Total but not resting energy expenditure is increased in infants with ventricular septal defects

OBJECTIVE: The purpose of this study was to determine the effect of left-to-right shunting on the resting energy expenditure (REE), total energy expenditure (TEE), and energy intake in a group of 3- to 5-month-old infants with moderate to large unrepaired ventricular septal defects (VSDs) compared with age-matched, healthy infants. METHODS: Eight infants with VSDs and 10 healthy controls between 3 to 5 months of age participated in the study. Indirect calorimetry was used to measure REE and the doubly-labeled water method was used to measure TEE and energy intake. An echocardiogram and anthropometric measurements were performed on all study participants. Daily urine samples were collected at home for 7 days. Samples were analyzed by isotope ratio mass spectrometry. Data were compared using analysis of variance. RESULTS: No significant differences were found in REE (VSD, 42.2 +/- 8.7 kcal/kg/d; control, 43.9 +/- 14.1 kcal/kg/d) or energy intake (VSD, 90.8 +/- 19.9 kcal/kg/d; control, 87.1 +/- 11.7 kcal/kg/d) between the groups. The percent total body water was significantly higher in the VSD infants and the percent fat mass was significantly lower. TEE was 40% higher in the VSD group (VSD, 87.6 +/- 10.8 kcal/kg/d; control, 61.9 +/- 10.3 kcal/kg/d). The difference between TEE and REE, reflecting the energy of activity, was 2.5 times greater in the VSD group. CONCLUSIONS: REE and energy intake are virtually identical between the two groups. Despite this, infants with VSDs have substantially higher TEE than age-matched healthy infants. The large difference between TEE and REE in VSD infants suggests a substantially elevated energy cost of physical activity in these infants. These results demonstrate that, although infants with VSDs may match the energy intake of healthy infants, they are unable to meet their increased energy demands, resulting in growth retardation.     

中西医结合治疗老年高脂血症

目的：探讨中西医结合治疗高脂血症的临床疗效。方法：符合高脂血症标准的老年患者120例，随机分为A、B2组各60例，A组采用益肾化淤、利湿化浊为主的中药及西药辛伐他汀片治疗；B组则单纯用辛伐他汀片治疗。治疗前及治疗4周后2组均行全套血脂水平测定。结果：与B组比较，A组血清总胆固醇（TC）及甘油三酯（TG）均明显下降，HDL明显上升（均P〈0．05）；A组临床控制率明显高于B组（P〈0．05）；治疗后A组患者未见肝功能损害，B组转氨酶及转肽酶轻度异常，2例。停药3个月后，A组复发率低于B组（2．2％、8．8％，P〈0．05）。结论：中西医结合治疗老年高脂血症的临床效果明显优于单一的一种治疗方法，值得临床进一步推广应用。     

音乐疗法对门诊输液患者心理的影响

目的探讨中医五行音乐疗法对门诊输液患者心理安抚的作用与效果。方法2006年3月-2007年3月，按四时节气的不同，依据中医的五行相克理论，对治疗组的408例门诊输液患者进行音乐干预，而同期对照组396例门诊输液患者不接受音乐疗法。采用自制的调查表，获取他们对环境和服务的满意程度。结果治疗组患者，对门诊输液的满意度较对照组高，差异有统计学意义，P〈0.01。治疗组患者，对医院和本部的投诉率较对照组低，差异有统计学意义，P〈0.01。结论音乐疗法对门诊输液患者的心理有一定的安抚作用。     

肾脏受累为主的抗中性粒细胞胞质抗体相关性血管炎患者的预后及其相关危险因素分析

目的 探讨肾脏受累为主的抗中性粒细胞胞质抗体(ANCA)相关性血管炎患者的预后及其影响因素.方法 对2006-2008年我院诊断的64例肾脏受累为主的ANCA相关性血管炎患者进行回顾性分析,并对其进行前瞻性随访,使用Logistic回归、Cox回归等分析与患者肾脏预后有关的危险因素.结果 ①共入选64例患者,其中男性40例,女性24例,平均年龄(59.9±2.0)岁.随访21～55个月,平均(38±16)个月,期间34例(53％)患者出现死亡或进入长期肾脏替代治疗.②预后不同的2组患者起病时血肌酐[分别为(624±246)、(245±127) μmol/L,t=7.17,P=0.005]、红细胞沉降率(ESR)[分别为(112±24)、(76±48) mm/l h,t＝3.74,P＜0.01]、血浆白蛋白[分别为(294±31)、(316±42) g/L,t=-2.27,P=0.01]、血红蛋白[分别为(79±13)、(99±33) g/L,t=-3.23,P＜0.01 ]差异均有统计学意义.Logistic回归及Cox回归分析证实起病时血肌酐[β=1.004,95％可信区间(CI) 1.002～1.006,P＜0.01]及ESR[β=1.018,95％CI1.000～1.037,P=0.046]是预测患者预后的独立危险因素.③ROC曲线结果显示起病时血肌酐和ESR曲线下面积分别为0.95,0.80;敏感性均为94％,特异性分别为93％和70％.结论 以肾脏受累为主的ANCA相关性血管炎患者预后差,起病时血肌酐水平和ESR可能是判断患者预后的重要影响因素.     

八项肝纤维化血清标志物比较研究

目的比较血清血小板衍生生长因子-BB(PDGF-BB)、转化生长因子-β1(TGF-B1)、基质金属蛋白酶抑制剂-1(TIMP-1)、基质金属蛋白酶-1(MMP-1)、透明质酸(HA)、Ⅲ型前胶原(PC Ⅲ)、Ⅳ型胶原(C Ⅳ)和层黏连蛋白(LN)及外周血单个核细胞(PBMC)内TIMP-1 mRNA、MMP-1 mRNA在肝纤维化中的诊断价值。方法常规肝穿活检、组织病理学诊断；RT-PCR检测PBMCs中MMP-1 mRNA、TIMP-1 mRNA水平；酶标法检测血清PDGF-BB、TGF-β1、TIMP-1和MMP-1含量；放射免疫法检测血清HA、PC Ⅲ、C-Ⅳ和LN含量。结果经ROC曲线分析，血清PDGF-BB、TIMP-1、HA、PC Ⅲ、C-Ⅳ、LN和TIMP-1 mRNA的AUC分别为0．985、0．726、0．318、0．728、0．727、0．583、0．463、0．876；血清PDGF-BB和PBMCs中TIMP-1 mRNA的灵敏度和特异度分别为90％、95％，73．7％、100％；两者联合检测的灵敏度为97．4％，特异度为95．0％。结论八项指标中，血清PDGF-BB的诊断价值最大。在筛选肝纤维化患者时，以血清PDGF-BB、PBMC中TIMP-1 mRNA联合检测最佳。     

日本血吸虫SjCa8基因的原核表达及其免疫学特征分析

目的表达和纯化日本血吸虫钙结合蛋白(SjCa8),研究其免疫学特征。方法重组质粒pET32a ( )-SjCa8经诱导表达后,获取纯化蛋白SjCa8,利用ELISA、Western-blot和动物保护性实验检测SjCa8的免疫学特征。结果成功获取了纯化蛋白SjCa8,该蛋白能免疫识别血吸虫感染小鼠血清和血吸虫病患者血清。SjCa8免疫Balb/c小鼠可获得较高滴度的特异性抗体,诱导宿主产生35．31%的减虫率和35．68%的减卵率。结论纯化蛋白SjCa8具有良好的免疫原性和免疫反应性,具有作为血吸虫病免疫诊断和疫苗候选分子的研究价值。     

Localization of epitopes for human factor VIII inhibitor antibodies by immunoblotting and antibody neutralization

Human factor VIII(FVIII) inhibitors are pathologic, circulating antibodies that inactivate FVIII. We have examined the location of epitopes on the FVIII protein for inhibitors from hemophilia A and nonhemophilic individuals. The inhibitors were of type I or type II in the kinetics of their inactivation of FVIII. A cDNA clone of human FVIII was used to express defined FVIII protein fragments in Escherichia coli for immunoblotting with inhibitor plasma. An epitope for 18 heavy-chain inhibitors was localized to the aminoterminal 18.3 Kd of the A2 domain. Two of these inhibitors also recognized an epitope located between A1 and A2 domains. Similarly, an epitope for 23 light- chain inhibitors was localized to the C2 domain. Weaker epitopes for 13 of the same inhibitors within the C1 and C2 domains were also observed. Four of the 23 inhibitors in addition bound strongly to the A3 domain. Most inhibitors (22 of 23) were neutralized in vitro only by the FVIII fragments to which they bound on immunoblots; however, one inhibitor that was neutralized by a fragment containing the A1 domain did not bind to it on immunoblots. Conversely, 3 of 3 inhibitors that bound to the A3 domain and 5 of 15 that bound to the A2 domain were not neutralized by the corresponding fragments. The epitope specificity of an inhibitor did not depend on its source or type. Our results show that FVIII inhibitors bind to limited areas within the heavy and light chains of FVIII. Some inhibitor plasmas contain additional antibodies that may not be inhibitory.     

散发性大肠癌CpG岛甲基子表型的基因表达

目的探讨CpG岛甲基子表型阳性的散发性大肠癌的基因表达特征。方法对71例散发性大肠癌采用甲基化特异性PCR法行p14ARF、人类mut-s同系物1(hMLH1)、p16INK4a、6-氧-甲基鸟嘌呤-DNA甲基转移酶(MGMT)和肿瘤甲基化位点1(MINT1)共5个基因启动子甲基化的检测,确定CpG岛甲基子表型;进行K-ras、APC、P53、Bax和转化生长因子βⅡ受体(TGFβRⅡ)共5个基因的免疫组化检测。分析散发性大肠癌CpG岛甲基子表型和基因表达之间的关系。结果71例散发性大肠癌中,CpG岛甲基子表型阳性率为21．1％(15／71);K-ras、APC、P53、Bax和TGFβRⅡ蛋白阳性表达率分别为43．7％(31／71)、42．3％(30／71)、47．9％(34／71)、71.4％(50／70)和59．2％(42／71)。CpG岛甲基子表型和APC、P53、Bax、TGFβRⅡ蛋白表达均无显著相关性,但与K-ras蛋白表达显著相关,CpG岛甲基子表型阳性者K-ras蛋白阳性表达率显著高于CpG岛甲基子表型阴性者(66.7％比37．5％, P=0．043)。结论CpG岛甲基子表型阳性的散发性大肠癌中K-ras蛋白呈高表达,提示多基因同时甲基化与K-ras蛋白的激活表达密切相关,两者的关系表明表遗传学机制可以间接引起遗传学改变。