急性心肌梗死冠状动脉内抽吸物的病理分析

Objective To analyze the components of retrieved materials from the culprit lesion in ST-segment elevation myocardial infarction (STEMI) patients by manual aspiration during primary percutaneous coronary intervention (PCI). Methods Visible retrieved materials were collected, fixed in formalin and processed for paraffin embedding, sectioned and stained with hematoxylin and eosin (HE). The retrieved materials were microscopically divided into erythrocyte-rich thrombi, platelet/fibrin-rich thrombi, combined thrombi (similar proportions of erythrocytes and platelet/fibrin components), atherosclerotic plaque materials and edematous components. Based on pathological findings, thrombus materials were classified into fresh (< 1 d), lytic (1-5 d), frash/lytic and organized thrombi(>5 d) after formation. All patients were further classified into plaque positive and plaque negative groups. Clinical and angiographic data were also obtained for analyzing possible association between pathological findings and surrogates of myocardial reperfusion, including myocardial blush grade (MBG), enzymatic estimated infarction size (peak CK and CK-MB levels), left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) which were assessed 16 h after procedure. Results Visible samples were collected from 49 patients by manual catheter aspiration (thrombus components in 46 patients, atherosclerotic plaque only in 3 patients). Frequency of erythrocyte-rich thrombi, platelet/fibrin-rich thrombi and combined thrombi were 41.3% (19/46), 30.4% (14/46) and 28.2% (13/46), respectively. The incidence of fresh, lyric, fresh/lytic and organized thrombi were 47. 8% (22/46), 32. 6% (15/46), 10.9% (5/46) and 8.7% (4/46), respectively. Plaque materials were found in 57.1% (28/49) patients, including ruptured plaque accompanied by thrombus formation [8.2% (4/49)], fibrous plaque [6.1% (3/ 49)] and thickened intima [2.0% (1/49)]. Baseline characteristics did not differ between plaque positive (n=28) and plaque negative (n=21) groups. Ratios of MBG 3 were higher in plaque positive group than in plaque negative group [82.1% (23/28) vs. 52. 4% ( 11/21 ), P=0.025]. Peak CK and CK-MB levels were lower in the former than in the later [(1705±1647)U/L vs. (2629±2013)U/L, P=0. 042; (146± 136) μg/L vs. (258±215) μg/L, P=0.016; respectively]. Furthermore, LVEF were higher in plaque positive group than in plaque negative group (0.59±0. 10 vs. 0.52±0.08, P=0.012). Conclusion Manual catheter aspiration during primary PCI in STEMI patients is an effective way for removing thrombus and plaque materials, and plaque debulking before stenting or pre-dilation and this procedure might probably improve myocardial reperfusion, limit infarction size and improve cardiac function.     

预防医学图书馆的采访工作

预防医学专业图书馆,是贯彻“预防为主”的方针,服务于卫生防疫事业,建国五十年卫生防病工作取得了令人瞩目的成就。一些危害大、流行广、死亡率高的烈性传染病,如天花、鼠疫、黑热病、回归热等疾病得到了彻底消灭和控制。预防医学文献的收集不同于基础医学和临床医学,它必须根据防病工作的重心,变化情况不断地转移和延伸。随着改革开放对外交流不断发展深入,市场经济体制在新形势下繁荣昌盛,新的传染病、传染源也在不断地产生,如艾滋病、疯牛病、戊型肝炎、大肠杆菌Ｏ157感染等疾病,对人民健康构成了新的威胁。目前我国处于“两次卫生革命…     

柯萨奇病毒A组10型所致手足口病临床特征分析

目的 回顾性分析柯萨奇病毒A组10型(Coxsackie virus A10,Cox-A10)所致手足口病患儿临床表现，构建实验室联合指标预测模型。方法 回顾性分析2018年7月—2021年8月成都市公共卫生临床医疗中心手足口病住院患儿临床资料，分析Cox-A10手足口病患儿的临床特征和实验室检查，并与柯萨奇病毒A组6型(Cox-A6)和柯萨奇病毒A组16型(Cox-A16)手足口病患儿比较，构建Cox-A10实验室联合指标预测模型。结果 1 878例实验室确诊手足口病患儿中Cox-A10、Cox-A6、Cox-A16阳性分别为159、1 556、163例。Cox-A10组患儿发病年龄较Cox-A16组偏小；发热和高热病例多见，口腔出疹率高，手、足、臀部出疹和多形态皮疹相对少见，多部位出疹率较低；白细胞计数升高明显，以中性粒细胞增多为主，C反应蛋白及降钙素原升高病例数较多，C反应蛋白升高与其他两组间差异有统计学意义(χ²=5.833、21.069,P<0.05)。白细胞计数、中性粒细胞绝对值、单核细胞绝对值及C反应蛋白对Cox-A10有重要鉴别价值，建立Co...     

肝静脉,下腔静脉综合征3例报告

1990～ 1998年间我院收住肝静脉、下腔静脉造影证实的肝静脉、下腔静脉综合征 (原称Ｂｕｄｄ -Ｃｈｉａｒｉ综合征 ) ,就其诊治中的一些特点结合文献复习报告如下。临床资料　 3例均为女性 ,年龄分别为 2 0、 4 5与 78岁。 3例主诉均有腹痛、腹胀、双下肢浮肿。体征均见腹部膨隆、大量腹水、下胸壁腹腰背部静脉显露 ,血流向上 ,肝脾肿大及双下肢水肿。 1例伴右侧胸水 ,1例伴轻度黄疸。腹水检查发现 2例草黄色、清亮的漏出液 ,蛋白分别为 2 2ｇ/Ｌ、2 3 3ｇ/Ｌ ;1例为血性渗出液伴胸水 ,蛋白 4 8ｇ/Ｌ ,血象、肝功能基本正常。内镜下食管静脉…     

流动敏感黑血序列三维T1WI增强扫描在脑转移瘤中的应用价值

【摘要】目的：探讨3.0T磁共振流动敏感黑血序列三维T1加权增强扫描（FSBB 3D CE-T1WI）在脑转移瘤中的应用价值。方法：回顾性将2021年1月－2022年8月在本院就诊且经临床和影像检查证实的52例脑转移患者纳入研究。所有患者分别行颅脑FSBB 3D CE-T1WI、FSE CE-T1WI和快速梯度回波序列三维T1加权对比增强（FFE 3D CE-T1WI）扫描，采用卡方检验或Fisher精确概率检验比较3个序列之间病灶检出率的差异。结果：经随访证实颅内转移灶总数为371个，FSBB 3D CE-T1WI的检出率99.73%（370/371）， FFE 3D CE-T1WI的检出率为83.02%（308/371），FSE CE-T1WI的检出率为78.44%（291/371），三者之间检出率的差异有统计学意义（χ2=82.748，P＜0.05）。分层分析：直径＜3mm的转移灶共160个，FSE CE-T1WI、FFE 3D CE-T1WI和FSBB 3D CE-T1WI的检出率分别为50.62%、60.62%和99.37%，三个序列之间检出率的差异有统计学意义（χ2=101.436,P＜0.05）；对于直径3~10mm的转移灶，FSE CE-T1WI、FFE 3D CE-T1WI和FSBB 3D CE-T1WI的检出率分别为99.38%、100%和100%，三个序列之间检出率的差异无统计学意义（P>0.05）；对直径>10mm的转移灶，三个序列的检出率均为100%，差异无统计学意义（P>0.05）。结论：FSBB 3D CE-T1WI在检出脑转移瘤方面要优于常规和高分辨序列MR增强扫描，值得临床推广。     

诺如病毒研究进展

诺如病毒(Norovirus,NVs) 属于杯状病毒科诺如病毒属,是引起病毒性胃肠炎的重要病原.该病原最初由Kapikian于1972年通过免疫电镜法对1968年美国诺瓦克市一次急性腹泻暴发的患者粪做一日和尚撞一天钟提纯进行抗原体反应得到,当时被命名为诺瓦克病毒.     

模拟pph治疗脱垂痔52例临床分析

2000年以来,我采用类pph术治疗二、三期混合痔并直肠黏膜脱垂之脱垂痔疗效满意,价格低廉.适合于无pph设备医院推广,查阅资料未见到此种方法报道.     

右上肺“球形病灶”治验

肖××,女,44岁,某厂工人。初诊日期1972年7月4日。患者干咳少痰,午后燥热,周身乏力,月余不愈,遂去北京市××区结核病防治所检查,经 X 线摄片,发现右上肺有一“球形阴影”,诊为“右上肺结核瘤”。在该院肌注链霉素(每日一克)、口服雷米封一个月,自觉症状无好转,且出现嘴唇麻木,乃停用链霉素和雷米封,来