缝隙连接蛋白43在缺血性心律失常中的作用

目的探讨心肌缺血时,心肌缝隙连接蛋白43(connexin43,Cx43)与缺血性心律失常的关系。方法对戊巴比妥钠麻醉大鼠进行30min的冠状动脉缺血。大鼠分为不处理或者接受缺血预适应(ischemic preconditioning,IPC)、静脉注射线粒体ATP磷酸敏感性钾通道(mitoKATP)开放剂二氮嗪(Dia)3组,其余2组为在接受IPC、Dia的基础上加用5羟基奎酸(5-HD)。测量各组的血流动力学指标和心律失常。采用Western blotting检测Cx43的磷酸化程度。结果与对照组相比,IPC、Dia能促进Cx43磷酸化,减少心律失常的发生率,线粒体ATP敏感性钾通道阻断剂5-HD能消除IPC和Dia的上述作用。结论IPC通过开放线粒体ATP敏感性钾通道促进Cx43磷酸化和电耦联,进而抑制心律失常的发生。     

自发高血压大鼠心肌肥厚与心室颤动阈值的关系

 【目的】探讨自发高血压大鼠心肌肥厚与心室颤动阈值的关系。【方法】20只雄性自发高血压大鼠，随机分成10周龄组（n=10）和18周龄组（n=10）；10只10周龄雄性Wistar大鼠为对照组。分别测定3组大鼠的动脉收缩压、心脏质量指数、心室有效不应期和心室颤动阈值。【结果】①自发高血压大鼠的动脉收缩压和心脏质量指数明显高于Wistar大鼠（P〈0．001），心室颤动阈值明显低于Wistar大鼠（P〈0．001）；②自发高血压大鼠中，18周龄自发高血压大鼠的动脉收缩压和心脏质量指数明显大于10周龄自发高血压大鼠（P〈0．001），心室颤动阈值明显低于10周龄自发高血压大鼠（P〈0．001）；③不同周龄自发高血压大鼠和Wistar大鼠之间，心室有效不应期没有明显差异（P〉0．05）；④Wistar大鼠中心脏质量指数与动脉收缩压及心室颤动阈值均无明显相关关系，不同周龄自发高血压大鼠中，心脏质量指数与动脉收缩压及心室颤动阈值均呈明显相关关系；动脉收缩压和心脏质量指数与心室颤动阈值呈负相关（P〈0．001）；⑤心脏质量指数、动物周龄和种类是影响心室颤动阈值的主要因素（P〈0．001）。【结论】肥厚心肌的心室颤动阈值降低；动脉收缩压愈高，心肌肥厚程度愈明显，心室颤动阈值愈低。     

颈动脉内中膜厚度及斑块分级在预测冠心病中的作用

 【目的】界定颈动脉内中膜厚度及其斑块分级在估测冠心病中的最佳预测值。【方法】用高频超声检测125例患者颈总动脉内中膜厚度、颈动脉分叉处内中膜厚度，以及颈动脉斑块分级，评价它们估测冠心病的作用，并用ROC曲线评价它们的诊断价值。【结果】冠心病组颈总动脉及分叉处内中膜增厚、斑块分级高，与对照组比较差异有统计学意义，P〈0．05；ROC分析显示颈总动脉及分叉处内中膜增厚、斑块分级均可估测冠心病，其曲线下面积分别为0．70、0．75、0．74；将颈总动脉分叉处内中膜增厚≥1．3mm，颈总动脉内中膜增厚≥0．9mm，颈动脉斑块分级≥2定义为阳性，3者联合评价其阳性积分，则ROC曲线下面积为0．82，以3者中任2项阳性为预测值估测冠心病，灵敏度95．3％，特异度84．2％，阳性预测值85．3％，阴性预测值86．4％。【结论】颈动脉超声检查颈总动脉及其分叉处内中膜厚度、颈动脉斑块分级可用于估测冠心病。以3者联合评价诊断价值高。     

内皮祖细胞移植修复大鼠颈总动脉内皮损伤

 [目的]探讨内皮祖细胞修复动脉内皮损伤的作用.[方法]建立大鼠颈总动脉内皮损伤模型,16只大鼠随机等分为内皮祖细胞移植组和对照组.体外诱导大鼠外周血单个核细胞为内皮祖细胞.在动脉损伤后,将5-溴脱氧尿苷标记的内皮祖细胞注入损伤动脉段,14 d后取损伤动脉段和对侧正常动脉段.采用病理学方法、免疫组织化学和图像分析技术评价内皮祖细胞的修复效果.[结果]内皮祖细胞移植组的损伤动脉段5-溴脱氧尿苷免疫组化为阳性.内皮祖细胞移植组损伤动脉段的新生内膜厚度较对照组明显减轻（43.5±5.5）μm vs（90.7±12.7）μm,P＜0.05;内皮祖细胞移植组的再内皮化程度明显高于对照组77.8%±0.1%vs52.2%±0.1%,P＜0.05.[结论]内皮祖细胞具有修复动脉内皮细胞损伤的作用,内皮祖细胞可作为心血管疾病细胞移植疗法的种子细胞.     

抗滋养细胞膜抗原抗体水平与妊娠期高血压疾病的关系

目的：探讨抗滋养细胞膜抗原(TA)抗体水平与妊娠期高血压疾病(HDCP)的关系。方法：应用酶联免疫吸附方法(ELISA)检测40例正常妇女和92例HDCP晚孕妇女［包括妊娠期高血压或轻度子痫前期23例，重度子痫前期41例，子痫28例；并发胎儿生长迟缓(FGR)21例］外周静脉血和新生儿脐血血清中抗TA IgG、IgM水平。结果： HDCP组、子痫组及重度子痫前期组母血中抗TAIgG、IgM阳性率均比正常组显著增加，且随HDCP 加重IgM阳性率显著增加(P<0.05)。 HDCP组、子痫组及重度子痫前期组脐血中抗TA IgG、IgM阳性率均比正常组显著增加，且HDCP组及子痫组IgM阳性率均比正常组显著增加(P<0.05) 。HDCP未并发FGR组脐血中IgM阳性率低于并发FGR组(P<0.05)。结论：HDCP患者母血及脐血中 抗TA IgG、IgM升高可能是妊娠期高血压疾病发生的主要原因。     

Kinematic navigation in total knee replacement--experience from the first 50 cases.

BACKGROUND/PURPOSE: Proper alignment of the prosthesis is critical in total knee replacement (TKR) to minimize long-term wear, risk of osteolysis, and loosening of the prosthesis. This study examined the accuracy of lower limb alignment obtained using a kinematic navigation system for TKR, and the extra time needed to adopt this system. METHODS: From August 2002 to April 2003, 71 patients with knee osteoarthritis underwent 79 primary TKR operations by the same surgical team. Fifty of these operations were performed with the aid of the CT-free kinematic navigation system, and the remaining 29 were performed with conventional manual methods. Results, including operation time, radiographic alignment of the prosthesis and complications, for the two groups were compared. RESULTS: Patients in the kinematic navigation group achieved better accuracy in the coronal plane than the conventional group in terms of postoperative mechanical axis (1.89 +/- 0.63 degrees vs. 3.38 +/- 1.07 degrees ). Less variation was noted in the navigation group (femur: SD 1.88 degrees vs. 7.12 degrees ; tibia: SD 1.54 degrees vs. 2.99 degrees ), although the difference in the mean values was not significant (p = 0.475 and 0.55, respectively). The operation time (from skin to skin) in the navigation group (100.6 +/- 4.3 minutes) was longer than that in the conventional group (92.7 +/- 5.1 minutes; p = 0.027). Two perioperative fractures occurred in the navigation group, both of which were attributed to patient factors as opposed to operation procedures. No major complications such as infection or pulmonary embolism occurred during this study. CONCLUSION: Use of a kinematic navigation system in TKR provides better accuracy than conventional manual methods. The technique is easy to use, has a short learning curve, and requires an additional operation time of less than 10 minutes. Precise alignment can be achieved with the aid of navigation in most cases.     

Safety and immunogenicity of heptavalent pneumococcal conjugate vaccine booster in taiwanese toddlers.

BACKGROUND/PURPOSE: Pneumococcal infection causes high morbidity and mortality in children. Prevention of pneumococcal diseases by effective vaccination is an urgent need. This study evaluated the safety and immunogenicity of heptavalent pneumococcal conjugate (7VPnC) vaccine (serotypes 4, 6B, 9V, 14, 18C, 19F, 23F) booster dose administered at 15-20 months of age in Taiwanese toddlers. METHODS: Fifty-eight healthy Taiwanese toddlers who were primed with three doses of the 7VPnC vaccine in infancy received a booster dose in an open-label, noncomparative trial. Routine oral polio vaccine and diphtheria toxoid, tetanus toxoid, and pertussis vaccine were administered concomitantly. Surveillance for safety was conducted after vaccination. Antibody concentration to each of the seven pneumococcal serotypes was measured before and 1 month after the booster dose. RESULTS: Mild to moderate local reactions were common (45-50%). Fever, fussiness, restlessness, and loss of appetite were the most frequent systemic reactions (31-50%). Before the booster dose of vaccine, 68% (for serotype 18C) to 100% (for serotype 14) of subjects had antibody concentrations >or= 0.2 microg/mL to different pneumococcal serotypes. After the booster dose, the geometric mean concentration of IgG increased significantly (p < 0.001) for all seven serotypes indicating the induction of immunologic memories. Ninety-eight percent of the toddlers had antibody concentration >or= 0.2 microg/mL against all serotypes after the booster. CONCLUSION: The 7VPnC vaccine containing the prevalent serotypes in Taiwan is safe and effective in boosting immunity against pneumococcal disease in Taiwanese children.     

Initial 10-year experience of sperm cryopreservation services for cancer patients.

Offering sperm cryopreservation to preserve the fertility of male cancer patients is a relatively recent service in Asia. This study analyzed the types of cancer, timing of collection, sperm quality, and utilization for reproductive services by patients during a 10-year period at a medical center in Taiwan. A total of 75 oncology patients elected to freeze sperm for fertility preservation at our medical center during the initial 10 years of the availability of this service. The mean age of the patients was 25.7 years. Storage was discontinued in 13 (17%) patients and their survival duration was 13.1 +/- 11.1 months. The utilization rate of sperm cryopreservation was 2.8% (75/2642). The types of cancer varied, with leukemia (35%), lymphoma (25%), and testicular cancer (13%) comprising the largest groups. A significantly lower sperm count was found in patients with chronic myelogenous leukemia, suggesting the need for earlier sperm collection after initiation of cancer treatment. Only three (4%) patients utilized their specimens for reproductive purposes. There was no clinical pregnancy during the study period, although one biochemical pregnancy was achieved. The low rates of sperm cryostorage for fertility preservation in cancer patients in this study suggest that there is a need for greater emphasis of this option for male oncology patients whose fertility is likely to be affected by chemotherapeutic treatment.     

剖宫产术后早期活动及早期进食的探讨

目的探讨剖宫产术后早期活动及早期进食对产妇的影响。方法将2005年1月至6月在我院行剖宫产术的210例产妇随机分为两组:观察组和对照组各105例。观察组采用术后早期活动早期进食的方法即:剖宫产病人术后去枕平卧6小时后改为半卧位,每2小时翻身一次,术后6小时给予流质饮食;对照组采用术后去枕平卧6小时,12小时后改为半卧位及12小时进食流质食物的传统护理方法,分别对剖宫产术后病人恢复情况进行观察、比较、分析。结果观察组术后进食时间、肛门排气时间、泌乳时间、第一次离床活动时间、拔除尿管时间、拔除尿管后自主排尿情况均优于对照组,而腹胀、泌尿系统感染等并发症均少于对照组。结论剖宫产术后早期活动和早期进食可促进产妇的康复。     

分娩期连续电子胎心监护用于胎儿评估

1背景 在美国，每4例孕妇中有3例在产群中及分娩时使用电子胎儿监护（EFM）（NCHS1993）。1989年，美国妇产科学院（ACOG1989）发表了一项声明，对于低危妊娠既可使用EFM，也可使用间断性胎心听诊；但是，美国预防保健委员会（USPSTF1989）和加拿大的定期健康检查委员会（CTFPHE1994）对高危妊娠仍保留使用EFM。尽管有人对EFM的效果和安全性表示担忧（Thacker 1987：Thacker 1995），