地市级医院射频消融治疗阵发性室上性心动过速质量控制的体会

对５７例阵发性室上性心动过速病人进行射频消融治疗，其中房室旁道４１例（４３条旁道），房室结双径路１６例。成功率９８．２５％，无严重并发症发生。旁道消融无复发病例，房室结改良成功１５例中２例复发，均经再次消融成功。对射频消融初期的质量控制有以下做法：①加强心脏电生理理论学习，进行专业队伍建设。②完善必要设备。③根据设备条件严格掌握适应证和治疗终点。④消融前进行系统电生理检查，避免先入为主。体会：开展工作时以高起点要求可以使工作进展顺利并有利于技术操作规范化和专业队伍建设     

急性冠状动脉综合征患者血清肌钙蛋白I水平与血管内超声的对比分析

目的比较血清肌钙蛋白I(cTn I)升高与否的急性冠状动脉综合征(ACS)患者的冠状动脉病变特点.方法在行冠状动脉介入治疗前用血管内超声检测62例ACS患者的75处病变.根据血清cTn I是否升高将患者分为两组cTn I升高组34例(cTn I>0.15 ng/ml)和cTn I正常组28例(cTn I≤0.15 ng/ml).分析病变处与近端和远端参考段,包括血管外弹力膜面积、管腔面积及斑块负荷,并计算斑块面积和重塑指数,继之确定重塑方向(正、负、无重塑);此外对每组的软硬斑块进行识别和比较. 结果cTn I升高组重塑指数大于cTn I正常组(1.01±0.25对0.83±0.11,P<0.01),正重塑常见于cTn I升高组(46.5%对6.3%,P<0.001),负重塑常见于cTn I正常组(81.3%对39.5%,P<0.05).cTn I升高组患者的病变斑块面积比cTn I正常组大[(11.9±5.2) mm2对(9.1±3.4) mm2,P<0.05];前者远端参考段斑块面积也比后者大[(5.5±3.4) mm2对(3.8±1.8) mm2,P<0.05].cTn I升高组患者与cTn I正常组相比有增高的血栓形成率(P<0.05).结论cTn I升高的ACS患者存在较多血栓和正重塑,有较大的病变处斑块面积和远端参考段斑块面积.他们的冠状动脉病变较cTn I正常的患者严重、复杂.     

葛根总黄酮对实验性哮喘大鼠的预防效应

目的:探讨脾T淋巴细胞亚群在实验性大鼠哮喘模型中的表达,和葛根总黄酮对T淋巴细胞亚群及对实验性哮喘的预防作用。方法:实验于2003-03-01/04-02在解放军总医院实验动物中心完成。用卵蛋白致敏并激发建立了SD大鼠哮喘模型,32只大鼠随机分为4组,每组8只。为正常对照组、卵蛋白激发哮喘发作组、葛根总黄酮灌胃组、葛根总黄酮预防组,每组分别测定动脉血血气作为哮喘严重程度的缺氧评定指标,测定血液中白细胞介素4水平,同时采用流式细胞仪观察脾T细胞亚群的变化。结果:4组32只大鼠均进入结果分析。①各组大鼠血气结果:卵蛋白激发哮喘发作组动脉血氧分压低于正常对照组和葛根总黄酮灌胃组犤(4.24±2.20),(10.04±1.13),(9.68±1.35)kPa,P<0.01犦;卵蛋白激发哮喘发作组剩余碱低于正常对照组和葛根总黄酮灌胃组犤(1.82±1.31),(2.77±2.18),(2.67±2.18)mmol/L,P<0.01犦;卵蛋白激发哮喘发作组血氧饱和度低于正常对照组和葛根总黄酮灌胃组犤(51.8±35.9),(64.55±29.87),(62.51±40.31)%,P<0.05犦。②各组大鼠脾T淋巴细胞亚群变化:葛根总黄酮预防组CD4+低于卵蛋白激发哮喘发作组(13.19±3.33,18.37±1.98,P<0.01),葛根总黄酮预防组CD8+高于卵蛋白激发哮喘发作组(8.01±0.42,6.25±0.63,P<0.01),葛根总黄酮预防组CD4+/CD8+低于卵蛋白激发哮喘发作组(1.61±0.35,2.94±0.32,P<0.01)。③白细胞介素4:卵蛋白激发哮喘发作组为(85.2±12.3)ng/L,比正常对照组和葛根总黄酮预防组大鼠显著增高犤(3.3±0.7),(7.7±1.0)ng/L,P<0.01犦。结论:脾T淋巴细胞亚群的活化参与哮喘的发病过程,葛根总黄酮可以抑制免疫细胞T淋巴细胞的活化和过表达,可能通过恢复CD4+/CD8+比值,加强CD8+T淋巴细胞对CD4+T淋巴细胞的抑制作用,抑制嗜酸性粒细胞增生和IgE的合成从而阻断哮喘发病。     

改良加藤法普查日本血吸虫病的效果评价

目的评价改良加藤法在血吸虫病大规模现场普查中的实施效果。方法在湖北、江西、江苏、四川和云南5省流行区随机选择8个调查点,用ELISA法进行血清学筛查,对阳性反应者,同时采用尼龙绢集卵孵化法(粪孵法)和改良加藤法进行病原学检查。以尼龙绢集卵孵化法为金标准,估算改良加藤法漏检率。结果ELISA法共筛查9853人,阳性2824人。采用改良加藤法和尼龙绢集卵孵化法共检查3853人,调查点的感染率在0.10%~11.77%之间,两法检出阳性508人,其中加藤阳性355人,粪孵阳性456人。改良加藤法的漏检率为30.12%,粪孵法的漏检率为10.24%。8个调查点疫情分轻、重度两组,两组改良加藤法漏检率分别为64.34%及18.47%,差异有显著性(P<0.01)。结论不同地区大规模现场查病,单一使用改良加藤法漏检率偏高,联合运用改良加藤法和粪孵检查可提高血吸虫卵的检出率。     

Gluconeogenesis and fasting in cerebral malaria

BACKGROUND: In healthy subjects after an overnight fast, glucose production is for approximately 50% derived from glycogenolysis. If the fast is prolonged, glucose production decreases due to a decline in glycogenolysis, while gluconeogenesis remains stable. In cerebral malaria, glucose production is completely derived from gluconeogenesis after an overnight fast. It is not known if glucose production also decreases during fasting when its only source is gluconeogenesis. DESIGN: Glucose production was measured by infusion of [6,6-2H2]glucose in seven patients with cerebral malaria after prolonging a fast from 20.30 to 00.30 hours. RESULTS: Glucose production decreased by approximately 10% (27.4 +/- 2.1 to 24.7 +/- 1.6 micromol/kg/min, p = 0.05), without changes in the plasma concentrations of glucoregulatory hormones, FFA or precursors. CONCLUSIONS: In the patients with cerebral malaria, glucose production decreases during fasting due to a decrease in the rate of gluconeogenesis. These data suggest that the decrease in the rate of glucose production during short-term fasting is actively regulated and not simply due to shrinkage of glycogen content, as in the absence of glycogenolysis, glucose production decreases at the same rate as normally seen in healthy subjects whose glucose production is for approximately 50% derived from glycogen and in whom gluconeogenesis is stable.     

The rhesus rotavirus gene encoding protein VP3: location of amino acids involved in homologous and heterologous rotavirus neutralization and identification of a putative fusion region.

The complete gene 4 nucleotide sequence was determined for rhesus rotavirus and each of 11 viral variants selected by neutralizing monoclonal antibodies. Gene 4 is 2362 bases in length and encodes a protein, VP3, of 776 amino acids with a calculated Mr of 86,500. A conserved trypsin cleavage site, located at amino acid 247, divides VP3 into VP8 and VP5. Neutralizing monoclonal antibodies directed at VP3 were used to select variants that escaped neutralization. Each variant contains a single gene 4 mutation that permits viral growth in the presence of the antibody. Variant mutations were identified in six distinct neutralization regions in VP8 and VP5. Five of the six neutralization regions were found in VP8. The VP8 regions were primarily associated with strain-specific or limited heterotypic rotavirus neutralization. One region was identified in VP5 by three monoclonal antibodies that neutralize a broad range of rotavirus serotypes. The VP5 neutralization region is largely hydrophobic and is similar to putative fusion sequences of Sindbis and Semliki Forest viruses.     

Participation of cyclin A in Myc-induced apoptosis.

The involvement of c-Myc in cellular proliferation or apoptosis has been linked to differential cyclin gene expression. We observed that in both proliferating cells and cells undergoing apoptosis, cyclin A (but not B, C, D1, and E) mRNA level was elevated in unsynchronized Myc-overexpressing cells when compared with parental Rat1a fibroblasts. We further demonstrated that Zn(2+)-inducible cyclin A expression was sufficient to cause apoptosis. When Myc-induced apoptosis was blocked by coexpression of Bcl-2, the levels of cyclin C, D1, and E mRNAs were also elevated. Thus, while apoptosis induced by c-Myc is associated with an elevated cyclin A mRNA level, protection from apoptosis by coexpressed Bcl-2 is associated with a complementary increase in cyclin C, D1, and E mRNAs.     

A Qualitative Study of Stigma and Discrimination against People Living with HIV in Ho Chi Minh City,Vietnam

Stigma and discrimination against people living with HIV/AIDS (PLHIV) are a pressing problem in Vietnam, in particular because of propaganda associating HIV with the “social evils” of sex work and drug use. There is little understanding of the causes and sequelae of stigma and discrimination against PLHIV in Vietnam. Fifty-three PLHIV participated in focus group discussions in Ho Chi Minh City. Nearly all participants experienced some form of stigma and discrimination. Causes included exaggerated fears of HIV infection, misperceptions about HIV transmission, and negative representations of PLHIV in the media. Participants faced problems getting a job, perceived unfair treatment in the workplace and experienced discrimination in the healthcare setting. Both discrimination and support were reported in the family environment. There is a need to enforce laws against discrimination and provide education to decrease stigma against PLHIV in Vietnam. Recent public campaigns encouraging compassion toward PLHIV and less discrimination from healthcare providers who work with PLHIV have been encouraging.