Usefulness of myocardial performance index for assessing right ventricular function after percut
肌联蛋白基因截断突变致家族性扩张型心肌病的研究进展
[2]Adams JE, Abendschein DR, Jaffe AS. Biochemical markers ofmyocardial injury. Is MB creatine kinase the choice for the 1990s? Circulation, 1993, 88: 750-763.[3] Tate JR. Troponin revisited 2008: assay performance. Clin Chem LabMed, 2008, 46: 1489-1500.[4] Zimmermann R, Baki S, Dengler TJ, et al. Troponin T release afterheart transplantation. Br Heart J, 1993, 69: 395-398.[5] Labarrere CA, Nelson DR, Cox CJ, et al. Cardiac-specific troponin Ilevels and risk of coronary artery disease and graft failure following heart transplantation. JAMA, 2000, 284: 457-464.[6] 薛莉, 王彦卿. 心肌肌钙蛋白 Ⅰ 与慢性心力衰竭. 中国循环杂志,2005, 20: 244.[7] 刘春萍, 陆慰萱, 王孟昭, 等. 急性肺血栓栓塞血浆肌钙蛋白I 的改变及其对预后的评估. 中国循环杂志, 2004, 19: 50-52.[8] Erbel C, Taskin R, Doesch A, et al. High-sensitive troponin Tmeasurements early after heart transplantation predict short-and long-term survival. Transpl Int, 2013, 26: 267-272.[9] Potapov EV, Wagner FD, Loebe M, et al. Elevated donor cardiactroponin T and procalcitonin indicate two independent mechanisms of early graft failure after heart transplantation. Int J Cardiol, 2003, 92: 163-167.[10] Riou B, Dreux S, Roche S, et al. Circulating cardiac troponin T inpotential heart transplant donors. Circulation, 1995, 92: 409-414.[11] Venkateswaran RV, Ganesh JS, Thekkudan J, et al. Donor cardiactroponin-I: a biochemical surrogate of heart function. Eur J Cardiothoracic Surg, 2009, 36: 286-292.[12] Lin KY, Sullivan P, Salam A, et al. Troponin I levels from donors肌联蛋白基因截断突变致家族性扩张型心肌病的研究进展李发有综述，范洁审校扩张型心肌病（DCM） 是一种原因不明的以心腔左心室和（或）双心室扩大、心肌收缩功能减弱为主要特征的异质性心肌病。
专题报告一：主管药师在药物治疗中的个体化管理
专题报告一：主管药师在药物治疗中的个体化管理引言：个体化药物治疗管理是当今临床药学工作中的重要组成部分，其核心理念是根据患者的个体特点和药物代谢特征，制定个性化的治疗方案，以最大程度地提高治疗效果和减少不良反应的发生。
本报告将结合主管药师在现职期间的实践经验，对个体化药物治疗管理进行详细分析和讨论。
材料与方法：在过去一年的工作中，我主要从事以下工作：对患者的病历进行全面评估，包括疾病诊断、用药情况、用药依从性和不良反应等方面。
根据患者的具体情况，制定个体化的药物治疗方案，包括药物选择、剂量调整和用药时间等。
定期监测患者的治疗效果和药物安全性，及时调整治疗方案。
结果：通过个体化药物治疗管理，我成功解决了许多复杂病例，取得了良好的临床效果。
例如，一位高血压患者因肾功能不全而无法耐受常规的降压药物，经过个体化管理后，成功控制了血压，并改善了肾功能。
另外，一位老年患者因多种慢性疾病而需要复杂的药物治疗，经过个体化管理后，减少了不良反应的发生，提高了生活质量。
讨论：个体化药物治疗管理的核心在于将患者放在治疗决策的中心，根据其疾病特点、用药史、生活方式等因素制定个性化的治疗方案。
这种管理模式不仅可以提高治疗效果，还可以增加患者对治疗的依从性和满意度。
然而，个体化管理也存在一些挑战，如需耗费更多的时间和精力、需要具备更高的临床判断能力等。
在个体化治疗中，药师发挥着重要作用。
他们需要对药物的药理学、药代动力学等方面有深入的了解，能够根据患者的具体情况制定合适的治疗方案，并监测治疗效果和不良反应的发生。
同时，药师还需要与医生、护士等多学科团队成员密切合作，共同制定综合性的治疗方案，实现个体化治疗的最佳效果。
结论：个体化药物治疗管理是现代临床药学工作的重要内容之一。
作为主管药师，我们应不断学习和提升个体化管理的水平，为患者提供更加安全、有效的药物治疗服务，真正实现以患者为中心的医疗理念。
附加材料：1、患者病历资料2、个体化治疗方案示例3、药师介入临床治疗的依据3、治疗效果监测记录表参考文献：［1］中国心血管健康与疾病报告编写组 . 中国心血管健康与疾病报告 2021 概要［J］. 中国循环杂志，2022，37（6）：553-578. DOI：10.3969/j.issn.1000-3614.2022.06.001.［2］中华医学会心血管疾病学分会，中国康复医学会心脏预防与康复专业委员会，中国老年学和老年医学会心脏专业委员会，等 . 中国心血管疾病一级预防指南［J］. 中华心血管疾病杂志，2020，48（12）：1000-1038. DOI：10.3760/112148- 20201009-00796. ［3］卫生部统计信息中心 .2013 年中国卫生统计年鉴［Z］. 2013. ［4］赵静，赵淑清 . 老年高血压病患者脂质代谢异常及其与心血管疾病发生风险的相关性分析［J］. 老年医学与保健，2022，28（3）：544-548. DOI：10.3969/j.issn.1008-8296.2022.03.019.［5］W ANG S，WU H，ZHANG Q，et al．Impactof baseline prehypertension on cardiovascular events and all-cause mortality in the general population：a meta-analysis of prospective cohortstudies ［J］. International Journal of Cardiology，2013，168（5）： 4857-4860.［6］吴桂贤，吴兆苏，王薇，等 . 1992—2002 年北京一组队列人群心血管疾病危险因素变化趋势研究［J］. 中华心血管疾病杂志，2005，33（8）：748-753.［7］徐绮，沈节艳，施榕，等 . 社区中年人群缺血性心血管疾病危险评估及分析［J］. 中国全科医学，2015，18（24）：2894- 2897，2902. DOI：10.3969/j.issn.1007-9572.2015.24.005.［8］ROSENGARTEN J A，SCOTT P A，MORGAN J M. Fragmented QRS for the prediction of sudden cardiac death：a meta-analysis ［J］. Europace，2015，17（6）：969-977.［9］SESSA F，ANNA V，MESSINA G，et al. Heart rate variability as predictive factor for sudden cardiac Death ［J］. Aging，2018，10（2）： 166-177.［10］CAMM A J，PRATT C M，SCHWARTZ P J，et al. Mortality in patients after a recent myocardial infarction： a randomized，placebo-controlled trial of azimilide using heart rate variability for risk stratification ［J］. Circulation，2004，109（8）：990-996.［11］KHANDOKER A H，PALANISW AMI M，KARMAKAR C K. Support vector machines for automated recognition of obstructive sleep apnea syndrome from ECG recordings［J］. IEEE Trans Inf Technol Biomed，2009，13：37-48.［12］TAKUO A，TOSHIAKI N，HIROKO Y，et al. Clinical Usefulness of New R-R Interval Analysis Using the Wearable Heart Rate Sensor WHS-1 to Identify Obstructive Sleep Apnea：OSA and RRI Analysis Using a Wearable Heartbeat Sensor ［J］.J Clin Med， 2020，9（10）：3359. DOI：10.3390/jcm9103359.附加材料：1、患者病历资料患者姓名：XX性别：XX年龄：XX体重：XX主诉：高血压合并肾功能不全病史：患者有高血压病史10年，长期口服降压药物，包括ACEI类药物、钙通道阻滞剂等，但血压控制不理想。
手术室护理分层培训实践研究进展
手术室护理分层培训的实践与研究进展【摘要】手术室是治疗病人的特殊区域，手术室护理质量的好坏直接影响患者的生命安全和临床疗效，随着医学技术的发展，一些新型医疗设备应用到手术室，为抢救患者、治疗患者提供了强有力的保障。
熟悉掌握使用各种医疗设备才能确保各种救治的顺利进行，而且新的医疗设备逐步更新，因此加强对手术室护理人员的培训，提高护理人员的业务素质至关重要，本文结合工作实际和有关文献报道对手术室护理分层培训的方法、培训方式和研究进展情况进行阐述。
【关键词】手术室护理；分层培训；实践；研究进展手术室是治疗病人的特殊区域，手术室护理质量的好坏直接影响患者的生命安全和临床疗效，随着医学技术的发展，一些新型医疗设备应用到手术室，为抢救患者、治疗患者提供了强有力的保障[1]。
熟悉掌握使用各种医疗设备才能确保各种救治的顺利进行，而且新的医疗设备逐步更新，因此加强对手术室护理人员的培训，提高护理人员的业务素质至关重要，本文结合工作实际和有关文献报道对手术室护理分层培训的实践与研究进展阐述如下。
1手术室护理分层培训的方法1.1进入手术室的新同志，要集中安排岗前培训。
由护士长向新进入手术室的新同志介绍手术室的环境、各种规章制度、无菌技术要求以及术中应注意的事项等。
1.2对低年资护士的培训低年资护士在年龄上比较有优势，年轻富有朝气，精力充沛，学习热情高，因为工作经验少，要及时进行教育，由高年资的护师带教，不断强化无菌观念、护理安全意识[2]，把多年来的经验传授给年轻的护理人员，积极创造轻松、和谐的工作学习环境，以提高培训效果。
对具体的手术配合以一对一方式带教，逐步过渡到巡回工作和亲自参与手术配合。
1.3专科轮训经过上述基本培训后的护士，已能独立完成各科常见中小手术的配合。
对这一阶段护士进行专科轮训，将他们分到各专科小组，在专科组长的带领下，进一步强化专科手术的配合，逐步参加一些重大的手术，熟练掌握专科设备仪器的使用保养，提高对护生的带教能力。
自我效能感专业文献资料
Honourary President’s Address –2007Facilitating Optimal Motivation and Psychological Well-Being Across Life’sDomainsEDWARD L.DECIRICHARD M.RYANUniversity of RochesterAbstractSelf-determination theory (SDT)differentiates motivation,with autono-mous and controlled motivations constituting the key,broad distinction.Research has shown that autonomous motivation predicts persistence and adherence and is advantageous for effective performance,espe-cially on complex or heuristic tasks that involve deep information pro-cessing or creativity.Autonomous motivation is also reliably related to psychological health.Considerable research has found interpersonal contexts that facilitate satisfaction of the basic psychological needs for competence,autonomy,and relatedness to enhance autonomous moti-vation,which comprises intrinsic motivation and well-internalized ex-trinsic motivation.SDT has been applied in varied cultures and in many life domains,and research is reviewed that has related autono-mous and controlled motivation to education,parenting,work,health care,sport,and close relationships.Keywords :autonomy,self-determination theory,autonomy support,intrinsic motivationThe topic of motivation concerns what moves people to act,think,and develop.The central focus of motivation research is therefore on the conditions and processes that facilitate persis-tence,performance,healthy development,and vitality in our hu-man endeavors.Although,clearly,motivational processes can be studied in terms of underlying mechanisms in people’s brains and physiology,the vast amount of variance in human motivation is not a function of such mechanisms but is instead a function of the more proximal sociocultural conditions in which actors find them-selves.These social conditions and processes influence not only what people do but also how they feel while acting and as a consequence of acting.Most theories of human motivation have therefore focused on the effects of social environments,including the rewards,incentives,and relationships inherent in them,to better understand what activates and sustains effective functioning,not only because that is where variation is most readily observed but also because it is the most practical focus for interventions.In doing so,most theories have treated motivation as a unitary concept that varies primarily in amount (e.g.,Bandura,1996;Baumeister &Vohs,2007).They have assumed that more motivation,however catalyzed,will yield greater achievement and more success-ful functioning.Self-determination theory (SDT;Deci &Ryan,2000;Ryan &Deci,2000),in contrast,has maintained that there are differ-ent types of motivation—specifically,autonomous and controlled motivation—and that the type of motivation is generally more impor-tant than the amount in predicting life’s important outcomes.Auton-omous motivation involves behaving with a full sense of volition and choice,whereas controlled motivation involves behaving with the experience of pressure and demand toward specific outcomes that comes from forces perceived to be external to the self.SDT began with the premise that the most useful theories of motivation would be broad in scope,encompassing a wide range of phenomena;use concepts that have phenomenological or personal meaning for people;be derived using empirical methods;and have principles that can be applied across life’s domains.As such,the theory has developed with these guiding criteria,and that may be the reason why in the past 2decades it has generated an enormous amount of research elaborating many aspects of the theory and addressing issues in many applied domains,such as parenting,health care,education,work,sport,psychotherapy,and so forth.SDT assumes that people are by nature active and self-motivated,curious and interested,vital and eager to succeed be-cause success itself is personally satisfying and rewarding.The theory recognises,however,that people can also be alienated and mechanized,or passive and disaffected.SDT accounts for these differences in terms of the types of motivation,which result from the interaction between people’s inherent active nature and the social environments that either support or thwart that nature.More specifically,resulting from empirical methods and inductive rea-Edward L.Deci and Richard M.Ryan,Department of Psychology,University of Rochester.This article was based on the 2007Honourary Presidential address to the Canadian Psychological Association by Edward L.Deci.The theory de-velopment and research review presented in this article have been done as a joint effort of the two authors.Correspondence concerning this article should be addressed to Edward L.Deci,Department of Psychology,Box 270266,University of Rochester,Rochester,NY 14627.E-mail:deci@Canadian PsychologyCopyright 2008by the Canadian Psychological Association 2008,Vol.49,No.1,14–230708-5591/08/$12.00DOI:10.1037/0708-5591.49.1.1414soning,the theory has proposed that all humans need to feel competent,autonomous,and related to others(Deci&Ryan, 2000).Social contexts that facilitate satisfaction of these three basic psychological needs will support people’s inherent activity, promote more optimal motivation,and yield the most positive psychological,developmental,and behavioural outcomes(Ryan& Deci,2000).In contrast,social environments that thwart satisfac-tion of these needs yield less optimal forms of motivation and have deleterious effects on a wide variety of well-being outcomes.SDTIn this article,we present some central components of SDT and review both basic and applied research.We begin with a discus-sion of the differentiation of motivation within the SDT tradition, which started with the distinction between intrinsic and extrinsic motivation(Deci&Ryan,1985).Intrinsic and Extrinsic MotivationIntrinsic motivation involves doing a behaviour because the activity itself is interesting and spontaneously satisfying.When intrinsically motivated,people perform activities because of the positive feelings resulting from the activities themselves.People are interested in what they are doing,and they display curiosity, explore novel stimuli,and work to master optimal challenges (Deci,1975;White,1959).Extrinsic motivation,in contrast,in-volves engaging in an activity because it leads to some separate consequence.The clearest examples of extrinsically motivated behaviours are those performed to obtain a tangible reward or to avoid a punishment.Various theories besides SDT have used the intrinsic–extrinsic distinction,but they have typically maintained that these two types of motivation are additive,resulting in total motivation(e.g., Atkinson,1964;Porter&Lawler,1968).Considerable research beginning in the early1970s focused on intrinsic motivation in humans and tested this additivity proposition by examining whether providing people with extrinsic rewards for doing an intrinsically interesting activity would affect their intrinsic moti-vation for the activity(e.g.,Deci,1971).The reasoning was that, if the level of intrinsic motivation had either decreased or in-creased by the addition of extrinsic rewards,it would mean that the two types of motivation are not additive.If the effect of the extrinsic reward had decreased intrinsic motivation,it would in-dicate that the two types of motivation tend to work against each other rather than being additive or synergistically positive.By1999,over100published experiments had examined this issue,and the results of a meta-analysis confirmed that,overall, extrinsic rewards decreased intrinsic motivation across a range of ages,activities,rewards,and reward contingencies(Deci,Koest-ner,&Ryan,1999).In other words,when people were given extrinsic rewards such as money or awards for doing an intrinsi-cally interesting activity,their intrinsic motivation for the activity tended to be undermined.That is,the rewards led them to lose interest in the activity.There were,however,limiting conditions to this finding.For example,rewards that are noncontingent or are not specifically dependent on doing an activity or achieving some standard tend not to undermine intrinsic motivation for the target activity because they tend not to be perceived as controlling one’s behaviour.In spite of these important limiting conditions,the meta-analysis still concluded that tangible rewards do tend to interact negatively with intrinsic motivation,so the two types of motivation are not additive,and the total motivation is unlikely to be the best predictor of the quality of people’s behaviour and experience.Many additional studies have examined the effects of other extrinsic motivators on intrinsic motivation,and several of these motivators,including threats of punishment(Deci&Cascio, 1972),deadlines(Amabile,DeJong,&Lepper,1976),and surveil-lance(Plant&Ryan,1985),were found to decrease intrinsic motivation.In contrast,the provision of choice was found to enhance intrinsic motivation(Zuckerman,Porac,Lathin,Smith,& Deci,1978).In interpreting these findings,we have argued that when people are intrinsically motivated,they feel a sense of autonomy as their basic need for autonomy is satisfied.Then, when people are rewarded,threatened,surveilled,or evaluated, they tend to feel pressured and controlled,and that diminishes satisfaction of their autonomy need,whereas when they are offered choice,they tend to experience greater autonomy satisfaction (Deci&Ryan,2000).In contrast to tangible rewards,positive performance feedback has been found in some instances to enhance intrinsic motivation rather than undermine it(e.g.,Deci et al.,1999).This appears to be because it directly conveys positive competence information,thus satisfying the need for competence,without being experienced as controlling.We refer to events that convey competence without being controlling as being informational.As well,studies have shown that negative feedback tends to undermine intrinsic moti-vation by thwarting people’s need for competence(e.g.,Vallerand &Reid,1984),leaving them amotivated—that is,with little in-trinsic or extrinsic motivation.Interpersonal climates.Additional studies have found that the general ambience of a situation,such as the interpersonal climate of homes,classrooms,or work groups,can also affect people’s intrinsic motivation.Social climates that feel pressuring and con-trolling undermine intrinsic motivation,whereas those that feel supportive and informational enhance intrinsic motivation(Deci, Connell,&Ryan,1989;Deci,Schwartz,Sheinman,&Ryan,1981; Vansteenkiste,Simons,Lens,Sheldon,&Deci,2004). Finally,research has shown that the effects of events such as tangible rewards or positive feedback can be influenced by the nature of the social context within which they are administered. For example,although tangible rewards have been found to un-dermine intrinsic motivation,if the interpersonal context is infor-mational and supportive of people’s autonomy,the rewards could have a positive effect(Ryan,Mims,&Koestner,1983).In parallel fashion,if positive feedback is administered in a controlling con-text,it will tend to decrease(rather than increase)intrinsic moti-vation(Ryan,1982).Autonomy and independence.SDT has always been concerned with understanding actions that are autonomous and volitional—that is,actions for which people feel a full sense of choice and endorsement of an activity—and intrinsic motivation represents a prototype of this experience.It is important to recognise,however, that autonomy is not the same thing as independence(Ryan& Lynch,1989),although some psychologists have interpreted it that way(e.g.,Markus,Kitayama,&Heiman,1996).Autonomy means to act volitionally,with a sense of choice,whereas independence15SDT,MOTIVATION,AND PSYCHOLOGICAL WELL-BEINGmeans to function alone and not rely on others.People can act independently for various reasons—for example,because they think they should to be viewed as competent or mature or because they don’t like being in relationships in which they depend on others.Acting independently in either of these cases would not at all constitute autonomy or volition;indeed,the independent be-haviours would be controlled.In the first case,the individuals would feel pressured to be independent,and in the second they would be rejecting involvement with others,perhaps because they have been hurt and are not able to confront the pain.Conversely, people can depend or rely on others because they find the engage-ment and reliance comforting and satisfying,as they enjoy a sense of relational mutuality.In short,the point is that people can be either autonomous or controlled in their relative independence,and they can be either autonomous or controlled in their relative dependence(Soenens et al.,2007).Differentiating Extrinsic MotivationAlthough research has shown that extrinsic motivators often undermine intrinsic motivation because they are experienced as controlling,it is also the case that people can feel autonomous while being extrinsically motivated.SDT addresses this issue using the concept of organismic integration.Theories that use organismic rather than mechanistic assump-tions about the nature of people(e.g.,Piaget,1971;Rogers,1963; Werner,1948;White,1960)view development as the process through which humans internalize,elaborate,refine,and integrate inner structures or representations of themselves and their world. Although this integrative process is often viewed as a natural propensity or endowment,SDT emphasises that internalization and integration will function more or less effectively,depending on the degree to which organisms experiences ambient supports for basic psychological need satisfaction.That is,people are inclined to internalize and integrate within themselves the regulation of ac-tivities that were initially prompted and/or regulated by external factors.However,for this process to operate effectively,people must experience satisfaction of the basic psychological needs.To the extent that the needs are thwarted,people will be less effective at internalizing and integrating regulations.More specifically,SDT proposes that there are three types of internalization that differ in the degree to which the regulations become integrated with a person’s sense of self.The least effective type of internalization is referred to as introjection.It involves people taking in an external contingency,demand,or regulation but not accepting it as their own.Instead,it remains somewhat alien to them and tends to control them much as it did when it was still external.With introjection,people tend to feel controlled,and the control is buttressed by contingent self-esteem and ego in-volvement,with implicit offers of pride and self-aggrandizement after success,as well as implicit threats of guilt,shame,and self-derogation after failure.In a sense,introjection represents only a partial internalization,for people take in a control without feeling a sense of ownership of it and then allow it to pressure and control them.The second type of internalization is referred to as identification and involves people accepting the importance of the behaviour for themselves and thus accepting it as their own.In other words,they identify with the value of the activity and willingly accept respon-sibility for regulating the behaviour.When people have identified with a regulation,they engage in the behaviour with a greater sense of autonomy and thus do not feel pressured or controlled to do the behaviour.Finally,integration is the third type of internalization, in which people have succeeded at integrating an identification with other aspects of their true or integrated self.They reciprocally assimilate a new identification with their sense of who they are. Integration represents the fullest type of internalization and is the means through which extrinsically motivated behaviours become truly autonomous or self-determined.The three types of internalized extrinsic motivation—introjection,identification,and integration—along with external regulation,fall along a continuum in the sense that the degree of autonomy reflected in the behaviours regulated by these types of extrinsic motivation varies systematically.Behaviours regulated by introjects,although more autonomous than behaviours regu-lated externally,are still quite controlled and represent the least autonomous form of internalization.Behaviours regulated by iden-tifications are more autonomous than are those regulated by in-trojects.People have accepted the regulations with their underlying values and thus are volitional when enacting the behaviours.Fi-nally,behaviours regulated by integrations are the most autono-mous type of extrinsic motivation.As such,integrated regulation bears similarity to intrinsic motivation,for both are accompanied by a sense of volition and choice.Still,the two types of motivation differ in that intrinsic motivation is based on interest in the behav-iour itself,whereas integrated extrinsic motivation is based on the person having fully integrated the value of the behaviour.The latter is still a type of extrinsic motivation,for it remains instru-mental to some other outcome,whereas with intrinsic motivation the activity itself is interesting and enjoyable.Ryan and Connell (1989)developed an approach to assessing types of regulation, focusing on external,introjected,identified/integrated,and intrin-sic,and they found that types of regulation that were theoretically closer together along the relative autonomy continuum were more highly correlated with each other than were those farther apart. Autonomous and Controlled MotivationThe conception of internalization and types of regulation have shifted the primary differentiation within SDT from a focus on intrinsic versus extrinsic motivation to a focus on autonomous versus controlled motivation.External and introjected regulations are forms of controlled motivation,whereas identified/integrated and intrinsic regulation are forms of autonomous motivation.Of course,all types of autonomous and controlled motivation are types of motivation that reflect a person’s intention to act,although they may result in different quality outcomes.In contrast to mo-tivation,amotivation reflects the lack of intention to act.Amoti-vation results from a person not valuing a behaviour or outcome, not believing that a valued outcome is reliably linked to specific behaviours,or believing that there are behaviours instrumental to a valued outcome but not feeling competent to do those instru-mental behaviours.Figure1shows a graphic representation of amotivation,extrin-sic motivation,and intrinsic motivation,along with the various types of regulation,as they fall along the continuum of relative autonomy or self-determination.16DECI AND RYANThe Consequences of Autonomous and Controlled MotivationDozens of experimental and field studies have now examined the correlates and consequences of autonomous and controlled motivation.Consistently,autonomous regulation has been associ-ated with greater persistence;more positive affect;enhanced per-formance,especially on heuristic activities;and greater psycho-logical well-being.For example,autonomous motivation has been found to promote greater conceptual understanding(e.g.,Grolnick &Ryan,1987);better grades(e.g.,Black&Deci,2000);more creativity(e.g.,Koestner,Ryan,Bernieri,&Holt,1984);enhanced persistence at school and sporting activities(e.g.,Pelletier,Fortier, Vallerand,&Brie`re,2001;Vallerand&Bissonette,1992);more control over prejudice(Legault,Green-Demers,Grant,&Chung, 2007);better productivity and less burnout at work(e.g.,Fernet, Guay,&Senecal,2004);healthier lifestyles and behaviours(e.g., Pelletier,Dion,Slovenic-D’Angelo,&Reid,2004);greater in-volvement and better outcomes from psychotherapy(Zuroff et al., 2007);and higher levels of psychological well-being(e.g.,Ryan, Rigby,&King,1993),among other positive outcomes. Facilitating Internalization and IntegrationBecause the evidence is abundant that not only intrinsic moti-vation but also well-internalized forms of extrinsic motivation are associated with more positive human experience,performance, and health consequences,SDT researchers have devoted consid-erable effort to an exploration of the social conditions that facili-tate internalization and the autonomous enactment of behaviours. On the basis of empirical and theoretical considerations,we pro-posed that conditions supportive of the basic psychological needs would facilitate internalization and integration.Specifically,feel-ing involved with and related to a family or group will facilitate internalization of values and behaviours endorsed in that setting. Feeling competent to enact the behaviours will also increase the chances of fully internalizing the regulation of those behaviours, and being encouraged and supported to think about the value of the behaviour to oneself may facilitate identifying with and integrating the behaviour’s value and regulation.Examination of the effects of contextual factors on internaliza-tion and integration has been conducted in numerous studies.For example,a laboratory experiment found that internalization was increased by providing individuals with a rationale for doing an uninteresting activity,acknowledging the participants’perspec-tives and feelings about the activity,and supporting the experience of choice while minimising the use of pressure to do the behaviour (Deci,Eghrari,Patrick,&Leone,1994).Furthermore,the exper-iment revealed that,when a high level of these supports was provided,participants tended to integrate the behavioural regula-tions,whereas a low level of the supports led to introjected regulation.Studies in schools have similarly revealed,that when parents were perceived as more autonomy supportive,their chil-dren displayed greater internalization of school-related behaviours (e.g.,Chirkov&Ryan,2001;Grolnick,Ryan,&Deci,1991). The factors that facilitate internalization of extrinsic motivation are quite similar to those that help to maintain intrinsic motivation, and they revolve around the idea of significant others—for exam-ple,parents,teachers,managers,friends—relating to the target individuals from those individuals’perspectives so as to support and encourage them to explore,initiate,endorse,and engage in behaviours that are interesting and/or important for them.Facili-tating internalization may take somewhat more structure and guid-ance than maintaining intrinsic motivation so the values and reg-ulations to be internalized will be salient,but it is important that such structure and guidance be presented in an autonomy-supportive way.Goals and AspirationsThe work that we have discussed to this point focuses on the regulatory processes for behaviours—that is,on whether the rea-sons they are engaging in the behaviours are autonomous versus controlled.Other research conducted within the SDT framework concerns the content of the goals or outcomes that people are pursuing,whether for autonomous or controlled reasons.For ex-ample,research by Kasser and Ryan(1996)showed that people’s long-term goals tended to fall into one of two factor analytic categories.One category included such goals as amassing wealth, becoming famous,and projecting an attractive image.It was labelled extrinsic goals because they are focused on external indicators of worth.In contrast,the other category included per-sonal growth,building relationships,and being generative for the community and was labelled intrinsic goals because these goals are more directly linked to satisfaction of the basic psychologicalFigure1.The types of motivation and regulation within self-determination theory,along with their placement along the continuum of relative self-determination.17SDT,MOTIVATION,AND PSYCHOLOGICAL WELL-BEINGneeds for autonomy,competence,and relatedness.Studies reported by Kasser and Ryan indicated that people who placed relatively strong emphasis on the extrinsic aspirations displayed low levels of psychological well-being,whereas those who placed relatively strong emphasis on the intrinsic aspirations displayed high levels of well-being.In short,the content of people’s overarching goals was clearly associated with indicators of their psychological health.Research further showed that people who emphasised extrinsic aspirations tended to be more controlled in their pursuit of the goals,whereas people who emphasised intrinsic aspirations tended to be more autonomous.However,Sheldon,Ryan,Deci,and Kasser(2004)found that the content of people’s goals predicted their mental health even after controlling for the reasons or mo-tives for which they were pursuing the goals.Thus,the two variables—intrinsic goals and autonomous regulation—contribute independent variance to well-being.Other research on goals and aspirations has experimentally manipulated people’s goals.For example,some people performing a learning task were told that it would help them make money(an extrinsic aspiration),and others were told that it would help their personal growth(an intrinsic aspiration).Results indicated that people who did the learning while believing that it would help them make money learned the material less well and subsequently performed more poorly than those who learned while believing that it would help their personal growth(Vansteenkiste,Simons, Lens,et al.,2004).Autonomy Across CulturesOne of the central assertions of SDT is that the basic psycho-logical needs for relatedness,competence,and autonomy are uni-versal—that is,important for people of all cultures.This stands in contrast to the cultural-relativist view held by many cross-cultural psychologists(e.g.,Markus et al.,1996),which maintains that needs are learned within cultures.In particular,cultural relativists argue that autonomy is a Western ideal and is taught in Western cultures that focus on individualism but that it is not important in Eastern cultures,so it plays little role in the lives of East Asians and people from other traditionalist cultures.Instead,the cultural relativists argue,relatedness is the important need in cultures that emphasize collectivism and interdependence.The SDT view,how-ever,suggests that cultures influence people in profound and important ways but that all humans have certain needs.The way the needs tend to get satisfied may differ by culture,but the fact of their needing to be satisfied for people to experience optimal well-being does not depend on culture.Several studies involving Western and Eastern cultures have found that satisfaction of the autonomy need promotes psycholog-ical health in Eastern cultures just as it does in Western cultures. For example,Chirkov,Ryan,Kim,and Kaplan(2003)found that in South Korea,Russia,and Turkey,as well as in the United States,having more fully internalized cultural values and enacting them more autonomously was associated with greater psycholog-ical health.It is interesting that having one’s values for collectiv-ism or individualism match the predominant values in one’s cul-ture was not as important for psychological health as was enacting the values autonomously.Satisfaction of the autonomy need was indeed important in each culture,which is consistent with the idea of the universality of that need.Numerous specific studies in varied cultures are consistent with the universality of basic needs for autonomy,competence,and relatedness.For example,Ryan et al.(1999)found that,in Russia, holding strong extrinsic aspirations,which is associated with lower autonomy,was predictive of poorer psychological well-being. Sheldon,Elliot,et al.(2004)showed how autonomy predicted wellness in four distinct cultures.Ryan,La Guardia,Solky-Butzel, Chirkov,and Kim(2005)found that,across varied cultures,reli-ance on others was facilitated by autonomy support.This growing body of work suggests that,despite surface differences in cultural values,underlying optimal motivation and well-being in all cul-tures are very basic and common psychological needs.Autonomy Support in Various Life Domains Autonomy support involves one individual(often an authority figure)relating to target individuals by taking their perspective, encouraging initiation,supporting a sense of choice,and being responsive to their thoughts,questions,and initiatives.When peo-ple’s autonomy is supported,they often feel free to follow their interests and consider the relevance and importance for themselves of social values,mores,and norms.Many of the studies of auton-omy support have been conducted in various field settings.We now consider a sampling of these studies crossing several life domains.Autonomy Support in SchoolsVarious factors affect whether the interpersonal climate of a classroom tends to be more autonomy supportive or more control-ling,but among the more important of these is the orientation of the teacher.Some teachers believe it is their job to be sure that students do things correctly,to convey to the students that they should do as they are told,and to use controls in an attempt to ensure that the students do.Other teachers,however,believe it is important for students to initiate behaviours,to learn from both their successes and failures,and to try to solve problems for themselves rather than relying on the teacher to tell them what to do.At the beginning of a school year,Deci et al.(1981)assessed the degree to which teachers in fourth through sixth grades were oriented toward controlling students versus supporting their auton-omy.Two months later,they assessed students’intrinsic motiva-tion,perceived competence,and self-esteem.They found that,in classrooms in which teachers were autonomy supportive,students were more intrinsically motivated—being curious,preferring chal-lenges,and making independent mastery attempts.The students of autonomy-supportive teachers also felt more competent at school-work and had higher self-esteem.A study by Chirkov and Ryan (2001)found that teacher autonomy support in both Russia and the United States was important for high school students to internalize motivation for schoolwork,be well adjusted,and feel good about themselves.In studies by Vansteenkiste,Simons,Soenens,and Lens(2004), the framing of both intrinsic and extrinsic goals was conducted with an autonomy-supportive versus controlling communication style.The autonomy-supportive style led to greater learning and performance outcomes than did the controlling style.This main18DECI AND RYAN。
急性冠脉综合征与部分炎性因子的关系
微循环学杂志,2021,31(2):62-65©2021CHINESE JOURNAL OF MICROCIRCULATIONdoi:10.3969/j.issn.1005—1740.2021.02.013急性冠脉综合征与部分炎性因子的关系荣媛综述张黎军沃审校［中图分类号］R543.3+［文献标识码］A［文章编号］1005—1740(2021)02—0062—04【摘要】急性冠脉综合征(ACS)是一种心血管急症。
中性粒细胞/淋巴细胞比率(NLR)、血小板/淋巴细胞比率(PLR)、红细胞分布宽度(RDW)、G反应蛋白(CRP)和脂蛋白-磷脂酶A2CLP-PLA2)是反映全身或局部炎症的生物标志物，可能参与ACS炎症进展、血栓形成及斑块破裂过程，与ACS和ACS的PCI术后死亡风险相关。
深入了解和合理应用这些炎性指标有助于从炎症机制早期防治ACS和再发心肌梗死。
【关键词】急性冠脉综合征；中性粒细胞/淋巴细胞比率；血小板/淋巴细胞比率；红细胞分布宽度；G反应蛋白；脂蛋白-磷脂酶A2Relationship between Acute Coronary Syndromes and Some BiomarkersRONG Yuan,ZHANG Li-jun*Department of Geriatrics,Renmin Hospital of Wuhan University,Wuhan430060,China；*Cor-respondingauthor【Abstract】Acute coronary syndrome(ACS)is a cardiovascular emergency.Neutrophilst and lymphocyte ratio (NLR),platelet and lymphocyte ratio(PLR),red blood cell distribution width(RDW),C-reactive protein(CRP) and lipoprotein-phospholipase A2(LP-PLA2)are biomarkers which can reflect systemic or local inflammation,they may participate in the inflammation,thrombus formation and plaque rupture process in ACS,associated with the risk of ACS and PCI postoperative death.Understanding and rational application of these inflammatory markers are helpful for the early prevention and treatment of ACS and recurrent myocardial infarction from the inflammatory mechanism.【Key words】Acute coronary syndrome；Neutrophll and lymphocyte ratio；Platelet and lymphocyte ratio；Red blood cell distribution width；C-reactive protein；Lipoprotein-phosphatase A2急性冠脉综合征(Acute Coronary Syndrome, ACS)包括ST段抬高型心肌梗死、非ST段抬高型心肌梗死以及不稳定型心绞痛。
急性冠脉综合症患者血清同型半胱氨酸水平与冠状动脉病变程度的关系
急性冠脉综合症患者血清同型半胱氨酸水平与冠状动脉病变程度的关系目的探讨急性冠脉综合症患者血清同型半胱氨酸（Hcy）水平与冠脉病变程度的关系及临床意义。
方法60例急性冠脉综合征患者作为研究组（AMI组30例和UAP组30例），将同期30例健康体检者作为对照组。
所有人均取外周静脉血检测血清Hcy，分析血清Hcy水平与Gensini评分的关系。
结果和对照组血清Hcy水平相比，急性冠状动脉综合征（AMI组与UAP组）的血清Hcy 水平更高，差异有统计学意义（P＜0.05）；AMI组和UAP组的血清Hcy水平对比发现，前者高于后者，差异有统计学意义（P＜0.05）；通过对比AMI组和UAP 组的Gensini评分发现，前者高于后者，差异有统计学意义（P＜0.05）。
结论ACS 患者血清Hcy水平与冠状动脉病变程度密切相关。
标签：急性冠脉综合征；同型半胱氨酸；关系实践提示，同型半胱氨酸（Hcy）和动脉粥样硬化之间可能存在病理联系。
大量研究人员通过研究发现，冠心病（CHD）、动脉粥样硬化的独立危险因素之一就是Hcy水平增高[1]。
而近些年，国内外研究人员不断对Hcy与心肌梗死及其预后的关系进行研究。
为了探讨ACS患者血清Hcy水平以及其与冠状动脉病变程度的相关性，特作此研究，现将具体情况总结如下，以供参考。
1 资料与方法1.1 一般资料将本院2013～2014年收治的急性冠状动脉综合征（ACS）患者60例作为研究组，将不稳定性心绞痛患者30例纳入UAP组，其中男17例，女13例，年龄46～76岁；将急性心肌梗死患者30例纳入AMI组，其中男16例，女14例，年龄45～74岁。
另外将同期到我院体检的健康体检者30名作为对照组，其中男16例，女14例，年龄48～74岁。
所有患者年龄、性别对比，差异无统计学意义（P>0.05）。
UAP组、AMI组、对照组中的患者和健康体检者在本次研究开始前的一年内均未服用维生素B族、叶酸。
高尿酸血症与急性冠脉综合征的相关性
高尿酸血症与急性冠脉综合征的相关性彭民安;刘传垠;万凤福;王雪樵;易志强【摘要】目的:探讨高尿酸血症与急性冠脉综合征之间的相关性.方法:对178例冠心病患者进行血尿酸测定,并与正常对照组比较；同时将冠心病组患者分为急性冠脉综合征组和稳定性心绞痛组,进行血尿酸水平比较.结果:冠心病组血尿酸水平显著高于正常对照组(P＜0.05)；高尿酸血症患者的冠心病发生率明显高于正常尿酸者；急性冠脉综合征组血清尿酸水平显著高于稳定性心绞痛组(P＜0.05).结论:高尿酸血症与急性冠脉综合征发生密切相关.【期刊名称】《赣南医学院学报》【年(卷),期】2013(033)003【总页数】3页(P358-360)【关键词】高尿酸血症;急性冠脉综合征;血尿酸【作者】彭民安;刘传垠;万凤福;王雪樵;易志强【作者单位】江西省吉安市中心人民医院,江西吉安343000;江西省吉安市中心人民医院,江西吉安343000;江西省吉安市中心人民医院,江西吉安343000;江西省吉安市中心人民医院,江西吉安343000;江西省吉安市中心人民医院,江西吉安343000【正文语种】中文【中图分类】R541.4尿酸是核酸代谢的产物，尿酸生成过多和(或)排泄减少均可致高尿酸血症。
自1951年Gertler[1]等首次提出尿酸与心血管疾病之间可能存在复杂的相互作用以来，国内外学者围绕这一问题展开了大量研究。
目前大量国外资料表明高尿酸症与冠心病在流行病学、发病机制及治疗上密切相关，受到临床重视。
本研究旨在探讨高尿酸血症与急性冠脉综合征的相关性。
1 资料与方法1.1 一般资料研究对象为于2010年1月至2012年8月在我院经冠状动脉造影检查确诊为冠心病的178例冠心病患者，其中男97例，女81例，平均年龄(59.8±11.3)岁。
选择同期门诊体检无明显冠心病病史的180例患者(无典型心绞痛症状及普通心电图和活动平板试验均无心肌缺血改变)作为对照组，其中男98例，女82例，平均年龄(54.3±10.1)岁;冠心病组中又分为急性冠脉综合征组和稳定性心绞痛组，其中急性冠脉综合征组92例，稳定性心绞痛组86例。
腺苷负荷试验心肌核素显像对冠心病的诊断价值.
腺苷负荷试验心肌核素显像对冠心病的诊断价值【摘要】目的分析腺苷负荷试验心肌核素显像诊断冠心病的敏感性、特异性及其特点。
方法住院患者行冠状动脉造影和腺苷负荷试验心肌核素显像检查。
腺苷总量为１４０μｇ／（ｋｇ·ｍｉｎ），６ｍｉｎ匀速静脉泵入，腺苷泵入３ｍｉｎ时静脉推注９９ｍ锝－甲氧基异丁基异腈核素显像９２５ＭＢｑ，１ｈ后进行心肌断层显像，若异常，次日行静息心肌显像。
结果腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性和特异性为８７．０％和６４．２％。
前降支病变４８例，心肌核素前壁低灌注４１例，回旋支病变３３例，侧壁低灌注２７例，右冠脉病变３８例，下壁低灌注３７例，右冠脉病变较前降支或回旋支病变的心肌核素显像阳性率高（Ｐ＜０．０５）。
结论腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性较高。
【关键词】冠状动脉疾病放射性核素显像腺苷Ｔｈｅａｐｐｌｉｃａｔｉｏｎｏｆａｄｅｎｏｓｉｎｅｓｔｒｅｓｓｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｔｏｍｏｇｒａｐｈｉｅｉｍａｇｉｎｇｉｎｄｅｔｅｃｔｉｎｇｃｏｒｏｎａｒｙａｒｔｅｒｙｄｉｓｅａｓｅ（ＷＡＮＧＹｉ，ＺＨＥＮＧＦｅｎｇ．ＤｅｐａｒｔｍｅｎｔｏｆＳｅｎｉｏｒｗａｒｄ，Ｃｈｉｎａ－ＪａｐａｎＦｒｉｅｎｄｓｈｉｐＨｏｓｐｉｔａｌＢｅｉＪｉｎｇ，１０００２９Ｃｈｉｎａ．）【Ａｂｓｔｒａｃｔ】ＯｂｊｅｃｔｉｖｅＴｏａｎａｌｙｚｅｔｈｅｓｅｎｓｉｔｉｖｉｔｙａｎｄｓｐｅｃｉｆｉｃｉｔｙｏｆａｄｅｎｏｓｉｎｅｓｔｒｅｓｓｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｔｏｍｏｇｒａｐｈｉｃｉｍａｇｉｎｇｆｏｒｔｈｅｄｉａｇｎｏｓｉｓｏｆｃｏｒｏｎａｒｙａｒｔｅｒｙｄｉｓｅａｓｅ（ＣＡＤ）．ＭｅｔｈｏｄｓＡｄｅｎｏｓｉｎｅｗａｓｉｎｆｕｓｅｄｉｎｔｒａｖｅｎｏｕｓｌｙａｔａｒａｔｅｏｆ１４０μｇ／（ｋｇ·ｍｉｎ）ｆｏｒ６ｍｉｎｕｔｅｓ．３ｍｉｎｕｔｅｓａｆｔｅｒａｄｅｎｏｓｉｎｅｉｎｆｕｓｉｏｎ，９２５ＭＢｑｏｆ９９ｍＴｃ－ＭＩＢＩｗｅｒｅｉｎｊｅｃｔｅｄｉｎｔｒａｖｅｎｏｕｓｌｙ．ＳＰＥＣＴｍｙｏｃａｒｄｉａｌｉｍａｇｉｎｇａｃｑｕｉｓｉｔｉｏｎｗａｓｏｂｔａｉｎｅｄ１ｈｏｕｒｓａｆｔｅｒａｄｅｎｏｓｉｎｅｉｎｆｕｓｉｏｎ．Ｉｆｔｈｅｒｅｓｕｌｔｗａｓａｂｎｏｒｍａｌｒｅｓｔｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｉｍａｇｉｎｇｗｏｕｌｄｂｅｐｅｒｆｏｒｍｅｄｎｅｘｔｄａｙ．ＲｅｓｕｌｔｓＴｈｅｓｅｎｓｉｔｉｖｉｔｙａｎｄｓｐｅｃｉｆｉｃｉｔｙｏｆａｄｅｎｏｓｉｎｅｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｔｏｍｏｇｒａｐｈｉｃｉｍａｇｉｎｇｆｏｒｔｈｅｄｉａｇｎｏｓｉｓｏｆＣＡＤｗｅｒｅ８７．０％ａｎｄ６４．２％．Ｔｈｅｓｅｎｓｉｔｉｖｉｔｙｏｆａｄｅｎｏｓｉｎｅｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｔｏｍｏｇｒａｐｈｉｃｉｍａｇｉｎｇｆｏｒｄｉａｇｎｏｓｉｎｇｃｏｒｏｎａｒｙｓｔｅｎｏｓｉｓｉｎｌｅｆｔａｎｔｅｒｉｏｒｄｅｓｃｅｎｄｉｎｇ，ｌｅｆｔｃｉｒｃｕｍｆｌｅｘａｎｄｒｉｇｈｔｃｏｒｏｎａｒｙａｒｔｅｒｙａｒｅ４１／４８，２７／３３ａｎｄ３７／３８．Ｔｈｅｒｅｗａｓｎｏｓｅｖｅｒｅａｄｖｅｒｓｅｓｉｄｅｅｆｆｅｃｔｄｕｒｉｎｇａｄｅｎｏｓｉｎｅｓｔｒｅｓｓｔｅｓｔ．ＣｏｎｃｌｕｓｉｏｎＡｄｅｎｏｓｉｎｅｓｔｒｅｓｓｍｙｏｃａｒｄｉａｌｐｅｒｆｕｓｉｏｎｔｏｍｏｇｒａｐｈｉｃｉｍａｇｉｎｇｉｓａｎｕｓｅｆｕｌｎｏｎ－ｉｎｔｅｒｖｅｎｔｉｏｎａｌｍｅｔｈｏｄｆｏｒｄｅｔｅｃｔｉｎｇｃｏｒｏｎａｒｙａｒｔｅｒｙｄｉｓｅａｓｅ．【Ｋｅｙｗｏｒｄｓ】Ｃｏｒｏｎａｒｙｄｉｓｅａｓｅ，Ｒａｄｉｏｎｕｃｌｉｄｅｉｍａｇｉｎｇ，Ａｄｅｎｏｓｉｎｅ作为运动试验心肌灌注显像的替代方法之一，腺苷负荷试验心肌灌注显像已经被广泛应用于冠心病的诊断和对预后的评价。
大黄对脓毒症肠黏膜屏障保护作用的研究进展
在于表达基因的启动子中。如这些区域 的ＣｐＧ被异常高甲基化．则ｆｆ｛现基闪表 达异常（表达抑制）。甲基化十扰基阂表 达的机制可能有两种：（１）ＣｐＧ甲基化本 身使得转录因子不能有效结合到启动子 上；（２）甲基化的ＣｐＧ叮被特异性蛋白因 子如甲基化ＤＮＡ结合蛋白（ＭＢＰ）识别和 结合，后者再招募，｝￡它蛋白因子结合到 启动子上，由此导致基ｌ周转录沉默。 哺乳动物ＣｐＧ甲基化有两种方式： 维持甲基化和重头甲基化。维持甲基化 是指甲基化的ＤＮＡ在每次复制后．由于 半保留复制．新生的ＤＮＡ链为非甲基化 状态，此时特定的ＤＮＭＴ以半甲基化的 ＤＮＡ为模版，对非甲基化的ＤＮＡ链进行 甲基化修饰．由此使的复制后的ＤＮＡ双 链仍能保持亲代ＤＮＡ的甲基化状态．如 果没有甲基转移酶活性．染色体ＤＮＡ经 多轮复制后，Ｉ）ＮＡ将会出现被动去甲基 化；重头甲基化则是指对非甲基化的 ＤＮＡ进行甲基化修饰．主要发生在胚胎 发育早期，用于胚胎早期细胞设定甲基 化状态ｆ“。
ＯＦＣＤ（ｏｃｕｌｏ—ｆａｅｉｏ—ｅａｒｄｉｏ—ｄｅｎｔａｌ ｓｙｎｄｒｏｍｅ）
而提高这两个酶的活性，从而有助于从 头甲基化【”。Ｅ１．Ｍａａｒｒｉ等ｆ８］研究发现．正 常人群中存在一种稀有的ＤＮＭＴ３Ｉ。变异 体．这种变异体含有氨基酸突变Ｒ２７１Ｑ． 生物学性质分析发现，这种ＤＮＭＴ３Ｌ变 异体辅助ＤＮＭＴ３Ａ ＤＮＡ重头甲基化的 功能明湿减弱。从而导致基因组ＤＮＡ的 低甲基化，而这种低甲基化主要出现在 亚端粒区。
ａｎｄ
Ｔｅｓｏｎａｎｃｅ［Ｊ］．
［１５］Ｒｕｂｉｎｓｈｔｅｉｎ Ｒ。Ｈａｌｏｎ
ａ１．Ｕｓｅｆｕｌｎｅｓｓ ｏｆ ｔｏｍｏｇｒａｐｈｉｃ ａｃｕｔｅ
ｅｍｉｓｓｉｏｎ
ｔｏｍｏｇｒａｐｈｙ
［Ｊ］．
Ｒｅｄｉ０１．２００８，６５（１）：１１２－１１９．
血清N末端B型钠尿肽原在不明原因呼吸困难病因分析中的临床意义_1000001375815511
血清Ｎ末端Ｂ型钠尿肽原在不明原因呼吸困难 病因分析中的临床意义
陈杨陈妍吴丽平
（四川省攀枝花十九冶医院心内科，攀枝花６１７０２３）
【摘要】
目的探讨血清Ｎ末端Ｂ型钠尿肽原（ＮＴ—ｐｍＢＮＰ）在不明原因呼吸困难病因分析的临床意义。方法针对 急诊入院不明原因呼吸困难的患者，应用电化学发光法检测患者血清ＮＴ—ｐｍＢＮＰ的浓度；详细追问病史、体格检查，结 合心电图、心脏彩超、胸片、肺功能测定等相关检查，进一步明确患者呼吸困难的原因。结果心源性呼吸困难怠者血清 ＮＴ—ｐｍＢＮＰ浓度在８２９．２０—１８７００．５０ ｐｇ／ｍｌ间，Ｍ’一ｐｍＢＮＰ呈偏态分布，中位数水平分别为４４７４．８０ ｐｇ／ｍｌ，非心源性 呼吸困难患者血清ＮＴ—ｐｒ０ＢＮＰ浓度在１０．２０一３８９．５０ ｐｇ／Ｉｎｌ间，ＮＴ—ｐｍ ＢＮＰ呈偏态分布，中位教水平分别为
［４］
ｄｙｓｎｏｅａ ｃｌｉｎｉｃ ｆｏｒ ｔｈｅ
ｐｒｉｍａｒｙ
ｈｅａｌｔｈ
ｃａ坤ｓｅｃｔｉｏｎ［Ｊ］．Ｊ
Ｉｎｔｅｒｎ
２００１，２５０（５）．４２２－４２８． ［２］Ｔａｌｗａｒ ｓ，Ｄｏｗｌｌｉｃ ＰＦ，Ｎｇ
ｕｍ：Ｔｈｅ ｐｏｔｅｎｔｉａｌ
ＵＳｅ
ＬＬ，ｅｔ
ａ１．Ｔｏｗａｒｄｓ
ｓｉｇｎｉｆｉｃａｎｔ ｉｎ ｓｔａｔｉｓｔｉｃｓ．Ｃｏｎｃｌｕｓｉｏｎｓ
Ｔｈｅ ｓｅｒｕｍ ＮＴ—ｐｗＢＮＰ ｃｏｎｃｅｎｔｒａｔｉｏｎ
ｓｉｇｎｉｆｉｃａｎｔ ｉｎ ｄｉｓｃｅｒｎｉｎｇ ｏｆ ｃａｒｄｉａｃ
ｏｒ
ｎｏｎ—ｃａｒｄｉａｃ ｄｙｓｐｎｅａ．
【Ｋｅｙ ｗｏｒｄｓ】
Ｎ—ｔｅｒｍｉｎａｌ ｐｒｏ—ｂｒａｉｎ ｎａｔｒｉｕｒｅｔｉｃ
【Ａｂｓｔ随ｃｔ】
Universal Definition of Myocardial Infarction
New Universal Definition of Myocardial InfarctionAthanasios G. Pipilis, MDRecently, a joint ESC/ACCF/AHA/WHF Task Force published an expert consen-sus document on the universal definition of myocardial infarction [1]. The following points are extracts from this document that summarize its main features.The main reason for agreeing on a new definition of myocardial infarction derives from the development and the wide availability of very sensitive and specific serological biomarkers that are able to detect even minimal myocardial necrosis.Acute myocardial infarction is diagnosed when there is evidence of myocardial cell necrosis in the clinical setting of myocardial ischemia. In contrast to the historical World Health Organization (WHO) definition where symptoms, ECG and enzymes had equal weight for the diagnosis (the presence of any two would suffice), today bi-omarkers take precedence with imaging having also a diagnostic role. Consequently, acute myocardial infarction is diagnosed if a rise and fall of cardiac biomarkers (prefer-ably troponin) is detected together with at least one of the following: a) symptoms of ischemia, b) new ST-T changes or new left bundle branch block (LBBB), c) development of pathological Q waves and d) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.Prior myocardial infarction requires for its diagnosis any of the following criteria: a) new Q waves, b) imaging of a regional loss of viable myocardium that is thinned and fails to contract and c) pathological findings of a healed or healing myocardium.c L I N I c A L c L A s s I f I c A t I O N O f m Y O c A r D I A LI N f A r c t I O NThe clinical classification of myocardial infarction consists of 5 types:a) Type 1: Spontaneous myocardial infarction related to ischemia due to a primary coronary event (plaque erosion, rupture, fissuring, dissection)b) Type 2: Myocardial infarction secondary to ischemia due to either increased oxygen de-mand or decreased supply (spasm, embolism, anemia, arrhythmia, hypertension, hypoten-sion)c) Type 3: Sudden unexpected death (biomarkers may have not been obtained or not yet raised)d) Type 4: Myocardial infarction associated with percutaneous coronary intervention (PCI) (type 4a) and stent thrombosis (type 4b). To diagnose peri-procedural necrosis in patients with normal baseline troponin values, biomarkers should be greater than 3 times the th percentile URL (upper reference limit).e) Type 5: Myocardial infarction associated with coronary artery bypass grafting (CABG). To diagnose peri-operative necrosis biomarkers should be greater than 5 times the th per-centile URL, together with new Q waves, LBBB, graft or native artery occlusion or imaging of new loss of viable myocardium.Associate Director of Cardiology, Hygeia Hospital, AthensHOSPITAL CHRONICLES 2008, SUPPLEMENT: 52–53Address for correspondence:E-mail: athanasios.pipilis@hygeia.grNEW UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION53c A r D I A c b I O m A r K E r s , E c G & I m A G -I N GAlthough elevation of troponin is indicative of myocardial cell damage it does not indicate the mechanism. Therefore several conditions with elevated troponin do not imply overt ischemic heart disease (for example cardiac failure, renal failure, drug toxicity, sepsis, pulmonary embolism).Electrocardiographic manifestation of ischemia that may lead to myocardial infarction are ST segment elevation (with hyperacute symmetrical increased amplitude T-waves being an early finding) or ST segment depression. New ST eleva-tion requires a J point in two contiguous leads ≥0.2 mV in men and ≥0.15 mV in women for leads V2-V3 and ≥0.1 mV for the other leads. New ST depression and T wave changes requires horizontal or down-sloping depression ≥0.05 mV in two contiguous leads and/or T wave inversion ≥0.1 mV in two contiguous leads with a prominent R wave or R/S ratio >1.Imaging techniques are applied in the acute and the healing or healed phase of myocardial infarction. Rest echocardiography is the commonest method used but cannot distinguish ischemia from infarction. Radionuclide imaging, stress echocardiography and magnetic resonance imaging (MRI) can be used to identify viability of myocardial tissue.I m P L I c A t I O N sThe new definition of myocardial infarction has several epidemiological and clinical trial implications. In epidemiol-ogy, since biomarkers are able to detect smaller infarcts the incidence of non STEMI is increased while unstable angina is becoming a rarer diagnosis. Therefore, comparison of tempo-ral trends of myocardial infarction incidence in registries will be affected and historical controls may be difficult to evaluate. In clinical trials with myocardial infarction as an outcome, an attempt to quantify myocardial damage by multiples of the th percentile URL of the biomarker is encouraged so that comparisons between various severity categories of infarction can be made possible.Finally, the new definition, with more patients with limited myocardial injuries being diagnosed as myocardial infarctions may have psychological, legal, insurance and professional consequences.s U G G E s t E D r E A D I N G1. Thygesen K, Alpert JS, White HD on behalf of the ESC/ACCF/AHA/WHF Joint Task Force for the redefinition of myocardial infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525-2538 & J Am Coll Cardiol 2007;50:2173– 5.2. The Joint ESC/ACC Committee. Myocardial infarction rede-fined—a consensus document of the Joint ESC/ACC Commit-tee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol 2000; 36: 5 –6 .3. Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac dis-ease. J Am Coll Cardiol 2006;48:1–11.4. French JK, White HD. Clinical implications of the new defini-tion of myocardial infarction. Heart 2004; 0: –106.5. Zimetbaum PJ, Josephson ME. Use of the electrocardiogram in acute myocardial infarction. N Engl J Med 2003;348: 33– 40.6. Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the electrocar-diogram. Part I: the electrocardiogram and its technology. A scientific statement from the AHA Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the ACC Foundation; and the Heart Rhythm Society. J Am Coll Cardiol 2007;4 :110 –27.7. Korosoglou G, Labadze N, Hansen A, et al. Usefulness of real-time myocardial perfusion imaging in the evaluation of patients with first time chest pain. Am J Cardiol 2004; 4:1225–318. Wagner A, Mahrholdt H, Holly TA, et al. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 2003;361:374 – . . Gosalia A, Haramati LB, Sheth MP, Spindola-Franco H. CT detection of acute myocardial infarction. Am J Roentgenol 2004;182: 1563–6.10. Peels C, Visser CA, Kupper AJ, Visser FC, Roos JP. Usefulness of two-dimensional echocardiography for immediate detection of myocardial ischemia in the emergency room. Am J Cardiol 1 0;65:687– 1.11. Udelson JE, Beshansky JR, Ballin DS, et al. Myocardial perfu-sion imaging for evaluation and triage of patients with suspect-ed acute cardiac ischemia: a randomized controlled trial. JAMA 2002;288: 26 3–700.12. Kavsak PA, MacRae AR, Lustig V, et al. The impact of the ESC/ACC redefinition of myocardial infarction and new sensi-tive troponin assays on the frequency of acute myocardial in-farction. Am Heart J 2006 Jul;152(1):118-25.。
急性心肌梗死患者血清C-反应蛋白的水平及临床意义
急性心肌梗死患者血清C-反应蛋白的水平及临床意义发表时间：2009-12-16T10:05:52.500Z 来源：《中外健康文摘》第27期供稿作者：张建忠祝晓玲[导读] 探讨急性心肌梗死患者血清C-反应蛋白(CRP) 的水平及临床意义张建忠祝晓玲(天津市大港油田总医院急诊医学科天津大港 300280)【中图分类号】R542.2 【文献标识码】A 【文章编号】1672-5085(2009)27-0085-02【摘要】目的探讨急性心肌梗死患者血清C-反应蛋白(CRP) 的水平及临床意义。
方法对急性心肌梗死患者40例及正常对照组40例进行血清CRP的检测, 进行比较。
结果急性心肌梗死患者组血清CRP含量明显高于正常对照组。
结论血清CRP对于急性心肌梗死患者的病情判断或预后估计有重要的临床意义。
【关键词】急性心肌梗死 CRP 血清CRP是通过肺炎球菌细胞壁提取的C-多糖在Ca2+存在的条件下出现沉降反应而被发现的。
CRP是感染、外伤、异常免疫状态、恶性增生物等组织损伤时表达的炎性细胞因子，特别是在白介素-6及-1，TNF-a等作用由肝细胞产生的[1]。
正常人血清中CRP含量甚微,当机体患感染和非感染性炎症时,CRP 含量可迅速上升。
本研究通过检测急性心肌梗死患者血清CRP 的含量,研究它在急性心肌梗死病变中可能的作用。
1 资料和方法1.1 研究对象40例急性心肌梗死患者均为我院2007年10月至2009年6月发病后24h内入院的确诊病例，均为男性,年龄40～68岁,平均48.23岁，均经冠脉造影证实，健康体检者40例。
并排除可引起CRP改变的其他疾病，住院后进行血清CRP 的检测。
1.2 方法1.2.1 急性心肌梗死患者血清CRP 的检测起病24小时内空腹抽血3～5ml ,离心后取血清。
血清CRP 的含量采用免疫比浊法，用美国全自动生化分析仪测定。
1.2.2 统计学方法采用SpSS14.0统计软件包进行统计数据处理，数据均用均数±标准差（x-±s）表示，采用独立样本t检验，P＜0.05表示差异有显著性，P＜0.01表示差异有非常显著性。
心脏强化MR识别室性心律失常瘢痕指导消融治疗
David Andreu,Jose Toma´s Ortiz-Pe´rez, Tim Boussy,et al European Heart Journal Advance Access published January 6, 2014
研究生：陆夏敏 导 师：周长钰
2014.3.5
研究背景
联合心外膜和心内膜标测可提高某些病人室性心律失常（VA）消融的效果。 在大多数病人中，选择何种标测及消融方式尚难确定。心内膜消融失败后大都 会考虑心外膜消融，然而术中抗凝会增加心外膜消融的并发症。规划手术方案 并避免并发症需要更多的信息。
Figure 3 Example of the identification of the origin of ventricular arrhythmias using electrocardiogram (ECG) information. Ischaemic patient with anterior infarction. (A)ECGof the ventricular tachycardia. The origin of this ventricular tachycardia is located in the inferoapical septum (Segment 14 in the 17-segment model), according to the Miller algorithm (anterior infarction, left bundle branch block, left superior axis, and late progression of R-wave precordial pattern). (B) Baseline contrast-enhanced cardiac magnetic resonance short-axis image of the same patient. The white arrowidentifies an endocardial hyper-enhancement in the inferoapical septum. (C) Activation map during the ventricular tachycardia (right anterior oblique view). It is possible to identify the ventricular tachycardia exit site from the scar in the inferoapical septum. Ablation at this point terminated the ventricular tachycardia. Usefulness of ce-CMR in identifying the ventricular arrhythmia substrate Page 5 of 11Downloaded from / at ESC Member on January 12, 2014
左前降支闭塞合并左回旋支次全闭的下壁心肌梗死1例
左前降支闭塞合并左回旋支次全闭的下壁心肌梗死1例摘要：急性心肌梗死是临床常见的心血管危重疾病，心电图提示急性下壁ST段抬高型心肌梗死常见罪犯血管为右冠状动脉或左回旋支，本例患者行冠脉造影后发现，主要病变部位为少见的左前降支，同时合并严重左回旋支病变，可能干扰术者判断，术中需充分评估冠脉各支血管情况，避免遗漏重要病变而错过最佳治疗时机。
关键词：急性心肌梗死冠脉造影心电图急性心肌梗死是临床常见的心血管危重疾病，若不能得到及时的治疗，可能会严重影响患者的心脏功能，诱发恶性心律失常，甚至导致患者死亡。
对于急性ST段抬高型心肌梗死的患者，最重要的治疗是开通患者的血管，急诊行冠脉造影、介入治疗开通血管是首选的治疗手段。
1 临床资料患者，男性，50岁，因”胸痛2小时“入院。
患者2小时前爬楼梯后感胸痛不适，呈胸骨后撕裂感，持续不缓解，自行敲打心前区未见明显缓解，未重视。
10分钟后感喉部撕裂感，胸痛不缓解，呼叫120后转至当地卫生院查心电图见下壁导联ST段抬高（图1），立即转诊至我院。
图1 患者卫生院心电图患者既往高血压病史10余年、糖尿病病史8年，未正规治疗，吸烟史30年，每天20支/包。
入院生命体征：血压126/76mmHg，脉搏80次/分，呼吸20 次/分体温36.5℃。
查体无殊。
床边心超提示：各房室大小及比例大致正常范围，左室收缩功能65%；舒张期心包腔内未见明显游离液性暗区；静息状态下左室壁未见节段性运动异常。
各瓣膜未见中等或以上程度返流信号。
血液检验结果未回报。
患者诊断考虑急性下壁ST段抬高型心肌梗死，予替格瑞洛180mg，阿司匹林300mg负荷，立即转运至导管室，急诊行冠脉造影提示：左回旋支中段95%狭窄，左前降支近段50%狭窄，中段40%狭窄，远段血流缓慢；右冠中段50%狭窄，左室后支开口80%狭窄（图2-3）。
结合患者心电图结果，考虑左回旋支闭塞再通可能，行左回旋支药物支架1枚植入术。
重复造影见左前降支远段近心尖处闭塞，TIMI血流0级（图4），行左前降支远段血栓抽吸，球囊扩张。
如何提高你的健美操健身能力英语作文
如何提高你的健美操健身能力英语作文Title: Enhancing My Aerobic Fitness: A Journey to Improved Physical Strength and EnduranceAs an individual committed to leading a healthy andactive lifestyle, I have long recognized the importance of regular exercise and physical activity in maintaining optimal physical and mental well-being. One of the cornerstones of my fitness regimen has been the practice of aerobic exercise, specifically in the form of high-intensity interval training (HIIT) and dance-based workouts. These dynamic and engaging activities have not only challenged me physically but have also provided a sense of joy and accomplishment in my fitness journey.Embarking on this journey, I have set my sights on enhancing my aerobic fitness, with the goal of improving my overall strength, endurance, and cardiovascular health. Toachieve this, I have adopted a multifaceted approach that encompasses a variety of high-intensity interval training (HIIT) exercises, dance-based workouts, and a well-balanced diet.High-Intensity Interval Training (HIIT): The cornerstone of my aerobic fitness regimen, HIIT has proven to be a highly effective and efficient way to elevate my heart rate, build muscular strength, and improve overall cardiovascular health. By incorporating a series of intense, short-duration exercises followed by periods of active recovery, I have been able to push my body to its limits and experience significant improvements in my fitness level.One of the key HIIT exercises I have incorporated into my routine is the burpee. This compound exercise, which combines a squat, a push-up, and a jump, has challenged me both physically and mentally, as it requires a high level of coordination, strength, and endurance. By performing sets ofburpees with short rest periods, I have witnessed a marked increase in my heart rate, muscular endurance, and overall aerobic capacity.In addition to burpees, I have also integrated other HIIT exercises into my routine, such as jumping jacks, mountain climbers, and high-knee sprints. These exercises, when performed in quick succession with minimal rest, have helped me to develop a greater level of cardiovascular fitness and muscular endurance.Dance-Based Workouts: Recognizing the importance of maintaining a well-rounded fitness regimen, I have also incorporated dance-based workouts into my routine. These dynamic and energetic sessions have not only challenged me physically but have also provided a sense of joy andcreativity in my fitness journey.One of the dance-based workouts I have particularly enjoyed is Zumba, a high-energy, Latin-inspired fitnessprogram that combines elements of dance and aerobic exercise. The infectious rhythms and lively choreography have kept me engaged and motivated throughout each session, pushing me to move my body in new and dynamic ways.In addition to Zumba, I have also explored other dance-based workouts, such as hip-hop and contemporary dance. These styles have allowed me to develop greater coordination, balance, and overall body awareness, further enhancing my aerobic fitness and muscular control.Nutrition and Recovery: Alongside my rigorous exercise regimen, I have also paid close attention to my nutrition and recovery practices. Recognizing that a well-balanced diet is crucial for supporting my fitness goals, I have made a conscious effort to incorporate a variety of nutrient-dense foods into my daily meals.I have focused on consuming a diet rich in lean proteins, complex carbohydrates, and healthy fats, which have providedme with the necessary fuel to power through my intense workouts. Additionally, I have made a concerted effort tostay hydrated by drinking plenty of water throughout the day, further supporting my body's recovery and overall performance.To aid in my recovery, I have also incorporatedstretching and foam rolling into my post-workout routine. These practices have helped to alleviate muscle soreness, improve flexibility, and promote faster recovery, allowing me to maintain a consistent and sustainable exercise regimen.Challenges and Overcoming Plateaus: As with any fitness journey, I have faced various challenges and setbacks alongthe way. One of the most significant hurdles I have encountered is the dreaded fitness plateau, where my progress seems to stall despite my continued efforts.To overcome these plateaus, I have adopted a dynamic and adaptable approach to my training. I have regularly evaluated my workout routines, made adjustments to the intensity,duration, and exercise selection, and incorporated new challenges to keep my body and mind engaged.Additionally, I have sought guidance from experienced fitness professionals, who have provided valuable insightsand strategies to help me break through these plateaus. Through their expert advice and support, I have learned the importance of rest, recovery, and periodization in mytraining, ensuring that my body is adequately prepared to handle the increasing demands of my workouts.Conclusion:As I continue on my journey to enhance my aerobic fitness, I am filled with a sense of pride and accomplishment. The progress I have made, both physically and mentally, has beena testament to my dedication, resilience, and unwavering commitment to living a healthy and active lifestyle.Through the integration of high-intensity interval training, dance-based workouts, and a well-balanced diet, Ihave not only improved my physical strength and endurance but have also cultivated a deep sense of joy and fulfillment in my fitness journey.Moving forward, I am excited to continue pushing the boundaries of my capabilities, embracing new challenges, and striving for even greater heights in my aerobic fitness. With each step, I am confident that I will emerge stronger, more resilient, and better equipped to lead a life of optimal health and wellness.。
毕业评价个人特长自我评价
毕业评价个人特长自我评价英文回答：Personal Strengths Self-Evaluation.Throughout my academic journey, I have developed and honed a number of personal strengths that have contributed to my success. These strengths have not only helped me excel academically, but also in various extracurricular activities and personal endeavors. In this self-evaluation, I will discuss some of my key strengths and provide examples of how they have positively impacted my life.One of my greatest strengths is my ability to communicate effectively. I am a confident and articulate speaker, which has allowed me to excel in presentations, debates, and discussions. I am able to clearly convey my thoughts and ideas, and I am also a good listener, which enables me to understand and respond appropriately to others. This strength has been particularly beneficial ingroup projects and team activities, as I can effectively communicate and collaborate with my peers.Another strength of mine is my strong work ethic. I am highly motivated and committed to achieving my goals. I am diligent in completing tasks and assignments, and I always strive for excellence. This has helped me maintain a high level of academic performance and has also enabled me to take on leadership roles in various organizations. My strong work ethic has not only helped me succeed academically, but has also instilled a sense of discipline and dedication in other aspects of my life.I am also a proactive and resourceful individual. I am always seeking opportunities for personal growth and development. I actively seek out challenges and take initiative to overcome obstacles. I am not afraid to step out of my comfort zone and try new things. This strength has allowed me to learn new skills and acquire knowledge in diverse areas. It has also helped me adapt to different situations and be flexible in my approach.Furthermore, I possess strong organizational skills. I am able to effectively manage my time and prioritize tasks.I am detail-oriented and ensure that I meet deadlines and deliver high-quality work. This strength has been particularly helpful during busy periods, as it allows me to stay focused and productive. It also helps me balance my academic responsibilities with my extracurricularactivities and personal commitments.In conclusion, I have identified several personal strengths that have played a crucial role in my academic and personal success. These strengths include effective communication, a strong work ethic, proactiveness, and organizational skills. I believe that these strengths will continue to serve me well in my future endeavors, and I am committed to further developing and refining them.中文回答：个人特长自我评价。
左室肥厚及其鉴别诊断-改版1
流行病学
高血压患者中左室肥厚的几何类型
The study was a community-based cross-sectional study, and comprised 4270 hypertension patients with integrated clinical and echocardiographic data.
肥厚型心肌病
H-E染色
心脏淀粉样变性
阿尔新蓝染色 (alcian blue) J Am Coll Cardiol 2011;57:891–903 Progress in Cardiovascular Diseases, 2010;52:347–361.
鉴别诊断
常见左室疾病的临床特点
肥厚型心肌 心脏淀粉样变
像计测）
✓ 无需依赖几何假设计算
• UCG三维评估（在一系列2D横断面上进行脱机重构或实时3D超声心动图） • CMR断面重构
影响学诊断—评估指标
LV mass index：左室质量指数
• 采用体表面积或身高对LV质量进行校正，但对LV 质量测量进行标准化的最佳方法仍存争议。
• 对于肥胖症和心血管病患者，使用LV质量身高指 数（LV质量/身高2.7）可提高LV肥厚的检出率
心脏磁共振
CMR可清晰显示HCM的非对称性肥厚
J of Cardiovasc Trans Res. 2009; 2:415-425
German
southwest Germany northwest Germany
Regional differences in the prevalence of left ventricular hypertrophy within Germany Eur J Cardiovasc Prev Rehabil 2009; 16:392–400
小肠憩室内出血经胃镜治疗一例
４ ＬｅｂｅｒｔＰ，ＥｒｎｓｔＯ，ＺｉｎｓＭ．Ａｃｑｕｉｒｅｄｄｉｖｅｒｔｉｃｕｌａｒｄｉｓｅａｓｅｏｆｔｈｅ
国际消化病杂志２０２１年６月第４１卷第３期 ＩｎｔＪＤｉｇＤｉｓ，Ｊｕｎｅ２５，２０２１，Ｖｏｌ．４１，Ｎｏ．３
·２３１·
对于较小的憩室采用影像学方法观察较为困难和 复杂［２５］。空肠憩室的发病率较回肠高，多为先天性 发育异常所致，获得性憩室的发病率极低［２］。大多 数小肠憩 室 患 者 无 症 状［３，６］，可 在 其 他 疾 病 的 诊 治 过程中被偶 然 发 现；但 有 时 由 于 食 物、消 化 液 等 潴 留在憩室中，会反复出现腹部隐痛、饱胀、恶心等慢 性症状，因 症 状 无 特 异 性 而 往 往 被 忽 视，造 成 临 床 漏诊及病情延误。当发生急性并发症时，病情往往 较重，常见的急性并发症包括憩室炎、消化道出血、 肠梗阻、肠扭转等［７８］。临床医师在面对这些并发症 时，往往不 易 联 想 到 是 由 于 小 肠 憩 室 引 起 的，容 易 延误诊治时间。
参 考 文 献
１ Ｋａｓｓｉｒ Ｒ，ＢｏｕｅｉｌＢｏｕｒｌｉｅｒ Ａ，Ｂａｃｃｏｔ Ｓ，ｅｔ ａｌ．Ｊｅｊｕｎｏｉｌｅａｌ ｄｉｖｅｒｔｉｃｕｌｉｔｉｓ：Ｅｔｉｏｐａｔｈｏｇｅｎｉｃｉｔｙ，ｄｉａｇｎｏｓｉｓａｎｄｍａｎａｇｅｍｅｎｔ［Ｊ］． ＩｎｔＪＳｕｒｇＣａｓｅＲｅｐ，２０１５，１０：１５１１５３．
综上所述，虽然本例患者由于胃切除术后的特 殊性而在胃镜下完成了小肠憩室的止血术，但仍对 操作技术具有较高的要求。本例患者的诊治经过 提示，对于 反 复 的 消 化 道 出 血，在 胃 镜 及 结 肠 镜 检 查呈阴性 结 果 的 情 况 下，应 考 虑 小 肠 出 血 的 可 能， 及时采取相应的诊治手段明确诊断并止血。
人髓过氧化物酶和心脏脂肪酸结合蛋白在急性心肌梗死诊断中的意义
人髓过氧化物酶和心脏脂肪酸结合蛋白在急性心肌梗死诊断中的意义伏长青;朱晓珏;曹晖【摘要】目的研究人髓过氧化物酶(MPO)、心脏脂肪酸结合蛋白(FABP3)检测在急诊胸痛患者早期诊断中的临床意义,并与传统急性心肌梗死(AMI)三项:肌钙蛋白I(cTnI)、肌酸激酶MB同工酶(CK-MB)、肌红蛋白(Myo)的临床检测数据进行对比.方法随机收集出现典型胸痛症状,之后被确诊为AMI的急诊患者,传统AMI三项检测阳性和阴性的患者共135例,进行MPO和FABP3检测,并分析各指标之间的相关性.结果所有入选病例的MPO值都超过医学决定水平92 ng/ml,cTnI、CK-MB、Myo检测阳性组患者的MPO水平与阴性组相比,差异有统计学意义(P＜0.05);所有患者FABP3检测结果超过临界值3.0 ng/ml,cTnI、CK-MB、Myo检测阳性组患者的FABP3水平与阴性组相比差异有统计学意义(P＜0.05).结论 MPO和FABP3均为早期AMI的独立预测因子,在出现胸痛的急诊患者中应用,可提高AMI诊断的准确性,减少有典型AMI症状的患者而肌钙蛋白等指标检测为阴性时的漏诊率.【期刊名称】《临床输血与检验》【年(卷),期】2015(017)006【总页数】3页(P501-503)【关键词】髓过氧化物酶;心脏脂肪酸结合蛋白;急性心肌梗塞【作者】伏长青;朱晓珏;曹晖【作者单位】215621 江苏省张家港市乐余人民医院检验科;张家港市第一人民医院检验科;张家港市第一人民医院检验科【正文语种】中文【中图分类】R446.11;R542.2+2急性心肌梗死(AMI)已成为导致人类死亡的头号杀手，预防心肌梗死的最有效方法是早期预防、早期诊断、早期治疗。
传统的AMI 三项检测(cTnI、CK-MB、Myo)虽然广泛应用于临床AMI 的辅助诊断，但这些传统指标水平的升高往往在AMI发生4 h 后［1，2］，不能早期预警心肌坏死发生的风险，造成AMI 早期就诊患者出现误诊或漏诊。