CD1小鼠动脉导管Kca mRNA表达情况研究

目的 研究高电导钙离子激活的钾通道（Kca)mRNA在妊娠晚期胎鼠和新生CD1小鼠动脉导管（DA）上的表达情况。以期阐明Kca在小鼠DA关闭调控方面的作用。方法 采用逆转录聚合酶链反应（RT-PCR）和Southern杂交方法。检测了经剖宫产分娩的妊娠d17,d18和d19CD1胎鼠，以及自然产d1新生小鼠DAKcamRNA的表达情况。结果 KcamRNA表达于胎鼠DA，以d19表达水平最高，但新生小鼠DA无KcamR-NA表达。结论 KcamRNA在胎鼠DA有表达，但出生后无表达，提示在宫内低氧环境中Kca可能是维持DA开放状态的一个重要因素。而生后无表达则可能与DA的关闭有关。     

人参皂甙单体Rb1联合异博定对多药耐药细胞系K562/HHT的耐药逆转作用

目的 探讨中药钙离子通道拮抗剂人参皂甙单体Rbl联合异博定，对白血病多药耐药细胞系(K-562／HHT)的耐药逆转作用。方法 药物敏感试验采用四唑氮盐(MTT)比色试验法。结果 20μmol/L Rbl、10fμmol/L Rbl联合5μmol/L异博定耐药逆转倍数分别为4．4、12．5倍。结论 Rbl联合异博定可以显著增强Rbl逆转活性。     

Restoration of bowel continuity after surgery for acute perforated diverticulitis: should Hartmann’s procedure be considered a one‐stage procedure?

Objective Hartmann’s procedure (HP) still remains the most frequently performed procedure in acute perforated diverticulitis, but it results in a end colostomy. Primary anastomosis (PA) with or without defunctioning loop ileostomy (DI) seems a good alternative. The aim of this study was to assess differences in the rate of stomal reversal after HP and PA with DI and to evaluate factors associated with postreversal morbidity in patients operated for acute perforated diverticulitis. Method All 158 patients who had survived emergency surgery for acute perforated diverticulitis in five teaching hospitals in The Netherlands between 1995 and 2005 and underwent HP or PA with DI were retrospectively studied. Age, gender, ASA‐classification, severity of primary disease, delay of stoma reversal, surgeon’s experience, surgical procedure and type of anastomosis were analysed in relation to outcome after stoma reversal. Results Of the 158 patients, 139 had undergone HP and 19 PA with DI. The reversal‐rate was higher in patients with DI (14/19; 74%) compared to HP (63/139; 45%) (P = 0.027) Delay between primary surgery and stoma reversal was shorter after PA with DI compared with HP (3.9 vs 9.1 months; P < 0.001). Cumulative postreversal morbidity after HP was 44%. Early surgical complications occurred in 22 of 63 patients. Morbidity after DI reversal was 15% (P < 0.001). Three patients died after HP reversal, none died after DI reversal. Anastomotic leakage was observed in 10 patients after HP reversal. This was less frequently observed when the operation was performed by a specialist colorectal surgeon (10%vs 33%; P = 0.049) and when a stapled anastomosis was performed (4%vs 24%; P = 0.037). Conclusions Reversal of HP should only be performed by an experienced colorectal surgeon, preferably performing a stapled anastomosis, or probably not be performed at all, as it is accompanied by high postoperative morbidity and even mortality. It is important that these findings are taken in account for when performing primary emergency surgery for acute perforated diverticulitis.     

Urgent reversal of warfarin with prothrombin complex concentrate

BACKGROUND: When life-threatening bleeding occurs in patients on warfarin, timely reversal becomes imperative. In the USA, warfarin effect is commonly reversed with fresh frozen plasma (FFP). The use of FFP is complicated by delays in correction, volume overload and often, inadequate correction. OBJECTIVE: Evaluate the feasibility and efficacy of a protocol for rapid administration of prothrombin complex concentrate (PCC) in the setting of the urgent need for reversal of warfarin. METHODS/PATIENTS: We instituted a policy for rapid delivery and administration of PCC. Appropriate patients received 25-50 U kg(-1) of PCC. The prothrombin time (PT)/International Normalized Ratios (INR) was recorded before and immediately after dosing, and 24 h postdosing. Patients requiring surgical interventions were cleared for the operating room (OR) immediately. Fifty-eight patients were treated, with a median age of 75.5 years (range 26-92). RESULTS: The median INR on presentation was 3.8 (1.4-52.8). Immediately following PCC administration the median INR was 1.3 (0.9-5.7), only two patients with INRs exceeding 2.0. The benefit was maintained at 24 h with a median INR of 1.5 (1.1-3.4). Four patients experienced thrombotic events during their hospitalization, (two deep vein thrombosis, two non-q-wave myocardial infarction) although none was attributed to PPC therapy. CONCLUSIONS: PCC administration is an effective treatment modality for the correction of warfarin anticoagulation in the urgent setting. Advantages over FFP include more timely correction, absence of volume overload and potentially more complete correction. Broader use of PCC in this setting appears to be appropriate.     

Is cirrhosis reversible?

Abstract   Cirrhosis has traditionally been considered as an irreversible end-stage of liver disease. In recent years clinical and histologic improvement has been documented in many patients if the primary disease can be controlled. Hepatic fibrosis can be resorbed from the liver through the action of proteinases. This causes fibrous septa to become delicate and in some instances to disappear. After septa are resorbed cirrhosis is not present according to the histologic definition. However, an early event in the formation of cirrhosis is obliteration of small portal and hepatic veins; regeneration of these veins is necessary to complete the process of reversal of cirrhosis. New systems of histologic analysis are necessary to define the cirrhotic state, such as the Laennec staging system.     

New and developing anesthesia drugs

Introduction: In recent years, new anesthetic drugs with potentially better pharmacokinetic and pharmacodynamic properties are under development with good progress. Some of the most promising drugs are reviewed in this article.

Areas covered: A literature review was performed using Ovid and Medline as the search engine. Articles published from January 2000 to December 2016 were included for review. Efforts have been made to eliminate duplicated studies.

Expert opinion: This is an up-to-date review on new and developing anesthesia drugs. It will give readers information on the pharmacology and clinical significance of these new drugs.     

Effects of dorsomedial thalamic lesions on spatial discrimination reversal in the rat.

Eight rats with lesions of the dorsomedial thalamus and 10 rats with sham operations were compared on acquisition and subsequent reversals of a spatial discrimination. The rats with thalamic damage showed greater perseveration to the incorrect choices (p less than 0.002) and made fewer reversals (p less than 0.05) and more errors (p less than 0.02) during the 100 reversal trials following initial acquisition than did the sham-operated animals. The two groups did not differ on the original acquisition.     

Neonatal alcohol exposure impairs acquisition of eyeblink conditioned responses during discrimination learning and reversal in weanling rats

Discrimination and reversal of the classically conditioned eyeblink response depends on cerebellar-brainstem interactions with the hippocampus. Neonatal "binge" exposure to alcohol at doses of 5 g/kg/day or more has been shown to impair single-cue eyeblink conditioning in both weanling and adult rats. The present study exposed neonatal rats to acute alcohol intubations across different developmental periods (postnatal day [PND] 4-9 or PND7-9) and tested them from PND26-31 on discriminative classical eyeblink conditioning and reversal. A high dose of alcohol (5 g/kg/day) dramatically impaired conditioning relative to controls when exposure occurred over PND4-9, but produced mild or no impairments when delivered over PND7-9. These findings support previous claims that developmental exposure period plays a critical role in determining the deleterious effects of alcohol on the developing brain. A lower dose of alcohol (4 g/kg/day) delivered from PND4-9--lower than has previously been shown to affect single-cue eyeblink conditioning--also produced deficits on the discrimination task, suggesting that discrimination learning and acquisition of responding to CS+ during reversal may be especially sensitive behavioral indicators of alcohol-induced brain damage in this rat model.     

AMI合并CS患者IABP术辅助治疗后主要终点事件相关影响因素的分析

目的 分析急性心肌梗死(AMI)合并心源性休克(CS)患者主动脉内球囊反博(IABP)术辅助治疗后主要终点事件的相关影响因素。方法 将我院125例AMI合并CS患者(2019年8月～2021年5月)作为研究对象,收集其临床资料(性别、年龄、治疗方法、合并症等),行Logistic回归分析,以了解AMI合并CS患者IABP术辅助治疗后主要终点事件的相关影响因素。结果 125例AMI合并CS患者IABP术辅助治疗后存活75例,存活率为60.00%(75/120),死亡50例,死亡率为40.00%(50/125);存活组、病死组的年龄、吸烟、伴有高血压、伴有糖尿病、伴有脑梗死、前壁梗死、冠脉病变支数多、IABP治疗后并发心排量不足、IABP治疗后并发肺部感染、PCI术后TIMI血流分级Ⅱ级、平均动脉压、TC、FBG、BUN水平对比,差异具有统计学意义(P＜0.05);Logistic多元回归方程分析发现,年龄≥75岁、合并糖尿病、冠状动脉病变支数多、术后心肌梗死溶栓试验(TIMI)血流分级为Ⅱ级、IABP并发心排量不足为AMI合并CS患者IABP术辅助治疗后主要终点事件的危险因素(P＜0.05)。结论 影响AMI合并CS患者IABP术辅助治疗后主要终点事件发生情况的因素较多,年龄、合并糖尿病、冠状动脉病变支数、术后TIMI血流分级、IABP并发症等均可引起不良预后,对此,临床应针对高危因素进行积极干预。     

Therapeutic doses of neostigmine,depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double‐blind,placebo‐controlled,randomised volunteer study

Neostigmine reverses non‐depolarising neuromuscular blockade, but may cause muscle weakness when administered after full recovery of neuromuscular function. We hypothesised that neostigmine in therapeutic doses impairs muscle strength and respiratory function in awake healthy volunteers. Twenty‐one volunteers were randomised to receive two doses of either intravenous (i.v.) neostigmine 2.5 mg with glycopyrrolate 450 μg (neostigmine group, n = 14) or normal saline 0.9% (placebo group, n = 7). The first dose was administered immediately after obtaining baseline measurements, and the second dose was administered 15 min later. All 14 volunteers in the neostigmine group received the first dose, mean (SD) 35 (5.8) μg.kg^?1, but only nine of these volunteers agreed to receive the second dose, 34 (3.5) ?g.kg^‐1. The primary outcome was hand grip strength. Secondary outcomes were train‐of‐four ratio, single twitch height, forced expiratory volume in 1 s, forced vital capacity, forced expiratory volume in 1 s/forced vital capacity ratio, oxygen saturation, heart rate and mean arterial pressure. The first dose of intravenous neostigmine with glycopyrrolate resulted in reduced grip strength compared with placebo, ?20 (20) % vs. +4.3 (9.9) %, p = 0.0016; depolarising neuromuscular blockade with decreased single twitch height, ?14 (11) % vs. ?3.8 (5.6) %, p = 0.0077; a restrictive spirometry pattern with decreased predicted forced expiratory volume in 1 s, ?15 (12) % vs. ?0.47 (3.4) %, p = 0.0011; and predicted forced vital capacity, ?20 (12) % vs. ?0.59 (3.2) %, p < 0.0001 at 5 min after administration. The second dose of neostigmine with glycopyrrolate further decreased grip strength mean (SD) ?41 (23) % vs. +1.0 (15) %, p = 0.0004; single twitch height ?25 (15) % vs. ?2.5 (6.6) %, p = 0.0030; predicted forced expiratory volume in 1 s ?23 (24) % vs. ?0.7 (4.4) %, p = 0.0063; and predicted forced vital capacity, ?27.1 (22.0) % vs. ?0.66 (3.9) %, p = 0.0010. Train‐of‐four ratio remained unchanged (p = 0.22). In healthy volunteers, therapeutic doses of neostigmine induced significant and dose‐dependent muscle weakness, demonstrated by a decrease in maximum voluntary hand grip strength and a restrictive spirometry pattern secondary to depolarising neuromuscular blockade.