脑卒中发生前血液动力学指标的异常变化

目的分析和探讨脑卒中发生前脑血管血液动力学指标的异常变化,为卒中高危状态的识别提供参考。方法在基线调查和检测后,收集前瞻性研究人群中随访新发的脑卒中患者(200例)作为试验组,在同一人群中选择基线调查时病程在1年以内的卒中患者(227例)作为对照组,分析和比较两组间脑血管血液动力学指标及其积分值的差异。结果试验组卒中发生前的血液运动学指标普遍低于对照组,血液动力学指标则普遍高于对照组,除最小流速舒张压与临界压的差值外,其他指标两组间有显著的统计学差异(P<0.05)。试验组的血液动力学积分值(51.32±31.37)显著低于对照组(58.44±31.63),P<0.05。结论脑卒中发生前脑血管血液动力学损害程度高于病程1年内的卒中患者,可能是脑卒中的重要预警信号。     

郧阳地区健康人群血液流变学指标参考值的研究

目的检测郧阳地区健康人群的血液流变学各项指标,初步建立适宜本地区人群血液流变学的正常参考值范围。方法严格挑选1043名不同性别、年龄、职业的健康人(男性548名,女性495名),用R80自动血液流变仪检测其血液流变学指标并对结果作统计学处理。结果相同年龄不同性别男女组间各切变率的全血粘度值、血浆粘度值、红细胞压积、血沉等指标均有显著差异(P<0.05),而不同年龄同性别组间的血液流变学指标无显著差异,但50岁～75岁男女组,血液流变学指标有增高趋势。结论建立本地区正常参考范围,为临床相关疾病的早期预防、诊断、疗效及预后观察提供实验室依据。     

血管回声跟踪技术对不同年龄正常人群颈动脉弹性功能的定量检测

探讨超声ET技术对颈动脉弹性功能的检测及不同年龄组颈动脉弹性值。应用ET技术检测145人颈动脉的β、Eρ、AC、AI及PWVβ，年龄22～84岁，平均47．0岁，男75例，女70例。年龄分5组：20～29岁，30～39岁，40~49岁，50~59岁，≥60岁。比较各年龄组左右两侧、男女之间及各组间动脉弹性的差异。左右两侧及性别之间颈动脉弹性指标无差异；随着年龄的增高，β、Eρ、AI、PWVβ增高，AC降低。正常人群不同年龄组的左右两侧及男女之间颈动脉弹性无差异；随着年龄的增高，颈动脉的弹性降低；ET技术可以敏感检测颈动脉的弹性功能状态。     

中风患者脑血管血液动力学参数变化及相关性分析

本文观察了中风患者脑血管血液动力学参数(CVHP)变化并分析了CVHP各指标的相关性联系及对脑血流量的影响。结果表明中风患者CVHP各指标均显著差于对照组(P<0.05～0.01);CVHP各指标均可见显著相关性联系;颈动脉最小血流量(Qmin、最小血流速度(Vmin)、平均血流速度(Vmean)、脑血管外周阻力(R)、脑血管零压顺应性(Co)、颈动脉最大血流量(Qmax)、和最大血流速度(V(max))及平均动脉血压(MBP)对脑血流量的多元回归方程起着主要作用。     

西藏那曲藏族成人体成分分析

目的:收集西藏那曲藏族居民体成分数据,探讨其体成分分布及随年龄变化特点,并分析其超重和肥胖现状。方法:采用随机整群抽样法抽取那曲藏族成年人共646例(男359例,女287例),采用生物电阻抗法检测受试者体成分各指标,所获数据录入SPSS 20.0软件,进行统计分析。结果:除脂肪量、体脂率女性明显高于男性外,其他指标男性均高于女性,各指标性别间差异有统计学意义;男性体脂率、内脏脂肪等级随年龄增长呈上升趋势,BMI、脂肪量50~岁组达峰值,其他指标在30~岁组达峰值;女性蛋白质含量随年龄增长呈下降趋势,内脏脂肪等级随年龄增长呈上升趋势,其他指标在40~岁组达峰值。年龄与BMI、脂肪量、体脂率、内脏脂肪等级间呈正相关关系,与其他指标间无明显相关关系;各指标各年龄组间比较具有一定程度的统计学差异。男性超重和肥胖率分别为34.5%和15.9%,女性为23%和20.6%,且随年龄增加超重和肥胖率呈上升趋势。结论:西藏那曲藏族成人体成分特点与已有报道的其他地区、民族有所不同,不同地区的藏族成人体成分各指标也各具特点,那曲藏族围绝经期女性及50岁以上男性是脂肪相关慢性疾病防治的关键人群。     

脑出血及高血压的脑血管动力学检测与临床意义

脑循环动力学参数(CVDI)改变的阳性率脑出血为94.3％,高血压为98.4％。其中高血压动态阻力(DR)升高明显.脑出血临界压力增高,而临界压与舒张压差(DP)降低更明显。脑出血CVDI异常与CT诊断一致占71.4％,不一致者血肿侧仍存在着CVDI的异常.脑出血较之高血压CVDI改变的特点为①外周阻力R(?)、颈动脉血流量(Qmean、CP、DP更易发生变化。②运动学四项指标下降更明显.③微循环障碍更明显.④CP增高DP降低。     

海洋石油职工血清胃蛋白酶原含量水平分析

目的研究海洋石油职工血清胃蛋白酶原(pepsinogen,PG)含量水平,探讨海洋石油职工人群血清PG异常情况及不同年龄段和性别间血清PG含量的变化规律。方法定量检测3607名体检人员血清胃蛋白酶原亚群(PGⅠ、PGⅡ)含量,然后用SPSS13.0软件对检测人群不同年龄段间、性别间血清PGⅠ、PGⅡ、PGⅠ/PGⅡ(PGR)结果进行统计分析。结果统计结果表明,血清PGⅠ含量随着年龄段的升高逐渐降低,而PGⅡ的含量逐渐升高,PGR随着年龄段升高而降低;各年龄段统计结果显示,20～29岁组与其它各组的血清PGⅠ含量都存在显著性差异,PGⅡ和PGR只与50～60岁组存在显著性差异,30～39岁组与40～49岁组之间只有血清PGⅡ含量存在显著性差异,而50～60岁人群血清PGⅠ、PGⅡ和PGR与50以下各年龄段都存在显著性差异。随着年龄段的升高血清PG检测阳性率也呈现逐渐升高的趋势,50～60岁人群血清PG检测阳性率达到25.03%,但是男性和女性人群血清PG水平和检测阳性率无差别。结论随着年龄的升高,海洋石油职工血清PGⅠ和PGⅡ水平都有趋向异常的趋势,异常率也明显升高;PG是胃黏膜特异性的指标,所以定期对海洋石油职工进行血清PG检测对动态监测胃黏膜具有非常重要的意义。     

便携式脑循环功能分析仪的研制

介绍了一种结构新颖的便携式脑循环功能分析仪的基本原理、参数算法和仪器设计方法.该仪器动用超声多普勒、超声脉冲和臂式自动血压模块检测颈动脉血流速度、血管管径及肱动脉舒张压和收缩压.根据血液动力学原理建立了简化的脑血管动力学参数计算方法,可获得人体颈动脉系统外周阻力、动态阻力、临界压力及搏动指数等反映脑循环功能状况的动力学参数.该仪器结构精巧、操作便捷、指标敏感,适用于各级医院、医疗机构,特别是基层医院和社区康复中心对脑血管病进行早期诊断.     

高血压与脑血管梗塞病人血液流变学与脑血液动力学的相关性研究

脑血液动力学与血液流变学的相关性研究对于脑血管疾病的诊断治疗具有重要的意义。本研究通过对高血压、脑血管梗塞及其他非心脑血管病病人的血液流变学与脑血液动力学指标相关性分析表明,脑血液动力学参数受红细胞压积的影响最大,且与全血高切粘度、血浆粘度、全血低切粘度、红细胞聚集指数、血沉等血液流变学指标也有明显的相关性。红细胞压积对脑血液动力学诸参数影响大小的程度依次为动脉舒张压、血管扩张度、脑血管外周阻力、临界压力、脑动脉脉搏波波速。脑血液动力学与血夜流变学两组指标相比,脑血液动力学指标在反映高血压与脑血管梗塞的病理性变化方面更为明显。     

不同年龄段人群行走足底压力特征分析

目的获取不同年龄段人群正常行走时足底压力的动力学参数,为设计制作不同年龄段鞋垫和运动鞋提供理论依据,最大程度减小足部发生损伤的风险。方法使用Footscan测力平板对4个年龄段120名受试者(20～30、30～40、40～50、50～60岁男女各15名)足底压力峰值、压强峰值进行测试。结果足底压力峰值随着年龄增长不断变化,大部分呈上升趋势,只有在第1趾骨区域随着年龄的增长压力峰值逐渐减小,第1趾骨区域女性足底压力峰值在逐渐减小;大部分受试者第2、4拓骨头受力明显高于第1、5跖骨; 50～60岁年龄段男性第2跖骨压力峰值也明显大于20～50岁年龄段人群(P0. 05)。随着年龄增长,仅仅第1趾骨压力峰值逐渐减小,其余区域均呈现增长现象;压强峰值有显著变化,尤其以第2、3跖骨变化最大,呈上升趋势(P0. 05)。结论人体足底各分区的压力、压强随着年龄增长并非一成不变,找出每个年龄段人群足底压力特点,制定相应的运动鞋,才能更好发挥运动鞋的功能。     

颈动脉分叉部的三维CT血管成像解剖测量

背景：解剖测量是临床医学的基础,可为临床影像学诊断与外科手术提供依据与参考。利用三维CT血管成像技术进行相关解剖测量具有明显的技术优势与很好的应用前景。 目的：应用64排螺旋CT血管成像对颈动脉分叉部的形态结构进行测量,为相关研究提供解剖基础。 方法：查阅2008年6月至2010年6月于厦门大学附属中山医院影像科行头颈部64排螺旋CT血管成像受检者的扫描图像,随机选取颈动脉分叉部无明显病变者92例。其中男45例,女47例;≤40岁者40例,> 40岁者52例。利用其断面图像进行三维成像处理,获得满意的三维图像后,对颈动脉分叉部相关结构进行解剖学测量。 结果与结论：三维图像可清晰显示颈动脉分叉部结构,实现其结构的单独和多结构、多方向观察及测量。测量结果显示受试者颈动脉分叉角为(43.5±12.3)°,颈总动脉远端内径(6.83±0.65) mm,颈内动脉膨大区近端内径(7.25±1.04) mm,颈内动脉膨大区最大内径(8.15±1.35) mm,颈内动脉膨大区远端内径(5.03± 0.55) mm,颈外动脉内径(4.22±0.60) mm。与≤40岁组比较,>40岁组颈动脉分叉角度、颈内动脉膨大区近端内径、颈内动脉膨大区最大内径、颈内动脉膨大区远端内径均明显粗大,颈外动脉内径明显细小(P < 0.05),而颈总动脉内径差异无显著性意义(P > 0.05)。与男性组比较,女性组颈动脉分叉部各测量指标均显著细小(P < 0.05)。左、右侧组测量值比较,除颈动脉分叉角左侧明显大于右侧外,其他测量指标差异均无显著性意义(P > 0.05)。三维CT可客观、准确测量颈动脉分叉部相关解剖值,具有个体化特征,可为相关应用解剖、疾病诊断及介入或手术治疗提供客观依据。     

Functional asymmetry in carotid sinus cardiac reflexes in humans

Summary The reflex cardiac response to activation (CBA) and inactivation (CBI) of the left and right carotid baroreceptors was studied in 30 healthy subjects, aged between 24 and 38 years. The CBA was evoked by applying negative pressure (from –20 to –60 mmHg) for 10 s to the left and right carotid sinus regions separately or both together, using two small neck capsules. The CBI was produced by applying left and right positive neck pressure (from 20 to 60 mmHg) for 10 s. The blood flow velocity was measured non-invasively with a Doppler scanner placed in the suprasternal notch. Blood flow acceleration was calculated and used as an indication of left cardiac contractility. Heart rate was measured continuously. Differences were found between right and left carotid sinus responses to CBA and CBI. The maximal response of the R-R interval was significantly greater during right CBA than during left CBA (the average gain: R-R·mmHg^–1 2.69 ms·mmHg^–1 and 1.75 ms·mmHg^–1 respectively). Also, the reflex CBI response was significantly greater for the right (3.16 ms·mmHg^–1) than for the left (2.22 ms·mmHg^–1 The reflex decrease/increase in blood-flow acceleration in response to CBA/CBI was significantly greater during left than during right-sided activation/inactivation. It is suggested that the functional asymmetry was related to differences in right/left-sided cardiac innervation as well as to central ipsilateral projection of the carotid baroreceptor afferents to the nuclei tractus solitarii.Research fellow from the A. von Humboldt Foundation from the Department of Physiology, Medical Academy, Warsaw, Poland     

Baroreceptor and somatic sensory regulation of kidney function in two-kidney, one-clip Goldblatt hypertensive rats.

The aim of this investigation was to characterize the renal haemodynamic and tubular responses to somatic afferent nerve stimulation following the removal of afferent nerve input from the atria or the carotid sinuses in chloralose-urethane-anaesthetized Sprague-Dawley rats and two-kidney, one-clip Goldblatt hypertensive rats. Bilateral stimulation of the brachial nerve plexi at 15 V, 1.3 Hz for 0.2 ms resulted in an increase in systemic blood pressure in each group of 10-40%, while renal perfusion pressure was maintained at a constant level. There were significantly larger falls in left renal blood flow and combined left and right glomerular filtration rate in all groups following selective denervation of either the cardiopulmonary or the carotid sinus baroreceptors, respectively. Brachial nerve stimulation decreased urine flow rate and absolute and fractional sodium excretion from both kidneys in Sprague-Dawley intact animals by 53, 65 and 59%; in vagotomized animals by 68, 77 and 63%; and in carotid sinus denervated animals by 86, 90 and 48%, respectively. The renal response in the Goldblatt group were similar to the normotensive group, but the main contribution of the total response was from the untouched left kidney. The inhibitory influence of the vagus and carotid sinuses on the renal sympathetic nerve-mediated sodium and water resorption appeared to be enhanced in the Goldblatt hypertensive rats when compared with the normotensive rats. The renal functional responses to somatic afferent nerve stimulation appeared to be well preserved in the renovascular hypertensive rats, although there were important differences in the contributions to the responses from the left and right kidneys. Furthermore, the baroreceptors exerted a greater influence on basal renal function in the hypertensive rats.     

Anatomical variations in human carotid bodies.

The variations in anatomical structure and position of both carotid bodies were noted in 100 consecutive subjects who came to necropsy. Considerable variations in form were found. Although most carotid bodies (83% on the right and 86% on the left) were of the classic ovoid type, an appreciable minority was bilobed (9% on the right and 7% on the left) or double (7% on the right and 6% on the left); 1% were leaf shaped. All these anatomical variants have to be distinguished from the pathologically enlarged carotid body that may have a smooth or finely nodular surface. Anatomical variants (such as the bilobed) may themselves enlarge as a consequence of carotid body hyperplasia.     

Motor planning ability is not related to lesion side or functional manual ability in children with hemiplegic cerebral palsy

Optimal task performance requires anticipatory planning to select the most appropriate movement strategy. There is conflicting evidence for hemispheric specialisation of motor planning, with some suggesting left hemisphere dominance, claiming that children with right hemiplegic cerebral palsy (HCP) are therefore disproportionally affected. An alternative view is that there is a positive relationship between functional ability (rather than side of lesion) and motor planning skill. We aimed to compare children with right and left HCP on motor planning ability and to explore its relationship with functional manual ability. Participants were 76 children with HCP (40 left HCP; 30 female), aged 4–15 years (Mean 9.09, SD 2.94). Motor planning was assessed using a measure of end-state comfort, which involved turning a hexagonal handle 180° without readjusting grasp. This is difficult, or in some cases impossible, to achieve unless an appropriate initial grasp is adopted. Children completed 24 turns (12 clockwise), which were video recorded for offline scoring. Functional manual ability was assessed with the ABILHAND-Kids questionnaire, completed by parents. Contrary to the existing literature, no differences were observed between right and left HCP. However, a significant interaction between direction of turn and side of hemiplegia indicated a preferential bias for turns in the medial direction, consistent with the “medial over lateral advantage”. There was no relationship between functional ability and motor planning. Therefore, motor planning may not be a priority for therapeutic intervention to improve functional ability in HCP.     

Prevalence and severity of atherosclerosis in different arterial territories and its relation with obesity

BackgroundThere is uneven association between obesity, traditional risk factors, and cardiovascular events. We aimed to analyze the relation between cardiovascular risk factors, including obesity, with the severity of atherosclerosis in different arterial territories.MethodsArteries from five territories (circle of Willis, carotids, coronaries, aorta, and renal) were taken from 185 persons, newborn to 90 years undergoing autopsy in the Forensic Medical Service in Mexico City, to determine atherosclerotic lesions by histopathological study. Lesions were classified according to the American Heart Association grading system as early (types I–III) and advanced (types IV–VI). The degree of atherosclerosis was correlated with arterial territories and risk factors.ResultsFrequencies of advanced lesions according to arterial territories were as follows: circle of Willis, 28%; right carotid, 36%; left carotid, 25%; right coronary, 71%; left coronary, 85%; right renal, 26%; left renal, 29%; and aorta, 52%; P=.0001, for all analyses. There was a higher risk for advanced lesions with increasing body mass index (BMI) (P=.004). However, after adjusting for age, gender, smoking status, hypertension, and diabetes mellitus, BMI was not independently associated with advanced lesions.ConclusionsCoronary arteries are significantly more affected than other arterial territories regardless of risk factors, showing the effect of local and systemic factors in the severity of atherosclerosis. We did not find an independent association between advanced atherosclerotic lesions and obesity.     

颈动脉分叉区域的神经血管解剖及其对颈动脉内膜剥脱术的临床意义

目的　通过对尸体标本的颈动脉分叉区域内的神经、血管进行解剖研究,为安全有效地开展颈动脉内膜剥脱术提供形态学依据及解剖学基础。 方法 选取20例（40侧）无明确心、脑血管疾患的尸体解剖标本（男11例、女9例）,采取颈动脉内膜剥脱术式入路对颈动脉分叉区域内的神经、血管进行解剖研究,明确血管和神经的形态学及结构特点。 结果 颈总动脉分叉部形态可分为Ⅰ、Ⅱ、Ⅲ型,分别占比为10%、52.5%、37.5%。分叉位置以甲状软骨为界,左侧颈总动脉分叉部高度在其上缘以上、平上缘和上缘以下的占比分别为55%、37.5%、7.5%;相较之下右侧分别为62.5%、27.5%、10%。男性颈总、颈内、颈外动脉内径均大于女性（P<0.05）;男性颈动脉分叉角度大于女性（P<0.05 ）。双侧颈总、颈内、颈外动脉内径相比无统计学意义（P>0.0 5）;左侧颈动脉分叉角度大于右侧（P<0.05）。 结论　通过对颈动脉分叉区域内的神经、血管进行解剖研究,对颈动脉内膜剥脱术术中血管与神经的保护具有重要的临床意义。     

超声心动图右心功能指标在肺血栓栓塞症溶栓前后的变化

目的通过超声心动图检测大面积和次大面积肺血栓栓塞症(PTE)患者溶栓前后的右心功能指标,评价急性期溶栓效果。方法 29例患者(大面积者8例,次大面积者21例),其中男性10例,女性19例;年龄30～75岁,平均年龄59岁(标准差12岁)。均接受溶栓治疗。溶栓前和溶栓后24h观察超声心动图检查指标:左右心室舒张末期前后径(LVED、RVED)、左右心室舒张期横径(LVDD、RVDD)、左右心房舒张期横径(LADD、RADD)、右心室前壁厚度(RVAWT)、右心室前壁运动幅度(RVAWM)、主肺动脉内径(PAD)、三尖瓣反流压差(TRPG)、肺动脉收缩压(SPAP)。计算RVED/LVED、RVDD/LVDD和RADD/LADD比值。结果除RADD外(P=0.041),溶栓前大面积PTE组和次大面积PTE组患者间各指标未见显著性差异。溶栓后大面积者RVAWM、LVED和LADD明显升高(P=0.024,P=0.003,P=0.043);次大面积者LVED明显升高(P=0.001),RVDD、RADD、RADD/LADD比值、TRPG和SPAP明显下降(P=0.003,P=0.016,P=0.006,P<0.001,P<0.001)。结论溶栓治疗可改善PTE患者右心功能不全,超声心动图对PTE的疗效评价有重要意义。     

Relationship of angiotensin-converting enzyme gene polymorphism to carotid wall thickness in middle-aged men

The insertion/deletion (I/D) polymorphism of the human angiotensin-converting enzyme (ACE) gene is a major determinant of circulating ACE levels. The D allele has been suggested to be a potent risk factor for coronary artery disease; however, the effect of the ACE gene on carotid atherosclerosis remains controversial. We therefore studied the relationship between the ACE gene I/D polymorphism and carotid artery intima-media thickness (IMT). A random sample of 300 men aged 50-59 years living in southern Finland were selected, and 233 agreed to participate (74%). Data were collected in 219 subjects. Quantitative B-mode ultrasonography was used to measure the maximum near and far wall IMT of right and left common, bifurcation, and internal carotid artery. The mean maximum IMT (overall mean) was calculated as the mean of 12 maximum IMTs at 12 standard sites. Patients with an IMT higher than 1.7 mm in at least one of 12 standard sites were assumed to have carotid atherosclerosis. The I/D polymorphism was determined by polymerase chain reaction. Overestimation of the frequency of the DD genotype was eliminated by insertion-specific primer and the inclusion of 5% dimethylsulfoxide. No significant differences were found in carotid wall thickness between the three genotypes; the overall mean IMT were 1.18 +/- 0.30, 1.22 +/- 0.24, and 1.08 +/- 0.40 mm in genotypes of II, ID, and DD, respectively. Similarly, the ACE genotypes and allele frequencies did not differ significantly between the subjects with and those without carotid atherosclerosis. There was no association in the subgroups among only nonsmoking subjects or subjects without chronic medication. The present data indicate that the I/D polymorphism of the ACE gene is not related to carotid IMT and is unlikely to play a major role in carotid atherosclerosis.     

The aortic bodies of spontaneously hypertensive (SHR) and normotensive rats--a study concerning location and size

The aortic bodies, including the right and left subclavian bodies and the superior aorticopulmonary bodies, were examined in inbred normotensive control rats (NCR) of the Wistar strain and in spontaneously hypertensive rats (SHR) of the OKAMOTO-AOKI strain. Paraganglia were found in all rats of either group. They were located near to the left common carotid artery and less frequently between the branching right subclavian and right common carotid artery. Superior aorticopulmonary bodies were rarely seen. No significant differences were found regarding the volume of individual aortic bodies when comparing these paraganglia in NCR and SHR. However, aortic bodies are more numerous in SHR and therefore the total volume of aortic body tissue per rat is significantly larger in this strain. There was good correlation between the total volume of aortic bodies and the total volume of carotid bodies in both strains of rats studied. These findings indicate, that the paraganglionic system as a whole is enlarged in SHR. This enlargement probably is caused genetically and not a result of increased blood pressure.