双能量CT在颈部淋巴结病变评估中的研究进展

头颈部淋巴结病变的早期发现及定性诊断至关重要,有助于临床及时采取干预措施及制定治疗方案,延缓或终止疾病进展。目前双能量CT的多组图像,如虚拟平扫图像、碘图、虚拟单能量图像、光谱亨斯菲尔德单位衰减曲线及混合图像等已逐步用于评估头颈部淋巴结病变,为淋巴结病变的定性、分期及病理分型提供了诸多量化指标。本文就双能量CT的多组后处理图像及相关参数在颈部淋巴结病变评估中的研究进展作一综述。     

心率震荡不同指标对急性心肌梗死风险的预测价值

目的〓〖HTK〗研究急性心肌梗死（AMI）患者窦性心率震荡（HRT）的各个指标对预后的预测价值。〖HTW〗方法〓〖HTK〗选择AMI患者110例，测量HRT的3个参数：震荡斜率起始时间（TT）、震荡初始（TO）和震荡斜率（TS）及其他指标。〖HTW〗结果〓〖HTK〗① 随访患者93例，平均随访（18.70±12.65）个月，发生终点事件者20例；② 事件组TT、TO高于非事件组，TS低于非事件组（P＜0.05）, 事件组HRT较非事件组明显减弱；③ 单因素及多因素分析均表明，TT与TO、TS结合时对再发心脏事件的优势比最强（OR单＝8.632；OR多＝6.056，P＜0.01）。〖HTW〗结论〓〖HTK〗TT与TO、TS结合对AMI后再发心脏事件的预测价值最大，HRT可作为其有效预测因子。     

Total Arterial Revascularisation in Left Ventricular Dysfunction

Despite the excellent results achievable withcoronary artery bypass operations using a singlein-ternal mammary artery(I MA)graft to the left an-terior descending coronary artery(LAD)and addi-tional saphenous vein grafts,the long-term paten-cy of vein grafts in the coronary artery circulationhas beenless than that of arterial grafts.Choosingthe conduit with the highest early and long-termpatency for all of the diseased coronary arteries isone way to i mprove outcomes of coronary arterybypass …     

肝硬化失代偿期病人自我管理障碍因素的质性研究

目的 探讨影响肝硬化失代偿期病人自我管理的障碍因素,为制定提高肝硬化失代偿期病人自我管理水平策略提供参考依据。方法 运用现象学研究法,采用目的抽样选取2022年3—4月山西白求恩医院消化内科13例肝硬化失代偿期病人作为研究对象进行半结构化访谈。结果 提炼出自我管理障碍内因(不良心理及情绪、认知偏差、既往习惯影响、多种疾病共存),自我管理障碍外因(家庭-社会支持缺乏、经济压力、信息获取障碍、公共卫生事件)2个主题,8个亚主题。结论 目前肝硬化失代偿期病人存在自我管理不足的现象,大多数病人对于如何实现自我管理往往不知所措,自我管理体验不良;同时病人自我管理行为中断性较高。医护人员及有关部门应加强对该疾病自我管理的重视,提供切实有效的帮助,以提高病人自我管理水平,全面改善生活质量。     

Giant cell arteritis associated with acute Q fever – A case report

Q fever is a worldwide spread zoonotic disease, caused by the gram-negative intracellular bacillus Coxiella burnetii. Apart from its most common manifestations, Q fever has been reported to occasionally mimic autoimmune diseases. We herein present a case of acute Q fever in a 69-year-old man, manifesting as prolonged fever with pneumonitis, in whom biopsy of the temporal artery revealed giant cell arteritis. Moreover, PCR testing of the biopsy specimen was positive for Coxiella burnetii, thus further supporting the possibly infectious etiology of some cases of biopsy proven giant cell arteritis, with implications for treatment.     

Primary Care Physicians’ Perspectives in Leading Breast Cancer Follow-Up Care

IntroductionLimited data exist on the barriers associated with transitioning breast cancer follow-up care to primary care physicians (PCPs). This study aimed to describe the current perspectives of PCPs in managing breast cancer follow-up.MethodAn online survey was distributed to PCPs in Toronto, ON, Canada. Questions examined PCPs’ view of transitioning breast cancer follow-up care to their practices.ResultsOf 800 PCPs invited, 126 responded (response rate: 15.7%). The types of practice models amongst respondents included blended capitation (42.9%), blended salary (27%), and fee-for-service (17.5%). Seventy-seven percent of respondents stated they provided follow-up care. Approximately half of the respondents stated they were somewhat comfortable providing follow-up care. PCP-led follow-up care was considered either very (49.2%) or somewhat appropriate (30.2%). When asked about financial remuneration, 43.7% of respondents stated it was somewhat important. The factors that influenced the feasibility of PCP-led follow-up care included receipt of a detailed follow-up care plan provided by the specialist after discharge (81%), the ability to re-refer to specialists rapidly (56.3%), and the ability to obtain regular updates of best practice changes (59.5%). The preferred means of educational updates included E-mail (40.5%), continuing medical education events (30.2%), and electronic medical records (19.8%). When the fee model was taken into consideration there was no significant difference in opinions regarding follow-up care.ConclusionsTransitioning to a PCP-led model was supported by most of the PCPs who participated in this study. Their perspective on PCP-led follow up care and barriers associated with implementation of this model of care needs to be further explored with future studies that include larger sample size and a more diverse PCP population.     

Hydrogen sulfide inhibits development of atherosclerosis through up-regulating protein S-nitrosylation

Hydrogen sulfide (H₂S) is an important gaseous signaling molecule that serves many important regulatory roles in physiological and pathophysiological conditions. H₂S exerts an anti-atherosclerotic effect through mediating the biological functions of nitric oxide (NO). However, its mechanism of action is unclear. The purpose of this study is to explore the effect mechanism of H₂S on the development of atherosclerosis with regard to protein S-nitrosylation. A total of 45 male apoE^−/− mice were randomly divided into three groups. Atherosclerosis was induced by Western diet (21% fat and 0.15% cholesterol) with/without administration of a H₂S donor (NaHS) or an endogenous cystathionine γ-lyase inhibitor (d, l-propargylglycine) for 12 weeks. After 12 weeks, plasma lipid and plasma NO levels were measured. Aortic gross lesion area and histopathological features of aortic lesion were determined. Additionally, the level of S-nitrosylated proteins in vascular smooth muscle cells (VSMCs) was detected using immunofluorescence in aorta. Rat VSMCs were performed in an in vitro experiment. Inducible nitric oxide synthase (iNOS) protein expression, NO generation, protein S-nitrosylation, and cell proliferation and migration were measured. We found that H₂S significantly reduced the aortic atherosclerotic lesion area (P = 0.006) and inhibited lipid and macrophage accumulation (P = 0.004, P = 0.002) and VSMC proliferation (P = 0.019) in apoE^−/− mice. H₂S could up-regulate levels of plasma NO and protein S-nitrosylation in aorta VSMCs. However, d, l- propargylglycine had the opposite effect, increasing the lesion area and the content of lipids and macrophages in the lesions of apoE^−/− mice and down-regulating plasma NO levels and protein S-nitrosylation in aorta VSMCs. In vitro experiments, H₂S could significantly reverse the reduction of iNOS expression and NO generation induced by oxidized low-density lipoprotein in VSMCs. Moreover, H₂S could increase the protein S-nitrosylation level of VSMCs in a dose-dependent manner, and the effect could be inhibited by iNOS inhibitors. In addition, proliferation and migration of VSMCs could be inhibited by H₂S in a dose-dependent manner, which could be blocked by an iNOS inhibitor or protein S-nitrosylation removal agent. Our data suggest that H₂S could inhibit the development of atherosclerosis by up-regulating plasma NO and protein S-nitrosylation, thereby inhibiting the proliferation and migration of VSMCs.