微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

Baicalin-loaded PEGylated lipid nanoparticles: characterization,pharmacokinetics, and protective effects on acute myocardial ischemia in rats

Context: Baicalin has many pharmacological activities, including protective function against myocardial ischemia by antioxidant effects and free radical scavenging activity. However, its rapid elimination half-life in plasma and poor water solubility limits its clinical efficacy.

Objective: Novel baicalin-loaded PEGylated nanostructured lipid carriers (BN-PEG-NLC) were developed to improve bioavailability of BN, to prolong retention time in vivo and to enhance its protective effect.

Methods: In this study, BN-PEG-NLC were prepared by the emulsion-evaporation and low temperature-solidification method using a mixture of glycerol monostearate and polyethylene glycol monostearate as solid lipids, and oleic acid as the liquid lipid. The physicochemical properties of NLC were characterized. The pharmacokinetic and pharmacodynamic behaviors of BN-PEG-NLC or BN-NLC were evaluated in acute MI rats.

Results and discussion: The particle size, zeta potential, and entrapment efficiency for BN-PEG-NLC were observed as 83.9?nm, ?32.1?mV, and 83.5%, respectively. The release profiles of BN from both BN-PEG-NLC and BN-NLC were fitted to the Ritger–Peppas modal, which presented burst release initially and prolonged release afterwards. Pharmacokinetics results indicated that BN-PEG-NLC exhibited a 7.2-fold increase in AUC in comparison to BN solution, while a 3-fold increase in comparison to BN-NLC. Biodistribution results revealed that BN-PEG-NLC exhibited higher heart drug concentration compared with BN-NLC as well as BN solution. In the present study, BN-PEG-NLC significantly ameliorated infarct size.

Conclusion: The results of the present study imply that PEG-NLC could be the biocompatible carriers for heart-targeted drug delivery to improve myocardial ischemia.     

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnoses and Surgical Results in 12 Pediatric Patients

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital condition. It responds well to early diagnosis and treatment, but otherwise the prognosis is poor. We present our case series of 12 patients (mean age, 2 ± 2.58 yr; age range, 2 mo–8 yr), emphasizing the diagnostic process and discussing our surgical results. The diagnosis of ALCAPA should be suspected in infants who have dilated cardiomyopathy with electrocardiographic changes that suggest ischemia, and in older children who have isolated mitral regurgitation. When clinical suspicion is high, the results of 2-dimensional echocardiography combined with color-flow Doppler studies in expert hands can establish the diagnosis, thus avoiding angiography in critically ill infants. The treatment of choice in our patients was transfer and reimplantation of the left coronary artery onto the ascending aorta. There were 2 deaths: both were infants in extremis who underwent emergency surgery. An older child with severe ventricular dysfunction was given mechanical ventricular assistance and then heart transplantation. As of this report, all 10 survivors remained well and asymptomatic.     

Isolated Anisocoria as a Presenting Stroke Code Symptom is Unlikely to Result in Alteplase Administration

Background

Acute stroke codes may be activated for anisocoria, but how often these codes lead to a final stroke diagnosis or alteplase treatment is unknown. The purpose of this study was to assess the frequency of anisocoria in stroke codes that ultimately resulted in alteplase administration.

Successful Use of Surgically Placed Impella 5.0 and Central Extracorporeal Membrane Oxygenation Circuit in a Patient with Postcardiotomy Shock

The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support.     

Cognition in breast cancer survivors: A pilot study of interval and continuous exercise

Objectives

The current study investigated the effects of two exercise interventions on cognitive function amongst breast cancer survivors.

黄芪活血功效及现代药理学研究进展

黄芪始载于《神农本草经》,有补气升阳、益卫固表,利水消肿,托毒生肌之效。被誉为补气健脾之要药,临床上常用于气虚乏力、脾虚泄泻等疾病,已为医者所熟知。近年来,研究学者围绕其补气、健脾、利水功效机制已有较全面的认识。然陶弘景在《本草经集注》首载黄芪"逐五脏间恶血",表明本品兼有活血作用。目前,对于本品活血作用机制阐释,中医常基于"补气活血""气行血行"理论进行论证,但并不等同于本品无活血作用。通过梳理历代本草文献中对黄芪的记载,发现其活血作用应用广泛。综合传统方剂与现代方剂中有关其活血作用的应用,本品在方中行活血通络、活血利水、活血扶正作用,尤能体现其活血作用。且现代药理学研究在有关瘀血病理指标的分子机制中,黄芪有很好的调控作用,表明黄芪有活血作用,但未深入探究,存在研究价值。该文从历代文献对黄芪活血功效的论述、黄芪活血作用的临床应用及现代药理学研究深入探讨其活血作用机制,以期扩展黄芪的临床应用范围,为临床治疗提供理论指导。     

平肝定眩汤治疗肝阳上亢型后循环缺血性眩晕60例临床观察

目的:观察平肝定眩汤对肝阳上亢型后循环缺血性眩晕的疗效。方法:选取2017年6月-2018年10月烟台业达医院收治的后循环缺血性眩晕的患者120例,按随机数字表法分为治疗组和对照组。治疗组和对照组各60例,两组一般的资料经统计学方法,差异无统计学意义(P>0.05),具有可比性。两组均给予改善循环,控制血压、血糖,调节血脂,抗血小板聚集等基础治疗。治疗组给予平肝定眩汤,对照组给予平眩胶囊。两组疗程均为4周,观察两组患者治疗前后总体症状,脑血流速度、血脂、血糖等指标改善情况。采用SPSS 11.0统计学软件进行计算。结果:治疗组总有效率91.7%(55/60),对照组总有效率61.6%(37/60),两组疗效比较有统计学意义(P<0.05)。治疗组三酰甘油(Triglyceride,TG)、血清总胆固醇(Serum Total Cholesterol,TC)、HDL-C、LDL-C治疗后显著改善,与治疗前比较,差异有统计学意义(P<0.05);对照组TG及TC治疗前后差异有统计学意义(P<0.05),高密度脂蛋白胆固醇(High Density Liptein Cholesterol,HDL-C)及低密度脂蛋白胆固醇(Low Density Liptein Cholesterol,LDL-C)治疗前后比较,差异无统计学意义(P>0.05)。两组治疗后TC比较,差异有统计学意义(P<0.05)。两组治疗后空腹血糖(Fasting Plasma Glucose,GLU)明显降低(P<0.05),两组间的治疗后比较,差异无统计学意义(P>0.05)。治疗组治疗后椎动脉(Vertebral Artery,VA)、基底动脉(Basilarartery,BA)平均血流速度(Mean Blood Flow Velocity,VM)明显提高,与对照组治疗后相比较,差异具有统计学意义(P<0.05)。结论:平肝定眩汤治疗后循环缺血性眩晕在改善患者症状、降低血液黏稠度,改善脑血流状况方面疗效显著。     

SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性和安全性观察

目的 观察SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性及安全性。 方法 回顾性分析2017年2月-2018年11月于大连市中心医院采用SWIM技术治疗的后循环大血管闭 塞所致急性缺血性卒中患者的临床资料，评价该技术的疗效和安全性，并分析影响患者预后的因素。 观察指标为术后即刻成功再通（mTICI≥2b）、90 d良好预后（mRS评分≤2分），以及术后24 h任何颅内 出血、90 d全因死亡。 结果 共纳入35例患者，平均年龄66.1±12.1岁，男性26例（74.3%），基线NIHSS评分22（15～34）分。 术后即刻成功再通率为94.3%（33/35），90 d良好预后率为45.7%（16/35），24 h颅内出血率为17.1% （6/35），90 d全因死亡率为37.1%（13/35）。单因素分析显示，基线NIHSS评分较低（P =0.001）、基 线后循环ASPECTS评分较高（P =0.016）、发病至到院时间较短（P =0.039）、发病至再通时间较短 （P =0.047）、血管成功再通率较高（P =0.036）以及饮酒比例较低（P =0.042）与良好预后相关。 结论 使用SWIM技术治疗后循环急性缺血性卒中相对安全、有效。