Comparison of vibration perception thresholds in individuals with diffuse upper limb pain and carpal tunnel syndrome

The study objective was to compare vibration perception and patterns of blood flow in outpatients with diffuse upper limb pain disorder (ULPD), carpal tunnel syndrome (CTS) and age and sex matched healthy controls. Vibration perception and discrimination thresholds were compared in subjects with ULPD (n=27), CTS (n=27) and healthy matched controls (n=54). Vibration measurements were taken bilaterally at three sites: (a) over the dorsum of the second and (b) fifth metacarpals and (c) the palmar aspect of the first and second metacarpals, corresponding to the innervation territories of the radial, ulnar and median nerves, respectively. Non-invasive assessments of peripheral blood flow were also performed in both limbs. When compared to healthy controls, subjects with ULPD had widespread elevation of vibration thresholds both ipsilateral and contralateral to the symptomatic limb. Subjects with CTS had similarly elevated vibration thresholds at sites both adjacent to and distant from the site of peripheral nerve injury. The responses to cold pressor testing of the upper limbs were physiologically normal in both the CTS and ULPD patient groups. Furthermore, there were no significant differences in the haemodynamic responses between the patient groups. The global elevation of vibration thresholds in subjects with both ULPD and CTS is consistent with altered central nervous system mechanisms, common to both conditions, which may be either adaptive to or maintaining the perception of pain.     

皮下注射蛙皮缩胆囊肽诱发急性胰腺炎的早期胰腺微循环损伤特征

目的探索急性胰腺炎（ＡＰ）实验动物模型的早期胰腺局部微循环损伤特征及其规律。方法用异硫氰酸荧光素（ＦＩＴＣ）标记红细胞（ＦＩＴＣＲＢＣ）活体微循环技术、微血管树脂和墨汁灌注光镜和扫描电镜技术,对蛙皮缩胆囊肽（ｃａｅｒｕｌｅｉｎ）诱发ＡＰ早期胰腺局部微循环改变进行动态观察。结果实验组血淀粉酶均增高;光镜及扫描电镜显示胰腺小叶内动脉括约肌早期出现损伤,细胞胞浆内大量空泡形成,表现为持续痉挛,所属微动脉支配区域毛细血管床构形紊乱;ＦＩＴＣＲＢＣ显示胰腺微循环的流速减慢、流量减少（Ｐ＜００１）;机能毛细血管密度减少、出现灌注不稳定和不规则间歇性灌流（Ｐ＜００５）。结论ＡＰ早期胰腺微循环紊乱的始动环节是胰腺小叶内动脉括约肌损伤及其痉挛,是导致胰腺缺血、微循环障碍的早期关键因素。     

复方白芷胶囊的活血化瘀作用

目的：观察复方白芷胶囊的活血化瘀作用。方法：用冰水中游泳和sc肾上腺素制造大鼠急性血瘀模型，观察复方白芷胶囊对血液流变性的影响；用肾上腺素制造大鼠肠系膜急性微循环障碍模型，观察其对微循环障碍的改善作用；以体外法，用凝血酶原时间(PT)及活化部分凝血活酶时间(KPTT)试剂盒测定血液凝固时间，观察其对PT及KPTT的影响。结果：复方白芷胶囊能明显降低大鼠的全血粘度和血浆粘度及血小板粘附率，减轻血瘀大鼠血液的粘、凝状态，防止血栓形成；可抑制肾上腺素引起的大鼠肠系膜微循环细动脉管径缩小、流速减慢、毛细血管开放量减少、流态改变，并改善这些现象；可显著延长家兔PT，对KPTT有延长的趋势，但无统计学意义。结论：复方白芷胶囊有改善血液流变性及微循环障碍的作用，有抑制外源性凝血系统的作用．故有活血化瘀作用。     

镇脑宁胶囊对动物脑微循环的影响

目的 观察镇脑宁胶囊对动物脑微循环的影响.方法 采用结扎右侧颈总动脉法建立小鼠脑缺血模型,描记造模前5 min、造模后10、20、30 min小鼠脑血流量,计算血流量下降率;采用静脉注射高分子右旋糖苷法致大鼠脑微循环障碍,记录出现微循环障碍的时间,以及注射20 min后同一视野的血管流速、血液流态以及网点数.结果 结扎右侧颈总动脉后,脑缺血小鼠于10、20、30 min大脑皮层血流量明显下降,分别为(71±13)％、(71±15)％和(74±16)％(P＜0.01);与模型组比较,镇脑宁胶囊1500 mg/kg和750 mg/kg给药后,在结扎后10、20、30 min内,小鼠大脑皮层血流量均有明显增加(56％、51％、50％和42％、49％、51％,P＜0.01).注射高分子右旋糖苷后,微循环障碍模型组大鼠的血液流速差为( 572±177) μm/s,出现微循环障碍时间为(232±70)s;镇脑宁胶囊600 mg/kg和300 mg/kg给药后均能使血液流态改变减轻(P＜0.01),血液流速分别增加26％,36％,出现微循环障碍的时间分别延长53％,34％ (P＜0.01或P＜0.05).结论 镇脑宁胶囊通过改善动物脑微循环治疗偏头痛.     

中药水蛭素对微循环及体液免疫的影响

目的研究中药水蛭素的作用机制,为临床提供理论依据。方法分别取小鼠44只、48只,随机分成4组,每组11只、12只。模型对照组给予生理盐水,阳性对照组给予活化丹,实验组分别给予不同剂量的中药水蛭素。连续灌胃用药5天、8天,小鼠尾静脉注射垂体后叶素使血流速度减慢,腹腔注射绵羊红细胞(SRBC)进行免疫。取血、离心处理后,显微视像循环仪测定小鼠耳廓动脉的血流变化,分光光度计测定HC50值。结果中药水蛭素能加快小鼠耳廓的血流速度,提高小鼠血清溶血素抗体的水平。结论中药水蛭素具有促进微循环的作用,同时对小鼠的体液免疫具有显著的影响。     

RheoNet Registry Analysis of Rheopheresis for Microcirculatory Disorders With a Focus on Age-Related Macular Degeneration

The purpose of establishing the RheoNet registry was to evaluate the safety and efficacy of rheopheresis, a specific method of therapeutic apheresis used to treat microcirculatory disorders. Apheresis centers providing rheopheresis therapy and physicians caring for the underlying disease were asked to participate in the registry, and the registry data were analyzed for safety and tolerability. Age-related macular degeneration (AMD) was selected as a model disease to evaluate efficacy. The RheoNet registry was successfully established recording 7722 rheopheresis treatments of 1110 patients, including 833 AMD patients. The mean age of patients was 72 years. Adverse events (AE) were reported in 5.67% of treatments, but termination of the treatment session was only required in 0.48%. Transient hypotension was the most frequently reported AE. No age-related increase in AE was observed. Ophthalmological data of 428 eyes (of 279 treated patients) with dry AMD could be analyzed; 85 eyes of 55 untreated AMD patients served as the control. At 6.75 ± 5.25 months post-baseline, 42% of the treated eyes had improved visual acuity. The proportion of eyes with a decline in visual acuity was 17%, compared to 40% in the untreated controls (P < 0.01). The RheoNet registry has been successfully established and data analysis revealed that rheopheresis is a safe outpatient treatment for microcirculatory disorders. Moreover, RheoNet currently provides the largest evaluation of the efficacy of rheopheresis for dry AMD. Registry analysis contributes to a safe and appropriate use of rheopheresis in clinical practice.     

~(86)Rb摄取示踪法评定几种中草药提取物对心、肾组织微循环灌流量的影响

以８６铷（８６Ｒｂ）摄取示踪法检测评定了缬草、红藤、姜黄三种中草药的七种不同的提取物对健康清醒小鼠及垂体后叶素—蔗糖静脉注射所致心肌缺血大鼠的心、肾组织微循环灌流量的影响。结果显示：缬草挥发油、缬草环烯醚萜可以显著增加健康小鼠心、肾微循环灌流量，改善心肌缺血；姜黄与红藤提取物也可增加心肌微循环灌流量；药典规范的缬草浸膏对心、肾微循环灌流量则无明显影响     

脑血管顺应性获得过程中微循环的变化

目的　探讨脑血管顺应性获得过程中微循环的变化。方法　选择Wistar大鼠 18只 ,分成 2组 :A组 ,右颈总动脉结扎当天 (n =8) ;B组 ,右颈总动脉结扎 3d后 (n =10 ) ,3d后 ,行左侧颈总动脉结扎。采用低血压法使平均动脉压下降到 5 0mmHg ,维持 3 0min后 ,使血压恢复到原来的水平 ,90min后 ,用激光多谱勒法测定双侧半球脑表 2 5处局部脑血流 (lCBF)。以 2 5处lCBF的中位数代表区域脑血流 (rCBF)。结果　在脑缺血前后 ,A组的左右双侧大脑半球rCBF值的变化差异无显著性 (P >0 .0 5 )。B组双侧颈总动脉结扎后 ,缺血中以及缺血后 90min ,右侧脑血流较左侧脑血流显著增高 (P <0 .0 5 )。结论　颈总动脉闭塞后所造成的脑缺血在 3d内完成了脑血管顺应性的建立 ,其机制为脑微循环状态得到改善。     

肿瘤坏死因子-α对微循环障碍大鼠心功能的影响

目的:观察微循环障碍大鼠心功能的变化,探讨肿瘤坏死因子-α(TNF-α)对其心功能的影响。方法:30只SD大鼠随机分为模型组和对照组,每组各15只。模型组用自体微血栓法致大鼠冠脉微血管堵塞,造成微循环障碍。采用冠脉压力温度测量导丝检测冠脉微循环阻力指数(IMR),心脏超声检测左室短轴缩短率(FS),颈动脉心室内插管法评估大鼠左室收缩压(LVSP)和左室舒张末压(LVEDP),ELISA检测血清中TNF-α的含量,比较两组大鼠以上各指标的差异。将造模成功的14只微循环障碍大鼠按照TNF-α的含量分为高炎组(≥170pg/ml,n=7)和低炎组(<170pg/ml,n=7),比较两组大鼠心功能的差异。结果:与对照组比较,模型组大鼠IMR明显增加(P<0.05),FS明显降低(P<0.05),LVSP显著降低(P<0.01),而LVEDP显著升高(P<0.01);模型组血清TNF-α的含量较对照组显著增加(P<0.05)。高炎组FS和LVSP较低炎组均明显降低(P<0.05或P<0.01),而LVEDP显著升高(P<0.05)。结论:冠状微循环障碍大鼠心功能受损与TNF-α水平升高有关。     

Microcirculatory perfusion derangements during continuous hemofiltration with fixed dose of ultrafiltration in stabilized intensive care unit patients

Introduction

Acute kidney injury (AKI) is a well-known complication in critically ill patients. Little is known about the timing and the ultrafiltration dose after initial resuscitation. In vivo microscopy of the microcirculation has been suggested as alternative for the assessment of volume status. Previous studies contribute to the understanding that intravascular hypovolemia is reflected by microcirculatory blood flow changes not detected by conventional methods. The aim of our study was to assess microcirculatory blood flow changes during negative fluid balance ultrafiltration in patients with oliguric AKI.

Materials and methods

Patients with oliguric AKI on renal replacement therapy were included after hemodynamic stabilization. Target was a predefined negative fluid balance; subsequently, a stepwise decrease in amount of substitution fluid was achieved. The data were recorded at baseline and after each change.

Results

Fifteen patients were included in the study. Microcirculatory blood flow index did not change significantly between baseline and endpoint (2.90 [2.87-3.00] vs 2.90 [2.75-3.00], P = .57). During treatment, heart rate decreased from 96 (80-111) to 94 (79-110) beats per minute (P = .01), without a significant change in mean arterial blood pressure (80 [68-95 mm Hg] vs 79 [65-91 mm Hg], P = .5).

Conclusion

Microcirculatory blood flow is not altered by reduced substitution during renal replacement therapy.