丹参川芎嗪治疗冠心病心绞痛的临床疗效观察

目的:探讨丹参川芎嗪治疗冠状动脉粥样硬化性心脏病(简称冠心病)心绞痛的疗效。方法:选择住院治疗的冠心病心绞痛患者120例,随机分为观察组60例及对照组60例。对照组接受临床常规治疗,观察组在常规治疗基础上加入丹参川芎嗪治疗,均治疗2周。治疗2周后评估两组患者的临床症状变化情况,应用彩色多普勒超声诊断仪检测心功能参数,抽取外周静脉血检测一氧化氮(Nitric Oxide,NO)、组织型纤溶酶原激活物抑制剂-1(Plasminogen Activator Inhibitor-1,PAI-1)含量。结果:治疗2周后,两组的临床症状、心功能参数、NO、PAI-1含量均较治疗前优化(P<0.05)。其中观察组的心绞痛发作次数、单次发作持续时间少于对照组,疼痛程度轻于对照组(P<0.05);超声心电图参数左室舒张末期容积(EDV)、收缩末期容积(ESV)水平低于对照组,左室射血分数(LVEF)水平高于对照组(P<0.05);观察组PAI-1水平下降,NO水平升高。结论:丹参川芎嗪注射液治疗冠心病心绞痛的疗效确切,在缓解心绞痛症状、改善心功能、微循环方面具有优势。     

Intraoperative cerebral blood flow monitoring in neurosurgery: A review of contemporary technologies and emerging perspectives

Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery.     

In vivo analysis of intestinal permeability following hemorrhagic shock

AIM: To determine the time course of intestinal permeability changes to proteolytically-derived bowel peptides in experimental hemorrhagic shock. METHODS: We injected fluorescently-conjugated casein protein into the small bowel of anesthetized Wistar rats prior to induction of experimental hemorrhagic shock. These molecules, which fluoresce when proteolytically cleaved, were used as markers for the ability of proteolytically cleaved intestinal products to access the central circulation. Blood was serially sampled to quantify the relative change in concentration of proteolytically-cleaved particles in the systemic circulation. To provide spatial resolution of their location, particles in the mesenteric microvasculature were imaged using in vivo intravital fluorescent microscopy. The experiments were then repeated using an alternate measurement technique, fluorescein isothiocyanate(FITC)-labeled dextrans 20, to semi-quantitatively verify the ability of bowel-derived low-molecular weight molecules( 20 k D) to access the central circulation.RESULTS: Results demonstrate a significant increase in systemic permeability to gut-derived peptides within 20 min after induction of hemorrhage(1.11 ± 0.19 vs 0.86 ± 0.07, P 0.05) compared to control animals. Reperfusion resulted in a second, sustained increase in systemic permeability to gut-derived peptides in hemorrhaged animals compared to controls(1.2 ± 0.18 vs 0.97 ± 0.1, P 0.05). Intravital microscopy of the mesentery also showed marked accumulation of fluorescent particles in the microcirculation of hemorrhaged animals compared to controls. These results were replicated using FITC dextrans 20 [10.85 ± 6.52 vs 3.38 ± 1.11 fluorescent intensity units(× 105, P 0.05, hemorrhagic shock vs controls)], confirming that small bowel ischemia in response to experimental hemorrhagic shock results in marked and early increases in gut membrane permeability. CONCLUSION: Increased small bowel permeability in hemorrhagic shock may allow for systemic absorption of otherwise retained proteolytically-generated peptides, with consequent hemodynamic instability and remote organ failure.     

耳复康口服液对小鼠微循环障碍的影响

摘 要 目的：观察耳复康口服液对肾上腺素致急性血瘀症小鼠微循环障碍的影响。方法: 将小鼠随机分为模型组,脑得生片组（1.35 g·kg^-1）,高(30 ml·kg^-1)、中(15 ml·kg^-1)、低(7.5 ml·kg^-1)剂量耳复康口服液组,用微循环仪观察正常小鼠给药1 h后毛细血管开放数。尾静脉注射肾上腺素造成耳廓微循环障碍,观察造模后2 min小鼠的毛细血管开放数及血流情况。结果:和模型组相比,高、中、低剂量耳复康口服液对正常小鼠耳廓毛细血管开放数无明显影响(P＞0.05);与模型组相比,高、中剂量耳复康口服液可显著改善肾上腺素致小鼠耳壳微循环障碍模型微循环血流情况(P＜0.05或P<0.01),可明显对抗肾上腺素所致小鼠耳壳微循环障碍模型毛细血管网开放数的减少(P<0.05)。结论:耳复康口服液有改善微循环障碍的作用。     

灵长类动物子宫内膜异位症病证结合模型构建初探

目的　探索食蟹猴子宫内膜异位症（简称内异症）病证结合模型构建的方法。 方法　（1）6只雌性食蟹猴随机分为实验组5只、对照组1只,实验组开腹行宫颈环扎术,对照组仅开腹。（2）于术前、术中及术后第1、2、3个月运用PSI测量猴舌血液灌注量。（3）术后3个月腹腔镜探查,因均未见内异症病灶,改进建模方法：将猴分为实验组4只、对照组2只,实验组月经期收集子宫内膜组织盆腔内注射,连续使用3个月免疫抑制剂,对照组不作处理。 结果　（1）宫颈环扎后3个月后腹腔镜探查,两组均未见内异症病灶。（2）猴子术后2月舌部血液灌注量明显高于对照组,差异有统计学意义（P<0.05）。（3）每只猴的舌面及舌底血液灌注量变化趋势一致。（4）改进建模方案后3个月腹腔镜探查示,实验组重度盆腔粘连、子宫表面血管增生并充血明显,一只猴可见内异症病灶,对照组则无。 结论　收集子宫内膜盆腔内注射、加用免疫抑制剂可以构建食蟹猴内异症模型。运用PSI测量猴舌部血液灌注量的方法稳定可行,有望成为疾病病证结合模型舌象的量化评价方法。     

Effects of terlipressin on microcirculation of small bowel mesentery in rats with endotoxic shock

Background

Septic shock is still related to unacceptably high morbidity and mortality. Microcirculatory alteration has been demonstrated to be one important reason associated with this evolution. Vasoactive drugs are often used to restore adequate arterial pressure and tissue perfusion in septic shock. To define the roles of different drugs, the effects of terlipressin (TP) on the microcirculation of small bowel mesentery in rats with endotoxic shock were evaluated and compared with those of norepinephrine (NE).

Methods

Twenty-five adult male Wistar rats were randomized to the control (n = 5), TP (n = 10), and NE (n = 10) groups. After endotoxic shock was induced by intravenous lipopolysaccharide administration for 30 min, rats in the NE and TP groups were infused with saline 5 mL/kg/h and simultaneously given NE 4 μg/kg/min or TP 8 μg/kg/h. The mean arterial pressure, heart rate, blood gas analysis, and microvascular blood flow images of small bowel mesentery were recorded.

Results

After fluid resuscitation and vasopressor infusion, the mean arterial pressure was restored to the baseline values in the NE and TP groups. In the TP group, the heart rate was significantly lower compared with the NE group (P = 0.013). The proportion of perfused vessels and the microvascular flow index (MFI) were significantly increased; furthermore, the heterogeneity index of small vessels was markedly decreased in both the interventional groups with respect to the control group. Compared with the NE group, the MFI was significantly higher (P < 0.05) and the heterogeneity index was significantly lower (P < 0.05) in the TP group.

Conclusions

Both TP and NE improved hemodynamic and microcirculatory alterations in rats with endotoxic shock. Compared with NE, TP was more effective in promoting MFI and improving the heterogeneity of small bowel mesentery in rats.     

参麦注射液对充血性心力衰竭患者微循环的影响研究

目的研究观察参麦注射液对充血性心力衰竭患者微循环的影响。方法将本院于2011年12月-2013年12月收治的70例充血性心力衰竭患者随机分为对照组（常规充血性心力衰竭治疗组）35例和观察组（常规充血性心力衰竭治疗加参麦注射液组）35例,然后将两组患者治疗前和治疗后1周与2周时的甲襞微循环积分值及其他指标进行统计与比较。结果观察组治疗后1周与2周时的甲襞微循环积分值均低于对照组,而其他指标也均好于对照组（P〈0.05）,两组患者治疗后1周与2周时统计结果之间差异均有统计学意义。结论参麦注射液对充血性心力衰竭患者微循环的影响较大,在充血性心力衰竭患者中的应用价值较高。     

Biophotonic methods in microcirculation imaging

Visible and near-infrared light, particularly in the wavelength region of 600–1100 nm, offer a window into human and animal tissues due to reduced scattering and absorption. We review the main biophotonic methods applied to visualisation and assessment of the microcirculation and document the progress made over the past 10 years in particular. Applications, particularly in human skin, are of special topical importance due to an improved knowledge of its role and its value as a surrogate for other organs in drug testing at a time when drug development is under severe pressure.