Saving the zone of stasis: Is glutathione effective?

One of the main subjects that burn researches are focused on is saving the zone of stasis. There are many molecules that are used for this purpose, but all have their drawbacks. Glutathione is one of the major buffer molecules of the cells and is known to increase the thermo-resistance of the cells. In this study, the effect of the systemic glutathione on the zone of stasis was evaluated. The results showed that glutathione is an effective molecule for saving the zone of stasis. It is well-known cheap, and easy to use.     

Protective effect of human recombinant copper-zinc superoxide dismutase on zone of stasis survival in burns in rats

Superoxide dismutase, acting as a scavenger of oxygen free radicals, has shown mixed results in increasing burn wound survival. Originally, we demonstrated that human recombinant copper-zinc superoxide dismutase (Hr-CuZnSOD) could increase the survival of failing ischemic flaps in a rat model. Because of the possible similar pathophysiology of tissue ischemia in flaps and the zone of stasis in burns, we conducted a later study using 2 groups of rats with standardized intermediate burns, to ascertain whether Hr-CuZnSOD could increase zone of stasis survival in rats. The results showed that postburn Hr-CuZnSOD failed to improve zone of stasis survival in burns. We decided to undertake a new controlled study to ascertain whether there is a protective effect of Hr-CuZnSOD in cases of intermediate burns. We used 2 groups of rats, one of which received prophylactic treatments with Hr-CuZnSOD before the induction of standardized intermediate burns. Results showed that preburn Hr-CuZnSOD also failed to improve zone of stasis survival in burns. Further studies are needed to adequately understand the effect of oxygen free radicals in burn wound pathophysiology and to determine whether Hr-CuZnSOD has a role in the clinical management of burns or should be abandoned.     

肝气郁结证勃起功能障碍小鼠模型建立的实验研究

目的:建立肝气郁结证小鼠勃起功能障碍(ED)模型,检测小鼠性器官的变化,揭示ED发生的可能机制。方法:昆明种小鼠,雄性24只,雌性48只,雌雄小鼠都均分为正常组、肝郁组、肝郁加强组。采用束缚盒慢性应激法,逐渐增加束缚强度与时间,造成小鼠肝郁,再阻止雄鼠舔嗅及爬背,压抑其性活动,诱发加强肝气郁结证ED模型。结果:小鼠自主行为、性活动观察及体重均表现出明显的差异性。性器官脏器指数有递减趋势,其病理切片显示正常对照组优于肝郁组及肝郁加强组。结论:束缚盒慢性应激法可造成小鼠肝气郁结证ED,加强因素可增强ED的程度。     

大白鼠下腹壁TRAM皮瓣血供特点的实验研究

目的 探讨以腹壁上动脉为蒂的大白鼠下腹壁ＴＲＡＭ皮瓣的血运特点。方法 在大白鼠下腹壁设计并建立动脉供血不足，静脉回流部分受阻以及增加ＩＶ区静脉回流的３种ＴＲＡＭ皮瓣实验模型。结果 （１）以腹壁上动脉供血的大白鼠下腹壁ＴＲＡＭ皮瓣其成活面积可至双侧前线。（２）腹壁上动脉主干主要营养ＴＲＡＭ皮瓣的Ⅰ区和Ⅱ区。（３）静脉回流部分受阻可造成ＴＲＡＭ皮瓣Ⅲ区和Ⅳ区的坏死。（４）增加ＴＲＡＭ皮瓣第Ⅳ区尖端的皮     

血液透析血瘀证患者的血脂水平及临床意义

目的：研究维持性血液透析患者中血瘀证患者的血脂水平及临床意义。方法：维持性血液透析患者78例以统一的中医辨证分型标准分为两组，血瘀组40例，对照组38例；检测患者的血脂、尿素清除指数（Kt／V）、血红蛋白、血总蛋白、血白蛋白、甲状旁腺素（iPTH）及C反应蛋白（CRP），并对血瘀证患者的血脂水平进行分析。结果：血瘀证组患者三酰甘油水平高于对照组，两组之间有统计学差异（P〈0．05）。血瘀证组患者高密度脂蛋白和栽脂蛋白A1水平低于对照组：两组之间具有统计学差异（P〈0．05）。结论：维持性血液透析患者中血瘀证患者的脂质代谢紊乱程度较无血瘀证患者严重。     

输精管结扎术后痛性结节和附睾郁积症与抗精子抗体的关系

本文采用Kibrick、Franklin-Dukes和Isojima三种试验法,对输精管结扎术后无并发症者253例,有痛性结节和附睾郁积症者20例,以及未作输精管结扎的正常对照者319例的血清进行了检测。其结果显示输精管结扎术后这三种方法的阳性率和滴度都有非常显著的提高,但在输精管结扎术后有和无痛性结节及附睾郁积症两组间,这三种方法的阳性率无显著差异。在有这两种并发症组中,Franklin-Dukes试验的滴度高而kibrick和Isojima试验的滴度却低。因此,测定血清中的抗精子抗体对诊断痛性结节和附睾郁积症以及估价其严重程度是无助的。     

慢性肾脏病合并代谢综合征患者的中医证候分析

目的:对慢性肾脏病(CKD)合并代谢综合征(MS)患者的中医证候进行回顾性研究,了解CKD合并MS的证候特征,为CKD的个体化诊治提供指导。方法:收集2007年～2009年住院或门诊的CKD患者,其中CKD合并MS组121例,CKD非合并MS组123例,设计中医证候临床观察表,对两组病人临床脉证进行调查研究。结果:(1)CKD合并MS组男性患病人数明显高于女性,年龄大于CKD非合并MS组。两组病程及慢性肾脏病的分期差异无统计学意义。(2)代谢综合征各组分比较:CKD合并MS组腰围(W)、BMI、高血压发生率、FPG、TG、LDL-C明显高于CKD非合并MS组(P<0.01)。HDL-C明显低于CKD非合并MS组(P<0.05)。(3)两组病人肾损害比较:Scr、BUN、24h尿蛋白定量、血尿及肾衰竭发生率两组相比差异无统计学意义(P<0.05)。CKD合并MS组UA明显高于CKD非合并MS组(P<0.001)。(4)两组病人中医证候的比较:虚证中合并MS组以脾肾气虚多见,非合并MS组以气阴两虚多见;实证中合并MS组以血瘀、痰湿、热盛多见,非合并MS组以湿热、血瘀为多见;合并MS组实证中两证以上相兼的现象较非合并MS组常见;合并MS组血瘀证和热盛证兼夹、血瘀和痰湿证兼夹、血瘀、痰湿和热盛证兼夹多见,非合并MS组以血瘀和湿热证兼夹、湿热和热盛证兼夹多见。两组总的证候均以虚实夹杂为主要特征。结论:CKD合并MS的中医证候特点以虚实夹杂,多证相兼为主要特征。虚证以脾肾气虚为主,实证以血瘀、痰湿、热盛为主。     

Influence of topical heparin on stasis-induced thrombosis of microvascular anastomoses.

An experiment was done to determine whether topical heparin and the association of anastomoses with dependent tissue (free flaps) exert any influences on stasis-induced microvascular thrombosis. Rat femoral vessel anastomoses with or without free flap construction were used in a total of 50 male Sprague-Dawley rats. Saline either with or without heparin was used for intralumenal irrigation during the anastomosis. Following anastomotic repair, the femoral vessels were reclamped, inducing stasis for either 2 or 4 hr. Our results showed that static blood had little adverse effect on thrombosis at the arterial anastomosis when reclamped for up to 4 hr in both standard and flap-associated anastomoses. Topical heparin significantly reduced the incidence of stasis-induced thrombosis of venous anastomoses. The venous patency rates in standard anastomoses were lower than those in flap-associated anastomoses after both 2 and 4 hr of stasis. From these results, we conclude the following. 1) Arteries may be reclamped for up to 4 hr without detriment despite static blood being in contact with the anastomotic site. 2) Topical heparin may be helpful in increasing the patency rate of venous anastomoses after a period of blood stasis. 3) Free flap construction may play a role in decreasing stasis-induced microvascular thrombosis.     

Effect of venous stasis on the consolidation of fractures

In an experimental study of 60 rabbits (120 preparations) in which a bilateral fibular osteotomy was performed, a group of 40 rabbits had ligation of the vena cava, and a group of 20 rabbits were used as controls. The results were evaluated by microscopic study by H&E, PAS abd Alcian Blue staining and showed that venous stasis accelerates the process of fracture healing by increasing fibroblastic and osteoblastic proliferation and bone production. The effects of changes in pH, and concentrations of oxygen and carbon dioxide are suggested as the factors that modify the mechanism of osteogenesis, and greater quantities of mucopolysaccharide substances were observed at the fracture site in the group with venous stasis.     

Management of venous stasis ulcer: long-term follow-up

In this study 112 patients (122 lower limbs) who had chronic venous stasis ulceration refractory to conservative management were treated surgically. Subfascial ligation was performed on 118 limbs and the long saphenous vein was removed in 4. Complications consisted of postoperative thrombophlebitis (2%), wound infection (2%) and wound infection with ulcer necrosis (1.5%). These all responded to conservative management. Follow-up (mean 7.9 years, median 11 years) showed a good or excellent result in 82% of cases, with healing of the ulcer and no ulcer recurrence despite significant noncompliance with support stockings. This paper is a long-term follow-up study of a surgical procedure for chronic venous stasis ulcers. The authors believe that the 82% good and excellent results may indicate that surgical intervention for refractory venous ulcers is a worthwhile procedure, providing potentially satisfactory long-term results.     

IgA肾病血瘀证血清蛋白组学的初步研究

目的：应用表面增强激光解吸/电离飞行时间质谱技术（SELDI-TOF-MS技术）检测IgA肾病患者的血清蛋白质指纹图谱,试图寻找IgA肾病血瘀证相关的差异蛋白质,从蛋白质水平探索IgA肾病血瘀证血清的标志物.方法：采集于2011年10月～2013年2月肾内科住院的IgA肾病患者的血液样本共30例（血瘀证14例,非血瘀证16例）,同时采集健康人血液样本15例.研究各组病例血清蛋白质指纹图谱,所有蛋白质质谱采用Biomarker Wizard分析之后用Biomarker Patterns Software软件识别IgA肾病血瘀证特异表达的蛋白质,并建立证候决策模型.结果：（1）IgA肾病血瘀证患者与正常人血清蛋白质指纹图谱数据比较,经分析检测到30个蛋白质峰差异具有统计学意义（P＆lt;0.05）.（2）IgA肾病血瘀证患者与非血瘀证患者血清蛋白质指纹图谱数据比较,经分析检测到42个蛋白质峰差异具有统计学意义（P＆lt;0.05）.（3）IgA肾病血瘀证差异表达蛋白峰的筛选及证候决策模型的建立.经筛选质荷比为1 092.71（低表达）、1 972.32（低表达）、2 687.74（低表达）、3 196.19（高表达）、3 249.02（高表达）、8 567.20（高表达）、8 713.48（高表达）的7个蛋白峰组成的证候决策模型能很好区分IgA肾病血瘀证,该模型的敏感性为92.85%,特异性为93.75%,进一步对决策模型进行盲法验证,此模型对血瘀证的诊断敏感性为85.71%,特异性为81.25%.结论：M/Z为1 092.71、1 972.32、2 687.74、3 196.19、3 249.02、8 567.20、8 713.48的7个蛋白峰可能是区分IgA肾病血瘀证与非血瘀证的血清蛋白标志物.     

Influence of a temporary synthetic skin substitute on capillary stasis in burns

The prognosis of deep partial thickness burns depends on several factors e.g. infection, wound dehydration, mechanical trauma etc. As shown by Zawacki years ago, the prognosis can be influenced by immediate post-burn application of various dressings. Appropriate dressings can cause early reversal of the capillary “stasis zone”, improving the prognosis. In his study, Zawacki showed that he could achieve the best results by using porcine skin grafts. In our study, we repeated Zawacki’s experimental model, replacing porcine skin graft with a temporary synthetic skin substitute, Omiderm^?. Deep partial thickness burns were inflicted on guinea pigs, who were then divided into three groups and treated as follows: removal of burn blister, burn blister left intact and removal of burn blister which was then replaced by Omiderm. At various times the animals were sacrificed and perfusion with India ink was performed in order to evaluate capillary stasis and its reversal. Upon statistical analysis of results we found that by using Omiderm we achieved early reversal of the stasis zone, as compared to the other groups. It seems to us that appropriate early treatment of deep partial thickness burns can make a significant difference to the prognosis of the burn wound.     

溃疡性结肠炎瘀血状态的试验研究

为观察溃疡性结肠炎（UC）患者是否存在瘀血,以及瘀血与疾病的活动性关系,本试验从血小板活化的角度,检测了UC患者体内血小板活化的各项指标。结果UC患者的血小板计数（PLT）、血小板α颗粒膜蛋白-140（GMP-140）、血栓素B2（TXB2）均高于正常人,血小板平均容积（MPV）低于正常人;同时Uc患者的PLT、GMP-140、TXB2与疾病的活动性分别呈正相关,MPV与疾病的活动性呈负相关。结果表明,UC发病过程中存在瘀血,并且瘀血与疾病的活动性密切相关。本试验进一步认识了UC的发病机制,不但为判断UC是否存在瘀血提供了有力的实验室依据,而且也为衡量中医药治疗UC的疗效提供了可靠标准,更加拓宽了中医药治疗UC的思路。     

Impact of alpha1-blockers in men with spinal cord injury and upper tract stasis

OBJECTIVE: Our objective was to determine the effectiveness of alpha1-blockers on upper tract stasis in men with spinal cord injury (SCI) who use reflex voiding for bladder management. METHODS: A retrospective chart review of men with SCI at or above T6, who used reflex voiding for bladder management and had upper tract stasis diagnosed by renal scan. Inclusion was based on the availability of the following tests both before and after alpha1-receptor blockade: renal scan, urodynamic studies, and arterial pressures. Part I evaluated the impact of alpha1-blockers on upper tract stasis. Part II evaluated the impact of alpha1-blockers on urodynamic parameters in those with and without resolution of stasis. Statistical methods: Chi-square test was used to determine the statistical significance of resolution of upper tract stasis. Student's t test for 2-paired samples was used to evaluate whether urodynamic parameters differed significantly before and after treatment with alpha1-blockers. MAIN OUTCOME MEASURES: Urodynamic parameters evaluated included mean changes in opening pressure, maximum detrusor voiding pressure, and duration of uninhibited contraction. RESULTS: Ten men with upper tract stasis were identified (15 renal units). After >6 months on alpha1-receptor antagonist therapy, upper tract stasis resolved in 8 of the 10 men (11 renal units) and persisted in 2 men (4 renal units). (P = .00026). The only urodynamic parameter that significantly changed in those with resolution of upper tract stasis was the duration of the uninhibited contraction (resolution of stasis: -57 seconds; P < .001), persistence of stasis: +12 seconds (P < .05). No significant change in opening pressures occurred in either those with resolution of stasis or persistent stasis (P < .78). Maximum arterial pressures during voiding statistically decreased with the use of alpha1-blockers (152 mmHg vs 135 mmHg; P < .01). CONCLUSIONS: alpha1-Receptor-antagonist therapy improved upper tract stasis in men with SCI. The urodynamic parameter that changed in those with resolution of upper tract stasis was the duration of uninhibited contractions, which decreased significantly.     

Trends in the incidence of venous stasis syndrome and venous ulcer: a 25-year population-based study

BACKGROUND: The incidence rates of venous stasis syndrome and venous ulcer are uncertain, and trends in incidence are unknown. METHODS: We performed a retrospective review of the complete (inpatient and outpatient) medical records of a community population (Olmsted County, Minnesota) to estimate the incidence of venous stasis syndrome and venous ulcer during the 25-year period, 1966 to 1990, and to describe trends in incidence. RESULTS: A total of 1131 patients received a first lifetime diagnosis of venous stasis syndrome. A total of 263 patients received a first lifetime diagnosis of venous ulcer. The overall incidence of venous stasis syndrome and venous ulcer were 76.1 and 18.0 per 100,000 person-years, respectively. The incidence of both was higher in women than in men (83.7 vs 67.4 per 100,000 person-years for venous stasis syndrome; 20.4 vs 14.6 per 100,000 for venous ulcer) and increased with age for both sexes. There was no clear trend in the incidence of venous stasis syndrome over the 25-year period. Compared with 1966 to 1970, the incidence of venous ulcer decreased in 1971 to 1980, but was unchanged after 1981. Among 945 patients with venous stasis only, 60 subsequently had a venous ulcer. The average (+/- SD) time from venous stasis diagnosis to development of a venous ulcer was 5.0 (+/- 5.0) years. CONCLUSION: Venous stasis syndrome and venous ulcer are common, especially in the elderly population. The incidence of venous stasis syndrome has not changed since 1966, and venous ulcer incidence is unchanged since 1981. More accurate identification of patients at risk for venous stasis syndrome and venous ulcer and more effective prevention are needed.     

不同门静脉淤血去除量对肝移植术后内毒素血症及肝功能恢复的影响

目的 探讨肝移植术中不同门静脉淤血去除量对术后内毒素血症及肝功能恢复的影响.方法 将2006年2月至2007年11月收治的47例肝移植患者按术中门静脉淤血去除量的不同分为两组:A组(n=26,门静脉淤血去除50 ml)和B组(n=21,门静脉淤血去除200 ml),检测受者手术前后血清内毒素、D-乳酸、肿瘤坏死因子-α、白细胞介素-6、肝功能及凝血功能的变化情况并进行分析比较.结果 两组在性别、年龄、原发疾病类型、Child-pugh分级、供肝冷缺血时间、手术时间、无肝期时间、手术方式、出血量、输血量及术前各项检测指标无显著差异的条件下,B组术后血清内毒素、D-乳酸、肿瘤坏死因子-α、白细胞介素-6、谷氨酸转氨酶、天冬氨酸转氨酶、凝血酶原时间、部分凝血活酶时间均明显低于A组(P<0.05);前白蛋白明显高于A组(P<0.05).结论 肝移植术中门静脉淤血去除200 ml效果优于50 ml,可以更好地减轻术后内毒血症,并有助于肝功能的恢复.     

Binswanger's disease with normal pressure hydrocephalus. Case report]

A 72-year-old hypertensive male was hospitalized with progressive gait disturbance (small step gait), urinary incontinence, and dementia. Computed tomography (CT) showed ventriculomegaly with periventricular lucency. T2-weighted magnetic resonance imaging revealed wide periventricular high-signal intensity and small infarctions in the basal ganglia. CT cisternography demonstrated ventricular stasis and convexity stasis of the contrast medium. Continuous intracranial pressure monitoring showed increased B wave percentage, low pressure volume index, and high outflow resistance. These findings indicated the coexistence of normal pressure hydrocephalus. After ventriculoperitoneal shunting, gait disturbance was greatly improved and urinary incontinence disappeared. The development of Binswanger's disease may be partially due to disturbed cerebrospinal fluid (CSF) dynamics. The possible pathophysiology of CSF dynamics in relation to Binswanger's disease is discussed. Detailed investigations of CSF dynamics are important in patients with Binswanger's disease, especially in the early stage.     

Hepatobiliary and gastrointestinal imaging after pancreaticoduodenectomy —A comparative study on Billroth I and Billroth II reconstructions

This study was conducted to compare the passage of bile and food through the remnant alimentary tract between 2 and 6 months following pancreaticoduodenectomy in patients undergoing Billroth I (Imanaga) and Billroth II (Child) reconstructions, using dual scintigraphy. In the patients who underwent Child's operation (n=14), hepatobiliary scintigraphy showed a prominent stasis of bile tracer in the proximal jejunal loop and a significant time delay before the bile and food became mixed at the upper jejunum. On the other hand, in the patients who underwent Imanaga's operation (n=9) no bile stasis in the proximal jejunal loop was found and the time taken before the two agents became mixed was similar to that of healthy controls (n=7). The time taken for the two agents to mix at the upper jejunum was 65.8±7.9 min in the patients after Child's operation, 17.3±2.5 min in those after Imanaga's operation, and 18.5±2.8 min in the healthy controls, respectively. Continuous stasis of bile in the proximal loop and severe postcibal asynchronism in patients who undergo Child's operation can therefore cause reflux cholangitis and absorptive disturbances in the long postoperative term. The results of this study suggest that Imanaga's reconstruction is a more physiological procedure than Child's reconstruction following pancreaticoduodenectomy.     

基于数据挖掘技术研究治疗膝骨关节炎肾虚血瘀型方剂的组方配伍规律

目的:基于中医传承辅助平台分析期刊与专利文献中治疗膝骨关节炎肾虚血瘀型方剂的用药配伍规律。方法:筛选2013年1月至2019年1月中国知网、维普、万方、超星、读秀学术、超星汇雅图书、国研等数据库中治疗膝骨关节炎肾虚血瘀型的方剂,通过中医传承辅助平台构建方剂数据库,利用该软件集成的关联规则及熵聚类等数据挖掘算法,总结治疗膝骨关节炎肾虚血瘀型方剂中的用药频次、常用药对、潜在药对及发现新处方。结果:通过对85首治疗膝骨关节炎肾虚血瘀型方剂所含药物的频次统计分析,得到常用药物33味,其中牛膝、川芎、当归、杜仲、甘草、独活的使用频次较高;使用频次较高的药对有26个,其中川芎与牛膝、当归与牛膝位居前2位,杜仲与牛膝、当归与川芎并列第3位;通过熵层次聚类分析法发现关联系数较高的潜在药对44个及潜在新处方10个。结论:治疗膝骨关节炎肾虚血瘀型的方剂多以补益肝肾为主,兼以活血化瘀、通络止痛为辅,挖掘得到的新处方具有潜在的临床应用和新药开发价值。     

下肢深静脉血栓形成的证候要素研究

目的:探讨下肢深静脉血栓形成证候要素的分布规律。方法:对近28年来下肢深静脉血栓形成证候文献进行筛选,构建相关数据系统,对其证候要素分布规律进行研究。结果:下肢深静脉血栓形成的常见证候要素为湿、热、血瘀、脾阳虚;常见证候要素靶位为脾,其中急性期的基本证候要素为湿、热,非急性期常见证候要素为血瘀、湿和脾阳虚。结论:下肢深静脉血栓形成的病机变化是以血瘀为基础,受多因素影响、虚实错杂的复杂过程。证候研究中,简化成证候要素的形式具有更强的可操作性。