PAROXYSMAL TACHYCARDIA IN INFANCY AND CHILDHOOD II. Paroxysmal Ventricular Tachycardia and Fibrillation

A retrospective 3–20-years follow-up study of 1 infant and 10 children with paroxysmal ventricular tachycardia (8 cases) or fibrillation (3 cases) is presented. Additional heart disease has been observed in 60% (myocarditis 3 cases, cardiomyopathy 3 cases, congenital heart disease 1 case). Symptoms of tachycardia were: palpitation, tiredness, weakness, dyspnoea, precordial and abdominal pain. Syncopes were observed in 3 cases; 1 child had no symptoms. Tachycardia of hours to days' duration have been noted in 8 patients, 7 had tachycardia of repetitive type with a-v dissociation, one continuous tachycardia without any intervening sinus beats after the onset of tachycardia and with retrograde atrial activation. The remaining 3 children had brief malignant tachycardia, i.e. stress-provoked bursts of ventricular activity occasionally converting to ventricular fibrillation causing syncope. The diagnosis of brief malignant tachycardia had to be based on exercise ECG (2 cases) or long-term ECG-monitoring by telemetry (one case). One child with cardiomyopathy had died at the time of follow-up and the 3 patients with brief malignant tachycardia had experienced repeated life-threatening attacks—one of which had to be stopped by emergency d.c. countershock. The period of attacks ceased in 5 cases within 2 years after onset, in 1 patient, 9 years elapsed between first and second attack. Preventive treatment with betablocking agents proved beneficial in the 3 children with brief malignant tachycardia.     

Early-life nutritional and environmental determinants of thymic size in infants born in rural Bangladesh

Aim:  The aim was to assess the impact of nutritional status and environmental exposures on infant thymic development in the rural Matlab region of Bangladesh.
Methods:  In a cohort of N_max 2094 infants born during a randomized study of combined interventions to improve maternal and infant health, thymic volume (thymic index, TI) was assessed by ultrasonography at birth and at 8, 24 and 52 weeks of age. Data on birth weight, infant anthropometry and feeding status were also collected.
Results:  At all ages, TI was positively associated with infant weight and strongly associated with the month of measurement. Longer duration of exclusive breastfeeding resulted in a larger TI at 52 weeks. TI at birth and at 8 weeks correlated positively with birth weight, but by 24 and 52 weeks and when adjusted for infant weight this effect was no longer present. Thymic size was not affected by pre-natal maternal supplementation or by socioeconomic status but was correlated to arsenic exposure during pregnancy.
Conclusion:  In this population of rural Bangladeshi infants, thymic development is influenced by both nutritional and environmental exposures early in life. The long-term functional implications of these findings warrant further investigation.     

Preimplantation diagnosis of non-deletion Duchenne muscular dystrophy (DMD) by linkage polymerase chain reaction analysis

The use of preimplantation diagnosis for sex determination and detection of exon deletion means that unaffected babies can be born to parents suffering from Duchenne muscular dystrophy (DMD). However, those who do not have exon deletion should also be considered for further investigation. A new method, known as linkage analysis, has been developed to diagnose the presence of non-deletion DMD in preimplantation embryos. Linkage analysis uses informative intragenic and flanking markers to track the chromosome bearing the mutated gene. The present study reports the analysis of two polymorphic sites, in blastomeres biopsied from embryos from a female carrier of DMD. A single male embryo was obtained who had inherited alternate maternal alleles to the woman's affected surviving son, and this embryo was transferred.      

高压氧对脑源性神经干细胞分化的影响

目的:探讨高压氧对缺血缺氧脑源性神经干细胞模型向神经元细胞分化的影响。方法:实验于2006-01/05在中南大学湘雅医院神经病学实验室完成。YLC0.5/1A型动物实验高压氧舱(湖北武汉)。①实验选取清洁级SD新生鼠10只,无菌条件下分离脑组织,克隆传代培养脑源性神经干细胞。将第3代细胞制成单细胞悬液,分装在不同的25mL培养瓶中,分为正常对照组、模型对照组、高浓度氧组、高气压组、高压氧组,1瓶/组。②除正常对照组外,其余各组均复制神经干细胞缺血缺氧模型。当培养的神经干细胞达80%融合时换为新鲜的完全培养基,次日将培养基弃去,换用新鲜的无血清DMEM/F12培养基,并将细胞置于体积分数为0.93的N2、0.05的CO2、0.02的O2培养箱中37℃培养,3h后用于相关指标检测。③从每组取1mL细胞悬液移入96孔酶标板,在酶联免疫检测仪490nm波长处测定各孔吸光度值,检测神经干细胞活力。④将各组神经干细胞悬液接种于盖玻片上涂有多聚赖氨酸的培养皿中,Nestin免疫荧光染色后加入去除生长因子的血清DMEM/F12培养基,各组在不同条件下继续培养:高气压组培养皿置于高压氧动物舱内,采用压缩空气给予0.2MPa压力1h(加、减压时间各15min,稳压30min),1次/d,连续7d;高压氧组在高气压组基础上,稳压时舱内氧浓度保持在80%以上;高浓度氧组不加压,只保持舱内氧浓度在80%以上;正常对照组和模型对照组在加入去除生长因子的血清DMEM/F12(含体积分数为0.2的胎牛血清)中培养7d进行诱导分化。各组神经干细胞进行特异免疫荧光染色,观察细胞分化情况。⑤采用显微镜在200倍视野下进行细胞计数,每组观察10张盖玻片,每张盖玻片观察6个不重复视野,计算各组神经干细胞分化为神经元及胶质细胞的百分率。结果:①造模后神经干细胞活力的观察:与正常对照组比较,模型对照组、高浓度氧组、高气压组、高压氧组神经干细胞复制缺血缺氧模型后吸光度值均明显下降(t=-4.357,P<0.05),表明神经干细胞经缺血缺氧后数目减少,生长活力下降。②脑源性神经干细胞诱导分化情况:诱导分化3d后,各组微管相关蛋白2免疫细胞化学染色可见神经元样细胞,胶质原纤维酸性蛋白免疫细胞化学染色可见星形胶质样细胞,半乳糖脑苷脂免疫细胞化学染色可见少突胶质样细胞。③各组神经干细胞分化结果比较:高压氧组神经元及胶质细胞分化率较正常对照组基本相似(t=0.324,P>0.05),但神经元分化率明显高于模型对照组、高浓度氧组、高气压组(t=2.667～5.424,P<0.05),胶质细胞分化率低于此3组(t=-5.424～-2.667,P<0.05)。结论:高压氧处理能够上调脑源性神经干细胞向神经元分化的比例。     

老龄活体供肾移植55例

目的:探讨老龄活体供肾移植的供受体围手术期并发症、近远期疗效及安全性.方法:中南大学湘雅三医院2004年4月至2009年4月共完成285例活体肾移植,其中供体年龄≥ 55岁55例(老龄组),供体年龄＜ 55岁230例(中青年组),比较两组供受体术后住院时间、手术并发症、肾功能恢复情况、急性排斥反应(AR)及肾功能延迟恢复(DGF)发生率、人/肾存活率之间的差异.结果:两组供体术后平均住院时间、术后1周平均血肌酐值(SCr)和肾小球滤过率(GFR)以及围手术期并发症发生率差异无显著性(P ＞ 0.05).老龄组受体术后SCr恢复时间、AR和DGF发生率分别为(3.77 ± 1.73)d、21.82%和3.63%,中青年组分别为(3.23 ± 1.97)d、26.64%和3.27%,两组比较差异均无统计学意义(P ＞ 0.05).老龄组受体术后1、2年SCr高于中青年组,但差异无统计学意义(P ＞ 0.05).两组受体术后1、2年人/肾存活率相似,差异无统计学意义(P ＞ 0.05).结论:术前严格控制老龄活体供体纳入标准、对供体进行全面系统的综合评估,老龄活体供肾移植与中青年活体供肾移植具有相似的近远期疗效,可作为缓解当前供体需求紧张的一种安全可行的途径.     

Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Berlowitz DR, Hoenig H, Cowper DC, Duncan PW, Vogel WB. Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Objectives

To examine the impact of comorbidities in predicting stroke rehabilitation outcomes and to examine differences among 3 commonly used comorbidity measures—the Charlson Index, adjusted clinical groups (ACGs), and diagnosis cost groups (DCGs)—in how well they predict these outcomes.

Design

Inception cohort of patients followed for 6 months.

Setting

Department of Veterans Affairs (VA) hospitals.

Participants

A total of 2402 patients beginning stroke rehabilitation at a VA facility in 2001 and included in the Integrated Stroke Outcomes Database.

Interventions

Not applicable.

Main Outcome Measures

Three outcomes were evaluated: 6-month mortality, 6-month rehospitalization, and change in FIM score.

Results

During 6 months of follow-up, 27.6% of patients were rehospitalized and 8.6% died. The mean FIM score increased an average of 20 points during rehabilitation. Addition of comorbidities to the age and sex models improved their performance in predicting these outcomes based on changes in c statistics for logistic and R² values for linear regression models. While ACG and DCG models performed similarly, the best models, based on DCGs, had a c statistic of .74 for 6-month mortality and .63 for 6-month rehospitalization, and an R² of .111 for change in FIM score.

Conclusions

Comorbidities are important predictors of stroke rehabilitation outcomes. How they are classified has important implications for models that may be used in assessing quality of care.     

超声造影检测心肌梗死患者受损左室壁的价值

目的探讨超声造影在检测心肌梗死患者左室壁受损范围中的价值。方法对75名发生心肌梗死的患者进行实时心肌造影,分别于超声造影前后观察心内膜边界显示情况,评价和比较节段室壁运动情况。结果超声造影后左室心内膜边界的显示较造影前明显清晰,受损节段与未受损节段的对比增强。以冠状动脉造影结果为标准,造影检测的灵敏度、特异度和准确度均高于造影前（p〈0．05）。结论实时超声造影能有效增强左室心内膜边界显示和受损心肌边界显影,提高对左室壁受损范围检测的准确性。     

Medical utilization and cost outcomes for poststroke veterans who receive assistive technology devices from the Veterans Health Administration

The study objectives were to (1) advance understanding of the relationship between provision of assistive technology devices (ATDs) and healthcare consumption and outcomes in a system that does not limit provision of ATDs to in-home use and (2) determine how the provision of ATDs relates to inpatient/outpatient utilization and costs of services for veterans 12 months poststroke when controlling for case-mix. This was a retrospective study using Department of Veterans Affairs administrative/workload databases to identify 12,046 veterans with stroke during fiscal years 2001 and 2002. Measures were functional gain, inpatient days, outpatient visits, and inpatient and outpatient costs during the first year poststroke. Motor gain for veterans receiving ATDs was higher than for veterans not receiving ATDs (20 vs 9 Functional Independence Measure points, p < 0.001). Provision of a low-end manual wheelchair was associated with increased inpatient days and costs (both p < 0.001). Provision of a power wheelchair was associated with increased inpatient (p = 0.03) and outpatient costs (p < 0.001). Provision of a scooter was associated with increased outpatient visits and outpatient costs (both p < 0.001). Scooters, walking aids, and power wheelchairs were associated with increased outpatient visits, perhaps functioning as outpatient/community enablers.     

Enhanced co-stimulatory ability of synovial fluid accessory cells in rheumatoid arthritis

We have established in vitro assays that allow the examination of co- stimulatory function of rheumatoid arthritis (RA) antigen-presenting cells (APC). Synovial fluid (SF) and peripheral blood (PB) APC co- stimulatory ability was compared in the activation of peptide-specific human T-cell clones. T-cell receptor (TCR) stimulation by peptide or anti-CD3 antibody allowed the direct comparison of SF and PB APC co- stimulatory activity, separately from their ability to process antigen. SF APC from 15 RA patients consistently enhanced T-cell proliferation when compared to their PB counterparts. Moreover, increasing the numbers of PB APC present resulted in only a minor increase in T-cell proliferation, failing to achieve levels stimulated by SF APC. We propose that the enhanced co-stimulatory function of synovial APC may be a significant factor in the persistence of local immune responses in RA.      

Factor VIII gene inversions in severe hemophilia A: results of an international consortium study

Twenty-two molecular diagnostic laboratories from 14 countries participated in a consortium study to estimate the impact of Factor VIII gene inversions in severe hemophilia A. A total of 2,093 patients with severe hemophilia A were studied; of those, 740 (35%) had a type 1 (distal) factor VIII inversion, and 140 (7%) showed a type 2 (proximal) inversion. In 25 cases, the molecular analysis showed additional abnormal or polymorphic patterns. Ninety-eight percent of 532 mothers of patients with inversions were carriers of the abnormal factor VIII gene; when only mothers of nonfamilial cases were studied, 9 de novo inversions in maternal germ cells were observed among 225 cases (approximately 1 de novo maternal origin of the inversion in 25 mothers of sporadic cases). When the maternal grandparental origin was examined, the inversions occurred de novo in male germ cells in 69 cases and female germ cells in 1 case. The presence of factor VIII inversions is not a major predisposing factor for the development of factor VIII inhibitors; however, slightly more patients with severe hemophilia A and factor VIII inversions develop inhibitors (130 of 642 [20%]) than patients with severe hemophilia A without inversions (131 of 821 [16%]).