Mitral valve replacement in the presence of massive posterior annular calcification

Replacement of the mitral valve in the presence of extensive calcification of the posterior annulus is a technical challenge. The heavily calcified annulus often results in difficulties of seating the prosthesis and later periprosthetic leakage. A radical calcium debridement may leave a friable and thin annulus that contributes to the risks of prosthesis dehiscence and ventricular perforation. To avoid technical difficulties and associated catastrophic complications, we devised a new technique of mitral valve replacement that allows a surgeon to implant a prosthesis securely. This technique involves inserting a larger single tilting disc mechanical valve (Medtronic Hall disc) with intra-atrial anchorage over the posterior sector of the calcified annulus, orienting the working (major) orifice of the mechanical valve anteriorly, and thereby tilting the lesser occluder segment of the disc upward into the atrium and away from the calcification in diastole. By utilizing this method, we have successfully performed mitral valve replacement in two patients who exhibited massive calcification of the posterior mitral annulus. Postoperative transeosophageal echocardiography showed excellent hemodynamic performance of the implanted valves. We therefore recommend this simple, safe, and time-saving procedure as a feasible method to deal with this surgical dilemma.     

大鼠大脑中动脉缺血和再灌注后环氧合酶-2mRNA表达的研究

目的研究大鼠大脑中动脉缺血和再灌注模型中环氧合酶－２（ＣＯＸ－２）基因的表达。方法原位杂交方法。结果缺血３０ｍｉｎ再灌注组,血流再通４ｈ后缺血区的大脑皮层有很强的表达并持续２４ｈ。缺血９０ｍｉｎ再灌注组和持续缺血组在缺血区以外的广泛大脑皮层显著表达,在海马的齿状回两侧及纹状体也发现表达。ＣＯＸ－２ｍＲＮＡ的表达可被ＭＫ－８０１抑制。而ＮＢＱＸ和倍他米松对其表达没有影响。结论在缺血区、缺血周边部、缺血远隔区有ＮＭＤＡ受体介导的ＣＯＸ－２表达,阐明上述区域花生四烯酸代谢活性化     

Long-range GABAergic projection in a circuit essential for vocal learning

The anterior forebrain pathway (AFP) in the passerine song system is essential for song learning but not for song production. Several lines of evidence suggest that area X, a major nucleus in the AFP, forms part of the avian striatum. A key feature of striatal projection neurons is that they use the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Some area X neurons express GABA-like immunoreactivity, but the neurotransmitter phenotype of the projection neurons is largely unknown. To determine whether area X projection neurons are GABAergic, we used immunocytochemistry and confocal microscopy to examine whether these neurons in adult male zebra finches express the GABA synthetic enzyme glutamic acid decarboxylase (GAD). We observed numerous large and small GAD+ somata in area X, and dense GAD+ terminals, but no GAD+ somata in the target of area X, the medial nucleus of the dorsolateral thalamus (DLM). The density of GAD+ terminals in DLM was strongly reduced by ibotenic acid lesions of area X. After tracer injection into the DLM, all of the retrogradely labeled neurons in area X were GAD+. After tracer injection into area X, the vast majority of anterogradely labeled terminals in DLM were GAD+. We conclude that area X neurons projecting to DLM express GAD and are thus likely GABAergic. If this projection is indeed inhibitory, information processing in the AFP is substantially more complicated than previously realized. Moreover, because a GABAergic projection to a thalamic target is reminiscent of pallidal rather than of striatal circuitry, area X may contain both striatal and pallidal components.     

肉毒碱治疗TPN大鼠肝脂肪变性的研究

目的 探讨在全胃肠外营养（ＴＰＮ）中补充肉毒碱减轻肝脂肪变性的作用。方法 １８只正常Ｗｉｓｔａｒ大鼠和１９只肝硬化Ｗｉｓｔａｒ大鼠分别随机分为６组,Ａ１组、Ａ２组,自由进食和进水（各６只）;Ｂ１组、Ｂ２组,ＴＰＮ（分别６只、７只）;Ｃ１组、 ,ＴＰＮ加肉毒碱（各６只）。各组实验结束后测肝功能,肝脂肪及行肝脏的组织学检查。结果 ＴＰＮ组肝内脂肪显著２,ＴＰＮ＋肉毒碱组肝内脂肪明显减少。结论 在ＴＰＮ     

对肝外胆管梗阻时“软藤征”的再认识

本文回顾性分析了48例“软藤征”的病因,其中恶性疾病28例(占58.3％),良性疾病20例(占41.7％)。据本文资料,作者认为“软藤征”是肝管分叉部及肝外胆管急性完全(或接近完全)性梗阻时肝内胆管扩张的特征性X线表现,并非恶性梗阻特有,良性梗阻亦常见。作者指出,只要肝内胆管无或仅有轻度炎症,胆管具有良好的弹性和扩张性,不论良、恶性病变都可出现“软藤征”。那种认为当梗阻病变未显示时,仅根据“软藤征”即可作出恶性梗阻诊断的观点很值得商榷。作者认为,“软藤征”的定性及病因诊断主要应根据PTC或ERCP,或二者联合显示梗阻局部病变的形态学特征来确定。     

Intracellular signaling pathways that regulate dendritic spine morphogenesis

Rac is a member of the Rho family of small GTPases and acts as a molecular switch. When GTP-bound, Rac binds specific effectors to induce downstream signaling events, including actin cytoskeletal rearrangements (Hall, Science 1998;279:509-514). Herein we review the recent evidence suggesting that Rac is involved in the morphogenesis of dendritic spines (Luo et al., Nature 1996;379:837-840; Nakayama et al., J Neurosci 2000; 20:5329-5338). In addition, we discuss how Rac activity is regulated by guanine nucleotide exchange factors, which may be further regulated by extracellular factors. Thus, the Rac signal transduction pathway may provide links between extracellular ligands or synaptic activity and the regulation of the actin cytoskeleton in spine morphogenesis.     

P波离散度对急性心肌梗死并发房颤的意义

目的　探讨P波离散度 (Pd)对急性心肌梗死并发房颤的预测价值。 方法　 选 36例急性心肌梗死并发房颤的患者 ,观察其P波离散度 ,P波最大时限 (Pmax)。选 80例单纯急性心肌梗死的患者 ,作对照分析。 结果　急性心肌梗死并发房颤的Pd、Pmax与对照组比较有明显差异 (P <0 .0 1)。 结论　P波离散度可作为急性心肌梗死患者并发房颤的一预测指标。     

电针治疗对老年性痴呆大鼠血清β淀粉样蛋白及生长因子水平的影响

目的:观察电针对老年性痴呆(AD)模型大鼠β-淀粉样蛋白及转化生长因子(TGF-α)的影响,揭示针灸治疗的作用机理和针灸治疗AD的免疫基础。方法:建立AD大鼠模型,随机分为电针组、喜得镇组、模型自然恢复组、假手术组,观察血清β-AP和TGF-α水平。结果:电针组和喜得镇组大鼠血清β-AP水平明显下降(P<0.05),但仍明显高于假手术组。结论:电针能降低AD模型大鼠血清中β淀粉样蛋白及TGF-α。