前白蛋白变化率对肝衰竭预后的预测作用

目的探讨血清前白蛋白(PALB)变化率与肝衰竭预后的关系。方法回顾性分析98例肝衰竭患者的临床资料,对患者进行Child-Pugh分级,并把患者分为好转组与未愈组,收集住院期间初始及末次PALB及其他主要肝功能指标的数值,并计算出PALB及其他主要肝功能指标的变化率。结果入院时患者的初始PALB数值明显下降,且Child-Pugh分级越高,数值越低。好转组与未愈组患者的初始PALB数值相近,当血清PALB数值快速升高时,好转组人数明显多于未愈组;当数值下降时,好转组人数明显少于未愈组;当数值升高不明显时,未愈组与好转组差异无统计学意义,但未愈组人数要多于好转组。PALB变化率的敏感度最高,特异度较总胆红素、凝血酶原活动度、国际标准化比值变化率低,而ROC曲线下面积最大。结论肝衰竭患者初始PALB明显比正常值低,而且病情越重,血清中PALB数值越低,但患者预后与初始PALB无相关性,而与PALB变化率相关。大部分PALB快速升高者,预后好;大部分PALB下降或升高缓慢者,预后差。而且PALB变化率对于预后的预测价值要高于其他主要肝功能指标。     

胎儿超声心动图诊断左心发育不良综合征13例报道

目的:探讨应用胎儿超声心动图对左心发育不良综合征(HLHS),诊断方法及诊断价值。方法:对胎儿超声心动图检出的13例HLHS胎儿的超声资料与病理解剖结果对照,分析胎儿超声心动图诊断要点。结果:经病理证实为HLHS 13例,均与超声诊断结果一致,超声诊断正确率100%。13例HLHS患儿中,Ⅰ型2例(15.4%),Ⅱ型5例(38.4%),Ⅲ型2例(15.4%),Ⅳ型4例(30.8%)。超声提示13例均显示左、右心系统比例极端不对称,左心室小、发育不良,右心系统比例增大,主肺动脉内径比例失调,主肺动脉血流方向呈反向。结论:产前胎儿超声心动图作为一种安全、便捷、经济及有效的检查方法,对胎儿左心发育不良综合征的检出具有重要的价值。     

Successful transfemoral antegrade valve-in-valve implantation of a SAPIEN XT valve into a degenerated mitral valve prosthesis

Transfemoral aortic valve implantation has become an important interventional technique for patients with severe aortic stenosis and high surgical risks. The mitral valve has been a much greater challenge for interventional procedures, and no percutaneous mitral valve implantation system has yet been developed and approved. Here, we report the successful transfemoral, antegrade, valve-in-valve implantation of the SAPIEN XT valve (Edwards Lifesciences) into a degenerated mitral valve bioprosthesis. The patient was an 81-year-old woman with severe regurgitation of her 27 mm Epic mitral valve prosthesis (St. Jude Medical), suffering from dyspnea on mild exertion with a calculated logistic EuroScore of 48% and an Society of Thoracic Surgeons score of 29%. Thus, another surgical mitral valve replacement was refused by the patient and was considered as extremely high risk by the cardiac surgeon. Therefore, a transfemoral valve-in-valve implantation was planned. The femoral vein was used as an access site, followed by a transseptal puncture and placement of a super-stiff wire into the left ventricle. Then, the septum was dilated and a 26 mm SAPIEN XT valve was inserted through the septum and then inserted into the mitral valve prosthesis. Under rapid pacing, a very slow inflation of the balloon was performed, leading to a stable valve-in-valve implantation without any regurgitation. The patient was transferred to a normal ward after 2 days. This procedure is an off-label, technically very challenging, high-risk implantation that could be attempted in very select patients after discussion by a heart team and by experienced implanters.     

High‐sensitive Troponin T measurements early after heart transplantation predict short‐ and long‐term survival

Following heart transplantation, cardiac biomarkers remain elevated for several weeks eventually as a result of membrane leakage of the donor organ. We now test the predictive power of blood levels of troponin T (TNT) measured by the new hsTNT assay (Roche Diagnostics, Roche Diagnostics, Mannheim, Germany) early after heart transplantation. TNT was determined in 141 cardiac allograft recipients and 40 controls. Our findings demonstrate that patients who died within the first year after transplantation had significantly higher median hsTNT serum levels 6 weeks after transplantation (156 ng/l ± 203 vs. 29 ng/l ± 21, P = 0.0002). Using ROC analysis, a serum hsTNT concentration of 33.55 ng/l 6 weeks after transplantation was found to be the best cutoff to predict death at 1 year (HR 0.16, 95%CI:0.05–0.46, P = 0.001) with a sensitivity of 90.91% and a specificity of 70.97%. In addition, survival at 5 years (HR 0.15, 95% CI 0.06–0.35, P < 0.0001) was significantly better among patients below that cutoff value. In multivariate analysis, hsTNT serum level 6 weeks after transplantation emerged as an independent predictor for first‐year mortality (hsTNT–HR 0.90, 95% CI: 0.81–1.00, P = 0.03). Cardiac troponin T concentrations early after transplantation as measured with a highly sensitive assay represent a strong and independent risk predictor of death after heart transplantation.     

脐带间充质干细胞在遗传性痉挛性截瘫中的应用

目的观察脐带间充质干细胞（UC-MSC）治疗遗传性痉挛性截瘫（HSP）的临床疗效及安全性。方法2010年9月及2011年4月,分别给予一HSP家系父子2人行UC-MSC鞘内注射治疗,两个疗程,每次1×106 cells/Kg,每周1次,4次为1个疗程。采用改良的Ashworth肌张力分级标准（MAS）、国际合作共济失调评分量表（ICARS）及日常生活量表（ADL）,对患者治疗前后神经功能、日常生活能力进行评定。结果第一疗程结束1个月与治疗前比较,2人MAS分级、ICARS及ADL评分均降低,两人行走站立稳定性及言语流利程度较治疗前改善;第二疗程结束后1个月与该疗程治疗前比较,2人ICARS及ADL评分降低,儿子肌张力进一步降低,父亲双上肢共济失调减轻。2人治疗后均未见明显不良反应发生。末次治疗结束后随访20个月,父、子俩分别于第二疗程治疗结束7个月及8个月后,症状继续加重。结论 UC-MSC鞘内注射治疗是安全的,可在一定时间内一定程度上减轻患者临床症状,提高患者生活质量,延缓疾病进展,但疗效不能持久。     

COVID-19 manifestations in people with Parkinson’s disease: a USA cohort

Journal of Neurology - With the explosion of COVID-19 globally, it was unclear if people with Parkinson’s disease (PD) were at increased risk for severe manifestations or negative outcomes....     

基于增强图卷积神经网络的病毒形态识别方法研究

背景 透射电子显微镜（TEM）是检测病毒的重要手段,传统TEM检测常依靠专家手工观察,操作步骤繁琐,且已有机器学习方法易受到背景、噪声的影响,导致病毒检测方法准确率差、效率低且耗时长。 目的 探讨增强图卷积神经网络（EGCN）对TEM图像中的病毒形态自动识别问题,以提高TEM病毒检测的效率。 方法 EGCN模型利用卷积神经网络（CNN）提取像素间的局部特征信息,并结合样本特征之间的最近邻关系利用图卷积网络（GCN）进行图特征学习。在模型优化中联合优化群体超分类损失和分类交叉熵损失以提高EGCN模型对病毒类别信息特征的提取能力,较CNN对TEM病毒图像特征具备更强的特征提取能力。 结果 通过不同方法在15类TEM病毒图像数据集上开展实验,EGCN达到3.40%的top-1错误率、1.88%的top-2错误率、96.65%的精确度和96.60%的召回率,并通过一系列对比实验表明EGCN模型可以有效避免TEM图像中背景、噪声等的影响,提高对病毒识别的准确率。 结论 EGCN可以有效解决病毒形态识别任务,为病毒的诊断提供重要的参考价值。     

Pathology, natural history and treatment of abdominal aortic aneurysms

With increasing age of the population and improvement of diagnostic tools, the incidence of abdominal aortic aneurysms (AAA) has been rising steadily. Despite an improvement in operative and interventional treatment options, AAA is the cause of death in 1-3% of men over 65 years of age in industrial countries, mostly due to rupture [1]. Therefore, routine screening for AAA by ultrasonography has been postulated in the past: a 60 year old man with an abdominal aortic diameter of less than 3 cm has a life-time risk of developing AAA close to zero. However, routine screening has not been found to be cost effective. Despite of the results of two well-designed studies, the limits of AAA qualifying the patient for surgery or intervention in contrast to conservative treatment is still a matter of debate. The present review article summarizes the current knowledge of the pathology, incidence, risks, natural course as well as symptoms and current treatment strategies of AAA on the basis of the recent literature.