基于一测多评法对丁蔻理中丸中6种成分的质量控制研究

目的:建立一测多评法同时测定丁蔻理中丸中白术内酯Ⅲ、白术内酯Ⅰ、丁香酚、6-姜辣素、8-姜酚、10-姜酚6种成分的含量。方法:以白术内酯Ⅰ为内标物,建立白术内酯Ⅰ与白术内酯Ⅲ、丁香酚、6-姜辣素、8-姜酚、10-姜酚之间的校正因子,计算待测成分含量,并将外标法测定值与一测多评法计算值进行对比,验证所建立一测多评法的准确性。结果:白术内酯Ⅲ、白术内酯Ⅰ、丁香酚、6-姜辣素、8-姜酚和10-姜酚分别在1.09~21.80μg·mL-1、0.71~14.20μg·mL-1、13.67~273.40μg·mL-1、6.04~120.80μg·mL-1、1.46~29.20μg·mL-1、1.78~35.60μg·mL-1范围内线性关系良好;各成分一测多评法计算值与外标法实测值无显著性差异。结论:利用校正因子对丁蔻理中丸中6种成分的含量测定是可行的,一测多评法可以用于丁蔻理中丸的质量评价研究。     

某院2148例Ⅰ类切口手术围术期预防性应用抗菌药物调查分析

目的调查某院Ⅰ类切口手术围术期预防性抗菌药物的应用情况,为临床合理用药提供参考。方法回顾性分析2018年某院2148例Ⅰ类切口手术患者的临床病历资料,对其围术期抗菌药物的预防性应用情况进行统计分析,包括抗菌药物预防性使用情况、品种选择分布情况、给药时机、用药时间以及联合用药情况等。结果 2148例患者中, 467例患者围术期预防性使用抗菌药物,占21.74%。467例患者中,抗菌药物品种使用频率最高的是注射用头孢唑啉,占比为39.61%(185/467),其次为第三代头孢类抗菌药物头孢甲肟,占比为22.91%(107/467),以及氟喹诺酮类左氧氟沙星注射液,占比为10.49%(49/467);抗菌药物品种选择合格率为39.61%(185/467)。467例患者中,术前>1.0 h给药341例,占73.02%;术前0.5~1.0 h给药28例,仅占6.00%;术后给药98例,占20.99%。467例患者中,总预防用药时间≤24 h 121例,占25.91%;总预防用药时间>24 h 346例,占74.09%。467例患者中,单独使用抗菌药物462例,占98.93%;二联使用抗菌药物5例,占1.07%。结论某院Ⅰ类切口手术围手术期抗菌药物预防性使用情况仍存在预防用药品种选择不当、给药时机不当、用药时间过长等不合理情况,须采取综合干预措施。     

Factors associated with microvascular occlusion in patients with ST elevation myocardial infarction after primary percutaneous coronary intervention

ObjectiveThis study aimed to determine predictors of microvascular occlusion (MVO) in patients with ST elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (pPCI).MethodsThis retrospective, observational study consecutively included 113 patients with STEMI undergoing pPCI. Cardiac magnetic resonance imaging was used to determine the presence of MVO in these patients. Biomarkers in serum were routinely tested 1 day after pPCI. Multivariable logistic regression analysis was used to evaluate significant predictors of occurrence of MVO.ResultsThere were 62 patients in the MVO group and 51 patients in the non-MVO group. C-reactive protein (CRP), thrombomodulin, lymphatic vessel endothelial hyaluronan receptor-1, syndecan-1, and troponin T (TnT) levels after the procedure were significantly higher in the MVO group than in the non-MVO group. CRP (hazard ratio [HR]=1.036), TnT (HR=1.316), and syndecan-1 (HR=1.986) levels were independently associated with MVO in patients with acute myocardial infarction after pPCI.ConclusionsLevels of CRP, TnT, and syndecan-1 can be used as serum biomarkers for MVO in patients with STEMI receiving pPCI.     

Clinical outcomes and survival analysis in patients with psycho-cardiological disease: a retrospective analysis of 132 cases

ObjectivesThe deleterious effects of psychological problems on coronary heart disease (CHD) are not satisfactorily explained. We explored influential factors associated with mortality in psycho-cardiological disease in a Chinese sample.MethodsOf 7460 cardiac patients, we selected 132 patients with CHD and mental illness. Follow-up was conducted via telephone. We analyzed clinical characteristics, clinical outcomes, and survival.ResultsThe clinical detection rate of psycho-cardiological disease in the overall patient population was 1.8%. Of these, 113 patients completed follow-up; 18 died owing to cardiovascular diseases during follow-up. Kaplan–Meier analysis showed dysphagia, limb function, self-care ability, percutaneous coronary intervention, low-density lipoprotein, total cholesterol, pro-brain natriuretic peptide and high-sensitivity (hs) troponin T had significant associations with cumulative survival. Cox regression analysis showed total cholesterol (hazard ratio [HR]: 2.765, 95% confidence interval [CI]: 1.001–7.641), hs troponin T (HR: 4.668, 95% CI: 1.293–16.854), and percutaneous coronary intervention (HR: 3.619, 95% CI: 1.383–9.474) were independently associated with cumulative survival.ConclusionsThe clinical detection rate of psycho-cardiological disease was far lower than expected. Normal total cholesterol and hs troponin T were associated with reduced cardiovascular disease mortality over 2 years. Percutaneous coronary intervention is a prognostic risk factor in patients with psycho-cardiological disease.     

过氧化物还原酶I-硫氧还蛋白、超氧化物歧化酶及过氧化氢酶在大鼠肝脏缺血再灌注损伤中的表达变化

目的 观察过氧化物还原酶I-硫氧还蛋白(PrxI-Trx)、超氧化物歧化酶(SOD)及过氧化氢酶(CAT)抗氧化体系在大鼠肝脏缺血再灌注损伤模型中的表达变化,探讨其在抗氧化应激反应中的作用。方法 通过无损伤血管夹钳夹通往大鼠肝左叶、肝中叶的血管和胆管蒂,30 min后松
开血管夹,制造大鼠70%肝脏缺血再灌注损伤模型。损伤再灌注6h后取血和肝脏。全自动生化分析仪测丙氨酸氨基转移酶（ALT）含量。HE法观察大鼠肝脏形态学改变。采用RT-PCR的方法观察在肝脏缺血再灌注损伤中PrxI-Trx、SOD、CAT氧化还原体系mRNA水平的表达变化。采用Western
blotting测定PrxI、SOD和CAT的蛋白表达水平。结果 与对照组相比,血清中ALT水平和HE结果均显示肝脏缺血再灌注损伤组大鼠肝细胞明显受损。PrxI-Trx、SOD和CAT的mRNA水平明显升高。同时,PrxI、SOD和CAT的蛋白表达水平也明显升高。结论 PrxI-Trx、SOD和CAT在肝脏缺血再灌
注损伤中均发挥了抗氧化应激作用,对肝细胞具有保护作用。     

The impact of obstructive sleep apnoea severity on cardiac structure and injury

BackgroundObstructive sleep apnoea (OSA) is an important factor in the development and progression of heart failure (HF). The prevalence of OSA is higher in patients with HF than in the general population. We sought to test the hypothesis that OSA severity was predictive of ventricular function and cardiac injury [as assessed by high-sensitivity cardiac troponin I(hs-cTnI)].MethodsA total of 60 patients were recruited after evaluation for sleep disturbances using the Jenkins Sleep Questionnaire (JSQ) and Epworth Sleepiness Scale (ESS). Subsequently, they underwent polysomnography thus confirming the diagnosis of OSA and were equally divided into three groups according to OSA severity grade. Following polysomnography, the next morning patients underwent venous blood sampling and echocardiography.ResultsWe observed a statistically significant association (P = 0.009) between diastolic dysfunction grades and severity grades of OSA. All the three diastolic dysfunction variables E/A ratio, deceleration time and E/e’ ratio had a significant association(P < 0.05) with severity grades of OSA. There was a marginally significant positive correlation (ρ = 0.3244, p = 0.04) between AHI events per hour and mitral E/e’ ratio. There was a statistically significant association(P < 0.001) between hs-cTnI value among different severity grades of OSA.ConclusionsHere in our study, we found OSA a potential risk factor for development of myocardial injury and diastolic dysfunction. Severe grades of OSA are associated with higher grades of diastolic dysfunction and circulating levels of hs-cTnI. These data are consistent with the notion of a vicious cycle of frequent apnoea's or hypoxemia and recurrent myocardial injury, which could increase the risk of heart failure especially diastolic dysfunction in OSA.     

Cardiac Troponin I association with critical illness and death risk in 726 seriously ill COVID-19 patients: A retrospective cohort study

Background: For coronavirus disease 2019 (COVID-19), early identification of patients with serious symptoms at risk of critical illness and death is important for personalized treatment and balancing medical resources.Methods: Demographics, clinical characteristics, and laboratory tests data from 726 patients with serious COVID-19 at Tongji Hospital (Wuhan, China) were analyzed. Patients were classified into critical group (n = 174) and severe group (n= 552), the critical group was sub-divided into survivors (n = 47) and non-survivors (n = 127).Results: Multivariable analyses revealed the risk factors associated with critical illness in serious patients were: Advanced age, high respiratory rate (RR), high lactate dehydrogenase (LDH) level, high hypersensitive cardiac troponin I (hs-cTnI) level, and thrombocytopenia on admission. High hs-cTnI level was the independent risk factor of mortality among critically ill patients in the unadjusted and adjusted models. ROC curves demonstrated that hs-cTnI and LDH were predictive factors for critical illness in patients with serious COVID-19 whereas procalcitonin and D-Dimer with hs-cTnI and LDH were predictive parameters in mortality risk.Conclusions: Advanced age, high RR, LDH, hs-cTnI, and thrombocytopenia, constitute risk factors for critical illness among patients with serious COVID-19, and the hs-cTnI level helps predict fatal outcomes in critically ill patients.     

131Ⅰ-SAP的制备及应用安全性研究

目的探讨一种新型淀粉样变性诊断标记物131I-SAP的制备方法及其应用安全性。方法应用Iodogen法对SAP标准品进行131I标记;纸层析法测定131I-SAP的标记率与放射化学纯度。将131I-SAP分别于4℃和37℃新鲜人血清中0h,24h,48h,72h和96h,测定放射化学纯度,评价其体外稳定性。对131I-SAP进行热原、异常毒性等安全性实验。结果131I-SAP的标记率为70.6%,96h后的放射化学纯度仍大于90%。热原、异常毒性实验均为阴性。结论131I-SAP具有较好的体外稳定性,并且无热原及明显毒性反应,适合进一步临床实验及应用的安全性。     

1例原发性Ⅰ型高草酸尿症儿童病人行肝肾联合移植术的观察与护理

回顾性分析1例原发性I型高草酸尿症患儿行肝肾联合移植术的临床资料,总结该患儿围术期的护理特点。术后住院期间虽出现过急性排斥反应、胆道狭窄和反复尿路结石,但经过临床积极的治疗和精心的护理,临床症状均缓解,术后肝肾功能恢复良好,患儿存活至今,定期随访。原发性Ⅰ型高草酸尿症虽然较罕见,但是病情发展严重,而且儿童病人行肝肾联合移植术护理难度较成人大,严密的症状观察,及早发现,积极的护理干预,有助于患儿的预后。     

不同种类交联剂对牙本质Ⅰ型胶原生物改性作用的研究进展

建立稳定的树脂-牙本质混合层是提高修复体粘接耐久性的有效方法。交联剂对牙本质的生物改性可增强胶原的力学性能及抗酶解性,抑制脱矿进程并促进牙本质再矿化,具有预防龋齿以及改善粘接剂性能的临床价值。本文分类阐述不同交联剂对牙本质Ⅰ型胶原的生物改性作用。