83例6个月以下婴儿室间隔缺损的外科治疗

目的 总结外科手术治疗小婴儿期室间隔缺损(VSD)的临床经验.方法 对2000-2005年83例＜6月龄VSD患儿,年龄12 d至6(4.3±1.2)个月,体重3～6.5(5.1±0.8)kg.膜周部VSD 74例,干下型VSD 8例,膜周部并肌部VSD1例.术前中、重度肺动脉高压69例(83.1%).所有患儿均在浅低温体外循环下手术.结果 全组手术死亡4例,手术病死率为4.8%.术后主要并发症为肺动脉高压危象、肺部感染和心律失常.结论 随着麻醉、体外循环、手术技术和围术期监护处理措施的进步,在小婴儿期施行VSD的外科手术已成为安全的治疗方式.术后对肺高压的处理是手术成功的关键.     

Hemodynamic analysis of descending versus ascending aortomyoplasty, and comparison with intra-aortic balloon pump

Objective: Descending and ascending aortomyoplasty are two surgical procedures intended to induce hemodynamic benefits similar to those of the intra-aortic-balloon-pump (IABP). To date, there have been no studies comparing the two surgical techniques. The objective of this study was to compare coronary blood flow augmentation and afterload reduction as produced by descending and ascending aortomyoplasty counterpulsation Methods: Twenty-two mongrel dogs (18–35 kg) underwent IABP application (n=7), descending (n=8), or ascending (n=7) aortomyoplasty. Left anterior descending (LAD) coronary artery blood flow was measured using a Transonic Doppler flow probe. Left ventricular pressure as well as aortic pressures proximal and distal to either the aortomyoplasty site or the IABP position were monitored continuously. Results: Descending aortomyoplasty induced higher elevation in the LAD blood flow during assisted beats (27% from 10.8±4 to 13.8±6 ml/min, P<0.001) than that induced by either ascending aortomyoplasty (19% from 11.7±5 to 14±5 ml/min, P<0.001) or IABP counterpulsation (18% from 8.6±3 to 10.2±4 ml/min, P<0.001). Conversely, while ascending aortomyoplasty reduced the left ventricular end-diastolic pressure by 16% (from 60±18 to 50±22 mmHg, P<0.001), similar to the 16% after load reduction achieved by the IABP counterpulsation, descending aortomyoplasty failed to induce afterload reduction. Conclusions: Descending aortomyoplasty produces higher coronary blood flow augmentation than either ascending aortomyoplasty or IABP. However, afterload reduction comparable to that achieved by IABP was observed only with ascending aortomyoplasty and not with descending aortomyoplasty.     

100例高血压病患者短程心率变异性分析

目的:评价自主神经活动在高血压病中的调节作用。方法:观测100例高血压病(Ⅰ组)和54例正常人(Ⅱ组)及高血压病伴心电图改变(ⅠA组)和不伴心电图改变(ⅠB组)心率变异性(以下称HRV)时域参数SDNN、rMSSD、PNN50、Bottom4项指标。结果:Ⅰ组与Ⅱ组差异有显著性(P<0.05);ⅠA组与ⅠB组组差异无显著性(P>0.05)。结论:在高血压病中,交感神经张力增高,副交感神经活动减弱及损伤可能是HRV降低的重要因素。     

正常小鼠胃肠运动昼夜节律及药物作用的影响

目的：观察小鼠胃肠运动昼夜节律及药物对节律的影响。方法：小鼠不同时间点灌胃给予蒸馏水及实验药物，同步测定胃排空及小肠推进运动情况。结果：小鼠胃排空及小肠推进运动存在昼夜节律；普瑞博思促进胃肠运动存在时间效应，但对节律无明显影响；阿托品抑制胃肠运动可使原有昼夜节律消失。结论：小鼠胃肠运动功能存在昼夜节律，药物对胃肠运动功能的作用存在时间效应，可使节律发生不同变化。     

Repeated measurements of mite and pet allergen levels in house dust over a time period of 8 years

BACKGROUND: Studies of the association between indoor allergen exposure and the development of allergic diseases have often measured allergen exposure at one point in time. OBJECTIVE: We investigated the variability of house dust mite (Der p 1, Der f 1) and cat (Fel d 1) allergen in Dutch homes over a period of 8 years. METHODS: Data were obtained in the Dutch PIAMA birth cohort study. Dust from the child's mattress, the parents' mattress and the living room floor was collected at four points in time, when the child was 3 months, 4, 6 and 8 years old. Dust samples were analysed for Der p 1, Der f 1 and Fel d 1 by sandwich enzyme immuno assay. RESULTS: Mite allergen concentrations for the child's mattress, the parents' mattress and the living room floor were moderately correlated between time-points. Agreement was better for cat allergen. For Der p 1 and Der f 1 on the child's mattress, the within-home variance was close to or smaller than the between-home variance in most cases. For Fel d 1, the within-home variance was almost always smaller than the between-home variance. Results were similar for allergen levels expressed per gram of dust and allergen levels expressed per square metre of the sampled surface. Variance ratios were smaller when samples were taken at shorter time intervals than at longer time intervals. CONCLUSION: Over a period of 4 years, mite and cat allergens measured in house dust are sufficiently stable to use single measurements with confidence in epidemiological studies. The within-home variance was larger when samples were taken 8 years apart so that over such long periods, repetition of sampling is recommended.     

Changes of Unit Discharge of the Medullary Respiratory Neurons during Apnea

Changes of the neuronal discharge of 128 medullary respiratory unitswere recorded and studied during the period of expiratory apnea induced reflexlyby intracarotid sinus injection of sodium citrate in rabbits.Generally,theneuronal discharge of inspiratory units began,stopped and recovered at the sametime with those of the phrenic nerve.But,about 5% the phase-spanninginspiratory units near the obex showed a different time course with the dischargeof the phrenic nerve.They fired continuously in a low frequency while thephrenic nerve was quiet.When increasing progressively and approaching to acertain level,the firing rate increased abruptly and at the same time phrenic nervebegan to fire.So it seemed that they acted as the pacemaker of inspiration.Comparison of the cycle-triggered histograms(CTH)of these inspiratory unitswith those of phrenic nerve showed clearly the above mentioned phasicrelationship.They started firing before the phrenic nerve,but they reached theirmaximal rate and then declined and stopped quite in accordance with the phrenicnerve.It is,therefore,reasonable to assume that the central mechanism of theswitch from expiratory apnea to inspiration may originate from this kind ofneurons.Most of the expiratory units show tonic discharges during the period of apneawith a higher discharge rate than normal and then the rate decreases just beforerecovery of phrenic firing.In addition,small portion of the expiratory units weredepressed as the phrenic discharge ceased.The function of these two differentkinds of neurons in the mechanism of development of respiratory rhythm is,apparently,different.     

生物瓣膜失功能原因分析

目的对植入人体内1年以上损坏的生物瓣膜作损坏原因的临床分析。方法1993年6月至2004年6月,共41例(47只)生物瓣膜失功能病人行再次手术换瓣。两次换瓣间隔时间1~16年,平均(9.7±4.1)年。对失功能生物瓣膜进行标本观察及病理学检测。结果47只带支架生物瓣膜中,瓣架无一损坏,42只瓣膜发生瓣叶撕裂或穿孔,35只有不同程度的钙化现象,且在瓣环表面和瓣脚周围有纤维组织增生,2只瓣膜有赘生物及血栓形成;47只生物瓣膜中损坏较重的瓣膜送病理学检查发现大量吞噬细胞和单核细胞浸润。结论生物瓣膜早期损坏以破损撕裂为主,晚期以钙化和破损撕裂等多种因素的复合病损结果出现。     

Testing for familial aggregation of functional traits

In a genetic epidemiology study of a trait, prior to collecting genotype data the foremost task is to test for familial aggregation and examine heritability. Recently, functional traits have drawn attentions from investigators. Here, to test for familial aggregation of a functional trait in the family studies, a test constructed based on the leading functional principal component of heritability, which is a summary measure of temporal genetic variation in a functional trait, is proposed. The p‐value of the test can be approximated by a permutation procedure given the family structure. The asymptotic distribution of the test statistic is derived. Simulations are carried out to examine the size and the power of the test. The proposed methods are applied to the total cholesterol data in the Framingham Heart Study. Copyright © 2009 John Wiley & Sons, Ltd.     

不同疗法对肌筋膜疼痛病人的自主神经功能的影响

目的：本研究的目的是观察注射疗法及复合小针刀疗法治疗肌筋膜疼痛综合征对自主神经系统功能的影响。方法：选择40例诊断明确的肌筋膜疼痛病人，随机分为两组，每组20例。Ⅰ组：采用注射疗法治疗；IS组：采用注射疗法加小针刀治疗。观察两组病人治疗前后心率变异（HRV）的频域变化，低频LF、超低频LLF、高频HF、低高频比LF／HF及心率变异指数HR-Ⅵ；用视觉模拟评分法（VAS）评定治疗前后疗效并随访观察其远期疗效。结果：①HRV频域指标组内比较：LF、LLF、HF以及HRVI治疗前舆治疗后1min比较有显着性差异（P〈0．05），与5min、10min比较有非常显着性差异（P〈0．01）。LF／HF治疗前与治疗后5min、10min比较有显着性差异（P〈0．05）。组间治疗后1、5、10min，两两比较无显着性差异。②组间比较：病人治疗后临床症状、VAS评分均较治疗前降低．治疗前后IS组有非常显着性差异（P〈0．01）。两组VAS降低率有非常显着性差异（P〈0．01）。③回访病例中，两组治疗有效率比较有显着性差异（P〈0．05）。结论：注射疗法以及复合小针刀疗法均可有效改善肌筋膜疼痛病人的自主神经功能，其机制可能是通过调节、稳定自主神经系统功能达到缓解疼痛。注射疗法复合小针刀疗法的远期疗效优于单纯注射疗法。