I-Atherosclerosis yimbangela ehamba phambili yesifo senhliziyo, ehlala inkokeli yehlabathi jikelele ekufeni.I-Insulin-like growth factor I (IGF1) ibonakaliswe ukunciphisa iziganeko ze-cardiovascular.Ulawulo lwe-IGF1 lunciphisa i-atherosclerosis kunye nokunciphisa i-plaque macrophages kwi-ApoE-deficient (Apoe- /-) iigundane zondla ukutya okunamafutha amaninzi.Iziphumo zethu zangaphambili ze-in vitro zibonisa ukuba i-macrophages idlala indima enkulu ekulungelelaniseni imiphumo ye-IGF1 kwii-atherosclerotic plaques, kodwa indlela echanekileyo ihlala ingacacanga. ukukhusela i-atherosclerosis.
Emva kokuzala inoveli macrophage-specific IGF1-overexpressing transgenic iimpuku zibe Apoe-/- imvelaphi (MF-IGF1 iimpuku), savavanya umthwalo atherosclerotic plaque, uzinzo, kunye recruitment monocyte.We yakhawulezisa uphuhliso atherosclerosis ngokondla izilwanyana eliphezulu- ukutya okunamafutha iinyanga ezintathu.Sikwavavanye i-cholesterol efflux kunye nokwakheka kweeseli ze-foam kwi-vivo nakwi-vitro.
I-Macrophage IGF1 i-overexpression iyancipha umthwalo we-plaque nge-30%, iyancipha i-macrophages ye-plaque nge-47%, kunye neempawu ezikhuthazwayo ezizinzisa i-plaque phenotype.Ukuqashwa kwe-Monocyte kwancitshiswa nge-70% kwi-MF-IGF1 iigundane kwaye ihambelana nokunciphisa i-27% ye-CXC ejikelezayo. i-chemokine ligand 12 (CXCL12) .I-CXCL12 amanqanaba eprotheyini ancitshiswe kwiiplaques kunye ne-peritoneal macrophages kwi-MF-IGF1 iigundane.In vitro, i-IGF1 ivalwe ngokupheleleyo i-oxidized low-density lipoprotein (oxLDL) -ukwanda okuxhomekeke kwi-PCCL12 mRNA% ukuguqulwa kwe-CX (98%). <0.01), kunye ne-IGF1 unyango lunciphisa iprotheyini ye-CXCL12 (ukunciphisa i-56%, i-P <0.001).
I-CXCL12 inciphisa ukubonakaliswa kwe-ATP-ebopha i-cassette transporter A1 (ABCA1), i-cholesterol transporter engundoqo eyenza i-cholesterol efflux esuka kwi-macrophages.Sifumene ukunyuka kwe-2-fold kumanqanaba eprotheni ye-ABCA1 kwi-macrophages ye-peritoneal ehlukanisiweyo kwi-MF-IGF1 iigundane. kwi-cholesterol efflux ngokulayisha i-peritoneal macrophages kunye ne-oxLDL kwaye ifumene i-42% yokunyuka kwe-efflux kwi-MF-IGF1 iigundane.Siphinde safumana i-27% yokunyuka kwe-cholesterol efflux kwiiseli ze-THP-1 eziphathwa nge-IGF1 (100 ng / mL) nge-apolipoprotein AI. njenge-cholesterol receptor.
Iziphumo zethu zibonisa ukuba i-macrophage IGF1 iyanciphisa i-atherosclerosis kwaye inciphisa i-CXCL12, i-chemokine esanda kubandakanyeka kwi-atherosclerosis progression.IGF1 inokunciphisa i-CXCL12 ngokunciphisa ukuqeshwa kwe-monocyte kunye nokwandisa i-ABCA1, ngaloo ndlela isebenzise i-atheroprotective effect, ngaloo ndlela ikhulise amandla e-cholesterol efflux.
Iinguqu kwi-TTR gene (rs76992529; Val122Ile) zibonwa kuphela kubantu bokhokho base-Afrika (i-population frequency: 3-4%) ekhokelela ekuphangeni kwe-tetrameric transthyretin complex, efumaneka kwi-hereditary transthyretin amyloidosis.I-Degeneration (hATTR) iqokelela njenge-extracellular amyloid fibrils.Ukuqikelela impembelelo yale ntlukwano ye-amyloidogenic ye-TTR kwingozi yentliziyo (HF) kunye nonobangela wokufa kwabantu abaninzi base-Afrika baseMelika baseMelika kunokubonelela ngengqiqo ngokubaluleka kolu tshintsho. .Sivavanye abathathi-nxaxheba abamnyama kwiGeographic and Racially Different Couses of Stroke (REGARDS) kuphononongo lokuphonononga umbutho weTTR Val122Ile uguquko kunye ne-HF kunye nokufa konke okubangela.
Siye savavanya abathathi-nxaxheba abamnyama baseMelika abazimeleyo kwi-REGARDS isifundo ngaphandle kwe-HF kwisiseko.I-Poisson regression yayisetyenziselwa ukuqikelela iziganeko zokungaphumeleli kwentliziyo kunye nayo yonke into ebangela ukufa.Sasebenzisa i-multivariate-adjusted Cox regression model accounting ye-demographic, ikliniki kunye nentlalontle. izinto, kunye nemvelaphi yemfuza yase-Afrika yokuvavanya umngcipheko we-HF kunye nokusweleka kwezinto zonke kubantu abane-TTR Val122Ile eyahlukileyo yofuzo xa kuthelekiswa nabo bangenayo inguqu.
Phakathi kwabathathi-nxaxheba abamnyama abangama-7,514 (iminyaka ephakathi: iminyaka engama-64; i-61% yabasetyhini), ukuphindaphindwa kwabemi be-TTR Val122Ile eyahlukileyo yayiyi-3.1% (abathwali abangama-232; abangama-7,282 abangathwali). (95% CI: 11.5-21.9) phakathi kwabathwali abahlukeneyo kunye ne-7.2 (95% CI: 6.6-7.9) phakathi kwe-variant noncarriers.Val122Ile abathwali abahlukeneyo babenomngcipheko ophezulu wokuphuhlisa i-HF xa kuthelekiswa nabangabathwali (HR: 2.46 [95% CI CI) : 1.72-3.53]; P <0.0001) .Isiganeko sokufa kwabantu bonke (kwi-1000 umntu-iminyaka) yayingu-41.5 (95% CI: 34.6-49.7) phakathi kwabathwali abahlukeneyo kunye ne-33.9 (95% CI: 32.5) -3 phakathi kweenguqu ezingathwaliyo.Val122Ile abathwali abahlukeneyo babenomngcipheko ophezulu wokufa kwezinto zonke xa kuthelekiswa nabangabathwali (HR: 1.44 [95% CI: 1.18-1.76]; P = 0.0004) .Imo ye-TTR eyahlukileyo yomphathi kunye nesini azange Ukusebenzisana ne-HF kunye neziphumo zokusweleka kwezizathu zonke.
Kwiqela elikhulu labantu abamnyama baseMelika, sibonisa ukuba ukuguqulwa kwe-amyloid Val122Ile kwi-TTR gene inxulunyaniswa nomngcipheko ophezulu we-HF malunga ne-2.5 kunye nomngcipheko ophezulu we-40% wokufa kwayo yonke into. Ngokufika kwe-hATTR eninzi. zonyango, ubukho beTTR Val122Ile mutation edla ngokufunyanwa kubantu bokhokho baseAfrika bunokubonwa njengento enokusetyenzwa ngokonyango kwaye kufikelelwe kwangoko kunyango.
Ukusebenza kwe-guanylate cyclase/natriuretic peptide receptor A (GC-A/NPRA) yi-cardiac hormones e-atrial kunye ne-brain natriuretic peptides (ANP kunye ne-BNP) ivelisa isithunywa sesibini i-cGMP.cGMP ivula umqondiso osezantsi kunye neziphumo zebhayoloji ze-ANP/NPRA ze-diuretic. , i-diuretic, i-vasodilatory, iimpendulo ze-antimitotic kunye nemiphumo ye-antihypertrophic ye-cardiac.Intetho ye-Npr1 gene (i-encoding GC-A/NPRA) ilawulwa zizivuseleli ezininzi zangaphandle kunye nezangaphakathi, kodwa iindlela ze-hormonal kunye ne-epigenetic ezilamla umgaqo we-Npr1 ayaziwa. Olu pho nonongo yayikukujonga indima yevithamin D (vitD) ekulawuleni i-Npr1 gene transcription and expression by regulating epigenetic factors.
Uphononongo lwethu lwe-bioinformatic ye-murine Npr1 umgqugquzeli ubonakalise ubukho bezinto ezine ze-vitD zokuphendula (i-VDREs) kwi--583 ukuya kwi-495 kwingingqi ye-transcription start site, kunye ne-VDRE-efana ne-VDRE-efana nokulandelelana kokuvumelana. , ulwakhiwo lwaye lwadluliselwa ngokukhawuleza kwiiseli ze-rat thoracic aortic smooth muscle (RTASMCs) kunye neeseli ze-mouse mesangial (MMCs) kwaye zilinganiswe kwiikiti ezimbini zokuvavanya i-luciferase.Umsebenzi wokukhutshelwa.
Uvavanyo lwe-Luciferase lubonise ukuba unyango kunye ne-vitamin D3 (1α,25-dihydroxy; VD3) yandisa umsebenzi womgqugquzeli we-Npr1 ngaphezu kwe-6-fold kwi-dose-dependent form.I-Western blot kunye nohlalutyo lwe-densitometric lubonise ukuba amanqanaba eprotheni ye-NPRA kwi-MMCs anda kakhulu ngokunyuka kwe-VD3 Ugxininiso, i-3.5-fold in RTASMCs kunye ne-4.7-fold in RTASMCs, kwaye umphumo ophezulu wabonwa kwi-100 nM.VD3 yandisa izinga leprotheyini ye-vitD receptor (VDR) ngendlela exhomekeke kwidosi.Phambi kwe-VD3, i-histone Umsebenzi we-deacetylase (i-HDAC) wawunqatshelwe i-50% njengoko ilinganiswe ngumsebenzi we-HDAC / inhibition ELISA kit.Ngaphezu koko, unyango kunye ne-VD3 encitshisiweyo yeklasi ye-enzymes ye-HDAC, i-HDAC1 kunye ne-HDAC3 amanqanaba eprotheni, kunye ne-dose-dependently improved histones, i-H3 kwi-lysine i-residues ye-9 kunye I-14 (H3-K9 / 14 ac) kunye ne-lysine H4 kwi-asidi ye-asidi 12 (H4-K14ac).
Iziphumo zibonisa ukuba i-VD3 i-epigenetically ilawula i-Npr1 i-gene expression ngokulawula ukuguqulwa kwe-histone.Ukuchongwa kweethagethi ze-epigenetic ze-vitamin D ukubonakaliswa njengabalawuli be-Npr1 ye-gene transcription kunye ne-protein expression iya kuba nefuthe elibalulekileyo kwi-hypertension kunye nokulawulwa kwe-cardiovascular regulation.
ibonise ukuba ukudibanisa kunye ne-superconductivity kuphuculwe ukuqhutyelwa kwe-intracellular kwizibini ze-cardiomyocytes ezizimeleyo, ukuphucula ukudibanisa kunye nokusebenza kwe-ventricular ekhohlo.
Iimvavanyo zenziwa kusetyenziswa ubukrelekrele bokwenziwa ngaphakathi kweeseli zisebenzisa i-quantum concepts of entanglement and superconductivity;i-intracellular conductance electrical conductance kwi-gap junctional (GI) eyenziwa yi-enalapril (E.) kunye ne-angiotensin II (Ang II) yalinganiswa.E.Ijova kwi-1 ug / ml (25 ug / ml) ngaphezu kwemizuzu ye-4. I-plateau ifikeleleke kwi-valve kwi-106% ephuma kwi-bag. kwakungekho thafa.
Sicinga ukuba i-plateau ifikeleleke emva kokunciphisa ukudibanisa, kodwa kungekhona nge-Ang II.
Isifo seCoronavirus (COVID-19) sisuka kusulelo olungenazimpawu ukuya kutsho kwisigulo esiqatha esinokusilela kwamalungu amaninzi. Uphononongo lwakutsha nje lubonise unxulumano phakathi kwamanqanaba asezantsi e-serum lipid, oko kukuthi, i-high-density lipoprotein (HDL), low-density lipoprotein (LDL), kunye nenani lilonke. i-cholesterol (TC), kunye nobunzima besifo se-COVID-19. Nangona kunjalo, iziphumo azikho kulandelelwano, kwaye ubungakanani bombutho awaziwa ngoku.
Senze uphononongo olucwangcisiweyo kunye nohlalutyo lwe-meta-1) umahluko kumanqanaba e-HDL, i-LDL, i-TC, kunye ne-triglyceride (TG) phakathi kwezigulana ze-COVID-19 kunye nolawulo olusempilweni 2) kunye nangaphandle kokugula kakhulu kunye ne-COVID-19 isigulana sesi-3) COVID- Isigulane se-19 safa kwaye sasinda.Sifake amanqaku avela kwi-PubMed kunye ne-Embase ukususela ngoSeptemba 1, 2021.Sihlalutye umahluko odibeneyo odibeneyo (pMD) kumanqanaba e-lipid (mg / dL) kumaqela angasentla usebenzisa i-random-effects meta-analysis. kunye nokuvavanya upapasho kusetyenziswa iploti yefanitshala.
Kumanqaku angama-441 afunyenweyo, amanqaku angama-29 (amaqela angama-26 abuyela emva kunye naba-3 abalindelekileyo) adibana neendlela zokubandakanywa, kunye netotali yabathathi-nxaxheba abangama-256,721. Izigulana ezine-COVID-19 zinemigangatho esezantsi ye-HDL (pMD = -6.95) kunye ne-TC (pMD = -14.9) (Itheyibhile 1 kunye neFigure 1). Amanqanaba e-LDL kunye ne-TG awazange ahluke phakathi kwezigulane ezine-COVID-19. Izigulana ezimandundu ze-COVID-19 zazinamanqanaba asezantsi e-HDL (pMD = -4.4), LDL (pMD = -4.4 ) kunye ne-TC (pMD = -10.4) xa kuthelekiswa nezigulana ezingekho qatha ze-COVID-19. Izigulana ezibhubhileyo zazinamanqanaba asezantsi e-HDL (pMD = -2.5), LDL (pMD = -10.6) kunye ne-TC (pMD = -14.9). Amanqanaba e-TG awohlukanga kubungqongqo okanye ukufa kwe-COVID-19.
Uhlalutyo lwethu lubonise ukuba abaguli abane-COVID-19 babenamanqanaba asezantsi elipid egazi xa kuthelekiswa nolawulo olusempilweni. Kwizigulana ze-COVID-19, amanqanaba asezantsi eHDL, LDL, kunye ne-TC anxulunyaniswa nobungqongqo kunye nokufa. ukudumba kunye nokungasebenzi kakuhle kwesibindi.Amanqanaba elipid egazi anokujongwa njengezinto ezinokubakho kwi-COVID-19 kwizigulana.
I-Atrial kunye ne-brain natriuretic peptides (ANP kunye ne-BNP) zijikeleza i-hormone yemvelaphi yentliziyo edlala indima ebalulekileyo ekulawuleni uxinzelelo lwegazi kunye ne-homeostasis yamanzi kunye nokuphucula ukulungiswa kwentliziyo ngemiphumo ye-vasodilatory kunye ne-diuretic.Zombini i-ANP kunye ne-BNP zisebenza ngokuzibophelela kwi-transmembrane guanylate cyclase / natriuretic i-peptide receptor-A (GC-A/NPR-A) Ukuphazamiseka kweSistim ye-Npr1 gene (i-encoding GC-A / NPRA) iphumela ekugqithiseni umthamo, uxinzelelo lwegazi, kunye nokungaphumeleli kwentliziyo. .Injongo yolu phononongo yayikukuphanda ukuba ngaba i-Npr1 idlala indima ebalulekileyo ekulawuleni i-glucose homeostasis kwi-Npr1 gene-disrupted mouse.
Amadoda nabafazi abadala (iiveki eziyi-16-18) Npr1 knockout haplotype (Npr1+/-, 1-copy), wild-type (Npr1+/+, 2-copy) kunye nophindaphindo lwegene (Npr1+ +/++, 4 -copy) Iimpuku bazila ukutya iiyure ze-16 kwaye babenokufikelela ngokukhululekile kumanzi. Ukulawulwa komlomo kunye ne-intraperitoneal ye-glucose (2 g / kg ubunzima bomzimba) kwenziwa kwiigundane ukumisela uvavanyo lokunyamezela i-glucose yomlomo (OGTT) kunye novavanyo lwe-intraperitoneal glucose tolerance (IPGTT) . amanqanaba agqitywe ngomsila wegazi kwi-0, 15, 30, 60, 90, kunye nemizuzu eyi-120 usebenzisa i-AlphaTRAK Blood Glucose Monitoring System (Zoetis Inc, Kalamazoo, MI) .Uxinzelelo lwegazi lwe-Systolic (SBP) lunqunywe yi-computer engabonakaliyo. indlela yomsila-cuff (Visitech 2000).
Iziphumo zibonise ukuba amanqanaba e-glucose yegazi kwiigundane ze-2-copy (OGTT: 101 ± 4 mg / dL) yanda ukuya kutsho kwimizuzu eyi-15 emva kwe-glucose (2 g / kg ubunzima bomzimba) yokulawula kwaye yehla ukuya kufuphi namanqanaba e-basal kwimizuzu ye-120 kumadoda. .kunye nabasetyhini 98 ± 3 mg / dL, IPGT: amadoda 100 ± 3 mg / dL, amabhinqa 97 ± 4 mg / dL), kanti kwiigundane ze-1-ikopi, amanqanaba eglucose yegazi ahlala ephakanyisiwe nangemva kwemizuzu ye-120 (OGTT: amadoda 244 ± I-6 mg / dL, i-female 220 ± 4 mg / dL, i-IPGT: indoda 250 ± 5 mg / dL, ibhinqa i-225 ± 6 mg / dL) xa kuthelekiswa ne-2-copy iigundane. Imizuzu ye-120 (OGTT: 78 ± 3 mg / dL kumadoda, i-73 ± 2 mg / dL yabasetyhini, i-IPGT: 76 ± 4 mg / dL yamadoda kunye ne-70 ± 3 mg / dL yabasetyhini).dL) xa kuthelekiswa ne-2-copy mice.I-SBP yayiphezulu kakhulu kwiigundane ze-1 (134 ± 3 mmHg kumadoda kunye ne-125 ± 3 mmHg kubasetyhini) kune-2-ikopi yeegundane (101 ± 2 mmHg kumadoda kunye ne-92 ± I-2 mmHg kubasetyhini) .Ngokunjalo, iigundane ze-4-ikopi nazo zine-SBP ephantsi kakhulu kune-2-ikopi yeegundane (85 ± 3 mmHg kumadoda kunye ne-78 ± 2 mmHg kubasetyhini) . kunye ne-IPGTT.
Iziphumo zangoku zibonisa ukuba i-Npr1 ithintele kakhulu ukunyuka okubukhali kumanqanaba e-glucose yegazi kulandela umngeni we-glucose kunye nokuphucula ukunganyamezeli kwe-glucose kwi-wild-type kunye ne-gene-replicated mice, ebonisa ukuba i-Npr1 idlala indima ebalulekileyo ekulawuleni amanqanaba e-glucose kunye nokulahlekelwa kwe-Npr1 Action ichaphazela kakubi. umsebenzi wezintso kunye nentliziyo kwiigundane eziguqukayo.Lo msebenzi wawuxhaswa yi-NIH grant (HL062147).
ISibhedlele saseMbindi weArkansas Veterans Healthcare uJohn L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas
Izigulane ezinesifo esingapheliyo sezintso (CKD) kunye ne-non-ST-segment elevation myocardial infarction (NSTEMI) zimela umngeni omkhulu wekliniki.Isivumelwano phakathi kwezifundo ezihleliweyo kunye nokuqwalasela akuqinisekanga. unyango ngokomlinganiselo ofanayo (2) Ngaba iziphumo ziphenjelelwa ngamanqanaba okusebenza kwezintso?(3) Ngaba izinga lokusweleka liyafana kunyango lwechiza kuphela kuphononongo olungakhethi buso nolophononongo?
Izifundo zikhethwe ngokusekelwe kule migaqo ilandelayo: (1) iingxelo ezihleliweyo okanye zokuqwalaselwa kwezigulane ezine-NSTEMI kunye ne-CKD (2) inani lezigulane kunye nokufa okukhoyo kunyango olungenayo kunye nolondolozo kwinqanaba ngalinye lomsebenzi wezintso, kubandakanywa uqikelelo lwe-glomerular filtration rate (eGFR ) I-30-60 kunye ne-<30.Uhlalutyo lwe-meta kunye nothelekiso lweqela elingaphantsi lwagqitywa ngokubala ukulinganisa okungafaniyo kokufa okuvela kwi-invasive ngokuchasene nonyango olulondolozayo.
(1) Izifundo ezihlanu ezihleliweyo kunye nezifundo ezine zokuqwalasela zidibene neendlela zokukhetha, kunye nezigulane ezingama-362,486 ezifumana unyango olungenayo okanye olulondolozayo phakathi kwe-1994 kunye ne-2020.
(2) Kwizifundo ezingabonakaliyo, umlinganiselo wokungafani kokufa ngenxa yonyango olungenayo i-eGFR 30-60 yayingu-0.739, ixesha lokuzithemba (CI) ngu-0.382-1.431, p = 0.370.Kuphononongo lokuqwalaselwa kwe-eGFR 30-60, umlinganiselo weengxaki zonyango oluhlaselayo lokufa yayingu-0.144, CI 0.012-0.892, p=0.037.
(3) Kwizifundo ezizenzekelayo, umlinganiselo weengxaki zokufa ngenxa yonyango olungenayo i-eGFR <30 yayingu-0.790, CI 0.135-4.63, p = 0.794. Kwizifundo zokuqwalasela, izigulane ezine-eGFR <30 zine-odds ratio ye-0.384 ukufa, CI 0.281-0.552, p <.05.
(4) Umngcipheko wokufa kwizigulane ezine-eGFR 30-60 eziphathwa ngonyango olulondolozayo kuphela ngu-0.128 (CI -0.001-0.227) kwiqela lokufunda elingenasiphelo kunye ne-0.44 (CI 0.227-0.6525) kwiqela lokufunda lokujonga, p< 0.01 .Kuphononongo olungacwangciswanga Umngcipheko weMedian wokufa wawuyi-0.345 (CI -0.103-0.794) kwizigulane ezine-eGFR <30 ezifumana unyango olulondolozayo lwedwa kunye ne-0.463 (CI 0.00-0.926) kwizifundo zokujonga, p = 0.579.
(1) Nangona isiphumo esilungileyo sonyango olungenayo kuzo zombini izifundo ezihleliweyo kunye nokungenelela, umlinganiselo weengxaki zokufa kwizifundo zokuqwalasela wawubaluleke kakhulu.
(2) Uphononongo lokuqwalasela lubonise ukuba unyango olungenayo lunomlinganiselo ophantsi kakhulu wokufa kwizigulane ezine-eGFR 30-60 kunye ne-eGFR <30.
(3) Izigulane kwiqela lokujonga zinomngcipheko ophezulu wokufa kunye nonyango olulondolozayo lodwa.
(4) Uphando olongezelelweyo luyafuneka ukuphuhlisa imodeli yokukhetha izigulane eziza kuzuza kakhulu kunyango olungenayo okanye olulondolozayo.
(5) Ukulinganiselwa kolu cwaningo kubandakanya ukungafani kwenani lezigulane kumaqela okufunda, ukungabikho kwedatha ye-hemodynamic kunye ne-angiographic ngokwe-eGFR, kunye nokuba kungenzeka ukuba ezinye izifundo zibandakanya izigulane ezine-angina pectoris ezingazinzanga ngaphandle kwe-NSTEMI.
Nangona ukuqhubela phambili kwezobuchwepheshe kwi-cardiology, ukutshatyalaliswa kwe-cardiogenic njengengxaki ye-acute myocardial infarction ihlala ingumngeni wezonyango.Kutshanje, i-National Cardiogenic Shock Management Standardization Campaign yasungulwa e-United States, kwaye i-National Cardiogenic Shock Initiative ijolise ekuphuculeni ubomi, ngakumbi kwizigulane. kunye ne-acute coronary syndrome (ACS) .Injongo yethu yayikukufumanisa indlela i-cardiogenic shock yesibini kwi-ACS efuna ukuxhaswa kwe-mechanical circulatory ilawulwa kwiziko lethu kunye nokuthelekisa iimpawu zeklinikhi phakathi kwabasindileyo nabangengabo.
Uphononongo olwenziwa emva kwezigulane ezineminyaka eyi-18 ukuya kwengama-89 eminyaka efuna inkxaso yethutyana yokujikeleza komatshini kwindawo ye-ACS kwiZiko lezoNyango leYunivesithi yaseTexas Lubbock ukusuka ngo-Agasti 2018 ukuya ku-Agasti ka-2019. Uvavanyo olusisixa lusetyenziselwe ukuguquguquka ngokweendidi kunye nokuqhubekayo.
Izigulane ze-39 zizonke zibandakanyiwe, i-90% yayingamadoda, iminyaka yobudala yayiyi-62 iminyaka, i-62% inesifo sikashukela, kwaye i-index mass body mass yayiyi-29.01 ± 5.84 kg / m2.I-Intra-aortic balloon pump yayiyeyona nto isetyenziswa ngokuqhelekileyo. isixhobo sokuxhasa, esilandelwa yi-Impella (92% vs 8%).Izinga lokufa lilonke laliyi-18%.Izinga eliphezulu lentliziyo kunye ne-lactate ekumkelwe ngexesha lokusetyenziswa kwenkxaso yomatshini kwakudityaniswa nokufa (105 bpm vs 83.91 bpm, p=0.02) (6.85) mmol / l vs 2.55 mmol / lp, 0.003. I-Percutaneous coronary intervention (PCI) Ubukho benkxaso yangaphambili ye-mechanical okanye i-coronary artery bypass grafting (CABG) kwi-44% yezigulane yayidibene nokuphila (53% vs 0% p = 0.01) .
Ukuphakama kwentliziyo kunye namanqanaba e-lactate ngexesha lokubekwa kwenkxaso yomatshini kudibaniswa nokufa kwizigulane ezine-cardiogenic shock secondary to acute coronary syndrome.Ukuqaliswa kwenkxaso yomatshini ngaphambi kokuba i-PCI idibaniswe nokusinda.Izifundo ezinkulu kunye nezingqongqo zifunekayo ukucacisa le mibutho.
Ukulawula i-hidradenitis suppurativa (HS) ingaba ngumngeni.Kwiimeko ezininzi, iimpawu zezigulane ziphuculwe emva kokungenelela kokuqala kolondolozo.Ngelishwa, ezinye iimeko ziba yi-refractory kwaye zikhokelela ekubuyiseleni izimonyo kunye nobuhlungu.Utyando luhlala lusetyenziselwa ukuchithwa okanye ukususa izicubu ezichaphazelekayo ukukhuthaza ukuphilisa .Sichaza isigulana ebesingafuni utyando esathi senziwe unyango lweradiation ye-electron beam.
Indoda eneminyaka engama-44 ubudala ibonakaliswe ukutyeba kweempundu, i-gluteal cleft, iperineum, kunye nethanga lamazwe amabini i-HS. Isigulana sasingafuni ukuchithwa ngotyando kunye nonyango ngamayeza okubulala iintsholongwane kunye ne-corticosteroids. idosi iyonke ye-30 Gy kwi-10 iidosi ezahluliweyo kwaye igcine impendulo engaphelelanga kwiiveki ezi-2 emva kokuqala konyango.Uvavanyo lomzimba olunenjongo ngaphakathi kwenyanga ye-1 yonyango lubonise ukuncipha kwe-25% kwindawo yonke yokuvuvukala kunye nokuphawulwa komgangatho ophakanyisiweyo. iindawo.Ngelo xesha, izigulane zichaze ukunciphisa i-subjective kwiintlungu kunye nokukhupha amanzi.Impendulo yayibhekwa njengento ehlala ixesha elide kwi-6 kunye neenyanga ze-12 emva kwonyango.
Unyango lweradiation luneenzuzo ze-anecdotal kwiintlobo ngeentlobo zezifo ezinobungozi kwaye zifundwe kwiidosi eziphantsi (ngamanye amaxesha iidosi enye) kulawulo lwe-HS.Sikhethe ukusebenzisa ikhosi yokwahlula esikholelwa ukuba yeyona ikhuselekileyo kwaye mhlawumbi ithatha ixesha elide ngokwemigaqo ukunciphisa iziphumo ebezingalindelekanga.
Indawo yonyango yesigulane ebonisa i-hidradenitis suppurativa kwi-buttocks, i-gluteal cleft, i-perineum kunye namathanga amabini ngaphambi kokuba unyango
Unyango lwemitha ye-electron engaphezulu lusebenza ekunyangeni izifo ezinobungozi kwaye lunesithembiso se-HS.Izifundo zedosi iyonke kunye neerejimeni zokwahlulwa ziyafuneka ukuze kwandiswe kwaye kukhokele ukusetyenziswa kwexesha elizayo.
Kubemi base-US jikelele, i-1 kubantu be-5,000 bane-mitochondrial myopathy.Izibonakaliso zekliniki zingahlulwa ngokufanelekileyo zibe ngamacandelo amathathu: i-ophthalmoplegia yangaphandle eqhubekayo, i-skeletal-CNS syndrome okanye i-myopathy elula.Ukukhubazeka kwentliziyo kwenzeka kwi-30-32% yamatyala, ngokukodwa njengoko I-hypertrophic cardiomyopathy, i-dilated cardiomyopathy, okanye i-conduction abnormalities.Sibonisa imeko yobuthathaka obungaphantsi kwe-bilateral, intlungu, kunye nokuvuvukala kunye nokuxilongwa kwe-muscle biopsy ye-mitochondrial myopathy.Inkcazo yecala: Umfundi oneminyaka engama-21 ubudala ophumeleleyo wathunyelwa kwisibhedlele sethu. emva kweeveki ze-3 zobuthathaka bomlenze, intlungu, kunye nokuvuvukala emva kokufika e-United States evela e-Indiya. Ukuhlolwa kwabonisa i-tachycardia, i-2 + amaphuzu e-pitting edema emadolweni omabini, i-4 / 5 ubuthathaka bebakala le-MRC, ububele obumnene kumaqela e-proximal kunye ne-distal muscle. kwimida ephezulu kunye nesezantsi, akukho reflexes ye-tendon enzulu, i-foot drop, kunye ne-ptosis ye-bilateral kunye nokunciphisa ukunyakaza kwe-extraocular.Iziphumo zebhubhoratri zangaphambili zibonise ukuba i-creatinine kinase yanda nge-691 IU / L, i-peptide yengqondo ye-natriuretic yanda nge-3437 pg / mL, i-troponin yanda nge-47.1 ng/L, i-myoglobin inyuke nge-195 ng/mL, kwaye i-lactate yonyuka nge-7.7 mmol / L, i-serum bicarbonate yehle nge-12 mmol/L.Iziphumo zokugqobhoza kweLumbar ekucingelwa ukuba yi-Guillain-Barre syndrome ayithembekanga ngenxa yeetephu ezibuhlungu. ukutenxa kunye nebloko ye-bundle yangaphambili ekhohlo.I-X-ray yesifuba kunye ne-CT angiography yesifuba / isisu / i-pelvis ibonise ukwanda kwentliziyo kunye nomthamo ogqithiseleyo. isigulana sangeniswa kwigumbi labagula kakhulu ngenxa yokuhla koxinzelelo olukhulu oluphefumlayo.I-Ophthalmology iqinisekisile i-ophthalmoplegia, ngaphandle kwe-cranial nerve palsy, i-myasthenia gravis, kunye ne-retinitis pigmentosa.I-Gq1b ye-antibody negative.I-autoimmune ebanzi kunye ne-infectious workup ayifaki galelo. i-rectus femoris muscle yesigulane ibonise i-blue and cytochrome-c oxidase-negative fibers ene-perimuscular and endomysial connective tissue, ehambelana ne-mitochondrial myopathy esebenzayo kunye nengapheliyo. I-Endomyocardial biopsy ibonise i-lymphocytic myocarditis esebenzayo. I-metoprolol, kunye ne-methylprednisolone.
I-Myopathy kufuneka ithathelwe ingqalelo kwi-diagnostic ehlukeneyo yezigulane ezine-syndrome ekrokrelwayo ye-Guillain-Barre.Sichaza imeko enomdla ye-myopathy kunye nokubonakaliswa kwentliziyo eveleleyo.I-Myositis ebonakalisa njenge-myocarditis kufuneka iphakamise ukukrokrelwa kwesifo se-mitochondrial.Amava ethu agxininisa ukubaluleka kokusebenzisa iqela le-interdisciplinary team. indlela yokuxilonga ii-pathologies ezinqabileyo ngokubandakanyeka kweendlela ezininzi ezahlukeneyo.
Injongo yolu phononongo yayikukuphonononga ukuba kunokwenzeka ukuxilonga i-Gaisbock kwizigulane ezine-polycythemia engapheliyo kunye noxinzelelo lwegazi.
Indoda eneminyaka engama-40 ubudala yaseCaucasian yangeniswa esibhedlele ngokudumba komlenze okonyukayo kunye nemfuno yeoksijini eyongeziweyo emva kweeveki ezimbini zokulaliswa esibhedlele nge-COVID-19 pneumonia. iminyaka elishumi kwiindwendwe ezininzi.Imbali yonyango yakutsha nje ibandakanya ukuxilongwa kwe-vein thrombosis (DVT) emlenzeni omnye kwiinyanga ezimbini ezinesiqingatha ezidlulileyo, kunye nonyango ngeXarelto.
Isigulane sichaze imbali ye-12 yeminyaka ye-testosterone ephantsi.Nangona kunjalo, akazange asebenzise naziphi na izongezo ze-testosterone kwiinyanga ezilithoba ezidlulileyo.Wachaza ukukhathala kwemini, ukuvuswa rhoqo ebusuku, kunye nokurhona rhoqo.Esi sigulane asizange sibe nesifundo sokulala okanye wasebenzisa i-CPAP.Isigulana satshaya isiqingatha secuba sokuhlafuna ngosuku nge-13 iminyaka elandelelanayo, ipakethe enye ngosuku, iminyaka eyi-10 elandelelanayo, kwaye wayeka ukutshaya iminyaka eyi-12 edlulileyo. Wachitha ixesha elininzi lobomi bakhe esenza umsebenzi onzima kwishishini lokwakha.
Ixesha lokuposa: Jun-29-2022