不同年龄段急性心肌梗死患者发病时间特征及预后分析

目的 分析不同年龄段急性心肌梗死(AMI)患者发病时间特征及预后情况。方法 回顾分析2012年1月至2015年6月收治的124例AMI患者临床资料,所有患者均行经皮冠状动脉腔内成形术(PTCA)治疗。将患者按不同年龄段分为A、B、C组3组。A组40例(38~49岁),B组43例(50~75岁),C组41例(76~81岁),比较分析每一组患者的支架植入率、血管开通时间、治疗情况、并发症、发病时间段、心肌标志物及预后情况。结果 3组患者经皮冠状动脉腔内成形术(PTCA)顺利,均获急性心肌梗死冠状动脉内溶栓后血流(TIMI)≥3级分流。A组支架置入率和术后并发症发生率较B、C两组少(P<0.05)。A组罪犯血管开通时间≤12 h,所占比例较B、C两组多(P<0.05)。A组合并糖尿病、高血压和高血脂症比例低于B、C两组(P<0.05),B、C两组并发症比例相当(P>0.05)。A组患者好发高峰时间为6:00~12:00,B、C两组好发高峰时间段0:00~6:00。3组心肌标志物比较中,A组CK升高显著高于B、C两组(P<0.05)。A、B、C3组患者院内病情好转率分别为95%、88.4%、83%,比较差异有统计学意义(P<0.05)。结论 不同年龄段AMI患者发病时间有一定的规律性,50岁以下患者较50岁以上患者院内预后好,应积极治疗;对于高龄患者,应注重术后并发症的预防和治疗。     

75岁以上老年人急性心肌梗死286例临床分析

目的 分析75岁以上老年人急性心肌梗死(AMI)的临床特点.方法 回顾性分析北京安贞医院自2008年8月至2011年5月收治的286例年龄＞75岁的AMI患者的临床资料,该组患者作为A组.选取同期75岁以下的AMI患者260例为B组.对2组的临床表现进行比较.结果 A组患者中182例(63.6％)无胸痛而有上腹痛、咽痛等其他重要表现,明显高于B组[ 52例(20.0％)],差异有统计学意义(P＜0.01).A组与B组病死率分别为16.3％(45/286)和3.3％ (8/260),A组病死率明显高于B组(P＜0.01).结论 75岁以上老年人AMI症状不典型,病死率高,临床应重视无胸痛者的其他重要初发症状.     

青年男性急性心肌梗死危险因素和冠状动脉造影特征

目的 探讨青年男性急性心肌梗死(AMI)发病危险因素及冠状动脉(冠脉)病变特点.方法 回顾性分析247例AMI男性患者临床资料.其中,青年(年龄21-44岁)患者88例(A组),中年(年龄45-59岁)患者159例(B组),分析两组AMI相关发病危险因素及冠脉病变年龄差异.结果 A组早发冠心病家族史、超重、不良生活方式患者比例及血清总胆固醇(TC)和低密度脂蛋白(LDL)水平均高于B组(P＜0.05).A组单支病变、冠脉Gensini总积分＜4分者多于B组,而多支病变者、冠脉Gensini总积分、罪犯血管Gensini积分少于B组(P＜0.05).结论 早发冠心病家族史、超重、不良生活习惯及高TC和LDL水平为青年早发AMI的关键因素,其中不良生活习惯为最重要因素.     

肌钙蛋白峰值与急性心肌梗死患者早期预后的关系探讨

目的 探讨急性心肌梗死( AMI)患者肌钙蛋白I(cTnI)峰值与早期预后的相关性.方法 收集2008年1月至2010年12月本院住院AMI患者162例的临床资料进行回顾性分析.根据cTnI峰值水平将患者分为A(cTnI ＜6 μg/L)、B( cTnI 6～60μg/L)、C(cTnI＞ 60 μg/L)3组,分别为48、96、18例.分析不同cTnI峰值水平与左心室射血分数(LVEF)、心源性休克发生率、新发心力衰竭发生率和院内死亡率之间的相关性.结果 A、B、C组cTnI峰值及LVEF分别为(2.4±1.6) μg/L、(55.5±4.3)％,(22.8士14.2)μg/L、(52.8±4.7)％,( 157.4±115.9) μg/L、(45.2±5.2)％.A组cTnI峰值最低,而LVEF值最高;C组cTnI峰值最高,而LVEF值则最低.A组与B组LVEF差异无统计学意义(P＞0.05),而C组与A组或B组差异均有统计学意义(P＜0.05).A组无死亡病例,心源性休克及新发心力衰竭的发生率最低[分别为2.1％(1/48)、6.2％ (3/48)],B组院内死亡率为4.2％(4/96),心源性休克及新发心力衰竭的发生率分别是7.3％(7/96)和18.7％(18/96),与A组相比,差异均无统计学意义(P＞0.05).C组院内死亡率达27.8％(5/18),心源性休克发生率38.9％(7/18),新发心力衰竭发生率为55.6％ (10/18).C组与A组及B组比较,差异均有统计学意义(P＜0.05).结论 cTnI峰值与AMI的早期预后密切相关,cTnI峰值越高其早期预后越差,LVEF越低,新发心力衰竭、心源性休克发生率及院内死亡率越高.     

急性心肌梗死患者介入治疗后心肌组织再灌注不良

目的 探讨急性心肌梗死(AMI)行急诊经皮冠状动脉介入(PCI)治疗后心肌再灌注不良及其对临床预后的影响.方法 回顾性分析68例AMI急诊PCI治疗患者(36-85岁)的临床资料.以ST段回落程度与心肌梗死溶栓治疗心肌灌注分级评估心肌组织再灌注状态,并将患者分为四组:A组27例(39.7％),再灌注良好;D组10例(14.7％),再灌注不良;B组20例(29.4％)和C组11例(16.2％)的再灌注状态介于A、D组之间.分析随访期间严重心血管不良事件(SCAE)的发生风险.结果 与A组比较,D组患者的左室射血分数低、梗死后心绞痛和远端栓塞发生率高、应用主动脉内气囊反搏辅助者比率增加、住院时间长、心源性病死率高(P＜0.05).以D组作为参照绘制生存曲线显示,A组随访期间SCAE的发生风险为2.7％(P＜0.01),C和B组分别为43.0％(P＞0.05)和24.0％ (P＜0.01).结论 AMI行急诊PCI治疗后致病血管再通者中,仅有不到40％患者的心肌组织得到了良好的再灌注,近、远期预后较好;有超过10％的患者心肌组织处于较差的再灌注状态,存在极高的SCAE发生风险.     

急性心肌梗死发病清晨高峰现象的影响因素分析

目的 探讨急性心肌梗死(AMI)发病清晨高峰现象的影响因素.方法 连续入选2002年10月到2006年9月北京大学人民医院发病时间明确的AMI患者,共874例.统计AMI发病时间的昼夜节律,找出AMI发病的清晨高峰,用多元非条件Logistic回归分析探寻AMI发病清晨高峰的影响因素.结果 AMI的发病时间有明显的昼夜节律,高峰在6:01～9:00时(146例,16.7%,与其他时间段比较,P＜0.05).多元非条件Logistic回归分析显示,男性(OR=1.74,95%CI:1.11～2.73,P＜0.05)、高血压病史(OR=1.71,95%CI:1.17～2.51,P＜0.01)和梗死前心绞痛(OR=1.61,95%CI:1.08～2.38,P＜0.05)是AMI发病清晨高峰的独立危险因素.结论 AMI的发病时间有明显的清晨高峰现象,男性、高血压病史和梗死前心绞痛是AMI发病清晨高峰的独立危险因素.

Abstract：

Objective To investigate the morning peak of onset time in patients with acute myocardial infarction(AMI) and its risk factors. Methods A retrospective analysis of patients(n = 874) diagnosed with AMI between October 2002 and September 2006 in Peking University people's hospital was carried out. We calculated the number and the percentage of AMI cases and found out the morning peak time of AMI's onset. The clinical factors in relation to the peak time of AMI's onset were analyzed using multivariate unconditional Logistic regression. Results There was a circadian rhythm of AMI with a peak incidence during 6:01-9:00 (P＜0. 05, compared with other times). Logistic regression analysis showed that the risk factors of the morning peak of AMI's onset included men (0R= 1.74, 95% CI: 1.11-2.73, P＜0.05), the history of hypertension (OR =1.71, 95% CI:1. 17-2.51, P＜ 0.01) and the preinfarction angina(OR = 1.61, 95%CI:1.08-2. 38, P＜0.05). Conclusions AMI is more likely to happen in the morning hours. Men, hypertension and the preinfarction angina are the independent risk factors associated with AMI's onset.     

急性心肌梗死患者行冠状动脉介入术后心电图演变与心功能的关系

目的 探讨对急性ST段抬高型心肌梗死(AMI)患者行急诊冠状动脉介入术(PCI)后ST段回落程度、T波早期倒置与心功能及预后的关系.方法 ST段抬高型前壁AMI接受PCI患者62例,其中男40例,女22例.按PCI术后1hST段回落程度分两组:ST段回落≥50％组(A组,n=52),ST段回落＜50％组(B组,n=10);按术后24hT波是否倒置再分为两组:倒置组(C组,n=47),未倒置组(D组,n=15).观察A、B及C、D组6个月内左心功能改善的差异.结果 A组、C组患者6个月内左心功能恢复优于B组、D组(P＜0.05).结论 AMI患者PCI再灌注治疗后对ST段和T波的分析是一种简便、实用的预测心功能的方法.     

急性心肌梗死急诊溶栓的临床观察

目的探讨急性心肌梗死(AMI)急诊溶栓的疗效和安全性。方法60例AMI患者被随机分为急诊溶栓组(A组)和入院后溶栓组(B组),各30例。A组患者诊断为AMI后,在急诊科立即给予尿激酶(UK)静脉点滴,B组患者按常规办完入院手续后再按上述方法溶栓治疗。结果从发病到开始溶栓的时间: A组(145±33)min,B组(253±116)min(P<0．05)。梗死相关血管开通率:A组86．7％,B组63．3％(P< 0．05)。A、B两组的并发症发生率相似。结论急诊溶栓可缩短AMI患者溶栓开始的时间,增加冠状动脉的再通率,安全可行。     

老年急性心肌梗死患者梗死前心绞痛与临床预后的关系（附78例分析）

目的 评估老年急性心肌梗死(AMI)患者梗死前心绞痛(PIA)与临床预后之同的关系.方法 78例ST段抬高型AMI患者分为两组:A组46例PIA患者与B组32例无PIA患者.观察两组基础临床情况、梗死后心绞痛、心衰、住院期间及随访30天主要心脏不良事件(MACE,死亡/再梗死/再次靶血管重建)发生率.结果 78例患者平均年龄71.5岁,男52例(66.7%),女26例(33.3%).伴随高血压患者62例(79.4%),糖尿病17例(21.8%),高脂血症19例(24.4%).心功能Killip I级58例(74.3%).A、B两组病人临床终点事件比较:梗死后心绞痛发生率(9.5%与20%,P=0.63);心衰发生率(23.6%与13.1%,P=0.67),住院期间及随访30天,MACE发生率(4.3%与3.1%,P=1.00).结论 本组研究认为老年AMI患者梗死前心绞痛与临床预后无明显相关性.     

溶栓治疗31例高龄急性心肌梗死临床观察

目的:探讨高龄急性心肌梗死(AMI)患者溶栓治疗的临床疗效.方法:将64例AMI患者按年龄分为2组,其中≥70岁组31例,＜70岁组33例.所有患者均采用尿激酶150万U溶栓治疗,比较2组治疗效果及预后.结果:≥70岁组预后良好者26例(83.87%),死亡5例(16.13%);＜70岁组预后良好者29例(87.88%),死亡4例(12.12%).2组比较无显著性差异(P＞0.05).结论:≥70岁高龄AMI病人对溶栓治疗仍然安全有效.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.