Rehabilitation care for pain in elderly knee replacement patients

BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P<0.05).The VAS scores of both groups significantly decreased,with no significant difference observed between the groups at each time point(P>0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after discharge(47.52 vs 45.81,P>0.05).However,the knee joint function scores of patients in the observation group were significantly higher than those in the control group at the 2nd(59.38 vs 53.19,P<0.05)and 3rd month(71.92 vs 64.34,P<0.05)following discharge.CONCLUSION The utilization of programmed pain nursing in conjunction with collaborative nursing for out-of-hospital care of TKA patients has demonstrated favorable outcomes,encompassing pain reduction,enhanced prognosis,and improved nursing quality for patients.

Reliability evaluation of IGBT power module on electric vehicle using big data

There are challenges to the reliability evaluation for insulated gate bipolar transistors(IGBT)on electric vehicles,such as junction temperature measurement,computational and storage resources.In this paper,a junction temperature estimation approach based on neural network without additional cost is proposed and the lifetime calculation for IGBT using electric vehicle big data is performed.The direct current(DC)voltage,operation current,switching frequency,negative thermal coefficient thermistor(NTC)temperature and IGBT lifetime are inputs.And the junction temperature(T_(j))is output.With the rain flow counting method,the classified irregular temperatures are brought into the life model for the failure cycles.The fatigue accumulation method is then used to calculate the IGBT lifetime.To solve the limited computational and storage resources of electric vehicle controllers,the operation of IGBT lifetime calculation is running on a big data platform.The lifetime is then transmitted wirelessly to electric vehicles as input for neural network.Thus the junction temperature of IGBT under long-term operating conditions can be accurately estimated.A test platform of the motor controller combined with the vehicle big data server is built for the IGBT accelerated aging test.Subsequently,the IGBT lifetime predictions are derived from the junction temperature estimation by the neural network method and the thermal network method.The experiment shows that the lifetime prediction based on a neural network with big data demonstrates a higher accuracy than that of the thermal network,which improves the reliability evaluation of system.

Metagenomic analysis revealing the metabolic role of microbial communities in the free amino acid biosynthesis of Monascus rice vinegar during fermentation

Free amino acid(FAA)is the important component of vinegar that infl uences quality perception and consumer acceptance.FAA is one of the major metabolites produced by microorganisms;however,the microbial metabolic network on FAA biosynthesis remains unclear.Through metagenomic analysis,this work aimed to elucidate the roles of microbes in FAA biosynthesis during Monascus rice vinegar fermentation.Taxonomic profiles from functional analyses showed 14 dominant genera with high contributions to the metabolism pathways.The metabolic network for FAA biosynthesis was then constructed,and the microbial distribution in different metabolic pathways was illuminated.The results revealed that 5 functional genera were closely involved in FAA biosynthesis.This study illuminated the metabolic roles of microorganisms in FAA biosynthesis and provided crucial insights into the functional attributes of microbiota in vinegar fermentation.

Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit

BACKGROUND Cirrhotic patients with acute-on-chronic liver failure(ACLF)in the intensive care unit(ICU)have a poor but variable prognoses.Accurate prognosis evaluation can guide the rational management of patients with ACLF.However,existing prognostic scores for ACLF in the ICU environment lack sufficient accuracy.AIM To develop a new prognostic model for patients with ACLF in ICU.METHODS Data from 938 ACLF patients in the Medical Information Mart for Intensive Care(MIMIC)database were used to develop a new prognostic model(MIMIC ACLF)for ACLF.Discrimination,calibration and clinical utility of MIMIC ACLF were assessed by area under receiver operating characteristic curve(AUROC),calibration curve and decision curve analysis(DCA),respectively.MIMIC ACLF was then externally validated in a multiple-center cohort,the Electronic Intensive Care Collaborative Research Database and a single-center cohort from the Second Hospital of Hebei Medical University in China.RESULTS The MIMIC ACLF score was determined using nine variables:ln(age)×2.2+ln(white blood cell count)×0.22-ln(mean arterial pressure)×2.7+respiratory failure×0.6+renal failure×0.51+cerebral failure×0.31+ln(total bilirubin)×0.44+ln(internationalized normal ratio)×0.59+ln(serum potassium)×0.59.In MIMIC cohort,the AUROC(0.81/0.79)for MIMIC ACLF for 28/90-day ACLF mortality were significantly greater than those of Chronic Liver Failure Consortium ACLF(0.76/0.74),Model for End-stage Liver Disease(MELD;0.73/0.71)and MELD-Na(0.72/0.70)(all P<0.001).The consistency between actual and predicted 28/90-day survival rates of patients according to MIMIC ACLF score was excellent and superior to that of existing scores.The net benefit of MIMIC ACLF was greater than that achieved using existing scores within the 50%threshold probability.The superior predictive accuracy and clinical utility of MIMIC ACLF were validated in the external cohorts.CONCLUSION We developed and validated a new prognostic model with satisfactory accuracy for cirrhotic patients with ACLF hospitalized in the ICU.The model-based risk stratification and online calculator might facilitate the rational management of patients with ACLF.

Overexpression of PbrGA2ox1 enhances pear drought tolerance through the regulation of GA_(3)-inhibited reactive oxygen species detoxification and abscisic acid signaling

Drought stress is a devastating natural disaster driven by the continuing intensification of global warming,which seriously threatens the productivity and quality of several horticultural crops,including pear.Gibberellins(GAs)play crucial roles in plant growth,development,and responses to drought stress.Previous studies have shown significant reductions of GA levels in plants under drought stress;however,our understanding of the intrinsic regulation mechanisms of GA-mediated drought stress in pear remains very limited.Here,we show that drought stress can impair the accumulation of bioactive GAs(BGAs),and subsequently identified PbrGA2ox1 as a chloroplast-localized GA deactivation gene.This gene was significantly induced by drought stress and abscisic acid(ABA)treatment,but was suppressed by GA_(3)treatment.PbrGA2ox1-overexpressing transgenic tobacco plants(Nicotiana benthamiana)exhibited enhanced tolerance to dehydration and drought stresses,whereas knock-down of PbrGA2ox1 in pear(Pyrus betulaefolia)by virus-induced gene silencing led to elevated drought sensitivity.Transgenic plants were hypersensitive to ABA,and had a lower BGAs content,enhanced reactive oxygen species(ROS)scavenging ability,and augmented ABA accumulation and signaling under drought stress compared to wild-type plants.However,the opposite effects were observed with PbrGA2ox1 silencing in pear.Moreover,exogenous GA_(3)treatment aggravated the ROS toxic effect and restrained ABA synthesis and signaling,resulting in the compromised drought tolerance of pear.In summary,our results shed light on the mechanism by which BGAs are eliminated in pear leaves under drought stress,providing further insights into the mechanism regulating the effects of GA on the drought tolerance of plants.

Diagnosis and treatment of biliary mucinous cystic neoplasms: A single-center experience

Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Afflliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female(75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients(44.9%) had no symptoms. Serum carbohydrate antigen(CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34(70.8%) had low-grade intraepithelial neoplasms(LGINs), and 14(29.2%) had high-grade intraepithelial neoplasms(HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin(CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival(OS) of BMCNs was not reached. The longest survival time was 137 months.The 5-and 10-year OS rates were 100% and 85.4%, respectively. The 5-and 10-year recurrence-free survival(RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.

Construction of a Cu@hollow TS-1 nanoreactor based on a hierarchical full-spectrum solar light utilization strategy for photothermal synergistic artificial photosynthesis

The artificial photosynthesis technology has been recognized as a promising solution for CO_(2) utilization.Photothermal catalysis has been proposed as a novel strategy to promote the efficiency of artificial photosynthesis by coupling both photochemistry and thermochemistry.However,strategies for maximizing the use of solar spectra with different frequencies in photothermal catalysis are urgently needed.Here,a hierarchical full-spectrum solar light utilization strategy is proposed.Based on this strategy,a Cu@hollow titanium silicalite-1 zeolite(TS-1)nanoreactor with spatially separated photo/thermal catalytic sites is designed to realize high-efficiency photothermal catalytic artificial photosynthesis.The space-time yield of alcohol products over the optimal catalyst reached 64.4μmol g−1 h−1,with the selectivity of CH3CH2OH of 69.5%.This rationally designed hierarchical utilization strategy for solar light can be summarized as follows:(1)high-energy ultraviolet light is utilized to drive the initial and difficult CO_(2) activation step on the TS-1 shell;(2)visible light can induce the localized surface plasmon resonance effect on plasmonic Cu to generate hot electrons for H2O dissociation and subsequent reaction steps;and(3)low-energy near-infrared light is converted into heat by the simulated greenhouse effect by cavities to accelerate the carrier dynamics.This work provides some scientific and experimental bases for research on novel,highly efficient photothermal catalysts for artificial photosynthesis.

Prediction of cell-cell communication patierns of dorsal root ganglion cells:single-cell RNA sequencing data analysis

Dorsal root ganglion neurons transmit peripheral somatic information to the central nervous system,and dorsal root ganglion neuron excitability affects pain perception.Dorsal root ganglion stimulation is a new approach for managing pain sensation.Knowledge of the cell-cell communication among dorsal root ganglion cells may help in the development of new pain and itch management strategies.Here,we used the single-cell RNA-sequencing(scRNA-seq)database to investigate intercellular communication networks among dorsal root ganglion cells.We collected scRNA-seq data from six samples from three studies,yielding data on a total of 17,766 cells.Based on genetic profiles,we identified satellite glial cells,Schwann cells,neurons,vascular endothelial cells,immune cells,fibroblasts,and vascular smooth muscle cells.Further analysis revealed that eight types of dorsal root ganglion neurons mediated proprioceptive,itch,touch,mechanical,heat,and cold sensations.Moreover,we predicted several distinct forms of intercellular communication among dorsal root ganglion cells,including cell-cell contact,secreted signals,extracellular matrix,and neurotransmitter-mediated signals.The data mining predicted that Mrgpra3-positive neurons robustly express the genes encoding the adenosine Adora2b(A2B)receptor and glial cell line-derived neurotrophic factor family receptor alpha 1(GFRα-1).Our immunohistochemistry results confirmed the coexpression of the A2B receptor and GFRα-1.Intrathecal injection of the A2B receptor antagonist PSB-603 effectively prevented histamine-induced scratching behaviour in a dose-dependent manner.Our results demonstrate the involvement of the A2B receptor in the modulation of itch sensation.Furthermore,our findings provide insight into dorsal root ganglion cell-cell communication patterns and mechanisms.Our results should contribute to the development of new strategies for the regulation of dorsal root ganglion excitability.

Research progress of alkaline earth metal iron-based oxides as anodes for lithium-ion batteries

Anode materials are an essential part of lithium-ion batteries(LIBs),which determine the performance and safety of LIBs.Currently,graphite,as the anode material of commercial LIBs,is limited by its low theoretical capacity of 372 mA·h·g^(−1),thus hindering further development toward high-capacity and large-scale applications.Alkaline earth metal iron-based oxides are considered a promising candidate to replace graphite because of their low preparation cost,good thermal stability,superior stability,and high electrochemical performance.Nonetheless,many issues and challenges remain to be addressed.Herein,we systematically summarize the research progress of alkaline earth metal iron-based oxides as LIB anodes.Meanwhile,the material and structural properties,synthesis methods,electrochemical reaction mechanisms,and improvement strategies are introduced.Finally,existing challenges and future research directions are discussed to accelerate their practical application in commercial LIBs.

Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy

AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.METHODS:This was a retrospective and cross-sectional study.Consecutive 25-gauge(25-G)PPV cases operated for PDR from May 2018 to April 2020.According to the FVPMs images outlined after operations,subjects were assigned into three groups:arcade type group,juxtapapillary type group,and central type group.All patients were followed up for over one year.General characteristics,operation-related variables,postoperative parameters and complications were recorded.RESULTS:Among 103 eyes recruited,the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different(both P<0.01),with 95(92.23%)FVPMs located in the nasal quadrants,and 74(71.84%)in the inferior.The eyes with a central FVPM required the longest operation time,with silicon oil used in most patients,generally combined with tractional retinal detachment(RD)and rhegmatogenous RD,the worst postoperative bestcorrected visual acuity(BCVA)and the highest rates of recurrent RD(all P<0.05).FVPM type,age of onset diabetes mellitus,preoperative BCVA,and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement(all P<0.05).Compared with the central type group,the arcade type group had higher rates of BCVA improvement.CONCLUSION:FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels.Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.

Intelligent 3D garment system of the human body based on deep spiking neural network

Background Intelligent garments,a burgeoning class of wearable devices,have extensive applications in domains such as sports training and medical rehabilitation.Nonetheless,existing research in the smart wearables domain predominantly emphasizes sensor functionality and quantity,often skipping crucial aspects related to user experience and interaction.Methods To address this gap,this study introduces a novel real-time 3D interactive system based on intelligent garments.The system utilizes lightweight sensor modules to collect human motion data and introduces a dual-stream fusion network based on pulsed neural units to classify and recognize human movements,thereby achieving real-time interaction between users and sensors.Additionally,the system incorporates 3D human visualization functionality,which visualizes sensor data and recognizes human actions as 3D models in real time,providing accurate and comprehensive visual feedback to help users better understand and analyze the details and features of human motion.This system has significant potential for applications in motion detection,medical monitoring,virtual reality,and other fields.The accurate classification of human actions contributes to the development of personalized training plans and injury prevention strategies.Conclusions This study has substantial implications in the domains of intelligent garments,human motion monitoring,and digital twin visualization.The advancement of this system is expected to propel the progress of wearable technology and foster a deeper comprehension of human motion.

Application Strategies of BIM Technology in Highway Electromechanical Engineering

The transportation system is vital for social and economic development.With the rapid economic development,the demand for highways has been increasing.Mechanical and electrical engineering is a crucial part of highway construction,affecting the expressway’s later use.Applying building information modeling(BIM)technology in highway electromechanical engineering allows for the visibility and simulation of mechanical and electrical engineering construction,providing scientific guidance for construction.In this research,the author analyzes the advantages of BIM technology in highway electromechanical engineering and the basic composition of electromechanical engineering.The research proposes strategies and cases for applying BIM technology in highway electromechanical engineering.The ultimate goal of this research is to improve the construction of highways in terms of electromechanical engineering.

基于in silico技术探究益母草在化妆品中的应用前景

益母草具有行血养血,活血化瘀的作用,临床应用广泛,常用来主治妇科疾病,近年来益母草的美容应用逐渐受到关注。本研究利用in silico技术平台,通过文献计量学对益母草的研究现状和未来的发展态势进行了预测,同时结合网络药理学对益母草皮肤美容的功效及物质基础进行预测,结果表明益母草的活性成分萜类化合物及益母草碱可通过NADPH、PDPK1、MAOB、VEGF2、SIRT2等靶点有效促进血液流动,改善皮肤微循环,调节激素代谢,降低炎症反应,抵御氧化应激,具有延缓皮肤老化,滋养皮肤的功效。本研究为益母草作为化妆品植物功效原料的物质基础及功效机理提供了理论基础,同时证明了益母草作为化妆品功效原料的独特性,具备良好的发展前景。

应用瑞加诺生负荷D-SPECT评价定量血流分数在经皮冠状动脉介入治疗中的作用

目的应用瑞加诺生负荷动态单光子发射计算机断层扫描(dynamic single-photon emission computed tomography,D-SPECT)评价定量血流分数(quantitative flow ratio,QFR)在经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的作用。方法选择2021年6月31日至2023年6月31日在河北医科大学第一医院心内科住院行择期PCI术的200例不稳定型心绞痛患者,年龄(57.56±8.23)岁,按照随机数字表法分为常规组(n=100)和QFR组(n=100),试验采用双盲法进行。常规组根据医师经验行PCI术治疗,QFR组根据QFR测定结果行PCI治疗。所有入选患者术前及PCI术后7 d,应用瑞加诺生负荷D-SPECT,分别采集短轴、垂直长轴、水平长轴的图像,计算心肌17节段分布下心肌灌注总积分、心肌缺血总节段数情况。结果PCI术前两组患者心肌缺血节段数(7.59±3.14 vs.7.48±3.36,P=0.811)、心肌灌注总积分(15.87±7.61 vs.15.63±5.97,P=0.860)差异无统计学意义,QFR组PCI术后7 d的心肌缺血节段数(5.58±3.36 vs.6.51±2.14,P=0.020)和心肌灌注总积分(10.55±4.41 vs.12.96±6.50,P=0.002)显著优于常规组(P<0.05)。结论应用QFR指导PCI可以更好改善患者心肌缺血程度。

应用D-SPECT评估红芪饮片对经皮冠状动脉介入治疗相关心肌损伤的影响

应用动态单光子发射计算机断层成像(D-SPECT)评价红芪饮片对经皮冠状动脉介入治疗(PCI)相关心肌损伤的影响。红芪治疗后患者血浆肌钙蛋白Ⅰ、肌酸激酶同工酶、N末端脑钠肽前体的水平明显低于常规治疗(P<0.05),心肌缺血节段数和心肌灌注总分明显低于常规治疗(P<0.05)。红芪饮片可显著改善PCI相关心肌损伤。

Effects of humanized nursing care on negative emotions and complications in patients undergoing hysteromyoma surgery

BACKGROUND Uterine fibroids,are prevalent benign tumors affecting women of reproductive age.However,surgical treatment is often necessary for symptomatic hysteromyoma cases.This study examines the impact of humanized nursing care on reducing negative emotions and postoperative complications in patients receiving hysteromyoma surgery.AIM To investigate the impact of humanized nursing care on patients undergoing hysteromyoma surgery.METHODS Among patients who underwent hysteromyoma surgery at the Fudan University Affiliated Obstetrics and Gynecology Hospital,200 were randomly assigned to either the control group(n=100)or the humanized nursing care group(n=100).The control group received traditional nursing care,while the humanized nursing care group received a comprehensive care plan encompassing psychological support,pain management,and tailored rehabilitation programs.In addition,anxiety and depression levels were assessed using the hospital anxiety and depression scale preoperatively and postoperatively.Postoperative complications were evaluated during follow-up assessments and compared between both groups.RESULTS The humanized nursing care group demonstrated a significant decrease in anxiety and depression levels compared to the control group(P<0.05).The rate of postoperative complications,including infection,bleeding,and deep venous thrombosis,was also markedly lower in the humanized nursing care group(P<0.05).CONCLUSION Humanized nursing care can effectively alleviate negative emotions and reduce the incidence of postoperative complications in patients undergoing hysteromyoma surgery.This approach should be considered a crucial component of perioperative care for these patients.Further research may be needed to explore additional benefits and long-term outcomes of implementing humanized nursing care in this population.

DMMIC derivatization-assisted liquid chromatography-mass spectrometry method for metabolite profiling of the glutathione anabolic pathway in esophageal cancer tissues and cells

In this work,a new pyrylium derivatization-assisted liquid chromatography-mass spectrometry(LC-MS)method was developed for metabolite profiling of the glutathione anabolic pathway(GAP)in cancer tissues and cells.The pyrylium salt of 6,7-dimethoxy-3-methyl isochromenylium tetrafluoroborate(DMMIC)was used to label the amino group of metabolites,and a reductant of dithiothreitol(DTT)was employed to stabilize the thiol group.By combining DMMIC derivatization with LC-MS,it was feasible to quantify the 13 main metabolites on the GAP in complex biological samples,which had good linearity(R^(2)=0.99810.9999),precision(interday precision of 1.6%e19.0%and intraday precision of 1.4%e19.8%)and accuracy(83.4%-115.7%).Moreover,the recovery assessments in tissues(82.5%e107.3%)and in cells(98.1%e118.9%)with GSH-^(13)C2,^(15)N,and Cys-^(15)N demonstrated the reliability of the method in detecting tissues and cells.Following a methodological evaluation,the method was applied successfully to investigate difference in the GAP between the carcinoma and para-carcinoma tissues of esophageal squamous cell carcinoma(ESCC)and the effect of p-hydroxycinnamaldehyde(CMSP)on the GAP in KYSE150 esophageal cancer cells.The results demonstrate that the developed method provides a promising new tool to elucidate the roles of GAP in physiological and pathological processes,which can contribute to research on drugs and diseases.

国医大师周仲瑛融贯古今创建病机理论新体系学术思想述要

概述了国医大师周仲瑛教授以创建中医病机理论新体系为核心学术思想的探索历程、学术意义,对其理论内涵进行解读。作为中医高等教育教材建设的开拓者,周仲瑛教授创建了中医内科脏腑辨证纲要,坚持不懈开展病机理论创新研究,取得丰硕的学术成果,充实、发展了中医理论学术体系。在对外感热病和内伤急难症临床诊疗过程中,系统创建了瘀热论、癌毒论等病机新理论,据此立法用药能够提高临床疗效,感悟出辨识病机是辨证论治的关键环节。周仲瑛教授晚年以整体观为指引,提出“病机十三条”,构建了中医病机辨证新体系,突出复合病机、病机要素因果链对临床复杂性病证的指导价值,形成以“审证求机,活化辨证”思想为灵魂的理论。该理论突破了从单一病机或固定证型辨证论治的僵化思维,以整体观思想重构了中医理论框架,是现代中医学的一次重大学术创新。

应用D-SPECT评估远程缺血预适应联合腺苷注射液在PCI患者中的作用

目的应用D-SPECT评价远程缺血预适应联合腺苷注射液在经皮冠状动脉介入治疗(PCI)患者中的作用。方法选择需行冠状动脉造影术及支架植入术患者300例,按照随机数字表法分为常规治疗组(150例)和试验组(150例),常规治疗组给予冠状动脉粥样硬化性心脏病PCI术常规治疗,试验组在PCI术当日通过血压计袖带分别在左、右上臂充气至200 mmHg,持续加压5 min诱导2次远程缺血预适应,然后在患者PCI术中以50μg/(kg·min)泵入腺苷注射液至术毕,其他治疗同常规治疗组,并对所有患者进行冠状动脉SYNTAXⅡ评分。应用静息D-SPECT+瑞加诺生负荷D-SPECT评估PCI术前及PCI术后7 d的心肌17节段分布下心肌灌注总积分、心肌缺血总节段数和左心室射血分数情况。结果PCI术前2组患者心肌缺血节段数、心肌灌注总积分、左心室射血分数情况差异无统计学意义(P>0.05),PCI术后7 d试验组的心肌缺血节段数、心肌灌注总积分、左心室射血分数情况显著优于常规治疗组(P<0.05),2组患者在药物不良反应方面差异无统计学意义(P>0.05)。结论远程缺血预适应联合腺苷注射液在PCI患者中应用安全有效。

冠状动脉内注射重组人TNK组织型纤溶酶原激活剂及腺苷注射液对急性ST段抬高型心肌梗死的疗效分析

目的评价急诊直接经皮冠脉介入(PPCI)治疗中经指引导管冠状动脉内注射重组人TNK组织型纤溶酶原激活剂及腺苷注射液对急性ST段抬高型心肌梗死(ASTEMI)的疗效。方法选择行急诊PPCI的ASTEMI患者,按照随机数字表法分为对照组和治疗组。对照组给予PPCI术常规治疗,若PPCI后梗死相关动脉(IRA)达到TIMI血流3级,则终止手术;若TIMI血流≤2级,则应用指引导管于冠脉内注射硝普钠、硝酸甘油、替罗非班改善冠状动脉微循环功能障碍(CMD),直到IRA达到TIMI血流3级。治疗组是在PPCI术常规治疗基础上,术中开通IRA后应用指引导管于冠状动脉内注射重组人TNK组织型纤溶酶原激活剂8 mg及腺苷注射液200μg,若IRA达到TIMI血流3级,则终止手术;若TIMI血流≤2级,则再次注射腺苷注射液改善CMD,直到IRA达到TIMI血流3级。观察指标,①心肌损伤指标:术前及术后12、24、36、48 h的血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、N端B型脑钠肽(NT-pro BNP)水平;②心肌灌注指标:术后校正的TIMI帧数(CTFC)、术后90 min IRA导联ST段回落值(STR);③心肌缺血的程度:术后3 d行静息D-SPECT+腺苷负荷D-SPECT检查,观察心肌17节段分布下心肌灌注总积分、心肌缺血总节段数情况;④术后30 d的药物不良反应:皮下瘀斑、牙龈出血、消化道出血、泌尿系出血、血红蛋白下降、脑出血;⑤术后30 d的主要不良心血管事件(MACE):心脏死亡、心肌梗死、心力衰竭、靶血管再次血运重建情况。结果①心肌损伤指标:术前的cTnI、CK-MB、NT-pro BNP水平两组患者差异均无统计学意义(均P>0.05),心肌损伤指标治疗组均在术后12 h显著低于对照组(均P<0.05),之后均趋势下降,术后48 h两组差异均无统计学意义(均P>0.05)。②心肌灌注指标:治疗组术后CTFC均显著优于对照组(P<0.05)。应用秩和检验,治疗组术后90 min STR显著优于对照组(Z=2.437,P=0.014)。③心肌缺血的程度:两组患者在术后3 d行静息D-SPECT+腺苷负荷D-SPECT检查,在心肌17节段分布下心肌灌注总积分、心肌缺血总节段数情况,治疗组在负荷缺血节段数、静息灌注总评分、负荷灌注总评分均显著优于对照组(均P<0.05)。④术后30 d的药物不良反应:两组患者在皮下瘀斑、牙龈出血、消化道出血、泌尿系出血、血红蛋白下降、脑出血发生率均无统计学差异(P>0.05)。⑤术后30 d的MACE情况:两组患者在心脏死亡、心肌梗死、心力衰竭、靶血管再次血运重建情况以及总MACE发生率均无统计学差异(P>0.05)。结论急诊PPCI中经指引导管冠状动脉内注射重组人TNK组织型纤溶酶原激活剂及腺苷注射液对ASTEMI患者安全、有效,可改善心肌损伤、心肌灌注和心肌缺血。