国人的心房动脉(一)心房动脉的分支、口径和行径分布

1.本文对国人新鲜离体心脏50例(30例铸型标本,20例解剖标本)的心房动脉的分支起点、口径和行径分布进行了观察和测量。 2.窦房结动脉多数为第一或第二房前支。起于右冠状动脉者26例(52％),口径1.2～2.2mm。起于左冠状动脉24例(48％),口径1.1～2.0mm。行径均和房间前沟及房间肌束有关。左、右窦房结动脉以“逆时针”型终止于上腔静脉口的多见。以“逆时针”型绕上腔静脉口时多数在界沟附近有一下行袢,此袢在房间后沟内仅见2例,与McAlpine的观察结果不同。本文有6例为其它起点的窦房结动脉,其中4例起于左房旋支,2例为右冠状动脉末端终支的延伸。 3.Kugel动脉为左、右冠状动脉的近端分支,可来自左或右窦房结动脉或左、右房前支。从房间前沟下部入隔(入隔时口径为0.1～1.2mm)。在隔内的行径,分布较恒定,沿卵圆窝下缘后行,并可与心房后壁的左、右冠状动脉的分支吻合,为冠状动脉重要的侧副循环途径。 4.房室结动脉起于右冠状动脉占94％,起于左冠状动脉占6％。口径为0.4～1.9mm,多为1支。2例为双房室结动脉,均起自右冠状动脉。有2例房室结动脉起于左室后支,穿行左室后壁的心肌,经左、右房室口之间到达房室结。房室结动脉在房室交叉点处起于冠状动脉“U”形弯曲顶端的占44.23％,起于平直型冠状动脉的占36.5％,有“U”形弯曲但不起于“U”形顶端的占19.24％。此动脉行在左、右房室口之间的行径以中间型居多,左偏型及右偏型少见。 5.本文对心房动脉的某些形态特点及其与临床应用的意义进行了讨论。     

人体心脏房室结、房室环及主动脉后结的巨微解剖

目的解剖分离人体心脏房室结和房室环的结构,阐述它们的形态特征及相互关系。方法通过体视显微镜解剖12例人体心脏的房室结、主动脉后结及房室环,再进行组织学观察,并绘图演示它们的结构关系。结果在二尖瓣环和三尖瓣环靠近冠状窦前缘处分别暴露了左、右房室环(12/12),直径分别为(0.69±0.12)mm、(0.78±0.13)mm。此处的左、右房室环穿行在房室隔内的心房肌与心室肌之间的间隙中,向房室结方向延伸。主动脉后结在主动脉根后方的房间隔中被探查到(7/9),它的后上方的房间隔间隙中有肌纤维与其相连,它的前下方分出左、右房室环,并且此处的左环比右环粗。在中心纤维体后方的心内膜下的深部,主动脉后结与房室结之间有直接的心肌组织连接通路,这条通路有别于另两条通路(左、右房室环)。结论主动脉后结和房室环可通过体视显微镜解剖暴露,主动脉后结与房室结之间有3条通路。     

家猪房室交界区的组织学观察

利用石蜡切片 ,HE和 Masson染色 ,光镜观测了 7例猪房室交界区的形态学和组织学特征。家猪房室结位于冠状窦口前方 ,大小为 7.0 2× 2 .6 5× 1.2 9mm3。传导细胞分两类 :1细胞短柱状 ,有时有分叉 ,细胞质内有横纹 ,核相对较大 ,此类细胞多位于结上部和前部 ;2典型的移行细胞 ,多位于结的后部和下部。有 2例存在副房室结。结上部和前部、房室束、右束支内的细胞在形态上介于 Purkinje细胞和心肌之间 ,未见典型的 P细胞。说明猪的传导细胞与其它哺乳动物有差异 ,但不同形式的传导细胞却在履行相同的传导功能     

人心脏房室连接区的动脉吻合

本文利用冠状动脉造影法、显微解剖法和腐蚀法研究了14例成年国人心脏房室连接区的动脉吻合。参与该区吻合的动脉有:房室结动脉、Kugel 动脉、冠状窦口支、第一支和第二支前中隔动脉、后上中隔动脉、第一支后中隔动脉及降隔动脉等。这些动脉在房中隔下部和室中隔上部形成丰富的冠状动脉间吻合和冠状动脉内吻合。在冠状动脉软 X 线造影的心脏标本中,每例都见有吻合,最多一例达9处。就正常人心脏而言,连接区动脉吻合支的内径多在101～200μm 之间。在冠心病和心脏肥大的例子中,吻合支有增粗的趋势,最粗一例其内径达320μm。文中对房室结动脉终末分支的特点作了描述。观察到它与其它七支动脉均可形成吻合,连接区可经这些吻合支接受其它动脉的供应。同时房室结动脉又是联系左、右冠状动脉的重要侧支循环途径。鉴于房室连接区动脉吻合的特点,本文认为一旦出现冠状动脉闭塞并波及房室结动脉时,有可能建立有效的侧支循环以代偿连接区的缺血。     

心脏介入治疗与解剖(续)

2 心律失常介入与解剖。2．1 阵发性室上性心动过速的介入治疗。2．1．1 房室结折返性心动过速。正常情况下，房室结是心房、心室之间的唯一电学通道，位于房间隔近三尖瓣环处的前方，Koch三角的前上角。所谓Koch三角是指右房内由Todaro腱、冠状静脉窦口和三尖瓣隔瓣围成的三角形区域。房室结在其中穿过中心纤维体延续为希氏束。房室交界区由三部分组成，即位于房间隔前上区域的前上部分，冠状窦口处延伸而来的后下部分和真房室结。房一结连接区有三个独特的房结束，即上束、中束和侧束。后两融合成近端房结束，并与真房室结相连。上房结束是快径的一部分，中、侧束是慢径的一部分。     

家猪房室结组织学观察和定量分析

目的 :研究家猪房室结的组织学和细胞特征 ,为探讨房室结的传导和心律失常发生机制提供解剖学资料。方法 :利用家猪含房室结组织块的连续切片 ,光镜观测和图像分析。结果 :家猪房室结位于冠状窦口前方 ,大小为7.0 2× 2 .65× 1 .2 9mm3,形态前后径略长的铁饼形 ,传导细胞分两类 :(1 )心肌样细胞 ,此类细胞多位于结上部和前部 ;(2 )典型的移行细胞 ,这种细胞多位于结的后部和下部。图像分析表明 :心肌样细胞 >一般心肌细胞 >T细胞。有 2例的房室结左前方存在副房室结。结论 :家猪房室结的位置比其它哺乳动物低 ;结上部和前部细胞主要为心肌样细胞 ,典型的P细胞少见 ,纤维细胞明显多于传导细胞     

心房动脉的形态特点及其临床意义

目的:为心房切开术或经心房介入治疗术时防止伤及心房的动脉提供解剖学基础。方法:20例正常成人心脏标本,解剖观测心房动脉的分支分布特点。结果:右心房动脉有2~6支,平均3.4支,起于右冠状动脉外侧壁,起始处和分支处外径为(1.5±0.6)mm和(1.3±0.5)mm,主干长(20.0±9.8)mm。左心房动脉有2~4支,平均2.4支,左房前支和左房中支均起于左冠状动脉的上壁,左房后支有20％(4例)起始于右冠状动脉。起始处和分支处外径为(1.2±0.6)mm和(1.1±0.6)mm,主干长(14.6±5.6)mm。心房动脉多数与冠状动脉呈直角分布于心房肌,窦房结动脉行于右心房的界沟内。结论:(1)左、右心房的动脉多数以直角起于冠状动脉,向上分布于心房;(2)在心房切开术时应远离冠状沟,切口应与冠状沟呈直角方向,在右心房前外侧的切口应离开界沟2 cm左右并与该沟呈平行方向,能有效防止伤及心房和窦房结的动脉。     

心房动脉的应用解剖

目的:为心房切开术或经心房介入治疗术提供心房动脉的解剖学基础.方法:对27例成人心的心房动脉进行解剖,重点观测营养房间隔及左心耳的动脉的起源并测量其外径、主干长度.结果:右心房动脉有2～4支,平均3.0支,均起于右冠状动脉右侧壁,起始处外径为(1.6±0.4) mm,左心房动脉有2～5支,平均3.0支,92.6%分支起于旋支,7.4%的分支来自右冠状动脉.营养房间隔的动脉行于前房间沟下部,48.1%(13例)由右冠状动脉发出,起始处外径为(1.3±0.4) mm,主干长度为(21.0±9.6) mm,51.9%(14例)由旋支发出,起始处外径为(1.2±0.4) mm,主干长度为(9.0±4.2) mm;左心耳动脉有1～5支,平均2.3支,除1例起于右冠状动脉外,其余均起于旋支,起始处外径(0.7±0.4) mm,主干长度(13.1±6.7) mm.根据其行走特点可分为4型.结论:进行心腔内直视手术时需注意房间隔动脉及左心耳动脉的走行特点,以防伤及,引起血供障碍.     

右冠状动脉开口异位1例

在局部解剖的过程中,发现右冠状动脉开口位置异常1例(附图),报道如下:下,动脉口直径为0.4cm,其主干先在升主动脉根部与肺动脉干之间紧贴升主动脉壁向右行走0.9cm距离,继行于肺动脉与右心耳下方的右冠状沟内,向右绕过右缘至膈面走行于后室间沟,于心尖处与前室间支末梢吻合,沿途分支有:右圆锥支、右室支、右缘支、右房支、房事结支。左冠状动脉开口于左主动脉窦内,动脉口直径为0.4cm,心脏其它部位未见异常。 本例右冠状动脉分支和分布虽属正常,但其始段贴着升主动脉壁行走,当主动脉充盈扩张时,可能影响到右冠状动     

房室交界区三角的观察和测量

在110例人心(成人70,儿童40)上,观察了由冠状窦口、Todaro腱及三尖瓣隔瓣附着缘围成的房室交界区三角,对上述各边界及室间隔膜部进行了测量。三角的三个角各有不同结构占据,前上角为房室结,顶角有冠状窦和心最小静脉开口,后下角深面为右冠状动脉“U”形袢。就上述特点结合临床进行了讨论。     

Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay

The present case report describes a patient with an artificial mitral valve and dual chamber pacemaker implanted due to perioperative complete atrio-ventricular block. One year later an upgrade to cardiac resynchronization therapy (CRT) combined with ICD function was performed due to significant progression of heart failure symptoms. Beneficial effects of CRT are demonstrated, but unfavourable haemodynamic consequences of right atrial appendage pacing are also underlined. Important interatrial conduction delay during atrial paced rhythm resulted in a significant time difference between optimal sensed and paced atrio-ventricular delay (AVD). This report provides a practical outline how to determine the interatrial delay and the sensed-paced AVD offset under echocardiography in patients treated with CRT.     

Dandy-Walker (like) malformation,atrio-ventricular septal defect and a similar pattern of minor anomalies in 2 sisters: A new syndrome?

We report on sisters with similar craniofacial anomalies, a brain malformation in the area of the posterior fossa, and a congenital heart defect. The craniofacial findings include macrocephaly, a prominent forehead and occiput, foramina pari-etalia, hypertelorism, downslanting palpebral fissures, a depressed nasal bridge, narrow palate, and apparently low-set ears. Patient 1 had a Dandy-Walker malformation with communicating hydrocephalus, aplasia of the posterior portion of the cerebellar vermis, and high insertion of the confluent sinus, while in patient 2, a Dandy-Walker variant was found with aplasia of the cerebellar vermis and hypo-plasia of the hemispheres, large cisterna magna, high insertion of the confluent sinus, but no hydrocephalus. Both sibs were moderately mentally retarded. The older sister had a complete atrio-ventricular canal and died after unsuccessful heart operation at 31/2 years. The younger had a successful operation on a cleft mitral valve and septum primum defect. Chromosomes were normal. The occur-rence of a distinct and similar pattern of congenital anomalies in sisters born to healthy parents points toward a “new” syndrome caused by the homozygous state of an autosomal recessive gene.     

Localization of natriuretic peptides in the cardiac pacemaker of Atlantic salmon (Salmo salar L.)

This study describes the location of the primary pacemaker at the sino-atrial (SA) junction and the localization of salmon cardiac peptide (sCP) and ventricular natriuretic peptide (VNP) in Atlantic salmon (Salmo salar L.). The pacemaker tissue appeared lightly stained and composed of: (1) wavy nerve bundles with oval elongated wavy appearing nuclei with pointed ends, (2) ganglion cells (12–22 μm) with granular cytoplasm and (3) wide muscle fibers with large nuclei (modified cardiomyocytes) clearly distinguishing them from the other myocardial cells. Pacemaker tissue was further evaluated using immunohistochemical staining. Immunoreactivity of natriuretic peptides (sCP and VNP) antisera showed specific staining in pacemaker ganglion cells in addition to the cardiomyocytes. Positive staining with anti-CD3? antisera in the pacemaker ganglion cells is a novel finding in teleosts and is consistent with observations in mammals. In conclusion, the Atlantic salmon pacemaker was shown to be located at the SA node and to harbor sCP and VNP peptides, suggesting a possible neuromodulatory and/or neurotransmitter role for these cardiac hormones within the teleost heart.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.