Differentiation of cardiac murmurs by dynamic auscultation

The techniques described in this monograph will aid in the accurate identification of the origin of a cardiac murmur or abnormal heart sound. They do not necessarily reveal the presence or severity of cardiac disease. No maneuver is 100% accurate in elucidation of cardiac abnormalities, and a given maneuver's effectiveness varies in its application. The systematic application of a combination of maneuvers improves the accuracy of diagnosis. Auscultatory findings must be interpreted with consideration of the total clinical examination including history, other physical findings, ECG, chest x-ray, and possibly an echocardiogram. Thus, the careful physiological approach to the physical examination represents a powerful noninvasive tool that can be used in combination with other information to accurately diagnose cardiac disease in many patients and efficiently direct further evaluation when necessary.     

7-溴化乙氧苯四氢巴马汀抗心律失常作用的机理

7-溴化乙氧苯四氢巴马汀(7-bromoethoxybenzene-tetrahydropalmatine,EBP)10及30μmol/L均能明显延长豚鼠乳头状肌动作电位时程(APD),但对动作电位幅度(APA),静息电位(RP),超射(OS),零期最大上升速率(V_max)无显著影响。EBP能按剂量抑制犬浦氏纤维慢内向电流(I_si)及钾外向电流(I_x)的峰值。     

Elevated expression and altered pattern of activity of DNA methyltransferase in liver tumors of rats fed methyl-deficient diets

DNA methyltransferase (MTase) activity in nuclear extracts from neoplastic and preneoplastic livers of rats fed a methyl-deficient diet (MDD) is elevated compared with that seen in the livers of control rats. Nuclear proteins were prepared in the presence of protease inhibitors including trans-epoxy succinyl-L-leucylamido-(4- guanido)butane and were fractionated by isoelectric focusing. In normal, control liver, two distinct MTase fractions were observed. In MDD-induced malignant liver, a third fraction, in addition to the previous two, was also seen. Both the DNA substrate and the cytosine site specificities of the third MTase fraction differ from those of the other two fractions. The distinct MTase activity in liver tumor has significantly more de novo MTase activity than do the MTase fractions of normal, control liver. Thus, normal and neoplastic rat livers differ in DNA MTase fractionation patterns and site specificities. The altered DNA MTase activity observed in rat liver tumors caused by MDDs may be one of the critical factors contributing to cancer formation through abnormal DNA methylation.      

Oral hygiene and occlusal disharmony in Mexican-American children

Ninety-five Mexican-American children ranging in age from 5 to 13 years of age and residing in Muscatine, Iowa were examined using the Simplified Oral Hygiene Index (OHI-S) and the Orthodontic Treatment Priority Index (TPI) to test the hypothesis that the children with the most severe handicapping malocclusions would also exhibit the poorest oral hygiene. An approximately equal number of males and females were divided according to age into three groups (5–7, 8–10 and 11–13). The TPI and OHI-S scores for each child within a group were ranked so that the Spearman rank correlation coefficient could be calculated and tested for significance using the "t" test. There was observed to be no significant correlation between oral hygiene as scored by the OHI-S. and occlusal disharmony as scored by the TPI.     

Quality of life in pediatric epilepsy: demographic and disease-related predictors and comparison with healthy controls

The purpose of the present study was to compare the health-related quality of life (HRQOL) of children with epilepsy with that of healthy controls and to examine predictors of HRQOL, including current treatment, seizure severity, and comorbid neurological impairments. The epilepsy group consisted of 41 children, aged 4-19 years. The control group consisted of 41 age-matched healthy children seen for well child care in a community pediatric practice. Results demonstrated that the HRQOL of the epilepsy group was significantly more limited than that of the control group. For children with epilepsy, comorbid neurological impairments and number of antiepileptic medications were associated with diminished HRQOL. Duration of illness, age of onset, seizure severity, and treatment type were not predictive of diminished HRQOL. The present findings suggest that presence of comorbid neurological impairments and number of medications are the best predictors of reduced HRQOL in children with epilepsy and may present a subgroup of patients with additional treatment needs.     

牛骨形态发生蛋白对骨质疏松性椎体骨折愈合过程中局部血管内皮生长因子表达的作用

目的:观察骨质疏松性椎体骨折愈合过程中,局部血管内皮生长因子动态表达,探讨牛骨形态发生蛋白促进SD大鼠骨质疏松性椎体骨折愈合的作用机制。方法:实验于2005-07/2006-07在解放军兰州军区总医院骨研所完成。①牛骨形态发生蛋白的制备:青海小牦牛大腿骨,-4℃条件下,粉碎,按Urist改良方法提取。②选择雌性SPF级8个月龄SD大鼠96只,去除双侧卵巢建立骨质疏松模型。随机分为2组:实验组和对照组,每组48只。③术后3个月行L5椎体开窗建立人工骨折模型,实验组置牛骨形态发生蛋白10mg 纤维蛋白复合体;对照组注入等量无血清培养液。④于手术后3,7,10,14,21,28,56,84d每组麻醉状态处死6只,用苏木精-伊红染色、免疫组织化学及定量聚合酶链反应检测骨折愈合不同时间的标本血管内皮生长因子及血管内皮生长因子mRNA的动态表达,阳性信号为胞浆内棕色颗粒。结果:96只SD大鼠全部进入结果分析。①骨折愈合不同时间组织学观察:实验组术后7d纤维骨痂形成,21d新生骨组织与旧骨组织出现融合,56～84d软骨性骨痂已逐渐被骨性骨痂取代,骨折部位髓腔再通,出现成熟板层骨,骨折基本愈合。对照组术后7d未见典型纤维性骨痂;21d新生骨组织大都游离与孤立存在,术后28d骨小梁仅有少部分连结成网状,56～84d部分骨缺损存在,不见成熟板层骨,大部分髓腔不通,骨折愈合延迟。②骨折不同时间血管内皮生长因子免疫组织化学结果:实验组血管内皮生长因子在7d左右可见有阳性表达的细胞,14d有分泌高峰,对应循环数(CT值)最小,两组比值最大。而对照组未见明显分泌高峰。③实时荧光定量聚合酶链反应检测结果:对照组在造模后1,2,4,6,8周时,椎体内的血管内皮生长因子mRNA的表达量明显低于实验组(P<0.01)。结论:牛骨形态发生蛋白可促进大鼠骨质疏松性椎体骨折部位血管内皮生长因子的动态表达,可在受体骨折部位局部促进骨折生长。     

骨形态发生蛋白对去势大鼠股骨颈骨形态、骨密度和骨生物力学的影响

目的:观察在去势大鼠股骨颈植入牛骨形成蛋白后其骨形态、骨密度及骨强度的变化。方法:实验于2006-06/12在解放军兰州军区兰州总医院骨科研究所完成。①实验材料:普通级3个月龄wistar雌性大鼠60只。骨形态发生蛋白冻干粉剂(从幼龄牦牛新鲜长骨皮质中提取)。②实验分组:以同一只大鼠左右肢体为对照,右侧为实验侧,左侧为对照侧。③大鼠摘除卵巢制作绝经后骨质疏松模型经双能X射线骨密度仪检测筛选出造模成功的44只大鼠,实验侧距大转子0.5cm处股骨颈植入牛骨形成蛋白冻干粉剂,对照侧植入牛血清白蛋白。④实验评估:术后4周、8周时麻醉下处死大鼠取材,应用苏木精-伊红染色,组织切片后光镜下观察、CT扫描、双能X射线骨密度仪及万能生物力学机观察大鼠股骨颈骨形态学、骨皮质厚度、骨密度及骨强度的变化。结果:纳入造模成功后的44只大鼠均进入结果分析。①股骨颈骨组织形态学观察:4周时实验侧股骨颈局部骨小梁完整、连续性尚好;对照侧股骨颈局部骨小梁稀少、连续性中断,不完整。8周时实验侧股骨颈骨小梁致密,数量增多、完整,连接成网状结构、分布均匀;对照侧股骨颈骨小梁稀疏、变细、间距变大,呈髓腔扩大。②骨皮质厚度、骨密度及生物力学测定:4周时实验侧和对照侧股骨颈皮质厚度无明显差异,骨密度及最大载荷有明显差异(P<0.05);8周实验侧较对照侧骨皮质厚度明显增加、骨密度、最大载荷均增高[皮质厚度:(2.632±0.042),(1.728±0.034)mm,骨密度:(0.210±0.026),(0.182±0.029)g/mm2,最大载荷:(97.2±8.1),(85.6±7.9)N,P均<0.05]。结论:植入牛骨形成蛋白可以提高去势大鼠股骨颈局部骨皮质厚度、骨密度及生物力学强度,这将可能为绝经后骨质疏松性股骨颈骨折的防治提供一种新的途径。     

人脂肪干细胞体外培养特性及成脂成软骨分化

目的:观察人脂肪组织间充质干细胞体外分离培养及成脂、成软骨诱导分化的生物学性状,探讨其作为软骨组织工程种子细胞的可行性。方法:实验于2006-08/2007-03在吉林大学中日联谊医院前列腺疾病防治研究中心完成主要工作。实验方法:①人脂肪组织来源于健康成年女性腹部吸脂术,酶消化法分离出脂肪间充质干细胞,接种于含体积分数为0.10胎牛血清的高糖DMEM培养基进行原代培养。②取第3代脂肪间充质干细胞,采用细胞计数法测定细胞生长曲线,流式细胞仪测定CD13、CD34抗原的表达,免疫荧光法测定CD34抗原的表达。③取第3代脂肪间充质干细胞,用含体积分数为0.10胎牛血清、0.5mmol/LIBMX、1μmol/L地塞米松、10μmol/L胰岛素的成脂诱导培养基和含体积分数为0.01胎牛血清、10μg/L转化生长因子β1、50nmol/L抗坏血酸、6.25mg/L胰岛素的成软骨诱导培养基分别诱导分化。④每天用倒置显微镜观察细胞形态及增殖变化,油红"O"、AB-PSA染色和Ⅱ型胶原免疫细胞化学染色检测成脂、成软骨分化情况。结果:①体外培养的脂肪间充质干细胞呈扁平的长梭形,细胞形态均一,传代稳定。间质细胞相关标志CD13和干细胞相关标志CD34表达阳性。②定向诱导后表现出脂肪细胞和软骨细胞特性。经成脂诱导,细胞内出现空泡,油红"O"染色呈红色;经成软骨染色,AB-PSA染色呈紫红色,Ⅱ型胶原免疫细胞化学染色胞浆呈棕黄色。结论:脂肪干细胞能向软骨细胞方向诱导分化,可作为软骨组织工程种子细胞。