不同浓度异丙酚对离体兔心肌动作电位的影响

目的:观察不同浓度异丙酚对家兔心肌细胞动作电位时程的影响.方法:成年家兔24只,制备Langendorff离体心脏灌注模型,K-H液灌注10 min后随机均分为对照组(C组)、低浓度异丙酚组(LP组)及高浓度异丙酚组(HP组),C组继续灌注K-H液60 min,LP和HP组分别灌注含4mg/L与8 mg/L异丙酚的K-H液60 min;记录3组家兔平衡灌注10 min (T0)、继续灌注5 min (T1)、30 min (T2)、60 min (T3)时右心室前壁三层心肌动作电位,计算单相动作电位复极20％、50％、90％的时程(MAPD20、MAPD50、MAPD90).结果:与T0比较,LP组和HP组T1～ T3时MAPD20、MAPD50、MAPD90延长(P＜0.05);与T1比较,两组T2～T3时MAPD20、MAPD50、MAPD90延长(P＜0.05);与T2比较,两组T3时MAPD20、MAPD50、MAPD90延长(P＜0.05);同一时点与C组和LP组比较,HP组T1～T3时MAPD20、MAPD50、MAPD90延长(P＜0.05).结论:丙泊酚灌注时间延长和高浓度丙泊酚灌注,可延长心肌细胞动作电位的复极过程,这可能是临床使用丙泊酚导致心律失常的机制之一.     

“肌壁大部分切除-子宫重建术”对卵巢功能的影响

目的研究"肌壁大部分切除-子宫重建术"(major uterine wall resection and reconstruction of the uterus,MURU)对卵巢功能的影响。方法根据超声子宫单侧肌壁厚度(前壁、后壁或宫底)或腺肌瘤最大直径分为轻、中、重三度。选取无生育要求的16例中、重度子宫腺肌症患者(观察组)行MURU术,并于术中放置LNG-IUS。另选取同期16例子宫肌瘤患者(对照组)行子宫肌瘤剔除术,观察两组术前、术后不同时段血清AMH值的变化情况。结果两组手术均获成功,无术中及术后并发症;子宫肌瘤组AMH随时间变化差异均无统计学意义(P>0.05)。子宫腺肌症组AMH随时间变化差异亦无统计学意义(P>0.05)。将两组AMH分别在术前、术后1、3、6个月进行对比,差异无统计学意义(P>0.05)。结论 MURU术后近期不影响卵巢功能,但长期影响,有待进一步追踪、观察。     

肋间神经阻滞在胸腔镜自发性气胸术后镇痛的应用

目的 探讨肋间神经阻滞在电视辅助胸腔镜(VATS)自发性气胸术后镇痛的应用价值.方法 120例自发性气胸患者均接受择期患侧单操作孔VATS探查和肺大疱切除术,随机分为3组:A组为单纯肋间神经阻滞组,采用0.375％罗哌卡因5 ml在切口所在肋间及其上下各1个肋间的椎旁阻滞肋间神经;B组为肋间神经阻滞+经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)组,方案为氟比洛芬酯注射液200 mg+芬太尼20 μg/kg+盐酸昂丹司琼注射液16 mg;C组为单纯PCIA,方案同B组.观察并记录3组患者术后2、6、24、48 h(T1～T4)在静息状态和活动状态下的视觉模拟评分(VAS评分);记录B组和C组术后各时段静脉镇痛泵用量,及额外要求注射盐酸哌替啶的患者例数及用量.结果 除A组T3时点静息状态外,A组和B组患者在术后T1～T3时点静息及活动状态的VAS评分明显低于C组(P＜0.05),尤以T1和T2时点为明显;T4时点B组和C组的VAS评分低于A组(P＜0.05),但B、C组间的差异无统计学意义.结论 肋间神经阻滞+PCIA是胸腔镜自发性气胸手术后比较满意的镇痛方案,肋间神经阻滞对胸腔镜自发性气胸手术后24 h内的急性疼痛的镇痛效果明显优于单纯PCIA.     

Association between Plasma Leptin Level and Systemic Inflammatory Markers in Patients with Aggressive Periodontitis

Background:

Increasing evidence supports an association between periodontitis and systemic diseases. Leptin is involved both in the energy metabolism and inflammatory processes and is suggested to be a link between periodontal infection and systemic health. The present study aimed to evaluate the peripheral leptin concentration in patients with aggressive periodontitis (AgP) and to explore the relationship between leptin and systemic inflammation.

Methods:

Ninety patients with AgP visiting the Clinic of the Periodontology Department, Peking University School and Hospital of Stomatology between July 2001 and May 2006, and 44 healthy controls (staff and student volunteers in the same institute) were recruited. Plasma levels of leptin and inflammatory cytokines including interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were measured by enzyme-linked immunosorbent assay. Correlation and multiple linear regression analysis were performed to analyze the association between plasma leptin level and other variables.

Results:

Plasma leptin level of AgP group was significantly higher than that of the control group (19.7 ± 4.4 ng/ml vs. 7.5 ± 1.3 ng/ml, P < 0.01). After controlling for age, gender, and body mass index, positive correlation was observed between plasma leptin concentration and log-transformed levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α and CRP), and the partial correlation coefficients ranged from 0.199 to 0.376 (P < 0.05). Log-transformed IL-1β and IL-6 levels entered the final regression model (standardized β were 0.422 and 0.461 respectively, P < 0.01).

Conclusions:

Elevated plasma leptin concentration may be associated with increased systemic levels of inflammatory markers in AgP patients.     

Clinical Characteristics,Radiological Features and Gene Mutation in 10 Chinese Families with Spinocerebellar Ataxias

Background:

Spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders that primarily cause the degeneration in the cerebellum, spinal cord, and brainstem. We study the clinical characteristics, radiological features and gene mutation in Chinese families with SCAs.

Methods:

In this study, we investigated 10 SCAs Chinese families with SCA1, SCA3/Machado–Joseph disease (MJD), SCA7, SCA8. There were 27 people who were genetically diagnosed as SCA, of which 21 people showed clinical symptoms, and 6 people had no clinical phenotype that we called them presymptomatic patients. In addition, 3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing. Clinical characteristic analyses of each type of SCAs and radiological examinations were performed.

Results:

We found that SCA3/MJD was the most common subtype in Han population in China, and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats; the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score; and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset.

Conclusions:

Collectively our study is a systematic research on SCAs in China, which may help for the clinical diagnosis and prenatal screening of this disease, and it may also aid toward better understanding of this disease.     

Safety and Efficacy of Low Dosage of Urokinase for Catheter-directed Thrombolysis of Deep Venous Thrombosis

Background:

Catheter-directed thrombolysis (CDT) has been a mainstay in treating deep venous thrombosis (DVT). However, the optimal dosage of a thrombolytic agent is still controversial. The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT.

Methods:

A retrospective analysis was performed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012. Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography. The therapeutic safety was evaluated by adverse events. A venography or duplex ultrasound was performed to assess the outcome at 6 months, 1 year and 2 years postoperatively.

Results:

The mean total dose of 3.34 (standard deviation [SD] 1.38) million units of urokinase was administered during a mean of 5.18 (SD 2.28) days. Prior to discharge, Grade III (complete lysis) was achieved in 154 (36%) patients; Grade II (50–99% lysis) in 222 (52%); and Grade I (50% lysis) in 51 (12%). The major complications included one intracranial hemorrhage, one hematochezia, five gross hematuria, and one pulmonary embolism. Moreover, no death occurred in the study.

Conclusions:

Treatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.     

Effects of Moderate Hyperventilation on Jugular Bulb Gases under Propofol or Isoflurane Anesthesia during Supratentorial Craniotomy

Background:

The optimal ventilated status under total intravenous or inhalation anesthesia in neurosurgical patients with a supratentorial tumor has not been ascertained. The purpose of this study was to intraoperatively compare the effects of moderate hyperventilation on the jugular bulb oxygen saturation (SjO₂), cerebral oxygen extraction ratio (O₂ER), mean arterial blood pressure (MAP), and heart rate (HR) in patients with a supratentorial tumor under different anesthetic regimens.

Methods:

Twenty adult patients suffered from supratentorial tumors were randomly assigned to receive a propofol infusion followed by isoflurane anesthesia after a 30-min stabilization period or isoflurane followed by propofol. The patients were randomized to one of the following two treatment sequences: hyperventilation followed by normoventilation or normoventilation followed by hyperventilation during isoflurane or propofol anesthesia, respectively. The ventilation and end-tidal CO₂ tension were maintained at a constant level for 20 min. Radial arterial and jugular bulb catheters were inserted for the blood gas sampling. At the end of each study period, we measured the change in the arterial and jugular bulb blood gases.

Results:

The mean value of the jugular bulb oxygen saturation (SjO₂) significantly decreased, and the oxygen extraction ratio (O₂ER) significantly increased under isoflurane or propofol anesthesia during hyperventilation compared with those during normoventilation (SjO₂: t = −2.728, P = 0.011 or t = −3.504, P = 0.001; O₂ER: t = 2.484, P = 0.020 or t = 2.892, P = 0.009). The SjO₂ significantly decreased, and the O₂ER significantly increased under propofol anesthesia compared with those values under isoflurane anesthesia during moderate hyperventilation (SjO₂: t = −2.769, P = 0.012; O₂ER: t = 2.719, P = 0.013). In the study, no significant changes in the SjO₂ and the O₂ER were observed under propofol compared with those values under isoflurane during normoventilation.

Conclusions:

Our results suggest that the optimal ventilated status under propofol or isoflurane anesthesia in neurosurgical patients varies. Hyperventilation under propofol anesthesia should be cautiously performed in neurosurgery to maintain an improved balance between the cerebral oxygen supply and demand.     

Short-term Safety and Efficiency of Cryoablation for Renal Sympathetic Denervation in a Swine Model

Background:

Renal sympathetic nerves are involved in the reflective activation of the sympathetic nervous system in circulatory control. Catheter-based renal denervation (RDN) ameliorated treatment-resistant hypertension safely, but 10%–20% of treated patients are nonresponders to radiofrequency denervation. The purpose of this study was to investigate the safety and efficiency of cryoablation for sympathetic denervation in a swine model and to explore a new way of RDN.

Methods:

Seven swines randomly assigned to two groups: Renal cryoablation (CR) group and control group. The control group underwent renal angiogram only. The CR group underwent renal angiogram plus bilateral renal cryoablation. Renal angiograms via femoral were performed before denervation, after denervation and prior to the sacrifice to access the diameter of renal arterial and the pressure of aorta abdominalis. Euthanasia of the swine was performed on 28-day to access norepinephrine (NE) changes of the renal cortex and the changes of renal nerves.

Results:

Cryoablation did not induce severe complications at any time point. There was no significant change in diameter of renal artery. CR reduced systolic blood pressure (BP) from 145.50 ± 9.95 mmHg at baseline to 119.00 ± 14.09 mmHg. There was a slight but insignificant decrease in diastolic BP. The main nerve changes at 28-day consisted of necrosis with perineurial fibrosis at the site of CR exposure in conjunction with the nerve vacuolation. Compared with the control group, renal tissue NE of CR group decreased by 89.85%.

Conclusions:

Percutaneous catheter-based cryoablation of the renal artery is safe. CR could effectively reduce NE storing in the renal cortex, and the efficiency could be maintained 28-day at least.     

葛根复合胶囊对小鼠酒精性肝损伤的保护作用研究

目的研究葛根复合胶囊对小鼠酒精性肝损伤的保护作用。方法采用灌胃50%酒精(12m L/kg)的方式建立小鼠急性酒精性肝损伤模型,研究不同剂量(100,300,500mg/kg)葛根复合胶囊(CCPL)对酒精性肝损伤小鼠活动状态,血清丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST),肝脏氧化应激参数丙二醛(MDA)和谷胱甘肽过氧化物酶(GSH-Px),以及肝脏组织病理学的影响。结果中、高剂量CCPL可显著降低酒精性肝损伤小鼠血清中ALT和AST活性,并能显著升高肝脏中GSH-Px活性(P<0.05或P<0.01)。低、中、高剂量CCPL均可显著降低酒精性肝损伤小鼠肝脏中MDA含量(P<0.05或P<0.01),且具有量效关系,最大降幅为54.4%;其中高剂量组与阳性对照护肝片效果相当。此外,CCPL对酒精性肝损伤小鼠肝脏组织的病理学改变有较强拮抗效应。结论葛根复合胶囊对小鼠酒精性肝损伤具有较好的保护作用,能为以葛根为主要原料开发具有解酒护肝功效的膳食补充剂或药物奠定了基础。     

二炮某部军人心理应激水平与心理弹性、认知偏向和积极情绪的关系

目的 探讨军事心理应激水平与军人心理弹性、认知偏向及积极情绪的关系.方法 采用军事心理应激自评问卷(PSET)、心理弹性量表(CD-RISC)中文版正负性情绪量表(PANAS-C)和正负性认知偏向量表(APNIS)对536名二炮某部官兵进行抽样调查.结果 ①心理应激总分与负性情绪、负性认知偏向呈显著正相关(r值分别为0.44、0.41,P＜0.01);与正性情绪、心理弹性和正性认知偏向均呈显著负相关(r值分别为-0.29、-0.30、-0.27,P＜0.01).②心理应激高分组与低分组在心理弹性、正负性情绪、正负性认知偏向上均存在显著差异(P＜0.01).③负性情绪、负性认知偏向、正性认知偏向和积极情绪可有效预测军事心理应激水平,总解释率为36％.④积极情绪在正性认知偏向对心理应激水平的影响中起部分中介作用,在心理弹性与心理应激水平之间起完全中介作用.结论 军人心理应激水平与其心理弹性、正负性情绪和认知偏向密切相关.积极的情绪、合理的认知以及心理弹性的增加都有助于缓减军人心理应激症状,促进心理健康.