Innocent Bystander or Marker of Pathology!

Mitral annular calcification is known to be associated with conduction abnormalities, embolic phenomena, endocarditis, mitral regurgitation, and thromboembolic cerebrovascular events in the younger population. The size of our elderly population is growing dramatically with the fastest growth in those aged greater than 85 years. The incidence of mitral annular calcification increases sharply in these “very elderly group of patients.” To determine if mitral annular calcification in the elderly patients has the same implications as in the younger population, electrocardiographic and echocardiography (M-mode, two-dimensional, Doppler) data from 553 octogenarian patients who were referred for a variety of clinical indications were analyzed. Patients with mitral annular calcification were quantified into mild, moderate, and severe, and the association of each was determined with various cardiac abnormalities. Mitral annular calcification was found in 59% of the octogenarian patients. Out of these, mild mitral annular calcification was present in 38%, moderate in 40%, and severe mitral annular calcification in 22% of the patients. Mild mitral annular calcification was not associated with an increased incidence of any cardiac abnormalities. Moderate mitral annular calcification was also not associated with any increased incidence of significant aortic stenosis, conduction abnormalities, and enlarged left ventricular size. However, severe mitral annular calcification was associated with all these findings. Moderate and severe mitral annular calcification were associated with significant mitral regurgitation and left ventricular hypertrophy. Thus, in the majority of elderly patients with mild and moderate mitral annular calcification (78%), its presence merely represents an aging process and an innocent bystander as compared to elderly patients without mitral annular calcification. However, only severe mitral annular calcification is strongly associated with cardiac abnormalities. Therefore, quantification of mitral annular calcification in the elderly is important before associating it with various cardiac abnormalities. (ECHOCARDIOGRAPHY, Volume 8, May 1991)     

犬内皮与平滑肌细胞的短期静态联合培养

目的:为获得组织工程化自体血管,观察体外静态培养条件下犬内皮细胞与平滑肌细胞联合培养组织学及形态学的特征。方法:实验于2004-07/2005-06在首都医科大学宣武医院外科院级实验室完成。①实验材料:雄性杂种犬,3个月龄,体质量8～12kg。②实验方法:贴块法及酶解法对犬内皮细胞及平滑肌细胞进行原代分离培养及扩增,将第Ⅱ代平滑肌细胞以1×109L-1的密度种植于胶原膜上培养13d,再将第Ⅱ代内皮细胞接种于生长平滑肌细胞的胶原膜上2d。③实验评估:行苏木精-伊红染色同时扫描电镜和透射电镜观察平滑肌细胞和内皮细胞在胶原载体上联合培养后的形态。结果:苏木精-伊红染色见平滑肌细胞较均匀的分布于支架材料表面及内部;扫描电镜下,平滑肌细胞可以在胶原载体材料上生长,增殖明显并在短期内形成多层细胞。内皮细胞与平滑肌细胞联合培养2d就可在平滑肌细胞层表面获得连续的单层内皮细胞层。结论:在短期静态培养条件下犬的血管平滑肌细胞和内皮细胞可以在胶原载体材料上形成具有两层细胞结构的组织工程化动脉血管组织片。     

自体造血干细胞的体外净化

目的:综合分析自体造血干细胞体外净化的方法。资料来源:应用计算机检索Medline 1991-01/2003-12有关自体造血干细胞体外净化方法的文章,检索词“purging,HSCT”,并限定文章语言种类为English。同时计算机检索CNKI数据库1991-01/2003-12有关自体造血干细胞体外净化方法的文章,检索词“体外净化,PUVA”,并限定文章语言种类为中文。资料选择:对相关资料进行整理,选取同一领域、不同方面的文献,以近期发表或权威杂志的文章优先。资料提炼:共检索到42篇有关自体造血干细胞体外净化方法的文献,其中24篇文章符合要求。排除18篇,其中15篇系重复同一研究,3篇为Meta分析。资料综合:自体造血干细胞的体外净化方法很多,如物理方法、生物学方法、药物方法、免疫净化、基因净化等。每种净化方法都有其各自的优势和不足,如淋巴系统疾病可以采用免疫净化;慢性粒细胞白血病患者可考虑反义技术;大多数患者则均可以考虑药物净化的方法。结论:针对不同的疾病,可以选择不同的净化方法,还可以将几种净化方法联合起来,其效果和方法的改进也在不断的研究探索中。     

长期住院慢性精神分裂症患者的生活质量

目的:评估长期住院的慢性精神分裂症患者的生活质量,并分析影响因素。方法:纳入2004-01/08在北京回龙观医院住院的慢性精神分裂症患者163例。以年龄、性别、受教育程度为匹配条件,按照2∶1的比例选择本院职工及医院所在社区内82例健康自愿者为对照组。采用健康状况调查问卷进行生活质量评价:包括36个条目,归纳为8个分量表:生理机能,生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能和精神健康。分数越高,表明该方面的功能状况越好,生活质量越高。结果:发放调查问卷245份,收回有效问卷245份。①精神分裂症患者健康状况调查问卷各维度评分均低于对照组,两组比较差异有显著意义。②相关分析发现长期住院的慢性精神分裂症患者健康状况调查问卷评分与阳性与阴性症状量表评分、副反应量表呈负相关(P<0.05～0.001)。健康状况调查问卷评分与性别呈正相关(P<0.05～0.001),与年龄、婚姻状况、病期、住院时间、目前状态、躯体疾病呈负相关(P<0.05～0.001)。结论:长期住院的慢性精神分裂症患者的生活质量低下,影响因素包括精神病状态、药物副反应、年龄、性别、病期、住院时间、婚姻状况、躯体疾病。     

常压模拟高住低练对红细胞相关指标和促红细胞生成素、低氧诱导因子-1mRNA表达影响的研究与进展

目的:常压模拟高住低练训练法是近年来提出来的一种新型的高原训练方法,可以解决传统高原训练中存在的不足。就高住低练训练法对红细胞相关指标和促红细胞生成素、低氧诱导因子-1基因表达的影响作一综述,旨在促进高住低练训练法在中国的发展和应用,使其更好地为运动员竞技水平的提高服务。资料来源:应用计算机检索PubMed1972-01/2005-12的相关文章,同时根据相关的参考文献检索了部分文章,检索词“simulated living high-training low training(HiLo),indices of red blood cell,effect;erythropoietin(EPO)、Hypoxia inducible factor-1(HIF-I),Gene”限定语言种类为English,同时计算机检索http://cnki.hunnu.edu.cn1996/2006的相关文章,限定文章种类为中文,检索词“:高住低练,红细胞相关指标,影响,促红细胞生成素,低氧诱导因子,基因。”资料选择:对资料进行初审,选取实验包括常压模拟高住低练运动模型中关于红细胞相关指标和促红细胞生成素基因、低氧诱导因子-1基因表达的影响方面的文献,查找相关文献的全文,判断是否确实是相关研究。纳入条件:①随机对照实验研究。②实验包括对照组与干预组。排除条件:①综述文献。②重复的同一研究。资料提炼:共查找到90篇相关研究文章,38篇符合纳入标准。排除的52篇系为同一研究和综述文献。资料综合:Levine在高住低练训练法的试验发现:高住低练训练组最大摄氧量平均增加了5%,红细胞平均增加了9%,运动能力得到改善,而对照组无论是最大摄氧量、红细胞、还是运动能力均无显著性变化。②高住低练训练法能促使低氧诱导因子-1的产生而对促红细胞生成素的调控,使促红细胞生成素的产生和血红素浓度的变化,促红细胞生成素增加引起红细胞量和Hb浓度的增加;血红素浓度增加可以提高血液运输氧的能力和组织氧化能力。居住在适宜高度(大于2000～2500m),通过持续增加促红细胞生成素的量,诱导红细胞和血红素浓度的增加,改善氧运输能力、提高最大摄氧量,可以有效地提高运动成绩。③高住低练训练法引起低氧诱导因子-1mRNA表达,其如何对促红细胞生成素进行调控和信号的转达,高住低练训练法导致血液成分变化对运动能力的影响等问题的研究。可以更清楚地认识高住低练训练法对机体运动能力影响的机制,为提高运动成绩提供帮助。结论:高住低练训练法可促进促红细胞生成素、低氧诱导因子-1基因表达和红细胞的生成,提高血红蛋白浓度和红细胞比容,而有效地提高运动员的运动能力。     

Sputum Examination in the Screening and Diagnosis of Pulmonary Tuberculosis in the Elderly

Pulmonary tuberculosis is not uncommon in the elderly, particularlythose in institutions, and is notoriously difficult to diagnose.Few bacilli are excreted by individuals with non-cavitatingdisease and positive cultures are usually required to confirmthe diagnosis. Radiography is a poor screening method, and therole of the Mantoux test in this population controversial. Thevalue of sputum culture as a screening procedure in elderlypeople with a productive cough was therefore investigated. Ina prospective surveillance study over 26 months, all permanentresidents in homes for the elderly were entered on the basisof a productive cough for 3 weeks or more irrespective of anyknown or presumed cause. Both smears and cultures were performedon sputum specimens, and Mantoux tests and chest radiographswere performed on those who were sputum positive. The 205 subjects investigated yielded 446 smears, seven of whichwere positive for acid-fast bacilli, and 433 cultures, 32 ofwhich were positive for M. tuberculosis. From this 19 patientswith pulmonary tuberculosis were identified, 18 of whom hadnon-cavitating disease on chest radiography. The numbers ofbacilli in these patients were shown to be low and the excretionpattern haphazard. Smears were not sufficiently sensitive todiagnose non-cavitating tuberculosis in this population, andthe sputum must be cultured in order to exclude the diagnosis.Four negative cultures are required in order to exclude thepresence of pulmonary tuberculosis.     

Epicardial Mapping: Ventricular Epicardial Activation is Unaffected by Heart Position

Epicardial ventricular mapping was performed in five dogs during sinus rhythm with a sock array containing 41 bipolar electrodes. Maps were generated with a computer-assisted mapping system when the heart was in situ and when the heart was lifted by 44 degrees out of the chest. Times of earliest and latest epicardial activation in these two states did not differ. Despite a different frontal plane QRS axis, location of earliest activation was not affected by lifting the heart. In two of the five animals, the site of latest epicardial activation was minimally different from the heart in situ, but the general pattern of epicardial activation was unchanged. Therefore, the change in frontal plane QRS axis with lifting the heart was due to a change in heart position rather than a general change of heart activation.