经鼻加温加湿高流量吸氧对重症肺炎伴呼吸衰竭患儿血气指标、肺功能及细胞因子水平的影响

摘要 目的：观察经鼻加温加湿高流量吸氧（HFNC）对重症肺炎伴呼吸衰竭患儿血气指标、肺功能及细胞因子水平的影响。方法：选取南京医科大学附属儿童医院2020年3月~2022年3月期间收治的86例重症肺炎伴呼吸衰竭患儿,按照随机数字表法分为经鼻持续气道正压通气（nCPAP）组和HFNC组,各为43例。对比两组临床相关指标、血气指标、肺功能及细胞因子水平,同时观察两组镇静剂使用、预后及并发症发生情况。结果：HFNC组的机械通气时间、咳嗽缓解时间、肺部啰音消失时间、入住儿童重症监护室（PICU）时间均短于nCPAP组（P<0.05）。两组患儿治疗后心率（HR）升高,呼吸频率（RR）下降,且HFNC组的变化大于nCPAP组（P<0.05）。两组患儿治疗后pH值、血氧分压（PO₂）、血氧饱和度（SpO₂）、氧合指数（OI）均升高,且HFNC组高于nCPAP组（P<0.05）。两组患儿治疗后用力肺活量（FVC）、1s用力呼气容积（FEV1）、用力呼气时最高呼气流速（PEF）升高,且HFNC组高于nCPAP组（P<0.05）。两组患儿治疗后降钙素原（PCT）、白细胞介素（IL-6）和肿瘤坏死因子（TNF-α）下降,且HFNC组低于nCPAP组（P<0.05）。HFNC组镇静剂使用、再住院例数均少于nCPAP组（P<0.05）。两组死亡例数、并发症发生率组间对比未见统计学差异（P>0.05）。结论：HFNC可有效缓解重症肺炎伴呼吸衰竭患儿的临床症状,改善血气指标、肺功能及细胞因子水平。     

血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平与冠心病患者冠状动脉病变严重程度的关系及其预测价值分析

摘要 目的：探讨血清载脂蛋白B（ApoB）/载脂蛋白A1（ApoA1）比值、三酰甘油（TG）/高密度脂蛋白胆固醇（HDL-C）比值、乳酸脱氢酶（LDH）及碱性磷酸酶（ALP）水平与冠心病（CHD）患者冠状动脉病变严重程度的关系及其预测价值。方法：选取2019年1月-2021年12月因胸痛来我院检查并收治的185例患者,根据检查结果是否为CHD分为CHD组（120例）和对照组（65例）,根据Gensini评分将CHD组分为轻度狭窄亚组36例、中度狭窄亚组55例、重度狭窄亚组29例。入院后检测血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平。采用Spearman相关系数分析CHD患者血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与Gensini评分的相关性,采用多因素Logistic回归分析CHD的影响因素;受试者工作特征（ROC）曲线分析血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平对CHD的预测价值。结果：与对照组比较,CHD组吸烟、饮酒、高血压、糖尿病比例和血清总胆固醇（TC）、TG、低密度脂蛋白胆固醇（LDL-C）、ApoB、ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平升高,HDL-C、ApoA1水平降低（P＜0.05）。轻度、中度、重度狭窄亚组血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平依次升高（P＜0.05）。CHD患者血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与Gensini评分呈正相关（P均＜0.001）。多因素Logistic回归分析显示,高血压、血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平升高为CHD的独立危险因素（P＜0.05）。ROC曲线分析显示,血清ApoB/ApoA1比值、TG/HDL-C比值、LDH及ALP水平联合预测CHD的曲线下面积大于单独预测（P＜0.05）。结论：血清ApoB/ApoA1比值、TG/HDL-C比值、LDH、ALP水平与CHD患者冠状动脉病变严重程度有关,且联合预测CHD的价值较高。     

基于老年综合评估结果指导治疗对老年冠心病患者心功能、脂代谢和生活质量的影响

摘要 目的：探讨基于老年综合评估结果指导（CGA）治疗对老年冠心病患者心功能、脂代谢和生活质量的影响。方法：本次研究将2020年6月-2022年1月在江苏省人民医院心血管内科接受治疗的106例老年冠心病患者,采用随机数字法将其随机分为对照组（常规药物治疗,53例）与研究组（对照组的基础上结合CGA治疗,53例）。对比两组疗效、心功能、脂代谢和生活质量相关情况。结果：研究组的临床总有效率为94.34%,明显高于对照组的79.25%（P<0.05）。研究组治疗3个月后左心室舒张期末内径（LVEDD）、左心室收缩期末内径（LVESD）低于对照组,左心室射血分数（LVEF）高于对照组（P<0.05）。研究组治疗3个月后高密度脂蛋白胆固醇（HDL-C）高于对照组,甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）低于对照组（P<0.05）。研究组治疗3个月后病情、体力、医疗状况、一般生活、社会心理状况、工作状况各维度评分高于对照组（P<0.05）。研究组的住院期间心脏不良事件总发生率低于对照组（P<0.05）。结论：基于CGA治疗老年冠心病,可有效改善心功能、脂代谢,降低住院期间不良事件发生率,提高患者的生活质量。     

Aluminum in Saudi children

Aluminum was determined in serum samples obtained from 533 Saudi female pupils aged 6–8 years who attended primary public school in Riyadh City, Capital of Saudi Arabia. The aluminum mean value was 23.21 ± 15.25 g 1^–1 in the range of 5.98–206.93 g 1^–1. Serum aluminum levels of pupils attending the Northern school area were higher than levels found in pupils from other school areas (Southern, Eastern and Central). Renal variables had no correlation with serum aluminum. On the other hand, a significant positive correlation was found between serum aluminium above 49.2 g 1^–1 and urea (r = 0.6, P < 0.002). Although 53% of the screened schools had aluminum in water above the European Union (EU) acceptable limit of 50 g 1^–1, there were no differences in aluminum in water between the four different school areas in Riyadh. Factors such as drinking water, diet and the use of aluminum utensils may have contributed to this result. As there is a bulk of literature which highlights the adverse developmental effects of aluminum on children and infants, it would be advantageous to establish regular aluminum monitoring.     

Pathological changes of myocardial cytoskeleton in cardiomyopathic hamster

Immunocytochemical investigation was performed on the cytoskeletal proteins in cardiac tissue of the cardiomyopathic hamster. Male cardiomyopathic UM-X7.1 hamsters at 180 days of age (n=8) and age- and sex-matched normal BIO-RB hamsters (n=8) were used in this study. Immunofluorescence microscopy using monoclonal antibodies against desmin, -actinin, titin, and vincullin was employed. The heart weight to body weight ratio was significantly increased in the heart of cardiomyopathic hamster compared with that of normal hamster. In cardiomyopathic hamster, the left ventricular cavity was markedly dilated. Light microscopically, hypertrophy and atrophy of myocytes and myocardial fibrosis were prominently observed in cardiomyopathic myocardium. Immunocytochemically, desmin, -actinin and titin showed the cross striations along the myofibers in normal myocardium. In contrast, in cardiomyopathic myocardium, desmin was irregularly distributed in myocytes and the amount of desmin was increased. Loss of cross striations of -actinin and titin were frequently observed. Immunofluorescence against vinculin was not significantly altered. We conclude that the alterations of cytoskeletal proteins in myocardial cells may relate to decreased myocardial function in cardiomyopathic hamster failing heart.     

Mammalian-heart adenylate deaminase: Cross-species immunoanalysis of tissue distribution with a cardiac-directed antibody

A sheep antiserum against purified rabbit-heart adenylate deaminase (EC 3.5.4.6) (AMPD) was developed and validated as an immunologic probe to assess the cross-species tissue distribution of the mammalian cardiac AMPD isoform. The antiserum and the antibodies purified therefrom recognized both native and denatured rabbit-heart AMPD in immunoprecipitation and immunoblot experiments, respectively, and antibody binding did not affect native enzyme activity. The immunoprecipitation experiments further demonstrated a high antiserum titer. Immunoblot analysis of either crude rabbit-heart extracts or purified rabbit-heart AMPD revealed a major immunoreactive band with the molecular mass (81 kDa) of the soluble rabbit-heart AMPD subunit. AMPD in heart extracts from mammalian species other than rabbit (including human) was equally immunoreactive with this antiserum by quantitative immunoblot criteria. Although generally held to be in the same isoform class as heart AMPD, erythrocyte AMPD was not immunoreactive either within or across species. Nor was AMPD from most other tissues [e.g., white (gastrocnemius) muscle, lung, kidney] immunoreactive with the cardiac-directed antibody. Limited immunoreactivity was evidenced by mammalian liver, red (soleus) muscle, and brain extracts across species, indicating the presence of a minor cardiac(-like) AMPD isoform in these tissues. The results of this study characterize the tissue distribution of the cardiac AMPD isoform using a molecular approach with the first polyclonal antibodies prepared against homogeneous cardiac AMPD. This immunologic probe should prove useful at the tissue level for AMPD immunohistochemistry.     

Alterations of β-adrenoceptor-G-protein-regulated adenylyl cyclase in heart failure

Alterations of receptor-G-protein-regulated adenylyl cyclase activity have been suggested to represent an important alteration leading to contractile dysfunction in the failing human heart. Recent experiments suggest that the ₁-adrenoceptor(₁AR) density and mRNA levels are reduced, while ₂-adrenoceptors and stimulatory G-proteins are unchanged (mRNA and protein level). Functional assays demonstrated that the catalyst of the adenylyl cyclase is not different between failing and nonfailing myocardium. Inhibitory G-proteins are increased (pertussis toxin substrates, protein and mRNA) and correlate to the reduced inotropic effects of -adrenoceptor agonists and of CAMP-PDE inhibitors. Gi-coupled m-cholinoceptors and A₁-adrenergic receptors are unchanged in density and affinity. Stimulation of these receptors resulted in an unchanged antiadrenergic effect on force of contraction. In conclusion, a downregulation of ₁-AR and an increase of Gi have been observed as signal transduction alteration in failing human myocardium. These alterations are due to alterations of gene expression in the failing heart and are related to a defective regulation of force of contraction in heart failure.     

Factors involved in capillary growth in the heart

Growth of capillaries in the heart occurs under physiological circumstances during endurance exercise training, exposure to high altitude and/or cold, and changes in cardiac metabolism or heart rate elicited by modification of thyroid hormone levels. Capillary growth in all these conditions can be linked with increased coronary blood flow, decreased heart rate, or both. This paper brings evidence that, although increased blood flow due to long-term administration of coronary vasodilators results in capillary growth, a long-term decrease in heart rate induced by electrical bradycardial pacing in rabbits and pigs, or by chronic administration of a bradycardic drug, alinidine, in rats, stimulates capillary growth with little or no change in coronary blood flow. Decreased heart rate results in increased capillary wall tension, increased end-diastolic volume and increased force of contraction, and thus stretch of the capillary wall. This could lead to release of various growth factors possibly stored in the capillary basement membrane. Correlation was found between capillary density (CD) and the levels of low molecular endothelial cell stimulating angiogenic factor (ESAF) both in rabbit and pig hearts with CD increased by pacing. There was no relation between expression of mRNA for basic fibroblast growth factor and CD in sham-operated and paced rabbit hearts. In contrast, mRNA for TGFß was increased in paced hearts, and the possible role of this factor in the regulation of capillary growth induced by bradycardia is discussed.     

The medical utility of genomics data in neuropsychiatry: mutational genetics versus association genetics

The long anticipated ‘genetic revolution’ in neuropsychiatry has yet to have an impact on the practice of clinical medicine. Excitement in the 1980s over major genetic breakthroughs in schizophrenia and manic depression, for example, has been replaced in the late 1990s by the sobering realization that most common neuropsychiatric disorders are multifactorial. Despite considerable effort and resources, no ‘causative’ genetic variation has been identified that plays a definitive major role in any common neuropsychiatric disorder.     

Space proton flux and the temporal distribution of cardiovascular deaths

 The influence of solar activity (SA) and geomagnetic activity (GMA) on human homeostasis has long been investigated. The aim of the present study was to analyse the relationship between monthly proton flux (>90 MeV) and other SA and GMA parameters and between proton flux and temporal (monthly) distribution of total and cardiovascular-related deaths. The data from 180 months (1974–1989) of distribution in the Beilinson Campus of the Rabin Medical Centre, Israel, and of 108 months (1983–1991) from the Kaunas Medical Academy, were analysed and compared with SA, GMA and space proton flux (>90 MeV). It was concluded: (1) monthly levels of SA, GMA and radiowave propagation (Fof2) are significantly and adversely correlated with monthly space proton flux (>90 MeV); (2) medical-biological phenomena that increase during periods of low solar and/or geomagnetic activity may be stimulated by physical processes provoked by the concomitant increase in proton flux; (3) the monthly number of deaths related (positively or negatively) to SA are significantly and adversely related to the space proton flux (>90 MeV). Received: 14 January 1996 / Accepted: 14 October 1996