慢传输型便秘的病因研究进展

慢传输型便秘是一种临床很常见的疾病,其症状十分顽固,但目前它的病因尚不清,所以给临床治疗带来很大困难。现就慢传输型便秘的多种发病原因,尤其是结肠蠕动方面的研究进展加以探讨,希望能给临床工作者带来一些帮助。     

玻璃化解冻和慢速解冻在程序化冷冻胚胎解冻移植中的比较研究

目的 探讨玻璃化解冻(vitrificative thawing,VT)和慢速解冻(slow thawing,ST)对程序化冷冻胚胎解冻移植的影响,优化程序化冷冻胚胎的解冻方案,从而提高不孕不育临床治疗效果.方法 选取2016年1月至2018年12月解放军第九六〇医院生殖医学中心行解冻胚胎移植的400例患者,使用随机数...     

血浆suPAR水平与冠状动脉慢血流的相关性分析

目的 观察血浆可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平、高敏C反应蛋白(hs-CRP)与冠状动脉慢血流的关系,探讨suPAR在冠脉慢血流中的作用及影响冠脉慢血流的相关因素。方法 选取疑诊为冠心病但冠脉造影正常的患者,据冠脉TIMI桢数将患者分为慢血流组(53例)和正常对照组(42例),记录其冠心病危险因素,检测血浆suPAR、hs-CRP水平等。结果 两组间糖尿病、高血压病、高脂血症、早发冠心病家族史等比率及血脂水平均无明显差异,慢血流组吸烟率较对照组明显升高 (72％ VS 48％,P=0.02)。同对照组相比,慢血流组血浆suPAR水平(3.01±0.05 vs 1.33±0.06,P＜0.001)和hs-CRP水平(1.07±0.04 vs 0.71±0.05,P＜0.001)均明显升高,差异具有统计学意义。一元回归分析显示,血浆suPAR、hs-CRP水平与冠脉TIMI桢数均呈明显正相关(R2=0.83,P＜0.001;R2=0.71,P＜0.001)。多元回归分析显示,suPAR、hs-CRP、吸烟均与冠脉TIMI桢数呈正相关(R2=0.64,P＜0.001),其中suPAR的影响力最大(标准化β=0.62)。结论 血浆suPAR、hs-CRP水平、吸烟与冠脉慢血流呈明显正相关,而且血浆suPAR水平对冠脉慢血流的预测价值最高。     

冠状动脉慢血流患者血清炎性标志物的检测水平及意义

目的:探讨重要炎症因子高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)及肿瘤坏死因子-α(TNF-α)在冠状动脉慢血流(CSF)发生发展中的作用及临床意义。方法:选择经冠状动脉造影(CAG)检查诊断为CSF患者20例,CAG显示无管腔狭窄及无慢血流的正常血流速度(NCF)者24例为对照组,使用校正的TIMI血流分级(CTFC)方法评价冠状动脉血流速度,并分别测定2组的血清高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)及肿瘤坏死因子-α(TNF-α)。结果:2组在年龄、性别、高血压史、早发冠心病家族史、吸烟及血脂等方面均无明显差别。CSF组血清MMP-9、TNF-α水平较NCF组明显增高(P<0.05),但2组的hs-CRP、IL-6水平差异无统计学意义。结论:血清MMP-9、TNF-α2种炎症因子可能介导或参与了CSF形成的发生、发展过程,对血清MMP-9、TNF-α水平的检测及对CSF的诊断有一定的判断作用,值得临床进一步地探讨。     

缓速和快速插胃管法的效果对比

目的探讨胃管插入速度与一次插管成功率及患者反应之间的关系。方法将98例需插胃管的意识清醒的患者随机分为两组,分别采用缓速插管法和快速插管法插入胃管,比较两组插管所需时间、一次插管成功率及患者的反应情况。结果缓速插管法和快速插管法所需时间分别为(25±3.2)s、(12±0.8)s,一次插管成功分别为47例和38例,两组的插管时间、一次成功率和患者反应均有显著性差异(P<0.05或P<0.01)。结论缓速插管法优于快速插管法。     

Carbamates and Benzodiazepines have different effects on detoxified alcoholics' sleep polygraphy

We showed in a previous work that tetrabamate (molecular complex composed of febarbamate, difebarbamate and phenobarbital) induced delta sleep in alcoholics, compared to diazepam. The aim of the present study was to test the hypothesis that the effect of tetrabamate on delta sleep was due to the carbamate part of the drug. We compared the effects of diazepam, tetrabamate, and meprobamate on 32 recently detoxified alcoholic inpatients' sleep polygraphy. Except for sleep duration and wake after sleep onset, tetrabamate and meprobamate groups had a similar polygraphic profile, in contrast to diazepam. Compared to the diazepam group, tetrabamate and meprobamate groups showed a decrease in stage 2 and an increase in stage 4. The effects of tetrabamate and meprobamate on stage 4, compared to diazepam, had comparable amplitudes. We propose the hypothesis that carbamates exert their action on delta sleep through an antagonist effect on 5HT-2 or histamine H1 receptors.     

Electrical stimulation of the ventral tegmental area evokes sleep‐like state transitions under urethane anaesthesia in the rat medial prefrontal cortex via dopamine D1‐like receptors

The role of dopamine in regulating sleep‐state transitions during, both natural sleep and under anaesthesia, is still unclear. Recording in vivo in the rat mPFC under urethane anaesthesia, we observed predominantly slow wave activity (SWA) of <1 Hz in the local field potential interrupted by occasional spontaneous transitions to a low‐amplitude‐fast (LAF) pattern of activity. During periods of SWA, transitions to LAF activity could be rapidly and consistently evoked by electrical stimulation of the ventral tegmental area (VTA). Spontaneous LAF activity, and that evoked by stimulation of the VTA, consisted of fast oscillations similar to those seen in the rapid eye movement (REM)‐like sleep state. Spontaneous and VTA stimulation‐evoked LAF activity occurred simultaneously along the dorsoventral extent of all mPFC subregions. Evoked LAF activity depended on VTA stimulation current and could be elicited using either regular (25–50 Hz) or burst stimulation patterns and was reproducible upon repeated stimulation. Simultaneous extracellular single‐unit recordings showed that during SWA, presumed pyramidal cells fired phasically and almost exclusively on the Up state, while during both spontaneous and VTA‐evoked LAF activity, they fired tonically. The transition to LAF activity evoked by VTA stimulation depended on dopamine D₁‐like receptor activation as it was almost completely blocked by systemic administration of the D₁‐like receptor antagonist SCH23390. Overall, our data demonstrate that activation of dopamine D₁‐like receptors in the mPFC is important for regulating sleep‐like state transitions.     

房室结慢径区域消融对迷走神经功能及心房颤动易感性的影响

Objective Atrioventricular node reentrant tachycardia (AVNRT) ablation may effect the vagal response,which is indicated by sinus tachycardia. On the other hand,atrial fibrillation (AF) ,which was found to be associated with vagal irmervation, often coexists with AVNRT. However,little is known about the im-pact of slow pathway ablation on local vagal innervation to atria. Methods In 11 dogs, bilateral cervical sympa-thovagal trunks were decentralized and metoprolol was given to block sympathetic effects. Linear lesion was per-formed from coronary sinus (CS) ostium to the middle area of Koch triangle. Atrial effective refractory period(ERP) ,vulnerability window (VW) of AF, and sinus rhythm cycle length (SCL) were measured at high fight atrium (HRA),low right atrium (LRA), distal (CSd) and proximal CS (CSp) at baseline with and without vagal stimulation before and after ablation. The histological study was also performed. Results (1) SCL during vagal stimulation remained unchanged before and after ablation(107±19)bpm vs (108±8) bpm (P > 0.05). (2) After ablation, ERP during vagal stimulation remained unchanged at HRA (55±34) ms vs (69 ±37) ms (P >0.05),and decreased slightly at CSd (42±32) ms vs (55±30) ms (P =0.08). However,at LRA and CSp,ERP was significantly decreased after ablation (19±21) ms vs (66±24) ms (P <0.001) ; and (7± 18) ms vs (46±24) ms (P < 0.001), respectively. (3) AF was difficult to be induced at baseline before and after ablation in all sites (VW close to 0). While during vagal stimulation, after ablation VW of AF significantly decreased at LRA (1±3) ms vs (49±36) ms (P < 0.005) and CSp (10±12) ms vs (45±34) ms (P < 0.05) ,decreased slightly at CSd after ablation (35±37) ms vs (57±28) ms (P =0.07) ,and remained un-changed at HRA (63±31) ms vs (63±25) ms (P > 0.05). (4) The altered architecture of individual gan-glia was histologically observed. Conclusions The decreased ERP shortening to vagal stimulation in CS and LRA induced by slow pathway ablation indicates that ablation in such area may result in the vagal dennervation in LRA and CS,thereby attenuating the susceptibility to vagal mediated AF. While unchanged SCL,ERP short-ening and VW to vagal stimulation in sinus node area and HRA indicate that slow pathway ablation did not change the vagal innervation to these sites.     

冠状动脉慢血流患者的腺苷负荷心肌灌注显像研究

目的:评价腺苷负荷心肌灌注单光子发射计算机断层扫描(SPECT)在诊断冠状动脉慢血流(CSF)中的临床价值。方法:根据冠状动脉造影(CAG)结果不同,分为CSF组、正常血流(NCF)组和CAG阳性组。使用校正的TIMI血流分级方法评价冠状动脉血流速度。3组均行CAG、静息心电图(ECG)、腺苷负荷ECG、静息及腺苷负荷SPECT检查,评价其心肌血流灌注情况。结果:CSF组腺苷负荷SPECT诊断心肌缺血阳性率(84%),明显高于平静ECG(20%)及腺苷负荷ECG(52%)。CSF组在腺苷负荷SPECT中显示心肌缺血的范围和程度高于NCF组,低于CAG阳性组。结论:CSF与心肌缺血关系密切,腺苷负荷SPECT可以作为检测CSF者心肌缺血的一种有效的无创性检查方法。