腹腔间隔室综合征动物模型的构建特点

背景：腹腔间隔室综合征导致多器官功能损害的具体机制尚不十分清楚,为深入研究其发病机制及病理生理过程,需要合适的动物模型。 目的：就腹腔间隔室综合征动物模型的制备过程中可能遇到的相关问题进行讨论,包括制备模型的标准、方法、动物的选择及监测腹压的方式。 方法：由第一作者检索PubMed数据及CNKI数据库1990/2011有关腹腔间隔室综合征及腹腔高压及相关动物模型方面的文献。 结果与结论：一个成功的腹腔间隔室综合征动物模型最好能保持腹腔压力的稳定,并能持续一定的时间,同时尽可能少的影响实验结果。所以无论选择腹腔灌注气体还是灌注液体模型的测量腹腔内压并维持压力的稳定是关键。腹腔灌注液体模型无法动态监测腹压,且压力波动较大,与之相比腹腔灌注气体模型测压较为方便,若使用电子供气系统动态监测则更为理想。生理模型是前瞻性的实验,但现有的生理模型有待改进。     

胺碘酮治疗器质性心脏病并恶性室性心律失常的疗效观察

目的 观察胺碘酮治疗器质性心脏病并恶性室性心律失常的近期疗效。方法 对收入CCU符合入选条件的68例器质性心脏病并恶性室性心律失常患者随机分为2组。治疗组36例：部分病例采用胺碘酮转复；其余采用电转复，成功后用胺碘酮维持窦性心律（窦律）。对照组32例：应用利多卡因转复及维持窦律，将两组转复及维持窦律结果进行比较。结果 治疗组总有效率77．8％（28／36），明显高于对照组56．25％（18／32），P〈0．05，部分利多卡因无效患者用胺碘酮仍有效。结论 胺碘酮是治疗恶性室性心律失常最有效药物之一，其临床疗效优于利多卡因。     

消化道恶性肿瘤伴癌性腹水患者腹腔化疗前后血清及腹水IL-6和sIL-6R水平变化的意义

目的：探讨腹腔化疗对癌性腹水患者血清及腹水IL-6及sIL-6R水平影响及其临床意义。方法：采用放免法测定病人腹腔化疗前、治疗后四周血清及腹水IL-6水平变化,用ELISA同时测定sIL-6R水平变化,并与正常对照组相对比。结果：消化道恶性肿瘤伴癌性腹水患者血清IL-6和sIL-6R水平较正常对照组明显升高,腹水IL-6和sIL-6R水平较血清IL-6和sIL-6R水平明显增高。腹腔化疗后血清IL-6和sIL-6R水平下降,腹水IL-6和sIL-6R水平变化与血清水平变化相平行。且血清及腹水IL-6及sIL-6R水平变化与腹腔化疗是否有效有密切关系。结论：监测癌性腹水患者血清及腹水IL-6及sIL-6R水平变化是判断及预测腹腔化疗是否有效的途径之一。     

非手术脊柱减压系统DRX9000治疗椎间盘源性腰痛的临床初步报告

目的观察非手术脊柱减压系统DRX9000治疗椎间盘源性腰痛的疗效。方法对50例椎间盘源性腰痛患者进行非手术脊柱减压系统DRX9000治疗,在治疗开始时、治疗1周后、治疗2周后、治疗4周后、整个疗程结束时都对患者进行腰椎活动度、压痛点、双下肢运动感觉、肌力、神经反射的检查并记录,填写《汉化Oswestry功能障碍评分表》,根据分值的变化对疗效进行评估。50例患者均完成了20次治疗。结果 50例患者汉化Oswestry功能障碍评分平均分从治疗前的24.64分,变为治疗1周后13.12分,治疗2周后11.74分,治疗4周后9.70分,治疗结束后9.22分。治疗有效率为86%。将汉化Oswestry功能障碍评分的分值换算为功能障碍指数（CODI）后,发现随着治疗时间的增加,CODI降低的人数逐渐增多。随访50例患者,得到其中36人完整资料,平均随访时间6.2个月,汉化Oswestry功能障碍评分平均分为5.75分。结论非手术脊柱减压系统DRX9000治疗椎间盘源性腰痛,患者恢复良好,效果优。     

鼻窦具有神经和肌源性特征的低度恶性肉瘤:28例临床病理分析

本文介绍一种独特的以同时具有神经和肌源性分化的鼻窦低度恶性梭形细胞肉瘤。作者回顾分析28例肿瘤,其中女性21例,男性7例,年龄24～85岁,平均52岁,50岁女性具有明显的好发倾向。临床症状以鼻塞多见,累及多个部位,以鼻腔和筛窦最常受累。眼观:多个息肉样肿块,灰白灰红色,最大径4 cm,质地较典型的炎症性鼻息肉硬。镜检:     

γ-突触核蛋白是一种反应性滤泡树突状细胞、滤泡树突状细胞肉瘤、卡波西肉瘤、良性和恶性血管源性肿瘤的新标记物

突触核蛋白组成了一个仅存在于脊椎动物的小的可溶性神经蛋白质家族,其作用是促使突触前神经终端的囊泡快速释放神经递质。生物化学研究结果显示α-Synuclein表达于骨髓的正常巨核细胞和红系幼稚细胞以及血液循环中的血小板和红细胞中。     

A new flexible pressure sensor contributes to the early diagnosis of acute compartment syndrome

Acute compartment syndrome (ACS) is a surgical emergency, caused by the sharp increase of interstitial pressure within a closed osteofascial compartment, which can impair local circulation and functions. A non-invasive sensor is needed of satisfactory sensitivity to continuously monitor the alterations of the ACS pressure, which could be used as a supplementary means in the early diagnosis of ACS. A prepared “pasting-type” flexible pressure sensor was used to establish an extracorporeal pig-skin model with a soft-tissue expander device to simulate compartment syndrome conditions. An acrylic panel was inserted into the pig skin, allowing the soft-tissue expander to expand in one direction, which is similar to the movements of a patient’s bones in real life. The touch spot of the flexible pressure sensor was attached to the rind by medical tape, to record the internal and external pressure data. Relationships between the internal and external pressures at different thickness (0.87 mm, 3.53 mm and 3.97 mm), as well as that of the 3.97 mm thickness under various initial internal pressures (0.5 mmHg, 25 mmHg and 44 mmHg) were measured. Significant differences were observed in the range of internal pressures at various pig-skin thickness. After adding the acrylic panel, the measured ranges were significantly increased, with the lowest measurable internal pressure being 5 mmHg. Moreover, alterations in external pressure were also greater than in models without acrylic panels. The external pressure measured by the sensor was able to reflect an increase in intra-organizational pressure. This may be a new non-invasive and sustainable method for early diagnosis of ACS.     

猪腹腔高压模型的建立及腹腔高压对门静脉血炎症细胞因子表达的影响

目的 探讨猪腹腔高压动物模型的建立方法,以及腹腔高压对门静脉血中肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-10等炎症细胞因子表达的影响。方法 选取健康家猪6只,体质量25.2~28.4（26.86±0.85）kg。采用多水囊叠加方法制备腹腔高压动物模型,并放置门静脉导管。在腹腔高压动物模型制备前和模型制备过程中腹腔压力为0、5、10、15、20、25、30 mmHg（1 mmHg=0.133 kPa）时,分别抽取门静脉血5 mL,采用免疫荧光法检测其中炎症细胞因子TNF-α、IL-6、IL-10的表达水平。观察对比制备腹腔高压动物模型前及制备过程中不同腹腔压力时门静脉血中TNF-α、IL-6、IL-10的变化情况,采用简单线性回归分析TNF-α、IL-6、IL-10表达水平与腹腔压力的关系。结果 6只实验动物均成功完成模型制备,实验过程中无死亡。腹腔压力达到30 mmHg时腹腔水囊注入液量为2 560~2 720 mL。腹腔高压动物模型制备前及制备过程中不同腹腔压力点,门静脉血中炎症细胞因子TNF-α、IL-10表达水平呈先上升后下降趋势,IL-6表达水平呈上升趋势,差异均有统计学意义（F=15.66、40.37、34.67,P值均<0.001）。线性回归分析显示：TNF-α表达水平与腹腔压力呈负相关性,回归方程分别为$\widehat{Y}$_TNF-α=-0.013X_腹腔压力+1.346（R²=0.341,P<0.001）;IL-6、IL-10表达水平均与腹腔压力呈正相关,回归方程分别为$\widehat{Y}$sub>IL-6=0.013X_腹腔压力+0.222（R²=0.777,P<0.001）, $\widehat{Y}$_IL-10=0.022X_腹腔压力+0.402（R²=0.642,P<0.001）。结论 采用多水囊叠加方法可成功制备腹腔高压动物模型。腹腔压力的升高,促进IL-6的表达,对TNF-α、IL-10的表达先促进后抑制。腹腔高压加重了机体的炎症反应。     

Time/frequency mapping of the heart rate,blood pressure and respiratory signals

The discrete Wigner distribution (DWD) was implemented for the time/frequency mapping of variations of R-R interval, blood pressure and respiratory signals. The smoothed cross-DWD was defined and the modified algorithm for the smoothed auto- and cross-DWD was proposed. Spurious cross-terms were suppressed using a smoothing data window and a Gauss frequency window. The DWD is easy to implement using the FFT algorithm. Examples show that the DWD follows well the instantaneous changes of spectral content of cardiovascular and respiratory signals which characterise the dynamics of autonomic nervous system responses.     

Diurnal changes of blood pressure,heart rate and body temperature during sleep in the rat

We have studied diurnal changes in mean arterial pressure (MAP), heart rate (HR) and body temperature (Tb) during wake (W), non-rapid eye movement sleep (NREMS) and REM sleep (REMS) in the rat. Although HR and Tb show a similar sinusoidal diurnal variation during all vigilance states, the diurnal profile for the MAP is vigilance-state dependent. During W, MAP values are higher during the dark phase, during NREMS, no significant diurnal change is seen, and during REMS, the MAP exhibits a reversed diurnal change, being higher during the light phase. The low frequency component (0.25–0.725 Hz) in the power spectral density of the blood pressure, an index of sympathetic activity, is also higher during the light phase than the dark phase in REMS. The present findings suggest that diurnal changes in MAP in the rat result from the wake rhythm, and that the mechanism for the diurnal control of MAP may be different from that for HR or Tb.     

Very high frequency oscillations in the heart rate and blood pressure of heart transplant patients

The authors studied the recently reported very high frequency (VHF) peaks in the heart rate (HR) and blood pressure (BP) power spectra of heart transplant (HT) patients. These VHF peaks appear at frequencies much higher than the respiratory frequency, in addition to the typical low-frequency and high-frequency peaks. Twenty-five recordings obtained from 13 male HT patients (0.5–65 months following surgery) were compared with recordings from 14 normal male subjects. The ECG, continuous BP and respiration were recorded during 45 min of supine rest. Eight recordings from HT patients were excluded owing to arrhythmias. Spectral analysis was performed on all other recordings. VHF peaks were found in the spectra of both BP and HR in nine recordings obtained from six HT patients. In some cases, the power in the VHF peaks was markedly higher than that of the high-frequency peak. No VHF peaks were observed in eight recordings obtained from four HT patients or in recording from any of the normal subjects. No correlation was found between the incidence of VHF peaks and time after transplant. It was proved that the VHF peaks were not artifactual, and their significance within the framework of the theory of communication systems is discussed. The presence of those peaks was attributed to vagal denervation.     

Changes of splanchnic perfusion after applying positive end expiratory pressure in patients with acute respiratory distress syndrome

Background:

Positive end-expiratory pressure (PEEP) improves oxygenation and can prevent ventilator- induced lung injury in patients with acute respiratory distress syndrome (ARDS). Nevertheless, PEEP can also induce detrimental effects by its influence on the cardiovascular system. The purpose of this study was to assess the effects of PEEP on gastric mucosal perfusion while applying a protective ventilatory strategy in patients with ARDS.

Materials and Methods:

Thirty-two patients were included in the study. A pressure–volume curve was traced and ideal PEEP, defined as lower inflection point + 2cmH₂O, was determined. Gastric tonometry was measured continuously (Tonocap). After baseline measurements, 10, 15 and 20cmH₂O PEEP and ideal PEEP were applied for 30 min each. By the end of each period, hemodynamics, CO₂ gap (gastric minus arterial partial pressures), and ventilatory measurements were taken.

Results:

PEEP had no effect on CO₂ gap (median [range], baseline: 18 [2–30] mmHg; PEEP 10: 18 [0–40] mmHg; PEEP 15: 17 [0–39] mmHg; PEEP 20: 16 [4–39] mmHg; ideal PEEP: 19 [9–39] mmHg; P = 0.19). Cardiac index also remained unchanged (baseline: 4.7 [2.6–6.2] l min⁻¹ m⁻²; PEEP 10: 4.4 [2.5–7] l min⁻¹ m⁻²; PEEP 15: 4.4 [2.2–6.8] l min⁻¹ m⁻²; PEEP 20: 4.8 [2.4–6.3] l min⁻¹ m⁻²; ideal PEEP: 4.9 [2.4–6.3] l min⁻¹ m⁻²; P = 0.09).

Conclusion:

PEEP of 10–20 cmH₂O does not affect splanchnic perfusion and is hemodynamically well tolerated in most patients with ARDS, including those receiving inotropic supports.     

Effects of p-synephrine alone and in combination with selected bioflavonoids on resting metabolism, blood pressure, heart rate and self-reported mood changes

Bitter orange (Citrus aurantium) extract is widely used in dietary supplements for weight management and sports performance. Its primary protoalkaloid is p-synephrine. Most studies involving bitter orange extract and p-synephrine have used products with multiple ingredients. The current study assessed the thermogenic effects of p-synephrine alone and in conjunction with the flavonoids naringin and hesperidin in a double-blinded, randomized, placebo-controlled protocol with 10 subjects per treatment group. Resting metabolic rates (RMR), blood pressure, heart rates and a self-reported rating scale were determined at baseline and 75 min after oral ingestion of the test products in V-8 juice. A decrease of 30 kcal occurred in the placebo control relative to baseline. The group receiving p-synephrine (50 mg) alone exhibited a 65 kcal increase in RMR as compared to the placebo group. The consumption of 600 mg naringin with 50 mg p-synephrine resulted in a 129 kcal increase in RMR relative to the placebo group. In the group receiving 100 mg hesperidin in addition to the 50 mg p-synephrine plus 600 mg naringin, the RMR increased by 183 kcal, an increase that was statistically significant with respect to the placebo control (p<0.02). However, consuming 1000 mg hesperidin with 50 mg p-synephrine plus 600 mg naringin resulted in a RMR that was only 79 kcal greater than the placebo group. None of the treatment groups exhibited changes in heart rate or blood pressure relative to the control group, nor there were no differences in self-reported ratings of 10 symptoms between the treatment groups and the control group. This unusual finding of a thermogenic combination of ingredients that elevated metabolic rates without corresponding elevations in blood pressure and heart-rates warrants longer term studies to assess its value as a weight control agent.     

Effects of acupuncture on obstructive sleep apnea severity,blood pressure control and quality of life in patients with hypertension: A randomized controlled trial

Obstructive sleep apnea (OSA) is a common condition among patients with hypertension and treatment with continuous positive airway pressure (CPAP) can decrease blood pressure (BP). However, CPAP is not well tolerated by a significant proportion of patients. The authors investigated the effects of acupuncture on OSA severity and BP control in patients with hypertension. Hypertensive patients with mild to moderate OSA (apnea–hypopnea index, 5–30 events/hr) were randomly assigned to receive acupuncture or sham‐acupuncture treatment. Patients were assessed at baseline and after 10 acupuncture sessions using polysomnography, 24‐hr ambulatory BP monitoring and a quality of life questionnaire. Forty‐four patients (34% men; mean age, 57.0 ± 5.4 years; body mass index, 29.6 ± 3.2 kg/m²; apnea–hypopnea index, 16.3 ± 6.7 events/hr) completed the study. There were no differences in pre–post‐intervention apnea–hypopnea index, daytime or nocturnal BP, or quality of life between the acupuncture and sham‐acupuncture groups (p > .05). Acupuncture therapy in hypertensive patients with OSA did not reduce OSA severity, daytime or nocturnal BP, or quality of life.     

Different effects of eicosapentaenoic acid and olive oil on blood pressure,intracellular free platelet calcium,and plasma lipids in patients with essential hypertension

Summary In a randomized, double-blind, crossover study our specific aim was to examine the effects of a dietary fish oil or olive oil supplementation on blood pressure, intracellular free platelet calcium, plasma lipoproteins, and circulating vasoactive substances such as norepinephrine, epinephrine, and renin in patients with essential hypertension. Ten hypertensive patients (WHO classes I, II) were randomly assigned to receive 9 g fish oil or 9 g olive oil daily for 6 weeks after a 4-week baseline period. The 6-week treatment periods were separated by a 4-week wash-out. During treatment with fish oil diastolic blood pressure decreased from 103±1 to 98±2 mmHg (P<0.05) but did not change significantly during olive oil intake. Systolic blood pressure was not affected by either treatment. Intracellular free platelet calcium decreased in patients receiving fish oil (from 102±8 nM to 86±6 nM, P < 0.05) but was not significantly altered by olive oil treatment. In contrast, the dose-response curve for thrombin-induced intracellular free platelet calcium was not altered by the fish oil enriched diet. Plasma triglycerides decreased by approximately 40% in the fish oil group while low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol were not altered. Renin activity, norepinphrine, and epinephrine in plasma were not influenced by fish oil supplementation. We conclude that a moderate increase in dietary fish oil reduces diastolic blood pressure, intracellular free platelet calcium, and plasma triglycerides in patients with essential hypertension. The decrease in basal intracellular free platelet calcium concentration does not seem to be due to a diminished responsiveness of the calcium messenger system to thrombin.This work was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG) Ha-1388/2-3