Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.     

综合治疗脑梗塞68例观察

脑梗塞是常见病，且大部分可引起偏瘫，失语，智能障碍等后遗症，严重影响病人的生存质量，广州市第六人民医院于１９９５年１月～１９９７年６月采用中西药物，传统治疗，功能障碍治疗，心理治疗，氦氖激光血管内照射，血液光量子疗法，高压氧等综合治疗脑梗塞６８例，总疗程３个月，结果，总有效率９４．１％，显效率６４．１％，明显高于单用药物治疗的显效率，说明综合治疗可提高疗效，减少后遗症及致残率，且病程越短，疗效越好     

急性脑梗死患者脑微出血的发病情况及其危险因素分析

目的探讨急性脑梗死患者脑微出血的发病情况及其危险因素。方法选择急性脑梗死患者75例,男51例,女24例,年龄42～83（64.9±10.8）岁。行头颅CT、磁敏感成像（SWI）检查,依据脑微出血检出的结果分成阳性组（23例）与阴性组（52例）,比较两组的一般资料,探讨脑微出血发病的危险因素。结果SWI检查的检出率比CT检出率高（χ2=27.17,P＜0.05）。阳性组年龄、高血压病、糖尿病患病率均较阴性组高,差异均有统计学意义（均P＜0.05）;两组性别、血脂异常、心房颤动、冠心病、吸烟、饮酒情况比较,差异均无统计学意义（均P＞0.05）。logistic回归分析显示年龄增长、高血压病是脑微出血的独立危险因素（P＜0.05）。结论急性脑梗死患者合并存在脑微出血的比例高,SWI检查是检测脑微出血的敏感方法,年龄大、高血压病与脑微出血的发生密切相关。     

Dissociation between lactate accumulation and acidosis in middle cerebral artery-occluded rats assessed by P and H NMR metabolic images under A 2-T magnetic field

The relationships among tissue edema, lactate accumulation, and intracellular pH in middle cerebral artery (MCA)-occluded rats were investigated with multiecho ¹H magnetic resonance imaging and spatially resolved metabolic images constructed by ¹H and ³¹P nuclear magnetic resonance (NMR) chemical shift imaging (CSI). For the effective and sensitive detection of NMR signals from the brain, outer volume suppression (OVS), reduced k-space sampling and proton irradiation were incorporated into the CSI sequences. The consecutive three measurements of calculated T₂ image, lactate image, and pH image which were required for 3.75 h were repeated for four cycles of 1–16 h after MCA occlusion. Tissue edema and lactate accumulation in the infarcted region were gradually and consistently increased during the 15-h observation period. In contrast, severe acidosis was already detected on the first pH image (2–4.7 h after MCA occlusion); thereafter, the degree of acidosis became milder and showed no further progression. The dissociation between the time courses of the lactate accumulation and pH decrease was clearly demonstrated by the NMR metabolic images. Acid-base balance in cerebral infarction might be affected not only by lactate production but also by complicated interactions with tissue edema and some other factors.     

基于多路可视图的健康与心梗患者心电图信号复杂网络识别

可视图(visibility graph, VG)算法已被证明是将时间序列转换为复杂网络的简单且高效的方法,其构成的复杂网络在拓扑结构中继承了原始时间序列的动力学特性.目前,单维时间序列的可视图分析已趋于成熟,但应用于复杂系统时,单变量往往无法描述系统的全局特征.本文提出一种新的多元时间序列分析方法,将心梗和健康人的12导联心电图(electrocardiograph, ECG)信号转换为多路可视图,以每个导联为一个节点,两个导联构成可视图的层间互信息为连边权重,将其映射到复杂网络.由于不同人群的全连通网络表现为完全相同的拓扑结构,无法唯一表征不同个体的动力学特征,根据层间互信息大小重构网络,提取权重度和加权聚类系数,实现对不同人群12导联ECG信号的识别.为判断序列长度对识别效果的影响,引入多尺度权重度分布熵.由于健康受试者拥有更高的平均权重度和平均加权聚类系数,其映射网络表现为更加规则的结构、更高的复杂性和连接性,可以与心梗患者进行区分,两个参数的识别准确率均达到93.3%.     

急性心肌梗死患者D-二聚体、cTnT及心肌酶谱联合检测的临床意义

为探讨急性心肌梗死患者D-二聚体、肌钙蛋白及心肌酶谱联合检测的临床意义,选择30例健康者（对照组）和100例患者（病例组）进行D-二聚体、肌钙蛋白及心肌酶谱（AST、LDH、CK、CK-MB）检测,并把100例患者（病例组）分为3组,分别为36例AMI组,34例不稳定型心绞痛（UAP）组,30例稳定型心绞痛（SAP）组。结果表明,AMI组及UAP组中D-二聚体、肌钙蛋白及心肌酶谱（AST、LDH、CK、CK—MB）的升高程度较SAP组和健康对照组显著增高（P〈0．05）;AMI组肌钙蛋白（cTnT）较UAP组明显增高（P〈0．05）;UAP组肌钙蛋白（cTnT）较对照组明显增高（P〈0．05）;D-二聚体、肌钙蛋白及心肌酶谱（AST、LDH、CK、CK—MB）的升高程度与心肌梗死的面积正相关（P〈0．01）。提示D-二聚体、肌钙蛋白及心肌酶谱（AST、LDH、CK、CK—MB）联合检测有助于急性心肌梗死诊断的提高。     

急性脑梗死介入治疗术后护理

总结了15例急性脑梗死患者动脉介入治疗术后的护理体会,阐述了术后在心理护理、呼吸道护理、持续抗凝治疗、防止脑出血以及出院指导、康复锻炼等方面所采取的措施,这些是预防重要并发症发生,使患者顺利康复的重要因素。     

超声心动图联合动态心电图检查对急性心肌梗死诊断和预后评估的价值

为探讨超声心动图联合动态心电图检查在急性心肌梗死(AMI)患者诊断和预后评估中的应用价值,本研究选取2016年6月~2018年6月我院收治并确诊的100例AMI患者作为观察组,另选取同期100例非冠心病患者作为对照组。以AMI患者心源性死亡为终点事件,将观察组分为死亡组(n=15)和存活组(n=85)。所有患者均采用飞利浦IU-Elite及EPIQ5彩色多普勒超声诊断仪进行超声心动图检查,采用DMS-3004A进行标准的12导联动态心电图检查。比较各组患者心率震荡指标[震荡起始(TO)、震荡斜率(TS)]、心率变异性指标[NN间期标准差(SDNN)、QT离散度(QTd)、经心率校正的QT离散度(QTcd)]及心功能指标[左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]水平的变化。结果显示,观察组TO、QTd、QTcd、LVEDD均明显高于对照组,TS、SDNN、LVEF均明显低于对照组,差异有统计学意义(P<0.05)。死亡组TS、SDNN均明显低于存活组,差异有统计学意义(P<0.05);死亡组TO高于存活组,QTd、QTcd、LVEF、LVEDD均低于存活组,但差异无统计学意义(P>0.05)。本研究结果表明,AMI患者心率震荡(HRT)明显减弱甚至消失,HRV、LVEF明显降低,LVEDD、QTd明显增大,QT间期明显延长。超声心动图和动态心电图联合检查对AMI患者诊断及预后评估均有重要的临床应用价值。     

Cardiac markers: a clear cause for point-of-care testing

Point-of-care testing (POCT) in patients with ischemic heart disease is driven by the time-critical need for fast, specific, and accurate results to initiate therapy instantly. According to current guidelines, the results of the cardiac marker testing should be available to the physician within 30 min (“vein-to-brain” time) to initiate therapy within 60–90 min (“door-to-needle” time) after the patient has arrived at the emergency room or intensive care unit. This article reviews the current efforts to meet this goal (1) by implementing POCT of established biochemical markers such as cardiac troponins, creatine kinase MB, and myoglobin, in accelerated diagnosis and management workflow schemes, (2) by improving current POCT methods to obtain more accurate, more specific, and even faster tests through the integration of optical and electrochemical sensor technology, and (3) by identifying new markers for the very early and sensitive detection of myocardial ischemia and necrosis. Furthermore, the specific requirements for cardiac POCT in regard to analytical performance, comparability, and diagnostic sensitivity/specificity are discussed. For the future, the integration of new immunooptical and electrochemical chip technology might speed up diagnosis even further. However, every new development will have to meet the stringent method validation criteria set for corresponding central laboratory testing.