治疗血浓度下抗癫(癎)药对未成熟脑发育影响的实验研究

目的 探讨抗癫(癎)药物(AEDs)在治疗血浓度下对未成熟脑发育的影响.方法 以AEDs血浓度达到临床治疗稳态血浓度为实验剂量,设立健康幼鼠及成年SD大鼠氯硝西泮(CNP)、苯巴比妥(PB)、丙戊酸(VPA)、托吡酯(TPM)实验组及正常对照组(各18只).AEDs灌胃5周,于停药后次日、2周及1个月末,行Morris水迷宫及穿梭箱测试.停药当天记录体重、脑重,海马及额叶组织行苏木素-伊红(HE)、尼氏染色及电镜观察.结果 (1)停药后次日及2周的穿梭箱实验,幼鼠CNP和PB组逃避潜伏期明显长于对照组.即使停药后1个月,幼鼠CNP[(6.05±2.04)s]及PB组[(5.81±1.75)s]与对照组的差异仍有统计学意义[(4.75±2.43)s,P＜0.01].而停药后2周,成年鼠各AEDs组与对照组已无差异;(2)Morris水迷宫实验,分别于停药后次日、2周及1个月,幼鼠CNP和PB组登平台潜伏期均长于对照组.而成年鼠各组登平台潜伏期于停药后2周已无差异;(3)幼鼠CNP组脑重(1.67±0.04)g,PB组脑重(1.66±0.04)g,较对照[(1.75±0.06)g]轻;(4)神经元广泛变性坏死,神经细胞数[CNP组为(76.87±18.60)个/200倍视野,PB组(72.60±17.26)个/200倍视野]较对照少[(109.13±33.73)个/200倍视野,P＜0.01];(5)停药1个月后,PB组幼鼠神经元超微结构仍异常.结论 长期服用PB、CNP可引起未成熟脑学习记忆功能及脑组织病理学持续异常,PB对未成熟脑的损伤存在可能是不易恢复的.     

二尖瓣置换合并射频迷宫术的体外循环管理

目的探讨二尖瓣置换合并射频迷宫术的体外循环 (CPB)方法。方法 :76例风湿性心脏二尖瓣病变合并房颤患者实施瓣膜置换时 ,采用心内直视射频消融迷宫术对其合并的心房纤颤予以治疗。先期的 13例 (A组 )患者在CPB转流阻闭升主动脉后进行射频消融术和二尖瓣置换 ;后期 6 3例 (B组 )采用阻断上下腔静脉后先射频消融右心房 ,再行二尖瓣置换和左房射频消融。结果 :A组 13例患者CPB转流 (10 4± 2 5 )min ,主动脉阻断 (6 1± 11)min。B组 6 3例患者CPB转流 (81± 19)min ,主动脉阻断 (47± 11)min ;应用冷晶体心肌保护患者开放升主动脉后心脏自动复跳率 5 5 .9% ,应用冷血心肌保护患者心脏自动复跳率 71.4 %。术后恢复窦性心律 6 4例 ,占 84 .2 %。结论 :在二尖瓣置换合并射频迷宫术的体外循环中阻闭升主动脉前先射频消融左房可以明显缩短体外循环时间和主动脉阻断时间 ;应用冷血心肌保护液可以加强心肌保护效果且射频消融迷宫术治疗顽固性房颤效果明显     

Epicardial radiofrequency ablation for chronic atrial fibrillation undergoing simultaneous on-pump beating coronary artery bypass grafting

Off-pump coronary artery bypass grafting has become an attractive surgical alternative for myocar-dial revascularization because of the advantage of myocardial protection and other benefits of patients. However, it is still regarded as a controversial treatment for the coronary artery disease accompanied by atrial fibrillation (AF). A significant number of patients in need of coronary revascularization have chronic AF. Although the Cox-Maze III procedure is the gold standard for the surgical treatment of AF, few of these patients undergo AF operations at the time of their coronary bypass grafting. We report herein a case of the pulmonary vein isolation to eliminate the AF by means of epicardial radiofrequency ablation combined with 2 vessels coronary artery bypass grafting on the beating heart with the aid of cardiopulmonary bypass.     

射频消融迷宫术治疗心房纤颤

作者采用射频消融迷宫术治疗心房纤颤２０例，其中１９例合并风湿性二尖瓣病的患者，同时行瓣膜替换术，１例合并房间隔缺损患者进行修复。射频消融的路线采用小板井嘉夫的手术径路。术后１６例恢复窦性心律，占８０％，未恢复窦性心律的４例，２例为房颤，１例为房扑，另１例为结性心律。射频消融迷宫术耗时短，仅增加钳闭主动脉时间平均２０．５分钟，无术后出血的潜在危险。但术后７～１０天之内，有１８例出现过房颤、房扑、房速等室上性心律失常，可能由于射频消融不均匀，干扰心房的心电活动所致。     

Enhanced zinc consumption causes memory deficits and increased brain levels of zinc

Zinc deficiency has been shown to impair cognitive functioning, but little work has been done on the effects of elevated zinc. This research examined the effect on memory of raising Sprague-Dawley rats on enhanced levels of zinc (10 ppm ZnCO3; 0.153 mM) in the drinking water for periods of 3 or 9 months, both pre- and postnatally. Controls were raised on lab water. Memory was tested in a series of Morris Water Maze (MWM) experiments, and zinc-treated rats were found to have impairments in both reference and working memory. They were significantly slower to find a stationary platform and showed greater thigmotaxicity, a measure of anxiety. On a working memory task, where the platform was moved each day, zinc-treated animals had longer latencies over both trials and days, swam further from the platform, and showed greater thigmotaxicity. On trials using an Atlantis platform, which remained in one place but was lowered on probe trials, the zinc-treated animals had significantly fewer platform crossings, spent less time in the target quadrant, and did not swim as close to the platform position. They had significantly greater latency on nonprobe trials. Microprobe synchrotron X-ray fluorescence (microSXRF) confirmed that brain zinc levels were increased by adding ZnCO3 to the drinking water. These data show that long-term dietary administration of zinc can lead to impairments in cognitive function.     

Hippocampal neuron and synaptophysin-positive bouton number in aging C57BL/6 mice

A loss of hippocampal neurons and synapses had been considered a hallmark of normal aging and, furthermore, to be a substrate of age-related learning and memory deficits. Recent stereological studies in humans have shown that only a relatively minor neuron loss occurs with aging and that this loss is restricted to specific brain regions, including hippocampal subregions. Here, we investigate these age-related changes in C57BL/6J mice, one of the most commonly used laboratory mouse strains. Twenty-five mice (groups at 2, 14, and 28–31 months of age) were assessed for Morris water-maze performance, and modern stereological techniques were used to estimate total neuron and synaptophysin-positive bouton number in hippocampal subregions at the light microscopic level. Results revealed that performance in the water maze was largely maintained with aging. No age-related decline was observed in number of dentate gyrus granule cells or CA1 pyramidal cells. In addition, no age-related change in number of synaptophysin-positive boutons was observed in the molecular layer of the dentate gyrus or CA1 region of hippocampus. We observed a significant correlation between dentate gyrus synaptophysin-positive bouton number and water-maze performance. These results demonstrate that C57BL/6J mice do not exhibit major age-related deficits in spatial learning or hippocampal structure, providing a baseline for further study of mouse brain aging.     

母源性BDE-209胃灌后对子鼠学习记忆能力的影响以及血清BDE-209浓度的测定

目的研究母鼠在妊娠期及哺乳期接触十溴联苯醚(brominated diphenyl ethers-209,BDE-209)对子鼠的学习记忆能力的影响以及血清BDE-209的浓度测定。方法通过胃灌的方法造成Wistar大鼠BDE-209[300mg/(kg.d)]的暴露模型,直至生育出的子鼠断乳,通过Y型迷宫测试子鼠的学习记忆能力。然后分别取母鼠及子鼠的血清进行BDE-209的测定。结果终生胃灌BDE-209组的大鼠学习能力为89.65±6.68,记忆能力为平均为4.75±1.25,均较对照组(学习能力68.85±9.28,记忆能力8.05±0.76)有明显的下降,差异有统计学意义(P<0.01);妊娠期以及哺乳期均胃灌组学习能力为74.40±8.26,较正常对照组有下降,差异有统计学意义(P<0.05),但记忆能力下降差异无统计学意义(P>0.05);单纯哺乳期胃灌组较对照组学习记忆能力下降差异无统计学意义(P>0.05);母鼠血清中BDE-209的含量与子鼠正相关。结论BDE-209可以通过胎盘屏障以及母乳进入胎鼠体内并有一定程度的蓄积,并且可以影响发育中的子鼠神经系统,降低子鼠的学习记忆能力检测。     

Delayed improvement of autonomic nervous abnormality after the Maze procedure: time and frequency domain analysis of heart rate variability using 24 hour Holter monitoring

Objective—To analyse heart rate variability in patients with atrial fibrillation after the Maze procedure, to investigate whether the procedure damages the cardiac autonomic fibres supplying the sinus node.
Design and patients—Time and frequency domain analyses of RR variability were performed using 24 hour Holter monitoring one month after surgery in 12 patients with atrial fibrillation who underwent the Maze procedure (Maze group) and in seven patients who underwent cardiac surgery without the Maze procedure (control group). Mean RR intervals (mRR) and the standard deviation of successive RR intervals (SDRR) were determined by time domain analysis, and high frequency (HF), low frequency (LF), and total power (TP) spectral components of RR variability were calculated by frequency domain analysis. Holter monitoring was also performed at six and 12 months after cardiac surgery in the Maze group.
Results—Circadian variation (mean (SD)) in mRR (daytime to night time difference: 119 (60) v 302 (143) ms), SDRR (daytime: 8.4 (3.3) v 37.0 (12.0) ms), TP (daytime: 46.7 (16.0) v 171.8 (30.4) ms), HF (daytime: 19.6 (9.9) v 36.7 (7.1) ms²), and LF/HF (daytime: 0.31 (0.07) v 1.18 (0.46)) was decreased in the Maze group at one month compared with the control group (p < 0.01), but showed improvement at six and 12 months (p < 0.05).
Conclusions—Surgery combined with the Maze procedure markedly suppressed the circadian variation of heart rate over a 24 hour period within one month after surgery, mainly because of damage to the innervation of the sinus node. However, at six and 12 months there was restoration of circadian variation, probably as the result of reinnervation of the sinus node.

Keywords: autonomic nervous system;  heart rate variability;  Maze procedure