Neuromuscular block with vecuronium reduces the rapidly extracted auditory evoked potentials index during steady state anesthesia

PURPOSE: During clinical monitoring, vecuronium appeared to reduce the rapidly extracted auditory evoked potentials index (A-line ARX index or AAI) to some extent. A prospective and randomized study was designed to analyze this phenomenon. METHODS: Forty adult patients undergoing elective surgery were studied. After tracheal intubation, anesthesia was maintained with an end-tidal isoflurane concentration (F(ET)ISO) of 1.0% for 20 min, then a 10-mL dose of either vecuronium 0.05 mg*kg(-1), 0.1 mg*kg(-1), 0.2 mg*kg(-1) or saline was administered in a randomized, double-blind design. The AAI and bispectral index (BI(hx)) were monitored throughout the study and analyzed off-line. RESULTS: BI(hx) was unaltered after the administration of saline or vecuronium. The mean of the averaged (per patient) AAI values recorded from two minutes to ten minutes after the administration of saline or vecuronium 0.05 mg*kg(-1) did not differ significantly from the corresponding mean recorded from 15 min to 20 min after F(ET)ISO maintained 1.0% (P = 0.678, 0.169), however after the administration of vecuronium 0.1 mg*kg(-1) or 0.2 mg*kg(-1), AAI was reduced from 18.3, 18.0 to 14.8, 13.4 (P = 0.016, 0.017). CONCLUSIONS: Neuromuscular block with vecuronium reduces AAI in patients during steady state anesthesia without surgical stimuli, while BI(hx) is unaltered. The cut-off values of AAI for events should be determined according to the level of neuromuscular blockade when monitoring the depth of anesthesia/sedation.     

Joint capsule matrix turnover in a rabbit model of chronic joint contractures: Correlation with human contractures.

To evaluate changes in matrix molecules of the joint capsule, the right knees of 24 skeletally mature female NZW rabbits were immobilized while the contralateral limb served as an unoperated control. The immobilization was discontinued at 8 weeks and the rabbits were divided among four groups (n = 6) based on the number of weeks the right knees were remobilized: 0, 8, 16, or 32. Three rabbits (six knees) that did not have operations provided normal control joint capsules. The mRNA levels for collagen types I, II, and III, and MMP-1 and -13 were significantly increased in the joint capsules of the contracture knees in all groups when compared to normal and contralateral limb joint capsules. In contrast, the mRNA levels for TIMP-1, -2, and -3 were decreased in the joint capsules of the contracture knees in all groups when compared to normal and contralateral limb joint capsules. The mRNA levels for lumican and decorin were increased in the joint capsules of the contracture knees in all groups when compared to normal capsules. Many of the changes observed in this animal model are similar to those observed in human joint capsules from posttraumatic elbow contractures, supporting the value of this rabbit model.     

前列腺癌去雄激素治疗不良反应的预防和处理

目的观察去雄激素治疗前列腺癌的不良反应,并探讨其预防和治疗。方法回顾性分析1998年7月-2006年1月112例去雄激素治疗晚期前列腺癌的临床资料。结果112例患者中,97例完成了不良反应的调查。随访3-36月,去雄激素治疗后潮热、性功能障碍、病理性骨折发生率分别为46％、75％、4％;患者潮热、精神疲乏、四肢乏力、纳差症状明显加重(P<0．05);性功能明显减退(P<0．05)。12例潮热症状严重者使用抗抑郁药博乐欣(25mg,tid)1-2周症状减轻。7例有骨转移性疼痛或严重骨质疏松患者,应用唑来膦酸4mg静脉滴注,每45d一次,骨痛症状缓解。结论去雄激素对前列腺癌患者生活质量有一定影响。博乐欣可减轻患者潮热症状,唑来膦酸可预防和治疗去雄激素相关的骨质疏松并发症。     

开放手术观察腰椎间盘突出症溶核失败45例分析

目的 通过开放手术观察分析椎间盘髓核化学溶解术治疗腰椎间盘突出症失败原因。方法 收集溶核失败的腰椎间盘突出症45例行开放手术治疗。结果 术中见45例硬膜外脂肪完全消失，43例髓核未见溶解，2例髓核溶解呈糊状但未被吸收，21例伴有侧隐窝狭窄，15例突出物与神经根粘连，20例黄韧带增厚，2例椎管骨性狭窄，14例突出物钙化。结论 腰椎间盘突出症病变间隙合并有侧隐窝狭窄、神经根粘连、椎管狭窄、突出物钙化等，不是溶核治疗的适应证。     

Innervation of the trapezius muscle: is cervical contribution important to its function?

OBJECTIVE: To study the effect of the cervical plexus and the accessory nerve to the function of the trapezius muscle. STUDY DESIGN AND SETTING: Eighteen adult male Sprague-Dawley rats were randomly divided into three groups. The neurotomies were performed in the left sides and the right sides served as within-subject controls. In group A, the accessory nerve was transected. The C2-5 were transected in group B, and both of the accessory nerve and C2-5 were cut in group C. The electrophysiologic, myophysiologic, and histologic changes of the muscles were measured. RESULTS: There were significant differences (P < 0.05) between the three groups in the recovery rates of the transverse area of the muscles. The CMAP recorded from the experimental sides in group B were similar to the control sides. The values of the maximum tension of the tetanus contraction between the two sides showed no differences either (P > 0.05). CONCLUSION: The accessory nerve supplies the most important motor input to the trapezius. Motor innervations of the cervical plexus are not very significant.     

运动性肥大心肌活细胞胞浆游离Ca2+动态变化的激光共聚焦研究以及局部IGF-Ⅰ和AngⅡ的变化

目的:研究运动与心脏重塑过程中心肌胞浆游离Ca2 ([Ca2 ]c)动态变化的生物学机制.方法:采用激光扫描共聚焦显微技术(LSCM)对STDIn Ca2 荧光试剂负载的运动肥大心肌活细胞[Ca2 ]c动态变化进行研究,采用放射免疫测定运动小鼠心肌局部IGF-Ⅰ和AngⅡ含量.结果:运动肥大心肌[Ca2 ]c变化表现为基值稳态和峰值显著升高,达峰时间延长(P＜0.001).心肌局部IGF-Ⅰ和AngⅡ显著升高(P＜0.001).结论:运动性心肌肥大与[Ca2 ]c变化、机械信号、IGF-Ⅰ和AngⅡ关系密切,机械信号、IGF-Ⅰ和AngⅡ可能是引起[Ca2 ]c显著升高,增强心肌收缩能力的胞外刺激因素.     

用酶联免疫吸附术观察向附睾注射鱼肝油酸钠后抗精子抗体的变化

本研究用酶联免疫吸附术观察8只家兔在附睾注射鱼肝油酸钠后血清及精浆中的抗精子抗体。血清抗精子抗体阳性率为37.5～50.0%,最早检出率为术后2个月,6～7月达高峰。精浆抗精子抗体阳性率为25%,最早检出率为术后4个月,且此时己达高峰。与输精管结扎资料相比,发现血清抗精子抗体检出率偏低,而精浆相应抗体偏高,表明向附睾注射鱼肝油酸钠引起的免疫反应有别于结扎,以生殖道局部为主。