Effect of work-induced hypertrophy on muscle glucose metabolism in lean and obese mice

Summary The effect of work-induced hypertrophy (without any concomitant change in circulating parameters) on skeletal muscle metabolism was studied in lean mice and in goldthioglucose obese-mice. Soleus muscle was functionally overloaded in one leg by tenotomy of gastrocnemius muscle 4 days before muscle isolation, muscle in the other leg being used as control. Basal deoxyglucose uptake and glycolysis were markedly increased in overloaded muscles compared with control muscles, together with a ten-fold increase in fructose 2–6 bisphosphate content. In the presence of maximally effective insulin concentrations, deoxyglucose uptake and glycolysis were identical in overloaded and control muscles of lean mice, while the effects of overload and insulin were partly additive in muscles of goldthioglucose-obese mice. The sensitivity to insulin and insulin binding to muscles were not modified in overloaded muscles. Insulin-stimulated glycogenogenesis was decreased by about 50% probably due to a lower amount of glycogen synthase in overloaded than in control muscles. Thus, in muscles of goldthioglucose-obese mice work-induced hypertrophy increased the response to maximal insulin concentrations without modifying the altered insulin sensitivity and decreased insulin binding.     

肺动脉环缩术治疗不同年龄伴肺动脉高压单心室

目的 总结肺动脉环缩术( PAB)在不同年龄段伴肺动脉高压先天性心脏病患儿行单心室修复术中的应用效果.方法 49例合并重度肺动脉高压仅能行单心室修复的复杂畸形患儿,男31例,女18例;年龄0.2～10岁,平均(7.8±3.8)岁;体重5～24 kg,平均(8.82 ±4.24) kg;经皮血氧饱和度( SPO2)0.85～1.00,平均(0.90±0.04);术前肺动脉平均压(mPAP) 52 ～91 mm Hg(1 mm Hg =0.133kPa),平均(54.6±16.8) mmHg.合并单心室13例,三尖瓣闭锁12例,室间隔缺损远离两大动脉伴左心室发育不良型右室双出口11例,三尖瓣重度狭窄5例,心室不均衡型完全型房室通道5例,十字交叉心3例.根据年龄分为3组:≤0.5岁17例、0.5 ～2.0岁17例、≥2.0岁15例.全组均先期行PAB,静脉吸入复合麻醉,吸入氧浓度40％时,SPO20.85,肺动脉平均压20 mm Hg.对比分析3组术后SPO2、mPAP、呼吸机使用时间、ICU停留时间以及手术死亡比率.结果 手术死亡1例系1岁6个月患儿,死因为肺部感染.全组术后肺动脉压明显下降.3组术后SPO2、mPAP、呼吸机使用时间、ICU停留时间均无明显区别.随访6 ～72个月,1例1岁2个月患儿术后2个月因误吸死亡;3例已完成双向格林或全腔肺动脉吻合术.结论PAB能有效降低不同年龄段伴肺动脉高压拟行单心室修复的先心病患儿的肺动脉压力,术后效果良好.     

Ventricular assist device support in children and adolescents with heart failure: the Children's Medical Center of Dallas experience

Children with heart failure unresponsive to medical therapy are left with few options for survival. Ventricular assist devices (VADs) are life-saving options for such patients, allowing for bridge to transplantation or cardiac recovery. Retrospective review of cases from May 2006 to October 2010 was undertaken. Fourteen patients underwent implantation of VADs for refractory heart failure. Mean age was 9 years (range 1-17 years), and weight was 41 kg (range 9.7-71 kg). Indications for support: end-stage cardiomyopathy (n = 8), myocarditis (n = 3), univentricular failure (n = 2), and congenital heart disease/postcardiotomy (n = 1). Level of limitation at time of implant included critical cardiogenic shock in six (43%) and progressive decline in eight (57%). Extracorporeal membrane oxygenation was used as a bridge to VAD in five (36%) patients. Preimplant variables: 86% of patients requiring mechanical ventilation (mean 10.3 days), hyperbilirubinemia in 75%, and acute renal insufficiency in 79%. Device selection was systemic VAD in 11 (79%) and biventricular assist device in three (21%). Berlin Heart EXCOR was used in eight patients, while six patients received a Thoratec implantable VAD or paracorporeal VAD. Mean duration of support was 68 days (range 8-363 days). Overall survival was 79%. Ten patients (71%) were successfully bridged to transplantation, three (21%) died while on a device, one remains on support, and no patients were weaned from VAD. Children supported for single ventricle heart failure had a 50% survival with none currently bridged to transplantation. Complications included bleeding requiring reoperation in 21% (n = 3), stroke in 29% (n = 4), and driveline infections in 7% (n = 1). In two patients, a total of six pump exchanges were performed for thrombus formation. Survival for pediatric patients of all ages is excellent using current device technology with a majority of patients being successfully bridged to transplantation. Morbidity is acceptably low considering the severity of illness. Significant challenges exist with long-term extracorporeal support due to lack of donor availability and the high incidence of preformed alloantibodies especially in the failing single ventricle.     

鬼箭羽钩藤复方液对心肌肥大大鼠L型钙电流的影响

 目的 探讨鬼箭羽钩藤复方液对高血压性心肌肥大的影响.方法 利用腹主动脉缩窄法建立高血压性心肌肥大模型,利用灌胃法给予中药治疗,采用离体大鼠心脏 Langendorff 灌注法急性分离心肌细胞,利用膜片钳全细胞技术记录L型钙电流,比较正常对照组、高血压模型组及中药治疗组之间的区别.结果 高血压模型组的L型钙电流密度显著高于正常对照组(P＜0.05);中药治疗组的L型钙电流密度显著小于高血压模型组(P＜0.05),与正常对照组相比无显著性差异(P＞0.05).结论 鬼箭羽钩藤复方液具有逆转高血压性心肌肥大的作用.     

经尿道电气化切除术治疗良性前列腺增生症(附1532例报告)

目的 :总结和评价经尿道前列腺电气化切除术 (TUVP)治疗良性前列腺增生症 (BPH)的疗效。方法 :采用铲式气化切割环 ,经尿道气化切除前列腺 1 5 32例。结果 :最大尿流率 (Qmax)由手术前 (7.7± 3.8)ml/s到术后 (1 7.9± 3.2 )ml/s;国际前列腺症状评分由术前 (2 9.5± 3.6 )分到术后 (9.1± 2 .9)分 ;生活质量评分由术前 (5 .5± 0 .3)分到术后 (1 .9± 0 .3)分 ;术中前列腺包膜穿孔 2例 ;术后尿失禁 2例 ,前尿道狭窄 1 7例 ,后尿道狭窄 7例 ;无电切综合征及死亡病例。结论 :TUVP治疗BPH创伤小、出血少、疗效好、术后康复快     

经小脑延髓裂入路显微手术切除儿童第四脑室肿瘤

目的 报道经小脑延髓裂入路显微外科手术切除儿童第四脑室肿瘤的临床疗效。方法 采用枕下正中切口、小脑延髓裂入路在手术显微镜下切除第四脑室肿瘤18例。结果 手术治疗18例，其中肿瘤全切除13例，近全切除5例。术后无l例出现小脑性缄默综合征。出现脑积水3例，2例经行侧脑室．腹腔分流后好转，l例因急性梗阻性脑积水死亡。结论 经小脑延髓裂入路，不需切开小脑蚓部，可避免损伤正常小脑组织，应用显微外科技术有助切除第四脑室肿瘤，提高手术疗效。     

右室双出口解剖条件影响矫治手术选择和生存的危险因素分析

目的：通过分析右室双出口的解剖特点、手术选择和结果，以筛选解剖条件中内在的相关规律及与矫治手术死亡相关的危险因素。方法：109例右室双出口病儿，根据不同的室间隔缺损(VSD)位置、大血管位置和并发畸形等解剖特点分类，VSD位置分别与大血管位置和手术方法选择进行相关性检验，Logistic逐步回归筛选与住院死亡相关的危险因素，并建立术前预测死亡概率的模型。结果：主、肺动脉位置为侧侧位或主动脉右前斜位，VSD大多为主动脉下，手术方法以心室内矫治(IVR)为主；大血管位置为前后位，VSD大多为肺动脉瓣下，手术方法以Rastelli和大动脉转位术(ASO)为主。主动脉右前斜位、主动脉瓣下VSD的相对危险度小于1，主动脉左前斜位、VSD远离大动脉开口及左室发育不良等解剖条件的相对危险度大于1，Logistic回归方程组内考核的符合率为80．7％。结论：VSD位置和大血管位置及手术方法选择之间有显著的相关性，主动脉右前斜位、左前斜位、主动脉下VSD或VSD远离大动脉开口及左室发育不良等解剖条件对住院死亡有显著影响。     

One and a half ventricle repair for Ebstein’s anomaly

The surgical strategy for patients having Ebstein’s anomaly and hypoplastic right ventricle is controversial. An 11-year-old boy patient having such condition, with estimated end-diastolic volume index of the atrialized and functional right ventricle being 70% of normally expected values, underwent biventricular repair. Immediately after the surgery, however, he developed right heart failure with the central venous pressure of 11 mmHg. He consequently underwent additional bidirectional cavopulmonary anastomosis, thereby converting the biventricular repair into one and a half ventricle repair. He recovered uneventfully and is doing well 2 years after the surgery.