速度向量成像技术评价急性心肌缺血左心室扭转运动

目的建立新西兰大白兔急性心肌缺血动物模型,应用速度向量成像(VVI)技术分析急性心肌缺血状态下左心室扭转运动的变化特点。方法新西兰大白兔40只,随机分为急性心肌缺血组和假手术组,于冠状动脉结扎术前和术后30 min内行超声心动图检查并采集动态图像,脱机行VVI分析,测量左心室心尖水平及心底水平的旋转角度峰值、旋转速度峰值、解旋速度峰值。结果急性心肌缺血组术后,心底水平左心室旋转角度、旋转速度及解旋速度有减低趋势,但与术前及假手术组比较差异无统计学意义(P0.05);心尖水平左心室旋转角度、旋转速度及解旋速度均明显减低,与术前及假手术组比较差异均有统计学意义(P0.05),左心室整体扭转角度、速度和解旋速度术后改变趋势与心尖水平相似,与术前及假手术组比较差异均有统计学意义(P0.05)。结论急性心肌缺血后,左心室扭转和解旋功能受损,主要由心尖部旋转和解旋减低引起。VVI技术能够客观、准确地检测实验兔左心室扭转的变化特征,为急性心肌缺血的早期诊断提供了一种新的、无创的、可靠的定量工具。     

胆道高压对内脏大神经的影响及其意义

为了探讨胆道高压对内脏大神经的影响及其在重症急性胆管炎(ACST)发病机理中的意义。本实验采用自制“盲囊”加压装置制成家兔急性胆道加压模型,同步动态记录内脏大神经放电频率和血压变化,结果表明:在150mmHg(20kPa)加压条件下,内脏大神经放电频率于1分钟内即明显增加(P<0.01),且右侧远较左侧明显(P<0.01),同时血压也明显下降(P<0.01)。如迅速减压,则放电频率和血压均在短期内恢复至加压前水平。阻断右侧内脏大神经,则血压下降不明显(P>0.05)。实验结果提示,内脏大神经活动与重症急性胆管炎早期的血压下降有关,值得深入探讨。     

急诊玻璃体手术治疗眼后段异物伤的临床观察

目的:探讨急诊玻璃体手术治疗眼后段异物伤的临床疗效。方法:回顾性分析2005-01/2010-12在我院诊断为后段眼内异物的眼球穿通伤,急诊行玻璃体切割、异物取出术患者32例32眼的临床资料。结果:患者30例一次性取出异物。术后视力改善12例,视力不变的10例,视力下降的10例。术后继发性青光眼4例,视网膜脱离3例,眼球萎缩的2例。术中1例因角膜混浊、1例因眼内出血加重终止手术,择期手术成功取出异物。结论:急诊行玻璃体切割、异物取出术是治疗眼内异物的有效而及时的处理方法。     

胆道高压对Oddi括约肌动力学的影响

目的和方法：探讨胆道压力对Ｏｄｄｉ括约肌的影响和急性梗阻性化脓性胆管炎（ＡＯＳＣ）时胆道高压的形成机制，采用家兔复制急性胆道盲囊加压模型。结果：胆道加压至８ｋＰａ（６０ｍｍＨｇ）的数分钟内，Ｏｄｄｉ括约肌电活动明显增强；Ｏｄｄｉ括约肌压力显著升高（Ｐ＜００５），甚至出现持续痉挛；同时伴有右内脏大神经放电频率增强和动脉血压的进行性下降（Ｐ＜００５）。而用０６％利多卡因阻滞右腹腔神经丛后，再行胆道加压则以上反应不能发生。若在加压后行腹腔神经丛阻滞术，Ｏｄｄｉ括约肌收缩或痉挛也可逐渐缓解。结论：急性胆道梗阻可能诱发Ｏｄｄｉ括约肌收缩增强，使胆道内压进一步升高，形成恶性循环，机制可能与内脏神经活动有关     

Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and mortality. However, the underlying mechanism is unclear. In this cross-sectional study, we investigated the influence of OSA on metabolic syndrome (MetS) and inflammation, which were considered as cardiovascular risks. A total of 144 consecutive male patients who underwent standard polysomnography were enrolled. Fasting blood samples were obtained from all patients for glucose, high-sensitivity C-reactive protein (hs-CRP) and lipids measurement. A metabolic score was established as the total number of the positive diagnostic criteria of metabolic syndrome for each patient. Systolic blood pressure, diastolic blood pressure, fasting glucose, hs-CRP and metabolic score significantly increased with the aggravation of OSA severity. Metabolic score increased from 1.74 ± 1.20 to 2.89 ± 0.99 with OSA severity (p = 0.000). hs-CRP increased from 0.68 (0.43–1.10) to 1.44 (0.62–4.02) mg/L with OSA severity (p = 0.002). After adjustment for confounders, apnea–hypopnea index and body mass index (BMI) were the major contributing factors for metabolic score (β = 0.257, p = 0.003 and β = 0.344, p = 0.000, respectively), lowest O₂ saturation and BMI were the independent predictors of hs-CRP (β = ?0.255, p = 0.003 and β = 0.295, p = 0.001, respectively). OSA is independently associated with sum of metabolic components and hs-CRP.     

超声诊断胎儿肺发育不良的临床价值

目的 探讨多个超声指标用于产前诊断胎儿肺发育不良的临床价值.方法 应用彩色多普勒超声诊断仪,检查271例正常胎儿,建立5个超声指标(肺面积、肺面积与胎儿质量比、胸围与腹围比、肺面积与胸廓面积比、肺面积与头围比)的正常值范围,以低于正常范围二倍标准差为肺发育不良胎儿判断标准.通过对30例肺发育不良高危胎儿的研究,并与尸体解剖及追踪结果对照,比较各超声指标的临床价值.结果 肺面积及肺面积与头围比随孕周增加而增加,肺面积与胎儿质量比随孕周增加而减少,胸围与腹围比、肺面积与胸廓面积比随孕周增加变化较小.肺面积、肺面积与胎儿质量比、胸围与腹围比、肺面积与胸廓面积比、肺面积与头围比用于产前诊断胎儿肺发育不良的准确率分别为83%、97%、50%、70%、87%.肺面积与胎儿质量比诊断准确率最高,灵敏度为95%(20/21),特异度为9/9,阳性预测值为100%(20/20).结论 肺面积与胎儿质量比能较好地预测致死性肺发育不良,具有临床实用性.     

Protection against hepatic ischemia/reperfusion injury via downregulation of toil-like receptor 2 expression by inhibition of Kupffer cell function

AIM: To elucidate the mechanism of liver protection by inhibition of Kupffer cells (KCs) function.METHODS: All the animals were randomly divided into three groups. Blockade group (gadolinium chloride solution (GdCl3) injection plus ischemia/reperfusion (I/R) injury):GdCl3 solution was injected once every 24 h for 2 d via the tail vein before I/R injury. Non-blockade group (saline solution injection plus I/R injury): saline instead of GdCl3 as a control was injected as in the blockade group. Sham group: saline was injected without I/R injury. Liver samples were collected 4 h after blood inflow restoration. The blockade of the function of KCs was verified by immunostaining with an anti-CD68 mAb. Toll-like receptor 2 (TLR2) was immunostained with a goat antimouse polyclonal anti-TLR2 antibody. Membrane proteins were extracted from the liver samples and TLR2 protein was analyzed by Western blot. Portal vein serum and plasma were taken respectively at the same time point for further detection of the levels of tumor necrosis factor-α (TNF-α) and alanine aminotransferase (ALT), an indicator of liver function.RESULTS: Compared to non-blockade group, CD68+ cells significantly reduced in blockade group (OPTDI, optical density integral): 32.97±10.55 vs 185.65±21.88,P＜0.01)and the liver function impairment was relieved partially (level of ALT: 435.89±178.37 U/L vs890.21±272.91 U/L,P＜0.01). The expression of TLR2 protein in blockade group significantly decreased compared to that in non-blockade group (method of immunohistochemistry, OPDTI: 75.74±17.44vs 170.58±-25.14, P＜0.01; method of Western blot,A value: 125.89±15.49 vs433.91±35.53, P＜0.01). The latter correlated with the variation of CD68 staining (r = 0.745,P＜0.05). Also the level of portal vein TNF-α decreased in blockade group compared to that in non-blockade group (84.45±14.73 ng/L vs112.32±17.56 ng/L, P＜0.05), but was still higher than that in sham group (84.45±14.73 ng/Lvs 6.07±5.33 ng/L, P＜0.01).CONCLUSION: Inhibition of the function of KCs may protect liver against I/R injury via downregulation of the expression of TLR2.     

2型糖尿病患者血糖波动与亚临床动脉粥样硬化的关系

目的探讨2型糖尿病患者血糖波动与亚临床动脉粥样硬化的关系。方法170例年龄35～70岁、病程在1年以内、无亚临床动脉粥样硬化的2型糖尿病患者随机分为4组,分别给予不同的药物方案治疗。定期复查空腹血糖、早餐后2h血糖、糖化血红蛋白和血管彩色超声等指标,共随访3年。结果3年结束时,4组之间血糖波动指标比较差异无显著性(P>0.05),4个血糖波动指标的分层分析显示,亚临床动脉粥样硬化发生率均随血糖波动的增加而呈升高的趋势,尚未达到统计学差异。Logistic回归分析显示,亚临床动脉粥样硬化的发生与吸烟、高血脂、高龄、腹型肥胖、早餐后2h血糖与空腹血糖差值波动有关,而不同的干预方式对亚临床动脉粥样硬化的发生有影响(P<0.001)。结论早餐后2h血糖与空腹血糖差值波动大是2型糖尿病患者亚临床动脉粥样硬化的危险因素之一,吸烟、高血脂、高龄、腹型肥胖均是2型糖尿病患者亚临床动脉粥样硬化的危险因素。