Objective To investigate the change characteristics of brain natriuretic peptide(BNP) after offpump coronary artery bypass grafting (OPCAB), and observe the relationship of BNP with atrial fibrillation, intensive care unit(ICU) stay time, time of withdrawing trachea tube, and usage of intraaortic balloon pump(IABP). Methods We retrospectively analyzed the clinical data of 168 consecutive patients with coronary artery diseases who underwent OPCAB in Beijing Anzhen Hospital from September 2009 to March 2010. There were 133 males and 35 females with an age of 60.77±9.32 years. BNP was determined before operation, on the operative day just after operation, and day 1, 2 and 3 after operation. At the same time, the relationship between BNP and ICU stay time, time of withdrawing trachea tube, occurrence of atrial fibrillation, and usage of IABP were also recorded. Results There were two inhospital deaths, due to low cardiac output syndrome, infection and circulatory failure respectively. BNP increased significantly after operation with the peak level occurring 1 day after operation, after which it decreased gradually. BNP level in patients with their left ventricular ejection fraction(LVEF) under 50% was significantly higher than that in patients with LVEF equal to or above 50% before and after operation(the median BNP level at the second postoperative day: 2 198.20 pg/ml vs. 531.65 pg/ml, Plt;0.05). BNP in patients using IABP was significantly higher than that in patients without using IABP before and after operation(the median BNP level at the first postoperative day: 5 066.75 pg/ml vs. 745.20 pg/ml, Plt;0.05). The ROC value was 0.834 when perioperative BNP was used to predict the possibility of using IABP. BNP in patients with postoperative atrial fibrillation was also significantly higher than that in patients without atrial fibrillation(the median BNP level at the first postoperative day: 1 070.60 pg/ml vs. 747.80 pg/ml, Plt;0.05). BNP was positively correlated with using IABP(at the third postoperative day: r=0.437, Plt;0.05), prognosis(at the first postoperative day:r=0.224, Plt;0.05), time of withdrawing trachea tube(at the third postoperative day: r=0.440, Plt;0.05), ICU stay time(at the third postoperative day: r=0.477, Plt;0.05). Conclusion BNP can be considered as one of the diagnostic criteria for ventricular dysfunction, and preoperative high BNP level is a risk factor for using IABP and ICU stay time equal to or longer than 3 days.
【摘要】 目的 探讨无症状人群高尿酸血症与高甘油三酯血症的相关性，为临床疾病的预防和治疗提供实验基础研究。 方法 回顾分析2008年5月-2009年5月门诊体检中200名无临床症状高血尿酸者（A组）的血脂检查情况，并与同期200例血尿酸正常者（B组）的血脂检查情况进行比较分析。A组：男121例，女79例；年龄20～60岁，平均43岁。男性患者血尿酸gt;420 mmol/L，女性患者gt;360 mmol/L。 B组：男115例，女85例；年龄20～60岁，平均41岁。男性患者血尿酸为99～420 mmol /L，女性患者为99～360 mmol/L。两组性别和年龄差异无统计学意义（Pgt;0.05）。 结果 A组甘油三酯、总胆固醇、低密度脂蛋白、高密度脂蛋白分别为（3.09±0.98）、（4.05±1.07）、（3.38±0.98）、（1.30±0.51）mmol /L；B组为（1.65±0.86）、（3.99±0.99）、（2.97±0.89）、（1.41±0.66）mmol /L。 A组甘油三酯较B组比较，差异有统计学意义（Plt;0.01）；总胆固醇、低密度脂蛋白、高密度脂蛋白比较，差异无统计学意义（Pgt;0.05）。经相关性分析，A组血尿酸与甘油三酯呈正相关（r=0.69， Plt;0.01）。 结论 血尿酸代谢与甘油三酯代谢之间有一定的联系。【Abstract】 Objective To explore the correlation between hyperuricemia and hypertriglyceridemia in asymptomatic people to provide the basic information for clinical prevention and treatment. Methods The blood lipid (TG, TC, LDL, and HDL) levels in 200 asymptomatic individuals with high uric acid (A group) and 200 sex-and age-matched ones with normal serum uric acid (B group) were examined and the results of the two groups were compared. Results The concentration of triacylglycerol, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were (3.09±0.98), (4.05±1.07), (3.38±0.98), and (1.30±0.51) mmol/L, respectively in group A; and were (1.65±0.86), (3.99±0.99), (2.97±0.89), and (1.41±0.66) mmol /L, respectively in group B. The concentration of TG in group A was obvious higher than that in group B (Plt;0.01). However, the differences of their total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were not significant (Pgt;0.05). The increase of TG was obvious compared with TC(Plt;0.01), LDL (Plt;0.01), and HDL (Plt;0.01) in group A; while the comparisons in group B were not significant (Pgt;0.05). Conclusion Uric acid metabolism correlates with triacylglycerol metabolism.
目的：研究青蒿琥酯诱导人胃癌SGC-7901细胞凋亡作用及其可能机制.方法：应用流式细胞术（FCM）、透射电镜（TEM）等方法检测不同浓度下青蒿琥酯对人胃癌SGC-7901细胞生长的影响，并应用Western Blot法检测凋亡相关基因Bcl-2、Bax的表达水平。结果：经青蒿琥酯处理后，人胃癌SGC-7901细胞凋亡率升高，并具有时间浓度依赖性（Plt;0.05），癌细胞被阻滞于G0/G1期；电镜观察肿瘤组织中散在凋亡细胞及凋亡小体；Western Blot法检测到凋亡相关基因Bcl-2表达减弱，Bax表达增强（Plt;0.05）。结论：青蒿琥酯能有效抑制人胃癌SGC7901细胞增殖并诱导其凋亡，其机制可能与下调凋亡相关基因Bcl-2、上调Bax表达有关。
目的:〖HT5”SS〗探讨原发性喉部恶性淋巴瘤的临床诊断治疗方案,提出早期诊断此类疾病的合理有效方法。〖HTH〗方法:〖HTSS〗对临床29例病理确诊原发于喉部的恶性淋巴瘤患者临床资料进行回顾性分析,并且与同时期原发于鼻腔鼻窦的恶性淋巴瘤患者临床资料对比分析。〖HTH〗结果:〖HTSS〗29例原发性喉部恶性淋巴瘤病例均进行了手术干预,在术中或术后病理明确诊断后进行了后继的放射及化学综合治疗,病员的平均住院日较原发于鼻腔鼻窦的恶性淋巴瘤患者为长。〖HTH〗结论:〖HTSS〗本病的合理有效的诊断治疗,需早期明确诊断和判定病变累及范围,在尽可能早期获取病理诊断基础上,提高对喉部影像学的认识,对于此类疾病及时制订合理有效的治疗方案,获得更好的预后有着重要意义。
At present, interventional therapy for structural heart disease is in a period of vigorous development. Among them, transcatheter aortic valve replacement, as a representative of the interventional treatment of heart valve disease, has made rapid progress, which is a bright spot in the field of cardiovascular disease. The future development of transcatheter tricuspid valve repair/replacement is also promising. With the availability of important clinical evidence, the indications of transcatheter aortic valve replacement have been extended to the full risk range of severe aortic stenosis. More and more data showed that transcatheter mitral and tricuspid valve interventions could effectively alleviate patients’ symptoms and improve their prognosis. Transcatheter valve interventions have developed rapidly and have made tremendous progress in China. This article will review and interpret the important progress in the field of transcatheter valve interventions.
Mitral valve regurgitation is one of the most common heart valve diseases, of which secondary mitral valve regurgitation (sMR) has large proportion and poor prognosis. For patients who still have symptoms after the guideline-directed management and therapy, the effects of surgery are controversial, and transcatheter therapy provides a new option. Transcatheter edge-to-edge repair has become one of the recommended therapies by the guidelines, meanwhile transcatheter mitral valve annuloplasty and transcatheter mitral valve replacement are developing. However, the etiological mechanism of sMR is complex and diverse. There is an interaction between cardiac function and structure and sMR in dynamic change. It brings challenges to the selection of indicators and evaluation timing. The complex anatomical structure also makes it more difficult to design instruments and select surgical methods. This paper reviews the challenges and progress of transcatheter therapy for sMR.
Mitral regurgitation is the most prevalent valvular heart disease, with a poor prognosis that brings a heavy burden to population health and socio-economics. Transcatheter repair is a relatively mature technique for mitral regurgitation, but is strict in anatomical screening and the reduction of regurgitation is limited. With the advance in techniques and technology, transcatheter replacement has become an attractive treatment modality for mitral regurgitation in succession to transcatheter repair. At present, several replacement devices have initiated clinical trials to establish feasibility. Early data has shown that transcatheter replacement for mitral regurgitation is safe and effective, which needs to be confirmed with larger population and longer follow-up. Besides, some technical challenges remain to be addressed, in order to increase accessibility of this innovative technology.
As the indications for transcatheter aortic valve replacement (TAVR) expand, multi-valve lesions are becoming more common in clinical practice. Moderate to severe atrioventricular regurgitation, particularly when persistent after TAVR, significantly increases the risk of adverse events. Therefore, many studies have evaluated factors that contribute to the improvement of atrioventricular regurgitation. However, this field remains controversial due to the heterogeneity of retrospective studies and the lack of randomized controlled trials. Despite advances in atrioventricular valve intervention techniques, evidence for atrioventricular regurgitation intervention after TAVR is still scarce. The management decision for atrioventricular regurgitation in patients who underwent TAVR is complex and must take into account the severity of valve disease, anatomical characteristics, quality of life, and procedural complexity. We conducted a review of atrioventricular regurgitation in patients who have received TAVR in hope that it will help decision-making in clinical practice.
Objective To evaluate the cl inical effectiveness and advantages of one-stage posterior debridement, bone graft, and internal fixation for thoracic tuberculosis. Methods The data were retrospectively analysed, from 21 cases of thoracic tuberculosis undergoing one-stage posterior debridement, bone graft, and internal fixation between June 2007 andNovember 2009. There were 16 males and 5 females with an average age of 42.2 years (range, 22-73 years). The average disease duration was 13.2 months (range, 7-21 months). The lesions were located at the level of T5, 6 (1 case), T6, 7 (1 case), T8, 9 (4 cases), T9, 10 (3 cases), T10, 11 (5 cases), T11, 12 (6 cases), and T9-11 (1 case). According to the Frankel grading criterion, the neurological function was rated as grade B in 2 cases, grade C in 6 cases, grade D in 10 cases, and grade E in 3 cases. The preoperative Cobb angle was (26.3 ± 9.2)°. The erythrocyte sedimentation rate (ESR) was (35.9 ± 11.2) mm/ 1 hour. Results Thoracic tuberculosis was confirmed in postoperative pathological examination in all 21 cases. All incisions healed primarily without fistules formation. The average follow-up time for 21 patients was 16.2 months (range, 1-3 years). Bony fusion was achieved within 7-12 months (mean, 9 months) without pseudoarthrosis. No loosening and breakage of internal fixation were found, and no local recurrence occurred. The ESR decreased to (25.1 ± 8.9) mm/1 hour at 1 week postoperatively, showing significant difference when compared with preoperative value (t=5.935, P lt; 0.01); it decreased to (14.1 ± 4.6) mm/1 hour at 3 months postoperatively. According to Frankel grade, the neurological function was significantly improved at 1 year after operation (χ2=13.689, P=0.003). The average Cobb angle was (17.1 ± 4.5)° at 1 years postoperatively, showing significant difference when compared with preoperative value (t=7.476, P lt; 0.01). Conclusion One-stage posterior debridement, bone graft, and internal fixation has a good cl inical effectiveness for thoracic tuberculosis with less injury and complete focal cleaning, as well as a goodeffectiveness of spinal canal decompression and kyphosis deformity correction.
Objective To explore the appl ication of submental island flaps in repairing pharyngeal fistula after total laryngectomy. Methods From July 2002 to February 2006, 9 cases of concomitant pharyngeal fistula (including 7 cases of laryngeal carcinoma and 2 cases of hypopharyngeal neoplasms) were repaired with submental island flaps after total laryngectomy. All patients were male and their ages were 52-71 years (mean 61.8 years). Pharyngeal fistula occurred 5-62 days (mean 14.7 days) after total laryngectomy. The diameter of medial pharyngeal fistula ranged from 1.9 cm to 4.1 cm. All patients failed to respond to conservative therapy for 25-46 days. The size of submental island flap was 2.5 cm × 2.4 cm to 4.6 cm × 4.0 cm. After the pharyngeal fistula were repaired with submental flap, the donor site were sutured directly. Results All of the nine submental flaps were survived and no local necrosis or wound infection occurred. Incision at donor site healed by first intention and no obvious scar formed. Fistula occurred 10 days after operation and was cured after symptomatic treatment in one patient who received radiotherapy before operation; other patients achieved the satisfactory results of one-stage repair. The gastric tube was pulled out 14 to 22 days after operation, all of the patients have no sense of swallow obstruction. Nine patients were followed up for 10-38 months (mean 27 months). The ppearance of neck was satisfactory. Conclusion Because of its short distance, abundant blood supply, convenient operation and minimal donor-site morbidity, the submental island flap is a good alternative mthod in repairing pharyngeal fistula.