Coronary arterial repair in patients with stable angina pectoris or acute coronary syndrome after ultrathin biodegradable polymer sirolimus-eluting stent implantation at 1-year follow-up by coronary angioscopy

Background

Imaging modality-based evidence is limited that compares the extent of coronary arterial repair after percutaneous coronary intervention between patients with stable angina pectoris (SAP) and those with acute coronary syndrome (ACS).

Methods

Between December 2018 and November 2021, a single-center, nonrandomized, observational study was conducted in 92 patients with SAP (n = 42) or ACS (n = 50), who were implanted with Orsiro sirolimus-eluting stent (O-SES) providing a hybrid (active and passive) coating and underwent 1-year follow-up by coronary angioscopy (CAS) after implantation. CAS assessed neointimal coverage (NIC), maximum yellow plaque (YP), and mural thrombus (MT).

Results

Baseline clinical characteristics were comparable between the SAP and ACS groups. The follow-up periods were comparable between the two groups (390.1 ± 69.9 vs. 390.6 ± 65.7 days, p = 0.99). The incidences of MT at 1 year after implantation were comparable between the two groups (11.4% vs. 11.1%, p = 0.92). The proportions of “Grade 1” in dominant NIC grades were highest in both groups, and the proportions of maximum YP grades and MT were comparable between the two groups.

Conclusion

O-SES-induced coronary arterial repair at the site of stent implantation, irrespective of the types of coronary artery disease.     

The glutamate receptor 2 subunit controls post-synaptic density complexity and spine shape in the dentate gyrus

In adult brain the majority of AMPA glutamate receptor (GluR) subunits contain GluR2. In knock-out (KO) mice the absence of GluR2 results in consequences for synaptic plasticity including cognitive impairments. Here the morphology of dendritic spines and their synaptic contacts was analysed via three-dimensional reconstruction of serial electron micrographs from dentate gyrus (DG) of adult wild type (WT) and GluR2 KO mice. Pre-embedding immunocytochemical staining was used to examine the distribution and subcellular localization of AMPA receptor GluR1 and N -methyl- d -aspartate receptor NR1 subunits. There were no significant changes in synapse density in the DG of GluR2 KO compared with WT mice. However, in GluR2 KO mice there was a significant decrease in the percentage of synapses on mushroom spines but an increase in synapses on thin spines. There was also a large decrease in the proportion of synapses with complex perforated/segmented post-synaptic densities (PSDs) (25 vs. 78% in WT) but an increase in synapses with macular PSDs (75 vs. 22%). These data were coupled in GluR2 KO mice with significant decreases in volume and surface area of mushroom spines and their PSDs. In both GluR2 KO and WT mice, NR1 and GluR1 receptors were present in dendrites and spines but there was a significant reduction in NR1 labelling of spine membranes and cytoplasm in GluR2 KO mice, and a small decrease in GluR1 immunolabelling in membranes and cytoplasm of spines in GluR2 KO compared with WT mice. Our data demonstrate that the absence of GluR2 has a significant effect on both DG synapse and spine cytoarchitecture and the expression of NR1 receptors.     

纤维支气管镜在ICU机械通气患者中的应用

探讨对机械通气并发呼吸机相关性肺炎患者应用纤维支气管镜行支气管肺泡灌洗治疗的效果和安全性。     

右美托咪定联合羟考酮对纤维支气管镜插管患者镇静作用研究

目的 探讨右美托咪定联合羟考酮对纤维支气管镜插管患者的镇静作用。方法 选取2016年9月至2018年9月在台州市第一人民医院行纤维支气管镜插管的患者92例,采用数表法随机分为对照组和研究组,每组各46例。对照组患者静脉滴注舒芬太尼0.1μg/kg和右美托咪定1.0μg/kg,研究组患者静脉滴注羟考酮0.10mg/kg和右美托咪定1.0μg/kg。比较两组患者进入手术室情况稳定时（T0）、麻醉5min后（T1）、患者麻醉药物输注完成即刻（T2）、患者插管完成即刻（T3）各时间段的Ramsay镇静评分和血流动力学相关指标检查,以及插管状况、并发症、术中知晓发生率。结果 两组患者T0、T1时间段Ramsay镇静评分比较,差异无统计学意义（P>0.05）,T2、T3时间段Ramsay镇静评分比较,差异有统计学意义（P<0.05）,且T2、T3时间段研究组的Ramsay镇静评分高于对照组,差异有统计学意义（P<0.05）。比较两组患者在T0、T1时间段的心率、有创平均动脉压、收缩压及舒张压,差异均无统计学意义（P>0.05）,T2时间段时研究组的心率、有创平均动脉压、收缩压及舒张压高于对照组,T3时间段时研究组低于对照组,差异均有统计学意义（P<0.05）。比较两组患者在各时间段的血氧饱和度,差异无统计学意义（P>0.05）。研究组患者的插管评分、完成插管时间、并发症发生率、术中知晓发生率均显著低于对照组,一次性插管成功率明显高于对照组,差异均有统计学意义（P<0.05）。结论 右美托咪定联合羟考酮对纤维支气管镜插管患者镇静效果显著,可维持患者血流动力学稳定,提高一次性插管成功率,降低患者并发症和术中知晓发生率。     

电子支气管镜联合多层螺旋CT三维重建在儿童肺部感染诊治中的临床价值研究

目的 探讨电子支气管镜联合多层螺旋CT(MSCT)三维重建在儿童肺部感染诊治中的临床价值.方法 选取2019年1月至2020年6月我院收治的50例肺炎患儿,均接受电子支气管镜联合MSCT三维重建,评估电子支气管镜联合MSCT三维重建结果 、病原学检查结果 .结果 联合检查与电子支气管镜的肺部感染阳性率比较无统计学差异(...     

两种喉罩定位方法在鼻内窥镜手术中的应用

目的 观察听诊和纤维支气管镜评分两种喉罩定位方法在鼻内窥镜手术中的应用.方法 将60例使用喉罩通气全麻的成年患者随机分为2组,分别通过听诊法(L组)和纤维支气管镜评分法(F组)评估喉罩位置,记录置人情况和纤维支气管镜评分,潮气量(Vt)、呼气末二氧化碳分压(PETCO2)、气道峰压(Peak)和最大漏气压.结果 听诊法和纤维支气管镜评分法判断喉罩对位后,两组患者最大漏气压、Vt、PErCO2、Peak差异均无统计学意义(P＞0.05).L组喉罩一次到位成功25例,明显高于F组(15例,P＜0.05).两组患者喉罩对位后纤支镜评分差异有统计学意义(P＜0.05),L组有15例患者纤支镜评分为2分,F组所有患者评分均在3分以上.结论 采用听诊法和纤维支气管镜评分定位法判断喉罩对位都可以满足临床通气需要.听诊法简单可靠,即使纤支镜评分2分,也可达到良好的通气和密闭效果,满足手术需要.     

儿童喉、气管异物的诊治分析

目的探讨儿童喉、气管异物的临床特点及诊治手段。方法分析2001年1月到2005年6月间经硬质气管镜或纤维支气管镜确诊的87例喉、气管异物患儿的临床特点、影像学改变、并发症、异物取除方法。结果气管、喉异物占同期呼吸道异物的10.7%(87813),1～3岁组占73.6%。93.1%有异物吸入史,喘鸣占67.8%、吸气性凹陷40.2%、发绀27.6%、声音嘶哑19.5%、气管拍击音4.6%。6例(6.9%)患儿病情突变,表现发绀、呼吸困难,神志不清。胸片异常30.2%,胸透异常26.5%。硬质气管镜取异物63例并全部取出(100%),其中3例为纤支镜取异物未成功者;纤支镜取异物20例,取出17例(85.0%),两者成功率差异无显著性(P>0.5),但纤支镜取异物耗时不确定,并有5例异物通过鼻后孔时跌落入食道。结论儿童喉、气管异物典型症状不多见,异物吸入史为敏感指标;胸片、胸透异常率低,应及时作纤支镜检查,取除喉、气管异物首选硬质气管镜。     

支气管镜检查并发大出血原因分析和救治方法探讨

目的探讨支气管镜检查并发大出血的原因和救治方法。方法回顾性分析1983年12月￣2004年12月内进行的23826例支气管镜检查并发37例大出血患者的临床资料和救治方法。结果支气管镜检查并发大出血比例为1.6‰。37例大出血患者原发病为肺癌18例,肺结核7例,支气管结核3例,支气管扩张并感染5例,支气管息肉2例,支气管结石和支气管异物各1例。37例病人中行病灶或支气管黏膜活检术26例,肺组织活检术8例,刷检术3例,钳取结石和异物各1例。37例大出血患者均经支气管镜下局部灌入4℃冷盐水+1∶10000肾上腺素+凝血酶(500￣20000u)或使用OlympusPSD-30型高频电刀电凝止血成功。结论支气管镜检查并发大出血的原因主要是因为气管内新生物、支气管黏膜或肺组织活检时用力过度引起组织撕裂或血管破裂。经支气管镜局部注入止血药物或高频电刀电凝止血效果显著,并能清除积血,防止窒息,是一种安全有效的止血方法,值得临床推广应用。     

现代儿科呼吸介入技术在喉喘鸣中的应用进展

喉喘鸣是由多种病因引起、常伴多种临床表现的婴幼儿临床症状,病因不仅包括咽喉部疾病,亦可由声门下及气管病变引起,故纤细柔软的可弯曲支气管镜可对其进行全面评估及诊断,文章根据解剖部位对喉软化等13种疾病进行镜下诊断。且随着介入呼吸病学的快速发展,消融术、球囊扩张术及支架置入术等支气管镜介入技术为引起喉喘鸣的相关疾病提供了微创的治疗方法。未来随着越来越多的儿科呼吸介入医生关注咽喉部病变的诊疗,将会极大提升喉喘鸣的诊疗水平。