Temas de actualidad en cardiología: riesgo vascular y rehabilitación cardiaca

Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions.     

Impacto da frequência posológica na adesão terapêutica em doenças cardiovasculares crónicas: revisão sistemática e meta‐análise

Introduction and ObjectiveNon‐adherence to drug treatment is a major health problem. In Europe, it has been estimated that 9% of cardiovascular events can be attributed to non‐adherence. The complexity of dosing regimens is one of the factors identified as contributing to non‐adherence. In this systematic review we aimed to assess the impact of dosing frequency on adherence to drug treatment in patients with chronic cardiovascular disease.MethodsMEDLINE and the Cochrane Library (November 2013) were searched for randomized controlled trials (RCTs) comparing different dosing regimens (once‐daily administration vs. two or more daily administrations) and assessing adherence to therapy in patients with chronic cardiovascular disease. Only trials with at least five months of follow‐up were included. The results of the studies were pooled through a random effects meta‐analysis. Relative risk (RR) and 95% confidence interval (CI) were derived. Statistical heterogeneity was calculated using the I² test.ResultsFour RCTs (a total of 2557 patients) were included. Dosing regimens with once‐daily administration were associated with a significant 56% reduction in risk of non‐adherence to drug therapy (RR: 0.44; 95% CI: 0.35‐0.54, I²=25%).ConclusionsFew clinical trials have assessed the long‐term impact of dosing frequency on medication adherence in chronic cardiovascular disease. The best available evidence suggests that taking medication once daily decreases the risk of non‐adherence to treatment by approximately 50%. The impact on clinical outcomes remains to be established.     

纳米羟基磷灰石/聚酰胺66复合材料融合器行经椎间孔腰椎椎体间融合术的影像学研究

目的:将纳米羟基磷灰石/聚酰胺66(n-HA/PA66)复合材料融合器应用于经椎间孔腰椎椎体间融合术,探讨其在恢复、维持腰椎曲度和椎间高度及融合率等方面的作用及意义.方法:将2012年2月至7月符合纳入和排除标准的50例退行性腰椎疾病的患者(其中腰椎间盘突出症32例,腰椎滑脱18例),应用n-HA/PA66复合材料融合器进行经椎间孔腰椎椎体间融合术治疗,其中男34例,女16例;年龄22～64岁,平均52.16岁.术前、术后1周及术后2、4、6、8个月,分别行腰椎X线检查、腰椎三维重建CT;根据腰椎X线,测量术前、术后不同时期的腰椎曲线指数、相对椎间隙高度、Taillard指数、节段前凸角和全腰椎前凸角,并对其进行分析.结果:所有患者获得随访,时间8～13个月,平均11.32个月.术后1周腰椎曲线指数、相对椎间隙高度、Taillard指数、节段前凸角和全腰椎前凸角与术前比较差异均有统计学意义,而术后不同时期比较差异均无统计学意义.腰椎融合时间为4～8个月.结论:n-HA/PA66复合材料融合器能较好地恢复、维持腰椎正常序列、矢状面力线及稳定性,而且融合率更高、并发症少.     

Mapping mesoscale cortical connectivity in monkey sensorimotor cortex with optical imaging and microstimulation

To map in vivo cortical circuitry at the mesoscale, we applied a novel approach to map interareal functional connectivity. Electrical intracortical microstimulation (ICMS) in conjunction with optical imaging of intrinsic signals (OIS) was used map functional connections in somatosensory cortical areas in anesthetized squirrel monkeys. ICMS produced activations that were focal and that displayed responses which were stimulation intensity dependent. ICMS in supragranular layers of Brodmann Areas 3b, 1, 2, 3a, and M1 evoked interareal activation patterns that were topographically appropriate and appeared consistent with known anatomical connectivity. Specifically, ICMS revealed Area 3b connections with Area 1; Area 1 connections with Areas 2 and 3a; Area 2 connections with Areas 1, 3a, and M1; Area 3a connections with Areas M1, 1, and 2; and M1 connections with Areas 3a, 1, and 2. These somatosensory connectivity patterns were reminiscent of feedforward patterns observed anatomically, although feedback contributions are also likely present. Further consistent with anatomical connectivity, intra-areal and intra-areal patterns of activation were patchy with patch sizes of 200–300 μm. In summary, ICMS with OIS is a novel approach for mapping interareal and intra-areal connections in vivo. Comparisons with feedforward and feedback anatomical connectivity are discussed.     

趋化因子受体 CXCR7在原发性肝细胞肝癌中的表达及意义

【目的】探讨趋化因子受体 CXCR7在原发性肝细胞肝癌（PHC）中的表达情况及其临床意义。【方法】应用组织芯片和免疫组化法检测35对肝癌、癌旁组织和6例正常肝组织中 CXCR7的表达,并分析其表达与肝癌临床病理特征及预后的相关性。【结果】CXCR7在 35例 PHC 患者组织中的阳性表达率为88．6％（31／35）,显著高于配对癌旁肝组织37．14％（13／35）以及正常肝组织0（0／6）;CXCR7的高表达与 PHC 组织学分型、临床分期、淋巴结转移和血清 AFP 含量呈正相关（ P ＜0．05）,与其他临床指标无相关性（ P ＞0．05）;CXCR7阳性表达患者的中位生存时间相对于阴性表达患者均较短,且差异具有统计学意义（ P ＝0．001）。【结论】CXCR7在 PHC 患者中的阳性表达情况与临床预后密切相关,并且可分别作为独立的预测 PHC 患者预后的指标。     

改良Alvarado评分系统与妊娠期急性阑尾炎病理结果的相关性

[目的]探讨改良Alvarado评分系统与妊娠期急性阑尾炎术后病理结果的相关性及其在妊娠期急性阑尾炎诊断中的应用价值.[方法]回顾性收集2004年1月至2013年1月本院施行妊娠期阑尾切除术的69例临床资料,对各患者Alvarado系统评分结果与病理诊断进行分析.[结果]单纯型组患者平均Alvarado系统评分得分为(4.2±1.6)分,进展型组为平均得分为(7.0±1.9)分,两组间比较差异有统计学意义(P<0.01);评分系统与病理结果呈正相关关系(P<0.01).[结论]改良Alvarado评分系统能帮助早期诊断妊娠期急性阑尾炎并有助于选择外科治疗方案,对减少非必要性急诊手术率和急性穿孔的危险性上有重要价值.     

40例深部浸润型子宫内膜异位症的临床特点、MRI影像表现及治疗效果分析

[目的]探讨深部浸润型子宫内膜异位症(DIE)临床特点、MRI影像表现及治疗效果.[方法]回顾性分析2014年2月至2016年2月确诊的85例子宫内膜异位症患者临床、MRI影像学及治疗相关资料,通过与非DIE人群比较总结DIE临床特点,观察DIE患者MRI影像学表现及治疗效果.[结果]85例患者中病理证实DIE 40例,DIE组重度痛经、性交痛、附件囊肿活动度、宫骶韧带结节发生率分别为92.5%、65.0%、72.5%、67.5%显著高于非DIE组(n=45)的33.3%、11.1%、42.2%、17.8%,差异有统计学意义(P<0.05),DIE组阴道直肠隔结节5例,后穹窿蓝色结节15例,而非DIE组无.MRI显示DIE患者累及子宫宫骶韧带27例(子宫骶骨韧带增厚、两侧不对称或韧带内结节);T1WI、T2WI序列多以高信号为主.治疗总有效率90.6%;术后6个月患者临床症状评分、CA125水平较术前均明显下降(P<0.05).[结论]DIE患者以重度痛经、性交痛为其典型临床症状,阴道直肠隔结节、后穹窿蓝色结节为DIE判断敏感表现;MRI对DIE病变范围准确显示,在DIE术前诊断中有重要作用;根据临床症状及MRI检查结果采取相应的治疗方法效果良好.     

维拉帕米和Na+/H+通道阻滞剂对大鼠肝脏热缺血再灌注损伤的影响及其机制

[目的]研究维拉帕米(VP)和5-N-乙基-异丙基阿米洛利(EIPA)单独及联合作用对大鼠肝脏热缺血再灌注损伤保护作用及其机制.[方法]50只SD大鼠随机分成空白组(A组),缺血再灌注组(B组),EIPA 缺血再灌注组(C组),维拉帕米 缺血再灌注组(D组),EIPA VP 缺血再灌注组(E组),每组10只.缺血前10 min自尾静脉注入药物.制备95%肝脏缺血模型,缺血30 min,再灌注2 h后取静脉血、肝脏标本,比较各组之间的肝功能(ALT, AST),肝组织匀浆XOD活性,肝组织Ca2 浓度以及肝组织形态学变化.[结果]VP和EIPA组各项检测指标与缺血再灌注组比有显著性差异,联合用药组与单独用药组比较有显著性差异(P＜0.05).[结论]维拉帕米和EIPA预处理能减轻肝脏缺血再灌注损伤,联合用药有协同保护作用,效果更明显.     

疣状胃炎内镜表现和病理的相关性研究

【目的】研究疣状胃炎内镜表现和病理结果的相关性。【方法】选择门诊接受胃镜检查的123名患者,将内镜诊断的疣状胃炎与病理结果进行对照分析。【结果】疣状胃炎的内镜诊断与病理糜烂相关（P〈0．05）,相关系数为0．177;内镜诊断和病理胃炎程度也有相关趋势（P〈0．01）,相关系数为o,368;但和病理肠上皮化生无相关性（P〉0．05）,相关系数为0．162。【结论】疣状胃炎内镜表现和病理诊断有一定的相关性,具有一定的临床意义。