Comparação dos efeitos de sulfato de magnésio e da dexmedetomidina sobre a qualidade da visibilidade em cirurgia endoscópica sinusal: estudo clínico randomizado

Background and objectivesEven a small amount of bleeding during endoscopic sinus surgery can corrupt the endoscopic field and complicate the procedure. Various techniques, including induced hypotension, can minimize bleeding during endoscopic sinus surgery. The aim of this study was to compare the surgical vision quality, haemodynamic parameters, postoperative pain, and other effects of magnesium, a hypotensive agent, with that of dexmedetomidine, which was initially developed for short‐term sedation in the intensive care unit but also is an alpha 2 agonist sedative.Method60 patients between the ages of 18 and 45 years were divided into either the magnesium group (Group M) or the dexmedetomidine group (Group D). In Group M, magnesium sulphate was given at a pre‐induction loading dose of 50 mg kg⁻¹ over 10 min and maintained at 15 mg kg⁻¹ h⁻¹; in Group D, dexmedetomidine was given at 1 mcg kg⁻¹ 10 min before induction and maintained at 0.6 mcg kg⁻¹ h⁻¹. Intraoperatively, the haemodynamic and respiratory parameters and 6‐point intraoperative surgical field evaluation scale were recorded. During the postoperative period, an 11‐point numerical pain scale, the Ramsay sedation scale, the nausea/vomiting scale, the adverse effects profile, and itching parameters were noted.ResultsGroup D showed a significant decrease in intraoperative surgical field evaluation scale scale score and heart rate. The average operation time was 50 min, and Group M had a higher number of prolonged surgeries. No significant difference was found in the other parameters.ConclusionsDue to its reduction of bleeding and heart rate in endoscopic sinus surgery and its positive impacts on the duration of surgery, we consider dexmedetomidine to be a good alternative to magnesium.     

MEMBRANE Na &#180 +;-K &#180 +; ATPase MEDIATED CASCADE IN BIPOLAR MOOD DISORDER,MAJOR DEPRESSIVE DISORDER,AND SCHIZOPHRENIA RELATIONSHIP TO HEMISPHERIC DOMINANCE

The isoprenoid pathway produces digoxin, an endogenous membrane Na &#180 +;-K &#180 +; ATPase inhibitor and regulator of neurotransmitter transport. The objective of the study was to relate digoxin status and hemispheric dominance to the pathogenesis of psychiatric disorders--bipolar mood disorder, major depressive disorder, and schizophrenia. The following parameters were assessed in bipolar mood disorder during the manic phase and depressive phase of the illness as well as in major depressive disorder, and schizophrenia: HMG CoA reductase activity, tryptophan and tyrosine catabolic patterns, red blood cell (RBC) Na &#180 +;-K &#180 +; ATPase activity, and serum magnesium. These parameters were compared to individuals of dif fering hemispheric dominance. The levels of serum digoxin and HMG CoA reductase activity were found to be decreased in the depressive phase of bipolar mood disorder and major depressive disorder with a cor responding increase in RBC Na &#180 +;-K &#180 +; ATPase activity and serum magnesium levels. There was increase in tyrosine and tyrosine catabolites, and a reduction in tryptophan and its catabolites, in the serum in the depressive phase of bipolar mood disorder and major depressive disorder. The neurotransmitter patterns and digoxin levels in the depressive phase of bipolar mood disorder/major depressive disorder correlated with those in right-handed/left hemisphere dominant individual. The neuro transmitter patterns and digoxin levels in the manic phase of bipolar mood disorder and schizophrenia correlated with those in left-handed/right hemisphere dominant individuals. Digoxin status and hemispheric domi nance could correlate with the pathogenesis of psychiatric disorders--schizophrenia, major depressive disorder, and bipolar mood disorder.     

Relaxant effects of metoclopramide and magnesium sulfate on isolated pregnant myometrium: an in vitro study

BackgroundMetoclopramide and magnesium sulfate are extensively used agents in obstetrics. In this study, the relaxant properties of metoclopramide and magnesium sulfate on pregnant myometrium, together with the possible reversing influences of oxytocin and cabergoline (a dopamine D₂ receptor agonist), were investigated.MethodsMyometrial strips from 24 parturients were randomly allocated to four groups: control (Group CON), magnesium sulfate and oxytocin (Group MSO), metoclopramide and oxytocin (Group MEO), and metoclopramide and cabergoline (Group MEC). Myometrial strips were mounted on a myograph bathed in Krebs buffer. Saline (Group CON) and five incremental doses of magnesium sulfate (Group MSO) or metoclopramide (Groups MEO and MEC) were sequentially microinjected into the bath. Subsequently, oxytocin (Groups CON, MSO and MEO) or cabergoline (Group MEC) was microinjected into the bath. The myometrial contractile characteristics after each drug injection, including contractile force, interval and duration, were analyzed.ResultsMagnesium sulfate was more potent for prolonging myometrial contractile interval than reducing contractile force. Metoclopramide relaxed myometrial contractions by inhibiting contractile force and prolonging contractile interval in a concentration-dependent manner. Oxytocin reversed both the inhibited contractile force and the prolonged contractile interval caused by a high concentration of magnesium sulfate but accelerated the contractile interval and had no significant effect on the contractile force suppressed by metoclopramide. The relaxant effects of metoclopramide were completely reversed by cabergoline.ConclusionsBoth magnesium sulfate and metoclopramide relaxed myometrial contractions, and exhibited different responses to subsequent oxytocin treatment. The relaxant mechanism of metoclopramide may be via blockade of dopamine D₂ receptor, which requires further investigation.     

硫酸镁联合银杏达莫治疗慢性肺源性心脏病的疗效观察

目的探讨硫酸镁联合银杏达莫治疗慢性肺源性心脏病的疗效。方法将笔者所在医院2011年3月～2012年3月72例慢性肺源性心脏病患者随机分成对照组和治疗组,对照组患者进行常规的抗感染、保持呼吸道通畅、利尿、扩张血管、纠正电解质平衡等治疗;治疗组在对照组的基础上加用硫酸镁和银杏达莫。观察两组患者治疗前后心功能、肺动脉收缩压的改善情况,并进行临床观察分析。结果治疗组的总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论硫酸镁联合银杏达莫治疗慢性肺源性心脏病疗效显著,临床上建议进一步推广运用。     

Plasma Peroxyl Radical-Trapping Capacity in Severe Preeclampsia is Strongly Related to Uric Acid

The total peroxyl radical-trapping antioxidant parameter (TRAP) of plasma from nine patients suffering from severe preeclampsia was compared with that from nine control patients sharing the same weeks of pregnancy. Measurement of TRAP was by a new chemiluminescent method. The mean TRAP in preeclamptic patients was 1288 ± 110 µmol/l and in control patients 970 ± 153 µmol/l (p<0.001). TRAP was highly correlated with plasma uric acid (r=0.86), and 91% of the increase in TRAP was due to increase in uric acid, which raises a question of the possible antioxidative role of uric acid in preeclampsia.     

Local release of magnesium from mesoporous TiO2 coatings stimulates the peri-implant expression of osteogenic markers and improves osteoconductivity in vivo

Local release of Mg ions from titanium implant surfaces has been shown to enhance implant retention and integration. To clarify the biological events that lead to this positive outcome, threaded implants coated with mesoporous TiO₂ thin films were loaded with Mg-ions and placed in the tibia of rabbits for 3 weeks, after surface characterization. Non-loaded mesoporous coated implants were used as controls. Peri-implant gene expression of a set of osteogenic and inflammatory assays was quantified by means of real-time quantitative polymerase chain reaction. The expression of three osteogenic markers (OC, RUNX-2 and IGF-1) was significantly more pronounced in the test specimens, suggesting that the release of Mg ions directly at the implant sites may stimulate an osteogenic environment. Furthermore, bone healing around implants was evaluated on histological slides and by diffraction-enhanced imaging (DEI), using synchrotron radiation. The histological analysis demonstrated new bone formation around all implants, without negative responses, with a significant increase in the number of threads filled with new bone for test surfaces. DEI analysis attested the high mineral content of the newly formed bone. Improved surface osteoconductivity and increased expression of genes involved in the bone regeneration were found for magnesium-incorporation of mesoporous TiO₂ coatings.     

硫酸镁联合尼莫地平治疗弥漫性轴索损伤的临床分析

目的 研究弥漫性轴索损伤(DAI)患者的血清镁离子浓度以及联合尼莫地平早期给予镁离子治疗对其预后的影响. 方法 将南方医科大学珠江医院神经外科自2006年9月至2010年6月收治的99例DAI患者按随机数字表法分为2组,入院时均检测血清镁离子浓度,均予尼莫地平持续静脉注射,连续使用1周.另治疗组给予250g/L硫酸镁静脉滴注,连续使用3d;对照组不使用硫酸镁.结合随访情况,分析患者预后与入院时镁离子浓度及与硫酸镁治疗的关系. 结果 2组患者间病死率比较差异无统计学意义(P＜0.05),治疗组恢复良好率及轻残率均明显高于对照组,差异有统计学意义(P＜0.05).2组患者入院时血清镁离子浓度均对格拉斯哥预后分级评分(GOS)无明显影响. 结论 入院时血清镁离子水平不能影响患者的预后.对比单独使用尼莫地平,伤后早期联合应用250 g/L硫酸镁持续静脉滴注,虽不能有效降低患者死亡率,但可降低重残率,改善患者的预后和生存质量.     

Essential elements in depression and anxiety. Part I

Essential elements are very important for the proper functioning of the human body. They are required for fundamental life processes such as cell division and differentiation and protein synthesis. Thus a deficiency of these essential elements is associated with an enormous health risk that can ultimately lead to death. In recent years, studies have provided valuable information on the involvement of essential elements in psychiatric disorders, in particular depression and anxiety.There is strong evidence indicating that deficiency of essential elements can lead to the development of depressive and/or anxiogenic behaviour and supplementation can enhance therapeutic effect of antidepressants and anxiolytics. This review presents the most important results from preclinical and clinical studies showing involvement of essential elements such as zinc, magnesium, lithium, iron, calcium and chromium in depression and anxiety. From these studies it is evident that different types of depression and anxiety respond to treatment at different receptors indicating that the underlying mechanisms are slightly different. Furthermore, administration of low dose antidepressants supplemented with an element is effective and can reduce unwanted side effects in different types of depression/anxiety.     

川芎嗪联合硫酸镁治疗妊娠期高血压疾病的效果及不良反应分析

目的：探究临床治疗妊娠期高血压疾病的理想方法，从而为相关临床治疗和研究提供借鉴依据。方法：选取本院2009年1月-2012年12月收治的128例妊娠期高血压疾病患者作为研究对象，按照随机数字表法将其分为对照组和观察组各64例。对照组给予硫酸镁治疗，观察组在此基础上给予盐酸川芎嗪治疗。观察比较两组患者采用不同临床治疗方法后的临床治疗效果以及不良反应发生情况。结果：观察组的治疗总有效率90.63%明显高于对照组的73.44%，比较差异有统计学意义（字2=6.4133，P=0.0113），观察组的不良反应发生率7.81%明显低于对照组的21.88%，比较差异有统计学意义（字2=5.0063，P=0.0253）。结论：在临床针对妊娠期高血压疾病患者实施治疗的过程中，采用川芎嗪联合硫酸镁进行治疗的临床效果显著，是临床治疗妊娠期高血压疾病的理想选择。