‘Ins’ and ‘outs’ of triple therapy

Chronic oral anticoagulant treatment is obligatory in patients (class I) with mechanical heart valves and in patients with atrial fibrillation with CHADS2 score >1. When these patients undergo percutaneous coronary intervention with placement of a stent, there is also an indication for treatment with aspirin and clopidogrel. Unfortunately, triple therapy is known to increase the bleeding risk. For this group of patients, the bottom line is to find the ideal therapy in patients with indications for both chronic anticoagulation therapy and percutaneous intervention to prevent thromboembolic complications such as stent thrombosis without increasing the risk of bleeding. (Neth Heart J 2010;18:444-50.)     

经皮椎间盘镜与椎间孔镜技术治疗腰椎间盘突出症临床对比分析

目的:比较椎间盘镜髓核摘除术(microendoscopic discectomy,MED)与椎间孔镜髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症的优缺点、安全性及临床疗效。方法:分析和回顾2012.06-2015.06第四军医大学唐都医院骨科收治的共计118例腰椎间盘突出症患者。经严格的进行纳入和排除标准筛选,其中椎间盘镜组共纳入患者46例,椎间孔镜组患者共纳入患者72例。对所有患者均进行了6个月以上的术后随访,记录和分析两组患者在手术时间、卧床时间、出血量、切口长度、疼痛、并发症等指标。并通过Macnab腰椎功能评分等对两组患者的功能恢复进行比较。结果:在术后,两组患者在疼痛评分及功能恢复方面均有明显的提高,且两组之间并无显著统计学差异(P0.05)。而椎间孔镜组在手术时间、卧床时间,总花费等指标中要优于椎间盘组(P0.05)。但在住院时间,出血量,切口长度及并发症等方面两组无明显的显著性差异(P0.05)。结论:两种手术方式作为脊柱微创手术,能够有效地治疗腰椎间盘突出症,安全程度较高,各有其优劣性,在临床中应根据不同的患者的实际情况进行个性化的选择。     

输尿管软镜与经皮肾镜钬激光碎石术对肾结石患者肾功能的影响

目的：观察输尿管软镜下钬激光碎石术与经皮肾镜下钬激光碎石术治疗肾结石对患者肾功能影响。方法：选择本院于2012 年5 月-2015 年5 月收治的单发肾结石且结石直径均≤ 2 cm的患者180 例作为研究对象,根据配对分组法分为两组,每组90 例,A组采取输尿管软镜下钬激光碎石术治疗,B组采取经皮肾镜下钬激光碎石术治疗。分别于手术前后测定两组患者尿Kim-1 及血清NGAL、Cys-C水平,评估患者肾功能。结果：两组术前及术后6 h、12 h、24 h、72 h尿Kim-1 水平比较均无统计学差异（P>0. 05）;A 组术后48 h尿Kim-1 水平显著低于B组（P<0.05）。两组术后6 h、12 h、24 h尿Kim-1 水平均高于术前（P<0.05）。两组术后 6 h、12 h、24 h、48 h、72 h血清NGAL水平均高于术前,P<0.05。两组患者术前2 h、术后6 h血清Cys-C 水平均无显著统计学差异 （P>0.05）;术后12 h、24 h、48 h、72 h血清Cys-C 水平均A 组均高于B 组（P<0.05）。结论：输尿管软镜下钬激光碎石术与经皮肾镜 下钬激光碎石术治疗肾结石均对患者肾功能造成损伤,但输尿管软镜下钬激光碎石术对肾小球损伤更为严重,经皮肾镜下钬激 光碎石术对肾小管损伤较为严重,临床应注意。     

急性心肌梗死患者冠脉介入治疗后血浆apelin的变化及作用

目的:观察急性心肌梗死(AMI)患者围手术期血浆apelin的表达变化,分析AMI合并2型糖尿病(T2DM)患者血浆apelin的表达与预后的相关性,探讨apelin在冠脉介入治疗(PCI)中的心脏保护作用。方法:72例于2012年2月~8月在我院心内科接受冠状动脉造影确诊为AMI并成功完成PCI的冠心病患者,分别在术前、术后0小时、术后4小时、术后24小时收集血清,酶联免疫吸附法测定血浆apelin-13水平;进一步对糖尿病及非糖尿病AMI患者(每组各20例)进行亚组分析,随访两组患者在术后6个月时主要不良心脑血管事件(MACCE)。结果:AMI患者术后0 h组apelin水平与术前基线水平明显降低(31.54±5.48 vs35.15±6.48 ng/L,P0.05);术后4小时及24小时组apelin水平较术前明显升高(39.65±5.48 vs 35.15±6.48 ng/L,43.93±5.37 vs35.15±6.48 ng/L,P0.05)。糖尿病与非糖尿病组apelin水平术前无明显差异;糖尿病组在术后各时间点的apelin水平均明显高于非糖尿病组(31.12±5.50 vs 29.21±6.53 ng/L,40.57±5.37 vs 33.49±3.89 ng/L,43.50±7.41 vs 34.54±3.52 ng/L,P0.05)。两组术后6个月随访T2DM组LVEF值改善明显高于NT2DM组,但MACCE事件无明显差异。结论:AMI患者PCI术后存在血浆apelin表达的升高,其中糖尿病患者在术后血浆apelin表达较非糖尿病患者明显增高,提示PCI冠脉血运重建可促进糖尿病患者apelin分泌,调节胰岛素抵抗改善预后。     

Patent ductus arteriosus in adults – indications and possibilities for closure

Patent ductus arteriosus (PDA) is a rare diagnosis in adults, since symptoms and signs usually occur in infancy and most cases are treated shortly after diagnosis. We present two patients who were first diagnosed with PDA during adulthood. The first case represents a more severe form of PDA, where the need for closure of the PDA is obvious. In the second case the sequelae of the PDA are less clear. In both patients, closure of the PDA (surgically in one case, percutaneously in the other) was successful.     

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

Aim

To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF).

Materials and methods

We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954–2010.

Results

The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3 years (range 70–87 years) were collected. The cohort was subdivided into female (mean age 84.3 years) and male (mean age 75.2 years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset.

Conclusions

A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.     

冠状动脉介入治疗对冠心病患者Caspase-3,9 水平的影响

目的:通过对冠心病患者经皮冠状动脉介入治疗(PCI)前后血清Caspase-3,9水平变化的观察,探讨冠状动脉介入治疗对冠心病患者血清Caspase-3,9水平的影响。方法:冠状动脉介入组(PCI组)30例和单纯造影组(CAG组)29例,在术前0.5h,术后3h,术后6h,术后12h,术后24h,术后48h分别测定血清Caspase-3,9水平。结果:CAG组术前与术后的血清Caspase-3,9水平差异均无统计学意义,PCI组术后3h、6h的Caspase-3水平较术前0.5h均有降低趋势,差异均有统计学意义(P<0.05),PCI组术后48h的Caspase-9水平与术后3h、6h相比均有升高趋势,差异均有统计学意义(P<0.05)。结论:PCI术后狭窄或闭塞的冠状动脉血管重新恢复血供,血清中Caspase-3,9水平在PCI术后先降低后又逐渐升高,提示再灌注后可出现细胞的凋亡程度加重,血清中Caspase-3,9的水平可作为心肌再灌注损伤后细胞凋亡程度的评估指标并可作为诊断临床症状不典型的再灌注损伤的一个指标。PCI术可有效改善心肌血供,减少因术前缺血缺氧造成的细胞凋亡,但PCI术后再灌注损伤可进一步加重细胞凋亡。     

经皮穴位电刺激联合常规镇痛对无痛人流术后宫缩痛镇痛效果及机制研究

摘要 目的：探讨经皮穴位电刺激联合常规镇痛对无痛人流术后宫缩痛镇痛效果及机制。方法：选择来我院行无痛人流患者100例。根据随机数字表法分为两组。对照组行术后常规镇痛治疗,同时在内关、合谷、三阴交最酸胀处黏贴电极但是不进行穴位刺激。观察组在术后常规镇痛基础上行经皮穴位电刺激治疗。对比不同时间点两组患者的机体一般情况、不同时间点两组患者的宫缩痛疼痛情况、T3时正性负性情绪量表评分、T3时血清P物质、前列腺素、5-羟色胺、β-内啡肽、强啡肽水平、T4点时的心理状态评分及满意度评分。结果：对照组T1、T2点时的BP、HR、RR、SpO₂明显较同组T0点低,对照组T3点与观察组T1、T2、T3点时BP、HR、RR、SpO₂与同组T0点对比无统计学意义（P>0.05）;对照组T1、T2点时的BP、HR、RR、SpO₂明显较观察组同时间点低（P<0.05）。T0点,两组VAS评分对比无统计学意义（P>0.05）;T1、T2、T3点时间,观察组的VAS评分明显较对照组低（P<0.05）;对照组T1、T2点的VAS评分明显较同组T0点高,观察组T1、T2、T3点的VAS评分明显较T0点低（P<0.05）。观察组的正性情绪明显较对照组高,负性情绪明显较对照组低（P<0.05）。观察组的血清P物质、前列腺素、5-羟色胺、β-内啡肽、强啡肽水平明显较对照组低（P<0.05）。观察组的心理状态评分明显较对照组低,满意度评分明显较对照组高（P<0.05）。结论：经皮穴位电刺激联合常规镇痛可明显改善无痛人流术后宫缩痛镇痛效果、患者心理状态及满意度,可能与其可降低血清P物质、前列腺素、5-羟色胺、β-内啡肽、强啡肽水平有关。     

血浆脑钠肽对不同年龄急性冠脉综合征患者介入治疗术后临床预后的意义

目的：探讨并比较血浆脑钠肽（BNP）对不同年龄组急性冠脉综合征（ACS）患者经皮冠脉介入（PCI）术后临床主要不良心脏事件（MACE）的预测价值。方法：回顾分析2007年12月至2010年3月因ACS在我院行PCI的患者,分为260岁和〈60岁两组,入院常规检验BNP,随访住院期间及出院后6个月内MACE（包括死亡、心源性休克、再发心绞痛、非致命性再次心肌梗死、非致命性心力衰竭、心律失常、靶血管血运重建、再次入院复合终点）的发生情况。结果：随访269例260岁患者,失访7例（2．6％）,118例〈60岁患者,失访3例（2．5％）,262例≥60岁患者的年龄与BNP水平显著正相关（r=0．368,P〈0．01）,而115例〈60岁患者无显著相关性（r=-0．014,P〉0．05）。年龄≥60岁患者BNP水平与〈60岁患者比较,差异显著（P〈0．01）,年龄260岁患者MACE与〈60岁患者比较,差异显著（P〈0．01）,两组患者BNP水平与LVEF呈显著负相关（P均〈0．01）。多因素logistic回归分析显示：BNP可独立预测两组患者住院期间及出院后6个月内MACE（≥60岁OR=4．369P〈0．01;〈60岁OR=7．773P〈0．01）发生率。两组患者BNP水平对MACE预测的ROC曲线结果比较,差异无统计学意义（P〉0．05）。结论：不同年龄患者BNP水平及MACE发生率存在差异,但年龄并不影响BNP对ACS患者临床预后的预测价值。     

Effect of octanol:water partition coefficients of organophosphorus compounds on biodistribution and percutaneous toxicity

Knowledge of partition coefficient (log P) data can play a critical role in understanding the pharmacokinetic and pharmacodistributive properties of toxic organophosphorus (OP) compounds. Using a recently published gas chromatographic method, the octanol:water log P values for the compounds tabun (GA), sarin (GB), cyclosarin (GF), and O-ethyl-S-(2-diisopropylaminoethyl) methylphosphonothiolate (VX) were determined to be 0.384 +/- 0.033, 0.299 +/- 0.016, 1.038 +/- 0.055, and 0.675 +/- 0.070, respectively. Based on these data, the log P value of the fluorophosphonate fragment, common to GB, soman (GD), and GF, was determined to be -2.256 +/- 0.273. The predictive value for absorption and distribution of the determined log P values was compared to measured values. The time to onset of local fasciculations (47.3, 29.0, 8.8, 8.5, and 6.3 min, respectively) in guinea pigs exposed percutaneously to equilethal doses of GA, VX, GF, GB, or GD was used as an indicator of dermal penetration. There was a good correlation (r = 0.95) between the measured log P value and the rate of onset of local fasciculations. Assuming a direct correspondence, equilibrium tissue:blood log P may be estimated from octanol:water log P. Comparison of the estimated and directly measured tissue:blood log P revealed a correlation of 0.8 for GD in liver, muscle, and adipose tissue. Our results demonstrate the use of log P data to both predict absorption and determine the distribution of OP compounds in tissues. This facilitates further estimates of in vivo OP effects from in vitro experiments.