R on T型与R on P型室性早搏

根据室性早搏(室早)发生在心动周期的时相不同，可分为收缩期室早和舒张期室早。收缩期室早是指发生在心室收缩期，即对应于心电图QRS波群起点至T波终点间的早搏，相当于心室肌细胞动作电位的0～3相。其又可分为收缩早期(QRS波群起点至QRS波群终末部)，收缩中期(J点至T波顶峰)；收缩晚期室早(T波顶峰至T波终点)。舒张期室早是指发生在心室舒张期，对应于T波终点至QRS波群起点间的早搏，     

Acting on Reflection: the Effect of Reflection on Students’ Clinical Performance on a Standardized Patient Examination

Background Little evidence exists to support the value of reflection in the clinical setting. Objective To determine whether reflecting and revisiting the “patient” during a standardized patient (SP) examination improves junior medical students’ performance and to analyze students’ perceptions of its value. Design Students completed a six-encounter clinical skills examination, writing a guided assessment after each encounter to trigger reflection. SPs evaluated the students with Medical Skills and Patient Satisfaction checklists. During the last three encounters, students could opt to revisit the SP and be reevaluated with identical checklists. Participants One hundred and forty-nine third year medical students. Measurements Changes in scores in the Medical Skills and Patient Satisfaction checklists between first visit and revisit were tested separately per case as well as across cases. Results On the medical skills and patient satisfaction checklists, mean revisit scores across cases were significantly higher than mean first visit scores [12.6 vs 12.2 (pooled SD = 2.4), P = .0001; 31.2 vs 31.0 (pooled SD = 3.5), P = .0001)]. Sixty-five percent of the time, students rated “reflect–revisit” positively, 34% neutrally, and 0.4% negatively. Five themes were identified in the positive comments: enhancement of (1) medical decision making, (2) patient education/counseling, (3) student satisfaction/confidence, (4) patient satisfaction/confidence, and (5) clinical realism. Conclusions Offering third year medical students the option to reflect and revisit an SP during a clinical skills examination produced a small but nontrivial increase in clinical performance. Students perceived the reflect–revisit experience as enhancing patient-centered practices (counseling, education) as well as their own medical decision making and clinical confidence.     

Experimental and clinical study on effect of endovascular dilation on symptomatic cerebral vasospasm

Objective To undertake animal experimentation and clinical study on the safety and efficacy of percutaneous transluminal angioplasty (PTA) and intraarterial papaverine (IAP) infusion for treatment of refractory symptomatic cerebral vasospasm (CVS). Methods In the experimental study, vasospasm was induced in rabbits by double injections of blood into the cisterna magMa, IAP infusion was given on either the 4th day or the 7th day after occurrence of subarachnoid hemorrhage (SAH), and then neurological observation, angiography, light and electron microscopy were done, In the clinical study, since September 1996, 22 patients with refractory symptomatic CVS involving 50 vascular territories received dilation therapy by PTA and IAP within 24 hours of clinical neurological deterioration. Results In the experimental study, all the rabbits except two in the ‘the 4th day‘ group showed angiographic dilation in all of the spastic basilar arteries, and neurological improvement; in the ‘the 7th day‘ group angiographic dilation appeared in 4 (57. 1% ) out of 7 rabbits. After 24 hours, 1 rabbit in each group had recurrence of neurological deficits and angiographic constriction. In the clinical study after aneurysm clipping or endovascular coil embolization was done, within 72 hours of SAH all patients underwent endovascular treatment: PTA alone in 3 cases, IAP alone in 14 cases, PTA and lAP in the remaining 5 cases. All vessel segments were dilated satisfactorily after endovascular treatment. Clinical improvement was significant in 13 eases,moderate in 7, minimal or none in 2; 2 cases died on the 7th day after endovascular dilation treatment. Conclusion Endovascular dilating techniques, namely, PTA, IAP and a combination of PTA and IAP, are safe and effective for treatment of symptomatic CVS refractory to medical therapy.     

Which parameters on magnetic resonance imaging determine Q waves on the electrocardiogram?

Studies have demonstrated that patients with Q-wave infarctions on the electrocardiogram (ECG) frequently have nontransmural scar formation, whereas non-Q-wave infarctions may have transmural scars. The precise pathophysiologic substrate that underlies Q waves remains unclear. Magnetic resonance imaging (MRI) is the preferred technique to evaluate patients who have infarction because information can be obtained on function, contractile reserve (viability), and scar tissue. Consecutive patients (n = 69) who had coronary artery disease and a history of myocardial infarction underwent MRI; the protocol included MRI at rest, small-dose dobutamine MRI, and contrast-enhanced MRI. Parameters included left ventricular ejection fraction, left ventricular volumes, end-diastolic wall thickness and contractile reserve in the infarct region, transmurality and spatial extent of scar tissue, total scar score, and quantified percent left ventricular scar tissue. MRI data were related to the presence/absence of Q waves on the ECG. Q waves were present in 39 patients (57%). Univariate analysis identified transmurality, spatial extent, total scar score, and quantified percent scar tissue as predictors of Q waves. Multivariate analysis demonstrated that quantified percent scar tissue was the single best predictor of Q waves on the ECG. A cut-off value of 17% infarcted tissue of the left ventricle yielded a sensitivity and specificity of 90% to predict the presence/absence of Q waves. When quantified percent scar tissue was removed from the model, spatial extent of infarction was the best predictor. Thus, Q waves on the ECG correlate best with quantified percent scar tissue on contrast-enhanced MR images.     

Vagus efect on pylorus-preserving gastrectomy

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In Vitro Study on Mesenchymal Stem Cells： Anti-apoptotic Effects on Cardiac Myocytes

Objectives To investigate the anti-apoptotic effects of mesenchymal stem cells （MSCs） on hypoxic injured cardiac myocytes in vitro. Methods MSCs were isolated from bone marrow of Sprague-Dawley （SD） rats, and cardiac myocytes from neonatal rats. The rat cardiac myocytes were co-cultured with MSCs or MSC-conditioned media in anoxia （95% N2 ±5% CO2） for 72 hours. Cell apoptosis was measured by Hoechst 33258 staining. The expression of Bcl-2 and Bax in cardiac myocytes was tested by Western Blot. Results The apoptotic rate was 51.6% ± 2.4% when cardiac myocytes were cultured in continuous hypoxia and was significantly decreased when cardiac myocytes were cocultured with MSCs or MSC-conditioned media （ 15.1% ± 5.4% and 24. 0% ± 4.2% respectively, P 〈 0. 001 ）. The decreased expression of Bax in the cardiac myocytes was greatly related to the decreasing of apoptosis, but there was no difference in Bcl-2 expression among these groups. Conclusions Co-cultured MSCs showed significant anti-apoptotic effects on cardiac myocytes in continuous hypoxia. The mechanism may be the interact of cell to cell and paracrine of cytokines which effected the expression of Bax in the cardiac myocytes.     

What's new on antithrombotics?

Management of venous thromboembolism disease could be improved by new drugs with lower risk of bleeding and without the need of regular monitoring of anticoagulant effect. In this way, idraparinux, anti-Xa inhibitor, has been compared to conventional therapy (coumarins) for the treatment of deep vein thrombosis and pulmonary embolism. Is it worth to treat patients more than six months? This has been evaluated in an interesting study. Prophylaxis after hip replacement surgery is indicated to reduce the risk of venous thromboembolism, new drugs are under investigation. Dabigatran etexilate, a direct thrombin inhibitor, has been shown as effective as enoxaparin in reducing the risk of venous thromboembolism after total hip replacement surgery. In 2007, new european guidelines for non-STsegment elevation acute coronary syndromes have been published. Two new antithrombotic drugs, bivalirudin and fondaparinux, are now part of the different possible choices according to specific considerations. New factor Xa and factor IIa inhibitors are under investigation and are compared to heparin in PCI for NSTE-ACS. Fondaparinux and more recently otamixaban have given interesting results. These new recommendations have not yet taken into account new data published in 2007. What will be the positioning of prasugrel, a new thienopyridine, after the results of theTRITON trial? In patients with SCA treated by PCI, prasugrel reduced the ischemic events, while increasing major bleedings. In 2007, numerous publications and meta-analyses on drug-eluting stents (DES) have been published and tempered the fear about a possible increase in mortality with the use of DES.     

Comments on the editorial by Riggio ＆ Ageloni on the ascitic fluid analysis

Angeloni et al published a landmark study on the use of Coulter counters in spontaneous bacterial peritonitis (SBP) diagnosis. Riggio and Angeloni have recently published an editorial on the ascitic fluid analysis in diagnosis and monitoring of SBP. Herein, some points of interest are discussed.     

Studies on gallstone in China

INTRODUCTIONGallstone is one of the common primary diseases of bilesystem.Chinese researchers have done comprehensive andthorough studies on it,but there are still some problems wehave not solved.It is necessary to review the achievements wehave made in this field recently,to summarize the experiencesand find the tendency so as to provide a sound foundation forthe researches in the new century.Due to the popularizationof molecular biological research methods,a rapid developmentof modern imaging techniques and medical equipment,thebasic and clinical studies of cholelithiasis have set foot on the     

Studies on MDM2 oncogene expression and its effect on pancreatic carcinoma cells

14.3.Cyst and tumor of Panereas960717 St“di”on MDMZ曲cogene expression andits effect on Pane代atic eareinoma eells.GUO Hongtao(郭洪涛),et al.压pt Pathol,PUMC HosP,CAMS,Beijing,100730.Chin J Pathol 1996;25(4):232一235. In order to study the interrelation.and interaetionbetween MDMZ one娘ene and wild tyPe p53 in humanPanereatie eaneer,we studied the expression and amPli-fieation of MDMZ oneogene and its antagonistie effeeton wild type p53 by use of gene reeombination,genetransdue…     

Observation on the efficacy of hetrazan oil on cats infected with Brugia malayi.

Cats were inoculated with 50 infective larvae of Brugla malayi on volar surfaceof hind legs. 5% DEC (diethylcarbamazine) in mineral oil was smeared on the lefthind leg one and three weeks after infection.     

Should We Measure C‐reactive Protein on Earth or Just on JUPITER?

Evidence for the role of inflammation in the pathogenesis of atherosclerosis is compelling and has generated interest in high‐sensitivity C‐reactive protein (hs‐CRP) as a marker of cardiovascular risk. Data regarding hs‐CRP and cardiovascular risk, though largely consistent, is of unclear clinical relevance. Most recently, the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) trial has led to further debate regarding the utility of hs‐CRP. This article provides a comprehensive review of the data regarding cardiovascular risk and hs‐CRP with an emphasis on the JUPITER trial and concludes with an evidence‐based analysis of the current role of hs‐CRP in cardiovascular risk assessment. Copyright © 2010 Wiley Periodicals, Inc.     

Study on the protective effect of grape procyanidins on DNA damage induced by irradiaton.

To study the protective effect of grape procyanidins (GPC) on the irradiated DNA damage. Methods: In vivo study: After orally administration of GPC, mice in different groups were exposed to whole-body ~(60)Co γ-rays at a dose of 2.     

Update on traveler’s diarrhea

Diarrhea is one of the most common health problems among travelers. Although enterotoxigenic Escherichia coli is implicated most commonly, enteroaggregative E. coli has recently been described as a major pathogen. Shigella, Campylobacter, and Salmonella organisms are less common causes of acute diarrhea, and intestinal protozoa are typical causes of protracted diarrhea. Although education is the mainstay of prevention measures, behavior modification has been shown to be difficult. Chemoprevention is rarely required with the availability of effective treatment, but there has been some interest in the use of vaccines. Maintenance of hydration is most important in children. In addition to bismuth preparations and loperamide, newer agents being developed for symptomatic relief include zaldaride maleate and racecadotril. Fluoroquinolones effectively treat severe traveler’s diarrhea, and even a single dose may be sufficient. However, with the emergence of resistance, particularly in Campylobacter infection, other agents are required; interest has focused on azithromycin and rifaximin.