Cerebral hypoperfusion in immediate postoperative period following coronary artery bypass grafting, heart valve, and abdominal aortic surgery

Perioperative levels of jugular bulb oxyhaemoglobin saturation(Sj_O2) and lactate concentration (Lj), and postoperative durationof Sj_O2<50% were compared between patients undergoing coronaryartery bypass grafting (CABG) (n=86), heart valve (n=14) andabdominal aortic (n=16) surgery. Radial artery and jugular bulbblood samples were aspirated after induction of anaesthesia,during re-warming on cardiopulmonary bypass (CPB) (36°C),on arrival in the intensive care unit (ICU) and, subsequently,at 1, 2 and 6 h after ICU admission. Most patients having heartsurgery were hypocapnic at 36°C on CPB. Following CABG andheart valve surgery, many patients were hypocapnic whereas afterabdominal aortic surgery, most were hypercapnic. During CPBand postoperatively, Sj_O2 and Lj were significantly correlatedto Pa_CO2 and the arterial concentration of lactate (La) respectively(P<0.05). After correction for arterial carbon dioxide tension(Pa_CO2) and La, there were no significant changes in Sj_O2 orLj on CPB. Postoperatively, having corrected for Pa_CO2, therewere significant effects on Sj_O2 over all groups as a resultof time from surgery (P<0.001) and its interaction with operationtype (P<0.001). Following correction for La, there were nopostoperative effects on Lj. No significant differences (P=0.2)in duration of Sj_O2<50% existed between patients undergoingCABG (1054 (82) min), abdominal aortic (893 (113) min) and heartvalve (1073 (91) min) surgery. The lack of significant reciprocaleffects on Lj combined with the frequency of hypocapnia andstrong influence of Pa_CO2on Sj_O2, suggest that Sj_O2<50% duringCPB and after cardiac surgery represents hypoperfusion as aconsequence of hypocapnia rather than cerebral ischaemia. Br J Anaesth 2001; 87: 229–36     

Contrast in the efficacy of hDAF mouse hearts between ex vivo perfusion and transplantation into primates

Abstract: In recent experiments, in which we compared hDAF transgenic rat hearts perfused with 15% human serum in the Langendorff device and hDAF rat hearts transplanted into cynomolgus monkeys, we demonstrated that in the ex vivo heart perfusion model both homozygous and heterozygous hDAF hearts survived longer as nontransgenic controls. Surprisingly, we found that only homozygous hDAF hearts were protected against hyperacute rejection in vivo. The first aim of this study was to determine whether perfusion of mouse hearts with higher human serum concentrations or human blood might explain some of the differences found in survival time of the recently performed experiments with rat heart xenografts. Secondly, we investigated whether the observed differences in survival times of rat xenografts between in vivo and ex vivo transplantation would also hold for mouse hearts transgenic for hDAF. An ex vivo model was used to perfuse hDAF mouse hearts and controls with human serum or blood, and hDAF transgenic hearts and controls were transplanted into cynomolgus monkeys. hDAF transgenic mouse hearts survived significantly longer than their controls when perfused with 15% human serum, but no difference was found when 30% human serum was used, or when these hearts were transplanted into cynomolgus monkeys. However, in both the in vivo and ex vivo models the amount of PMNs adhering to the vascular endothelium was significantly lower in hDAF transgenes as compared with their controls. In conclusion, in the ex vivo situation, the efficacy of hDAF transgenesis in preventing HAR is limited by serum complement concentration.     

葡萄糖对光滑球拟酵母发酵生产丙酮酸的影响

在30L发酵罐中研究了初始葡萄糖质量浓度和补料方式对光滑球拟酵母WSH-IP303发酵生产丙酮酸的影响．实验确定116.4g/L左右是较为适宜的初始葡萄糖质量浓度,发酵58h时丙酮酸质量浓度和产率分别为58.0g/L和0.516g/g．采用初始葡萄糖质量浓度为53.4g/L,发酵24h分批补料至葡萄糖总质量浓度为115g/L的培养方式,发酵64h时丙酮酸质量浓度和产率分别为60.2g/L和0.559g/g;采用初始葡萄糖质量浓度为62.6g/L,发酵24h开始连续补料至葡萄糖总质量浓度为115g/L的培养方式,发酵72h时丙酮酸质量浓度和产率分别为63.3g/L和0.586g/g,与葡萄糖总质量浓度相似(115g/L)的分批发酵相比,丙酮酸产量分别提高了3.8%和9.1%．实验结果表明适宜的初始葡萄糖质量浓度能促进光滑球拟酵母发酵生产丙酮酸;尽管葡萄糖补料培养可适度提高丙酮酸的产量及产率,但生产强度却有所下降．     

透明质酸钠黏弹性补充治疗膝骨性关节炎的远期疗效观察

目的:通过回顾性分析关节腔注射透明质酸钠对膝骨性关节炎的远期效果,为黏弹性补充疗法提供临床依据.方法:2006年1月至2007年8月治疗膝骨性关节炎181膝(120例),其中轻度61膝,中度72膝,重度48膝.采用透明质酸钠关节腔内注射治疗,每次2 ml,每周1次,连续5周为1个疗程.应用VAS视觉模拟标尺法、日本骨科协会(JOA)的膝关节骨性关节炎评分系统,分别于治疗前及治疗后1个月、1、2年进行疗效评估.结果:①VAS疼痛分值:治疗前平均(7.26±1.83)分,治疗后1个月平均(1.85±1.21)分,随访1年时平均(2.54±1.40)分,随访2年时平均(3.07±1.51)分,均比治疗前降低.②JOA膝关节功能评分:治疗前平均(18.7±6.6)分,治疗后1个月平均(84.3±15.5)分,1年平均(75.4±22.4)分,2年平均(64.8±25.6)分,均较治疗前提高.③远期疗效评估:采用JOA评分方法,181膝治疗后1个差45膝.随着时间推移,疗效逐渐下降.治疗2年时轻度患者优16膝,良22膝,可15膝,差8膝;中度患者优16膝,良20膝,可21膝,差15膝;重度患者优8膝,良8膝,可10膝,差22膝.结论:关节腔注射透明质酸钠对膝骨性关节炎具有良好的远期疗效,尤其对轻、中度骨性关节炎更为满意,对重度骨性关节炎近期疗效尚可,远期疗效较差.     

α-硫辛酸对阻塞性黄疸大鼠肝细胞线粒体内能量代谢保护作用及机制

目的 探讨α-硫辛酸对阻塞性黄疸大鼠肝细胞线粒体内能量代谢的保护作用及其机制. 方法 将72只SD雄性大鼠随机分为对照组(SO组),胆总管结扎+0.9%氯化钠溶液组(BDL+NS组),胆总管结扎α-硫辛酸组(BDL+LA组).分别于术后7 d、14 d和2l d检测肝细胞线粒体内MDA、SOD、ATP、ADP和AMP含量并计算总腺苷酸(TAN)和能荷(EC). 结果 BDL+NS组各时间点肝细胞线粒体内MDA、ADP、AMP含量明显升高,而SOD、ATP、EC含量却明显降低.胆总管结扎7 d、14 d时,肝细胞线粒体内MDA含量BDL+LA组比BDL+NS组低,差异有统计学意义(P＜0.01);2l d时,AMP、MDA含量BDL+NS组和BDL+LA中都更进一步升高,但两组比较差异无统计学意义(P＞0.05).胆总管结扎7 d、14 d时,肝细胞线粒体内SOD含量、ATP含量BDL+LA组比BDL+NS组下降程度有显著性差异(7 d,P＜0.01;14 d,P＜0.05);21 d时,两组肝细胞线粒体内SOD含量都进一步下降,但差异无统计学意义(p＞0.05). 结论 α-硫辛酸在阻塞性黄疸早、中期有保护线粒体能量代谢作用,减轻了阻塞性黄疸时肝的损伤.     

丹酚酸B和高氧液对兔肢体缺血再灌注损伤代谢酶的影响

目的探讨高氧液和丹酚酸B对肢体缺血再灌注损伤的影响。方法选用健康新西兰家兔24只,随机分为4组,在缺血前从耳缘静脉推注等量的生理盐水(A组)、高氧液(B组)、丹酚酸B(C组)或高氧液加丹酚酸B(D组),夹阻股动静脉,建立肢体缺血再灌注损伤模型,在缺血前和再灌注4h抽血检测LDH、CK,取腓肠肌作LDH酶组织化学染色。结果再灌注4h,血清肌酸激酶活性较前明显升高,高氧液和丹酚酸B可以抑制其升高(P0.01),两者有协同作用(P=0.05);血清乳酸脱氢酶活性较前明显升高,高氧液和丹酚酸B可以抑制其升高(P0.01),两者有协同作用(P0.01)。LDH酶组织化学显色见:相对于对照组其他组组织织LDH酶活性较低,以联合用药组最低。结论高氧液和丹酚酸B对缺血再灌注损伤起预防作用,而且两者有协同作用。     

生物可降解输尿管支架在输尿管战创伤治疗中的降解特性

目的 建立一种新的输尿管战创伤动物模型,观察生物可降解输尿管支架在输尿管战创伤治疗中的降解特性.方法 使用自行研制的火器弹片伤制造模具,对模型建立组9条比格犬的随机一侧输尿管制造火器弹片伤后清创缝合,分别于术后40、80、120 d行静脉肾盂造影评估.再对阳性对照组9条比格犬的双侧输尿管均制造火器弹片伤,随机一侧放置聚乳酸可降解输尿管支架,另一侧放置双J管,分别于术后加、80、120d行静脉肾盂造影评估,支架行表面微观形貌及元素分析.结果 模型建立组9条比格犬,损伤侧术后出现肾积水,并逐渐加重.阳性对照组的9条比格犬,术后双侧均未见明显肾积水;可降解支架随时间推移逐渐降解,尤其术后80 d开始观察到降解速度明显加快;支架表面无钙沉积,而双J管表面可观察到明显钙沉积和结石形成,且随时间进展加重.结论 生物可降解支架在治疗输尿管火器弹片伤过程中,在起到了支撑、引流、预防肾积水作用后,随时间推移逐渐降解,并可避免结石形成.     

尿苷二磷酸葡萄糖醛酸转移酶1A9基因多态性对麦考酚酸浓度的影响

目的 了解中国汉族肾移植受者尿苷二磷酸葡萄糖醛酸转移酶1A9(UGT1A9)基因多态性对体内麦考酚酸(MPA)浓度的影响.方法 使用聚合酶链反应-连接酶检测反应(PCR-LDR)方法对196例汉族肾移植受者的UGT1A9编码基因进行单核苷酸基因多态性(SNP)检测,分别检测C-440T/T-331C、C-2152T、T-275A和T98C突变位点.移植后第28天,通过检测3个时间点(服用吗替麦考酚酯前、服药后0.5 h和2 h)的血浆MPA浓度来推算血浆MPA浓度的时间曲线下面积(MPA-AUC0-12),对SNP和MPA-AUC0-12进行相关性分析.结果 受者的UGT1A9编码基因中,未发现C-2152T、T-275A、T98C突变;C-440T/T-331C突变频率为14.29%(28/196).-440/-331位点CT/TC突变型受者的MPA-AUC0-12为(40.6±11.8)mg·h·L-1,野生纯合(CC/TT)基因型受者的MPA-AUC0-12为(37.6±14.2)mg·h·L-1,两者相比较,差异无统计学意义(P＞0.05).结论 中国汉族肾移植受者的UGT1A9编码基因中,C-2152T、T-275A、T98C突变的发生频率较低,-440/-331位点突变多为杂合基因型.-440/-331位点的SNP与受者血浆MPA浓度没有明显的相关性.     

熊果酸对人骨肉瘤MG63细胞的影响

目的 探讨熊果酸(UA)对人骨肉瘤MG63细胞的影响作用及其机制.方法 体外培养骨肉瘤MG63细胞,应用浓度为10、20、50、100 μmol/L的熊果酸干预骨肉瘤MG63细胞,噻唑蓝(MTT)比色法检测细胞的增殖,逆转录-聚合酶链反应(RT-PCR)技术检测细胞中骨形态发生蛋白(BMP)-2和BMP-6的mRNA的表达,并应用蛋白印记技术检测相应蛋白的表达水平.结果 熊果酸干预组的肿瘤细胞增殖被明显抑制,72 h时100 μmol/L组的增殖活性为(0.25±0.03),而10μmol/L组的增殖活性为(0.86±0.10),差异有统计学意义(P＜0.05),各浓度组在24、48、72 h时的增殖活性差异均有统计学意义(P＜0.05);BMP-2和BMP-6 mRNA和蛋白的表达水平在实验组和对照组间差异均有统计学意义(P＜0.05),而两对照组之间差异无统计学意义(P＞0.05).结论 熊果酸能够抑制骨肉瘤MG63细胞的增殖,并能够促进细胞中BMP-2和BMP-6的表达.     

体外光动力学反应调节角质形成细胞分泌细胞因子的研究

目的探讨不同强度光动力学反应对角质形成细胞（HaCat）分泌某些细胞因子的影响。方法将0．O～12．8mol／L的5-氨基酮戊酸（AI。A）与HaCat细胞共同培养,检测胞内原卟啉IX（PpIX）含量;经632．8nrfl激光照射后测定细胞死亡率。依据细胞死亡率（0％～10％）确定ALA浓度区间（0．0～1．6mmol／L）,继而检测该区间内细胞（包括照射组与非照射组）上清液中白介素-1α（IL-1α）、IL-6、碱性成纤维细胞生长因子（bFGF）、内皮素一1（ET-1）和a肿瘤坏死因子（TNF—α）的水平。结果ALA浓度可调控胞内PpIX含量和光动力反应强度,在0．O～1．6mmol／L：区间与细胞死亡率（≤10％）呈线性正相关（rs=0．451,r2=0．606,P〈0．05）,且IL—1α、bFGF和TNF-α水平随着ALA浓度增加而逐渐升高（皆P〈0．05）,IL-6和ET-1水平则无显著变化（皆P〉0．05）。结论通过增强光动力反应可促进HaCat细胞分泌某些细胞因子,以提高对某些皮肤病的疗效。