大豆异黄酮抗血小板聚集作用的实验研究

[目的 ]研究大豆异黄酮对血小板聚集性的影响 .[方法 ]普通饲料中添加 2 0 g/kg大豆异黄酮混合物 ,饲喂GK/Jcl糖尿病大鼠 2 0周 ,测定其血小板聚集率 .利用ODS柱层析和高效液相色谱技术分离大豆异黄酮 ,体外观察大豆异黄酮单体对人血小板聚集率的影响 .[结果 ]长期食用大豆异黄酮的GK/Jcl糖尿病大鼠血小板聚集率显著降低 .在人体外血小板聚集实验中 ,大豆异黄酮均抑制腺嘌呤核苷二磷酸钠、胶原蛋白和肾上腺素诱导的血小板聚集 ,大豆异黄酮类型中金雀异黄素的最强 ,其 5 0 %抑制浓度值分别为 0 38,0 30 ,0 2 3mmol/L .[结论 ]大豆异黄酮具有血小板聚集抑制效应 ,在大豆抗血小板聚集中起着重要作用 .     

Hybrid Therapy of Radiofrequency Catheter Ablation and Percutaneous Transvenous Mitral Commissurotomy in Patients With Atrial Fibrillation and Mitral Stenosis

AF Ablation and PTMC. Background: The rhythm control of atrial fibrillation (AF) associated with mitral stenosis (MS) is often difficult using antiarrhythmic drugs (AADs), even after a percutaneous transvenous mitral commissurotomy (PTMC). Few studies have examined the efficacy and safety of simultaneously performing radiofrequency catheter ablation (RFCA) and a PTMC in patients with MS and AF. Methods: Twenty consecutive patients with drug‐resistant AF and rheumatic MS underwent RFCA combined with a PTMC (n = 10; persistent AF‐8, long‐lasting [>1 year] persistent AF‐2; RFCA group) or transthoracic direct cardioversion (DC) following a PTMC (n = 10; persistent AF‐7, long‐lasting persistent AF‐3; DC group). In all patients, the mitral valve morphology was amenable to a PTMC, and more than 2 AADs had been ineffective in maintaining sinus rhythm (SR). In the RFCA group, a segmental pulmonary vein isolation (PVI) was performed in the initial 5 patients, and an extensive PVI was performed in the remaining 5. Results: During a mean follow‐up period of 4.0 ± 2.7 years, 8 patients (80%) in the RFCA group were maintained in SR, as compared to 1 (10%) in the DC group (hazard ratio, 0.16; 95% confidence interval, 0.03 to 0.75; P = 0.008 by the log‐rank test). The prevalence of the concomitant use of class I and/or class III AADs was comparable between the 2 groups (P = 0.70). No complications occurred during the procedure or follow‐up period in either group. Conclusions: The hybrid therapy using RFCA and a PTMC was safe and feasible, and significantly improved the AF free survival rate compared to DC following a PTMC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 284–289, March 2010)     

Hepatocellular Carcinoma with Invasion of the Right Intrahepatic Bile Duct Observed by Peroral Cholangioscopy: a Case Report

A 48-year-old chronic alcoholic with previous hepatitis B virus infection presented with recurrent episodes of obstructive jaundice secondary to hepatocellular carcinoma. The obstructive nature of the jaundice was confirmed by the peroral cholangioscopic findings of a friable nodular mass partially obstructing the right hepatic duct, and by relief of obstructive signs and symptoms after endoscopic sphincterotomy freed the common bile duct of “dark greenish formed materials”.     

Evaluation of residual neuromuscular blockade using modified double burst stimulation

Background: To assess the degree of residual neuromuscular blockade, double burst stimulation (DBS) is commonly applied in the clinical setting. However, fades in response to DBS_3,3 can rarely be identified manually when train-of-four (TOF) ratios are ≧0.70, and, in contrast, fades in response to DBS_3,2 are felt manually in an undesirably high proportion of cases, even at TOF ratios greater than 0.7. We investigated whether a new monitoring method, modified DBS, would be useful to determine an adequate degree of recovery from neuromuscular blockade. For modified DBS, two burst stimuli were applied at an interval of 750 ms. The first stimulation in the modified DBS consisted of two stimuli of 0.3 ms duration at 50 Hz and the second of two stimuli of 0.2 ms duration at 50 Hz. Methods: Forty-five adult patients undergoing elective nitrous oxide-oxygen-isoflurane anesthesia were randomly divided into one of three groups: DBS_3,3 group (n=15), DBS_3,2 group (n=15), or modified DBS group (n=15). During recovery from vecuroni-um-induced neuromuscular blockade, on both forearms, DBS_{3, 3}, DBS_{3, 2}, and modified DBS were delivered in the DBS_{3, 3} group, DBS_{3, 2} group, and modified DBS group, respectively. One hand and forearm (fixed arm) were immobilized to quantify the degree of neuromuscular blockade mechanically, and the contralateral arm (free arm) was unrestrained. An observer deter-mined tactilely on the free arm the presence or absence of fade in response to the three DBS patterns. Results: Probabilities of detection of fade in response to the DBS_{3, 3} were 67% (TOF ratio of 0.51–0.60), 40% (0.61–0.70), 19% (0.71–4).80), 5% (0.81–0.90), and 0% (0.91–1.00). Those to the DBS₃, ₂ were 95% (0.51–0.60), 93% (0.61–0.70), 83% (0.71–0.80), 65% (0.81–0.90), and 38% (0.91–1.00). Those to modified DBS were 90% (0.51–0.60), 86% (0.61–0.70), 65% (0.71–0.80), 25% (0.81–0.90), and 3% (0.91–1.00). The modified DBS was more sensitive in diagnosing residual neuromuscular blockade than DBS_{3, 3} at the TOF ratio of 0.51–0.90, but was less sensitive than DBS_{3, 2} at the TOF ratio of 0.81–1.00 (P < 0.05). Conclusion: Our results indicate that the modified DBS may be a useful stimulation pattern to diagnose the adequacy of recovery from neuromuscular blockade.     

Effective dose of granisetron in the reduction of nausea and vomiting after breast surgery

Background: Prophylactic use of granisetron, a selective Shydroxytryptamine type 3 receptor antagonist, reduces the incidence of nausea and vomiting after breast surgery. This study was undertaken to determine the minimum effective dose of granisetron in the reduction of postoperative nausea and vomiting (PONV) in patients undergoing general anaesthesia for breast surgery.
Methods: In a randomized, double-blind manner, 120 female patients aged 42–66 years were assigned to receive either placebo (saline) or granisetron in a dose of 20 μg · kg^-1, 40 μg · kg^-1 and 80 μg · kg^-1 i.v. immediately before the induction of anaesthesia. A standard general anaesthetic technique was employed throughout. The POW and safety assessments were performed continuously during the first 24 h after anaesthesia.
Results: There were no significant differences among the groups with regard to patient demographics, surgical procedures, anaesthetics administered and analgesics given. The incidence of PONV was 47%, 43%, 17% and 17% after administration of placebo and granisetron 20 μg -kg^-1, 40 μg kg^-1 and 80 μg kg^-1, respectively. Granisetron 40 μg kg^-1 was as effective as 80 μ g - kg^-1 and both resulted in significant reductions of the incidence of PONV compared with placebo and granisetron 20 μg kg^-1 ( P < 0.05). No differences in the incidence of adverse events were observed among the groups.
Conclusion: Granisetron 40 μg · kg^-1 appears to be the minimum effective dose for reducing POW in patients undergoing general anaesthesia for breast surgery.     

Minimum alveolar concentration of sevoflurane for tracheal extubation in children

Background: One advantage of tracheal extubation during deep anaesthesia is that respiratory complications are reduced. Sevoflurane is a suitable anaesthetic agent for children. This study was conducted to determine the minimum alveolar concentration of sevoflurane required to prevent cough or movement during and after tracheal extubation (MAC_extubation).
Methods: We studied 30 nonpremedicated children, aged 2–10 yr, undergoing plastic surgery. They were allocated randomly to five groups (end-tidal sevoflurane concentrations: 2.0, 2.5, 3.0, 3.5, 4.0%). After surgery, 60% nitrous oxide was discontinued and the target concentration of sevoflurane was maintained for at least 10 min in 100% oxygen, then the trachea was extubated to determine MAC_extubation. Logistic regression was used to estimate MAC_extubation. of sevoflurane.
Results: MAC_extubation. was 2.3 (0.2; standard error)% (95% confidence limits: 1.2% and 2.7%).
Conclusions: Tracheal extubation in 50% of anaesthetized children age 2–10 yr may be accomplished without coughing or moving at 2.3% end-tidal concentration of sevoflurane.