QT dispersion in patients with mitral valve prolapse is related to the echocardiographic degree of the prolapse and mitral leaflet thickness.

BACKGROUND: Ventricular arrhythmias are common in patients with mitral valve prolapse (MVP). Previous studies have provided evidence that a higher degree of systolic mitral valve displacement and the presence of a thickened anterior mitral leaflet are related to an increased incidence of complex ventricular arrhythmias and risk of sudden death in these patients. The aim of our study was to investigate whether QT dispersion in patients with MVP is associated with the echocardiographic degree of the prolapse and mitral leaflet thickness. METHODS: QT and JT intervals and dispersions were measured in 89 patients with primary mitral valve prolapse (26 men and 63 women with mean age 39 +/- 14 years). All patients underwent a full echocardiographic examination and a scoring system was used to determine the degree of MVP. Anterior mitral leaflet thickness was also measured. Twenty-four hour Holter monitoring was used to assess ventricular arrhythmogenesis. RESULTS: According to their echocardiographic score. patients were divided into three groups (Group A. B and C) reflecting the different degrees of the prolapse. QT dispersion in patients with the highest degree of MVP, i.e. Group C was significantly greater (65 +/- 13 ms) than that of the other two groups (Group A: 38 +/- 14 ms, P<0.005 and Group B: 45 +/- 12 ms, P<0.005). Similar differences between groups were also found for JT dispersion. Multiple regression analysis revealed that among the demographic and clinical variables that were tested, only the echocardiographic degree of the prolapse and anterior mitral leaflet thickness were independently associated with QT dispersion. Holter monitoring showed that the incidence of complex ventricular arrhythmias was also higher in patients with more severe MVP. CONCLUSIONS: Our results indicate that QT and JT dispersions are related to the echocardiographic degree of MVP and mitral leaflet thickness. The echocardiographic assessment of the severity of the prolapse may help to identify a subgroup of patients at increased risk of life-threatening arrhythmias.     

The Shock Energy Required for Successful Defibrillation Depends on the Degree of Disorganization of the Reentrant Activation Pattern

Regardless of how it is initiated, the final stage of sudden cardiac death is ventricular fibrillation (VF), a completely disorganized electrical activity of the ventricles, characterized by multiple reentrant circuits. There is only one known therapy for VF, a strong electrical shock, normally referred to as electrical defibrillation. In this study we investigate the hypothesis that the energy level required to stop fibrillation is dependent on the actual level of organization of the underlying reentrant activity. A three-dimensional bidomain model with unequal anisotropy ratios incorporating stochastic variations of the conductivity tensor was used. The active membrane behavior was described by the Courtemanche model of the human atrial action potential incorporating an acetylcholin (ACh) dependent K ⁺ current and electroporation. A spatial variation of [ACh] was used to obtain repolarization gradients allowing to control the degree of disorganization. Depending on the ACh settings, either a single rotor developed or spiral wave breakup evolving into fibrillatory like activity was observed. Shocks of varying strength and timing were delivered to both activation patterns and the probability of shock success as a function of shock strength was determined. Results indicate that arrhythmias with a higher degree of disorganization need significantly higher shock strengths to defibrillate.     

Alcohol use and cognition at mid-life: the importance of adjusting for baseline cognitive ability and educational attainment

BACKGROUND: The nature of the relationship between cognition and alcohol consumption remains controversial. Studies have reported negative, positive, and nonsignificant effects of alcohol consumption on cognition. Problematic throughout the literature is that baseline cognitive ability has not been adequately controlled in previous studies, and even educational attainment is only sometimes controlled. Because such variables may be associated with both alcohol intake and later-life cognition, we hypothesize that the observed relationship between alcohol intake and cognition may change when these variables or other conditions in early life have been controlled. METHODS: We examined the relationship of alcohol intake and cognition at age 53 using the Wisconsin Longitudinal Study, which has followed Wisconsin high school graduates from 1957 to 1992. Our measures include cognitive ability test scores from the freshman and junior years of high school, educational attainment, an abstract reasoning test score at age 53, alcohol intake at age 53, and other measures. RESULTS: When no controls were used, both men and women with low levels of alcohol consumption at 53 (i.e., 0-1 drink per day) had better scores on the abstract reasoning subtest of the Wechsler Adult Intelligence Scale (WAIS-R) at age 53 than subjects who never drank or currently did not drink. However, after adjusting for adolescent-measured cognitive ability and educational attainment, men with low levels of consumption no longer had higher abstract reasoning scores than nondrinking men, but they still did have higher abstract reasoning scores than men who drank more than one drink per day. For women, adjusting for cognitive ability and educational attainment eliminated all significant effects of alcohol on cognition, and reversed the nonsignificant result that women with higher consumption had the highest cognition scores. These results demonstrate the importance of adjusting for baseline cognitive ability when attempting to study the effect of long-term alcohol use patterns on cognition, and that educational attainment cannot be considered a valid substitute for baseline cognition scores. CONCLUSIONS: Much of the apparent benefit of moderate alcohol intake on cognition in our society may well be explained by differential rates of alcohol consumption among subjects with differing baseline cognitive ability scores. Neither is there evidence that moderate alcohol intake reduces cognitive functioning.     

早期特发性帕金森病患者认知功能障碍观察

目的探讨早期特发性帕金森病（IPD）患者认知功能障碍。方法采用对额叶认知功能障碍相对敏感的神经心理学测试。方法词语流畅性测验、连线测验、伦敦塔测验，对21例早期PD患者和21名年龄、性别、受教育程度相匹配的正常对照者进行观察比较。结果早期帕金森病患者与对照组比较其类似于额叶认知功能障碍评分较差（词语流畅性测验P〈0．05、连线试验P〈0．01、伦敦塔测验P〈0．05）。结论早期IPD患者额叶认知功能显著降低，其机制可能与额叶、纹状体多巴胺环路中递质紊乱有关。     

2型糖尿病的非糖尿病一级亲属的血管内皮功能受损

2型糖尿病患者及非糖尿病的2型糖尿病一级亲属血浆一氧化氮和内皮素1水平下降,且与肥胖、胰岛素抵抗呈正相关。     

口腔白斑患者相关健康状况的问卷调查研究

目的：研究口腔白斑对患者口腔健康及生活质量的影响,并分析其影响因素提出相应的护理对策。方法：选取2014年8月～2015年1月在我院口腔黏膜科就诊的50名口腔白斑患者作为研究组（ OLK组）,同时选取50名健康成人作为对照组。采用口腔健康影响程度量表（ OHIP-14量表）,分别从身体机能、口腔舒适度、心理情况和独立能力四个方面对白斑患者和健康成人进行口腔健康及相关生活质量的评估,并分析结果,提出针对口腔白斑患者的护理对策。结果：与健康成人相比,口腔白斑患者的身体机能、口腔舒适度、心理情况和独立能力均显著降低,差异具有统计学意义（P＜0.05）。结论：口腔白斑会降低患者相关生活质量,全身及口腔护理和心理干预将有助于提高口腔白斑患者的口腔健康及相关生活质量。     

Lymphocyte subset abnormalities,autoantibodies and their relationship with HLA DR types in children with Type 1 (insulin-dependent) diabetes and their first degree relatives

Summary Type 1 (insulin-dependent) diabetes mellitus is associated with abnormalities of circulating lymphocyte subsets and autoantibodies. To investigate the prevalence of these in non-diabetic siblings and non-diabetic parents of children with Type 1 diabetes, we analysed T-cell subsets of function and activation in 31 families with an index case of Type 1 diabetes and related these to autoantibodies and HLA DR type. Using two and three colour cytofluorimetry, we studied total and activated (HLA-DR+) CD3+, CD4+, CD8+ lymphocytes and on CD4+ lymphocytes the CD45RA/RO “naive” and “memory” cell phenotypes. Diabetic children (mean duration of disease 3.1 years) had a reduced total lymphocyte count (p <0.05), their non-diabetic siblings a reduced CD4+ T-helper cell count (p <0.05), and their parents a reduced percentage and number of CD3+ T cells (p <0.01 and p <0.05) compared with age-matched control subjects. Diabetic children, their siblings and parents all had significantly increased levels of activated CD4+ T-helper cells (p <0.01, p <0.05 and p <0.01). In diabetic children and their siblings there was a significant over-expression of the CD45RO “memory” cell marker and significant under-expression of the CD45RA “naive” cell marker, whilst these were normal in the parents. Islet cell antibody positive diabetic children had significantly higher levels of CD45RO-expressing CD4+ lymphocytes than those who were islet cell antibody negative (p <0.05). Amongst the siblings and parents, possession of HLA-DR4 was associated with lower percentages of CD4+ and higher percentages of CD8+ T cells. These findings extend current knowledge about the role of immunoregulatory CD45RA/ RO cells in Type 1 diabetes. In addition, they demonstrate lymphocyte subset abnormalities in unaffected family members, some of which may be influenced by HLA DR alleles. [Diabetologia (1994) 37: 155–165] Received: 1 March 1993 and in final revised form: 16 August 1993     

不同麻醉方法对老年患者人工髋关节置换手术后认知功能的影响

[目的]比较不同麻醉方式对于老年患者人工髋关节置换术后认知功能障碍（POCD ）发生的影响。[方法]选拟择期行髋关节置换术的老年患者90例,性别不限,年龄65～90岁,体质量44～78 kg ,ASA分级Ⅰ～Ⅲ级。随机将其均分为三组各30例：静吸复合全麻组（GA组）,腰硬联合麻醉组（CSEA组）,神经阻滞麻醉组（NB组）。GA组静脉注射咪达唑仑0．03 mg/kg,利多卡因0．5mg/kg,芬太尼3μg/kg,丙泊酚1．5～2mg/kg,维库溴铵0．1mg/kg麻醉诱导,术中吸入七氟烷0．8～1．0 M AC ,根据需要间断给予芬太尼和维库溴铵;CSEA组L2～3穿刺,蛛网膜下腔给予0．5％布比卡因8～10 mg后置入硬膜外导管,麻醉平面上界调节在患侧T8以下,术中根据手术需要硬膜外追加0．5％罗哌卡因3～5 mL ;NB组在神经刺激仪定位下行患侧腰丛＋坐骨神经阻滞。分别于手术前24h,手术后6h,24h,3d,7d采用简易认知状态检查（MMSE）量表进行认知功能评分,并比较各组差异。[结果]与术前比较,GA组在术后6 h ,24 h MMSE评分明显降低（ P＜0．05）,CSEA组与NB组在术后6 h MMSE评分明显降低（ P ＜0．05）,与GA组比较,CSEA组与NB组在术后6 h ,24 h MMSE评分明显高于GA组（ P ＜0．05）。术后6 h ,24 h时CSEA组与NB组POCD发生率明显低于GA组（ P ＜0．05）。[结论]老年患者在人工髋关节置换术全麻比腰硬联合麻醉、下肢神经阻滞麻醉在术后6h,24h的 POCD 发生率更高,各种麻醉方式在手术后3d,7d的POCD发生率无明显差别。     

医学生职业责任感认知现状调查及培养策略探讨

目的 了解医学生对职业责任感的认知现状及变化特点,并提出相应的教育培养策略.方法 采用分层抽样方法随机抽取2000名在校医学生进行问卷调查,建立并录入Excel2003数据库,使用SPSS17.0进行主成分分析处理.结果 一年级至五年级医学生对职业责任感认知的主成分得分为0.5975、0.6235、0.6433、0.6118、0.6024;在校医学生对职业责任感认知状况的发展存在着反复与曲折;影响医学生职业责任感认知的因素侧重于两个方面.结论 在校医学生对职业责任感的认知发展并不稳定,有反复现象,须正视其发展规律并根据影响因素合理引导与培养.     

舒适护理在肾病性高度水肿中的应用研究

目的探讨舒适护理在肾病性高度水肿中的应用效果。方法将2011年11月～2012年11月本科收治的肾病综合征合并高度水肿患者60例,随机分为两组,对照组给予常规基础护理,观察组在对照组护理基础上,增加舒适护理;比较两组患者水肿消退情况、皮肤感染、住院时间、对护理工作满意度。结果观察组水肿完全消退27例（90％）,显著优于对照组21例（70％）;皮肤感染发生率为3．33％,显著低于对照组的16．66％;平均住院时间显著低于对照组,差异均有统计学意义（P〈0．05）。在患者的满意度调查中,观察组也远远高于对照组（P〈0．05）,患者对护理工作的满意度提高,效果满意。结论舒适护理在肾性水肿中的应用,可以有效降低皮肤感染的发生率、缩短住院时间,增加患者的满意度。同时,对改善肾病性水肿的预后减少并发症具有重要作用。