急性冠脉综合征患者冠状动脉计算机断层扫描血管成像斑块定量分析的对比研究

目的 应用冠状动脉计算机断层扫描血管成像(CCTA)斑块定量分析,比较急性冠脉综合征(ACS)和稳定性冠心病(SCAD)患者冠状动脉斑块成分与负荷特征。方法 回顾性纳入2021年1月至3月就诊于中国人民解放军总医院第一医学中心心血管内科的116例冠心病(CAD)患者的临床资料,根据患者临床诊断结果将其分为ACS组(81例)和SCAD组(35例)。2组患者均在14 d内先后接受CCTA和冠状动脉造影检查。采用CCTA斑块定量分析软件测量各类斑块成分体积及负荷、最小管腔直径和重构指数(RI)、偏心指数(EI)等影像学指标并比较分析。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ²检验。结果 ACS组患者较SCAD组患者具有更大的总斑块负荷(TPB)、非钙化成分负荷(NCPB)和脂质成分负荷(LPB),差异均有统计学意义[(60.5±11.2)%和(51.7±14.4)%,(58.9±12.0)%和(50.1±15.2)%,17.9%(11.6%,27.6%)和14.2%(7.5%,20.8%),均P<0.0...     

辛伐他汀治疗无症状性颈动脉粥样硬化的疗效观察

目的采用颈动脉超声观察辛伐他汀治疗无症状性颈动脉粥样硬化的疗效。方法对参加我院健康体检时经彩超检查发现有颈动脉斑块的观察病例68例，每晚服用辛伐他汀，连续4月，观察颈动脉斑块的面积变化以及血脂的动态改变。结果68例观察者共发现斑块112个，服药4月后发现低回声斑块面积消退幅度达32％，混合性斑块达25％，高回声斑块只有9％，平均消退幅度22％，除高回声斑块外，其他均有明显统计学意义（P〈0．05）。患者的TC下降与治疗前比较有显著差异（P〈0．01），TG、LDL的下降与治疗前比较有明显差异（P〈0．05），HDL有所升高，但无统计学意义。结论通过观察服用辛伐他汀4月后斑块的面积变化以及血脂的改变结果表明，坚持服用他汀类药物，可以达到稳定与消退斑块的作用。     

苦参总碱抗柯萨奇B病毒作用机理的研究

在证实苦参具有抗柯萨奇Ｂ病毒（ＣＶＢ）作用的实验基础上，作者以纯化ＣＶＢ３作为病毒蛋白质对照，通过空斑测定及病毒蛋白质Ｌ－３５Ｓ－甲硫氨酸标记等方法，了解到纯化苦参总碱抗ＣＶＢ的作用机理是不影响病毒吸附、穿入，但它能进入细胞内影响病毒的生物合成，主要表现为抑制病毒蛋白质的合成。     

牙周炎患者种植义齿修复后口腔自我维护的临床观察

目的：探讨菌斑显示剂在牙周炎患者种植义齿修复后口腔维护中的作用。方法整群选择2013年5月—2015年2月在医院进行义齿修复的62例患者共78颗种植体作为研究对象,随机分为观察组和对照组,每组31例39颗种植体。在修复后的口腔自我维护中,对照组给予一般维护,观察组在此基础上给予菌斑显示剂,比较两组患者的牙周参数和种植体周围黏膜炎发生率。结果种植体完成修复2周后,两组患者PLI、SBI、PD和菌斑指数与对照组相较差异无统计学意义(P>0.05);修复3个月后所有患者观察组PLI、SBI、PD和菌斑指数均优于对照组(P<0.05);种植修复后1年内,观察组种植体周围粘膜炎平均发生率为45.6%,对照组为59.4%,差异有统计学意义(P<0.05)。结论系统的口腔自我维护能够显著降低牙周炎患者种植体周围黏膜炎的发生率,使用菌斑显示剂让患者对菌斑有良好的自我控制效果显著。     

胆汁胰液混合液溶解颈动脉粥样硬化斑块的体外实验研究

目的观察并评价胆汁胰液混合液在体外对颈动脉粥样硬化斑块的溶解效果。方法把手术取出的颈动脉粥样硬化斑块分为不稳定斑块与稳定斑块,在37℃下分别加入新鲜胆汁胰液混合液,观察并记录二者在胆汁胰液混合液中的溶解情况。结果不稳定斑块和稳定斑块内层的脂质核心均可迅速被胆汁胰液混合液软化溶解,而外层的纤维帽则均不被溶解。不稳定斑块因脂质核心占比大而溶解效果显著,而稳定斑块因其脂质核心小,溶解效果相对较差。结论本研究发现胆汁胰液混合液中的某种或某几种成分对颈动脉粥样硬化斑块有一定的溶解作用,本研究尝试提出可能的溶解机制,并在下一步探究胆汁胰液混合液中溶解颈动脉粥样硬化斑块的有效成分。     

Improving interprofessional practice for vulnerable older people: gaining a better understanding of vulnerability

A key focus for professionals working with older people in the community is on those who are vulnerable, although this vulnerability is not well defined. This study sought the views of health and social care professionals and older people on vulnerability, identifying significant differences between professional and older people’s perspectives. It found that for older people, vulnerability is an emotional response to being in a specific situation, whereas for professionals, the vulnerability of those on their case loads relates to them having certain or a combination of characteristics (physical, psychological and social). The paper concludes that interprofessional care for older people in the community could be improved firstly by asking older people if they ever feel vulnerable and if so, in what situations and secondly by focusing team efforts on addressing the issues raised by older people in response to these questions.     

Vulnerable young people and alcohol use: a qualitative exploration

Background: Evidence suggests vulnerable young people are at a greater risk of alcohol engagement and have higher levels of substance misuse. However, research exploring alcohol use within populations of vulnerable young people is limited. Aims: The aim of the study was to explore young people’s attitudes to alcohol, seeking to gain insights into drinking practices within a group of educationally marginalised, and therefore vulnerable young people and their support staff. Methods: The views on alcohol use of 13 young people were explored through focus groups whilst the views of seven support staff were explored using semi-structured interviews. Findings: From an analysis based on grounded theory, a central theme of difficult lives appeared to mediate alcohol use in young people who are educationally marginalised. Young people appeared disengaged from parental/guardian support and placed an importance on social networks in facilitating social and peer support with the aim of gaining protection and a sense of escape. Conclusion: Educationally marginalised young people appear predisposed to an increased risk of engagement with alcohol. In their need for protection and support from daily hardships and isolation, they place greater importance of social membership, which in turn can increase the likelihood of engagement with alcohol.     

Non-invasive measurement of coronary plaque from coronary CT angiography and its clinical implications

Coronary CT angiography (CTA) is increasingly used worldwide for direct, non-invasive evaluation of the coronary arteries. Advances in computed tomography (CT) technology over the last decade have enabled such reliable imaging of the coronary arteries. Beyond arterial stenosis, coronary CTA also permits assessment of atherosclerotic plaque (including plaque burden) and coronary artery remodeling, previously only achievable through invasive means. It has been shown that coronary plaque volumes for non-calcified and mixed plaques and the arterial remodeling index, correlate closely with invasive intravascular ultrasound. Several studies have also shown a strong relationship of adverse plaque features imaged by coronary CTA with acute coronary syndrome, all-cause death, major adverse cardiovascular events and myocardial ischemia. The aim of this review is to summarize current methods for quantitative measurement of atherosclerotic plaque features from coronary CTA and to discuss their clinical implications.     

Noncalcified atherosclerotic lesions with vulnerable characteristics detected by coronary CT angiography and future coronary events

BackgroundThe ability of coronary CT angiography (CTA) findings such as plaque characteristics to predict future coronary events remains controversial.ObjectiveWe investigated whether noncalcified atherosclerotic lesions (NCALs) detected by coronary CTA were predictive of future coronary events.MethodsA total of 511 patients who underwent coronary CTA were followed for cardiovascular events over a period of 3.3 ± 1.2 years. The primary end point was defined as hard events, including cardiac death, nonfatal myocardial infarction, or unstable angina that required urgent hospitalization. Early elective coronary revascularizations (n = 58) were excluded. The relationship between features of NCALs and outcomes is described.ResultsA total of 15 hard events (2 cardiac deaths, 7 myocardial infarctions, 6 cases of unstable angina that required urgent hospitalization) were documented in the remaining 453 patients with modest risks during a follow-up period of 3.3 ± 1.2 years. For these hard events, a univariate Cox proportional hazard model showed that the hazard ratio for the presence of >50% stenosis was 7.27 (95% CI, 2.62–21.7; P = .0002). Although the presence of NCAL by itself was not statistically significant, NCALs with low attenuation and positive remodeling (low-attenuation plaque [LAP] and positive remodeling [PR]; plaque CT number ≤34 HU and remodeling index ≥1.20) showed an adjusted hazard ratio of 11.2 (95% CI, 3.71–36.7; P < .0001). With C-statistics analysis, when both LAP and PR and >50% stenosis were added, the C-statistic was significantly improved compared with the basal model adjusted for age, sex, and log₂ (Agatston score +1) (0.900 vs 0.704; P = .0018).ConclusionsIdentification of NCALs with LAP and PR characteristics by coronary CTA provides additional prognostic information to coronary stenosis for the prediction of future coronary events.