含氯消毒液氧化还原电位与杀菌效果关系的研究

目的研究一种含氯消毒粉水溶液氧化还原电位变化与其杀菌效果的关系。方法以悬液定量杀菌试验方法对该消毒液不同氧化还原电位条件下杀菌效果进行了观察。结果以含有效氯50 mg/L不变的条件下,该消毒液的氧化还原电位分别为700、800、900、980 mV,对悬液内大肠杆菌作用5 min,杀灭对数值分别为2.45、2.83、6.75和6.75;对金黄色葡萄球菌作用5 min,杀灭对数值分别为2.22、3.11、6.41和6.41。以含有效氯300 mg/L,氧化还原电位分别为900、980、1050 mV,对枯草杆菌黑色变种芽孢作用30 min,杀灭对数值分别为0.79、2.91和6.23。结论提高含氯消毒剂的氧化还原电位值,可明显提高其杀菌能力。     

老年退行性心脏瓣膜病与多器官疾病发生的调查分析

目的：分析老年退行性心脏瓣膜病（SDHVD）与多器官疾病的发生状况。方法老年人3896例,男2884例,女1012例,年龄60～103（78±13）岁。所有研究对象均进行心脏彩超、体检、相关辅助检查,并对多器官疾病进行分析。结果3896例患者中,SDHVD1225例（31.4%）,无SDHVD2671例（68.6%）,SDHVD组与对照组多器官疾病的发病率分别为高血压病49.3%vs 28.4%,冠心病38.5%vs23.8%,心力衰竭36.2%vs 17.3%,肺心病6.3%vs 3.1%,脑卒中21.6%vs 9.6%,肾功能不全6.9%vs 3.2%,胃食管反流病21.3%vs 10.3%,两组比较差异均有统计学意义（P＜0.05）,而糖尿病为11.2%vs 12.1%,两组比较差异无统计学意义（P＞0.05）。结论 SDHVD组多器官疾病显著增高,可能由于SDHVD心脏重构改变,血流动力学异常,促发了多器官疾病的发生。     

Early ECG Abnormalities Associated with Transcatheter Closure of Atrial Septal Defects Using the Amplatzer® Septal Occluder

Conduction abnormalities and arrhythmias may occur in patients following secundum atrial septal defect (ASD) closure using the Amplatzer® septal occluder (ASO). Therefore, the aim of this study was to prospectively perform ambulatory ECG monitoring to assess the electrocardiographic effects of transcatheter closure (TCC) of ASD using the ASO device.From 5/97 to 3/99, 41 patients with secundum ASD, underwent TCC using the ASO device at a median age of 9.2[emsp4 ]y. (0.5–87[emsp4 ]y.) and median weight of 34[emsp4 ]kg (5.6–88[emsp4 ]kg.). Ambulatory Holter monitoring was performed pre- and immediately post TCC. Holter analysis included heart rate (HR), ECG intervals, supraventricular ectopy (SVE), ventricular ectopy (VE), and AV block.No change in baseline rhythm was noted in 37 patients (90%). Changes in AV conduction occurred in 3 patients (7%), including intermittent second degree AV block type II, and complete AV dissociation post closure. SVE was noted in 26 patients (63%) post closure, ranging from 5–2207 supraventricular premature beats (SVPB), including 9 patients (23%) with non-sustained supraventricular tachycardia (SVT), 3 of whom had short runs of SVT prior to closure. A significant increase in post-closure number of SVPB per hour (p=0.047) was noted. No significant difference was noted in PR interval, ventricular premature beats per hour, or QRS duration. Conclusions: Based on ambulatory ECG analysis, TCC of ASD with the ASO device is associated with an acute increase in SVE and a small risk of AV conduction abnormalities, including complete heart block. Long term follow-up studies will be necessary to determine late arrhythmia prevalence and relative frequency compared with standard surgical ASD repair.     

Radiofrequency catheter ablation of septal accessory pathways in the pediatric age group

Radiofrequency catheter ablation (RCA) of septal accessory pathways may be technically challenging in children due to the risk of inadvertent atrioventricular (AV) block in the setting of small cardiac dimensions. Outcomes were reviewed for all patients aged < or =19 years with manifest and concealed septal accessory pathways undergoing RCA since 1990 at a single institution. One hundred forty-five procedures were performed in 127 patients (mean age 11.6 years). The number of studies according to accessory pathway location were: anteroseptal (n = 36), midseptal (n = 20), mouth of coronary sinus (n = 40), middle cardiac vein (n = 6), right posteroseptal (n = 21), and left posteroseptal (n = 22). Ablation was deferred for 9 patients (6 anteroseptal and 3 midseptal) in favor of additional pharmacologic trials. Acute success rates for targeted accessory pathways were: anteroseptal (96%), midseptal (94%), mouth of coronary sinus (88%), middle cardiac vein (100%), right posteroseptal (100%), and left posteroseptal (96%). Recurrence rates during follow-up were: anteroseptal (14%), midseptal (12%), mouth of coronary sinus (3%), right posteroseptal (4%), and left posteroseptal (4%). Permanent second or third degree AV block occurred in 4 of 136 RCA attempts (3%), involving 2 anteroseptal and 2 midseptal pathways. In 3 of these 4 cases, a high probability of block was anticipated from prior ablation efforts, prompting pacemaker insertion before or in conjunction with RCA. Thus, in the pediatric age group, acute RCA success rates for septal accessory pathways can exceed 90%. The risks of AV block and accessory pathway recurrence are most relevant to anteroseptal and midseptal pathways. These data may be factored into patient selection and the decision whether to ablate.     

老年睡眠呼吸暂停综合征与糖尿病关系的流行病学调查

目的调查老年人睡眠呼吸暂停综合征(SAS)与2型糖尿病(T2DM)的关系。方法对3286例老年人,采用家访式问卷调查,其中男1824人,女1462人,年龄60~92岁,平均(69±8)岁。随机抽样628人进行多导睡眠仪检查。结果3286例老年人群中SAS患者为959人(29.2%);糖尿病105例(3.2%),其中SAS组84例(8.8%),无SAS组为21例(0.9%),2组比较差异显著(P<0.01)。Logistic多元回归分析SAS是T2DM的独立危险因素(P<0.01)。结论本调查资料提示,老年人SAS患病率为29.2%。SAS组T2DM的发生率显著高于无SAS组,两者呈显著正相关关系。     

Cardiac Resynchronization Therapy (and Multisite Pacing) in Pediatrics and Congenital Heart Disease: Five Years Experience in a Single Institution

Introduction: Clinical evidence supports the use of cardiac resynchronization therapy (CRT) in adults with heart failure, but experience in pediatrics and congenital heart disease (CHD) is limited in terms of patient numbers and follow-up. We sought to determine the functional assessment and clinical outcomes in pediatric and CHD CRT patients followed uniformly at one institution.
Methods: Retrospective review of 60 consecutive patients who underwent CRT between 2002 and 2007.
Results: At implantation, median age was 15.0 years (5 months to 47 years). Overall, 46 patients had CHD (77%) and 14 had dilated cardiomyopathy. Prior to CRT, 92% were on heart failure treatment drugs and 55% had pacemakers. Median follow-up time was 0.7 years (1 day–5.3 years). Median QRS width decreased from 149 to 120 ms (P < 0.001). Median ejection fraction (EF) increased from 36% to 42% (P < 0.001) and improvement was particularly evident in the group with CHD. Of note, 8 of 13 patients with single ventricle morphology had a "strong CRT response," defined as either an improvement of 2–3 ordinal points in NYHA classification and/or increased ventricular function by ≥ 10 EF units. Overall, an improvement in functional status was observed in 39 of 45 patients (87%) with sufficient follow-up data.
Conclusions: Children and CHD patients treated with CRT have acute improvement in ventricular function, but implantation may require individualized planning and unconventional approaches. Future important goals include preimplant determination of CRT responders in pediatric and CHD patients, optimizing lead placement and programing, as well as long-term CRT device management issues.     

Full-length but not truncated CD34 inhibits hematopoietic cell differentiation of M1 cells

CD34 is expressed on human and murine hematopoietic stem and progenitor cells and its clinical usefulness for isolation of stem/progenitor cells has been well established. Although expression of CD34 is regulated in a developmental stage-specific manner, the function of CD34 is not known. Recently we have shown that both a full-length and truncated form of CD34 protein is expressed by hematopoietic cells (Blood 84:691, 1994). To test whether failure to suppress either form of CD34 could affect terminal myeloid differentiation, we constitutively expressed these CD34 proteins in murine M1 myeloid leukemia cells, which can be terminally differentiated to macrophages by treatment with interleukin-6 of leukemia inhibitory factor. Surprisingly our results show that forced expression of the full-length but not the truncated form of CD34 impedes terminal differentiation by these agents. Because the difference between the two forms of CD34 protein resides in the length of their respective cytoplasmic tail domains, our findings strongly suggest that the cytoplasmic domain region of full-length CD34 is responsible for the observed maturation arrest phenotype. These findings suggest a potential negative regulatory role for full-length CD34 in hematopoietic cell differentiation and may explain, at least in part, the block in maturation observed in CD34+ acute myeloid leukemia.