单中心155例维持性血透患者中医证型与钙、磷代谢关系差异性研究

目的:观察在我院就诊维持性血液透析(MHD)患者的中医证型及钙磷代谢的关系,为进一步研究中医中药在改善钙磷代谢紊乱、改善患者生存质量方面奠定一定的理论基础。方法:选取2017年07月~09月在武汉市中西医结合医院血透透析中心维持性血液透析的ESRD患者,根据《慢性肾衰的诊断、辨证分析及疗效评定(试行方案)》制定的辨证分型标准确定所有纳入患者中医证型,并且收集血钙(Ca)、血磷(P)、全段甲状旁腺激素(PTH)等生化指标进行分析,揭示其相互之间的关系。结果:(1)MHD患者本虚证中以脾肾气虚证居多,其次为脾肾阳虚证;标实证中以湿浊证、湿热证、瘀血证居多。(2)不同本虚证患者的钙磷代谢相关生化指标检查比较后,发现肝肾阴虚型患者Ca最高,为2.18±0.19mmol/L,脾肾阳虚证Ca水平最低,为1.95±0.27 mmol/L,较肝肾阴虚型具有统计学差异(P0.05),但两者较其他三型均无统计学意义。(3)阴阳两虚组P水平最高,为1.94±0.53 mmol/L,与其他四证之间具有统计学差异(P0.05),脾肾阳虚组最低,为1.59±0.53 mmol/L,与除阴阳两虚外的其他三型无统计学意义。(4)阴阳两虚型PTH平均值最高,为483±178 pg/ml,较其他四型有统计学意义(P0.05),脾肾阳虚型PTH值最低,为290士151 pg/ml,但较除阴阳两虚外的其他三型无统计学意义。结论:MHD患者钙磷代谢与不同中医证型之间存在相关性。     

基于真实世界探讨三级综合性医院慢性肾脏病中医证型与疾病关联的多中心研究

目的:分析综合性医院慢性肾脏病中医证型分布规律及其与临床分期、生化指标、生活质量指数的关系,为慢性肾脏病中西医结合规范化诊治提供依据。方法:采用多中心横断面现场调查方法,在上海地区7家三级综合性医院收集322例慢性肾脏病患者的人口学、中医证候学、实验室检查资料以及生活质量指数SF-36量表,探讨慢性肾脏病中医证型的分布规律及中医证型与临床生化指标、生活质量指数的关系。结果:共调查成年患者322例,其中男169例(52. 4%),女153例(47. 6%),男女比为1. 1:1;年龄21～80(54. 8±13. 2)岁;原发性肾小球疾病182例(56. 5%),高血压肾损害82例(25. 5%),糖尿病肾病25例(7. 8%);其他病因33例(10. 2%);倦怠乏力、畏寒肢冷、口干目涩、大便不实、失眠多梦等症状是慢性肾脏病患者较常见的临床症状;中医证候分布以脾肾气虚证最多见(42. 8%),其次为脾肾气阴两虚证(18. 6%)及阴阳两虚证(18. 6%),而在兼证中以湿热证最常见(12. 9%);中医主证分布情况在不同慢性肾脏病分期差异有统计学意义(P 0. 01),随着疾病进展,脾肾气虚、阴阳两虚证有上升趋势,脾肾阳虚、脾肾气阴两虚、肝肾阴虚呈下降趋势;而中医兼证分布在不同慢性肾脏病分期差异无统计学意义(P 0. 05);脾肾气虚证的e GFR-EPI值显著低于脾肾阳虚、脾肾气阴两虚及肝肾阴虚证,均P 0. 05,阴阳两虚证的e GFR-EPI值显著低于肝肾阴虚证;脾肾气虚证的血红蛋白水平显著低于脾肾阳虚、脾肾气阴两虚、肝肾阴虚,分别为P 0. 05、P 0. 05、P 0. 01,阴阳两虚证的血红蛋白水平显著低于肝肾阴虚证,P 0. 01;脾肾气虚证的舒张压水平显著低于脾肾阳虚、脾肾气阴两虚、肝肾阴虚、阴阳两虚证,分别为P 0. 01、P 0. 05、P 0. 05、P 0. 01;脾肾气虚证的高密度脂蛋白显著低于脾肾气阴两虚及肝肾阴虚证,分别为P 0. 01、P 0. 05;从生活质量指数来看,脾肾气虚及阴阳两虚证患者的总分显著低于其他证型(P 0. 01)。结论:慢性肾脏病患者中医证型分布与疾病进展可能相关,脾肾气虚、阴阳两虚证有上升趋势,中医证型与尿蛋白、血红蛋白、肾功能损害、生活质量指数等指标密切相关。     

肾实质细胞早衰与IgA肾病进展病机的关系研究

目的:本研究拟探讨肾实质细胞早衰与IgA肾病气虚、阴虚向阴阳两虚证候演变的关系。方法:纳入2016年01月～2017年06月151例已行肾活检的IgA肾病患者,根据《IgA肾病中医证候流行病学临床调查表》进行中医辨证,分析各证型患者临床和实验室指标,以及肾实质细胞衰老之间的关系。采用牛津病理分型评分分析肾组织病理损伤。利用免疫组化检测肾实质细胞衰老标志物P16和DcR2的表达。Spearson相关分析IgA肾病患者肾实质细胞早衰与中医证型之间关系。结果:151例IgAN患者脾肾气虚证患者比例最高,为51例(33. 8%);气阴两虚证患者为48例(31. 8%);肝肾阴虚证为30例(19. 9%);脾肾阳虚证为22例(14. 6%)。脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证牛津病理分型评分依次升高,分别为(4. 2±3. 3)、(5. 4±3. 6)、(8. 2±4. 2)、(12. 4±3. 2)。脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证P16肾小球阳性细胞比例依次升高,脾肾气虚证(42. 1±4. 6)%明显低于脾肾阳虚证(57. 2±5. 1%,P 0. 05)。这四种证型患者P16阳性肾小管细胞比例也依次升高,脾肾气虚证(25. 1±7. 6)%、气阴两虚证(35. 4±11. 2)%、肝肾阴虚症(53. 8±10. 6)%明显低于脾肾阳虚证(85. 1±13. 1)%(P 0. 05)。脾肾气虚证、气阴两虚证、肝肾阴虚证、脾肾阳虚证DcR2阳性肾小管细胞比例依次升高,分别为(25. 1±7. 6)%、(35. 4±11. 2)%、(53. 8±10. 6)%、(85. 1±13. 1)%,组间差异有统计学意义(P 0. 05)。P16、DcR2阳性肾实质细胞比例分别与IgA肾病中医证型差异有统计学意义(P 0. 05)。结论:肾实质细胞早衰可能是IgA肾病气虚、阴虚向阴阳两虚证候演变的重要细胞学基础。     

糖尿病肾病患者中医证候与生化指标的相关分析

目的:探讨糖尿病肾病的中医证候分布规律,并进行不同中医证候生化指标比较,为中医证候研究提供比较客观可靠的数据支持和理论依据。方法:对观察对象进行DKD分期,收集患者实验室数据,定量主要症状和体征及中西医诊断,采用SPSS19.0统计软件进行数据的统计分析。结果:对DKD患者各证侯与生化指标的相关分析得出:DKD本虚证中CREA值由阴虚燥热→气阴两虚→脾肾阳虚→阴阳两虚,呈逐渐递增趋势,GHb A1C只有在气阴两虚证存在显著性差异(P0.05),GFR在阴阳两虚证和阴虚燥热证中均存在显著性差异(P0.05),U-TP/24 h在阴阳两虚证和阴虚燥热证中均存在显著性差异(P0.05)。GFR在痰瘀证、湿热证、寒湿证、血瘀证各标实证中均存在显著性差异(P0.05),U-TP/24 h(g/L)在痰瘀证和湿热证中存在显著性差异(P0.05)。结论:DKD中医各证型与GHb A1C、GFR、U-TP/24 h水平变化有显著的相关性,观察相关检验指标对确定中医证型有一定的指导意义。     

慢性肾脏病患者动脉硬化中医证型分布与血klotho蛋白、FGF23水平的相关性研究

目的:探讨慢性肾脏病动脉硬化患者中医证型与血klotho蛋白、FGF23水平的关系,探究中医病机及辨证论治的规律。方法:296例慢性肾脏病患者,根据彩超测定颈动脉内膜厚度进行分组,按照慢性肾衰竭中医辨证分型标准进行辨证分型。检测血清klotho蛋白、FGF23水平等指标,分析不同中医证型与各项参数的关系。结果:CIMT增厚组在本虚证型中以脾肾气虚最多(50.3%),依次为脾肾阳虚证(17.4%),气阴两虚证(16.1%),肝肾阴虚证(9.3%),阴阳两虚最少(6.8%),与CIMT正常组对应的证型分布比较均差异有统计学意义(P0.05)。CIMT增厚组在邪实证以湿浊证最多(36.6%),依次为血瘀证(33.5%),水气证(13%),湿热证(9.9%),浊毒证最少(6.8%),与CIMT正常组对应的证型分布比较差异有统计学意义(P0.05)。CIMT增厚组血klotho蛋白明显较CIMT正常组降低,FGF23水平较CIMT正常组升高,有统计学意义(P0.05)。本虚证型中脾肾气虚组血klotho蛋白明显低于其他组(P0.05),FGF23水平明显升高(P0.05),邪实证中湿浊组及血瘀组分别与其他组比较FGF23明显升高(P0.05),Logistic回归分析表明年龄、FGF23和Hs CRP、伴发糖尿病、脾肾气虚证、血瘀证、湿浊证是CIMT增厚的独立危险因素。结论:慢性肾脏病患者动脉硬化与血klotho蛋白、FGF23水平密切相关,在脾肾气虚证、湿浊证、血瘀证表现最明显。     

单中心440例维持性血透患者中医证候分布规律及相关性因素分析

目的:研究武汉市中西医结合医院维持性血液透析(MHD)患者中医各证型的分布特点及相关因素,为进一步研究中医中药在改善血透患者生存质量方面奠定一定的理论基础。方法:选取2017年03月~09月在武汉市中西医结合医院血透透析中心维持性血液透析的440例患者,运用统计学方法,分析其中医各证型的分布规律及中医虚证与性别、年龄、透析龄及Hb、ALB、Scr、Ca、P、PTH、CRP等实验室指标的相关性。结果:(1)440例MHD患者本虚证中以脾肾气虚证居多,其次为脾肾阳虚证,肝肾阴虚证及气阴两虚证患者接近,阴阳两虚证患者最少;标实证中以瘀血证居多,其次是湿浊证及湿热证,热毒证及风动证较为少见。(2)脾肾气虚和脾肾阳虚患者合并湿浊证、湿热证、血瘀证者居多;肝肾阴虚患者合并湿热证者居多(P0.05);气阴两虚,阳阳两虚合并瘀血证者居多;风动证、热毒证仅见于肝肾阴虚及阴阳两虚患者。结论:武汉市中西医结合医院MHD患者中医证型的分布具有一定的规律性,其中医虚型与性别,血红蛋白,白蛋白,钙,C反应蛋白及Kt/V有不同程度的相关性,与透析龄、年龄、磷、甲状旁腺激素、血肌酐无明显相关性。     

绝经后骨质疏松合并2型糖尿病血清25羟维生素D水平研究

目的 探讨绝经后骨质疏松合并2型糖尿病血清25羟维生素D的水平.方法 选择2010年1月至2011年1月我科住院的51例患者,包括绝经后骨质疏松合并2型糖尿病患者25例,年龄72.38±9.11岁,非糖尿病绝经后骨质疏松妇女26例,年龄68.04±8.28岁.采用美国Norland双光能X线骨密度检测仪对所有患者进行腰椎L2 -L4和左侧股骨近端(包括Neck、Troch、Ward三角区)骨密度测量,并测定身高、体重,病程空腹血糖( FBG)、糖化血红蛋白(HbAlc)、甘油三脂(TG)、胆固醇(TC)、高密度脂蛋白( HDL-C)、低密度脂蛋白(LDL-C),采用酶联免疫吸附法测定两组患者血清25羟维生素D,比较两组25羟维生素D水平.结果 绝经后骨质疏松合并2型糖尿病组患者血清25-羟维生素D 23.31±12.01 ng/ml,较非糖尿病骨质疏松患者36.43±25.91ng/ml低,差异具有统计学意义(P＜0.05);绝经后骨质疏松合并2型糖尿病组患者空腹血糖7.51±1.83mmol/L、糖化血红蛋白6.70±1.26、甘油三脂1.80±0.74mmol/L较骨质疏松组空腹血糖5.55±1.22mmol/L、糖化血红蛋白5.86±1.05、甘油三脂1.16±0.41 mmol/L增高(P＜0.05);2型糖尿病合并绝经后骨质疏松患者L2～4、Neck、Ward's三角区、Troch的骨密度分别为0.75±0.11g/cm2、0.64±0.11g/cm2、0.54±0.13g/cm2、0.44±0.12g/cm2与对照组0.76±0.16g/cm2、0.69±0.18g/cm2、0.54±0.11g/cm2、0.47±0.12g/cm2相比较,差异没有统计学意义(P＞0.05).结论 绝经后骨质疏松合并2型糖尿病患者较未合并2型糖尿病骨质疏松维生素D缺乏更严重.     

腰痹的证治

腰痹为肢体痹之一,在风湿病中有着重要的地位,为常见痹病之一.收集研究历代医家论治腰痹的经验,结合临床实践,总结出腰痹的病因病机(虚、邪、瘀)和证治方案,辨证分为虚邪瘀3候7型:邪实候(风湿痹阻证、寒湿痹阻证、湿热痹阻证),正虚候(肝肾阴虚证、气血亏虚证),痰瘀候(气滞血瘀证、痰瘀互结证).临床应用,取得良好的效果.     

男性2型糖尿病患者骨密度研究

目的 探讨男性2型糖尿病与骨质疏松的关系.方法 采用美国Norland双能X线骨密度检测仪对22例男性2型糖尿病(T2DM)患者及25例健康体检者进行腰椎L2-L4和左侧股骨近端(包括Neck、Troch、Ward三角区)骨密度测定,并测定空腹血糖(FBG)、糖化血红蛋白(HbAlc)、甘油三脂(TG)、胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),结合年龄、病程、体重指数(BMI)等因素进行研究.结果 糖尿病组患者空腹血糖9.89±3.27 mmol/L、糖化血红蛋白8.24 ±1.43、甘油三脂2.27±1.41 mmol/L、低密度脂蛋白2.88±0.91 mmol/L较正常对照组空腹血糖5.60±1.00 mmol/L、糖化血红蛋白4.62±0.68、甘油三脂1.32±0.86 mmol/L、低密度脂蛋白2.28±1.06mmol/L显著增高(P＜0.05);糖尿病患者Neck、ward三角区、Troch的骨密度分别为0.88±0.21g/cm2、0.63±0.11 g/cm2、0.73±0.08 g/cm2均低于正常对照组的1.02±0.06 g/cm2、0.76±0.14g/cm2、0.83±0.09 g/cm2,具有显著统计学意义(P＜0.05),而腰椎骨密度1.06±0.20 g/cm2与正常人1.17±0.14 g/cm2相比无明显差异(P＞0.05).结论 男性2型糖尿病患者更易发生骨质疏松,骨折的危险性也高于正常人,早期筛查血糖及骨密度具有重要意义.     

绝经后女性2型糖尿病骨密度研究

目的探讨女性绝经合并2型糖尿病患者骨密度的变化。方法采用美国Norland双光能X线骨密度检测仪对2009年8月至2010年4月在我科住院的58例患者进行腰椎L2～L4和左侧股骨近端(包括Neck、Troch、Ward三角区)骨密度测量,其中非糖尿病绝经后妇女31例,绝经合并2型糖尿病患者27例,并测定空腹血糖(FBG)、糖化血红蛋白(HbAlc)、甘油三脂(TG)、胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C),结合年龄、病程、绝经年限等因素进行研究。结果绝经合并2型糖尿病组患者空腹血糖9.71±3.36mmol/L、糖化血红蛋白8.19±1.38、甘油三脂2.25±1.37mmol/L、低密度脂蛋白2.82±0.86mmol/L较对照组非糖尿病绝经组空腹血糖5.60±1.03mmol/L、糖化血红蛋白4.55±0.64、甘油三脂1.31±0.94mmol/L、低密度脂蛋白2.26±1.10mmol/L显著增高(P0.05);绝经合并2型糖尿病组患者Neck、Ward三角区、Troch的骨密度分别为0.78±0.11g/cm2、0.50±0.14g/cm2、0.59±0.08g/cm2均低于对照组的0.89±0.06g/cm2、0.62±0.08g/cm2、0.71±0.11g/cm2,具有显著统计学意义(P0.05),而腰椎骨密度0.83±0.11g/cm2与正常人0.86±0.14g/cm2相比无明显差异(P0.05)。结论女性绝经合并2型糖尿病患者更易发生骨质疏松,骨折的危险性也高于未合并糖尿病人群,早期筛查血糖及骨密度具有重要意义。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.