同型半胱氨酸及C反应蛋白水平与急性心肌梗死患者介入术后左心室重构的相关性

目的探究同型半胱氨酸及C反应蛋白水平与急性心肌梗死患者介入术后左心室重构的相关性。方法选取2018年6月～2019年6月我院收治的介入术治疗的急性心肌梗死患者98例作为试验组,选取同期健康体检者98例作为对照组。依照1年的随访结果将试验组存在左心室重构患者30例作为A组,不存在左心室重构患者68例作为B组。对比两组同型半胱氨酸(Hcy)、C反应蛋白(CRP)、左心室射血分数(LVEF)、左室收缩末期容积指标(LVESV)、左心室舒张末期容积(LVEDV)等指标水平。对比试验组中A、B两组LVEF、LVESV、LVEDV、Hcy、CRP等指标水平。结果试验组LVESV、LVEDV、Hcy、CRP均高于对照组,LVEF低于对照组(P0.05)。试验组中A组LVESV、LVEDV、Hcy、CRP均高于B组,LVEF低于B组(P0.05)。结论 Hcy和CRP水平与急性心肌梗死患者介入术后左心室重构的发生存在一定的相关性,临床上对Hcy和CRP水平进行监测能对急性心肌梗死患者介入术后左心室重构的发生进行预测。     

实时三平面超声心动图评价心肌梗死患者左心室总体收缩功能的研究

目的 探讨实时三平面超声心动图(RT-3PE)测量心肌梗死患者左心室总体收缩功能的可行性、准确性和重复性.方法 同期应用RT-3PE和二维超声心动图(2DE)双平面Simpson法测量30例心肌梗死患者左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)和左心室射血分数(LVEF),并与单光子发射计算机断层成像术(SPECT)测值进行对比研究,同期由同一和不同的检查者应用RT-3PE进行重复测量并将测量结果进行比较.结果 (1)RT-3PE和2DE Simpson法所测LVEDV分别为(86.67±37.64)、(86.43±38.25)ml,LVESV分别为(42.13±37.42)、(41.06±32.47)ml,SPECT测量的LVEDV和LVESV分别为(108.70±66.27)、(55.90±61.68)ml,RT-3PE和2DE Simpson法测得LVEDV和LVESV分别与SPECT比较差异有统计学意义(t=3.63、2.76、3.37、2.54,P均＜0.01或0.05);3种方法所测LVEF值之间差异无统计学意义(P＞0.05).(2)RT-3PE测得LVEDV、LVESV和LVEF与SPECT相应的测量值密切相关(r=0.943、0.965、0.816,P均＜0.01);2DE Simpson法测得LVEDV、LVESV和LVEF与SPECT相应的测量值相关性较好(r=0.896、0.957、0.721,P均＜0.01).Altman-Bland一致性分析显示RT-3PE所测左心室容积和收缩功能与SPECT测值的一致性高于2DE Simpson法.(3)同一和不同的检查者采用RT-3PE重复测量结果之间差异无统计学意义(P＞0.05),且有良好的相关性,同一检查者采用RT-3PE两次测量LVEDV、LVESV和LVEF的相关性良好(r=0.968、0.984、0.883,P均＜0.01);不同检查者采用RT-3PE测量LVEDV、LVESV和LVEF的相关性也很好(r=0.948、0.970、0.899,P均＜0.01).结论 RT-3PE是一种能够快速、准确测量心肌梗死患者左心室总体收缩功能的影像技术.     

急性心肌梗死首次发作后左室非同步运动对左室功能早期改变的影响

目的探讨急性心肌梗死患者左室非同步运动是否可作为左室射血分数(LVEF)降低的一个独立影响因素。方法急性心肌梗死首次发作患者(梗死组)47例,经皮冠状动脉介入治疗术后2~4 d,实时三维超声心动图观测左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、LVEF及左室非同步指数(SDI)。体检健康者35例作为对照组。结果与对照组比较,梗死组LVESV、SDI增高,LVEF减低(均P0.01),SDI与LVEF呈负相关(r=-0.948,P0.01)。多重线性回归分析,与LVEF相关的因素有体质量、心电图ST段改变、冠状动脉病变条数、LVEDV、LVESV及SDI。结论患者体质量、心电图ST段异常、冠状动脉病变条数、LVEDV、LVESV及SDI均可作为可作为评估、预测左室功能的重要指标,尤以心电图ST段异常及SDI影响较大。     

三维超声心动图自动定量技术评估冠心病患者经皮冠状动脉介入术后左心室容积及收缩功能

目的探讨三维超声心动图自动定量(3DEA)技术对评估冠心病(CHD)患者经皮冠状动脉介入(PCI)术后左心室收缩功能的临床应用价值。方法选取50例行PCI的CHD患者,分别于术前及术后1个月、3个月行超声心动图检查,应用二维双平面Simpson's法(2DBP)及3DEA技术测量左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)及左心室射血分数(LVEF)。结果3DEA测量的LVEDV、LVESV及LVEF与2DBP法测值相关性高(r=0.92、0.90、0.84);与PCI术前相比,3DEA技术及2DBP法测量的PCI术后1个月、3个月LVEDV、LVESV均减低,LVEF均增加(P均<0.05),与PCI术后1个月比较,PCI术后3个月3DEA测量的LVEDV、LVESV减低,LVEF增加(P均<0.05),而2DBP测量的LVEDV、LVESV及LVEF差异均无统计学意义(P均>0.05)。与2DBP比较,3DEA技术分析时间短、重复性高(P均<0.05)。结论3DEA技术分析时间短、重复性高,与2DBP测值相关性高,能监测到PCI术后左心室容积及功能改善,对冠心病患者PCI术后疗效评估及长期随访具有临床应用价值。     

超声心动图与多层螺旋CT评价左心功能的分析

将我院收治的36例患者作为研究对象,运用心脏超声心动图(心动图组)和多层螺旋CT(CT组)对患者左心室功能进行检查,比较两种方法测量的左心室参数结果,并进行对比分析。结果运用心脏超声心动图和多层螺旋CT检查患者左心室功能评价结果显示,左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF)左心室每搏输出量(LVSV)、左心室心肌质量(LVMM)参数等比较差异无统计学意义(P0.05);其中LVEDV、LVESV、LVSV具有较高的相关性,LVEF、LVMM相关性中等。运用多层螺旋CT检查和心脏超声心动图对左心室功能检查具有准确、可靠的效果,但多层螺旋CT能够行冠状动脉造影检查,有效显示心脏冠状动脉、静脉的病变状况。     

急性心肌梗死后自体脊髓干细胞注射治疗的Meta分析

目的本系统综述旨在较为全面地评估应用骨髓干细胞治疗心肌梗死后患者左心室收缩功能改善情况,反映骨髓干细胞治疗心肌梗死的现状。方法以"急性心肌梗死"、"骨髓干细胞"为关键词计算机检索Cochrane图书馆(2011年第3期)、ISI Web of Knowledge(建库～2012年)、MEDLINE(建库～2012年)、EMbase(建库～2012年)、PubMed(建库～2012年)。以中文关键词"急性心肌梗死"、限定词"骨髓干细胞"计算机检索万方数据库(建库～2012年)、中国知网(建库～2012年)、维普资讯(建库～2012年),对符合质量标准的随机对照试验(RCT)进行Meta分析。统计学分析采用RevMan5.0.25软件。结果共纳入11个RCT包括1029例患者。Meta分析显示,骨髓干细胞治疗与安慰剂治疗组相比其左心室射血分数(LVEF)提高[2.08,95%CI(1.04,3.13),P<0.0001];左心室收缩末内径(LVESV)减小[-5.16,95%CI(-7.64,-2.67),P<0.0001];左心室舒张末期内径(LVEDV)无改善[-1.65,95%CI(-4.92,1.61),P=0.32]。结论目前证据显示骨髓干细胞治疗急性心肌梗死能提高患者左心室射血功能和左心室收缩功能,但是不能改善患者左心室舒张功能。     

实时三维超声心动图测量室壁瘤患者左心室容积和收缩功能的可行性研究

目的探讨实时三维超声心动图(RT-3DE)检测室壁瘤患者左心室容积和收缩功能的可行性和准确性。方法应用RT-3DE及左心室造影分别测量21例室壁瘤患者的左心室舒张末容积(LVEDV)、收缩末容积(LVESV)和射血分数(LVEF),将RT-3DE测值与左心室造影测值相比较。结果 RT-3DE能显示室壁瘤患者左心室的整体形态,其测量的LVEDV、LVESV较左心室造影测值偏小,差异有统计学意义(P0.05),而LVEF差异无统计学意义(P0.05)。但两种方法测量LVEDV、LVESV、LVEF的相关性r值分别为0.76、0.86、0.67,相关性较好。结论 RT-3DE能够准确测量室壁瘤患者左心室容积和收缩功能。     

三维超声心动图评价心脏再同步化治疗术后即刻左心室同步性改变

目的 探讨实时三维超声心动图(RT-3DE)评估心脏再同步化治疗(CRT)后即刻左心室同步性改变的价值.方法 选择慢性心力衰竭拟行CRT患者62例,采用RT 3DE评价CRT术前以及术后即刻左心室16节段收缩末期容积达峰时间标准差(Tmsv16-SD),计算术前以及术后6个月左心室舒张末期容积变化率(△LVEDV)、左心室收缩末期容积变化率(△LVESV)以及左心室射血分数变化率(△LVEF),筛选预测CRT反应的最佳Tmsv16-SD截断值.结果 △Tmsv16 SD与△LVEDV (r=0.563,P＜0.001)、△LVESV (r=0.612,P＜0.001)以及△LVEF (r=0.442,P＜0.001)呈线性正相关;以△Tmsv16-SD=5.4％为截断值,预测CRT反应的ROC曲线下面积为0.857 (95％ CI:0.760～0.953),灵敏度为85.0％、特异度为86.4％.结论 慢性心力衰竭CRT术后即刻左心室同步性改善可以显著改善CRT疗效,△Tmsv1 6-SD可能是预测CRT反应的新的有效指标.     

自体骨髓干细胞移植治疗糖尿病周围神经病变的系统评价

目的 系统评价自体骨髓干细胞移植治疗糖尿病周围神经病(diabetic peripheral neuropathy,DPN)的疗效和安全性.方法 计算机检索CBM (1978～2011.6)、CNKI (1979～2011.6)、MEDLINE (1950 ～ 2011.6)、PubMed (1950～2011.6)、EMbase (1970 ～ 2011.6)和The Cochrane Library(2011年第3期),收集自体骨髓干细胞移植治疗DPN的随机对照试验(RCT),并追溯纳入研究的参考文献.由2位研究者按照纳入与排除标准筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析.结果 最终纳入4个RCT,共计68例DPN患者、136条患肢,但大多数纳入研究的方法学质量较差.Meta分析结果显示:自体骨髓干细胞治疗糖尿病周围神经病变可使肢体疼痛、麻木、冷感、间歇性跛行、静息痛显著好转甚至消失;与常规治疗相比,自体骨髓干细胞治疗DPN可显著提高双下肢胫神经的感觉神经传导速度[MD=5.75,95％CI (3.86,7.64),P＜0.000 01]及胫神经运动神经传导速度[MD=4.04,95％CI (0.90,7.18),P=0.001],也能显著提高腓神经的感觉神经传导速度[MD=7.47,95％CI (4.00,10.94),P＜0.000 1]及运动神经传导速度[MD=3.83,95％CI (0.07,7.58),P=0.0s].且无不良反应报告.结论 现有证据显示,自体骨髓干细胞移植治疗对DPN有一定疗效.但由于缺乏高质量的RCT支持,上述结论尚需开展更多高质量RCT加以验证.     

尼可地尔对ST段抬高型心肌梗死患者PCI术后心肌血流灌注及再灌注心律失常发生率的影响

目的探讨尼可地尔对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌血流灌注及再灌注心律失常发生率的影响。方法选择2018年7月至2019年7月郑州市金水区总医院收治的STEMI患者115例作为研究对象,采用随机数字表法分为对照组(n=57)及研究组(n=58)。两组均行常规药物治疗,对照组在此基础上,给予直接PCI治疗;研究组在对照组基础上给予尼可地尔治疗。比较两组心肌血流灌注、心功能[左心室射血分数(LVEF)、左心室舒张末容量(LVEDV)、左心室收缩末容量(LVESV)、左室舒张末期前后径(LVEDD)]及再灌注心律失常发生率。结果研究组心肌血流灌注分级优于对照组(Z=3.279,P 0.05)。两组治疗后LVEF均升高,且研究组比对照组高,LVEDV、LVESV、LVEDD均降低,且研究组比对照组低(P 0.05)。对照组再灌注心律失常发生7例(12.28%,7/57),研究组再灌注心律失常发生1例(1.725%,1/58)。与对照组相比,研究组再灌注心律失常发生率略低,但差异未见统计学意义(χ~2=3.357,P=0.028)。结论尼可地尔可有效改善STEMI患者PCI术后的心肌血流灌注,提高心功能,减少再灌注心律失常发生率。     

汉族和藏族Rh表型分布特征比较研究

目的:比较广东汉族和西藏藏族Rh表型分布特征。方法:用微柱凝胶法检测200例汉族和50例藏族样本Rh表型并进行比较。结果:汉族共检出DCCee(55.00%)、DCcEe(29.00%)、DCcee(7.00%)、DccEE(5.50%)、DccEe(3.00%)、dccee(0.50%)6种表型,藏族共检出DCCee(28.00%)、DCcEe(54.00%)、DCcee(2.00%)、DccEE(8.00%)、DccEe(8.00%)5种表型。汉族和藏族在DCCee和DCcEe这2种表型分布中均存在差异(P<0.01),汉族以RhCC(55.00%)和Rhee(62.5%)纯合子多见,而藏族以RhCc(56.00%)和RhEe(62.00%)杂合子多见(P<0.01))。结论:西藏藏族与南方汉族人群的Rh表型分布差异较大,藏族Rh表型有自己的地域分布特点。     

云南省西北地区家畜体表蜱类形态学与分子生物学鉴定

目的 调查云南省西北地区家畜体表蜱的种类及其种群遗传进化情况。方法 采集家畜体表寄生的蜱虫,经形态学鉴定后,用PCR法扩增蜱样本的16S rDNA和ITS2基因片段,测序后进行序列分析。结果 共采集成蜱样本1 275只,经形态学鉴定为1科3属4种,其中微小扇头蜱1 263只（占99.1%）,卵形硬蜱7只（占0.6%）,锐跗硬蜱4只（占0.3%）,未知血蜱1只（占0.1%）。样品分子鉴定结果与形态学鉴定结果一致。16S rDNA序列分析显示,蜱P6与印度微小扇头蜱（EU918188）的相似性最高为99.8%,与中国云南微小扇头蜱（JX051062）的相似性99.4%;蜱P2与美国卵形硬蜱（U95900）的相似性最高为93.8%;蜱P1与日本锐跗硬蜱（AB105167）的相似性最高为95.9%;蜱P4与澳大利亚parva血蜱（JX573136）的相似性为90.5%,与中国云南长角血蜱（JX051064）的相似性为88.7%。ITS2序列分析显示,蜱P6与来自老挝（KC503276）、中国云南（KC203364）的微小扇头蜱的相似性均为99.9%;蜱P2与日本卵形硬蜱（D88857）的相似性最高为96.1%;蜱P1与日本锐跗硬蜱（AB605168）的相似性最高为95.3%;蜱P4与罗马尼亚Haemaphysalis parva血蜱（FN296282）的相似性最高为91.0%。结论 云南地区家畜体表存在微小扇头蜱、卵形硬蜱、锐跗硬蜱和一种与parva血蜱相关的新型血蜱。     

鲍曼不动杆菌的临床感染分布及耐药特征分析

目的 分析河北省沧州市人民医院临床分离的鲍曼不动杆菌对临床常用抗菌药物的敏感性,为临床抗感染治疗提供依据.方法 药敏试验采用纸片扩散法,数据采用WHONET5.4软件处理.结果 130株鲍曼不动杆菌主要来源于痰液标本107株(82.3%),分泌物标本11株(8.5%),尿液标本5株(3.8%).科室分布主要见于重症医学科37株(28.5%),神经外科31株(23.8%),呼吸内科24株(18.5%).对庆大霉素耐药率最高(85.4%),对米诺环素耐药率最低(12.3%),对亚胺培南和美罗培南耐药率分别为33.8%、34.6%,对阿米卡星、哌拉西林、头孢他啶、环丙沙星、甲氧苄啶/磺胺甲噁唑、氨苄西林/舒巴坦、头孢吡肟和左氧氟沙星耐药率均在50%以上.130株鲍曼不动杆菌中发现11株为泛耐药鲍曼不动杆菌(8.5%).结论 该院临床分离的鲍曼不动杆菌主要来自痰液标本,以ICU等科室为主,耐药性严重,存在泛耐药株,需引起预防医院内感染和临床抗感染工作的重视.     

Adenosine inhibits tumor necrosis factor-alpha release from mouse peritoneal macrophages via A2A and A2B but not the A3 adenosine receptor

Adenosine is elaborated in injured tissues where it suppresses inflammatory responses of essentially all immune cells, including production of proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha). Most of the anti-inflammatory actions of adenosine have been attributed to signaling through the A(2A) adenosine receptor (A(2A)AR). Previously, however, it has been shown that the A(3)AR agonist N(6)-(3-iodobenzyl)adenosine-5'-N-methylcarboxamide (IB-MECA) potently inhibited TNF-alpha release from macrophages obtained from A(2A)AR "knockout" (A(2A)KO) mice, suggesting that the A(3)AR may also regulate cytokine expression. Here, we confirmed that the A(2A)AR is the primary AR subtype that suppresses TNF-alpha release from thioglycollate-elicited mouse peritoneal macrophages induced by both Toll-like receptor-dependent (TLR) and TLR-independent stimuli, but we determined that the A(2B)AR rather than the A(3)AR mediates the non-A(2A)AR actions of adenosine since 1) the ability of IB-MECA to inhibit TNF-alpha release was not altered in macrophages isolated from A(3)KO mice, and 2) the A(2B)AR antagonist 1,3-dipropyl-8-[4-[((4-cyanophenyl)carbamoylmethyl)oxy]phenyl]xanthine (MRS 1754) blocked the ability of the nonselective AR agonist adenosine-5'-N-ethylcarboxamide (NECA) to inhibit TNF-alpha release from macrophages isolated from A(2A)KO mice. Although A(2B)ARs seem capable of inhibiting TNF-alpha release, the A(2A)AR plays a dominant suppressive role since MRS 1754 did not block the ability of NECA to inhibit TNF-alpha release from macrophages isolated from wild-type (WT) mice. Furthermore, the potency and efficacy of adenosine to inhibit TNF-alpha release from WT macrophages were not influenced by blocking A(2B)ARs with MRS 1754. The data indicate that adenosine suppresses TNF-alpha release from macrophages primarily via A(2A)ARs, although the A(2B)AR seems to play an underlying inhibitory role that may contribute to the anti-inflammatory actions of adenosine under select circumstances.     

Assessing progression to impaired glucose tolerance and type 2 diabetes mellitus

BACKGROUND: A prospective evaluation of the relationship between insulin secretion and insulin sensitivity, derived from the fasting state, is needed in clinical practice in order to identify the worsening of glucose metabolism. In this study the authors examine whether the product of insulin sensitivity and insulin secretion, assessed from the fasting state, predicts progression from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) and from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A cohort of 300 subjects with NGT and 75 subjects with IGT were followed up over a 5-year period. Insulin sensitivity was calculated using the Belfiore index (B) and insulin secretion by the homeostasis model analysis beta-cell (HOMA-beta cell) index: the product of B-beta is expressed as: (40 x Ins(0) pmol L(-1))/Glu(0) mmol L(-1){[(Glu(0) mmol L(-1)x Ins(0) pmol L(-1)) + 1] - 3.5[(Glu(0) mmol L(-1) x Ins(0) pmol L(-1)) - 1]}, where Glu(0) is fasting glucose and Ins(0) is fasting insulin. RESULTS: From baseline at the end of the follow-up period, the product B-beta decreased 10.7% and 52.2% in progressors to IGT and T2DM, respectively. The product B-beta predicts the progression from NGT to IGT [relative risk (RR) 2.7, CI(95%) 1.2-9.1] and from IGT to T2DM (RR 5.3, CI(95%) 1.3-8.55). The cut-off point for the product B-beta that better predicts progression from NGT to IGT is 0.25 (sensitivity 88%, specificity 92%) and from IGT to T2DM 0.15 (sensitivity 92%, specificity 95%). CONCLUSIONS: Adaptation of insulin secretion to compensate for decreased insulin sensitivity during transition to IGT and T2DM can be successfully assessed with simple measures derived from the fasting state. The product B-beta predicts the development to IGT and T2DM.     

心源性缺氧缺血性脑病患者血浆内皮素和血浆降钙素基因相关肽的研究

目的　探讨血内皮素 (endothelin ,ET)和血浆降钙素基因相关肽 (calcitoninggenerelatedpeptide,CGRP)在心源性缺氧缺血性脑病 (hypoxic ischemicencephalopathy ,HIE)中的变化。 方法　应用放射免疫分析法测定单纯急性心肌梗死 (AMI)及急性心肌梗死伴发心源性HIE 2 4小时内及第 7天血浆ET和CGRP水平。结果　心源性HIE组 2 4小时内血浆ET明显高于AMI组 (P <0 .0 1) ,血浆CGRP明显低于AMI组 (P <0 .0 1) ,至第 7天HIE组ET及CGRP水平与AMI组ET及CGRP水平差异已无统计学意义 (P均 >0 .0 5 )。结论　ET和CGRP与心源性HIE的病程演变有密切关系     

Comparison of four methods for measuring elevation of FRC in mechanically ventilated infants

The aim of the study was to compare measurements of the elevation of functional residual capacity (FRC) above the relaxation volume obtained in 34 mechanically ventilated infants (median weight 2.6 kg, range 1.2–9) from four different methods: (1) direct measurement of the complete exhalation volume after brief disconnection from the ventilator, (2) calculated measurement from total positive end-expiratory pressure (PEEP) measured by end-expiratory occlusion of the breathing circuit, (3) extrapolated evaluation from the mathematical model of Brody, (4) extrapolated evaluation from the passive expiration method. We considered the direct measurement (1) as the “gold standard”. Measurements obtained by total PEEP (2) and by the Brody's mathematical model (3) provided similar results than the direct measurement. Conversely, graphical extrapolation from the passive expiration method (4) underestimated the elevation of FRC. In conclusion, we suggest using the mathematical extrapolation from the Brody's model to evaluate the elevation of FRC in mechanically ventilated infants: this method is non-invasive, does not require disruption of gas flow, can be easily performed with all the neonatal ventilators, and allows continuous breath-by-breath measurements. Received: 15 September 1998/Accepted: 15 July 1999     

Histamine release from leucocytes during migraine attack

Spontaneous histamine release (SHR) from leucocytes (basophils) of 27 migraine patients was investigated during various phases of attack. Mean SHR during the first 3 h of attack (33.7%) was increased compared with the mean SHR from leucocytes of healthy persons (15.9%), but differed insignificantly from the mean SHR in symptom-free periods. Histamine release (HR) from leucocytes of healthy persons suspended in migraine sera from different time-periods of attack was also increased compared with HR in control sera, i.e. high HR could be induced by passive transfer of serum. But the mean HRs in sera from different time-periods of attack were insignificantly different from the mean HR in sera from symptom-free periods. The increased SHR may contribute to vascular hyperreactivity in migraine.     

Pathways of glutamine and organic acid metabolism in renal cortex in chronic metabolic acidosis

The metabolism of labeled glutamine and of several labeled organic acid anions was compared in tissue slices of renal cortex from chronically acidotic and alkalotic littermate dogs. (15)NH(3) formation and (15)N-amideglutamine utilization were significantly increased by slices from acidotic animals providing further evidence for the similarity of the metabolic responses seen in the tissue slice system and the physiologic effects produced by chronic metabolic acidosis on renal metabolism in the intact animal. Slices from acidotic dogs formed more (14)CO(2) and glucose-(14)C than did slices from alkalotic animals when labeled glutamine, citrate, or malate was used as substrate but (14)CO(2) production from pyruvate-1-(14)C was slightly reduced in acidotic tissue. With most of the substrates used glucose-(14)C formation was small compared with (14)CO(2) formation. Using the amount of glucose-(14)C formed, the expected (14)CO(2) production was calculated based on the hypothesis that the primary site of action of metabolic acidosis is on a cytoplasmic step in gluconeogenesis. The actual difference in (14)CO(2) production between slices from acidotic and alkalotic animals always greatly exceeded this predicted amount, indicating that stimulation of gluconeogenesis represents a minor metabolic response to chronic metabolic acidosis. Evidence from experiments with citrate labeled in various positions showed that metabolic acidosis has its principal effect on an early step in substrate metabolism which must be intramitochondrial in location.     

Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation

OBJECTIVE: To investigate the effects of expanded cardiac rehabilitation with multifactorial interventions on metabolic and inflammatory markers, exercise performance and on established cardiovascular risk factors. DESIGN: Single-centre prospective randomized controlled trial. SETTING: A university hospital. SUBJECTS: Two hundred and twenty-four patients with an acute myocardial infarction or patients undergoing coronary artery by-pass grafting. INTERVENTION: Patients were randomized to expanded cardiac rehabilitation including stress management, increased physical training, staying at a 'patient hotel' and cooking sessions, or to usual cardiac rehabilitation. MAIN MEASURES: Biochemical risk markers and exercise performance; follow-up was one year. RESULTS: There were no significant differences between the two treatment groups in the changes of biochemical risk markers or in exercise performance. Thus, low-density lipoprotein (LDL)-cholesterol levels decreased from 3.00 (0.97) to 2.54 (0.66) mmol/L in the intervention group and from 3.20 (0.85) to 2.54 (0.63) mmol/L in the control group, fibrinogen levels decreased from 5.30 (2.00) to 4.25 (1.01) g/L in the intervention group and from 5.29 (1.89) to 4.33 (0.83) g/L in the control group and C-reactive protein (CRP) levels decreased from 3.04 (2.79) to 2.09 (2.13) mg/L in the intervention group and from 4.01 (3.49) to 2.39 (2.49) mg/L in the control group. Total workload (W) improved from 118 (35) to 136 (34) in the intervention group and from 117 (36) to 133 (39) in the control group. CONCLUSION: There was no further significant benefit in biochemical risk markers or in exercise performance among patients undergoing the expanded rehabilitation as compared to the control group which received usual cardiac rehabilitation.