Lp-PLA2、Hcy在动脉粥样硬化性心脑血管疾病的应用研究

目的探讨和研究检测血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)之间的相互联系,诊断动脉粥样硬化性心脑血管疾病提供更多的参考依据。方法通过随机数表法从2015年10月至2016年10月因胸痛于该院治疗的患者中选取80例作为研究对象,根据患者冠脉造影是否伴有病变将其分为试验组和对照组,每组各40例,入组患者均通过全自动免疫分析仪进行Lp-PLA2、Hcy水平检测,并探讨两组间,差异以及与动脉粥样硬化性心脑血管疾病间的相互联系。结果与对照组相比,试验组患者Lp-PLA2及Hcy水平明显增加,差异有统计学意义(P0.05);随访期间,和对照组相比,试验组患者心脑血管疾病的发生率明显增加,差异有统计学意义(P0.05)。结论动脉粥样硬化性心脑血管疾病患者多伴有不同程度的Lp-PLA2及Hcy水平增加,临床应重视对二者的检测,提高临床诊疗水平。     

血浆脂蛋白相关性磷脂酶 A2水平与脉搏波传导速度相关性临床研究

目的：探讨血浆脂蛋白相关性磷脂酶 A2水平（Lp-PLA2）与脉搏波传导速度（PWV）的相关性。方法采用横断面研究方法,收集168例非心脑血管动脉粥样硬化性疾病患者,检查所有入选者血浆 Lp-PLA2水平以及 PWV,同时收集其他相关资料。依据血浆 Lp-PLA2水平分为正常组和升高组,比较两组相关资料以及与 PWV 相关的独立危险因素。结果与正常组相比,Lp-PLA2水平升高组 PWV 及血浆 Lp-PLA2水平明显升高,差别具有统计学意义（P ＜0.01）;其余各指标如年龄、吸烟情况、糖尿病等两组间无明显差别。多重线性回归分析提示,年龄、高血压以及血浆Lp-PLA2水平均与 PWV 独立相关,其他传统危险因素如吸烟、血糖以及胆固醇等与 PWV 无独立相关性。结论在动脉粥样硬化早期,血浆 Lp-PLA2水平升高与脉搏波传导速度具有独立相关性。     

心脑合病危险因素的横断面调查

目的通过与冠心病心绞痛、动脉粥样硬化性血栓性脑梗死危险因素的对比,探讨冠心病心绞痛合并动脉粥样硬化性血栓性脑梗死(简称心脑合病)的危险因素,为心脑合病的预防提供依据。方法采用横断面调查方法,纳入冠心病心绞痛、动脉粥样硬化性血栓性脑梗死和心脑合病患者的危险因素资料,运用SPSS 17.0软件对危险因素先进行单因素分析,然后应用logistic回归模型筛选心脑合病的独立危险因素。结果最终纳入冠心病心绞痛1?002例、动脉粥样硬化性血栓性脑梗死患者963例和心脑合病患者982例。三种疾病在患者年龄(P=0.000?0)、性别(P<0.000?1)、静息生活方式(P=0.000?0)、体重指数(BMI)(P=0.000?0)、糖尿病(P=0.001?9)、高血压(P<0.000?1)、糖尿病合并高血压(P<0.000?1)、吸烟(P<0.000?1)、饮酒(P<0.000?1)以及合并三种以上危险因素(P=0.000?0)等方面,其差异均有统计学意义。logistic多元回归分析显示,患者年龄[OR=1.690,95%CI(1.420,2.012)]、高血压[OR=1.558,95%CI(1.312,1.850)]、BMI异常[OR=1.356,95%CI(1.158,1.587)]及静息生活方式[OR=1.319,95%CI(1.107,1.572)]是心脑合病的独立危险因素。结论高龄、高血压、BMI异常和有静息生活方式的人易患心脑合病,应加强干预。     

急性脑梗死患者血浆同型半胱氨酸浓度与颈动脉粥样硬化的相关性

目的:探讨动脉粥样硬化性血栓性脑梗死与血浆同型半胱氨酸(Hcy)浓度及颈动脉粥样硬化(atherosclerosis,AS)的关系。方法:应用HPLC-FD法测定87例急性脑梗死患者和80例对照者血浆HCY浓度,应用彩色多普勒超声仪测量左右颈总动脉内膜中层厚度(carotidarteryintimal-medialwallthickness,IMT)。结果:病例组空腹血浆Hcy浓度(15.28±4.33)μmol/L较对照组(11.32±3.86)μumol/L高(t=6.28,P<0.001),两组中血浆Hcy升高者分别为31.0%(27/87)和6.3%(5/80),差异有显著性意义(χ2=14.966,P<0.001);病例组55例、对照组66例行颈动脉B超检测,左、右颈总动脉IMT差异均有显著性意义(t=3.647,4.118,P<0.001),颈AS斑块发生率差异有显著性意义(χ2=6.145,P=0.013),而颈动脉中-重度狭窄发生率差异无显著性意义(χ2=0.062,P=0.803)。结论:高HCY血症是脑梗死的独立危险因素,B超检测的颈AS与脑梗死相关。     

脂蛋白相关磷脂酶A2与急性缺血性脑卒中的相关性研究

目的 通过检测急性缺血性脑卒中患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)浓度,探讨两者的关系,为临床诊断、治疗提供依据.方法 选择急性缺血性脑卒中患者(151例)为研究对象,未卒中患者(100例)作对照,血浆Lp-PLA2检测采用酶联免疫吸附法(ELISA).结果 (1)急性缺血性脑卒中组血浆Lp-PLA2浓度高于对照组,差异有统计学意义(t=21.307,P=0.000).血浆Lp-PLA2浓度与急性缺血性脑卒中的风险呈正相关.(2)各型急性缺血性脑卒中血浆Lp-PLA2浓度差异均无统计学意义(P＞0.05).结论 Lp-PLA2是急性缺血性脑卒中的危险标志物,测定Lp-PLA2浓度有助于制定预防策略,为急性缺血性脑卒中的预防及临床治疗提供依据.     

血清游离脂肪酸与老年2型糖尿病患者并发冠心病相关危险因素分析

目的探讨血清游离脂肪酸(FFA)及同型半胱氨酸(Hcy)、C反应蛋白(CRP)、空腹血糖(FPG)、血脂等因素对老年2型糖尿病患者合并冠心病的影响。方法选取2015年1月1日至2015年12月31日已确认为2型糖尿病合并冠心病老年住院患者84例(A组),同期入院单纯2型糖尿病老年患者79例(B组),同时选取健康体检老年人50例为对照(C组),测定3组研究对象FFA、Hcy、CRP、空腹血糖(FPG)、血脂水平,通过Logistic回归分析其与2型糖尿病并发冠心病的相关性。结果 3组研究对象血清FFA、Hcy、CRP、FPG水平比较,差异均有统计学意义(F=86.150、22.970、34.970、65.060,P=0.000)。相关分析结果显示FFA、Hcy、CRP、FPG与老年2型糖尿病患者并发冠心病呈正相关(r=0.563、0.327、0.316、0.369,P=0.000)。Logistic回归分析显示FFA(OR=1.005,95%CI为1.003~1.008,P=0.000)、Hcy(OR=1.062,95%CI为1.008~1.119,P=0.024)、CRP(OR=1.165,95%CI为1.081~1.255,P=0.000)、FPG(OR=1.227,95%CI为1.046~1.440,P=0.012)是2型糖尿病合并冠心病的危险因素。结论 FFA、Hcy、CRP、FPG是老年2型糖尿病患者并发冠心病的危险因素,糖尿病患者严格控制血糖同时,积极控制FFA、Hcy、CRP水平可能延缓或减少冠心病并发症的发生。     

同型半胱氨酸与2型糖尿病合并微血管病变相关性及影响因素分析

目的探讨同型半胱氨酸(Hcy)与2型糖尿病(T2DM)患者合并微血管病变的相关性,研究影响血浆Hcy代谢的相关因素。方法选取本院收治的T2DM患者325例,根据微血管并发症情况分为合并微血管病变组(A组)和未合并微血管病变组(B组)。采集患者肘静脉空腹血和餐后2h血,分别检测Hcy、血糖指标、肝功能和肾功能等生化指标并进行比较分析。应用多因素二元Logistic回归分析影响T2DM患者发生微血管病变的危险因素以及影响Hcy水平的相关因素。结果合并微血管病变的T2DM患者血浆Hcy为(12.3±3.7)μmol/L,明显高于未合并微血管病变组的(9.7±3.2)μmol/L,差异有统计学意义(t=6.784,P0.05)。多因素二元Logistic回归分析显示,Hcy是T2DM患者发生微血管病变的独立危险因素之一[OR及95%CI为4.120 (1.123-8.424),P0.05],影响T2DM患者Hcy水平的危险因素为合并高血压[OR及95%CI为5.047(2.203-9.133),P0.05]、高水平糖化血红蛋白(HbA1c)[OR及95%CI为1.674 (1.102-3.456),P0.05]。高水平肾小球滤过率(GFR)是其保护性因素[OR及95%CI为0.885 (0.802-0.923),P0.05]。结论血浆Hcy是T2DM患者发生微血管病变的危险因素,可用于提示T2DM早期微血管并发症的存在,T2DM患者血浆中Hcy水平与合并高血压、HbA1c和GFR水平有关。     

Lp-PLA2水平与急性动脉粥样硬化脑梗死患者常见危险因素的相关性分析

目的研究血浆脂蛋白相关磷脂酶A2(Lp-PLA2)和急性动脉粥样硬化脑梗死(Acute cerebral infarct,ACI)常见影响因素的关系。方法将本院2017年8月至2019年8月收治的急性动脉粥样硬化ACI患者100例纳入观察组,同期取100例健康体检者纳入对照组,收集两组基本信息,并给予Lp-PLA2、血脂指标、C反应蛋白(CRP)、同型半胱氨酸(Hcy)等实验室指标检测。比较两组实验室指标水平、既往病史与行为习惯、Lp-PLA2水平与不同亚型ACI患者Lp-PLA2水平,分析Lp-PLA2与急性动脉粥样硬化ACI常见危险因素相关性。结果两组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、纤维蛋白(Fib)相比较,差异均无统计学意义(P>0.05)。观察组高密度脂蛋白胆固醇(HDL-C)较对照组低,C反应蛋白(CRP)、同型半胱氨酸(Hcy)较对照组高,差异有统计学意义(P<0.05)。观察组糖尿病史、高血压史占比较对照组高,差异有统计学意义(P<0.05)。重型ACI组患者Lp-PLA2水平较中型、轻型ACI组高,差异有统计学意义(P<0.05)。Lp-PLA2与急性动脉粥样硬化ACI酗酒、吸烟、高血压史负相关(r=-0.271、-0.243、-0.297,P=0.003、0.002、0.002),与CRP呈正相关(r=0.297,P=0.002)。结论Lp-PLA2与急性动脉粥样硬化ACI酗酒、吸烟、高血压史、CRP存在相关性。     

H型高血压患者血浆同型半胱氨酸水平变化对动脉粥样硬化性疾病的影响

目的探讨血浆同型半胱氨酸(Hcy)水平变化对H型高血压患者动脉粥样硬化性疾病的影响,以及H型高血压患者动脉粥样硬化的相关危险因素,为临床治疗提供参考。方法检测207例H型高血压患者、200例非H型高血压患者及200名体检健康者(正常对照组)血压、血浆Hcy、总胆固醇(TC)、三酰甘油(TG)、脂蛋白(a)[Lp(a)],尿酸(UA)、肌酐(Cr)等,同时进行颈动脉超声检查。按照血浆Hcy水平分为H1、H2、H3、H44个亚组。结果 H型高血压组Lp(a)、Cr水平高于非H型高血压组及正常对照组(P0.05);H型高血压组和非H型高血压组TG、UA水平均高于正常对照组(P0.05);其他检查指标3个组之间差异均无统计学意义(P0.05)。H型高血压组重度高血压患者所占比例高于非H型高血压组(P=0.02),其内膜中层厚度(IMT)大于非H型高血压组(P=0.011);H型高血压组动脉粥样硬化发生率也高于非H型高血压组(P=0.032)。H1、H2、H3、H4 4个亚组的患者中动脉粥样硬化斑块发生率、IMT差异有统计学意义(P0.05);高Hcy水平[比值比(OR)=2.515,P=0.036]、重度高血压(OR=2.216,P=0.038)和高Lp(a)(OR=2.189,P=0.041)是H型高血压患者发生动脉粥样硬化的危险因素。结论 H型高血压患者发生动脉粥样硬化风险更高,在治疗高血压的同时,定期监测Hcy水平对于H型高血压的治疗及预后具有重要意义。     

动脉硬化性脑梗死患者血浆Lp-PLA2水平及临床意义

目的:通过检测动脉硬化性脑梗死(ACI)患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平,探讨其与脑梗死体积、神经功能缺损程度的关系,为评价病情提供帮助.方法:选择ACI患者(128例)和未卒中对照者(88例)为研究对象,采用酶联免疫吸附法(ELISA),检测血浆Lp-PLA2的水平.行头颅核磁共振检查计算脑梗死体积大小,按美国国立卫生研究所中风量表(NIHSS评分)进行神经功能缺损程度评估.结果:(1)ACI组血浆Lp-PLA2水平高于对照组,差异有统计学意义(t=22.506,P=0.000).(2)Lp-PLA2与HDL-C负相关(rs=-0.804,P=0.000),与TC、LDL-C正相关(r=0.919,P=0.000;r=0.914,P=0.000).(3)血浆Lp-PLA2水平随脑梗死体积增加而呈递增趋势,但差异无统计学意义(F=0.845,P=0.296);(4)血浆Lp-PLA2水平随神经功能缺损程度增加而呈递增趋势,差异有统计学意义(F=132.93,P=0.000).Spearman相关分析显示,神经功能缺损程度与血浆Lp-PLA2水平正相关(rs=0.829,P=0.001).结论:ACI患者血浆Lp-PLA2水平升高,其与神经功能缺损程度相关,而与脑梗死体积无关.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.