Treatment of underlying atrial fibrillation: paced rhythm obscures recognition

OBJECTIVES: The purpose of this study was to evaluate the rate of recognition of atrial fibrillation (AF), use of warfarin and prevalence of cerebrovascular accident (CVA) in paced versus unpaced patients during admission to a tertiary care teaching hospital. BACKGROUND: The presence of AF underlying a continuously paced rhythm may be under recognized and result in a lower rate of anticoagulation and higher incidence of CVA. METHODS: The identification of AF on 12 lead electrocardiogram (ECG) and telemetry, "optimal use" of anticoagulants that is, warfarin or aspirin, when warfarin is contraindicated and history of prior CVA was studied in three groups: 1) group A with continuously paced rhythm on ECG and telemetry (n = 30), 2) group B with intermittently paced rhythm on ECG and telemetry (n = 59), and 3) group C with persistent AF and no permanent pacemaker (n = 50). RESULTS: The identification and documentation of AF was significantly lower in the continuously paced group A (20%) versus the intermittently paced group B (44%). Both groups A and B were substantially lower than unpaced controls. "Optimal use" of anticoagulants was significantly lower in group A (40%) compared with groups B (78%) and C (72%) but was not different between groups B and C. The prevalence of prior CVA was not significantly different between the three groups. CONCLUSIONS: All ECGs in patients with paced rhythm should be examined closely for underlying AF to prevent under-recognition and under-treatment with anticoagulants.     

红霉素致小鼠肝脏毒性效应的基因表达谱变化

目的 利用小鼠毒理基因芯片观察红霉素致balb/c小鼠肝脏毒性效应的基因表达谱变化.方法 建立红霉素致balb/c小鼠肝毒性效应模型,利用本室构建的小鼠毒理基因芯片检测1、3、7d小鼠肝脏基因表达谱变化,结合层次聚类和生物信息数据库检索对差异表达基因进行初步信息分析.结果 各时相组共发现239个差异表达基因,其基本表达模式分为4群,结合功能分析涉及脂肪分解代谢、蛋白质合成与降解、氧化应激、炎症发生、凋亡相关信号转导等多方面机制.结论 毒理芯片的检测展示了红霉素致肝脏毒性效应的基因表达谱变化基本轮廓,为进一步阐明其肝毒性机制提供了众多线索.     

4个与营养代谢相关基因对小鼠的血清生化指标的影响

目的研究4个与营养代谢相关基因(DL、Tr、Pe、P3)对BALB/c小鼠的血液生化指标的影响。方法将4个基因的反义核酸微量定量注入小鼠侧脑室。设反义核酸实验组、随机序列核酸对照组和生理盐水对照组3组;3次注射后于第4天取血清进行生化指标测定。结果DL和Tr实验组与对照组分别在6项指标上有显著性差异,Pe实验组、P3实验组与对照组分别有4项和3项指标有显著性差异。结论3个反义核酸实验组(DL、Tr和P3)BABL/c小鼠的血中甘油三酯含量都显著高于对照组,尤其是Tr反义核酸实验组的胆固醇含量也显著高于对照组,且都超出正常值范围,进一步证明Tr基因与脂类代谢有一定的相关性。另外上述3个反义核酸实验组(DL、Tr和P3)的血中葡萄糖含量也明显高于对照组并超出正常值范围,说明这些基因还可能与糖代谢相关。     

透明质酸诱导人肺腺癌A549细胞表达血管内皮生长因子-C

目的：研究透明质酸（HA）对体外培养的人肺腺癌A549细胞表达血管内皮生长因子-C（VEGF-C）的影响。方法：体外培养的A549细胞被随机分为三组，对照组：无血清培养基（FSM）培养；HA10ug／ml组和HA20ug／ml组：分别用HA10ug／ml和20ug／ml的FSM培养，48h后，分别用RT-PCR、Westernblot和免疫荧光方法检测A549细胞VEGF-CmRNA和蛋白表达。结果：对照组VEGF-CmRNA和蛋白表达为弱阳性；HA10ug／ml和HA20ug／ml组VEGF-CmRNA和蛋白表达皆呈强阳性。HA20ug／ml组与HA10ug／ml组相比，VEGF-CmRNA和蛋白表达皆显著增加（P〈0．01）。结论：HA能呈剂量依赖性地诱导A549细胞表达VEGF-C。     

碱性成纤维细胞生长因子在酒精性肝病大鼠中的表达及抗纤复方1号对其影响

目的：探讨碱性成纤维细胞生长因子（BFGF）在酒精性肝病大鼠肝脏中的表达及抗纤复方I号对其表达的影响。方法：Wistar大鼠给予乙醇8～10g·kg^-1·^-1，3次灌胃12周制备酒精性肝病大鼠模型为酒精组，对照组给予等量生理盐水，中药组在给予同酒精组等量乙醇的基础上，给予抗纤复方I号水煎剂4．0mL·ks^-1·d^-1，2次灌胃，共12周。实验4、8、12周末分批处死动物，HE及VG染色观察肝脏组织学改变。应用免疫组织化学技术检测BFGF在酒精性肝病过程中的定位及表达，并用病理图象分析仪对其结果进行半定量分析。结果：造模12周时，酒精组大鼠肝脏呈现重度脂肪变性，点片状肝细胞坏死及炎性细胞浸润，纤维条索形成；而中药组大鼠仅呈现轻度脂肪变，无纤维条索形成。BFGF表达在正常对照组主要位于血管内皮细胞的胞浆中，中药组表达同正常对照组基本一致；在酒精组BFGF的表达除位于血管内皮细胞外，还位于窦周细胞、纤维间隔内浸润细胞的胞浆及汇管区、纤维间隔区的细胞外基质中。结论：在酒精性肝病BFGF的表达增强，抗纤复方I号能降低其表达。     

Organizational characteristics and issues affecting the longevity of self-help groups for parents of children with special needs

In this article, the organizational characteristics and issues affecting the maintenance of nine self-help groups for parents of children with special needs are discussed. Qualitative data were collected through interviews with 20 parents and observation of six group meetings. For continued existence, groups must deal with the challenges of encouraging new leaders, attracting new members, obtaining funds or assistance to support their activities, and meeting the changing needs of members. Important organizational characteristics associated with longevity are committed and effective leadership, community connections that help provide needed funds or practical assistance, and the willingness of group members to change activities to meet changing needs. This information can be used by parents and service providers to plan new groups, recruit group members, and ensure the effective functioning of groups as they change over time.     

Possible effect of gestational age on the detection of fetal nucleated erythrocytes in maternal blood.

Maternal venous blood samples, obtained from six pregnant women, were used as a source of fetal nucleated erythrocytes (NRBC). Fetal cell enrichment was potentiated by flow sorting with the monoclonal antibodies TfR, Leu-4, and Leu-M3. Single copy Y chromosomal DNA sequences were detected in samples obtained from two women at 11 and 12 weeks' gestation. Y DNA sequences were absent in a subsequent sample from one of these women at 19 weeks and in two other women at 16 and 20 weeks. All four women delivered males. Y DNA sequences were not detected in two women who delivered females. By combining these results with prior data on the detection of Y chromosomal DNA sequences in maternal blood from male-bearing pregnancies, a relationship between gestational age and feto-maternal transfer of NRBC is suggested.     

Normal fetal Doppler inferior vena cava, transtricuspid, and umbilical artery flow velocity waveforms between 11 and 16 weeks' gestation.

OBJECTIVES: Our objectives were to determine flow velocity waveform patterns in the fetal inferior vena cava and to relate these waveforms to transtricuspid and umbilical artery waveforms and fetal heart rate in early gestation. STUDY DESIGN: Doppler waveforms were recorded in 40 normal fetuses at 11 to 16 weeks of gestation. Only transvaginal scanning was carried out at 11 to 12 weeks and only transabdominal scanning was used at 15 to 16 weeks. RESULTS: The ratio of time velocity integrals of flow from the inferior vena cava during systole and early diastole, the percentage of reverse flow in this vessel, the pulsatility index from the umbilical artery, and the fetal heart rate were negatively correlated with gestational age. Peak E-wave and A-wave velocities and E/A ratios from the transtricuspid waveforms were positively correlated with gestational age. CONCLUSION: Early normal pregnancies are associated with remarkable changes in fetal flow velocity waveforms at both the cardiac and the extracardiac level.     

Cognitive patterns in school-age children with end-stage liver disease.

Although children with end-stage liver disease (ESLD) have been found to have cognitive delays, the relationship between patterns of cognitive function and diagnostic category, age of onset, duration and severity of disease has not been assessed before transplantation. Verbal and performance IQ (VIQ, PIQ) scores and scores on Bannatyne's cognitive factors for 43 children with ESLD were compared with those of 15 control children with cystic fibrosis (CF) and with existing normative data. Children with biliary atresia had deficits in PIQ, spatial and sequential scores. Children with alpha-1 antitrypsin deficiency did not differ significantly from CF controls but did show deficits compared with normative data. Children with onset of disease in the first year of life had deficits on all cognitive measures compared with both control groups. In contrast, children with later onset differed from the normative population only on VIQ and the acquired knowledge factor. In multiple regression analyses, duration of disease and indexes of liver dysfunction combine to predict cognitive scores. These preliminary findings suggest that children with early onset of liver disease are at high risk for cognitive impairment.     

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.