EXTERNAL MALLEOLUS ACTION ON ANKLE STABILITY IN FIBULAR RESECTION

In the management of ankle joint fractures, re- duction and fixation of the lateral malleolus should be emphasized. The lateral maUeolus should have anatomical reduction and fixation should be reliable. Fibular integrity is essential in stabilizing the ankle joint. Routine section of the fibula may result in separation of the inferior tibiofibular joint, ankle instability and talus displacement. Eventually this leads to traumatic arthritis. So special attention should be paid to fibular resection, even partial removal of the fibula for transplantation should be carried out carefully.     

JX-1对雄性小鼠生殖细胞致突变作用的研究

本文采用小鼠精子试验和小鼠睾丸DNA合成抑制试验,检测了JX-1对雄性生殖细胞的致突变作用。实验结果表明JX-1对小鼠精子总数、精子活动率及精子畸形率均无统计学意义的增加,与小鼠睾丸DNA合成抑制试验阴性反应一致。作者认为JX-1对雄性生殖细胞为一种非诱变剂。     

脊麻药复合微量芬太尼对防治牵拉反应的探讨

目的 探讨脊麻药中复合微量芬太尼对牵拉反应的防治效果。方法 选择美国麻醉医师协会（american society of anesthesiologists，AsA）Ⅰ-Ⅱ级、足月、初产及单胎而需行剖宫产术的病人60例，随机分成2组，每组30例。2组病人的年龄、性剐、体重、局麻药用量、麻醉方法均无显著性差异，均选用腰硬联合麻醉（combined spinal—epidural anesthesia，CSEA）。A组：等比重0．5％罗哌卡因9-11mg＋芬太尼10μg。B组：等比重0．5％罗哌卡因9-11mg。观察术中牵拉反应和生命体征并记录，进行统计学处理。结果 2组间麻醉前、后相对应的MAP（平均动脉压）、HR（心率）、RR（呼吸频率）和SpO2（血氧饱和度）变化均无显著性差异（JP〉0．05），2组间新生儿Apgar评分均无显著性差异（P〉0．05），比较2组术中的牵拉反应，A组明显优于B组，有显著性差异（P〈0．05）结论 脊麻药中加入微量芬太尼对牵拉反应有良好的防治效果。     

Experimental study on the immunosuppressive effects of gui zhi tang

In this paper the immunosuppressive effects of Gui Zhi Tang (a famous Chinese medicine) on the murine immune functions are reported. Varying dosages of Gui Zhi Tang administrated orally, i.p. and i.m. were able to inhibit the amounts of PFC, SRFC and the DTH response induced by BSA and the proliferation response of murine spleen cells to Con A and LPS. Further studies showed that Gui Zhi Tang had the inhibitory effect on Interleukin-2 production of murine spleen cells, which might be one of the mechanisms leading to the immunosuppressive effects of Gui Zhi Tang.     

The correlation between TNF-α, IL-6 in cervical mucous during follicular development and ovulation stimulation in different protocols

Objective To investigate the correlation between TNF-α and IL-6 levels in cervical mucous during follicular development and ovulation stimulation in different protocols.Methods 36 infertile women were set up as experimental groups,divided into CC, HMG, IVF-ET group,each group consisted of 12 infertile women and 15 women with normal menstrual cycles were choiced as control group.Cervical mucous during follicular phase, luteal phase and ovulation phase were collected.TNF-α, IL-6 levels in cervical mucous were measured by radioimmunology assay (RIA).Follicular development were monitored by transvaginal ultrasonagraphy.Results (1) TNF-α levels in cervical mucous of experimental groups and control group were periodically various among the reproductive cycle.It increased during follicular phase, reached to peak during ovulation phase, and decreased during luteal phase (P＜0.05).IL-6 levels had no obvious periodical changes.(2) Compared with CC and control group, levels of TNF-α,IL-6 in HMG and IVF-ET group were significantly higher (P＜0.05).(3) Levels of TNF-α and IL-6 in cervical mucous were positively correlated with the dominant follicle diameter (r=0.261, r=0.192 respectively,P＜0.05).(4) TNF-α and IL-6 showed positive correlation in the reproductive cycle (r=0.782,P＜0.05).Conclusions (1) TNF-α level shows a cyclic change in the reproductive cycle and peaks during ovulation,whereas IL-6 level does not.(2) TNF-α and IL-6 may play a certain role in the process of follicular development and ovulation.(3)The levels of TNF-α and IL-6 are up-regulated by gonadotrophic hormone.(4) TNF-α and IL-6 may have coordination properties and participate in the same biological effects.     

Impact of a specialized outpatient heart failure follow-up program on hospitalization frequency and functional status of patients with advanced heart failure.

BACKGROUND: High rates of morbidity and mortality are observed in patients with advanced heart failure (AHF). AHF is now considered the most costly syndrome in cardiology owing to the substantial economic burden associated with hospitalizations for acute decompensation. A management program that involves specialized follow-up by a multidisciplinary team has been suggested as a desirable strategy for improving outcomes for these patients. ObjectivE: To evaluate the impact of a specialized outpatient heart failure (HF) follow-up program for patients with AHF on frequency and duration of hospitalization for HF and functional status. METHODS: We retrospectively studied 167 consecutive patients with AHF who were referred to the outpatient HF follow-up program in our institution between January and November 2002, of whom 147 followed for > or =30 days were included in the analysis. In addition to demographic and baseline clinical characteristics, HF medication and NYHA functional class, the number and duration of hospitalizations for HF during the previous 12 months were recorded and compared at the time of referral and after a follow-up period of 6.5+/-3 months. RESULTS: Of the 147 patients analyzed (aged 60.8+/-13 years; 79% male; left ventricular ejection fraction 27+/-11%), 67% were in NYHA functional class III, 20% in class II and 13% in class IV at the time of referral. There was a significant improvement in functional class during the mean follow-up period: 55% of the patients were in class III, 37% in class II, 5% in class I and 3% in class IV (p<0.0001). The proportion of patients on beta-blockers or spironolactone increased from 33% and 51% at the time of referral to 69% and 71% respectively after referral (p<0.0001). In the 12 months before referral, 39% of the patients had been hospitalized for acute decompensation of HF (87 hospitalizations - mean 7.2/month) versus 13% of the patients during the mean follow-up period (25 hospitalizations - 3.8/month, p<0.0001). No significant differences were found in the proportion of patients on angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, digoxin or diuretics, or in the mean duration of hospitalization before and after referral. ConclusioN: The specialized follow-up of patients with AHF by a team with expertise in HF resulted in significant therapeutic optimization. Increased use of beta-blockers and spironolactone was associated with significant improvement in functional capacity and significant reduction in hospitalizations.     

Stress cardiomyopathy in thromboembolic arterial disease.

Apical ballooning is a novel clinical entity reported in different contexts of physical and psychological stress, which is more common in middle-aged women. Of unknown etiology, the syndrome is characterized by a sudden and transient dilatation of the left ventricular apex in the absence of obstructive atherosclerotic coronary disease or evidence of myocardial necrosis, with total late recovery of ventricular function. The authors report the case of a 53-year-old woman who was admitted to the emergency room with left arm ischemia and low cardiac output, requiring ventilatory support. Left catheterization showed typical medial and apical myocardial dysfunction, with normal coronary arteries. Transesophageal echocardiography revealed a thrombus attached to the lower face of the aortic arch, which probably explained the thromboembolism of the arm but was unlikely to be the cause of the left ventricular dysfunction since there were no enzymatic or electrocardiographic signs of myocardial necrosis and normal wall motion was fully recovered.     

Modulation of arterial stiffness with intensive competitive training.

BACKGROUND: Aerobic exercise training has been associated with beneficial effects on the cardiovascular system, improving arterial compliance, possibly related to a positive impact on the endothelium. The effects of competitive aerobic exercise are not so well documented. This prompted us to evaluate the possible modulation of arterial properties in a group of athletes and their response to the aging process. METHODS: 423 healthy males were enrolled in a cross-sectional study, 212 of whom were competitive athletes and 211 were controls. All underwent carotid-femoral pulse wave velocity (PWV) evaluation, and casual blood pressure and other relevant anthropometric data were evaluated. RESULTS: To control the effects of age, each group was divided into two subgroups with an age cut-point of 20 years. PWV was 6.3 +/- 0.9 m/s (athletes) vs. 7.0 +/- 1.0 m/s (controls) for ages <20 years, and 7.6 +/- 1.2 m/s (athletes) vs. 8.1 +/- 0.9 m/s (controls) for ages >20 years, with statistically significant differences in both comparisons. A linear regression model with logarithmic tendency analysis with age as the independent determinant of PWV revealed a different progression of age-related deterioration of aortic compliance between the two groups (athletes and controls). CONCLUSIONS: Our data documented better compliance indices in competition athletes compared with controls, which may reflect optimization of endothelial function. This improvement was age-dependent, being less pronounced as the athletes grow older, which could be due partially to sustained stretching effects on the arterial walls in long-term competitors.     

Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness.

BACKGROUND: Portugal has one of the highest mortality rates from stroke, a high prevalence of hypertension and probably a high salt intake level. AIM: To evaluate Portuguese salt intake levels and their relationship to blood pressure and arterial stiffness in a sample of four different adult populations living in northern Portugal. METHODS: A cross-sectional study evaluating 24-hour urinary excretion of sodium (24 h UNa+), potassium and creatinine, blood pressure (BP), and pulse wave velocity (PWV) as an index of aortic stiffness in adult populations of sustained hypertensives (HT), relatives of patients with previous stroke (Fam), university students (US) and factory workers (FW), in the context of their usual dietary habits. RESULTS: We evaluated a total of 426 subjects, mean age 50 +/- 22 years, 56% female, BMI 27.9+/-5.1, BP 159/92 mmHg, PWV 10.4+/-2.2 m/s, who showed mean 24h UNa+ of 202 +/- 64 mmol/d, corresponding to a daily salt intake of 12.3 g (ranging from 5.2 to 24.8). The four groups were: HT: n = 245, 49 +/- 18 years, 92% of those selected, 69% treated, BP 163/94 mmHg, PWV 11.9 m/s, 24 h UNa+ 212 mmol/d, i.e. 12.4 g/d of salt); Fam: n = 38, 64 +/- 20 years, 57 % of those selected, BP 144/88 mmHg, PWV 10.5 m/s, 24 h UNa+ 194 mmol/d, i.e. 11.1 g/d of salt; US: n = 82, 22 +/- 3 years, 57% of those selected, BP 124/77 mmHg, PWV 8.7 m/s, 24h UNa+ 199 mmol/d, i.e. 11.3 g/d of salt; FW: n = 61, 39 9 years, 47% of those selected, BP 129/79 mmHg, PWV 9.5 m/s, 24 h UNa+ 221 mmol/d, i.e. 12.9 g/d of salt. The ratio of urinary sodium/potassium excretion (1.9 (0.4) was significantly higher in HT than the other three groups. In the 426 subjects, 24h UNa+ correlated significantly (p < 0.01) with systolic BP (r = 0.209) and with PWV (r=0.256) after adjustment for age and BP. Multivariate analysis showed that BP, age and 24h UNa+ correlated independently with PWV taken as a dependent variable. CONCLUSIONS: Four different Portuguese populations showed similarly high mean daily salt intake levels, almost double those recommended by the WHO. Overall, high urinary sodium excretion correlated consistently with high BP levels and appeared to be an independent determining factor of arterial stiffness. These findings suggest that Portugal in general has a high salt intake diet, and urgent measures are required to restrict salt consumption in order to prevent and treat hypertensive disease and to reduce overall cardiovascular risk and events.