高血压患者颈动脉粥样硬化与血脂、血压和血尿酸水平的相关性分析

目的:探讨高血压患者颈动脉粥样硬化(CAS)与血脂、血压以及血尿酸水平的相关性。方法:选择2017年2月至2018年8月在我院就诊的高血压患者117例作为研究组,另选择同期在我院进行体检的健康志愿者50例作为对照组。采用彩色多普勒超声诊断仪测定所有受试者的颈动脉内中膜厚度(IMT),并根据研究组患者的颈动脉IMT将其分为斑块组(IMT≥1.3 mm,33例)、IMT增厚组(1.0 mm≤IMT1.3 mm,49例)和IMT正常组(IMT1.0 mm,35例)。比较研究组与对照组受试者IMT,同时分别比较研究组与对照组受试者以及不同IMT高血压患者平均收缩压(SBP)、平均舒张压(DBP)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及尿酸水平,并采用Pearson相关性分析法分析高血压患者IMT与各指标的相关性。结果:与对照组比较,研究组IMT、SBP、DBP、TC、TG、LDL-C、血尿酸水平升高,HDL-C水平降低,差异均有统计学意义(P0.05)。斑块组患者SBP、DBP、TC、TG、LDL-C、血尿酸水平高于IMT增厚组和IMT正常组,HDL-C水平低于IMT增厚组和IMT正常组,差异均有统计学意义(P0.05);IMT增厚组患者SBP、DBP、TC、TG、LDL-C、血尿酸水平高于IMT正常组,HDL-C水平低于IMT正常组,差异均有统计学意义(P0.05)。Pearson相关性分析显示,高血压患者的IMT与SBP、DBP、TC、TG、LDL-C、血尿酸均呈正相关,与HDL-C呈负相关(P0.05)。结论:高血压患者IMT与血脂、血压和血尿酸水平均有明显相关性,血压、血脂、血尿酸参与了高血压患者CAS的发生与发展。     

2型糖尿病合并高血压患者个性化延续护理研究

为探讨个性化延续护理对2型糖尿病合并高血压患者生活质量及服药依从性影响,本研究选取2015年6月至2017年1月在哈励逊国际和平医院治疗的150例2型糖尿病合并高血压患者,随机分组,对照组患者应用常规护理,试验组患者给予个性化延续护理,观察比较两组患者血糖、血压、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)、自尊量表(self-esteem scale,SES)、依从性差异。结果显示,12个月后试验组患者空腹血糖(7.59±1.26) mmol/L,糖化血红蛋白(glycated hemoglobin, HbAIC)(5.62±1.28)%较对照组明显下降(p<0.05);12个月后试验组患者收缩压(116.08±9.41) mmHg、舒张压(90.35±6.92) mmHg明显低于对照组(p<0.05);试验组患者SAS (35.13±4.27)分、SDS (31.42±2.09)分、SES (25.01±5.85)分同对照组比较明显改善(p<0.05);试验组患者依从性97.33%、不良生活习惯改善94.67%、健康知识掌握98.67%同对照组比较显著升高(p<0.05)。本研究结论初步表明针对2型糖尿病合并高血压患者应用个性化延续护理可改善患者血糖和血压水平,提高患者生活质量和治疗依从性,值得推广应用。     

颈动脉斑块LRNC特征可诊断2型糖尿病患者急性脑梗死的风险

2型糖尿病可能加重颈动脉斑块的易损性并增加缺血性中风的风险,关于2型糖尿病患者伴有颈动脉斑块特征的急性中风亚型鲜有研究报道。本研究旨在探讨2型糖尿病患者颈动脉斑块特征与MRI确定的急性脑梗死病变特征之间的关系。本研究以颈内动脉区急性脑血管病患者为研究对象,所有患者分为2型糖尿病组和非2型糖尿病组,分别行颈动脉和脑部MRI扫描,测定同侧颈动脉斑块的形态和特征,以及颅内和颅外颈动脉狭窄。基于中风亚型和急性脑梗塞病变模式对患者进行评估。研究结果表明,与非2型糖尿病患者相比,2型糖尿病患者颈动脉型IV-VI病变的患病率更高,斑块负荷更大,以及富脂质坏死核(LRNC)更大。在有症状的颈动脉LRNC患者中,与非2型糖尿病组相比,2型糖尿病组颈内动脉区出现较多的伴有大穿孔动脉梗塞形态和较大的急性脑梗塞。LRNC%>23.5%的颈动脉斑块是2型糖尿病患者存在颈动脉狭窄的急性脑梗塞病变的独立危险因素。颈动脉斑块特征的量化,尤其是MRI诊断的富脂质坏死核对中风风险具有潜在应用价值。     

Insect walking techniques on thin stems

The attachment ability of insects on surfaces are associated not only with the micro- and nanostructure of the adhering part of an attachment device, but also with the global scale kinematics responsible for contact formation and release. In the present study, the locomotory techniques of several representatives of insects from four different orders (Orthoptera, Heteroptera, Coleoptera, and Hymenoptera), possessing different types of attachment structures, are described. The study is based on video recordings of insects walking on a flat surface and on cylindrical rods of various thickness, imitating plant stems. Attachment devices of tarsi and pretarsi were visualized using Scanning Electron Microscopy. The results show a different manner in the use of adhesive structures on substrates with various curvatures. Insects bearing attachment pads on proximal tarsomeres usually touch flat and curved substrates using all tarsomeres, whereas insects with their attachment devices on the distal tarsomeres usually walk on flat surfaces using the distal tarsomeres of the overextended tarsus. On substrates, with diameters comparable to or larger than the tarsus length, insects walk above the stem by clasping the stem with the bent tarsi. On thin stems, insects clasp the stem between their tarsi and hang under the stem. Thus, on thin and thick rods, forces applied to attachment organs act in opposite directions. There are two methods of leg positioning for walking on a rough flat substrate. In the first case, the tarsus is straightened and the rough substrate is gripped between the claws and the proximal complex of attachment devices (tarsal euplantulae, fossulae spongiosa, and terminal spurs of tibiae). In the second case the tibia does not touch the substrate; the insect is supported only by distal tarsomeres. The tarsus is in an overextended condition. On rods, with diameters comparable to or larger than the tarsus length, insects walk by clasping the stem with the bent tarsi. This posture is characteristic for the majority of insects independent of the tarsal position they normally use while walking on a plane. If the rod’s diameter is smaller than the tarsus length, walking insects usually clutch it between contralateral tarsi. Using such a posture they are supported by interlocking or by strong friction, generated by attachment devices of the proximal tarsomeres, and do not use attachment devices of the pretarsus. Contact with the substrate is reinforced due to the coordinated contralateral clutch using all supporting legs. It is concluded that the use of different types of attachment structures correlates with locomotory techniques. Handling Editor: Heikki Hokkanen     

肱动脉内皮依赖性舒张功能鉴别左室舒张功能假性正常化的价值

目的:研究冠心病患者左室舒张功能假性正常化与肱动脉内皮依赖性舒张功能的关系。方法:将75例行选择性冠状动脉造影的患者按冠状动脉病变程度分为单/双支病变组和三支病变组两组,选取48例健康志愿者作为对照组。检测左室舒张功能指标二尖瓣口血流频谱E峰、A峰、E/A比值,同时观察休息时肱动脉反应性充血后内径变化率。结果:单/双支病变组(第一组)E峰、E/A比值下降,肱动脉反应性充血后内径变化率低于正常对照组(P<0.05);三支病变组(第二组)E峰、E/A值无明显改变,肱动脉反应性充血后内径变化率明显低于对照组(P<0.01)。结论:肱动脉内皮依赖性舒张功能可作为鉴别冠心病左室舒张功能假性正常的指标。     

丁苯酞对颈动脉狭窄大鼠认知功能及海马CA1区神经元凋亡的影响及相关机制研究

摘要 目的：探讨与研究丁苯酞对颈动脉狭窄大鼠认知功能及海马CA1区神经元凋亡的影响及相关机制。方法：将颈动脉狭窄大鼠大鼠（n=42）随机为三组-模型组、低剂量丁苯酞（20 mg/kg）组和高剂量丁苯酞（40 mg/kg）组,每组14只。低剂量丁苯酞组与高剂量丁苯酞组每天给予20 mg/kg、40 mg/kg丁苯酞灌胃治疗,对照组给予等剂量的生理盐水灌胃,持续21 d。结果：低剂量丁苯酞组与高剂量丁苯酞组治疗第7 d、第14 d、第21 d的BBT评分低于模型组（P<0.05）,高剂量丁苯酞组低于低剂量丁苯酞组（P<0.05）。低剂量丁苯酞组与高剂量丁苯酞组治疗第21 d、第28 d的海马CA1区神经元凋亡指数低于模型组,高剂量丁苯酞组低于低剂量丁苯酞组（P<0.05）。低剂量丁苯酞组与高剂量丁苯酞组治疗第21 d、第28 d的脑组织超氧化物歧化酶（Superoxide dismutase,SOD）活性高于模型组（P<0.05）,丙二醛（Malondialdehyde,MDA）活性低于模型组（P<0.05）,高剂量丁苯酞组与低剂量丁苯酞组对比差异都有统计学意义（P<0.05）。低剂量丁苯酞组与高剂量丁苯酞组治疗第21 d、第28 d的海马CA1区BCL2-Associated X（Bax）、B淋巴细胞瘤-2（B-cell lymphoma-2,bcl-2）蛋白相对表达水平高于模型组（P<0.05）,高剂量丁苯酞组高于低剂量丁苯酞组（P<0.05）。结论：丁苯酞在颈动脉狭窄大鼠的应用能提高海马CA1区Bax、Bcl-2蛋白的表达,抑制神经元的凋亡,改善氧化应激状态,从而提高大鼠的认知功能。     

International Courts and State Compliance: An Investigation of the Law of the Sea Cases

This article investigates the effect of dispute settlement decisions under the 1982 United Nations Convention on the Law of the Sea (UNCLOS) and whether and how states, particularly great powers, comply with these decisions. State practice suggests that an overwhelming majority of the decisions by UNCLOS dispute settlement bodies have been implemented. Significantly, not only small states but also the permanent members of the United Nations Security Council have complied with UNCLOS dispute settlement decisions even when they “lost” in the proceedings that were unilaterally initiated against them.     

Effects of pretreatment with a xanthine oxidase inhibitor on free radical levels during carotid endarterectomy

Objective: Free radicals contribute to the tissue damage caused by ischaemia-reperfusion. The aim of the present study was to investigate whether preoperative antioxidant therapy (allopurinol) affects free radical levels in cerebral venous blood in connection with surgery for carotid artery stenosis.

Materials and methods: Twenty-five patients were randomised into the study. Thirteen were controls and 12 were pretreated with allopurinol the day before surgery. Before, during and after surgery, blood samples were drawn from the ipsilateral jugular vein. Radical levels were measured using the spin trap technique ex vivo using OXANOH as the spin trap. Multivariate statistics were used with Principal Component Analysis and Partial Least Square regression analysis.

Results: Radical levels increased with diabetes, high leukocyte count, high creatinine and a high degree of contralateral stenosis. Radical levels decreased with high age, blood pressure, collateral circulation as well as operation for left-side carotid artery stenosis. After pretreatment with allopurinol, several of the relationships noted in the control group were eliminated, i.e. leukocyte count, side of operation, Betapred pretreatment and collateral circulation.

Conclusions: Radical levels can be determined in connection with surgery for carotid artery stenosis using an ex vivo spin trap method. With preoperative antioxidant therapy the relationships between enhanced radical levels and clinical data, as seen in control subjects, disappeared. This might indicate a beneficial effect of preoperative pretreatment with antioxidants.     

Circulating oxidized low-density lipoprotein and common carotid artery intima-media thickness in a random sample of middle-aged men

Circulating oxidized low-density lipoprotein (oxLDL) has been suggested to play an important role in atherosclerosis development. According to previous observations, oxLDL correlates with clinically manifest coronary and carotid artery disease. We investigated the association between the oxLDL concentration measured directly in plasma and common carotid artery intima-media thickness (IMT) in a population-based, case-control study in middle-aged men from Southern Finland. oxLDL was determined in 214 men by a commercially available sandwich ELISA test (Mercodia). Carotid artery IMT was measured at 12 standardized segments by B-mode ultrasonography (at the near and far wall of the left and right common carotid arteries, bifurcations and internal carotid arteries), and the overall mean maximum IMT (MMaxIMT) was calculated. The MMaxIMT of the carotid arteries was significantly associated with circulating oxLDL (r_s=0.16, p=0.018). In a stepwise multiple regression model with MMaxIMT as dependent variable and systolic blood pressure, smoking, oxLDL, HDL cholesterol and apolipoprotein B as covariates, systolic blood pressure (=0.22, p<0.001), oxLDL (=0.15, p=0.022) and smoking (=0.17, p=0.014) showed an independent association with IMT (R²=0.10, p<0.001). Our results show that oxLDL measured directly from plasma is independently associated with subclinical carotid artery atherosclerosis in middle-aged men.     

Rethinking historical controls

Inference from traditional historical controls, i.e. comparing a new treatment in a current series of patients with an old treatment in a previous series of patients, may be subject to a strong selection bias. To avoid this bias, Baker and Lindeman (1994) proposed the paired availability design. By applying this methodology to estimate the effect of epidural analgesia on the probability of Cesarean section, we made two important contributions with the current study. First, we generalized the methodology to include different types of availability and multiple time periods. Second, we investigated how well the paired availability design reduced selection bias by comparing results to those from a meta-analysis of randomized trials and a multivariate analysis of concurrent controls. The confidence interval from the paired availability approach differed considerably from that of the multivariate analysis of concurrent controls but was similar to that from the meta-analysis of randomized trials. Because we believe the multivariate analysis of concurrent controls omitted an important predictor and the meta-analysis of randomized trials was the gold standard for inference, we concluded that the paired availability design did, in fact, reduce selection bias.