镉中毒肾损害病理学及电子探针X—射线扫描分析

用氯化镉制成亚慢性镉中毒肾损害动物模型,系统地观察了肾脏组织学,超微结构及 Cd~( ),Ca~( )变化。结果表明:近曲小管是镉中毒肾损害最早、最主要的部位,膜性细胞器受损是其超微结构病理改变的特点,胞浆多泡膜层体(MB)、暗黑颗粒及核内包涵体可能是镉中毒性肾损害的特征性病变。肾脏镉含量随染毒时间而进行性升高,但电子探针 X-射线波谱扫描分析肾组织细胞、亚细胞内却未发现游离镉的富集,而胞浆 Ca~( )富集增多,提示以大分子结合形式存在,钙稳态失调与镉毒性肾损害机理有关。     

复合PCR鉴定沙门菌的方法

沙门菌属于肠杆菌科，是具有鞭毛、能运动的革兰阴性杆菌，而且它是导致食源性疾病的主要病原菌之一。为了加强口岸执法管理、缩短检验检疫流程和提高检验检疫工作效率，本实验拟建立复合聚合酶链反应快速检验鼠伤寒沙门菌的方法，以求提高检验工作准确性和速度。本实验在参考国内外文献的基础上，设计了两对引物，建立了较稳定的PCR检测系统。本实验中，使用了不同的菌株作为比较，证实了系统特异性良好，并且从不同的食品来源检出的沙门菌，皆能被本实验系统鉴定检出。使用复合PCR技术，能快速、准确的鉴定肠炎沙门菌和鼠伤寒沙门菌，并且较之经典的鉴定方法，时间上提前了2—3d。     

Case study. Respirator selection for clandestine methamphetamine laboratory investigation

First responders to illicit drug labs may not always have SCBA protection available. Air-purifying respirators using organic vapor cartridges with P-100 filters may not be sufficient. It would be better to use a NIOSH-approved CBRN respirator with its required multi-purpose cartridge system, which includes a P-100 filter. This would remove all the primary drug lab contaminants—organic vapors, acid gases, ammonia, phosphine, iodine, and airborne meth particulates. To assure the proper selection and use of a respirator, it is recommended that the contaminants present be identified and quantified and the OSHA 29 CFR 1910.134 respirator protection program requirements followed.     

中国不同年龄和性别的健康人心电图T波的特点

４３２２ 例从出生到 ８５ 岁健康人心电图 Ｔ 波纵向研究，表明心电图 Ｔ 波有显著的年龄和性别差异。从出生到８５ 岁高龄 Ｔ 波电轴变化，由出生时的左前→右前→（再）左前→左后→（再）左前象限。新生儿 Ｔ 波振幅最小，儿童最大，６０ 岁以上高龄人 Ｔ 波振幅低于青壮年人。 Ｔ 波振幅男大于女在 ５ 岁后较明显，男女 Ｔ 波振幅差值胸前导联大于肢导联，在胸前导联男性 Ｔ 波振幅一般是女性的 １５ 倍～２．０ 倍。     

Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients’ perceptions and expectations

Background

Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources.

Methods

We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients’ experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach.

Results

While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients’ main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and – occasionally - from health workers.

Conclusions

Our findings suggest a wide gap between patients’ end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.

     

Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries

To evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. 130 patients (mean age: 54?±?17) presenting with troponin-positive acute chest pain and unobstructed coronary arteries were included. All patients were managed according to European Society of Cardiology guidelines, including echocardiography, and had CMR within 6.2?±?5.3?days of presentation. During follow-up, major adverse cardiovascular events (MACE) were recorded. CMR provided a diagnosis in 100 of 130 patients (76.9%), with the remaining 30 (23.1%) having a normal examination. CMR diagnosed 37 (28.5%) acute myocardial infarctions, 34 (26.1%) myocarditis, 28 (21.5%) apical ballooning syndromes and 1 (0.8%) hypertrophic cardiomyopathy. When a single diagnosis was suspected by the referring physician, CMR validated this diagnosis in 32 patients (76.2%). CMR provided a formal diagnosis in 61 patients (69.3%) in which the clinical diagnosis was uncertain between at least two possibilities. CMR corrected a wrong diagnosis in 10 patients (7.7%). CMR-suggested diagnosis led to a modification of therapy in 42 patients (32.3%). Median follow-up was 34?months (interquartile range 24–49) in 124 patients. Sixteen patients (12.9%) experienced MACE. MACE rate was not different between patients with a conclusive CMR and normal CMR. In patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.     

钾离子通道开放剂停搏液对未成熟心肌电生理特性的影响

目的观察钾离子通道开放剂加入St.Thomas Ⅱ液内,能否改善缺血后未成熟心肌的保护作用.方法未成熟新西兰大耳白兔(2～3周)24只随机分为对照组、处理组和预处理组(各组n＝8),取离体心脏乳头肌标本.对照组充氧台氏液灌注平衡60分,St.Thomas Ⅱ号液灌注停跳30分,充氧台氏液复灌60分.处理组将钾离子通道开放剂Nicorandil加入St.Thomas Ⅱ号液灌注停跳30分.预处理组使用特异性钾离子通道阻滞剂Glibenclamide在平衡期后15分预处理乳头肌标本.利用传统玻璃微电极技术记录心肌细胞动作电位变化.结果①处理组乳头肌停跳后静息电位低于对照组和预处理组,有显著性差异(P＜0.05).②处理组停跳时间短于其他2组,有显著性差异(P＜0.05).③复灌早期处理组50%动作电位时程(APD50、)、90%动作电位时程(APD90)短于停跳前,有显著性差异(P＜0.01),而对照组和预处理组APD50、APD90都明显延长,有显著性差异(P＜0.05),但2组间无显著性差异.④再灌注后处理组动作电位振幅(APA)、动作电位超射值(OS)及动作电位最大复极速度(Vmax)的恢复优于对照组和预处理组,有显著性差异(P＜0.05),而对照组和预处理组间无显著性差异.结论钾离子通道开放剂Nicorandil停搏液可以引起心肌细胞停跳在超极化状态,减轻心肌缺血再灌注损伤,提高再灌注后心肌功能的恢复率.     

Monophasic action potential recordings during acute changes in ventricular loading induced by the Valsalva manoeuvre.

OBJECTIVE--The strong association between ventricular arrhythmia and ventricular dysfunction is unexplained. This study was designed to investigate a mechanism by which a change in ventricular loading could alter the time course of repolarisation and hence refractoriness. A possible mechanism may be a direct effect of an altered pattern of contraction on ventricular repolarisation and hence refractoriness. This relation has been termed contraction-excitation feedback or mechano-electric feedback. METHODS--Monophasic action potentials were recorded from the left ventricular endocardium as a measure of the time course of local repolarisation. The Valsalva manoeuvre was used to change ventricular loading by increasing the intrathoracic pressure and impeding venous return, and hence reducing ventricular pressure and volume (ventricular unloading). PATIENTS--23 patients undergoing routine cardiac catheterisation procedures: seven with no angiographic evidence of abnormal wall motion or history of myocardial infarction (normal), five with a history of myocardial infarction but with normal wall motion, and 10 with angiographic evidence of abnormal wall motion--with or without previous infarction. One patient was a transplant recipient and was analysed separately. SETTING--Tertiary referral centre for cardiology. RESULTS--In patients with normal ventricles during the unloading phase of the Valsalva manoeuvre (mean (SD)) monophasic action potential duration shortened from 311 (47) ms to 295 (47) ms (p less than 0.001). After release of the forced expiration as venous return was restored the monophasic action potential duration lengthened from 285 (44) ms to 304 (44) ms (p less than 0.0001). In the group with evidence of abnormal wall motion the direction of change of action potential duration during the strain phase was normal in 7/21 observations, abnormal in 6/21, and showed no clear change in 8/21. During the release phase 11/20 observations were normal, five abnormal, and four showed no clear change. In those with myocardial infarction four out of five patients had changes that resembled those with normal ventricles but the changes were less pronounced. There were no differences in any of the three groups between the changes in monophasic action potential duration in patients taking beta blockers and those who were not. The changes in monophasic action potential duration in the transplanted heart resembled those in the group with normal ventricles. Inflections on the repolarisation phase of the monophasic action potential consistent with early afterdepolarisations were seen in three of the patients with abnormal wall motion and in none of those with normal wall motion. CONCLUSIONS--These results are further evidence that changes in ventricular loading influence repolarisation. When wall motion was abnormal the effects on regional endocardial repolarisation were often opposite in direction to those when it was normal. Thus regional differences in wall motion could generate local electrophysiological inhomogeneity which may be relevant to the association of arrhythmia with impaired left ventricular function.