家族性房间隔缺损并房室传导阻滞一家系分析

目的分析1个汉族人的家族性房间隔缺损并房室传导阻滞家系的表型和遗传模式。方法对家系成员行病史采集、体格检查、心电图及心脏超声检查,分析其临床特点,制作家系图谱,采用系谱法分析疾病遗传模式。结果家系成员5代78例,血缘关系成员55例,先天性心脏病患者16例。16例患者中房间隔缺损10例、房室传导阻滞12例、脑梗死6例、婴幼期死亡3例。所有家系成员均无先天性上肢畸形。结论该家系疾病主要表现为房间隔缺损和房室传导阻滞,遗传模式为常染色体显性遗传,经检索认为是目前国内最为明确的家族性房间隔缺损并房室传导阻滞的家系报道。     

细胞块免疫细胞化学在乳腺癌术前辅助化疗中的意义

目的：探讨细胞块免疫细胞化学在乳腺癌术前辅助化疗中的临床价值。方法：用10ml持笔式负压穿刺器穿刺乳腺癌患者肿物,血浆凝血酶方法制做成细胞块,选择术前已做细胞块,并且术后有病理组织学对照的乳腺癌90例分别进行免疫组化标记。抗体选用ER、PR、cerbB-2、P53、VEGF、Ki67。结果：细胞块免疫细胞化学结果：阳性率分别为ER68％、PR63％、cerbB-230％、P5334％、VEGF57％、ki6779％。术后病理组织免疫组化结果：ER70％、PR66％、cerb-232％、P5337％、VEGF59％、Ki6781％。结论：持笔式负压穿刺器穿刺乳腺癌组织,血浆凝血酶法制做的细胞块,不仅操作简便快捷、安全、不需特殊设备,而且可连续切片做多种抗体检测以满足诊断需要,其免疫细胞化学结果和术后病理免疫组织化学结果对比无明显差异。乳腺癌辅助化疗前用细胞块制备的标本检测ER、PR、cerbB-2、P53、VEGF、Ki-67,能了解乳腺癌患者内分泌情况及恶性程度和预后,为术前辅助化疗及内分泌治疗提供必要的参考指标,从而对乳腺癌患者进行针对性的个体化疗方案,增加乳腺癌患者保乳手术机会,提高患者的生存期和治愈率。     

下颌垂直向功能性移位后髁突软骨的形态学及组织学改建

目的:通过诱发大鼠下颌骨垂直向功能性移位,阐明这一方向上的位移在髁突改建中的作用.方法:5周龄雌性SD大鼠40只,随机分为实验组和对照组,实验组大鼠佩戴上颌后牙(牙合)垫,使下颌骨发生垂直向功能性移位.实验组大鼠进一步分为4组,每组5只,分别在佩戴袷垫后第3、6、9、12天处死.采用组织形态学测量及AB-PAS染色,定量分析髁突的形态及软骨的组织学变化.采用SPSS11.0软件包对对照组和实验组的各项指标进行统计学分析.结果:下颌垂直向功能性移位后12d,髁突高度较对照组显著增加,前斜面更倾斜;髁突后上区前成软骨细胞及成软骨细胞层厚度在实验第3～6天无明显差异,第9天开始出现显著变化,实验组较对照组显著增厚,这种变化持续到实验第12天;肥大软骨细胞层厚度在实验第3、9、12天,实验组与对照组无显著差异,在实验第6天较对照组显著减少,间充质细胞层变化不大.结论:下颌垂直向功能性移位可致髁突高度增加、前斜面更倾斜,髁突软骨厚度的增加是髁突高度增加的组织学基础,垂直向移位也是构成功能性矫治器促进下颌骨发育的重要方面.     

阈下剂量氯胺酮用于臂丛神经阻滞镇痛镇静效果观察

目的观察阈下剂量（0．4mg／kg）加入局麻药用于臂丛神经阻滞的镇痛、镇静效果。方法60例ASA评级Ⅰ～Ⅱ级侄臂丛神经阻滞下的上肢手术患者,随机双肓法分为三组,每组20例,局麻药为0．375％布比卡因和1％利多卡因混合液20ml作肌间沟臂丛神经阻滞。A组：复合氯胺酮0．4mg／kg;B组：氯胺酮0．4mg／kg,肌注;C组：不用氯胺酮。记录麻醉起效时间、镇痛持续时间、术后12h、24h、48h视觉模拟评分（VAS）,注药后10min、30min的镇静／警觉评分（OAA／S）及麻醉期倒谵妄、多语、头晕、视物不清、呼吸抑制等不良反应。结果A组较其他两组麻醉起敬时间短,镇痛持续时间长;A组和B组术后12h、24h、48hVAS均低于C组,A组则更优于B组（P〈0．05）;A组和B组在注药后均有一定镇静作用,注药10rain后OAA／S评分A组较B组低（P〈0．05）,30rain后两组无明显区别（P〉0．05）;视物不清、头晕等发应率A组和B组无显著性差异（P〉0．05）,但较C组高（P〈0．05）。结论臂丛神经阻滞加用阈下剂量氯胺酮能缩短麻醉起效时间,有短时间的镇静作用,明显增强镇痛作用和延长术后镇痛时间。     

Long-term blockade of L/N-type Ca2+ channels by cilnidipine ameliorates repolarization abnormality of the canine hypertrophied heart

Background and purpose:

The heart of the canine model of chronic atrioventricular block is known to have a ventricular electrical remodelling, which mimics the pathophysiology of long QT syndrome. Using this model, we explored a new pharmacological therapeutic strategy for the prevention of cardiac sudden death.

Experimental approach:

The L-type Ca²⁺ channel blocker amlodipine (2.5 mg·day⁻¹), L/N-type Ca²⁺ channel blocker cilnidipine (5 mg·day⁻¹), or the angiotensin II receptor blocker candesartan (12 mg·day⁻¹) was administered orally to the dogs with chronic atrioventricular block for 4 weeks. Electropharmacological assessments with the monophasic action potential (MAP) recordings and blood sample analyses were performed before and 4 weeks after the start of drug administration.

Key results:

Amlodipine and cilnidipine decreased the blood pressure, while candesartan hardly affected it. The QT interval, MAP duration and beat-to-beat variability of the ventricular repolarization period were shortened only in the cilnidipine group, but such effects were not observed in the amlodipine or candesartan group. Plasma concentrations of adrenaline, angiotensin II and aldosterone decreased in the cilnidipine group. In contrast, plasma concentrations of angiotensin II and aldosterone were elevated in the amlodipine group, whereas in the candesartan group an increase in plasma levels of angiotensin II and a decrease in noradrenaline and adrenaline concentrations were observed.

Conclusions and implications:

Long-term blockade of L/N-type Ca²⁺ channels ameliorated the ventricular electrical remodelling in the hypertrophied heart which causes the prolongation of the QT interval. This could provide a novel therapeutic strategy for the treatment of cardiovascular diseases.     

治疗机托架对鼻咽癌整体挡铅位置的影响及相应的质量控制措施

目的：治疗机托架和托盘对鼻咽癌整体挡铅挡块的影响及采取的相应的控制措施进行探讨。方法：在BJ-6B型直线加速器上设置90。的机架角度和0。的准直器角度,在托架里插入有机板,有机板上设置与照射野灯光十字投影线相重合的十字定位刻线,然后变换机架角为270°。观察有机板在有、无整体挡铅时十字刻线与照射野灯光十字投影线误差的程度。结果：整体挡铅固定有机板与治疗机托架之间等机械因素存在固有的安装间隙,在机架角为270°时有机板会因重力的缘故朝这些间隙位移,从而使有机板上的整体挡铅块也随之在照射野中出现位置偏移,折算到源轴距位置处有0-5．2mm的位置误差。结论：在整体挡铅固定有机板上设置准确的十字定位线,以此作为整体挡铅在固定有机板上的浇铸和位置检验的基准,并作为整体挡铅在托架位置处与照射野十字灯光投影线对准的标记线,可以预先了解整体挡铅位置偏移情况进而采取控制措施。     

球后神经阻滞麻醉与表面麻醉在青光眼手术中应用的比较

目的球后神经阻滞麻醉与表面麻醉应用于青光眼小梁切除术优、缺的比较。方法回顾分析78例表面麻醉与73例球后麻醉下的青光眼小梁切除术,将两者在术前焦虑程度、术中疼痛程度、术中配合程度及术中麻醉并发症方面进行比较。结果实验组与对照组恐惧程度差异无显著意义（P〉0．05）,两组患者疼痛程度及术中配合程度无显著差异（P〉0．05）,两组术中并发症的发生率有显著差异（P〈0．05）。结论表面麻醉下可以顺利完成青光眼手术,操作简单、安全、术中并发症少见,应作为青光眼手术的主要麻醉主法。但在某些特殊病例、特殊情况下应须使用球后麻醉。     

氟维司群PLA-block-mPEG微球在大鼠体内的药动学研究

分别以嵌段共聚物(聚乳酸-单甲氧基聚乙二醇,分子量比为40 000:2 000)和非嵌段共聚物(聚乳酸-聚羟乙酸,分子量均为40 000,摩尔比分别为75:25、50:50)作为载体材料,采用乳化-液中干燥法制备包载氟维司群的微球.大鼠单剂量(50 mg/kg)皮下注射3种氟维司群微球,采用LC-MS/MS法测定血药浓度,计算药动学参数.结果表明,使用嵌段共聚物制备的微球,药-时曲线较平稳,释放效果较好.     

Increased myocardial collagen turnover in patients with progressive cardiac conduction disease

Background: Histopathologically, progressive cardiac conduction disease (PCCD) is characterized by progressive fibrosis and sclerodegenerative changes in the proximal and distal conduction system of the heart. Therefore, we sought to determine the serum levels of myocardial collagen turnover markers, extracellular matrix components, transforming growth factor β₁ (TGFβ₁), and bone morphogenic protein‐7 (BMP‐7) in this population. Methods: Study population included 20 patients (6 M/14 F, mean age 76 ± 8 years) with acquired, permanent 2:1, or complete atrioventricular block and compared with age‐ and sex‐matched, asymptomatic, healthy control subjects (n = 18, 6 M/12 F, mean age 75 ± 7 years). Serum myocardial collagen turnover markers:matrix metalloproteinases (MMP‐1, 2, 9), tissue inhibitor of matrix metalloproteinase (TIMP‐1), amino‐terminal propeptide of procollagen type I (PINP) and type III (PIIINP), carboxy‐terminal telopeptide of collagen type I (CITP), and carboxy‐terminal propeptide of procollagen type I (PICP), serum extracellular matrix components (laminin and fibronectin), TGFβ₁, and BMP‐7 levels were measured in both groups. Results: Serum PICP (849 ± 396 vs 631 ± 294 ng/mL, P = 0.04), PIIINP (3.7 ± 1.3 vs 3 ± 1 μg/L, P = 0.03), CITP (0.68 ± 0.35 vs 0.48 ± 0.25 ng/mL, P = 0.037), and plasma MMP‐9 (58.8 ± 56 vs 25.9 ± 17.3 ng/mL, P = 0.006) levels were higher in patient population compared to control subjects. Serum MMP‐1 (24.1 ± 20.5 vs 13.6 ± 7.5 ng/mL, P = 0.045) and MMP‐2 (1310 ± 139 vs 1186 ± 163 ng/mL, P = 0.01) levels were higher in control subjects compared to patient population. There was no difference in serum TIMP‐1, PINP, laminin, fibronectin, TGFβ₁, and BMP‐7 levels between two groups. Conclusion: Our findings demonstrate the presence of increased myocardial collagen turnover and active fibrotic process in patients with PCCD compared to control subjects.