99Tcm-S2-51对兔骨水泥髓腔灌注后肺血栓形成及其干预措施的放射免疫显像研究

目的 应用99Tcm-S2-51检测骨水泥灌注后兔肺血栓的形成,并探讨预防肺栓塞发生的干预措施.方法 大耳白兔16只,体重2.5～3.0 kg,随机分为4组.A组(未干预组):骨髓腔灌注骨水泥并加压;B组(盐酸肾上腺素组):骨髓腔内用盐酸肾上腺素盐水(1:10 000)冲洗髓腔后灌注骨水泥并加压;C组(生物蛋白胶组):用生物蛋白胶喷洒骨髓腔后灌注骨水泥并加压;D组(空白对照组):骨髓腔不灌注骨水泥.每组动物在骨水泥灌注前耳缘静脉注入99Tcm-S2-51 2 ml,骨水泥灌注后60、120和180min进行核素显像,测定活体肺放射活性后,立即处死动物,取出完整肺组织,测定离体肺放射活性后肺组织固定进行病理学检测.结果 骨水泥髓腔灌注并加压后60、120和180 min,肺组织的放射活性,A组分别为(11.48±2.35)、(14.41±3.10)和(18.25±5.01) ID/pixels,B组分别为(8.21±3.21)、(10.19±2.40)和(11.32±3.12) ID/pixels,C组分别为(4.06±1.04)、(5.68±2.80)和(7.40±1.12) ID/pixels,各时间点组间差异有统计学意义.病理学检查显示肺部有血栓形成,骨水泥髓腔灌注前应用盐酸肾上腺素或生物蛋白胶,肺部放射活性明显下降.结论 99Tcm-S2-51可以用于骨水泥灌注后兔肺血栓形成的动态观察.应用盐酸肾上腺素和生物蛋白胶可以降低骨水泥肺栓塞的发生率.     

骨水泥型髋关节置换术中盐酸肾上腺素髓腔冲洗的护理配合

目的总结盐酸肾上腺素髓腔冲洗在骨水泥型髋关节置换术中的护理配合方法。方法对40例行骨水泥型髋关节置换术患者术中均使用1∶500 000肾上腺素生理盐水冲洗并浸湿纱布填塞髓腔。术前加强心理护理,备好手术物品,正确配制肾上腺素生理盐水;术中严格无菌操作,并密切观察患者血压、心率等生命体征变化等。结果骨水泥植入后患者血压、心率、SpO2变化不明显,出血(127.44±76.25)mL,均未发生骨水泥植入综合征。仅1例患者术后出现偶发室早,及时处理后症状缓解。结论盐酸肾上腺素盐水冲洗髓腔能有效预防骨水泥植入综合征的发生以及减少术中出血,保证手术治疗效果。     

纤维蛋白胶联合转染金属蛋白酶组织抑制剂-1预防自体移植静脉再狭窄

目的 为减少冠状动脉旁路移植术后移植静脉再狭窄,探讨术中应用纤维蛋白胶联合转染金属蛋白酶组织抑制剂-1(TIMP-1)对自体移植静脉再狭窄的影响及其作用机制.方法 将24只新西兰大耳白兔随机分为3组,每组8只,即非支架组(NS组)、纤维蛋白胶外支架组(FS组)、纤维蛋白胶联合转染TIMP-1组(TS/FS组) 建立兔颈外静脉颈总动脉旁路移植术模型.术后28 d取出移植静脉桥,进行组织病理分析移植静脉内膜厚度、中膜厚度及内膜面积、中膜面积,用逆转录-聚合酶链反应(RT-PCR)和Western blot法检测各组移植静脉中TIMP-1基因的表达.结果 术后28d,TS/FS组移植静脉内膜厚度及内膜面积分别为(37.98 ±4.19) μm及(0.557±0.049) mm2,与NS组的( 76.87±4.32) μm、(1.025 ±0.103)mm2及FS组的(50.28 ±4.69) μm、(0.743±0.052) mm2比较,明显减少(P＜0.05);TS/FS组移植静脉中膜厚度及中膜面积分别为(28.45 ±3.01) μm及(0.458 ±0.053) mm2,与NS组的(55.98±4.33) μm、(0.944±0.084) mm2及FS组的(36.46±4.36) μm、(0.643 ±0.056)mm2比较,差异有统计学意义(P＜0.05).与NS组和FS组比较,TS/FS组TIMP-1基因的mRNA和蛋白表达明显增强,差异有统计学意义(P＜0.05).结论 纤维蛋白胶联合血管外膜TIMP-1转染能够实现移植静脉TIMP-1基因的过表达;纤维蛋白胶外支架联合TIMP-1对移植静脉内膜和中膜增生有协同抑制作用.     

以纤维蛋白胶为载体的注射型骨修复材料对兔桡骨骨缺损修复的实验研究

目的　了解以纤维蛋白胶 (FS)为载体的注射型骨修复材料修复兔桡骨节段性骨缺损的能力 ,为其临床的应用提供实验依据。方法　实验分组为 :实验组b (FS +bFGF +牛BMPbBMP)、对照组b1(FS +bBMP)、实验组r (FS +bFGF +rhBMP- 2 )、对照组r1(FS +rhBMP)、对照组FS。于 70只新西兰白兔右侧桡骨干处造成 1 5cm缺损 ,然后严密缝合皮下组织及皮肤 ,将各组材料经正常皮肤注射骨缺损处 ,术后不同时间进行放射学、组织学和骨密度等方法检查 ,对其成骨效应进行研究。结果　在以bBMP为成骨因子的实验区中 ,实验组b骨缺损区在成骨活跃程度、骨密度和再生髓腔结构等方面均显著优于对照组b1,使骨缺损得到了较彻底的修复 (P <0 0 1) ;同样 ,在以rhBMP - 2为成骨因子的实验区中 ,实验组r骨缺损区在成骨活跃程度、骨密度和再生髓腔结构等方面均显著优于对照组r1,使骨缺损得到了较彻底的修复 (P <0 0 1) ,对照组FS不能产生骨性愈合。结论　以FS为载体复合BMP和bFGF的注射型骨修复材料具有高效的骨修复能力。     

纤维蛋白胶复合BMP对去卵巢山羊骨密度和松质骨中OPG表达的影响

目的 了解纤维蛋白胶（Fibrin sealant,FS）复合BMP2局部成骨机制,为其临床应用提供实验依据.方法 将9只2岁雌性山羊施行卵巢切除术,以每个山羊桡骨远端为一个实验单位,共18个单位,随机分为：生理盐水组（NS）、纤维蛋白胶组（FS）、实验组（FS＋BMP2）,每组6个单位.术后6个月,分别在各组桡骨远端一次性注射生理盐水、纤维蛋白胶和纤维蛋白胶复合BMP2.注射5周后,应用双能X线吸收仪（DEXA）测量各组山羊桡骨远端的骨密度（BMD）;在桡骨远端取活组织,利用免疫组织化学染色及图像分析方法对组织切片进行图像分析,观察纤维蛋白胶复合BMP2对去势山羊松质骨骨保护素（OPG）表达的影响.结果 ①与NS组比较FS＋BMP2组桡骨远端BMD明显升高（P＜0.01）,FS组BMD变化不明显（P＞0.05）;FS＋BMP2组BMD明显高于FS组和NS组（P＜0.01）.②FS＋BMP2组灰度值明显低于NS组和FS组（P＜0.01）;NS组和FS组灰度值差别不明显（P＞0.05）.结论 局部注射纤维蛋白胶复合BMP2具有高效的骨诱导活性,对局部骨质疏松骨折具有预防作用.     

外源性VEGF联合“夹心法”矫治半侧颜面短小的实验研究

目的:探索血管内皮生长因子、纤维蛋白胶及珊瑚人工骨复合物结合下颌骨外板劈开即"夹心法"成骨过程中组织形态学变化,为进一步的实验研究及以后的临床应用提供理论依据。方法:以小型猪为实验对象,A组左侧行下颌骨外板劈开,颗粒状珊瑚羟基磷灰石、血管内皮生长因子及纤维蛋白胶(CHA+VEGF+FS)复合物植入术,右侧作为正常对照组。B组左侧行下颌骨外板劈开,颗粒状珊瑚羟基磷灰石、血管内皮生长因子及纤维蛋白胶(CHA+VEGF+FS)复合物植入术;右侧行下颌骨外板劈开,颗粒状珊瑚羟基磷灰石及纤维蛋白胶(CHA+FS)复合物植入术。通过组织形态学观察等手段研究VEGF对新骨形成过程的影响,评估术后效果。结果:研究发现CHA+VEGF+FS复合物植入后可以促进珊瑚人工骨实现早期血管化,从而减低骨再生过程中珊瑚人工骨的无效降解。结论:CHA+VEGF+FS夹心法可以为珊瑚人工骨提供更好的成骨条件,从而更好实现骨再生,最终使得其可以作为矫治半侧颜面短小导致的下颌骨发育不良畸形的有效手段之一。     

高频振荡通气及与肺表面活性物质联用对吸入性损伤家兔肺炎性反应的影响

目的 了解高频振荡通气(HFOV)及HFOV与肺表面活性物质(PS)联合应用对吸人性损伤家兔肺组织炎性反应的影响.方法 将新西兰大白兔24只制成重度蒸气吸入性损伤模型,按随机数字表法分为对照组、HFOV组和HFOV+PS组,每组8只,分别行定容通气、HFOV及HFOV+PS治疗.治疗3.5 h时取各组家兔肺组织标本,行病理学检查及肺损伤评分,检测髓过氧化物酶(MPO)及半胱氨酸天冬氨酸蛋白酶1(caspase-1)活性,测定TNF-α、IL-18、IL-10和IL-13含量及其mRNA的表达情况.结果 (1)各组吸入性损伤家兔肺组织出现不同程度病理学改变,以对照组最明显,HFOV+PS组最轻.对照组、HFOV组、HFOV+PS组肺损伤评分各为(3.71±0.43)、(2.87±0.26)、(2.08±0.28)分,组间两两比较,差异均有统计学意义(P<0.01).(2)HFOV组和HFOV+PS组家兔MPO、caspase-1活性明显低于对照组(P<0.01),并且HFOV+PS组明显低于HFOV组(P<0.05).(3)HFOV组和HFOV+PS组家兔TNF-α、IL-18含量及其mRNA表达量明显低于对照组(P<0.01),IL-10和IL-13含量及其mRNA表达量明显高于对照组(P<0.01);HFOV+PS组这几项指标较HFOV组变化更明显(P<0.05).结论 HFOV能减轻吸入性损伤家兔肺组织炎性反应和肺损伤,联合应用PS效果更佳.     

家兔部分肝脏切除术中应用纤维蛋白胶防治术后出血及胆汁渗漏的实验研究

目的 研究部分肝脏切除术中使用纤维蛋白胶防治术后出血及胆汁渗漏的效果.方法 制作家兔部分肝脏切除模型,将40只家兔按随机数字表法随机分为假手术组(n=10)、对照组(n=10)和实验组(n=20).其中假手术组行单纯开腹术,对照组与实验组行肝脏部分切除术,对照组采用电刀烧灼肝脏创面,实验组在烧灼后再在肝脏创面喷洒纤维蛋白胶.术后观察动物进食、体重以及不良反应发生情况,定时记录腹腔引流量,检测腹腔引流液中血红蛋白(hemoglobin,Hg)、白细胞(WBC)、总胆红素(TBil)以及血中谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)和TBil的水平.结果 实验组平均出血量和手术时间分别为(16.0±2.7)ml和(23.7±2.9)rain,明显低于对照组的(20.8±3.5)ml和(27.3±2.9)min(P＜0.01);实验组动物的腹腔引流量、引流液中Hg、wBC和TBil水平均随时间延长而逐渐降低(P＜0.05),其中实验组术后腹腔引流液中Hg水平在术后第1、2和7 d明显低于对照组(P＜0.05),TBil水平在术后1、2、3、5和7 d均明显低于对照组(P＜0.05);术后对照组和实验组的ALT、AST、LDH和TBil水平均显著高于假手术组(P＜0.01),而实验组的ALT、AST(除第3 d以外)和LDH水平显著低于对照组(P＜0.05);3组动物进食良好,体重增加,无不良反应和死亡发生.结论 肝脏部分切除术中使用纤维蛋白胶对防治术后创面出血和胆汁渗漏是安全有效的.     

减压型髓腔锉减少扩髓诱发脂肪栓塞的实验研究

目的观察减压型髓腔锉能否减轻髋关节置换术中扩髓诱发的脂肪栓塞,为预防人工关节置换过程中的脂肪栓塞提供参考。方法12只杂种犬随机分为实验组和对照组,每组6只。模拟髋关节置换术的扩髓过程,实验组使用减压型髓腔锉扩髓,其外表面刻有齿槽,主要作用部分呈锥形,尖端直径6.4mm。沿其中央纵轴有一直径4mm的孔与两端相通,在距离尖端77mm处有一侧向支管。对照组使用普通髓腔锉扩髓。扩髓过程中记录髓腔内压力峰值、血液动力学指标。动物处死后,Leica图像分析仪计算肺组织内脂肪栓塞的面积,进行t检验。结果实验组、对照组髓内压力分别为(22.4±7.7)kPa和(34.5±10.2)kPa,两者间差异有非常显著性意义(P<0.01);肺组织内脂肪栓塞面积百分比分别为0.21%和0.64%,两者间差异有显著性意义(P<0.05);平均肺动脉压分别为(1.7±0.4)kPa和(2.2±0.4)kPa,差异有显著性意义(P<0.05)。结论普通髓腔锉可诱发脂肪栓塞,并造成对血流动力学的影响;减压型髓腔锉使扩髓时髓腔内压力得到释放,减少了肺组织内的脂肪栓塞,降低了肺动脉压的增加。     

全髋置换术扩髓及骨水泥灌注对血液动力学的影响及其机制

目的：观察全髋置换术中扩髓及骨水泥灌注对血液动力学的影响并探讨其机制。方法：选择在硬膜外联合全身麻醉下行全髋置换术成年患进18例，记录扩髓前，扩髓即刻，髓腔冲洗，骨水泥灌注即刻，灌注后3、5、10分钟时动脉压（SBP、DBP）、中心静脉压（CVP）；用食道超声多普勒监测以上时点心排血量（CO）、每搏量（SV）、血流加速度（ACC）、峰流速（PV）、体循环阻力（TSVR）、左心室射血时间指数（LVETI）以及各时血血气参数。结果：（1）骨水泥灌注即刻，灌注后3、5分钟SBP、DBP显著下降（P＜0．01）；扩髓即刻，髓腔冲洗，骨水泥灌注后3、5、10分钟时CVP均显著增加（P＜0．01），骨水泥灌注即刻CVP明显下降（P＜0．01）；（2）骨水泥灌注即刻，灌注后3、5分钟、CO、SV、ACC、PV显著下降（P＜0．01），LVETI明显延长，TSVR在骨水泥灌注即刻，灌注后3分钟也明显下降（P＜0．01）；（3）髓腔冲洗、骨水泥灌注即刻PaO2显著下降（P值分别小于0．1和0．05）；PaCO2均在正常生理范围内，但在髓腔冲洗时有明显增加（P＜0．01）。结论：全髋置换术扩髓可引起不程度的脂肪栓塞，骨水泥灌注时骨水泥具有短暂直接扩张血管和较持久的抑制心肌收缩功能作用。     

Use of fibrin sealant for reinforcing arterial anastomoses

Despite improvements in needles, sutures, and technique, hemorrhage remains a problem in cardiovascular surgery. In this study conventional vascular suture lines and suture lines reinforced with fibrin sealant are compared for blood loss and burst strength. Bilateral femoral arteries in 20 dogs were divided at 50% of their circumference and repaired with six 6-0 polypropylene sutures. Ten animals were systemically heparinized (3 mg/kg), and 10 were not on anticoagulants. The right femoral artery anastomosis was treated with fibrin sealant in all animals, and the left suture line served as the control. Three minutes after initiation of the sealing procedure, blood flow was reinstituted in both femoral arteries. After 3 minutes a significant difference in blood loss between the conventional suture technique and fibrin-reinforced anastomoses was noted in both heparinized (12.1 +/- 2.79 vs. 0.13 +/- 0.06 ml/min; p less than 0.01) and nonheparinized dogs (8.45 +/- 1.37 vs. 0.20 +/- 0.08 ml/min; p less than 0.001). After 30 minutes volume inflow and pressure catheters were inserted into snared compartments encompassing the femoral artery anastomosis. Continuous pressure recordings during volume loading with normal saline solution demonstrated increased bursting pressures of the fibrin-sealed suture lines in both the heparinized (317.5 +/- 13.18 vs. 135 +/- 23.17 mm Hg; p less than 0.001) and nonheparinized animals (474.5 +/- 26.82 vs. 311 +/- 29.31 mm Hg; p less than 0.001). Histologic examination revealed no fibrosis or foreign body reaction and complete resorption of the fibrin sealant within 3 weeks. Fibrin sealant, a powerful hemostatic agent produced from human donors not suffering from hepatitis, decreases blood loss and strengthens suture lines.(ABSTRACT TRUNCATED AT 250 WORDS)     

A new method to close an intestinal wall defect using fibrin glue and polyglycolic acid felt sealant

Purpose

This study aimed to propose an alternative method of suture closure for an intestinal wall defect using 2 absorbable materials.

Methods

An oval intestinal wall defect was created in the duodenum, ileum, or colon of rabbits. The defect was first covered by polyglycolic felt, which was then completely covered by fibrin glue to make a fibrin glue and polyglycolic acid felt (FGPAF) sealant without any suture procedures. The rabbits with a simple suture closure for the defect were used as controls. The bursting pressure of the treated intestine was measured, and macro- and microscopic observations were carried out for 6 months.

Results

Seven rabbits treated with the FGPAF sealant used in each of the 3 operated regions survived without any signs of peritonitis or intestinal obstruction, similar to the controls. The mean bursting pressure of the segment with wall defect closed by single layer sutures and the segment with FGPAF sealant was 69.7 mm Hg (n = 6) and 70.6 mm Hg (n = 7), respectively. A histologic study at 1 week after operation revealed that the FGPAF circumferentially adhered to the edge of the defect with fibrous tissue extension into the sealant; whereas when performing a laparotomy at 1 month after operation, a round mass consisting of the remnant FGPAF mixed with plant residues of daily chows was found loosely attached to the serousal surface.

Conclusion

These results suggest that the present technique may be useful for the new technique of intestinal wall closure.     

Production and clinical application of fibrin sealant with high concentrated fibrin (fibrin patch)

OBJECT: The sealing properties of fibrin sealant with high concentrated fibrin (fibrin patch) were examined. MATERIAL AND METHODS: A commercial fibrin sealant (Bolheal) produced from pooled human plasma was utilized for this study. The fibrin sealant made of fibrinogen and thrombin solutions mixed in a volume ratio 5:1 was applied as the fibrin sealant with high concentrated fibrin (fibrin patch). The burst pressure of the fibrin clots of either 1:1 or 5:1 mixing ratio, which sealed the small holes, was measured by a water-leak preventing model. The tensile strength of the fibrin patch was measured by the breaking pressure of the fibrin clot. The burst pressure of the fibrin patch, which sealed the dural defect with a diameter of 15 mm, was compared with that of expanded polytetrafluoroethylene (ePTFE). RESULTS: The burst pressure was elevated from 287 +/- 23.1 to 445 +/- 30.5 mmHg by changing the mixing ratio from 1:1 to 5:1. The breaking pressure of the fibrin patch showed 131 +/- 25.4 mmHg and that of the patch mixed at the ratio of 1:1 showed 46.6 +/- 9.9 mmHg. The result of dural repair with the fibrin patch revealed higher sealing effectiveness than that of ePTFE. The burst pressure averaged 70.5 +/- 21.4 mmHg in the fibrin patch samples and 51.4 +/- 13 mmHg in the ePTFE samples. CONCLUSION: The fibrin patch revealed higher performance as a sealant and has the potential to be a candidate for acceptance as the new dural repair material.     

The hemodynamic behavior of arterial anastomosis using fibrin sealant: experimental study in swine

The wide use of biological sealants as a reinforcement for arterial sutures and the small experimental base in literature motivated this study. Our aim was to evaluate the flow, tear pressure, and the need of reinforcement stitches in sutured arteries after a cross-section. This research project complied with the Helsinki convention. The Tissucol (Baxter) fibrin sealant was used in all experiments. The femoral and carotid arteries of 17 swine from the same breed (weighing from 15 to 20 kg) were cross-sectioned after heparinization and subjected to anastomoses using a single continuous plane of 7-0 prolene. We worked with 68 artery samples, 34 in the treatment group and 34 in the control group. For each animal, one carotid and one femoral artery randomly received fibrin sealant with the contralateral side being used as a control. The need and the number of reinforcement stitches were recorded. Ten minutes after protamine infusion, the animals were sacrificed and the arteries were catheterized respecting 1 cm proximal and distal. The arteries were measured and placed on a flow meter to evaluate the flow rate of 10 mL of 0.9% NaCl in a 50 cm high column. The arteries were then subjected to air infusion at increasingly higher pressures (stepwise increases of 25 mm Hg), the grafts were dipped in 0.9% NaCl solution, the first air leakage was observed, and the tear pressure recorded. Data was analyzed with EpiInfo 6 data manager. The external diameters and thickness of the arteries were similar in both the treatment and control group. There was no significant difference between the groups regarding the tear pressure (P = 0.329), flow rate (P = 0.943), and the number of samples with a tear pressure above 200 mm Hg. However, the sealant reduced the number of reinforcement stitches necessary (P = 0.029). We conclude that fibrin sealant reduces the need of additional stitches; however, it does not change the tear pressure nor significantly reduces the flow.     

阴茎海绵体内注射川芎嗪对兔阴茎勃起效应的影响

目的 观察阴茎海绵体内注射川芎嗪对兔阴茎勃起效应的影响.方法 12只成年雄性新西兰大白兔,静脉麻醉后游离一侧颈总动脉和阴茎海绵体,颈总动脉插管与电生理记录仪连接监测平均动脉压(MBp),阴茎海绵体内置入25 G针头与电生理记录仪连接用于测定阴茎海绵体内压(ICP).通过在兔阴茎海绵体内注射不同剂量(0.5～5.0 mg/kg)川芎嗪和等体积生理盐水,分别记录ICP变化(ICP)、阴茎膨胀持续时间(DT)和MBp的变化.结果 阴茎海绵体内分别注射不同剂量的川芎嗪(0.5、1.0、2.0、5.0 mg/kg),ICP分别由基线增加至(19.1±3.7)、(24.8±2.1)、(30.2±4.8)、(39.7±6.1)mm Hg(1 mm Hg=0.133 kPa), ICP为6.5～25.8 mm Hg,最大ICP为(25.8±5.9)mm Hg,DT为(8.5±2.8)～(22.9±7.3)min.阴茎海绵体内注射川芎嗪呈剂最依赖性提高ICP(P<0.05),对MBp没有显著影响(P>0.05).结论 川芎嗪呈剂量-效应依赖性地增强兔阴茎勃起效应.     

Partial nephrectomy with fibrin glue repair: measurement of vascular and pelvicaliceal hydrodynamic bond integrity in a live and abbatoir porcine model

PURPOSE: Some of the challenges during partial nephrectomy include control of bleeding and repair of the pelvicaliceal system. Fibrin tissue sealants have recently been used to achieve hemostasis and collecting system closure in open and laparoscopic partial nephrectomy. However, there exist little data regarding the intrinsic strength of the bond, especially when applied to the vasculature and the urinary collecting system of the transected kidney. We examined the hydrodynamic bond integrity of a commercially available fibrin tissue sealant in a live porcine animal model undergoing partial nephrectomy. MATERIALS AND METHODS: Open partial nephrectomy was performed in 19 porcine renal units. Collecting system entry was confirmed by methylene blue instillation into the proximal ureter. Fibrin tissue sealant was used to repair 16 renal units, that is 8 kidneys hardened in vivo for 10 minutes and 8 hardened in vivo for 60 minutes. In an additional 3 renal units monopolar electrocautery was used to achieve hemostasis (no fibrin glue used). The strength of vasculature repair was performed by infusing saline into the renal artery (renal vein ligated) and measuring pressure at bond rupture. Similarly the integrity of pelvicaliceal repair was evaluated by retrograde infusion of saline into the collecting system via the proximal ureter and measurement of pressure at bond rupture. RESULTS: Fibrin tissue sealant was successful in achieving prompt hemostasis and it was subjectively superior to cautery alone with regard to bleeding control. Mean renal vascular and pelvicaliceal burst pressure for fibrin sealant treated kidneys was 378 (median 420) and 166 mm Hg (median 170), respectively. There was no significant difference in 10 vs 60-minute hardening times in treated kidneys. In comparison, vascular and pelvicaliceal burst pressure for nontreated (cautery alone) kidneys was 230 (median 220) and 87 mm Hg (median 90), respectively. CONCLUSIONS: Commercially available fibrin tissue sealants can provide supraphysiological renal parenchyma and collecting system sealing pressures after partial nephrectomy. This information supports the potential use of fibrin sealants during open and laparoscopic partial nephrectomy.     

厄贝沙坦氢氯噻嗪片对血压晨峰及左心室质量相关参数的影响

目的观察厄贝沙坦氢氯噻嗪片对中老年原发性高血压患者血压晨峰（MBPS）及左心室质量（LVM）相关参数的影响。方法选择120例轻中度原发性高血压患者,口服厄贝沙坦氢氯噻嗪片150mg／12.5mg,4-8周不达标者剂量加倍,治疗12个月,应用动态血压监测（ABPM）评价治疗前后MBPS的变化,应用超声心动图评价LVM相关参数的变化。结果（1）经厄贝沙坦氢氯噻嗪片治疗后,MBPS（＋）的患者减少,MBPs（-）的患者增多,与治疗前比较差异有统计学意义（P〈0.01）。（2）治疗后MBPS（＋）患者晨峰程度较治疗前明显降低[收缩压（SBP）差值（16.1±1.8）mmHg（1mmHg=0.133kPa）比（29.4±2.8）mmHg,舒张压（DBP）差值（10.2±2.3）mmHg比（21.2±2.2）mmHg,P〈0.01],而MBPS（-）患者晨峰程度较治疗前无明显下降[SBP差值（11.2±2.4）mmHg比（10.1±1.2）mmHg,DBP差值（5.9±1.9）mmHg比（6.8±3.2）mmHg]。（3）MBPs（＋）和MBPS（-）患者治疗后LVM相关参数较治疗前均明显减小,且MBPs（＋）患者治疗后左心室后壁厚度、LVM、LVM指数与MBPS（-）患者治疗后比较差异有统计学意义（P〈0.05）。结论厄贝沙坦氢氯噻嗪片能有效遏制MBPS的发生,降低晨峰程度,并能逆转左心室肥厚。     

Experimental evaluation of photocrosslinkable chitosan as a biologic adhesive with surgical applications.

BACKGROUND: In various surgical cases, effective tissue adhesives are required for both hemostasis (eg, intraoperative bleeding) and air sealing (eg, thoracic surgery). We have designed a chitosan molecule (Az-CH-LA) that can be photocrosslinked by ultraviolet (UV) light irradiation, thereby forming a hydrogel. The purpose of this work was to evaluate the effectiveness and safety of the photocrosslinkable chitosan hydrogel as an adhesive with surgical applications. METHODS: The sealing ability of the chitosan hydrogel, determined as a bursting pressure, was assessed with removed thoracic aorta, trachea, and lung of farm pigs and in a rabbit model. The carotid artery and lung of rabbits were punctured with a needle, and the chitosan hydrogel was applied to, respectively, stop the bleeding and the air leakage. In vivo chitosan degradability and biologic responses were histologically assessed in animal models. RESULTS: The bursting pressure of chitosan hydrogel (30 mg/mL) and fibrin glue, respectively, was 225 +/- 25 mm Hg (mean +/- SD) and 80 +/- 20 mm Hg in the thoracic aorta; 77 +/- 29 mm Hg and 48 +/- 21 mm Hg in the trachea; and in the lung, 51 +/- 11 mm Hg (chitosan hydrogel), 62 +/- 4 mm Hg (fibrin glue, rubbing method), and 12 +/- 2 mm Hg (fibrin glue, layer method). The sealing ability of the chitosan hydrogel was stronger than that of fibrin glue. All rabbits with a carotid artery (n = 8) or lung (n = 8) that was punctured with a needle and then sealed with chitosan hydrogel survived the 1-month observation period without any bleeding or air leakage from the puncture sites. Histologic examinations demonstrated that 30 days after application, a fraction of the chitosan hydrogel was phagocytosed by macrophages, had partially degraded, and had induced the formation of fibrous tissues around the hydrogel. CONCLUSIONS: A newly developed photocrosslinkable chitosan has demonstrated strong sealing ability and a great potential for use as an adhesive in surgical operations.     

Commercial fibrin sealants are not equivalent in a rabbit liver-resection model which quantitatively evaluates hemostasis and formation of adhesions

A rabbit partial liver resection model was used to determine the hemostatic effectiveness of a new fibrin sealant. Persistent bleeding, with a mean bleeding time of 372 s and blood loss of 18 ml, from a resected lobe of the liver was achieved after rabbits in the untreated control group had been infused continuously with unfractionated heparin over 20 min with 0.2 IU/ml at a rate of 1 ml/min. Spraying the resected surface with the new fibrin sealant, Quixil, reduced bleeding to < 1 ml and the post-resection bleeding times was 25 s. Bleeding time, blood loss and the volume of sealant used in the rabbit model were inversely correlated with the thrombin concentration in the sealant. In direct comparisons with Tissucol and Beriplast, Quixil was associated with the shortest bleeding times, the lowest volume of sealant used and the lowest score of abdominal adhesions.