Atherosclerosis yog qhov ua rau cov kab mob plawv, uas tseem yog tus thawj coj hauv ntiaj teb hauv kev tuag.Insulin-zoo li kev loj hlob yam I (IGF1) tau pom tias yuav txo qis cov kab mob plawv.Kev tswj hwm ntawm IGF1 txo atherosclerosis thiab txo cov plaque macrophages hauv ApoE-deficient (Apoe- /-) nas noj cov zaub mov muaj roj ntau.Peb cov txiaj ntsig yav dhau los hauv vitro qhia tias macrophages ua lub luag haujlwm tseem ceeb hauv kev kho cov teebmeem ntawm IGF1 hauv atherosclerotic plaques, tab sis qhov tseeb mechanism tseem tsis meej. tiv thaiv atherosclerosis.
Tom qab yug me nyuam tshiab macrophage-specific IGF1-overexpressing transgenic nas mus rau hauv Apoe-/- keeb kwm yav dhau (MF-IGF1 nas), peb soj ntsuam atherosclerotic plaque load, stability, thiab monocyte recruitment. Kev noj zaub mov muaj roj rau peb lub hlis.Peb kuj tau soj ntsuam cov roj cholesterol efflux thiab ua npuas ncauj cell tsim hauv vivo thiab hauv vitro.
Macrophage IGF1 overexpression downregulated plaque lub nra los ntawm 30%, txo cov plaque macrophages los ntawm 47%, thiab txhawb cov yam ntxwv uas stabilize cov plaque phenotype.Monocyte recruitment raug txo los ntawm 70% nyob rau hauv MF-IGF1 nas thiab correlated nrog ib tug 27% txo nyob rau hauv circulating theem ntawm CX. Chemokine ligand 12 (CXCL12).CXCL12 protein ntau tau txo nyob rau hauv cov plaques thiab peritoneal macrophages nyob rau hauv MF-IGF1 nas.In vitro, IGF1 kiag li thaiv oxidized low-density lipoprotein (oxLDL) - nyob ntawm qhov nce hauv CXCL12 mRNA reduction, P98% <0.01), thiab IGF1 kev kho mob txo CXCL12 protein (56% txo, P<0.001).
CXCL12 txo qhov kev qhia ntawm ATP-binding cassette transporter A1 (ABCA1), ib qho tseem ceeb cov roj cholesterol transporter uas kho cov roj cholesterol efflux los ntawm macrophages.Peb pom 2-fold nce ntawm ABCA1 protein ntau hauv peritoneal macrophages cais los ntawm MF-IGF1 nas. Nyob rau hauv cov roj cholesterol efflux los ntawm loading peritoneal macrophages nrog oxLDL thiab pom ib tug 42% nce nyob rau hauv efflux nyob rau hauv MF-IGF1 nas.Peb kuj pom ib tug 27% nce nyob rau hauv cov roj cholesterol efflux nyob rau hauv THP-1 hlwb kho nrog IGF1 (100 ng / mL) nrog apolipoprotein AI. raws li cov cholesterol receptor.
Peb cov txiaj ntsig tau pom tias macrophage IGF1 txo qis atherosclerosis thiab txo qis CXCL12, ib qho chemokine tshiab koom nrog kev mob atherosclerosis.IGF1 tuaj yeem txo CXCL12 los ntawm kev txo qis monocyte recruitment thiab nce ABCA1, yog li exerting nws atheroprotective nyhuv, yog li ua kom muaj peev xwm.
Kev hloov pauv hauv TTR noob (rs76992529; Val122Ile) tsuas yog pom nyob rau hauv cov tib neeg ntawm African caj ces (pej xeem zaus: 3-4%) uas ua rau muaj kev tsis sib haum xeeb ntawm tetrameric transthyretin complex, uas pom nyob rau hauv keeb kwm ntawm transthyretin amyloidosis.Degeneration (hATTR) accumulates raws li extracellular amyloid fibrils.Kev kwv yees qhov cuam tshuam ntawm amyloidogenic TTR variant ntawm lub plawv tsis ua hauj lwm (HF) kev pheej hmoo thiab tag nrho cov-ua rau tuag nyob rau hauv ib tug loj, ntau haiv neeg pawg neeg African Americans yuav muab kev pom rau cov kev soj ntsuam tseem ceeb ntawm no variant. .Peb tau soj ntsuam cov neeg koom nrog dub hauv Geographic thiab Racially Different Uas Ua Rau Mob stroke (REGARDS) txoj kev tshawb fawb los tshuaj xyuas cov koom haum ntawm TTR Val122Ile kev hloov pauv nrog HF thiab tag nrho-ua rau kev tuag.
Peb tau soj ntsuam tus kheej tshaj tawm cov neeg Asmeskas cov neeg tuaj koom hauv REGARDS txoj kev kawm yam tsis muaj HF ntawm lub hauv paus.Poisson regression tau siv los kwv yees qhov tshwm sim ntawm lub plawv tsis ua hauj lwm thiab tag nrho-ua rau kev tuag.Peb siv ntau hom kev hloov kho Cox regression qauv accounting rau pej xeem, kho mob thiab kev sib raug zoo. yam tseem ceeb, thiab cov noob caj noob ces African caj ces los ntsuas qhov kev pheej hmoo ntawm HF thiab tag nrho-ua rau kev tuag ntawm cov tib neeg nrog TTR Val122Ile genetic variant piv nrog cov tsis muaj qhov sib txawv.
Ntawm 7,514 tus neeg tuaj koom dub (hnub nyoog nruab nrab: 64 xyoo; 61% poj niam), cov pej xeem zaus ntawm TTR Val122Ile variant yog 3.1% (232 tus neeg nqa khoom; 7,282 tus neeg tsis yog neeg nqa khoom).Qhov tshwm sim ntawm HF (ib 1000 tus neeg-xyoo) yog 15.9 (95% CI: 11.5-21.9) ntawm variant carriers thiab 7.2 (95% CI: 6.6-7.9) ntawm variant noncarriers.Val122Ile variant carriers muaj kev pheej hmoo siab dua ntawm kev tsim HF piv nrog cov tsis muaj cab (HR: 2.46 [95% CI : 1.72–3.53]; P<0.0001).Qhov tshwm sim ntawm tag nrho cov ua rau tuag (ib 1000 tus neeg-xyoo) yog 41.5 (95% CI: 34.6-49.7) ntawm cov neeg nqa khoom sib txawv thiab 33.9 (95% CI: 32). ntawm cov variant non-carriers.Val122Ile variant carriers muaj kev pheej hmoo siab ntawm tag nrho cov neeg tuag vim kev tuag piv nrog cov neeg tsis muaj cab (HR: 1.44 [95% CI: 1.18-1.76]; P = 0.0004).TTR variant carrier status thiab poj niam los txiv neej tsis tau cuam tshuam nrog HF thiab txhua qhov ua rau tuag taus.
Nyob rau hauv ib pawg loj ntawm cov neeg Amelikas dub, peb pom tau hais tias amyloid Val122Ile kev hloov pauv hauv TTR noob yog txuam nrog kwv yees li 2.5-fold siab dua ntawm HF thiab kwv yees li 40% siab dua qhov kev pheej hmoo ntawm tag nrho cov neeg tuag. Nrog rau qhov tshwm sim ntawm ntau hATTR. Kev kho mob, qhov muaj TTR Val122Ile kev hloov pauv uas feem ntau pom nyob rau hauv cov neeg African caj ces yuav raug txiav txim siab kho mob thiab ua kom nkag mus rau kev kho mob sai.
Kev ua kom cov guanylate cyclase / natriuretic peptide receptor A (GC-A / NPRA) los ntawm lub plawv cov tshuaj hormones atrial thiab hlwb natriuretic peptides (ANP thiab BNP) ua rau tus xa xov thib ob cGMP.cGMP ua rau lub suab qis thiab cov teebmeem lom ntawm ANP / NPRA rau diuretic. , diuretic, vasodilatory, antimitotic teb thiab mob plawv antihypertrophic teebmeem.Qhov kev qhia ntawm Npr1 noob (encoding GC-A / NPRA) yog tswj los ntawm ob peb sab nraud thiab sab hauv stimuli, tab sis cov hormonal thiab epigenetic mechanisms uas kho Npr1 kev cai tsis paub. ntawm txoj kev tshawb no yog los tshuaj xyuas lub luag haujlwm ntawm cov vitamin D (vitD) hauv kev tswj hwm Npr1 gene transcription thiab kev qhia los ntawm kev tswj cov txheej txheem epigenetic.
Peb txoj kev tshawb fawb bioinformatic ntawm murine Npr1 tus neeg txhawb nqa tau nthuav tawm muaj plaub lub ntsiab lus vitD cov lus teb (VDREs) hauv thaj av -583 txog -495 ntawm qhov chaw pib sau ntawv, nrog rau VDRE zoo li kev pom zoo ib ntus.To characterize the mechanisms regulating Npr1 promoter act. , cov qauv tsim tau hloov pauv mus rau hauv kab lis kev cai nas thoracic aortic du leeg hlwb (RTASMCs) thiab nas mesangial hlwb (MMCs) thiab ntsuas rau cov khoom siv tshuaj ntsuam xyuas dual luciferase.Transcriptional kev ua.
Luciferase kev soj ntsuam pom tau hais tias kev kho mob nrog vitamin D3 (1α,25-dihydroxy; VD3) nce Npr1 kev txhawb nqa kev ua haujlwm ntau dua 6-fold hauv kev siv tshuaj ntau dua.Western blot thiab densitometric tsom xam pom tias NPRA protein ntau hauv MMCs nce ntxiv nrog nce VD3. concentration, 3.5-fold hauv RTASMCs thiab 4.7-fold hauv RTASMCs, thiab cov nyhuv siab tshaj plaws tau pom ntawm 100 nM.VD3 nce qib protein ntawm vitD receptor (VDR) nyob rau hauv ib koob tshuaj-nyob ntawm seb muaj VD3, histone. deacetylase (HDAC) kev ua haujlwm yog 50% inhibited raws li kev ntsuas los ntawm HDAC kev ua haujlwm / txwv tsis pub ELISA cov khoom siv. Tsis tas li ntawd, kev kho mob nrog VD3 txo cov chav kawm I HDAC enzymes, HDAC1 thiab HDAC3 protein ntau, thiab koob tshuaj-nyob ntawm kev txhim kho histones, H3 ntawm lysine residues 9 thiab 14 (H3-K9/14 ac) thiab lysine H4 ntawm acid residue 12 (H4-K14ac).
Cov txiaj ntsig tau qhia tias VD3 epigenetically tswj Npr1 gene qhia los ntawm kev tswj hwm histone hloov kho.Kev txheeb xyuas cov hom phiaj ntawm cov vitamin D signaling raws li kev tswj hwm ntawm Npr1 gene transcription thiab protein qhia yuav muaj qhov cuam tshuam tseem ceeb rau kev kub siab thiab kab mob plawv.
qhia tau hais tias entanglement thiab superconductivity txhim kho intracellular conduction nyob rau hauv khub ntawm cais cardiomyocytes, txhim kho coupling thiab sab laug ventricular muaj nuj nqi.
Cov kev sim tau ua los ntawm kev siv cov kev txawj ntse hauv cov hlwb siv cov ntsiab lus quantum ntawm entanglement thiab superconductivity;intracellular hluav taws xob conductance thoob plaws qhov sib txawv ntawm qhov sib txuas (GI) tshwm sim los ntawm enalapril (E.) thiab angiotensin II (Ang II) raug ntsuas.Txhaj ntawm 1 ug / ml (25 ug / ml) dhau 4 feeb.A toj siab mus txog ntawm lub valve ntawm 106% ntws los ntawm lub hnab.Ang II. Txhaj ntawm 1 ug / min, GI raug txo (55%) thiab tsis muaj toj siab.
Peb xav tias lub toj siab tau mus txog tom qab txo qhov kev cuam tshuam, tab sis tsis yog nrog Ang II.Hauv lub xeev superconducting, E. coli tau zoo dua los txhim kho kev sib txuas ntawm myocytes tsis ua haujlwm, txhim kho sab laug ventricular muaj nuj nqi.
Tus kab mob Coronavirus (COVID-19) muaj xws li kev kis tus kab mob asymptomatic mus rau kev mob hnyav nrog ntau lub cev tsis ua haujlwm. Cov kev tshawb fawb tsis ntev los no tau pom tias muaj kev sib koom ua ke ntawm cov ntshav lipoprotein qis, xws li high-density lipoprotein (HDL), low-density lipoprotein (LDL), thiab tag nrho. Cov roj cholesterol (TC), thiab COVID-19 qhov mob hnyav.Txawm li cas los xij, cov txiaj ntsig tsis sib xws, thiab qhov twg ntawm lub koom haum tsis paub tam sim no.
Peb tau ua qhov kev tshuaj xyuas thiab ntsuas ntsuas ntawm 1) qhov sib txawv hauv HDL, LDL, TC, thiab triglyceride (TG) qib ntawm cov neeg mob COVID-19 thiab kev tswj hwm kev noj qab haus huv 2) nrog thiab tsis muaj mob hnyav nrog COVID-19 Tus Neeg Mob 3) COVID- 19 tus neeg mob tuag thiab muaj sia nyob.Peb tau suav nrog cov ntawv los ntawm PubMed thiab Embase txij li lub Cuaj Hlis 1, 2021.Peb tau txheeb xyuas qhov sib txawv ntawm qhov sib txawv (pMD) hauv qib lipid (mg / dL) ntawm cov pab pawg saum toj no uas siv cov txiaj ntsig random-ffects meta-analysis. thiab soj ntsuam kev tshaj tawm kev tsis ncaj ncees uas siv cov phiaj xwm funnel.
Ntawm 441 tsab xov xwm retrieved, 29 tsab xov xwm (26 retrospective cohorts thiab 3 prospective cohorts) tau raws li cov txheej txheem suav nrog, nrog rau tag nrho cov neeg koom nrog 256,721. Cov neeg mob uas muaj tus kab mob COVID-19 tau qis dua HDL (pMD = -6.95) thiab TC (pMD = -14.9) (Table 1 thiab daim duab 1). LDL thiab TG qib tsis txawv ntawm cov neeg mob uas muaj thiab tsis muaj COVID-19. Cov neeg mob COVID-19 hnyav tau qis dua HDL (pMD = -4.4), LDL (pMD = -4.4). ) thiab TC (pMD = -10.4) piv nrog cov neeg mob uas tsis muaj mob hnyav rau COVID-19. Cov neeg mob tuag tau qis dua HDL (pMD = -2.5), LDL (pMD = -10.6) thiab TC (pMD = -14.9). TG qib tsis txawv ntawm COVID-19 qhov hnyav lossis kev tuag. Tsis muaj ib qho ntawm cov kev tshuaj ntsuam saum toj no tau qhia txog kev tsis ncaj ncees rau kev tshaj tawm.
Peb qhov kev soj ntsuam tau pom tias cov neeg mob uas muaj COVID-19 muaj cov ntshav lipid qis dua piv rau kev tswj hwm kev noj qab haus huv.Hauv COVID-19 cov neeg mob, qis HDL, LDL, thiab TC qib tau cuam tshuam nrog kev mob hnyav thiab kev tuag. o thiab lub siab ua haujlwm tsis zoo.Cov ntshav lipid tuaj yeem tshawb xyuas raws li qhov muaj peev xwm ua rau muaj txiaj ntsig zoo hauv cov neeg mob COVID-19.
Atrial thiab hlwb natriuretic peptides (ANP thiab BNP) yog cov tshuaj hormones ntawm lub plawv keeb kwm uas ua lub luag haujlwm tseem ceeb hauv kev tswj cov ntshav siab thiab cov kua dej homeostasis thiab txhim kho kev kho plawv los ntawm vasodilatory thiab diuretic teebmeem.ANP thiab BNP ua los ntawm kev khi rau transmembrane guanylate cyclasetic/natriure peptide receptor-A (GC-A / NPR-A).Systemic cuam tshuam ntawm Npr1 gene (encoding GC-A / NPRA) ua rau ntim ntau dhau, kub siab, thiab lub plawv tsis ua haujlwm.Txawm li cas los xij, lub hauv paus txheej txheem tsis tau txheeb xyuas meej. .Lub hom phiaj ntawm txoj kev tshawb no yog los tshawb xyuas seb Npr1 ua lub luag haujlwm tseem ceeb hauv kev tswj cov piam thaj homeostasis hauv Npr1 gene- cuam tshuam cov nas.
Cov txiv neej laus thiab poj niam (16-18 lub lis piam) Npr1 knockout haplotype (Npr1+/-, 1-copy), hom qus (Npr1+/+, 2-copy) thiab noob duplication (Npr1+ ++/++, 4 -copy) nas tau yoo mov rau 16 teev thiab muaj kev nkag mus rau dej dawb.Qhov ncauj thiab intraperitoneal tswj cov piam thaj (2 g / kg lub cev qhov hnyav) tau ua hauv cov nas kom txiav txim siab qhov ncauj qhov ncauj glucose tolerance test (OGTT) thiab intraperitoneal glucose tolerance test (IPGTT) ntshav qabzib. Cov qib tau txiav txim siab los ntawm cov ntshav qab zib ntawm 0, 15, 30, 60, 90, thiab 120 feeb siv AlphaTRAK Ntshav Glucose Monitoring System (Zoetis Inc, Kalamazoo, MI).Systolic ntshav siab (SBP) tau txiav txim siab los ntawm lub khoos phis tawj uas tsis muaj kev cuam tshuam. tail-cuff method (Visitech 2000).
Cov txiaj ntsig tau pom tias cov ntshav qabzib hauv 2-coj nas (OGTT: 101 ± 4 mg / dL) tau nce mus rau qhov siab kawg ntawm 15 feeb tom qab cov piam thaj (2 g / kg lub cev qhov hnyav) kev tswj hwm thiab txo qis mus rau ze rau qib basal ntawm 120 feeb hauv cov txiv neej. .thiab poj niam 98 ± 3 mg / dL, IPGT: txiv neej 100 ± 3 mg / dL, poj niam 97 ± 4 mg / dL), hos hauv 1-coj nas, cov ntshav qabzib tseem nce siab txawm tias tom qab 120 feeb (OGTT: txiv neej 244 ± 6 mg / dL, poj niam 220 ± 4 mg / dL, IPGT: txiv neej 250 ± 5 mg / dL, poj niam 225 ± 6 mg / dL) piv rau 2-copy nas. 120 feeb (OGTT: 78 ± 3 mg / dL rau txiv neej, 73 ± 2 mg / dL rau poj niam, IPGT: 76 ± 4 mg / dL rau txiv neej thiab 70 ± 3 mg / dL rau poj niam).dL) piv rau 2-copy nas.The SBP tau nce siab dua hauv 1-copy nas (134 ± 3 mmHg hauv cov txiv neej thiab 125 ± 3 mmHg hauv cov pojniam) dua li cov nas 2-copy (101 ± 2 mmHg hauv cov txiv neej thiab 92 ± 2 mmHg rau poj niam). Ib yam li ntawd, 4-copy nas kuj tseem muaj SBP qis dua cov nas 2-copy (85 ± 3 mmHg hauv cov txiv neej thiab 78 ± 2 mmHg hauv cov poj niam). Cov ntshav qabzib siab tshaj plaws tau qis dua nrog OGTT piv. nrog IPGTT.
Cov kev tshawb pom tam sim no qhia tau tias Npr1 tiv thaiv qhov nce siab hauv cov ntshav qabzib tom qab kev sib tw ntawm cov piam thaj thiab ameliorated qabzib intolerance hauv cov tsiaj qus thiab cov gene-replicated nas, qhia tias Npr1 plays lub luag haujlwm tseem ceeb hauv kev tswj cov piam thaj thiab poob ntawm Npr1 Kev Ua Phem cuam tshuam. Lub raum thiab lub plawv ua haujlwm hauv cov nas mutant.Qhov haujlwm no tau txais kev txhawb nqa los ntawm NIH nyiaj pab (HL062147).
Central Arkansas Veterans Healthcare System John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas
Cov neeg mob uas muaj kab mob raum ntev (CKD) thiab tsis yog-ST-segment nce myocardial infarction (NSTEMI) sawv cev rau qhov kev sib tw tseem ceeb.Qhov kev pom zoo ntawm kev tshawb fawb randomized thiab kev soj ntsuam tsis paub tseeb. Kev kho mob tib yam (2) Cov txiaj ntsig puas cuam tshuam los ntawm theem ntawm lub raum kev ua haujlwm?(3) Puas yog kev tuag tus nqi tib yam nrog kev kho tshuaj ib leeg hauv kev tshawb fawb randomized thiab soj ntsuam?
Cov kev tshawb fawb tau raug xaiv raws li cov hauv qab no: (1) randomized los yog soj ntsuam cov ntaub ntawv ntawm cov neeg mob nrog NSTEMI thiab CKD (2) tus naj npawb ntawm cov neeg mob thiab kev tuag muaj rau invasive thiab conservative kev kho mob ntawm txhua theem ntawm lub raum ua hauj lwm, nrog rau kwv yees glomerular filtration rate (eGFR. ) 30–60 thiab <30.A meta-analysis nrog subgroup kev sib piv tau ua tiav los ntawm kev xam qhov sib txawv ntawm qhov sib txawv rau kev tuag los ntawm kev cuam tshuam txog kev kho mob.
(1) Tsib qhov kev tshawb fawb randomized thiab plaub qhov kev soj ntsuam tau ntsib cov qauv xaiv, nrog rau tag nrho ntawm 362,486 tus neeg mob tau txais kev kho mob lossis kev saib xyuas ntawm 1994 thiab 2020
(2) Hauv kev tshawb fawb randomized, qhov sib txawv ntawm kev tuag vim kev kho mob hauv cov neeg mob nrog eGFR 30-60 yog 0.739, kev ntseeg siab lub sijhawm (CI) yog 0.382-1.431, p = 0.370.Nyob rau hauv kev tshawb fawb soj ntsuam ntawm eGFR 30-60, qhov sib txawv piv rau kev kho mob rau kev tuag yog 0.144, CI 0.012-0.892, p = 0.037.
(3) Hauv kev tshawb fawb randomized, qhov sib txawv ntawm kev tuag vim kev kho mob hauv cov neeg mob nrog eGFR <30 yog 0.790, CI 0.135–4.63, p = 0.794.Hauv kev soj ntsuam, cov neeg mob eGFR <30 muaj qhov sib txawv ntawm 0.384 rau tuag, CI 0.281–0.552, p<.05.
(4) Qhov nruab nrab txoj kev pheej hmoo ntawm kev tuag ntawm cov neeg mob nrog eGFR 30-60 kho nrog kev saib xyuas kev kho mob ib leeg yog 0.128 (CI -0.001-0.227) hauv pawg randomized kawm thiab 0.44 (CI 0.227-0.6525) hauv pawg soj ntsuam kev tshawb fawb, p< 0.01 ib.Hauv kev tshawb nrhiav randomized qhov kev pheej hmoo ntawm kev tuag yog 0.345 (CI -0.103–0.794) hauv cov neeg mob eGFR <30 tau txais kev kho mob ib leeg thiab 0.463 (CI 0.00–0.926) hauv kev soj ntsuam kev tshawb fawb, p = 0.579.
(1) Txawm tias muaj txiaj ntsig zoo ntawm kev kho mob hauv ob qho tib si randomized thiab interventional kev tshawb fawb, qhov sib txawv piv rau kev tuag hauv kev soj ntsuam kev tshawb fawb yog qhov tseem ceeb.
(2) Cov kev tshawb fawb soj ntsuam tau pom tias kev kho mob cuam tshuam muaj qhov sib txawv qis dua rau kev tuag hauv cov neeg mob nrog eGFR 30-60 thiab eGFR <30.
(3) Cov neeg mob hauv pab pawg soj ntsuam muaj kev pheej hmoo siab ntawm kev tuag nrog kev saib xyuas ib leeg.
(4) Kev tshawb fawb ntxiv yog xav tau los tsim qauv rau kev xaiv cov neeg mob uas yuav tau txais txiaj ntsig zoo tshaj plaws los ntawm kev kho mob lossis kev saib xyuas.
(5) Cov kev txwv ntawm txoj kev tshawb no suav nrog qhov sib txawv ntawm cov neeg mob hauv pawg kev tshawb fawb, tsis muaj cov ntaub ntawv hemodynamic thiab angiographic raws li eGFR, thiab muaj peev xwm ua rau qee qhov kev tshawb fawb suav nrog cov neeg mob uas tsis ruaj khov angina pectoris dua li NSTEMI.
Txawm hais tias kev siv thev naus laus zis hauv kev kho plawv, cardiogenic poob siab raws li qhov teeb meem ntawm myocardial infarction tseem yog ib qho kev nyuaj rau kev kho mob. Tsis ntev los no, National Cardiogenic Shock Management Standardization Campaign tau pib hauv Tebchaws Meskas, thiab National Cardiogenic Shock Initiative lub hom phiaj los txhim kho kev ciaj sia, tshwj xeeb tshaj yog rau cov neeg mob. Nrog mob plawv mob plawv (ACS).Peb lub hom phiaj yog los txiav txim seb yuav ua li cas cardiogenic poob siab thib ob rau ACS uas yuav tsum muaj kev tswj xyuas cov khoom siv hluav taws xob hauv peb lub koom haum thiab los sib piv cov kev kho mob ntawm cov neeg muaj sia nyob thiab cov neeg tsis muaj sia nyob.
Kev tshawb nrhiav rov qab los ntawm cov neeg mob hnub nyoog 18-89 xyoo uas xav tau kev txhawb nqa lub tshuab ua haujlwm ib ntus hauv ACS qhov chaw ntawm University of Texas Lubbock Medical Center txij thaum Lub Yim Hli 2018 txog Lub Yim Hli 2019.Survivor thiab cov tsis muaj sia nyob tau muab piv rau.Fisher qhov kev sim thiab Wilcoxon qeb- sum test tau siv rau categorical thiab nruam hloov pauv.
Tag nrho ntawm 39 tus neeg mob tau suav nrog, 90% yog txiv neej, lub hnub nyoog nruab nrab yog 62 xyoo, 62% muaj ntshav qab zib, thiab qhov ntsuas lub cev qhov hnyav yog 29.01 ± 5.84 kg / m2.Intra-aortic balloon twj tso kua mis yog cov khoom siv ntau tshaj plaws. cov cuab yeej txhawb nqa, ua raws li Impella (92% vs 8%).Qhov kev tuag tag nrho yog 18%. Lub plawv dhia siab thiab lactate ntawm kev nkag mus rau kev siv tshuab kev txhawb nqa tau cuam tshuam nrog kev tuag (105 bpm vs 83.91 bpm, p = 0.02) (6.85 mmol/l vs 2.55 mmol/lp, 0.003. Percutaneous coronary intervention (PCI) Kev muaj cov neeg kho tshuab ua ntej los yog coronary artery bypass grafting (CABG) hauv 44% ntawm cov neeg mob tau cuam tshuam nrog kev ciaj sia (53% vs 0% p = 0.01) .
Lub plawv dhia siab thiab qib lactate thaum muab kev txhawb nqa tshuab yog cuam tshuam nrog kev tuag ntawm cov neeg mob uas muaj cardiogenic poob siab thib ob mus rau mob coronary syndrome.Kev pib ntawm cov neeg kho tshuab kev txhawb nqa ua ntej PCI tau cuam tshuam nrog kev muaj sia nyob. Cov kev tshawb fawb loj dua thiab nruj dua yog xav tau los qhia cov koom haum no.
Kev tswj hwm tus kab mob hidradenitis suppurativa (HS) tuaj yeem nyuaj.Ntau zaus, cov neeg mob cov tsos mob tau zoo dua tom qab kev cuam tshuam kev saib xyuas thawj zaug.Hmoov tsis zoo, qee qhov mob ua rau lub cev tsis muaj zog thiab ua rau kom zoo nkauj thiab mob rov qab.Kev phais feem ntau yog siv los rhuav tshem lossis tshem tawm cov ntaub so ntswg los txhawb kev kho mob. .Peb piav qhia txog tus neeg mob uas yog refractory rau kev phais uas underwent nto electron beam hluav taws xob kho.
Ib tug txiv neej muaj hnub nyoog 44 xyoo nthuav tawm nrog diffuse thickening ntawm pob tw, gluteal cleft, perineum, thiab ob sab ncej puab HS.Tus neeg mob tau refractory rau phais debridement thiab kho nrog tshuaj tua kab mob thiab corticosteroids.Nws tau txais kev sib cais-kawm electron beam hluav taws xob kho nrog a tag nrho cov koob tshuaj ntawm 30 Gy hauv 10 qhov sib faib tshuaj thiab khaws cia ib feem ntawm cov lus teb rau 2 lub lis piam tom qab pib kev kho mob.Lub hom phiaj kev kuaj lub cev tsis pub dhau 1 lub hlis ntawm kev kho mob pom qhov txo qis ntawm 25% ntawm tag nrho cheeb tsam ntawm qhov mob thiab cim flattening ntawm cov tsa ceg. Cov cheeb tsam.Thaum lub sijhawm ntawd, cov neeg mob tau qhia txog kev txo qis hauv qhov mob thiab tso dej.Cov lus teb tau suav hais tias nyob ruaj khov ntawm 6 thiab 12 lub hlis tom qab kho.
Kev kho hluav taws xob hluav taws xob muaj cov txiaj ntsig tsis zoo rau ntau yam kab mob benign thiab tau kawm ntawm cov koob tshuaj tsawg (qee zaus ib koob tshuaj) hauv kev tswj hwm ntawm HS.Peb tau xaiv los siv cov chav kawm sib cais uas peb ntseeg tias muaj kev nyab xeeb tshaj plaws thiab muaj peev xwm ntev tshaj plaws nyob rau hauv cov nqe lus ntawm txo cov kev mob tshwm sim.
Tus neeg mob qhov chaw kho mob qhia hidradenitis suppurativa hauv pob tw, gluteal cleft, perineum thiab ob sab ncej puab ua ntej kho
Superficial electron beam radiation therapy yog qhov zoo hauv kev kho tus kab mob benign thiab tuav cov lus cog tseg rau refractory HS.Studies ntawm tag nrho cov koob tshuaj thiab fractionation regimens yog xav tau los kho kom zoo thiab qhia kev siv yav tom ntej.
Hauv cov pej xeem hauv Teb Chaws Asmeskas, 1 ntawm 5,000 tus neeg muaj mitochondrial myopathy.Cov tsos mob tshwm sim tuaj yeem faib ua peb pawg: mob hnyav sab nraud ophthalmoplegia, skeletal-CNS syndrome lossis myopathy yooj yim.Cardiac abnormalities tshwm sim hauv 30-32% ntawm cov neeg mob, feem ntau yog hypertrophic cardiomyopathy, dilated cardiomyopathy, lossis conduction abnormalities.Peb nthuav tawm ib rooj plaub ntawm ob sab qis qis qis qis qis, mob, thiab o nrog cov leeg nqaij kuaj mob ntawm mitochondrial myopathy.Cov lus piav qhia: Ib tug txiv neej hnub nyoog 21 xyoo kawm tiav raug xa mus rau peb lub tsev kho mob. tom qab 3 lub lis piam ntawm ceg tsis muaj zog, mob, thiab o tom qab tuaj txog hauv Tebchaws Meskas los ntawm Is Nrias teb.Kev kuaj pom tachycardia, 2+ cov ntsiab lus ntawm pitting edema nyob rau hauv ob lub hauv caug, 4/5 MRC-qib tsis muaj zog, me me rhiab nyob rau hauv proximal thiab distal nqaij pawg. ntawm sab sauv thiab sab qis, tsis muaj qhov sib sib zog nqus tendon reflexes, ko taw poob, thiab ob sab ptosis thiab txwv tsis pub muaj zog ntxiv. Cov kev kuaj sim ua ntej pom tias creatinine kinase nce 691 IU / L, lub paj hlwb natriuretic peptide nce 3437 pg / mL, troponin nce 47.1 ng / L, myoglobin nce los ntawm 195 ng / mL, thiab lactate nce los ntawm 7.7 mmol / L, serum bicarbonate txo los ntawm 12 mmol / L.Lumbar puncture ua rau xav tias Guillain-Barre syndrome tsis ntseeg siab vim kev raug mob kais.Electrocardiogram pom sab laug axis. Kev sib txawv nrog rau sab laug anterior bundle block. Chest X-ray thiab CT angiography ntawm hauv siab / plab / plab plab pom pom lub plawv o thiab ntim ntau dhau.Nws lub txaj ECHO pom me ntsis sab laug systemic hypokinesia, 40-44% qis ejection feem, thiab me me pulmonary hypertension. Tus neeg mob tau txais mus rau hauv chav kho mob hnyav vim qhov poob qis hauv qhov siab tshaj plaws hauv lub siab.Ophthalmology paub tseeb tias ophthalmoplegia, tsis suav nrog cranial paj palsy, myasthenia gravis, thiab retinitis pigmentosa.Gq1b antibody negative.Extensive autoimmune thiab kis kab mob ua haujlwm tsis muaj kev cuam tshuam. ntawm tus neeg mob lub rectus femoris cov leeg pom cov pob zeb xiav thiab cytochrome-c oxidase-negative fibers nrog nce perimuscular thiab endomysial connective cov ntaub so ntswg, zoo ib yam nrog active thiab chronic thawj mitochondrial myopathy.Endomyocardial biopsy pom active lymphocytic myocarditis. Metoprolol, thiab methylprednisolone.
Myopathy yuav tsum tau txiav txim siab nyob rau hauv qhov kev kuaj mob sib txawv ntawm cov neeg mob uas xav tias Guillain-Barre syndrome.Peb qhia txog cov xwm txheej nthuav dav ntawm myopathy nrog cov kev mob plawv zoo.Myositis manifesting li myocarditis yuav tsum tsa qhov kev tsis txaus siab ntawm tus kab mob mitochondrial.Peb qhov kev paub qhia txog qhov tseem ceeb ntawm kev siv pab pawg neeg sib tham. Txoj hauv kev los kuaj xyuas qhov tsis tshua muaj pathologies nrog qhov sib txawv ntawm ntau qhov kev koom tes.
Lub hom phiaj ntawm txoj kev tshawb no yog tshawb nrhiav qhov muaj peev xwm ntawm kev kuaj mob Gaisbock hauv cov neeg mob uas muaj mob polycythemia thiab kub siab.
Ib tug txiv neej rog rog 40 xyoo Caucasian tau mus pw hauv tsev kho mob nrog cov ceg o rov tshwm sim thiab xav tau oxygen ntxiv tom qab ob lub lis piam mus pw hauv tsev kho mob nrog COVID-19 mob ntsws.Tom qab tshuaj xyuas tus neeg mob keeb kwm kev kho mob, nws tau pom tias tsis kho mob ntshav siab thiab polycythemia spanning. ib xyoo caum ntawm ob peb mus ntsib.Cov keeb kwm kho mob tsis ntev los no suav nrog kev kuaj mob ntawm cov hlab ntsha sib sib zog nqus (DVT) hauv tib ceg ob thiab ib nrab lub hlis dhau los, thiab kho nrog Xarelto.
Tus neeg mob tau tshaj tawm txog 12-xyoo keeb kwm ntawm testosterone qis.Txawm li cas los xij, nws tsis tau siv cov tshuaj testosterone rau cuaj lub hlis dhau los.Nws qhia txog kev qaug zog nruab hnub, nquag tsaug zog thaum hmo ntuj, thiab nquag snoring.Tus neeg mob no tsis tau pw tsaug zog los yog siv CPAP.Tus neeg mob haus luam yeeb ib nrab ntawm ib lub kaus poom ntawm ib hnub rau 13 xyoo sib law liag, ib pob rau ib hnub, rau 10 xyoo sib law liag, thiab txiav luam yeeb 12 xyoo dhau los.Nws siv nws lub neej feem ntau ua haujlwm hnyav hauv kev tsim kho.
Post lub sij hawm: Jun-29-2022