动脉波形分析计算心排出量及临床应用

动脉波形分析技术用于测量心排出量(arterial pressure-based cardiac output,APCO)和每搏输出量变异指数(stroke volume variation,SVV)是一项新的微创血流动力学技术,它能够连续通过对外周动脉的波形特征结合患者的基本信息(年龄、性别、身高、体重等)进行分析测定心排出量(CO),并且不需要通过其他方法来校准.临床上已经显示出可以接受的准确性和良好的即时性和方便性,但也存在一定的局限性,如在一些心脏疾病如主动脉返流、二尖瓣返流或给予α1受体激动药,APCO并不能准确反映心排血量.     

体外冲击波对兔输尿管形态及组织学影响的研究

目的 :探讨冲击波 (SW )对输尿管形态的影响。方法 :将 4 2只成年兔随机分为 7组 ,每组 6只。第 1组为正常对照组 ;第 2～ 6组为液电式SW组 ;第 7组为电磁式SW组。各组接受冲击并在冲击后不同时间取材。全部标本行常规病理检查并予评分。结果 :第 2～ 5组和第 7组 ,肉眼可见焦点周围组织有出血、水肿等改变 ,输尿管直径较冲击前显著增加 (P <0 .0 1 )。光镜下可见平滑肌细胞变性及管腔狭窄 ,病理量化评分显著高于正常组 (P <0 .0 5 ) ;电镜下则有肌细胞线粒体破坏等改变。第 6组形态改变不明显 ,病理评分和正常组的区别无显著性意义。结论 :临床剂量的冲击波能导致输尿管多种病理变化。冲击后第 5天 ,输尿管形态已基本恢复正常。由液电式和电磁式冲击波所致的输尿管急性损伤程度无明显的区别     

频闪喉镜对声带病理情况观察的研究

对1997年以来423例病态喉的频闪喉镜表现进行分析,结果显示声带有病理改变者其粘膜波、振幅、闭合相、运动周期性、对称性均有不同程度的变化,这种变化能直接反映声带病变的深度及范围,对喉部疾病的诊断、鉴别诊断、治疗指导及预后评价具有重要意义.     

Fragmentation process of current laser lithotriptors

Background and Objective: Flashlamp pumped dye (FPDL), Q-switched Nd:YAG, and alexandrite lasers are the most clinically used laser lithotriptors. Although calculi are fragmented by laser induced mechanical stresses for all lithotriptors, different fragment sizes and fragmentation efficiencies have been reported. In this work the effect of the pulse duration and pulse shape on the fragmentation processes is studied. Material and Methods: Fragmentation processes are characterized on model stones and on sensing target fibers. Stone fragmentation and cavitation bubble generation are observed by video flash photography. Shock wave occurrence and strength are monitored with an hydrophone. Results: For the FPDL, stone fragmentation is induced by the collapse of the large cavitation bubble formed. For the Q-switched Nd:YAG, fragmentation is already observed during the laser pulse, at the plasma onset, although further fragmentation can occur at the bubble collapse. For pulse durations corresponding to the alexandrite, an intermediate fragmentation regime is observed. Conclusion: For the first time the physical basis of the observed differences in the fragmentation efficiencies of current laser lithotriptors is described. For nanosecond durations the fragmentation processes are governed by plasma induced shock waves. On the contrary, for microsecond durations fragmentation is governed by cavitation. The high fragmentation efficiency of microsecond lasers is due to a high laser energy transfer into cavitation. © 1995 Wiley-Liss, Inc.     

主动脉瓣机械瓣置换术后交替脉

报道４例因主动脉瓣关闭不全行主动脉瓣置换术后的患者在术后早期出现脉搏交替现象，此时心电图为整齐的窦性心律，所记录的脉搏图形高低交替，如扪诊桡动脉时则会发现桡动脉搏数为心电图示心率的一半。患者术后均顺利恢复，显示这一现象为一过性的、良性的过程。推测这一现象出现的原因可能是术后早期主动脉瓣不再有回流，因而巨大的左室腔充盈不足，加之左室收缩力尚低，不能在每次收缩时都能射出同等量的血流所致     

The relation between conduction velocity and axonal length

Motor evoked potentials (MEPs) obtained by electrical root stimulation and F waves were used to examine the proximal nerve conduction velocity (CV) to tibialis anterior (TA), extensor digitorum brevis (EDB), flexor carpi radialis (FCR), and abductor pollicis brevis (APB) muscles in 40 humans. By subtracting motor latencies obtained by stimulating the peripheral nerve at the same point from the F-wave and MEP latencies, we could measure the CV over identical proximal segments. It was found that proximal CV to TA and FCR was significantly higher than to EDB and APB, respectively. Combining the data of the proximal CV to all four muscles in relation with axonal length resulted in a highly significant inverse relationship (r² = 0.77). Thus the axonal length explained to a large extent the higher CV of the arm nerves and also the inverse relation between body height and CV. The distal CV was always lower than proximal CV; however, there was no support for an additional effect of this gradient in explaining the relationship between CV and height since it was constant for all body heights. © John Wiley & Sons, Inc.     

Only activated but not non-activated presynaptic α2-autoreceptors interfere with neighbouring presynaptic receptor mechanisms

Summary Experiments were carried out in rabbit cerebrocortical slices in order to find out whether the attenuation by presynaptic ₂-autoreceptors of effects mediated by presynaptic opioid - and adenosine A₁-receptors requires activation of the ₂-receptors. The slices were preincubated with ³H-noradrenaline and then superfused with medium containing desipramine 1 mol/l. They were stimulated electrically either with single pulses or with trains of 32 pulses at 1 Hz.The overflow of tritium elicited by a single pulse amounted to 0.21% of the tritium content of the tissue. It was Ca²⁺-dependent and tetrodotoxin-sensitive and not changed by rauwolscine 1 mol/l or yohimbine 0.3 mol/l. Ethylketocyclazocine (EK; 0.1–10 nmol/l) and R-(–)-N⁶-phenylisopropyladenosine (PIA; 1–1,000 nmol/1) potently inhibited the overflow evoked by a single pulse, and their effects were not changed by yohimbine. — The overflow of tritium elicited by trains of 32 pulses at 1 Hz amounted to 0.92% of the tritium content of the tissue and was increased approximately fourfold by yohimbine 0.3 mol/l. EK and PIA were less potent inhibitors than in the one pulse experiments. Yohimbine greatly enhanced the effects of EK and PIA. The enhancement was even more pronounced when the Ca²⁺ concentration in the medium was reduced in order to obtain a control tritium overflow similar to that evoked by 32 pulses in the absence of yohimbine.The results demonstrate that there is no ₂-adrenergic autoinhibition when noradrenaline release is elicited by a single pulse. Under these conditions, the non-activated presynaptic ₂-adrenoceptor does not interfere with presynaptic opioid - and adenosine A₁-receptor mechanisms. It is only when the autoreceptor is activated by released noradrenaline that it attenuates neighbouring presynaptic receptor mechanisms, and this attenuation is removed by ₂-adrenoceptor antagonists.Send offprint requests to N. Limberger at the above address     

不同剂量体外冲击波治疗肱骨外上髁炎的疗效对比

目的 比较不同能流密度的体外冲击波(extracorporeal shock wave, ESW)治疗肱骨外上髁炎(lateral epicondylitis, LE)的短期临床疗效,探索ESW的最佳治疗剂量。方法 将120例LE患者分为A、B、C和D 4组,均使用ESW治疗4周,各组的能流密度分别为0.06、0.08、0.10、0.12 mJ/mm²。分别在治疗前及治疗后4、24及48周,比较4组患者疼痛视觉模拟量表(visual analogue scale, VAS)评分、肱骨外上髁炎功能评估(patient-rated tennis elbow evaluation, PRTEE)评分及末次随访患者满意度和复发率。结果 按时间点比较,各组VAS评分治疗前最高,治疗后48周降至最低(P<0.05),4组患者满意度及复发率比较差异无统计学意义(P>0.05),但C组患者满意度(96.67%)明显高于A组(80%),差异具有统计学意义(P=0.04)。按组间比较观察,治疗前各组患肘VAS评分差异无统计学意义(P>0.05);治疗后4、24和48...     

Human slow-wave sleep and the cerebral cortex

SUMMARY  Recent hypotheses about the roles of human slow-wave sleep (hSWS—delta EEG activity) are appraised. The possible linkage between hSWS and the functions of the prefrontal cortex (PFC) are explored with respect to normal subjects and to disorders involving PFC deficits.     

Quantitative Characterization of Epicardial Wave Fronts During Regional Ischemia and Elevated Extracellular Potassium Ion Concentration

This study applied zero-delay wave number spectral estimation as a means of quantifying the changes in activation and recovery sequences of propagating plane waves on the epicardial surface of in situ porcine hearts during regional hyperkalemia and ischemia. Unipolar electrograms (104) were recorded from the left ventricular surface of nine hearts using a plaque electrode array with 1 mm spatial sampling intervals. The objectives were (1) to define a set of parameters capable of quantifying the spatial and temporal changes in measured extracellular potentials associated with localized ischemia prior to the onset of conduction block; (2) to elevate regional levels of extracellular potassium ion concentration and quantify potential changes due to this known physiologic manipulation; and (3) to use quantitative parameters to make statistical comparisons in order to distinguish wave fronts during normal, ischemic and hyperkalemic conditions. Results showed that the parameters of wave number and average temporal frequency and the associated power, as determined from the wave number spectrum, provided statistically significant (p < 0.05) quantification of changes in wave front features during normal and ischemic or hyperkalemic conditions. The results were consistent with results obtained from conventional time–space domain methods like isochronal mapping and electrograms, with the advantage of a quantitative result enabling simple comparisons and trend analysis for large numbers of heart beats. © 1998 Biomedical Engineering Society. PAC98: 8759Wc, 8722Fy, 8780+s