论清代才媛张因的文学交游

清代文士家庭重视对女性的教育,学识是女性家庭文化背景的体现。清代才媛张因出自书香门第,与才士黄文旸结为夫妻,多有唱和。张因跟随黄文旸游历,曾为闺秀老师,寓居西湖,与阮元、孔璐华等结识,参加了曲江亭雅集。她与才媛们唱和,作品被刊刻成集。对张因文学交游的爬梳,有利于了解清代江南地区才媛文学活动的特点。

Correlation between angiotensinogen gene and primary hypertension with cerebral infarction in the Li nationality of China

Objective To investigate the relationship of four single nucleotide polymorphism （SNP） haplotypes in the angiotensinogen （AGT） gene to the primary hypertension with or without cerebral infarction in the Li nationality of Hainan, China. Methods Total 300 subjects were allocated into three different groups： Groupl, 100 patients who have primary hypertension; Group 2, 100 patients who have primary hypertension with cerebral infarction; and control group, 100 healthy individuals. The genotypes of all subjects were determined by PCR-sequencing to analyze the four poly- morphisms at position - 152 （G-A）, -20 （A-C）, - 18 （C-T）, and -6 （A-G） in the promoter region of AGT. Results The frequen- cies ofCT genotype of AGT-18 and T allele in Group 1 （P = 0.003, P = 0.004） and Group 2 （P = 0.002, P = 0.002） were both significantly higher than in healthy controls. The frequency of G allele of AGT-6 was significantly higher in Group 2 than in the control group （P = 0.016）, while there is no significant difference between Group 1 and the control. Haplotype analysis revealed that H6 haplotype frequency which included -20C and -6G was significantly increased in Group 2 （P = 0.003） compared with the control group, while H5 haplotype frequency which included -20C and -18T was signifi- cantly increased in Group 1 （P = 0.006） versus the control. Conclusion The -20 （A-C） and - 18 （C-T） of the AGT may play an important role in pathogenesis of primary hypertension; and -20 （A-C）, -18 （C-T）, and -6 （A-G） may be the genetic risk factors for the onset of primary hypertension with cerebral infarction in the Li nationality of Halnan, China.

Analysis of Three-dimensional Crack Propagation by Using Displacement Discontinuity Method

A technique for modelling of three-dimensional(3D)quasi-statically propagating cracks in elastic bodies by the displacement discontinuity method(DDM)was described.When the crack is closed,the Mohr-coulomb rule on the two contacted surfaces of the crack must be satisfied.A simple iterative method was adopted in order to consider three different states of cracks.Under the assumption that the advance of the point on the crack front would occur only in the normal plane which is through this edge point,the maximum energy release rate criterion is modified to be used as the criterion for the crack growth.With discretization,the process of crack propagation can be seen as the advance of the vertices of the crack front.The program MCP3D was developed based on these theories to simulate the 3D quasi-static crack propagation.A numerical example of a penny-shaped crack subject to tension and compression in an infinite elastic media was analyzed with MCP3D,and the results in comparison with others' show that the present method for 3D crack propagation is effective.

Is NEDD4-1 a negative regulator of phosphatase and tensin homolog in gastric carcinogenesis?

The expression of phosphatase and tensin homolog (PTEN ), a tumor suppressor gene, is frequently downregulated in gastric carcinomas due to mutation, loss of heterozygosity, and promoter hypermethylation. However, it is unknown if additional mechanisms may account for the down-regulation of PTEN expression. While neuronal precursor cell-expressed developmentally down-regulated 4-1 (NEDD4-1) is believed to be a potential dual regulator of PTEN, there are conflicting reports regarding their interaction. To gain further insight into the role of NEDD4-1 and its association with PTEN in gastric carcinoma development, we measured the protein expression of NEDD4-1 and PTEN in gastric mucosae with various pathological lesions and found that NEDD4-1 increased from normal gastric mucosa to intestinal metaplasia and decreased from dysplasia to gastric carcinoma. These changes did not correlate with PTEN expression changes during gastric carcinogenesis. Moreover, we found similar results in protein levels in the primary tumors and adjacent non-tumorous tissues. These results differ from a previous report showing that expression of NEDD4-1 is up-regulated in gastric carcinomas, and show a more complex pattern of NEDD4-1 gene expression during gastric carcinogenesis.

ASSOCIATION ANALYSIS OF POLYMORPHISMS OF ACE GENE AND AGT GENE WITH ESSENTIAL HYPERTENSION IN CHINESE HAN'S POPULATION

Objective. To investigate whether the polymorphisms in the angiotensin converting enzyme (ACE) gene and angiotensinogen (AGT) gene are associated with essential hypertension. Methods. A case-control study was carried out using 103 hypertensive (HT) and 131 normotensive (NT) subjects. The insertion/deletion(I / D ) polymorphism of the ACE gene and the methionine→threo- nine variant at position 235 (M235T) of the AGT gene were determined by the polymerase chain reaction (PCR) technique and PCR/restriction fragment length polymorphism (PCR/RFLP) analysis, respective- ly. Results. The differences of D allele frequency and genotype distribution of the ACE gene between NT and HT groups were statistically significant (X^2=18.12, P<0. 005 ). The T235 allele frequency of the AGT gene was 69% in NT Chinese group (approximately 1. 38 to l. 64 fold that in Caucasians), and was greater in female HT than in NT (0. 82 vs 0. 72, X^2= 8. l, P<0. 025). A correlation between M235T molecular variant of the AGT gene and I/D molecular variant of ACE gene to hypertension was found. Cbeclusions. The possession of D allele of the ACE gene might be a marker for predisposition to hyper- tension. The T235 allele of the AGT gene was more common in Chinese than in Caucasians, and might contribute to the risk for hypertension in female Chinese.

Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy

AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.

The effect of hamstring flexibility on peak hamstring muscle strain in sprinting

Background:The effect of hamstring flexibility on the peak hamstring muscle strains in sprinting,until now,remained unknown,which limited our understanding of risk factors of hamstring muscle strain injury(hamstring injury).As a continuation of our previous study,this study was aimed to examine the relationship between hamstring flexibility and peak hamstring muscle strains in sprinting.Methods:Ten male and 10 female college students participated in this study.Hamstring flexibility,isokinetic strength data,three-dimensional(3D)kinematic data in a hamstring isokinetic test,and kinematic data in a sprinting test were collected for each participant.The optimal hamstring muscle lengths and peak hamstring muscle strains in sprinting were determined for each participant.Results:The muscle strain of each of the 3 biarticulated hamstring muscles reached a peak during the late swing phase.Peak hamstring muscle strains were negatively correlated to hamstring flexibility(0.1179 ≤ R2≤ 0.4519,p = 0.001) but not to hip and knee joint positions at the time of peak hamstring muscle strains.Peak hamstring muscle strains were not different for different genders.Peak muscle strains of biceps long head(0.071 ± 0.059) and semitendinosus(0.070 ± 0.055) were significantly greater than that of semimembranosus(0.064 ± 0.054).Conclusion:A potential for hamstring injury exists during the late swing phase of sprinting.Peak hamstring muscle strains in sprinting are negatively correlated to hamstring flexibility across individuals.The magnitude of peak muscle strains is different among hamstring muscles in sprinting,which may explain the different injury rate among hamstring muscles.

No association between phosphatase and tensin homolog genetic polymorphisms and colon cancer

AIM: To investigate the association between single nucleotide polymorphisms (SNPs) in the phosphatase and tensin homolog (PTEN) tumor suppressor gene and risk of colon cancer. METHODS: We utilized a population-based casecontrol study of incident colon cancer individuals (n= 421) and controls (n = 483) aged ≥ 30 years to conduct a comprehensive tagSNP association analysis of the PTEN gene. RESULTS: None of the PTEN SNPs were statistically significantly associated with colon cancer when controlled for age, gender, and race, or when additionally adjusted for other known risk factors (P > 0.05). Haplotype analyses similarly showed no association between the PTEN gene and colon cancer. CONCLUSION: Our study does not support PTEN as a colon cancer susceptibility gene.

Bianchi-Type II String Cosmological Models with Bulk Viscosity

The locally rotationally symmetric Bianchi-type II string cosmological models with bulk viscosity are obtained, where an equation of state, , and a relation between metric potentials, , are adopted. The physical features of the models are also discussed. In special cases the model reduces to the string models without viscosity that was previously given in the literatures.

Analysis of drop deformation dynamics in turbulent flow

Drop breakage and coalescence influence the particle formation in liquid-liquid dispersions. In order to reduce the influencing factors of the whole dispersion process, single drops where coalescence processes can be neglected were analyzed in this work. Drops passing the turbulent vicinity of a single stirrer blade were investi- gated by high-speed imaging. In order to gain a statistically relevant amount of drops passing the area of interest and corresponding breakage events, at least 1600 droplets were considered for each parameter set of this work. A specially developed fully automatic image analysis based on Matlab was used for the evaluation of the resulting high amount of image data. This allowed the elimination of the time-consuming manual analysis and further- more, allowed the objective evaluation of the drops＇ behavior. Different deformation parameters were consid- ered in order to describe the drop deformation dynamics properly. Regarding the ratio of both main particle axes （0axes）, which was therefore approximated through an ellipse, allowed the determination of very small de- viations from the spherical shape. The perimeter of the particle （0peri） was used for the description of highly de- formed shapes. In this work the results of a higher viscosity paraffin oil （ηd =127 mPa. s） and a low viscosity solvent （petroleum, ηd = 1.7 mPa-s） are presented with and without the addition of SDS to the continuous water phase. All results show that the experimentally determined oscillation but also deformation times underlie a wide spreading. Drop deformations significantly increased not only with increasing droplet viscosity, but also with decreasing interfacial tension. Highly deformed particles of one droplet species were more likely to break than more or less spherical particles. As droplet fragmentation results from a variety of different macro-scale de- formed particles, it is not assumed that a critical deformation value must be reached for the fragmentation pro- cess to occur. Especially for highly deformed particles thin particle filaments are assumed to induce the breakage process and, therefore, be responsible for the separation of drops.

Acoustic emission activity in directly tensile test on marble specimens and its tensile damage constitutive model

For understanding acoustic emission （AE） activity and accumulation of micro-damage inside rock under pure tensile state, the AE signals has been monitored on the test of directly tension on two kinds of marble specimens. A tensile constitutive model was proposed with the damage factor calculated by AE energy rate. The tensile strength of marble was discrete obviously and was sensitive to the inside microdefects and grain composition. With increasing of loading, the tensile stress-strain curve obviously showed nonlinear with the tensile tangent modulus decreasing. In repeated loading cycle, the tensile elastic modulus was less than that in the previous loading cycle because of the generation of micro damage during the prior loading. It means the linear weakening occurring in the specimens. The AE activity was corresponding with occurrence of nonlinear deformation. In the initial loading stage which only elastic deformation happened on the specimens, there were few AE events occurred; while when the nonlinear deformation happened with increasing of loading, lots of AE events were generated. The quantity and energy of AE events were proportionally related to the variation of tensile tangent modulus. The Kaiser effect of AE activity could be clearly observed in tensile cycle loading. Based on the theory of damage mechanics, the damage factor was defined by AE energy rate and the tensile damage constitutive model was proposed which only needed two property constants. The theoretical stress-strain curve was well fitted with the curve plotted with tested datum and the two property constants were easily gotten by the laboratory testing.

POLYMORPHISM OF ANGIOTENSIN CONVERTING ENZYME GENE AND GENETIC SUSCEPTIBILITY TO ASTHMA WITH FAMILIAL AGGREGATION

Angiotensin converting enzyme (ACE) plays a key role in the metabolism of angiotensin Ⅱ (AT Ⅱ) and inactivation of bradykinins and tachykinins, which are potent bronchialconstrictors and mediators of inflammation asthma, and ACE is heavily expressed in the lungs. An insertion deletion (D/I) polymorphism of ACE gene has been shown to be associated with levels of ACE. We investigate whether the polymorphism of ACE gene is associated with asthma and bronchial responsiveness. Methods. A case control study was carried out in 50 asthmatics, 7 families with at least 2 asthmatic individuals, and 50 healthy subjects. The insertion/deletion (I/D) polymorphism of ACE gene was amplified by polymerase chain reaction (PCR). Methacholine brocho provocation and pulmonary function tests were performed in all asthmatics. Results. There was an higher gene frequency of DD genotype of ACE gene in asthmatic subjects and families individuals compared with healthy subjects (46%, 53% vs 16%, P<0 05; odd ratio 4 98). Anhigher prevalence of DD genotype of ACE was in patients with bronchial hyperresposiveness (BHR) (67%vs 33%, P<0 05; odd ratio 3 8). Accordingly, the mean values of FEV 1% and FEV 1/FVC were higher in asthmatics carrying non DD alleles than patients with DD genotype (73 78% vs 56 56%, P<0 05; 79 19% vs 69 29%, P<0 05, respectively). Conclusion. These results suggested that DD allele of ACE genotype was significantly involved in genetic susceptibility to asthma. DD genotype of ACE might be a risk factor for the degree of airway obstruction, it could also be implicated in pathogenesis of bronchial hyperresponsiveness.

DYT1 MUTATIONS AMONGST EARLY ONSET PRIMARY DYSTONIA PATIENTS IN CHINA

Objective To investigate the frequency of GAG deletion in the DYT1 gene among early onset primary dystonia patients in China. Methods Thirteen patients with early onset primary torsion dystonia were screened for mutation in exon 5 of the DYT1 gene using denaturing high-performance liquid chromatography （DHPLC） and DNA sequencing, and the results were confirmed with polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Results The GAG deletion mutation which results in Glu302del in exon 5 of the DYT1 gene was found in 5 patients. The detecting results were consistent between with DHPLC and PCR-RFLP. We did not find any other mutations in the DYT1 gene. Conel^iotm The GAG deletion in the DYT1 gene is common amongst early onset primary torsion dystonia patients in Chin＆ The frequency of DYT1 mutation is not significantly different between European and Asian patients with early onset primary dystonia.

Chronic constipation:Facilitator factor for development of varicocele

AIM:To evaluate the possible relationship between varicocele and chronic constipation.METHODS:Between April 2009 and May 2010,a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated.Patients were divided into two groups.In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist.All of them were evaluated by color Doppler ultrasonography.All patients with constipation,except for the healthy controls of the second group,underwent a colonoscopy to identify the etiology of the constipation.In the first group,we determined the rate of chronic constipation in patients with varicocele and in the second group,the rate of varicocele in patients with chronic constipation.In both groups,the rate of the disease was compared with age-matched healthy controls.In the second group,the results of colonoscopies in the patients with chronic constipations were also evaluated.RESULTS:In the first group,mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years,respectively(P < 0.05).In the second group,mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years,respectively(P < 0.05).In the first group,chronic constipation was observed in 8 of the 69 patients with varicocele(11.6%) and 3 out of 60 in healthy controls(5%),respectively.In this regard,there was no statistical significance between varicocele patients and the healthy control(P = 0.37).In the second group,varicocele was observed in 16 of the 66 patients with chronic constipation(24.24%) and 12 out of 60 in healthy controls(20%) respectively.Similarly,there was no statistical significance between chronic constipation and healthy controls(P = 0.72).Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele,in the second group.In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids.In this regard,there was no statistical significance between chronic constipation and healthy controls(P = 0.80).CONCLUSION:Chronic constipation may not be a major predictive factor for the development of varicocele,but it may be a facilitator factor for varicocele.

Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation

AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.RESULTS: The incidence of early rebleeding after EVL was 7.60%,and the morbidity of rebleeding was 26.9%.Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83,95% CI: 9.39-420.56,P < 0.001],the number of bands placed (OR 17.36,95% CI: 4.00-75.34,P < 0.001),the extent of varices (OR 15.41,95% CI: 2.84-83.52,P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35,95% CI: 1.93-66.70,P = 0.007).CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites,number of rubber bands used to ligate,severity of varices and prolonged PT.Effective measures for prevention and treatment should be adopted before and after EVL.

Crack fluid identification of shale reservoir based on stress-dependent anisotropy

Shale reservoirs are typically very tight, and crack are only a small part of the reservoir. The directional arrangement of cracks leads to the anisotropic characteristics of shale, and the type of fluid filled in cracks affects the shale reservoir evaluation and late development. Many rock physics theories and methods typically use second-and fourthorder crack density tensors to characterize the elastic anisotropy induced by cracks as well as the normal-to-tangential crack compliance ratio to distinguish between dry and saturated cracks. This study def ines an anisotropic crack f luid indicator for vertical transversely isotropy(VTI) media with vertical symmetry axis which is the integration of the normal-to-tangential crack compliance ratio in three directions. A new dimensionless fourth-order tensor, including crack f luid type, azimuth distribution, and geometric shape, is constructed by substituting the normal and tangential compliance into the fourth-order crack density tensor, which can also be used to identify the type of crack fluid in the VTI media. Using the Callovo–Oxfordian shale experimental data, the variation of the elastic properties of dry and saturated shale samples with axial stress is analyzed. The results demonstrate that the anisotropic crack f luid indicator of water-bearing shale samples is less than that of the dry shale samples and that the dimensionless fourth-order tensor of water-bearing shale samples is nearly one order of magnitude greater than that of the dry shale samples. Therefore, the anisotropic crack f luid indicator and dimensionless fourth-order tensor can ref lect the crack f luid type in shale samples and can be used for shale reservoir prediction and f luid identif ication.

Phosphatase and Tension Homolog Overexpression in Insulin Resistant Diabetic Adipose Tissue

Objective To investigate the expression of phosphatase and tension homolog(PTEN) in adipose tissue of KKAy diabetic mice, a mouse model of type 2 diabetes. Methods KKAy diabetic mice were fed with high fat diet for 4 weeks. After blood glucose met the criteria of diabetes(over 16.7 mmol/L), mice were randomly divided into 3 groups: a control group(without any treatment), a rosiglitazone group(treated with rosiglitazone 12.5 mg/kg·d once per day), and a metformin group(treated with metformin 3 g/kg·d twice daily). After 4 weeks, we then determined the expression of PTEN and phosphoserine 473-Akt(pS473-Akt) in the epididymal adipose tissue with Western blots. The mice in each group were further divided into the insulin(-) subgroup and insulin(+) subgroup, which were intraperitoneally injected with saline and insulin(5 mU/g body weight), respectively. Results The expression of PTEN was elevated in the epididymal adipose tissue obtained from KKAy diabetic mice compared with that from the C57BL/6J mice(P<0.001). In accordance with the enhanced expression of PTEN, the level of pS473-Akt stimulated by insulin was decreased in the adipose tissue of KKAy mice compared to the C57BL/6J mice(P<0.001). Treatment with the insulin-sensitizing agents, rosiglitazone and metformin did not inhibit the elevated expression of PTEN in adipose tissue of KKAy diabetic mice. Conclusion PTEN may play an important role in the development of insulin resistance in adipose tissue of type 2 diabetes mice model.

Phosphatase and tensin homolog expression related to cetuximab effects in colorectal cancer patients: A meta-analysis

AIM: To investigate the correlation between expression of phosphatase and tensin homolog (PTEN) and cetuximab effects in colorectal cancer. METHODS: We searched PubMed, EMBASE and ASCO to identify eligible studies. Finally, 8 randomized control studies were included in the meta-analysis. STATA 10.0 Software was used to investigate heterogeneity among individual studies and to summarize all the studies. Risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the strength of the association. RESULTS: Compared with 20 of 266 patients with loss of PTEN, 206 of 496 patients with intact PTEN protein expression had a better objective response rate to cetuximab-based therapy (RR, 4.75; 95% CI, 2.59-8.72; P < 0.001). PTEN positivity was associated with better progression-free survival (PFS) (HR, 0.675; 95% CI, 0.473-0.964; P = 0.031) but not with better overall survival (OS) (HR, 0.608; 95% CI, 0.411-0.899; P = 0.013). In patients with KRAS wild-type status, PTEN positivity did not predict a longer PFS or OS (PFS: HR, 0.707; 95% CI, 0.440-1.138; P = 0.154; OS: HR, 0.943; 95% CI, 0.646-1.377; P = 0.761). CONCLUSION: Expression of PTEN is related to the effect of cetuximab in colorectal cancer patients and should be considered in treatment with cetuximab.

Caffeine Crystallization Induction Time Measurements Using Laser Scattering Technique and Correlation to Surface Tension in Water and Ethanol

Caffeine nucleation induction times were measured at 30 °C and 40 °C in water and ethanol solvents employing laser light absorption technique. Supersaturation concentrations and liquid/solid phase surface tensions were calculated from crystallization induction times using classic homogeneous nucleation theory. Induction time and surface tension decreased at higher temperature.

REGULATING EFFECTS OF VASCULAR ENDOTHELIAL GROWTH FACTOR AND ANG Ⅱ ON FROG'S PERICARDIAL STOMATA, MESOTHELIUM AND ANGIOGENESIS

To observe the regulating effects of vascular endothelial growth factor (VEGF) and angiotensinⅡ (ANG II) on the frog’s pericardium, lymphatic stomata and angiogenesis so as to reveal their effects and mechanism on the mesothelial permeability, lymphatic stoma regulation and myocardial hypertrophy. Methods. VEGF and ANGⅡ were injected into the frog’s peritoneal cavity so as to examine the changes of the pericardial stromata by using transmission electron microscopy, scanning electron microscopy and computerized imaging analysis. Results. Scattered distributed pericardial stomata were found on the parietal pericardium of the frog with a few sinusoid mesothelial cells, whose blood supply was directly from the cardiac chambers flowing into the trabecular spaces of the myocardium (because there are no blood vessels in the myocardium of the frog). The average diameters of the pericardial stomata in VEGF and ANGⅡ groups were 1.50μ m and 1.79μ m respectively, which were much larger than those in the control group (0.72μ m, P Conclusions. VEGF and ANGⅡ could strongly regulate the pericardial stomata by increasing their numbers and openings with larger diameters and higher distribution density. They could also increase the sinusoid areas with the result of the higher permeability of the pericardium, which clearly indicated that VEGF and ANGⅡ could speed up the material transfer of the pericardial cavity and play an important role in preventing myocardial interstitial edema. Yet there was no strong evidence to show the angiogenesis in the myocardium.