Early Prognoses of 200 Renal Allografts Harvested from Non–Heart–Beating Cadavers

When the concept of brain death is not widely accepted, the viability of renal allografts of non–heart–beating cadaveric donors is one of the serious concerns for transplant surgeons. At our center, 200 kidneys were harvested from cardiac arrest donors using the regional in situ cooling technique, and they were transplanted into recipients treated with cyclosporine (CS). The ages of donors ranged from 7 months to 67 years. At the bedside a specially designed double balloon catheter, 14F, was inserted into the aorta through the femoral artery just before or immediately after the cardiac arrest. A venous drainage tube was also placed in the vena cava. Following the cardiac arrest, both balloons of the aortic catheter were inflated, and regional in situ cooling with cold Lactate Ringer's solution started using the infusion pump at 20mL/kg/min. In the OR, both kidneys were removed en bloc and preserved in Collins'type solution. They were then transplanted into 200 patients treated with CS and steroid. After the transplant operations, 33 patients (16.5%) had immediate renal function, but 14 grafts (7.0%) were not successful and the patients have never had renal function. When several factors such as donor age, warm ischemic time (WIT; 12.3 ± 14.1 minutes), in situ cooling time (IST; 78.1 ± 18.0 minutes) and total ischemic time (TIT; 619 ± 340 minutes) were associated with the post–transplant renal function, only the donor age had significant correlation both with the posttransplant dialysis period and lowest serum creatine level, as follows: 10.5 days (≤ 40 years) vs. 14.6 days (>40 years); P < 0.05, and 1.16mg/dL (≤ 30 years) vs. 1.83 mg/dL (> 50 years) P < 0.001, respectively. Our findings indicate; 1) Due to the in situ cooling technique, the renal grafts of non–heart–beating cadavers can be expected to have relatively good function in the CS–treated recipients; 2) donor age is instrumental in predicting post–transplant renal function as well as the duration of ATN; 3) WIT, 1ST and TIT have no association with the post–transplant renal function if the duration of renal ischemia is within the acceptable range.     

肛泰软膏治疗内痔湿热下注型随机双盲双模拟平行对照临床研究

目的客观评价肛泰软膏治疗痔疮的临床疗效及其安全性.方法观察内痔患者43例,其中治疗组(用肛泰软膏)24例,对照组(用肛泰贴脐片)19例.采用随机双盲双模拟平行对照的方法给药并观察疗效.结果治疗组显效率为70.83%,总有效率为95.83%,且无明显不良反应;与对照组疗效比较无显著性差异(P＞0.05).结论肛泰软膏适用于中医辨证属湿热下注型的内痔和以内痔为主要症状的混合痔,对痔出血、肛门下坠、肿痛、局部不适症状改善较为明显.     

中西医结合治疗小儿肾炎肾病型紫癜性肾炎远期疗效观察

应用中西医结合方法治疗21例肾炎肾病型紫癜性肾炎疗效满意,有16例痊愈或完全缓解,5例部分缓解。平均随访7.34年,未发现有肾功能不全者。应用雷公藤多甙配合中药或加强的松的治疗方法较好,副作用少。积极防治上呼吸道感染。对减少病情反复起重要作用。     

选择性头颅降温治疗急性脑梗死的临床研究

目的 探讨选择性头颅降温治疗急性脑梗死的临床疗效。方法 44例经头颅CT或MR证实的急性脑梗死患者被随机分为头颅降温组(24例)和对照组(20例)，降温组在常规药物治疗脑梗死的同时加用头颅降温治疗，对照组只予以常规药物治疗，两组患者分别于治疗前和治疗后1、3、7、21、90d进行神经功能评分，并于治疗前、治疗后21d及90d行Barthel指数评分。结果 治疗7d以后降温组ESS积分增加值显著高于对照组；降温组Barthel指数增加值在治疗后21d和90d均显著高于对照组。结论 头颅降温治疗可以促进急性脑梗死患者的神经功能恢复，对缺血性脑损伤具有保护作用，头颅降温对急性脑梗死是一种安全有效的治疗方法。     

Cochlear basal and apical differences reflected in the effects of cooling on responses of single auditory nerve fibers

Responses of single auditory nerve fibers in the Mongolian gerbil were examined before and during rapid, moderate cooling of the cochlea. Reducing cochlear temperature from 35–39°C to 29–32°C led to stable, reversible changes in spontaneous firing rates (SRs), and responses to tonebursts, as characterized by frequency tuning curves and rate-versus-intensity curves. The nature and extent of effects of cooling were strongly linked to characteristic frequency (CF). Rate thresholds at the CF were increased by 0–15 dB for fibers with CFs below 8 kHz, and by 10–30 dB for higher CFs. Although SRs were generally reduced, the percent reduction in SR was strikingly CF dependent. For fibers with CFs below 4 kHz, the reduction did not exceed 50% of the initial SR. For higher CFs, the reduction was always greater than 50%. The effects of cooling on intensity curve shape differed qualitatively for fibers with CFs below and above 3–4 kHz. The slope of the curve was reduced by an average of 50% for lower CFs, but on average was unchanged for higher CFs. Cooling-related increases in CF threshold probably reflect impairment of active mechanical processes. The CF dependence of these increases suggests either that active mechanical processes are more impaired in the cochlear base relative to the apex, or that they play a more crucial role in determining sensitivity in the base. The CF-dependent changes in SR and in the shape of rate-intensity curves caused by cooling correspond to an enhancement of basal/apical differences seen at normal temperatures. They are best explained by longitudinal gradients in the properties of the inner hair cells and their afferent synapses. Basal and apical differences in the distribution of SRs and in supra-threshold response properties suggest that stimulus coding strategies differ between low and high frequency regions of the cochlea.     

Thermogenetic response to mild hypothermia in anaesthetized infants and children

Metabolic correlates were related to room, core body and skin temperatures in 66 anaesthetized infants and children. Forty-one who had normal cardiorespiratory function were undergoing minor lower abdominal surgical procedures and were spontaneously breathing O₂/air mixture and halothane (body weight, 3.4–25.3 kg). Twenty-five had congenital heart malformations; 14 were cyanotic (weight, 3.4–24.3 kg) and 11 were acyanotic (weight, 3.7–20 kg). These 25 had balanced anaesthesia with halothane and their lungs were mechanically ventilated. Oxygen consumption (V?o₂), i. e. heat production, and CO₂ elimination (V?co₂) were measured by mass spectrometry. Indirect calorimetry was used for calculation of energy consumption. Temperatures were recorded in the lower third of the oesophagus (core temperature), at the mammillary level along the anterior axillary line (skin temperature), and in room air. Oesophageal temperatures ranged from 34.0°C to 38.1°C and skin temperatures from 32.1°C to 37.4°C (mean ± SD, 34.5°C ± 1.2°C). Heat production (V?o₂) was not related to body, skin or room temperatures. In concordance V?co₂ and energy expenditure were unrelated to the measured temperatures. Thermogenesis is thus eliminated in infants as well as in children, by the anaesthetic techniques used in the current study. This emphasizes the importance of prevention of heat loss in paediatric anaesthesia. Since the reduced skin and body temperatures in this study did not increase oxygen consumption, temperature regulation via an enhanced V?o₂ does not appear as a factor that aggravates hypoxaemia in cyanotic infants and children with congenital heart malformations.     

Theoretical limits on brain cooling by external head cooling devices

Numerous experimental studies have demonstrated that mild hypothermia is a rather promising therapy for acute brain injury in neonates. Because measurement of the resultant cooling of human brain in vivo is beyond current technology, an understanding of physical factors limiting the possible brain cooling would be a substantial achievement. Herein brain cooling by external head cooling devices is studied within the framework of an analytical model of temperature distribution in the brain. Theoretical limits on brain hypothermia induced by such devices are established. Analytical expressions are obtained that allow evaluation of changes in brain temperature under the influence of measurable input parameters. We show that a mild hypothermia can be successfully induced in neonates only if two necessary conditions are fulfilled: sufficiently low cerebral blood flow and sufficiently high value of the heat transfer coefficient describing the heat exchange between the head surface and a cooling device.     

10％的盐水冰袋用于体外循环术后高热患者降温效果的研究

目的探讨采用10％的盐水冰袋冰敷在体外循环术后高热患者物理降温中的效果。方法对124例体外循环术后高热患者的物理降温效果进行比较，研究组60例，应用10％的盐水冰袋作为物理降温的用具；对照组64例，使用传统的橡胶冰袋冰敷作为物理降温用具。记录降温后不同时间患者体温下降的情况。结果2组病例冰枕冰敷后0．5，1．5h降温效果差异无显著性（P〉0．05）；冰枕冰敷后2．5，4．0h降温效果差异有显著性（P〈0．05）。结论10％的盐水冰袋冰敷具有降温效果好、持续时间长，冰袋内为霜水，患者感觉舒适，值得临床推广应用。     

Autonomic responses to lateralized cold pressor and facial cooling tasks

Asymmetry in central nervous system (CNS) control of autonomic nervous system (ANS) activity, a widely debated topic, was investigated via lateralized presentation of two ANS challenges: cold pressor, which elicits primarily sympathetic activation, and facial cooling, a predominantly vagal task. Seventy‐three university students (37 female) engaged in these tasks while cardiovascular and electrodermal measures were acquired. Compared to right‐side cold pressor, left cold pressor elicited generally larger cardiac, blood pressure, and skin conductance responses, but did not evoke asymmetric changes in heart rate variability. Facial cooling elicited significant increases in vagally mediated heart rate variability, but they were also not lateralized. These findings are consistent with reports of right hemisphere dominance in sympathetic regulation, but indicate that CNS vagal control is relatively symmetric. These results are framed in terms of polyvagal theory and neurovisceral integration two influential models of CNS‐ANS integration in the service of adaptive environmental engagement.