• 【慢性鼻-鼻窦炎伴哮喘的临床特点。】 复制标题 收藏 收藏
    DOI:10.1016/j.anl.2006.05.002 复制DOI
    作者列表:Kim HY,Dhong HJ,Chung SK,Chung YJ,Kim MG
    BACKGROUND & AIMS: OBJECTIVE:This study was directed at identifying clinical features of chronic rhinosinusitis with asthma, and examining the differences of the postoperative outcomes in asthmatics and nonasthmatics. STUDY DESIGN AND SETTING:Twenty-one asthmatic and 77 nonasthmatic patients who underwent functional endoscopic sinus surgery (FESS) were entered into the study. The following six parameters were determined in asthmatic and nonasthmatic groups; the presence of allergy, previous sinus surgery, severity of preoperative rhinosinusitis symptoms, improvements in postoperative rhinosinusitis symptoms, preoperative disease extent, and postoperative endoscopic outcomes. RESULTS:Symptom scores improved significantly in both asthmatics and nonasthmatics postoperatively, and asthmatics exhibited significantly worse postoperative endoscopic outcomes compared with nonasthmatics. No difference was found in other parameters between two groups. Multivariate analysis revealed asthma continues to be an independent predictor of success. CONCLUSIONS:The present study found that chronic rhinosinusitis in asthmatics showed worse postoperative outcomes than in nonasthmatics, and every attempt should be made for the improvement of surgical results in these patients.
    背景与目标:
  • 【内镜经胸交感神经切断术对严重心绞痛心率变异性的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9149(97)00169-0 复制DOI
    作者列表:Tygesen H,Claes G,Drott C,Emanuelsson H,Lomsky M,Lurje L,Rådberg G,Wennerblom B,Wettervik C
    BACKGROUND & AIMS: Endoscopic transthoracic sympathicotomy (ETS) is a recently developed technique to divide sympathetic nerves. ETS has been shown to improve symptoms and reduce ischemia in patients with severe angina pectoris. Low heart rate variability (HRV) in patients with ischemic heart disease carries an adverse prognosis. HRV reflects autonomic response of the heart and a shift in the sympathovagal balance towards parasympathetic dominance could be a marker of improved prognosis. HRV might also be used as an indicator of surgical success in sympathetic heart denervation. Heart rate was recorded in 57 patients before and after ETS. Registration was recorded during controlled respiration in the supine position and at tilt test over 10 minutes and spectral analysis was performed. Twenty-four hour Holter recordings were analyzed in the time domain. During the controlled setting, the high-frequency (HF) component (0.15 to 0.40 Hz) increased significantly whereas the low-frequency (LF) component (0.04 to 0.15 Hz) did not change significantly. The LF/HF ratio at tilt test was reduced from 1.3 to 0.8 (p <0.01). The time-domain analysis showed a significant increase of the mean RR interval (923 to 1,006 ms, p <0.001) and indexes reflecting parasympathetic tone also increased significantly (the root-mean square of difference measured from 24.3 to 29.5 ms, p <0.001 and the proportion of adjacent RR intervals >50% measured from 5.5% to 8.2%, p <0.01), whereas measurements reflecting global HRV did not change. In addition to relief of symptoms and reduced ischemia in severe angina pectoris, ETS caused a shift of sympathovagal balance toward parasympathetic tone. This might explain the anti-ischemic effect and have prognostic implications.

    背景与目标: 内镜经胸交感神经切开术 (ETS) 是最近开发的一种分裂交感神经的技术。ETS已被证明可以改善严重心绞痛患者的症状并减少缺血。缺血性心脏病患者的低心率变异性 (HRV) 具有不利的预后。HRV反映了心脏的自主反应,交感神经平衡向副交感神经优势的转变可能是预后改善的标志。HRV也可以用作交感神经去神经支配手术成功的指标。在ETS前后记录了57例患者的心率。在仰卧位和倾斜测试的控制呼吸过程中记录了10分钟以上的记录,并进行了光谱分析。在时域中分析了24小时Holter记录。在受控设置期间,高频 (HF) 分量 (0.15至0.40Hz) 显着增加,而低频 (LF) 分量 (0.04至0.15Hz) 没有显着变化。倾斜试验时的LF/HF比从1.3降低到0.8 (p <0.01)。时域分析显示,平均RR间隔显着增加 (923至1,006 ms,p <0.001),反映副交感神经张力的指标也显着增加 (从24.3至29.5 ms测量的均方根差异,p <0.001和相邻RR区间的比例> 50% 从5.5% 到8.2% 测量,p <0.01),而反映整体HRV的测量没有变化。除了缓解症状和减少严重心绞痛的缺血外,ETS还导致交感神经平衡向副交感神经张力转移。这可能解释了抗缺血作用并具有预后意义。
  • 【持续静脉和皮下吗啡治疗慢性癌症疼痛的前瞻性,患者内交叉研究。】 复制标题 收藏 收藏
    DOI:10.1016/s0885-3924(96)00329-6 复制DOI
    作者列表:Nelson KA,Glare PA,Walsh D,Groh ES
    BACKGROUND & AIMS: The dose, efficacy, and side effects of continuous intravenous infusion (CIVI) of morphine were compared with continuous subcutaneous infusion (CSCI) of morphine in patients with chronic cancer pain. Eligible patients were referred to the Palliative Care Program and were receiving a stable dose of CIVI of morphine. The design was a within-patient, one-way crossover; in which each patient provided data before and after a switch from CIVI to CSCI of morphine. "Rescue" doses were 50% of the hourly dose given every 2 hours as needed. Morphine was infused intravenously (i.v.) and subcutaneously (s.c.) via a McGaw/AccuPro Volumetric Infusion Pump. After baseline data, including side effects and pain assessment, were obtained, patients were evaluated twice daily for toxicity and analgesic efficacy. Those who had a stable CIVI dose for 48 consecutive hr were crossed over to the CSCI at the same dose as the intravenous (i.v.) phase. A stable dose was defined as no dose change, four or less rescue doses in the previous 24 hr, and a pain rating of none or mild. CIVI was considered equal to CSCI if these criteria were maintained for 96 consecutive hr. Fifty-seven patients were entered, and 40 were evaluable (15 women and 25 men). The median age was 67 (range 30-83 years). All 40 participants, after maintaining a stable dose throughout the i.v. phase, crossed to the s.c. phase and remained on s.c. for at least 48 hr. Thirty-two patients maintained a stable dose throughout the i.v. and s.c. phases. The mean stable i.v. dose (day 2) was 5.05 mg/hr, and the mean stable s.c. dose (day 4) was 5.7 mg/hr (P = 0.01). The mean number of rescue doses on day 2 was 0.83 per 24 hr versus 0.80 per 24 hours on day 4 (P = 0.6). The mean categorical pain score on day 2 was 0.83, and on day 4, 0.85 (P = 0.7). The mean visual analogue scale (VAS) on day 2 was 22.9 mm versus 17.6 mm on day 4 (P = 0.1). The mean incidence of side effects on day 2 was 1.7, and on day 4, 2.0 (P = 0.2). No patient was withdrawn or had a dose reduction due to unacceptable toxicity. There were two reports of local toxicity (mild erythema) at the SC needle insertion point, which required a site change. All of our 40 patients had adequate pain control with CIVI and CSCI morphine. Of the eight participants who were not maintained on the same i.v. and s.c. dose, all had adequate pain control and a similar side-effect profile on a higher s.c. morphine dose. These data suggest that the i.v. and s.c. routes are equianalgesic for most patients when administered as a continuous infusion. Pain control and side-effect profiles are quite similar and acceptable. s.c. morphine is an excellent alternative to i.v. morphine in both inpatients and outpatients requiring parenteral morphine for pain.

    背景与目标: 比较了慢性癌痛患者持续静脉输注 (CIVI) 吗啡与持续皮下输注 (CSCI) 吗啡的剂量,疗效和副作用。符合条件的患者被转诊到姑息治疗计划,并正在接受稳定剂量的CIVI吗啡。该设计是患者内部的单向交叉; 其中每个患者在吗啡从CIVI切换到CSCI之前和之后提供数据。“抢救” 剂量是根据需要每2小时给予的每小时剂量的50%。通过McGaw/AccuPro容积输液泵静脉内 (i.v.) 和皮下 (s.c.) 注入吗啡。获得包括副作用和疼痛评估在内的基线数据后,每天两次评估患者的毒性和镇痛效果。那些连续48小时稳定的CIVI剂量的人以与静脉 (i.v.) 阶段相同的剂量交叉到CSCI。稳定剂量定义为无剂量变化,在之前的24小时内有四个或更少的抢救剂量,并且疼痛等级为无或轻度。如果连续96个小时保持这些标准,CIVI被认为等于CSCI。进入了57名患者,其中40名可评估 (15名女性和25名男性)。中位年龄为67岁 (范围30-83岁)。所有40名参与者在整个静脉内保持稳定剂量后。阶段,越过s.C.阶段并保留在s.c.至少48小时。32名患者在整个静脉内保持稳定剂量。和南卡罗来纳州阶段。平均稳定的静脉注射。剂量 (第2天) 为5.05 mg/hr,平均稳定s.c.剂量 (第4天) 为5.7 mg/hr (P = 0.01)。第2天的平均抢救剂量为每24小时0.83次,而第4天的平均抢救剂量为每24小时0.80次 (P = 0.6)。第2天和第4天的平均分类疼痛评分为0.83,0.85 (P = 0.7)。第2天的平均视觉模拟量表 (VAS) 为22.9毫米,第4天为17.6毫米 (P = 0.1)。第2天和第4天的平均副作用发生率为1.7,2.0 (P = 0.2)。没有患者因不可接受的毒性而退出或剂量减少。有两份关于SC针插入点局部毒性 (轻度红斑) 的报告,需要改变部位。我们的40名患者均使用CIVI和CSCI吗啡进行了足够的疼痛控制。在没有保持相同i.v.的八名参与者中。和南卡罗来纳州剂量,都有足够的疼痛控制,并且在较高的s.C.上有相似的副作用。吗啡剂量。这些数据表明,静脉注射和南卡罗来纳州当作为连续输注给药时,大多数患者的途径是等镇痛。疼痛控制和副作用特征非常相似且可以接受。吗啡是静脉注射的绝佳替代品需要胃肠外吗啡治疗疼痛的住院患者和门诊患者的吗啡。
  • 【骨髓衰竭综合征中的染色体不稳定性。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Babu Rao V,Colah RB
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【B细胞慢性淋巴细胞白血病患者T细胞中的信号分子和细胞因子产生: 氟达拉滨和阿仑单抗治疗的长期影响。】 复制标题 收藏 收藏
    DOI:10.1080/10428190600565503 复制DOI
    作者列表:Kiaii S,Choudhury A,Mozaffari F,Rezvany R,Lundin J,Mellstedt H,Osterborg A
    BACKGROUND & AIMS: :Fludarabine and alemtuzumab are routinely used for treatment of B-cell chronic lymphocytic leukemia (B-CLL). The present study aimed to compare the expression of signaling molecules and cytokine production by T cells of B-CLL patients in long-term unmaintained remission/plateau phase following fludarabine or alemtuzumab treatment with that of indolent/untreated B-CLL patients and healthy donors. The frequency and intensity of TCR-CD3zeta chain, p56lck, p59fyn, ZAP-70, PI3-kinase and interferon (IFN)-gamma/interleukin (IL)-4 production in CD4 and CD8 T cells was examined by flow cytometry. T-cell function was assessed by stimulation with purified protein derivative (PPD) and phytohemagglutinin (PHA). Despite a reduction in number, the expression of IFN-gamma/IL-4 in T-cells in patients was significantly higher than in healthy donors. The intensity of most signaling molecules in treated patients was relatively unaffected vs. healthy donors but lower than untreated-indolent patients. However, the total number of T cells which expressed each of the signaling molecules was decreased in patients, with no difference between fludarabine- and alemtuzumab-treated patients. The T-cell response to PHA but not PPD was reduced in treated patients. The results suggest that, despite some alterations in signaling molecules and a reduction in T-cell number, overall T-cell functions may be relatively well preserved long-term after treatment with fludarabine and alemtuzumab.
    背景与目标: : 氟达拉滨和阿仑单抗通常用于治疗b细胞慢性淋巴细胞白血病 (b-cll)。本研究旨在比较在氟达拉滨或阿仑单抗治疗后长期未维持缓解/平台期的b-cll患者的T细胞与惰性/未治疗的b-cll患者和健康的T细胞的信号分子表达和细胞因子产生供体。通过流式细胞术检查CD4和CD8 T细胞中TCR-CD3zeta链,p56lck,p59fyn,ZAP-70,PI3-kinase和干扰素 (IFN)-γ/白细胞介素 (IL)-4产生的频率和强度。通过纯化蛋白衍生物 (PPD) 和植物血凝素 (PHA) 刺激来评估T细胞功能。尽管数量减少,但患者T细胞中IFN-γ/IL-4的表达显着高于健康供体。与健康供体相比,接受治疗的患者中大多数信号分子的强度相对不受影响,但低于未经治疗的惰性患者。然而,在患者中表达每种信号分子的T细胞总数减少,而氟达拉滨和阿仑单抗治疗的患者之间没有差异。在治疗的患者中,T细胞对PHA的反应降低,但对PPD的反应降低。结果表明,尽管信号分子发生了一些变化,T细胞数量减少,但在用氟达拉滨和阿仑单抗治疗后,总体T细胞功能可能长期保持良好。
  • 【缬沙坦在心肌梗死后和心力衰竭患者中的应用。】 复制标题 收藏 收藏
    DOI:10.3317/jraas.2006.019 复制DOI
    作者列表:Liu PP,Maggioni A,Velazquez EJ
    BACKGROUND & AIMS: :Left ventricular (LV) dysfunction and/or heart failure (HF) are frequent complications of hypertension and myocardial infarction (MI), placing affected patients at increased risk of significant morbidity and premature death. Given that the renin-angiotensin-aldosterone system (RAAS) is activated and of pathophysiological importance in such patients, a strong therapeutic rationale exists to target the main effector mechanism (that is, angiotensin II [Ang II]) in order to lessen the associated morbidity and mortality burden. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce mortality and LV dysfunction and to slow disease progression in patients with HF, including high-risk, post-MI patients. However, ACE inhibitors (ACE-Is) may not provide optimal long-term RAAS blockade (a finding that is associated with a worse prognosis) and many patients are unable to tolerate such therapy (because of troublesome dry cough, for example). In contrast, Ang II receptor blockers (ARBs) may block the RAAS more completely than ACE-Is and appear to be better tolerated. Several large-scale trials gave evaluated the efficacy of ARBs in patients with LV dysfunction and/or HF (including high-risk, post-MI patients), and have confirmed their utility as an efficacious and well-tolerated alternative to ACE-Is in this setting.
    背景与目标: : 左心室 (LV) 功能障碍和/或心力衰竭 (HF) 是高血压和心肌梗塞 (MI) 的常见并发症,使受影响的患者具有显着发病率和过早死亡的风险。鉴于肾素-血管紧张素-醛固酮系统 (RAAS) 在此类患者中被激活并且具有病理生理重要性,因此存在针对主要效应机制 (即血管紧张素II [Ang II]) 的强有力的治疗依据,以减轻相关的发病率和死亡率负担。血管紧张素转换酶 (ACE) 抑制剂已被证明可降低HF患者 (包括高危MI后患者) 的死亡率和LV功能障碍,并可减缓疾病进展。然而,ACE抑制剂 (ACE-Is) 可能无法提供最佳的长期RAAS阻断 (这一发现与更差的预后相关),并且许多患者无法耐受这种治疗 (例如,由于麻烦的干咳)。相比之下,Ang II受体阻滞剂 (arb) 可能比ACE-Is更完全地阻断RAAS,并且似乎具有更好的耐受性。几项大规模试验评估了ARBs在LV功能障碍和/或HF患者 (包括高危MI后患者) 中的疗效,并已证实其作为ACE-Is的有效且耐受性良好的替代方法在这种情况下。
  • 【慢性伤口愈合过程中趋化因子和炎性细胞因子的变化。】 复制标题 收藏 收藏
    DOI:10.1046/j.1524-475X.1997.50405.x 复制DOI
    作者列表:Fivenson DP,Faria DT,Nickoloff BJ,Poverini PJ,Kunkel S,Burdick M,Strieter RM
    BACKGROUND & AIMS: :Wound healing is a complex process resulting from an interplay of processes including coagulation, inflammation, angiogenesis, and epithelialization. The chemokine family has been shown to contain members that are potent regulators of many of these pathways. Because we have previously shown that chemokines "pool" in biologic wound dressings, we studied the levels of CXC and CC chemokines, along with key inflammatory mediators, serially from a group of patients undergoing therapy for chronic venous leg ulcers. After 8 weeks, all patients had marked clinical healing of their ulcers (median 63.3% reduction in size) with two of 10 completely healed. Wound fluids extracted from dressings showed high levels of platelet factor-4 and interferon-gamma-inducible protein, with a trend toward increases in the ratio of the sums of the angiogenic versus angiostatic CXC chemokines (p = 0.082) in the tissues collected from the center of the ulcers during wound closure. Neutrophil-activating peptide-2 and interleukin-8 accounted for the most changes in wound fluid angiogenic chemokines, with significant differences both as compared with baseline levels and with patients' plasma level noted at various time points between weeks 0 and 8. The level of angiostatic chemokines, interferon-y inducible protein 10 and platelet-activating-4, fell most significantly between weeks 0 and 3 as compared with plasma levels. The observed shift toward angiogenic CXC chemokines suggests that effective healing in chronic venous insufficiency ulcers appears to "move" the ulcer bed toward a state more conducive to epithelialization,characteristic of the proliferative phase of wound healing. CC chemokines were also elevated at baseline in the wound fluid samples as compared with the patients' plasma levels. Macrophage inflammatory protein-1 (3 and regulated on activation, normal T expressed and secreted (RANTES) levels decreased with healing, whereas there were significant increases in the tissue levels of monocyte chemoattractant protein-1 and macrophage inflammatory protein-1 a over the first 4 weeks of therapy (p< or = 0.05 for both). Coincident with these changes was a steady increase in the ratio of interleukin-1 R/interleukin-1 receptor antagonist protein in the ulcer center tissues, which also correlated with healing (p < 0 .05) as compared with a decreasing ratio at the ulcer edge, and a biphasic response in the wound fluids. These findings suggest that advanced wound care techniques help move the ulcer from a chronic inflammatory state into one more characteristic of the late inflammatory/early proliferative phase of wound healing. Chemokines may play a critical role in the pathogenesis of chronic venous ulcers through their effects on angiogenesis and/or the progression of inflammatory reactions at the site of injury.
    背景与目标: 伤口愈合是一个复杂的过程,由凝血、炎症、血管生成和上皮形成等过程的相互作用产生。趋化因子家族已被证明包含许多这些途径的有效调节剂。因为我们以前已经表明趋化因子在生物伤口敷料中 “聚集”,所以我们连续研究了一组接受慢性静脉腿部溃疡治疗的患者的CXC和CC趋化因子以及关键炎症介质的水平。8周后,所有患者的溃疡临床愈合明显 (中位63.3% 缩小),其中10例中有2例完全愈合。从敷料中提取的伤口液显示出高水平的血小板因子-4和干扰素-γ 诱导蛋白,在伤口闭合期间从溃疡中心收集的组织中,血管生成与血管抑制CXC趋化因子 (p = 0.082) 的总和比率呈增加趋势。中性粒细胞激活肽-2和interleukin-8占伤口流体血管生成趋化因子的最大变化,与基线水平和患者血浆水平相比,在第0周和第8周之间的不同时间点存在显着差异。与血浆水平相比,血管抑制趋化因子,干扰素y诱导蛋白10和血小板活化4的水平在第0周和第3周之间下降最明显。观察到的向血管生成CXC趋化因子的转变表明,慢性静脉功能不全溃疡的有效愈合似乎使溃疡床 “移至” 更有利于上皮形成的状态,这是伤口愈合增生期的特征。与患者血浆水平相比,伤口液体样品中的CC趋化因子在基线时也升高。巨噬细胞炎性蛋白-1 (3) 和受激活调节,正常T表达和分泌 (RANTES) 水平随愈合而降低,而在治疗的前4周内,单核细胞趋化蛋白-1和巨噬细胞炎性蛋白-1 a的组织水平显着增加 (两者p <或 = 0.05)。与这些变化同时发生的是,interleukin-1 R/interleukin-1受体拮抗剂蛋白的比例在溃疡中心组织,与溃疡边缘的比率降低相比,这也与愈合相关 (p <0.05),和伤口液体中的双相反应。这些发现表明,先进的伤口护理技术有助于将溃疡从慢性炎症状态转移到伤口愈合的晚期炎症/早期增生期的另一个特征。趋化因子可能通过其对血管生成的影响在慢性静脉溃疡的发病机理中发挥关键作用和/或损伤部位炎症反应的进展。
  • 【氟硝西泮长期治疗导致继发性肾上腺功能衰竭。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2265.2006.02622.x 复制DOI
    作者列表:Müssig K,Friess E,Wudy SA,Mörike K,Häring HU,Overkamp D
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【未能启动: 促进iNKT细胞的细胞因子分泌。】 复制标题 收藏 收藏
    DOI:10.1016/j.immuni.2006.08.012 复制DOI
    作者列表:Locksley RM
    BACKGROUND & AIMS: :In this issue of Immunity, Bezbradica et al., (2006) uncover an unsuspected role for the cytokine GM-CSF in the thymic development of invariant NKT cells, a role that licenses these cells to secrete effector cytokines upon activation in the periphery.
    背景与目标: : 在本期《免疫》中,bezbratica等人 (2006) 揭示了细胞因子gm-csf在不变NKT细胞的胸腺发育中不可怀疑的作用,该作用允许这些细胞在外围激活时分泌效应细胞因子。
  • 【人暴发性肝衰竭中胱天蛋白酶的肝内激活。】 复制标题 收藏 收藏
    DOI:10.1111/j.1478-3231.2006.01300.x 复制DOI
    作者列表:Leifeld L,Nattermann J,Fielenbach M,Schmitz V,Sauerbruch T,Spengler U
    BACKGROUND & AIMS: BACKGROUND/AIMS:Apoptosis has been implicated in the pathogenesis of fulminant hepatic failure (FHF) potentially involving caspases. Thus far, apoptosis in FHF has mainly been studied in animal models while human data are sparse. METHODS:Caspases-3, -8 and -9 activities and Fas expression were analyzed in correlation to TdT-mediated dUTP nick end labelling (TUNEL) positive apoptotic cells in livers of patients with FHF (n=26), chronic liver disease (CLD) (n=60) and normal controls (NC) (n=10). RESULTS:Numbers of TUNEL-positive cells were higher in FHF than in CLD and NC (P<0.001) correlating to the intrahepatic activities of caspase-3. The highest caspase-3 activities were found in fulminant hepatitis B, significantly surpassing those in FHF of any other etiology. In fulminant hepatitis B, caspase-9 activity was also higher than in controls, while caspase-8 activation was not higher than in NC. Unlike caspase-3, caspases -8 and -9 activities were not correlated to the numbers of TUNEL positive cells. Fas expression was also the highest in FHF but did not differ between hepatitis B virus-FHF and other FHF. CONCLUSIONS:Our data indicate differential activation of intrahepatic caspases in FHF depending on the underlying etiology. Massive activation of caspases in fulminant hepatitis B confirms a pivotal role of apoptotic pathways in the pathogenesis of human fulminant hepatitis B.
    背景与目标:
  • 【成年先天性心脏病患者的亚临床甲状腺功能减退。】 复制标题 收藏 收藏
    DOI:10.1007/s00246-012-0571-6 复制DOI
    作者列表:Martínez-Quintana E,Rodríguez-González F,Nieto-Lago V
    BACKGROUND & AIMS: :Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.
    背景与目标: : 亚临床甲状腺功能减退通常是无症状的,但它可能与各种不良的心脏结局有关。为了深入了解促甲状腺激素 (TSH) 在先天性心脏异常中的作用,本研究测量了成年先天性心脏病 (GUCHD) 患者不同亚型的血清TSH浓度。在249例GUCHD患者中测量了血清TSH (参考范围,0.34-5.6 mIU/L),肌酐,胆固醇,C反应蛋白 (CRP),N末端proB型利钠肽 (NT-pro-BNP) 和24小时蛋白尿。在TSH水平高于5.6 mUI/L的24例GUCHD患者 (9.6% 例) 中,9例为紫绀 (37.5% 例),7例 (29.1% 例) 患有唐氏综合症。血清TSH超过5.6 mIU/L的GUCHD患者的血清NT-pro-BNP水平 (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) 和CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] 与TSH水平为5.6 mIU/L或更低者比较,血清肌酐、血脂、或两组之间的24小时蛋白尿。TSH超过5.6 mIU/L的GUCHD患者的T4浓度在正常范围内 (0.89 ± 0.23 ng/dL)。在多变量分析中,发绀 (优势比 [or],6,399; 95% 置信区间 [CI] 2,296-17,830; p <0.001),唐氏综合征 (OR,6,208; 95% CI,1,963-19,636; p = 0.002) 和NT-pro-BNP浓度 (OR,1,001; 95% CI,1,000-1,002; p < 0.026) 被证明是TSH水平高于5.6 mIU/L的危险因素。由于亚临床甲状腺功能减退会带来心血管风险,因此作者假设TSH筛查应包括在患有发绀或唐氏综合症的GUCHD患者的常规随访评估中。
  • 【Cornelia de Lange综合征: 149患者的先天性心脏病。】 复制标题 收藏 收藏
    DOI:10.1016/j.medcli.2017.03.051 复制DOI
    作者列表:Ayerza Casas A,Puisac Uriol B,Teresa Rodrigo ME,Hernández Marcos M,Ramos Fuentes FJ,Pie Juste J
    BACKGROUND & AIMS: INTRODUCTION:Cornelia de Lange syndrome (CdLS) is produced by mutations in genes that encode regulatory or structural proteins of the cohesin complex. Congenital heart disease (CHD) is not a major criterion of the disease, but it affects many individuals. The objective of this study was to study the incidence and type of CHD in patients with CdLS. MATERIAL AND METHOD:Cardiological findings were evaluated in 149 patients with CdLS and their possible relationship with clinical and genetic variables. RESULTS:A percentage of 34.9 had CHD (septal defects 50%, pulmonary stenosis 27%, aortic coarctation 9.6%). The presence of CHD was related with neonatal hospitalisation (P=.04), hearing loss (P=.002), mortality (P=.09) and lower hyperactivity (P=.02), it being more frequent in HDAC8+ patients (60%), followed by NIPBL+ (33%) and SMC1A+ (28.5%). While septal defects predominate in NIPBL+, pulmonary stenosis is more common in HDAC8+. CONCLUSIONS:Patients with CdLS have a high incidence of CHD, which varies according to the affected gene, the most frequent findings being septal defects and pulmonary stenosis. Perform a cardiologic study in all these patients is suggested.
    背景与目标:
  • 【中药新极丸通过Akt/Nrf2途径保护心脏免受缺血/再灌注损伤。】 复制标题 收藏 收藏
    DOI:10.3892/mmr.2017.6732 复制DOI
    作者列表:Yuan Q,Chen R,Zheng X,Meng M,Kao Y,Liu J,Gan X,Shi M,Fu J,Jiang S,Yu H
    BACKGROUND & AIMS: :The cardioprotective drugs used for treatment against ischemia/reperfusion (MI/R) injury have been well evaluated and are considered inadequate. The Chinese herbal medicine formula, Xinji pill (XJP) has been used traditionally for the prevention and treatment of ischemic heart diseases for decades. In the present study, the cardioprotective effects of XJP against MI/R injury were assessed in vivo and its possible mechanism was examined. Male Sprague‑Dawley rats were selected for establishing an MI/R model, which was induced by ischemia for 30 min followed by 24 h reperfusion. Drugs and saline were administered intragastrically from day 14 prior to MI/R. Blood samples were collected for biochemical detection. The rats were then sacrificed and cardiac muscle tissues were harvested. The mRNA expression levels of antioxidant genes were measured by reverse transcription‑quantitative polymerase chain reaction and the protein levels were measured by western blotting. Pretreatment with XJP for 14 days protected the heart against I/R‑induced myocardial function disorder, protected against heart injury, as demonstrated by normalized serum levels of lactate dehydrogenase and creatine kinase, and suppressed oxidative stress. XJP markedly upregulated the expression of antioxidant genes, including superoxide dismutase, catalase, glutathione reductase and glutathione peroxidase, and promoted the protein expression of heme oxygenase‑1 and NFE2‑related factor 2 (Nrf2) in the heart tissues. Furthermore, Akt kinase was confirmed to be upstream of Nrf2 in the XJP treatment. LY294002, a specific inhibitor of Akt, significantly eliminated the cardioprotective effects of XJP. In conclusion, these results demonstrated that XJP exhibited notable cardioprotective properties, in which the Akt/Nrf2 signaling pathway may be involved.
    背景与目标: : 用于治疗缺血/再灌注 (MI/R) 损伤的心脏保护药物已得到很好的评估,被认为是不充分的。几十年来,中药配方新基丸 (XJP) 一直用于预防和治疗缺血性心脏病。在本研究中,在体内评估了XJP对MI/R损伤的心脏保护作用,并研究了其可能的机制。选择雄性sprague-dawley大鼠建立MI/R模型,该模型由缺血30分钟然后再灌注24小时诱导。从MI/R开始的第14天开始胃内给药和生理盐水。采集血样进行生化检测。然后处死大鼠并收获心肌组织。通过逆转录定量聚合酶链反应测量抗氧化基因的mRNA表达水平,并通过蛋白质印迹法测量蛋白质水平。用XJP预处理14天可以保护心脏免受I/r诱导的心肌功能障碍,防止心脏损伤,如乳酸脱氢酶和肌酸激酶的标准化血清水平所示,并抑制氧化应激。XJP显着上调了抗氧化基因的表达,包括超氧化物歧化酶,过氧化氢酶,谷胱甘肽还原酶和谷胱甘肽过氧化物酶,并促进了血红素氧合酶-1和NFE2相关因子2 (Nrf2) 在心脏组织中的蛋白表达。此外,在XJP治疗中,Akt激酶被证实是Nrf2的上游。LY294002是一种特殊的Akt抑制剂,显著消除了XJP的心脏保护作用。总之,这些结果表明XJP表现出显着的心脏保护特性,其中可能涉及Akt/Nrf2信号通路。
  • 【脊髓损伤个体生活方式与冠心病危险因素的纵向关联.】 复制标题 收藏 收藏
    DOI:10.1038/sc.2012.153 复制DOI
    作者列表:de Groot S,Post MW,Snoek GJ,Schuitemaker M,van der Woude LH
    BACKGROUND & AIMS: OBJECTIVE:To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related to fitness, smoking, alcohol, body mass and low-fat diet) and coronary heart disease risk factors during that period. DESIGN:Prospective cohort study. PARTICIPANTS/METHODS:Individuals with SCI (N=130). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and BMI were determined at discharge from inpatient rehabilitation and 1 and 5 years after discharge. Using multilevel regression models, the effects of lifestyle (drinking alcohol, smoking, active lifestyle and self-care) on the lipid profiles and BMI were determined. RESULTS:After correction for lesion and personal characteristics, no changes in lipid profiles in the five years after discharge were seen, whereas the BMI increased significantly with 1.8 kg m(-2). A high percentage was at risk of cardiovascular disease due to high BMI (63-75%) or HDL (66-95%). The individuals who indicated to maintain their fitness level as good as possible and the individuals with a low BMI showed better lipid profiles. Individuals with a more active lifestyle showed higher HDL levels. Individuals who avoid smoking showed a 1.5 kg m(-2) higher BMI. CONCLUSION:Lipid profiles seem to stabilize in the years after discharge from inpatient SCI rehabilitation, whereas the BMI increased. Lifestyle factors associated with a favorable lipid profile and BMI could be identified.
    背景与目标:
  • 【先天性心脏病的心脏T1标测: 用于测量心肌细胞外体积分数的推注与输注方案。】 复制标题 收藏 收藏
    DOI:10.1007/s10554-017-1191-2 复制DOI
    作者列表:Al-Wakeel-Marquard N,Rastin S,Muench F,O H-Ici D,Yilmaz S,Berger F,Kuehne T,Messroghli DR
    BACKGROUND & AIMS: :Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.
    背景与目标: : 反映弥漫性心肌纤维化的心肌细胞外体积分数 (ECV) 可以在施用基于g的细胞外造影剂之前和之后用T1映射心血管磁共振 (CMR) 测量。ECV测量所需的血液和心肌对比浓度之间的平衡可以通过灌注对比输注 (平衡对比-CMR) 获得。我们假设,通过单次对比推注也可以实现平衡,以准确测量先天性心脏病 (CHD) 患者的弥漫性心肌纤维化。前瞻性地纳入健康对照 (n   =   17; 中位年龄24.0岁) 和CHD患者 (n   =   19; 25.0岁)。在推注前,推注后15分钟以及在不断输注g-DOTA期间,使用改良的Look-Locker反转恢复T1映射,获得左心室 (LV),室间隔 (IVS) 的血池和心肌的T1值,和右心室 (RV) 在单个心室中平面中的短轴或横向方向。在CHD患者 (分别为r   =   0.94、0.95和0.74; P  <  0.01) 和健康对照组 (分别为r   =   0.96、0.89和0.64; P  <  0.05) 中,仅推注和推注LV、IVS和RV的ECV显著相关。Bland-Altman图显示,任何分析区域的技术之间都没有明显的偏差。通过仅推注T1映射测量的LV和RV心肌的ECV与冠心病患者的推注测量非常吻合。仅推注方法的使用有助于将ECV测量结果集成到现有的CMR成像协议中,从而可以在临床常规中评估CHD中的弥漫性心肌纤维化。

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