SHANGHAI——1型气动隔膜血泵离体实验的初步结果

气动隔膜式血泵是目前各种人工心脏血泵中发展最成熟的一种血泵。在各国人工心脏研究小组中得到广泛的应用。尤其在最近几年、由气动隔膜式血泵组成的全人工心脏在临床应用上已取得了可喜的成功,而气动隔膜式左心辅助泵的动物实验研究和临床应用研究就更加普遍。1985年我们研究室研制成功一种中型气动隔膜式左心辅助泵——SHANGHAI—Ⅰ型血泵。它将对后期心功能衰竭的病人有一定的治疗作用。并对心脏直视手术后不能脱离人工心肺机的病人,有暂时辅助心室衰竭的作用,能减轻心室的负荷,有利于受创心肌的术后恢复。本文的目的是对SHANGHAI-Ⅰ型血     

一种磁液悬浮心室辅助装置主动停工在体实验动物研究

目的磁液悬浮心室辅助装置(以下简称为血泵)主动停工在体实验动物研究,旨在观察停泵后血液的反流情况和血泵的血液相容性、生物相容性,以及实验动物生理状态,为后期实验以及临床应用积累可靠数据。方法选用健康绵羊1只,左侧开胸建立左心辅助模型。正常运行6周后主动停泵,停服抗凝药物华法林。观察实验动物生理状态,记录血泵停工羊术前及1～12周血液、生化、凝血检查结果并进行研究。血泵停工后16周进行超声检查。结果左心辅助模型建立成功,血泵运行期间工况良好,实验羊在血泵停工前后6周精神状态良好、活动自如、进食良好、尿便正常。血泵停工后16周的超声显示人工血管未堵塞,有反向血流。结论此血泵停工,对血液相容性、对实验羊生理状态和脏器功能未见明显影响,人工血管通畅且未见血栓,对左心功能无明显影响。为后期临床应用过程中出现意外停泵的处理提供一定参考依据。此血泵血液相容性好。后续将进行左心辅助低剂量抗凝治疗及多组停工实验进行不断完善。     

小型人工心脏在上海诞生

人工心脏可分全人工心脏和心室辅助泵。置换全人工心脏不多见,目前为止,仅美国置换过五例。而心室辅助泵应用较为普遍。上海第二医科大学人工心脏研究室研制成一种带电机和电池重800g的左心辅助泵,替代山羊心脏实验,存活了32小时,目前即将从动物实验向临床试用过渡。这种小型左心辅助泵为电动叶轮式,能植入体内,病人活动自如,生活正常。流量大于10升压力150 mmHg,溶血发生率仅为目前使用的人工心肺机的三分之一。特别是采用国际上尚     

标记辅助导入的原理与应用

标记辅助导入是分子遗传信息应用于动物育种的一个重要方面, 其目的是在标记信息的辅助下将一个品种(供体)中的一个或多个优良基因导入另一个品种(受体), 同时还要尽可能地保持受体群体原有的遗传背景。在标记辅助导入过程中, 标记信息既可用于辅助前景选择, 即对目标基因携带者的选择, 以保证目标基因的正确导入, 也可用于辅助背景选择, 即对受体基因组的选择, 以加快受体遗传背景的恢复。本文介绍了标记辅助导入的原理和基本方法, 综述了目前已提出的不同前景选择和背景选择方法以及消除遗传累赘(与目标基因连锁的不利基因)的方法, 同时列举了标记辅助导入在动物上的一些成功应用。     

左心辅助循环的发展与应用

左心辅助循环是指在一定时间内，使用机械方法部分或完全替代左心做功，减少左心负荷和氧耗量，增加心肌血供，改善心肌代谢，使左心得以休息，有利于左心功能恢复。     

兔体外辅助循环模型的建立

用40只新西兰兔,在常温不停跳下,采用左心房插管引流,左股动脉灌注的方法,建立兔左心辅助体外循环动物模型,39只模型成功建立.术中血压、心率及体温等各项生理指标基本稳定,与开胸前柑比,各项指标变化均小于5%.     

经左心温度稀释法测定心排血量新型导管的应用研究

目的：介绍一种新型经左心使用温度稀释法测量心排血量（CO）的导管和方法。方法：健康杂种犬8只,采用自身对照,经右心使用肺动脉气囊漂浮导管,经动脉使用自制的左心测定管,其放置部位分两种情况：前端在左心室内和在主动脉根部。在控制呼吸、停呼吸、控制性降压中、控制性降压后5min四种情况下同时测量心排血量。结果：肺动脉导管与左心导管在两种不同部位情况下测得CO呈正相关,γ分别为0.986和0.989,心脏指数（CI）也呈正相关,γ分别为0.983和0.985 左心导管在两种不同部位情况下所测CO之间与CI之间也显著相关,γ分别为0.992、0.988。结论：制作的左心测定管所测心排血量与肺动脉气囊漂浮导管所测值之间有良好相关性,且设计简单,操作方便。     

人工心脏的临床管理

目的：探讨人工心脏临床应用中的管理要点。方法：2001年1月-8月共有4例病人行人工心脏植入术,其中终末期扩张性心肌病合并心衰2例（1例术前2次心跳骤停）,肥厚性心肌病多次心跳骤停1例,急性大面积心梗并心源性休克1例。2例植入Berlin-Heart人工心脏;2例植入Medos人工心脏（其中1例为双心室辅助,其余3例为左心辅助）。术后采用四联抗凝治疗,专人定时密切监测人工心脏血泵和主机工作情况。结果：本组所有病人术后心功能均得到明显改善,其中2例于术后第55天,52天心功能基本恢复并成功撤除人工心脏,1例因术前出现多器官功能不全,术后虽然血流动力学有所改善,但终因严重肝肾功能衰竭于第10天死亡,人工心脏工作期间无机械故障发生。结论：人工心脏作为终末期心衰病人心脏移植前的过渡治疗,或作为长期应用以促进心肌功能的恢复。其作用显著,在应用过程中应加强对人工心脏系统的各项管理,使其在长期的运作中更为安全,有效。     

无创呼吸机辅助治疗时机对急性左心衰竭并发Ⅱ型呼吸衰竭患者的影响

目的:探究早期与延迟无创呼吸机辅助治疗急性左心衰竭并发Ⅱ型呼吸衰竭的临床疗效。方法:选择2012年8月到2015年8月期间,我院收治临床确诊急性左心衰竭并发Ⅱ型呼吸衰竭患者68例为研究对象,将随着随机分为观察组(35例)和对照组(33例);观察组患者行早期无创呼吸机辅助治疗,对照组给予延迟无创呼吸机辅助治疗;观察并比较两组间治疗前后呼吸频率(RR)、心率(HR)、动脉氧分压(PaO_2)及平均动脉压(MAP)、气管插管及气管切开通气率、住院时间及治疗有效率的情况。结果:疗后两组患者RR、HR、MAP均下降,MBP升高(P0.05),且观察组患者RR、HR及MAP均低于对照组,PaO_2均高于对照组,差异均有统计学意义(P0.05);治疗后观察组患者有效率显著高于对照组,气管切开及插管发生率、病情好转时间、住院时间均低于对照组(P0.05)。结论:急性左心衰竭并发Ⅱ型呼吸衰竭患者早期行无创呼吸机辅助治疗能显著改善患者症状、提高治疗有效率,缩短患者住院时间,具有较高的临床价值。     

成人降主动脉置换术中三种体外循环灌注技术的应用

目的总结分析成人降主动脉置换术中各种体外循环灌注的技术特点和管理方法。方法 2006年1月至2009年12月,共有60例患者行降主动脉置换手术。按体外循环灌注技术类型分为3组：左心转流组4例,股动静脉转流组37例,上下半身分别灌注组19例。三组预充均采用勃脉力A和胶体,常规加入白蛋白和激素,监测混合静脉氧饱和度和血细胞压积,积极应用超滤技术和自体血液回收技术。结果术中转流平稳,血流动力学稳定,监测指标均在正常范围,仅出现9例并发症（截瘫、偏瘫、谵妄、苏醒延迟、低氧血症）。结论成人降主动脉置换术中根据不同的手术方式,正确选择和熟练应用相应的灌注技术是决定手术成功的重要因素。     

The failure of therapist assistance and stepped-care to improve weight loss outcomes

Objective: This investigation was designed to examine whether: (i) individuals could successfully lose 5% of their body weight with minimal assistance, (ii) weight loss would be improved by the addition of therapist assistance, and (iii) individuals unsuccessful at losing 5% total body weight during the minimal assistance phase (with or without therapist assistance) would benefit from a weekly weight loss group. Methods and Procedures: Fifty‐four overweight or obese adults (BMI > 27 kg/m²) initially participated in a 14‐week self‐help (SH) or therapist‐assisted SH (TASH) weight loss program. Participants who were unsuccessful at losing 5% total body weight were stepped‐up to a 3‐month, group‐based behavioral weight loss program (BWLP) with weekly weigh‐ins. Results: Although ～60% of the participants were successful at losing 5% of their total body weight (lb) during the minimal assistance phase (M = 10.6; s.d. = 11.5; P < 0.01), treatment outcome was not improved by the addition of therapist assistance. For individuals who were unsuccessful at losing 5% of total body weight during a minimal assistance phase, the addition of a group‐based BWLP did not improve their weight loss. Discussion: While many individuals were quite successful at losing weight with minimal assistance, other individuals evidenced difficulties losing weight, even when participating in a greater intensity intervention (i.e., BWLP group).     

组织多普勒成像对射血分数正常的心衰患者左心功能评价

目的:探讨组织多普勒成像(TDI)技术评价射血分数正常的心衰患者左室长轴功能特点。方法:选取30名健康人(Ⅰ组)、EF>50%的心衰患者30名(Ⅱ组)和EF<50%的心衰患者30名(Ⅲ组)作为研究对象,采用TDI在二尖瓣环室间隔(ivs)、侧壁(l)、前壁(a)、后壁(p)、下壁(d)测量其Sm、DSm、IVCTm、TSm、Em、Am、IVRTm、TEm等指标。结果:Ⅰ组、Ⅱ组、Ⅲ组DSm、Sm逐渐减低,(P<0.05);而IVCTm、TSm逐渐升高(P<0.05);IVRTm、TEm在Ⅰ组、Ⅲ组、Ⅱ组逐渐升高(P<0.05);DSm及TEm在诊断EF>50%心衰患者心功能的指标中ROC曲线下面积最大,同样DSp及TEp在五个位点中ROC曲线下面积最大。结论:射血分数正常的心衰患者存在收缩减低;DSm及TEm是诊断EF>50%心衰患者心功能比较有效的指标;后壁是诊断的最佳位点。     

Effects of maternal quality and mating status on female reproductive success in the polygynous spotless starling

Female mating status may affect reproductive success in avian polygynous mating systems through a combination of differences in female parental quality and status-dependent male assistance in parental care. Traditionally the literature has emphasized male assistance, neglecting evidence for consistency in female parental quality independent of mating status or repeatability in status. We studied the effects of male assistance on breeding success and its association with female mating status in a population of the polygynous spotless starling, Sturnus unicolor, during 3 years. Nestling provisioning by males improved the fledging success of late (mostly second) but not early (mostly first) broods. Reproductive success of females was affected mainly by female maternal quality: (1) primary and secondary females did not differ in output for early broods and in seasonal output despite a greater male assistance at primary nests; (2) monogamous females were more successful despite receiving no more help than other females; and (3) primary and secondary females had different clutch sizes before male assistance in parental care could operate. Female mating status was not significantly repeatable within seasons or between years. Females who changed status between years were as successful when rearing broods as secondary females as they were as primary or monogamous females. Breeding success (proportion of eggs resulting in fledglings) and clutch size were significantly repeatable between years for late but not for early clutches. Performance showed no strong association with female age or condition. Female breeding success seems to be weakly affected by male assistance in this sedentary, colonial species, and more dependent on inherent differences between females. Copyright 2002 The Association for the Study of Animal Behaviour. Published by Elsevier Science Ltd. All rights reserved.     

A giant pseudoaneurysm becoming apparent after cardiac resynchronisation therapy

A 57-year-old male patient with coronary artery disease developed a pseudoaneurysm after an inferior infarct in 1997. He underwent coronary bypass surgery and resection of the pseudoaneurysm located at the inferior wall. Unfortunately, the pseudoaneurysm recurred due to dehiscence of the patch, necessitating a second surgical intervention. After six years he developed progressive heart failure due to severe left ventricular dysfunction. He was referred to our institution for cardiac resynchronisation therapy (CRT) because of drug refractory heart failure which was associated with a left bundle branch block, ejection fraction of 12%, and a NYHA class IV status. After successful implantation of a biventricular pacemaker, a remarkable clinical recovery was observed. Left ventricular function improved and echocardiography now demonstrated that the pseudoaneurysm at the inferior wall had recurred for the third time. This diagnosis could not be established by preoperative echocardiography.     

Cheyne-Stokes respiration in patients hospitalised for heart failure

BackgroundPrevious studies showing a strong relationship between Cheyne-Stokes respiration and the severity of left ventricular systolic dysfunction have usually been done in selected patient populations with lower age and a higher proportion of males than the "typical" in-hospital patient with heart failure. The purpose of the present study was test the strength of this relationship in unselected patients admitted to hospital due to decompensated chronic heart failure.MethodsWe evaluated 191 patients (32% women), mean age 73 years, ready for discharge from the heart failure unit in the University Hospital of Malmö, Sweden. The patients underwent echocardiography for determination of left ventricular ejection fraction and left ventricular inner diastolic diameter. A respiratory investigation during sleep was performed the last night before discharge.ResultsWe found that 66% of the patients had Cheyne-Stokes respiration more than 10% of the total recording time. Only 7 (3.6%) of the patients had predominantly obstructive apnoeas. There was a significant but very weak relationship between left ventricular ejection fraction and left ventricular inner diastolic diameter on one hand and Cheyne-Stokes respiration on the other. Age was a stronger determinant of Cheyne-Stokes respiration than any of the cardiac or other clinical variables.ConclusionAlthough presence of Cheyne-Stokes respiration indicates left ventricular dysfunction, its severity seems only weakly related to the severity of heart failure. Age was found to be a stronger determinant, which may reflect the underlying age-dependency found also in healthy subjects. Due to age restrictions or other selection criteria, the importance of age may have been underestimated in many previous studies on factors associated with Cheyne-Stokes respiration.     

Alexander Böhm (1971–2012)

On November 28, 2012 Alexander (Alex) Böhm, a bacterial geneticist, died at age 41, only a few months after taking up a position as an assistant professor at the LOEWE Center for Synthetic Microbiology in Marburg, Germany. Earlier in 2012 Alex had been diagnosed with an aggressive form of thyroid cancer that left him little time to live his scientific and personal dreams.     

血浆IIA 分泌型磷脂酶A2 水平与冠脉支架术后再狭窄关系

目的:测定稳定型冠心病患者支架植入术(percutanous coronary intervention,PCI)前血浆IIA分泌型磷脂酶A2(group IIAsecretory phospholipase A2,ⅡA-sPLA2)的水平,以探讨该酶与冠脉支架术后再狭窄的可能关系。方法:稳定型冠心病行PCI患者63例,非冠心病患者39例,健康正常对照组42例,分别取外周静脉血测定血浆ⅡA-sPLA2酶浓度。PCI患者6个月后复查造影。结果:PCI患者术前该酶浓度显著高于正常对照组(P<0.05),支架内再狭窄率34.9%,再狭窄(restenosis,RS)患者支架术前该酶水平与无再狭窄患者该酶水平无统计学差异(P>0.05)。结论:PCI患者术前血浆ⅡA-sPLA2酶浓度显著高于正常对照组,但可能与支架术后再狭窄无关。     

The Sequential External Counter Pulsator: A New Circulatory Assist Device

The three goals of cardiac assistance are: (1) To maintain systemic blood flow; (2) To reduce cardiac work and tension development; and (3) To increase oxygen availability to the heart. Toward these ends, various devices and techniques have been developed, including several different types of vascular shunts in combination with or without extracorporeal oxygenation of blood, implantable auxiliary ventricle and augmentation of diastolic pressure by direct counter pulsation of blood through femoral cannulae or intra-aortic balloon.The sequenced counter pulsator is an external cardiac assist device being developed for the therapy of low output syndromes. Investigation in the laboratory has shown that it is capable of increasing cardiac output and diastolic systemic pressure with concomitant reduction in left ventricular end-diastolic pressure. Therefore, it appears to be clinically useful in patients with low cardiac output syndromes.     

Modeling the relationship between LVAD support time and gene expression changes in the human heart by penalized partial least squares

MOTIVATION: Heart failure affects more than 20 million people in the world. Heart transplantation is the most effective therapy, but the number of eligible patients far outweighs the number of available donor hearts. The left mechanical ventricular assist device (LVAD) has been developed as a successful substitution therapy that aids the failing ventricle while a patient is waiting for the donor heart. We obtained genomics data from paired human heart samples harvested at the time of LVAD implant and explant. The heart failure patients in our study were supported by the LVAD for various periods of time. The goal of this study is to model the relationship between the time of LVAD support and gene expression changes. RESULTS: To serve the purpose, we propose a novel penalized partial least squares (PPLS) method to build a regression model. Compared with partial least squares and Breiman's random forest method, PPLS gives the best prediction results for the LVAD data.     

定量组织速度成像预测心肌梗死PCI 术后心功能不全的研究

目的:应用定量组织速度成像技术(QTVI)检测经皮冠状动脉介入治疗(PCI)后的ST段抬高的急性心肌梗死(STEMI)患者左心室收缩功能的改变;评价QTVI指标对该类患者未来发生心力衰竭的预测价值。方法:选择行急诊PCI术治疗的冠状动脉单支病变的急性心肌梗死患者,术后一周测量患者的左心室射血分数(LVEF),LVEF<50%者排除,LVEF≥50%者入选。共38例。并设正常对照组30例。入选者继续测二尖瓣环室间隔侧和左室侧壁侧QTVI曲线上心室收缩期速度峰值(Sa),并计算左室平均收缩期速度峰值(mean Sa)。术后12个月随访,查LVEF。结果:PCI术12个月后有17位患者LEVF<50%,21位患者LEVF≥50%。入选的STEMI者术后7天的左室平均Sa波峰值低于正常对照组。术后12个月出现LVEF减低(<50%)的患者,其术后7天的左室平均Sa波峰值低于PCI术12个月后LVEF正常的患者(P<0.01)。结论:通过QTVI检测二尖瓣环的运动速度能够早期发现单支病变所致的急性心肌梗死患者在急诊PCI术后的左心室功能受损;PCI术后LVEF正常的STEMI患者,术后7天QTVI测得的左室平均Sa波峰值减低可能预示着将来发展为LVEF减低的左心室收缩功能不全。