Kubicek每搏心输出量计算公式的三维有限元仿真研究

我们从 Kubicek模型三维有限元仿真的角度对 Kubicek每搏心输出量计算公式的临床应用价值进行了研究。在计算机仿真研究中 ,我们对比了模型仿真结果、具体采用 Kubicek每搏心输出量计算公式所得结果以及所设模型的理论计算结果。仿真结果表明 :模型中阻抗改变与主动脉中血液容积改变之间存在着近似的线性关系 ,证明了 Kubicek每搏心输出量计算公式具有一定的临床应用价值 ,同时也为心阻抗血流图基础理论提供了新的研究途径。     

Airway responses to antigen challenge in allergic rhinitis and allergic asthma

The density dependence of the maximum expiratory flow-volume curve, functional residual capacity (FRC), and specific airway conductance (SGaw) were determined before and during bronchial provocation with ragweed extract in 27 subjects with ragweed hypersensitivity and a history of either bronchial asthma (16 subjects) or allergic rhinitis (11 subjects). Mean baseline SGaw was significantly lower while mean volume of isoflow (Visov) and FrC were significantly higher in subjects with bronchial asthma. During antigen challenge, 10 of 16 subjects with bronchial asthma (63%) and five of 11 subjects with allergic rhinitis (45%) showed a greater than 35% decrease in SGaw ("reactors"): mean relative decreases in SGaw from baseline were 46% and 53%, respectively. The remaining subjects showed a less than 35% decrease in SGaw ("nonreactors") with mean relative decreases of 9% (allergic asthma) and 6% (allergic rhinitis). Mean Visov increased in all subjects with bronchial asthma and in eight of 11 subjects with allergic rhinitis. A significant increase in FRC (6%) was seen only in the "reactors" with bronchial asthma. Following antigen challenge, the beta adrenergic agonist, isoetharine, increased SGaw and decreased Visov. We conclude that in asymptomatic subjects with ragweed hypersensitivity, (1) central and peripheral airway function is more abnormal in subjects with bronchial asthma than in subjects with allergic rhinitis, (2) subjects of both groups show quantitatively and qualitatively comparable airway responses during antigen challenge with a decrease in SGaw or an increase in Visov, possibly representing increase in central and/or peripheral airflow resistance, respectively, (3) Visov may be a more sensitive indicator of airway response to antigen challenge than SGaw, and (4) the bronchodilator effects of a beta adrenergic agonist on antigen-induced bronchospasm are similar in both groups.     

The external laryngeal nerve: surgical and anatomic considerations. Report of 50 total thyroidectomies

This surgical anatomy study aimed to evaluate the possibility of identifying the external laryngeal nerve during thyroid surgery and the possible variations of nerves at risk. Fifty patients underwent total thyroidectomies during a period of 12 months. Using a neurostimulator, the distal motor branch of the external laryngeal nerve was searched. Electrical stimulation of a nervous branch aimed to provoke a global contraction of the cricothyroid in order to identify with certitude the external laryngeal nerve. The external laryngeal nerve was identified in 20% of cases. Its course was, with almost equal frequency, either (1) between the vessels of the superior thyroid pedicle or (2) superficial and anterior to the fascia of the cricothyroid muscle. The external laryngeal nerve is hard to find during thyroid surgery, even with a neurostimulator. It can be vulnerable during thyroid surgery but only in cases of anatomic variations. Searching for the nerve systematically during thyroid surgery does not seem to be useful. Several precautions when dissecting the superior pole of the thyroid gland seem to be necessary and sufficient to respect the external laryngeal nerve.     

Hormone changes induced by 37.5-h head-down tilt (−6°) in humans

Endocrine regulation of hormones and electrolytes during 37.5 h of –6° head down tilt (HDT) was studied in 13 men. The acute effects of simulated weightlessness are today well documented, but no study has been made concerning the hormone changes between 12 h and 2 days of HDT. Plasma volume showed a maximal increase of 9.23 (SEM 1.97) % after 6.5 h (P<0.01) and had returned to prestudy levels after 13.5 h of HDT. From 1.5 h to 4 h of HDT, C-terminus and N-terminus atrial natriuretic peptide (ANP) concentrations in plasma were increased by about 50% (P<0.01) and thereafter declined to pre-HDT levels. Plasma renin activity (PRA) was decreased by 47% (P<0.05) after 4 h of HDT; PRA increased after 23.5 h to 60%; noradrenaline concentration decreased immediately and remained low up to 37.5 h. Diuresis and natriuresis were evident during the 1st day of HDT, resulting in a marked increase in the urinary Na⁺. These results showed that the initial hormone (ANP, PRA) changes during HDT did not last more than 13.5 h and that after 24 h a new state would seem to have been established to adapt the body to hypovolaemia.     

A Multi-Response Analysis of Learned Heart Rate Control

Thirty college students were classified on the basis of cold-pressor blood pressure responses and then randomly assigned to one of three treatment groups. One group merely tracked a visual analog display of their heart rate (tracking group). A second group attempted to increase and decrease its heart rate without the visual display (no-feedback group). A third group attempted to increase and decrease their heart rates with the aid of the visual heart rate display (feedback group). Results indicated that the heart rate changes produced by both the feedback and no-feedback groups were significantly greater than those observed in the tracking group. There was no significant difference between the former two groups. Results also demonstrated that high cold-pressor reactors were able to produce significantly larger heart rate changes than the low reactor subjects. A correlational analysis of physiological responses accompanying heart rate change suggested that the response topographies of the high and low cold-pressor reactors differed as well. Finally, results indicated no relationship between coronary-prone personality characteristics, as measured by the Jenkins Activity Scale, and either cold-pressor reactivity or heart rate control performance.     

Morphometric categorization of the human oocyte and early conceptus

Morphometrical procedures were used to quantitatively evaluate human oocytes and embryos in an IVF programme. The metaphase II oocyte was an irregular 3.5 x 10(6) microns 3 sphere of 1.05 coefficient of form. The ooplasmic volume of 1.4 x 10(6) microns 3 was reduced by 10% by fertilization. The zona pellucida behaved as a stable and almost spherical envelope of 1.8 x 10(6) microns 3 volume and 17 microns thickness. Through the first three cleavages, mean blastomere reduces 28.5% volume per division, evolving from an irregular spherical shape with 0.9 coefficient of form to an ellipsoid (0.8) at the 8-cell stage. The coefficient of diversity between sister blastomeres progressively moved from 1.4 to 1.6 during the first two (2n) cleavages. The coefficient of diversity also increased at 3-cell (2.2) and 6-cell (2.6) asynchronous divisions. Morphologically abnormal embryos showed some morphometrical differences. Embryos which successfully implanted and progressed to birth showed a higher coefficient of diversity between sister blastomeres.     

Possible Relation of p53 and mdm-2 Oncoprotein Expression in Thyroid Carcinoma: A Molecular-Pathological and Immunohistochemical Study on Paraffin-Embedded Tissue

Routinely processed tissues from a series of benign and malignant thyroid lesions were immunohistochemically investigated with antibodies against p53 and mdm-2. p53 was immunolocalized in <10% of nuclei in 2/80 nodular goiters, 2/60 follicular adenomas, 26/68 follicular carcinomas, 7/40 papillary carcinomas, 3/10 “insular” carcinomas, and 10/31 anaplastic carcinomas. More than 10% positively stained nuclei were found in 2 widely invasive follicular, 2 insular, and 15 anaplastic carcinomas. All p53-positive cases showed a concomitant immunohistochemical mdm-2 expression; an immunohistochemical colocalization on serial section was demonstrated in 12 anaplastic carcinomas. Screening by polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis of these 12 cases revealed no relevant mutations in the coding regions of exons 2–11 of the p53 gene. Additionally, 1 follicular adenoma, 6 follicular carcinomas (4 minimally and 2 widely invasive), 1 papillary, and 2 poorly differentiated insular carcinomas were mdm-2 positive without immunohistochemically detectable p53 expression. These results provide evidence that wild-type p53 expression in thyroid carcinomas may be associated with mdm-2 induced formation of stable complexes. However, the role of p53 mutations and p53 protein inactivation owing to other factors (e.g., mdm-2) in the progression of thyroid carcinomas is still poorly understood.     

甲状腺疾病患者血清可溶性白细胞介素2受体测定的临床意义

某些甲状腺疾病时血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平及其与游离甲状腺素（ＦＴ＿４）、游离三碘甲腺原氨酸（ＦＴ＿３）和促甲状腺素（ＴＳＨ）水平的相关性比较。结果发现甲状腺机能亢进症（甲亢）未治疗组（Ａ）及甲亢未治疗伴突眼组（Ｄ）血清ｓＩＬ－２Ｒ明显升高；甲状腺机能减退症（甲减）经治疗甲状腺功能灭常组（Ｇ）ｓＩＬ－２Ｒ明显高于甲减未治疗组（Ｆ）；１０例毒性弥漫性甲状腺肿（Ｇｒａｖｅｓ病）患者经抗甲状腺药物治疗后ｓＩＬ－２Ｒ明显降低；Ｇｒａｖｅｓ病及甲减患者血清ｓＩＬ－２Ｒ均与ＦＴ＿３呈正相关。提示除自身免疫外，甲状腺素水平也是甲状腺疾病患者血清ｓＩＬ－２Ｒ水平的重要调节因素。     

自体甲状腺组织与干细胞移植治疗甲状腺功能减退症的研究进展

不可逆性甲减患者需要终身服用甲状腺激素，对患者的日常工作和生活造成了很大的不便。随着近年来对自体甲状腺组织与干细胞移植研究的进展，有望解决甲减病人终身服药这一问题。自体甲状腺组织移植的动物实验以及人体试验均表明：甲状腺移植物不但能够存活，而且能够发挥作用。最新的胚胎干细胞（Embryonic stemcell，ESC）研究证明，ESC可以分化为甲状腺滤泡细胞。