Objective To investigate the clinical characteristics of inferior acute myocardial infarction (IAMI) with different inferior ST segment change.Methods The clinical data of 64 cases with acute anterior wall myocardial infarction from January 2010 to February 2012 in the hospital were prospectivly analyzed.According to wall leads ECG ST segment in the change situation,they were divided into three groups,group A (16 cases),under the wall (]Ⅱ,Ⅲ,aVF) of at least two lead ST segment elevation ≥0.1mV,group B(26 cases) under the wall(Ⅱ,Ⅲ,aVF) of at least two lead ST segment depression,group C (22 cases) under the wall(Ⅱ,Ⅲ,aVF) only a lead or no ST segment change.The infarct related artery,acute anterior wall myocardial infarction with different inferior ST-T change (infarction related coronary artery,IRCA),the infarct size and heart function were studied.Results IRCA in the three groups was consistent.The comparison of IRCA among the three groups showed that,A group of patients with “around the apical LAD” COSCO segment,accounting for 81.25％,and 26 cases in B group were not “around the apical LAD”,which was not “around the apical LAD” in 18 cases,8 cases of non-“ around the apex” COSCO LAD,of 22 patients in C group,21 cases non-“ around the apical LAD”,1 case was “around the apical LAD” COSCO,and the difference was statistically significant(F =6.32,5.92,7.08,4.11,all P ＜ 0.05).Conclusion IRCA is the LAD of acute anterior wall myocardial infarction of inferior ST segment changes may be related with the length of LAD and the lesion site,changes of inferior ST segment of anterior wall AMI can predict the IRCA position and LAD morphology,consistent with most studies.Patients with anterior wall and inferior wall ST segment elevation if IRCA is “around the apical LAD”,the infarction area is smaller,better heart function.

No Abstract Available.
Inovirus* ; Pandemics* ; Vibrio parahaemolyticus* ; Vibrio*

A procedure was introduced for determining the thickness of the articular cartilage of the patella. The results revealed that the cratilage was thicker at the site of contact between the patella and the femur than in other parts. CT and X-ray images were used to investigate movement of the patella from full extension to full flexion of the knee joint. As the flexion increased, the patella prorated, i, e., the site of contact with the epicondyle and condyle of the femur shifted from the lateral to the medial facet of the articular face, as deduced from the decrease in the bicondylo-patellar angle. Vertically, the patella moved from the epicondyle to the condyle level, but the distance between the apex of the patella and the tuberosity of the tibia remained almost unchanged. Serial slices (5 mm thick) of a plaster replica of the patella cut at right angles to the central ridge showed a change in the angle between the two facets of the articular face from the proximal to the distal side. The same results were obtained with CT slices. These findings suggest that adequate pressure stimulates development of the cartilage and that CT is a good method for studying movement of the patella.

The systolic time intervals (STI's) and the diastolic time (DT) as functions of the RR interval during exercise were proved to be described by cubic regression equations that converge to the origin of the coordinates. Using the equations, we compared I) the systolic time and DT of trained and untrained men, and II) examined the relations between parameters of STI's. I) Forty healthy male subjects aged 19-22 years old were divided into three groups, i, e., 8 long distance runners (group LD), 16 men with relatively high fitness (group A) and 16 men with relatively low fitness (group B) . They performed submaximal exercise test using a cycle ergometer for measuring the time of electromechanical systole (QS₂) and DT. After test, maximal exercise test was conducted to determine the maximal heart rate (HRmax) in each subject. Means±SD of the minimum QS₂ and the minimum DT of the 40 subjects predicted from the regression equations at the HRmax were 209.7±12.5 and 108.2±15.6 ms, their ratio being about 2: 1. The QS₂ was significantly shorter, whereas DT was longer in the group LD than in the groups A and B at the HR of more than 120 bpm. II) Ten healthy male subjects aged 19-22 years old performed submaximal exercise to clarify the relations between any two of QS₂, the left ventricular ejection time (LVET) and the preejection period (PEP) at the same HR: there were positive and negative significant correlations between QS₂ and LVET, and between LVET and PEP, respectively, at the HR of more than 100 bpm. These results reveal that, when the HR is increased in exercise, the left ventricular systolic time (QS₂) is shortened while the diastolic time is lengthened for the subjects trained as long distance runners. The shortening of the systolic time is mainly caused by shortening of LVET. The changes in the systolic and diastolic times suggest that contractility of cardiac muscle is enhanced during exercise of above moderate intensity after an extensive period of the aerobic training.

Objective: To evaluate the effect of arsenic (As) on the porphyrin biosynthetic pathway, urine samples from patients with endemic chronic arsenic poisoning were examined.Subjects and Methods: The subjects were 16 patients, who had been exposed to As from burning coal for 8 to 25 years, and-16 controls living in the same region in Guizhou Province in southwest China. Concentrations of urinary As, porphyrins and ALA were determined by induced coupled plasma mass spectrometry (ICP-MS), high performance liquid chromatography (HPLC) with a reversed-phase column and fluorescence detector, and colorimetric spectrophotometry, respectively.Results: Concentrations of As in patients and controls, 184.40 ± 200.04 and 86.82 ± 64.20 μ g/g creatinine (mean ± SD) respectively, were significantly different (p<0.05). The concentrations of various kinds of urinary porphyrins, including isomers I and III of coproporphyrin and pentacarboxylporphyrin, were determined. Positive correlations were observed between As and porphyrins (e.g. total porphyrins, hexacarboxylporphyrin and coproporphyrin III) or between As and ALA in male and female patients. However, porphyrin and ALA concentrations were not significantly different between the patients and the controls. Urinary porphyrin concentrations in females were higher than those in males.Conclusion: Exposure to As from burning coal may influence porphyrin biosynthesis.
Porphyrins ; g <3> ; Coal ; Urinary ; Chronic

A 32-year-old woman with Marfan's syndrome who had had a heart murmur in childhood was admitted due to congestive heart failure. Her echocardiography showed anterior and posterior leaflet prolapse of the mitral valve, and also severe mitral valve regurgitation. Her chest CT scan showed no evidence of an enlarged ascending aorta. We performed mitral valve replacement using a mechanical valve, because the long-term results of mitral valve repair for Marfan's syndrome are unknown. We reviewed the literature for other examples of this rare adult case with isolated mitral regurgitation associated with Marfan's syndrome.

Reoperations after operations for acute type A aortic dissection were performed in two cases under deep hypothermic circulatory arrest. In case 1, the aortic arch replacement was performed with an inclusion technique seven years ago. The reason for reoperation was the leak from the suture lines of all anastomosis sites. Three sites of leak were closed putting sutures with pledgets. In case 2 the graft replacement of the ascending aorta was performed five years ago. The reason for reoperation was the persistent dissection from the aortic arch to the thoracic descending aorta due to the new entry formation at the site of the aortic clamp. At first the graft replacement of the thoracic descending aorta was performed, followed by arch replacement. As these conditions are preventable, we should perform the open distal anastomosis technique without using a clamp and graft replacement of aortic arch with the branched graft. Moreover, deep hypothermic circulatory arrest may appear to be a valuable adjunct for reoperation after operation on acute type A dissection.

A 72-year-old woman had undergone resection and graft replacement of the proximal ascending aorta for a DeBakey type II aortic dissection. She presented again 7 years later with progressive dyspnea and a cough. Computed tomography confirmed an aortic arch aneurysm and Doppler echocardiography demonstrated aortopulmonary shunting. Cardiac catheterization revealed a fistula between the aorta and pulmonary artery with a 54.3% left-to-right shunt and a Qp/Qs of 2.19. Operative repair was performed under profound hypothermic circulatory arrest with selective cerebral perfusion. The aortopulmonary artery fistula was closed from within the aneurysm using an equine pericardial patch and the transverse aortic arch was resected and replaced with a graft. The patient recovered uneventfully and was discharged on postoperative day 43.

Studying the correlation between the results of the Common Achievement Test (basic objective structured clinical examination [OSCE] and computer-based testing [CBT]) and the results of advanced OSCE in the same examinees is necessary to improve clinical clerkships and to establish the role of each examination.
1) Ninety-seven students took the Common Achievement Test CBT and the basic OSCE in their fourth year and took the advanced OSCE in their sixth year. The Common Achievement Test basic OSCE were composed of interview, chest, abdomen, neurology, and head and neck stations, and the CBT included blocks 1-4 and 5-6. The advanced OSCE had 3 scenarios in the chest station, 2 in the abdomen station, and 4 in the neurology station. Each scenario had 3 items. We also examined the pass analysis on the basis of these 3 items in the advanced OSCE.
2) The results of the Common Achievement Test basic OSCE interview did not correlate significantly with the results of the interview station of the advanced OSCE. The results of physical examinations in the Common Achievement Test basic OSCE, excluding the chest, did not correlate significantly with the results of the physical examination stations of the advanced OSCE.
3) In the advanced OSCE, an adequate medical interview is necessary for the physical examination. An adequate physical examination is also necessary for answering the written tests (e.g., differential diagnosis). 4) Students should have sufficient basic knowledge and motivation for successfully performing clinical clerkships, because the correlations among the results of the advanced OSCE interview, the OSCE total score, the Common Achievement Test basic OSCE and CBT score were extremely strong.
5) The advanced OSCE, the Common Achievement Test basic OSCE, and CBT have distinct characteristics and roles.