室壁应力与应变的关系评价高血压病左室收缩功能

目的　探索用室壁应力 (stress)与应变 (strain)的关系评价高血压病左室收缩功能的临床价值。方法　研究对象为 5 5例高血压病患者和 3 0例健康人。应用超声心动图计算左室射血分数 (EF)、心指数 (CI)、重量指数 (LVMI)和相对室壁厚度 (RWT) ,并联合袖带肱动脉血压值计算左心室收缩期室壁经线峰值应力 (Pσm)。根据LVMI和RWT将高血压病分为左室正常构型和左室重构两组。在数字化超声工作站中应用定量组织速度成像 (QTVI)获取左室前壁心肌 2个节段长轴应变曲线和峰值收缩应变值 (PSS)。结果　①以EF ,CI表示的心脏收缩功能 ,在高血压病左室正常构型组值中无明显变化 ;而在高血压病左室重构组中下降 ,差异具有极显著意义 (P <0 .0 1)。②Pσm在高血压病两组中较对照组均有增高 (P <0 .0 5～ 0 .0 1) ,两组间比较差异具有极显著意义 (P <0 .0 1)。③高血压病两组左室前壁基底段 (Bas)和中段 (Mid)的 pSS值均显著下降 (P <0 .0 1) ,两组间比较差异具有极显著意义 (P <0 .0 1)。④直线相关分析结果显示高血压病两组Pσm与PSSBas和PSSMid均呈显著负相关。根据正常构型组Pσm与PSSBas直线回归方程计算 ,在相同Pσm水平 ,左室重构组PSSBas的实测值显著低于预测值及实测值与预测值的比值较正常构型组显著下降 ,差     

Kümmell病的临床治疗进展

目的:系统评价自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合相关指标,为成人长骨骨折不愈合治疗提供参考依据。方法:计算机检索PuMed、Embase、Cochrane图书馆、中国知网(CNKI)、万方数据期刊全文数据库及中国生物医学文献数据库(CBM)发表的对于自体骨移植与骨形成蛋白治疗成人长骨骨折不愈合的随机对照试验,检索时间从建库至2019年3月。由2名研究者按照纳入和排除标准独立进行筛选文献,提取资料,并采用Jadad评价量表对纳入的文献进行质量评价。采用RevMan 5.3统计学软件对两种方法的感染发生率、成功愈合率、二次手术率、住院时间及术中失血量进行Meta分析。结果:共纳入7个随机对照试验研究,共652例患者,自体骨移植组有410例,骨形成蛋白组有242例。Meta分析结果显示:自体骨移植组与骨形成蛋白组在感染发生率[RR=1.32,95%CI(0.90,1.93),P=0.16],成功愈合率[RR=0.95,95%CI(0.84,1.08),P=0.43],二次手术率[RR=1.16,95%CI(0.43,3.12),P=0.76]及住院时间[MD=0.69,95%CI(-0.38,1.75),P=0.21]方面比较差异无统计学意义。自体骨移植组术中失血量明显高于骨形成蛋白组[MD=223.00,95%CI(32.72,413.28),P=0.02]。结论:对于成人长骨骨折不愈合的治疗,骨形成蛋白可以获得和自体骨移植一样的骨折愈合率,同时可以明显减少术中失血量。骨形成蛋白可能更适合成人长骨骨折不愈合的治疗。     

Surgical ventricular reconstruction and subendocardial resection for the treatment of refractory ventricular tachycardia

We describe a case of 64-year-old female patient with ventricular tachycardia intractable to medical treatment and acute heart failure following myocardial infarction. Emergency surgical ventricular reconstruction and subendocardial resection was undertaken. We discuss the option of surgical intervention in this difficult and unusual clinical scenario.     

Ceruloplasmin gene‐deficient mice with experimental autoimmune encephalomyelitis show attenuated early disease evolution

We conducted a microarray study to identify genes that are differentially regulated in the spinal cords of mice with the inflammatory disease experimental autoimmune encephalomyelitis (EAE) relative to healthy mice. In total 181 genes with at least a two‐fold increase in expression were identified, and most of these genes were associated with immune function. Unexpectedly, ceruloplasmin (Cp), a ferroxidase that converts toxic ferrous iron to its nontoxic ferric form and also promotes the efflux of iron from astrocytes in the CNS, was shown to be highly upregulated (13.2‐fold increase) in EAE spinal cord. Expression of Cp protein is known to be increased in several neurological conditions, but the role of Cp regulation in CNS autoimmune disease is not known. To investigate this, we induced EAE in Cp gene knockout, heterozygous, and wild‐type mice. Cp knockout mice were found to have slower disease evolution than wild‐type mice (EAE days 13–17; P = 0.05). Interestingly, Cp knockout mice also exhibited a significant increase in the number of astrocytes with reactive morphology in early EAE compared with wild‐type mice at the same stage of disease. CNS iron levels were not increased with EAE in these mice. Based on these observations, we propose that an increase in Cp expression could contribute to tissue damage in early EAE. In addition, endogenous CP either directly or indirectly inhibits astrocyte reactivity during early disease, which could also worsen early disease evolution. © 2014 Wiley Periodicals, Inc.     

高效液相色谱法测定多维元素片中泛酸的含量

目的建立复合多维元素片中泛酸的含量测定方法。方法高效液相色谱法,C18色谱柱(250mm×4.6mm,5μm);流动相:乙腈-1mL·L-1磷酸水溶液(5∶95);流速:1.0mL·min-1;柱温:25℃;检测波长:200nm。结果泛酸质量浓度在1.32¹32.32μg·mL-1范围内具有良好的线性关系,相关系数r=0.999 9,平均回收率为99.3%,RSD为1.4%(n=12)。结论该方法快速简便,结果准确,适用于多维元素片中泛酸含量测定。     

Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

BackgroundManagement of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC.MethodsThis is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups.Results1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001).ConclusionCurative approaches may guarantee long-term survival in case of recurrence.     

提高医学院校文科生生物化学教学质量策略探讨

生物化学是医学院校学生一门重要的公共基础课。大多数学生认为生物化学这门课程内容庞杂、名词术语繁多、抽象难懂、学习难度大,尤其对于生物学科与化学学科基础薄弱的文科生来讲,学习过程吃力,学习效果不理想,期末挂科率较高。本研究从文科生学习生物化学遇到的困难及教师面临的教学现状出发,找出问题,探讨具体应对策略,旨在提高学生学习生物化学课的兴趣和效果。     

Acute and Fulminant Myocarditis: a Pragmatic Clinical Approach to Diagnosis and Treatment

Purpose of Review

To review the clinical features of acute myocarditis, including its fulminant presentation, and present a pragmatic approach to the diagnosis and treatment, considering indications of American and European Scientific Statements and recent data derived by large contemporary registries.

Recent Findings

Patients presenting with acute uncomplicated myocarditis (i.e., without left ventricular dysfunction, heart failure, or ventricular arrhythmias) have a favorable short- and long-term prognosis: these findings do not support the indication to endomyocardial biopsy in this clinical scenario. Conversely, patients with complicated presentations, especially those with fulminant myocarditis, require an aggressive and comprehensive management, including endomyocardial biopsy and availability of advanced therapies for circulatory support. Although several immunomodulatory or immunosuppressive therapies have been studied and are actually prescribed in the real-world practice, their effectiveness has not been clearly demonstrated. Patients with specific histological subtypes of acute myocarditis (i.e., giant cell and eosinophilic myocarditis) or those affected by sarcoidosis or systemic autoimmune disorders seem to benefit most from immunosuppression. On the other hand, no clear evidence supports the use of immunosuppressive agents in patients with lymphocytic acute myocarditis, even though small series suggest a potential benefit.

Summary

Acute myocarditis is a heterogeneous condition with distinct pathophysiological pathways. Further research is mandatory to identify factors and mechanisms that may trigger/maintain or counteract/repair the myocardial damage, in order to provide a rational for future evidence-based treatment of patients affected by this condition.

     

Regulation of neutrophil migration and superoxide production by recombinant tumor necrosis factors-alpha and -beta: comparison to recombinant interferon-gamma and interleukin-1 alpha

We compared the ability of recombinant human tumor necrosis factor- alpha (rHuTNF-alpha) and tumor necrosis factor-beta (rHuTNF-beta) to stimulate polymorphonuclear neutrophil (PMN) migration and superoxide production. Significant PMN migration occurred across polycarbonate filters after stimulation with rHuTNF-alpha at concentrations ranging from 10(-7) to 10(-10) mol/L and at 10(-7) to 10(-8) mol/L for rHuTNF- beta and N-formylmethionyl-leucyl phenylalanine (FMLP), whereas recombinant human interferon-gamma was only minimally active at 10(-7) mol/L and recombinant human interleukin-1 alpha was inactive at the doses tested. In addition, antibodies to rHuTNF-alpha completely inhibited rHuTNF-alpha but not rHuTNF-beta or FMLP-induced PMN migration. Combinations of rHuTNF-alpha and rHuTNF-beta (at similar molar concentrations) stimulated PMN migration levels comparable to that obtained with rHuTNF-alpha alone. Checkerboard analyses performed by placing different concentrations of rHuTNF-alpha and rHuTNF-beta above and below polycarbonate filters of microchemotaxis chambers demonstrated that rHuTNF-alpha and rHuTNF-beta stimulated both chemotactic and chemokinetic responses by PMN. Additional studies demonstrated that 1 X 10(-8) mol/L rHuTNF-alpha and 3 X 10(-9) mol/L rHuTNF-beta (which represents 10(4) U/mL of each cytokine) were similar in their ability to induce superoxide production by PMNs; however, at ten- to 100-fold lower molar concentrations (10(3) and 10(2) units), rHuTNF-alpha was significantly more active than rHuTNF-beta. At the doses tested, both cytokines were less active than phorbol myristate acetate at stimulating O2- release. The results demonstrate that rHuTNF- alpha and rHuTNF-beta differ quantitatively but not qualitatively in their effects on PMN functions in vitro and suggest that rHuTNF-beta may be less toxic than rHuTNF-alpha in vivo.     

美托洛尔缓释片治疗原发性高血压并舒张压性心力衰竭的疗效观察

目的：探讨美托洛尔缓释片治疗原发性高血压（EH）并舒张压性心力衰竭（DHF）患者的临床疗效。方法：选取2010年7月-2013年4月本院就诊的126例EH合并DHF患者作为研究对象,所有患者给予美托洛尔缓释片治疗12个月。分别观察治疗前后患者的血压、心率、VEGF和hs-CRP水平的变化,同时观察心脏结构、左室功能参数变化及心功能分级的变化情况。结果：治疗后,左室舒张末径（LVEDD）和左室收缩末径（LVESD）显著减小,二尖瓣返流现象显著减轻,左室射血分数（LVEF）、左室高峰充盈数（LVPFR）显著增加,收缩压、舒张压、脉压和心率以及VEGF和hs-CRP、N末端钠肽原（NT-proBNP）均显著降低,上述指标治疗前后比较差异均具有统计学意义（P＆lt;0.05）。结论：美托洛尔缓释片治疗EH并DHF患者,能显著改善患者的心脏功能,治疗效果显著,值得在临床上进一步推广。