NT-proBNP对胺碘酮用于急诊阵发房颤复律疗效的预测价值

目的:研究N末端B型利钠肽原(N-terminal pro B-type natriuretic peptide, NT-proBNP)对胺碘酮用于急诊阵发性非瓣膜病心房颤动疗效的预测价值。方法:收集2016-2017年于宣武医院急诊科诊断为阵发性非瓣膜病房颤(发病48h内)的患者共110例,记录所有患者人院时一般资料、既往病史、临床症状体征、实验室数据及测定肌钙蛋白I(Troponin-I, TnI)水平和基线NT-proBNP水平,均给予胺碘酮静脉转复治疗。按照胺碘酮转复情况分为成功组和失败组。结果:静脉应用胺碘酮成功转复91例(82.7%),平均转复时间8.15小时(SD10.16),转复失败者24 h内心室率均控制在100次/min以下,均无严重不良反应。成功组血浆基线NT-pro BNP水平显著低于失败组(P0.05);而两组患者性别、年龄、入室血压、心室率、胸痛、房颤持续时间、入室心电图ST段压低、Tn I水平、冠心病史、高血压、糖尿病、房颤史比较差异均无统计学意义(P0.05)。二元logistic回归分析显示NT-proBNP的自然对数,即In(NT-proBNP)为急诊房颤胺碘酮复律疗效的主要影响因素。结论:对于非瓣膜病房颤急性发作48 h的患者,胺碘酮转复是安全有效的;基线NT-proBNP水平是药物复律成功的重要预测因子,如基线NT-proBNP水平较高,则复律成功率低,为了避免药物的不良反应,可考虑控制心室率,而不是复律治疗。     

心房颤动患者血清脑钠肽水平变化的临床研究

目的：探讨患者心房颤动（房颤,AF）发作时对血清脑钠肽水平的影响。方法：选择阵发性房颤组、持续性房颤组、对照组（窦性心律）患者各30例,观察各组血清脑钠肽水平;并对阵发性房颤组中心室率≤100 beats/min与心室率〉100 beats/min的患者进行亚组分析;观察阵发性房颤组复律后24 h和30 d血清脑钠肽水平。结果：阵发性房颤组和持续性房颤组血清脑钠肽水平明显高于对照组（P〈0.01）,房颤复律后血清脑钠肽水平很快下降。结论：血清脑钠肽水平在房颤发作时明显升高,血清脑钠肽水平的升高与房颤的发作有关。     

老年冠心病患者伴有心梗史对围术期发生心血管事件的影响

目的：探讨有或无心梗史对老年冠心病患者围术期发生心血管事件的影响。方法：择期行非心脏手术的老年冠心病患者128例,按照有无心梗史分为心梗史组（n=63）和无心梗史组（n=65）。监测麻醉前15min、术中、术后30min ECG,统计sT-T改变和各型心律失常,记录术后急性心肌梗死的发生。结果：术中心梗史组ST-T改变发生率、sT段抬高的最大幅度、心律失常总发生率、房颤和室内传导阻滞（完左、完右）的发生率均高于无心梗史组（P〈0．05,P〈0．01）;术后ST-T改变发生率、ST段压低最大幅度、ST段抬高的最大幅度以及心梗发生率均大于无心梗史组（P〈0．05,P〈0．01）;且术后4～7d心梗发生率较高（P〈0．05）。结论：有心梗病史是老年冠心病手术患者心血管事件的危险因素。     

急性心力衰竭患者血清Adropin、sST2、Gal-3水平与预后的关系分析

目的:探讨急性心力衰竭患者血清Adropin、可溶性ST2受体(s ST2)、半乳糖凝集素-3(Gal-3)水平与预后的关系。方法:选取2015年6月～2019年6月期间内蒙古自治区人民医院收治的154例急性心力衰竭患者纳入心衰组,另选同期在内蒙古自治区人民医院进行健康体检的100例志愿者为对照组。对比心衰组、对照组血清Adropin、s ST2、Gal-3水平,并将心衰组患者按美国纽约心脏病协会(NYHA)心功能分级分为II级组(n=38)、III级组(n=64)、IV级组(n=52),对比三组患者的血清Adropin、s ST2、Gal-3水平。心衰组患者经治疗出院后,根据患者的预后效果分为预后良好组(n=95)和预后不良组(n=59),采用单因素和Logistic多元回归分析急性心力衰竭患者预后不良的影响因素。结果:心衰组血清Adropin、s ST2、Gal-3水平均高于对照组(P0.05)。心衰组患者中随着心功能分级的升高,患者的血清Adropin、s ST2、Gal-3水平均显著升高(P0.05)。预后不良患者59例,发生率为38.31%。单因素分析结果显示,预后不良组和预后良好组患者在年龄、性别、体质指数(BMI)、吸烟史、饮酒史、基础疾病、血常规指标的比较无统计学差异(P0.05)。预后不良组患者的心功能分级、血清Adropin、s ST2、Gal-3水平均高于预后良好组(P0.05)。Logistic多元回归分析显示,心功能分级为IV级、Adropin≥10ng/mL、s ST2≥150μg/m L、Gal-3≥5μg/L是急性心力衰竭患者预后不良的危险因素(P0.05)。结论:急性心力衰竭患者血清Adropin、s ST2、Gal-3水平显著升高,并随患者的病情加重而升高,血清Adropin、s ST2、Gal-3水平的变化会影响患者的预后。     

左房内径、血清尿酸水平与老年心房颤动的相关性分析

目的:探讨左房内径(LAD)、血清尿酸(UA)水平与老年心房颤动的相关性。方法:选择2013年1月至2016年7月在我院住院的60岁以上的非瓣膜性房颤患者,共166例,其中持续性房颤组85例,阵发性房颤组81例,选择同期无房颤的高血压、冠心病老年患者83例作对照组。通过心脏彩超检查检测LAD、左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVDS)、左心室射血分数(LVEF),以≥40 mm为左房内径增大。并采用生化分析检测患者血清UA水平。结果:(1)持续性房颤组LAD、LVEF、左心房增大发生率均显著高于阵发性房颤组和对照组,而阵发性房颤组以上指标均明显高于对照组,差异具有统计学意义(P0.05)。(2)持续性房颤组和阵发性房颤组患者血清UA水平均显著高于对照组,但持续性房颤组和阵发性房颤组之间血清UA水平比较差异无统计学意义(P0.05)。结论:左心房内径大小、血尿酸水平与老年患者心房颤动的发生密切相关。     

心电图ST段不同改变与急性心肌梗死患者冠脉造影病变特点及生活质量的相关性研究

目的:探讨心电图ST段不同改变与急性心肌梗死患者冠脉造影病变特点及生活质量的相关性。方法:选取选取2015年6月到2017年6月在本院接受治疗的急性心肌梗死患者208例,根据心电图ST段的改变情况将患者分为ST段抬高组(124例)、ST段压低组(64例)、ST段无偏移组(20例),所有患者进行冠脉造影检查和常规治疗,比较治疗前三组患者的冠脉造影情况和冠脉狭窄程度,比较治疗1个月后三组患者的生活质量评分。结果:在ST段抬高组中,共检测出单支血管闭塞病变99例,占79.84%,两支或两支以上血管病变25例,占20.16%,其中侧支循环开放19例,开放率为15.32%。在ST段压低组中,共检测出单支血管非闭塞病变6例,占9.38%,两支或两支以上血管非闭塞病变56例,占87.50%,单支血管闭塞病变2例,占3.13%,其中侧支循环开放34例,开放率为53.13%。在ST段无偏移组中,单支血管闭塞病变15例,占75.00%,单支或多支血管非闭塞病变5例,占25.00%,其中侧支循环开放7例,开放率为35.00%。ST段抬高组、ST段无偏移组患者的冠脉狭窄程度以重度狭窄为主,ST段压低组患者的冠脉狭窄程度以中度狭窄为主,三组患者的轻度狭窄、中度狭窄、重度狭窄整体比较存在统计学差异(P0.05)。三组患者的疼痛评分、躯体受限评分、精神及活动评分整体比较具有统计学差异(P0.05),ST段压低组的上述评分均显著高于ST段抬高组和ST段无偏移组(P0.05)。结论:心电图ST段不同改变与急性心肌梗死患者冠脉造影病变密切相关,且ST段压低患者的预后通常较好。     

房颤不同时期结构重构的血清学变化

目的:探讨转化生长因子-β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制因子-1(TIMP-1)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)与阵发性或持续性房颤结构重构的关系。方法:入选患者分为3组,其中持续性房颤组30例、阵发性房颤组45例,以及32例阵发性室上速(包括预激综合征)作为对照组,通过ELISA方法检测上述患者左房血清的TGF-β1、MMP-9、TIMP-1、TNF-α、IL-6、IL-10水平,超声测量左心房长径。分析上述细胞因子水平与阵发性房颤或持续性房颤的关系。结果:阵发性房颤组与对照组相比,左房内径增大、TGF-β1、TNF-α升高(P0.05),IL-10、TIMP-1降低(P0.05),MMP-9无统计学差异。持续性房颤组与对照组相比,TGF-β1无统计学差异(P0.05),MMP-9、TNF-α、IL-6均升高(P0.05),IL-10、TIMP-1降低(P0.05);阵发性房颤组TGF-β1高于持续性房颤组(P0.05),持续性房颤组左房内径及MMP-9高于阵发性房颤组(P0.05)。结论:阵发性房颤患者左房扩大,已出现结构重构,结构重构的血清学变化以TGF-β1升高为主;持续性房颤患者结构重构血清学变化以MMP-9、IL-6升高为主。     

急性脑梗死血清肌钙蛋白-T升高的临床观察

目的:探讨急性脑梗死患者血清肌钙蛋白水平升高与梗死严重程度、梗死部位和预后的关系。方法:247例急性脑梗死患者,在住院的第一天内完成12导联心电图及血清肌钙蛋白-T(cTnT)水平的检查。以0.5ng/ml为界,将患者分为cTnT水平升高组和cTnT水平正常组。结果:26例(10.5%)血清cTnT水平升高。与cTnT水平正常组相比,cTnT水平升高组患者入院时NIHSS评分更严重,岛叶受累的发生率更高,预后较差,异常心电图发生率较高。结论:血清cTnT水平升高的急性脑梗死患者梗死更严重,预后较差,这些患者大多岛叶受累和ECG异常。     

急性ST段抬高型心肌梗死患者血清NT-proBNP、P-selectin联合IMA预测PCI术后心电图ST段回落的临床价值研究

摘要 目的：探讨急性ST段抬高型心肌梗死（ASTEMI）患者血清N末端B型利钠肽前体（NT-proBNP）、P-选择素（P-selectin）联合缺血修饰白蛋白（IMA）预测经皮冠状动脉介入治疗（PCI）术后心电图ST段回落（STR）不良的临床价值。方法：选取2020年1月～2022年7月南京医科大学第二附属医院急诊科收治的100例ASTEMI患者，根据PCI术后心电图STR分为STR不良组和STR良好组，另选取同期50名体检健康志愿者为对照组。采用酶联免疫吸附法检测血清NT-proBNP、P-selectin和IMA水平。采用多因素Logistic回归分析ASTEMI患者PCI术后心电图STR不良的影响因素，采用受试者工作特征（ROC）曲线分析血清NT-proBNP、P-selectin、IMA水平对ASTEMI患者PCI术后心电图STR不良的预测价值。结果：与对照组比较，ASTEMI组PCI术前血清NT-proBNP、P-selectin和IMA水平升高（P＜0.05）。根据心电图STR将ASTEMI患者分为STR不良组35例和STR良好组65例。STR不良组与STR良好组PCI术后血清NT-proBNP、P-selectin和IMA水平低于PCI术前（P＜0.05）；STR不良组PCI术前和PCI术后血清NT-proBNP、P-selectin和IMA水平高于STR良好组（P＜0.05）。STR不良组Killip分级≥2级比例和肌钙蛋白I高于STR良好组，ST段偏差总和低于STR良好组（P＜0.05）。多因素Logistic回归分析显示，Killip分级≥2级和NT-proBNP、P-selectin、IMA升高为ASTEMI患者PCI术后心电图STR不良的独立危险因素（P＜0.05）。ROC曲线分析显示，血清NT-proBNP、P-selectin联合IMA预测ASTEMI患者PCI术后心电图STR不良的曲线下面积（AUC）大于NT-proBNP、P-selectin和IMA单独预测。结论：血清NT-proBNP、P-selectin和IMA水平升高与ASTEMI患者PCI术后心电图STR不良独立相关，三者联合预测ASTEMI患者PCI术后心电图STR不良的价值较高。     

超敏C反应蛋白与阵发性房颤射频消融术后早期复发的关系

目的：前瞻性研究超敏C反应蛋白（hsCRP）与阵发性心房颤动射频消融术后早期复发的关系。方法：接受CARTO指导房颤射频消融术的非瓣膜性阵发性房颤患者57例,平均年龄（53.32±9.98）岁,其中男42例,女15例。术前及术后5 d连续测定外周血hsCRP和高敏肌钙蛋白T （hs-cTnT）水平,记录体表心电图,行24 h动态心电图检查。术后5 d内,32名患者（56.14%）为窦性心律,为未复发组,25名（43.86%）复发房颤,为复发组。结果：未复发组与复发组患者的hsCRP与hs-cTnT日均升高量显著正相关,P=0.044,r=0.268。而两组间基线临床特征、手术前后血浆hsCRP、hs-cTnT水平、血浆hsCRP及hs-cTnT的总升高量（峰值水平-术前水平）、日均升高量（总升高量/达到峰值所用天数）无明显统计学差异（P均>0.05）。结论：房颤射频消融术后hsCRP升高变化与心肌损伤程度相关,与早期复发无直接关系,尚不能作为预测房颤术后早期复发的高危因子。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Feeding the vertebrate retina from the Cambrian to the Tertiary

The retina of the vertebrate eye is metabolically active and requires nutritive support. During the last 540 million years it has evolved into forms as complicated and nutritionally demanding as those found in avian or primate eyes. Diffusion from the choroid is generally able to supply the metabolic needs of thin retinae. However, when the thickness exceeds the limits of diffusion, structures are needed to supplement the vascular supply from the choroid. These supplemental nutritive devices include the choroidal gland, the falciform process and preretinal vascular plexus of fish, the conus papillaris of lizards, the pecten oculi of birds, the intraretinal vessels of mammals and a few novel systems that remain difficult to classify. These vascular systems are among the most variable features of the vertebrate eye. Here, we review classical and recent findings regarding such retinal nutrition systems, propose a three category classification for them based on histologic origins and speculate on the evolutionary forces which drove their development.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan