于低RDW组(分别为19.73%vs.8.42%,15.04%vs.6.65%,22.68%vs.9.12%,36.22%vs.14.45%,均P <0.001)。RDW作为连续变量,多因素分析结果显示,RDW越高,医院病死率(OR=1.227,95%CI 1.190~1.265)、ICU病死率(OR=1.180,95%CI 1.141~1.220)、28 d病死率(HR=1.161,95%CI 1.138~1.185)和1年病死率(HR=1.177,95%CI 1.159~1.195)越高。分组后回归分析结果显示,与低水平RDW组相比,高水平RDW组患者的医院病死率增加0.912倍(OR=1.912,95%CI 1.683~2.172),ICU病死率增加0.673倍(OR=1.673,95%CI 1.452~1.928),28 d病死率增加0.850倍(HR=1.850,95%CI 1.675~2.043),1年病死率增加1.045倍(HR=2.045,95%CI 1.891~2.212),且存在统计学意义(P <0.001)。结论入ICU首次RDW增高是危重症患者死亡的危险因素。     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Rosamicin in Urethral and Vaginal Secretions and Tissues in Dogs and Rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.     

Similarities and differences in clients treated and in medications prescribed by APRNs and psychiatrists in a CMHC

This study is part of a larger study comparing prescribing practices of psychiatrists and advanced practice psychiatric nurses (APRNs) using the following three groups of patients: patients treated by psychiatrists, those treated by APRNs, and those treated by both APRNs and psychiatrists at different times in 1 year. Demographics for 5507 patients were examined. A subsample of APRNs and psychiatrists prescribed similar total numbers of medications. Psychiatrists prescribed more types of antidepressant medications other than the SSRI antidepressants, and they prescribed more than twice the number of benzodiazepines. APRNs prescribed more SSRIs and spent more time with clients during medication visits.     

Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls.MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.     

Racial differences in oxidative stress and inflammation: in vitro and in vivo

African American race is an independent risk factor for enhanced oxidative stress and inflammation. We sought to examine whether oxidative-stress and inflammatory markers that are typically measured in humans also differ by race in cell culture. We compared levels between African American and Caucasian young adults and then separately in human umbilical vein endothelial cells (HUVECs) from both races. We found heightened oxidative stress and inflammation in the African Americans both in vitro and in vivo. African American HUVECs showed higher nitric oxide (NO) levels (10.8 ± 0.4 vs. 8.8 ± 0.7 μmol/L/mg, p = 0.03), Interleukin-6 (IL-6) levels (61.7 ± 4.2 vs. 23.9 ± 9.0 pg/mg, p = 0.02), and lower superoxide dismutase activity (15.6 ± 3.3 vs. 25.4 ± 2.8 U/mg, p = 0.04), and also higher protein expression (p < 0.05) of NADPH oxidase subunit p47phox, isoforms NOX2 and NOX4, endothelial nitric oxide synthase (NOS), inducible NOS, as well as IL-6. African American adults had higher plasma protein carbonyls (1.1 ± 0.1 vs. 0.8 ± 0.1 nmol/mg, p = 0.01) and antioxidant capacity (2.3 ± 0.2 vs. 1.1 ± 0.3 mM, p = 0.01). These preliminary translational data demonstrate a racial difference in HUVECs much like that in humans, but should be interpreted with caution given its preliminary nature. It is known that racial differences exist in how humans respond to development and progression of disease, therefore these data suggest that ethnicity of cell model may be important to consider with in vitro clinical research.