The influence of depth of anesthesia and blood pressure on muscle recorded motor evoked potentials in spinal surgery. A prospective observational study protocol

Journal of Clinical Monitoring and Computing - For high-risk spinal surgeries, intraoperative neurophysiological monitoring (IONM) is used to detect and prevent intraoperative neurological injury....     

转化生长因子β1转染骨髓间充质干细胞向软骨细胞的分化

目的:通过转化生长因子β1基因转染大鼠的骨髓间充质干细胞,观察目的基因的分泌情况及干细胞向软骨细胞分化效果,为构建新型的软骨组织工程学种子细胞提供新思路。方法:实验于2005-10/2006-09在中国医科大学细胞生物实验室完成。实验材料:6周龄Wistar大鼠10只,质粒pcDNA3.1-TGF-β1(由吉林大学徐莘香教授惠赠),转化生长因子β1、Ⅱ型胶原小鼠抗大鼠单克隆抗体(Neomaker公司)。实验分组:分为未经转染的骨髓间充质干细胞(未转染组)、转染空载的骨髓间充质干细胞(转染空载体组)和转染转化生长因子β1的骨髓间充质干细胞(转染转化生长因子β1组)。实验方法:①密度梯度离心法和贴壁分离法相结合分离、纯化大鼠骨髓间充质干细胞,免疫荧光法检测细胞表面标志。②质粒pcDNA3.1-TGF-β1扩增、提取、鉴定。③转化生长因子β1基因转染骨髓间充质干细胞。实验评估:①四甲基偶氮唑盐法测定筛选后细胞的增殖活性。②Westernblot检测转染后细胞转化生长因子β1和Ⅱ型胶原蛋白表达。结果:①免疫荧光法检测骨髓间充质干细胞:CD29和CD44表达阳性,CD34和CD45表达阴性。②pcDNA3.1-TGF-β1真核表达载体的酶切鉴定:基因测序与GeneBank cDNA序列相符。③转染基因对骨髓间充质干细胞增殖活性的影响:基因转染后骨髓间充质干细胞的增殖力变强,转染组的细胞增殖力高于未转染组和转染空载体组。④转化生长因子β1表达:转染后的骨髓间充质干细胞较未转染和转染空载体的骨髓间充质干细胞分泌转化生长因子β1蛋白增加。⑤Ⅱ型胶原的蛋白表达:在转化生长因子β1目的基因转染后的骨髓间充质干细胞Ⅱ型胶原蛋白表达较未染和转染空载体的骨髓间充质干细胞增强。结论:应用基因转染技术将转化生长因子β1目的基因导入骨髓间充质干细胞中,在蛋白质水平鉴定转染成功,且骨髓间充质干细胞成软骨分化所需的特异性细胞外基质Ⅱ型胶原明显升高,使骨髓间充质干细胞在保持很强的体外传代增殖能力同时,又能产生、表达转化生长因子β1。     

Long-term follow-up of and infectivity in blood donors with hepatitis C antibodies and persistently normal alanine aminotransferase levels

BACKGROUND: Little is known about the prevalence of serum hepatitis C virus (HCV) RNA in blood donors with HCV antibodies and persistently normal alanine aminotransferase (ALT) levels. STUDY DESIGN AND METHODS: Thirty-nine anti-HCV-positive donors with normal ALT on four determinations at 3-month intervals were further tested monthly for 6 months, and they had normal ALT values. The presence of HCV RNA was determined in these 39 donors. RESULTS: Serum HCV RNA was detected in 16 of 39 donors, 14 of 14 who reacted on second-generation recombinant immunoblot assay (RIBA-2) and 2 of 15 who were indeterminate. None of the 10 RIBA-2-nonreactive donors had evidence of viremia. The 15 RIBA-2- indeterminate samples were tested with third-generation RIBA (RIBA-3); the results showed reactivity in 5 (including the 2 HCV RNA positive), an indeterminate pattern in 7, and nonreactivity in 3 (all RNA negative). Among HCV RNA-positive subjects, mean age (p < 0.05), mean ALT (p < 0.001), signal-to-cutoff (S:CO) ratio on second-generation enzyme-linked immunosorbent assay (p < 0.001), and gamma globulin levels (p < 0.05) were higher than those among HCV RNA-negative subjects. During 6 additional months of ALT monitoring, completed by 36 of 39 donors, increased values were detected in 6 (5 HCV RNA positive). In 4 of those 6, however, ALT levels were less than 1.5-fold the upper normal limit. HCV RNA results were unchanged at the end of 1-year follow-up. CONCLUSION: Forty-one percent of anti-HCV-positive donors with persistently normal ALT had active HCV infection. Long-term ALT monitoring allowed the detection of significantly increased enzyme values in only 2 of 16 viremic donors. Reactivity on RIBA-2 or -3, greater age, mean ALT levels in the upper range of normal, higher S:CO ratio on second-generation enzyme-linked immunosorbent assay, and higher gamma globulin levels were predictive of viremia.     

Thrombomodulin mutant mice with a strongly reduced capacity to generate activated protein C have an unaltered pulmonary immune response to respiratory pathogens and lipopolysaccharide

The thrombomodulin-protein C-protein S (TM-PC-PS) pathway exerts anticoagulant and anti-inflammatory effects. We investigated the role of TM in the pulmonary immune response in vivo by the use of mice with a mutation in the TM gene (TM(pro/pro)) that was earlier found to result in a minimal capacity for activated PC (APC) generation in the circulation. We here demonstrate that TM(pro/pro) mice also display a strongly reduced capacity to produce APC in the alveolar compartment upon intrapulmonary delivery of PC and thrombin. We monitored procoagulant and inflammatory changes in the lung during Gram-positive (Streptococcus pneumoniae) and Gram-negative (Klebsiella pneumoniae) pneumonia and after local administration of lipopolysaccharide (LPS). Bacterial pneumonia was associated with fibrin(ogen) depositions in the lung that colocalized with inflammatory infiltrates. LPS also induced a rise in thrombin-antithrombin complexes in bronchoalveolar lavage fluid. These pulmonary procoagulant responses were unaltered in TM(pro/pro) mice, except for enhanced fibrin(ogen) deposition during pneumococcal pneumonia. In addition, TM(pro/pro) mice displayed unchanged antibacterial defense, neutrophil recruitment, and cytokine/chemokine levels. These data suggest that the capacity of TM to generate APC does not play a role of importance in the pulmonary response to respiratory pathogens or LPS.     

Polymorphonuclear motility: measurement by computer-linked image analysis

Most methods of measuring neutrophil motility provide information mainly about the performance of a small proportion of the fastest moving cells. Application of a computer-linked image analysis technique, using the "Quantimet," provides a convenient, automated method of measuring the motility of the whole cell population. This makes it possible to test whether changes in motility represent a homogeneous alteration affecting all cells or a change in the numbers or performance of a subset of cells. In this study the neutrophils from patients with uncomplicated rheumatoid arthritis were found to perform similarly to normals, while cells from patients with Felty's syndrome were markedly slower. This was an overall, homogeneous slowing of the whole cell population, not due to a loss of fast moving cells.     

The relationships between cardiovascular magnetic resonance imaging variables of acute myocardial infarction and both left ventricular dysfunction and immediate postreperfusion ST segment recovery

Objective

The aim of this study is to explore the relationships between cardiovascular magnetic resonance imaging (CMR)-determined variables of acute myocardial infarction and both left ventricular (LV) dysfunction and immediate postreperfusion ST segment recovery.

Methods

In 79 patients with first acute myocardial infarction, 8 different ST segment recovery (STR) variables were measured 30 and 60 minutes after percutaneous coronary intervention. Cardiovascular magnetic resonance imaging was performed 5 ± 2 and 104 ± 11 days after admission. Using k-means cluster analysis, 3 CMR risk groups for LV dysfunction (low LV ejection fraction at baseline and follow-up) were identified based on combinations of infarct size (IS), infarct transmurality, and microvascular obstruction. Stepwise discriminant analysis was used to determine which STR variable best discriminated between CMR risk groups.

Results

Baseline LV ejection fraction improved in all groups but remained lowest in the high-risk group (41% ± 7% and 44% ± 6%), as compared with the intermediate (51% ± 5% and 56% ± 5%) and low-risk groups (56% ± 7% and 58% ± 5%). Infarct size was significantly different among the groups (34% ± 5%, 19% ± 4%, and 6% ± 4%; P < .001) and mainly determined the effect on LV dysfunction. Of all STR variables, worst lead residual ST deviation 30 minutes after reperfusion accurately discriminated between the high- and combined low-/intermediate risk groups.

Conclusion

Worst lead residual ST deviation 30 minutes after reperfusion allows accurate identification of patients at high risk for LV dysfunction, which was mainly related to IS rather than transmurality or microvascular obstruction.     

Sodium bicarbonate improves sprint performance in endurance cycling

ObjectivesOral sodium bicarbonate intake (NaHCO₃) may improve performance in short maximal exercise by inducing metabolic alkalosis. However, it remains unknown whether NaHCO₃ also enhances all-out performance at the end of an endurance competition. Therefore, the present study investigated the effect of stacked NaHCO₃ loading on sprint performance following a 3-h simulated cycling race.DesignDouble-blind randomized placebo-controlled cross-over study.MethodsEleven trained male cyclists (22.3 (18.3–25.3) year; 73.0 (61.5–88) kg; VO₂max: 63.7 (57–72) ml kg^?1 min^?1) ingested either 300 mg kg^?1 body weight NaHCO₃ (BIC) or NaCl (PL). NaHCO₃ or NaCl was supplemented prior to (150 mg kg^?1) and during (150 mg kg^?1) a 3-h simulated cycling race with a 90-s all-out sprint (90S) at the end. Capillary blood samples were collected for determination of blood pH, lactate and HCO₃^? concentrations. Analysis of variance (lactate, pH, HCO₃^?) and paired t-test (power) were applied to compare variables across condition (and time).ResultsNaHCO₃ intake improved mean power during 90S by ～3% (541 ± 59 W vs. 524 ± 57 W in PL, p = 0.047, Cohen’s D = 0.28, medium). Peak blood lactate concentration and heart rate at the end of 90S were higher (p < 0.05) in BIC (16.2 ± 4.1 mmol l ¹, 184 ± 7 bpm) than in PL (12.4 ± 4.2 mmol l^?1, 181 ± 5 bpm). NaHCO₃ ingestion increased blood [HCO₃^?] (31.5 ± 1.3 vs. 24.4 ± 1.5 mmol l^?1 in PL, p < 0.001) and blood pH (7.50 ± 0.01 vs. 7.41 ± 0.03 in PL, p < 0.05) prior to 90S.ConclusionsNaHCO₃ supplementation prior and during endurance exercise improves short all-out exercise performance at the end of the event. Therefore, sodium bicarbonate intake can be applied as a strategy to increase success rate in endurance competitions.