Clinical predictors of cardiovascular implantable electronic device-related infective endocarditis

Background: Cardiovascular implantable electronic device (CIED)‐related infective endocarditis (CIED‐IE) is a serious complication of cardiac device infection and is associated with increased mortality. At present, there exist no criteria to predict CIED‐IE in patients who present with CIED infection. Methods: We retrospectively reviewed all cases of CIED infection seen at Mayo Clinic Rochester between 1991 and 2008. CIED‐IE was classified using pathologic and clinical criteria. Clinical predictors of CIED‐IE were identified using logistic regression, and quantified using a summary score and plotted against the distribution of CIED‐IE. Results: Ninety‐three (22.4%) of the 416 patients with CIED infection had CIED‐IE. Host factors including chronic immunomodulator therapy exclusive of corticosteroid (odds ratio [OR], 3.79 [confidence interval (CI) 1.10, 13.04]), chronic corticosteroid therapy (OR, 2.15 [CI 0.93, 5.00]), hemodialysis (OR, 3.24 [CI 1.39, 7.55]), or remote infection (OR, 1.77 [CI 0.99, 3.14]) were associated with increased odds of CIED‐IE. Patients with CIED‐IE were at increased odds of presenting with fever (OR, 3.78 [CI 1.93, 7.40]), or malaise (OR, 1.87 [CI 1.02, 3.41]), and have findings of leukocytosis (OR, 3.61 [CI 1.51, 8.62]). In marked contrast, they were at decreased odds of exhibiting signs/symptoms of infection at the generator pocket site (OR, 0.19 [CI 0.10, 0.36]). Summary scores of 6 and 11 predicted CIED‐IE in approximately 50% and 90% of cases, respectively. Conclusions: Certain comorbid conditions and systemic manifestations of infection were associated with CIED‐IE. In contrast, pocket site infection was negatively associated with CIED‐IE. These findings should assist clinicians in identifying patients who would more likely benefit from further investigation of CIED‐IE with transesophageal echocardiography. (PACE 2011; 34:450–459)     

军队文职人员护理骨干执行卫勤保障任务现状的调查

目的了解军队文职人员护理骨干在执行卫勤保障任务中存在的问题。方法采用自制的调查问卷对参加全军第3批文职人员护理骨干任职教育培训班的83名文职人员进行调查。结果文职人员护理骨干在执行卫勤保障任务中存在的主要问题排在前三的依次是:执行大型卫勤保障任务的机会太少、平时科室工作繁忙、工作与训练矛盾突出,对卫勤保障任务的目的、目标及自身的职责范围不是很明确。结论相关部门应适当增加文职人员执行大型卫勤保障任务的机会,部门之间搞好协调工作,缓解工作和训练的矛盾,在卫勤保障中明确任务的目的、目标和参训人员的职责范围,以提高文职人员的卫勤保障能力。     

普伐他汀联合髓芯减压术治疗激素性兔股骨头坏死的实验研究

目的研究普伐他汀联合髓芯减压术治疗激素性兔股骨头坏死对组织病理学、骨形态发生蛋白2(BMP2)和血管内皮生长因子(VEGF)mRNA表达水平的影响。方法 45只实验大白兔制作成激素性股骨头坏死模型后随机分为三组:髓芯减压术治疗组(A组),普伐他汀联合髓芯减压术治疗组(B组)和模型组(C组),每组各15只。观察各组各时期兔股骨头毛细血管数、管径、骨陷窝空缺百分比以及BMP2、VEGFmRNA表达水平。结果 A、B两组第4周BMP-2、VEGFmRNA表达水平(7.4±1.1,8.0±1.0;0.118±0.027,0.129±0.023)与C组比较无统计学差异(7.2±0.8;0.117±0.024)(P>0.05)。而B组第8周和第12周BMP-2、VEGFmRNA表达水平(10.5±2.4,13.8±3.2;0.341±0.047,0.562±0.059)明显高于A组(8.0±1.7,8.8±2.0;0.137±0.033,0.149±0.048)、C组(7.6±1.6,7.7±1.8;0.126±0.035,0.131±0.041)(P<0.05);且随治疗时间延长,B组BMP-2、VEGFmRNA表达水...     

Hormone cross-regulation in the tadpole brain: developmental expression profiles and effect of T3 exposure on thyroid hormone- and estrogen-responsive genes in Rana pipiens

During metamorphosis, the tadpole neuroendocrine brain is a major target for the organisational effects of hormones acting via both endocrine feedback mechanisms and local hormone production. While the receptor-mediated actions of thyroid hormones in brain development have been well described, there is evidence that thyroid hormones could also be an important modulator of estrogen action during metamorphosis. To better understand hormone action and potential cross-regulation between thyroid hormone and estrogen, we examined changes in thyroid hormone receptors (TRalpha and TRbeta) and the estrogen receptor (ERalpha) in the brain of Rana pipiens throughout metamorphosis and in response to 48 h waterborne triiodothyronine (T3) exposure (0.5, 5 and 50 nM). We also measured mRNA levels of iodothyronine deiodinase (D2 and D3) and aromatase, key enzymes responsible for local synthesis and availability of thyroid hormones and estrogen, respectively. A real-time PCR strategy targeting these genes was developed using either a fluorescent dual-labelled probe- or SYBR Green I-based method. TRbeta mRNA levels were increased during development and in response to T3 exposure. Deiodinase (D2 and D3) enzymes were differentially regulated during development, but mRNA levels of both were increased with 50 nM T3 exposure. ERalpha and aromatase mRNA levels significantly increased at metamorphic climax, but whereas estrogen receptor alpha mRNA levels were increased by 50 nM T3, aromatase mRNA levels were decreased. These results (1) demonstrate that the developing amphibian brain is an important site for stage-specific thyroid hormone regulation of nuclear receptors and hormone synthesis enzymes and (2) provide the basis for further studies exploring the physiological and functional significance of the cross-regulation between thyroid status and estrogen-sensitive genes in the brain during amphibian metamorphosis.     

非诺贝特治疗大鼠左心室肥厚

目的研究非诺贝特逆转腹主动脉缩窄(AAC)大鼠左心室肥厚的作用,并初步探讨其对 Akt/GSK3β信号通路的影响。方法采用 AAC 法建立心肌肥厚模型。术前1周和术后4周灌胃给予非诺贝特[80 mg/(kg·d)],观察了其对血流动力学参数、超声参数、左室质量(LVM)/体质量(BM)、心肌超微结构的影响。同时检测了心肌组织中 Akt 和 GSK3β蛋白磷酸化的表达变化。结果 1)与假手术组相比,大鼠腹主动脉缩窄4周后,主动脉收缩压(AoSP)、主动脉舒张压(AoDP)、左室内压(LVESP、LVEDP)明显升高(P<0.05);室内压最大上升速率(+dp/dt_(max))和室内压最大下降速率(-dp/dt_(min))明显减少(P<0.05),而非诺贝特治疗后,+dp/dt_(max)、-dp/dt_(min)明显上升(P<0.05);AoSP、AoDP、LVESP 无明显变化(P>0.05)而 LVEDP 稍降(P<0.05)。2)手术后4周 AAC 大鼠呈现出明显的向心性肥厚,室间隔(IVSd 和 IVSs)及左室后壁厚度(PWTd 和 PWTs)(P<0.05)、LVM/BM[LVM:(2.94±0...     

血管紧张素转换酶2基因转染对人血管内皮细胞中氧化应激水平的影响

背景血管紧张素转换酶2(ACE2)是迄今为止发现的人类 ACE 的第一个同源基因,是血管紧张素Ⅱ(AngⅡ)的主要降解酶,但其在氧化应激中的调控作用尚不清楚。目的探讨重组 ACE2基因转染对体外培养人血管内皮细胞中由 AngⅡ诱导的 NAPDH 氧化酶 p22~(phox)表达和丙二醛(MDA)水平的影响。方法克隆和构建含人 ACE2基因全长的重组质粒(pACE2),并将之转染人人血管内皮细胞中。分别采用实时定量 PCR 和 Western印迹技术检测转染细胞中的 p22~(phox)的 mRNA 与蛋白表达情况。采用硫代巴比妥酸比色法测定细胞中 MDA 含量。结果 AngⅡ(100 nmol/L)和 AngⅣ(100 nmol/L)刺激后均可诱导人内皮细胞中 p22~(phox)的 mRNA 及蛋白表达大大增加,伴有细胞中 MDA 水平升高(n=6,P 均<0.01)。pACE2基因转染可抑制细胞中由 AngⅡ和 AngⅣ诱导的 p22~(phox)表达,同时伴 MDA 水平下调(n=5～6,P 均<0.01)。结论 ACE2基因过表达可明显抑制人内皮细胞中 p22~(phox)的表达,而且降低 MDA 水...     

上皮性卵巢癌组织中EGFR、KRAS的表达变化及意义

目的观察表皮生长因子受体（EGFR）、鼠Kirsten肉瘤病毒致癌基因（KRAS）蛋白在上皮性卵巢癌（下称卵巢癌）组织中的表达变化,并探讨其临床意义。方法采用免疫组化SP法检测45例卵巢癌组织中的EGFR、KRAS蛋白,另选18例卵巢良性肿瘤组织和30例正常卵巢组织为对照。结果卵巢癌组织中EGFR、KRAS蛋白表达明显高于卵巢良性肿瘤和正常卵巢组织（P均〈0．05）。EGFR阳性表达率与卵巢癌临床分期有关（P〈0．05）,KRAS蛋白阳性表达率与卵巢癌临床分期、分化程度有关（P〈0．05）;卵巢癌组织中EGFR与KRAS蛋白表达呈正相关（r=0．613,P〈0．05）。结论卵巢癌组织中EGFR、KRAS蛋白表达明显上调,且两者呈正相关关系,在卵巢癌的发生、发展中起重要作用;KRAS蛋白可能为卵巢癌发生发展的始动因素,可作为卵巢癌的早期诊断指标之一。     

The role and performance of chest X-ray for the diagnosis of tuberculosis: A cost-effectiveness analysis in Nairobi,Kenya

Background  

The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by CXR) with an alternative pathway using CXR as a screening tool (CXR followed by ZN).     

淋巴细胞绝对数减少在非霍奇金淋巴瘤中的临床意义

目的:探讨非霍奇金淋巴瘤(NHL)患者初发时淋巴细胞绝对数(ALC)与其临床特征的相关性,并探讨其预后参考价值。方法:回顾性分析2007年1月-2010年10月间我院新确诊的210例NHL患者的临床特征,结合随访资料,分析不同ALC水平与NHL患者各临床特征及其预后的相关性。结果:在本组NHL病例中,中位年龄58岁,结外淋巴瘤占有一定比例(47.1%)。ALC中位数为1.2(0.1～13.9)×109/L,25%～75%的置信区间分界值为(0.7～1.8)×109/L。我们发现,ALC<1.2×109/L时,其与患者的年龄、性别、淋巴瘤类型、临床分期、IPI预后指数、骨髓浸润、贫血等临床特征并无显著相关性,但常伴有LDH水平的升高,且表现B症状,而此类患者临床缓解率相对较低,死亡率较高(P<0.05)。继续以ALC<1.0×109/L作为分界点时,除上述特点外,年龄差异开始具有统计学意义,ALC减少更多见于老年淋巴瘤患者(P<0.01)。最后以ALC<0.7×109/L作为临床分界点时,ALC减少的NHL患者除了涵盖上述临床特点外,T细胞淋巴瘤所占比例也明显升高(P<0.01),此类患者临床分期更晚,IPI积...