中心静脉穿刺置管在大面积烧伤治疗中的应用

对我院近年来收治的大面积烧伤患者进行回顾性病历资料统计。结果发现108例患者应用中心静脉穿刺置管,其中98例(90.7％)经股静脉入路;7例(6.4％)经右锁骨下静脉,3例(3％)经颈内静脉。2例发生气胸,需行胸腔闭式引流。提示中心静脉穿刺置管应用于烧伤病人方便抢救和治疗,但医生和护理人员一定要充分了解其并发症,并且重视一些严重并发症如血管损伤致出血、胸膜损伤致气胸、以及心包填塞、气体栓塞等的预防、诊断和处理。     

Comparative study of simple versus complex stenting of coronary artery bifurcation lesions in daily practice in Chinese patients

BACKGROUND: Recently, several randomized and controlled trials have demonstrated great advantages of a drug-eluting stent (DES) with respect to significant reduction in restenosis and recurrence of symptoms, and improvement in clinical outcomes after percutaneous coronary intervention (PCI). Little is known about the comparative effects of the 1-DES plus the kissing balloon technique with the 2-DES for bifurcation angioplasty in a Chinese population. METHODS: From April 2004 to June 2006, 566 consecutive Chinese patients underwent DES implantation for true bifurcation lesions, including 346 1-DES with the kissing balloon technique (300 male, 57.7 +/- 11.5 y old) and 220 2-DES (183 male, 58.1 +/- 10.7 y old) were analyzed. Clinical and angiographic follow-up was performed after 7 mo. RESULTS: The major adverse cardiac event (MACE) rates were higher in the 2-DES group than in the 1-DES group (5.5% versus 2.0%; p = 0.032), which was mainly contributed to by acute myocardial infarction (AMI) (4.5% versus 1.4%; p = 0.032), rather than death and target lesion revascularization (TLR) (0% versus 0.5%; p = 0.389, 1.4% versus 2.7%; p = 0.352). Stent thrombosis rates were higher in the 2-DES group than in the 1-DES group (0.6% versus 2.7%; p = 0.042), except for 1 late-stent thrombosis in the 2-DES group, and all of them were subacute stent thrombosis (2 in the 1-DES group and 5 in the 2-DES group). The 7 mo angiographic follow-up rate was 36.4%. In the main branch there was no difference in restenosis rate in the 1-DES group compared with the 2-DES group (9.8% versus 11.9%; p = 0.652), but in the side branch the restenosis rate was higher in the 1-DES group (33.6% versus 15.5%; p = 0.004). However, there was no difference in in-segment late loss between the 2 groups, either in the main or side branch. CONCLUSION: Compared with the 2-DES strategy, if a final kissing balloon could be achieved, the 1-DES strategy may be more efficient and safe.     

Differentiating Psoriatic Arthritis From Psoriasis Without Psoriatic Arthritis Using Novel Serum Biomarkers

Objective

There is a high prevalence of undiagnosed psoriatic arthritis (PsA) in patients with psoriasis. Identifying soluble biomarkers for PsA will help in screening psoriasis patients for appropriate rheumatology referral. We therefore aimed to investigate whether serum levels of novel markers previously discovered by quantitative mass spectrometric analysis of synovial fluid and skin biopsies performs better than the C‐reactive protein (CRP) level in differentiating PsA patients from those with psoriasis without PsA (PsC).

Methods

In this case–control study, serum samples were obtained from 100 subjects with PsA, 100 with PsC, and 100 healthy controls. Patients with PsA and PsC were group matched for age, sex, psoriasis duration, and Psoriasis Area and Severity Index and were not currently receiving biologic treatment. Using enzyme‐linked immunosorbent assay, 4 high‐priority markers (Mac‐2‐binding protein [M2BP], CD5‐like protein [CD5L], myeloperoxidase [MPO], and integrin β5 [ITGβ5]), as well as previously established markers (matrix metalloproteinase 3 [MMP‐3] and CRP level) were assayed. Data were analyzed using logistic regression. Receiver operating characteristic (ROC) curves were plotted.

Results

In comparisons to controls, CD5L, ITGβ5, M2BP, MPO, MMP‐3, and CRP level were independently associated with PsA, while only CD5L, M2BP, and MPO were independently associated with PsC alone. In comparisons to PsC, ITGβ5, M2BP, and CRP level were independently associated with PsA. ROC analysis of this model shows an area under the curve (AUC) of 0.85 (95% confidence interval [95% CI] 0.80–0.90). The model that included CRP level alone had an AUC of 0.71 (95% CI 0.64–0.78).

Conclusion

CD5L, ITGβ5, M2BP, MPO, MMP‐3, and CRP level are markers for PsA. The combination of ITGβ5, M2BP, and CRP level differentiates PsA from PsC, and performs better than CRP level alone.

     

电镜技术在四类医学媒介生物分类鉴定中的应用研究

目的 利用扫描电镜技术对形态相似的医学媒介生物种类进行观察、描述、比较分析,为此类媒介生物的鉴定提供新的方法.方法 选择媒介4类17种,常规标本制作并在电镜下观察其超微结构,并进行描述比较和分析.结果 共观察到4类媒介6类触角感受器,具有不同程度的种间差异.结论 对医学媒介生物触角感受器的研究,为更好地把握各类感受器的功能,揭示触角的感受机理和防治医学媒介提供新的途径.     

Attenuation of Reserpine-Induced Pain/Depression Dyad by Gentiopicroside Through Downregulation of GluN2B Receptors in the Amygdala of Mice

Epidemiological studies demonstrate that pain frequently occurs comorbid with depression. Gentiopicroside (Gent) is a secoiridoid compound isolated from Gentiana lutea that exhibits analgesic properties and inhibits the expression of GluN2B-containing N-methyl-d-aspartate (NMDA) receptors in the anterior cingulate cortex of mice. However, the effects of Gent on the reserpine-induced pain/depression dyad and its underlying mechanisms are unclear. Reserpine administration (1 mg/kg subcutaneous daily for 3 days) caused a significant decrease in the nociceptive threshold as evidenced by the reduced paw withdrawal latency in response to a radiant heat source and mechanical allodynia. Behavioral detection indicated a significant increase in immobility time during a forced swim test, as well as decreased time in the central area and total travel distance in an open field test. Furthermore, reserpinized animals exhibited increased oxidative stress. Systemic Gent administration dose-dependently ameliorated the behavioral deficits associated with reserpine-induced pain/depression dyad. At the same time, the decrease in biogenic amine levels (norepinephrine, dopamine, and serotonin) was integrated with the increase in caspase-3 levels and GluN2B-containing NMDA receptors in the amygdala of the reserpine-injected mice. Gent significantly reversed the changes in the levels of biogenic amines, caspase-3, and GluN2B-containing NMDA receptors in amygdala. However, Gent did not affect the expression of GluN2A-containing NMDA receptors. The inhibitory effects of Gent on oxidative stress were occluded by simultaneous treatment of GluN2B receptors antagonist Ro25-6981. Our study provides strong evidence that Gent inhibits reserpine-induced pain/depression dyad by downregulating GluN2B receptors in the amygdala.     

肝硬化并发菌血症研究进展

菌血症是肝硬化患者的常见并发症,肝硬化菌血症的发生率随肝病严重程度递增,一旦发生菌血症,则提示预后较差。叙述了肝硬化并发菌血症的危险因素、诊断要点、治疗方法、预防及预后五个方面的研究进展,认为早期防治菌血症对肝硬化患者的预后有重要意义。