• 【心肌梗死溶栓治疗后出血的发生率和预测因素。链激酶和组织纤溶酶原激活剂在闭塞冠状动脉 (GUSTO) 中的全球利用。】 复制标题 收藏 收藏
    DOI:10.1161/01.cir.95.11.2508 复制DOI
    作者列表:Berkowitz SD,Granger CB,Pieper KS,Lee KL,Gore JM,Simoons M,Armstrong PW,Topol EJ,Califf RM
    BACKGROUND & AIMS: BACKGROUND:Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials.

    METHODS AND RESULTS:We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and treatment assignment among 41,021 patients in the GUSTO-I trial of thrombolysis for acute myocardial infarction. Of the 40,903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% experienced moderate hemorrhage at a variety of sites. The most common sources of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more bleeding was seen with the therapies of streptokinase plus intravenous heparin and the streptokinase and tissue plasminogen activator plus intravenous heparin combination. In multivariate analysis, the four most powerful independent predictors of hemorrhage were older age, lighter body weight, female sex, and African ancestry; they remained the most important predictors of bleeding when multivariate analysis was performed on patients who did not undergo invasive procedures. The presence of serious hemorrhage was associated with other undesirable outcomes (recurrent events, left ventricular dysfunction, arrhythmia, or stroke).

    CONCLUSIONS:Important predictors of bleeding in this population are increased age, lighter weight, female sex, African ancestry, and experiencing invasive procedures. Other nonhemorrhagic adverse clinical outcomes were associated with moderate and severe bleeding, which was in turn associated with increased length of hospital stay and mortality at 30 days.

    背景与目标: 背景 : 尽管溶栓治疗在降低急性心肌梗死死亡率方面的益处已得到充分证实,但在大型试验中,出血类型和出血危险因素的描述较少。
    方法和结果 : 在GUSTO-I急性心肌梗死溶栓试验中,我们分析了41,021名患者的基线特征,结局和出血发生率,按位置,严重程度和治疗分配。在40,903例有完整数据的患者中,1.2% 例严重出血,11.4% 例在不同部位出现中度出血。最常见的出血来源与手术有关。溶栓方案与出血发生率密切相关; 链激酶加静脉肝素以及链激酶和组织型纤溶酶原激活剂加静脉肝素联合治疗的出血相对较多。在多变量分析中,出血的四个最有效的独立预测因子是年龄较大,体重较轻,女性和非洲血统; 当对未接受侵入性操作的患者进行多变量分析时,它们仍然是出血的最重要预测因子。严重出血的存在与其他不良结果 (复发事件,左心室功能障碍,心律失常或中风) 相关。
    结论 : 该人群出血的重要预测因素是年龄增加,体重减轻,女性,非洲血统,经历侵入性手术。其他非出血性不良临床结局与中度和重度出血相关,而中度和重度出血又与30天时的住院时间和死亡率增加相关。
  • 【人冠状动脉粥样斑块切除术中肝细胞生长因子的免疫组织化学分析: 与转化生长因子 β 亚型的比较。】 复制标题 收藏 收藏
    DOI:10.1007/s004280050050 复制DOI
    作者列表:Ueda H,Imazu M,Hayashi Y,Ono K,Yasui W,Yamakido M
    BACKGROUND & AIMS: The expression and localization of hepatocyte growth factor/scatter factor (HGF/SF) were examined immunohistochemically in 59 human coronary artery lesions retrieved by directional coronary atherectomy and compared with the localization of transforming growth factor beta isoforms (TGF-beta 1, -beta 2, and -beta 3). In 21 of the 59 specimens (35.6%) HGF-like immunoreactivity (HGF-IR) was revealed. The HGF immunopositivity rate of 45% (14/31) in thrombotic tissue was significantly (P < 0.05) higher than the rates of 7.3% (4/55), 7.1% (3/42), and 0% (0/14) in fibrous tissue, neointimal hyperplasia and atheromatous gruel, respectively. Immunoreactivity for HGF was much weaker than that for TGF-beta isoforms in these components except in thrombotic tissue. These cells exhibiting strong HGF-IR were inflammatory cells such as monocytes/macrophages in thrombotic tissue, in tissue lesions adjacent to a thrombus, and outside the capillary walls in a portion of the neovascularized lesions. Smooth muscle cells (SMCs) hardly demonstrated HGF-IR. In contrast, in control coronary arteries obtained at autopsy, the HGF-IR was strongly expressed in SMCs. These findings suggest that HGF produced by macrophages play a part in the process of coronary plaque formation attributable to thrombus in man.

    背景与目标: 通过免疫组织化学检查了通过定向冠状动脉粥样斑块切除术检索的59例人冠状动脉病变中肝细胞生长因子/散射因子 (HGF/SF) 的表达和定位,并将其与转化生长因子 β 亚型 (tgf-β1,-β2和-β3) 的定位进行了比较。在59个标本中的21个 (35.6%) 中,HGF样免疫反应性 (hgf-ir) 被揭示。血栓组织中45% (14/31) 的HGF免疫阳性率显着 (P < 0.05) 高于纤维组织,新内膜增生和动脉粥样硬化稀粥中的7.3% (4/55),7.1% (3/42) 和0% (0/14)。分别。除血栓形成组织外,这些成分中HGF的免疫反应性比TGF-β 同工型的免疫反应性弱得多。这些表现出强hgf-ir的细胞是炎性细胞,例如血栓形成组织中,与血栓相邻的组织病变以及部分新生血管病变的毛细血管壁外部的单核细胞/巨噬细胞。平滑肌细胞 (smc) 几乎不显示HGF-IR。相反,在尸检获得的对照冠状动脉中,hgf-ir在smc中强烈表达。这些发现表明,巨噬细胞产生的HGF在人类血栓形成引起的冠状动脉斑块形成过程中发挥了作用。
  • 【螺旋ct血管造影对腹主动脉瘤的术前影像学评估。】 复制标题 收藏 收藏
    DOI:10.1016/s0009-9260(97)80132-8 复制DOI
    作者列表:Errington ML,Ferguson JM,Gillespie IN,Connell HM,Ruckley CV,Wright AR
    BACKGROUND & AIMS: PURPOSE:A prospective evaluation of spiral CT angiography (SCTA) as the sole pre-operative imaging modality for abdominal aortic aneurysm repair.

    MATERIALS AND METHODS:Spiral CT angiography was compared with conventional transfemoral angiography in 30 patients and results correlated with surgical findings in 22 patients. The following features were assessed: renal artery number and disease; upper and lower aneurysm extent; aneurysm size; perianeurysmal inflammation; iliac artery disease; radiation dose; and contrast usage.

    RESULTS:Spiral CT angiography agreed with conventional angiography in all cases of severe stenosis or occlusion of renal arteries and had 90% agreement overall for renal artery disease. Two of nine accessory renal arteries seen at conventional angiography were missed. For showing aneurysm extent SCTA was 100% sensitive, and performed better than conventional angiography. Aneurysm size was better shown with SCTA. In iliac disease SCTA, as performed in this study, was poor for mild-moderate disease, but detected four of six severely stenosed/occluded iliac arteries seen at conventional angiography. Prospective sensitivity for perianeurysmal inflammation was 33%. Radiation dose for SCTA was approximately twice and contrast dose approximately three times that for conventional angiography.

    CONCLUSION:Spiral CT angiography can provide all the necessary imaging information to plan aneurysm repair in the non-claudicant.

    背景与目标: 目的 : 对螺旋ct血管造影 (SCTA) 作为腹主动脉瘤修复的唯一术前成像方式的前瞻性评估。
    材料和方法 : 将30例患者的螺旋ct血管造影与常规经股动脉造影进行了比较,结果与22例患者的手术结果相关。评估了以下特征: 肾动脉数量和疾病; 上,下动脉瘤范围; 动脉瘤大小; 动脉瘤周围炎症; 髂动脉疾病; 辐射剂量; 和造影剂使用。
    结果 : 在所有严重肾动脉狭窄或闭塞的病例中,螺旋ct血管造影与常规血管造影一致,并且在肾动脉疾病方面总体上90% 一致。在常规血管造影中观察到的9条副肾动脉中有2条被遗漏。对于显示动脉瘤范围,SCTA 100% 敏感,并且比常规血管造影更好。SCTA能更好地显示动脉瘤大小。在本研究中进行的SCTA在轻度-中度疾病中较差,但在常规血管造影术中发现了六个严重狭窄/闭塞的动脉中的四个。33% 了对动脉瘤周围炎症的前瞻性敏感性。SCTA的辐射剂量约为常规血管造影的两倍,造影剂剂量约为常规血管造影的三倍。
    结论 : 螺旋ct血管造影可以提供所有必要的成像信息,以计划非幽闭者的动脉瘤修复。
  • 【使用MR数字减影血管造影评估儿童颅内病变的血液供应。】 复制标题 收藏 收藏
    DOI:10.1007/s00247-006-0268-1 复制DOI
    作者列表:Chooi WK,Connolly DJ,Coley SC,Griffiths PD
    BACKGROUND & AIMS: BACKGROUND:MR digital subtraction angiography (MR-DSA) is a contrast-enhanced MR angiographic sequence that enables time-resolved evaluation of the cerebral circulation. OBJECTIVE:We describe the feasibility and technical success of our attempts at MR-DSA for the assessment of intracranial pathology in children. MATERIALS AND METHODS:We performed MR-DSA in 15 children (age range 5 days to 16 years) referred for MR imaging because of known or suspected intracranial pathology that required a dynamic assessment of the cerebral vasculature. MR-DSA consisted of a thick (6-10 mm) slice-selective RF-spoiled fast gradient-echo sequence (RF-FAST) acquired before and during passage of an intravenously administered bolus of Gd-DTPA. The images were subtracted and viewed as a cine loop. RESULTS:MR-DSA was performed successfully in all patients. High-flow lesions were shown in four patients; these included vein of Galen aneurysmal malformation, dural fistula, and two partially treated arteriovenous malformations (AVMs). Low-flow lesions were seen in three patients, all of which were tumours. Normal flow was confirmed in eight patients including two with successfully treated AVMs, and in three patients with cavernomas. CONCLUSION:Our early experience suggests that MR-DSA is a realistic, non-invasive alternative to catheter angiography in certain clinical settings.
    背景与目标:
  • 【环氧二十碳三烯酸通过鸟嘌呤核苷酸结合蛋白激活冠状平滑肌中的K通道。】 复制标题 收藏 收藏
    DOI:10.1161/01.res.80.6.877 复制DOI
    作者列表:Li PL,Campbell WB
    BACKGROUND & AIMS: Epoxyeicosatrienoic acids (EETs) are endothelium-derived arachidonic acid metabolites of cytochrome P450. They dilate coronary arteries, open K+ channels, and hyperpolarize vascular smooth muscles. However, the mechanisms of these smooth muscle actions remain unknown. This study examined the effects of EETs on the large-conductance Ca(2+)-activated K+ channel (KCa) in smooth muscle cells of small bovine coronary arteries. In cell-attached patch-clamp experiments, 11,12-EET produced a 0.5- to 10-fold increase in the activity of the KCa channels when added in concentrations of 1, 10, and 100 nmol/L. In the inside-out excised membrane patch mode, 11,12-EET was without effect on the activity of the KCa channel unless GTP (0.5 mmol/L) or GTP and ATP (1 mmol/L) were added to the bath solution. In the presence of GTP and ATP, the increase in the KCa channel activity with 11,12-EET in inside-out patches was comparable to that in cell-attached patches. This effect of 11,12-EET in inside-out patches was blocked by the addition of GDP-beta-S (100 mumol/L). In outside-out patches, 11,12-EET also increased the KCa channel activity when GTP and ATP were added to the pipette solution. The addition of a specific anti-Gs alpha antibody (100 nmol/L) in the pipette solution completely blocked the activation of the KCa channels induced by 11,12-EET. An anti-G beta gamma or anti-Gi alpha antibody was without effect. We conclude that 11,12-EET activates the KCa channels by a Gs alpha-mediated mechanism. This mechanism contributes to the effects of EETs as endothelium-derived hyperpolarizing factors to hyperpolarize and relax arterial smooth muscle.

    背景与目标: 环氧二十碳三烯酸 (EETs) 是细胞色素p450的内皮衍生的花生四烯酸代谢产物。它们扩张冠状动脉,打开K通道,并使血管平滑肌超极化。然而,这些平滑肌作用的机制仍然未知。这项研究检查了EETs对小冠状动脉平滑肌细胞中大电导Ca(2) 激活的K通道 (KCa) 的影响。在细胞附着的膜片钳实验中,当以1、10和100 nmol/L的浓度添加时,11,12-eet使KCa通道的活性增加了0.5至10倍。在由内向外切除的膜贴片模式中,11,12-eet对KCa通道的活性没有影响,除非将GTP (0.5 mmol/L) 或GTP和ATP (1 mmol/L) 添加到浴液中。在存在GTP和ATP的情况下,由内而外的贴片中11,12-eet的KCa通道活性增加与细胞附着的贴片相当。由内而外的贴片中11,12-eet的这种作用被添加GDP-β-S (100 mumol/L) 所阻断。在向外贴剂中,当将GTP和ATP添加到移液器溶液中时,11,12-eet也会增加KCa通道活性。在移液器溶液中添加特异性抗Gs α 抗体 (100 nmol/L) 完全阻断了由11,12-eet诱导的KCa通道的激活。抗G β γ 或抗Gi α 抗体无效。我们得出的结论是,11,12-eet通过Gs α 介导的机制激活了KCa通道。该机制有助于EETs作为内皮衍生的超极化因子,使动脉平滑肌超极化和松弛。
  • 【舒张期颈动脉纵向壁运动对衰老和冠状动脉疾病状态均敏感,而与动脉僵硬无关。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2017.04.026 复制DOI
    作者列表:Au JS,Valentino SE,McPhee PG,MacDonald MJ
    BACKGROUND & AIMS: :We investigated the ability of systolic and diastolic carotid artery longitudinal wall motion (CALM) to delineate expected differences in arterial health in individuals representing a range of both age and health status. We recruited 161 younger healthy adults (aged 24 ± 5 y), 51 older healthy adults (aged 70 ± 5 y) and 14 adults with coronary artery disease (aged 67 ± 8 y) for resting assessment of CALM and arterial stiffness. All CALM parameters were reduced in the old healthy adults and adults with coronary artery disease compared with the young healthy adults (p < 0.01), with diastolic velocity and maximum diastolic acceleration being further reduced in the adults with coronary artery disease than in the older healthy adults (p < 0.01). Diastolic CALM parameters were more strongly related to age (β range: -0.46 to -0.53) than systolic CALM parameters (β range: -0.24 to -0.44). In contrast to previous examinations of a variety of CALM parameters, diastolic CALM may provide superior promise in terms of characterizing arterial wall properties, with additional sensitivity to cardiovascular disease status.
    背景与目标: : 我们研究了收缩期和舒张期颈动脉纵向壁运动 (CALM) 描绘代表年龄和健康状况范围的个体的动脉健康预期差异的能力。我们招募了161名年轻的健康成年人 (24 ± 5岁),51名老年健康成年人 (70 ± 5岁) 和14名患有冠状动脉疾病的成年人 (67 ± 8岁) 进行静息评估平静和动脉僵硬度。与年轻健康成年人相比,老年健康成年人和患有冠状动脉疾病的成年人的所有CALM参数均降低 (p <0.01),与老年健康成年人相比,患有冠状动脉疾病的成年人的舒张速度和最大舒张加速度进一步降低 (p <0.01)。舒张期平静参数与年龄 (β 范围: -0.46至-0.53) 的相关性高于收缩期平静参数 (β 范围: -0.24至-0.44)。与以前对各种平静参数的检查相比,舒张期平静在表征动脉壁特性方面可能具有出色的前景,并且对心血管疾病状态具有额外的敏感性。
  • 【可溶性形式的膜攻击复合物可独立预测经直接经皮冠状动脉介入治疗的ST抬高型心肌梗死患者的死亡率和心血管事件。】 复制标题 收藏 收藏
    DOI:10.1016/j.ahj.2012.08.018 复制DOI
    作者列表:Lindberg S,Pedersen SH,Mogelvang R,Galatius S,Flyvbjerg A,Jensen JS,Bjerre M
    BACKGROUND & AIMS: BACKGROUND:The complement system is an important mediator of inflammation, which plays a pivotal role in atherosclerosis and acute myocardial infarction (AMI). Animal studies suggest that activation of the complement cascade resulting in the formation of soluble membrane attack complex (sMAC), contributes to both atherosclerosis and plaque rupture and may be the direct cause of tissue damage related to ischemia/reperfusion injury. However clinical data of sMAC during an AMI is sparse. Accordingly the aim was to investigate the prognostic role of sMAC in patients with ST-segment elevation myocardial infarction (STEMI). METHODS:We included 725 STEMI-patients admitted to a single, high-volume invasive heart centre, treated with primary percutaneous coronary intervention (PCI), from September 2006 to December 2008. Blood samples were drawn immediately before PCI. Plasma sMAC was measured using an in-house immunoassay. Endpoints were all-cause mortality (n = 62) and the combined endpoint (n = 122) of major cardiovascular events (MACE) defined as cardiovascular mortality and admission due recurrent AMI or heart failure. Follow-up time was 12 months. RESULTS:During 12 months of follow-up 62 patients died from all causes and 122 patients reached the combined end-point of MACE. Patients with high sMAC (>75th percentile) had increased risk of both all-cause mortality and MACE. Even after adjustment for confounding risk factors by Cox-regression analyses, high levels of sMAC remained an independent predictor of all-cause mortality (hazard ratio 1.81 [95% CI 1.06-3.06; P = .029]) and MACE (hazard ratio 1.70 [95% CI 1.16-2.48; P = .006]). CONCLUSIONS:High plasma sMAC independently predicts all-cause mortality and MACE in STEMI-patients treated with PCI.
    背景与目标:
  • 【在假定的眼结核患者中,通过正电子发射断层扫描/计算机断层扫描 (PET/CT) 研究全身摄取18-fdg的模式。】 复制标题 收藏 收藏
    DOI:10.3109/09273948.2012.697596 复制DOI
    作者列表:Mehta S
    BACKGROUND & AIMS: AIM:To report the patterns and sites of 18-FDG uptake in patients of presumed ocular tuberculosis. MATERIALS AND METHODS:The clinical and investigational findings of 11 patients were reviewed retrospectively. These included 6 males and 5 females with a mean age of 46.2 years. 21 eyes were included in the data analysis. Clinical presentations include 15 eyes with anterior uveitis, 2 eyes with retinal vasculitis, 2 eyes with panuveitis and 2 eyes with multifocal choroidopathy. RESULTS:Two distinct patterns of systemic uptake emerged. Pattern 1: No detectable systemic uptake (4 patients). Pattern 2: Detectable systemic uptake. a. Chest disease only (2 patients). b. Disseminated pattern, uptake seen at multiple sites (4 patients). c. Extrapulmonary only (1 patient). CONCLUSIONS:Ocular tuberculosis may often be part of a wider disseminated disease.
    背景与目标:
  • 【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:
  • 【EPIC-Norfolk眼科研究正常参与者的水流出结构的谱域光学相干断层扫描成像。】 复制标题 收藏 收藏
    DOI:10.1136/bjophthalmol-2012-302147 复制DOI
    作者列表:Day AC,Garway-Heath DF,Broadway DC,Jiang Y,Hayat S,Dalzell N,Khaw KT,Foster PJ
    BACKGROUND & AIMS: PURPOSE:To measure the dimensions of aqueous outflow structures and to investigate associations with intraocular pressure (IOP) and ocular biometry parameters in an older British population. METHOD:Fifty-two participants from the European Prospective Investigation of Cancer-Norfolk eye study underwent imaging using the Heidelberg Spectralis optical coherence tomographer with an anterior segment module. Pseudophakic participants and those known or suspected to have glaucoma were excluded, leaving 46 participants for analysis. Schwalbe's line (SL), scleral spur (SS), Schlemm's canal (SC) diameter and the trabecular meshwork cross-sectional area (TM cross-sectional area (CSA)) were identified and traced using ImageJ software. IOP was measured using the Ocular Response Analyser. Ocular biometry was measured by partial coherence interferometry. RESULTS:The mean (SD) subject age was 65.7 years (5.6). The SL and SS were identifiable in all nasal and temporal scans. The mean SL-SS distance was 800 μm (104) nasally and 808 μm (102) temporally. Repeatability of SS-SL, SS-SC, SC and TM CSA was good to excellent, and reproducibility fair to good. Nasal SL-SS distance was inversely associated with anterior chamber depth (ACD) (p=0.007, -116 μm per mm ACD, R(2)=0.18). Multiple linear regression showed nasal TM CSA was significantly associated with age and IOP (age: p=0.025, 0.007 mm(2) per decade of age; IOP: p=0.029, -0.0012 mm(2) per mm Hg, R(2)=0.23). CONCLUSIONS:Aqueous outflow structures can be measured by optical coherence tomography, and their dimensions vary significantly with ocular biometric characteristics and IOP. Further investigation is required to determine associations between outflow structure sizes in different populations and pathologies, including ocular hypertension and glaucoma.
    背景与目标:
  • 【用傅立叶域光学相干断层扫描评估超声介导的葡萄糖对正常,良性和癌性人肺组织通透性的影响。】 复制标题 收藏 收藏
    DOI:10.1117/1.JBO.17.11.116006 复制DOI
    作者列表:Wei H,Wu G,Guo Z,Yang H,He Y,Xie S,Guo X
    BACKGROUND & AIMS: :The objective of this study was to evaluate the effects of ultrasound-mediated analyte diffusion on permeability of normal, benign, and cancerous human lung tissue in vitro and to find more effective sonophoretic (SP) delivery in combination with the optical clearing agents (OCAs) method to distinguish normal and diseased lung tissues. The permeability coefficients of SP in combination with OCAs diffusion in lung tissue were measured with Fourier-domain optical coherence tomography (FD-OCT). 30% glucose and SP with a frequency of 1 MHz and an intensity of 0.80  W/cm2 over a 3 cm probe was simultaneously applied for 15 min. Experimental results show that the mean permeability coefficients of 30% glucose/SP were found to be (2.01±0.21)×10(-5)  cm/s from normal lung (NL) tissue, (2.75±0.28)×10(-5)  cm/s from lung benign granulomatosis (LBG) tissue, (4.53±0.49)×10(-5)  cm/s from lung adenocarcinoma tumor (LAT) tissue, and (5.81±0.62)×10(-5)  cm/s from lung squamous cell carcinoma (LSCC) tissue, respectively. The permeability coefficients of 30% glucose/SP increase approximately 36.8%, 125.4%, and 189.1% for the LBG, LAT, and LSCC tissue compared with that for the NL tissue, respectively. There were statistically significant differences in permeability coefficients of 30% glucose/SP between LBG and NL tissue (p<0.05), between LAT and NL tissue (p<0.05), and between LSCC and NL tissue (p<0.05). The results suggest that the OCT functional imaging technique to combine an ultrasound-OCAs combination method could become a powerful tool in early diagnosis and monitoring of changed microstructure of pathologic human lung tissue.
    背景与目标: : 这项研究的目的是评估超声介导的分析物扩散对体外正常,良性和癌性人肺组织通透性的影响,并找到与光学清除剂 (OCAs) 结合更有效的超声电泳 (SP) 递送方法,以区分正常和患病的肺组织。用傅里叶域光学相干断层扫描 (fd-oct) 测量SP与OCAs扩散在肺组织中的渗透系数。在3厘米探针上同时施加频率为1 MHz且强度为0.80   W w/cm2的30% 葡萄糖和SP 15分钟。实验结果表明,30% 葡萄糖/SP对正常肺 (NL) 组织的平均渗透系数为 (2.01 ± 0.21)× 10(-5)  cm cm/s,肺良性肉芽肿 (LBG) 组织 (2.75 ± 0.28)× 10(-5)  cm/s,肺腺癌肿瘤 (LAT) 组织 (4.53 ± 0.49)× 10(-5)  cm/s,和 (5.81 ± 0.62)× 10(-5)  cm cm/s分别来自肺鳞状细胞癌 (LSCC) 组织。与NL组织相比,LBG、LAT和LSCC组织的30% 葡萄糖/SP的渗透系数分别增加约36.8% 、125.4% 和189.1%。LBG与NL组织之间 (p<0.05),LAT与NL组织之间 (p<0.05) 以及LSCC与NL组织之间 (p<0.05) 的30% 葡萄糖/SP的渗透系数差异有统计学意义。结果表明,OCT功能成像技术结合超声-OCAs组合方法可以成为早期诊断和监测病理性人肺组织微观结构变化的有力工具。
  • 【在荷兰心胸中心接受孤立冠状动脉旁路移植术的患者中,抗血小板治疗的围手术期管理。】 复制标题 收藏 收藏
    DOI:10.1007/s12471-017-1006-z 复制DOI
    作者列表:Janssen PWA,Claassens DMF,Willemsen LM,Bergmeijer TO,Klein P,Ten Berg JM
    BACKGROUND & AIMS: BACKGROUND:International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). METHODS:A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014. RESULTS:Eleven centres responded to the survey. Acetylsalicylic acid monotherapy was discontinued before surgery in 6 centres. In patients with an acute coronary syndrome receiving dual antiplatelet therapy (DAPT), most centres discontinued the P2Y12 inhibitor preoperatively. DAPT was restarted after surgery in 4 centres. However, 6 centres continued DAPT in patients who had undergone coronary stenting within one month of surgery. In patients with coronary stents, variation in the management of antiplatelet therapy increased in proportion to the interval between stenting and surgery. A total of 70 patients were included in the registry. Acetylsalicylic acid monotherapy was discontinued in 51% of patients and restarted in all patients. P2Y12 inhibitor treatment was discontinued before surgery in 70% of patients and re-initiated after CABG in 29%. CONCLUSIONS:Major differences were observed in the preoperative and postoperative management of antiplatelet treatment between different Dutch cardiothoracic centres and within a single centre. Part of this variation is probably due to lack of evidence and differences between the current guidelines; however, many of the strategies were not in accordance with any of these guidelines.
    背景与目标:
  • 【探索已发表的关于运动训练和体育锻炼的指导的横断面样本的方法学质量和临床实用性,以进行冠心病的二级预防。】 复制标题 收藏 收藏
    DOI:10.1186/s12872-017-0589-z 复制DOI
    作者列表:Abell B,Glasziou P,Hoffmann T
    BACKGROUND & AIMS: BACKGROUND:Clinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance. METHODS:We included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool. RESULTS:Fifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as "guidelines", however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with 'applicability' the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and 'rigour of development' rated lowest for other guidance types (mean score 33%). CONCLUSIONS:While a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians.
    背景与目标:
  • 【胸腔镜前脊柱融合手术后肺体积的变化: 三维计算机断层扫描研究。】 复制标题 收藏 收藏
    DOI:10.1097/BRS.0000000000001949 复制DOI
    作者列表:Yu CG,Grant CA,Izatt MT,Labrom RD,Askin GN,Adam CJ,Little JP
    BACKGROUND & AIMS: STUDY DESIGN:Lung volumes and thoracic anatomy were measured from low-dose computed tomography (CT) scans preoperatively and 2 years following thoracoscopic anterior spinal fusion (TASF) for adolescent idiopathic scoliosis (AIS). OBJECTIVE:The aim of this study was to assess changes in lung volume after TASF surgical correction. SUMMARY OF BACKGROUND DATA:AIS patients are known to have decreased pulmonary function as a consequence of their spinal and ribcage deformity. Several studies have evaluated changes in pulmonary function clinically after scoliosis correction surgery showing varied results. To date, there have been no published studies using CT to evaluate lung volume changes following TASF. METHODS:Twenty-three female AIS patients with both pre- and 2 years postoperative low-dose CT scans were selected from an ethically approved, historical databank. Three-dimensional lung volumes were reconstructed to determine anatomical lung volumes. Right and left lung volumes, total lung volume, and right-to-left lung volume ratio were obtained as well as hemithoracic symmetry, to indicate the extent of thorax deformity. Cobb angle, rib hump, levels fused in surgery, and patient height were used for correlation analysis with the lung volume results. RESULTS:Left lung volume, total lung volume, and hemithoracic ratio all increased significantly 2 years after surgery. There was no significant change in right-to-left lung volume ratio (P = 0.36). Statistical regression found significant positive correlation between lung volume changes, reduction in Cobb angle, increase in height, and improvement in hemithoracic symmetry ratio. CONCLUSION:TASF resulted in a statistically significant increase in lung volume following surgery, as well as improvement in the symmetry of the thoracic architecture; however, the postoperative lung volumes remained in the lower 50th percentile relative to females without thoracic deformity. Furthermore, change in lung volume was significantly correlated with changes in Cobb angle, hemithoracic asymmetry, and increased patient height, which are important consequences of thoracic deformity correction surgery. LEVEL OF EVIDENCE:3.
    背景与目标:
  • 【地形相关的地震层析成像揭示了西藏东部的垂直地壳运动。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-017-03578-z 复制DOI
    作者列表:Zhang X,Wang Y,Gao R,Xu T,Bai Z,Tian X,Li Q
    BACKGROUND & AIMS: :Using a topography-dependent tomographic scheme, the seismic velocity structure of the Eastern Tibetan Plateau, including the uplifted Longmenshan (LMS) orogenic belt, is accurately imaged in spite of the extreme topographic relief in the LMS region and thick sedimentary covers in the neighbouring Sichuan Basin. The obtained image shows a high-resolution upper crustal structure on a 500 km-long profile that is perpendicular to the LMS. The image clearly shows that the crystalline basement was uplifted within the LMS orogenic belt, and that the neighbouring Songpan-Ganzi Terrane was covered by a thick flysch belt, with evidence of near-surface thrust faults caused by convergence between Eastern Tibet and the Sichuan Basin. The indication that the lower crust beneath the LMS was folded and pushed upwards and the upper crust was removed by exhumation, supports the concept of a lower crustal channel flow beneath Eastern Tibet. The image also reveals that the destructive Wenchuan earthquake of year 2008 occurred in the upper crust, directly at the structural discontinuity between Eastern Tibet Plateau and the Sichuan Basin.
    背景与目标: : 采用地形相关的层析方案,尽管LMS地区地形起伏极端,邻近的四川盆地沉积覆盖层较厚,但仍准确成像了包括隆升龙门山 (LMS) 造山带在内的青藏高原东部地震速度结构。所获得的图像显示了垂直于LMS的500   km长轮廓上的高分辨率上地壳结构。图像清楚地表明,LMS造山带内的结晶基底隆起,邻近的松潘-甘孜地体被厚的飞石带覆盖,有西藏东部和四川盆地之间的会聚引起的近地表逆冲断层的证据。LMS下方的下地壳被折叠并向上推动,而上地壳被挖掘出的迹象支持了西藏东部下方的下地壳通道流的概念。该图像还揭示了2008年汶川破坏性地震发生在上地壳上,直接发生在青藏高原东部和四川盆地之间的结构不连续处。

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