不同免疫剂治疗扩张型心肌病患儿心功能和临床预后评价

目的观察比较泼尼松联用硫唑嘌呤和大剂量静脉用免疫球蛋白(IVIG)对扩张型心肌病(DCM)患儿心功能及预后的影响。方法将DCM患儿20例分为治疗Ⅰ和Ⅱ组,分别在传统抗心衰治疗基础上加泼尼松联用硫唑嘌呤和大剂量IVIG,治疗1个疗程后评价心功能,检测治疗前后左房横径(LA)、左室舒张期内径(LV)、左室射血分数(LVEF)、心脏指数(CI),并计算其治疗前后变化。所有病例随访1年,计算1年存活率。结果治疗Ⅱ组心功能明显优于治疗Ⅰ组(P均<0.05);两组LA、LV、LVEF和CI治疗后较治疗前均有明显改善(P均<0.05);治疗Ⅰ组各参数变化明显低于治疗Ⅱ组(P均<0.05),其1年存活率明显低于治疗组Ⅱ(P<0.05)。结论泼尼松联用硫唑嘌呤和大剂量IVIG均能改善DCM患儿心功能,但IVIG疗效优于泼尼松联用硫唑嘌呤。     

Tissue plasminogen activator genetic polymorphisms do not influence tissue plasminogen activator release in patients with coronary heart disease

OBJECTIVES: To determine if polymorphisms of the tissue plasminogen activator (t-PA) gene influence acute endogenous t-PA release in patients with coronary heart disease (CHD). METHODS: Forearm blood flow and plasma t-PA concentrations were measured in response to intra-brachial infusion of substance P and sodium nitroprusside in 96 patients with stable CHD. Genotyping was performed using a Taqman polymerase chain reaction assay specifically designed to detect the polymorphisms of interest: (i) Alu-repeat insertion/deletion sequence; (ii) C-->T substitution in an upstream enhancer region (-7351 C/T); (iii) T-->C in exon 6 (20 099 T/C); and (iv) T-->A (27 445 T/A) in intron 10. RESULTS: Substance P and sodium nitroprusside caused dose-dependent increases in forearm blood flow in all patients (P < 0.001 for all) that were independent of the four genetic polymorphisms. Similarly, there were no differences in basal plasma t-PA antigen concentrations or net t-PA release between genotypes. Compared to non-smokers, smokers exhibited impaired substance P-induced vasodilatation (P < 0.001) and t-PA release (P = 0.05). CONCLUSIONS: Despite confirming our previous findings in cigarette smokers, we have found no effect of polymorphisms of the t-PA gene on two complementary aspects of endothelial function. We conclude that genetic variation of the t-PA locus is unlikely to have a major influence on acute t-PA release in subjects with established CHD.     

Urinary cyclic AMP response to bovine parathyroid hormone during treatment with neuroleptics

The urinary cyclic AMP response to bovine parathyroid hormone and urinary concentrating ability (max Uosm) after des-amino-D -arginine vasopressin were studies in nine volunteers and seven patients receiving long-term neuroleptic treatment. Max Uosm was lower in the patient group (770 ± 70 mosmol/kg) compared with the controls (948 ± 152 mosmol/kg) but the trend to a lower cAMP response to bovine PTH was not statistically significant. These results suggest that, although adenylate cyclase inhibition may contribute, other mechanisms are also important in the genesis of reduced uring concentrating ability in patients treated with psychotropic drugs.     

茶色素对冠心病及高血压病病人血小板功能的影响

目的：探索茶色素对冠心病、高血压病病人血小板功能的影响。方法：冠心病病人３６例（男性２１例，女性１５例；年龄６４±ｓ４ａ）；高血压病病人３０例（男性１８例，女性１２例；年龄５８±８ａ）。采用茶色素２５０ｍｇ，ｐｏ，ｔｉｄ，３０ｄ为一个疗程。结果：治疗后ＴＸＢ２下降，６－ｋｅｔｏ－ＰＧＰ１α上升，ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１α比值下降（Ｐ＜０．０１或Ｐ＜０．０５），ＧＭＰ－１４０下降（Ｐ＜０．０５），ＰａｇＴ，ＰａｄＴ下降（Ｐ＜０．０５）。结论：茶色素具有降低血小板表面活性作用，抑制血小板聚集和粘附，抗血栓形成，改善微循环，对冠心病和高血压病病人起到积极的防治作用。     

ITERATIVE DYNAMIC PROGRAMMING FOR MINIMUM ENERGY CONTROL PROBLEMS WITH TIME DELAY

This paper presents the use of iterative dynamic programming employing exact penalty functions for minimum energy control problems. We show that exact continuously non-differentiable penalty functions are superior to continuously differentiable penalty functions in terms of satisfying final state constraints. We also demonstrate that the choice of an appropriate penalty function factor depends on the relative size of the time delay with respect to the final time and on the expected value of the energy consumption. A quadratic approximation (QA) of the delayed variables is much better than a linear approximation (LA) of the same for relatively large time delays. The QA improves the rate of convergence and avoids the formation of ‘kinks‘. A more general way of selecting appropriate penalty function factors is given and the results obtained using four illustrative examples of varying complexity corroborate the efficacy of the method.     

竹荪深层发酵菌丝体对小鼠免疫功能的影响及其抗肿瘤作用

过对食药用真菌──竹荪深层发酵菌丝体提取液对小鼠免疫功能及S－180肿瘤细胞的作用观察，表明其发酵菌丝体可明显提高小鼠腹腔巨噬细胞的吞噬功能（P＜0．01），并显著增加免疫器官的重量（P＜0．05）；对小鼠S－180肿瘤的抑瘤率为40．63％。     

非瓣膜病房颤患者左心耳血流动力学的TEE研究

应用多平面经食管超声心动图技术（Ｍ－ＴＥＥ），对３０例健康人和３０例非瓣病房颤患者（ＮＶＡＦ）心底短轴切面测量了左心耳最大直径，同一心动周期内左心耳最大及最小面积及左心耳最大空速度，产将ＮＶＡＦ患者按照自发显影及血栓的有无分为２组。发现ＮＶＡＦ组左心耳增大，收缩力及血流速度均减低，且这种变化在有血栓和有血栓形成倾向的患者中更为明显。     

The Prospective Assessment of Autonomic Nerve Function by Pupillometry in Adolescents with Type 1 Diabetes Mellitus

The study aimed to compare the longitudinal assessment of autonomic nerve function by computerized infrared pupillometry and standard cardiovascular tests in adolescents with diabetes. Adolescents (n = 150) were assessed at two time points (T1 and T2). The median time interval between assessments was 1.5 (range 0.9–3) years. At T1 the median age was 14.5 (range 8.3–19.5) years and the median duration was 6.5 (range 1.1–16) years. The pupillary variables assessed included the resting pupil diameter, the maximum constriction velocity, and the reflex amplitude of constriction. Heart rate reflexes were assessed in response to deep breathing, the Valsalva manoeuvre, and on standing from a lying position (30/15 ratio). Between visits there was a significant decrease in maximum constriction velocity (6.0 mm s^?1 vs 6.3 mm s^?1, p = 0.0001) and resting pupil diameter (6.2 mm vs 6.3 mm, p = 0.001). At reassessment pupillary abnormalities increased from 32 (21 %) to 45 (30%), with 17 (54 %) of the initial abnormalities persisting. Adolescents with abnormally slow maximum constriction velocity compared to those with normal maximum constriction velocity had a higher glycated haemoglobin (HbA_1c%) at T2 (p = 0.02) and between assessments (p = 0.01). Cardiovascular test abnormalities did not increase between visits and the persistence of initial abnormalities was low (21 %). In summary, pupillometry appears a more sensitive test of autonomic nerve dysfunction in adolescents with diabetes than assessment of cardiovascular reflexes.     

左心室舒张(充盈)功能的影响因素

本文用X线电影摄影方法评价了49例左室舒张(充盈)功能的影响因素。冠心病(CAD)组23例,高血压病组12例,正常对照组14例。左室充盈功能或顺应性主要受冠脉病变严重程度的影响。冠脉狭窄程度越重,并有陈旧性心肌梗塞、室壁运动异常、EF下降,则充盈功能受损愈明显。血压、年龄因素对舒张充盈功能的影响较小。在CAD组中,心率与1/3充盈分数呈负相关,与正常化高峰充盈率(NPFR)不相关,而EF则与NPFR相关良好。