骨桥蛋白在心肌梗死后心力衰竭中研究进展

骨桥蛋白是一种糖基化的多功能蛋白,其具有激活细胞内信号传导、参与炎症细胞的趋化聚集、促进肿瘤的生长迁移等多种生物学功能。近年来研究表明其在心肌梗死后的炎症反应、心室重塑、细胞外基质沉积及肾素-血管紧张素-醛固酮系统的过度激活中具有重要的作用,同时其与心肌梗死后心力衰竭的严重程度及顸后亦密切相关。本文就骨桥蛋白在心肌梗死后心力衰竭中研究进展做一综述。     

血清Cys C的检测对肾移植术后患者肾功能评价的临床意义

探讨分析血清胱抑素C(Cys C)水平在肾移植术后患者肾功能监测中的应用价值.对25例肾移植成功患者在术前、术后第1、3、5、7、10天的血清Cys C、Scr、β2-MG、BUN水平进行动态监测,同时随机抽取健康体检者中的20例作为对照组.发现移植组的Cys C、Scr、β2-MG、BUN水平在术前均明显高于健康对照组(P＜0.01).这四项指标在手术后第一天都有所下降,且术后第1、3、5、7、10天的水平都比术前低(P＜0.01).四项指标与GFR的关系均为显著性负相关(P＜0.01),其中血清Cys C与GFR的相关性最好.Cys C、Scr、β2-MG、BUN检测后的ROC曲线下面积分别是:0.937、0.838、0.798、0.772,其差异都具有统计学意义(P＜0.05).血清Cys C优于Scr、β2-MG、BUN,在肾移植患者术后的动态监测中具有重要的临床应用价值.     

达标心率对缺血型心肌病和扩张型心肌病患者的影响

为观察达标心率对缺血型心肌病（ICM）和扩张型心肌病（DCM）患者预后的影响,所有入选ICM和DCM患者均给予常规抗心力衰竭药物及β受体阻滞剂（β-b）治疗,使心率维持于55次/分~60次/分,观察随访1年时的病死率、再入院率、舒张末期左室内径（LVEDd）、左室射血分数（LVEF）、氨基末端脑利钠肽前体（NT-proBNP）水平来评估二者的预后。结果显示,随访结束时ICM患者较DCM患者再入院率低（P=0.037）,LVEDd低（P=0.034）,LVEF高（P=0.028）,收缩压高（P=0.029）;对于ICM患者,随访结束时较出院时LVEDd低（P=0.047）,LVEF高（P=0.018）,收缩压高（P=0.042）。因此,心率达标对ICM患者有助于改善预后,对DCM患者改善不明显,ICM患者心率达标时获益更大。     

Media exposure to terrorism and people's risk perception: The role of environmental sensitivity and psychophysiological response to stress

Terrorist attacks have a destabilizing impact on the general population, causing distress and fear. However, not all individuals are equally susceptible to the effects of terror threat. This study aimed to examine whether exposure to terrorism-related pictures interacted with individual differences in environmental sensitivity and psychophysiological response to stress to explain people's risk perception, operationalized as perceived likelihood of a terrorist attack and willingness to trade off one's privacy to increase national security. Ninety-five university students were randomly assigned to one of two conditions (terrorism-related vs. neutral pictures). After watching the pictures, they answered questions concerning risk perception and completed questionnaires. Stress was induced by the Mannheim Multicomponent Stress Test, during which heart rate was recorded. Results showed that the perceived likelihood of future attacks was affected by the interaction between exposure to terrorism pictures and psychophysiological reactivity to stress, whereas willingness to trade off one's privacy to improve national security was influenced by the interaction between exposure to terrorism pictures and environmental sensitivity. The study suggests that individuals high in sensitivity and psychophysiological stress reactivity are particularly affected by terrorism-related pictures. Psychologists should direct their efforts to raise general awareness of the negative effects, especially for some people, of such media coverage.     

Pre-liver transplant psychosocial evaluation predicts post-transplantation outcomes

Psychosocial factors greatly impact the course of patients throughout the liver transplantation process. A retrospective chart review was performed of patients who underwent liver transplantation at Hadassah-Hebrew University Medical Center between 2002 and 2012. A composite psychosocial score was computed based on the patient’s pre-transplant evaluation. Patients were divided into two groups based on compliance, support and insight: Optimal psychosocial score and Non-optimal psychosocial score. Post-liver transplantation survival and complication rates were evaluated. Out of 100 patients who underwent liver transplantation at the Hadassah-Hebrew University Medical Center between 2002 and 2012, 93% had a complete pre-liver transplant psychosocial evaluation in the medical record performed by professional psychologists and social workers. Post-liver transplantation survival was significantly higher in the Optimal group (85%) as compared to the Non-optimal group (56%, p = .002). Post-liver transplantation rate of renal failure was significantly lower in the Optimal group. No significant differences were observed between the groups in other post-transplant complications. A patient’s psychosocial status may impact outcomes following transplantation as inferior psychosocial grades were associated with lower overall survival and increased rates of complications. Pre-liver transplant psychosocial evaluations are an important tool to help predict survival following transplantation.     

慢性心力衰竭的早期识别及预防

慢性心力衰竭(心衰)的预防是全球范围急待解决的公众健康问题.以往的流行病学研究已经证明了心衰发生的危险因素及其标志性指标(既A期心衰).发现有心衰的高危因素的个体是心衰预防的关键步骤.高血压和冠心病是最常见的心衰危险因素,糖尿病、心脏瓣膜病、血脂异常及肾功能不全与心衰的危险性高度相关.但无论是有这些心衰危险因素的患者(A期)或已经有心脏结构异常但还无临床症状的患者(B期),还是已经发展为有临床症状的心衰患者(C期及D期),都可能被忽视而不能快速诊断及适当治疗.因此,提高公众关注心衰意识将有助于正确的诊断及治疗,提高患者对心衰指南的依从性,而且更重要的是重视易导致心衰的危险因素,从而指导治疗.     

Type D personality and cardiovascular reactivity to an ecologically valid multitasking stressor

Previous research investigating the influence of Type D personality on cardiovascular reactivity to stress in healthy young adults is somewhat mixed. The present study sought to investigate this question using an ecologically valid laboratory stressor. Beat-to-beat blood pressure and heart rate were measured in 77 healthy young adults during exposure to multitasking stress. Mood and background stress were both associated with Type D personality when Type D was conceptualised as a dimensional construct, with less robust findings observed using the traditional dichotomous typological approach. However, the continuous Type D construct added limited predictive value of the self-report measures above that of its constituent components, negative affectivity (NA) and social inhibition (SI). Further, an inverse relationship between the continuous Type D construct and blood pressure reactivity to multitasking stress was observed. In summary, our findings suggest that Type D personality is predictive of blunted cardiovascular reactivity to stress in healthy individuals when Type D is considered as a dimensional construct and the independent influence of NA and SI is controlled for. Further, our findings suggest that Type D does not predict additional variance in mood and background stress above that of NA and SI when these constituent factors are considered independently.     

养老机构冠心病患者服药依从性现状及影响因素

采用Morisky推荐的MAQ对锦州市养老机构中153名冠心痛患者的服药依从性进行测评,探讨冠心病患者的服药依从性现状及影响因素.结果显示,养老机构冠心病患者服药依从性差的比率为81.7％,影响服药依从性的因素为文化程度、服药种类、医疗背景、入住年限.养老机构的护理人员应对上述因素给予更多的关注,从而提高其服药依从性,进而提升其临床治疗效果.     

冠心病患者微量白蛋白尿与C反应蛋白的关系

研究冠心病患者微量白蛋白尿与血清C反应蛋白(CRP)相关性.研究对象为接受冠状动脉造影确诊为冠心病的住院患者87例,检测其尿白蛋白/肌酐浓度值(ACR)、血清C反应蛋白水平及其他指标,并与35例冠状动脉造影为非冠心病的患者进行比较.冠心病组lgACR及lgCRP水平明显高于正常对照组(P＜0.05).lgACR与lgCRP呈正相关(r=0.275,P=0.005),且均为冠心病的独立预测因素.冠心病患者微量白蛋白尿与血清C反应蛋白均明显增加.ACR、CRP均为冠心病的独立预测因素.在微量白蛋白尿的发生过程中可能有低度炎症(CRP)的参与.     

从库恩历史主义看心力衰竭发病机制的研究历程

本文从古希腊Hippocrates的描述作为回顾起点,阐述对心衰发病机制认识过程的六次演变;分析其中的学术背景、重要事件和人物的历史贡献,并从库恩历史主义视角进行深入的哲学思考,有助于总结蕴涵在这一历史进程的经验和规律,有利于培养科学方法论、启迪和开拓科研思路。