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.     

Interleukin-6 alters the cellular responsiveness to clopidogrel, irinotecan, and Oseltamivir by suppressing the expression of Carboxylesterases HCE1 and HCE2

Carboxylesterases constitute a class of enzymes that play important roles in the hydrolytic metabolism of drugs and other xenobiotics, patients with liver conditions such as cirrhosis show increased secretion of proinflammatory cytokines [e. g., interleukin-6 （IL- 6）] and decreased capacity of hydrolysis. In this sfudy, we provide a molecular explanation linking cytokine secretion directly to the decreased capacity of hydrolytic biotransformation. In both primary hepatocytes and HepG2 cells, treatment with IL-6 decreased the expression of human carboxylesterases HCE1 and HCE2 by as much as 60%. The decreased expression occurred at both mRNA and protein levels, and it was confirmed .by enzymatic assay. In cotransfection experiments, both HCE1 and HCE2 promoters were significantly repressed, and the repression was comparable with the decrease in HCE1 and HCE2 mRNA, suggesting that transrepression is responsible for the suppressed expression. In addition, pretreatment with IL-6 altered the cellular responsiveness in an opposite manner of overexpression of HCE1 and HCE2 toward various ester therapeutic agents （ e. g., clopidogrel）. Transfection of HCE1, for example, decreased the cytotoxicity induced by antithrombogenic agent clopidogrel, whereas pretreatment with IL-6 increased the cytotoxicity. Such a reversal was observed with other ester drugs, including anticancer agent irinotecan and anti-influenza agent oseltamivir. The altered cellular responsiveness was observed when drugs were assayed at sub-and low-micromolar concentrations, suggesting that suppressed expression of carboxylesterases by IL-6 has profound pharmacological consequences, particularly with those that are hvdrolvzed in an isoform-specific manner.     

Gesundheitsschutz bei Hitzeextremen in Deutschland: Was wird in Ländern und Kommunen bisher unternommen?

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Hitzeextreme sind eines der greifbarsten gesundheitlichen Risiken des Klimawandels. In der Prävention setzt Deutschland auf...     

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。     

玻璃纤维桩在严重缺损牙齿修复中的应用

目的:在自行研制了弹性模量介于牙釉质和牙本质之间的玻璃纤维增强树脂桩的基础上,追踪观察其在严重缺损牙齿修复中的效果。方法:选择2005-08/2006-10在桂林医学院附属医院行桩核冠修复并能配合修复后半年复查的患者69例,用自行研制的直径分别为1.4,1.8,2.1mm的圆柱形玻璃纤维/树脂复合材料桩钉对84个严重缺损牙进行桩核冠修复,其中52个前牙,32个后牙;桩修复体直径为2.1mm者22个,1.8mm者39个,1.4mm者23个。半年后进行临床和X射线复查,桩完好、根完好、核完好及冠未脱落或松动者为纤维桩修复成功;同时观察有无材料宿主反应。结果:84个桩核冠修复体复查有2个桩和1个核松动、脱落,修复成功率为96.4%;前后牙及不同直径桩修复成功率的对比差异无显著性意义(P>0.05);所有利用纤维桩修复缺损患牙的患者均未发现有材料宿主反应。结论:玻璃纤维增强树脂桩的力学性能达到修复要求,桩可通用于各牙位,直径1.4,1.8和2.1mm等3种规格的桩都适用于临床修复。初步证明玻璃纤维增强树脂桩是一种有价值的修复方式,但还需进行更长期和更大样本的临床观察。