病毒序列促转基因在斑马鱼胚胎发育过程中的高效表达

目的探讨转基因在斑马鱼胚胎发育过程中高效表达的有效途径和手段。方法以增强处理的绿色荧光蛋白(GFP)作为报告基因,在表达质粒的两翼连接构建腺关联病毒(adeno-assoc iated virus,AAV)来源的病毒性反转末端重复序列(inverted term inal repeats,ITR s),以显微注射方式注入斑马鱼受精卵的单一细胞和双细胞时相。结果病毒序列中的ITR s可使转基因表达效率达到33.0%,远远高于未与病毒序列结合的质粒。结论源于病毒的ITR s可显著促进转基因在斑马鱼胚胎发育过程中的表达。     

电针调控骨骼肌胰岛素受体底物-1磷酸化改善胰岛素抵抗的机制

目的:观察电针对2型糖尿病大鼠骨骼肌胰岛素受体底物-1(IRS-1)磷酸化水平的影响,从而探讨电针治疗2型糖尿病的可能机制.方法:采用2型糖尿病肥胖大鼠作为研究对象.将成模后的14只ZDF大鼠随机分为模型组、电针组,每组7只;另将7只ZL大鼠设为空白组.干预4周,检测空腹血糖(FBG),并以Western Blot法检...     

Treatment of Vascular Skin Lesions with the Variable Pulse 595 nm Pulsed Dye Laser

BACKGROUND: In the dermatology field, variable-pulse 595 nm pulsed dye lasers (PDLs) are now being widely used to treat vascular skin lesions. However, there is little information available on variable-pulse 595 nm PDL treatment of dark-skinned patients. OBJECTIVE: The objective of this study was to evaluate the outcome of variable-pulse 595 nm PDL treatment on Korean patients. METHOD: Two hundred thirty-nine patients (Fitzpatrick skin phototypes III to V) with vascular skin lesions, such as nevus flammeus, telangiectasia, or hemangioma, were included in this study. All patients were treated with a variable-pulse 595 nm PDL, and the outcomes were assessed by comparing preoperative and postoperative photographs. RESULTS: The average number of treatments per patient was 4.29, and 51.9% of patients showed a good (51-75% clearance) to excellent (76-100% clearance) response. For nevus flammeus, 48.0% of the patients achieved good to excellent results. The gender and age of the patients did not influence the clinical response; however, lesions of the head and neck were found to respond more favorably to treatment. For telangiectasia, 78.0% of patients showed good to excellent results, and, again, the gender and age of the patients did not alter the treatment outcome. For hemangioma, the male to female ratio of patients was 1.0:3.1 and 54.1% of the patients achieved a good to excellent response. Superficial hemangioma showed a better clinical response than deep hemangioma, and the lesions of younger patients responded more favorably than those of older patients. CONCLUSION: The variable-pulse 595 nm PDL was found to be effective for treating several vascular skin lesions in dark-skinned patients. However, there were differences in treatment outcome owing to disease, age, and the location of the lesions.     

糙叶五加茎化学成分研究

目的基于脂多糖(LPS)诱导的巨噬细胞RAW264.7和小胶质细胞BV2为生物活性导向模型研究糙叶五加Acanthopanax henryi茎的化学成分。方法采用硅胶柱色谱、凝胶柱色谱、制备薄层及重结晶等方法进行分离纯化,利用波谱分析结合理化性质鉴定化合物的结构。结果从糙叶五加茎甲醇提取物的醋酸乙酯萃取部位中分离得到18个化合物,分别鉴定为对羟基苯甲酸(1)、反式对羟基肉桂酸(2)、反式咖啡酸甲酯(3)、咖啡酸(4)、反式松柏醛(5)、丁香醛(6)、香草醛(7)、6-甲氧基-7-羟基香豆素(8)、反式芥子醛(9)、十一烷二酸单甲酯(10)、(-)-芝麻素(11)、3-O-咖啡酰奎宁酸(12)、5-O-咖啡酰奎宁酸(13)、1,3-双咖啡酰奎宁酸(14)、1,4-双咖啡酰奎宁酸(15)、1,5-双咖啡酰奎宁酸(16)、豆甾醇(17)、β-谷甾醇(18)。结论化合物10为首次从五加科植物中分离得到;除化合物12、14、17、18外,其他化合物均为首次从该植物中分离得到。     

Flexion compromises ventilation with the laryngeal tube suction II in children

Background: There are insufficient data as to the influence of the head and neck flexion, extension, and rotation on the ventilation with laryngeal tube suction II^® (LTS II). The purpose of this study was to investigate the influence of the head and neck position on oropharyngeal sealing pressure (primary outcome) and ventilation score (secondary outcome) during ventilation with the LTS II in children. Methods: We studied 33 children scheduled for elective surgery. Oropharyngeal sealing pressure and ventilation score were measured with the head and neck in a neutral position, flexed, extended and rotated to the right. The ventilation score was scored from 0 to 3 based on three items (no leakage with an airway pressure of 15 cmH₂O, bilateral chest excursion, and a square wave capnogram; each item scored 0 or 1 point). Peak inspiratory pressure (PIP) at a tidal volume of 10 ml·kg^?1 and fiberoptic laryngeal views were also assessed in each position. Results: Although the sealing pressure was lower in the extended position [22 (8) cmH₂O] than that in the neutral position [25 (7) cmH₂O], there was no significant leakage during ventilation with a tidal volume of 10 ml·kg^?1. In the neutral, extended and rotated positions, the median ventilation scores were better (3 point respectively) than that with the head and neck flexed (1 point). PIP was decreased with the head and neck extended or rotated but was significantly increased in flexion position. During fibreoptic examination, the vocal cords were more easily seen in extension and right rotation, compared with the neutral position and flexion. Conclusions: Although oropharyngeal sealing pressure is decreased with the head and neck extended, effective ventilation with LTS II can be performed like in the neutral position or the rotated position. While the sealing pressure is maintained with the head and neck flexed, flexion compromises the ventilation with LTS II in children.     

The Psychological Impact of Implantable Cardioverter-Defibrillator Recalls and the Durable Positive Effects of Counseling

Background: It is known that patients with lifesaving devices such as implantable cardioverter-defibrillators (ICDs) may be alarmed and worried by recalls or alerts related to their ICDs.
Objectives: This study aimed to determine whether counseling has any short- or long-term benefits, and to look for characteristics that identify those most worried and those most in need of counseling.
Methods: Among 100 patients with recall or alert ICDs, 14 were pacer dependent; 50 had ICDs for 1° prevention and 22 were women. Patients completed a survey indicating how worried they were on learning of the recall or alert (0–10 scale). After counseling and advice in accordance with manufacturer guidelines, patients were asked to indicate their level of worry, and were again asked after 6 months.
Results: For all patients, the "worry level" at the initial interview was 5.0 ± 3.7, falling to 2.2 ± 3.0 after counseling (P < 0.001) and 1.4 ± 2.3 after 6 months (P < 0.001 vs both earlier levels). There were no significant differences between those implanted for 1° versus 2° prevention or for pacer dependency. Women were initially more worried than men, but not for the long term. The 49 patients whose ICDs could be managed by reprogramming or software fix had significant reduction in worry after counseling and at 6 months compared to others. The 18 patients recommended for operative intervention remained more concerned after counseling (3.5 ± 3.3 vs 1.9 ± 2.9, P = 0.043).
Conclusions: Patients' concerns resulting from ICD recalls or alerts can be reduced by appropriate counseling. Those patients whose ICDs could be reprogrammed to safer parameters had the most reduction in worry levels.     

Value of Pre-Hospital Discharge Defibrillation Testing in Recipients of Implanted Cardioverter Defibrillators

Opinions vary regarding the need to perform defibrillation testing prior to hospital discharge in recipients of state-of-the-art cardioverter defibrillators (ICDs). Our protocol is to perform predischarge ICD testing 1 day after implant. This report includes 682 consecutive implants. Adverse observations at testing were grouped into (1) risk of defibrillation failure, (2) surgical complications, (3) sensing/pacing issues or narrow defibrillation margin warranting closer follow-up, or (4) findings correctable by device reprogramming. Among the 682 patients, 63% had single-chamber and 37% dual-chamber or biventricular ICDs. In 48 patients (7%) there were 69 concerns and/or interventions, with overlaps among the four categories, including one failure to defibrillate (0.15%), and six other patients at risk. Surgical complications included 11 hematomas (1.6%), and six lead dysfunctions. Closer follow-up was indicated in 19 patients (2.7%), for high pacing thresholds in seven, sensing issues in seven, and <10 J defibrillation margin in five. Device reprogramming was needed in 31 patients (4.5%), for tachycardia detection and therapy settings in 12, and for pacing/sensing functions in 22 patients. In eight patients ventricular fibrillation could not be induced. There was no morbidity or mortality due to testing. The state-of-the-art ICDs delivering biphasic shocks are remarkably reliable. The routine pre-hospital discharge defibrillation testing of such ICDs may be optional and left to the physicians' discretion.     

Extension of Life-Table Methodology to Allow for Left-Censoring in Survival Studies of Pacing Devices Followed by Commercial Monitoring Services

The actuarial life-table is commonly used to describe lifetime data of living subjects and manufactured products. The life-table method allows subjects to come under observation at different times and, thus, to have differing lengths of follow-up, by assuming all subjects begin their lifetimes relative to the outcome of interest at some common point in time. As time progresses, subjects are withdrawn from the life-table when their period of observation has elapsed. This pattern of follow-up is often termed "right-censoring." An important feature of the classical life table approach is that the time at which the subject is placed at risk is known, and the status relative to the outcome of interest is known for the entire time at risk. Sometimes, however, subjects cannot be observed for some period after the beginning of their lifetimes. The example to be considered involves follow-up data collected by a commercial pacemaker monitoring service, to which patients subscribe, generally at some point following the actual implant of the pacemaker. Since the outcome of interest is device failure after implant, some means of dealing with the lack of information between implant and initiation of follow-up is needed. The extension of the actuarial life-table to accommodate this "left-censoring" will be described in this paper.     

Amiodarone: Value of Programmed Electrical Stimulation and Holter Monitoring

The value of programmed electrical stimulation (PES) and Holter monitoring in the assessment of amiodarone efficacy was reviewed. Many physicians have been disturbed by the persistent inducibility of arrhythmias in patients treated with amiodarone, who nevertheless do very well during the follow-up period. Noninducibility was associated with a favorable prognosis among 366 VT patients. Eighty-eight (24%) were noninducible on amiodarone, and 10% of these had recurrences, vs 39% in patients who remained inducible. Further, increased difficulty of induction with PES or induction of a slower or better tolerated VT may indicate a favorable outlook, and add to the value of PES. Few papers rigorously employed Holter monitoring in the assessment of amiodarone. In general, suppression of previously frequent arrhythmias implies excellent protection for patients with benign arrhythmias and moderate protection with malignant arrhythmias. By Holter assessment in 186 VT patients, arrhythmias were suppressed in 114 (61%), and 18% of these had recurrences vs 50% in patients whose arrhythmias were not suppressed. Studies attempting to correlate the results of PES and Holter monitoring in the same patients are lacking and may prove useful.