蕲蛇酶对短暂性脑缺血发作患者凝血/纤溶系统的影响

目的:探讨蕲蛇酶治疗对短暂性脑缺血发作(TIA)患者凝血和纤溶指标的影响。方法:80例TIA患者随机分为蕲蛇酶处理组和对照组,所有病例均接受标准的综合治疗,并在入院时检测凝血酶原时间(PT)、活化部分凝血激酶时间(aPTT)、纤维蛋白原(Fg)和D二聚体(DD)水平,然后在入院后3、5、7、10d时重复测定上述指标。随访时间为3个月。主要转归指标为急性脑梗死和死亡。结果:2组患者基线PT和aPTT水平无明显差异(P>0.05)。治疗组Fg水平在第5天后迅速下降,DD浓度在第3天后开始逐步下降;对照组Fg和DD水平至第10天时仍然保持在第3天和第5天时的高峰水平。治疗组短期转归明显优于对照组(P<0.05)。结论:蕲蛇酶治疗能有效降低Fg和DD水平,改善TIA患者的近期转归。     

疏血通注射液对高卒中风险短暂性脑缺血发作患者纤溶系统及预后的影响

目的探讨疏血通注射液对高卒中风险的短暂性脑缺血发作(transient ischemic attack,TIA)患者凝血-纤溶系统及短期预后的影响。方法 70例ABCD2评分6分～7分TIA患者随机分为两组。所有患者均接受标准的综合治疗,治疗组加用疏血通注射液。所有患者诊断后24h内行凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fg)、D-二聚体(DD)及组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制剂(PAI)浓度测定,在入院后3d、5d、7d、10d重复测定上述指标。随访时间为3个月。主要转归指标为急性脑梗死和死亡。结果两组患者基线均存在t-PA下降及Fg、PAI水平增高。治疗组患者Fg水平于第5天下降,PAI浓度于第7天下降;对照组观察期内Fg、PAI浓度无显著差异。治疗组短期转归明显优于对照组(P<0.05)。结论疏血通注射液治疗能有效降低Fg和PAI水平,改善高卒中风险的TIA患者近期转归。     

脑胶质母细胞瘤患者凝血／纤溶系统功能的变化及意义

目的：探讨脑胶质母细胞瘤患者凝血/纤溶系统功能的变化及临床意义。方法选择脑胶质母细胞瘤患者（A组）、良性脑部疾病患者（B组）和健康体检者（C组）各50名,检测各组血浆凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、抗凝血酶Ⅲ（AT-Ⅲ）及D-二聚体（DD）水平,并进行比较。结果与C组比较,A组血浆PT、TT、APTT、FIB、AT-Ⅲ和DD水平均明显降低（P均＜0．05）;而B、C组各指标比较P均＞0．05。结论脑胶质母细胞瘤患者常伴随高凝与纤溶亢进状态;检测血浆PT、TT、APTT、AT-Ⅲ、FIB和DD对筛查脑胶质母细胞瘤具有重要意义。     

溶栓治疗对急性心肌梗死患者凝血与纤溶系统的影响

目的：探讨急性心肌梗死（AMI）患者凝血及纤溶系统变化及其临床意义。方法：对51例AMI患者（37例溶栓治疗，14例未溶栓治疗）在治疗前，治疗后4h、12h、24h、48h、1周测定凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤溶酶原（PCG）活性、α2抗纤溶酶（α2AP）活性、纤维蛋白原（Fg）含量、D二聚体（D-Dimer）含量。结果：AMI溶栓治疗后4h，PCG、α2AP活性及Fg含量大幅度降低，D－Dimer含量明显增高，PT、APTT明显延长；溶栓后48h各项指标已分别恢复至溶栓前水平。结论：溶栓治疗可使AMI患者凝血活性明显减弱，纤溶活性明显增强，但溶栓剂的作用时限短暂，监测PT、APTT、Fg等指标对预防出血有一定意义。     

健康急进高原者纤溶系统变化的研究

目的：探讨健康急进高原者纤溶系统的变化。方法：总共50名青年男性入选本试验，均为从四川省（海拔400m）招募的新兵。在乘飞机从四川进入拉萨（海拔3658m）之前及之后3d，测定血凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fg）、纤溶酶原（Plg）、纤溶酶抑制物、D-二聚体（DD）含量。结果：进入高原后，PT、TT、APTT、DD比在平原时增高，FIB、Plg、纤溶酶抑制物降低（P〈0．05）。结论：健康人急进高原后纤溶系统变化显著。     

冠心病秽浊痰阻证与纤维蛋白原的关系探讨

目的观察冠心病秽浊痰阻证与血浆纤维蛋白原（Fg）含量的关系。方法选取冠心病秽浊痰阻证111例、冠心病非秽浊痰阻证94例。健康对照组为同期门诊体检未发现异常者96名，入院时抽取空腹静脉血，测定Fg、部分活化凝血活酶时间（AFVF）、凝血酶原时间（PT）。结果Fg含量冠心病秽浊痰阻证组〉冠心病非秽浊痰阻证组〉健康对照组，3组Fg含量差异有统计学意义（P〈0．01），APTT和PT差异无统计学意义（P〉0．05）。结论纤维蛋白原可能参与冠心病秽浊痰阻证的病理变化。     

急性脑梗死患者可溶性细胞间黏附分子-1和某些凝血指标的变化及其意义

目的：探讨急性脑梗死患者血清可溶性细胞间黏附分子-1（sICAM-1）和某些凝血指标的变化及其意义.方法：用双抗夹心酶联免疫吸附法测定69例急性脑梗死患者和30名健康对照者sICAM-1含量，并检测他们的某些凝血指标，包括血小板计数、凝血酶原时间（PT）、活化的部分凝血激酶时间（aPTT）、凝血酶时间和纤维蛋白原（FIB）含量。结果：脑梗死患者血清sICAM-1和FIB含量明显高于对照组（P〈0．01），PT较正常对照组明显延长（P〈0．05），sICAM-1含量与梗死面积显著相关（P〈0.01）。结论：急性脑梗死患者血清sICAM-1和FIB浓度显著增高，前者与脑梗死面积相关。     

血小板参数和凝血指标与溶栓治疗关系的探讨

目的 动态观察急性脑梗死患者溶栓治疗过程中血小板参数及凝血指标的变化规律,探讨血小板参数和凝血指标与溶栓治疗的关系.方法 应用血细胞分析仪检测180例急性脑梗死患者（实验组）和180例健康体检者（对照组）的血小板计数（PLT）、血小板平均体积（MPV）和大血小板比率（P-LCR）,血凝分析仪检测凝血酶原时间（PT）、部分活化凝血活酶时间（APTT）、纤维蛋白原（Fg）及凝血酶时间（TT）,动态观察溶栓前及溶栓后1、2、4小时和48小时血小板参数和凝血指标的变化.结果 溶栓前脑梗死患者的MPV、P-LCR和Fg含量均高于对照组（P均＜0.05）,PLT、PT和APTT显著低于对照组（P均＜0.05）;溶栓治疗后,MPV、P-LCR和Fg含量显著下降,PLT、PT和APTT显著升高（P均＜0.05）.结论 溶栓治疗过程中,动态监测急性脑梗死患者的血小板参数（PLT、MPV和P-LCR）和凝血指标（PT、APTT、Fg）,可反映患者凝血功能的变化,对脑梗死患者的溶栓治疗具有一定的参考价值.     

不稳定心绞痛血凝/纤溶系统变化临床研究

目的 探讨对强化药物治疗反应不同的两组不稳定性心绞痛病人血凝及纤溶指标变化规律，及其在不稳定性心绞痛危险度分层中的意义。方法 不稳定心绞痛病人共163例作为治疗组（UA组），依强化治疗72小时病情是否得到良好控制分为UAA、UAB两个亚组，另20例稳定性心绞痛为对照组SA组，所有病例均进行凝血酶原时间（PT）、分凝血活酶时间（APTT）、纤维蛋白原（FG）、D－二聚体（DD）测定，并于第3天、5天、7天、10天UA再重复测定上述指标。随访90天内被迫采取心脏介入治疗、发生心肌梗死及死亡情况。结果 临床首次检测结果均提示PT、APTT在UAA、UAB与SA间无差异、也无预后意义（P＞0.05)，UAA组FG血液浓度水平于病程经五天达高峰后迅速下降，而DD血液浓度水平于第三天后开始逐步下降；UAB组则FG、DD血液浓度水平至病程第十天则仍然保持它们在第5天及第3天的高峰水平，UAA、UAB两组病人的短期预后亦有明显差异（P＜0.05)。结论 DD、FG血液浓度水平在起病后前十天保持高水平是难治性不稳定性心绞痛的血液学标志，同时也是提示病人近期预后较差的预报因子。     

丹参粉针剂对高血压患者凝血功能的影响

目的观察丹参粉针剂对高血压患者凝血功能的影响。方法入选120例初诊为轻中度原发性高血压患者,根据治疗方案分为常规降压治疗组(常规降压组)或丹参粉针剂治疗组(丹参治疗组),每组60例。丹参治疗组在常规降压治疗基础上加用丹参粉针剂400mg加入5%葡萄糖注射液250mL,1次/日,共2周。另入选50名同期年龄、性别相匹配之健康体检者为对照组。检测对照组观察前及两组高血压患者治疗前后凝血功能各项指标:纤维蛋白原(Fg)、血小板计数(PLT)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤溶酶原激活物抑制物-1(PAI-1)、组织纤溶酶原激活物(t-PA)和D-二聚体(DD)的变化,并比较各组间的差异。结果与对照组比较,高血压患者存在凝血功能紊乱现象,具体表现为TT、PT和APTT下降,Fg、PLT、PAI-1和DD升高,t-PA降低(均P<0.05)。与治疗前比较,两组高血压患者治疗后凝血功能改善,表现为TT、PT和APTT延长,Fg、PLT、PAI-1和DD下降,t-PA升高;与常规降压组比较,丹参治疗组凝血功能各项指标改善程度更显著(P<0.05)。结论丹参粉针剂有助于改善高血压患者的凝血功能障碍。     

Blatchford,Rockall,MELD评分在肝硬化食管胃底静脉曲张出血患者预后评价中的应用

[目的]评估Blatchford,Rockall,MELD评分系统对肝硬化胃底食管静脉曲张患者预后的预测价值。[方法]选择2009年2月~2013年2月我院收治的肝硬化胃底食管静脉曲张出血患者146例,采用Blatchford,Rockall,MELD评分系统对患者进行评分和危险度分级,计算各个危险度患者的再出血率、病死率。采用ROC曲线下面积分析3种评分系统对患者6个月内死亡的预测价值。[结果]生存组和死亡组患者Blatchford评分差异均无统计学意义。而生存组患者Rockall和MELD评分均小于死亡组(P0.05)。随着Blatchford,Rockall,MELD评分的增加,肝硬化胃底食管静脉曲张出血患者再出血率和病死率均逐渐增加。Blatchford评分低危组再出血比率高于其余2种评分系统,而Rockall评分高危组患者再出血比率显著高于其余2种评分组(P0.05)。在病死率方面,Rockall高危组患者病死率高达94.1%,显著高于其余2种评分系统(P0.05)。Blatchford,Rockall,MELD评分系统评价患者6个月内病死率的ROC曲线下面积分别为0.56、0.61、0.85(P0.05)。[结论]Blatchford,Rockall,MELD评分系统可作为肝硬化胃底食管静脉曲张出血患者危险性和预后的评估指标,而MELD评分系统对患者死亡的预测价值优于其余2种评分系统。     

心脏起搏器参数的计算机辅助测量方法及其实现

报告一种计算机辅助的起搏器参数自动测试系统,它可全自动地测试以下起搏器参数:脉冲幅度;脉冲宽度频率(基本起搏频率、磁频率、干扰转换频率、干扰起搏频率);灵敏度;逸搏间期;反拗期及芯片电流消耗等。系统根据国际标准组织1989年颁布的埋藏式心脏起搏器标准(ISO5841—1)和我国于1990年制订的埋藏式按需型心脏起搏器国家标准(GB,报批稿)进行检测,精心设计的硬件及软件系统使检测完全自动化,而且操作方便。文章同时给出了起搏器参数测量结果。     

Control of a hair bundle’s mechanosensory function by its mechanical load

Hair cells, the sensory receptors of the internal ear, subserve different functions in various receptor organs: they detect oscillatory stimuli in the auditory system, but transduce constant and step stimuli in the vestibular and lateral-line systems. We show that a hair cell''s function can be controlled experimentally by adjusting its mechanical load. By making bundles from a single organ operate as any of four distinct types of signal detector, we demonstrate that altering only a few key parameters can fundamentally change a sensory cell’s role. The motions of a single hair bundle can resemble those of a bundle from the amphibian vestibular system, the reptilian auditory system, or the mammalian auditory system, demonstrating an essential similarity of bundles across species and receptor organs.The hair bundles of vertebrates are mechanosensory organelles responsible for detecting sounds in the auditory system, linear and angular accelerations in the vestibular system, and water movements and pressure gradients in the lateral-line system of fishes and amphibians (1, 2). In each instance an appropriate stimulus deflects the bundles, depolarizing the hair cells from which they emerge (3). Hair bundles are not simply passive detectors, however, for they actively amplify their responses to mechanical stimulation (4, 5). Hair-bundle motility contributes to an active process that endows the auditory system with the ability to detect stimuli with energies near that of thermal fluctuations (6), to distinguish tones that differ by less than 0.2% in frequency (7), and to accommodate inputs varying over a millionfold range in amplitude (4, 8–11).Auditory, vestibular, and lateral-line organs respond to distinct patterns of mechanical input. The mechanical properties and environments of hair bundles differ correspondingly between different organisms, among receptor organs, and with the tonotopic position along individual auditory organs (12–15). A mathematical model predicts that the response of a hair bundle is regulated both by its intrinsic mechanical characteristics and by its mechanical load (16). Motivated by this proposition, we investigated how the load stiffness and constant force imposed on a bundle control its dynamics and response to external perturbations.     

Occurrence of cold activation of transfusion plasma during storage at +4 degrees C

BACKGROUND AND OBJECTIVES: The storage of transfusion plasma at +4 degrees C sometimes leads to the activation of several proteolytic systems. In this study the frequency of cold activation was investigated, as well as whether cold activation of plasma is an individually recurrent property of the donor. MATERIALS AND METHODS: Plasma units prepared from whole blood obtained from 100 male donors were stored at +2 degrees to +5 degrees C, in bags for 28 days and in cryotubes for up to 42 days. Samples from plasma units, collected by apheresis from 100 male donors, were stored in cryotubes for up to 42 days. Cold activation was measured weekly as kallikrein-like activity of plasma. Samples from repeat apheresis plasma units from 32 donors were measured 12-20 months later. The effects of storage on the contact, coagulation and fibrinolytic systems were determined. RESULTS: The cumulative frequency of cold-activated plasma units stored in bags was 5% on day 7 and 18% on day 28. After 42 days in cryotubes, 49% of the plasma units were cold activated. Large intraindividual differences in the onset-day of cold activation were observed in plasma samples of some donors. During cold activation, an increase in kallikrein-like activity was accompanied by a decrease in C1 esterase inhibitor activity and an increase in the concentrations of activated factor VII and fibrinopeptide A. The functional plasminogen level was unchanged, while a minor decrease in plasmin inhibitor activity was combined with a corresponding increase in the concentration of plasmin-plasmin inhibitor complex. CONCLUSIONS: The cumulative frequency of cold-activated plasma units increased in a time-dependent manner during storage at +2 degrees to +5 degrees C for 42 days. The intraindividual onset-day of cold activation varied widely between plasma samples of some donors. Cold activation was associated with a high degree of activation of the contact and coagulation systems. The fibrinolytic system was scarcely affected.     

Physiological Background Underlying Short-Term Heart Rate Variability

A large number of papers has been published on heart rate variability (HRV) based on the assumption that the specific components of HRV provide specific information about cardiac parasympathetic or sympathetic efferent nerve activity. However, neural control of the cardiorespiratory system is very complex, and the physiological phenomenon underlying HRV in different conditions are far from being fully understood. This review summarizes, in the light of current literature, a series of studies focused on the mechanisms by which fluctuations in neural outflows are transferred into HRV. In the interpretation of HRV analyses, it should be taken into account that: (1) HRV seems to be strongly influenced by the parasympathetic nervous system at all the frequency components; (2) due to sympathovagal interactions, sympathetic outflow is able to reduce the variations generated by vagal modulation also in the high frequency band; and (3) the variations in heart rate reflect fluctuations in the neural activity rather than the mean level of sympathetic or parasympathetic neural activity. Thus, we should be cautious in interpreting a specific component of HRV as a specific marker of sympathetic or parasympathetic cardiac control. Furthermore, due to the complexity of the cardiorespiratory control system, the analysis of short-term HRV should be performed in well-controlled conditions, in which the behavior of the autonomic nervous system is well documented.     

Prion diseases and the gastrointestinal tract.

The gastrointestinal (GI) tract plays a central role in the pathogenesis of transmissible spongiform encephalopathies. These are human and animal diseases that include bovine spongiform encephalopathy, scrapie and Creutzfeldt-Jakob disease. They are uniformly fatal neurological diseases, which are characterized by ataxia and vacuolation in the central nervous system. Although they are known to be caused by the conversion of normal cellular prion protein to its infectious conformational isoform (PrPsc) the process by which this isoform is propagated and transported to the brain remains poorly understood. M cells, dendritic cells and possibly enteroendocrine cells are important in the movement of infectious prions across the GI epithelium. From there, PrPsc propagation requires B lymphocytes, dendritic cells and follicular dendritic cells of Peyer's patches. The early accumulation of the disease-causing agent in the plexuses of the enteric nervous system supports the contention that the autonomic nervous system is important in disease transmission. This is further supported by the presence of PrPsc in the ganglia of the parasympathetic and sympathetic nerves that innervate the GI tract. Additionally, the lymphoreticular system has been implicated as the route of transmission from the gut to the brain. Although normal cellular prion protein is found in the enteric nervous system, its role has not been characterized. Further research is required to understand how the cellular components of the gut wall interact to propagate and transmit infectious prions to develop potential therapies that may prevent the progression of transmissible spongiform encephalopathies.     

Mechanisms of Insulin Action on Sympathetic Nerve Activity

Insulin resistance and hyperinsulinemia may contribute to the development of arterial hypertension. Although insulin may elevate arterial pressure, in part, through activation of the sympathetic nervous system, the sites and mechanisms of insulin-induced sympathetic excitation remain uncertain. While sympathoexcitation during insulin may be mediated by the baroreflex, or by modulation of norepinephrine release from sympathetic nerve endings, it has been shown repeatedly that insulin increases sympathetic outflow by actions on the central nervous system. Previous studies employing norepinephrine turnover have suggested that insulin causes sympathoexcitation by acting in the hypothalamus. Recent experiments from our laboratory involving direct measurements of regional sympathetic nerve activity have provided further evidence that insulin acts in the central nervous system. For example, administration of insulin into the third cerebralventricle increased lumbar but not renal or adrenal sympathetic nerve activity in normotensive rats. Interestingly, this pattern of regional sympathetic nerve responses to central neural administration of insulin is similar to that seen with systemic administration of insulin. Further, lesions of the anteroventral third ventricle hypothalamic (AV3V) region abolished increases in sympathetic activity to systemic administration of insulin with euglycemic clamp, suggesting that AV3V-related structures are critical for insulin-induced elevations in sympathetic outflow.     

Age-related effects of regular physical activity on hemostatic factors in men

Background Age-related changes in blood coagulation and fibrinolytic factors are associated with an increase in risk of thrombotic events. The purpose of this study was to assess the effects of age, regular aerobic exercise and detraining on blood coagulation and fibrinolytic factors in men. Methods Initially, 41 sedentary and 42 physically active men (20–64 years) were analyzed for plasma levels of coagulation and fibrinolytic factors. Twelve sedentary men were then subjected to 16-week aerobic exercise training and subsequent 2-week detraining. Their blood samples taken at rest were assayed for activity levels of prothrombin, coagulation factor (F) V, VII, VIII, IX, X, XI and XIII, antithrombin III, protein C and plasminogen, and for antigen levels of fibrinogen, prothrombin fragment 1 + 2 (F1 + 2), FIX, protein C, tissue-type plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1) and tPA/PAI-1 complex. Results Plasma levels of most coagulation factors, particularly for fibrinogen and FIX antigens as well as FXIII activity significantly increased with aging in sedentary men, while that tendency disappeared in physically active men. By the exercise training, plasma antigen and/or activity levels of most blood coagulation factors except for prothrombin and FIX decreased. These training-effects, however, disappeared after detraining, and in some cases even rebounded to higher levels than those of pre-training. Plasma antigen levels of tPA, PAI-1 and tPA/PAI-1 complex decreased with the training and remained low even after detraining. Conclusion Regular aerobic exercises give complex effects on expression of hemostatic factors, overall favoring the hemostatic balance to less thrombotic, partly cancelling out the age effects.     

心房颤动时心室反应的昼夜分布节律

目的探讨心脏自主神经系统（ＡＮＳ）对房室传导系统的昼夜持续性调节作用。方法患者分两组：组Ⅰ９３例，均为慢性心房颤动；组Ⅱ６０例，均为窦性心律者。对两组患者行２４小时动态心电图检测，观察其心室节律的昼夜分布特征。然后给组Ⅰ服用美托洛尔，并重复动态心电图检查。结果圆分布资料的统计学处理显示，组Ⅰ患者用药前与组Ⅱ的心室节律有相同的分布特征，即于５：００～６：００时达谷值，于１１：００～１２：００时达峰值。表明ＡＮＳ对窦房结与房室结兴奋与抑制时相的调控作用相似。组Ⅰ患者服用美托洛尔后其平均心室率下降，但其心室反应的昼夜分布特征无改变。结论ＡＮＳ对房室结区与窦房结的调控作用相似；美托洛尔仅能降低心房颤动患者平均心室率而不能影响房室结区的兴奋与抑制时相     

短波胃电刺激对大鼠孤束核及下丘脑c-fos表达的影响及其机制

目的 探讨肠肌间神经丛及中枢神经系统相关核团(孤束核及下丘脑)是否参与介导外源性短波胃电刺激调控中枢感觉功能.方法 雄性Wistar大鼠15只,分为对照组、胃电刺激组、去肠肌间神经丛组,均于胃底、胃体交界处植入一对电极,去肠肌间神经丛组大鼠同时胃浆膜面予苯扎氯胺处理,后两组均予短波胃电刺激,持续30 min.SP免疫组化法观察延髓孤柬核及下丘脑c-fos表达.结果 胃电刺激组和去肠肌间神经丛组大鼠每高倍视野下孤束核处c-fos阳性神经元数量分别为(71.6±7.4)和(63.4±10.8)个,下丘脑处则分别为(224.2±47.3)和(249.1±44.0)个,两组间差异无统计学意义(P＞0.05),但均显著高于对照组[(36.4±8.6)和(90.2±47.3)个,P值均＜0.05].结论 孤束核及下丘脑可能是介导短波胃电刺激治疗作用的中枢核团,而肠神经系统不参与介导此作用.