应激性血糖浓度对急性心肌梗死的影响

目的观察应激性高血糖浓度对急性心肌梗死预后的影响。方法选择符合急性心肌梗死诊断标准且有糖耐量异常患者183例,按入院后空腹血糖数值分为两组;糖耐量减低组65例,糖尿病组118例;观察两组患者血糖的变化、并发症发生的情况和死亡率。结果糖耐量减低组组患者出现并发症者18例,糖尿病组出现并发症者51例,χ2=4.30,P<0.05;糖耐量减低组30 d死亡6例,糖尿病组30 d死亡15例,χ2=0.50,P>0.05;糖耐量减低组1年内死亡12,糖尿病组1年内死亡38例,χ2=3.99,P<0.05。结论应激性高血糖浓度对缺血心肌的损害是肯定的,要及时监测和调控急性心肌梗死的血糖,阻断其对心肌细胞的进一步损害,以降低急性心肌梗死的病死率和并发症等。     

Hip Adduction and Abduction Strength Profiles Among Bantam,High School,Juniors, and Collegiate American Ice Hockey Players

BackgroundAdductor strains are the most common non-contact musculoskeletal injury sustained in ice hockey. Systematic reviews have determined higher level of play and lower hip adduction to abduction strength ratios to be associated with an increased risk of adductor strain across multiple sports. Limited research exists regarding hip adduction and abduction strength profiles across various levels of ice hockey players.PurposeTo compare isometric hip adduction and abduction strength profiles among bantam, high school, tier one juniors, and NCAA Division I collegiate ice hockey players. A secondary purpose was to identify whether differences in strength profiles between dominant and non-dominant limbs exist.Study DesignCross-sectional cohort study.MethodsA questionnaire of demographic data, hockey, and injury specific information was completed by all subjects. The mean of three reps of maximal hip isometric adduction and abduction strengths were quantified using a handheld dynamometer with external belt-fixation. Ratios of hip adduction-to-abduction strength were calculated and normalized for body weight.ResultsA total of 87 uninjured skaters were included in this study with a mean age of 17 years. Mean hip adductor-to-abductor ratios for Bantam hockey players were 121% followed by collegiate (115%), Juniors (111%), and high school (109%) hockey players. No statistically significant differences were found between peak hip adduction and abduction isometric strength and playing level. In addition, there was no difference between unilateral hip strength ratios and shooting hand or leg dominance. While 34.5% of subjects reported a history of adductor injury, no significant differences existed regarding strength ratios during bilateral comparison or when compared to their team norms. Three subjects were found to have unilateral ratios of less than 80%, while two subjects demonstrated bilateral ratios of less than 80%.ConclusionsSymmetry is illustrated between dominant and non-dominant legs in ice hockey players with and without a history of adductor injury. Results align well with previously established cross-sectional data from Australian football, with ratios of 103% in high school players, 107% in semi-professional players, and 113% in collegiate players.Level of EvidenceLevel 3     

Using the Smith-Watson-Topper Parameter and Its Modifications to Calculate the Fatigue Life of Metals: The State-of-the-Art

The Smith-Watson-Topper parameter (SWT) in its original form was designed to estimate the fatigue life of metal materials in a uniaxial load state (tension–compression) in the range up to fatigue crack initiation, with non-zero mean values. This parameter is based on the analysis of both stress and strain. Therefore, the stress–strain criterion is the focus, rather than the energy criterion. This paper presents the original SWT model and its numerous modifications. The first part presents different versions of this parameter defined by the normal parameters. Then, it presents versions defined through the tangent parameter and the most promising parameter defined through the tangent and normal parameters. It was noted that the final form of the equivalent value is defined either by stress or by an energy parameter. Therefore, the possible characteristics from which the fatigue life can be determined are also presented.     

中性粒细胞与高密度脂蛋白胆固醇比值对急性心肌梗死病人院内主要心血管不良事件的预测价值

目的探讨中性粒细胞与高密度脂蛋白胆固醇( HDL-C)的比值( NHR)对 AMI病人发生院内 MACE的预测价值以及 NHR与 Gensini评分量化的冠状动脉病变严重程度、左室射血分数( LVEF)量化的心脏泵功能的潜在关联。方法纳入 2018年 1月至 2022年 1月东南大学附属中大医院住院并接受冠状动脉造影的 546例 AMI病人。收集人口统计学数据、临床资料及计算 Gensini评分,依据住院期间是否发生 MACE,分为 MACE组( n=105)和非 MACE组( n=441)。使用受试者操作特征曲线(ROC曲线)检验 NHR预测院内 MACE的能力,并确定最佳截断值。使用多因素 logistic回归分析院内 MACE的影响因素,时,采用线性回归分析 NHR对 Gensini评分、 LVEF值的影响,并通过 Graphpad prism绘图进行可视化处理。院内 MACE定义同为:住院死亡、心源性休克、致血流动力学紊乱的恶性心律失常(包括室颤、持续性室速、高度及三度房室传导阻滞)等。结果MACE组的 NHR［13.64(9.89,18.19)］显著高于非 MACE组［7.73(5.83,10.07)］并且 NHR对 AMI病人院内 MACE具有较强的预测价值［AUC:0.84,95%CI:(0.79,0.88),P<0.001］调整混杂因素后,多因素二元,logistic回归分析显示 NHR是 AMI病人院内MACE的独立危险因素［OR:1.29,95%CI:(1.16,1.43),P<0.001］。线性回归分析显示 NHR与 AMI病人 Gensini评分呈显著正相关( P<0.001)与 LVEF呈显著负相关( P<0.001)。结论,本研究证实 NHR是 AMI病人院内 MACE的有力预测指标,是院内MACE的独立危险,因素之一,与 Gensini评分量化的冠状动脉病变严重程度呈显著正相关,与 LVEF量化的心脏泵功能呈显著负相关,可用于早期识别 AMI病人院内 MACE的高危人群,辅助临床诊疗。     

心脏扭转运动的研究进展

心脏扭转运动形式不但影响心脏正常的收缩功能,而且还能促进舒张早期心室充盈。不正常的扭转运动形式,提示心肌结构和功能改变。因此心脏扭转角度是临床一个非常有价值的诊断指标。本文就心脏扭转的解剖基础、检测方法及其意义作一综述。     

Digital eye strain and its associated factors in children during the COVID-19 pandemic

Purpose:This study was undertaken to identify the prevalence of symptoms related to the use of display devices and contributing factors in children engaged in distance learning during the COVID-19 pandemic.Methods:An online electronic survey form was prepared using Google Forms (Alphabet Co., Mountain View, CA) and sent to parents of children under the age of 18 years engaged in distance learning during the COVID-19 pandemic. The types of display devices children use, how often such devices are used, the symptoms of digital eye strain, and the severity and frequency of the symptoms were recorded, and the associations between the factors were analyzed.Results:A total of 692 participants were included. The mean age of the children was 9.72 ± 3.02 years. The most common display devices used were personal computers (n = 435, 61.7%) for online classes and smartphones (n = 400, 57.8%) for nonacademic purposes. The mean duration of display device use was 71.1 ± 36.02 min without a break and 7.02 ± 4.55 h per day. The most common reported symptom was headache (n = 361, 52.2%). Of the participants, 48.2% (n = 332) reported experiencing 3 or more symptoms. The multivariate analysis detected that being male (P = 0.005) and older age (P = 0.001) were independent risk factors for experiencing 3 or more symptoms.Conclusion:The increasing use of digital devices by children is exacerbating the problem of digital eye strain in children as a side effect of online learning. Public awareness should be improved.     

Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction

BackgroundIt has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior.MethodsA total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death.ResultsThere was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic.ConclusionDuring the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.     

救必应提取物心血管药理作用

研究表明:救必应醇提物具有降低冠脉流量、减慢心率及使心肌收缩力减弱,提高耐缺氧能力及抗心律失常作用;救必应水提物作用与醇提物相似,但减慢心率及减弱心肌收缩力的作用不明显。     

芎芍胶囊对心肌梗死大鼠缺血心肌血管新生的影响

目的:观察芎芍胶囊对心肌梗死大鼠缺血心肌血管新生的影响.方法:采用开胸结扎冠状动脉左前降支的方法建立心肌梗死模型,清洁级(或SPF级)SD大鼠(雌雄各半)分为模型组、高剂量组、中剂量组、低剂量组,每组8只,分别用生理盐水、芎芍胶囊高、中、低剂量进行灌胃给药,连续给药6周后采集血,分离样本,并按规定保存,用免疫组化评分法...     

不同频率电针“内关”穴对心肌缺血再灌注大鼠血管活性物质的影响

目的:比较不同频率电针"内关"穴对心肌缺血再灌注大鼠血液中血管活性物质含量的影响,并分析不同频率电针改善心肌缺血再灌注损伤的作用机制。方法:40只Wistar大鼠随机分为假手术组、模型组、高频电针组及低频电针组。除假手术组外,其余各组结扎左冠状动脉前降支30min并再灌注40min造成心肌缺血再灌注模型,高频电针组及低频电针组于结扎成功即刻起分别以120Hz及20Hz持续电针"内关"穴50min。采用放射免疫法检测各组血浆内皮素(ET)、心钠素(ANP)、血栓素B 2(TXB2)、6-酮-前列腺素F1α(6-Keto-PGF1α)含量,并采用硝酸还原酶法检测各组血清一氧化氮(NO)水平。结果:模型组与假手术组比较,血浆ET、ANP、TXB2含量显著升高(P0.05),血浆6-Keto-PGF1α含量显著下降(P0.05),血清NO含量有所下降,但差异无统计学意义(P0.05)。与模型组相比,高频电针组和低频电针组的血浆ET、ANP、TXB2含量均有显著降低,血浆6-Keto-PGF1α含量及血清NO含量显著升高(P0.05)。高频电针组血清NO含量显著高于低频电针组(P0.05)。结论:电针大鼠"内关"穴可以调节血管活性物质,这可能参与了对心肌缺血再灌注的治疗作用。此外,不同频率电针对血管活性物质的调节作用不完全相同,这可能是不同手法针刺疗效存在差异的原因之一。