心理干预对冠状动脉搭桥术病人抑郁心理影响的研究进展

从对手术的不了解、既往手术体验及情绪障碍、人格特征的差异、医护人员及医疗环境 4方面阐述了手术产生抑郁心理的相关因素。提出了针对性的术前、术后心理干预措施。     

The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes

ObjectiveTo identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values.Patients and MethodsConsecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed.ResultsOf 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these “missed” patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction.ConclusionThere were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non–ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.     

运动负荷气体交换法在老年人心肺功能状况评价中的应用

目的：比较正常组、慢阻肺组及冠心病组患者的心肺功能变化，评估无氧阈（AT）及相关指标在早期临床诊断及鉴别诊断的应用价值。方法：三组研究对象采用运动心肌功能仪和功率自行车，分别在AT时和峰值耗氧时刻，随机检测每人的AT出现时间，耗氧量（VO2）、公斤耗量（VO2／kg)、心率（HR）、通气量（VE）等心肺功能指标。结果：（1）AT出现时刻：冠心病组的AT出现时间明显早于正常组（P＜0．05），和慢阻肺组（P＜0．05），冠心病组的VO2/kg，VO2均明显地小于正常组与慢阻肺组（P＜0．05）；慢阻肺组的VE明显地小于正常组和冠心病组（P＜0．05）。（2）峰值耗氧时刻：慢阻肺组的VO2、VO2/kg和VE均明显地小于正常组（P＜0．05）。结论：在AT时，冠心病患者的AT出现时间明显提高，其VO2/kg和VO2均低于正常人，可做为早期诊断，指导康复治疗的指标，在峰值耗氧时刻，慢阻肺患者的VO2、VO2/kg和VE均明显小于正常人和冠心病患者，可做为评价心肺功能的病变程度的指标。     

CFD analysis in an anatomically realistic coronary artery model based on non-invasive 3D imaging: comparison of magnetic resonance imaging with computed tomography

Computational fluid dynamics (CFD) methods based on in vivo three-dimensional vessel reconstructions have recently been shown to provide prognostically relevant hemodynamic data. However, the geometry reconstruction and the assessment of clinically relevant hemodynamic parameters may depend on the used imaging modality. This study compares geometric reconstruction and calculated wall shear stress (WSS) values based on magnetic resonance imaging (MRI) and computed tomography (CT). Both imaging methods were applied to a same 2.5-fold upscale silicon model of the left coronary artery (LCA) main bifurcation. The original model is an optically digitized post mortem vessel cast. This digitized geometry is considered as a “gold standard” or original geometry for the MRI versus CT comparative study. The use of the upscale model allowed generating a high resolution CT raw data set with voxel size of 0.156 × 0.156 × 0.36 mm³ and a high resolution MRI data set with an equivalent voxel size of 0.196 × 0.196 × 0.196 mm³ for corresponding in vivo conditions. MRI based reconstruction achieved a mean Hausdorff surface distance of 0.1 mm to the original geometry. This is 2.5 times better than CT based reconstruction with mean Hausdorff surface distance of 0.252 mm. A comparison of the calculated mean WSS shows good correlation (r = 0.97) and good agreement among the three modalities with a WSS of 0.65 Pa in the original model, of 0.68 Pa in the CT based model and of 0.67 Pa in the MRI based model.     

骨髓基质干细胞心肌化诱导过程中转录因子NKx 2.5的表达

目的：研究5-氮杂胞嘧啶(5-azacytidine，5-aza)和二甲亚砜(dimethyl sulfoxide．DMSO)诱导人骨髓基质细胞(human bone marrow stromal cells，hBMSC)心肌分化过程中心肌特异转录因子NKx2.5表达的变化。方法：取传至第8代hM-SC，以3μmol/L的5-aza和DMSO诱导24h。1周后重复诱导1次。在诱导后1、2和3周3个时间点以半定量RT-PCR方法检测细胞心肌特异转录因子NKx2.5的表达变化。结果：hMSC经5-aza诱导后，约1周左右细胞明显变大，2周时细胞走向趋于一致．邻近细胞间连接较前紧密，并形成肌节样结构。RT-PCR的结果显示，5-aza可诱导心肌特异转录因子NKx2.5，并一直持续表达3周。在DMSO诱导hBMSC后1周，开始可检测到细胞发生转录水平变化NKx2.5表达，并均可持续表达至诱导后3周；NKx2.5表达量有随诱导后时间延长而增加的趋势。结论：5-aza和DMSO在体外可诱导心肌特异转录因子NKx2.5的表达，从而启动hMSC心肌化的过程。     

Mapping the brain pathways of declarative verbal memory: Evidence from white matter lesions in the living human brain

Understanding the contribution of the brain white matter pathways to declarative verbal memory processes has been hindered by the lack of an adequate model in humans. An attractive and underexplored approach to study white matter region functionality in the living human brain is through the use of non-aprioristic models which specifically search disrupted white matter pathways. For this purpose, we employed voxel-based lesion–function mapping to correlate white matter lesions on the magnetic resonance images of 46 multiple sclerosis patients with their performance on declarative verbal memory storage and retrieval. White matter correlating with storage was in the temporal lobe–particularly lateral to the hippocampus and in the anterior temporal stem–, in the thalamic region and in the anterior limb of the internal capsule, all on the left hemisphere, and also in the right anterior temporal stem. The same volumes were relevant for retrieval, but to them were added temporo-parieto-frontal paramedian bundles, particularly the cingulum and the fronto-occipital fasciculus. These 3D maps indicate the white matter regions most critically involved in declarative verbal memory in humans.     

硬化大脑中动脉及豆纹支管壁弹性结构改变及意义

本文用光镜、电镜观察了正常和硬化大脑中动脉及其豆纹支管壁弹性结构的形态。结果显示，硬化大脑中动脉内弹力膜断裂，且以外层断裂明显，波纹状外观消失；而豆纹支内弹力膜结构完整，波纹状外观清晰可见。平滑肌萎缩、变性，胶原纤维增多。提示硬化大脑中动脉破裂出血是内弹力膜破坏，平滑肌萎缩，管壁脆性增加所致；而豆纹动脉是根部存在＂中膜缺损＂，此外受血流冲击引起破裂的可能性大。     

New method of thrombus preparation using a fluid model for evaluation of thrombectomy devices in a swine model

Background

Mechanical thrombectomy is a promising new modality of interventional stroke treatment. Preparation of thrombus is a very important step for the evaluation of the mechanical thrombectomy devices. The objective of this study was to explore a new method of thrombus preparation with fluid model (FM) for assessment of thrombectomy devices used in the recanalization of acute ischemic stroke.

Methods

Elongation test and catheter injection test were used to evaluate the mechanical properties of thrombi prepared by FM and static model (SM). Histological structures of two artificial clots and specimens of stroke patients were compared. Radiopacity of thrombus made by FM was evaluated in a swine embolization model.

Results

The maximum tensile length of thrombi prepared by FM and SM were significantly higher (4.28 ± 0.23 cm vs 3.16 ± 0.13 cm, P < 0.01) and showed less breakage on catheter injection test (13% vs 60%, P < 0.05). Histological features of thrombi prepared by FM showed mixed thrombus structure, similar to thromboemboli retrieved from acute stroke patients, while clots generated by SM were replete with erythrocytes. A total of twelve vessels in two swine were successfully occluded (TIMI 0 or 1), with sufficient radiopacity of each injected thrombus.

Conclusion

The thrombus prepared by FM had good mechanical stability, sufficient radiopacity, and similar histological structure of thromboemboli retrieved from stroke patients, which make it possible to be used in the evaluation of thrombectomy devices.