急性肺栓塞患者BNP、CTnI、D-dimer水平改变及其临床意义

【目的】探讨检测急性肺栓塞患者的血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）及D‐二聚体（D‐dimer）水平变化的临床意义。【方法】选择本院2009年1月至2013年12月收治的急性肺栓塞患者64例,根据患者病情分为大面积肺栓塞组（ n ＝27）和非大面积肺栓塞组（ n ＝37）,对两组患者血浆cTnI、BNP及D‐dimer水平进行测定,观察比较两组患者各指标水平的变化及右心功能和病死率。【结果】大面积肺栓塞组BN P、血浆cTnI水平明显高于非大面积肺栓塞组,两组比较差异有显著性（ P ＜0．05）;两组D‐dimer浓度比较差异无统计学意义（ P ＞0．05）;大面积肺栓塞组的右心功能不全者和病死率均高于非大面积肺栓塞组,两组比较差异有统计学意义（ P ＜0．05）。【结论】检测BNP、cTnI及D‐dimer水平对APE患者临床诊断、临床决策及预后判断具有重要的临床意义。     

Prevalence and Risk Factors for Obesity After Liver Transplantation: A Single-Center Experience

Background

The study of weight gain after transplantation and its associated factors is necessary to propose strategies to prevent and treat this problem.

Objectives

This study aims to investigate factors affecting the development of obesity after liver transplantation (LTx).

Patients and Methods

Medical records of 343 liver transplantation cases, which were followed between January 2001 and January 2010 at Dokuz Eylul University, were retrospectively analyzed. Patient pre-liver transplantation height, body weight, body mass index (BMI) measurements, as well as changes in body weight at the beginning, 6 months, 12 months, and 5 years post-transplantation were observed. BMI measurements with records of immunosuppressive therapies were obtained.

Results

The study was carried out with the records of 226 patients. 151 patients (66.8%) were male; 75 (33.2%) were female. The mean age was 46.19 ± 10.2 years. 123 of these liver transplants were performed from living donors, while 103 were from cadaveric donors. The causes of liver transplantation were hepatitis D virus (HDV) infection (28%), hepatitis B virus (HBV) infection (24%), hepatitis C virus (HCV) infection (24%), alcoholic liver disease (9%), cryptogenic liver disease (9%), autoimmune hepatitis (4%), and other (2%). In this study, the prevalence of obesity was 21% at the end of the second year, decreasing to 14% by the end of the fifth year. The mean BMI gradually increased during the follow-ups, reaching 25.1 kg/m² and 26 kg/m² six months after liver transplantation and at the end of the first year, respectively (P < 0.002). Obesity developed in 18.2% of post-transplant patients who were receiving a calcineurin inhibitor (CNI). Regarding the development of obesity after transplantation, no statistically significant difference was found between patients using cyclosporine (CsA) and tacrolimus (TAC) (P = 0.07). Six months after liver transplantation, the mean body weight gain in the groups receiving steroids and not receiving steroids were 4.71 kg and 2.7 kg, respectively (P = 0.03). In the post-transplant period, there was no significant difference in patients who had received TAC and CsA for development of diabetes mellitus (DM), hypertension (HT), or hyperlipidemia (HL) (P = 0.30).

Conclusions

Obesity prevalence before and after liver transplantation was comparable. Education of obese patients prior to surgery and recommendation of medical nutrition therapy should be appropriate. Similar medical care for the non-obese subjects could prevent increase in obesity prevalence. Non-corticosteroid immunosuppressive agents had no significant effect on the development of weight gain and obesity. Avoiding the use of long-term steroid therapy and obesity education are the key measures for preventing obesity after liver transplantation.     

丁苯酞通过增强抗氧化活性保护局灶性脑缺血再灌注大鼠

目的 探讨丁苯酞对脑缺血再灌注损伤的保护作用和可能机制.方法 60只健康清洁级成年Sprague-Dawley大鼠,随机分为假手术组、生理盐水对照组、小剂量丁苯酞组和大剂量丁苯酞组,每组15只.应用线栓法建立局灶性脑缺血再灌注模型.再灌注开始时,小剂量丁苯酞组和大剂量丁苯酞组分别腹腔注射丁苯酞注射液100 mg/k和400 mg/kg,假手术组和生理盐水组分别腹腔注射生理盐水0.5 ml/kg.所有大鼠在缺血再灌注24h后处死.结果 小剂量丁苯酞组(t=1.488,P=0.000)和大剂量丁苯酞组(=2.362,P=0.000)神经功能缺损程度较生理盐水组均显著性改善,其中大剂量丁苯酞组较小剂量丁苯酞组改善更为显著(t=-0.873,P=0.000).小剂量丁苯酞组(t=18.589,P=0.000)和大剂量丁苯酞组(=36.963,P=0.000)脑梗死体积较生理盐水对照组显著性缩小,其中大剂量丁苯酞组梗死体积较小剂量丁苯酞组缩小更显著(t=-18.374,P=0.000).HE染色显示,生理盐水对照组神经元稀疏、大量变性坏死,细胞间隙增大,细胞间质空泡样改变.丁苯酞组神经元变性坏死明显减少,存活神经细胞增多,大剂量丁苯酞组改善更为显著.小剂量丁苯酞组和大剂量丁苯酞组SOD活性较假手术组和生理盐水对照组显著性增高(P均＜0.05),其中大剂量丁苯酞组SOD活性显著性高于小剂量丁苯酞组(t=80.199,P=0.000);小剂量丁苯酞组和大剂量丁苯酞组MDA水平较假手术组和生理盐水对照组显著性降低(P均＜0.05),其中大剂量丁苯酞组MDA水平显著性低于小剂量丁苯酞组(t=-1.308,P=0.000).结论 丁苯酞对缺血再灌注损伤的保护作用可能与机体抗氧化活性增强有关.     

Ultrasonography: usefulness in localization of the Norplant contraceptive implant system.

Norplant is a levonorgestrel-containing contraceptive system that consists of six small capsules (2.4 x 34 mm), which are placed subdermally. Owing to the relative newness of this contraceptive modality, problems with removal of the Norplant implants are just beginning to be reported; these consist primarily of inability to locate and remove all six implant capsules upon discontinuation. Ultrasonographic images of 14 women with the Norplant system in place were obtained in the axial and longitudinal planes. On axial view the capsules consisted of discrete circular individual areas of high echogenicity with prominent posterior shadowing. Capsules scanned in a longitudinal plane demonstrated echogenicity of the superior and inferior capsular walls, giving a tubular appearance. It was possible to demonstrate the depth of capsule placement, spatial relation to surrounding capsules, and orientation in relation to the skin surface. Ultrasonography therefore may provide a useful, noninvasive method for localization of nonpalpable Norplant implants, thus facilitating removal.     

On the role of the adrenergic receptors for extraneuronal amine uptake and retention in rat salivary glands in vitro

Summary The effect of an -receptor blocking agent, phenoxybenzamine, and a series of -receptor blocking agents on extraneuronal uptake and retention of radioactivity after incubation of rat salivary gland slices with ³H-noradrenaline or ³H-isoprenaline has been investigated. In some experiments with ³H-noradrenaline as substrate, neuronal uptake was prevented by adding protriptyline to the incubation medium. Phenoxybenzamine reduced extraneuronal accumulation of radioactivity after both ³H-noradrenaline and ³H-isoprenaline in a concentration-dependent manner, whereas after propranolol the levels of extraneuronally retained radioactive material were markedly increased, the efflux from the slices not being diminished. Some other nonselective and selective -receptor blocking agents with and without intrinsic activity were found to produce the same effect as propranolol upon the retention of radioactivity after incubation with ³H-noradrenaline and ³H-isoprenaline. When both phenoxybenzamine and propranolol were present in the incubation medium the effect of extraneuronally retained radioactivity after ³H-noradrenaline as well as after ³H-isoprenaline was the same as when only phenoxybenzamine was used. The metabolic pattern of the radioactivity in the slices revealed that the extraneuronally retained radioactive compounds consisted mainly of tritiated catabolites, especially 3-O-methylated ones. The relationship between the extraneuronal accumulation and adrenergic receptor mechanisms is discussed.     

Effects of alpha-methyl tyrosine and adrenergic blocking agents on the facilitating action of amphetamine and nicotine on learning in rats

dl-amphetamine sulphate (2 mg/kg) and nicotine (0.2 mg/kg) showed a facilitatory action on the acquisition of a conditioned response in a shuttle-box by rats and this was reversed by pretreatment with -MT (30 mg/kg).Pretreatment with dibenamine (10 mg/kg) impaired the action either of amphetamine or nicotine. Nethalide (5–10 mg/kg) exerted a partial protection on the depressant effect produced by the interaction between dibenamine and nicotine.Animals treated with -MT (30 mg/kg) and kept in the cold (4–6° C for 3 h) also showed a depressed learning capacity. dl-Dopa (200 mg/kg) provided a partial protection on the depressive effects caused by the interaction of -MT with amphetamine, nicotine or cold. It is suggested that the facilitatory learning action of amphetamine and nicotine involves a common adrenergic mechanism. The depressant effects of amphetamine, nicotine or cold after -MT treatment are attributed to depletion of functional pools of catecholamines.This work was supported by grant N 2911/67 from the Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina (O. A. Orsingher).     

Behavioural effects of d-amphetamine alone and in combination with antidepressants,antihistamines or other psychotropic drugs in young chicks

Antidepressants, antihistamines or other psychotropic drugs were administered before injection of d-amphetamine in 3–5 day old chicks. This pretreatment completely protected some animals against the characteristic behavioural changes seen after d-amphetamine 6 mg/kg i.p. In addition chlorpheniramine, chlorimipramine, imipramine, cocaine and diphenhydramine were also able to antagonize a dose of 10 mg/kg i.p. It was further noticed that well developed d-amphetamine symptoms were interrupted by subsequent treatment with imipramine.     

Human blood platelets as cellular models for investigation of membrane active drugs: Beta-adrenergic blocking agents

Summary Beta-adrenergic blocking agents inhibit serotonin uptake by human blood platelets; in addition they induce release of the previously accumulated amine in vitro. Propranolol was the most active drug, followed by alprenolol, Kl 255, Kö 592, INPEA, oxprenolol, pindolol, Kö 1366, practolol, and sotalol. Kinetic analysis revealed a mixed type of inhibition of serotonin uptake. A significant correlation between these parameters and the lipid solubilities of the respective drugs was found. In contrast to the active serotonin uptake labelled -sympatholytics were accumulated by the platelets passively, i. e. independently of temperature and of time of incubation. The degree of accumulation by human blood platelets and human erythrocyte ghosts was again correlated with the hydrophobicity of the compounds. Therefore, it is concluded that these effects of -adrenergic blocking agents are mainly unspecific in nature, depending on the lipid solubility of the drugs, and leading to conformational changes within the membranes. This assumption is supported by the electron microscopical findings in human platelets, indicating ultrastructural changes and cell lysis.Supported by a grant of the Deutsche Forschungsgemeinschaft.Part of this work has been presented at the 2^nd Int. Symp. on Metabolism and Membrane Permeability of Erythrocytes, Thrombocytes and Leucocytes, Vienna 1972 (Lemmer et al., 1972).     

The effects of various “nicotine-like” agents in the cat superior cervical ganglion in situ

Summary The effects of nicotine, lobeline, anabasine, cytisine, coniine, sparteine, piperidine, acetylcholine, tetramethylammonium (TMA) and dexamphet-amine, given as i.a. bolus injections, were studied in the cat superior cervical ganglion (SCG) in situ and compared with those of (DMPP) 1,1-dimethyl-4-phenylpiperazinium described in a preceding paper.Two main events are thought to determine the ganglionic response to these agents. A non-selective conductance increase of the ganglion cells by stimulation of nicotinic receptors is responsible for depolarization, firing, facilitation of ganglionic transmission and depolarization block. The accumulation of Na⁺ resulting from the altered conductance activates an electrogenic Na ⁺-pump which tends to increase the membrane potential and causes a delayed unspecific depression of ganglionic excitability. After agents with a brief agonistic action (acetylcholine, DMPP, TMA), the two mechanisms lead to a distinct biphasic effect on ganglionic polarity (initial depolarization, later hyperpolarization) and transmission (early and later block); with the nicotinic agonists of long duration of action the effect of the electrogenic Na⁺-pump was obscured by the long-lasting activation of nicotinic receptors and was usually revealed only by special pharmacological procedures. An additional preganglionic depression of transmitter release is very likely. A desensitization of nicotinic receptors occurred after high single or repeated doses of nicotine, resulting in a selective unsurmountable block. A competitive block of nicotinic receptors occurred after coniine. Local anaesthetic properties of lobeline and dexamphetamine interfered with the two main events when high doses were given. The only effect of sparteine was to produce a short-lasting hexamethonium-like block of transmission.     

The pharmacokinetics and metabolism of Kö 592 in man,dog and rat

Summary Plasma concentration, renal and faecal excretion, absorption and metabolism of the tritiated beta-adrenergic blocker Kö 592 were studied in man, dog and rat. The substance was absorbed to an extent of 90–100% in all species (rat within 30 min, dog within 80 min, man within 120 min). The half-life of radio-activity in the plasma was 3 h in man and dog, in the rat blood 11 h. Excretion is almost complete within the first 12 h in man and dog. While 10–20% of the substance appears in the faeces in rats, elimination in the dog and man is almost exclusively renal. Kö 592 is completely metabolized. The metabolites were isolated from urine and identified by mass spectrometry. With individual variations, 31% of the metabolites of man and dog were present as methylphenoxy lactic acid, 20% as p-hydroxy-Kö 592 and 50% as conjugates. Man conjugates only with glucuronic acid, the dog conjugates 50% with sulphate and 50% with glucuronide.