维吾尔族、汉族冠状动脉斑块64排螺旋CT特征与危险因素对照分析

目的:比较新疆维吾尔族(维族)与汉族冠心病患者冠状动脉粥样硬化斑块的64排螺旋CT特征与冠心病危险因素,探讨2个民族冠心病发病可能原因.方法:同期64排螺旋CT冠状动脉造影确诊为冠心痛的维族患者152例及汉族患者304例,分析其斑块成分、部位、血管狭窄程度及梗阻性斑块(狭窄≥50%的斑块)累及冠状动脉的分支数,并采集患者性剐、年龄、身高、体质量及高血压病史、糖尿病痛史、吸烟吏、家族史,三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平进行比较.结果:维族冠,心痛患者斑块发生率高于汉族(P<0.05),斑块发生在回旋支的比例高于汉族(P<0.05),斑块引起管腔中、重度狭窄比例高于汉族(P<0.05),梗阻性斑块累及多支比例高于汉族(P<0.05);2个民族宽块成分差异无统计学意义(P>0.05).维族冠心痛患者体质量指数高于汉族(P<0.05),2个民族高血压、糖尿痛、吸烟史、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇比较差异无统计学意义(P>0.05).结论:2个民族冠状动脉粥样硬化斑块特征存在差异,维族冠状动脉粥样硬化斑块发生率高、病变程度较汉族重,可能与维族体质量指数高于汉族有关.     

冠心病合并糖代谢异常患者临床及冠状动脉病变特点分析

目的分析冠心病合并糖代谢异常患者的临床及冠状动脉病变特点。方法行冠状动脉造影检查确诊为冠心病患者1 250例分为血糖正常组344例、空腹血糖受损组146例、糖耐量受损组312例与2型糖尿病组448例,观察男、女性冠心病患者糖代谢异常发生率,比较各组临床资料,并采用Gensini积分法等评价冠状动脉病变程度。结果女性冠心病患者糖代谢异常发生率为77.8%,高于男性的70.9%(P<0.05);女性患者空腹血糖水平明显高于男性患者(P<0.05),高三酰甘油血症、低高密度脂蛋白胆固醇血症、高总胆固醇血症、高低密度脂蛋白胆固醇血症比例高于男性患者(P<0.05),单支病变比例及支架内再狭窄率高于男性患者(P<0.05),冠状动脉狭窄程度积分及病变范围积分低于男性患者(P<0.05)。结论女性冠心病合并糖代谢异常患者多见,多个冠心病危险因素并存,病变程度严重、架内再狭窄率高。     

血脂与老年冠心病患者颈动脉粥样硬化斑块的相关性

目的探讨血脂与老年冠心病(CHD)患者颈动脉粥样硬化斑块的相关性。方法选取276例老年CHD患者,根据有无颈动脉粥样硬化斑块分为斑块组(138例)和无斑块组(138例)。收集所有患者的一般资料,并检测其总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白B(apo B)、脂蛋白(a)[Lp(a)]、小而密低密度脂蛋白胆固醇(sd-LDL-C),计算sd-LDL-C/LDL-C比值、LDL-C/HDL-C比值、非高密度脂蛋白胆固醇(non-HDL-C)。根据斑块指数将颈动脉粥样硬化斑块的程度为0～3级4个级别。采用Spearman秩相关分析评估各项目与颈动脉粥样硬化斑块分级的相关性。采用多因素Logistic回归分析评估颈动脉粥样硬化斑块的危险因素。结果斑块组体质量指数(BMI)、糖尿病史比例、吸烟史比例和血清sd-LDL-C、Lp(a)、apo B、sd-LDL-C/LDL-C比值、LDL-C/HDL-C比值均高于无斑块组(P0.05),其他指标2个组之间差异均无统计学意义(P0.05)。颈动脉粥样硬化斑块1级、2级、3级患者血清sd-LDL-C、Lp(a)、apo B、sd-LDL-C/LDL-C比值依次升高(P0.05)。Spearman秩相关分析结果显示,sd-LDL-C、Lp(a)、apo B、sd-LDL-C/LDL-C比值与颈动脉粥样硬化斑块分级呈正相关(r值分别为0.502、0.396、0.475、0.415,P0.001)。多因素Logistic回归分析结果显示,有糖尿病史、有吸烟史和sd-LDL-C、Lp(a)、apo B、sd-LDL-C/LDL-C比值升高是老年CHD患者颈动脉粥样硬化斑块的危险因素[比值比(OR)值分别为2.203、2.147、1.514、1.829、1.412、1.376,P0.05]。结论老年CHD患者血清sd-LDL-C、Lp(a)、apo B水平和sd-LDL-C/LDL-C比值、LDL-C/HDL-C比值与颈动脉粥样硬化斑块密切相关。     

残粒脂蛋白-胆固醇与冠心病患者冠状动脉易损斑块的关系

目的 观察冠心病患者冠状动脉易损斑块情况及残粒脂蛋白-胆固醇(remnant lipoprotein-cholesterol, RLP-C)水平,探讨二者相关性及冠心病患者冠状动脉易损斑块的影响因素。方法 144例冠心病患者均行光学相干断层成像检查靶血管情况,根据图像斑块特征分为易损斑块组59例和非易损斑块组85例,比较2组性别、脂质弧、纤维帽厚度、巨噬细胞分级、斑块破裂、血栓形成比率等;检测2组血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等生化指标,计算RLP-C;采用Spearman相关法分析冠心病患者血清总胆固醇、低密度脂蛋白胆固醇、RLP-C水平与冠状动脉斑块破裂的相关性;采用多因素logistic回归分析冠心病患者冠状动脉易损斑块的影响因素。结果 易损斑块组男性比率(88.1%)及血清RLP-C[(0.46±0.39)mmol/L]、低密度脂蛋白胆固醇[(2.88±0.87)mmol/L]水平均高于非易损斑块组[77.6%、(0.39±0.69)mmol/L、(2.38±0.93)mmol/L](P<0.05),血肌酐、总胆红素、三酰甘油、总胆固醇、高密度脂蛋白...     

颈动脉斑块与缺血性脑血管病及其危险因素的关系

目的探讨缺血性脑血管病患者颈动脉粥样硬化斑块特点及其与缺血性脑血管病之间的关系,寻找颈动脉斑块危险因素。方法对115例颈内动脉粥样硬化缺血性脑血管病患者进行颈动脉超声检查,并检查血清甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白,分析引起颈动脉粥样硬化的危险因素。结果超声检查颈动脉粥样硬化斑块检出率为81.7%(94例),颈动脉中重度狭窄发生率为7.8%(9例)。缺血侧颈动脉斑块发生率(67.7%),其中软斑发生率(33.1%),均高于非缺血侧(48.5%,其中软斑20.4%,P<0.05)。斑块组发生高血压病的比例(85.1%)明显高于无斑块组(57.1%,P<0.05);且在软斑组长期烟酒史及男性比例高于稳定性斑块组(P<0.05)。结论缺血性脑血管病患者颈动脉粥样硬化以斑块居多,软斑为重要危险因素,高血压病在斑块发生发展中起重要作用。多因素分析表明,年龄、甘油三酯、总胆固醇和低密度脂蛋白影响颈动脉斑块的形成,而性别、烟酒史可能会影响斑块的稳定性。     

血尿酸与脑梗死患者颈动脉粥样硬化关系研究

目的 探讨脑梗死患者颈动脉粥样硬化程度与血尿酸的关系.方法 122例脑梗死患者按颈动脉硬化程度分为内膜-中膜增厚组、斑块形成组和管腔狭窄组,并设56例正常对照组;测定4组总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸及C-反应蛋白的浓度,进行比较分析.结果 内膜中膜增厚组、斑块形成组和管腔狭窄组的甘油三酯、低密度脂蛋白胆固醇、血尿酸及C-反应蛋白的浓度显著高于对照组(P<0.05).Logistic多元回归分析发现颈动脉粥样硬化程度与低密度脂蛋白胆固醇、血尿酸呈显著正相关(P<0.05).结论 甘油三酯、低密度脂蛋白胆固醇、血尿酸及C-反应蛋白与脑梗死患者的颈动脉粥样硬化程度正相关.低密度脂蛋白胆固醇、血尿酸是颈动脉粥样硬化的独立危险因素.     

乌鲁木齐市及桂林市维吾尔族和汉族高血压患者血尿酸代谢对比

目的:探讨乌鲁木齐市和桂林市维吾尔族和汉族高血压患者血尿酸代谢的差别。方法:共检测高血压患者208例,其中乌鲁木齐市(乌市)106例,维吾尔族(维族)60例,汉族46例,对照组30例;桂林市高血压患者102例,均为汉族,对照组30例。比较两市不同民族高血压患者及与正常人群代谢水平的差异。结果:①乌市患者血尿酸增高者(68.9%,73/106)高于对照组(23.5%,24/102),差异有显著性意义(P<0.01),维族高血压患者平均血尿酸显著高于汉族和对照组(P<0.05)。桂林市血尿酸增高者显著高于本市的对照组(P<0.01),显著低于乌市的高血压患者(P<0.01);乌市各组患者体质量均大于桂林市患者(P<0.05)。②乌市各组患者的高三酰甘油及高低密度脂蛋白胆固醇血症的检出率均显著高于桂林市患者(P<0.05～0.01),后者的低高密度脂蛋白胆固醇检出率显著高于乌市患者(P<0.05)。③两地高血压患者的体质量均与血尿酸呈正相关(r=0.322～0.445,P<0.05～0.001),血尿酸浓度与低密度脂蛋白胆固醇水平呈正相关(r=0.382,0.454,P<0.05～0.01);乌市高血压组血尿酸与三酰甘油呈正相关(r=0.612,P<0.001)。结论:乌鲁木齐市和桂林市维吾尔族和汉族血尿酸的差别为膳食不平衡、体质量及代谢异常有关。     

克拉玛依地区维吾尔族、汉族2型糖尿病患者血脂水平对比分析

目的探讨克拉玛依地区维吾尔族(简称维族)、汉族2型糖尿病患者的血脂异常特点及民族差异。方法收集克拉玛依地区1 015例维族、汉族2型糖尿病患者病历资料,回顾分析其总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平并进行比较。结果 2型糖尿病患者血脂异常发病率在不同性别及总体维族高于汉族,差异有统计学意义(男:P=0.025;女:P=0.013;总体:P=0.000)。各类型血脂异常发病率为:高胆固醇血症维族为22.80%,汉族为16.18%;高三酰甘油血症维族为46.50%,汉族为42.57%;混合型高脂血症维族为14.89%,汉族为11.81%;低高密度脂蛋白胆固醇血症维族为66.57%,汉族为52.19%。其中,高胆固醇血症男性及总体(男:P=0.026;总体:P=0.012)、低高密度脂蛋白胆固醇血症男女及总体(男:P=0.015;女:P=0.019;总体:P=0.000)维族高于汉族,差异有统计学意义(P0.05)。TC水平总体(P=0.042)、LDLC水平男性及总体(男:P=0.028;总体:P=0.030)维族高于汉族,差异有统计学意义(P0.05)。HDL-C水平男女及总体(男:P=0.000;女:P=0.010;总体:P=0.001)维族低于汉族,差异有统计学意义(P0.05)。结论克拉玛依地区2型糖尿病患者血脂异常发生率维族明显高于汉族,该地区2型糖尿病患者在部分血脂异常类型及部分血脂水平存在民族差异。     

长期服用抗精神病药物对慢性精神分裂症患者颈动脉粥样硬化影响的多因素分析

目的探讨长期服用抗精神病药物慢性精神分裂症患者颈动脉粥样硬化状况及其影响因素.方法对89例住院治疗的慢性精神分裂症患者统计临床资料,并进行肝脏和颈动脉超声检查,同时检测血清谷丙转氨酶、谷草转氨酶、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白水平,根据检测结果进行对比分析及逐步多元回归分析.结果本组89例患者中颈动脉粥样硬化病变检出率为27.0%,肝脏脂肪变检出率为33.7%;肝脏脂肪变患者颈动脉粥样硬化病变检出率(40.0%)显著高于无肝脏脂肪变患者(20.3%)(P<0.05);颈动脉超声检查正常组年龄显著小于颈动脉粥样硬化病变组(P<0.01),血清高密度脂蛋白水平显著高于颈动脉粥样硬化病变组(P<0.05);逐步多元回归分析显示年龄偏大、共患糖尿病、血清低密度脂蛋白与颈动脉粥样硬化病变呈显著正相关(P<0.05或0.01),血清高密度脂蛋白与颈动脉粥样硬化病变呈显著负相关(P<0.05).结论长期服用抗精神药物慢性精神分裂症患者颈动脉粥样硬化病变发生率较高,可能与患者年龄偏大、血糖升高或高血压、血脂异常等因素相关.     

冠状动脉粥样硬化患者血脂及修饰化脂蛋白水平研究

目的分析冠状动脉粥样硬化患者血脂、修饰化脂蛋白及脂蛋白相关磷脂酶A2水平,探究修饰化脂蛋白及脂蛋白相关磷脂酶A2与冠状动脉粥样硬化发生的关系。方法选取2016年9-12月因急性心肌梗死就诊于华西医院急诊科、最终诊断为冠状动脉粥样硬化性心脏病患者220例作为病例组,以同期在该院体检中心健康体检者200例作为对照组,比较病例组和对照组血脂及修饰化脂蛋白水平的差异。结果病例组空腹血糖、糖化血红蛋白高于对照组,胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平低于对照组,差异均有统计学意义(P0.05),三酰甘油水平两组差异无统计学意义(P0.05)。病例组氧化低密度脂蛋白、氧化高密度脂蛋白、糖化低密度脂蛋白、糖化高密度脂蛋白、脂蛋白相关磷脂酶A2水平均高于对照组,差异均有统计学意义(P0.05)。结论血脂不是冠状动脉粥样硬化发生和发展的主要因素,高血糖和高水平修饰化脂蛋白及脂蛋白相关磷脂酶A2与冠状动脉粥样硬化的形成关系密切。     

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.     

Issues and challenges in nursing and nursing education in Japan

In this editorial we discuss the challenges and issues in nursing and nurse education in Japan. These include a rapid growth in the number of universities offering nursing programs without sufficient time for preparation of faculty; issues in the traditional ways of teaching in classrooms; the appearance of nursing shortages in a country with the highest rate of longevity in the world; and the position of nursing faculty in a society that is largely male dominated.     

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.     

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.