猪心肌球蛋白及其轻,重链亚基的纯化和鉴定

采用一种改进的方法，从１００ｇ猪心室肌中提取心肌肌球蛋白３７０ｍｇ，并进一步分离和纯化其亚基成分，分别得到肌球蛋白轻链２４ｍｇ和重链２１０ｍｇ，核酸含量＜１％，不含有肌动蛋白、原肌球蛋白、肌钙蛋白及其它杂蛋白；ＳＤＳＰＡＧＥ显示，猪心肌球蛋白重链为２００～２２０ＫＤ一条带，肌球蛋白轻链则为２７ｋｄ、２１．４ｋｄ、１９ｋｄ三条带；纯化猪心肌球蛋白的Ｃａ２＋激活ＡＴＰ酶活性为０．２４μｍｏｌＰｉ／（ｍｇ·ｍｉｎ），但其分离后的亚基则无此活性。     

火器伤后胸心异物存留

目的：探讨火器伤后胸心异物存留摘除的指征、时机、方法及结果。方法：回顾性分析了３９例火器伤后胸心异物存留摘除者的一般资料、临床表现、不同处理方法的选择及效果。结果：１９例患者早期因凝固性血胸及肺持续漏气伴异物存留或异物存留伴胸腔及心包腔化脓性感染，在开胸清创时做了异物摘除；另２０例患者为胸伤伤情恢复后单纯异物存留，因异物位于肺门、心脏及大血管旁或远期并发症等，而后期开胸异物摘除。结论：火器性胸部穿透伤后，因异物本身或其他原因所致早期并发症者，应在开胸清创的同时摘除异物；胸伤伤情恢复而单纯胸心异物存留，应选择性摘除或因并发远期并发症而摘除。     

Abnormal cardiac histology in severe intrauterine growth retardation infants

Four infants with severe intrauterine growth retardation (IUGR) weighing less than 1000 g at birth developed heart failure and died in our unit, where heart failure of IUGR infants is the main reason of death in extremely low birth-weight infants. The causes of their heart failure are one of the main themes in current neonatal medicine. The subjects of this study were four small for gestational age infants; all died due to heart failure 5 to 10 days after birth. Microscopic specimens of hearts from autopsies were evaluated with respect to the following characteristics: thickness of myocardial fibers, maturation of nuclei, presence of dysgenesis or necrosis in myocardium, and amount of glycogen in the heart. Neither dysgenesis nor infarction of the heart was found but hypoplasia in myocardial fibers and decreased glycogen levels were observed. Maturation delay in myocytes' nuclei did not appear to be severe. We conclude that these infants' hearts failed to adapt to postnatal hemodynamic changes because of inadequate myocardial function and inadequate glycogen reserves.     

ADM对LNNA诱导的高血压心肌肥大的作用及机制探讨

本工作在ＬＮＮＡ经慢性ＮＯ封闭诱导的大鼠高血压心肌肥大模型上研究了ＡＤＭ对其心肌肥大和Ｍ５ＬＶ钠一钙交换功能损伤的作用。结果：一、较之对照组，ＬＮＮＡ组ＭＡＯ和ＬＶＩ分别增加５７．４％和１８。０％（Ｐ＜０．０１）．其ＭＳＬＶ经钠－钙交换蛋白的钙摄取则明显降低（Ｐ＜０．０１或０．０５）：二．ＡＤＭ组的ＭＡＰ和ＬＶＩ则分别较ＬＮＮＡ组降低１９．６％和１１．３％，而其ＭＳＬＶ的钙摄取则高于ＬＮＮＡ组（Ｐ＜０．０５）；三、对照组、ＬＮＮＡ组和ＡＤＭ组钠－钙交换蛋白摄取钙的Ｋｍ值分别为７．５１．７．０４和７．５７ｕＭ，而Ｖｍａｘ则分别为６．３８，４．３２和５．４５ｎｍｏｌ／。ｍｇｐｒ／ｍｉｎ。表明：ＡＤＭ能拮抗ＬＮＮＡ诱导的高血压心肌肥大和减轻其ＭＳｌｌＶ钠－钙交换功能的损伤，并且后者可能是ＡＤＭ拮抗心肌肥大的机制之一。揭示内源性ＡＤＭ的诱导和外源性给予ＡＤＭ可能有预防和／或延缓高血压心肌肥大发生发展的作用。     

人造心脏瓣膜替换术18例体会

本文报告风湿性心脏瓣膜病,人造心脏瓣膜替换术18例。术后因低心排、多脏器功能衰竭死亡3例。作者认为:人造心脏瓣膜替换术是治疗风湿性心脏瓣膜病的有效方法,但在新开展心脏瓣膜替换术的单位,应严格掌握手术适应症,以单瓣替换术为首选,严重多瓣膜病变,伴重要脏器功能不全者手术应慎重。     

十二指肠溃疡生活事件及社会支持的对照研究

目的 探讨十二指肠溃疡与生活事件及社会支持的关系。方法 采用生活事件量表（LES），社会支持评定量表（SSRS）对十二指肠溃疡患者（58例）与健康对照（67例）进行问卷测试与评价分析。结果 十二指肠溃疡患者在生活事件里正性刺激量，负性刺激量和总刺激量都明显高于健康对照组，十二指肠溃疡患者受到的主观支持比一般人群多；而客观支持比一般人群少，但十二指肠溃疡患者受到的总支持量并不比一般人多，而且，十二指肠溃疡患者对支持的利用度也不比一般人高。结论 十二指肠溃疡患者有明显的生活事件和不足的社会支持，对生活事件的刺激尤为敏感。     

The efficacy of fluconazole in treating prosthetic valve endocarditis caused byCandida glabrata: Report of a case

A case of active prosthetic valve infective endocarditis (PVE) due toCandida glabrata was successfully treated by the systemic administration of fluconazole. A 66-year-old Japanese man with infective endocarditis of unknown etiology underwent aortic and mitral valve replacement to treat severe aortic and mitral regurgitation associated with multiple organ failure. Postsurgical cultures of arterial blood were repeatedly positive forC. glabrata, and therefore fluconazole was administered either intravenously or orally at a dose of 400 mg/day for 46 days. During that time the signs of inflammation including fever such as an elevated white blood cell count and the presence of C-reactive protein (CRP) all improved while the blood cultures became negative. Fluconazole is thus considered to be effective in treating PVE caused byC. glabrata. When administering this treatment, it is also important to monitor the patient's renal and liver function.     

Influence of volume replacement with different HES–solutions on microcirculatory blood flow in cardiac surgery

A variety of hydroxyethyl starch (HES) preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found. A 5th group without ANH served as a control (10 patients in each group). In addition to systemic haemodynamics and various laboratory parameters, skin capillary blood flow was measured by laser Doppler flowmetry. Laser Doppler flow (LDF) was monitored simultaneously at the patient's forehead and forearm. Changes in systemic haemodynamics were similar in all ANH–patients. Systemic vascular resistance (SVR) was lowest after infusion of HES 200/0.5. The most pronounced increase in plasma viscosity was in patients of group 1 (450/0.7) (P<0.05) and plasma viscosity remained highest during the entire investigation period in these patients. After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. + 18%). Group 3 (200/0.62) showed the highest decrease in forehead–LDF. During CPB, forehead–LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5). At the end of the operation, LDF was most reduced in groups 1 (– 32%) and 3 (– 33%). Forearm–LDF increased in all ANH–patients. Immediately after ANH this increase was lowest in group 3 (200/0.62). In the further course of the investigation, no more differences were seen in any HES patients. The different HES preparations showed a different microcirculatory response. 6% HES 200/0.5 seems to be overall most suitable for volume replacement in cardiac surgery patients undergoing acute normovolemic haemodilution (ANH) due to the best effects on microcirculatory skin perfusion assessed by laser Doppler flow. HES 6% 200/0.62 showed the overall least positive effects with regard to skin capillary blood flow in this situation.     

先天性心脏病患儿术后多脏器功能障碍的预后分析

目的 探讨小儿先天性心脏病(先心病)术后多脏器功能障碍(MODS)预后情况及其影响因素,为对此类患儿进行针对性护理提供依据.方法 收集先心病术后并发MODS 77例患儿的临床资料.结果 11例放弃治疗出院,66例中44例救治存活,22例死亡.出现时间最早、累及最多的脏器为心脏;病死率最高的为累及中枢神经系统的患儿(57.69%),其次是累及血液系统的患儿(55.56%);患儿的病死率与累及脏器的数量呈显著正相关(P＜0.01).死亡患儿手术体外循环时间和主动脉阻断时间显著长于存活患儿(均P＜0.05),术中意外及术后心肺复苏发生率显著高于存活患儿(均P＜0.05).结论 先心病术后患儿应加强心功能监护,特别是体外循环时间＞120 min,主动脉阻断时间＞60 min及术中发生过意外情况、术后采取过心肺复苏术的患儿;尽早采取有利措施避免其他脏器功能受损是提高患儿存活率的关键.