Pulmonary valve stenosis associated with hypertrophic cardiomyopathy

Summary The association of pulmonic stenosis with hypertrophic cardiomyopathy is rare in infancy. Presented here is an infant with atypical picture of pulmonic stenosis and echocardiographic evidence of hypertrophic cardiomyopathy. At eight months of age, she had a successful percutaneous balloon valvuloplasty and has subsequently been managed with propranolol.     

Cell based approaches for evaluation of drug-induced liver injury

An improved understanding of mechanisms that underlie drug-induced liver injury (DILI) is required to enable design of drugs that have minimal potential to cause this adverse reaction in man. Available evidence suggests DILI arises in susceptible patients because of an imbalance between chemical insults (which are an inherent property of certain drugs and/or their metabolites) and the ability of the liver to mount compensatory/adaptive responses. In vivo safety testing in pre-clinical species ensures that drugs which enter clinical trials do not cause reproducible and dose-dependent liver injury in man, but is of limited value for exploration of underlying mechanisms and does not assess potential to cause rare idiosyncratic DILI. This review highlights the value that can be gained from in vitro studies using cultured hepatocytes and also hepatocyte-derived cell lines transfected with individual human cytochrome P450 (CYP450) isoforms. We have evaluated a range of mechanisms and endpoints (cell necrosis, mitochondrial injury, inhibition of biliary transporters and metabolite-mediated toxicity) using these model systems. Our data indicate that multiple mechanisms are likely to be involved in development of idiosyncratic DILI in man caused by numerous drugs, e.g. the anticonvulsant chlorpromazine.     

短期胰岛素泵强化治疗2型糖尿病的疗效观察

目的:探讨短期胰岛素泵强化治疗2型糖尿病的疗效。方法:将我院280例2型糖尿病患者随机分为治疗组及对照组,对照组患者采用常规多次胰岛素皮下注射,治疗组患者采用胰岛素泵持续皮下输注。结果:经过治疗,两组空腹血糖、餐后2h血糖均有显著降低,与治疗前比较差异有统计学意义(P<0.05);治疗组血糖控制达标时胰岛素用量、到控制满意所需时间、低血糖反应发生率均显著低于对照组,差异有统计学意义(P<0.05)。结论:应用胰岛素泵强化胰岛素治疗2型糖尿病更符合生理,快速、安全、可靠、方便、灵活,值得临床推广应用。     

Combined use of impella device and intra‐aortic balloon pump to improve survival in a patient in profound cardiogenic shock post cardiac arrest

Patients who suffer cardiogenic shock after cardiac arrest have a very poor prognosis. Left ventricular assist devices have proven to be useful in these patients to improve survival. Recently introduced percutaneous assist devices are easier to use and can be inserted quickly in the catheterization laboratory. We describe a case where intra‐aortic balloon pump by itself was not enough to provide hemodynamic support in a patient with cardiogenic shock after cardiac arrest. The Impella Recover^® LP 2.5 system (ABIOMED, Inc., Danvers, MA) was successfully used along with the balloon pump for hemodynamic support and resulted in dramatic improvement of the patient's condition. © 2009 Wiley‐Liss, Inc.     

OPCAB与CABG术后患者ICU监护的对比观察

目的探讨非体外循环心脏跳动下冠状动脉搭桥术（OPCAB）与体外循环下冠状动脉搭桥术（CCABG）术后ICU监护工作特点及临床意义。方法随机抽取甲组（n=32）OPCAB组；乙组（n=48）CABG组。通过对两组病人术后ICU内监护时间、辅助呼吸时间、住院总天数、术后引流量及术后并发症等方面作统计学处理和对比分析。结果两组患者术后ICU内监护时间、辅助呼吸时间、住院总天数、术后引流量均有显著性差异（P〈0．05）。结论非体外循环心脏跳动下冠状动脉搭桥术心功能稳定，并发症少，明显减少了药品使用和护理工作量，能为监护室的排班提供合理依据。     

Multimodal Flow Visualization and Optimization of Pneumatic Blood Pump for Sorbent Hemodialysis System

Abstract:  Renal Solutions Allient Sorbent Hemodialysis System utilizes a two-chambered pneumatic pump (Pulsar Blood Pump, Renal Solutions, Inc., Warrendale, PA, USA) to avoid limitations associated with peristaltic pumping systems. Single-needle access is enabled by counter-pulsing the two pump chambers, thereby obviating compliance chambers or blood reservoirs. Each chamber propels 20 cc per pulse of 3 s (dual access) or 6 s (single access) duration, corresponding to a peak Reynolds number of approximately 8000 (based on inlet velocity and chamber diameter). A multimodal series of flow visualization studies (tracer particle, dye washout, and dye erosion) was conducted on a sequence of pump designs with varying port locations and diaphragms to improve the geometry with respect to risk of thrombogenesis. Experiments were conducted in a simplified flow loop using occluders to simulate flow resistance induced by tubing and dialyzer. Tracer visualization revealed flow patterns and qualitatively indicated turbulence intensity. Dye washout identified dwell volume and areas of flow stagnation for each design. Dye erosion results indicated the effectiveness and homogeneity of surface washing. Compared to a centered inlet which resulted in a fluid jet that produced two counter-rotating vortices, a tangential inlet introduced a single vortex, and kept the flow laminar. It also provided better surface washing on the pump inner surface. However, a tangential outlet did not present as much benefit as expected. On the contrary, it created a sharp defection to the flow when transiting from filling to ejection.     

Budd—Chiari综合征腔内微创治疗的价值

为探讨微创腔内疗法在不同类型Budd-Chiari综合征（BCS）治疗中的价值，根据造影结果将BCS分成3型，Ⅰ、Ⅱ型又各分成3个亚型；56例Ⅰ、Ⅱ型患者接受了腔内疗法，其中Ⅰa、Ⅰb、Ⅱa、Ⅱb型采用PTA加下腔静脉支架置入术，Ⅰc、Ⅱc型附加脾肺固定术。结果支架成功置入54例,操作成功率96．7％；失败2例，其中肺栓塞死亡1例，心包填塞1 例。说明恰当的分型可指导BCS治疗方法的选择；腔内介入技术具有微创、简捷、创伤小的特点，适用于多数类型的BCS，是一种安全有效的方法，可取代大部分手术治疗。     

A qualitative test of the balloon model for BOLD-based MR signal changes at 3T.

The aim of this study was to adapt the balloon model for BOLD-based MR signal changes to a magnetic field strength of 3T and to examine its validity. The simultaneous measurement of BOLD and diffusion-weighted BOLD responses was performed. The amplitude of the BOLD peak was found to be similar for all subjects when a short visual stimulus of 6 sec was used. The rise-time to the BOLD peak and the shape and depth of the poststimulus undershoot varied significantly. A fit of the experimental BOLD responses was found to be possible by use of parameters within a reasonable physiological range. The relations between these parameters and their influence on the modeled BOLD responses is discussed. A prediction of the balloon model is the occurrence of a BOLD overshoot, i.e., a lag between the changes of the blood volume and the blood flow after the start of the stimulation. Experimental evidence for the existence of a BOLD overshoot is presented.     

Gastric fundic gland polyps: a clinico‐pathological study from North West Tasmania

Background: Fundic gland polyps (FGPs) of the stomach were originally described in association with familial polyposis syndromes. It is now known that the majority of these polyps occur in the sporadic setting and are incidentally seen in up to 1.9% of routine upper gastrointestinal endoscopes. The aim of this study was to look at the clinico‐pathological features of the FGPs and to analyse their relationship to Helicobacter pylori infection, proton pump inhibitor treatment, colonic polyps and malignancy. Methods: A search of the histopathology records for a period of 10 years from 1997 to 2006 identified 120 patients with a histologically confirmed diagnosis of FGPs. The clinical history, upper gastrointestinal endoscopy findings, histopathology and colonoscopy findings were recorded from the medical records and analysed. Results: FGPs were seen in 3.2% of patients undergoing routine upper gastrointestinal endoscopes. There was a definite association with long‐term proton pump inhibitor treatment. There was a strikingly low incidence of H. pylori infection in the study population. Although there was no dysplasia or malignancy in any of these polyps, one patient had concomitant adenocarcinoma of the stomach. In the subgroup of patients who also had colonoscopy during the study period, 19% had associated colonic polyps and 6% had associated colonic malignancies. Conclusions: Every new patient diagnosed with FGPs should have a thorough clinico‐pathological study to see if the polyps are part of a sporadic or syndromic setting. A long‐term follow‐up study of patients with FGPs and its association with colonic polyps may be warranted.