Role of Papillary Muscle Dysfunction in the Pathogenesis of Mitral Regurgitation in Myocardial Infarction:

To elucidate the pathogenesis of mitral regurgitation (MR) after myocardial infarction (MI), the incidence of papillary muscle dysfunction (PMD), mitral annular size, and the extent of wall-motion abnormalities were examined in 81 patients with previous MI by two-dimensional echocardiography and real-time two-dimensional Doppler flow imaging. The prevalence of pathological MR was lower in patients with anterior MI (36%) than in those with inferior (65%) or anterior and inferior MI (88%) (P < 0.01 vs anterior MI group). The incidence of PMD in patients with MR in the anterior MI group (15%) was lower than that in the inferior (50%, P < 0.01) or anterior and inferior MI group (43%, P < 0.05). The mitral annular dimension in patients with MR was significantly greater than in those without MR, but it was similar among the three groups. The extent of wall-motion abnormality correlated significantly with the area of MR jet in the anterior MI group (y = 3.1x + 15.5, r = 0.52, P < 0.01) and in the inferior MI group (y = 8.3x + 32.7, r = 0.57, P < 0.01). However, the slope of this relationship was significantly steeper in the inferior MI group than in the anterior MI group (P < 0.05). These results indicated that the degree of MR with inferior MI was greater than with anterior MI for a given MI area. PMD may play an important role in the higher prevalence and greater degree of MR in inferior MI.     

Fetal anaesthesia for intrauterine treatment

Fetal anaesthesia was performed 5 times in 1 patient to treat pleural effusions, obtain fetal blood sampling, provide albumin infusion, and establish and replace a pleuro-amniotic indwelling shunt catheter under ultrasound guidance. A maternal epidural catheter was placed and used for epidural anaesthesia for the first 4 anaesthetics. Fetal administration of pancuronium 0.15 mg·kg^?1 via the umbilical vein or 0.25 mg·kg^?1 intramuscularly was enough to produce immobilization without maternal effect. However, maternal pretreatment with intravenous diazepam and fentanyl was required for fetal sedation and analgesia, which was necessary for accurate and safe injection, and for suppression of fetal stress.     

冬凌草甲素通过改变Bax/Bcl-xL表达激活caspase-3诱导A375-S2细胞凋亡

目的　研究冬凌草甲素诱导人黑色素瘤A375 S2细胞凋亡的作用原理。方法　形态学观察 ,DNA凝胶电泳法及WesternBlot法。结果　冬凌草甲素能明显诱导A375 S2细胞发生凋亡 ,其作用呈明显的量效关系和时间依赖性。形态学观察可见凋亡小体的形成 ,琼脂糖凝胶电泳可见凋亡典型的DNA梯带 ;caspase 3的抑制剂能阻止caspase 3的活力升高 ;免疫印迹结果显示冬凌草甲素作用A375 S2细胞 12h改变Bax与Bcl xL蛋白的表达 ;且发现caspase 3的底物PARP蛋白在 12h时被降解。结论　冬凌草甲素 (34 3μmol·L-1)诱导A375 S2细胞凋亡 ,这种作用是通过改变了Bax/Bcl xL的表达比率 ,激活caspase 3而实现的。     

Stakeholders' perception of the desired Master's program for Kenya in community health nursing: Areas of competency*

Introduction: After the World Health Assembly approved the WHA 45.5 in 1992, which addressed the nursing shortage by refocusing nurses and midwives to meet community health needs, community demands for educated nurses and the needs of higher nursing education in developing countries increased. However, in developing countries that suffering from multiple resource deficiencies, such as Kenya, the strategic direction of higher education in nursing was unclear. Therefore, in Kenya, a major university school of nursing initiated a collaborative study with a well‐established Japanese nursing college to determine the service‐providers' perspective about upgrading the Master's community nursing curriculum. Purpose: The aim of the study was to describe the Kenyan stakeholders' perspective and the expected roles and abilities of Master's graduates in community nursing. Methods: This qualitative, cross‐sectional study used convenience sampling to obtain 21 participants. The content analysis of the data was based on 19 semistructured interviews. Results: Sixteen categories and 42 subcategories were derived from the five key questions that related to the expectations of the Master's program. The Master's graduates were expected to acquire knowledge and skills relating to administration, management, epidemiology, research, and education. The participants recognized that epidemiology, important for preventive care, was minimal among the current community health nurses. Also, Master's graduates must be prepared to manage health programs. Conclusion: The stakeholders expected that Master's graduates would become leaders in community health nursing, with a broad range of knowledge and skills, most notably in the areas of management and administration, epidemiology, and research. Those abilities should be reflected in the curriculum content.     

A Case of Crohn's Disease which Initially Presented with Diffuse Inflammation in the Rectum and Sigmoid Colon

Abstract: This case report describes a female patient with Crohn 's disease who had diffuse proctosigmoiditis without a longitudinal ulcer or cobblestone appearance at the initial attack. She was treated with sulfasalazine on the presumptive diagnosis of ulcerative colitis. Two and a half months later, painful ulcers in the oral cavity and a deep longitudinal ulcer in the sigmoid colon were found, and a non-caseous granuloma was revealed in the biopsy specimens taken from the sigmoid colon. A definitive diagnosis of Crohn's disease was established from these findings and treatment with a corticosteroid was effective.     

Duration of apnoea in anaesthetized children required for desaturation of haemoglobin to 95%: comparison of three different breathing gases

In this study, we compared three gas compositions to determine if the duration of apnoea for Spo₂ to decrease is proportionate to the oxygen fraction of the gas prior to apnoea. Twenty-five patients ASA physical status 1–2 aged two months to 12 years were included in the study. Anaesthesia was induced via a mask with 5% sevoflurane and 66% N₂O in oxygen. After paralysis with vecuronium (0.12 mg·kg^?1, i.v.) the trachea was intubated and anaesthesia was maintained with sevoflurane and N₂O in oxygen. When cardiovascular stability was obtained, the patient was randomly set to breathe one of three gas compositions: 1. oxygen (Fio₂ 1.0), 2. N₂O/O₂ (Fio₂ 0.4), and 3. air/O₂ (Fio₂ 0.4). All three gas compositions included 2–4% of sevoflurane to maintain anaesthesia. After more than eight min of each gas breathing, apnoea was begun by disconnecting the breathing circuit from the tracheal tube. The time from the start of apnoea (Spo₂ 100%) to Spo₂ of 95% (T₉₅) was measured. T₉₅ measured after breathing N₂O/O₂ and air/O₂ were 34.6 ± 5.7 and 28.8 ± 4.7% of that measured after oxygen breathing (P < 0.001 vs oxygen breathing, P < 0.001 vs oxygen and N₂O/O₂ breathing), respectively. Preoxygenation before intubation was validated to delay the haemoglobin desaturation brought about by apnoea. An induction technique using a low Fio₂ will allow rapid haemoglobin desaturation.     

Ascending Colon Stenosis:A Rare Presentation of Perforated Appendicitis

Abstract : Described is a 49-year-old Japanese male who developed an ascending colon stenosis secondary to perforated appendicitis. The patient was examined at our hospital because of an abdominal pain and the presence of a firm mass in the right flank. A barium enema and colonoscopic examination revealed an ascending colon stenosis with multiple nodular elevations. On laparotomy, an inflammatory mass, originating from a ruptured appendix, was found adhered to the cecum and the ascending colon. Thus, a right hemicolectomy was performed. Microscopic examination revealed a periappendiceal abscess with marked submucosal fibrosis and lymphoid hyperplasia of the ascending colon and cecum. Large intestinal stenosis is a rare complication of appendicitis, and there have been only a few reported cases involving the ascending and sigmoid colon, and the rectum. In these cases, however, the polypoid lesions as seen in our case have never been described. In reviewing the literature, we found only two other cases in which a coarse or a polypoid lesion, similar to our case, was noted in the cecum, though the mucosal change was localized and luminal stenosis did not occur. Thus, when a patient with an ascending colon stenosis is encountered, a possibility of periappendiceal abscess must be kept in mind.     

水飞蓟素和Fas激动性抗体CH11共同作用诱导A375-S2细胞凋亡

目的水飞蓟素和CH11共同作用诱导人黑色素瘤细胞A375-S2凋亡的分子机制。方法结晶紫法测定细胞生长抑制率;细胞凋亡的形态学观察,LDH法测定凋亡与坏死的比率;用免疫印迹法检测凋亡抑制性的去乙酰化酶SIRT1、Bc l-2家族成员(抗凋亡蛋白Bc l-2,Bc l-xL和促凋亡蛋白Bax)、细胞色素C和Caspase-3的表达。结果水飞蓟素和CH11共同作用能诱导A375-S2细胞发生凋亡;形态学观察可见凋亡小体的形成;免疫印迹法检测发现水飞蓟素和CH11共同作用的A375-S2细胞中Bax蛋白的表达增加,Bc l-2蛋白和Bc l-xL蛋白的表达降低,细胞色素C释放增加,pro-caspase-3表达量明显降低。结论水飞蓟素协同CH11能明显促进A375-S2细胞的凋亡。     

去甲斑蝥素诱导人黑色素瘤A375-S2细胞凋亡

目的:研究去甲斑蝥素(NCTD)诱导人黑色素瘤A375-S2细胞凋亡的机制.方法:采用MTT法、形态学观察、DNA凝胶电泳及Western blot检测法.结果:去甲斑蝥素可诱导A375-S2细胞发生凋亡.半胱氨酸天冬氨酸酶(caspase)-3,-9抑制剂可以部分的抑制NCTD诱导的细胞死亡.细胞凋亡时caspase-3,8,-9酶活力升高,caspase-3底物-caspase-3激活的DNA酶抑制物(ICAD)蛋白表达下降,同时Bcl-2/Bax、Bcl-xL/Bax蛋白表达比率明显降低.结论:去甲斑蝥素通过激活caspase和Bcl-2家族诱导A375-S2细胞凋亡.     

土槿皮乙酸体外诱导A375-S2细胞凋亡

目的 :研究土槿皮乙酸 (pseudolaricacidB)诱导A375 S2细胞凋亡的作用 ,探讨其抗癌作用机制。方法 :采用噻唑蓝 (MTT)法、形态学观察、DNA凝胶电泳及Westernblot检测法。结果 :土槿皮乙酸可剂量 时间依赖性的诱导A375 S2细胞凋亡 ,5 μmol·L^-1土槿皮乙酸处理 36h的细胞 ,Hoechst 332 5 8荧光染色后有明显的凋亡小体出现 ;凝胶电泳法显示有明显的DNAladder出现。细胞内抑制凋亡蛋白Bcl 2 ,Bcl xL和caspase激活的DNA酶抑制物(ICAD)表达量时间依赖性地减少 ,而促凋亡蛋白Bax表达量增加。结论 :土槿皮乙酸对A375 S2细胞的杀伤作用主要通过诱导细胞凋亡 ,降低Bcl 2 ,Bcl xL和ICAD蛋白的表达 ,增加Bax蛋白表达为其诱发A375 S2细胞凋亡的机制之一。