比较肝剪切波速与血清指标评估肝纤维化

目的比较剪切波速（SWV）与血清学指标对肝纤维化的诊断价值。方法对88例慢性肝纤维化患者（肝纤维化组）及50名健康人（对照组）行声脉冲辐射力成像,测量SWV,并检测血清透明质酸（HA）、层黏蛋白（LN）、Ⅳ型胶原（cⅣ）和Ⅲ型前胶原（PCⅢ）水平,比较两组间上述指标的差异;以肝穿活检病理检查结果作为金标准,比较上述指标ROC曲线下面积,评价其诊断肝纤维化效能。结果肝纤维化组和对照组肝脏SWV、血清HA和LN水平差异均有统计学意义（P均〈0．05）,CⅣ和PCⅢ差异均无统计学意义（P均〉O．05）,SWV、LN、HA、cⅣ和PCⅢ诊断肝纤维化的曲线下面积分别为0．88、0．72、0．68、0．53和o．50,SWV、LN和HA诊断肝纤维化界值分别为1．35m／s、46．21ng／ml和66．34ng／ml,其对应的敏感度分别为78．34％、65．56％和57．48％,特异度分别为83．23％、73．35％和67．46％。结论swV诊断肝纤维化的敏感度和特异度高于血清学指标。     

白花丹提取物对CCl4肝纤维化动物模型的影响

目的观察白花丹提取物与复方丹参滴丸对大鼠实验性肝纤维化的治疗效果,并进行比较。方法将40只SD大鼠随机分为空白对照组、模型对照组、白花丹组、复方丹参滴丸组。除空白对照组外,其余均用四氯化碳油剂皮下注射诱发大鼠肝纤维化,第8周处死动物,以测定血清谷丙氨酸转换酶、谷草氨基酸转换酶活性、透明质酸、层粘连蛋白、Ⅲ型前胶原、Ⅳ型胶原、总胆红素的含量作为指标观察白花丹提取物和复方丹参滴丸对慢性肝脏损害和抗肝纤维化的治疗作用。结果检测表明白花丹提取物和复方丹参滴丸均能不同程度降低血清中ALT、AST、TBIL、HA、LN、CIV、PCⅢ的含量,与模型组存在显著性差异（P〈0.05）。白花丹组与复方丹参滴丸组相比有统计学意义（P〈0.05）。结论复方丹参滴丸和白花丹提取物都有减轻大鼠实验性肝纤维化作用,增强实验性大鼠抵抗CCl4致慢性肝损伤能力和抗肝纤维化能力,其中白花丹提取物的作用更显著。     

慢性肾衰竭患者血清纤维化指标测定的临床意义

为了解慢性肾衰竭（chronic renal failure,CRF）患者不同分期的血清纤维化指标[血清透明质酸（HA）、Ⅳ型胶原（Ⅳ-C）、层黏连蛋白（LN）、Ⅲ型前胶原（PC—Ⅲ）]水平的临床意义,我肾病科对2004年1月～2007年12月收治的94例CRF患者随机进行了HA等相关指标的测定,     

扶正化瘀胶囊对慢性丙型肝炎血清细胞因子和纤维化指标的影响

目的：观察扶正化瘀胶囊对慢性丙型肝炎患者血清细胞因子和纤维化指标的影响。方法选择慢性丙型肝炎既往使用干扰素失败治疗目前已停药的肝纤维化患者60例,随机分为两组,每组各30例,分别给予扶正化瘀胶囊（实验组）和复方鳖甲软肝片（对照组）,疗程24周,停药后随访12周。从不同时段分析肝纤维化指标、血清血清肿瘤坏死因子α（TNF-α）、转化生长因子-β1（TGF-β1）、透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PC-Ⅲ）、Ⅳ型胶原（Ⅳ-C）及肝功能变化,并对治疗前后各项指标进行比较。结果两组患者治疗前、治疗后12周、治疗后24周、停药6周血清TNF-α、TGF-β1、PDGF、HA、LN、PC-Ⅲ、Ⅳ-C、ALT、ALT、AST和TBil较治疗前均明显改善,差异具有统计学意义（P均＜0.05）。实验组患者TNF-α和PDGF水平在治疗后12周、24周和停药6周较对照组显著下降,差异具有统计学意义（P均＜0.05）;实验组患者治疗12周后TGF-β1、HA、LN、PC-Ⅲ和Ⅳ-C水平显著下降,差异具有统计学意义（P均＜0.05）。两组患者治疗24周和停药6周后以上指标差异无统计学意义。而两组患者ALT、AST和TBil在治疗的各时段相比差异均无统计学意义。入组病例易出现恶心、胃胀、乏力等不良反应。结论两组患者用药后均可显著改善血清TNF-α、TGF-β1、PDGF、HA、LN、PC-Ⅲ、Ⅳ-C及肝功能等其他指标的水平,扶正化瘀胶囊在降低肝纤维化血清细胞因子,改善肝纤维化指标疗效较好。     

精液中HA、LN、PCⅢ、CⅣ与生育能力的相关性研究

目的探讨精液中透明质酸（HA）、层粘连蛋白（LN）、Ⅲ型前胶原（PCⅢ）和Ⅳ型胶原（CⅣ）与男性生育能力的相关性。方法采用放射免疫分析法析测60例男性有生育者和不育者精液中的HA、LN、PCⅢ和CⅣ，并进行了统计分析。结果正常生育组精液中HA、LN的含量与不育组有显著性差异。结论精液中HA、LN的含量可以作为了解生育能力的检测指标，同时为下一步应用外源性透明质酸治疗男性不育提供理论依据。     

姜黄素抑制大鼠肝纤维化的研究

目的：探讨姜黄素抑制肝纤维化的效应及其分子机制。方法：培养大鼠肝星状细胞(HSC)并以刀豆蛋白(ConA)激活,再用不同剂量姜黄素处理;建立大鼠四氯化碳(CCl4)肝纤维化模型,以不同剂量姜黄素处理各模型动物,检测其血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)和Ⅵ型胶原(Ⅵ.C)水平,检测肝组织纤维化程度和肝组织及HSC基质金属蛋白酶-2(MMP-2)的表达。结果：CCl4成功诱导肝纤维化大鼠模型。与模型组比较,姜黄素治疗后能降低血清肝纤维化各项指标(HA,LN,PCⅢ及Ⅵ.C)的表达（P<0.05）,肝组织纤维化评分明显降低（P<0.05）。姜黄素处理后,纤维化大鼠肝组织MMP-2呈剂量依赖性减少（P<0.05）,活化肝星状细胞MMP-2的表达呈剂量依赖性减少（P<0.05）。结论：姜黄素可通过减少MMP-2表达抑制大鼠肝纤维化。     

羟苯磺酸钙对慢性肾衰竭模型大鼠细胞外基质的影响

目的:观察羟苯磺酸钙对5/6肾切除慢性肾衰竭(CRF)大鼠血清细胞外基质(ECM)主要成分透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)的影响,探讨其抗肾纤维化的作用机制。方法:将大鼠随机分为假手术组、模型组和羟苯磺酸钙治疗组,除假手术组外,其余两组行5/6肾切除术建立肾衰竭模型,4周后3组分别饮用水或羟苯磺酸钙灌胃,观察各组大鼠肾功能、胱抑素C等及血清HA、LN、PCⅢ、Ⅳ-C含量;肾组织病理切片采用PAS染色,观察肾组织纤维化程度。结果:与模型组比较,羟苯磺酸钙组大鼠肾功能明显改善,血清细胞外基质含量减少。结论:羟苯磺酸钙可通过降低肾衰竭模型大鼠血清细胞外基质含量而发挥肾脏保护作用。     

诱骗受体3对大鼠移植肝脏的保护作用

目的将重组诱骗受体3（decoy receptor 3，DcR3）腺相关病毒（adeno-associated virus，AAV）感染移植肝，探讨DcR3对移植肝的保护作用。方法实验动物分为同基因肝移植组（G1）、同种异体肝移植组（G2）、AAV空病毒感染的同种异体肝移植组（G3）、重组DcR3／AAV感染的同种异体肝移植组（G4）。常规建立同种异体大鼠肝移植模型；术中取预先制备的浓缩1×10^9IU病毒颗粒感染移植肝；术后观察大鼠的存活时间、肝功能，荧光显微镜及光镜下观察DcR3在肝脏中的表达及肝脏病理改变。结果G4组的平均生存时间比G2、G3组显著延长，G2、G3组的平均生存时间差异无统计学意义。G4组大鼠术后15、20d的肝功能、肝脏病理改变分别与G2、G3组大鼠术后7、10d相似。结论DcR3对大鼠移植肝有显著的保护作用。     

脾切除对大鼠肝纤维化影响的实验研究

目的 研究脾脏对实验性大鼠肝纤维化的影响，探讨脾切除的应用价值。方法 利用四氯化碳和乙醇诱导Wistar大鼠肝纤维化及肝硬化模型。从造模前、肝纤维化期（早期肝硬化期）、肝硬化期三个层面观察脾切除组、脾大部切除组肝纤维化四项指标与肝组织病理改变的关系，以血常规三项指标动态观测整个实验中脾功能状态，并观察对比脾大部切除前后脾脏病理改变。结果 血清HA、CV、IV、PCⅢ与肝纤维化各个时期病理改变有相关性，血清LN与血清HA、CV、IV、PCⅢ变化趋势相同，但敏感性较差，从敏感性与特异性综合考虑可见血清HA〉CV、IV〉PCⅢ〉LN、PLT、WBC、RBC与脾功能之间有很好的相关性，但敏感性RBC逊于PLT、WBC。脾切除可明显减缓肝纤维化诱导进程，对已形成的肝纤维化模型亦有一定的缓解作用。结论 在减缓和逆转肝纤维化中脾切除术作用明显。当脾脏发生病理改变至脾功亢进时引起贫血，并明显促进肝硬化，似予全部切除为佳。血清肝纤维化四项指标HA、CV、IV、PCⅢ、LN与肝纤维化的病理诊断有良好的一致性，可作为无损伤诊断的依据，推荐前三项指标联合应用。PLT、RBC、WBC与肝纤维化及脾功亢进有较好的相关性，可作为临床评估脾亢分级的参考指标，其中PLT、WBC在肝纤维化及脾功亢进形成过程中变化较早且较为明显。     

大鼠肝切除术后肝损伤程度与肝再生状态的动态对比研究

目的：探讨肝切除术后肝损伤程度与肝再生状态的关系。方法：Wistar大鼠随机分为三组：（1）假手术组；（2）正常大鼠肝切除组；（3）肝硬化大鼠肝切除组，建立大鼠肝切除模型，观察围手术期血清和肝组织匀浆液中丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）水平、肝重／体重、肝再生率，以及应用免疫组化方法（SABC法）检测肝组织中增殖细胞核抗原（PCNA）的表达。结果：与正常大鼠相比，肝切除后肝硬化大鼠血清ALT和AST水平升高显著，持续时间较长（P＜0．05）；PCNA在肝切除后肝组织的表达显著延迟（P＜0．05），血清ALT和AST水平与肝再生率呈显著负相关（P＜0．05）。结论：肝损伤程度和肝再生状态呈负相关，肝损伤的程度影响肝再生状态，肝切除后检测血清ALT、AST水平的变化可以间接的了解肝再生情况。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.