剥切肋骨与切皮痛应激的对比研究

为了比较剥切肋骨和切皮的痛应激强度，选择２０例开胸手术病人，测定吸入５３％Ｎ２Ｏ时七氟醚的剥切肋骨和切皮ＭＡＣ，并监测循环应激反应。结果表明，七氟醚的剥切肋骨ＭＡＣ（ＭＡＣＲＥ）与切皮ＭＡＣ（ＭＡＣＳＩ）数值相同，均为０．８４±０．０２％。但循环监测显示，剥切肋骨时血压和心率升高比切皮时更显著（Ｐ＜０．００１）。提示在同一麻醉深度剥切肋骨的痛应激反应比切皮时稍大。     

曲马多对异氟醚的MAC和循环的影响

观察４１例患者应用曲马多后对异氟醚ＭＡＣ的影响及对血液动力学的影响。静滴曲马多２ｍｇ／ｋｇ，在３１～５５岁组和≥５６岁组患者的异氟酸ＭＡＣ值分别为１.０７％和０.９６％，静滴曲马多４ｍｇ／ｋｇ，在这两个年龄组异氟醚ＭＡＣ值分别为０．９８％和０．９０％。和基础值相比，静滴由马多４ｍｇ／ｋｇ后患者心率和血压分别增加 ２３． ５％（Ｐ＜０． ００１）和 ７． ７％（Ｐ＜０． ００１）， １０分钟后 Ⅱ组患者的心率和血压均显著高于Ⅰ组（Ｐ<０．０２和０．００２）。结果表明，曲马多可强化吸入麻醉药，大剂量时还有明显的循环效应。     

N^G—硝基—L—精氨酸甲酯的抗伤害作用及其对异氟醚麻醉作用的影响

目的 探讨Ｎ＾Ｇ－硝基－Ｌ－精氨酸甲酯（Ｌ－ＮＡＭＥ）的抗伤害作用及其对异氟醚麻醉作用、大鼠大脑不同脑区突触体一氧化氮合酶（ＮＯＳ）活性和一氧化氮（ＮＯ）的影响。方法 ３０只雄性ＳＤ大鼠,随机分为生理盐水对照组、Ｌ－ＮＡＭＥ异氟醚组和Ｌ－ＮＡＭＥ抗伤害组;分别测定给予Ｌ－ＮＡＭＥ后大鼠的甩尾潜伏期（ＴＦＬ）、最大镇痛效应百分率（％ＭＰＥ）、异氟醚最低肺泡有效浓度（ＭＡＣ）和大鼠不同脑区粗制突触体ＮＯＳ活性以及ＮＯ的生成。结果 Ｌ－ＮＡＭＥ可延长大鼠的ＴＥＬ,增加％ＭＰＥ,降低异氟醚的ＭＡＣ,抑制大脑不同脑区突触体ＮＯＳ活性和ＮＯ的生成（Ｐ〈０．０１）。结论 Ｌ－ＮＡＭＥ能通过对中枢神经系统突触体ＮＯＳ活性和ＮＯ生成的抑制,发挥其抗伤害和减轻异氟醚麻醉作用。     

Causes and Clinical Outcomes of Patients Who Are Ineligible for Transcatheter Mitral Valve Replacement

Objectives

The aim of this study was to gain insight into the causes and outcomes of patients who do not qualify for transcatheter mitral valve replacement (TMVR).

敲减MAC30通过PI3K/AKT抑制人乳腺癌细胞增殖并诱导其凋亡

目的:探讨MAC30在乳腺癌中的作用和机制。方法:使用慢病毒介导的Lenti-shRNA来沉默乳腺癌细胞MCF7和MDA-MB-231中MAC30的表达，并通过Western Blot检测相关蛋白的表达；采用CCK8法检测细胞增殖；Annexin V-FITC/PI双染色法检测细胞凋亡。结果:MAC30的表达下调后乳腺癌细胞的增殖率减少且凋亡率增加，通过Western Blot，发现MAC30 敲低后p-AKT，Cyclin D1和Bcl-2的表达明显下降，而BAX的表达增高。结论:敲减MAC30的表达后，可以明显抑制乳腺癌细胞增殖并诱导其凋亡，而MAC30可能是通过PI3K/AKT信号通路来调控乳腺癌的发生发展过程。因此，MAC30可能是一个治疗乳腺癌的潜在治疗靶点。     

韩氏（HANS）仪对七氟醚最低肺泡浓度（MAC）的影响

目的：将ＨＡＮＳ仪用于心血管手术的临床麻醉，观察其能否减少麻醉药的用量。方法：４０例５～１０岁先天性心脏病室间隔缺损（ＶＳＤ）、房间隔缺损（ＡＳＤ）患儿，随机分为Ⅰ组（单用七氟醚组）和Ⅱ组（ＨＡＮＳ加七氟醚复合组）。用体动反应上下交叉点（ｕｐａｎｄｄｏｗｎ）法分别测定两组的最低肺泡气浓度（ＭＡＣ）。结果：Ⅰ组即单用七氟醚组的ＭＡＣ值为２．７２±０．０７Ｖｏｌ％；而Ⅱ组即七氟醚加ＨＡＮＳ组的ＭＡＣ值为２．２４±０．１５Ｖｏｌ％，比空白组减少了１７．４％。两组间Ｐ值＜０．００１，有非常显著的区别。切皮的刺激使Ⅰ组的心率增加了３８．０％，收缩压增加了２３．０％，舒张压增加了３４．０％；而Ⅱ组即七氟醚加ＨＡＮＳ组心率增加了１６．０％，收缩压增加了１４．３％，舒张压增加了１３．７％。结论：ＨＡＮＳ可减少七氟醚的ＭＡＣ值１７．３８％，具有非常显著的统计学意义。在１ＭＡＣ左右，机体接受同样伤害性刺激时，ＨＡＮＳ具有一定的心血管稳定作用。     

Bone marrow aspiration, biopsy, and culture in the evaluation of HIV-infected patients for invasive mycobacteria and histoplasma infections

Bone marrow (BM) aspiration and biopsy are used commonly in clinical practice to diagnose invasive tissue infections caused by Mycobacterium avium intracellulare (MAC), Mycobacterium tuberculosis (TB), and Histoplasma capsulatum (HC) in patients with human immunodeficiency virus-1 (HIV) infection. However, the value of these invasive procedures relative to other diagnostic approaches has not been clearly defined. To determine the value of BM culture and BM histology in the diagnosis of opportunistic MAC/TB and HC infections in immunosuppressed patients with HIV, we retrospectively reviewed the records of 56 adult patients with HIV who underwent a single BM aspiration, biopsy, and culture because of unexplained fever and/or other clinical features suggestive of MAC/TB or HC infection. Thirty-two patients (57%) were ultimately diagnosed with MAC/TB or HC infection by positive cultures of BM, blood, sputum, or bronchoalveolar lavage fluid or by the histologic detection of organisms in biopsies of BM or other tissues. The diagnostic sensitivity of BM cultures was equal to that of blood cultures (20/32, or 63%). Granuloma and/or histologically apparent organisms were seen in BM biopsy specimens in 11 of 32 individuals (34%) ultimately diagnosed with MAC/TB or HC infections. Among these 11 cases, both granuloma and acid-fast staining organisms were found in the BM biopsy specimens of 2 individuals for whom both BM and blood cultures were negative. Certain clinical symptoms and signs at the time of BM examination were found by logistic regression analysis to be significantly associated with a subsequent diagnosis of MAC/TB or HC infections; these included high fever, long duration of febrile days prior to BM examination, and elevated direct bilirubin. In conclusion, while the diagnostic sensitivity of BM cultures was found to be no greater than that of blood cultures in detecting MAC/TB or HC infections in immunosuppressed HIV+ patients, histopathologic examination of BM specimens resulted in the relatively rapid identification of nearly one third of infected patients who underwent BM examination, and also identified infections in some patients who were culture negative. These findings support the continued use of BM aspiration, biopsy, and culture for the diagnosis of opportunistic MAC/TB or HC infections in immunosuppressed HIV+ patients, particularly when selected clinical features are present.     

1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification

Background

The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures.