Effects of hemorrhagic shock on endotoxemia and its molecular mechanism

AlthoughtherearegrowingevidencesindicatlugthatonlyweakendotoxemlaexistsintheearlystageafterhemorrhagicshockinhumanbeingsoranirnalsLI-3,antagonistsagainstendotoxinssuchasbacterlcldal/permeablllty--lucreproteinf'j,polymyxinBL4'andlactuloseL',exertsignificantprotectiveeffectsonthevictimsinshock.Thisseemsthatbacterlalendotoxinsplayanimportantroleinthedevelopmentofhemorrhagicshock.However,itremainsunclarifiedwhethertheroleofendotoxinsinshockisrelatedtotheincreaseofanIndividual'ssensitivitytoendot…     

Acute response of the arterial wall to pulsed laser irradiation

This study was designed to examine the acute response of normal arterial wall to pulsed laser irradiation. Irradiation with an Excimer or a Holmium YAG laser was performed in 15 normal iliac sites of 8 male New Zealand white rabbits. The excimer laser was operated at 308 nm, 25 Hz, 50 mj/mm²/pulse, and 135 nsec/pulse and the Ho:YAG laser was operated at 2.1 μm, 3.5 Hz, 400 mj/ pulse, 250 μsec/pulse. The excimer and Ho:YAG laser were coupled into a multifiber wire-guided catheter of 1.4 and 1.5 mm diameter, respectively. The mean luminal diameter increased similarly from 2.01 ± 0.29 to 2.46 ± 0.27 mm (P < 0.0005) and from 2.09 ± 0.53 to 2.45 ± 0.30 mm (P < 0.005) after excimer and Ho:YAG laser irradiation, respectively. Perforation occurred in 3 of 15 Ho:YAG irradiated sites and 0 of 15 excimer laser irradiated sites. The sites irradiated with excimer or Ho:YAG laser had similar histologic features, consisting of shedding of the endothelium, disorganization of internal elastic lamina, localized necrosis of vascular smooth muscle cells, and fissures in the medial layer. However, the sites irradiated with excimer laser had lower grading scores than those irradiated with the Ho:YAG laser (P<0.05). Irradiation with excimer or Ho:YAG laser of normal arteries results in: (1) vasodilation of the irradiated artery; (2) localized mechanical vascular injury, and (3) Ho:YAG laser induces more severe damage to the arterial wall than excimer. © 1993 Wiley-Liss, Inc.     

Blood flow variation and energy metabolism in the gastric mucosa following 7．5％ hypertonic saline resuscitation

Ｂｌｏｏｄｆｌｏｗｖａｒｉａｔｉｏｎａｎｄｅｎｅｒｇｙｍｅｔａｂｏｌｉｓｍｉｎｔｈｅｇａｓｔｒｉｃｍｕｃｏｓａｆｏｌｌｏｗｉｎｇ７．５％ｈｙｐｅｒｔｏｎｉｃｓａｌｉｎｅｒｅｓｕｓｃｉｔａｔｉｏｎＷａｎｇＪｕｎｙｉ（王俊义）；ＷｕＧｕｏｓｈｅｎｇ；（吴...     

Heparin–coated circuit during cardiopulmonary bypass

A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint–attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.5) participated in the study. Ten patients were randomized to be treated with heparin–coated equipment (CBAS) and reduced i.v. heparin (1.5 mg kg^-1) while 10 patients treated with identical but noncoated equipment and full heparinization (3 mg–kg^-1) served in a Control group. A vacuum suction was used to collect the blood from the operating field and it was autotransfused at weaning from extracorporeal circulation (ECC). Blood samples were obtained from the venous (precircuit) and arterial (postcircuit) side. We used a new and very specific method for detection of C5a based on monoclonal antibodies. The concentration of C5a was low in both groups during the operation but a significant increase was seen on days 1 and 2. In the Control group there was an increase from 10.2 ngml^-1±1.2 to 27.5 ng ml^-1 ± 4.8 on day 2 and in the CBAS group from 10.7 ng ml^-1 ± 1.2 to 35.6 ng ml^-1 ± 11.6 on day 2 (NS between groups). The granulocytes and total leukocyte count increased at the end of ECC and was maintained at the elevated level throughout the study period. The amount of free haemoglobin was high in the autotransfused blood in both groups. The present results confirm the feasibility of reducing general heparin when using heparin–coated systems but the study does not support the superiority of such coating with regard to biocompatibility in short procedures with a Theologically optimized circuit. The potential benefit from reduced heparin and protamine has not been fully evaluated.     

氟乙酰胺的极谱测定法

目的建立微量氟乙酰胺的极谱分析法。方法应用氟乙酰胺在高温强碱条件下的分解反应,利用极谱法对其分解产物形成的ALC-La-F-三元络合物在pH=4.90的含KNO3的六次甲基四胺缓冲液中的-0.67V处的络合物吸附波进行测定。结果在所选定的最佳条件下,氟乙酰胺的线性范围为5.0×10-8～1.2×10-6mol/L,回归方程y=3.49x+0.042,相关系数r=0.9996,方法的检测下限为2.0×10-8mol/L。结论该法可用于测定面粉中的氟乙酰胺。     

热休克蛋白70-2基因在大鼠隐睾中的表达及意义

目的 :探讨Hsp70 2基因表达在大鼠隐睾生精细胞中的作用。方法 :采用 2 2日龄Sprague Dawley雄性大鼠复制单侧隐睾模型 ,运用免疫组织化学SP法检测Hsp70 2和cdc2 基因在大鼠隐睾侧和对侧睾丸组织中的表达 ;运用生物素 dUTP 酶标亲和素测定法检测睾丸生精细胞凋亡。结果 :术后第 7d ,与对侧睾丸相比 ,隐睾侧Hsp70 2表达下降显著 (P <0 .0 1) ,cdc2 表达无显著性变化 (P >0 .0 5 ) ,生精细胞凋亡显著性增加 (P <0 .0 1)。术后第 14d ,隐睾侧生精细胞少见 ,Hsp70 2和cdc2 表达呈阴性。结论 :隐睾可以引起生精细胞发育停止和凋亡增加 ,这可能与Hsp70 2表达下降或不表达有关     

带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损

目的：介绍带血管蒂前臂后皮神经电缆式移植修复上臂桡神经缺损的应用解剖、手术方法及临床效果。方法：在２０侧成人上肢标本上，观测前臂后皮神经及桡侧副动脉的行程及外径，设计以桡侧副动脉为蒂的前臂后皮神经电缆式移植修复上臂桡神经缺损的新术式并应用于临床。结果：前臂后皮神经与桡侧副动脉伴行关系密切，具有形成带血管蒂前臂后皮神经转移的解剖学条件；前臂后皮神经横径２．０ｃｍ左右，可切取长度１５．０ｃｍ左右，折叠后可以修复７．０ｃｍ左右的桡神经缺损。同时，术中发现神经供体断端出血活跃，说明带血供的前臂后皮神经移植的血供是可靠的。临床应用８例，神经缺损３．５～６．０ｃｍ，随访１０个月～３年，效果满意。按陆裕朴介绍的评定标准：优４例，良３例，可１例。结论：该术式转移灵活，操作简单、安全、可靠，对供区影响小，是修复上臂桡神经缺损的一种有用的方法。     

谈医疗设备漏电对人体的电击

医疗设备可以为临床工作提供大量诊断信息和治疗手段，而医疗设备的漏电也会使病人电击灼伤以至危及生命。国务院发布《医疗事故处理条例》以后引起了医疗界高度重视，临床诊疗活动中如何安全使用医疗设备也是预防医疗事故的重要方面。本文着重介绍了电击的种类、对人体的危害及防护措施。     

Evidence that the enhancement of dopamine function by repeated electroconvulsive shock requires concomitant activation of D1-like and D2-like dopamine receptors

In this study, the behavioural response to dopamine D₁-like receptor agonists (SKF 38393, SKF 81297 and SKF 77434) and D₂-like receptor agonists (quinpirole and RU 24213), administered alone and in combination to rats treated repeatedly with electroconvulsive shock (five ECS over 10 days) or sham, was tested. Agonist-induced behaviour was monitored by automated activity meters and direct observation using a checklist scoring method. Repeated ECS (compared to sham controls) had no significant effect on the behavioural response to SKF 38393 (7.5 mg/kg SC), SKF 81297 (0.2 mg/kg SC), SKF 77434 (0.1 mg/kg SC), quinpirole (0.1 and 0.25 mg/kg SC) or RU 24213 (0.3 mg/kg SC), when administered alone. In contrast, repeated ECS markedly increased locomotion (activity counts and scores) induced by the non-selective dopamine agonist apomorphine (0.5 mg/kg SC) and by co-administration of a D₁-like agonist plus a D₂-like agonist [SKF 38393 (7.5 mg/kg SC) plus quinpirole (0.25 mg/kg SC), SKF 81297 (0.2 mg/kg SC) plus quinpirole (0.1 mg/kg SC), and SKF 77434 (0.1 mg/ kg SC) plus RU 24213 (0.3 mg/kg SC)]. This ECS-induced enhancement of dopamine-mediated behaviour was observed for up to 3 weeks after cessation of ECS treatment. In addition, ECS also enhanced the locomotor response to intra-accumbens SKF 38393 plus quinpirole (0.4 and 1.0 μg/side, respectively). These results provide evidence that the enhancement of dopamine function by repeated ECS requires concomitant stimulation of both D₁-like and D₂-like receptors, and that this effect is long-lasting. Received: 24 January 1997 /Final version: 5 March 1997     

婴幼儿先心病的体外循环研究

目的 :婴幼儿心内直视手术体外循环的研究。方法 :临床 115例婴幼儿分为体外循环管道不定型 (A组 )和体外循环管道定型 (B组 )两组。A组应用进口膜肺 35例 (5 7% ) ,鼓泡式氧合器 2 6例 (43% ) ,体外循环管道是临时改装。B组应用进口膜肺 4 9例 (91% ) ,鼓泡式氧合器 5例 (9% ) ,体外循环管道选择配置成型的婴幼儿管道 ,直径 6mm ,长度 10 0cm。结果 :两组患儿的年龄、体重无统计学差异 (P >0 0 1)。B组与A组相比 ,体外循环中晶体预充量由 (5 16± 172 )ml减少至 (40 0± 10 9)ml,差异性显著 (P <0 0 1)。总液量由 (933± 2 39)ml减少至 (6 2 5±171)ml,差异性显著 (P <0 0 1)。全血预充量由 (414± 183)ml减少至 (87± 10 6 )ml,差异性显著 (P <0 0 1)。两组稀释度无统计学差异 (P >0 0 1)。术后呼吸机辅助时间由 (2 4 4± 2 3 9)h缩短至 (13 2± 9 1)h ,差异性显著(P <0 0 1)。ICU时间由 (2 8± 1 5 )d缩短至 (1 6± 0 9)d ,差异性显著 (P <0 0 1)。全组 115例死亡 3例 (2 6 % )。结论 :选用优质婴幼儿膜肺 ,规范体外循环管道 ,总预充量控制在 5 0 0ml以下 ,保持较高的胶体渗透压是婴幼儿体外循环的关键