Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease

Background:

There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.

Methods:

All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.

Results:

Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.

Conclusions:

During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.     

显微手术治疗颅内动脉瘤术后CVS发生的相关因素及对预后的影响

目的  探讨显微手术治疗颅内动脉瘤的临床效果,并分析影响术后脑血管痉挛（CVS）发生的相关因素及对预后的影响。方法  回顾性分析2009年5月-2013年5月于郑州人民医院收治的128例颅内动脉瘤患者的临床资料。评价总体治疗效果,并分别应用单因素及Logistic多因素分析影响患者术后CVS发生的相关因素及对预后的影响。结果  128例患者总体治疗效果良好,术后发生CVS 32例（25.00%）,与非CVS组比较,CVS组术后治愈率显著下降,而死亡率显著上升,差异有统计学意义（P <0.05）。经单因素分析可知,影响患者显微手术术后CVS发生的相关因素包括年龄、Hunt-Hees分级、Fisher’s分级、动脉瘤位置、手术时机、感染、基础疾病、终板造瘘、腰穿次数、血糖及白细胞水平。经Logsitic多因素进一步分析可知,Hunt-Hees分级、Fisher’s分级、动脉瘤位置、终板造瘘、腰穿次数是影响显微手术治疗颅内动脉瘤术后CVS发生的独立危险因子,并影响预后。结论  显微手术治疗颅内动脉瘤临床效果良好,但须防范Hunt-Hees分级、Fisher’s分级、动脉瘤位置、终板造瘘、腰穿次数等影响术后CVS发生的独立危险因素,改善颅内动脉瘤患者预后。

     

辛伐他汀对肥胖哮喘小鼠气道炎症的作用及其机制

目的  探讨辛伐他汀对肥胖哮喘小鼠气道炎症的作用及其机制。方法  将60只C57BL/6J小鼠随机分为空白对照组、肥胖哮喘组、地塞米松治疗组和辛伐他汀治疗组。其中,肥胖哮喘组、地塞米松治疗组、辛伐他汀治疗组小鼠采用卵蛋白致敏、激发的方法和高脂饮食诱导建立肥胖哮喘模型。地塞米松治疗组每日给予地塞米松（0.5 mg/kg）饮水干预,辛伐他汀治疗组每日给予辛伐他汀（40 mg/kg）饮水干预,其余两组正常饮水。治疗4周后,计数存活小鼠,采外周血生化分析仪测定血糖、血脂、肝功能水平;收集支气管肺泡灌洗液,计数支气管肺泡灌洗液中白细胞总数及各炎症细胞所占比例;肺病理切片观察小鼠气道炎症和结构变化。结果  肥胖哮喘组、地塞米松治疗组、辛伐他汀治疗组气道炎症评分、回抽收集灌洗液中白细胞总数及中性粒细胞百分比、血清总胆固醇水平均较空白对照组升高,其中辛伐他汀治疗组上述指标较肥胖哮喘组、地塞米松治疗组下降,差异有统计学意义（P <0.05）。且总胆固醇水平与支气管肺泡灌洗液中中性粒细胞百分比呈正相关（r =0.724,P =0.020）。结论  辛伐他汀治疗可以减轻肥胖哮喘的气道炎症,改善哮喘病情,这一作用与其降低血脂水平有一定关系。

     

应用CNASCL-36标准评估HBVDNA定量检测试剂的抗干扰能力

目的评估乙型肝炎病毒(hepatitis B virus,HBV)脱氧核糖核酸(deoxyribonucleic acid,DNA)定量检测试剂的抗干扰能力。方法选择临界值、低值、中值和高值HBV DNA阳性血清样本,采用实时荧光定量PCR(quantitative real-time polymerase chain reaction,q-RT-PCR)技术检测1.63~17.25 g/L的血红蛋白(hemoglobin,Hb)或26.55~497.50μmol/L的总胆红素(total bilirubin,TBIL)对HBV DNA阳性样本检测结果的干扰,依据中国合格评定国家认可委员会(China National Accreditation Service for Conformity Assessment,CNAS)CL-36中的评价标准:偏差大于等于±7.5%时,判断检测结果受到干扰。结果当Hb浓度为7.75~17.25 g/L时,各样本均受到干扰;当Hb≤3.50 g/L时,各样本均未受到干扰。当TBIL浓度为274.60~399.15μmol/L时,仅HBV DNA=2.24×108IU/m L的样本检测未受到干扰;当TBIL=153.55μmol/L时,仅HBV DNA=4.62×102IU/m L的样本检测受到干扰;当TBIL=26.55μmol/L时,各样本均未受到干扰。结论该HBV DNA定量检测试剂具有一定的抗干扰能力:Hb≤3.50 g/L、TBIL≤26.55μmol/L对检测结果没有影响。     

历版《针灸学》针刺行针手法的对比研究

[目的] 对比我国历版《针灸学》中的针刺行针手法,研究分析其演变的原因、对临床的影响及发展趋势。 [方法] 通过查阅历版《针灸学》教材及针刺行针手法相关的文献,对比研究针刺行针手法的定义、种类等学术理论和临床实践应用的发展和变化。 [结果] 针刺行针手法的定义、种类变化与针刺行针手法的实际内涵未具体明确有关,在《针灸学》教材编著过程中,针灸专业领域的学术理论和临床实践的应用在不断地发展和变化,与编写者的学术思想以及教材内容设置的需要等也是密切相关的。[结论] 针刺行针手法的演变过程反映了不同时期对针刺行针手法的内涵理解和操作要求在不断变化,越来越强调针刺行针手法的可量化评价,以更贴近临床实际。针刺行针手法操作的规范化,也有利于针灸理论教学与临床实践相统一。     

The application of SFDI and LSI system to evaluate the blood perfusion in skin flap mouse model

Lasers in Medical Science - The aim of this study is to evaluate whether the blood perfusion to tissues for detecting ischemic necrosis can be quantitatively monitored by spatial frequency domain...     

The outcome of microvascular decompression for hemifacial spasm: a systematic review and meta-analysis

Microvascular decompression (MVD) is the first choice of surgery for hemifacial spasm (HFS). MVD surgery for vertebral artery (VA)-associated HFS is more difficult than for non-VA-associated HFS. There is controversy about the cure rate and complication of MVD for HFS in previous studies. We searched PubMed, Web of Science, and Embase for relevant publications. Based on the search results, we compared the outcomes of MVD for VA-associated HFS and non-VA-associated HFS. At the same time, we analyzed spasm-free rates and the complications and assessed the relationship between VA-associated HFS and gender, left side, and age. For analysis, six studies that included 2952 patients in the VA-associated group and 604 in the non-VA-associated group were selected. The effective rate of MVD was not significantly different between both groups (OR?=?1.16, 95% CI 0.81–1.67, P?=?0.42). Compared to non-VA-associated group, the transient complications (OR?=?0.64, 95% CI 0.46–0.89, P?=?0.008) and permanent complications (OR?=?0.28, 95% CI 0.15–0.54, P?=?0.0001) occurred more frequently in VA-associated group. The rate of hearing loss was significantly higher in VA-associated HFS than non-VA-associated HFS (OR?=?0.35, 95% CI 0.19–0.64, P?=?0.0007); the facial paralysis after operation was not significantly different between both groups (OR?=?1.25, 95% CI 0.91–1.72, P?=?0.17). There were older patients (WMD?=?3.67, 95% CI 3.29–4.05, P?<?0.00001) and more left-sided HFS (OR?=?0.23, 95% CI 0.19???0.29, P?<?0.0002) in the VA-associated HFS group than non-VA-associated HFS group, while the non-VA-associated HFS group was female-dominated (OR?=?1.58, 95% CI 1.32???1.89, P?<?0.00001). Both groups achieved good results in MVD cure rates. In VA-associated HFS, the complication rate of decompression and the rate of hearing loss after operation were higher than in non-VA-associated HFS, but the facial paralysis after operation was similar in both groups, and most complications were transient and disappeared during follow-up. VA-associated HFS is more prevalent in older adults, less prevalent in women, and more predominantly left-sided. More clinical studies are needed to better compare the efficacy and complication of MVD between both groups.

     

藏木香中1个新桉烷型倍半萜内酯

目的以活性追踪为导向对藏木香Inula racemosa根部活性倍半萜成分进行靶向分离,并考察其对尼日利亚菌素(nigericin)诱导人单核细胞白血病THP-1细胞中释放白细胞介素-1β(interleukin-1β,IL-1β)的抑制活性。方法借助各种色谱手段对其活性成分进行分离纯化,采用现代波谱技术(包括高分辨质谱、核磁共振、旋光等),并结合化学方法对其结构进行鉴定,采用ELISA法初步评价化合物1对nigericin诱导的THP-1细胞中IL-1β释放的抑制作用,并利用LDH法检测其对THP-1细胞的体外毒性。结果从藏木香石油醚萃取部位分离得到1个桉烷型倍半萜内酯,鉴定为藏木香素I(1),其2个水解产物分别为isotelekin(1a)和3-苯甲酰基丙烯酸(1b)。结论此桉烷型倍半萜内酯化合物1确定为新化合物,命名为藏木香素I,它对nigericin诱导THP-1细胞释放IL-1β具有显著的抑制活性,半数抑制浓度(IC_(50))为2.1μmol/L,而且其对nigericin诱导的THP-1细胞没有细胞毒性,并且表现出一定的保护作用。     

以“花”为例的微视频在药用植物学教学中的应用

"互联网+教育"的提出对传统药用植物学教学发起了很大的挑战,以花冠类型为例,详细介绍了微视频教学的全过程,以点带面,展示了依托于网络平台的微课和微视频作业教学法在药用植物学教学中的应用。论述了微视频教学应用的原则和优点,即重视学生在学习中的主体地位,培养学生自主学习的能力,培养学生的团结协作意识并给出了开拓微视频形式,丰富网络平台,改变课程评价方式,监测教学效果变化等建议。探讨了微视频在药用植物学教学中的发展前景。