脓毒症心肌病是脓毒症的一种常见且危重的心功能不全并发症,其发病机制涉及全身因素以及心肌细胞的分子、代谢和结构变化的相互作用.近年来,针对脓毒症心肌病的研究主要集中于抑制炎症风暴、减轻氧化应激、改善细胞能量代谢、维持线粒体功能、改善线粒体动力学状态、恢复细胞内离子稳态以及调节细胞自噬与凋亡动态平衡等方面.未来,更好地理解脓毒症心肌病的发病机制及影响因素有助于发现新的治疗靶点,改进目前的诊治策略,提高患者生存率,改善患者预后.

目的 探讨二维和三维超声心动图(2DE和3DE)指标在评估阵发性心房颤动(PAF)患者左心房早期重构中的价值.方法 选取PAF患者48例,正常者40例.采集常规超声心动图参数及三维图像,应用2DE、3DE和三维斑点追踪成像技术(3D-STI)测定左心房相关容积和应变指标,比较两组间的差异.结果 2DE和3DE提示PAF患者左心房各期容积均增大(P＜0.05).2DE测定的容积相关指标提示左心房三相功能均受损(P＜0.05);3DE测定的应变指标提示左心房应变受损(P＜0.05).结论 2DE和3DE指标评估左心房结构与功能改变可帮助发现PAF患者左心房功能的早期改变.

冠状病毒是一个常见而又古老的病毒大家系,近年来多次在人群中暴发流行,分别有2003年引起严重急性呼吸综合征的严重急性呼吸综合征冠状病毒(SARS-CoV)、2004年和2005年分别被发现的人冠状病毒NL63(HCoV-NL63)和人冠状病毒HKU1(HCoV-HKU1)、2012年发现的中东呼吸综合征冠状病毒(MERS-CoV),及2019年12月在我国流行的新型冠状病毒(2019-nCoV),目前国际病毒分类委员会已正式命名该病毒为SARS-CoV-2.冠状病毒广泛存在蝙蝠体内,但在鸟、猫、犬、猪、鼠、马、鲸鱼、穿山甲和人类也有发现,此病毒多次暴发流行引起了各界人士的关注,其所致疾病引起了严重恐慌,研究其病原学,可有助于掌握引起流行原因,及时控制病毒蔓延,并致力于阻止病毒的肆虐.

目的 分析优化院内综合急救流程对行直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者救治效果的影响,探讨影响院内综合急救流程的主要因素和改进措施.方法 纳入2017年7月至2018年12月青岛大学附属医院确诊的STEMI患者.2017年7月至2018年3月在胸痛中心建设、优化综合急救流程前行直接PCI患者为改进前组(92例),2018年4月至2018年12月在胸痛中心建设、优化综合急救流程后行直接PCI患者为改进后组(87例).观察并对比两组从进入医院大门到球囊扩张血管再疏通(D to B)时间、住院天数及随访3个月主要不良心血管事件(MACE,包括再发心肌梗死、心律失常、心原性休克、心力衰竭)发生率.结果 改进前组患者节点1[(17.21±5.11)min比(4.44±0.76)min,P<0.001]、节点2[(10.40±4.49)min比(5.68±0.77)min,P<0.001]、节点3[42.50(23.00,74.00)min比22.00(18.00,25.00)min,P<0.001]、节点4[(40.99±8.70)min比(22.71±4.01)min,P<0.001]、节点5[(5.51±1.04)min比(3.82±0.71)min,P<0.001]、节点9[(74.45±2.41)min比(16.83±0.92)min,P<0.001]、节点10[(22.78±4.12)min比(17.82±0.95)min,P<0.001]时间和D to B时间[(155.10±67.94)min比(83.20±14.74)min,P<0.001]均显著长于改进后组患者,差异均有统计学意义.两组节点6、节点7、节点8时间比较,差异均无统计学意义(均P>0.05).改进后组患者节点1[(4.44±0.76)min比10 min,P<0.001]、节点2[(5.68±0.77)min比10 min,P<0.001]、节点5[(3.82±0.71)min比10 min,P<0.001]、节点9[(16.83±0.92)min比20 min,P<0.001]时间较标准节点时间有很大改进,差异均有统计学意义,虽然节点3、节点4、节点8时间与标准节点时间比较,差异均无统计学意义(均P>0.05),但均符合标准时间.改进后组患者D to B整体平均时间[(83.20±14.74)min比90 min,P<0.05]短于标准时间,差异有统计学意义.改进后组患者随访3个月后MACE发生率(10.3％比25.0％,P=0.011)显著低于改进前组患者,平均住院时间[(6.67±0.77)d比(8.04±2.52)d,P<0.001]显著短于改进前组患者,差异均有统计学意义.结论 优化院内综合急救流程明显缩短了D to B时间,使得STEMI患者3个月总体心血管不良事件发生率显著降低.

目的 探究PP2对C6神经胶质瘤细胞增殖和迁移的影响及其机制.方法 根据处理情况将C6神经胶质瘤细胞分为空白对照组、50 μg/L成纤维细胞生长因子2(FGF2)处理组(简称FGF2处理组)、50μg/L FGF2和0.02 mol/L PP2共处理组(简称共处理组).采用Transwell小室和EdU实验检测PP2对C6神经胶质瘤细胞增殖和迁移的影响,采用蛋白质印迹方法检测酪氨酸蛋白激酶(Src)通路相关蛋白及核蛋白的表达.结果 不同浓度PP2处理均可抑制C6神经胶质瘤细胞的存活(F=10.25～56.18,P＜0.05、0.01).与FGF2处理组相比,共处理组细胞增殖率明显降低(F=32.23,P＜0.01),细胞迁移数量显著减少(F=22.15,P＜0.01).共处理组磷酸化成纤维细胞生长因子受体1(FGFR1)表达水平较FGF2处理组明显降低,差异有统计学意义(F=20.21,P＜0.01).在相同处理时间,FGF2处理组Src通路相关蛋白及核蛋白表达水平与共处理组比较差异均有显著性(F=10.17～278.11,P＜0.05、0.01).结论 PP2可通过靶向FGFR1和Src发挥抗肿瘤作用,这可能为研发神经胶质瘤的新型治疗药物提供一个新思路.

OBJECTIVE This study aims to investigate the effects of co-transfection of the genes for connective tissue growth factor (CTGF) and tissue inhibitor of metalloproteinase-1 (TIMP1) mediated by adeno-associated virus 2 (AAV2) on degenerative lumbar intervertebral discs in a primate model. METHODS Twelve 4-7 year-old rhesus monkeys weighing 4.5-7.0 kg were utilized. CTGF and TIMP1 genes carried by AAV2 were injected into the degenerative lumbar intervertebral discs. Cytokine expression and biological effects were determined using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and 35S-sulfate incorporation assays. A rhesus monkey model of intervertebral disc degeneration was successfully established. RESULTS At post-transfection, CTGF mRNA expression was higher in the transfection group than in the control group (P < 0.05). Furthermore, TIMP1 mRNA expression in the transfection group was several times the levels observed in the control group (P < 0.05). Moreover, type-II collagen mRNA expression was higher in the transfection group than in the control group (P < 0.05). In addition, higher aggrecan mRNA expression and synthesis were observed in the transfection group, compared to that in the control group (P < 0.05). CONCLUSION The stable expression of CTGF and TIMP1 genes in vivo promoted the synthesis of aggrecan and type II collagen in the nucleus pulposus in the rhesus monkey model of intervertebral disc degeneration, which has a potential for intervertebral disc regeneration.

Intra-aortic balloon pump counterpulsation (IABP) is widely used in acute myocardial infarction patients combined with cardiogenic shock and refractory cardiac failure and the patients who need angioplasty and coronary artery bypass grafting (CABG).Remarkable effect of IABP has been achieved in clinical application.However,there have still been controversies on clinical indications and application time of IABP.This article summarizes the current clinical situation of IABP.

目的 探讨急诊内科老年患者误诊因素分析与管理对策.方法 选取该院在2015年3月-2016年3月期间收治的40例急诊内科老年患者作为参照组,对此组患者实施常规管理措施,对参照组误诊患者的误诊原因进行分析,并制定相应的管理措施.选取该院在2016年4月-2017年4月期间收治的40例急诊内科老年患者作为实验组,对此组患者实施针对性的管理措施,对实验组误诊患者的误诊原因进行分析.对比两组患者的误诊率.结果 实验组患者中急性心肌梗死、急性胰腺炎、甲亢性心脏病以及冠状动脉瘘等误诊率相比于参照组患者中急性心肌梗死、急性胰腺炎、甲亢性心脏病以及冠状动脉瘘等误诊率,明显较低,组间差异有统计学意义(P＜0.05).结论 对急诊内科老年患者予以针对性管理措施,可有效的降低误诊率,提高诊断准确率,值得临床上借鉴以及进一步普及.

Objective To evaluate the efficacy and safety of levosimendan in the elderly patients with decompensated heart failure due to acute ST?elevation myocardial infarction ( STEMI) . Methods Eighty?five elderly pa?tients with decompensated heart failure due to STMEI in emergency department from January 2013 to August 2015 were se?lected and divided into two groups. The control group was treated with conventional anti?heart failure therapy,and the obser?vation group was treated with the conventional therapy and levosimendan. Clinical effects and adverse reactions in the two groups were observed and compared respectively. Results The heart rate and the level of N?terminal pro?B?type natri?uretic peptide ( NT?proBNP ) were significantly decreased after treatment. The level of left ventricular ejection fraction ( LVEF) significantly increased in two groups, especially in the observation group( P<0?05 or P<0?01) . There were signif?icant differences in improvement rate and effective rate and incidence rate of clinical adverse events between the two groups ( P<0?05) . Conclusions Levosimendan can significantly improve cardiac function and raise clinical therapeutic effect significantly in the elderly patients with decompensated heart failure due to STEMI, with less adverse reactions.

目的 基于气相色谱质谱联用技术(GC-MS)分析腰椎间盘突出症(LDH)模型兔血浆代谢谱的变化,研究其代谢组学特征及与其密切相关的代谢产物,探讨其分子机制及特征代谢物的潜在临床价值.方法 针刺注射法建立LDH兔模型,成模后应用GC-MS技术对8例模型组和8例对照组的兔血浆样本进行检测,对检测结果进行多变量统计学分析,筛选出有显著意义的差异代谢物,并对差异代谢物进行代谢网络分析.结果 与对照组相比,模型组血浆中的甘氨酸、丙氨酸、谷氨酸、苯丙氨酸、亚牛磺酸、乳酸、肌醇、牛磺酸含量增加(t=5.17～57.98,P＜0.01),而1-磷酸葡萄糖、甘油含量减少(t=8.05、5.37,P＜0.01).结论 通过对LDH模型兔血浆代谢组学分析,证明代谢组学方法用于LDH研究是可行的,找到了与LDH高度相关的代谢信息,有助于了解该疾病的分子机制,为临床诊治该病提供了新的方向.

目的：分析采用替罗非班治疗急性心梗冠脉介入术后C反应蛋白的变化情况，并分析其后期影响。方法：从某院接收的急性心梗并采用急诊冠脉介入手术的患者中抽取42例，将所有病例随机分为两组，对照组和治疗组，对照组采用常规性的抗心梗治疗方法；治疗组采用常规疗法的基础上，还增加了替罗非班治疗法，剂量控制400ml，每h注射12ml。治疗后观察两组病人血清中的C反应蛋白的含量，然后来判定病人心肌的受损状况。结果：通过一个月的治疗，治疗组中的C反应蛋白从原来的9.3±0.8mg/L降低到了5.4±0.9mg/L，而对照组的C反应蛋白从原来的9.5±0.7mg/L降低到了9.0±0.8mg/L，两组都存在C反应蛋白降低，但对照组变化较小，没有统计学意义（P＞0.05），两组之间的治疗效果存在较大差异（P＜0.01）。结论：在心肌梗死患者采用急诊介入术治疗后，采用替罗非班可以有效地降低C反应蛋白的含量，从而减少对心肌的损伤，改善患者的预后状况。

Objective To investigate the changes of free tri-iodothyronine(FT3)in acute ST-segment elevation myocardial infarction(STEMI)and its association with Global Registry of Acute Coronary Events(GRACE)risk score. Methods Seventy-three consecutive STEMI patients were enrolled,according to if the adverse major cardiac events(AMCE)happened during hospital stay,they were divided into AMCE group and no-AMCE group.The blood was collected within 24hours after the onset of chest pain to determine FT3.Meanwhile,23healthy individuals were enrolled to serve as controls. Results The levels of FT3of subjects in the three groups were as follows:MACE groupno-MACE groupthe control group(F=81.818,P0.01).The level of FT3in patients with STEMI was negatively correlated with GRACE risk score(r=-0.580,P0.01). Conclusion The lower FT3levers in STEMI patients are associated with the extent of severity of the disease,which can be used as an indicator for risk stratification.

Objective To study the effect of lentivirus-mediated TGF-β3,CTGF and TIMP1 co-transfection on degenerative intervertebral disc(DID) in rabbits. Methods A model of DID was created by an anulus needle puncture in 15 New Zealand white rabbits,50 μL of Lenti-TGF β3-P2A-CTGF-T2A-TIMP1 were injected into DID of rabbits in experimental group,and lentivirus was injected into DID in those in control group.They were independently cultured under the same condition.Imaging observation of DID was conducted 16 and 20 weeks after the procedures. Results The DID in the rabbits in the experimental group was dramatically relieved as compared with the control and puncture groups,the difference being significant between them(χ2=9.11,19.05;P<0.05). Conclusion Combined Lenti-TGF β3-P2A-CTGF-T2A-TIMP1 can successfully delay the degeneration of intervertebral discs.