宽胸通络汤治疗冠心病不稳定型心绞痛46例

目的观察宽胸通络汤治疗不稳定型心绞痛的临床疗效。方法将92例病人随机分为对照组(46例)和治疗组(46例),所有病例均符合诊断标准,对照组采用纯西医治疗,治疗组在西医治疗的基础上加宽胸通络汤,监测两组病人静息心电图、发作频率、ST段下降值(∑ST)、心肌耗氧量等各项指标。结果两组的临床疗效和静息心电图疗效比较差异有统计学意义(P<0.05),发作频率、∑ST、心肌耗氧量两组治疗后均有好转(P<0.05或P<0.01),但治疗组优于对照组(P<0.05)。结论宽胸通络汤治疗冠心病不稳定型心绞痛有很好的临床疗效。     

急性重症脑卒中患者早期肠内营养支持治疗的体会

目的:探讨早期规范肠内营养(EN)对急性重症脑卒中预后的影响。方法:将106例患者分为营养支持组(56例)和对照组(50例),在常规治疗的基础上,分别给予鼻饲整蛋白肠内营养素制剂及普通鼻饲奶。入院第1、14和21天分别检测两组的血红蛋白、血清白蛋白、前白蛋白、甘油三酯,统计两组第1、21天NIHSS评分、第7、21天时的感染及EN胃肠道并发症的发生率。结果:第14、21天两组各项营养指标均有下降,对照组下降更为明显(P<0.05);肠内营养组第7、21天感染发生率显著低于对照组(P<0.05),但第7天EN胃肠道并发症的发生率高(P<0.05)。两组NIHSS评分均有明显改善,肠内营养组改善更为显著(P<0.05)。结论:早期EN可明显改善重症脑卒中患者的营养状况,降低感染发生率,改善预后。     

内镜黏膜下剥离术治疗下咽部浅表癌的临床价值研究（含视频）

目的 评价内镜黏膜下剥离术（ESD）用于治疗下咽部浅表癌的安全性及有效性。方法 回顾性分析2015年9月至2018年3月在复旦大学附属中山医院内镜中心接受ESD治疗的9例下咽部浅表癌患者的临床病理资料。 结果 9例患者中男7例、女2例,平均年龄61.2岁（48~80岁）。切除病灶平均大小为16.3 mm（5~27 mm）,平均手术时间为52.2 min（30~90 min）。9例患者术中及术后均未发生出血、穿孔、气肿、呼吸困难等并发症。平均住院天数4.6 d（3~7 d）。术后病理包括上皮内高级别瘤变1例,鳞状细胞癌8例;在8例鳞状细胞癌患者中,肿瘤组织浸润深度均未突破固有膜。1例水平切缘阳性,患者术后接受了区域放疗。平均随访时间10.2个月（3~29个月）,所有患者未见复发或转移,未见食管入口狭窄。结论 ESD是治疗下咽部浅表癌安全有效的方法,具有良好的临床应用价值。     

Challenges to and opportunities for the implementation of non‐invasive positive pressure ventilation in the Asia‐Pacific region

Non‐invasive positive pressure ventilation (NPPV) is undoubtedly one of the most significant advancements in mechanical ventilation technology in the past 30 years. With accumulating evidence from clinical studies and support from clinical guidelines, NPPV is now widely used in hospitals and increasingly prescribed for home therapy in the Asia‐Pacific region. However, in comparison with the developed Western countries, overall use of NPPV in the region is lagging behind. This study reviews this imbalance of NPPV use both in the acute and domiciliary settings in the Asia‐Pacific region. Important issues related to NPPV use are also discussed along with speculation around potential strategies that could promote wider implementation of NPPV in the region. We hope this review will stimulate interest in the clinical application and potential research avenues for NPPV in the Asia‐Pacific region, and promote education and staff training in the technique.     

Potential ecological impacts of climate intervention by reflecting sunlight to cool Earth

As the effects of anthropogenic climate change become more severe, several approaches for deliberate climate intervention to reduce or stabilize Earth’s surface temperature have been proposed. Solar radiation modification (SRM) is one potential approach to partially counteract anthropogenic warming by reflecting a small proportion of the incoming solar radiation to increase Earth’s albedo. While climate science research has focused on the predicted climate effects of SRM, almost no studies have investigated the impacts that SRM would have on ecological systems. The impacts and risks posed by SRM would vary by implementation scenario, anthropogenic climate effects, geographic region, and by ecosystem, community, population, and organism. Complex interactions among Earth’s climate system and living systems would further affect SRM impacts and risks. We focus here on stratospheric aerosol intervention (SAI), a well-studied and relatively feasible SRM scheme that is likely to have a large impact on Earth’s surface temperature. We outline current gaps in knowledge about both helpful and harmful predicted effects of SAI on ecological systems. Desired ecological outcomes might also inform development of future SAI implementation scenarios. In addition to filling these knowledge gaps, increased collaboration between ecologists and climate scientists would identify a common set of SAI research goals and improve the communication about potential SAI impacts and risks with the public. Without this collaboration, forecasts of SAI impacts will overlook potential effects on biodiversity and ecosystem services for humanity.     

A Natural Model of Mouse Cardiac Myocyte Senescence

Many cardiac aging studies are performed on mice first and then, due to difficulty in mouse cardiomyocyte culture, applied the rat neonatal cardiomyocytes to further determine the mechanisms in vitro. Now, the technological challenge of mouse cardiomyocyte culture has been overcome and there is an increasing need for the senescence models of mouse cardiomyocytes. In this study, we have demonstrated that the senescence of mouse cardiomyocytes occurred with the extended culture time as shown by the increased β-galactosidase staining, increased p53 expression, decreased telomere activity, shorted telomere length, increased production of ROS, increased cell apoptosis, and impaired mitochondrial ΔΨm. These senescent responses shared similar results in aged mouse heart tissues in vivo. In summary, we have established and characterized a novel senescence model of mouse cardiomyocytes induced by the extended culture time in vitro. The cell model could be useful for the increased cardiac aging studies worldwide.     

Multidisciplinary Treatment of the Metabolic Syndrome Lowers Blood Pressure Variability Independent of Blood Pressure Control

Blood pressure (BP) variability (BPV) contributes to target organ damage independent of BP. The authors examined the effect of a 1‐year multidisciplinary intervention on BPV in patients with the metabolic syndrome (MetS) as defined by criteria from the Third Report of the Adult Treatment Panel. Forty‐four nondiabetic patients underwent clinical and biochemical profiling, 24‐hour ambulatory BP monitoring (ABPM), body composition, carotid intima‐media thickness, and carotid‐femoral pulse wave velocity (PWV). The intervention targeted all MetS components. BPV was assessed by the standard deviation of daytime systolic BP derived from ABPM. Patients with low and high BPV (lower or higher than the median daytime standard deviation of 11.6 mm Hg) did not differ in regards to systolic and diastolic BP, age, fasting glucose, glycated hemoglobin, and body mass index, but the high‐variability group had higher values of low‐density lipoprotein and leg fat. The 1‐year intervention resulted in weight reduction but not BP‐lowering. BPV declined in the high‐variability group in association with lowering of PWV, C‐reactive protein, glycated hemoglobin, alanine aminotransferase, asymmetric dimethylarginine, and increased high‐density lipoprotein cholesterol. A multidisciplinary intervention independent of BP‐lowering normalized BPV, lowered PWV, and enhanced metabolic control.