压力-应变环评估蒽环类药物对乳腺癌患者左室心肌做功的影响

目的 应用左心室压力-应变环（PSL）探讨蒽环类药物化疗对乳腺癌患者左心室心肌做功的影响。 方法 选取新疆医科大学第四临床医学院40例准备接受蒽环类药物化疗的乳腺癌患者,分别于化疗前及化疗第2、4、6周期后（T0、T2、T4、T6）采集患者左心室心尖四腔心、两腔心及三腔心切面超声心动图图像,测定并比较左心室心内膜、中层、外膜心肌纵向应变（EndoGLS、MidGLS、EpiGLS）和整体心肌做功指数（GWI）、整体有用功（GCW）、整体无用功（GWW）和整体做功效率（GWE）。 结果 常规超声心动图参数LVDD、IVSTD、E峰、A峰、E/A及LVEF于化疗各周期比较,差异均无统计学意义。T4、T6时GWI（1927.68±207.58mmHg和1853.30±208.32mmHg）和GCW（2191.68±212.14mmHg和2127.32±217.13mmHg）低于T0,差异有统计学意义（P<0.05）;T6时EndoGLS（-22.97±1.81%）、MidGLS（-20.32±1.62%）和EpiGLS（-18.06±1.53%）绝对值低于T0,差异有统计学意义（P<0.05）。相关性分析显示EndoGLS与GWI和GCW相关性较明显（r=-0.57和r=-0.56,均P<0.001）。 结论 PSL较斑点追踪分层应变技术能更早发现蒽环类药物化疗乳腺癌患者的左心室心肌做功改变,为定量评估蒽环类药物化疗乳腺癌患者的左心室收缩功能提供了一种新方法。     

血清sST2联合左心房前后径对房颤射频消融术后复发的预测

摘要： 目的 探讨术前血清sST2浓度以及sST2联合左心房前后径（LAD）对房颤射频消融术后复发的预测价值。 方法 研究2019年2月至2019年10月间在我院心内科住院并且进行射频消融手术治疗的心房颤动患者84例患者,其中阵发性房颤57例,持续性房颤27例,男性48人,女性36人,平均年龄64.24±10.168岁。收集所有患者术前一般临床资料和血液学指标。采用ELISA法检测患者血清sST2浓度。心脏超声于收缩末期胸骨旁长轴切面测量左心房前后径。所有入选的房颤患者于消融术后3、6、12月定期随访。采用单因素和多因素Cox回归分析sST2联合LAD对房颤术后复发的预测价值。 结果 通过单因素COX回归及多因素COX回归模型,提示血清sST2（HR 1.014,95%CI 0.986-1.035, P=0.035）、LAD（HR 1.271,95%CI 0.946-1.378, P=0.036）是影响房颤复发的独立危险因素;sST2联合LAD预测房颤复发的能力进一步提升,ROC曲线下面积为0.907,灵敏度0.846,特异度0.894。 结论 术前检测血清sST2浓度以及sST2联合超声测量LAD可对房颤射频消融术后复发提供预测价值。     

残余Syntax评分对左主干病变经皮冠脉介入 治疗患者预后的影响

目的：探讨残余SYNTAX评分（residual SYNTAX score,rSS）对左主干病变（Left main,LM）接受PCI的患者远期预后的影响。方法：回顾性分析我院接受LM病变PCI治疗的患者,收集其临床资料、实验室检查、冠脉造影及介入操作资料,并计算其基线SYNTAX评分（baseline SYNTAX score,bSS）和rSS,根据rSS分值进行分为rSS＜8、rSS≥8两组,所有患者接受3年随访。结果：高rSS组患者左主干+三支病变比例更高,LM钙化比例更高,LVEF更低、肌酐清除率更低、操作并发症发生率及IABP支持比例更高,预后方面,高rSS与更高的心源性死亡（1.13% vs. 0.51%,p=0.0458）、支架内血栓（2.36% vs. 1.35%,p=0.0440）、所有血运重建（12.43% vs. 8.09%,p=0.0002）、全因死亡+所有心肌梗死+所有的血运重建复合终点（19.11% vs.13.29%,p<0.0001）、心源性死亡+靶血管相关心肌梗死+靶血管血运重建的复合终点（4.28% vs. 2.78%,p=0.0286）发生率相关。回归分析表明,rSS≥8分、年龄、左室射血分数是全因死亡+所有心肌梗死+所有的血运重建复合终点发生的独立危险因素。结论：在接受LM介入治疗的患者人群,较高的残余SYNTAX评分是3年复合终点发生的独立危险因素。     

Heart failure in people with type 2 diabetes vs. those without diabetes: A retrospective observational study from South India

Background and aimDespite diabetes being an independent risk for HF, only some DM patients develop HF and hence our aim was to compare the clinical features of DM with and without HF and non-DM with and without HF.MethodsA retrospective observational study was conducted among 397 individuals who visited two tertiary care centres. They were classified into 4 groups – DM with HF(DM-HF), DM without HF, non-DM with HF(non-DM-HF) and non-DM without HF. We assessed and compared the clinical profile of DM with HF vs. DM without HF and non-DM with HF groups respectively.ResultsThe parameters such as age, BMI, BP, eGFR showed significant difference between the groups. People with DM-HF were older compared to DM without HF group(58.9 ± 9.2vs.49.5 ± 9.3; p < 0.001). An increasing trend was observed in HF prevalence with increasing duration of DM among the DM-HF group. DM-HF showed a higher prevalence of hypertension and coronary artery disease(CAD) by history than DM without HF group. DM-HF group(91.2%) had HF with preserved left ventricular ejection fraction(HFpEF) whereas a high proportion(43.5%) of non-DM-HF group had HF with reduced LV ejection fraction(HFrEF).ConclusionsThe DM-HF group differed from other groups significantly in age, diabetes duration, HbA1c level, prevalence of hypertension, CAD and HFpEF.     

True Strength of Ceramic Fiber Bundles: Experiments and Simulations

A study on the strength of ceramic fiber bundles based on experimental and computational procedures is presented. Tests were performed on single filaments and bundles composed of two fibers with different nominal fiber counts. A method based on fiber rupture signals was developed to estimate the amount of filament rupture during the test. Through this method, the fiber bundle true strength was determined and its variation with the initial fiber count observed. By using different load-sharing models and the single filament data as input parameter, simulations were also developed to verify this behavior. Through different approaches between experiments and simulations, it was noted that the fiber bundle true strength increased with the fiber count. Moreover, a variation of the fibers’ final proportion in the bundles relative to the initial amount was verified in both approaches. Finally, discussions on the influence of different load-sharing models on the results are presented.     

Eco-House Prototype Constructed with Alkali-Activated Blocks: Material Production,Characterization, Design,Construction, and Environmental Impact

The interest of the construction industry in alkali-activated materials has increased to the extent that these materials are recognized as alternatives to ordinary Portland cement-based materials in the quest for sustainable construction. This article presents the design and construction of a prototype of an eco-friendly house built from concrete blocks produced using alkali activation technology or geopolymerization. The prototype meets the requirements of the current Colombian Regulations for Earthquake Resistant Buildings (NSR-10) and includes standards related to the performance of the materials, design, and construction method for earthquake-resistant confined masonry of one- or two-story buildings. The alkali-activated blocks were obtained from different precursors (aluminosilicates), including a natural volcanic pozzolan, ground granulated blast furnace slag, fly ash, construction and demolition waste (concrete, ceramic, brick, and mortar), and red clay brick waste. The physical-mechanical characterization of the alkali-activated blocks allowed their classification according to the structural specifications of the Colombian Technical Standard NTC 4026 (equivalent to ASTM C90). The global warming potential (GWP) or “carbon footprint” attributed to the raw materials of alkali-activated blocks was lower (25.4–54.7%) than that of the reference blocks (ordinary Portland cement concrete blocks). These results demonstrate the potential of alkali-activated materials for application in the construction of eco-friendly houses.     

An alternative plane block for multiple rib fractures: Rhomboid Intercostal and Sub-Serratus block (RISS)

Rib fractures are a common injury, which occur after severe blunt chest trauma. Sufficient and early pain control is essential to avoid respiratory complications. In recent years, the serratus plane and the erector spinae plane blocks have been used in ED for pain related to rib fractures. The Rhomboid Intercostal and Sub-Serratus (RISS) block can be utilized for pain control in patients with multiple rib fractures. We report two cases of patients with multiple rib fractures in which pain reduction was achieved with application of the RISS block.     

B超引导下胸椎旁神经阻滞治疗急性带状疱疹肋间神经痛的研究

目的:探讨B超引导下胸椎旁神经阻滞在治疗急性带状疱疹肋间神经痛中的临床疗效。方法:80例胸背部急性带状疱疹伴肋间神经痛患者随机分为两组,每组各40例。A组(对照组)予常规抗病毒及按需口服镇痛药物治疗,B组(试验组)同时接受在B超引导下选择性胸椎旁神经阻滞治疗。观察治疗后7、14及30天两组患者疼痛视觉模拟评分(VAS)、辅助镇痛药用量、不良反应及后遗神经痛(PHN)发生率。结果:治疗后各观察时间点两组VAS评分均较治疗前降低(P0.009),组间比较差异显著,B组明显低于A组(P0.05)。辅助镇痛药物用量、PHN发生率B组亦显著低于A组(P0.05)。两组均无明显不良反应发生。结论:B超引导下胸椎旁神经阻滞联合抗毒治疗急性带状疱疹肋间神经痛安全有效,明显优于单纯药物治疗,并可减少后遗神经痛的发生率,值得临床推广应用。     

肩关节镜引导下肩胛上神经阻滞在肩袖损伤术后镇痛中的疗效分析

比较关节镜引导下肩胛上神经阻滞与超声引导下肌间沟臂丛神经阻滞联合全麻在肩关节镜下肩袖修补术后48 h的镇痛效果。方法 选择该院2018年4月－2018年6月侧卧位下行肩关节镜择期手术的患者50例,按随机数字表法随机分为A、B两组,各25例,均行气管插管全身麻醉,A组在全身麻醉后肩关节镜引导下用0.2%罗哌卡因20 ml行肩胛上神经阻滞,B组全身麻醉后在超声引导下用0.2%罗哌卡因20 ml行肌间沟神经阻滞。比较两组患者术后2、4、8、12、24和48 h静息状态下视觉模拟评分（VAS）、术后48 h内非甾体类止痛药用量、术后不良反应和术后48 h镇痛满意度。结果 A组和B组患者术后2、4、8、12、24和48 h的VAS评分分别为1（0.0,1.0）和1（0.0,2.0）分、1（1.0,1.5）和1（1.0,2.0）分、（2.52±1.48）和（3.80±2.60）分、（3.32±1.55）和（4.68±2.30）分、（2.60±1.35）和（3.56±1.39）分、（2.28±0.94）和（2.92±1.96）分;两组术后2、4和48 h的VAS评分差异无统计学意义（P >0.05）,术后8、12和24 h两组VAS评分,差异有统计学意义（P <0.05）;两组患者术后镇痛药氟比洛芬酯使用量分别为（62.00±38.94）和（92.00±49.33）mg,差异有统计学意义（P <0.05）;A组哌替啶使用率比B组少,差异有统计学意义（P <0.05）;术后48 h内A组患肢麻木感发生率为0.00%（0/25）,B组术后均有麻木感,48 h内麻木感逐渐消失;两组术后48 h镇痛满意度评分比较,差异有统计学意义（P <0.05）。结论 关节镜引导下肩胛上神经阻滞与常规超声引导下肌间沟臂丛神经阻滞比较,前者应用于肩关节镜术后8、12和24 h镇痛效果较好,副作用小,有利于早期康复,更易被患者接受。     

细胞学涂片及其联合细胞块免疫组化在超声内镜下细针穿刺活检术中的应用价值

目的探讨细胞学涂片及其联合细胞块免疫组化在超声内镜下细针穿刺活检术(EUS-FNA)中的应用价值。方法收集因占位性疾病行EUS-FNA的患者60例,将细胞学涂片及其联合细胞块免疫组化结果与手术病理及随访预后结果比较。结果 EUS-FNA下穿刺物细胞学涂片检查对肿瘤性占位的阳性检出率为78.6%(44/56),特异度为50.0%(2/4),准确度为76.7%(46/60);19例患者同时进行了细胞学涂片联合细胞块免疫组化检查,其对肿瘤性占位的阳性检出率为94.7%(18/19),准确度为94.7%(18/19),两者在该19例患者中对肿瘤性占位的检出率差异无统计学意义(P=0.250)。但在明确肿瘤性占位病理类型方面,细胞学涂片联合细胞块免疫组化检查优于单独细胞学涂片检查。结论在EUS-FNA下,细胞学涂片及其联合细胞块免疫组化检查对肿瘤性占位的检出率相当,联合细胞块免疫组化检查在明确病理类型上更有优势,更能指导后续治疗。