Effects of trientine,a metal chelator,on defective endothelium-dependent relaxation in the mesenteric vasculature of diabetic rats

Diabetes mellitus compromises endothelium-dependent relaxation of blood vessels. This has been linked to the generation of reactive oxygen species (ROS), which neutralise nitric oxide (NO) and interfere with vasodilator function. Experiments using chelators have emphasised the importance of ROS produced by transition metal catalysed reactions. However, particularly for the small arteries and arterioles that control microcirculatory blood flow, NO is not the only endothelium-derived mediator; endothelium-derived hyperpolarizing factor (EDHF) has a major role. EDHF-mediated vasodilation is severely curtailed by diabetes; however, little information exists on the underlying pathophysiology. Deficits in the EDHF system, alone or in combination with the NO system, are crucial for the development of diabetic microvascular complications. To further elucidate the mechanisms involved, the aim was to examine the effects of diabetes and preventive and intervention chelator therapy with trientine on a preparation that has well-defined NO and EDHF-mediated responses, the rat mesenteric vascular bed. In phenylephrine-preconstricted preparations, maximum vasodilation to acetylcholine was reduced by 35 and 44% after 4 and 8 weeks of streptozotocin-induced diabetes, respectively. Trientine treatment over the first 4 weeks gave 72% protection; intervention therapy over the final 4 weeks prevented deterioration and corrected the initial deficit by 68%. These responses depend on both NO and EDHF. When the latter mechanism was isolated by NO synthase inhibition, diabetic deficits of 53.4 (4 weeks) and 65.4% (8 weeks) were revealed, that were 65% prevented and 50% corrected by trientine treatment. Neither diabetes nor trientine altered vascular smooth muscle responses to the NO donor, sodium nitroprusside (SNP). Thus, the data suggest that metal catalysed ROS production makes a substantial contribution to defects in both the EDHF and NO endothelial mechanisms in diabetes, which has therapeutic implications for microvascular complications.     

N末端脑钠肽前体在围冠状动脉搭桥术期的变化及意义

N-末端脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)是体内脑钠肽前体(proBNP)裂解成脑钠肽(brain natriuretic peptide,BNP)时的产物,NT-proBNP的血浆浓度及稳定性比BNP更高,半衰期更长,属于钠尿肽系统的重要一员,本身无生物学活性。NT-proBNP主要由正常的心肌细胞合成和分泌,在心肌损伤或坏死后迅速升高,可反映机体代偿病理改变和恢复循环的能力,是心功能障碍性疾病,如心力衰竭、左室肥厚等诊断、疗效监测和预后评估等最佳的心肌标志物,临床通过测定血浆NT-proBNP水平用于急慢性充血性心力衰竭(congestive heart failure,CHF)的诊治及预后,本文主要就NT-proBNP在围冠状动脉搭桥术(Coronary Artery Bypass Grafting,CABG)期的变化及临床意义的新进展进行综述。     

小切口入路锁定钢板治疗老年肱骨近端骨折的临床疗效观察

目的:探讨小切口入路锁定钢板治疗老年肱骨近端骨折的疗效。方法:选取了80例肱骨近端骨折患者,按随机数字表法分为两组,对照组(39例)给予三角肌入路锁定钢板,观察组(41例)给予小切口入路锁定钢板治疗,通过观察并记录围手术期指标,术前术后3个月的Neer评分,术后24 h的凝血指标,随访3个月期间的并发症发生情况,评价小切口入路锁定钢板治疗老年肱骨近端骨折的疗效。结果:观察组手术、住院、骨折愈合所需时间均短于对照组(P0.05),两组术中出血量相比,无统计学差异(P.05),术前观察组与对照组Neer评分相比,无统计学差异(P0.05),术后3个月,观察组与对照组Neer评分均明显增加,且观察组高于对照组(P0.05)。术前两组凝血指标无明显差异,术后24 h,两组国际标准化比率(International Normalized Ratio,INR)相比无明显变化,血浆凝血酶原时间(prothrombin time,PT),活化部分凝血活酶时间(activated partial thromboplastin time,APTT)均明显降低(P0.05)。对照组血浆纤维蛋白原(Plasma fibrinogen,FIB)水平明显升高,观察组FIB术前术后24 h无明显变化(P0.05),术后24 h,两组患者PT,APTT,INR相比无统计学差异(P0.05)观察组FIB水平明显低于对照组(P0.05)。随访3个月期间,两组均未出现切口感染、血管神经损伤等严重并发症。结论:小切口入路锁定钢板对老年肱骨骨折具有较好的治疗效果,能显著改善患者肩关节功能,对血液系统影响较小,术后并发症少,值得临床推广使用。     

温敏性几丁糖填充兔眼玻璃体两种手术方式对比研究

目的:通过两种手术方式对兔眼玻璃体进行温敏性几丁糖填充,比较其眼压及并发症差异。方法:将18只白兔随机分为实验组和对照组,每组各9只,右眼均为手术眼,实验组白兔行玻璃体切割术并注入温敏性几丁糖,对照组通过1 m L注射器抽取玻璃体并填充温敏性几丁糖,术后随访1月,对比两组白兔术后眼压及手术并发症的差异性。结果:实验组手术前眼压(7.76±2.21)mm Hg与术后眼压(7.49±2.98)mm Hg无明显差异(P0.05),对照组手术前眼压(7.80±2.04)mm Hg与手术后眼压(5.17±0.96)mm Hg有统计学意义(P0.05)。对照组术后并发症发生率为44.4%(4/9),明显高于实验组22.2%(2/9)。结论:玻璃体腔注射温敏性几丁糖操作简单,但并发症较多,且易造成眼压改变;而玻璃体切割术后填充温敏性几丁糖并发症相对较少,眼压波动较小,但应注意并发性白内障的发生。     

肝部分切除治疗肝内胆管结石患者术后并发症及影响因素分析

目的:分析肝部分切除术治疗肝内胆管结石患者术后并发症及影响因素。方法:选取我院收治的肝内胆管结石患者117例,均采取肝部分切除术治疗,对其临床资料进行回顾性分析,研究术后并发症的发生情况,并对影响因素进行分析。结果:本组117例患者,并发症发生率35.04%,其中肝功能衰竭1例,胆道出血2例,消化道出血6例,腹腔感染6例,胆瘘6例,胸腔积液8例,切口感染12例。并发症组患者术前白蛋白、手术时间、既往胆道手术史水平与非并发症组比较,差异均有统计学意义(P0.05)。肝部分切除术后的并发症多因素Logistic回归分析结果显示,手术时间、既往胆道手术史均是术后并发症独立风险因素。结论:肝部分切除术治疗肝内胆管结石患者术后并发症发生率较高,以切口感染和胸腔积液为最,患者的既往手术史以及手术时间均是影响并发症发生的重要危险因素,做好针对性预防可预防并发症的发生。     

2型糖尿病发生大血管并发症的危险因素分析

目的:探讨2型糖尿病患者发生大血管并发症的危险因素.方法:选取哈尔滨医科医科大学附属第四医院内分泌科2012年1月至2012年12月住院的2型糖尿病患者共计200例,根据相关辅助检查结果将其分为2型糖尿病无大血管并发症(DMl)组和2型糖尿病合并大血管并发症(DM2)组,比较2组患者血清胆红素水平及相关指标的差异.应用多因素非条件Logistic回归分析法对2型糖尿病大血管并发症危险因素建立方程.结果:2型糖尿病合并大血管并发症组患者血清胆红素水平低于2型糖尿病无大血管并发症组(P＜0.01),以糖尿病合并大血管并发症为因变量,年龄、病程、糖化血红蛋白、低密度脂蛋白胆固醇、甘油三酯、总胆红素、总胆固醇、直接胆红素、间接胆红素水平为自变量,进行Logistic逐步回归分析,结果显示病程、血清低密度脂蛋白胆固醇、年龄和总胆固醇是2型糖尿病合并大血管并发症的独立危险因素,血清胆红素水平是其保护性因素.结论:病程、年龄、血清低密度脂蛋白胆固醇和总胆固醇水平是2型糖尿病合并大血管并发症的独立危险因素,而血清胆红素水平是其保护性因素.     

Complicaciones y pronóstico de pacientes ancianos diagnosticados de meningioma intracraneal

ObjectSurgical treatment in patients older than 70 years old with intracranial meningioma is still subject to controversy. The benefit/risk ratio of this surgery has not been assessed due to the lack of objective criteria. The aim of this study is to assess the surgical complications and outcomes in elderly patients in our centre.MethodA retrospective analysis was performed on patients with intracranial meningioma between January 2010 and March 2014. The incidence of post-surgical complications, as well as their associated risk factors, was also analysed. Functional outcomes were compared with Glasgow Outcome Scale and Karnofsky index with those who underwent surgery and those with conservative management. Finally, a comparison was made between patients younger than 70 years old operated on for intracranial meningioma.ResultsA total of 48 patients diagnosed with intracranial meningioma older than 70 years old, of which 37 were operated on and 11 were followed up with conservative management. There were no differences between the groups in neurological status at discharge (Glasgow Outcome Scale 5 67.6 vs. 72.2%, respectively). No differences were observed in functional outcome during 6 months of follow up in the Karnofsky index between surgical and non-surgical patients (P = .486). In the comparison between older and younger than 70 years old, there were no differences in the incidence of surgical complications (P = .64 in early complications and P = .23 in late complications).ConclusionThe results of the present study suggest that age should not be a limitation in surgical indications in patients older than 70 years old with intracranial meningioma. No statistical differences were found in functional status compared with conservative management or in surgical complications between younger and elderly patients.     

曲安奈德玻璃体注射治疗黄斑水肿的安全性长期随访分析

目的:观察2 mg、4 mg曲安奈德玻璃体注射治疗黄斑水肿的长期安全性。方法:将54例黄斑水肿患者分别采用2 mg和4mg不同剂量的曲安奈德玻璃体内注射,随访2年,观察眼压、晶状体、眼内炎症、视网膜、玻璃体等并发症。结果:两种剂量曲安奈德玻璃体内注射均可产生高眼压、白内障、非感染性眼内炎症;4 mg组白内障发生率明显高于2 mg组,其余并发症未见明显差异;两组患者均未出现严重、不可逆并发症。结论:2 mg和4 mg曲安奈德玻璃体注射治疗黄斑水肿均较安全,4 mg剂量更容易发生白内障,两种计量均需长期随访。     

经胰管预切开与双导丝技术在困难胆管插管中的插管效果及安全性对比

目的:比较经胰管预切开与双导丝技术在困难胆管插管中的插管效果及安全性。方法:收集我院2017年1月～2018年12月收治的60例经内镜逆行性胰胆管造影术、反复进入胰管的困难胆管插管患者,将患者按照入院先后顺序分为观察组和对照组,每组30例。两组患者分别经胰管预切开及双导丝技术辅助插管,对两组患者插管时间、插管成功率以及并发症的发生情况进行综合评价。结果:观察组患者插管时间短于对照组(P0.05),插管成功率为96.7%,显著高于对照组(73.3%,P0.05)。观察组和对照组患者并发症的发生率分别为10.0%、13.3%,组间差异无统计学意义(P0.05)。结论:对困难胆管插管患者,采用经胰管预切开的方式辅助插管操作简单,插管时间短,成功率高,且不增加并发症发生率。     

不同动脉途径行经皮冠状动脉介入治疗高龄冠心病的临床疗效观察

目的:探讨不同动脉途径行经皮冠状动脉介入治疗高龄冠心病的临床疗效和安全性。方法:选取2014年1月～2017年1月我院收治的265例高龄冠心病患者为研究对象,根据就诊顺序将受试者分为对照组132例及研究组133例,对照组患者给予股动脉途径(TFI)行经皮冠状动脉介入治疗,研究组患者给予桡动脉途径(TRI)行经皮冠状动脉介入治疗,比较两组患者的手术情况、手术前后各心功能指标变化、心血管不良事件及并发症的发生情况。结果:两组患者的手术成功率、支架数量、造影剂用量比较差异无统计学意义(P0.05),但研究组患者动脉穿刺时间、导管插入时间及X线曝光时间均长于对照组,卧床时间及住院时间均明显短于对照组(P0.05)。治疗后,两组患者的左心射血分数(LVEF)、左室收缩末期内径(LVESD)及左室舒张末期内径(LVEDD)较治疗前均明显改善,且研究组优于对照组(P0.05),研究组患者心血管不良事件发生率及各并发症发生率均显著低于对照组(P0.05)。结论:TRI与TFI在经皮冠状动脉介入术治疗高龄冠心病患者的手术效果相当,但TRI在改善患者心功能、减少心血管不良事件的效果更好且安全性更高,可做为高龄冠心病患者PCI治疗的首选途径。