定量脑电图对意识障碍患者预后的预测价值

目的 探讨定量脑电图(quantitative dectroencephalography,qEEG)中95%频谱边界频率(95% spectral edge frequency,SEF95)和全功率(total power,TP)对意识障碍患者预后的预测价值.方法 研究对象为2008年1月至2010年6月南方医院神经内科重症监护病房收治的意识障碍患者.患者入院后进行格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分,同时行脑电图监测.以患者出重症监护病房时的存活情况分为存活组和死亡组,比较两组年龄、性别、高血压、糖尿病、GCS评分、SEF95和TP,并对上述因素进行多变量logistic回归分析.对预后相关指标进行接受者操作特征(receiver operating characteristic,ROC)曲线分析,明确qEEG对意识障碍患者死亡的预测能力.结果 共纳入109例幕上病变患者,其中存活组79例,死亡组30例.死亡组GCS评分[(5±3)分对(9±3)分,P=0.000]和SEF95(7.0±4.0对10.0±4.0,P=0.002)均显著低于存活组.多变量logistic回归分析显示,GCS评分(优势比0.100,95%可信区间0.029～0.353]和SEF95(优势比0.853,95%可信区间0.740～0.983)为近期预后的独立预测因素.ROC曲线分析显示,GCS评分和SEF95越低,患者死亡的可能性越大.SEF95＜7.75时,判断死亡的敏感性为60.O%,特异性为72.2%,阳性预测值为82.6%,阴性预测值为45.0%;当GCS评分＜8分时,判断死亡的敏感性为83.3%,特异性为73.4%,阳性预测值为82.6%,阴性预测值为45.O%.结论 SEF95有助于意识障碍患者的预后判断,有望成为重症监护病房意识障碍患者床旁预后评价的重要手段.

Abstract：

Objective To investigate the predictive value of prognosis of the 95% spectral edge frequency (SEF95) and total power (TP) in quantitative electroencephalography (qEEG) in patients with disturbance of consciousness. Methods The patients with disturbance of consciousness admitted in the neurointensive care unit (NICU) in Nanfang Hospital from January 2008 to June 2010 were included. Glasgow Coma Scale (GCS) scores were performed on admission and EEG monitoring was performed simultaneously. The patients were divided into either a survival group or a death group according to the survival status of the patients at the time of leaving NICU. The age, sex, hypertension, diabetes, GCS scores, SEF95, and TP were compared between the two groups. A multivariate logistic regression analysis was performed for the above factors. The prognostic indicators were analyzed with the receiver operating characteristic (ROC) curves and the of qEEG predictive ability of death in patients with disturbance of consciousness were determined. Results A total of 109 patients with supratentorial lesions were enrolled in the study, 79 of them were in the survival group and 30 of them were in the death group. The GCS scores (5 ±3vs. 9 ±3, P =0. 000) and SEF95 (7. 0 ±4.0 vs. 10. 0 ±4. 0, P = 0. 002) in the death group were significantly lower than those in the survival group. Multivariate logistic regression analysis showed that GCS scores (odds ratio 0. 100, 95% confidence interval 0. 029-0. 353) and SEF95 (odds ratio 0. 853, 95% confidence interval 0. 740-0. 983) were the independent predictors of recent prognosis. ROC curve analysis showed that the lower the GCS scores and SEF95 were, the greater the likelihood of death in patients. When SEF95 was ＜7. 75, the sensitivity to determine the death was 60. 0%, the specificity was 72. 2%, the positive predictive value was 82. 6%, and the negative predictive value was 45. 0%; when the GCS score was ＜8, the sensitivity to determine the death was 83. 3%, the specificity was 73. 4%,the positive predictive value was 82. 6%, and the negative predictive value was 45. 0%. Conclusions SEF95 helps determine the prognosis of patients with disturbance of consciousness, and it is expected to become an important means of bedside assessment of prognosis in patients with disturbance of consciousness in NICU.     

后循环缺血性卒中的危险因素和影像学特征:回顾性病例系列研究

目的 探讨后循环缺血性卒中的主要危险因素以及合并糖尿病的后循环缺血性卒中患者的临床和影像学特征.方法 收集急性缺血性卒中患者的临床资料,并对后循环缺血性卒中组与前循环缺血性卒中组进行比较;后循环卒中患者进一步分为糖尿病组和非糖尿病组,比较两组血管危险因素和影像学特征;将后循环缺血性卒中患者按病变血管分布分为近段组、中段组、远段组和混合组,分析糖尿病与各组之间的相关性和影像学特征.结果 共纳入328例后循环缺血性卒中病例,其中男性194例,糖尿病组108例;前循环缺血性卒中336例,其中男性214例,糖尿病组59例.后循环缺血性卒中组糖尿病(32.9％ 对21.7％;x2=10.501,P=0.001)、高脂血症(60.1％对47.9％;x2=9.852,P=0.002)、既往卒中或短暂性脑缺血发作史(29.0％对22.0％;x2 =4.213,P=0.040)患者构成比均显著性高于前循环缺血性卒中组(P均＜0.05),而吸烟患者构成比显著性低于前循环缺血性卒中组(18.3％对26.2％;x2 =5.977,P=0.014);总胆固醇[(4.72±1.07) mmol/L对(4.56 ±0.98) mmol/L;t =2.079,P=0.038]、三酰甘油[(1.54±1.07) mmot/L对(1.33±0.71)mmol/L;t3.085,P=0.002]和低密度脂蛋白胆固醇[(2.91±0.90) mmol/L对(2.75±0.80)mmol/L;t 2.373,P=0.018]均显著性高于前循环缺血性卒中组,而高密度脂蛋白胆固醇显著性低于前循环缺血性卒中组[(1.13 ±0.31) mmol/L对(1.18±0.32)mmol/L;t2.045,P=0.041].多变量logistic回归分析显示,糖尿病[优势比(odds ratio,OR)1.560,95％可信区间(confidence interval,CI)1.086～2.239;P=0.016]和既往卒中或短暂性脑缺血发作史(OR 1.455,95％ CI 1.013～2.090;P=0.042)是后循环缺血性卒中的独立危险因素.在后循环缺血性卒中患者中,糖尿病组(n=108)高脂血症(66.7％对55.5％;x2=5.069,P=0.024)和饮酒(13.0％对4.5％;x2=7.568,P =0.006)患者构成比显著性高于非糖尿病组(n =220),心房颤动患者的构成比显著性低于非糖尿病组(3.7％对11.4％;x2=5.274,P=0.022);三酰甘油[(1.70±0.93) mmol/L对(1.45±1.11)mmol/L; t=1.989,P=0.048]、空腹血糖[(8.46±2.96) mmol/L对(5.30±0.96) mmol/L;t 10.706,P=0.000]和糖基化血红蛋白[(8.36±1.94)％对(6.07±0.55)％;t=10.576,P=0.000]显著性高于非糖尿病组;大动脉粥样硬化性卒中患者构成比显著性高于非糖尿病组(73.1％对60.0％;x2=5.457,P=0.019),而心源性脑栓塞显著性低于非糖尿病组(2.8％对9.1％;x2=4.428,P=0.035);后循环中段梗死患者构成比显著性高于非糖尿组(49.1％对31.4％;x2 =9.726,P=0.002);脑干梗死(60.2％对48.2％;x2 =4.182,P=0.041)和单发性脑干梗死(55.6％对30.5％;x2=19.235,P=0.000)患者构成比均显著性高于非糖尿病组.在单发性脑干梗死患者中,糖尿病组脑桥梗死(43.5％对25.9％;x2=10.374,P=0.001)和延髓梗死(7.4％对1.8％;P =0.023)患者构成比均显著性高于非糖尿病组.结论 糖尿病和既往卒中或短暂性脑缺血发作史是后循环缺血性卒中的独立危险因素.糖尿病与脑干梗死关系密切,更易导致脑桥梗死.     

40 Hz听性稳态反应预测大脑中动脉供血区梗死的恶性过程:回顾性病例系列研究

目的 探讨40 Hz听性稳态反应(40 Hz auditory steady-state response,40 Hz ASSR)对大脑中动脉供血区梗死患者恶性过程的预测价值.方法 收入神经重症监护病房(neuro-intensive care unite,NICU)的大脑中动脉供血区梗死患者入院后72 h内行40Hz ASSR以及脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)检查,同时行美国国立卫生研究院卒中量表(Naional Institutes of Health Stroke Scale,NIHSS)评分.采用多变量logistic回归分析确定恶性过程的影响因素.对恶性过程相关指标进行接受者操作特征(receiver operating characteristic,ROC)曲线分析,明确40Hz ASSR对大脑中动脉供血区梗死恶性过程的预测价值.结果 共纳入104例大脑中动脉供血区梗死患者,其中恶性过程组59例,非恶性过程组45例,两组基线NIHSS评分[(17.25±7.23)分对(20.40±8.09)分;t=-2.055,P=0.043)、梗死体积[(105.85±73.37)mm3对( 179.15±144.38)mm3;t=-3.011,P=O.004]、白细胞计数[(10.26±3.14)×109/L对(13.45±5.42)×109/L;t=-3.336,P=0.001]、40 Hz ASSR(Z=-3.237,P =0.001)和短潜伏期体感诱发电位(Z=-3.130,P=0.002)分级存在显著差异.多变量logistic回归分析显示,40 Hz ASSR[优势比(odds ratio,OR)3.347,95％可信区间(confidence interval,CI)1.630～6.872,P=0.014]、梗死体积(OR 1.006,95％ CI 1.001 ～1.012,P=0.003)和白细胞计数(OR 1.277,95％CI 1.074～1.402,P=0.001)为大脑中动脉供血区梗死患者出现恶性过程的独立预测因素.40 Hz ASSR为3级时预测恶性过程的敏感性为39.5％,特异性为94.4％.结论 40 Hz ASSR对大脑中动脉供血区梗死患者的恶性过程具有重要的预测价值.     

脑电图预测大面积大脑中动脉供血区梗死的恶性过程

目的 探讨脑电图(electroenphalography,EEG)对大面积大脑中动脉供血区梗死(large middle cerebral artert infarction,LMCAI)患者神经功能恶化的预测价值.方法 共纳入37例早期CT和(或)MRI显示脑梗死面积>大脑中动脉供血区50%的卒中患者,其中20例为恶性过程(恶性组),17例为良性过程(良性组);恶性组格拉斯哥-匹兹堡昏迷量表评分[(24±7)对(30±4),P=0.003]和美国国立卫生研究院卒中量表评分[(23±3)对(16±4),P=0.000]显著高于良性组.记录卒中发病24 h内的早期EEG.分析EEG变化特征与恶化性进程的相关性.结果 对侧枕部背景频率<8 Hz(17/20对3/20,P=0.000)、病灶内β频率≤20 Hz(19/26对7/26,P=0.001)、外界刺激时EEG无反应(11/12对1/12,P=0.002)、病灶侧半球弥漫性慢波(17/24对7/24,P=0.008)以及对侧局部慢活动(16/19对3/19,P=0.001)等与恶性过程相关,而病灶对侧枕部脑电活动频率≥8 Hz(14/17 对3/17,P=0.000)和病灶内β频率>20 Hz(10/11对1/11,P=0.001)与良性过程相关.结论 早期EEG对LMCAI恶性过程有一定的预测价值,可作为LMCAI患者的床边监测手段之一.     

血浆可溶性CD40配体、甲胎球蛋白和妊娠相关血浆蛋白-A与缺血性卒中患者颈动脉斑块的关系

目的 探讨急性缺血性卒中患者血浆可溶性CD40配体(soluble CD40ligand、sCD40L)、甲胎球蛋白和妊娠相关血浆蛋白-A(pregnancy associated plasma protein-A,PAPP-A)水平与颈动脉斑块的关系.方法 纳入急性缺血性卒中患者.采用颈动脉超声对颈动脉进行评估,根据评估结果分为颈动脉斑块组和非颈动脉斑块组,前者根据斑块性质进一步分为稳定斑块亚组和不稳定斑块亚组.采用酶联免疫吸附法检测血浆sCD40L、甲胎球蛋白和PAPP-A水平.对颈动脉斑块组与非颈动脉斑块组以及稳定斑块亚组与不稳定斑块亚组之间的人口统计学、既往史、合并症、实验室检查和血浆炎性标记物进行比较.采用多变量logistic回归分析探讨血浆炎性标记物与颈动脉斑块的关系.结果 共纳入200例急性缺血性卒中患者.其中,男性122例,女性78例,年龄33 ～ 87岁,平均(60.1±10.3)岁;颈动脉斑块组139例,非斑块组61例;稳定斑块亚组43例,不稳定斑块亚组96例.颈动脉斑块组平均年龄显著性大干非斑块组[(63.2±8.7)岁对(50.3±9.5)岁;t=10.179,P=0.000],男性(68.3％对44.3％;x2=10.336,P=0.001)、高血压(71.2％对54.1％;x2 =5.540,P＝0.019)、糖尿病(46.8％对29.5％;x2=5.199,P=0.023)和高脂血症(78.4％对37.7％;x2=31.31,P=0.000)患者的构成比显著性高于菲斑块组,总胆固醇[(5.7±1.1)mmol/L对(5.3±1.0)mmol/L;t＝2.433,P=0.016]、低密度脂蛋白胆固醇[(4.5±1.0) mmol/L对(4.1±0.9)mmol/L;t =2.683,P=0.008]和空腹血糖[(7.5±2.5)mmol/L对(6.4±2.1)mmol/L; t=3.002,P=0.003]以及sCD40L[(151.4±55.8)pg/ml对(102.8±65.9)pg/ml;t＝ 5.360,P=0.000]、甲胎球蛋白[(390.1±80.6)μg/ml对(352.9±98.6)μg/ml;t=2.591,P=0.011]和PAPP-A[(11.49±4.67) mIU/L对(8.46±3.99) mIU/L;t =4.409,P=0.000]水平显著性高于非斑块组.多变量logistie回归分析显示,高脂血症[优势比(odds ratio,OR)6.582,95％可信区间(confidence interval,CI)2.321～18.662;P =0.000]、sCD40L(OR6.372,95％ CI2.174 ～ 18.670;P=0.010)和甲胎球蛋白(OR4.101,95％ CI 1.012～ 16.619;P=0.048)为急性缺血性卒中患者存在颈动脉斑块的独立预测因素.稳定颈动脉斑块亚组平均年龄显著性小于不稳定斑块亚组[(59.6±9.3)岁对(64.1±7.2)岁;t=3.231,P=0.002],高血压患者构成比显著性低于不稳定斑块亚组(55.8％对78.1％;x2=7.213,P=0.007),总胆固醇[(5.4±0.9) mmol/L对(6.0±1.1)mmol/L;t =3.136,P=0.002]、低密度脂蛋白胆固醇[(4.0±1.2) mmol/L对(5.7±1.0)mmol/L;t=8.696,P=0.000],空腹血糖[(7.1±2.3)mmol/L对(7.9± 1.9) mmol/L; t=2.147,P=0.034]以及sCD40L[(135.3±74.3)pg/ml对(176.5±64.5)pg/ml;t=3.319,P=0.001]和PAPP-A[(10.96 ±5.02) mIU/L对(13.98 ±4.63)mIU/L;t ＝3.463、P ＝0.001]水平显著性低于不稳定斑块亚组,而高密度脂蛋白胆固醇水平则显著性高于不稳定斑块亚组[(1.2±0.2)mmol/L对(1.1±0.3)mmol/L;t =2.314,P=0.022].多变量logistic回归分析显示,高密度脂蛋白胆固醇(OR0.234,95％ CI0.060 ～0.906;P =0.022)是斑块不稳定的独立保护性因素,而sCD40L(OR 5.290,95％ CI1.613 ～ 17.351;P=0.029)和PAPP-A(OR4.125,95％ CI1.281～13.283;P=0.021)是斑块不稳定的独立预测因素.结论 sCD40L、PAPP-A和甲胎球蛋白水平与颈动脉斑块的存在和稳定性相关.血浆sCD40L和甲胎球蛋白增高是急性缺血性卒中患者存在颈动脉斑块的独立预测因素,而血浆sCD40L和PAPP-A水平增高是急性缺血性卒中患者颈动脉斑块不稳定的独立预测因素.     

孤立性脑桥梗死的临床和影像学特征:脑桥旁正中梗死与脑桥腔隙性梗死的比较

目的 探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展(progessive motor deficits,PMD)和短期预后的影响因素.方法 对初次发病24 h内入院的86例孤立性脑桥梗死患者进行回顾性分析,根据梗死灶最大直径和部位分为脑桥旁正中梗死(paramedian pontine infarction,PPI)和脑桥腔隙性梗死(lacunar pontine infarction,LPI),根据早期PMD情况分为PMD组和无PMD组,根据出院时改良Rankin量表(modified Rankin Scale,mRS)评分分为转归不良组(mRS评分＞2分)和转归良好组(mRS评分≤2分),对不同病例组的临床和影像学特征进行比较.结果 PPI组(n=35)高脂血症(57.14％对33.33％;x2=4.80,P=0.028)、偏瘫(97.14％对72.55％;x2=8.718,P=0.003)、基底动脉狭窄(45.71％对17.65％;x2=7.930,P=0.005)和出院时转归不良(54.29％对31.37％;x2=4.515,P=0.034)患者构成比以及基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(6.00 ±2.39)分对(4.61 ±3.41)分;t=2.087,P=0.040]均显著性高于LPI组(n＝ 51).PMD组(n=22)基线舒张压水平[(97.82±15.61)mm Hg对(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]以及PPI(63.64％对32.81％;x2=6.445,P＝0.011)和基底动脉狭窄(59.10％对18.75％;x2=12.922,P=0.000)的构成比均显著性高于无PMD组(n＝64).转归不良组(n＝ 35)基线NIHSS评分[(6.80±2.63)分对(3.73 ±2.55)分;t＝5.426,P＝0.000]和空腹血糖水平[(9.40±5.15) mmol/L对(6.56 ±2.69) mmol/L;t =2.985,P=0.004]以及PPI患者构成比(54.29％对31.37％;x2 =4.515,P＝0.034)均显著性高于转归良好组(n=51).多变量logistic回归分析显示,基底动脉狭窄是PPI发病[优势比(odds ratio,OR)3.801,95％可信区间(confidence interval,CI)1.357～10.646;P=0.011]和孤立性脑桥梗死早期PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)的独立危险因素,基线NIHSS评分≥5分是其短期转归不良的独立预测因素(OR4.277,95％ CI 1.505 ～ 12.151;P=0.006).结论 PPI主要与基底动脉分支病变有关,基线NIHSS评分≥5分可能是孤立性脑桥梗死短期转归不良的独立预测因素,其早期PMD和短期转归不良均可能与基底动脉病变有关.     

急性缺血性卒中的出血性转化和转归:回顾性病例系列研究

目的 探讨急性缺血性卒中的出血性转化(hemorrhagic transformation,HT)和转归.方法 回顾性收集急性缺血性卒中患者的人口统计学、血管危险因素、影像学和其他临床资料并进行比较;利用磁敏感加权成像(susceptibility weighted imaging,SWI)诊断HT,并将患者分为HT组和非HT组;应用改良Rankin量表评价临床转归.采用多变量logistic回归分析确定HT以及HT患者转归不良的独立危险因素.结果 共纳入96例急性缺血性卒中患者,其中34例出现HT(35.4％).HT组年龄[(66.21±7.04)岁对(61.21 ± 13.42)岁;t=2.020,P=0.046]和梗死体积[(3.88±2.20) cm3对(1.96±1.37)cm3;t =5.267,P =0.001]显著性大于非HT组,高血压(58.8％对30.6％;x2=7.228,P=0.007)、糖尿病(29.4％对6.5％;x2=9.293,P=0.002)、心房颤动(35.3％对3.2％;x2=18.128,P=0.000)、心源性脑栓塞(35.3％对3.2％;P =0.000)患者的构成比显著性高于非HT组,而小动脉闭塞性卒中患者的构成比显著性低于非HT组(38.2％对62.9％;P=0.032).多变量logistic回归分析显示,年龄[优势比(odds ratio,OR)1.168,95％可信区间(confidence interval,CI)1.059～ 3.412; P=0.021]、梗死体积(OR 3.461,95％ CI 1.317 ～6.270;P=0.044)和心房颤动(OR 1.284,95％ CI1.117 ～2.903; P=0.015)为HT的独立危险因素.在HT患者中,转归不良组年龄[(69.46±7.17)岁对(64.19±6.31)岁;=2.248,P=0.032]显著性大于转归良好组,高血压(84.6％对42.9％;x2 =5.781,P=0.016)、糖尿病(50.0％对14.3％;x2=6.053,P=0.014)、心源性脑栓塞(61.5％对19.0％;P=0.025)和血肿型HT(76.9％对19.0％;x2=11.104,P=0.001)的构成比显著性高于转归良好组.多变量logistic回归分析显示,糖尿病(OR 2.151,95％ CI1.179～3.218;P =0.023)、心房颤动(OR4.136,95％ CI 1.010～8.413;P=0.046)和血肿型HT(OR 2.134,95％ CI1.219 ～4.452;P=0.039)为HT患者发病3个月时转归不良的独立危险因素.结论 急性缺血性卒中患者HT发生率为35.4％,年龄、梗死体积和心房颤动为HT的独立危险因素,而糖尿病、心房颤动和血肿型HT为HT患者发病3个月时转归不良的独立危险因素.     

血清透明质酸水平与急性自发性脑出血患者转归的相关性

目的 探讨脑出血患者血清透明质酸水平与临床转归的相关性.方法 纳入明确诊断为急性自发性脑出血的患者,记录基线临床资料,在入院24 h内检测血清透明质酸水平,在发病3个月后采用改良Rankin量表评价临床转归,分为转归良好组(0～2分)和转归不良组(＞2分),对2组临床资料进行比较和分析.结果 共纳入321例患者,转归良好组184例,转归不良组137例.转归良好组年龄[(46.3±8.6)岁对(62.4± 10.5)岁;t=3.761,P=0.025]、体质指数[(24.1±5.3)kg/m2对(27.8±6.1)kg/m2;t=6.193,P=0.013]、血肿体积[(59.7±9.7)ml对(89.2±14.9)ml;=6.278,P＜0.001]、基线格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分[(6.3±1.5)分对(3.9±0.7)分;t=9.121,P＜0.001]、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(9.6±1.5)分对(16.3±4.5)分;=9.989,P＜0.001]和血清透明质酸水平[(376.2 ±22.9)ng/ml对(876.1±19.6)ng/ml;t=19.681,P＜0.001]与转归不良组存在显著统计学差异.多变量logistic回归分析显示,透明质酸[优势比(odds ratio,OR)4.396,95％可信区间(confidence interval,CI)1.912～6.897;P ＜0.001]、血肿体积(OR2.328,95％ CI 1.912 ～3.843;P=0.013)、NIHSS评分(OR2.662,95％ CI 1.127 ～2.976;P=0.023)和GCS评分(OR 0.879,95％ CI 0.097～0.969;P =0.046)是影响脑出血患者转归的独立因素.结论 基线血清透明质酸水平增高是急性自发性脑出血患者转归不良的独立预测因素.     

经皮穴位电刺激辅助麻醉对老年胸腔镜手术患者疼痛及快速康复的影响

目的观察经皮穴位电刺激(TEAS)对老年胸腔镜手术患者疼痛及快速康复的影响。方法60例行胸腔镜手术的老年患者,随机分为经皮穴位电刺激(T)组和对照(C)组。T组于麻醉诱导前30 min经皮穴位电刺激患者双侧合谷、内关、后溪及支沟穴,频率为2/100 Hz,电刺激强度由弱至强,逐渐调节至患者能耐受的最大值(10~15 mA),持续30 min;术中麻醉期间持续TEAS,刺激强度为30 mA,频率为2/100 Hz,直至手术结束。C组患者在相同的穴位上贴电极片,不进行相应的电刺激。结果T组患者舒芬太尼[(57.93±5.54)μg和(44.30±4.03)μg,t=-10.903,P=0.000]、瑞芬太尼[(1.56±0.26)μg和(1.08±0.18)μg,t=-8.3043,P=0.000]、丙泊酚[(763.23±62.04)mg和(559.20±46.44)mg,t=-14.420,P=0.000]及右美托咪定[(545.07±53.36)μg和(301.67±43.27)μg,t=-19.405,P=0.000],镇痛泵按压次数[(9.9±2.0)次和(2.9±1.3)次μg,t=-10.903,P=0.000],术后24 h[(3.53±1.07)分和(1.90±0.66)分,t=-7.090,P=0.000]、48 h视觉模拟评分法(VAS)[(1.37±0.61)分和(0.93±0.37)分,t=-4.660,P=0.000]评分均减少;T组患者术毕苏醒时间、拔管时间及离室时间均缩短,术后进食时间、开始早期下床活动时间提前,术后住院天数缩短,麻醉费用降低(均P<0.01或P<0.05);T组患者术毕恶心、呕吐、血氧饱和度下降、呼吸困难、头晕、躁动及嗜睡均较C组减少(均P<0.05);T组T1心率加快,平均动脉压降低。两组患者麻醉后脑电双频指数维持在40~60之间(均P<0.01)。结论经皮穴位电刺激辅助麻醉能有效减轻老年胸腔镜手术患者疼痛,促进术后快速康复。     

PPARγ基因C161T多态性与中国汉族人动脉粥样硬化血栓形成性梗死的相关性

目的 探讨中国汉族人群过氧化物酶体增殖物激活受体γ(peroxisome proliferatoractivated receptor γ,PPARγ)基因C161T多态性与动脉粥样硬化血栓形成性脑梗死(atherothrombotic infarction,ATI)的关系.方法 纳入ATI患者(ATI组)和同期无卒中、短暂性脑缺血发作和心肌梗死史的体检者(对照组),采用聚合酶链反应-限制性片段长度多态性方法检测PPARγ基因C161T基因型,比较ATI组与对照组基因型和等位基因频率.结果 共纳入ATI患者112例和对照者112例.ATI组年龄[(67.9±11.73)岁对(66.5±10.35)岁;t=0.386,P=0.701]和男性的构成比(61.61％对58.04％;x2=0.297,P=0.586)与对照组无显著性差异.ATI组高血压(59.82％对44.62％;x2 =5.171,P=0.023)和2型糖尿病(26.79％对9.82％;x2=10.778,P=0.001)患者构成比以及体质指数[(25.13±1.86) kg/m2对(24.11±1.81)kg/m2;t 3.543,P=0.001]、收缩压[(158.84±20.15) mm Hg对(135.82± 19.58)mm Hg,1 mm Hg=0.133 kPa;t=7.350,P=0.000]、舒张压[(76.90± 13.64) mm Hg对(68.90±8.52) mm Hg;t=4.374,P=0.000]和空腹血糖[(6.523±2.831) mmol/L对(5.706 ±2.177)mmol/L;t=2.026,P=0.044]均显著性高于对照组.ATI组CC、CT和TT基因型频率分别为77.7％、17.0％和5.4％,对照组分别为69.6％、22.3％和8.0％,两组间无显著性差异(x2=1.909,P=0.385).ATI组C和T等位基因频率分别为86.2％和13.8％,对照组分别为80.8％和19.2％,两组间亦无显著性差异(x2=2.331,P=0.127).结论 中国汉族人群PPARγ基因C161T多态性可能与ATI发病无关.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.