经皮椎间孔入路内镜下减压治疗单节段老年腰椎侧隐窝狭窄症36例

目的 探究经皮椎间孔入路内镜下减压治疗单节段老年腰椎侧隐窝狭窄症的临床疗效与安全性。方法 选择2015-08-2016-08于我院接受经皮椎间孔入路内镜下减压治疗的36例单节段老年腰椎侧隐窝狭窄症患者,术后第2d评估椎间孔成形、侧隐窝减压情况;手术前后统计对比腿痛视觉模拟评分(VAS)以及Oswsetry功能障碍指数(ODI);经Mac Nab评估临床疗效。结果 36例患者均顺利完成手术,平均手术时间为(78.4±31.3)min;患者均接受随访,平均随访时间为(28.6±15.6)个月;患者伴有内科疾病均未加重,平均住院天数为(2.1±0.7)d;患者术后1个月、3个月、6个月、12个月VAS评分、ODI评分较于术前明显改善(P0.05);经Mac Nab疗效评价,治疗优良率为86.1%;2例术后下肢麻木,经营养神经治疗2周后逐渐恢复。全部患者未出现伤口裂开、伤口感染、硬脊膜撕裂引发脑脊液漏、下肢深静脉血栓等相关并发症。结论 经皮椎间孔入路内镜下减压治疗老年单节段腰椎侧隐窝狭窄症患者,可有效减轻疼痛,改善功能障碍;同时该术式能够在局麻下进行,对患者全身影响较小,以控制并发症发生,具有微创、安全、有效等优势。     

经椎板间内镜椎管减压术治疗老年腰椎侧隐窝狭窄症

目的:探讨经皮椎板间入路内镜下椎管减压术治疗老年腰椎侧隐窝狭窄症的效果。方法:老年腰椎侧隐窝狭窄症患者196例,随机分为观察组和对照组各98例,观察组行经皮椎板间入路内镜下椎管减压术治疗,对照组行经皮椎间孔入路内镜下椎管减压术治疗。分别于术前和术后7 d、1个月、3个月采用视觉模拟评分(VAS)法评估下肢疼痛程度,Oswestry功能障碍指数(ODI)评定腰椎功能,采用侧隐窝角评估侧隐窝狭窄程度,依据MacNab标准评定手术效果,并记录手术并发症。结果:2组术后7 d、1个月、3个月VAS评分、ODI评分均低于术前(P0.05),且观察组均低于对照组(P0.05);观察组、对照组术后7 d软性侧隐窝角[(30.53±9.76)°、(27.27±8.39)°]、骨性侧隐窝角[(33.18±10.36)°、31.52±9.85)°]均大于术前[软性侧隐窝角(14.26±7.92)°、(14.51±6.83)°,骨性侧隐窝角(16.63±6.58)°、(17.02±7.73)°](P0.05),且观察组大于对照组(P0.05);术后3个月,观察组优良率(94%)与对照组(89%)比较差异无统计学意义(P0.05);2组均未出现神经根撕裂、永久性神经损伤等严重并发症。结论:相较于经皮椎间孔入路,经皮椎板间入路镜下椎管减压术对减轻老年腰椎侧隐窝狭窄症患者下肢疼痛、改善侧隐窝狭窄及腰椎功能,效果更明显。     

经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症

目的探讨经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症的效果。方法 2014年5月～2016年7月我科对81例神经根阻滞明确责任节段的老年腰椎侧隐窝狭窄症在局部麻醉下行椎间孔镜下椎间孔入路椎管扩大减压术。椎间孔成形后,切除突出的髓核组织及增厚的黄韧带,将侧方的椎管打开,神经根完全松弛。术后1、6、12个月及末次随访进行Oswestry功能障碍指数(Oswestry Disability Index,ODI),腰、腿疼痛视觉模拟评分(Visual Analogue Scale,VAS),改良MacNab标准评价疗效。结果 81例均完成手术,手术时间57～138 min,(68.4±31.9)min。81例随访24～48个月,(29.5±3.8)月。术后1、6、12个月及末次随访时ODI、腰痛VAS评分及腿痛VAS评分较术前显著好转(P0.05)。末次随访改良MacNab标准评估,优57例,良18例,可6例,优良率92.6%(75/81)。结论经皮椎间孔入路内镜下选择性责任节段减压治疗老年腰椎侧隐窝狭窄症,能很好地缓解症状,严重并发症少。     

经皮椎间孔镜TESSYS技术治疗腰椎侧隐窝狭窄症

目的 探讨经皮椎间孔镜TESSYS技术治疗腰椎侧隐窝狭窄症的安全性及早期疗效.方法 2017年3月～2019年1月,本科收治单节段腰椎侧隐窝狭窄症患者35例,均采用经皮椎间孔镜TESSYS技术行侧隐窝及神经根减压.比较患者术前、术后即刻、术后1个月、术后3个月、术后6个月、术后1年的腿痛VAS评分及腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)差异.术后1年采用改良MacNab标准评价手术疗效.结果 所有患者均顺利完成侧隐窝及神经根减压,手术时间50～125 min,平均(80.36±12.34)min;所有患者术后均获得随访12～15个月.患者术后即刻及各随访时期的腿痛VAS评分及ODI指数均较术前明显降低,差异有统计学意义(P<0.05).按改良MacNab标准评价疗效:优19例,良10例,可6例,优良率82.9％.结论 经皮椎间孔镜TESSYS技术治疗腰椎侧隐窝狭窄症的早期疗效显著,是有效的微创治疗方案.     

经皮微创椎板间入路椎间孔镜下椎管减压术对老年腰椎侧隐窝狭窄症的效果分析

目的研究经皮微创椎板间入路椎间孔镜下椎管减压术对老年腰椎侧隐窝狭窄症的临床疗效。方法纳入2014-06-2016-06,治疗的58例老年腰椎侧隐窝狭窄症患者,单节段狭窄44例,双节段14例,均采用经皮微创椎板间入路椎间孔镜下椎管减压术治疗。术后随访24～40个月,平均(30.45±3.94)月,观察其手术疗效和术后并发症情况。结果 58例患者均成功完成手术,手术平均时间(65.22±4.98)min;末次随访时,手术优良率93.10%;术后1个月、6个月和末次随访的VAS腰痛和下肢痛评分以及ODI评分均显著低于治疗前(P0.05);末次随访骨性与软性侧隐窝角均显著高于术前(P0.05)。结论经皮微创椎板间入路椎间孔镜下椎管减压术治疗老年腰椎侧隐窝狭窄症,能显著改善患者腰腿疼痛及活动功能,手术安全有效。     

经椎间孔入路治疗腰椎侧隐窝狭窄症的疗效

目的探讨经皮内镜下椎间孔入路治疗腰椎侧隐窝狭窄症的临床疗效。方法对32例腰椎侧隐窝狭窄伴或不伴腰椎间盘突出患者采用经皮内镜下椎间孔入路行侧隐窝减压伴或不伴髓核摘除手术。术后1、3个月采用VAS评分评估患者腰腿痛改善情况,术后6个月采用改良MacNab评分标准评估疗效。结果32例患者均顺利完成手术,随访6个月。VAS评分术前为8~10(9.18±0.71)分,术后1个月为0~3(1.29±0.67)分,术后3个月为0~2(1.51±0.49)分,术后1、3个月与术前比较差异均有统计学意义(P<0.05)。术后6个月改良MacNab评分优良率为93.75%(30/32)。无感染、医源性神经根损伤、硬膜撕裂等并发症发生。结论经皮内镜下椎间孔入路治疗腰椎侧隐窝狭窄症能获得满意疗效。     

椎间孔镜BEIS技术治疗老年腰椎侧隐窝狭窄症

目的 :探讨经皮椎间孔镜BEIS(broad easy immediate surgery)技术治疗老年腰椎侧隐窝狭窄症的安全性及有效性。方法:2014年2月至2016年5月,采用经皮椎间孔镜BEIS技术治疗21例老年腰椎侧隐窝狭窄症患者,其中男13例,女8例,年龄70~85岁,平均74.3岁。记录术前、术后1、12个月腿痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI),统计分析术前及术后各时间点的差异。用改良MacNab标准评价疗效。结果 :21例患者均顺利完成手术,手术时间90~130 min,平均110 min。所有病例获得随访,时间12~38个月,平均18个月。术前、术后1、12个月的VAS评分分别为8.47±1.23、1.78±0.72、0.68±0.32,术前、术后1、12个月的ODI评分分别为32.48±10.03、19.53±3.55、5.15±1.02,术后2个时间点随访的VAS评分及ODI评分,均较术前明显改善(P0.05)。术后12个月采用改良Mac Nab标准评定疗效,优14例,良5例,可2例。术后出现下肢感觉异常1例,给予保守治疗,术后3周恢复。1例肺气肿患者术后出现肺部感染,经抗感染治疗后控制。无椎体或椎间隙感染、血管及神经根损伤、硬脊膜撕裂脑脊液漏等并发症发生。结论:经皮椎间孔镜BEIS技术治疗老年腰椎侧隐窝狭窄症是一种安全、有效、微创的手术方法,但技术难度较大,特别是对于严重的椎间孔狭窄,经椎间孔入路操作困难,应严格把握手术适应证。术后可能并发神经激惹及术后感觉异常。     

经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病

目的讨论经皮椎间孔入路内镜下治疗老年腰椎融合术后邻椎病的临床疗效。 方法回顾性收集2015年1月至2016年8月山东省文登整骨医院脊柱脊髓科收治的老年腰椎融合术后出现邻椎病的患者34例,男性25例,女性9例,年龄61~81岁,平均年龄（66±7）岁。全部患者采用经皮椎间孔入路内镜减压手术。记录手术时间及术中应注意的事项。在术前、术后1、6、12个月及末次随访时,按MacNab标准进行临床疗效的评价,进行腰部及下肢的疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）;在6个月随访时,行腰椎MRI检查评估神经根减压状况,并进行腰椎正侧位、动力位片评价本次手术节段的稳定性。 结果34例患者均顺利完成手术,随访时间为24~44个月,平均（32±7）个月。手术时间54~142 min,平均（68±30）min。重复测量的方差分析显示,术后1、6、12个月、末次随访时,ODI较术前明显下降,差异具有统计学意义（F=2008.780,P<0.001）;腰痛VAS评分较术前明显下降,差异具有统计学意义（F=599.821,P<0.001）;下肢痛VAS评分较术前明显下降,差异具有统计学意义（F=601.751,P<0.001）;6个月随访时,改良MacNab标准评估：优27例、良5例、可2例,优良率为94.12%。1例出现置管过程中导丝断裂;1例出现出口神经根外膜的撕裂;1例患者出现出口根刺激症状。末次随访时,3例椎间失稳。未发生神经根及硬膜囊的损伤,未发生手术节段错误。 结论经皮椎间孔入路内镜治疗老年人腰椎融合术后邻椎病,创伤小,临床疗效好。     

经皮椎间孔入路内镜治疗腰椎融合术后邻椎病

[目的]探讨经皮椎间孔入路内镜下治疗邻椎病的临床疗效。[方法] 2014年1月～2017年12月腰椎融合术后出现邻椎病患者47例,男29例,女18例,年龄57～79岁,平均(64.91±7.12)岁。所有患者均为单侧症状。全部患者采用经皮椎间孔入路内镜减压手术,记录围手术期资料,采用Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)和MacNab标准评价临床疗效。[结果] 47例患者均完成手术,手术用时49～139 min,平均(59.91±32.42) min。4例穿刺过程中出现神经根刺激症状,3例术中出现硬膜囊损伤,均未造成严重不良后果。全部患者均未出现神经不可逆性损伤、椎间隙感染等相关并发症。随访12个月以上。随时间推移患者的ODI评分和VAS评分显著下降,不同时间点间差异有统计学意义(P0.05)。末次随访时按改良MacNab标准,临床结果评定为优35例、良8例。至末次随访时,动力位影像显示5例椎间失稳。[结论]经皮椎间孔入路内镜治疗腰椎融合术后邻椎病,创伤小,临床疗效好。     

经皮椎间孔镜技术治疗腰椎管狭窄症的早期临床疗效分析

[目的]探讨经皮椎间孔镜技术治疗腰椎管狭窄症的早期临床疗效及手术技巧。[方法]收集本院2014年11月~2015年9月收治的腰椎管狭窄症患者35例,均为单侧侧隐窝狭窄,均行症状侧侧方椎间孔入路,L4、5节段24例,L5S1节段11例。平均病程23.9个月,平均随访时间6.5个月。分别于术前及术后1 d、3个月和末次随访时行视觉疼痛模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和改良Mac Nab疗效评定标准对临床疗效进行分析评估,对患者术前和末次随访时X线片、CT和MRI影像学资料进行对比分析。并统计手术时间、术中出血量、术后并发症、住院时间等临床资料。[结果]腰痛VAS评分从术前(7.21±0.22)降至术后1 d、3个月、末次随访时的(1.97±0.19)分、(1.35±0.24)分、(1.13±0.25)分;腿痛VAS评分从术前(8.54±0.22)分降至术后1 d、3个月、末次随访时的(2.08±0.28)分、(1.11±0.16)分、(1.06±0.33)分,较术前均有明显改善;ODI评分分别从术前(75.89±2.61)分降至(23.22±3.09)分、(15.17±1.42)分、(13.85±1.26)分。末次随访时,依据改良的Mac Nab标准评估,优良率达91.4%。[结论]经皮椎间孔镜技术在早期可有效治疗腰椎管狭窄症,使神经根在侧隐窝处得到及时彻底减压及松解,临床效果显著。     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.