血栓抽吸联合PCI术前阿托伐他汀强化治疗急性ST段抬高型心肌梗死

目的:探讨急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗(PCI)中应用GOODMAN血栓抽吸装置联合术前阿托伐他汀强化治疗对心肌组织灌注及临床预后的影响.方法:选择梗死相关血管心肌梗死溶栓试验血流0级的急性ST段抬高型心肌梗死患者80例,随机分为血栓抽吸联PCI术前阿托伐他汀强化治疗组(试验组)40例和标准PCI治疗组(对照组)40例.比较两组患者术后心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、心电图ST段回落百分比、左心室射血分数(LVEF)及住院期间主要心血管不良事件(MACE).结果:试验组TIMI血流分级、TMPG、ST段回落百分比、LVEF均明显优于对照组(P＜0.05).两组患者住院期间MACE发生率比较,差异无统计学意义(P＞0.05).结论:在急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗(PCI)中应用血栓抽吸联合术前阿托伐他汀强化治疗安全可行,可有效清除冠状动脉内血栓,改善心肌组织灌注及术后心脏功能,并且不增加主要心血管事件的发生率.     

衰弱对老年急性冠脉综合征患者短期预后的影响

目的:探讨衰弱对老年急性冠脉综合征(ACS)患者短期预后的影响。方法:选择2015年8月1日至2015年12月31日在我院老年医学中心住院的181例ACS患者为研究对象。全面评估患者临床特征和合并症情况,采用国际老年营养学会提出的简易虚弱问卷(FRAIL)评估患者的衰弱情况,并根据评估结果将患者分为衰弱组(n=108)和非衰弱组(n=73)。采用门诊随访和电话随访的方式进行3个月随访,分析衰弱对ACS患者预后的影响。结果:共有181例患者纳入研究,随访率100%,其中衰弱患者108例(59.67%)。随访期两组患者再住院、全因死亡和再发急性心肌梗死等随访终点事件发生率比较,差异均有统计学意义(P0.05)。多因素Logistic回归分析结果提示衰弱是老年ACS患者短期再住院、全因死亡和再发急性心肌梗死的独立风险因素(OR=3.286,4.976,4.346;P=0.032,0.022,0.012)。结论:衰弱是老年ACS患者再住院、全因死亡和再发急性心肌梗死等短期预后的独立风险因素。     

急性ST 段抬高心肌梗死患者多支病变血运重建治疗策略的临床研究

目的:分析急性ST段抬高心肌梗死(acute ST segmentelevation myocardial infarction,STEMI)伴多支血管病变行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的策略,制定患者血运重建时机及最佳方案。方法:收集2008.10-2012.10期间急性ST段抬高心肌梗死伴多支血管病变行急诊PCI治疗患者资料,其中仅行罪犯血管PCI治疗组162例,多支血管PCI治疗组50例、阶段PCI治疗组112例,分析比较各组间短期(3个月)死亡率和1年、2年、3年死亡率及主要心血管事件(major cardiovascularevents,MACE)发生率。结果:①多支血管PCI组较罪犯血管PCI组有更高的短期死亡率(4.0%vs 2.5%,P0.05),但其降低MACE发生率(12.0%vs 15.4%,P0.05);②阶段PCI组较罪犯血管PCI组有更低的死亡率(短期和1年、2年、3年死亡率均P0.05)及MACE发生率(11.6%vs 15.4%,P0.05);③多支血管PCI组较阶段PCI组有更高的短期死亡率(4.0%vsl.8%,P0.05),长期随访无明显不同(6.0%vs 5.4%,P0.05);MACE的发生率无明显差异(12.0%vs 11.6%,P0.05)。结论:当血流动力学稳定时,合并多支血管病变的急性ST段抬高心肌梗死仅对罪犯血管行PCI,随后行阶段PCI处理非梗死病变血管,这一策略能显著改善患者的临床预后。     

高龄ST段抬高心肌梗死患者经皮冠状动脉介入术后的院内预后及其影响因素分析

目的:探讨高龄ST段抬高心肌梗死(STEMI)患者行直接经皮冠状动脉介入(PCI)术后住院期间的预后情况及其影响因素。方法:回顾性分析2009年1月至2013年12月因STEMI入住我院并行直接PCI的高龄患者(年龄≥75岁)的一般情况、既往史、入院情况、术中及术后情况、并发症等资料,总结分析该类患者住院期间的临床预后,并采用logistic回归模型对可能影响住院期间主要不良心脏事件(MACE)的危险因素进行分析。结果:研究共纳入127例患者,其中男性84例(66.14%),女性43例(33.86%),年龄79±3岁,住院时间13.07±7.80天,住院期间MACE的发生率为17.32%,其中死亡4例(3.15%)。单因素logistic回归分析显示入院时心功能(Killip分级)≥2级、完全性房室传导阻滞、窦性停搏与高龄STEMI患者直接PCI术后住院期间MACE的发生相关,具有统计学意义(P0.05)。而多因素logistic回归分析显示入院时心功能(Killip分级)和完全性房室传导阻滞是高龄STEMI患者住院期间MACE的危险因素。结论:高龄STEMI患者接受直接PCI治疗总体安全,影响其住院期间MACE的危险因素包括心功能不全和完全性房室传导阻滞。     

急性心肌梗死PCI术后早期T波倒置与左室功能的关系

目的:探讨急性ST段抬高心肌梗死直接PCI术后早期T波倒置与左心室功能的关系.方法:对急性ST段抬高心肌梗死直接PCI术后78例患者,以24小时抬高的T波是否倒置分组,采用超声心动描记术检测左室射血分数、心肌活动指数,评价早期T波倒置与左室功能的关系.结果:早期T波倒置组左心功能优于T波未倒置组(P＜0.01),T波深倒置组左心功能优于浅倒置组(P＜0.05).结论:急性ST段抬高心机梗死早期T波倒置可早期评估左心功能、判断预后.     

影响儿童重症病房新生儿发生急性肾损伤及预后相关因素分析

目的:评估在儿童重症病房(PICU)中治疗的新生儿发生急性肾损伤(AKI)及影响预后的相关因素。方法:对在我院PICU治疗的215例新生儿进行回顾性研究,采用KDIGO标准对患儿进行诊断与分级,根据新生儿是否发生AKI将新生儿分为AKI组(n=75)与非AKI组(n=140),收集并比较二组患者的临床资料,采用多元逻辑回归分析PCIU新生儿发生AKI的危险因素与AKI预后相关因素。结果:单因素逻辑回归分析表明,菌血症(OR=5.34,95%CI:1.37-20.33,P=0.013)、较低基线e GFR(OR=0.93,95%CI:0.89-0.97,P=0.002)与最大钠浓度(OR=1.11,95%CI:1.03-1.25,P=0.022)为新生儿发生AKI的独立相关因素。死亡率、长期LMV只与AKI(Ⅱ+Ⅲ)阶段相关(P0.05),而LOS无论调整前后均只与AKI(Ⅱ+Ⅲ)阶段相关(P0.05)。结论:PCIU治疗的AKI新生儿死亡率增加,菌血症、较低基线估计肾小球滤过率和最大钠浓度与急性肾损伤独立相关。     

不同输血策略对ICU贫血患者预后的影响

目的:分析输血策略对ICU贫血患者预后的影响。方法:采用限制性输血患者54例纳入A组,采用开放性输血患者50例纳入B组,调取相关资料,进行对比分析,并将患者预后分为死亡(n=6)、恶化(n=31)与好转(n=67)三类,其中死亡与恶化合计为预后不佳,进行多因素Logistic回归分析。结果:A组入院基础、ICU输红细胞前、出院时Hb值低于B组,器官衰竭个数高于B组,差异具有统计学意义(P0.05);APACHEⅡ评分(OR=0.93,95%CI0.89-0.92)、ICU输红细胞前Hb值(OR=0.99,95%CI0.94-1.02)、器官衰竭数量(OR=0.57,95%CI0.34-1.04)成为患者预后不佳独立风险因素,差异具有统计学意义(P0.05)。     

不同类型急性冠脉综合征患者心电图改变及临床意义研究

目的:研究不同类型急性冠脉综合征(ACS)患者的心电图改变及其临床意义。方法:选取我院心血管科收治的ACS患者285例,分为非ST段抬高性心肌梗死组(NSTEMI,153例)和ST段抬高性心肌梗死组(STEMI,132例)。记录两组患者心电图发生ST段改变导联数,利用冠状动脉造影确定受累血管数及狭窄程度。结果:NSTEMI组患者单支血管受累比例低于STEMI组,多支血管受累比例高于STEMI组,差异具有统计学意义(P0.05);两组患者血管狭窄程度无明显差异(P0.05)。NSTEMI组发生ST段改变的导联数与冠脉血管受累数目存在正相关(r=0.355,P=0.000),与血管狭窄程度无明显相关性(r=0.576,P=0.176)。STEMI组发生ST段改变的导联数与冠脉血管受累数目及血管狭窄程度均无明显相关性(r=-0.005,0.153;P=0.927,0.221)。结论:非ST段抬高性心肌梗死患者以多支血管受累为主,且发生ST段改变的导联数越多,发生多支血管受累的几率越大,ST段抬高性心肌梗死患者以单支血管受累为主。     

主动脉内球囊反搏术在急性心肌梗死患者中的临床应用

目的:探讨主动脉内球囊反搏术(IABP)在急性心肌梗死(AMI)患者中的临床应用.方法:收集从2008年1月至2008年12月因急性心肌梗死急诊入住我院CCU并行IABP及经皮冠状动脉介入治疗(PCI)病例32例,回顾性分析患者的临床特征、冠脉造影及介入治疗情况,观察使用IABP前后患者心率血压变化,IABP相关并发症,住院期间死亡率.结果:急性心肌梗死患者入院后及时在IABP支持下成功完成急诊PCI手术,患者应用IABP治疗后心率血压均得到明显改善.IABP相关并发症发生率仅9例,严重并发症0例,无术中死亡,住院期间死亡3例,其中合并心源性休克死亡2例.结论:主动脉内球囊反搏术在急性心肌梗死患者中的应用安全、有效,显著降低了急性心肌梗死患者的住院期间死亡率.     

经血栓抽吸导管应用替罗非班及硝普钠对急性前壁ST段抬高型心肌梗死患者急诊PCI治疗效果的影响

目的:探讨经血栓抽吸导管应用替罗非班及硝普钠对急性前壁ST段抬高型心肌梗死患者急诊经皮冠状动脉介入(PCI)治疗效果的影响。方法:选取2013年5月～2018年5月期间我院收治的急性前壁ST段抬高型心肌梗死患者80例,根据随机数字表法分为对照组(n=40,血栓抽吸术后行PCI治疗)和研究组(n=40,血栓抽吸术后,经导管注入替罗非班及硝普钠后再行PCI治疗),比较两组患者心电图ST段回落变化、心肌梗死溶栓治疗(TIMI)血流分级情况、心功能指标及不良心血管事件发生率。结果:研究组完全回落发生率高于对照组(P0.05);两组部分回落、无回落发生率比较差异无统计学意义(P0.05)。对照组PCI术后TIMI血流分级为3级的例数少于研究组(P0.05)。两组患者术后7 d左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)降低,且研究组低于对照组(P0.05);左室射血分数(LVEF)升高,且研究组高于对照组(P0.05)。术后6个月内研究组不良心血管事件总发生率为7.50%(3/40),低于对照组的25.00%(10/40)(P0.05)。结论:急性前壁ST段抬高型心肌梗死患者经血栓抽吸导管应用替罗非班及硝普钠后行PCI,可提高心功能、心肌灌注状态及心电图ST段完全回落率,并减少不良心血管事件的发生率。     

Recent advances in the study of Kaposi's sarcoma-associated herpesvirus replication and pathogenesis

It has now been over twenty years since a novel herpesviral genome was identified in Kaposi's sarcoma biopsies. Since then, the cumulative research effort by molecular biologists, virologists, clinicians, and epidemiologists alike has led to the extensive characterization of this tumor virus, Kaposi's sarcoma-associated herpesvirus(KSHV; also known as human herpesvirus 8(HHV-8)), and its associated diseases. Here we review the current knowledge of KSHV biology and pathogenesis, with a particular emphasis on new and exciting advances in the field of epigenetics. We also discuss the development and practicality of various cell culture and animal model systems to study KSHV replication and pathogenesis.     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

The structure, reproduction and taxonomy of Vidalia and Osmundaria (Rhodophyta, Rhodomelaceae)

Comprises species occurring mostly in subtidal habitats in tropical, subtropical and warm-temperate areas of the world. An analysis of the type species, V. spiralis (Sonder) Lamouroux ex J. Agardh, a species from Australia, establishes basic characters for distinguishing species in the genus. These characters are (1) branching patterns of thalli, (2) flat blades that may be spiralled on their axis, (3) width of the blade, (4) primary or secondary derivation of sterile and fertile branchlets and (5) position of sterile and fertile branchlets on the thalli. Application of the latter two characters provides an important basic method for separation of species into three major groups. Osmundaria , a genus known only in southern Australia, was studied in relation to Vidalia , and its separation from the Vidalia assemblage is not accepted. Species of Vidalia therefore are transferred to the older genus name, Osmundaria. Two new species, Osmundaria papenfussii and Osmundaria oliveae are described from Natal. Confusion in the usage of the epithet, Vidalia fimbriala Brown ex Turner has been clarified, and Vidalia gregaria Falkenberg, described as an epiphyte on Osmundaria pro/ifera Lamouroux, is revealed to be young branches of the host, Osmundaria prolifera.     

New or rare chromosome counts in Artemisia L. (Asteraceae, Anthemideae) and related genera from Kazakhstan

Fifteen chromosome counts of six Artemisia taxa and one species of each of the genera Brachanthemum, Hippolytia, Kaschgaria, Lepidolopsis and Turaniphytum are reported from Kazakhstan. Three of them are new reports, two are not consistent with previous counts and the remainder are confirmations of very scarce (one to four) earlier records. All the populations studied have the same basic chromosome number, x = 9, with ploidy levels ranging from 2x to 6x. Some correlations between ploidy level, morphological characters and distribution are noted.