CHANGES OF PLASMA ENDOTHELIN CONCENTRATIONSBEFORE AND AFTER PERCUTANEOUS BALLOONMITRAL VALVULOPLASTY IN PATIENTSWITH MITRAL S

ＣＨＡＮＧＥＳＯＦＰＬＡＳＭＡＥＮＤＯＴＨＥＬＩＮＣＯＮＣＥＮＴＲＡＴＩＯＮＳＢＥＦＯＲＥＡＮＤＡＦＴＥＲＰＥＲＣＵＴＡＮＥＯＵＳＢＡＬＬＯＯＮＭＩＴＲＡＬＶＡＬＶＵＬＯＰＬＡＳＴＹＩＮＰＡＴＩＥＮＴＳＷＩＴＨ　ＭＩＴＲＡＬＳＴＥＮＯＳＩＳＹｉｎＲｕ...     

SERUM AMYLOID P COMPONENT NOT ASSOCIATED WITH C4B一BINDING PROTEIN IN HUMAN SERUM SHOWN BY CROSSED IMMUNOELECTROPHORESIS IN TH

ＳＥＲＵＭＡＭＹＬＯＩＤＰＣＯＭＰＯＮＥＮＴＮＯＴＡＳＳＯＣＩＡＴＥＤＷＩＴＨＣ４Ｂ一ＢＩＮＤＩＮＧＰＲＯＴＥＩＮＩＮＨＵＭＡＮＳＥＲＵＭＳＨＯＷＮＢＹＣＲＯＳＳＥＤＩＭＭＵＮＯＥＬＥＣＴＲＯＰＨＯＲＥＳＩＳＩＮＴＨＥＰＲＥＳＥＮＣＥＯＦＣＡＬＣＩＵ...     

DETECTION OF BORRELIA BURGDOFERI DNA IN GRANULOMATOUS TISSUES FROM PATIENTS WITH SARCOIDOSIS USING POLYMERASE CHAIN REACTION

ＤＥＴＥＣＴＩＯＮＯＦＢＯＲＲＥＬＩＡＢＵＲＧＤＯＦＥＲＩＤＮＡＩＮＧＲＡＮＵＬＯＭＡＴＯＵＳＴＩＳＳＵＥＳＦＲＯＭＰＡＴＩＥＮＴＳＷＩＴＨＳＡＲＣＯＩＤＯＳＩＳＵＳＩＮＧＰＯＬＹＭＥＲＡＳＥＣＨＡＩＮＲＥＡＣＴＩＯＮＩＮＳＩＴＵＴＥＣＨＮＩＱＵＥＸ...     

INTEGRATION OF TRADITIONAL AND MODERN METHODS IN THE IDENTIFICATION OF AFB CULTURES ISOLATED FROM CLINICAL SPECIMENS OF PATIE

ＩＮＴＥＧＲＡＴＩＯＮＯＦＴＲＡＤＩＴＩＯＮＡＬＡＮＤＭＯＤＥＲＮＭＥＴＨＯＤＳＩＮＴＨＥＩＤＥＮＴＩＦＩＣＡＴＩＯＮＯＦＡＦＢＣＵＬＴＵＲＥＳＩＳＯＬＡＴＥＤＦＲＯＭＣＬＩＮＩＣＡＬＳＰＥＣＩＭＥＮＳＯＦＰＡＴＩＥＮＴＳＷＩＴＨＳＫＩＮＤＩＳＥＡＳ...     

EFFECTS OF SYSTEMIC FLUCONAZOLE THERAPY ON IN VITRO ADHESION OF CANDIDA ALBICANS TO BUCCAL EPITHELIAL CELLS AND CHANGES OF TH

ＥＦＦＥＣＴＳＯＦＳＹＳＴＥＭＩＣＦＬＵＣＯＮＡＺＯＬＥＴＨＥＲＡＰＹＯＮＩＮＶＩＴＲＯＡＤＨＥＳＩＯＮＯＦＣＡＮＤＩＤＡＡＬＢＩＣＡＮＳＴＯＢＵＣＣＡＬＥＰＩＴＨＥＬＩＡＬＣＥＬＬＳＡＮＤＣＨＡＮＧＥＳＯＦＴＨＥＣＥＬＬＳＵＲＦＡＣＥＰＲＯＴＥＩＮ...     

IMPORTANCE OF ATRIAL CONTRIBUTION TO LEFT VENTRICULAR FILING IN MITRAL STENOSIS BEFORE AND AFTER BALLOON VALVULOPLASTY

ＩＭＰＯＲＴＡＮＣＥＯＦＡＴＲＩＡＬＣＯＮＴＲＩＢＵＴＩＯＮＴＯＬＥＦＴＶＥＮＴＲＩＣＵＬＡＲＦＩＬＩＮＧＩＮＭＩＴＲＡＬＳＴＥＮＯＳＩＳＢＥＦＯＲＥＡＮＤＡＦＴＥＲＢＡＬＬＯＯＮＶＡＬＶＵＬＯＰＬＡＳＴＹＹｕＪｉｎｄｅ（于金德）；ＧｏｎｇＬａｎｓｈ...     

COMPARISON OF FOUR METHODS TO GENERATE IMMUNOREACTIVE FRAGMENTS OF A MURINE MONOCLONAL ANTIBODY OC859 AGAINST HUMAN OVARIAN E

ＣＯＭＰＡＲＩＳＯＮＯＦＦＯＵＲＭＥＴＨＯＤＳＴＯＧＥＮＥＲＡＴＥＩＭＭＵＮＯＲＥＡＣＴＩＶＥＦＲＡＧＭＥＮＴＳＯＦＡＭＵＲＩＮＥＭＯＮＯＣＬＯＮＡＬ　ＡＮＴＩＢＯＤＹＯＣ８５９ＡＧＡＩＮＳＴＨＵＭＡＮＯＶＡＲＩＡＮＥＰＩＴＨＥＬＩＡＬＣＡＮＣＥＲＡ...     

A COMPARATIVE STUDY OF INTRAVENOUS ACCELERATED STREPTOKINASE DOSE REGIMEN WITH CONVENTIONAL DOSE REGIMEN FOR CORONARY THROMBO

ＡＣＯＭＰＡＲＡＴＩＶＥＳＴＵＤＹＯＦＩＮＴＲＡＶＥＮＯＵＳＡＣＣＥＬＥＲＡＴＥＤＳＴＲＥＰＴＯＫＩＮＡＳＥＤＯＳＥＲＥＧＩＭＥＮＷＩＴＨＣＯＮＶＥＮＴＩＯＮＡＬＤＯＳＥＲＥＧＩＭＥＮＦＯＲＣＯＲＯＮＡＲＹＴＨＲＯＭＢＯＬＹＳＩＳＸｕＣｈｅｎｇｂｉｎ...     

EFFECT OF EXCITATORY AMINO ACIDS．Ca~（2＋） ON DELAYED NEURONAL DEATH IN HIPPOCAMPUS FOLLOWING TRANSIENT FOREBRAINISCHEMIA IN GE

ＥＦＦＥＣＴＯＦＥＸＣＩＴＡＴＯＲＹＡＭＩＮＯＡＣＩＤＳ．Ｃａ~（２＋）ＯＮＤＥＬＡＹＥＤＮＥＵＲＯＮＡＬＤＥＡＴＨＩＮＨＩＰＰＯＣＡＭＰＵＳＦＯＬＬＯＷＩＮＧＴＲＡＮＳＩＥＮＴＦＯＲＥＢＲＡＩＮＩＳＣＨＥＭＩＡＩＮＧＥＲＢＩＬＳ￥ＸｕＣｈａｎｇｑｉ?..     

IMPLANTATION OF AUTOLOGOUS SKIN FIBROBLAST GENETICALLY MODIFIED TO SECRETE CLOTTING FACTOR IX PARTIALLY CORRECTS THE HEMORRHA

ＩＭＰＬＡＮＴＡＴＩＯＮＯＦＡＵＴＯＬＯＧＯＵＳＳＫＩＮＦＩＢＲＯＢＬＡＳＴＧＥＮＥＴＩＣＡＬＬＹＭＯＤＩＦＩＥＤＴＯＳＥＣＲＥＴＥＣＬＯＴＴＩＮＧＦＡＣＴＯＲＩＸＰＡＲＴＩＡＬＬＹＣＯＲＲＥＣＴＳＴＨＥＨＥＭＯＲＲＨＡＧＩＣＴＥＮＤＥＮＣＩＥＳＩＮ...     

经皮二尖瓣球囊扩张术后氨基末端B型利钠肽前体和肺毛细血管楔压的变化

目的研究经皮二尖瓣球囊扩张术(PBMV)后患者氨基末端B型利钠肽前体(NT-proBNP)与血流动力学变化的关系。方法采用快速NT-proBNP试验法检测58例成功施行PBMV的风湿性二尖瓣狭窄患者术前及术后1h、2h、24h血浆NT-proBNP浓度变化,术前及术后即刻测平均左房压(MLAP),同时行Swan-Ganz漂浮导管,测定肺毛细血管楔压(PCWP),彩色多普勒超声诊断仪测定二尖瓣口面积(MVA)和左房内径(LAD)及左室射血分数(LVEF)。将患者血浆NT-proBNP浓度与PCWP等血流动力学参数作相关分析。结果术后即刻测MLAP较术前比较差异有统计学意义([34.61±4.02]mmHg:[14.96±3.88]mmHg);术后24hLAD和MVA与术前比较P<0.01(术前分别为:[46.92±5.69]mm,[0.98±0.22]cm2,术后24h分别为:[41.24±7.32]mm,[1.43±0.30]cm2);术前和术后LVEF变化P=0.156(术前为[35.3±4.3]%,术后为[36.7±2.6]%);术后1h、2h、24h血浆NT-proBNP浓度变化、PCWP变化和术前比较有统计学意义(P<0.01);相关性分析显示,术后24h的NT-proBNP变化(ΔNT-proBNP)与MLAP变化(ΔMLAP)呈显著正相关(r=0.37,P<0.05);术后24h的NT-proBNP变化(ΔNT-proBNP)与MVA的扩大值(ΔMVA)及LAD的变化(ΔLAD)无相关性(分别为r=-0.047,P>0.05;r=0.036,P>0.05)。术后2h,NT-proBNP变化(ΔNT-proBNP)与PCWP变化(ΔPCWP)呈显著正相关(r=0.68,P<0.01)。结论风湿性二尖瓣狭窄患者血浆NT-proBNP水平的升高和左房压,PCWP升高显著相关。NT-proBNP水平对反映PBMV术后左房功能有重要意义。     

经皮二尖瓣球囊成形术前后RAAS的变化

对１７例风湿性心脏病二尖瓣狭窄患者经皮二尖瓣球囊成形术术前和术后一周分别检测血浆肾素（ＰＲＡ）、血管紧张素Ⅱ（ＡＴ－Ⅱ）和醛固酮（ＡＬＤ）。结果表明：术前ＰＲＡ，ＡＴ－Ⅱ和ＡＬＤ明显高于对照组；术后血流动力学明显改善，并伴有ＡＴ－Ⅱ和ＡＬＤ水平显著降低（Ｐ＜０．０５）。ＡＴ－Ⅱ下降与左房压下降呈弱正相关（ｒ＝０．４３ｌ）。揭示在心功能不全早期已有肾素－血管紧张素－醛固酮系统（ＲＡＡＳ）过度激活；术后，在血流动力学改善的同时，ＲＡＡＳ也有相应改变。     

再次经皮球囊二尖瓣成形术临床效果观察

目的观察再次经皮球囊二尖瓣成形术(PBMV)治疗PBMV后二尖瓣再狭窄的临床效果。方法 82例PBMV后二尖瓣再狭窄的病人,再次采用我科小弧度法PBMV治疗,并进行近远期疗效随访。结果 82例病人经再次PBMV治疗后,成功78例,成功率为95.1%。术后病人左心房平均压、二尖瓣口面积、跨瓣压差、肺动脉收缩压明显改善,与术前比较差异有显著性(t=2.35~4.76,P均<0.05);而左心房内径无明显改变(t=1.54,P>0.05)。78例病人术后随访(76±23)个月,结果二尖瓣口面积仍明显大于再次PBMV术前,跨瓣压差明显小于再次PBMV术前(t=2.16~3.68,P<0.05),且与术后即刻结果比较差异均无显著性(t=1.24~1.59,P均>0.05),大多数病人临床症状和生活质量明显改善。结论对于PBMV后再狭窄的病人,只要病例选择适当,手术操作正确,再次PBMV后即刻及远期疗效好。     

经皮二尖瓣球囊成形术对N-心钠素 和降钙素基因相关肽分泌的影响

探讨经皮二尖瓣球囊成形术（ＰＢＭＶ）对Ｎ－心钠素（Ｎ－ＡＮＰ）和降钙素基因相关肽（ＣＧＲＰ）分泌的 影响。方法：研究了２４例二尖瓣狭窄（ＭＳ）患者ＰＢＭＶ前后血浆Ｎ－ＡＮＰ和ＣＧＲＰ浓度的变化,两者的相关性,并研 究了Ｎ－ＡＮＰ与平均二尖瓣跨瓣压差（ＭＭＰＧ）、二尖瓣口面积（ＭＶＡ）、左房内径（ＬＡＤ）及血流动力学参数作相关分 析。结果：患者术前血浆Ｎ－ＡＮＰ浓度高于对照组（Ｐ＜０．００１）,术后显著下降（与术前比较,Ｐ＜０．００１）,但仍高于 对照组（Ｐ＜０．００１）;而ＣＧＲＰ水平则呈相反变化,Ｎ－ＡＮＰ与ＣＧＲＰ的血浆水平呈显著负相关（ｒ＝－０．４７２５,Ｐ＜ ０．０５）。血浆Ｎ－ＡＮＰ改变量（△Ｎ－ＡＮＰ）与ＭＭＰＧ改变量（△ＭＭＰＧ,ｒ＝０．６７７０,Ｐ＜０．００５）、ＬＡＤ的改变量（△ＬＡＤ,ｒ＝ ０．４７０４,Ｐ＜０．０２５）及平均左房压改变量（△ＭＬＡＰ,r＜＝０．７２７２,Ｐ＜０．００５）均呈正相关,与ＭＶＡ的改变量（△ＭＶA）呈 负相关（ｒ＝－０．６４５１,Ｐ＜０．００５）。结论：Ｎ－ＡＮＰ和ＣＧＲＰ在ＭＳ引起的病理生理改变中起重要作用,测定Ｎ－ＡＮＰ 和ＣＧＲＰ变化有可能作为判定ＮＳ狭窄程度及Ｐ?     

经皮球囊二尖瓣成形术15例报告

对１５例二尖瓣狭窄患者行经皮球囊二尖瓣成形术，１４例成功，１例因巨大右房致房间隔穿刺失败。房间隔穿刺采用Ｒｏｓｓ法，房间隔穿刺成功的标志以压力监测出现左房压力波形最为可靠。术后心尖部舒张期杂音均消失或减弱，心功能恢复Ⅰ级～Ⅱ级，血液动力学改善，二尖瓣口面积增大。严重并发症为二尖瓣重度返流，因此应根据身高选择球囊直径，采取逐步加大球囊直径进行扩张，对瓣膜本身病变严重者应选用较小直径球囊。     

The effect of transient balloon occlusion of the mitral valve on left atrial appendage blood flow velocity and spontaneous echo contrast: a comparison in sinus rhythm and atrial fibrillation patients

Objective To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm.Methods Thirty-five patients （21 in sinus rhythm and 14 in atrial fibrillation ） with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring. We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation. Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14 cm/s to 6±2 cm/s at peak balloon inflation and increased to 40±16 cm/s after balloon deflation. Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P&lt;0.001).During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P&lt;0.01).And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation. Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm.At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations.SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%). At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P&lt;0.05). LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P&lt;0.01). The mean time to achieve maximal SEC grade (2.5±1.2 s) correlated with the mean time to trough LAA velocities (2.3±1.1 s ) after balloon inflation. Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2.6±1.1 s vs 1.7±1.0 s, P&lt;0.05 and 2.8±1.4 s vs 1.9±1.3 s, P&lt;0.05, respectively).Upon deflation, the mean time to lowest SEC grade (2.9±1.8 s) correlated with the mean time to achieve maximal LAA velocities (2.7±1.6 s).Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2.0±1.6 s vs 3.5±1.5 s, P&lt;0.01 and 2.2±1.7 s vs 3.6±1.6 s, P&lt;0.05). Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients.Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm.     

分级次二尖瓣球囊成形术治疗重度二尖瓣狭窄的临床分析

目的观察分级次扩张法行经皮二尖瓣球囊成形术（PBMV）治疗风湿性心脏病重度二尖瓣狭窄（MS）的临床疗效。方法对38例风湿性心脏病重度MS病人采用分级次扩张法PBMV并对结果进行分析。结果术后肺动脉平均压、左房平均压、二尖瓣跨瓣压显著下降（P〈0．001），左房内径明显缩小（P〈0．05），二尖瓣口面积显著扩大（P〈0．001），操作相关并发症少。结论分级次扩张法PBMV治疗重度MS疗效好，成功率高．严重并发症少。     

经皮球囊二尖瓣成形术对P波离散度的影响

目的评价经皮球囊二尖瓣成形术（PBMV）对P波离散度（PWD）等心电学指标的影响。方法选择31例拟行PBMV术的风湿性心脏病（简称风心病）二尖瓣狭窄患者。于术前1d、术后1-2d、术后4—6月通过12导联同步心电图、心脏超声分别测出PWD、P波最大时限（Pmax）、P波最小时限（Pmin）、左房内径（LAD）、二尖瓣口面积（MVA）、平均二尖瓣跨瓣压差（MMG）。手术过程中在球囊扩张前后通过球囊导管测出平均左房压力（MLAP）。结果PWD、Pmax、Pmin术后较术前显著减小，术后4-6月较术后1-2d也有显著减小。术后1-2dPWD、Pmax、Pmin减小量与LAD、MMG、MLAp、MVA改善程度无显著相关性（均P〉0．05）。结论PWD、Pmax、Pmin的持续减小显示出PBMV术对风心病二尖瓣狭窄患者的良好效果。     

经皮球囊扩张术治疗风湿性二尖瓣狭窄的临床疗效

目的评价经皮球囊扩张术(PBMV)治疗风湿性二尖瓣狭窄的临床疗效.方法82例风湿性二尖瓣狭窄患者行胸前超声心动图(TTE)检查,对二尖瓣病变行Wilkin法评分(16分制),合并心房纤颤(AF)患者,再行食道超声心动图(TEE)检查,评分≤11分入选.手术采用改良Inove法,术前、后48～72 h分别测定二尖瓣口面积(MVA)、二尖瓣口跨瓣压差(MVPG)、左房内径(LAD)、二尖瓣返流(MR),术中测左房压力(LAP).AF者术后口服乙胺碘呋酮基础上电复律.结果术后MLAP及MVPG均较术前显著降低(P均＜0.01),MVA较术前明显增加(P＜0.01).而LAD在手术前后无显著变化(WT5"BX P).结论PBMV是治疗风湿性二尖瓣狭窄有效而可靠方法.