The metabolic syndrome and cardiovascular risk

There are four definitions of the metabolic syndrome that have been recommended by the World Health Organization (WHO), the European Group for Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Expert Panel (NCEP), and the American Association of Clinical Endocrinologists (AACE) separately since 1998. The prevalence of the metabolic syndrome reported from different studies has varied widely, mainly because of differences in the definitions of the syndrome and in the characteristics of the populations studied. Prospective studies on the relationship between the metabolic syndrome and cardiovascular risk are still scanty. Results from several studies including a large population-based Italian study, the Framingham Offspring Study, the Botnia Study, the Kuopio Ischemic Heart Disease Study, the National Health and Nutrition Examination Survey II Mortality Study, the San Antonio Heart Study, and the DECODE study have shown that the presence of metabolic syndrome using different definitions is associated with a significantly increased risk of total mortality and cardiovascular morbidity and mortality.     

Evaluation of effect of hybrid bioartificial liver using end-stage liver disease model

AIM: To study the role of hybrid bioartificial liver (HBL) in clearing proinflammatory cytokines and endotoxin in patients with acute and sub-acute liver failure and the effects of HBL on systemic inflammatory syndrome (SIRS) and multiple organ dysfunction syndrome (MODS).METHODS: Five cases with severe liver failure (3 acute and 2 subacute) were treated with HBL. The clinical signs and symptoms, total bilirubin (TBIL), serum ammonia,endotoxin TNF-~, 1L-6 and prothrombin activity (PTA),cholinesterase (CHE) were recorded before, during and after treatment. The end-stage liver disease (MELD) was used for the study.RESULTS: Two patients were bridged for spontaneous recovery and 1 patient was bridged for OLT successfully.Another 2 patients died on d 8 and d 21. The spontaneous recovery rate was 30.0%. PTA and CHE in all patients were significantly increased (P<0.01), while the serum TBIL,endotoxin,TNF-α, IL-6 were decreased. MELD score (mean 43.6) predicted 100% deaths within 3 mo before treatment with HBL. After treatment with HBL, four out of 5 patients had decreased MELD scores (mean 36.6). The MELD score predicted 66% mortalities.CONCLUSION: The proinflammatory cytokines (TNFα, IL-6 and endotoxin)can be significantly removed by hybrid bioartificial liver and HBL appears to be effective in blocking SIRS and MODS in patients with acute and sub-acute liver failure. MELD is a reliable measure for predicting short-term mortality risk in patients with end-stage liver disease. The prognostic result also corresponds to clinical outcome.     

肝癌根治术后经肝动脉辅助化疗的疗效评价

近年来,对肝癌的治疗效果有较大提高,以肝切除术为主的外科治疗仍是肝癌的首选治疗方法,但术后长期生存率却不令人满意,主要是因为肝癌术后有很高的复发率,据报道肝癌术后5年累计复发率超过80%。术前经肝动脉栓塞化疗(TACE)已被证明对肝癌术后的预后无意义,并可能促进肝硬化型肝癌患者肝功能的恶化。在近年的一些系统评价中,对术后经肝动脉化疗(TAC)模式的疗效分析也未能得出一致的结果。我们搜集已发表的随机对照试验(RCT)结果进行综合评价,进一步探讨术后TAC对肝癌预后的价值。     

Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy

Biventricular pacing results in left ventricular (LV) reverse remodeling in heart failure patients with wide QRS complexes. This study examines potential predictors of reverse remodeling. Echocardiography with tissue Doppler imaging was performed at baseline and 3 months after biventricular pacing in 30 patients (21 men and 9 women, mean age 62 +/- 14 years). There were 17 responders to reverse remodeling (defined as a reduction in LV end-systolic volume by >15%) and 13 nonresponders. Responders had significant improvement in 6-minute hall-walking distance (p = 0.006), metabolic equivalents (p = 0.02), peak oxygen uptake (p = 0.02), New York Heart Association functional class (p <0.001), and quality of life (p <0.001); an increase in the sphericity index (p = 0.007), ejection fraction (p <0.001), and diastolic filling time (p = 0.03); a decrease in myocardial performance index (p = 0.02), isovolumic relaxation time (p = 0.004), and mitral regurgitation (p = 0.007); and an improvement in systolic dyssynchrony (SD of the time to peak myocardial systolic contraction of the 12 LV segments as dyssynchrony index) (45.0 +/- 8.3 vs 32.5 +/- 14.5 ms, p = 0.003). In contrast, nonresponders only had a small degree of clinical improvement in New York Heart Association class (p = 0.03) and quality-of-life scores (p = 0.03), without any change in cardiac function, and worsening of systolic dyssynchrony (24.8 +/- 4.5 vs 34.1 +/- 13.5 ms, p = 0.02). When all the above factors were put into univariate and multivariate analyses models, systolic dyssynchrony was the only independent predictor of reverse remodeling (r = -0.76, p <0.001) (beta = -1.54, p = 0.007). A preimplant dyssynchrony index of 32.6 ms (+2 SDs from mean of 88 normal controls) was able to totally segregate responders from nonresponders of biventricular pacing. Thus, responders of LV reverse remodeling were associated with improvement in clinical status, cardiac function, and systolic synchronicity. Direct assessment of systolic synchronicity by tissue Doppler imaging is highly accurate in predicting responders to therapy.     

肝细胞损伤的分子生物学机制

随着医学研究的不断进展,我们对各种肝脏疾病的病因有了更加深入的了解,对疾病的治疗也渐渐从对症治疗转移到病因治疗,但是,在强调病因学治疗的同时,不应忽略对肝细胞的保护,因为肝细胞损伤是各型肝病共同的病理基础,是各种原因引起肝脏疾病的共同的表现.     

三维电解剖标测及单根环状标测电极指导下CPVA术治疗心房颤动

目的探讨在三维电解剖标测及单根环状标测电极指导下以环肺静脉口电隔离术（CPVA）为核心治疗心房颤动（房颤）的疗效。方法对32例房颤患者均在CARTO三维电解剖标测及单根环状标测电极指导下行CPVA,其中辅助行碎裂电位消融6例,上腔静脉消融术2例,三尖瓣峡部、二尖瓣峡部及冠状窦内消融各1例。结果26例阵发性房颤不再被诱发,6例慢性房颤中术中房颤终止2例、电复律转为窦性心律4例;手术操作时间（119&#177;37）min,X线透视时间（25&#177;12）min;随访（9&#177;5）个月成功率为90.6%。均无手术并发症。结论三维电解剖标测及单根环状标测电极指导下以CPVA为核心,其他消融方法为辅的房颤消融策略安全有效,可提高消融成功率,缩短手术时间,减少并发症、复发。     

依布硒啉对心肌缺血再灌注损伤大鼠心功能的保护作用及其机制

目的探讨依布硒啉(Ebs)对心肌缺血再灌注损伤大鼠心功能的保护作用及其机制。方法取24只雄性大鼠,结扎其冠状动脉左前降支30 min、灌注90 min制作心肌缺血再灌注损伤模型,观察Ebs对大鼠心功能、心肌酶学和脂质过氧化的影响。结果Ebs能够对抗心肌缺血再灌注引起的左心室内压(LVSP)、左心室内压最大上升与下降速率(±dp/dtmax)、动脉血压下降,并能够稳定心肌组织Na -K -ATPase和Ca2 -Mg2 -AT-Pase活性,降低丙二醛(MDA)含量和增高SOD活性。结论提示依布硒啉(Ebs)对大鼠心肌缺血再灌注引起的心功能减弱具有明显的保护作用,其机制可能为改善能量代谢障碍,抑制自由基生成或清除氧自由基。     

日本血吸虫病肝脾肿的临床流行病学调查

根据在一重疫区,以血吸虫性肝脾肿的临床流行病学调查为重点的社区研究资料,描述了该社区在持续若干年间断和不规则化疗后肝脾肿的临床流行病学状态,并阐述了该社区日本血吸虫感染的流行率,感染度和患病率之间的关系。作者发现,在该社区特定条件下,血吸虫感染是高流行率伴低感染度状态,同时显示相当高程度的肝脾肿患病率。研究资料分析结果提示,肝脾肿的发生与感染的积累和持续时间,并在一定程度上与感染度有关。作者还指出应用便携式超声诊断仪作超声影像诊断调查是衡量日本血吸虫病患病或病情的敏感工具。     

基质对日本血吸虫培养细胞SDH和LDH影响的研究

目的　研究细胞外基质 (ECM)对日本血吸虫培养细胞琥珀酸脱氢酶 (SDH)和乳酸脱氢酶 (L DH)代谢活力的影响 ,筛选适合培养细胞存活、生长的生物基质。　方法　将虫龄 2 1d的日本血吸虫细胞接种于预先涂有肝、肺、鼠尾胶等不同生物基质的小盖玻片上常规培养 ,运用酶细胞化学方法 ,在培养第 3d进行 SDH染色 ,第 7d作 L DH染色 ,显微镜观察并拍照 ,图像分析仪测定其含量 ,并作统计分析。　结果　不同 ECM培养的细胞 ,其 SDH、 L DH活性不同 ,着色颗粒颜色按对照组、鼠尾胶组、肺基质组、肝基质组依次加深。定量分析结果显示 ,肝、肺基质组培养细胞 SDH含量与对照组差异显著 (P<0 .0 1) ,而鼠尾胶组与对照组差异不显著 (P>0 .0 5 )。各基质组培养细胞的 L DH含量与对照组比较 ,差异显著 (P<0 .0 1) ;各基质组之间两两比较差异亦具有显著性。肝基质组培养细胞内两种酶含量最高。　结论　肝基质最适合日本血吸虫培养细胞的存活与生长。     

镍钛支架治疗80岁及以上老年人前列腺增生症64例分析

目的　探讨镍钛记忆合金网状支架治疗 80岁以上老年人前列腺增生症疗效和安全性。　方法　 64例患者年龄 80～ 89岁 ,平均 84 5岁。置管前按国际前列腺症状评分 (IPSS ,2 1 5± 7 6) ,并测量最大尿流〔Qmax ,(7 8± 3 5 )ml/s〕、残量尿〔RU ,(164 0± 10 4 0 )ml〕。于低位腰麻或硬膜外麻醉下置管 ,随访 1年 ,进行尿常规检查及IPSS、Qmax、RU测定 ,记录不适反应。　结果　置管成功 62例(96 9% ) ,平均置管时间 2 0～ 45min ,平均住院时间 12d。 43例患者术后出现尿频、尿急、血尿等症状。患者置管后 1年的IPSS、Qmax、RU分别为 14 1± 3 2、(14 8± 4 5 )ml/s、(4 6 0± 2 6 0 )ml。　结论　镍钛合金网状支架治疗前列腺增生症具有疗效好、损伤小、并发症少等优点 ,可作为治疗老年人前列腺增生症的方法之一