Effect of Selective Inflow Occlusion on Hemodynamic Conditions during Laparoscopic Left HemihepatectomyEffect of Selective Inflow Occlusion on Hemodynamic Conditions during Laparoscopic Left Hemihepatectomy

Background/Aims: Selective inflow occlusion instead of portal triad clamping was used during laparoscopic left hemihepatectomy in our institution. This study observed its hemodynamic effects during operation. Methodology: Hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were collected at 6 time points: after induction, after insufflation with CO2, after patient in reverse Trendelenburg position, after left branch of hepatic artery was occluded, after left branch of portal vein was occluded and after desufflation with patient supine. Results: No severe perioperative cardiopulmonary complications were observed. Occlusion of left branch of hepatic artery brought no significant hemodynamic change. Occlusion of left branch of portal vein increased CVP and CI and decreased SVR. CO2 inflation caused HR, MAP and SVR to increase. The change to reverse Trendelenburg position caused CVP and PAP to decrease. When placed in the supine position with deflation, MAP, CVP, PAP, PCWP and CI went to a higher than base level. HR and SVR returned to base level. Conclusions: Using selective inflow occlusion in laparoscopic left hemihepatectomy caused few hemodynamic changes before and after occlusion in patients without cardiopulmonary diseases. However, the change of position and inflation or deflation caused significant changes.     

Novel application of four-dimensional sonography with B-flow imaging and spatiotemporal image correlation in the assessment of fetal congenital heart defects

Aims: To evaluate the role of four‐dimensional (4D) ultrasound with B‐flow imaging and spatiotemporal image correlation (STIC) in the evaluation of normal fetal heart and congenital heart disease during pregnancy. Methods: Volume data sets of the fetal heart were acquired with automated transverse and longitudinal sweeps of the anterior chest wall. We studied 31 normal fetuses and 28 fetuses with congenital heart disease (6 with double‐outlet right ventricle, 5 with complete transposition of great arteries, 8 with tetralogy of Fallot, 3 with right aortic arch, 2 with persistent left superior vena cava, 3 with truncus arteriosus communis, and 1 with interruption of aortic arch) at gestation ages ranging from 18 to 39 weeks using transabdominal 4D B‐flow sonography with STIC (4D BF‐STIC). Results: Four‐dimensional BF‐STIC demonstrated dynamic angiographic features in both normal and abnormal fetal hearts. Four‐dimensional BF‐STIC images could not be obtained in two normal fetuses at 18.9 and 35.6 weeks because of the high fetal heart rate and inappropriate fetal position. Of the other 29 fetuses all extracardiac vessels such as aorta, pulmonary artery, ductus arteriosus, inferior vena cava, and ductus venosus could be detected on reconstructed images. In seven normal cases, a 4D image was recorded to allow simultaneous visualization of all four pulmonary veins. In the 28 fetuses with cardiac anomalies, 4D sonography with B‐flow imaging and STIC detected the “digital casts” of the outflow tracts, great arteries, and veins draining into the heart. These results demonstrate spatial relationship among these structures which provide important anatomical information. Conclusion: Four‐dimensional BF‐STIC provides a means of real time three‐dimensional evaluation of fetal extracardiac hemodynamics in the second and third trimesters. This novel technique assists in the evaluation of fetal cardiac hemodynamics and may play an important role in future fetal cardiac research and in the identification of anatomical features of different congenital cardiac anomalies. (Echocardiography 2012;29:614‐619)     

艾滋病合并结核性脑膜炎脑脊液特点分析

目的了解艾滋病合并结核性脑膜炎患者脑脊液特点。方法回顾性分析2012-01—2012-12在我院感染科住院的25例艾滋病合并结核性脑膜炎和在结核科住院的23例结核性脑膜炎患者的临床资料。按照是否感染HIV,将这些患者分为HIV组与非HIV组。比较2组患者临床资料、CSF常规、生化、ADA、TBDNA,外周血γ-干扰素体外释放试验(T-SPOT.TB)。结果艾滋病合并结核性脑膜炎患者与非HIV结核性脑膜炎患者脑脊液压力升高(≥180mmH2O)、白细胞数<500×106个/L、蛋白升高、氯化物下降、葡萄糖下降、ADA升高、TBDNA阳性率分别为88%和86.96%,92%和95.65%,92%和91.30%,72%和73.91%,60%和60.57%,56%和60.87%,和58.33%和60%;外周血γ-干扰素体外释放试验(T-SPOT.TB)阳性率分别为90%和80%,以上率的比较HIV组与非HIV组差异无统计学意义。2组间以上指标平均值比较:HIV组患者脑脊液白细胞数和TBDNA定量均显著低于非HIV组患者(P=0.002,P=0.011);HIV组患者外周血T-SPOT.TB平均值显著低于非HIV组(P=0.027)。HIV组CD4水平低于200cells/μL的患者占80%。结论结核性脑膜炎是艾滋病晚期的中枢神经系统机会性感染之一。有发热、头痛、恶心、呕吐、颈强直、意识障碍等临床表现。脑脊液压力升高,白细胞数轻、中度升高,蛋白升高,葡萄糖及氯化物降低,ADA升高的特点。外周血T-SPOT.TB阳性率高。与非HIV结核性脑膜炎患者相比脑脊液中白细胞及TBDNA定量平均值较低。     

奥卡西平对癫癎患儿外周血MDR1表达的影响

目的通过比较奥卡西平(oxcarbazepine,OXC)和卡马西平(carbamazepine,CBZ)对癫癎患儿外周血多药耐药基因1(MDR1)表达的影响,初步探讨长期应用OXC治疗癫癎对患儿外周血MDR1的诱导作用。方法 48例癫癎患儿分为2组,26例口服OXC,22例口服CBZ,治疗时间均超过12个月;25例无癫发作患儿为空白对照组。选择用药前、用药后6个月及12个月三个时间点,应用RT-PCR法测定患儿外周血MDR1-mRNA的表达。结果 OXC组和CBZ组外周血MDR1-mRNA表达在用药后6个月、12个月较对照组增高(P<0.01);OXC组和CBZ组患儿外周血MDR1-mRNA表达在用药后6个月及12个月较开始服药前均有增高(P<0.05);OXC组在用药6个月及12个月后外周血MDR1-mRNA表达和卡马西平组比较差异无统计学意义(P>0.05)。结论长期口服OXC和CBZ均会增加癫癎患儿外周血MDR1基因的表达。     

Ceramide is involved in alcohol-induced neural proliferation****

Prenatal alcohol exposure, especially during early pregnancy, can lead to fetal alcohol syndrome. The pharmacological and toxicological mechanisms of ethanol are related to the effects of ceramide. In this study, we established an alcohol exposure model in wild-type mice and in knockout mice for the key enzyme involved in ceramide metabolism, sphingomyelin synthase 2. This model received daily intragastric administration of 25% ethanol, and pups were used at postnatal days 0, 7, 14, 30 for experiments. Serology and immunofluorescence staining found that ethanol exposure dose-dependently reduced blood sphingomyelin levels in two genotypes of pups, and increased neural cell proliferation and the number of new neurons in the hippocampal dentate gyrus. Western blot analysis showed that the relative expression level of protein kinase C α increased in two genotypes of pups after ethanol exposure. Compared with wild-type pups, the expression level of the important activator protein of the ceramide/ceramide-1-phosphate pathway, protein kinase C α, was reduced in the hippocampus of sphingomyelin synthase 2 knockouts. Our findings illustrate that ceramide is involved in alcohol-induced neural proliferation in the hippocampal dentate gyrus of pups after prenatal ethanol exposure, and the mechanism may be associated with increased ex-pression of protein kinase C α activating the ceramide/ceramide-1-phosphate pathway.     

Anomalous expression of chloride transporters in the sclerosed hippocampus of mesial temporal lobe epilepsy patients

The Na+-K+-Cl-cotransporter 1 and K+-Cl-cotransporter 2 regulate the levels of intracellular chloride in hippocampal cells.Impaired chloride transport by these proteins is thought to be involved in the pathophysiological mechanisms of mesial temporal lobe epilepsy.Imbalance in the relative expression of these two proteins can lead to a collapse of Cl-homeostasis,resulting in a loss of gamma-aminobutyric acid-ergic inhibition and even epileptiform discharges.In this study,we investigated the expression of Na+-K+-Cl-cotransporter 1 and K+-Cl-cotransporter 2 in the sclerosed hippocampus of patients with mesial temporal lobe epilepsy,using western blot analysis and immunohistochemistry.Compared with the histologically normal hippocampus,the sclerosed hippocampus showed increased Na+-K+-Cl-cotransporter 1 expression and decreased K+-Cl-cotransporter 2 expression,especially in CA2 and the dentate gyrus.The change was more prominent for the Na+-K+-Cl-cotransporter 1 than for the K+-Cl-cotransporter 2.These experimental findings indicate that the balance between intracellular and extracellular chloride may be disturbed in hippocampal sclerosis,contributing to the hyperexcitability underlying epileptic seizures.Changes in Na+-K+-Cl-cotransporter 1 expression seems to be the main contributor.Our study may shed new light on possible therapies for patients with mesial temporal lobe epilepsy with hippocampal sclerosis.     

Extracts from rabbit skin inflamed by the vaccinia virus attenuate bupivacaine-induced spinal neurotoxicity in pregnant rats

Extracts from rabbit skin inflamed by the vaccinia virus can relieve pain and promote repair of nerve injury. The present study intraperitoneally injected extracts from rabbit skin inflamed by the vaccinia virus for 3 and 4 days prior to and following intrathecal injection of bupivacaine into pregnant rats. The pain threshold test after bupivacaine injection showed that the maximum possible effect of tail-flick latency peaked 1 day after intrathecal injection of bupivacaine in the extract-pretreatment group, and gradually decreased, while the maximum possible effect in the bupivacaine group continued to increase after intrathecal injection of bupivacaine. Histological observation showed that after 4 days of intrathecal injection of bupivacaine, the number of shrunken, vacuolated, apoptotic and caspase-9-positive cells in the dorsal root ganglion in the extract-pretreatment group was significantly reduced compared with the bupivacaine group. These findings indicate that extracts from rabbit skin inflamed by the vaccinia virus can attenuate neurotoxicity induced by intrathecal injection of bupivacaine in pregnant rats, possibly by inhibiting caspase-9 protein expression and suppressing nerve cell apoptosis.     

Non-invasive imaging of the crystalline structure within a human tooth

The internal crystalline structure of a human molar tooth has been non-destructively imaged in cross-section using X-ray diffraction computed tomography. Diffraction signals from high-energy X-rays which have large attenuation lengths for hard biomaterials have been collected in a transmission geometry. Coupling this with a computed tomography data acquisition and mathematically reconstructing their spatial origins, diffraction patterns from every voxel within the tooth can be obtained. Using this method we have observed the spatial variations of some key material parameters including nanocrystallite size, organic content, lattice parameters, crystallographic preferred orientation and degree of orientation. We have also made a link between the spatial variations of the unit cell lattice parameters and the chemical make-up of the tooth. In addition, we have determined how the onset of tooth decay occurs through clear amorphization of the hydroxyapatite crystal, and we have been able to map the extent of decay within the tooth. The described method has strong prospects for non-destructive probing of mineralized biomaterials.