Fear and the startle reflex: Blink modulation and autonomic response patterns in animal and mutilation fearful subjects

The present study was designed to examine the pattern of startle reflex modulation and autonomic responses for individuals high in animal or blood-injury fear when viewing pictures of their feared objects. Sixteen individuals in each fear group and 16 low-fear control individuals viewed 32 color slides depicting fear-relevant, unpleasant but fear-unrelated, neutral, and pleasant scenes. Free viewing times were assessed in a second phase of the procedure as an index of avoidance behavior. Exposure to pictures of feared objects resulted in a consistent startle reflex potentiation and behavioral avoidance in both fear groups. This activation of the basic aversive system was independent of the autonomic pattern of the fear responses, which differed for the high-fear groups. These results suggest that the probe startle response indexes the organism's basic motivational disposition and add new information to the assessment of fear.     

心衰患儿红细胞内外钙离子浓度的变化及临床意义 心衰患儿红细胞内外钙离子浓度的变化及临床意义

目的：为了深讨心肌细胞内钙离子浓度的变化与心力衰竭发生的关系。方法：原子吸收分光技术测定红细胞内外Ca2+含量。我们对住院的56例心力衰竭患儿进行了红细胞内及血浆钙离子浓度的测定，并与30例正常小儿对照。结果：心衰患儿红细胞内Ca2+浓度明显升高，血浆Ca2+浓度降低，与对照组相比有非常显著性差异（P＜0．001）。其升高程度与心衰呈正相关（r=0．63，P＜0．01），即心衰越重，心功能越差，红细胞内Ca2+浓度升高亦越明显。而当心衰纠正，心功能恢复后，红细胞内Ca2+浓度则明显下降，血浆Ca2+浓度也恢复正常。而不同病因所致的心衰，其间红细胞内Ca2+浓度升高程度无明显差异。结论：提示钙离子参与了心力衰竭的发生与发展。     

Incremental Value of Three-Dimensional Echocardiography Over Transesophageal Multiplane Two-Dimensional Echocardiography in Qualitative and Quantitative Assessment of Cardiac Masses and Defects

In the present study, we compared three-dimensionally (3-D) reconstructed images with multiplane two-dimensional (2-D) transesophageal echocardiographic (TEE) images in 17 patients with various cardiac masses and defects. To overcome the problem of making measurements from 3-D reconstructed images, we carefully "dissected" the 3-D dataset using paraplane and anyplane 2-D sections, which were then used to obtain the maximum sizes of the cardiac masses and defects. Of the 15 vegetations and 9 abscesses detected by 3-D TEE in 7 patients, only 8 (53%) vegetations and 4 (44%) abscesses were detected by multiplane 2-D TEE (P < 0.02). Also, the exact anatomical location, shape, geometry, and extent of various cardiac masses and defects were more clearly delineated by 3-D than 2-D TEE. The maximum dimensions of cardiac masses and defects were larger by 3-D than by 2-D TEE in 17 (89%) of the 19 lesions available for comparison (P < 0.002). In addition, 3-D TEE correlated more closely than 2-D TEE when compared to surgical measurements in three patients in whom they were available. Thus, it would appear that in several instances, the exact size of the cardiac lesion could only be assessed by analysis of the 3-D volumetric dataset. Out preliminary study has demonstrated the superiority of transesophageal 3-D reconstruction over multiplane 2-D TEE in both qualitative and quantitative assessment of various cardiac mass lesions and pathological defects.     

Effect of external high-frequency oscillation on severe cardiogenic pulmonary edema

Effective gas exchange can be maintained in animals without endotracheal intubation using external high-frequency oscillation (EHFO). The aim of this study was to evaluate the effect of EHFO in patients with respiratory failure due to severe cardiogenic pulmonary edema. Seven patients were ventilated with EHFO for 2h at 60 oscillations·min⁻¹, with a cuiras pressure of 36 cmH₂O (−26 to +10) and an inspiratory to expiratory ratio of 1:1, with EHFO. Blood gas values and hemodynamic parameters were measured. Significant increases were noted in cardiac index (2.3±0.5 to 2.5±0.5 l·m⁻²;P<0.05), stroke volume index (24±7 to 28±8 ml·m⁻²;P<0.05), and arterial O₂ pressure (Pao₂) (70±4 to 95±23 mmHg;P<0.01) without a change in pulmonary artery wedge pressure at 1 h after EHFO. The respiratory rate decreased from 28±3 to 22 ±3 breaths·min⁻¹ at 5 min after the termination of EHFO (P <0.01). Arterial CO₂ pressure (Paco₂) did not, however, decrease. Increased stroke volume without a change in pulmonary artery wedge pressure (preload) suggests either improved inotropic function of the left ventricle or reduced left ventricular afterload with EHFO. The use of EHFO may be effective not only for gas exchange but also for left ventricular function in patients with severe cardiogenic pulmonary edema.     

Ex vivo evaluation of ferromagnetism,heating, and artifacts produced by heart valve prostheses exposed to a 1.5-T MR system

Ex vivo testing techniques were used to determine the ferromagnetic qualities of, presence of heating in, and artifacts produced by 13 different heart valve prostheses exposed to a 1.5-T (64-MHz) magnetic resonance (MR) system. None of the heart valve prostheses showed a measurable deflection in the 1.5-T static magnetic field. Only minimal artifacts were produced during MR imaging with a fast spoiled GRASS (gradient-recalled acquisition in the steady state) pulse sequence. The largest temperature changes measured during a “worst case” MR imaging sequence (estimated average specific absorption rate, 2.5 W/kg; estimated spatial peak specific absorption rate, 7.6 W/kg) were +0.2°C with the implant imaged “in air” and +0.3°C with the implant imaged in normal saline. Therefore, MR procedures performed with a 1.5-T (64-MHz) MR system may be performed safely in patients with any of the 13 different heart valve prostheses evaluated in this study.     

羊心淋巴流阻断后血清生化指标的改变

为给临床心脏术后监测心淋巴管损伤程度及可能出现的并发症提供参考指标，以手术方法阻断羊心淋巴流并对其血清相关成份进行了测定。实验发现，实验组术后谷草转氨酶（ＳＧＯＴ）、谷丙转氨酶（ＳＧＰＴ）、碱性磷酸酶（ＡＫＰ）、乳酸脱氢酶（ＬＤＨ）均有不同程度的增高，以ＳＧＯＴ增高最为明显，术前均值为４７．５３Ｕ，术后２天增至１０４．２０Ｕ，高峰出现时间最早，多在术后２４小时。血清离子改变中低钾最为突出，血钾在术后２天明显降低（Ｐ＜０．０１），术后７天逐渐恢复，术后１４天恢复至术前水平。血清蛋白改变以球蛋白降低、白蛋白／球蛋白比值升高为主。提示心淋巴循环郁滞可导致心肌细胞损伤、毛细血管通透性和结构的改变。不同酶活性的变化对郁滞的敏感度存在着差异。     

手部创伤性骨关节缺损的处理

治疗手部骨关节缺损常采用植骨内固定、关节融合、关节成形及关节置换等方法．为总结经验，对１９８９年以来１０１例手部创伤性骨与关节缺损进行分析。单纯掌、指骨缺损３９例，行直接短缩对位，克氏针内固定６例，１例发主骨不连；对３３例缺损较大者用自体骨块植入克氏针交叉内固定，部分病例同时植人ＲＢＸ或异体骨粒，１０例发生延迟愈合，余全部正常愈合。骨与关节部分或完全缺损６２例，采用关节成形术４６例，其中以肋软骨移植效果最好，骨膜移植次之，筋膜衬垫或硅胶膜植入法较差；行关节融合术１１例．均达顺利融合；采用自体关节置换５例，均成活，术后关节活动度均＞７０°。我们认为：自体骨块植入克氏针交叉内固定，必要时植入ＲＢＸ骨粒．是治疗手部创伤性骨缺损的有效方法。关节缺损应按关节的重要性，分别采用关节融合术、关节成形术或关节置换术。     

室间隔缺损的介入封堵治疗

对介入封堵治疗室间隔缺损的应用情况以及适应症、并发症等作一综述．     

主动脉夹层50例临床分析

目的 探讨主动脉夹层(AD)的临床表现，以便早期诊断和治疗，降低死亡率。方法 对50例AD患者的临床表现、影像学检查、治疗经过及死亡原因进行回顾性分析。结果 50例行心脏超声检查，确诊者43例(90％)；21例行CT检查。21例诊断为主动脉夹层(100％)；行磁共振显像(MRI)27例，均确诊为主动脉夹层(100％)。经治疗好转出院42例(84％)，1例并发脑梗死且留有一侧肢体活动障碍后遗症。7例死亡(占14％)。结论 早期诊断，有效治疗是降低死亡率的关键，CT、MRI可提供可靠的确诊依据。     

心脏瓣膜置换术后中远期疗效分析

目的　分析探讨心脏瓣膜置换术的中远期疗效。方法　 1978年至 2 0 0 1年 12月 ,行瓣膜置换手术 2 14 1例 ,同期随访 16 81例 ,计 80 2 1 1人·年 ,平均 4 77人·年。通过回顾病因、手术方式、瓣膜类型等因素 ,观察术后病人心功能改善情况 ,病死率及并发症等 ,采用t检验 ,多因素回归等统计学方法分析。结果　 92例死亡。总体生存率 5年为 (92 3± 2 2 ) % ,10年生存率为 (90 1± 2 7) %。并发症有血栓栓塞、机械瓣膜功能障碍、瓣周漏、溶血、机械瓣膜感染性心内膜炎。术后心功能 (NYHA)与术前比较有明显的提高。结论　 1.机械瓣置换术后中远期疗效满意 ,病死率及并发症均较低 ;与术前心功能和手术种类直接相关 ;2 .使用保留瓣下结构及三尖瓣成形术对术后心功能恢复有明显效果 ;3.术中良好心肌保护是提高手术成功率的关键。