理气中药组方对糖尿病大鼠胃排空延迟的作用

目的:观察理气中药经验组方对糖尿病大鼠胃排空延迟的干预作用。方法:雌雄各半成年SD大鼠110只,随机分为正常组(A组)、糖尿病中药组(B组)、糖尿病胃复安组(C组)、糖尿病组(D组)。A组、D组1次/d按10 mL/只予0.9%生理盐水灌胃,B组1次/d按8 mL/只予中药煎剂灌胃,C组1次/d按0.5 mg/只予胃复安片灌胃。喂养12周后,行13C胃排空实验及甲基橙水溶液胃排空实验,观察各组大鼠胃排空情况。结果:糖尿病大鼠胃排空较正常大鼠明显延迟(P0.01),糖尿病大鼠胃排空延迟模型制作成功。糖尿病中药组和糖尿病胃复安组大鼠胃排空较糖尿病组快(P0.01);糖尿病中药组大鼠胃排空较糖尿病胃复安组大鼠快(P0.05)。结论:常规喂养12周后糖尿病大鼠出现胃排空延迟。理气中药陈皮、枳实、木香、香附组方煎剂和胃复安均能促进糖尿病大鼠胃排空,理气中药组方煎剂的效果优于胃复安。     

前房注射卡波姆建立大鼠高眼压模型的观察

目的　前房注射卡波姆建立大鼠高眼压模型，观察卡波姆升眼压效果及对大鼠眼前节和视网膜的影响。方法　随机选取30只SD大鼠，注射前3 d早晚测量基线眼压。右眼定为实验眼，左眼定为对照眼，右眼放出房水后将30 μL的5 g·L^-1卡波姆混悬液注入前房，每日早10时、晚22时在大鼠清醒状态下测量眼压。每周进行双眼眼前节照相并对比。4周末处死26只大鼠（另4只持续观察眼压变化至注射后9周）并取双眼眼球行HE染色，观察实验眼与对照眼视网膜形态，对比视网膜厚度及房角形态。结果　注射前，实验眼白天和夜间眼压分别为（11.10±0.90）mmHg（1 kPa=7.5 mmHg）和（11.92±1.07）mmHg，对照眼分别为（11.22±1.07）mmHg和（11.76±1.08）mmHg；实验眼与对照眼相比，白天、夜间眼压差异均无统计学意义（均为 P＞0.05）；白天与夜间眼压相比，实验眼、对照眼差异均有统计学意义（均为P<0.05）。卡波姆在前房中呈现出弥散型和沉积型两种存在方式，弥散型和沉积型大鼠1周内眼压分别为（17.83±3.54）mmHg和（13.00±1.55）mmHg，两者相比差异具有统计学意义（P＜0.05）。注射后第1天至第19天，实验眼与对照眼白天眼压相比差异均具有统计学意义（均为P＜0.05）；注射后第1天至第27天，实验眼与对照眼夜间眼压相比差异均具有统计学意义（均为P＜0.05）。实验眼视网膜形态发生改变，注射后4周视网膜厚度为（254.70±21.80）μm，与对照眼的（346.73±24.63）μm相比，差异有统计学意义（P=0.00）。实验眼前房充满卡波姆及虹膜的混合成分，紧贴角膜内皮并延伸至房角，堵塞小梁网结构，正常虹膜形态消失；对照眼房角形态正常。结论　前房注射卡波姆建立大鼠高眼压模型，可维持高眼压4周以上，昼夜眼压差异较为明显，夜间眼压较白天更高，4周后视网膜出现高眼压损伤后的表现。     

Magnetic resonance elastography with guided pressure waves

Magnetic resonance elastography aims to non-invasively and remotely characterize the mechanical properties of living tissues. To quantitatively and regionally map the shear viscoelastic moduli in vivo, the technique must achieve proper mechanical excitation throughout the targeted tissues. Although it is straightforward, ante manibus, in close organs such as the liver or the breast, which practitioners clinically palpate already, it is somewhat fortunately highly challenging to trick the natural protective barriers of remote organs such as the brain. So far, mechanical waves have been induced in the latter by shaking the surrounding cranial bones. Here, the skull was circumvented by guiding pressure waves inside the subject's buccal cavity so mechanical waves could propagate from within through the brainstem up to the brain. Repeatable, reproducible and robust displacement fields were recorded in phantoms and in vivo by magnetic resonance elastography with guided pressure waves such that quantitative mechanical outcomes were extracted in the human brain.     

Association of quadriceps angle with plantar pressure distribution,navicular height and calcaneo-tibial angle

ObjectiveThe aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA).MethodsA total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19–33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight.ResultsThere were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = −0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = −0.21, p < 0.037).ConclusionThese findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered.Level of evidenceLevel III, Diagnostic Study.     

Could non-HDL-cholesterol be a better marker of atherogenic dyslipidemia in obstructive sleep apnea?

Background/objectiveObstructive sleep apnea (OSA) is independently associated with dyslipidemia, a surrogate marker of atherosclerosis. Low-density lipoprotein (LDL)-cholesterol is accepted as a major independent risk factor for cardiovascular disease. However, non-high-density lipoprotein (HDL)-cholesterol is a better marker of atherogenic dyslipidemia and recommended as a target of lipid lowering therapy. We aimed to assess the prevalence of atherogenic dyslipidemia, and relationship between OSA severity and serum LDL-cholesterol and non-HDL cholesterol levels in OSA patients.MethodsWe retrospectively evaluated treatment naïve 2361 subjects admitted to the sleep laboratory of a university hospital for polysomnography. All subjects’ lipid profile including total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and non-HDL-cholesterol were measured.ResultsOut of 2361 patients (mean age 49.6 ± 11.9 years; 68.9% male, apnea-hypopnea index 36.6 ± 28.4/h), 185 (7.8%) had no OSA and 2176 (92.2%) had OSA. Atherogenic dyslipidemia prevalence was high (57–66%) in OSA patients, and especially increased in severe OSA compared to other groups (p < 0.05). Though total and LDL-cholesterol did not differ between those with and without OSA, non-HDL-cholesterol (p = 0.020), and triglycerides (p = 0.001) were higher and HDL-cholesterol levels (p = 0.018) were lower in OSA patients than non-OSA. Non-HDL-cholesterol was significantly correlated with OSA severity (p < 0.001) and hypoxia parameters (p < 0.01), whereas LDL-cholesterol showed no correlation.ConclusionsAtherogenic dyslipidemia is highly prevalent and non-HDL-cholesterol levels are significantly increased, predominantly in severe OSA patients. Non-HDL-cholesterol but not LDL-cholesterol, is significantly correlated with OSA severity and hypoxia parameters. Therefore, it could be better to use non-HDL-cholesterol, which is a guideline recommended target of lipid therapy, as a marker of atherosclerotic cardiovascular risk in OSA patients.     

Principles of pressure transducer function and sources of error in clinical use

The invasive measurement of physiological pressures is a common requirement in anaesthesia and intensive care medicine. From arterial blood pressure to intracranial pressure, these calculated variables give a swift graphical and numerical representation of a patient's current physiological status. This allows us to respond rapidly to conditions outside our preferred parameters and to carefully titrate treatment to target effects. These systems are, however, not infallible. An understanding of the principles of their function will promote appropriate use and an ability to recognize and react to sources of error. This article aims to furnish the reader with this level of understanding in order to inform their academic and clinical practice.     

丙泊酚复合瑞芬太尼喉罩全麻的效果分析与研究

目的 探讨丙泊酚复合瑞芬太尼喉罩全身麻醉(全麻)的效果。方法 62例腹腔镜、泌尿科、骨科、肛肠科、妇科等手术治疗的患者,随机分为实验组和对照组,每组31例。对照组采用常规气管插管静脉复合全麻,实验组给予靶控输注丙泊酚复合瑞芬太尼喉罩全麻。比较两组患者插入喉罩(插管)、插管1 min、插管3 min、拔出喉罩(拔管)1 min、拔管3 min时心率(HR)和平均动脉压(MAP)水平;不良反应发生情况、麻醉效果;全麻起效时间、维持全麻时间、术后苏醒时间。结果 实验组插管时、插管1 min、插管3 min、拔管1 min、拔管3 min的HR水平分别为(77.52±6.36)、(73.26±5.56)、(72.01±4.69)、(75.35±7.63)、(72.34±6.79)次/min,均低于对照组的(92.34±7.85)、(87.97±5.25)、(78.85±5.20)、(95.69±9.21)、(85.63±7.43)次/min,差异均具有统计学意义(P<0.05)。实验组插管时、插管1 min、插管3 min、拔管1 min、拔管3 min的MAP水平分别为(90.25±6.73)、(87.65±7.98)、(88.79±7.65)、(88.09±5.61)、(88.52±5.16)mm Hg(1 mm Hg=0.133 kPa),均低于对照组的(109.51±7.85)、(103.27±12.43)、(102.52±8.21)、(106.74±7.68)、(104.62±7.71)mm Hg,差异均具有统计学意义(P<0.05)。实验组不良反应发生率3.23%低于对照组的19.35%,差异具有统计学意义(P<0.05)。实验组麻醉总有效率96.77%均高于对照组的80.65%,差异均具有统计学意义(P<0.05)。实验组全麻起效、维持全麻、术后苏醒时间分别为(1.61±0.23)、(100.59±6.72)、(17.99±3.52)min,均短于对照组的(2.93±0.41)、(123.61±7.85)、(36.87±4.16)min,差异均具有统计学意义(P<0.05)。结论 针对腹腔镜等手术患者应用丙泊酚复合瑞芬太尼喉罩全麻对血液动力学影响小,不良反应发生率低,麻醉效果良好,降低对机体损伤,值得推广应用。     

Analysis of arterial hypertension pharmacotherapy in patients with obstructive sleep apnea syndrome

IntroductionObstructive sleep apnea (OSA) is often connected with arterial hypertension and it could also be a cause of secondary hypertension. Treatment of arterial hypertension and optimal blood pressure level are important for prevention of cardiovascular complications. It is not well known how to treat patients with OSA and arterial hypertension. Also many patients with OSA suffer from metabolic syndrome which worsen their prognosis.AimThe aim of our study was to assess arterial hypertension compensation in patients with metabolic syndrome and moderate to severe OSA and to analyze used pharmacotherapy.Materials and methods85 hypertensive patients (75 men) with metabolic syndrome, average age 53.6 ± 9.3 years, were evaluated using overnight sleep study with diagnosis of OSA, average apnea–hypopnea index (AHI) 56.3 ± 23. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and their current pharmacotherapy data were obtained. Appropriate combinations of antihypertensive drugs (patients with metabolic syndrome) were derived from ESH/ESC 2013 guidelines.ResultsArterial hypertension was well compensated in only 11.8% of the patients. 24.7% patients were treated according to current guidelines. Fisher's exact test with analysis of adjusted residues has found higher rate of blood pressure subcompensation in patients treated with triple+ combination of drugs (p = 0.035, 51.4% vs 10%).ConclusionOnly a small number of patients had optimal blood pressure level and were treated according to current ESH/ESC guidelines. We have to constantly appeal to all physicians to perform ABPM in patients with OSA.     

鼻塞式同步间歇正压通气(NIPPV)联合布地奈德雾化治疗新生儿急性呼吸窘迫综合征疾病的临床应用研究

目的:分析鼻塞式同步间歇正压通气(NIPPV)联合布地奈德雾化治疗ARDS(新生儿急性呼吸窘迫综合征)疾病的临床应用效果。方法:纳入病例是2017年5月—2019年11月收治的104例ARDS新生儿,随机平均分为两组。参照组52例采纳CPAP(持续气道正压通气通气)治疗,实验组52例采纳NIPPV+布地奈德雾化治疗,对比两组呼吸机通气时间、用氧时间、住院时间、血气指标以及并发症发生情况。结果:实验组呼吸机通气时间、用氧时间、住院时间均明显短于参照组,差异有统计学意义P<0.05;实验组治疗3 d后PaCO2明显低于参照组,实验组治疗3 d后PH以及PaO2明显高于参照组,差异有统计学意义P<0.05;实验组并发症发生率(3.85%,2/52)明显低于参照组(21.15%,11/52),差异有统计学意义P<0.05。结论:NIPPV+布地奈德雾化可有效缩短ARDS患者机械通气时间,改善血气指标,降低并发症发生率,值得借鉴。