冠状动脉旁路移植术97例

1临床资料2004-03/12行冠状动脉旁路移植术(CABG)97(男76,女21)例,年龄38～81岁,其中不稳定心绞痛者46例,陈旧性心肌梗死11例,合并室壁瘤6例,合并高血压78例,合并糖尿病39例,合并主动脉瓣关闭不全4例,二尖瓣关闭不全5例.冠脉造影示:单支病变(心肌桥)7例,3支及3支以上病变90例,心功能Ⅱ级36例,心功能Ⅲ级45例,Ⅳ级16例.心脏超声检查:EF＜20%者10例,EF 20%～40%者36例,EF 40%～50%以上者51例,属二次冠状动脉旁路移植术5例,其余均为首次搭桥.     

圆二色谱在单萜和木脂体化合物结构分析中的应用

报道了10个化合物的CD谱,其中栀子酮(1)、栀二醇(2)和木脂体(3～7)均为新化合物。应用5种规则,确定了它们的绝对构型。     

小檗碱对局灶性脑缺血大鼠血小板聚集及血浆TXB2和6－keto－PGF1a水平的影响

以大鼠可逆性大脑中动脉梗塞（ＭＣＡＯ）致局灶性脑缺血为模型，观察小檗碱对大鼠ＭＣＡＯ２４ｈ后血小板粘附、聚集、血栓形成及血浆ＴＸＢ２和ＰＧＩ２生成的影响。结果表明，小檗碱２０ｍｇ·ｋｇ－１·ｄ－１ｉｐｌ，３或５ｄ，明显降低ＭＣＡｏ２４ｈ后血小板粘附性及ＡＤＰ、胶原和花生四烯酸诱导的血小板聚集率，抑制血浆ＴＸＢ２水平。同剂量ｉｐ３或５ｄ，则抑制血栓形成。提示小檗碱可能通过其抗血小板粘附和聚集及影响花生四烯酸代谢而发挥抗脑缺血作用。     

NHS Trust Boards and Health and Well-being Boards: Do they play any role in the management of disparate levels of care for South Asian patients with Inflammatory Bowel Disease?

Aims:There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study was to investigate whether there was any association between the existence of disparate levels of care and the ethnic composition of the management boards of NHS Trusts and Health Boards. It also examined the ethnic composition of Health and Wellbeing Boards associated with these Trusts in EnglandMethod:NHS Trusts in England and Health Boards in Scotland, which had been involved in previous studies of disparate levels of care, were identified through a review of the relevant published papers. Health and Wellbeing Boards associated with these Trusts were then identified. Executive and non-executive membership of the NHS Trust, Health Boards and Health and Wellbeing Boards was determined through scrutiny of their web pages.Results:The proportion of Asians, who were executive officers, was significantly lower than the proportion who were non-executive board members both for trusts who offered disparate care (z = 2.22; p < 0.03) and those which did not (z = 2.24; p < 0.03). There was no significant difference in the proportion of Asians who were non-executive board members between the two types of trust. The proportion of ethnic minority members of English Health and Well-Being Boards, where there was evidence of disparate levels of care received by South Asian patients was significantly greater than on Boards where this was not the case. (z = 2.8. p < 0.005).Conclusions:The relation of these findings to disparate levels of care is unclear. However, it may point to a culture of tokenism, where either the members are not truly representative of underserved communities or they are unable to have any influence on local policy decisions. In either case there is an urgent need to develop better links with minority communities who are underserved so that issues can be effectively identified and remedied.     

Dyspnea and 8-year mortality among elderly men and women: The PAQUID cohort study

PAQUID is an epidemiological cohort which aims to study cerebral and functional factors of ageing. We have examined the relationship between dyspnea level at entrance into this cohort and mortality occurring during the subsequent 8 years. Dyspnea was evaluated by a questionnaire derived from a Fletcher's five-degree scale. Mortality was recorded during follow-up according to its date and cause. Of 2762 subjects (98.9%) initially giving their dyspnea level, 935 (33.5%) had died 8 years later including 444 (40%) men and 491 (29.4%) women. Mortality was closely related to dyspnea level (p < 0.0001) both in men and women, especially for grade 3 and over, even after adjusting on age, sex, smoking history and former occupation. These results show that dyspnea grade 3 or higher is an important predictive symptom of mortality, thus suggesting that this is a threshold defining the dyspneic subject.     

Identification of an allatostatin from the tobacco hornworm Manduca sexta.

A peptide (Manduca sexta allatostatin) that strongly inhibits juvenile hormone biosynthesis in vitro by the corpora allata from fifth-stadium larvae and adult females has been purified from extracts of heads of pharate adult M. sexta by a nine-step purification procedure. The primary structure of this 15-residue peptide has been determined: pGlu-Val-Arg-Phe-Arg-Gln-Cys- Tyr-Phe-Asn-Pro-Ile-Ser-Cys-Phe-OH, where pGlu is pyroglutamate). To our knowledge, this neuro-hormone has no sequence similarity with any known neuropeptide from other organisms. The synthetic free acid and amide forms showed in vitro activity indistinguishable from that of native M. sexta allatostatin. The ED50 of synthetic M. sexta allatostatin on early fifth stadium larval corpora allata in vitro was approximately 2 nM. This inhibition was reversible. In a cross-species study, M. sexta allatostatin also inhibited the corpora allata of adult female Heliothis virescens but had no effect on the activity of corpora allata of adult females of the beetle Tenebrio molitor, the grasshopper Melanoplus sanguinipes, or the cockroach Periplaneta americana.     

Deep veins of the calf: assessment with color Doppler flow imaging

The authors studied the ability of real-time ultrasound aided by color Doppler flow imaging to demonstrate the deep veins of the calf in ten healthy subjects and 49 patients (91 limbs) with suspected deep venous thrombosis. Posterior tibial and peroneal veins demonstrated flow accentuation in 98% (74 of 75) and 96% (72 of 75), respectively, of the limbs without thrombosis and in all 20 normal limbs. Sixteen legs were involved with deep venous thrombosis. Peroneal veins could not be seen in three legs with marked calf swelling due to proximal thrombosis. There were two cases of thrombosis limited to the calf, nine of popliteal thrombosis (seven with contiguous spread of thrombus), and five of thrombosis limited to above the knee (four with sparing of the deep veins of the calf). Visualization of anterior tibial veins, achieved in 65% of all legs, did not correlate with thrombosis. The authors conclude that color Doppler flow imaging can demonstrate patency of posterior tibial and peroneal veins in most patients without deep venous thrombosis and aid in detection of below-the-knee thrombosis.     

Length-dependent gametic CAG repeat instability in the Huntington's disease knock-in mouse

The CAG repeats in the human Huntington's disease (HD) gene exhibit striking length-dependent intergenerational instability, typically small size increases or decreases of one to a few CAGs, but little variation in somatic tissues. In a subset of male transmissions, larger size increases occur to produce extreme HD alleles that display somatic instability and cause juvenile onset of the disorder. Initial efforts to reproduce these features in a mouse model transgenic for HD exon 1 with 48 CAG repeats revealed only mild intergenerational instability ( approximately 2% of meioses). A similar pattern was obtained when this repeat was inserted into exon 1 of the mouse Hdh gene. However, lengthening the repeats in Hdh to 90 and 109 units produced a graded increase in the mutation frequency to >70%, with instability being more evident in female transmissions. No large jumps in CAG length were detected in either male or female transmissions. Instead, size changes were modest increases and decreases, with expansions typically emanating from males and contractions from females. Limited CAG variation in the somatic tissues gave way to marked mosaicism in liver and striatum for the longest repeats in older mice. These results indicate that gametogenesis is the primary source of inherited instability in the Hdh knock-in mouse, as it is in man, but that the underlying repeat length-dependent mechanism, which may or may not be related in the two species, operates at higher CAG numbers. Moreover, the large CAG repeat increases seen in a subset of male HD transmissions are not reproduced in the mouse, suggesting that these arise by a different fundamental mechanism than the small size fluctuations that are frequent during gametogenesis in both species.      

Long-term neuropsychological sequelae of early-treated congenital hypothyroidism: effects in adolescence

A cohort of over 100 children with congenital hypothyroidism (CH) detected via newborn screening was followed regularly throughout childhood and into adolescence. They were studied using a variety of different tests as part of three consecutive research components: semiannual/ annual psychological assessments using age-appropriate intelligence tests (phase I), detailed psychoeducational evaluations in grades 3 and 6 (phase II) and a thorough neuropsychological evaluation during adolescence (phase III). Controls for phase I were siblings and for phase II, classmates and siblings. Phase III controls were drawn from a larger control pool and were individually matched with each CH case for age and gender. The results showed that although the CH group was intellectually functioning well within the normal range by adolescence, the children were performing significantly below expectation. Longitudinal analyses showed significant declines in IQ with age, signifying that the CH group was failing to make the same age-related gains as controls. Children with CH showed significantly poorer performance in visuospatial, language and fine motor areas as well as selective attention and memory deficits. At school, they were initially below par in arithmetic but were able to catch up by grade 6; however, their teachers reported that they were not performing as well as controls in the classroom and they demonstrated more difficulty with more complex school subjects such as science and social studies. Correlational analyses indicated different manifestations of early hypothyroidism versus later treatment factors, suggesting that while some effects can be improved by better treatment and management approaches, others caused by prenatal and perinatal thyroid hormone insufficiency may persist.