Bronchial artery embolization: monitoring with somatosensory evoked potentials. Work in progress

Surgery remains the treatment of choice for massive and recurrent hemoptysis. In some instances, however, immediate surgical intervention is contraindicated. In these situations, bronchial artery embolization (BAE) has proved to be a successful definitive treatment for non-surgical candidates and a palliative therapy in patients requiring hemodynamic stabilization prior to surgery. The most serious complication of BAE is spinal cord ischemia. This relates directly to the potential anastomotic connections between the bronchial circulation and the anterior spinal artery. Somatosensory evoked potentials (SSEPs) have been used in the past to monitor spinal cord ischemia during procedures that threaten the vascularity of the spinal cord. The authors report two cases in which SSEPs were employed to monitor spinal cord ischemia during bronchial artery embolization.     

国产沉香化学成分的研究——Ⅲ.异白木香醇的结构测定和低沸点成分的分离与鉴定

自国产沉香(Aquilaria sinensis)[瑞香科(Thymeleaceae)植物]的挥发油中,经硅胶柱层析和离心薄层层析分离得到一新的倍半萜,命名为异白木香醇(isobaimuxinol),根据光谱(IR,~1HNMR,~(13)CNMR,2 D-NMR和MS)分析确定其结构式为(Ⅰ)所示,并用X-光衍射晶体解析进一步确定了其立体化学。同时,也从该植物挥发油的低沸点部分分离得到四个已知化合物:苄基丙酮,对甲氧基苄基丙酮,茴香酸和β-沉香呋喃。这些化合物均为首次从该植物中得到。     

Blood lactate and mixed venous-arterial PCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgry

Conventional indices of tissue perfusion after surgery involving cardiopulmonary bypass (CPB) may not accurately reflect disordered cell metabolism. Venous hypercarbia leading to an increased veno-arterial difference in CO₂ tensions (V-aCO₂ gradient) has been shown to reflect critical reductions in systemic and pulmonary blood flow that occur during cardiorespiratory arrest and septic shock. We therefore measured plasma lactate levels and V-aCO₂ gradients in 10 patients (mean age 57.2 years) following CPB and compared them with conventional indices of tissue perfusion. Plasma lactate levels, cardiac index (CI) and oxygen uptake all increased significantly (p<0.05 vs baseline levels) up to 3h following surgery. Oxygen delivery did not change. Plasma lactate levels correlated significantly with CI (r=0.47,p<0.01). V-aCO₂ fell significantly with time (p<0.01 vs baseline). There was an inverse relationship between V-aCO₂ and cardiac index and V-aCO₂ and lactate (r=–0.37,p<0.05;r=–0.3,p<0.05 respectively). We conclude that blood lactate, CI and increase progressively following CPB. An increase in lactate was associated with a decrease in V-aCO₂. An increase in V-aCO₂ was not therefore associated with evidence of inadequate tissue perfusion as indicated by an increased blood lactate concentration.     

Recovery of autologous erythrocytes in transfused patients

A microcapillary method utilizing phthalate esters or an ultracentrifuge method are both capable of separating autologous from homologous erythrocytes in polytransfused patients. The microcapillary technique which is readily adaptable to blood bank laboratories provides a previously unavailable method for defining blood group antigen typings in transfused patients. Such typings are of vital importance in the laboratory evaluation of transfused patients with multiple or weak blood group antibodies.     

脊髓全横断大鼠神经生长因子和脑源性神经营养因子表达及三七皂苷的干预效应

目的:神经生长因子和脑源性神经营养因子同属神经营养素家族,在神经系统发育及维持正常神经元功能中有重要作用。实验拟证实脊髓全横断损伤三七皂苷对大鼠神经生长因子及脑源性神经营养因子蛋白水平的表达变化产生了影响。方法:实验于2005-06/09在昆明医学院神经科学研究所完成。①实验材料:清洁级健康雌性SD大鼠72只,质量(200±20)g;三七皂苷由云南植物药业提供。②分组及实验过程:大鼠被随机分为4组:假手术组、单纯脊髓全横断损伤组、脊髓全横断损伤 生理盐水(0.5mL/次)组、脊髓全横断损伤 三七皂苷(100mg/kg/次)组,每组18只。于T10水平横断大鼠脊髓,假手术组仅剪开硬脊膜而不损伤脊髓。后2组于术后30min,4,24,48,72h腹腔注射给药各1次。③实验评估:各组于术后3,7及21d分别取6只大鼠L1～2段脊髓制作冰冻切片,采用免疫组织化学ABC法染色。观察并计数脊髓腹角神经生长因子、脑源性神经营养因子蛋白的表达变化;常规苏木精伊红染色观察脊髓的组织病理变化。结果:72只大鼠全部进入结果分析:①脊髓全横断损伤后脊髓出现明显的神经变性坏死、炎性浸润等病理变化,三七皂苷可减轻这些变化。②神经生长因子蛋白主要分布于灰质神经元胞浆及胶质细胞胞核中。在正常脊髓有少量表达,脊髓损伤后7d表达明显升高,直到伤后21d仍高于假手术组(P<0.05);三七皂苷可明显促进其表达,伤后3,7d均明显高于其他各组(P<0.05),在21d时下降但仍高于假手术组(P<0.05)。③脑源性神经营养因子蛋白主要分布于腹角的运动神经元胞浆中,胶质细胞未见着色。在正常脊髓有少量表达,脊髓损伤后7d表达明显升高(P<0.05),伤后21d已下降,同假手术组相比差异无显著性(P>0.05);三七皂苷可明显促进其表达,伤后3,7,21d均明显高于所有对照组(P<0.05)。结论:三七皂苷可减轻脊髓横断性损伤后继发损害,增加神经生长因子、脑源性神经营养因子表达量及提前神经生长因子、脑源性神经营养因子表达时间,提示其可以促进脊髓损伤早期修复。     

Studies on the mechanism of bacterial resistance to complement-mediated killing. II. C8 and C9 release C5b67 from the surface of salmonella minnesota S218 because the terminal complex does not insert into the bacterial outer membrane

The mechanism for consumption of terminal complement components and release of bound components from the surface of serum-resistant salmonella minnesota S218 was studied. Consumption of C8 and C9 by S218 occurred through interaction with C5b67 on the bacterial surface because C8 and C9 were consumed when added to S218 organisms previously incubated in C8-deficient serum and washed to remove all C5b67 on the bacterial surface because C8 and C9 were consumed when added to S218 organisms previously incubated in C8- deficient serum and washed to remove al but cell bound C5b67. Rapid release of (125)I C5 and (125)I C7 from the membrane of S218 was dependent on binding of C8 because (125)I C5 and (125)I C7 deposition in C8D serum was stable and was twofold higher in C8D than in PNHA, and addition of purified C8 or C8 and C9 to S218 previously incubated in C8D serum caused rapid release of (125)I C5 and (125)I C7 from the organism. Analysis by sucrose density gradient ultracentrifugation of the fluid phase from the reaction of S218 and 10 percent PNHS revealed a peak consistent with SC5b-9, in which the C9:C7 ratio was 3.3:1, but the NaDOC extracted bound C5b-9 complex sedimented as a broad peak with C9:C7 of less than 1.2:1. Progressive elution of C5b67 and C5b-9 from S218 but not serum-sensitive S. minnesota Re595 was observed with incubation in buffers of increasing ionic strength. Greater than 90 percent of the bound counts of (125)I C5 or (125)I C9 were released from S218 by incubation in 0.1 percent trypsin, but only 57 percent of (125)I C9 were released by treatment of Re595 with trypsin. These results are consistent with the concept that C5b-9 forms on the surface of the serum-sensitive S. minnesota S218 in normal human serum, but the formed complex is released and is not bactericidal for S218 because it fails to insert into hydrophobic outer membrane domains.