低分子肝素与普通肝素在介入手术中安全性与疗效的比较

肝素已经普遍用于冠状动脉介入术中,但是由于在应用过程中抗凝效果个体差异大、出血风险相对较高、并发症等问题的日益显现,已经引起了医生们的注意。相对而言,低分子肝素具有抗凝作用强、出血风险低、并发症发生率相对较低、无需实验室监测等优点,进而越来越广泛的在冠状动脉介入术中担当重要角色。普通肝素与低分子肝素在冠状动脉介入术中的有效性与安全性的比较是值得我们去探讨的,知道普通肝素与低分子肝素的优缺点后,可使我们在冠状动脉介入术中更好的选择抗凝药物,使手术的成功率大大提高,降低术后并发症的发生,减轻患者的痛苦。本文结合普通肝素与低分子肝素的药理作用及相关临床研究的结果,分析比较了普通肝素与低分子肝素在冠状动脉介入术中的有效性与安全性。     

刺激家兔颈交感神经对颈动脉窦反射的影响

在36只麻醉家兔观察了电刺激颈交感神经(CSN)对颈动脉窦压力感受器(CSB)活动的影响。所得结果如下:(1)电刺激 CSN 可使夹闭颈动脉引起的加压反射消失或倒转,△BP 从刺激前的 39.5±3.6mmHg 变为刺激时的-0.31±5.4mmHg(P<0.001)。(2)在电刺激CSN 时,静注新福林所诱发的颈动脉窦压力感受器-心率反射增强,表现为反射性心率减慢较刺激前更为明显。(3)在以50—200mmHg 的压力充胀两侧颈动脉窦的条件下,刺激 CSN 引起窦内压与平均动脉压的关系曲线下移,与刺激前曲线相比有明显差异(P<0.01)。(4)切断 CSN 后,动脉血压有所升高,提示 CSN 对 CSB 活动有紧张性调节作用。以上结果比较明确地表明家兔 CSN 对 CSB 活动有调节作用。此作用可能是 CSN 作用于窦壁平滑肌而间接引起的。     

血管紧张素转换酶基因多态性与冠心病发病的相关关系

目的:从分子遗传学角度分析血管紧张素转换酶(ACE)基因I/D多态与中国北方汉族人群中冠心病发病的相关关系。方法:本研究收集在沈阳军区总医院心内科住院的行冠脉造影检查的病例为研究对象,冠脉动脉照影检查显示冠状动脉主支狭窄程度大于等于70%的入选为冠心病组,冠状动脉照影检查显示冠状动脉主支狭窄程度小于20%的为对照组,共入选568名冠心病患者以及性别与年龄相匹配的529名对照个体为研究对象,利用测序的方法分析检测血管紧张素转换酶(ACE)基因I/D多态在冠心病组与对照组中的频率分布情况。结果:血管紧张素转换酶(ACE)基因I/D多态基因型频率符合Hardy-Weinberg定律。血管紧张素转换酶(ACE)基因I/D多态(II型,ID型和DD型)在我们入选的568例冠心病组分布频率分别为50.3%,30.3%和19.4%,而在我们入选的524例对照组中的分布频率为57.7%,31.2%和11.1%,研究发现血管紧张素转换酶(ACE)基因I/D多态可能是中国北方汉族人群冠心病发病的独立危险因素(P0.05);利用多元回归分析发现,在调整了冠心病的其他危险因素后,血管紧张素转换酶(ACE)基因I/D多态的变化仍然是中国北方汉族人群冠心病发病一个独立危险因素,可以预测中国北方汉族人群冠心病的发生。结论:在中国北方汉族人群中,血管紧张素转换酶(ACE)基因I/D多态可能是冠心病发病的独立危险因素,在临床上可以早期预判冠心病的发生。     

PCI治疗糖尿病患者左主干病变的临床研究

目的：研究经皮冠状动脉介入术（percutaneous coronary intervention,PCI）治疗合并冠状动脉左主干病变糖尿病患者的临床特 征及预后。方法：回顾性分析首次冠脉造影并提示冠状动脉左主干病变接受PCI治疗患者共2350 人,其中2 型糖尿病患者692 人,非糖尿病患者1658 人。比较两组患者的基本临床特征、冠脉造影及介入特点、随访结果等。结果：基线资料中糖尿病组患者的 高血压比例、高血脂比例、脑血管病比例、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol,HDL-C）与血肌酐（creatinine, Crea）值明显高于非糖尿病组,在造影及PCI资料中糖尿病患者左主干体部病变和全程病变明显高于非糖尿病患者,左主干病变 完全血运重建率以及药物洗脱支架（Drug eluting stent,DES）使用率明显低于非糖尿病组。糖尿病组患者主要心血管不良事件 （Major adverse cardiac events,MACE）发生率和全因死亡显著增高（13%vs 10%,P<0.05;7.7%vs 5.5%,P<0.05）。结论：PCI 治疗 合并糖尿病冠状动脉左主干病变患者存在可能的临床不良事件率增加的风险。     

Genome-wide Screen for Modulation of Hepatic Apolipoprotein A-I (ApoA-I) Secretion

Control of plasma cholesterol levels is a major therapeutic strategy for management of coronary artery disease (CAD). Although reducing LDL cholesterol (LDL-c) levels decreases morbidity and mortality, this therapeutic intervention only translates into a 25–40% reduction in cardiovascular events. Epidemiological studies have shown that a high LDL-c level is not the only risk factor for CAD; low HDL cholesterol (HDL-c) is an independent risk factor for CAD. Apolipoprotein A-I (ApoA-I) is the major protein component of HDL-c that mediates reverse cholesterol transport from tissues to the liver for excretion. Therefore, increasing ApoA-I levels is an attractive strategy for HDL-c elevation. Using genome-wide siRNA screening, targets that regulate hepatocyte ApoA-I secretion were identified through transfection of 21,789 siRNAs into hepatocytes whereby cell supernatants were assayed for ApoA-I. Approximately 800 genes were identified and triaged using a convergence of information, including genetic associations with HDL-c levels, tissue-specific gene expression, druggability assessments, and pathway analysis. Fifty-nine genes were selected for reconfirmation; 40 genes were confirmed. Here we describe the siRNA screening strategy, assay implementation and validation, data triaging, and example genes of interest. The genes of interest include known and novel genes encoding secreted enzymes, proteases, G-protein-coupled receptors, metabolic enzymes, ion transporters, and proteins of unknown function. Repression of farnesyltransferase (FNTA) by siRNA and the enzyme inhibitor manumycin A caused elevation of ApoA-I secretion from hepatocytes and from transgenic mice expressing hApoA-I and cholesterol ester transfer protein transgenes. In total, this work underscores the power of functional genetic assessment to identify new therapeutic targets.     

Extraction Of Transvenous ICD Leads In An Over-ninety Years Old Patient

There is a general consensus that once a part of an implanted cardiac device becomes infected, it is usually impossible to cure the infection without completely removing all prosthetic material from the body. Consequently the Heart Rhythm Society (HRS) included the pocket infection or erosion as a class I indication for pacemaker lead exctraction. However, the procedure still carries a high risk of life-threatening complications due to fibrotic attachments between leads, veins, valves or other endocardial structures, notwithstanding specific tools and techniques that have been developed to assist the lead removal, preventing tissue laceration.     

Metal‐Oxide‐Free Methylammonium Lead Iodide Perovskite‐Based Solar Cells: the Influence of Organic Charge Transport Layers

Metal‐oxide‐free methylammonium lead iodide perovskite‐based solar cells are prepared using a dual‐source thermal evaporation method. This method leads to high quality reproducible films with large crystal domain sizes allowing for an in depth study of the effect of perovskite film thickness and the nature of the electron and hole blocking layers on the device performance. The power conversion efficiency increases from 4.7% for a device with only an organic electron blocking layer to almost 15% when an organic hole blocking layer is also employed. In addition to the in depth study on small area cells, larger area cells (approx. 1 cm^?2) are prepared and exhibit efficiencies in excess of 10%.     

The cumulative effect of wetlands on stream water quality and quantity. A landscape approach

A method was developed to evaluate the cumulative effect of wetland mosaics in the landscape on stream water quality and quantity in the nine-county region surrounding Minneapolis—St. Paul, Minnesota. A Geographic Information System (GIS) was used to record and measure 33 watershed variables derived from historical aerial photos. These watershed variables were then reduced to eight principal components which explained 86% of the variance. Relationships between stream water quality variables and the three wetland-related principal components were explored through stepwise multiple regression analysis. The proximity of wetlands to the sampling station was related to principal component two, which was associated with decreased annual concentrations of inorganic suspended solids, fecal coliform, nitrates, specific conductivity, flow-weighted NH₄ flow-weighted total P, and a decreased proportion of phosphorus in dissolved form(p < 0.05). Wetland extent was related to decreased specific conductivity, chloride, and lead concentrations. The wetland-related principal components were also associated with the seasonal export of organic matter, organic nitrogen, and orthophosphate. Relationships between water quality and wetlands components were different for time-weighted averages as compared to flow-weighted averages. This suggests that wetlands were more effective in removing suspended solids, total phosphorus, and ammonia during high flow periods but were more effective in removing nitrates during low flow periods.     

颈动脉窦内压的变化速率对反射性降压效应的影响

在成年狗身上制备右侧孤离颈动脉窦,借助灌流装置用饱和氧的任氏液对其进行灌流。灌流压为搏动性的。通过改变每搏泵出量、灌流管道的阻力和弹性来调节灌流压及其变化速率。用多导生理记录仪同步记录股动脉血压、窦内灌流压及其变化速率。本文主要观察窦内压的变化速率对降压反射的影响。在8只狗身上共进行了93次实验。结果表明,在窦内压相同的情况下,灌流压的上升速率愈快,降压效应愈明显,而其下降速率则无显著作用。已有资料证明搏动性窦内压所引起的降压效应较非搏动性压力更为明显。由此可见,狗的颈动脉窦压力感受器不仅对搏动性压力而且对其上升的变化速率也很敏感。