Changes in cerebral oxygenation during cold (28 degrees C) and warm (34 degrees C) cardiopulmonary bypass using different blood gas strategies (alpha-stat and pH-stat) in patients undergoing coronary artery bypass graft surgery

BACKGROUND: Impaired cerebral oxygenation, which is reflected by measuring jugular bulb oxygenation, is thought to play an important role in the development of neurological injury after cardiac operations with cardiopulmonary bypass (CPB). The effects of cardiopulmonary temperature and blood gas strategy on cerebral oxygenation are not fully appreciated. METHODS: Sixty patients were randomly allocated into four equal groups (cold alpha-stat, cold pH-stat, warm alpha-stat and warm pH-stat) to compare the effect of these perfusion strategies on cerebral oxygenation monitored by jugular bulb oximetry [jugular bulb oxygen saturation (SjO(2)) and arterial-jugular bulb oxygen content difference (AjDO(2))]. Jugular bulb oxygen saturation and AjDO(2) were measured before CPB, after 5, 20, 40 min on CPB, at start and end of rewarming, 5 min before the end of CPB and 10 min after CPB. Two-way analysis of variance was used to model the lowest SjO(2) and highest AjDO(2) during CPB, with CPB temperature and blood gas management as contributing factors. RESULTS: Significant changes in SjO(2) were only related to the type of blood gas management, with no significant difference between warm and cold CPB patients. In addition, during rewarming, desaturation (SjO(2) 相似文献   

Phase I/II clinical trials of carbon ion therapy for prostate cancer

BACKGROUND: Heavy ion beams possess high linear energy transfer components and a prominent Bragg peak in the human body, resulting in higher relative biological effectiveness and improved dose distribution. To establish heavy ion therapy techniques for the treatment of prostate cancer, phase I/II clinical trials were initiated. METHODS: For 96 patients with T1b-T3 prostate cancer, three carbon ion beams were used to irradiate the prostate and seminal vesicles (20 times/5 weeks) with or without endocrine therapy. Radiation dose was expressed in GyE which was initially thought to be equivalent to photon dose. Total dose was gradually increased from 54 to 72 GyE. RESULTS: Carbon ion therapy was completed in 20 cases of T1b/T1c/T2aN0M0 as monotherapy, in 8 cases of T2b/T3pN0M0 with neoadjuvant endocrine therapy, and in 68 cases of T2b/T3N0/pN1M0 with neoadjuvant and adjuvant endocrine therapy. Median observation period was 47 months. Grade 3 late radiation morbidity of rectum and/or bladder/urethra developed in one and five cases who received 66 and 72 GyE of radiation, respectively. After these adverse effects were observed, total dose was decreased to 66 GyE and the radiation field was coned down during the treatment course. At 5 years, overall, cause-specific, clinical recurrence-free, and biochemical recurrence-free survival rates were 87.7, 94.9, 90.0, and 82.6%, respectively. Local control was achieved in all patients except one patient who received 54 GyE of radiation. CONCLUSIONS: The therapeutic techniques of carbon ion therapy have been established for patients with prostate cancer. Carbon ion therapy may exert excellent effect to the tissues of prostate cancer.     

Energy Reserves and Metal-storage Granules in the Hepatopancreas of <Emphasis Type="Italic">Oniscus asellus</Emphasis> and <Emphasis Type="Italic">Porcellio scaber</Emphasis> (Isopoda) from a Metal Gradient at Avonmouth,UK

Isopods taken from populations of Onsicus asellusand Porcellio scaberfrom long-term polluted sites in the vicinity of metal smelting works at Avonmouth, South West England, and from a control site near Tübingen, South Germany, were examined for the frequency and size of metal-containing granules (spherites), lipid droplets and glycogen in their hepatopancreas. The number and size of spherites in the hepatopancreas of O. asellus increased with decreasing distance to the smelter, but such a trend was not found in P. scaber. A trend towards massive reduction in hepatopancreatic energy reserves (lipid, glycogen) with increasing soil metal pollution was observed for O. asellus while, in contrast, the lipid and glycogen content of P. scabermidgut gland cells was independent of the distance to the smelter. In view of previous reports on metal accumulation and biochemical responses to metal pollution, we propose that the two investigated isopod species, which form stable populations in the Avonmouth metal gradient, use different strategies to survive.     

1989-2001年格鲁吉亚的卫生改革及对中国的启示--经济转型国家卫生改革经验报告(一)

对格鲁吉亚1989—2001年的基本国情、主要卫生改革措施、医疗保险制度改革、公共卫生服务改革、以家庭医学为中心的社区卫生服务改革等情况进行了总结分析,希望能对中国卫生改革实践有所借鉴和启示。     

高盐食品及海水中痕量元素Pb,Ni检测方法的研究

目的:建立测定高盐食品及海水中Pb,Ni检测的新方法。方法:研究应用利用注射器中填装吸附剂对高盐食品的消解液及海水中(pH>5)浓缩后用石墨炉原子吸收光谱法直接测定样品中痕量铅和镍[1]。本方法利用物理和化学的吸附作用富集测试元素同时避免了高浓度盐对石墨炉原子吸收光谱法的干扰。结果:选定了最佳测量条件,该方法只用一次洗提吸附剂即可满足实验需要,其回收率在94% ~98% 之间,相对标准偏差RSD控制在2% 左右。Pb,Ni的最低检出限为0 .2μg/L。结论:本法简便、快速、准确,灵敏度和精密度高。适用于高盐食品及海水样品中痕量Pb,Ni的测定。     

施用城市污泥对土壤中重金属积累和迁移的影响

目的 了解城市污泥农用后土壤重金属的积累和迁移。方法 于1998年分不同季节，从苏州、无锡、常州3个城市污水处理厂采集污泥样本，用原子吸收光谱仪分析样本中重金属(Pb、Zn、Cu、Cd、Hg、As)含量和不同形态含量，分析污泥农用后土壤重金属积累及迁移特性。结果 城市污泥重金属含量远高于土壤背景值，3城市污泥中Zn含量均超标，分别达到1199，00、784．00、1216．00mg／kg。长期施用能导致土壤重金属积累。污泥中重金属具有一定的活性和潜在迁移性。结论 城市污泥农用可能会导致土壤和生物体重金属积累，存在着一定的环境重金属积累风险。     

含体外培育牛黄的安宫牛黄丸治疗流行性乙型脑炎的临床研究

目的观察含体外培育牛黄的安宫牛黄丸治疗暑温风痰闭窍证(流行性乙型脑炎)的临床疗效及安全性.方法采用随机双盲和单盲对照法,与含天然牛黄的安宫牛黄丸对照研究,共治疗乙脑患者 260例,其中含体外培育牛黄的安宫牛黄丸治疗组 182例,对照组 78例.结果治疗组与对照组的愈显率分别为 94.50 %,88.46 %,总有效率分别为 99.45 %,97.44 %.两种牛黄的安宫牛黄丸均有较好的疗效,两组比较差异无显著性意义(P > 0.05). ECG及实验室各项检查表明,两种牛黄的安宫牛黄丸对病人均无明显毒副作用.结论含体外培育牛黄的安宫牛黄丸治疗流行性乙型脑炎疗效显著.     

氢化物发生—无色散原子荧光分析法进展及在中药微量元素分析中的应用

根据国内外文献,对氢化物发生—无色散原子荧光分析法的进展进行了评述,列举了该方法应用于中药中砷、汞、铅、镉、锑等微量元素分析的实例,并对HG-AFS分析法在中药分析中的应用前景进行了展望。     

心脏手术中心脏复苏困难的处理

目的探讨再阻断控制性温血灌注在心脏复苏障碍时的应用。方法回顾性分析16例发生心脏复苏困难患者:①体外循环(CPB)方法:采用中度低温、中度血液稀释,4∶1含血停搏液灌注心肌保护;②控制性温血再灌注方法:对5例主动脉开放后ST段抬高患者实施再次阻断升主动脉单纯温血灌注,7例发生心脏复苏困难患者给予再次阻断升主动脉高钾温血停搏液灌注。结果所有患者均顺利脱离CPB。结论解决主动脉开放后心脏复苏困难,再阻断控制性温血灌注是简单而有效的方法。     

Mutation of Arg723Gly in β-myosin heavy chain gene in five Chinese families with hypertrophic cardiomyopathy

Background Hypertrophic cardiomyopathy （HCM） is a form of cardiomyopathy with an autosomal dominant inherited disease, which is caused by mutations in at least one of the sarcomeric protein genes. Mutations in the beta-myosin heavy chain （β-MHC） are the most common cause of HCM. This study was to reveal the disease-causing gene mutations in Chinese population with HCM, and to analyze the correlation between the genotype and phenotype. Methods The exons 3 to 26 of MYH7 were amplified by PCR, and the PCR products were sequenced in five non-kin HCM patients. A 17-year-old patient was detected to be an Arg723Gly mutation carrier. Then his family was gene-screened, and the correlation between genotype and phenotype was analyzed. Results The mutation of Arg723Gly in a Chinese family with HCM was detected for the first time. With a C-G transversion in nucleotide 13 619 of the MYH7 gene, located at the essential light chain interacting region in S1, the replacement of arginine by glycine took place at amino acid residue 723. A two-dimensional echocardiogram showed moderate asymmetrical septal hypertrophy with left atria enlargement. There was no obstruction in the left ventricular outflow tract. In his family, a total of 13 individuals were diagnosed HCM and 5 of them were dead of congestive heart failure at a mean age of 66-year-old. Eight living members were all detected to carry the mutation, in which 3 developed progressive heart failure. Moreover, the heart function of the people evidently deteriorates when their age are older than 50. The mutation and the disease show co-separated. Conclusion The Arg723Gly mutation is a malignant type. In Chinese the mutation has the similar characters to the former report but has low degree malignant.