先天性心脏病介入治疗相关并发症分析

目的 探讨先天性心脏病经导管介入治疗的并发症及其防治方法.方法 回顾性分析本院心脏中心诊断为房间隔缺损(ASD)、室间隔缺损(VSD)和动脉导管未闭(PDA)的患者337例,其中成功行经导管介入治疗的325例患者术中和术后并发症;通过心电图和心脏超声观察术中和术后出现的并发症,出院后门诊随访心电图和心脏超声6个月至1年.结果 337例患者中325例成功行先天性心脏病介入治疗,总成功率96.4%,ASD组封堵成功率96.4%(162/168),VSD组94.8%(91/96),PDA组100%(73/73);严重并发症发生率2.8%(9/337),其中Ⅲ度房室传导阻滞6例,心包积液2例,严重主动脉瓣反流并亚急性感染性心内膜炎1例.经过相应治疗除合并亚急性感染性心内膜炎1例死亡外均治愈.结论 经导管介入治疗先天性心脏病,具有创伤小,成功率高,并发症低等特点,是安全、有效的治疗方法,术前正确诊断、术中准确操作和术后认真随访可以减少并发症的发生.     

四君子汤对脾虚大鼠肝、心肌、胃黏膜和骨骼肌细胞线粒体损伤的修复作用

背景:脾与线粒体具有相关性,中医脾主运化不仅仅是指食物在胃肠的消化吸收,更重要的是线粒体的生物氧化产能过程。目的:分析经典健脾益气方剂四君子汤对脾虚大鼠肝、心肌、胃黏膜和骨骼肌细胞线粒体损伤的修复作用。设计:随机对照观察。单位:广州中医药大学第一附属医院二内科和广州中医药大学。材料:实验于2004-06/12在广州中医药大学第一附属医院内科实验室和广州中医药大学测试中心完成。选择SD大鼠40只,由广州中医药大学动物中心提供。小承气汤由厚朴、枳实、大黄(比例3∶3∶2)组成;四君子汤由党参、白术、茯苓、甘草(比例2∶2∶2∶1)组成,均由广州中医药大学第一附属医院药剂科提供,并由该院制剂室制成100%煎剂。方法:大鼠饲养1周后按随机数字表法分成4组,即正常对照组、脾虚模型组、自然复健组和四君子汤组。除正常对照组外,其余3组均制作大鼠长期脾虚模型。①正常对照组大鼠常规喂养,生理盐水3mL/(次·只)灌胃,隔日1次,共34周。②脾虚模型组大鼠小承气汤3mL/(次·只)灌胃,隔日1次,同时隔日喂食,共34周。③自然复健组喂养方法前26周同脾虚模型组,26周后改为常规饲养,共34周。④四君子汤组喂养方法前26周同脾虚模型组;26周后改为常规饲养,同时用四君子汤灌胃8周,4mL/(次·只),1次/d。于实验34周末麻醉断头处死大鼠后,迅速取出骨骼肌、肝脏、胃黏膜、心肌组织,用双缩脲法测定线粒体悬液的蛋白量,并根据组织质量计算出每克组织的线粒体含量;应用透射电镜观察线粒体形态。主要观察指标:各组大鼠的骨骼肌、肝、心肌、胃黏膜组织线粒体含量及超微形态。结果:40只大鼠全部进入结果分析,无脱失。①实验34周末各组大鼠骨骼肌、肝、心肌、胃黏膜组织线粒体含量比较:脾虚模型组大鼠各组织线粒体含量均显著低于正常对照组(P<0.01);自然复健组显著高于脾虚模型组(P<0.05～0.01);四君子汤组大鼠各组织线粒体含量最高,除显著高于脾虚模型组和自然复健组外(P<0.05～0.01),并显著高于正常对照组(P<0.01)。②实验34周末各组大鼠骨骼肌、肝、心肌、胃黏膜组织线粒体形态比较:脾虚模型组大鼠心肌细胞线粒体高度肿胀;肝细胞线粒体致密质粒减少或消失,嵴断裂;骨骼肌细胞线粒体数量减少,线粒体变小,线粒体膜结构破坏;胃壁细胞线粒体减少,线粒体内部结构不清,胃主细胞线粒体峭断裂。自然复健组大鼠各组织的线粒体形态改变较轻,四君子汤组与正常对照组接近。结论:四君子汤具有提高脾虚大鼠骨骼肌、肝、心肌、胃黏膜组织细胞线粒体含量,修复线粒体损伤的作用。     

Polymeric gene carrier for insulin secreting cells: poly(L-lysine)-g-sulfonylurea for receptor mediated transfection.

Ex vivo transfer of therapeutic genes to cells is one of the potential strategies to prolong the life span of cell transplants. However, relatively safe non-viral carriers have not been extensively investigated due to their lower transfection efficiency. In this study, poly(L-lysine)-g-sulfonylurea varying SU content (PLL-SU) was synthesized to promote gene delivery efficacy to an insulin secreting cell line, RINm5F, which is known to express sulfonylurea receptor (SUR). The polymer formed complexes with a model reporter gene of pCMV-Luc (DNA) and the size of resulting particles was around 100 nm. The transfection efficiency of a polymer synthesized with 5 mol% of SU in the reaction feed (PLL-SU5%) to RINm5F cell was at least 5 times higher than that of PLL. The cytotoxicity of PLL-SU5%/DNA complex was equivalent to that of PLL/DNA complex. PLL-SU5% showed less transfection efficiency than PLL to NIH3T3 and HepG2 cells which are SUR negative. In RINm5F cells, the addition of free SU decreased the transfection efficiency of PLL-SU5%/DNA complex, suggesting that the complex shares the same receptors for SU. The PLL-SU5%/DNA complex seems to be internalized via SUR-mediated endocytosis pathway as suggested by vacuolar ATPases inhibition by Bafilomycin A1. It is noted that RINm5F cells treated with PLL-SU5%/DNA complex secreted more insulin than control, untreated cells, suggesting the insulinotropic effect of SU in PLL-SU5%. In conclusion, PLL-SU may be useful for transfer of therapeutic genes into insulin secreting cells.     

Characteristics of regional bone quality in cervical vertebrae considering BMD: Determining a safe trajectory for cervical pedicle screw fixation

This study aimed to report the mechanical strength and characteristics of the lateral mass and pedicle considering BMD for the safe insertion of pedicle screws in the subaxial cervical level. We evaluated BMD and Hounsfield unit (HU) values of cortical bones at the lateral mass and pedicle of C3‐7 from CT images in 99 patients. Patients were divided into three groups (Group A, T‐score ≥ ?1; Group B, ?2.5 < T‐score < ?1.0; Group C, T‐score ≤ ?2.5). The HU numbers of cortical bone in the vertebral canal (medial wall of the lateral mass; cHU), posterior wall of the transverse foramen (fHU), and medial wall, lateral wall, and trabecular area of the pedicle (mHU, lHU, and pHU, respectively) were measured on the CT images in the middle of the pedicle. A mechanical study was also performed to measure cortical bone strength using 10 fresh cadavers. The cHU and mHU values in Group C were higher than lHU and fHU in Groups A and B, and there was a wide gap between the pHU value and other areas. The penetrating force also had a close correlation with HU number. The mean penetrating force of the medial wall of the lateral mass and the posterior wall of the transverse foramen were 210.08 ± 110.46 and 50.51 ± 46.09 N, respectively. The cortical bones in the vertebral canal and medial wall of the pedicle were stronger than the lateral wall and the trabecular area. The cHU and mHU in the osteoporotic group were higher than fHU and pHU in the normal group. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:217–223, 2018.

     

C1q抗体在狼疮性肾炎诊断中的意义

目的检测系统性红斑狼疮(SLE)患者及非狼疮性肾病综合征患者的C1q抗体(C1qAb)的水平,探讨C1qAb在狼疮性肾炎诊断中的意义,并作C1qAb与抗核抗体(ANA)、抗ds鄄DNA和SLEDAI的相关性分析。方法用ELISA对106例SLE、30例非狼疮性肾病综合征患者和30名健康对照者外周血血清中C1qAb进行检测。同时将SLE患者分为狼疮性肾炎(LN)活动期组(A组,76例)和肾外全身症状组(B组,30例),比较各组C1qAb和其他免疫学指标的阳性率差异。分析C1qAb与ANA、抗ds鄄DNA和SLE病活动指数(SLEDAI)的相关性。结果A组C1qAb滴度为(218.4±179.3)IU/ml,明显高于B组(56±61)IU/ml(P<0.01),与肾病综合征组(33±29)IU/ml及对照组(25±21)IU/ml相比P<0.001。A组的C1qAb阳性率为67.1%,而B组阳性率仅为26.6%;肾病综合征组阳性率为6%。以上结果显示C1qAb与LN关系密切。LN活动期C1qAb水平升高,缓解期可恢复至正常。C1qAb的升高与抗ds鄄DNA的升高可同时出现(r=0.28),C1qAb与SLEDAI呈正相关(r=0.72)。结论C1qAb可作为诊断LN的一个重要实验室指标,与临床活动密切相关。     

Increased Complications for Schizophrenia and Bipolar Disorder Patients Undergoing Total Joint Arthroplasty

Background

Although it has been shown that anxiety and depression are associated with increased complications after total joint arthroplasty (TJA), the outcomes of TJA in patients with a history of psychosis are unknown. This study evaluated the influence of bipolar and schizophrenic disorders on complications after TJA, particularly aseptic and septic revisions.

Modulation of the nuclear factor kappa B pathway by Shp-2 tyrosine phosphatase in mediating the induction of interleukin (IL)-6 by IL-1 or tumor necrosis factor

Shp-2, a src homology (SH)2-containing phosphotyrosine phosphatase, appears to be involved in cytoplasmic signaling downstream of a variety of cell surface receptors, although the mechanism is unclear. Here, we have determined a role of Shp-2 in the cytokine circuit for inflammatory and immune responses. Production of interleukin (IL)-6 in response to IL-1 alpha or tumor necrosis factor (TNF)-alpha was nearly abolished in homozygous mutant (Shp-2(-/)-) fibroblast cells. The targeted Shp-2 mutation has no significant effect on the activation of the three types of mitogen-activated protein (MAP) kinases, extracellular signal-regulated kinase (Erk), c-Jun NH(2)-terminal kinase (Jnk), and p38, by IL-1/TNF, indicating that Shp-2 does not work through MAP kinase pathways in mediating IL-1/TNF-induced IL-6 synthesis. In contrast, IL-1/TNF-stimulated nuclear factor (NF)-kappa B DNA binding activity and inhibitor of kappa B (I kappa B) phosphorylation was dramatically decreased in Shp-2(-/)- cells, while the expression and activity of NF-kappa B-inducing kinase (NIK), Akt, and I kappa B kinase (IKK) were not changed. Reintroduction of a wild-type Shp-2 protein into Shp-2(-/)- cells rescued NF-kappa B activation and IL-6 production in response to IL-1/TNF stimulation. Furthermore, Shp-2 tyrosine phosphatase was detected in complexes with IKK as well as with IL-1 receptor. Thus, this SH2-containing enzyme is an important cytoplasmic factor required for efficient NF-kappa B activation. These results elucidate a novel mechanism of Shp-2 in cytokine signaling by specifically modulating the NF-kappa B pathway in a MAP kinase-independent fashion.     

网络成瘾患者父母教养方式及护理干预措施研究

目的 探讨网络成瘾患者父母教养方式及护理干预措施.方法 对80例住院网络成瘾患者进行父母教养方式问卷调查,并与普通在校学生进行对照.结果 在父母教养方式中,网络成瘾患者的情感温暖因子分较低,而惩罚、拒绝因子分较高,与普通在校学生比较有极显著性差异(P<0.01);而干涉保护方面的因子分与普通在校学生比较差异无显著性意义(P>0.05).结论 网络成瘾患者父母教养方式存在缺陷,可有针对性地制定护理干预措施,改善网络成瘾患者父母的教养方式,提高患者的治疗效果.     

阻塞性睡眠呼吸暂停低通气综合征合并高血压、高同型半胱氨酸血症的研究进展

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)、高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)及高血压病均为脑血管病的危险因素。目前对于同时存在OSAHS、HHcy及高血压病的情况研究仍较少,本文就OSAHS患者合并HHcy、高血压病的研究现状进行综述。