Therapeutic options and heart failure survival score predictability in an academic heart failure center: an analysis of 120 consecutive patients during a 1-year period

BACKGROUND: the incidence and prevalence of patients with advanced heart failure is increasing worldwide and the number of cardiac transplantations remains limited. AIMS: it was the aim of the study to describe our experience with the increasing number of available medical, interventional and cardiac surgery options, and to assess heart failure survival score predictability in an academic heart failure center within a 1-year follow-up. METHODS AND RESULTS: in all patients who were referred for cardiac transplant evaluation within a 12-month period between April 1998 and March 1999 at our Interdisciplinary Heart Failure and Transplant Program, our team assessed all medical interventions as well as interventional and surgical treatment options that were available, based on the clinical profile on initial presentation. In 92% of the 120 patients referred for cardiac transplantation evaluation, drug therapy could be optimized. A considerable number of patients could be subjected to an organ-preserving intervention or surgery, either PTCA (n=11), CABG (n=4), valve repair (n=7), multisite pacing (n=7), or partial ventricular resection (n=5). Only a small group of patients with the worst heart failure survival score were listed for heart transplantation (n=17) or received a ventricular assist device (n=3). CONCLUSIONS: within a contemporary cohort of advanced heart failure patients, only a small number of patients will undergo cardiac transplantation, which is predictable by the heart failure survival score. Most patients will undergo optimized medical therapy and a considerable number will be subjected to interventional or surgical treatment options.     

Phosphorylation of human cardiac troponin I G203S and K206Q linked to familial hypertrophic cardiomyopathy affects actomyosin interaction in different ways

cAMP-dependent protein kinase (PKA)-dependent phosphorylation of the two serine residues in the amino terminal region unique to cardiac troponin I (cTnI) is known to cause two effects: (i) decrease of the maximum Ca2+-controlled thin filament-activated myosin S1-ATPase (actoS1-ATPase) activity and mean sliding velocity of reconstituted thin filaments; (ii) rightward shift of the Ca2+ activation curves of actoS1-ATPase activity, filament sliding velocity, and force generation. We have studied the influence of phosphorylation of human wild-type cTnI and of two mutant cTnI (G203S and K206Q) causing familial hypertrophic cardiomyopathy (fHCM) on the secondary structure by circular dichroism spectroscopy and on the Ca2+ regulation of actin-myosin interaction using actoS1-ATPase activity and in vitro motility assays. Both mutations slightly influence the backbone structure of cTnI but only the secondary structure of cTnI-G203S is also affected by bis-phosphorylation of cTnI. In functional studies, cTnI-G203S behaves similarly to wild-type cTnI, i.e. the mutation itself has no measurable effect and bis-phosphorylation alters the actoS1-ATPase activity and the in vitro thin filament motility in the same way as does bis-phosphorylation of wild-type cTnI. In contrast, the mutation K206Q leads to a considerable increase in the maximum actoS1-ATPase activity as well as filament motility compared to wild-type cTnI. Bis-phosphorylation of this mutant cTnI still suppresses the maximum actoS1-ATPase activity and filament sliding velocity but does no longer affect the Ca2+ sensitivity of these processes. Thus, these two fHCM-linked cTnI mutations, although reflecting similar pathological situations, exert different effects on the actomyosin system per se and in response to bis-phosphorylation of cTnI.     

Circadian 5-HT production regulated by adrenergic signaling

Using on-line microdialysis, we have characterized in vivo dynamics of pineal 5-hydroxytryptamine (5-HT; serotonin) release. Daily pineal 5-HT output is triphasic: (i) 5-HT levels are constant and high during the day; (ii) early in the night, there is a novel sharp rise in 5-HT synthesis and release, which precedes the nocturnal rise in melatonin synthesis; and (iii) late in the night, levels are low. This triphasic 5-HT production persists in constant darkness and is influenced strongly by intrusion of light at night. We demonstrate that both diurnal 5-HT synthesis and 5-HT release are activated by sympathetic innervation from the superior cervical ganglion and show that these processes are controlled by distinct receptors. The increase in 5-HT synthesis is controlled by beta-adrenergic receptors, whereas the increase in 5-HT release is mediated by alpha-adrenergic signaling. On the other hand, the marked decrease in 5-HT content and release late at night is a passive process, influenced by the extent of melatonin synthesis. In the absence of melatonin synthesis, the late-night decline in 5-HT release is prevented, reaching levels roughly twice as high as that of the day value. In summary, our results demonstrate that 5-HT levels display marked circadian rhythms that depend on adrenergic signaling.     

High-fat diet intake from senescence inhibits the attenuation of cell functions and the degeneration of villi with aging in the small intestine,and inhibits the attenuation of lipid absorption ability in SAMP8 mice

We examined the effect of a high-fat diet from senescence as a means of preventing malnutrition among the elderly. The senescence-accelerated mouse P8 was used and divided into three groups. The 6C group was given a normal diet until 6 months old. The 12N group was given a normal diet until 12 months old. The 12F group was given a normal diet until 6 months old and then a high-fat diet until 12 months old. In the oral fat tolerance test, there was a decrease in area under the curve for serum triacylglycerol level in the 12N group and a significant increase in the 12F group, suggesting that the attenuation of lipid absorption ability with aging was delayed by a high-fat diet from senescence. To examine this mechanism, histological analysis in the small intestine was performed. As a result, the degeneration of villi with aging was inhibited by the high-fat diet. There was also a significant decrease in length of villus in the small intestine in the 12N group and a significant increase in the 12F group. The high-fat diet from senescence inhibited the degeneration of villi with aging in the small intestine, and inhibited the attenuation of lipid absorption ability.     

神经外科病房多重耐药菌感染的临床特点和护理对策

[目的]分析神经外科病房多重耐药菌(MDRO)感染的特点,探讨相应的护理对策。[方法]将2012年1月—2014年8月神经外科病房的56例培养标本作为研究对象,分析 MDRO 的数量、种类和感染部位。[结果]56份培养标本细菌耐甲氧西林金黄色葡萄球菌占37.50%、铜绿假单胞菌占25.00%、肺炎克雷伯菌占17.86%、大肠埃希菌占12.50%、鲍曼不动杆菌占7.14%,主要感染部位呼吸道占50.00%、泌尿道占25.00%、血液占1 9.64%、切口占5.36%。[结论]加强对各类人员的培训和宣教,积极实施护理干预可降低神经外科病房 MDRO 发生几率。     

酒依赖患者病情观察及护理干预

通过对56例酒依赖患者进行病情观察,制定相应的护理措施并实施,可以帮助患者减轻戒断症状及并发症,安全度过戒断期,从心理及生理上缓解或消除对酒的依赖,提高患者生活质量。     

正常孕11~16周孕妇子宫动脉血流多普勒特征的研究

目的分析正常孕11~16周孕妇子宫动脉血流多普勒超声特征。方法选取广州市妇女儿童医疗中心297名正常孕11~16周的单胎孕妇,根据每一孕周为一组共分为6组(11~11+6周、12~12+6周、13~13+6周、14~14+6周、15~15+6周、16~16+6周);按胎盘位置分为居中组、右侧组、左侧组;按子宫动脉阻力指数(RI)分为<0.60组、0.60~0.69组、0.70~0.79组、0.80~0.85组及≥0.85组;分析不同孕周、不同胎盘位置的子宫动脉的多普勒参数特征,及子宫动脉不同RI值舒张早期α切迹的出现频率。结果 (1)子宫动脉的平均双侧子宫动脉收缩期最大血流速度(S)与舒张末期血流速度(D)比值(S/D)、搏动指数(PI)、阻力指数(RI)随孕周增加而下降,但RIm、S/Dm值在各孕周之间差异无统计学意义;孕15、16周PIm值与11、12、13、14周相比,差异有统计学意义(P值<0.05)。各孕周PIm平均值为:11周1.96±0.39、12周1.94±0.45、13周1.79±0.43、14周1.79±0.36、15周1.51±0.43、16周1.50±0.30。(2)胎盘附着侧的子宫动脉RI、PI、S/D值均低于对侧,其中左侧胎盘组双侧RI差值为-0.04(t=-3.095,P=0.005)、双侧PI差值为-0.24(t=-3.232,P=0.004)、双侧S/D差值为-1.00(t=-2.965,P=0.007);右侧胎盘组双侧RI差值为0.04(t=6.159,P=0.000)、双侧PI差值为0.43(t=6.614,P=0.000)、双侧S/D差值为2.05(t=6.378,P=0.000);居中胎盘组双侧RI差值为0.02(t=4.150,P=0.000)、双侧PI差值为0.14(t=4.475,P=0.000)、双侧S/D差值为0.54(t=4.376,P=0.000)。(3)子宫动脉按RI分组的α切迹发生率:<0.60组,双侧均为0;0.60~0.69组,左侧为0.08、右侧为0.08;0.70~0.79组中,左侧为0.34、右侧为0.31;0.80~0.85组中,左侧为0.65、右侧为0.72;≥0.85组中,右侧为0.81,左侧为0.87。结论孕11~16周子宫动脉多普勒参数有可能作为检测子宫胎盘灌注的可靠方法之一。     

新生儿肺透明膜病应用经鼻持续正压通气治疗的评价

目的检验经鼻持续正压通气对新生儿肺透明膜病(HMD)的治疗效果。方法选取2010年7月至2013年7月在湖北医药学院附属东风医院就诊的HMD患儿64例作为研究对象,男40例,女24例,所有患儿均在出生2h内转入湖北医药学院附属东风医院接受治疗。将64例患儿分为两组,每组32例。两组患儿均给予常规的基础治疗,通气组另采用小儿呼吸机进行经鼻的持续正压通气治疗,观察两组患儿治疗后住院时间、并发症发生率、肺部感染率、持续肺泡内正压参数变化、两组患儿吸入氧分数参数变化和血气分析参数。结果两组患儿的基本资料比较差异无统计学意义(P0.05)。两组患儿治愈例数、住院时间、持续肺泡内正压参数、吸入氧分数参数和血气分析参数比较差异有统计学意义(P0.05)。结论经鼻持续正压通气对HMD在常规治疗的基础上可以达到良好的治疗效果,但是容易出现肺部并发症。     

便携式血糖仪系统准确性评价及血细胞比容对其检测结果的影响

目的评价便携式血糖仪系统准确性及血细胞比容对其检测结果准确性的影响。方法参照GB/T19634-2005的要求选择50例临床标本,选择当前应用广泛的5种型号血糖仪各2台,分别进行双份测定,与己糖激酶法结果比较,评价血糖仪的系统准确性。制备高、中、低血糖浓度各5个血细胞比容水平的标本,分别用5款血糖仪测定血糖浓度,与己糖激酶法结果比较,评价不同血糖浓度水平下血细胞比容对血糖仪检测结果准确性的影响。结果按照ISO 15197:2003的准确性判断标准,StatStrip Xpress、Accu-Check、Optium Xceed、Contour TS、Rightest GM300在准确限内的结果分别为100%、99%、97%、100%、75%;按照新版ISO 15197:2013的标准,StatStrip Xpress、Accu-Check、Optium Xceed、Contour TS、Rightest GM300在准确限内的结果分别为100%、99%、92%、98%、72%。在高、中、低3种血糖浓度、5个血细胞比容水平下,StatStrip Xpress的结果符合ISO15197:2003和ISO15197:2013的准确性要求;Accu-Check的结果满足ISO 15197:2003的准确性要求;Optium Xceed、Contour TS、Rightest GM300的检测结果超出了ISO15197:2003的最低允许限或无检测结果。结论血糖仪检测体系之间的准确性差异较大,部分血糖仪符合新版ISO15197:2013标准,大部分符合ISO15197:2003的要求,个别血糖仪达不到ISO15197:2003的准确性最低标准。在使用前需要对其进行评价或验证,同一医院不同血糖仪之间需要进行比对以确保血糖结果的准确可比。