5000/骨髓间充质干细胞治疗心肌梗死及随后心肺复苏的实验研究 (英文发表,作者希望加急到9月)

背景：至目前为止发表的心肺复苏论文所使用的基本为健康动物，而临床实际情况是在心肺复苏发生之前患者大多有严重的心脏疾病，并导致了心室颤动的发生。 目的：实验力图接近临床实际，观察骨髓间充质干细胞移植后心肌梗死大鼠心功能的变化，及对其心肺复苏结果的影响。 设计、时间及地点：随机对照动物实验，于2007-04/08在美国南加州大学和中山大学附属第二医院联合完成。 材料：成年SD雄性大鼠18只，随机分为模型对照组、细胞移植组，9只/组。另取1月龄SD大鼠1只用于制备骨髓间充质干细胞。 方法：两组大鼠均结扎左前降支冠状动脉建立心肌缺血模型，4周后再次开胸，细胞移植组梗死心肌局部注射PKH26荧光标记的骨髓间充质干细胞悬液0.1 mL(5×106个细胞)，模型对照组同法注射等量PBS。4周时诱导心室颤动及进行心肺复苏。 主要观察指标：移植后2，4周用超声心动图测量心功能；测量心肺复苏前及心肺复苏后4 h内的血液动力学参数的变化；在心肺复苏 72 h 后取心肌组织进行病理切片检查。 结果：与模型对照组比较，移植后2，4周细胞移植组射血分数均明显升高(P < 0.01)。在心肺复苏前及心肺复苏后4 h内，与模型对照组比较，细胞移植组心脏指数、左心室收缩压力上升到40 mm Hg(1 mm Hg= 0.133 kPa)时的上升速率、左心室舒张速率、左心室舒张末压均有明显改善(P < 0.01， P < 0.05)。与模型对照组比较，细胞移植组大鼠心肺复苏后可生存至72 h，生存时间明显延长(P < 0.05)。病理切片结果显示心肌内存在大量PKH26标记的骨髓间充质干细胞。 结论：大鼠心肌梗死后，骨髓间充质干细胞移植治疗能明显改善其心功能、心肺复苏前后的血流动力学参数以及生存时间。     

滇南小耳猪人工瓣膜置换模型的建立*

背景：猪和人的心脏解剖结构特点相似,是研究心血管疾病的理想模型。 目的：建立滇南小耳猪二尖瓣置换模型,应用心脏超声评估模型建立的可行性。 方法：成年猪10头,均于体外循环下经左心耳径路行二尖瓣置换,人工瓣膜为St.Jude双叶机械瓣,采用3种置换方式,并以心脏超声分析瓣膜置换后2周小耳猪心脏结构和功能的变化。 结果与结论：除1头因麻醉诱导期出现室颤死亡外其余均存活。心脏超声显示3种方式置换瓣膜后2周,猪心脏结构和功能与置换前无显著差异。人工机械瓣膜在猪体内的血流动力学和组织相容性均良好,二尖瓣置换前后猪的心脏结构及功能稳定。     

体内和体外两种方法猪小体积肝移植模型建立的比较

背景：猪肝结构与人类较为相似,结构相对简单,是研究活体肝移植较好的模型之一。供肝体积过小是临床成人活体肝移植面临的主要问题之一,探索稳定高效的动物模型对于推动小肝综合征的相关研究具有重要意义。 目的：对体内和体外2种小体积肝移植物获取方法进行对比分析,以提供一个理想的成功率高的猪小体积肝移植模型建立方法。 设计、时间及地点：随机对照动物实验,于2007-01/03在上海市泰科公司医疗培训部完成。 材料：选用健康成年实验用广西巴马小型猪42 只,制备21例次猪小体积肝移植模型。 方法：选取体质量相近的广西巴马小型猪作为供受体,将动物按随机数字表法分为2组,体内切除减体积组共10对动物,体外切除减体积组共11对动物。应用全频超声乳化吸引刀+滴水双极电凝镊分别通过体内和体外2种途径,切除部分肝叶以获取小体积供肝植入受体。 主要观察指标：小体积肝移植的无肝期时间、总手术时间、冷缺血时间、受体移植术中出血量和移植后肝断面胆漏例数。 结果：两组在无肝期时间、总手术时间和冷缺血时间差异无显著性意义（P > 0.05）。在移植术中出血量上,体外切除减体积组明显多于体内切除减体积组（P < 0.05）。体外切除减体积组移植后肝断面胆漏发生率亦较体内切除减体积组高（50%,20%,P < 0.05）。 结论：选取体质量相近的供受体,应用超声刀行体内切除减体积是猪小体积肝移植模型建立可行有效的方法。     

碳质股骨头生物相容性的动物实验*★

背景：已有大量的临床和体外实验研究表明，低温热解各向同性碳具有优良的生物学性能，但作为人工关节假体涂层，置入髋关节内的研究还鲜见报道，其在人工半髋关节假体置换中的生物学性能还没有得到验证。 目的：通过动物假体置入实验，观察经低温热解各向同性碳(含硅)喷涂后碳质股骨头假体的组织相容性及表面摩擦磨损特性。 设计、时间及地点：动物体内进行碳质人工半髋关节替换，随机对照动物实验，于2008-10/2009-04在解放军第二军医大学动物实验中心完成。 材料：碳质人工半髋关节由吉林市中心医院提供。股骨头以碳石墨材料为基体，沉积含硅的低温热解各向同性碳为涂层。 方法：对16只成年新西兰大白兔进行右侧半髋关节置换术，置入碳质股骨头假体。按照观察时间点随机分为术后6周组4只，术后11周组6只，术后21周组6只，其中21周组从18周开始在动物实验中心草坪上进行诱导性运动，2 h/d。 主要观察指标：通过大体、X射线片、组织切片观察假体置入后的组织相容性及界面摩擦磨损现象。 结果：碳质股骨头假体在动物体内无毒副作用，无明显炎症反应和异物反应，在碳质假体周围发现有新生软骨组织，运动实验后碳质股骨头表面没有明显磨损和碳颗粒游离现象。 结论：涂膜碳质材料作为人工股骨头具有优良的生物相容性和耐磨特能，是一种极具应用前景的人工假体材料。 关键词：碳质股骨头；人工髋关节；生物相容性；新生软骨；磨损     

体外构建犬组织工程化食管的 初步试验☆

背景：近年来组织工程技术的发展为人工食管的研究开辟了新的思路，有研究者应用体外培养的食管黏膜上皮细胞接种于复合高分子材料上，构建组织工程食管获得成功。 目的：探讨应用体外培养的犬食管黏膜上皮细胞种植于猪的主动脉脱细胞基质支架上，构建组织工程化人工食管的可行性。 设计：观察实验。 单位：泰山医学院中心实验室。 材料：实验于2004-06/2004-12在泰山医学院中心实验室完成，选用3只出生24 h 内杂种犬，由泰山医学院动物园提供。 实验过程中对动物的处置过程符合动物伦理学标准。二氧化碳培养箱MCO-15AC（ SANYO），RC-26低温高速离心机（杜邦）。胰蛋白酶、转铁蛋白、II型胶原酶（GIBCO）；DMEM、DispaseII分离酶、鼠抗人角蛋白单克隆抗体 （Sigma）。 方法：用酶-去污剂法对猪主动脉进行脱细胞处理，体外分离、培养、扩增新生杂种犬的食管黏膜上皮细胞，接种于去细胞基质支架体外培养，种植后3天、1周通过组织学及电镜观察食管黏膜上皮细胞在脱细胞基质支架上的生长情况。 主要观察指标：体外培养的食管黏膜上皮细胞的形态；脱细胞基质与犬食管上皮细胞的生物相容性。 结果： 酶化学除垢剂法能使猪主动脉细胞脱落，基质三维结构变疏松。 体外扩增的犬食管黏膜上皮细胞可以种植在脱细胞基质上并能生长，增殖。 结论：脱细胞的基质与犬食管上皮细胞具有良好的生物相容性，能结合在一起并形成人工食管移植体。     

人工硬脑膜DuraGenTM植入转归的实验研究

目的通过动物实验，观察人工生物型硬脑膜DuraGen^TM植入后的转归过程。方法将DuraGen^TM修补于15头实验猪右侧硬膜缺损处，左侧作为对照。在修补后1、3、6个月分别处死5头实验猪，行大体标本、光镜和电镜检查，观察人工生物型硬脑膜修补对硬脑膜缺损的作用。结果新生自体纤维组织逐步建立于植入物内．形成一个由新生纤维组织和植入物支架组织交织在一起的中间态结构。新生纤维组织逐渐增加，植入支架结构逐步吸收并最终被新生纤维组织所替代。结论人工生物型脑膜DuraGen^TM具有良好的组织相容性，是目前理想的硬脑膜修补材料。     

组织工程化生物活性骨膜应用于兔腰椎横突间的融合

背景：脊柱后路融合是在特殊解剖、特殊生物学作用下的骨性融合过程，影响因素很多，对融合材料的选择考虑因素亦很多。近年随着骨组织工程学的发展，种子细胞复合支架材料体外构建组织工程化骨膜有望解决这一临床难题。 目的：评价体外构建组织工程化生物活性骨膜为骨移植替代物应用于兔腰椎横突间融合的效果。 方法：体外构建组织工程化生物活性骨膜植入24只健康成年新西兰大白兔腰椎横突间，每只兔子取3个横突间隙(Left L4,5,6，Right L4,5,6)植入3种材料。复合支架组Right L4,5植入诱导后骨髓间充质干细胞复合猪小肠黏膜下层、单纯支架组Right L5,6植入无细胞支架即单纯小肠黏膜下层、自体髂骨组Left L5,6植入自体髂骨。术后12周处死动物进行大体标本、影像学、组织学观察。 结果与结论：大体标本比较复合支架组、自体髂骨组差异无显著性意义，均与单纯支架组比较差异有显著性义，影像学观察复合支架组、自体髂骨组上下横突间可见明显有骨小梁通过，单纯支架组未见骨密度影。复合支架组Ⅰ型胶原、骨钙素免疫组织化学染色强阳性，与自体髂骨组之间差异有显著性意义，单纯支架组未见阳性表达。实验提示利用猪小肠黏膜下层复合经诱导后向成骨细胞转化的骨髓间充质干细胞体外构建组织工程化生物活性骨膜是横突间融合骨移植的良好替代物。 关键词：小肠黏膜下层；骨髓间充质干细胞；组织工程化生物活性骨膜；脊柱融合；膜生物材料 doi:10.3969/j.issn.1673-8225.2010.08.001     

异种(猪)无细胞真皮基质的制备及体外生物相容性*

背景：人同种无细胞真皮基质作为一种永久性真皮支架,已成功应用于烧伤创面修复及美容医学等领域,但由于来源有限,限制了其应用。 目的：研制异种(猪)无细胞真皮基质,并对其体外生物相容性进行评价。 设计、时间及地点：体外细胞学对比观察实验,于2007-08/2008-06在中国辐射防护研究院生物材料与制药技术研究所实验室完成。 材料：实验猪由中国辐射防护研究院实验动物中心提供;人成纤维细胞来自武警山西总队医院健康儿童包皮环切术切除的包皮组织。 方法：无菌条件下获取健康小白猪猪皮,用高渗盐溶液-去污剂、胰酶消化及超声清洗的方法,制备猪无细胞真皮基质。体外培养人成纤维细胞,用猪无细胞真皮基质浸提液法及人成纤维细胞和猪无细胞真皮基质直接贴附法,评价猪无细胞真皮基质体外生物相容性。 主要观察指标：①猪无细胞真皮基质的组织学形态。②猪无细胞真皮基质的体外生物相容性。 结果：制备的猪无细胞真皮基质,完全去除了表皮和真皮中的细胞成分,保留了胶原基质。猪无细胞真皮基质浸提液对人成纤维细胞增殖无明显影响。人成纤维细胞可以在猪无细胞真皮基质上贴附、增殖。 结论：此种方法制备的无细胞真皮基质完全去除了表皮和真皮中的细胞成分,有较好的体外生物相容性。 关键词：猪无细胞真皮基质;人成纤维细胞;生物相容性     

猪外周血内皮祖细胞的体外分离培养及鉴定

背景：内皮祖细胞是一种能直接分化为血管内皮细胞的前体细胞,研究表明猪的心血管解剖结构较其他低等哺乳动物更接近于人类,用其建立心血管疾病模型更具临床意义。 目的：拟在体外建立猪外周血内皮祖细胞的分离培养方法。 设计、时间及地点：细胞学体外观察,于2007-09/2008-05在美国纽约州布法罗大学心血管疾病研究中心和首都医科大学病理生理学教研室完成。 材料：12周龄健康成年猪6只,由布法罗大学实验动物中心提供。 方法：采集猪外周血,以梯度密度离心法分离血单核细胞,按3×107/孔密度接种于预先包被Ⅰ型鼠尾胶原的6孔培养板,每孔加入EGM-2内皮细胞生长培养液2 mL,贴壁法纯化扩增,取传至第2代细胞用于指标检测。 主要观察指标：采用免疫荧光染色和流式细胞仪检测内皮祖细胞表面抗原的表达,通过内吞DiI-acLDL和Matrigel血管形成实验进行细胞功能学鉴定,将第2~10代细胞按500个/孔接种后检验其克隆形成能力。 结果：猪外周血单核细胞体外培养7~10 d后,出现呈铺路石样的细胞克隆,表达内皮祖细胞表面抗原CD9,CD31,CD105,VE-Cadherin,VEGFR2和内皮源性一氧化氮合酶,部分细胞表达干细胞标志c-Kit,但不表达CD133和造血祖细胞标志CD45。细胞能内吞DiI-acLDL,在Matrigel上可以形成毛细血管样结构,且具有很强的克隆形成能力。第2,4,6,8,10代细胞克隆数及内皮祖细胞总数均基本相似（F =0.167,F=0.195,P > 0.05）。 结论：梯度密度离心联合贴壁法可成功从猪外周血中分离培养出内皮祖细胞,体外扩增后细胞增殖能力无变化。     

慢性肺动脉栓塞实验动物模型构建的技术进展

目的：综述国内外关于慢性血栓栓塞性肺动脉高压(chronic thromboembolism pulmonary hypertension, CTEPH )实验动物模型构建技术的研究概况。 方法：应用计算机检索PubMed数据库2006/2009相关文章,检索词为“model of pulmonary thromboembolism”。同时计算机检索中国期刊全文数据库2003/2009相关文章,检索词为“肺动脉栓塞,实验”。此外还手工查阅相关专著数部。纳入标准：①文章所述内容应与CTEPH实验研究相关,包括慢性血栓栓塞性肺动脉高压流行病学,不同实验动物及不同制备方式。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准：①重复研究。②Meta分析。 结果与结论：目前用于CTEPH模型制备的实验动物主要有犬、猪和鼠等。很多研究者都尝试模仿深静脉血栓形成后,多次急性肺栓塞事件所导致的CTEPH形成机制,建立CTEPH验动物模型。建立犬CTEPH模型主要有反复自体血凝块注入法及陶瓷念珠输入法,可用于CTEPH病理生理特点、数字剪影检查、解剖研究以及肺动脉内膜剥脱手术和介入治疗等干预治疗血栓栓塞性肺动脉高压的研究与影像学诊断技术的研究。建立猪CTEPH模型主要采用体外注入栓子法,可用于影像技术诊断CTEPH研究。建立鼠CTEPH模型主要采用反复自体血凝块注入法与肺动脉结扎法,可用于CTEPH病理生理及诊断方面研究。目前对CTEPH的研究主要是使用犬、猪和鼠实验动物模型,各有优缺点,在具体的实验研究中需根据实验目的和设计选择适当的实验动物及制作方法,以便取得最佳的实验结果。     

Signal-averaged and standard electrocardiography in patients with newly diagnosed epilepsy

Antiepileptic drugs (AEDs) have been associated with cardiac conduction abnormalities and arrhythmias, predominantly in patients with predisposing cardiac conditions. Ventricular late potentials (VLPs) detected in the signal-averaged electrocardiogram (SAECG) may imply an increased risk of ventricular tachycardia or fibrillation. Twenty-six AED-naïve patients with newly diagnosed epilepsy and no clinical evidence of heart disease were examined with SAECG and standard ECG. Fifteen patients were treated with lamotrigine and ten with carbamazepine. No significant abnormality was found in the standard ECG or SAECG three to nine months after initiation of AED therapy. In one patient, a VLP was detected at baseline and subsequent MRI demonstrated significant right ventricular pathology; therefore, this patient was excluded from the rest of the study. This exclusion along with only newly diagnosed patients with a low total seizure count being included in the study may explain the lack of AED-induced electrocardiographic abnormalities in this patient cohort.     

Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation.

BACKGROUND: Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device. OBJECTIVES: The purpose of this study was to examine the association of emotional status after internal cardioverter defibrillator (ICD) implantation and subsequent arrhythmia events. METHODS: An analysis of data obtained in a prospective longitudinal study of responses to the ICD measured mood disturbance (Profile of Mood States; POMS) before implant and at 1, 3, 6, and 9 months postoperatively. Subjects included 144 men and 32 women with a mean age of 60 +/- 13 years and a mean left ventricular ejection fraction (LVEF) of 33 +/- 12%. Arrhythmia events were measured by self-report of shocks and by ICD device interrogation to obtain the number and type (defibrillation, cardioversion, and antitachycardia pacing) of therapies delivered by the ICD. For each time point, POMS scores of subjects who had arrhythmia events were compared with those who did not. For subjects who had ICD shocks, pre-event and post-event POMS scores were also compared. Multiple logistic regression was used at each time point to determine if clinical, demographic and psychological data could predict arrhythmia events. RESULTS: Patients with arrhythmia events had higher POMS scores throughout the 9 months of follow-up. Higher level of mood disturbance (specifically anxiety, fatigue, and confusion) at 1 and 3 months were independent predictors of subsequent arrhythmia events at 3 and 6 months after controlling for LVEF, the presence of coronary artery disease, pre-implant arrhythmia history, and the use of amiodarone and beta-blocking agents. There were no differences in POMS scores before and after ICD shocks, reinforcing the notion that negative emotions were a cause, rather than a consequence, of arrhythmia events. CONCLUSIONS: Mood disturbances, such as anxiety, may increase the risk for arrhythmia events after ICD insertion.     

急性脑梗死的心电图改变

观察72例脑梗死患者,合并心电图（ECG）改变59例,占81．9％。腔隙性脑梗死及脑血栓ECG以窦性心动过速及占室肥厚劳损多见,脑栓塞以心房纤颤多见。CT与ECG对照发现,额顶叶大面积梗塞80?G正常,颞顶叶大面积梗塞灶ECG均提示心房纤颤。指出ECG改变与脑梗塞死型及部位相关。本级9例脑栓塞均由心房纤颤及心肌梗死引起,积极防治心脏病可减少脑血管病的发病率。     

Electrocardiographic findings predict short-term cardiac morbidity after transient ischemic attack

BACKGROUND: Current guidelines recommend the use of electrocardiography (ECG) in the evaluation of transient ischemic attack (TIA), but the data supporting its value in acute management are sparse. OBJECTIVE: To determine whether ECG findings are useful as independent predictors of short-term cardiac or neurologic complications after TIA. METHODS: We included patients who presented to 1 of 16 emergency departments of a health maintenance organization in northern California and received a diagnosis of TIA from March 1, 1997, through February 28, 1998, for a 90-day follow-up. A cardiac event was defined as a hospitalization or a death due to myocardial infarction, ventricular arrhythmia, heart failure, or unstable angina. RESULTS: Among the 1327 patients with TIA for whom ECG findings were available for diagnostic coding, cardiac events occurred in 2.9%, strokes in 10.9%, recurrent TIAs in 13.7%, and deaths in 2.6% during 90-day follow-up. The ECG findings disclosed a new diagnosis of atrial fibrillation in 28 (2.3%) of the 1200 patients with no history of this condition. The 90-day risk for a cardiac event was greater in those who had any abnormal ECG findings (4.2% vs 0.6%; P<.001). This association remained significant after adjustment for medical history and examination findings (odds ratio, 6.9; 95% confidence interval, 1.6-29.5; P =.009). Left ventricular hypertrophy, atrial fibrillation, and atrioventricular conduction abnormalities were each independently associated with more than doubling of the risk. The ECG abnormalities were not associated with risk for stroke or death. CONCLUSIONS: Short-term cardiac morbidity is substantial after TIA. Electrocardiographic findings disclose new atrial fibrillation in a significant portion of patients with TIA and can identify a group of patients at a substantially higher risk for short-term cardiac events.     

以球囊封堵法建立猪心肌梗死模型的可行性研究

背景：国外20世纪90年代开始采用球囊封堵建立闭胸式心肌梗死动物模型，但术中室颤及血栓形成等因素降低了制作心肌梗死动物模型的成功率。目前国内建立球囊封堵闭胸式心肌梗死大动物模型的报道较少。 目的：应用球囊封堵法建立闭胸式猪心肌梗死模型，探索提高建模成功率的方法。 设计、时间及地点：随机对照动物实验，病理观察，于2008-07/2009-05在昆明医学院第一附属医院心内科及昆明医学院病理教研室完成。 材料：8~11月龄健康滇南小耳猪15只，体质量19~25 kg，随机数字表分为3组：假手术组、缺血再灌注组、缺血后处理组，每组5只。 方法：冠脉封堵后和再灌注期预防性静滴利多卡因1.0~2.0 mg/kg，以减少恶性心律失常的发生率，使用肝素防治血栓形成，在X射线监控下将球囊导管送至冠状动脉左前降支第一对角支的远端，假手术组只放置球囊至冠状动脉左前降支，不封堵；缺血再灌注组行球囊充气堵闭冠状动脉左前降支60 min后撤除球囊；缺血后处理组行球囊充气堵闭冠状动脉左前降支 60 min后，球囊放气30 s，充气30 s(循环8次)后撤除球囊。 主要观察指标：行冠脉造影、心电图及心肌酶检测评价心肌梗死模型的建立情况。3 d后行心肌三氯四氮唑染色及病理学检查验证心肌梗死。 结果：假手术组猪全部存活；缺血再灌注组4只成功建立心肌梗死模型，1只死于顽固性室颤；缺血后处理组全部成功建立心肌梗死模型。堵闭左前降支远端后，心电图V1~3导联上ST 段抬高，有病理性Q 波形成；心肌酶谱演变过程与人体心肌梗死过程基本一致。心肌梗死部位分别位于心尖、左心室前壁、前间隔部。三氯四氮唑染色后正常心肌呈砖红色，梗死区心肌颜色暗淡，呈灰白色；病理学检查显示，梗死区心肌正常结构破坏，胞浆浓缩，染色加深，横纹消失，核浓缩、溶解、碎裂，梗死区内有较多的红细胞，梗死区周围有较多肉芽组织增生及大量炎性细胞浸润。 结论：球囊封堵冠脉建立猪闭胸式心肌梗死模型对动物创伤性小，且最为接近临床实际的过程，术中使用利多卡因及肝素防治心律失常及血栓形成是成功建立该模型的有效方法，缺血后处理可能是提高建模成功率的因素之一。     

A case of Brugada syndrome with convulsive seizure during antidepressant administration: relation of antidepressant agents and arrhythmia leading to sudden death]

Brugada syndrome is an arrhythmogenetic disease characterized by electrocardiographic ST segment elevation in right precordial leads, which is called "coved type", and an increased risk of sudden death as the result of ventricular fibrillation. We presented a case of Brugada syndrome with a convulsive seizure, during administration of a tricyclic antidepressant for the treatment of a depressive state. A 43-year-old man with bipolar II disorder and obsessive-compulsive disorder was admitted to our hospital for the treatment of a depressive state. There was no medical history of heart failure. Nortriptyline was effective for his depressive as well as for obsessive symptoms. During the treatment, however, he presented a convulsive syncope. Electrocardiography (ECG) showed "coved type" ST segment elevation, and the patient consulted a cardiologist. Electrophysiological study revealed Brugada syndrome, and an implantable cardioverter defibrillator was placed. An overdose of antidepressants has been reported to produce a Brugada-type ECG because of its Na channel antagonism. However, in the present case, the abnormal ECG findings occurred following a usual dosage of nortriptyline. Thus, it is suggested that Brugada syndrome is related to a susceptibility to antidepressants in the present case. Every psychiatrist managing antidepressant therapy should be aware of Brugada syndrome and this ECG pattern, which may be a marker of sudden death.     

Mild cerebral hypothermia during and after cardiac arrest improves neurologic outcome in dogs

We previously found mild hypothermia (34-36 degrees C), induced before cardiac arrest, to improve neurologic outcome. In this study we used a reproducible dog model to evaluate mild hypothermia by head cooling during arrest, continued with systemic cooling (34 degrees C) during recirculation and for 1 h after arrest. In four groups of dogs, ventricular fibrillation (no flow) of 12.5 min at 37.5 degrees C was reversed with cardiopulmonary bypass and defibrillation in less than or equal to 5 min, and followed by controlled ventilation to 20 h and intensive care to 96 h. In Study A we resuscitated with normotension and normal hematocrit; Control Group A-I (n = 12) was maintained normothermic, while Treatment Group A-II (n = 10) was treated with hypothermia. In Study B we resuscitated with hypertension and hemodilution. Control Group B-I (n = 12) was maintained normothermic (6 of 12 were not hemodiluted), while Treatment Group B-II (n = 10) was treated with hypothermia. Best overall performance categories (OPCs) achieved between 24 and 96 h postarrest were in Group A-I: OPC 1 (normal) in 0 of 12 dogs, OPC 2 (moderate disability) in 2, OPC 3 (severe disability) in 7, and OPC 4 (coma) in 3 dogs. In Group A-II, OPC 1 was achieved in 5 of 10 dogs (p less than 0.01), OPC 2 in 4 (p less than 0.001), OPC 3 in 1, and OPC 4 in 0 dogs. In Group B-I, OPC 1 was achieved in 0 of 12 dogs, OPC 2 in 6, OPC 3 in 5, and OPC 4 in 1 dog. In Group B-II, OPC 1 was achieved in 6 of 10 dogs (p less than 0.01), OPC 2 in 4 (p less than 0.05), and OPC 3 or 4 in 0 dogs. Mean neurologic deficit and brain histopathologic damage scores showed similar significant group differences. Morphologic myocardial damage scores were the same in all four groups. We conclude that mild brain cooling during and after insult improves neurologic outcome after cardiac arrest.     

Electroencephalographic findings in coma caused by fatal chloroquine poisoning

A 19-year-old patient in deep anoxic coma after cardiopulmonary arrest due to suicidal acute overdosage of chloroquine was resuscitated at the intensive care unit. An EEG starting about 12 hours later and lasting for 93 minutes showed a rapid succession of diffuse ectopic rhythms, diffuse slow output, generalized periodic slow waves in paroxysmal episodes which preceded burst suppression patterns and definite establishment of electrocerebral silence. All these EEG patterns indicating a poor prognosis were registered about three hours before the patient died during irreversible ventricular fibrillation.     

冠状动脉堵闭法与栓塞法制备小型猪心肌梗死模型的对比

背景：冠状动脉栓塞法和球囊堵闭法为制备小型猪急性心肌梗死模型最常用的两种方法,但由于猪价格昂贵,制作心肌梗死模型后还要进行多种实验研究,故选择耗时短、损伤小、术后存活率高的手术方法非常必要。 目的：对比运用冠状动脉栓塞法与经皮腔内冠状动脉成形术球囊堵闭法制备猪急性心肌梗死动物模型的差异。 设计、时间及地点：随机分组,对比观察动物实验,于2009-05-08/08-03在昆明医学院第一附属医院心脏介入室完成。 材料：西双版纳小耳猪20只,体质量20~30 kg,雌雄不限,购自昆明医学院动物科,随机抽签法分成栓塞组(n=10)和堵闭组(n=10)。 方法：栓塞组麻醉后经股动脉置入球囊至冠状动脉前降支远端,给予球囊扩张压力202.65 kPa阻断前向血流1,2,5 min,每次间隔60 s,建立猪急性心肌梗死动物模型。堵闭组麻醉后经股动脉置入球囊到达冠状动脉前降支远端后,同样给予球囊扩张压力202.65 kPa阻断前向血流1,2,5 min,每次间隔60 s,然后持续阻断前向血流60 min,建立猪急性心肌梗死动物模型。 主要观察指标：通过冠脉造影、心电图、心肌酶谱、心脏彩超及病理学检测比较两种方法建立心肌梗死模型的异同。 结果：栓塞组有9只猪完成模型制备,1只因冠状动脉破裂死亡。术毕即见相关导联T波深倒,未见明显ST段抬高,术后1 d相关导联ST段抬高0.1~0.2 mV;手术共耗时11 h。堵闭组猪存活5只,4只因室颤死亡,1只不明原因死亡。术毕即见相关导联ST段明显抬高0.2~0.3 mV;手术共耗时24 h。两组实验动物心脏彩超均在梗死部见局部运动异常,术后4周栓塞组有3只,堵闭组1只左室室壁瘤形成。肌酸激酶同功酶及血浆肌钙蛋白均明显升高并呈动态演变,梗死区心肌坏死明显,细胞内结构溶解消失,两组比较无明显差异。 结论：运用栓塞法和堵闭法均能成功建立小型猪急性心梗动物模型。栓塞法较堵闭法更简易,造成的损伤较小,术后恢复较快,死亡率小。