致心律失常型右室心肌病临床分析

致心律失常型右室心肌病，旧称致心律失常右室发育不良，其特征为右室心肌进行性被纤维脂肪组织所置换，早期呈典型的区域性，逐渐可累及整个右心室甚至部分左心室，而室间隔很少受累。     

致心律失常性右室心肌病患者的护理

致心律失常性右室心肌病（ARVC）是一种以心律失常、心力衰竭及心源性猝死为主要表现的非炎性非冠状动脉性心肌疾病,多见于青少年时期。患者右心室常存在功能及结构异常,以右室心肌,特别是右室游离壁心肌逐渐被脂肪及纤维组织替代为特征。尽管心力衰竭是疾病晚期的重要并发症,但ARVC主要表现为室性心律失常和心源性猝死（SCD）。交感刺激是已知的心律失常促发因素,而过度的机械负荷可加重疾病的进程。     

护理随访对3例致心律失常性右室心肌病患者焦虑心理的影响研究

正致心律失常性右室心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)是一种以心律失常、心力衰竭及心源性猝死为主要表现的非炎性非冠状动脉性心肌疾病,多见于青少年时期。患者右心室常存在功能及结构异常,以右室心肌,特别是右室游离壁心肌逐渐被脂肪及纤维组织替代为特征。尽管心力衰竭是疾病晚期的重要并发症,但ARVC主要表现为室性心律失常和心源性猝死~([1])。其患病率约为1∶1000~1∶5000,青年     

致心律失常性右室性心肌病1例

致心律失常性右室性心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)是以室性心律失常和右室特殊的病理改变为特征一种疾病，j临床较为少见，我们遇到1例，报告如下。     

心脏移植术后心内膜心肌活检的临床病理研究

目的 总结分析心脏移植术后心内膜心肌活检(EMB)的临床病理学特征。方法 对14例心脏移植手术患者的49次EMB进行光镜观察，并结合临床资料和相关文献进行分析。结果14例中6例出现急性排斥反应，其中3例仅有1级排斥反应，3例具有1～3级排斥反应。后3例中有2例无明显临床症状，仅外周血淋巴细胞绝对数有一定程度增高，供受体混合淋巴细胞培养检查结果阳性。结论 EMB是诊断心脏移植术后急性排斥反应的“金标准”；结合临床症状、外周血淋巴细胞绝对数检测和供受体混合淋巴细胞培养可减少EMB的检查次数。     

结缔组织生长因子在大鼠心脏移植慢性排斥反应中的表达及意义

背景：慢性排斥反应限制了心脏移植患者的长期存活．有报道结缔组织生长因子因其与细胞增殖和胶原合成有关，似乎参与了此过程。 目的：假设结缔组织生长因子在大鼠心脏移植慢性排斥反应中发挥作用，实验拟验证其表达与心脏慢性排斥反应病理过程的关系。 设计、时间及地点：随机对照动物实验，于2007—04／08在中南大学湘雅二医院动物实验中心完成。 材料：取20只Wistar大鼠作为供体，20只SD大鼠作为受体，制作腹部异位心脏移植模型20例次；另选择10只Wistar大鼠作为对照。 方法：大鼠腹部异位心脏移植术后，给予环孢素A、霉酚酸酯和甲泼尼龙三联免疫抑制治疗。移植后2．8周分别按随机数字表法麻醉后处死10只受体大鼠．取心脏；10只Wistar大鼠心脏作为对照。 主要观察指标：采用苏木精-伊红染色及Van Gieson染色观察心肌病理形态、心肌血管密度及心脏血管狭窄程度：并进行心肌纤维化半定量评分。采用免疫组织化学法检测心肌组织结缔组织生长因予蛋自的表达：并分析结缔组织生长因子表达与慢性排斥反应过程中心肌血管病变及纤维化的相关性。 结果：①术后8周移植心脏血管狭窄程度、心肌纤维化评分及结缔组织生长因子蛋白表达量明显高于术后2周及正常心脏（P〈0．05-0．01）；术后8周移植心脏血管密度低于正常心脏（P〈0．05）；结缔组织生长因子在正常心脏基本没有表达。②心肌组织结缔组织生长因子蛋白表达灰度值与心肌纤维化、血管狭窄程度均呈负相关（r=0．734，-0．713，P〈0．01），表明结缔组织生长因子表达与心肌纤维化及血管狭窄程度呈正相关。结论：结缔组织生长因子在有心肌血管病变的移植心畦心肌组织中表达增强，其表达与心肌纤维化和心肌血管病变形成有关，在心肌移植排斥反应的病理过程中起重要作用。     

大鼠颅脑损伤后心肌损害及血浆和心肌血管紧张素的变化

背景颅脑损伤可以引起一系列的内脏并发症,其中心血管并发症日益引起人们的重视.目的探讨颅脑损伤所致循环和心脏局部血管紧张素Ⅱ及心脏局部血管紧张素Ⅱ1型受体水平的变化.设计随机对照动物实验.单位首都医科大学附属北京天坛医院和首都医科大学基础医学院.材料实验于2003/2004在首都医科大学中心实验室和北京天坛医院中心实验室进行.健康雌性Wistar大鼠40只,随机分为颅脑损伤组和对照组两组,每组20只.方法颅脑损伤组用局部重物撞击法建立大鼠颅脑损伤模型,对照组不打击.在撞击即时点后24 h取材,每组10只用于血管紧张素Ⅱ及其1型受体检测,另外10只用于心肌病例形态观察.主要观察指标①用均相竞争放免法测定血浆血管紧张素Ⅱ水平.②采用免疫组织化学方法检测心肌血管紧张素Ⅱ及其1型受体的表达.③采用酶反应速率法测定血清肌酸磷酸激酶同工酶活性.④苏木精-伊红染色,光镜,透射电镜观察大鼠心肌超微结构等病理形态学改变.结果40只大鼠进入结果分析.①血浆血管紧张素Ⅱ水平颅脑损伤组明显高于对照组[(965.52±176.71),(485.03±86.13)ng/L,P＜0.05].②血清肌酸磷酸激酶同工酶活性颅脑损伤组显著高于对照组[(12.77±4.07),(3.49±1.55)μkat/L,P＜0.05].③心肌血管紧张素Ⅱ及其1型受体的表达颅脑损伤组的阳性反应物面积与灰度值均高于对照组(P＜0.05).④苏木精-伊红染色颅脑损伤组心肌细胞胞浆强嗜酸性染色,明显的胞质皱缩,肌纤维断裂、减少或消失,可见心肌局灶性水样变性、溶解或坏死.超微结构的病理观察均见心肌病理损害.结论大鼠颅脑损伤可导致心肌损害的发生,血管紧张素系统变化可能是其因素之一.     

大鼠颅脑损伤后心肌损害及血浆和心肌血管紧张素的变化

背景：颅脑损伤可以引起一系列的内脏并发症，其中心血管并发症日益引起人们的重视。目的：探讨颅脑损伤所致循环和心脏局部血管紧张素Ⅱ及心脏局部血管紧张素Ⅱ1型受体水平的变化。设计：随机对照动物实验。单位：首都医科大学附属北京天坛医院和首都医科大学基础医学院。材料：实验于2003／2004在首都医科大学中心实验室和北京天坛医院中心实验室进行。健康雌性Wistar大鼠40只，随机分为颅脑损伤组和对照组两组，每组20只。方法：颅脑损伤组用局部重物撞击法建立大鼠颅脑损伤模型，对照组不打击。在撞击即时点后24h取材，每组10只用于血管紧张素Ⅱ及其1型受体检测，另外10只用于心肌病例形态观察。主要观察指标：①用均相竞争放免法测定血浆血管紧张素Ⅱ水平。②采用免疫组织化学方法检测心肌血管紧张素Ⅱ及其1型受体的表达。③采用酶反应速率法测定血清肌酸磷酸激酶同工酶活性。④苏木精-伊红染色，光镜，透射电镜观察大鼠心肌超微结构等病理形态学改变。结果：40只大鼠进入结果分析。①血浆血管紧张素Ⅱ水平：颅脑损伤组明显高于对照组[（965．52&;#177;176．71），（485．03&;#177;86．13）ng／L，P〈0．05]。②血清肌酸磷酸激酶同工酶活性：颅脑损伤组显著高于对照组[（12．77&;#177;4．07），（3．49&;#177;1．55）μkat／L，P〈0．05]。③心肌血管紧张素Ⅱ及其1型受体的表达：颅脑损伤组的阳性反应物面积与灰度值均高于对照组（P〈0．05）。④苏木精-伊红染色颅脑损伤组心肌细胞胞浆强嗜酸性染色。明显的胞质皱缩，肌纤维断裂、减少或消失，可见心肌局灶性水样变性、溶解或坏死。超微结构的病理观察均见心肌病理损害。结论：大鼠颅脑损伤可导致心肌损害的发生，血管紧张素系统变化可能是其因素之一。     

MR心肌延迟增强扫描在常见非缺血性心脏病中初步应用

目的研究常见非缺血性心脏病患者心肌病变的磁共振心肌延迟强化的影像学特征。方法回顾性分析25例非缺血性心脏病患者的磁共振心肌延迟强化特点及相应临床表现。结果 25例患者中9例患者心肌病变未出现延迟强化。6例为病毒性心肌炎,4例出现左室后壁、下壁心外膜下心肌可见斑片状延迟强化,1例室间隔部出现散在线状强化;6例为肥厚性心肌病,4例出现室间隔及左室壁出现延迟强化,表现为片状强化;12例为扩张性心肌病,4例在左心室间隔壁、侧壁可见线样强化,左室后下壁、前间隔壁各1例可见小片状强化,以心肌中层及外膜下心肌为主。1例为致心律失常型右室心肌病,延迟强化提示右室下壁及前壁可见片状强化。结论非缺血性心脏病患者心肌病变的磁共振心肌延迟强化具有一定特征,鉴别非缺血性心脏病的病因有赖于密切结合临床病史。     

致心律失常性右心发育不良6例

致心律失常性右心发育不良６例王世蓉华西医科大学附一院心内科致心律失常性右心发育不良（Ａｒｔｈｙｔｈｍｏｇｅｎｉｃｒｉｇｈｔｖｅｎｔｒｉｃｕｌａｒｄｙｓｐｌａｓｉａ，简称ＡＲＶＤ），亦称致节律紊乱性右心发育不良，是右室心肌病的一个临床亚型。其病理损害是...     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."