Loss of the nocturnal dip and increased variability of blood pressure in normotensive patients with noninsulin-dependent diabetes mellitus

Summary. Eleven normotensive diabetics with noninsulin-dependent diabetes mellitus (NIDDM) (mean age 52.5 SD 8.2 years) and 11 controls (mean age 47.4 SD 8.9 years) had their ambulatory blood pressure and heart rate recorded non-invasively by the Oxford Medilog System in standard hospital conditions. The results were averaged as hourly means of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) for the 24-h period and similarly for the ‘awake’ period (14.16 h) and the ‘asleep’ period (8–10 h). Hourly means for diabetics and controls showed no differences in blood pressure and heart rate over the 24 h. During sleep, control subjects showed a significant drop in SBP (P < 0.001), DBP (P < 0.001), MAP (P < 0.001) and HR (P < 0.001). However, this nocturnal dip in blood pressure could not be demonstrated in the diabetic group. Blood pressure variability was significantly increased in diabetics compared to controls during waking hours (P < 0.01). These results indicate that in noninsulin-dependent diabetics during sleep there is loss of the nocturnal dip of BP seen in normal subjects, and they have increased BP variability. These may be contributing factors to the development of hypertension and the accelerated target organ damage (TOD) seen in diabetes.,     

我国青年男子理想体重计算方法的探讨

在营养调查的基础上,以975名北方籍和921名南方籍青年为代表,以实测身高体重为依据,分别推出了理想体重计算公式。北方理想体重(kg)=[身高(cm)-150]×0.6+50;南方理想体重(kg)=[身高(cm)-150]×0.6+48。为检验样本的代表性,又另取北方籍783名青年和南方籍883名青年进行了验证,结果表明,推出的计算公式有较好的代表性。用推出的计算公式分别对1464名北方青年和2264名南方青年的身高体重进行分析,结果表明,新推出的计算公式比以往的计算公式更符合我国的情况,因而更具有实用意义。     

Hereditary Hypertriglyceridemic Rat: A New Animal Model of Metabolic Alterations in Hypertension

Hereditary hypertriglyceridemic rats (hHTg) were developed as a new genetic model for the study of relationships between blood pressure (BP) and metabolic abnormalities. This strain has been produced by selective inbreeding from Wistar rats according to the rise of plasma triglycerides induced by a high-sucrose diet. Though hHTg rats display hypertriglyceridemia, impaired glucose tolerrance, hyperinsulinemia, insulin resistance and increased BP even without nutritional stimuli, high sucrose feeding further aggravates these symptoms. High plasma triglycerides levels in hHTg rats seem to be a consequence of their hyperproduction. Impaired insulin action is responsible for the defective glucoregulation in this strain. The loss of insulin responsiveness might be due to a reduction in the number of glucose transporters. Highly significant relationships among plasma triglycerides, ouabain-resistant Na⁺ transport and BP were demonstrated in the hHTg rats. Segregating populations (F2 hybrids) should be used for genetic analysis of the primary role of lipid and/or ion transport abnormalities in the pathogenesis of this form of genetic hypertension.     

重型颅脑损伤持续颅内压及脑灌注压监护与预后关系

作者对５０例重型颅脑损伤患者（ＧＣＳ３－８分），及５０例伤情与诊断和手术方式基本相似的另一组患者进行颅内压（ＩＣＰ）与脑灌注压（ＣＣＰ）连续监测对比研究。结果表明，监护组除８例ＩＣＰ压力＜２．００ｋＰａ，ＣＰＰ＞９．３３ｋＰａ外，余４２例均有不同程度ＩＣＰ增高与ＣＰＰ降低。这些患者分别为创伤性颅内血肿、广泛性脑挫裂伤、继发性脑水肿或脑肿胀等，均采取积极的手术及综合治疗。死亡率为１４％。非监护组治疗方法与监护组相同，预后较差且并发症多，死亡率为２８％。作者认为，对重型颅脑损伤患者施行连续ＩＣＰ、ＣＰＰ监护，是降低并发症和死亡率，提高疗效的有力措施，具有重要的临床应用价值。     

Clarke's column in sporadic amyotrophic lateral sclerosis

Summary Histological, ultrastructural and morphometrical observations on Clarke's column were carried out in 18 patients with sporadic amyotrophic lateral sclerosis (ALS) and 15 age-matched control subjects. Of the 18 ALS patients 6 had been on a respirator before death. Bunina bodies were found in the neuronal cytoplasm in 7 of the 12 non-respirator-supported ALS patients and in 3 of the 6 respirator-supported patients. The number of spheroids was significantly higher in the non-respirator-supported patients (P<0.01) than in the control subjects; however, the number in the respirator-supported patients was about equal to that in the controls. The number of neurons in Clarke's column in the non-respirator-supported ALS patients was not reduced, but in the respirator-supported patients they tended to disappear with time after respiratory support. These findings suggest that Clarke's column neurons are also involved primarily in the disease process in sporadic ALS. However, they may begin to disappear only after the patients require respiratory support.Supported in part by a research grant for CNS degenerative diseases from the Ministry of Health and Welfare, Japan     

川芎嗪对脑外伤患者血栓素、前列腺环素及颅内压的影响

28例重度脑外伤患者分为川药嗪治疗组和一般治疗对照组,两组病人均于用药前和用药后3小时测定血浆和脑室内脑脊液(VCSF)中血栓素代谢产物(TXB_2)前列腺环素代谢产物6—酮—PGF_(la)(6KP)和颅内压。结果表明:两组治疗前血浆、VCSF中TXB_2及T/K均明显高于正常献血员对照组,川芎嗪能降低脑外伤患者血浆、VCSF中TXB_2及T/K值,对颅内压则无明显影响。提示川芎嗪能抑制脑外伤对血小板的激活、纠正循环血中TXA_2—PGI_2平衡失调,从而改善脑微循环。     

Comparison of the sphygmooscillographic method with the direct and auscultatory methods of measuring blood pressure

Objective. The objective of this study was to compare blood pressure (BP) measured by the sphygmooscillographic method with that measured by the direct and auscultatory methods.Methods. In 15 adult patients undergoing cardiac surgery, blood pressure was measured by the sphygmooscillographic and direct methods simultaneously on the same upper extremity. In another group of 86 children and 11 adults, blood pressure was measured by the sphygmooscillographic and auscultatory methods simultaneously, with one cuff. For the sphygmooscillographic measurement, we used sphygmomanometer-S, which measures blood pressure on the basis of the amplitude height (oscillometric) and the morphology (sphygmographic) of pulse waves recorded by a transducer placed in the cuff.Results. The systolic and diastolic blood pressure measured by the sphygmooscillographic method were both 2 mm Hg higher than those from the direct method; the mean blood pressure was 0.6 mm Hg higher. These differences were not significant. Compared with the auscultatory method, sphygmooscillographic systolic values were higher by 7 mm Hg, while diastolic values were lower by 9 mm Hg. These differences were significant.Conclusions. Blood pressure measurements obtained by the sphygmooscillographic method correlate well with the direct method for measuring blood pressure in children and adults; but, they do not correlate well with the auscultatory method.     

Physiological Effects of Mental Stress and Orthostasis in Young Insulin-Dependent Diabetic Patients

ABSTRACT. The effects of procedures which stimulate sympathetic activity, viz. mental stress induced by a colour-word conflict test (CWT) for 20 min, and orthostasis (ORT) for 8 min were studied in 8 young (16-20 yr) insulin-dependent diabetes mellitus (IDDM) patients and 9 age and sex-matched healthy controls. The IDDM patients showed no signs of neuropathy or retinopathy and their mean HbA_1c value was 8.4 ±0.6% (normal value < 5.0 %). Blood pressure and heart rate increased significantly during CWT and ORT in both groups. The changes in systolic blood pressure and heart rate were comparable in both groups during CWT; the IDDM group showed a higher ( p < 0.05) heart rate after 8 min of orthostasis, however. CWT and ORT elicited equivalent increases in noradrenaline in venous plasma in both groups ( p < 0.05), but the IDDM patients had 50% lower values ( p < 0.01) at rest, during CWT and at rest after CWT than controls. CWT and ORT evoked equivalent plasma adrenaline increases in both groups. The lipolysis marker, plasma glycerol, was about 40 % lower ( p < 0.05) in the IDDM group before and after CWT. Yet, mental stress evoked equivalent increases in glycerol levels ( p < 0.01) in both groups. These findings indicate that sympathetic activity in the young diabetic patients without signs of neuropathy may be blunted.     

An inexpensive, self-assembly pressure algometer

We have developed a simple instrument for pressure algometry. It can be made easily using components found in most anaesthetic rooms. Ten students were able to make the device using written instructions. All the resulting algometers performed within 10% accuracy limits for values up to 4 kgcm⁻².