Spontaneous demonstration of counterclockwise right atrial activation following successful isthmus ablation

We describe an uncommon case of typical flutter with symptomatic sinus node dysfunction, in which a permanent junctional rhythm developed following ablation of the cavo-tricuspid isthmus. This rhythm activated the right atrium in counter clockwise manner thus providing spontaneous proof of unidirectional isthmus block, a phenomenon that is usually demonstrated by proximal coronary sinus pacing.     

Iuteolin对糖尿病大鼠心脏功能的保护作用及其可能机制

目的：研究Iuteolin对链脲佐菌素诱导的Ⅰ型糖尿病大鼠心功能及心肌线粒体氧化应激的影响。方法：雄性SD大鼠,随机分成正常对照组,Iuteolin对照纽,糖尿病模型组,低剂量Iuteolin（10ms／（kg·d））灌胃治疗组,高剂量Iuteolin（100ms／（kg·d））灌胃治疗组。各组大鼠饲养8周后,测体重、血糖、心功能、左心室重量、心肌胶原含量及活性氧自由基（ROS）水平,分离心肌线粒体检测ROS水平、超氧化物歧化酶（SOD）活性及线粒体肿胀程度。结果：Iuteolin处理对糖尿病大鼠血糖无明显影响,但可减少糖尿病引起的体重下降。高剂量Iuteolin可显著减小糖尿病大鼠心室与体重比值,提高左室发展压,降低左室舒张末压。高剂量Iuteolin治疗后,糖尿病大鼠心肌ROS及胶原含量。心肌线粒体ROS水平与肿胀程度均明显下降,心肌线粒体SOD活性明显增加。结论：Iuteolin处理可显著改善糖尿病大鼠心功能．其机制可能与减轻心肌线粒体氧化应激及抑制线粒体肿胀有关。     

Advanced glycation endproducts are increased in rheumatoid arthritis patients with controlled disease

Introduction  

Advanced glycation end products (AGEs) are produced and can accumulate during chronic inflammation, as might be present in patients with rheumatoid arthritis (RA). AGEs are involved in the development of cardiovascular disease. The aim of this study is to evaluate whether AGEs are increased in patients with long-standing RA and whether AGE accumulation is related to disease activity, disease severity and measures of (premature) atherosclerosis, such as endothelial activation, endothelial dysfunction and intima media thickness (IMT).     

The polymorphic HCMV glycoprotein UL20 is targeted for lysosomal degradation by multiple cytoplasmic dileucine motifs

Human cytomegalovirus (HCMV) is a widespread and persistent beta-herpesvirus. The large DNA genome of HCMV encodes many proteins that are non-essential for viral replication including numerous proteins subverting host immunosurveillance. One of them is the barely characterized UL20, which is encoded adjacent to the well-defined immunoevasins UL16 and UL18. UL20 is a type I transmembrane glycoprotein with an immunoglobulin-like ectodomain that is highly polymorphic among HCMV strains. Here, we show that the homodimeric UL20, by virtue of its cytoplasmic domain, does not reach the cell surface but is targeted to endosomes and lysosomes. Accordingly, UL20 exhibits a short half-life because of rapid lysosomal degradation. Trafficking of UL20 to lysosomes is determined by several, independently functioning dileucine-based sorting motifs in the cytoplasmic domain of UL20 and involves the adaptor protein (AP) complex AP-1. Combined substitution of three dileucine motifs allowed strong cell surface expression of UL20 comparable to UL20 mutants lacking the cytoplasmic tail. Finally, we show that the intracellularly located UL20 also is subject to lysosomal degradation in the context of viral infection. Altogether, from these data, we hypothesize that UL20 is destined to efficiently sequester yet-to-be defined cellular proteins for degradation in lysosomes.     

RIFLE标准在高容量血液滤过治疗MODS患者疗效的评价

目的：探讨不同肾功能损害时期行高容量血液滤过（HVHF）治疗对多器官功能障碍综合征（MODS）疗效的影响。方法：采用RIFLE标准,将入选的MODS患者按急性肾损伤（AKI）分为AKIⅠ期（A组）、AKIⅡ期（B组）、AKIⅢ期（C组）,以不同AKl分期作为HYI-IF治疗的时机,对比分析不同时期行HVHF治疗MODS患者的死亡率、平均重症监护病房0CU）住院时间（T1）、平均机械通气时间（T2）、平均连续血液滤过治疗时间（T3）,并将HVHF治疗前和治疗24h后的APACHEⅡ评分、SOFA评分、血浆白介素-6（IL-6）、氧合指数、血浆肌酐（Cr）、平均动脉压-（MAP）等结果进行比较。结果：1、AKIⅢ期患者死亡率显著高于AKIⅠ期和AKIⅡ期患者（P〈0．01）;AKIⅡ期患者T1、T2和T3显著高于AKIⅠ期患者（P〈0．01）;2、与AKIⅠ期和AKIⅡ期患者比较,AKIⅢ期患者HVHF治疗前APACHEⅡ评分、SOFA评分、IL-6和Cr均显著增高（P〈0．05）;AKIⅡ期患者HVHF治疗前血浆IL-6显著高于AKIⅠ期患者（P〈0．01）;3、与HVHF治疗前比较,三组患者HVHF治疗24h后IL-6、氧合指数、cr和MAP均显著改善（P〈0．01）：AKIⅢ期患者治疗后的IL-6仍显著高于AKIⅠ期和AKIⅡ期患者;AKIⅠ期和AKIⅡ期患者HVHF治疗24h后APACHEⅡ评分SOFA评分显著降低（P〈0．01）,AKIⅢ期患者治疗前后APACHEⅡ评分和SOFA评分变化无显著统计学差异。结论：RIFLE标准及IL-6对判断预后有指导意义;AKIⅠ期和Ⅱ期行HVHF可明显改善MODS的预后,而AKIⅠ期行HVHF的疗效更好。     

预防心脏手术中体外循环致肺损伤的研究进展

体外循环是心内直视手术的一种重要手段,随着体外循环装置、心肌保护措施和心脏外科技术的不断完善与提高,心内直视手术并发症的发生率和死亡率已大大下降。但肺损伤仍是CPB后的主要并发症之一,而肺损伤后气体交换障碍可能造成严重的并发症,甚至死亡。本文综述了体外循环心脏手术后肺损伤的发生机制及预防措施的研究进展。     

胰十二指肠切除术后肠黏膜屏障损伤与肠道细菌移位的临床研究

目的:探讨胰十二指肠切除手术后肠道细菌移位(BT)与术后全身炎症反应综合征(SIRS)关系。方法:40例择期行胰十二指肠切除手术患者,于术前和术后1、3、5天采集外周血,进行血浆D-乳酸,全血细菌DNA检测.全血DNA提取后进行PCR扩增,采用靶基因为大肠杆菌特异性β半乳糖苷酶基因和16SrRNA基因。观察患者术后10天以监测SIRS情况。结果:术前PCR检测全血细菌DNA均为阴性,术后共有13例阳性。术后出现全身炎症反应综合征(SIRS)的患者PCR阳性率为85.7%(12/14),无SIRS组为3.8%(1/26()P<0.01)。PCR阳性组SIRS发生率为93.2%(12/13),阴性组为7.4%(2/27)(P<0.01).PCR阳性的患者外周血血浆D-乳酸浓度较PCR阴性者明显升高(P<0.01),有SIRS的患者外周血血浆D-乳酸浓度较无SIRS患者明显升高(P<0.01)。结论:胰十二指肠切除术后肠黏膜屏障损伤与BT关系密切,术后SIRS和与BT密切相关。PCR技术对术后SIRS有较好的早期预警价值。     

热射病合并多器官功能障碍综合征持续静- 静脉血液滤过治疗的护理

目的:探讨热射病合并多器官功能障碍综合征(MODS)持续静-静脉血液滤过(CVVH)的治疗作用并总结护理要点。方法:回顾分析2008年5月至2010年9月,我院收治的6例热射病合并MODS,及时运用CVVH并采取综合治疗措施,对治疗和护理进行总结。结果:6例患者5例痊愈,1例死亡。通过早期积极采用CVVH联合综合治疗措施,可快速降低患者体温,防止因高热引起的恶性循环。结论:CVVH是热射病合MODS有效治疗方法,其可早期纠正电解质及酸碱紊乱,且对代谢产物和炎症因子的清除也有重要作用。期间严密的观察与护理,以及配合治疗的连续性,是成功救治这类患者的关键。