诺欣妥对难治性心力衰竭患者心室重构及预后的影响研究

目的:探讨诺欣妥对难治性心力衰竭患者心室重构及预后的影响。方法:选择2017年9月～2017年12月复旦大学附属闵行医院心内科收治入院的难治性心衰患者150例并将其随机分为两组,每组各75例。所有患者均给予指南导向药物治疗(GDMT),治疗组在此基础上给予诺欣妥,起始剂量50 mg/次,2次/d,每隔2-4周倍增一次,直至剂量达到维持剂量200 mg/次,2次/d。所有患者均连续治疗4周。比较两组患者治疗前后左心室结构及功能改变、血清神经内分泌激素及脑钠肽(NT-proBNP)水平的变化、治疗期间的不良反应及随访期间的预后转归。结果:治疗后,治疗组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)均较治疗前显著降低,左室射血分数(LVEF)较治疗前显著升高,且均明显优于对照组(P0.05)。治疗后,两组患者血清肾素(RA)、血管紧张素(AngⅡ)及NT-proBNP水平均较治疗前明显降低,且治疗组以上指标均显著低于对照组(P0.05)。两组不良反应的发生率比较差异无统计学意义(P0.05)。治疗组心衰再住院率、心源性死亡率显著低于对照组(P0.05)。结论:诺欣妥用于治疗难治性心衰可有效改善患者心功能,逆转心脏重构,降低住院率及病死率,且不增加不良反应。     

靶剂量美托洛尔对老年糖尿病并慢性心衰的疗效及安全性分析

目的:探讨靶剂量美托洛尔治疗合并糖尿病的慢性心衰患者的临床疗效及安全性。方法:选取154例老年糖尿病并慢性心衰患者,随机分为观察组与对照组,每组77例,观察组患者予靶剂量美托洛尔及常规治疗方案,对照组仅按常规治疗方案进行治疗,比较两组患者治疗前后NYHA分级、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、6min步行距离及用药安全性。结果:与治疗前相比,观察组与对照组两组患者NYHA分级、LVESD、LVEDD、LVEF、6min步行距离均有明显改善(P0.05);与对照组患者治疗后相比,观察组患者治疗后以上指标改善更加显著(P0.05)。在随访的6个月内,观察组心脏事件发生率为3.90%,明显低于对照组的14.29%(P0.05)。两组患者平均空腹血糖、糖化血红蛋白不存在显著性差异(P0.05),观察组血脂、血糖、肝功能、肾功能等指标均未发生显著变化。结论:靶剂量美托洛尔治疗合并糖尿病的慢性心衰患者时,可显著改善患者的心功能及活动耐量,临床疗效好,安全性高,耐受性良好。     

中西医结合治疗老年心力衰竭合并2型糖尿病的疗效观察

目的:研究中医强心贴穴位贴敷结合常规西医治疗老年心力衰竭合并2型糖尿病患者的临床疗效,为中西医结合治疗老年心力衰竭合并2型糖尿病提供理论依据。方法:选择2014年11月-2016年5月于我院诊断与治疗的100例老年心力衰竭合并2型糖尿病患者,将其随机分为观察组与对照组,每组各50例,对照组患者仅给予常规抗心衰以及降血糖治疗,观察组患者在对照组治疗基础上加用强心贴穴位贴敷治疗。比较两组患者治疗前后左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、6 min步行距离以及甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖以及餐后两小时血糖水平的变化及治疗后的临床疗效,并采用SF-36量表评价治疗前后生活质量。结果:两组患者治疗后LVEDD、血清TG、LDL-C、TC水平均较治疗前显著降低、LVEF、6 min步行距离较治疗前显著升高,且观察组治疗后LVEDD、血清TG、LDL-C水平均明显低于对照组,LVEF、6 min步行距离、生理职能、社会功能、精神健康、躯体疼痛、情感职能、总体健康、活力评分、生理功能评分均显著高于对照组(P0.05),观察组治疗总有效率为92.00%,显著高于对照组(72.00%,P0.05);两组治疗后空腹血糖以及餐后两小时血糖比较差异无统计学意义(P0.05)。结论:相较于常规西医治疗,中医强心贴穴位贴敷联合西医治疗能够有效增强老年心力衰竭合并2型糖尿病患者的心脏功能,降低血脂水平,提高临床疗效。     

氯沙坦联合麝香保心丸治疗高血压并心衰患者的疗效分析

目的:探究氯沙坦联合麝香保心丸治疗高血压合并心衰患者的临床效果。方法:选取我院于2014年1月~2016年1月收治的152例原发性高血压合并心力衰竭患者,按照治疗方法的不同随机分为观察组和对照组,每组76例。对照组患者予以吸氧、β受体阻滞剂、利尿等常规治疗,观察组在常规治疗的基础上加用氯沙坦联合麝香保心丸治疗,比较两组患者治疗前后的血压、心功能、血清血清B型脑钠肽(BNP)及超敏C反应蛋白(hs-CRP)水平。结果:治疗后,两组患者的血压、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、水平和血清BNP、hs-CRP水平均较治疗前显著降低(P0.05),LVEF(%)水平较治疗前显著升高,且观察组患者的血压、LVEDD、LVESD水平和血清B型脑钠肽(BNP)、超敏C反应蛋白(hs-CRP)水平显著低于对照组(P0.05),LVEF(%)水平显著高于对照组(P0.05)。结论:氯沙坦联合麝香保心丸治疗高血压合并心衰患者的临床效果优于常规治疗,可有效控制血压并改善患者的心功能。     

诺欣妥对射血分数降低的心力衰竭患者血管内皮损伤及生活质量的影响

目的:探讨诺欣妥对射血分数降低的心力衰竭(heart failure patients with reduced ejection fraction,HFrEF)患者血管内皮损伤及生活质量的影响。方法:将复旦大学附属闵行医院心内科2017年9月～2018年6月收治的170例HFrEF患者随机分为两组,每组各85例。对照组均给予心衰(heart failure,HF)标准化治疗,研究组在此基础上给予诺欣妥治疗,起始剂量50 mg/次,2次/d,每隔2-4周增加1倍剂量,逐步调整至200 mg/次并作为维持剂量,2次/d。所有患者均连续治疗10周。比较两组患者治疗前后血管内皮功能指标、生活质量评分的变化,住院及随访期间的预后转归。结果:治疗后,两组血清一氧化氮(nitric oxide,NO)、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)水平均较治疗前明显升高,血清内皮素-1(endothelin 1,ET-1)水平较治疗前明显下降,且研究组上述指标水平明显优于对照组(P0.05)。两组治疗后躯体、情绪、其他领域及总分均较治疗前明显降低,且研究组除其他领域评分外其余维度评分及总分均明显低于对照组(P0.05)。与对照组比较,研究组住院期间全因死亡率、30 d内HF再住院率及随访期间不良心血管事件(adverse cardiovascular events,MACEs)发生率均显著降低(P0.05)。结论:诺欣妥治疗可使HFrEF患者明显获益,在改善血管内皮损伤、生活质量及近期预后方面效果显著优于心衰标准化治疗。     

厄贝沙坦对慢性心力衰竭患者血清骨桥蛋白水平的影响

目的:探讨厄贝沙坦对心力衰竭(心衰)患者血清骨桥蛋白(OPN)水平及心功能的影响.方法:选择心衰患者106例,随机分为两组,并随机接受厄贝沙坦治疗,每组均为53例,常规治疗组,予以利尿剂、洋地黄制剂和β受体阻滞剂常规治疗,厄贝沙坦组,在常规治疗下加用厄贝沙坦150 mg/d,治疗12周,比较治疗前后各组患者血清OPN、B型利钠肽(BNP)水平、左室射血分数(LVEF)及左室舒张末内径(LVEDd).结果:心衰患者随着心衰程度的加重,血清OPN、BNP水平及LVEDd逐渐升高,而LVEF逐渐降低(P＜0.0l);与治疗前相比,治疗后两组患者血清OPN及BNP水平均明显降低(P＜0.01),而LVEF升高,LVEDd降低(P＜0.05),但厄贝沙坦组OPN、BNP水平及LVEF、LVEDd较常规治疗组变化更显著(P＜0.05).结论:OPN可反映心衰严重程度及判断患者的预后,在常规心衰治疗的基础上加服厄贝沙坦能进一步降低血清OPN水平,改善心功能及心衰患者的预后.     

慢性心力衰竭患者胱抑素C的变化及意义

目的:观察慢性心力衰竭(Chronic Heart Failure,CHF)患者血清胱抑素C(Cystatin C)水平变化,探讨其与CHF之间的意义.方法:研究对象包括从2008年9月-2009年8月本院入选的CHF组70例,正常对照组30例,采用双抗夹心ELISA法检测血清Cystatin C含量,CHF患者心力衰竭程度按NYHA法分级,记录住院期间及出院6个月内全因病死率和因慢性心衰发作再入院率.结果:CHF组患者血清Cystatin C含量明显高于对照组,心功能Ⅳ级组血清Cystatin C浓度高于心功能Ⅱ、Ⅲ级组.根据慢性心衰患者血清中位数Cystatin C浓度,分为Cystatin C＞1.2mg/l组和Cystatin C＜1.2mg/l组.两组患者住院期间全因死亡率比较中未发现有明显差异;但高血清Cystatin C浓度组患者较低血清Cystatin C浓度组患者在住院期间死亡有增加的趋势.追踪随访6个月,高血清Cys C浓度组患者出院期间全因死亡率、因心衰再住院率有明显高于低浓度组,有统计学意义(P＜0.05).结论:Cystatin C与CHF的发生有密切关系,可以诊断CHF及反映CHF近中期预后一个很有前途的指标.     

沙库巴曲缬沙坦钠片治疗难治性心力衰竭的效果

目的观察沙库巴曲缬沙坦钠片(LCZ696)治疗难治性心力衰竭(RHF)的疗效及安全性。方法选择2017年6月～2018年12月我院收治的50例难治性心力衰竭患者,按随机法分为观察组(n=21例)与对照组(n=29例),对照组给予常规抗心衰治疗,观察组将常规抗心衰治疗中的血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)替换为LCZ696。治疗3个月后比较两组血浆NT-proBNP、6 min步行距离(6MWD)、左室射血分数(LVEF)、左室短轴缩短分数(LVFS)、肾功能、电解质的变化,评价两组的疗效及药物安全性。结果与同组治疗前基线水平较比,观察组治疗后NT-proBNP显著降低(P0.05),LVEF、LVFS、6MWD显著升高(均P0.05);与对照组比较,观察组治疗后NT-proBNP显著降低(P0.05),LVEF、LVFS、6MWD显著升高(均P0.05)。对照组治疗后NT-proBNP、LVEF、LVFS、6MWD与同组基线水平比较均无明显差异性(均P0.05)。与对照组比较,观察组治疗后血肌酐(CREA)、尿素氮(BUN)、血钾(K~+)、血钠(Na~+)水平均无显著性变化(P0.05)。两组患者治疗过程中均未出现低血压、高钾血症等不良反应。结论 LCZ696在改善RHF患者的活动耐量及心脏功能的效果好,安全性高,为RHF患者提供了一种新的治疗选择。     

左卡尼汀对慢性心力衰竭患者心功能的影响

目的:探讨左卡尼汀辅助治疗慢性心力衰竭的疗效及其安全性.方法:选取我科慢性心力衰竭住院患者60例,随机分为左卡尼汀治疗组和对照组.两组均接受利尿剂、洋地黄等常规抗心衰治疗,左卡尼汀治疗组在常规治疗基础上加用左卡尼汀3g/次,每天一次,连续静脉注射7d.治疗前后测定和比较两组患者的血清半乳糖凝集素3和脑钠尿肽(BNP)水平、6min最大步行距离(6MWT)、左室射血分数(LVEF)及心功能.结果:治疗前,两组Galectin-3、BNP水平、LVEF、6min最大步行距离比较均无统计学差异(P＞0.05).治疗后,两组Galectin-3、BNP水平均分别显著低于治疗前,而LVEF、6min最大步行距离均分别显著高于治疗前,差异均有统计学意义(P＜0.05),且左卡尼汀治疗组Galectin-3、BNP水平显著低于对照组,而LVEF、6 min最大步行距离显著高于对照组,差异均有统计学意义(P＜0.05).治疗后,左卡尼汀治疗组和对照组的治疗总有效率分别为96.7％和80％,左卡尼汀治疗组显著高于对照组(P＜0.05).两组不良反应的发生情况比较无明显统计学差异(P＞0.05).结论:常规治疗的基础上联合左卡尼汀可以显著改善心衰患者的心功能,增加其运动耐量,改善患者的预后,且无明显不良反应,值得在临床上推广应用.     

衰弱对老年急性冠脉综合征患者短期预后的影响

目的:探讨衰弱对老年急性冠脉综合征(ACS)患者短期预后的影响。方法:选择2015年8月1日至2015年12月31日在我院老年医学中心住院的181例ACS患者为研究对象。全面评估患者临床特征和合并症情况,采用国际老年营养学会提出的简易虚弱问卷(FRAIL)评估患者的衰弱情况,并根据评估结果将患者分为衰弱组(n=108)和非衰弱组(n=73)。采用门诊随访和电话随访的方式进行3个月随访,分析衰弱对ACS患者预后的影响。结果:共有181例患者纳入研究,随访率100%,其中衰弱患者108例(59.67%)。随访期两组患者再住院、全因死亡和再发急性心肌梗死等随访终点事件发生率比较,差异均有统计学意义(P0.05)。多因素Logistic回归分析结果提示衰弱是老年ACS患者短期再住院、全因死亡和再发急性心肌梗死的独立风险因素(OR=3.286,4.976,4.346;P=0.032,0.022,0.012)。结论:衰弱是老年ACS患者再住院、全因死亡和再发急性心肌梗死等短期预后的独立风险因素。     

Hebeloma species associated with Cistus

The genus Hebeloma has a number of species highly specific to Cistus and others that occur with several host genera. This paper discusses the species of Hebeloma that appear to be ectomycorrhizal with Cistus, judging from their occurrence when Cistus is the only available host. The previously unknown species H. plesiocistum spec. nov. is described. We also provide a key to the known Hebeloma associates of Cistus. Molecular analyses based on ITS sequence data further illustrate the distinctness of the newly described species and difficulties in the species delimitation with view to H. erumpens. Specific associations with Cistus may have evolved more than once within the genus Hebeloma.     

Association of the eukaryotic V1VO ATPase subunits a with d and d with A

Owing to the complex nature of V₁V_O ATPases, identification of neighboring subunits is essential for mechanistic understanding of this enzyme. Here, we describe the links between the V₁ headpiece and the V_O-domain of the yeast V₁V_O ATPase via subunit A and d as well as the V_O subunits a and d using surface plasmon resonance and fluorescence correlation spectroscopy. Binding constants of about 60 and 200 nM have been determined for the a-d and d-A assembly, respectively. The data are discussed in light of subunit a and d forming a peripheral stalk, connecting the catalytic A₃B₃ hexamer with V_O.

Structured summary

MINT-7012054: d (uniprotkb:P32366) binds (MI:0407) to A (uniprotkb:P17255) by fluorescence correlation spectroscopy (MI:0052)MINT-7012041: d (uniprotkb:P32366) binds (MI:0407) to A (uniprotkb:P17255) by surface plasmon resonance (MI:0107)MINT-7012028: d (uniprotkb:P32366) binds (MI:0407) to a (uniprotkb:P32563) by surface plasmon resonance (MI:0107)     

Prosthecium species with Stegonsporium anamorphs on Acer

Data from microscopic morphology, single-spore cultures, and DNA analyses of teleomorphs and anamorphs support the recognition of five species of Prosthecium with Stegonsporium anamorphs on Acer: P. acerinum sp. nov., the teleomorph of S. acerinum; P. acerophilum comb. nov., formerly known as Dictyoporthe acerophila; P. galeatum comb. nov., originally described as Massaria galeata; P. opalus sp. nov.; and P. pyriforme sp. nov., the teleomorph of S. pyriforme s. str. The morphology of both type specimens and freshly collected material was investigated. The teleomorphs have brown ellipsoidal ascospores with five distosepta and often a longitudinal distoseptum. The anamorphs of all species described here belong to Stegonsporium; their connection to the Prosthecium teleomorphs was demonstrated by morphology and DNA sequences of single spore cultures derived from both ascospores and conidia. The anamorphs and teleomorphs of all five Prosthecium species are described and illustrated by LM images, and a key to these species is provided. As perceived from this work, S. pyriforme is restricted to Europe and does not occur in North America, whereas S. acerinum is restricted to North America, not found in Europe. The host associations given in the literature are revised and evidence is provided that only A. opalus, A. pseudoplatanus, and A. saccharum are confirmed hosts of Prosthecium with Stegonsporium anamorphs. Molecular phylogenetic analyses of tef1, ITS rDNA, and partial nuLSU rDNA sequences confirm that the species with Stegonsporium anamorphs are closely related to P. ellipsosporum, the generic type species. Stilbospora macrosperma is confirmed as the anamorph of P. ellipsosporum by DNA data of single spore isolates obtained from both ascospores and conidia.     

Alkylation of isolated chromatin with N-methyl-N-nitrosourea and N-ethyl-N-nitrosourea

When isolated chromatin is incubated with the carcinogens N-methyl-N-nitrosourea (MeNU) and N-ethyl-N-nitrosourea (EtNU), DNA and chromosomal proteins become alkylated to increasingly greater extents as the carcinogen concentrations increase. With either MeNU or EtNU, the core and linker DNA of chromatin are alkylated to essentially identical extents. Alkylation of chromatin DNA as well as free DNA is drastically reduced at physiological ionic strengths (e.g. 0.15 M NaCl). The presence of 0.15 M NaCl, on the other hand, enhances alkylation of chromosomal proteins. While EtNU is much less reactive to DNA than MeNU, alkylation of chromosomal proteins relative to that of chromatin DNA has been found to be markedly greater with EtNU than with MeNU. Such a difference in their relative reactivities toward DNA and proteins may be related to the known difference of carcinogenic potency between these N-nitroso compounds.     

Association of upregulated Ras/Raf/ERK1/2 signaling with autism

Autism is a neurodevelopmental disorder characterized by impairments in social interaction, verbal communication and repetitive behaviors. BTBR mouse is currently used as a model for understanding mechanisms that may be responsible for the pathogenesis of autism. Growing evidence suggests that Ras/Raf/ERK1/2 signaling plays death-promoting apoptotic roles in neural cells. Recent studies showed a possible association between neural cell death and autism. In addition, two studies reported that a deletion of a locus on chromosome 16, which includes the MAPK3 gene that encodes ERK1, is associated with autism. We thus hypothesized that Ras/Raf/ERK1/2 signaling could be abnormally regulated in the brain of BTBR mice that models autism. In this study, we show that expression of Ras protein was significantly elevated in frontal cortex and cerebellum of BTBR mice as compared with B6 mice. The phosphorylations of A-Raf, B-Raf and C-Raf were all significantly increased in frontal cortex of BTBR mice. However, only C-Raf phosphorylation was increased in the cerebellum of BTBR mice. In addition, we further detected that the activities of both MEK1/2 and ERK1/2, which are the downstream kinases of Ras/Raf signaling, were significantly enhanced in the frontal cortex. We also detected that ERK1/2 is significantly over-expressed in frontal cortex of autistic subjects. Our results indicate that Ras/Raf/ERK1/2 signaling is upregulated in the frontal cortex of BTBR mice that model autism. These findings, together with the enhanced ERK1/2 expression in autistic frontal cortex, imply that Ras/Raf/ERK1/2 signaling activities could be increased in autistic brain and involved in the pathogenesis of autism.     

Deacidification by Schizosaccharomyces: interactions with Saccharomyces

The objective of this work was to study the partial consumption of malic acid in a semi-synthetic medium by Schizosaccharomyces yeast under wine-making conditions. The aim was to control the extent of deacidification by stopping the activity of Schizosaccharomyces by the addition of Saccharomyces yeast at different delayed intervals of time. This was thought possible because the Schizosaccharomyces yeasts are much more slower than the Saccharomyces yeasts and may be inhibited by the latter. In fact, the opposite was observed. Schizosaccharomyces exhibited a amensal effect against Saccharomyces: the Saccharomyces growth was inhibited by Schizosaccharomyces, this inhibition being proportional to the Schizosaccharomyces concentration, reversible, and sensitive to temperature. Such interactions similar to a killer effect have not been described before. At the same time a competition towards sugar was noted, being negative for Schizosaccharomyces since these yeasts have slower metabolic rates. Nevertheless, total demalication was nearly always possible because sufficient concentrations of Schizosaccharomyces were always reached. The delayed inoculation of Saccharomyces after Schizosaccharomyces was not a good solution to obtain partial deacidification.     

Infection of Promecotheca papuana with Synnematium jonesii

The fungus Synnematium jonesii was isolated from naturally infected adults of Promecotheca papuana and cultured in vitro. Caged beetles were successfully inoculated using an aqueous suspension of conidia and also a dust prepared from dried sclerotia. The implications of using this fungus for the control of P. papuana outbreaks is discussed.     

板蓝根颗粒对甲型流感病毒小鼠的作用

目的测定板蓝根颗粒抗流感病毒的药效作用。方法 A/California/7/2009（CA7）病毒滴鼻感染BALB/c小鼠观察14d,观察板蓝根对甲型H1N1流感病毒感染小鼠的保护作用,计算小鼠存活率、存活天数以及延长生命率。感染的小鼠第5天每组小鼠处死一半,取肺组织,观察板蓝根对甲型H1N1流感病毒感染小鼠肺组织的保护作用。结果板蓝根可明显延长甲型H1N1流感病毒感染小鼠的存活天数并提高存活率,病理结果显示板蓝根对甲型H1N1流感病毒感染的小鼠的肺组织有一定程度的保护作用,与模型组比较差异显著（P〈0.05）。结论板蓝根颗粒对甲型H1N1流感病毒感染的小鼠有较好的保护作用。