NT-proBNP对急性心肌梗死患者新发房颤的预测价值研究

目的探讨N末端B型脑利钠肽前体(NT-proBNP)对急性心肌梗死患者新发房颤的预测价值。方法从2008年1月至2010年12月收住我院心脏监护室的患者中入选急性心肌梗死(AMI)患者293例,按照患者住院期间是否出现房颤(AF)分为房颤组(n=43)和非房颤组(n=250)。比较两组间差异,分析血浆NT-proBNP水平对新发房颤的预测价值。结果 (1)AMI患者住院期间出现新发房颤的比例为14.7%;(2)房颤组患者NT-proBNP水平明显高于非房颤患者,且平均年龄较大,左心室射血分数、血红蛋白含量和肾小球滤过率(eGFR)均低于非房颤组;(3)多因素Logistic回归分析显示NT-proBNP可独立预测急性心肌梗死患者新发房颤(OR4.918,95%CI1.662-14.549,P=0.004)。结论血浆NT-proBNP水平可独立预测急性心肌梗死患者新发房颤的发生,可用于患者危险分层及指导早期预防治疗。     

Cardiac surgery at high altitude

Eleven children between 4 and 17 years of age underwent ligation of a patent ductus arteriosus during two medical camps in September 2003 and August 2004 at the Sonam Norboo Memorial District Hospital at Leh, Ladakh (11,400 feet above mean sea level). These children had a low mean arterial oxygen saturation while breathing room air. They were all acclimatized to high altitude. Surgery was performed under general anaesthesia with endotracheal intubation. Patients were extubated on the table. All children survived the operation and were discharged within 5-6 days following surgery. No surgical or anaesthetic complications were encountered. Simple cardiac surgical procedures such as ligation of a patent ductus arteriosus can be performed safely at high altitudes.     

Prognostic Implications of Lymphadenectomy in Esophageal Cancer After Neo-adjuvant Therapy: a Single Center Experience

Introduction  

The objective of this study is to explore the prognostic implications of lymphadenectomy in esophageal cancer patients after neo-adjuvant therapy.     

CYBA and GSTP1 variants associate with oxidative stress under hypobaric hypoxia as observed in high-altitude pulmonary oedema

HAPE (high-altitude pulmonary oedema) is characterized by pulmonary hypertension, vasoconstriction and an imbalance in oxygen-sensing redox switches. Excess ROS (reactive oxygen species) contribute to endothelial damage under hypobaric hypoxia, hence the oxidative-stress-related genes CYBA (cytochrome b-245 α polypeptide) and GSTP1 (glutathione transferase Pi 1) are potential candidate genes for HAPE. In the present study, we investigated the polymorphisms -930A/G and H72Y (C/T) of CYBA and I105V (A/G) and A114V (C/T) of GSTP1, individually and in combination, in 150 HAPE-p (HAPE patients), 180 HAPE-r (HAPE-resistant lowland natives) and 180 HLs (healthy highland natives). 8-Iso-PGF2α (8-iso-prostaglandin F2α) levels were determined in plasma and were correlated with individual alleles, genotype, haplotype and gene-gene interactions. The relative expression of CYBA and GSTP1 were determined in peripheral blood leucocytes. The genotype distribution of -930A/G, H72Y (C/T) and I105V (A/G) differed significantly in HAPE-p compared with HAPE-r and HLs (P≤0.01). The haplotypes G-C of -930A/G and H72Y (C/T) in CYBA and G-C and G-T of I105V (A/G) and A114V (C/T) in GSTP1 were over-represented in HAPE-p; in contrast, haplotypes A-T of -930A/G and H72Y (C/T) in CYBA and A-C of I105V (A/G) and A114V (C/T) in GSTP1 were over-represented in HAPE-r and HLs. 8-Iso-PGF2α levels were significantly higher in HAPE-p and in HLs than in HAPE-r (P=2.2×10(-16) and 1.2×10(-14) respectively) and the expression of CYBA and GSTP1 varied differentially (P<0.05). Regression analysis showed that the risk alleles G, C, G and T of -930A/G, H72Y (C/T), I105V (A/G) and A114V (C/T) were associated with increased 8-iso-PGF2α levels (P<0.05). Interaction between the two genes revealed over-representation of most of the risk-allele-associated genotype combinations in HAPE-p and protective-allele-associated genotype combinations in HLs. In conclusion, the risk alleles of CYBA and GSTP1, their haplotypes and gene-gene interactions are associated with imbalanced oxidative stress and, thereby, with high-altitude adaptation and mal-adaptation.     

Formulas Used by Tibetan Doctors at Men‐Tsee‐Khang in India for the Treatment of Neuropsychiatric Disorders and Their Correlation with Pharmacological Data

The aim of the present study was to identify formulas used at Men‐Tsee‐Khang (Tibetan Medical and Astrological Institute), India, for the treatment of neuropsychiatric disorders and to compare the Tibetan usage of particular ingredients with pharmacological data from the scientific database. Using ethnographic methods, five doctors were selected and interviewed. A correlation was observed between central nervous system disorders and rLung, one of the three humors in Tibetan medicine, which imbalance is the source of mental disorders, and ten multi‐ingredient formulas used to treat the imbalance of this particular humor were identified. These formulas utilize 61 ingredients; among them were 48 plant species. Each formula treats several symptoms related to rLung imbalance, so the plants may have therapeutic uses distinct from those of the formulas in which they are included. Myristica fragrans, nutmeg, is contained in 100% of the formulas, and its seeds exhibit stimulant and depressant actions affecting the central nervous system. Preclinical and clinical data from the scientific literature indicate that all of the formulas include ingredients with neuropsychiatric action and corroborate the therapeutic use of 75.6% of the plants. These findings indicate a level of congruence between the therapeutic uses of particular plant species in Tibetan and Western medicines. Copyright © 2012 John Wiley & Sons, Ltd.     

西藏西部地区儿童高原性心脏病临床分析及前列地尔靶向治疗评价

目的：探讨西藏西部地区儿童高原性心脏病的临床特点及应用前列地尔靶向治疗的临床疗效及安全性。方法：选择日喀则人民医院儿科2018年1月至10月收治的50例高原性心脏病患儿，随机分为观察组和对照组各25例。对照组患儿予以常规治疗：卧床休息，必要时镇静、吸氧、控制感染、利尿减轻心脏负荷、纠正水电解质酸碱平衡紊乱等处理。观察组患儿在常规治疗基础上应用前列地尔（凯时）5~10 ng/（h·kg）静脉泵入12 h，连续7~15 d。记录治疗前后患儿的血流动力学改变及超声心动图变化。结果：观察组患儿治疗后的肺动脉压下降程度、心脏超声指数上升程度均大于对照组（P均<0.05），且平均体动脉压治疗前后无明显变化（P>0.05），未发现明显不良反应。结论：高原性心脏病是西藏西部地区小儿常见的心脏疾病，呼吸道感染为常见诱发因素。前列地尔治疗小儿高原性心脏病，可有效降低肺动脉压力，改善患儿心功能，且无不良反应，初步评估安全性良好。