Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy

Objectives

There are minimal data regarding clinical outcomes and echocardiographic findings after transcatheter mitral valve-in-valve replacement (TMVR) compared with redo surgical mitral valve replacement (SMVR).

不同抗生素用药方案在预防腹膜透析置管术后腹膜炎中的比较

目的比较不同预防性用药方案在新置腹膜透析导管患者的使用情况,探讨抗生素用药在预防新置腹膜透析导管患者术后发生腹膜炎的重要性。方法回顾性分析2008年10月至2012年10月在北京大学深圳医院肾内科腹膜透析中心接受腹膜透析置管术开始行腹膜透析治疗的患者173例。按照预防性使用抗生素方法分为3组,A组:患者在腹膜透析置管术后3天内使用含有头孢唑啉0.25g/L的腹透液,共计101例次;B组:患者在腹膜透析置管术前3h静脉滴注头孢唑林0.5g,共计48例次;C组:患者术前及术后3天均未使用抗生素,共计24例次。比较3组患者术后14天内腹膜炎的发生率。结果 A组101例患者中1例出现腹膜炎,发生在术后第11天,占0.99%;B组48例患者中2例出现腹膜炎,均发生在术后第1天,占4.17%;C组24例患者中4例出现腹膜炎,3例发生在术后第1天,1例发生在术后第2天,占16.67%。对3组患者腹膜炎发生率进行两两比较,A组与C组比较,P=0.005,P<0.01,差异有统计学意义;B组与C组比较,P>0.05,差异无统计学意义;A组与B组比较,P>0.05,差异无统计学意义。结论腹膜透析置管术围手术期预防性抗生素用药十分有必要,术后腹腔内给药或术前一次静脉用药能有效预防术后腹膜炎发生。     

改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭

目的 评价改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭的临床疗效。方法收集2005年1月至2009年3月中山大学中山眼科中心青光眼专业实施改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭21例（21眼）的临床资料,对术后并发症及手术前后的眼压、视力、瞳孔等进行统计分析。 结果 术前眼压(48.25±3.14) mmHg,平均用降眼压药种类3.35种,明显高于出院时眼压(10.47±1.15)mmHg(t=11.4573,P＜0.01)及术后3个月眼压(13.86±0.93) mmHg(t=11.2641,P＜0.01)。出院视力(0.09±0.05)与术前视力(0.11±0.06)差异无统计学意义(沁0.8702,P= 0.3913),术后3个月视力(0.21±0.04)则稍好于术前（t=-2.7907,P=0.0112）。术前瞳孔垂直径(5.81±0.23) mm与出院时瞳孔垂直径(5.92±0.21 )mm差异无统计学意义（t=-1.5013,P=0.1672）。无严重并发症发生。 结论 改良小梁切除术是治疗伴有高眼压及大瞳孔的急性房角关闭的有效方法,术中分次放房水、巩膜瓣调节缝线、术毕形成前房等措施可有效减少严重并发症的发生。     

CABG in patients with left ventricular dysfunction: indications,techniques and outcomes

Ischemic chronic heart failure (CHF) represents one of the cardiovascular diseases with the worst degree of morbidity and mortality in the western world, and with the highest health care costs. Despite several studies demonstrated that surgical revascularization (CABG), especially in the presence of viable myocardium, improve heart function, and therefore, survival, the matter remains unclear and controversial. In the late 1970s, the Coronary Artery Surgery Study showed that a subgroup of patients with coronary artery disease, angina, and reduce LV function had a significant survival benefit after CABG compared to those treated medically. The key concept behind this observation was the presence of viable myocardium, which can resume function following revascularization. In contrary, the surgical treatment for ischemic heart failure (STICH) trial, which randomized patients with CAD and LV dysfunction to evidence-based medical therapy or CABG plus medical therapy, failed to demonstrate at a median follow-up of 56 months a significant difference between the CABG group and the medical therapy group in the rate of death from any cause. However, the results of the STICH extension study (STICHES) at 10 years follow-up demonstrated that CABG is associated with a significant reduction in all-cause mortality, cardiovascular mortality, and readmission for heart compared to optimal medical therapy (OMT) in patients with severe ischemic LV dysfunction. Therefore, this review discusses the available evidences in literature, from observational studies to randomized trials, including operative techniques and controversial issues, in order to better clarify the role of CABG in the current management of ischemic patients with LVD.     

氟伐他汀防治大鼠放射性胸膜炎的实验研究

目的观察氟伐他汀对大鼠放射性胸膜炎的防治作用。方法采用随机数字表法,将80只健康雌性SD大鼠分为对照组（n=8）、单纯放射组（n=36）、氟伐他汀组（n=36）。氟伐他汀组于照射前1周,给予20mg／（kg·d）氟伐他汀灌胃,直至活杀,其他组灌服等量生理盐水。单纯放射组和氟伐他汀组采用直线加速器全胸部照射,单次剂量20Gy。照射后对大鼠进行x线透视扫描,并在第15d、30d、60d以3．5％水合氯醛麻醉大鼠,剪开胸腔,对有胸水者进行病理和生化检查。结果单纯放射组放射性胸膜炎发生率为41．7％（15／36）。氟伐他汀组放射性胸膜炎发生率为19．4％（7／36）。两组之间的差异有统计学意义（x2=4．19,P〈0．05）。经过对比发现氟伐他汀组病理学改变轻于同期的单纯放射组。结论放射性胸膜炎在放射性肺损伤的早期即可出现,氟伐他汀能有效防治大鼠放射性胸膜炎。     

Inhalational anesthetics inhibit spreading depression: relevance to migraine

Cortical spreading depression (SD) has not been shown in the human neocortex by direct cortical recordings. However, animal studies suggest that cortical injury, such as that occurring during neurosurgical procedures, should result in the initiation of SD. It is possible that inhibition of SD by volatile anesthetic agents may partially explain the failure to observe SD in the human neocortex during surgery. This study examines the effect of the anesthetic agents α-chloralose, halothane, nitrous oxide and isoflurane on the initiation of cortical SD in the cat neocortex. SD was seen in 100% of cats anesthetized with α-chloralose ( n = 15), in 3 of 7 (42%) animals anesthetized with isoflurane ( p < 0.05, χ² with Yates correction) and none of the animals ( n = 4, 6 hemispheric preparations) anesthetized with halothane ( p < 0.005, χ² with Yates correction, halothane vs α-chloralose group). In all cases this inhibitory effect was reversible. In four animals the administration of nitrous oxide (66%) reduced the inspired concentration of isoflurane required to inhibit SD by 0.75%. This study suggests that halothane, and to a lesser extent isoflurane and nitrous oxide, protect against the initiation of cortical SD. This observation may partially explain why SD has not been demonstrated in human neocortex during surgery. Further studies are needed to determine if SD may occur under pathological conditions, such as during migraine with aura, where the cortex may be predisposed to SD.     

纤溶酶相关蛋白在冠心病患者中的表达

目的:了解冠心病患者是否存在组织型纤溶酶原激活物(t-PA)及纤溶酶原激活抑制物Ⅰ(PAI-Ⅰ)功能紊乱,以及这两个指标与血脂、胰岛素抵抗的相关关系。方法:选择2004年1月至2006年1月于我院住院就诊的冠心病患者作为观察对象。按临床类型分为SAP组、UAP组、AMI组、OMI组,并设健康对照组。检测t-PA、PAI-Ⅰ、胰岛素敏感性指数(IAI)、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)等指标。结果:(1)健康对照组t-PA高于各型冠心病组(P<0.05),AMI组t-PA低于其余各型冠心病组(P<0.05);健康对照组PAI-Ⅰ低于各型冠心病组(P<0.05),AMI组PAI-Ⅰ高于其余各型冠心病(P<0.05)。(2)t-PA与IAI呈正相关,与TC、TG、LDL呈负相关;PAI-Ⅰ则与IAI呈负相关,与TC、TG、LDL呈正相关。(3)各病例组t-PA于治疗后有所升高,PAI-Ⅰ于治疗后有所下降(P<0.05)。结论:冠心病患者存在明显的纤溶功能紊乱,且以急性期为重,并且纤溶功能紊乱与胰岛素抵抗、血脂异常等因素有关。