An Approach to the Rational Use of Revascularization in Heart Failure Patients

The most common cause of heart failure with reduced ejection fraction (HFrEF) is coronary artery disease. A multitude of factors come into play when deciding whether a patient with HFrEF and coronary artery disease should have coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention, or medical therapy alone. For candidates for percutaneous coronary intervention and CABG, evidence from large registries would suggest that patients with 2-vessel coronary artery diseases and proximal left anterior descending disease and all patients with 3-vessel coronary artery disease do better with CABG. For patients that are candidates for medical therapy with or without CABG, the results of the Surgical Treatment for Ischemic Heart Failure (STICH) trial indicate that with CABG, the reduction of mortality is not statistically significant (hazard ratio [HR], 0.86; P = 0.12). However, CABG is superior in reducing cardiovascular deaths (HR, 0.81; P = 0.05), and the combination of cardiovascular deaths and cardiovascular hospitalizations (HR, 0.74; P < 0.001). Patients undergoing CABG have an upfront risk that is eliminated by 2 years and thereafter do better. The assessment of cardiac viability or reversible ischemia does not appear to be helpful in determining which individuals will improve more with CABG. Patients with severe mitral regurgitation who undergo CABG appear to benefit from simultaneous valve repair but not from the addition of surgical ventricular reconstruction of the left ventricle, although in specific patients this might be considered. The totality of evidence would thus suggest that patients with HFrEF should be evaluated for the possibility of coronary revascularization if they are candidates for CABG.     

胞二磷胆碱联合重组人促红素治疗新生儿缺氧缺血性脑病的临床疗效及其对患儿神经功能的影响

背景 新生儿缺氧缺血性脑病(HIE)具有较高的病死率、致残率,临床主要采用胞二磷胆碱治疗新生儿HIE并取得了一定疗效,但该药物不良反应较多,一定程度上影响了临床疗效,因此探寻新的治疗方式对提高新生儿HIE的治疗效果具有重要的临床意义.目的 探讨胞二磷胆碱联合重组人促红素治疗新生儿HIE的临床疗效及其对患儿神经功能的影响...     

Effect of Splenic X-Irradiation on Bone Marrow Function: Experimental Studies of a Serum Mitotic Inhibitor in Rabbit and in Patients with Chronic Myelocytic Leukaemia

S ummary . The effect of a selective splenic irradiation on bone marrow function was studied in rabbits given a single splenic exposure with 300 r. of X-rays. Serum collected shortly thereafter decreased mitotic activity in suspensions of normal rabbit bone marrow. This in vitro inhibitory effect was only transiently demonstrable in the serum appearing 2 hours after irradiation and disappearing 3 hours later.
Five patients with chronic myelocytic leukaemia in relapse receiving splenic radiotherapy in large single doses of 200–400 r. (surface dose) were studied along these lines. Serum collected 3 hours after X-ray treatment was tested with suspensions of normal bone marrow and was found to decrease erythroblastic mitotic activity significantly below the control values observed with serum collected before irradiation. The magnitude of this in vitro effect was to some extent related to the spleen size and the radiation dose. No differences were observed between bone marrow suspensions incubated with pre-irradiation leukaemic serum and normal control serum.     

硝普钠联合重组人尿激酶原对急性ST段抬高型心肌梗死患者经冠脉介入后无复流的效果观察

目的 观察硝普钠联合重组人尿激酶原对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）后无复流的效果。方法 本研究对象为2018年3月至2019年3月就诊于本院的80例行PCI术的急性STEMI患者,采取随机数字表法分为两组,各40例。对照组采用硝普钠治疗,研究组为硝普钠联合重组人尿激酶原治疗。比较两组患者的临床疗效、心肌梗死溶栓治疗(TIMI)心肌灌注分级(TMPG)与校正的TIMI血流帧数计数(cTFG)、炎性因子以及不良事件发生率。结果 研究组的治疗总有效率（92.50%）高于对照组（72.50%）,用药后研究组TMPG（100.76±5.67）帧与cTFG（26.83±4.20）帧均低于对照组（105.29±6.03）帧、（30.76±5.59）帧,治疗7d后的白细胞介素-6（IL-6）、超敏C反应蛋白（hs-CRP）和内皮细胞特异性分子1（ESM-1）水平低于对照组,不良事件发生率（15.00%）比对照组（35.00%）低,差异有统计学意义（P＜0.05）。结论 硝普钠联合重组人尿激酶原对急性STEMI患者行PCI术后无复流的治疗效果较强,可以有效改善患者的TMPG,降低炎性反应,减少无复流以及不良事件的发生率。     

注射重组人促红细胞生成素对早产儿贫血及神经系统作用的防治分析

目的观察重组人类促红细胞生成素(recombinant human erythropoietin,rh-EPO)对早产儿贫血及脑损伤的防治效果。方法将在我科住院的早产后胎龄小于32周,体质量低于2000g的新生儿30例,按入院顺序随机分成两组,实验组15例,对照组15例。两组患儿生后均给予常规治疗,并同时在生后1、2、3d分别经静脉给予EPO1000U/kg(实验组)和250U/kg(对照组),比较两组早产儿的血红蛋白、红细胞数、血细胞比容。结果治疗组红细胞数、血红蛋白、血细胞比容均显著高于对照组(P0.05)。结论早期应用重组人类促红细胞生成素能有效防治早产儿贫血及保护神经系统,且用药安全,无明显不良反应。     

重组人血管内皮抑素联合GP方案治疗非小细胞肺癌的疗效观察

目的 观察重组人血管内皮抑素联合吉西他滨+顺铂方案(GP方案)治疗非小细胞肺癌的临床疗效.方法 53例非小细胞肺癌患者随机分为对照组(26例)和治疗组(27例).对照组采用GP方案治疗;治疗组采用重组人血管内皮抑素联合GP方案治疗.治疗结束后观察两组治疗总有效率及不良反应.结果 治疗组临床总有效率为66.7%,对照组临床总有效率为46.2%,差异有显著性(P<0.05);两组毒副反应比较差异无显著性差异(P>0.05).结论 重组人血管内皮抑素联合GP方案治疗非小细胞肺癌疗效显著,能明显改善患者的生活质量,值得临床推广应用.     

辛伐他汀对高血压合并动脉粥样硬化患者内皮功能的影响

目的探讨合并动脉粥样硬化的高血压患者内皮舒张功能与颈动脉硬化、hsCRP的关系以及辛伐他汀的干预作用。方法选取46例合并颈动脉斑块的高血压患者(研究组)和20例无颈动脉斑块的高血压患者(对照组),采用彩色多普勒超声检查颈动脉内膜中层厚度(IMT)、颈动脉斑块积分、血管内皮依赖性舒张功能(FMD)测定血超敏C反应蛋白(hsCRP)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、空腹血糖(FBG)等,研究组予以辛伐他汀20mg/晚口服,12周后复查上述指标。结果两组比较,研究组FMD低于对照组(7.6±1.9%vs9.7±2.2%),而IMT(1.32±0.51 vs 0.62±0.42mm)、hsCRP(5.81±1.62 vs 2.42±1.32mg/L)值高于对照组,差异有显著性(P<0.05);研究组辛伐他汀治疗后显著改善FMD(7.6±1.9%vs 10.5±2.6%),减低IMT、颈动脉斑块积分和hsCRP,分别为1.32±0.51 vs 1.13±0.32mm、6.85±0.61 vs 4.67±0.62mm和5.81±1.62 vs 3.03±1.41mg/L,P<0.05;相关分析示FMD与IMT(r=-0.53)、hsCRP(r=-0.45)、SBP(r=-0.36)、TC(r=-0.29)负相关(P<0.05)。结论合并动脉硬化的高血压患者内皮功能障碍较重,且内皮功能与多种心血管危险因素成负相关,辛伐他汀可以改善内皮功能,稳定动脉斑块。     

胎脑注射液对老龄小鼠细胞免疫功能影响的实验研究

本文研究了人胎脑注射液对老龄小鼠细胞免疫功能的影响。实验组小鼠腹腔巨噬细胞的吞噬率,吞噬指数,消化异物的能力以及酸性非特异性萘酯酶(ANAE)活性都显著高于对照组(P<0.001);外周血T细胞总数及亚群(点状颗粒型)也显著高于对照明(P<0.001)。结果表明,人胎脑注射液能显著的提高老年小鼠的细胞免疫功能,并能增强其体质。     

重组人血管内皮抑制素联合FOLFOX4方案治疗晚期结直肠癌的临床对照研究

背景：临床前和临床研究结果显示重组人血管内皮抑制素能抑制血管内皮细胞增殖、血管生成和肿瘤生长．且耐受性良好。目的：评价重组人血管内皮抑制素联合FOLFOX4方案治疗晚期结直肠癌（ACRC）的反应率（RR）、临床获益率（CBR）、中位疾病进展时间（TTP）和肿瘤进展率,观察患者生活质量（QOL）改善情况和药物不良反应。方法：收集50例病理学诊断为Ⅳ期、初治或复治、Karnofsky评分（KPS）≥60分的ACRC患者,随机分为试验组和对照组。试验组25例,联合应用FOLFOX4方案和重组人血管内皮抑制素（7．5mg／m^2,d1-14）。对照组25例,应用FOLFOX4方案＋安慰剂（0．9％NaCl溶液,用法同重组人血管内皮抑制素）。结果：50例患者均可评价疗效。试验组总RR（44．0％对16．0％,P-0．062）、总CBR（76．0％对48．0％,P=0．041）、总中位TTP（7．8个月对5．0个月,P=0．040）和QOL改善率（64．0％对36．0％,P=0．048）均高于对照组,肿瘤进展率低于对照组（P〈0．05）。初治患者中,试验组RR、CBR和中位TTP均显著高于对照组（P〈0．05）;复治患者中,试验组和对照组上述指标无明显差异。两组间不良反应发生率差异无统计学意义。结论：重组人血管内皮抑制素联合FOLFOX4方案能明显提高ACRC患者,尤其是初治患者的RR．延长中位TTP,在一定程度上改善患者的QOL,且安全性较好。     

人胎脑提取物对老龄小鼠脑细胞脂褐素含量及血SOD活性的影响

本文研究了人胎脑提取物对老龄小鼠细胞脂褐素及血超氧化物歧化酶(SDD)活性力的影响。连续腹腔注射一个月后,老龄小鼠脑细胞内脂褐素的含量明显低于对照组(P<0.01);SOD活性则与对照组间无明显差异。结果表明,人胎脑提取物能显著的减少老龄小鼠脑细胞内的脂褐素;故可能有抗衰老作用,但对SOD的活性影响不大。     

Human Studies with Glucagon-like-peptide-1: Potential of the Gut Hormone for Clinical Use

So far, a wealth of data originating from in vitro or animal experiments has been collected supporting the concept that the gut hormone, glucagon-like peptide-1 (GLP-1) may serve as a model molecule for the design of a new drug for the treatment of diabetes mellitus. This is supported by observations that GLP-1 has potent insulinotropic action in patients with non-insulin-dependent diabetes mellitus (NIDDM). It enhances β-cell sensitivity to glucose stimulated insulin secretion. GLP-1 may also have a role in the treatment of impaired glucose tolerance, where the β-cell is already insensitive to changes in plasma glucose concentrations. It may, as has previously been shown in animal models of ‘prediabetes’, delay the progressive decline in glucose tolerance to NIDDM. The glucose-dependent action of this peptide is an important feature in the treatment of NIDDM as it will protect against hypoglycaemic reactions, the most serious acute side-effect of antidiabetic therapy. Glucose utilization may be enhanced which would improve metabolic control in both NIDDM and IDDM. A glucagon lowering effect will further enhance metabolic control. This article reviews current experiences of the effects of GLP-1 in human studies. It points out the outcomes and limitations of previous trials and discusses future directions for the investigation of its potential use as a new agent in diabetes treatment.     

Clinical Benefit of Preserving Residual Renal Function in Dialysis Patients: An Update for Clinicians

Residual renal function (RRF) remains important even after beginning of dialysis. RRF contributes significantly to the overall health and well-being of patients on dialysis. It plays an important role in maintaining fluid balance, phosphorus control, nutrition, and removal of middle molecular uremic toxins and shows inverse relationships with valvular calcification and cardiac hypertrophy in patients on dialysis. RRF may allow for a reduction in the duration of hemodialysis sessions and the need for dietary and fluid restrictions in both patients on peritoneal dialysis and hemodialysis. More importantly, the loss of RRF is a powerful predictor of mortality. This article will review the evidence supporting the importance of RRF on outcome and outline potential strategies that may better preserve RRF in patients on dialysis.     

重组人心钠肽治疗急性心力衰竭血流动力学临床研究

目的:评价短期静脉应用不同剂量的重组人心钠肽治疗急性心力衰竭(心衰)患者的血流动力学效应及安全性.方法:本试验为随机、平行对照、多中心临床研究.顺序入选中国2家心血管临床中心的48例急性心衰患者,用药前应用Swan-Ganz导管进行血流动力学监测,将接受急性心衰常规治疗的设为对照组(n=12),急性心衰常规治疗的同时给予静脉泵入重组人心钠肽1h的患者,按用药速率分为0.05 μg/(kg·min)组(小剂量组,n=12)、0.1 μg/(kg·min)组(中剂量组,n=12)、0.2 μg/(kg·min)组(大剂量组,n=12).分别在用药前、给药后30 min、1 h、3 h、12 h测量并记录血流动力学参数,同时记录治疗前、后呼吸困难、其他临床症状以及全身临床情况.定期测量血压、心率、呼吸频率以及相关的血液生化指标,并对试验过程中出现的所有不良事件进行记录,进行安全性评估.结果:中剂量组的肺毛细血管楔压、肺动脉压在用药后30 min、1 h、3 h较用药前均下降,而心脏指数(CI)用药后30 min、1 h较用药前升高,差异有统计学意义(P<0.05或0.01).中剂量组的肺动脉压用药后30 min、1 h与对照组比较降低,差异有统计学意义(P<0.05).大剂量组用药后30 min、3 h、12 h及24 h与用药前比较呼吸频率均减慢,差异有统计学意义(P均＜0.05).在耐受性和安全性方面,心率及血生化检查用药后24h无明显变化.大剂量组发生2例与试验药物相关的低血压.48例患者未出现与试验药物相关的严重不良事件,无受试者因不良事件中途退出研究.结论:重组人心钠肽改善急性心衰患者的血流动力学效果明显,且能改善呼吸困难等临床症状,使用中剂量重组人心钠肽不但疗效较好,且不良事件较少,适宜临床应用.     

肌电生物反馈联合针刺对脑卒中偏瘫患者上肢功能的影响

目的：研究肌电生物反馈联合针刺对脑卒中后偏瘫患者上肢运动功能的影响。方法将60例脑卒中偏瘫患者分为对照组（30例）和治疗组（30例）,两组患者均接受常规康复,对照组在此基础上加用针刺治疗,治疗组（肌电生物反馈组）在对照组的基础上加用肌电生物反馈治疗,共治疗8周。治疗前、治疗后8周,测定偏瘫侧腕关节的主动背伸活动范围（AROM）,检测腕背伸肌最大收缩时 EMG 波幅,采用 Fugl Meyer 运动功能量表（FMA）评估上肢运动功能。结果两组患者经过治疗后,偏瘫侧腕关节的AROM、腕背肌最大收缩时 EMGG波幅、FMA评分均明显改善（P〈0.01）,且治疗组功能改善优于对照组（P〈0.05）。结论肌电生物反馈联合针刺能显著促进脑卒中偏瘫患者上肢运动功能的恢复。     

Investigation on the Thermodynamic Stability of Nanocrystalline W-Based Alloys: A Combined Theoretical and Experimental Approach

The stability of nanostructured metal alloys is currently being extensively investigated, and several mathematical models have been developed to describe the thermodynamics of these systems. However, model capability in terms of thermal stability predictions strongly relies on grain boundary-related parameters that are difficult to measure or estimate accurately. To overcome this limitation, a novel theoretical approach is proposed and adopted in this work to identify W-based nanocrystalline alloys which are potentially able to show thermodynamic stability. A comparison between model outcomes and experimental findings is reported for two selected alloys, namely W-Ag and W-Al. Experimental results clearly highlight that W-Ag mixtures retain a segregated structure on relatively coarse length scales even after prolonged mechanical treatments. Moreover, annealing at moderate temperatures readily induces demixing of the constituent elements. In contrast, homogeneous nanostructured W-Al solid solutions are obtained by ball milling of elemental powders. These alloys show enhanced thermal stability with respect to pure W even at high homologous temperatures. Experimental evidences agree with model predictions for both the investigated systems.     

On the Elimination of Infections Related to Oncogenic Human Papillomavirus: An Approach Using a Computational Network Model

Cervical cancer is the fourth most common malignancy in women worldwide, although it is preventable with prophylactic HPV vaccination. HPV transmission-dynamic models can predict the potential for the global elimination of cervical cancer. The random network model is a new approach that allows individuals to be followed, and to implement a given vaccination policy according to their clinical records. We developed an HPV transmission-dynamic model on a lifetime sexual partners network based on individual contacts, also accounting for the sexual behavior of men who have sex with men (MSM). We analyzed the decline in the prevalence of HPV infection in a scenario of 75% and 90% coverage for both sexes. An important herd immunity effect for men and women was observed in the heterosexual network, even with 75% coverage. However, HPV infections are persistent in the MSM population, with sustained circulation of the virus among unvaccinated individuals. Coverage around 75% of both sexes would be necessary to eliminate HPV-related conditions in women within five decades. Nevertheless, the variation in the decline in infection in the long term between a vaccination coverage of 75% and 90% is relatively small, suggesting that reaching coverage of around 70–75% in the heterosexual network may be enough to confer high protection. Nevertheless, HPV elimination may be achieved if men’s coverage is strictly controlled. This accurate representation of HPV transmission demonstrates the need to maintain high HPV vaccination coverage, especially in men, for whom the cost-effectiveness of vaccination is questioned.     

运动干预对尿毒症合并慢性心力衰竭患者心功能的疗效分析

目的　探讨有计划的运动干预对尿毒症合并慢性心力衰竭患者心功能的影响。方法　对86例尿毒症合并慢性心力衰竭患者,随机分为常规治疗组和运动干预组,两组患者给予等同条件的血液透析和基础治疗,常规治疗组避免任何运动干预,运动干预组另加在家步行（或慢跑）与抗阻力运动相结合的运动干预,观察疗程为10周。结果　常规治疗组NYHA心功能分级Ⅱ级患者所占比例由治疗前46.51%下降到44.19%;运动干预组NYHA心功能分级Ⅱ级患者所占比例由治疗前44.19%提高到69.77%,差异有统计学意义（P<0.05）。常规治疗组左心室射血分数（LVEF）由治疗前41.2%±6.5%提高到41.3%±7.1%;运动干预组LVEF由治疗前41.9%±7.0%提高到42.9%±6.4%,差异无统计学意义（P>0.05）。常规治疗组血清脑利钠肽（BNP）水平由治疗前1120.9±310.6　ng/L升高到1143.9±282.3　ng/L,运动干预组血清BNP水平由1083.3±294.3　ng/L下降到928.8±279.3　ng/L,差异有统计学意义（P<0.05）。结论　运动干预对合并慢性心力衰竭的维持性血液透析患者是安全的;运动干预可改善合并慢性心力衰竭的维持性血液透析患者NYHA心功能分级、血清BNP水平。     

Effect of Recombinant Human Growth Hormone Administration on Body Composition and Vascular Function and Structure in Old Male Wistar Rats

The process of ageing affects negatively both cardiovascular system and body composition. On the other hand, the hormones of the somatotrophic axis, growth hormone (GH) and insulin-like growth factor-I (IGF-I), whose production is reduced by age, are involved in the regulation of the cardiovascular system. The aim of this study was to investigate the effect of GH on body composition, vascular function and structure in old male rats. Old (20 months) and adult (4 months) male Wistar rats were used. One group of old animals was treated with GH for 4 weeks. Periepididimary fat weight, Specific Gravity Index (SGI), dose responses to Acetylcholine (ACh), Isoproterenol (Iso), Phenylephrine (Phe) and ACh in the presence of N^G-nitro-l-arginine metylester (l-NAME; ACh+l-NAME), as well as vascular morphology in aortic rings, were studied. Old rats showed increased fat weight and decreased SGI as compared to adult animals. GH increased SGI and tended to reduce fat weight. Old rats showed an impairment in the vasodilator response to ACh and Iso; GH significantly improved the vasodilatation induced by Iso, whereas the response to ACh was not significantly enhanced by GH treatment. There were no significant differences between adult and old rats in the contractile response to Phe, and GH did not show any effect. Contraction induced by ACh+l-NAME was higher in old rats as compared to adults, and treatment with GH significantly reduced this response. Aortic media area was increased in old rats, and GH administration reduced this parameter. In conclusion, GH shows beneficial effects on body composition, as well as on vascular function and morphology in old male rats.