Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis

From 1972 to 1980, 23 patients (Group A) with native valve infective endocarditis underwent surgical intervention, often for multiple indications, during the active stage of the infective process because of progressive class III and IV (New York Heart Association) heart failure (12 patients), persistent severe hypotension (3 patients), uncontrolled infection for over 21 days (11 patients), aortic root abscess (2 patients), and pericarditis (1 patient). Eighty-five patients (Group B) with active native valve endocarditis, matched for severity of illness, were treated medically. Two patients (9%) in Group A and 43 patients (51%) in Group B died during the hospital admission (p < 0.001). Any difference in long-term cumulative survival rate between the 2 groups was largely due to the beneficial impact of surgical management on the hospital mortality. Of 23 patients in Group A, 11 (48%) had an entirely uncomplicated postoperative course. Long-term mortality rates in those with aortic valve endocarditis treated medically (79%) were significantly higher than in those with mitral valve involvement (47%) (p < 0.05). Patients with aortic valve involvement treated surgically had a better hospital (p < 0.005) and long-term (p < 0.005) survival rate than those treated medically. Two groups at risk for postoperative complications were identified; 3 of 11 patients (27%) with uncontrolled infection had an early postoperative recurrence, and 4 of 7 patients (57%) with an aortic root abscess had postoperative prosthetic paravalvular regurgitation.

Surgery therefore effects a substantial reduction in hospital mortality in patients with complicated active infective endocarditis (9% versus 51%), but patients with preoperative prolonged periods of uncontrolled infection or with aortic root abscess are liable to postoperative complications.     

小蓟提取液对四种癌细胞生长抑制作用的研究

目的:研究小蓟提取液对癌细胞生长的抑制作用。方法:细胞形态观察和活细胞计数法研究小蓟提取液对人白血病细胞K562、肝癌细胞HepG2、宫颈癌细胞Hela、胃癌细胞BGC823生长的抑制作用。结果:小蓟提取液可使四种癌细胞发生皱缩、变圆、脱壁、碎裂等形态变化,生长受到明显抑制,抑制率最高可达88.27%。结论:小蓟有确切的抑癌作用,并与中医的气血理论、药物归经理论和肝肾同源理论相一致,再次说明了中医基本理论在体外细胞水平上也有良好体现,对实验室手段研究中医药同样有着重要指导意义。     

Progressive Disease in Children with Medulloblastoma/PNET During Preradiation Chemotherapy

The overall prognosis in children with medulloblastoma/PNET has not significantly improved over the past decade. Intensive neoadjuvant chemotherapy has not yet adequately explored. We evaluated the short-term clinical results of an intensive chemotherapy regimen in high risk children with newly diagnosed MB/PNET, after surgery and before radiation. Twelve previously untreated patients with high-risk medulloblastoma/PNET, according to Chang's classification, were treated with the following chemotherapy regimen: high dose carboplatin 600mg/m²/day on days 1 and 2; the same course was administered 4 weeks later. One month later, high dose cyclophosphamide 2g/m²/day on days 1 and 2, followed by an identical course 4 weeks later. Vincristine 1,5mg/m² iv was given on the first day of each course. Systemic evaluation of the disease included imaging of the entire neuraxis, including MRI of the entire spine. Out of 12 enrolled, 7 patients were able to be evaluated for a residual disease after surgery. After two cycles of high dose carboplatin, we noted I CR, 4 PR and 2 MR. After the subsequent two cycles of high dose cyclophosphamide we observed an additional response in 4 cases. On the other hand, 4 patients clearly showed evidence of PD immediately after the first course of cyclophosphamide (2 cases) or following the second course. Three of the 4 patients had shown respectively 1 CR and 2 PR after the second course of carboplatin. Whereas it was confirmed that 2 courses of high dose carboplatin is effective in high risk MB/PNET children, we observed an unacceptable number of PD during the subsequent high dose cyclophosphamide therapy. A review from the literature also suggests that, in general, the longer radiotherapy is delayed, the higher the incidence of PD. In the search for the optimal drug combination in sandwich chemotherapy for children with high risk MB/PNET, PD must be reduced to an acceptable incidence, since a high number of PD may significantly lower the probability of long-term survival.     

大鼠心肌再灌注白介素-8的变化及激素干预的影响

目的　探讨大鼠心肌缺血 /再灌注期间血清IL 8和CK MB的变化及甲基强的松龙对其的影响。方法　将大鼠随机分成空白对照组、缺血 /再灌注对照组、空白治疗组、缺血 /再灌注治疗组四组 ,在心肌缺血前用甲基强的松龙 (30mg/kg)对治疗组大鼠预处理 ,测定缺血0、 0 5h和再灌注 1、 2、 3h血清中IL 8和CK MB的含量。结果　CK MB从再灌注 1h开始逐渐升高 ,且在 2、 3h升高明显 (P <0 0 1) ;而IL 8从再灌注 2h开始显著性逐渐升高 (P <0 0 1)。治疗组CK MB、IL 8表现为升高延迟 ,即CK MB和IL 8均延迟至再灌注 3h开始升高 ,同时在再灌 2、 3h的二者血清浓度与对照组比较均显著性降低 (P <0 0 5 )。另外IL 8、CK MB两者水平呈显著性正相关 (P <0 0 0 1)。结论　大鼠在心肌缺血 /再灌注中可以产生IL 8,并有逐渐递增的趋势 ,甲基强的松龙可以抑制IL 8的产生 ,减少心肌的炎性损害 ,起保护心脏的作用     

急性心肌梗死时血清心脏肌钙蛋白Ⅰ的测定及临床意义

目的：测定急性心肌梗死（AMI）病人血清肌钙蛋白I（cTnI)和肌酸激酶同功酶（CK－MB）水平，以探讨其诊断AMI价值。方法：采用微粒子化学发光法，对21例AMI患，30例陈旧性心肌梗死患（OMI）和21例健康（对照组）进行血清cTnI,CK-MB测定，并对AMI患胸痛发生3－6小时，2天，3－6天，7－10天，11－14天共五个时段了测定。结果：AMI患发病早期cTnI,CK-MB阳性率均为90．5％，特异性分别为100％，78．4％，二比较有显差异（P＜0．01）。AMI患中各项指标的动态测定显示：在AMI发生早期，cTnI和CK－MB都有显升高，AMI 2天内cTnI和CK－MB阳性率分别为95．2％，90．5％。随时间推移而逐渐下降，3－6天，cTnI阳性率仍达90．5％，而后已按近正常，11－14天时血清中仍有cTnI的持续存在。结论：cTnI对诊断AMI具有高度特异性和敏感性，且诊断窗口时间较长，血清cTnI检测优于CK－MB。     

Sensitive and high sensitivity next generation cardiac troponin assays: more than just a name

In the 20 years that cardiac troponin testing has been available in clinical laboratories, the biomarker has revolutionised testing of patients with acute coronary syndromes. Cardiac troponin I and T testing has become the cornerstone for diagnosis of myocardial infarction and is useful for risk assessment and management of suspected acute coronary syndrome patients. As evidence and knowledge have evolved, it has become clear that even small troponin elevations are associated with adverse health outcomes. As a result there have been several generations of troponin assays, all toward tests that reliably detect lower concentrations of this critical analyte. Guidance for cardiac troponin interpretation has been in the form of myocardial infarction redefinition and evidence-based clinical and analytical guidelines. Although terminology naming generations for cardiac troponin assays has been inconsistent, state-of-the-art cardiac troponin assays are generally referred to as 'sensitive' assays and are in general compliance with analytical guidelines. Evidence shows that use of a sensitive troponin assay can result in diagnosis of myocardial infarction earlier. Next generation cardiac troponin I and T assays will likely be termed 'high sensitivity'; these assays should have the ability to measure troponin with a CV of total error of <10% at concentrations significantly lower than the 99 percentile of the normal reference population. As such, these assays should reliably measure troponin in most normal individuals and detect troponin changes (delta values) below the 99 percentile. This property may result in earlier ACS diagnosis and better management. Utilisation of high sensitivity troponin measurements may be useful for applications other than acute coronary syndromes including risk stratifying patients with renal insufficiency, heart failure, cardiac amyloid and screening elderly patients.     

Coronary heart disease in patients with diabetes: part II: recent advances in coronary revascularization

Although diabetic patients represent approximately one-quarter of all those undergoing revascularization, their outcomes after revascularization are usually worse compared with non-diabetic patients. We examined the recent advances in percutaneous and surgical revascularization that are relevant to the treatment of diabetic patients. A systematic review of publications in the past 5 years (2000 to 2005) relating to coronary revascularization in diabetes was undertaken. Early and mid-term follow-up of diabetic patients after revascularization indicates that the incidence of myocardial infarction and repeat revascularization are reduced in surgically treated patients compared with those treated by balloon angioplasty alone. Percutaneous coronary intervention (PCI) with bare metal stents has reduced the surgical advantage (for reintervention) in the early-mid-term; however, repeat revascularization in diabetic patients continues to be substantially higher after PCI. Advances in PCI include the use of drug-eluting stents and adjunctive drug therapies, such as abciximab. Glycemic control is an important determinant of outcome after revascularization in diabetic patients, and the impact of tight glycemic control after PCI is currently being investigated in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 in Diabetes). Improvements in PCI and coronary artery bypass graft surgery are leading to better results in diabetic patients, and clinical trials are presently comparing contemporary PCI with surgery.