血管回声跟踪技术评价慢性肾功能衰竭患者股总动脉内皮功能

目的：应用血管回声跟踪技术（echo-tracking,ET）评价慢性肾功能衰竭患者股总动脉内皮功能,并探讨该技术治疗慢性肾衰患者心血管并发症的临床意义。方法：选择2012年1月至12月在我院就诊的82例慢性肾功能衰竭患者为观察组,另选47例健康体检者为对照组。应用ET技术检测两组患者的左右侧股总动脉血管弹性指标,包括压力应变弹性系数（Ep）,脉搏波传导速度（PWVβ）,增大指数（AI）,硬度指数（β）和脉顺应性（AC）。观察两组患者的检测结果并进行比较。结果：观察组中,压力应变弹性系数（Ep）,脉搏波传导速度（PWVβ）,增大指数（AI）和硬度指数（β）均高于对照组所对应的值;而脉顺应性（AC）值低于对照组,两组差异有统计学意义（P〈0.05）。观察组中,需要透析的患者组β、PWVβ、Ep和AI的值均高于非透析患者组对应的值,AC值低于非透析患者组的值,差异有统计学意义（P〈0.05）。结论：ET对慢性肾功能衰竭患者心血管并发症的早期治疗,改善患者的愈后具有一定的临床指导意义。     

超声检查颈动脉粥样硬化情况和肱动脉FMD对稳定性心绞痛的价值

目的：探讨无创超声检查颈动脉粥样硬化情况和肱动脉FMD对SAP的价值。方法：将选取的65例SAP患者分为轻度狭窄组、中度狭窄组和重度狭窄组,超声检测所有病例的肱动脉FMD和颈总动脉IMT,并作Califf危险评分和As积分,分析观察指标间的关系。结果：cati行危险评分和As积分都随着冠脉狭窄程度的加深而增大,且二者呈正相关（P〈0．05）;颈总动脉IMT随着狭窄程度的加深而增大,肱动脉FMD则随着狭窄程度的加深而降低,二者呈负相关（P〈0．05）。结论：无创监测颈总动脉IMT和肱动脉FMD,可指导SAP临床风险的控制。     

超声检查颈动脉粥样硬化情况和肱动脉FMD 对稳定性心绞痛的价值

目的:探讨无创超声检查颈动脉粥样硬化情况和肱动脉FMD对SAP的价值。方法:将选取的65例SAP患者分为轻度狭窄组、中度狭窄组和重度狭窄组,超声检测所有病例的肱动脉FMD和颈总动脉IMT,并作Califf危险评分和As积分,分析观察指标间的关系。结果:Califf危险评分和As积分都随着冠脉狭窄程度的加深而增大,且二者呈正相关(P<0.05);颈总动脉IMT随着狭窄程度的加深而增大,肱动脉FMD则随着狭窄程度的加深而降低,二者呈负相关(P<0.05)。结论:无创监测颈总动脉IMT和肱动脉FMD,可指导SAP临床风险的控制。     

戒烟与吸烟对肺腺癌生存期影响的相关性研究

目的研究戒烟与吸烟对肺腺癌生存期（overall survival,OS）的影响。方法回顺分析2008年2月至2013年2月就诊于大连医科大学附属二院的肺腺癌患者的临床资料．根据患者确诊前后是否戒烟、吸烟指数对152例患者进行分组,采用电话随访的方式统计患者的生存期并进行统计学分析。,结果确诊前后戒烟的患者有较好的预后,其生存期较未戒烟患者长（χ2=3．99,P=0．046）;吸娴指数的大小对肺腺癌预后的影响差异无统计学意义（P〉0．05）。结论戒炯对肺腺癌患者的预后有着重要的意义,鼓励确诊患者戒炯可延长患者的生存期。     

双侧颈总动脉结扎对大鼠学习记忆相关脑区血流量的影响

目的为建立双侧颈总动脉结扎致大鼠血管性痴呆模型,观察了大鼠双侧颈总动脉结扎后不同脑区脑血流量的影响。方法采用激光多普勒血流仪,测定麻醉大鼠双侧颈总动脉结扎后１０ｍｉｎ内不同脑区脑血流量变化。结果大鼠双侧颈总动脉结扎后,平均脑血流量减少额区６７８３％、顶区５６８２％、枕区１６１６％、Ｍｙｎｅｒｔ基底核５１２１％、尾壳核４１１８％,海马ＣＡ１５１８３和海马ＣＡ２４１２１。结论大鼠双侧颈总动脉结扎后与学习记忆有关的脑区脑血流量均显著下降     

血管回声跟踪技术在2 型糖尿病合并高尿酸血症患者颈动脉弹性功能中 的评估价值

目的:应用血管回声跟踪技术(ET)评价2型糖尿病(T2MD)及合并高尿酸血症(HUA)患者颈动脉弹性的变化。方法:应用ET技术检测76例T2DM患者(其中合并HUA者为A组39例;尿酸正常者为B组37例)及40例健康体检者(C对照组)颈动脉弹性,计算僵硬度指数(β)、颈动脉压力-应变弹性系数(Ep)、顺应性(AC)、扩张指数(AI)及脉搏波传导速度(PWVβ)等各指标的变化。结果:A组研究对象β、EP、PWVβ水平均显著高于B组与C组(P0.05),AC水平显著低于B组与C组(P0.05);B组研究对象β、EP、PWVβ水平均显著高于C组(P0.05),AC水平显著低于C组(P0.05),各组间AI均无统计学意义。结论:ET技术能发现2型糖尿病及合并高尿酸血症患者早期颈动脉弹性的变化。     

间断性人工重力对模拟失重大鼠颈总动脉平滑肌细胞凋亡的影响

目的:研究3周模拟失重大鼠颈总动脉平滑肌细胞凋亡的变化及间断性人工重力对其的影响。方法:以尾部悬吊大鼠(SUS)模拟失重,同期每天悬吊23h、站立1h(STD)模拟间断性人工重力的对抗效果,用M30染色及Tunel染色方法观察3周SUS组、同步对照(CON)组及STD组颈总动脉平滑肌细胞早期和中晚期的凋亡情况,并用免疫组织化学方法及Western blot印迹方法观察各组大鼠颈总动脉组织Caspase-3的蛋白表达变化。结果:与CON组比较,SUS组大鼠颈总动脉平滑肌细胞M30染色阳性细胞明显减少,STD组M30染色阳性细胞较CON组及SUS组显著增加;SUS组Tunel染色阳性细胞较CON组及STD组显著减少,STD组Tunel染色阳性细胞较CON组及SUS组显著增加;SUS组Caspase-3的表达较CON组显著降低(P<0.05),STD组Caspase-3的表达较CON组及SUS组显著增高(P<0.01)。结论:模拟失重可引起大鼠颈总动脉平滑肌细胞凋亡减少,每日1 h的-Gx对抗使颈总动脉的凋亡增加。Caspase-3可能在调控模拟失重所致血管组织平滑肌细胞的凋亡中发挥作用。     

用血液流动的双弹性腔模型对正常人与主动脉功能不全患者舒 …

本文借助血液流动的双弹性腔模型的基本分析结果,给出一个对血管系统正常与非正常人舒张期压力进行频谱,功率谱,相位谱计算的方法,并应用电子计算机进行数据处理,从谱图的角度,对心血管系统正常与非正常人的舒张期压力的谱图进行了分析比较,及其谱图与其压力曲线的分析比较,为临床诊断的研究及应用提供参考。     

鼠颈总动脉超低温处理后的血管零应力状态研究

采用超低温冷冻方法除去鼠颈总动脉血管的内皮细胞,用Fung的残余应力方法研究血管零应力状态,用以了解超低温冷冻方法对血管力学性能如血管零应力状态是否有影响。结果发现超低温处理后血管的零应力状态时展开角有所增大。     

牵拉左心房和夹闭颈总动脉对猫下丘脑前部和后部单位放电的影响

在40只氯醛糖和乌拉坦麻醉的猫,观察了牵拉左心房肺静脉入口处(atrial stretch,AS)和关闭一侧颈总动脉(carotid occlusion,CO)对下丘脑前部(AH)和下丘脑后部(PH)单位放电的影响。共记录了185个自发放电单位。对 AS 有反应的 AH 和 PH 单位分别为46.3%和23.3%,其中均以出现抑制反应者居多。有少数单位仅在 AS 开始和停止时出现短暂的兴奋反应。在上述185个神经元中观察了85个对 AS 和 CO 两种刺激的反应,有15个(17.6%)对两种刺激均反应,其中被 AS 所抑制而为 CO 所兴奋的有11个,占73.3%(11/15)。这些结果表明:(1)AS 可对 AH 神经元活动起抑制作用;(2)AS 也可影响 PH 神经元活动;(3)动脉压力感受性和心房容量感受性刺激可会聚于同一下丘脑神经元。     

早期戒烟大鼠肺病理及炎性介质变化

目的观察早期戒烟后大鼠肺组织病理及炎性介质表达变化规律。方法选用Wistar雄性大鼠80只,随机分为对照组及早期戒烟后0天、1周、2周、4周、6周、8周、12周组。采用酶联免疫吸附方法测定各组大鼠血清中IL-8的蛋白质含量,S-P免疫组化学方法检测肺组织NF-κB p65的表达,并光镜下观察HE染色切片、对大鼠气道炎症进行病理学评分。结果早期戒烟组大鼠可见气道上皮细胞纤毛发生粘连、倒伏,上皮细胞空泡变形、坏死、增生,炎症细胞浸润;其血清IL-8浓度、肺组织NF-κB的表达及气道炎症病理评分在戒烟后各时相点较未吸烟对照组明显升高,有统计学意义（P〈0.05）。早期戒烟组大鼠血清IL-8的浓度、肺组织NF-κB的表达及肺组织病理炎症评分在戒烟后略有上升、且在戒烟后8周达到高峰,但随后在戒烟12周时可见IL-8的浓度有下降趋势,肺组织病理炎症反应有所减轻。结论早期戒烟大鼠在戒烟早期虽可见炎症反应略有加重,但随戒烟时间延长,仍可见炎症反应有所减轻。因此,提倡及早且坚持戒烟。     

Temperament and Impulsivity Predictors of Smoking Cessation Outcomes

Aims

Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes.

Methods

Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes.

Results

Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively.

Conclusion

Temperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.     

Transitions in Smoking Behaviour and the Design of Cessation Schemes

The intake of nicotine by smoking cigarettes is modelled by a dynamical system of differential equations. The variables are the internal level of nicotine and the level of craving. The model is based on the dynamics of neural receptors and the way they enhance craving. Lighting of a cigarette is parametrised by a time-dependent Poisson process. The nicotine intake rate is assumed to be proportional with the parameter of this stochastic process. The effect of craving is damped by a control mechanism in which awareness of the risks of smoking and societal measures play a role. Fluctuations in this damping may cause transitions from smoking to non-smoking and vice versa. With the use of Monte Carlo simulation the effect of abrupt and gradual cessation therapies are evaluated. Combination of the two in a mixed scheme yields a therapy with a duration that can be set at wish.     

Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg

This study aimed to measure changes in socioeconomic inequalities in smoking and smoking cessation due to the 2006 smoking ban in Luxembourg. Data were derived from the PSELL3/EU-SILC (Panel Socio-Economique Liewen Zu Letzebuerg/European Union—Statistic on Income and Living Conditions) survey, which was a representative survey of the general population aged ≥16 years conducted in Luxembourg in 2005, 2007, and 2008. Smoking prevalence and smoking cessation due to the 2006 smoking ban were used as the main smoking outcomes. Two inequality measures were calculated to assess the magnitude and temporal trends of socioeconomic inequalities in smoking: the prevalence ratio and the disparity index. Smoking cessation due to the smoking ban was considered as a positive outcome. Three multiple logistic regression models were used to assess social inequalities in smoking cessation due to the 2006 smoking ban. Education level, income, and employment status served as proxies for socioeconomic status. The prevalence of smoking decreased by 22.5% between 2005 and 2008 (from 23.1% in 2005 to 17.9% in 2008), but socioeconomic inequalities in smoking persisted. Smoking prevalence decreased by 24.2% and 20.2% in men and women, respectively; this difference was not statistically significant. Smoking cessation in daily smokers due to the 2006 smoking ban was associated with education level, employment status, and income, with higher percentages of quitters among those with a lower socioeconomic status. The decrease in smoking prevalence after the 2006 law was also associated with a reduction in socioeconomic inequalities, including differences in education level, income, and employment status. Although the smoking ban contributed to a reduction of such inequalities, they still persist, indicating the need for a more targeted approach of smoke-free policies directed toward lower socioeconomic groups.     

Effect of Tobacco Control Policies on Information Seeking for Smoking Cessation in the Netherlands: A Google Trends Study

Background

The impact of tobacco control policies on measures of smoking cessation behaviour has often been studied, yet there is little information on their precise magnitude and duration. This study aims to measure the magnitude and timing of the impact of Dutch tobacco control policies on the rate of searching for information on smoking cessation, using Google Trends search query data.

Methods

An interrupted time series analysis was used to examine the effect of two types of policies (smoke-free legislation and reimbursement of smoking cessation support (SCS)) on Google searches for ‘quit smoking’. Google Trends data were seasonally adjusted and analysed using autoregressive integrated moving average (ARIMA) modelling. Multiple effect periods were modelled as dummy variables and analysed simultaneously to examine the magnitude and duration of the effect of each intervention. The same analysis was repeated with Belgian search query data as a control group, since Belgium is the country most comparable to the Netherlands in terms of geography, language, history and culture.

Results

A significant increase in relative search volume (RSV) was found from one to four weeks (21–41%) after the introduction of the smoking ban in restaurants and bars in the Netherlands in 2008. The introduction of SCS reimbursement in 2011 was associated with a significant increase of RSV (16–22%) in the Netherlands after 3 to 52 weeks. The reintroduction of SCS in 2013 was associated with a significant increase of RSV (9–21%) in the Netherlands from 3 to 32 weeks after the intervention. No effects were found in the Belgian control group for the smoking ban and the reintroduction of SCS in 2013, but there was a significant increase in RSV shortly before and after the introduction of SCS in 2011.

Conclusions

These findings suggest that these tobacco control policies have short-term or medium-term effects on the rate of searching for information on smoking cessation, and therefore potentially on smoking cessation rates.     

Long-Term Benefits of Smoking Cessation on Gastroesophageal Reflux Disease and Health-Related Quality of Life

ObjectiveSmoking is associated with gastroesophageal reflux disease (GERD). Varenicline, a nicotinic receptor partial agonist, is used to aid smoking cessation. The purpose of this study was to prospectively examine the long-term benefits of smoking cessation on GERD and health-related quality of life (HR-QOL).MethodsPatients treated with varenicline were asked to fill out a self-report questionnaire about their smoking habits, gastrointestinal symptoms, and HR-QOL before and 1 year after smoking cessation. The prevalence of GERD, frequency of symptoms, and HR-QOL scores were compared. We also investigated associations between clinical factors and newly-developed GERD.ResultsA total of 141 patients achieved smoking cessation (success group) and 50 did not (failure group) at 1 year after the treatment. The GERD improvement in the success group (43.9%) was significantly higher than that in the failure group (18.2%). The frequency of reflux symptoms significantly decreased only in the success group. There were no significant associations between newly developed GERD and clinical factors including increased body mass index and successful smoking cessation. HR-QOL significantly improved only in the success group.ConclusionsSmoking cessation improved both GERD and HR-QOL. Smoking cessation should be recommended for GERD patients.     

Effect of Pay-For-Outcomes and Encouraging New Providers on National Health Service Smoking Cessation Services in England: A Cluster Controlled Study

Background

Payment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services.

Methods

Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level.

Results

The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1∙108, p<0∙001, 95% CI 1∙059 to 1∙160). Eighty-five providers held ‘any qualified provider’ contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings.

Conclusions

Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services.     

饮酒、吸烟与冠状动脉病变程度的相关性研究

目的:探讨饮酒、吸烟与冠状动脉病变程度的相关性。方法:抽取行冠脉造影的男性患者(343例),排除患有高血压病、糖尿病、肝肾功能等异常的患者,根据患者是否吸烟、饮酒将其分为四组,吸烟+饮酒组(86例),吸烟+非饮酒组(135例),饮酒+非吸烟饮酒组(16例),非吸烟+非饮酒组(106例)。通过Gensini积分系统评价和比较各组冠脉病变的情况,分析评估冠心病的风险因素以及饮酒、吸烟与冠心病的关系。结果:吸烟+非饮酒组Gensini评分最高(33.89±31.14)分别与另外三组有统计学意义(P0.05)。饮酒+非吸烟组最低(9.31±10.88),分别与另外三组有统计学意义(P0.05)。单因素分析结果显示年龄、饮酒、TG、HDL-C是发生冠心病的危险因素,logistic回归分析结果显示饮酒是发生冠心病的保护因素,年龄与TG是发生冠心病的危险因素。结论:吸烟为冠状动脉病变高危因素,饮酒是发生冠心病的保护因素。