Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients

Background

The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions.

Methods and Results

Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7–65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step‐by‐step closure of the right ventricular to the CA connections. No procedure‐related deaths occurred.

Conclusion

Congenital and post‐procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long‐term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail‐out strategies should be planned in all coronary interventions. (J Interven Cardiol 2013;26:287–294)

     

西藏某VCT门诊自愿咨询检测者HIV感染状况分析

目的分析艾滋病自愿咨询检测（VCT）门诊,自愿咨询检测者的艾滋病病毒（HIV）感染状况,为西藏预防HIV传播提供科学依据。方法收集整理2003-2012年西藏某VCT门诊自愿咨询者的人口学信息及HIV抗体检测结果,用描述性方法进行统计分析。结果1929名自愿咨询检测者中,检出HIV抗体阳性188例,阳性率9．75％;女性阳性率（12．94％）高于男性（8．40％）;15～44岁年龄组阳性率达9．92％,其阳性人数占所有阳性者中的94．15％（177／188）。小学及以下文化程度HIV阳性率较高,为17．92％,无业者高于其他职业;静脉注射吸毒阳性率高达62．50％。性传播占总数的89．89％。结论青壮年、小学及以下文化程度者及无业者是感染HIV的高危人群,性接触是主要的传播方式,应针对高危人群的特点,加强艾滋病的宣传教育以及行为干预工作,阻断HIV传播。     

损伤性癫痫模型大鼠海马和额叶突触蛋白的动态表达

Objective To observe the time course of changes in synaptophysin (P38) expression in the cortex and hippocampus of rats with posttraumatic epilepsy (PTE), and explore the role of synaptic plasticity in the epileptogenesis of PTE. Methods Thirty-seven male Sprague-Dawley rats were randomized into normal control group (n=5), sham-operated group (n=12) with intracortical saline injection, and PTE model group (n=20) with stereotactic FeCl<,2> injection (0.1 mol/L, 10 μ1) into the motor cortex. The expression of P38 in the brain cortex and hippocampus of the rats was detected immunohistochemically at 1 h and 7, 14 and 30 days after the injections. Results Most of the rats with FeCl<,2> injection developed isolated epileptiform discharges soon alter the injection. Compared with the sham-operated groups, the rats in PTE group showed significantly decreased P38 expression in the right frontal cortex at all the time points of measurement (P<0.05). At 1 h after FeCl<,2> injection, P38 expression in the polymorphic layer, stratum lacunosum and stratum radiatum of the right hippocampai CA3 area and DG molecular layer underwent no significant changes (P>05), but at 7 days, the expression increased significantly in all the stratum regions of the right hippocampal CA3 area, and this high expression level was maintained till 30 days after the injection. Conclusion Synaptic plasticity alterations in relation to P38 expression changes in the cortex and hippocampus may play an important role in the epileptogenesis of PTE in this rat model.     

急性下胫腓联合损伤的诊治体会

[目的]探讨急性下胫腓联合损伤按照一定分型标准的合理治疗方案及手术体会。[方法]从1997年10月．2003年10月收冶的126洲中，Ⅰ型、Ⅱ型损伤38例采用非手术治疗，Ⅱ型损伤88例采用手术切开复位螺钉内固定治疗。[结果]Ⅰ型、Ⅱ型损伤优良率100％，Ⅲ型损伤优良74例，呵11例，差3例。[结论]Ⅰ型、Ⅱ型损伤不必手术，保守治疗可取得较好效果，Ⅱ型损伤应用切开复位螺钉内固定，手术操作简单，疗效较好。     

单剂静脉滴注替加环素100mg后血,组织及体液药物浓度

替加环素为甘氨酰四环素类抗生素,对革兰阴性或阳性菌、厌氧菌及非典型病原体具有良好抗菌活性。体外对敏感及多重耐药金葡菌、肺炎链球菌、耐万古霉素肠球菌、产ESBLs肠杆菌科细菌和脆弱拟杆菌均具活性。作者进行了单剂静脉滴注替加环素100mg(30min)后组织渗透性研究。试验入选24~83岁患者104例(女64例,男40例),随机分成4组,分别在用药后4,8,12,或24h采集胆囊、胆汁、结肠、骨及滑膜液等组织或体液样本。滑膜液标本在手术进入关节腔后马上采集。脑脊液样本在静脉滴注开始后1.5h及24h采取。留取所有患者静脉滴注前、结束即刻及与采集组织或体液样本同一时间的血清。液质法(LC/MS/MS)测定血、组织和体液内替加环素浓度。单剂静脉滴注替加环素后3min血药浓度从1.94mg/L迅速下降至静脉滴注后1h的0.31mg/L。组织渗透性以组织或体液内AUC0-24与血AUC0-24的平均比值表示,分别为胆汁537,胆囊23,结肠2.6,肺2.0,骨0.41,滑膜液0.31,脑脊液0.11。替加环素主要经胆汁排泄,胆汁中药物浓度可为同期血浓度的123~7 616倍。但替加环素在骨组织中浓度较低。文献报道大鼠口服...     

Pharmacogenetics of tardive dyskinesia: combined analysis of 780 patients supports association with dopamine D3 receptor gene Ser9Gly polymorphism.

Variability among individuals in their therapeutic response to psychotropic drugs and in susceptibility to adverse effects is considerable. Pharmacogenetics addresses the contribution of genetic factors to this variability. An important focus of interest in pharmacogenetics has been on candidate genes that play a role in susceptibility to the antipsychotic drug-induced adverse effect, tardive dyskinesia (TD). Four published studies have reported an association between a serine (ser) to glycine (gly) polymorphism in exon 1 of the dopamine D3 receptor gene (DRD3) and TD; three failed to replicate this finding and one found an insignificant trend. We examined the association in a pooled sample of 780 patients (317 with TD and 463 without TD) drawn from 6 research centers, who were divided into 8 groups based on their population origin. The analysis employed stepwise logistic regression so as to allow confounding effects of group, age, and gender to be taken into account. TD was significantly associated with DRD3 gly allele carrier status (x(2)=4.46, df 1, p =.04) and with DRD3 genotype (x(2)=6.62, df 2, p =.04) over and above the effect of group. Similar positive effects were observed when controlling for age and gender (x(2)=5.02, df 1, p =.02 for gly allele carrier status; x(2) = 7.51, df 2, p =.002 for genotype). Examining abnormal involuntary movement scores as a continuous variable, we found that patients homozygous for the gly allele had significantly higher scores than ser-gly heterozygotes (p =.006) or ser-ser homozygotes (p <.0001). We also performed a meta-analysis that included, besides the groups in the combined analysis, three other published studies on DRD3 and TD. The Mantel-Haenszel pooled odds ratio for DRD3 gly allele carrier status increasing susceptibility to TD was 1.33 (95% CI 1.04-1.70, p =.02); the cumulative pooled estimate showed an odds ratio of 1.52 (95% CI 1.08-1.68, p <.0001). These findings support a small but significant contribution of the DRD3 ser9gly polymorphism to TD susceptibility that is demonstrable over and above population effects and the effect of age and gender on the phenotype.     

腓骨短肌腱重建下胫腓韧带联合

自1999年11月-2003年5月，采用腓骨短肌腱重建治疗下胫腓韧带联合分离39例，效果满意，报告如下。     

两种检测D-二聚体方法比较

目的对D二聚体(D-D)测定的方法进行比较。方法比色法(23例)、免疫比浊法(60例)用STAGO全自动化凝血仪测定。结果两组特异性较一致，阳性率以免疫比浊法较高。结论用自动化凝血仪配套试剂的免疫比浊法检测D-D具有高敏感性、高特异性与重复性好的优点，可作为检测D-D的首选方案。     

050The Angiogenesis Inhibitor Endostatin Impairs Wound Healing at Tumor‐inhibiting Doses

Effective blockade of the pluripotent cytokine TGF‐beta as a means of cutaneous scar reduction is a strategy with great potential. This desired effect may be achieved through the overexpression of mutant TGF beta receptors within the wound milieu. Our goal was to examine the effects of dominant negative mutant TGF‐beta receptor II (dnTGFRII) protein expression in a well‐established rabbit ear model of hypertrophic scarring. Serial injections of a retroviral construct encoding a truncated TGFβRII and the marker green fusion protein (pMSCV‐rIIdn‐GFP) were performed in 7mm punch wounds at day 10 and day 14 (two‐day injection group) or day 8, 10, 12 (three‐day injection group) post wounding. Delivery of a null vector (pMSCV‐GFP) at the same time points served as a negative control. Histomorphometric analysis of wounds harvested at day 28 revealed a statistically significant reduction (33%) in the scar elevation index in 2‐day treated and a more modest reduction in SEI (17.5%) in the 3‐day treated arm compared to null‐treated controls. Confocal microscopy confirmed stable transfection of the construct in both peri‐wound tissue as well as rabbit dermal fibroblasts transfected in vitro. Optimization of this novel application in retroviral gene therapy could lead to effective anti‐scarring strategies.