经导管植入式主动脉人工心脏瓣膜临床试验初步建议

用于治疗有症状的重度主动脉瓣狭窄的经导管植入式主动脉人工心脏瓣膜的研发日益增多,但并未有规范性临床试验指导意见,缺少安全性和有效性评价的统一原则,为了更好地引导研究者完成上市前临床试验研究,通过结合该类产品已完成的临床试验研究情况、心脏病治疗指南及国内心血管内科、心血管外科和临床统计学专家的意见,总结了目前对于该类产品临床试验的初步建议。在中国境内开展临床试验时,建议首先完成可行性研究;确证性研究按照产品应用人群风险收益分析,分别对开展安全性和有效性评价,建议优先选择不适合常规外科手术有症状的重度主动脉瓣狭窄患者作为受试人群。     

三七花总皂苷对人主动脉血管平滑肌细胞增殖及细胞内钙离子浓度的影响

目的:观察三七花总皂苷(PNFS)对血管平滑肌细胞增殖及细胞内钙离子浓度的影响.方法:采用去甲肾上腺素诱导的人主动脉血管平滑肌细胞增殖和钙超载模型,应用CCK-8法观察血管平滑肌细胞增殖活力;钙荧光指示剂Fluo-3/AM检测细胞内钙浓度变化.观察不同剂量PNFS对两者的影响.结果:PNFS能够改善去甲肾上腺素诱导的人主动脉血管平滑肌细胞增殖,降低细胞内钙离子浓度,并呈一定的量效关系.结论:PNFS对去甲肾上腺素诱导的人主动脉血管平滑肌细胞增殖有抑制作用,这一作用可能与降低细胞内钙离子浓度有关.     

缺氧诱导脂滴相关蛋白在糖尿病合并腹主动脉瘤中的表达

目的 通过生物信息学方法,寻找糖尿病合并腹主动脉瘤(AAA)患者中差异表达的基因,明确其功能,探讨发病机制.方法 从Gene Expression Omnibus(GEO)数据库中下载人糖尿病GSE21321和人腹主动脉瘤GSE7084数据集,以P<0.05及表达变化>2.0倍标准筛选差异基因.联合运用Gencript...     

颅内巨大动脉瘤的手术治疗

目的：颅内巨大动脉瘤虽然少见,但手术治疗困难,手术病死率和致废率仍较高。本对我院1980年以来手术治疗的30例颅内巨大动脉瘤作一回顾性分析。方法：动脉瘤瘤颈夹闭术13例,动脉瘤孤立后切除术11例;动脉瘤切除或孤立后载瘤动脉重建术2例;颈部颈内动脉结扎术2例;动脉瘤包裹术2例。结果 术后早期恢复良好为73．3％,中、重残为20％,死亡2例,病死率6．6％。动脉瘤瘤颈夹闭组的13例病人中、除1例术前Ⅳ级的前交通动脉瘤病人术后重残外,均恢复顺利。动脉瘤孤立或孤立后切除的11例病人中,4例术后早期出现不同程度的对侧肢体瘫痪,其中2例在术后3周内恢复正常,另2例分别在术后3个月和28个月恢复正常;1例大脑中动脉（MCA）动脉瘤术后因术野血肿再次手术清除血肿后,病人出院时能独立行走。单纯行颈部颈动脉结扎的2例病人出院时病情无明显变化。而仅行动脉瘤包裹术的2例病人均在术后因再出血死亡。结论 为消除巨大动脉瘤的占位效应和出血的潜在性,对颅内巨大动脉瘤提倡积极的直接手术治疗。动脉瘤瘤颈直接夹闭并保留载瘤动脉通畅是首选治疗,对必需行动瘤孤立且交叉循环不良的病例,应尽可能重建载瘤动脉。     

A型主动脉夹层术后谵妄的发生率和危险因素研究

目的研究A型主动脉夹层术后谵妄的发生率和相关危险因素。方法以A型主动脉夹层术后患者为研究对象,以意识错乱评估方法作为谵妄诊断工具,分析术后谵妄的发生率和危险因素。结果共有84例患者纳入研究,发生术后谵妄28例,发生率为33.3%。21例(75%)为一过性谵妄(<24 h);7例(25%)为持续性谵妄。Logistic多因素回归分析结果表明,脑梗死、深低温停循环时间、重症监护病房时间是术后谵妄的危险因素。结论既往脑梗死、深低温停循环时间、重症监护病房持续时间是术后谵妄的独立危险因素。     

2490名中老年干部钙化性主动脉瓣病的患病情况及超声心动图分析

本文分析了在2490名中老年干部中经超声心动图诊断的104例钙化性主动脉瓣病的超声心动图表现。发现其患病率随年龄增长成倍数递增,男性多于女性。该病不仅可以引起众所周知的AS,也可引起AI,以无冠瓣受累最多。轻—中度CAS及CAI尚不足以引起心脏解剖结构的明显改变,左室收缩功能也保持正常,但舒张功能却发生障碍。     

Mechanisms underlying vasorelaxant action of astragaloside IV in isolated rat aortic rings

1. Astragaloside IV is a component from the widely used traditional Chinese herb Astragalus membranaceus and its effect on rat aortic ring contraction and relaxation were investigated. 2. The aorta from male Sprague-Dawley rats was isolated in an organ bath and ring tension was recorded with or without endothelium. Cumulative effects of astragaloside IV on vessel contraction and relaxation were observed in the presence of various antagonists related to vessel activity. 3. Astragaloside IV showed concentration-dependent inhibition of vessel contraction induced by phenylephrine and potassium chloride. The amount of calcium released from intracellular stores sensitive to phenylephrine was also markedly reduced by astragaloside IV. There was dose-dependent vasorelaxation in endothelium-intact rings, which was partly inhibited by pre-incubation with nitric oxide (NO) synthase (NOS) Nomega-nitro-L-arginine methyl ester and guanylate cyclase inhibitor, 1H-[1,2,4] oxadiazolo [4,3-alpha] quinoxalin-1-one. Astragaloside IV also induced a significant increase in aortic tissue content of guanosine 3",5"-cyclic monophosphate (cGMP) both in vivo and in vitro. Endothelial NOS inhibitor Nomega-nitro-L-arginine prevented vasodilatation, whereas neuronal NOS inhibitor 7-nitroindazole did not show significant influence on the vessel relaxation of astragaloside IV. 4. In conclusion, astragaloside IV inhibited vessel contraction through blocking calcium influx and intracellular calcium release. The endothelium-dependent vessel dilation of astragaloside IV was attributed mainly to the endothelium-dependent NO-cGMP pathway.     

旁中心凹渗出性血管异常复合体

旁中心凹渗出性血管异常复合体(PEVAC)是指相干光断层扫描(OCT)成像显示在旁中心凹视网膜表层或深层毛细血管网出现的大而孤立的动脉瘤样病灶,被确定为一种独立的新疾病。患者多为中老年人,不伴有视网膜血管病变,但可合并近视或年龄相关性黄斑变性等。若合并视网膜血管性疾病如糖尿病视网膜病变、视网膜静脉阻塞时,被称为PEVAC样病变。疾病早期无渗出,后期可有视网膜内渗出引起视物变形或视力下降。一些病例长期随访病灶无变化或自发消散。可能需要与3型视网膜新生血管(RAP)和Ⅰ型MacTel鉴别。抗血管内皮生长因子(VEGF)疗法无效。有用微脉冲激光等治疗改善的个案。推测此病与视网膜微血管周细胞变性有关。     

Esophageal atresia: critical review of 10 years' experience

From January 1976 to October 1986, 107 cases of esophageal atresia (EA) were admitted to the Neonatal Surgical Unit of the Bambino Gesú Hospital of Rome; 86% of the children had a type III EA. Associated anomalies were present in 47%; they were multiple in 18%. Cardiological malformations were the most frequent followed by digestive, skeletal, urological, and chromosomal aberrations. Surgical treatment was attempted in all children except 3, who died before surgical correction, in an effort to perform an end-to-end anastomosis in a single layer through a transpleural approach. According to the results, children were divided into two groups of 50 patients each: group 1 (1976–1981); and group 2 (1981–1986). Anastomosis was possible in 69% of children (68.7% in group 1, 69.3% in group 2). After 1983, gastrostomy fell into gradual disrepute and a transanastomotic tube was used. Immediate complications were seen in 36.6% of cases; in no case did recurrence of the tracheoesophageal fistula occur. The overall mortality decreased from 50% (group 1) to 30% (group 2). In the two periods considered, the mortality according to Waterston's risk classes was 28.5% 5,8% (class A), 42.1% 11.7% (class B), 82.3% 68.7% (class C). Of a total of 41 deaths, 47% were due to severe associated malformations: bronchopneumopathy or prematurity seemed to have less importance in establishing the prognosis.Offprint requests to: P. Bagolan     

硫化氢对自发性高血压大鼠主动脉平滑肌细胞增生的影响

目的探讨硫化氢(H2S)对自发性高血压大鼠(SHR)主动脉平滑肌细胞(ASMC)增生的影响。方法体外培养SHR ASMC,将其分成对照组、10-5、10-4和l0-3 mol/L NaHS组,检测经H2S处理后ASMC细胞的增生指数和丝裂原活化蛋白激酶(MAPK)活性。结果与对照组相比,10-5、10-4和10-3 mol/L NaHS组增生指数显著降低(P<0.01),MAPK活性明显下降(P<0.05或P<0.01)。结论 H2S可抑制SHR ASMC增生和MAPK活性,推测可能通过MAPK信号途径介导。