甲基强的松龙对体外循环下心脏瓣膜置换患者肾功能的影响

背景与目的：有研究表明甲基强的松龙可减轻体外循环所致的肺损伤,但其对体外循环患者术后肾功能损害的作用尚不十分清楚。本文探讨甲基强的松龙是否有效抑制体外循环心内直视术中的炎症反应,并对肾脏有保护作用。方法：随机选取40例体外循环下择期行心脏瓣膜置换手术的患者,年龄30-55岁,心功能II～III级,随机分为甲基强的松龙组和对照组,每组20例。甲基强的松龙（MPS）组于体外循环前以甲基强的松龙10mg／kg预冲,对照组（Ns）以等量的生理盐水代替。于CPB前（T1）,CPB结束后2h（T2）、CPB结束后12h（T3）,CPB结束后24h（T4）,等时点留取中心静脉血和尿液,以酶联免疫吸附实验（ELISA）法检测炎性介质（IL-6、TNF—α、IL-10）;取尿上清液检测反映肾功能的早期敏感指标：尿-N-乙酰氨基-葡萄糖苷酶（NAG）、尿α1-微球蛋白（α1-MG）、尿视黄醇结合蛋白（RBP）的水平。结果：CPB前两组炎性介质和肾功检测指标,差异均无统计学意义（P〉0．05）,而CPB结束后,两组炎性介质的水平和肾功各项指标均较术前增高。与NS相比,MP组T2～T4时点IL-6水平明显降低（P〈0．05）。在T2～T3时点TNF-α的水平明显低于对照组（P〈0．05）。两组IL-10的水平在CPB后均增加,但在T2～T3时点MP组升高幅度明显高于NS组（P〈0．05）。与NS}匕较,MP组在CPB后各时点尿NAG、α1-MG、RBP的水平均明显降低（P〈0．05）。结论：CPB可导致全身炎性反应及肾功能损伤;甲基强的松龙可减轻炎性反应,同时对肾功能有一定的保护作用。     

单唾液酸神经节苷脂对大鼠体外循环脑损伤的影响

目的：单唾液酸神经节苷脂（GM-1）是神经细胞膜上的一种鞘糖脂,参与多种生理功能,具有抗氧化和神经保护作用,本课题主要探讨单唾液酸神经节苷脂对大鼠体外循环（CPB）脑损伤的影响。方法：成年雄性SD大鼠30只,14月龄,体重300-400g,采用随机数字表法,将大鼠随机分成3组（n=10）：假手术组（s组）、CPB组和GM-1组。采用右颈静脉腔房引流,右颈动脉灌注法建立大鼠CPB模型。CPB组和GM-1组行CPB1h,其中CPB组转流液中加入GM-120mg／kg,GM-1组给予等容量的生理盐水。CPB结束后3h和s组机械通气结束后3h时,断头取左侧脑组织,透射电镜下观察海马超微结构变化;TUNEL法检测海马神经元调亡情况。结果：电镜下CPB组海马可见异染色质明显边集、凝聚,线粒体嵴减少或空泡变性,细胞器消失等不可逆性的损伤改变;GM-1组神经元细胞核圆形,线粒体嵴少量减少,细胞器仍可见。与S组比较,CPB组和GM-1组海马神经元病理损伤严重,且凋亡神经元明显增多（P〈0．05）。与CPB组相比,GM-I组海马神经元病理损伤减轻,且凋亡神经元有所减少（P〈0．05）。结论：体外循环可导致以大鼠海马神经元超微结构发生改变为标志的脑损伤,GM-1可减轻CPB诱发的脑损伤,其机制可能与其抑制神经元凋亡有关。     

超滤在小儿先天性心脏病手术体外循环中肺保护效果

目的：观察超滤在小儿先心病手术体外循环中肺保护效果。方法：随机抽取先心病患者28例,分为超滤组14例,对照组14例,于体外循环（CPB）前,主动脉开放后恢复机械通气10min,对照组体外循环结束后10min（超滤组改良超滤后10min）三个时点分别监测血细胞压积（HCT）、气道阻力、C3a、CAa、肿瘤坏死因子（TNF—α）变化,观察比较补体激活引发炎性介质对肺损伤的程度。结果：超滤组C3a、CAa、TNF-α上升不明显,对照组有所上升,超滤组气道阻力明显下降,HCT增高,监测结果两组有明显差异。结论：体外循环中应用超滤技术能减轻炎性介质对肺损伤程度,并能降低术后并发症的发生。     

不同麻醉和术后镇痛方式对中老年胸科手术后胰岛素抵抗的影响

目的：探讨不同麻醉和术后镇痛方式对中老年胸科手术后胰岛素抵抗的影响。方法：中老年胸科手术患者80例随机分为治疗组与对照组各40例,两组都采用开胸手术治疗,于手术结束前30min硬膜外腔给予镇痛,治疗组采用舒芬太尼镇痛,对照组采用地佐辛镇痛。结果：两组镇痛后2h与镇痛后24h的HR和MVP对比差异明显（P〈0．05）,同时对照组不同时间点的组内对比差异明显（P〈0．05）,治疗组组内对比无明显差异。治疗组在镇痛后2h与镇痛后24h的VAS评分都明显少于对照组（P〈0．05）,Ramsay评分治疗组高于对照组（P〈0．05）。治疗组组内不同时间点胰岛素含量和胰岛素敏感性对比无明显差异,而对照组对比差异明显（P〈0．05）,同时镇痛后组间对比也有明显差异（P〈0．05）。结论：相对于地佐辛,舒芬太尼用于中老年胸科手术术后疼痛镇痛效果良好,能有效地抑制胰岛素抵抗与应激反应的发生,有很好的应用效果。     

犬体外循环模型建立及麻醉处理

目的建立CPB实验动物模型,加强围手术期麻醉管理,探索肺功能保护方法 ,以减少术后并发症的产生。方法 20只实验犬全部用于建立实验动物模型。丙泊酚复合麻醉后,开胸;全血肝素化后,连接体外循环管道开始体外循环,微量泵入丙泊酚50～150μg/（kg·min）维持麻醉;监测麻醉诱导前（T0）、气管插管即刻（T1）、CPB前即刻（T2）、降温至32.0℃（T3）、阻断主动脉前即刻（T4）、阻断主动脉后2min（T5）、开始复温即刻（T6）、停CPB即刻（T7）及停CPB后15min（T8）9个时间结点的鼻咽温度、平均动脉压（mean arterial pressure,MAP）及心率（heart rate,HR）。结果体外循环期间各时点鼻咽温度均低于T0及T2（P〈0.05）;T1、T2及体外循环期间各时点的MAP明显低于T0（P〈0.05）,体外循环期间各时点的MAP低于T2（P〈0.05）;T4的HR明显低于T0及T2（P〈0.05）。体外循环期间各时点MAP比较无统计学意义（P〉0.05）。结论犬体外循环模型建立的成败与手术技术和麻醉管理密切相关。     

低钙透析液联合醋酸钙对血液透析患者高磷血症的影响

目的：研究低钙透析液联合醋酸钙治疗对血液透析患者血磷、血钙及甲状旁腺激素iPTH水平的影响。方法：将30例维持性血液透析患者随机分为试验组和对照组,在试验期间所有患者均低磷饮食,两组透析液钙浓度均为1．25mmol／L,试验组同时给予醋酸钙治疗,对照组不应用醋酸钙治疗,三个月后观察和比较两组患者的血钙、血磷及血iPTH水平的变化。结果：治疗前,两组各组血磷、血钙、血磷和血iPTH的水平比较差异均无统计学意义（P〉0．05）。治疗后,对照组血钙水平明显下降（P〈0．05）,血iPTH水平略上升但无统计学意义（P〉0．05）,血磷水平无显著变化（P〉0．05）;试验组血iPTH水平略下降（P〉0．05）,血钙水平无明显变化（P〉0．05）,但血磷明显下降（P〈0．05）;且试验组血磷水平较对照组明显下降（P〈0．05）,血钙水平显著高于对照组（P〈O．05）,但在正常范围内,两组血iPTH水平比较无统计学意义（P〉0．05）。结论：低钙透析液联合醋酸钙治疗可有效降低血液透析患者的血磷水平,且不会导致高钙血症的发生。     

丙氨酰谷氨酰胺对体外循环瓣膜置换术患者的肺保护作用

目的:探讨丙氨酰谷氨酰胺对体外循环瓣膜置换术患者肺屏障功能的影响。方法:择期体外循环(cardiopulmonary bypass,CPB)下行心脏瓣膜置换术患者60例,随机分为3组,每组20例,分别为生理盐水组(C组)、复方氨基酸注射液组(A组)和Ala-GLn组(G组)。G组泵注丙氨酰谷氨酰胺0.4 g/(kg·d),A组和C组分别泵注等量的复方氨基酸注射液和生理盐水,三组均持续输注24 h。分别于:麻醉后(T_0)、开胸后CPB前(T_1)、主动脉开放30 min(T_2)、关胸(T_3)、术后5 h(T_4)、术后24 h(T_5)、术后48 h(T6),经静脉采血3 m L,检测血浆IL-6、TNF-α和SP-A的含量;采动脉血进行血气分析;观察ICU机械通气时间。结果:与T_0比较,三组患者在T_2、T_3、T_4、T_5时间点的血清TNF-α和IL-6含量均显著升高(P0.05);G组患者血清TNF-α和IL-6的浓度显著低于C组和A组(P0.05);与T_0比较,三组患者在T_2~T_5各时间点的SP-A水平显著升高(P0.05),G组患者血清SP-A含量显著低于C组和A组(P0.05);与T_0比较,三组患者在T_2~T_5时的RI值显著升高(P0.05),G组患者RI值显著低于C组和A组(P0.05);G组的机械通气时间比C组和A组显著缩短(P0.05)。结论:丙氨酰谷氨酰胺能降低体外循环瓣膜置换术患者的炎症反应,保护肺泡屏障功能,具有一定的肺保护作用。     

缺氧肺动脉平滑肌细胞中线粒体ATP敏感钾通道开放对细胞色素C的分布及细胞增殖的作用

为了探讨线粒体ATP敏感钾通道（mitochondrial ATP-sensitive K^＋channel,mito KATP）和线粒体膜电位（△ψm）在细胞缺氧信号转导中的作用以及对缺氧肺动脉平滑肌细胞中细胞色素C在细胞内的分布及细胞增殖的影响,本实验将人肺动脉平滑肌细胞进行常氧或24h缺氧培养,并将标本分为六组：（1）对照组;（2）mito KATP,开放剂diazoxide组;（3）mito KATP阻断剂5-HD组;（4）24h缺氧组;（5）24h缺氧＋diazoxide组;（6）24h缺氧＋5-HD组。利用激光共聚焦显微镜成像法检测△、ψm;线粒体／胞浆成分分离试剂盒（Bio Vision）分离线粒体和胞浆成分后,Western blot检测两者细胞色素C;Western blot检测细胞中caspase-9的蛋白表达量;MTT法及PI染色后流式细胞仪检测细胞增殖情况。结果显示：（1）diazoxide作用24h后,R-123荧光明显增强,胞浆细胞色素C与线粒体细胞色素C的比值明显降低,caspase-9的蛋白表达显著减少,细胞增殖明显增多、凋亡减少,与正常对照组相比较,均P〈0．05;而5-HD作用24h与正常对照组比较,上述指标无明显变化（P〉0．05）。（2）缺氧24h组,结果与diazoxide组相似,R-123荧光明显增强,胞浆细胞色素C与线粒体细胞色素C的比值明显降低,caspase-9的蛋白表达显著减少,细胞增殖明显增多、凋亡减少,与正常对照组相比较,均P〈0．05;24h缺氧＋diazoxide组与缺氧组相比较,R-123荧光明显增强,胞浆细胞色素C与线粒体细胞色素C的比值明显降低,caspase-9的蛋白表达显著减少,细胞增殖明显增多、凋亡减少（P〈0．05）;而24h缺氧＋5-HD组与缺氧组比较,R-123荧光明显降低,胞浆细胞色素C与线粒体细胞色素C的比值明显升高,caspase-9的蛋白表达显著增加,细胞增殖明显减少、凋亡增多（P〈0．05）。上述实验结果提示,缺氧可以引起mito KATP,的开放以及△ψm的去极化,并进而抑制细胞色素C从线粒体释放到胞浆,抑制线粒体凋亡途径,从而参与并影响肺动脉高压的发生、发展。     

氨甲环酸对体外循环术后炎症因子的影响

目的观察氨甲环酸(TA)对体外循环(CPB)围术期炎症因子的影响。方法将40例行体外循环心脏手术的患者随机分为实验组(A组)20例和对照组(B组)20例。A组在麻醉诱导后、体外循环结束时、手术结束时3个时段每次给予TA 10mg/kg;B组给予等量生理盐水。观察两组术前(T1),CPB停机时(T2),术后6h(T3)、12h(T4)和24h(T5)血IL-6、IL-8和CRP的计数水平。结果实验组血清中的IL-6和IL-8水平在CPB停机时、术后6h和12h均显著升高,术后24h均呈下降趋势,并显著低于对照组(P<0.05);CRP水平在术后12h显著升高,术后24h对照组较实验组显著升高(P<0.05)。结论氨甲环酸能减少CPB术后炎症因子的释放,减轻全身炎性反应。     

内磁疗法治疗癫痫初探与脑电图分析

为探讨磁环穴位内植治疗癫痫的疗效,将151例癫痫病人随机分为磁穴组（58例）,磁穴药物组（51例）对照组（42例）进行治疗对照组研究与脑电图分析,结果显示,磁穴组显效率明显高于对照组（P＜0．05）;磁穴药物组对照组总有效率显提高（P＜0．05）,其显效率更高（P＜0．01）;磁穴药物组显效率明显高于磁穴组（P＜0．05）,脑电图磁穴药物组与对照组有效率（P＜0．05）。提示磁环穴位内植用于癫痫的治疗具有较好的疗效,且安全可靠,常用抗癫痫药物配合磁环穴位内植治疗癫痫具有协同作用,可明显提高其治疗效果。     

Experimental ductus arteriosus: the relationships of atrial pressure, dilatation and flow with ANF secretion

The design of the study was to determine whether an increased blood flow as seen in shunt lesions could serve as a stimulus for the secretion of atrial natriuretic factor (ANF). Since atrial pressure, flow, and dilatation are closely related, an experimental ductus arteriosus model was utilized, in which acute changes of flow are assumed not to dilate the left atrium. In six dogs, a Dacron graft was constructed between the main pulmonary artery and the innominate artery. Constricting and releasing the tape around the graft adjusted the amount of "ductal" shunting. The total pulmonary flow and the shunt flow were measured by electromagnetic-flow transducers around the aortic root and around the graft. Plasma ANF concentration was measured from both cardiac atria. The size of the left atrium was determined from echocardiographic measurements made from a short-axis view. The total pulmonary flow varied between 1.2 and 5.8 1/min. The highest measured ANF was 396 pg/ml, and this was from the left atrium when the pressure was 18 mmHg, the highest left atrial pressure recorded. The highest right atrial pressure (5 mmHg) also correlated with the highest right-atrial level of ANF (366 pg/ml). The right atrial pressure had a significant correlation with plasma ANF concentration (R = 0.43, p less than 0.05). Pulmonary flow and plasma ANF concentration did not correlate; neither did left atrial size and ANF levels in 16 flow states where the size was measured. In the absence of atrial dilatation there was minimal stimulus for ANF secretion. A transient increase of left atrial pressure, without a concomitant significant atrial dilatation, did not serve as a significant stimulus for ANF secretion.     

Uncommon acquired Gerbode defect following extensive bicuspid aortic valve endocarditis

Gerbode defect is a rare type of left ventricle to right atrium shunt. It is usually congenital in origin, but acquired cases are also described, mainly following infective endocarditis, valve replacement, trauma or acute myocardial infarction. We report a case of a 50-year-old man who suffered an extensive and complex infective endocarditis involving a bicuspid aortic valve, the mitral-aortic intervalvular fibrosa and the anterior leaflet of the mitral valve. After dual valve replacement and annular reconstruction, a shunt between the left ventricle and the right atrium - Gerbode defect, and a severe leak of the mitral prosthesis were detected. Reintervention was performed with successful shunt closure with an autologous pericardial patch and paravalvular leak correction. No major complications occurred denying the immediate post-surgery period and the follow-up at the first year was uneventful.     

Ventricular septal defect with bidirectional shunting: Mathematical considerations

Previously proposed formulae for the quantitative estimation of bidirectional shunts across ventricular septal defects require determination of the oxygen contents of mixed venous, pulmonary artery, pulmonary venous, and aortic blood. Because these formulae do not take into account the mixing of oxygenated with unoxygenated blood within the ventricles, their use must result in underestimation of shunt flows in each direction. A mathematical model for a ventricular defect is examined, in which it is assumed that mixing of blood occurs in each of six sites in the venae cavae or right atrium, right ventricle, pulmonary artery, left atrium, left ventricle, and aorta. A total of fourteen streams of blood can flow from one to another of these mixing sites. As long as complete mixing occurs in the six specified mixing sites, any degree of mixing or non-mixing of the various streams is permitted. From the equations characterizing the model, formulae are derived in which the shunt flow in each direction is expressed in terms of the oxygen contents in the six mixing sites and the fractions of blood which enter the shunt from either side without prior mixing in a ventricular mixing site. The previously reported formulae, which apply when no ventricular mixing is allowed to occur, lead to theoretical minimum values for the shunt flows in each direction. At the opposite extreme where all the shunting blood is required to mix in a ventricle before entering the shunt, formulae for maximum possible shunt flows are also obtained. The absolute values for the left-to-right and right-to-left shunt flows, which must lie somewhere between the theoretical maximum and minimum values, cannot be computed from blood gas data alone. This work was supported in part by grant HE-07563 from the National Heart Institute of the National Institutes of Health and grants-in-aid from the American and North Carolina Heart Associations and the Life Insurance Medical Research Fund. Work completed during tenure as U.S.P.H.S. post-doctoral fellow.     

慢性低氧对大鼠左右心室的功能及TRPC亚家族表达的影响

目的：探讨慢性低氧3周对大鼠左右心室的影响以及规范性瞬时感受器电位亚家族（TRPC）在慢性低氧诱导的右心室心肌肥厚中的表达。方法：将SD雄性大鼠48只随机分为对照组（CON组）和慢性低氧肺动脉高压模型组（CH组）（n=24）,CH组将大鼠置于连续的慢性低氧（10％±0．2％）环境饲养三周以诱导大鼠发生心肌肥厚。通过左、右心室插管法测定右心室内压（RVSP）、左心室内压（LVSP）、心率（HR）、平均体循环动脉压（mSAP）、左、右心室内压力最大上升速率（＋dp／dtmax）、最大下降速率（-dp／dkmax）、右心肥大指数（RVMI）、左心肥大指数（LVMI）;HE染色观察左、右心室心肌组织切片;通过SYBR Green荧光定量PCR法检测CON组、CH组大鼠的肥厚侧心室心肌组织编码TRPC 1／3／4／5／6／7的rnRNA表达;结合real-time RT-PCR结果对mRNA表达有显著变化的TRPC亚型通过免疫印迹法检测相应蛋白的表达。结果：与CON组相比：CH组的RVSP、RVMI、右心室±dp／dtmax显著增高（P〈0．01）,LVSP、左心室±dp／dmax无显著变化,LVMI显著降低（P〈0．01）;CH组右心室心肌细胞显著增粗（P〈0．01）,细胞内肌原纤维数量增多,心肌纤维排列紊乱,细胞核深染,形状不整;左心室心肌纤维无明显改变;CH组编码TRPCI的mRNA和蛋白显著增高（P〈0．05）,而编码其余TRPC亚型的mRNA无显著变化。结论：慢性低氧3周可特异性诱导sD大鼠产生右心室心肌肥厚,上调了编码右心室心肌细胞TRPCI通道蛋白的mRNA和蛋白的表达,TRPCI可能参与了心肌肥厚的发生发展。     

CORRECTION OF ANOMALOUS VENOUS RETURN FROM THE RIGHT LUNG TO THE INFERIOR VENA CAVA (SCIMITAR DEFORMITY)

Anomalous pulmonary venous drainage to the inferior vena cava is a rare congenital cardiac defect. Oxygenated blood from the right lung enters the right atrium resulting in a left-to-right shunt. Because the radiographic shadow of the anomalous vein resembles a curved saber, this defect has been called the "scimitar" deformity. From 1958 through June 30, 1975, 11 patients underwent surgical correction of this anomaly at our institution with 10 survivors. Diagnosis was made by routine roentgenography of the chest in all but one patient. Eight patients had total correction which consisted of implanting the anomalous vein into the right atrium, opening the interatrial septum and applying a patch graft as a baffle to direct pulmonary venous blood into the left atrium. Five patients had associated cardiac defects which were also repaired. Three patients underwent pneumonectomy and all survived. The only operative death occurred in a 5-year-old female with an atrial septal defect and endocardial cushion defect. We believe the existence of a large left-to-right shunt justifies surgical intervention. The prognosis appears to depend upon the presence of other cardiac or pulmonary anomalies.     

Effect of sinus node on spontaneous release of natriuretic peptide in isolated atria

Experiments were conducted to examine the release of atrial natriuretic peptide (ANP) in an isolated atrium in the presence and absence of sinus node tissue. The first series of experiments were conducted with the aid of a metabolic chamber to examine the spontaneous release of ANP by the right atrium with and without the sinus node region. The left atrium was also studied. The right atrium with the sinus node, quiescent right atrium without the sinus node, and the left atrium were incubated at 35 degrees C in 10 mL of oxygenated Tyrode's solution. After 40 min of equilibration, the incubation medium was removed at 10-min intervals for the determination of immunoreactive ANP concentration. The right atria with the sinus node released the highest amount of ANP into the incubation medium (32.2 +/- 2.7 pg.min-1.mg-1), compared with quiescent right atria (20.9 +/- 3.7 pg.min-1.mg-1). The left atria released the least amount of ANP into the incubation medium (9.9 +/- 1.5 pg.min-1.mg-1) when compared with the quiescent right atria and the right atria. In the second series of experiments, the right atrium was divided into the sinus node region and the quiescent right atrium, and these tissues were studied in paired fashion with a modified Langendorff preparation. The right atrium without the sinus node and sinus node region were perfused with Tyrode's solution, equilibrated with 95% O2 and 5% CO2 at 37 degrees C with a constant flow of 0.5 mL/min.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rat corin gene: molecular cloning and reduced expression in experimental heart failure

Stored cardiac pro-atrial natriuretic peptide (pro-ANP) is converted to ANP and released upon stretch from the atria into the circulation. Corin is a serin protease with pro-ANP-converting properties and may be the rate-limiting enzyme in ANP release. This study was aimed to clone and sequence corin in the rat and to analyze corin mRNA expression in heart failure when ANP release upon stretch is blunted. Full-length cDNA of rat corin was obtained from atrial RNA by RT-PCR and sequenced. Tissue distribution as well as regulation of corin mRNA expression in the atria were determined by RT-PCR and RNase protection assay. Heart failure was induced by an infrarenal aortocaval shunt. Stretch was applied to the left atrium in a working heart modus, and ANP was measured in the perfusates. The sequence of rat corin cDNA was found to be 93.6% homologous to mouse corin cDNA. Corin mRNA was expressed almost exclusively in the heart with highest concentrations in both atria. The aortocaval shunt led to cardiac hypertrophy and heart failure. Stretch-induced ANP release was blunted in shunt animals (control 1,195 +/- 197 fmol.min(-1).g(-1); shunt: 639 +/- 99 fmol.min(-1).g(-1), P < 0.05). Corin mRNA expression was decreased in both atria in shunt animals [right atrium: control 0.638 +/- 0.004 arbitrary units (AU), shunt 0.566 +/- 0.014 AU, P < 0.001; left atrium: control 0.564 +/- 0.009 AU, shunt 0.464 +/- 0.009 AU, P < 0.001]. Downregulation of atrial corin mRNA expression may be a novel mechanism for the blunted ANP release in heart failure.     

Interaction between pesticides and essential metal copper increases the accumulation of copper in the kidneys of rats

Male Sprague-Dawley rats, weighing 175-200 g, six per group were fed AIN 93M diet (CON) or diets containing 500 mg Ca (LCa), 7 mg Zn (LZn), 2 mg Cu (LCu), 60 mg Zn (HZn), or 12 mg Cu (HCu) per kilogram of diet in the following combinations: control (CON), LCa+LZn (LC+Z), LCa+LZn+LCu (LC+Z+C), or HZn+HCu (HZ+C) without or with a pesticides mixture (PM); Endosulfan, Thiram, and Acephate were added to the diets at 25% of LD50/kg. Rats were fed for 2 wk (small intestinal changes) or 4 wk (tissues changes). Plasma Zn was 47% lower than CON in the experimental groups. Plasma Cu and ceruloplasmin concomitantly decreased in the LC+Z+C group and increased with the addition of PM. Kidney Cu was 40% lower in LC+Z+C group, than CON and increased by 31% with PM; in the HZ+C+PM group, kidney Cu was 38% higher than the HZ+C group. Mucosal and small intestines Ca declined by 47% in all experimental groups; PM increased Zn in the LC+Z+C and HZ+C groups; PM further decreased intestinal and mucosal Cu retention in the LC+Z+C and HZ+C groups. Data suggest that low levels of PM in the diet can induce Cu accumulation in the kidney when dietary Zn and Cu are low or high.     

乌司他丁可减轻全麻颈动脉内膜剥脱术患者的脑缺血/再灌注损伤

本研究拟观察乌司他丁减轻全身麻醉下,行颈动脉内膜剥脱术(CEA)的患者脑缺血再灌注损伤的有效性.将40例有症状的重度颈动脉狭窄,于全身麻醉下行单侧标准颈动脉内膜剥脱术的患者随机分为干预组与非干预组,每组20例.干预组在麻醉诱导前经静脉给予乌司他丁5×105 U,非干预组用等量生理盐水.分别于麻醉诱导后、颈动脉夹闭15 min、颈动脉开放15 min,以及术后第1,2,3天抽取患侧颈内静脉球部血液进行肿瘤坏子因子α(TNF-α)、丙二醛(MDA)检测;分别于麻醉诱导后、颈动脉夹闭15 min及开放15 min做动脉及颈内静脉球部血气分析;分别于麻醉诱导后及术后第1,2,3天抽取颈内静脉球部血液进行神经元特异性烯醇化酶(NSE)检测.干预组各时间点的TNF-α浓度均低于非干预组(P0.05),动脉-颈内静脉氧含量差值在颈动脉开放15 min时高于非干预组(P0.05),术后重症监护室驻留时间较非干预组降低38.7%((27.1α15.7)h vs.(44.1α29.6 h),P0.05).两组患者各时间点颈内静脉球部MDA和NSE含量无显著差异(P0.05).预防性给予乌司他丁能够减轻全麻CEA患者术中脑缺血/再灌注损伤性炎性反应,提高脑氧代谢能力,改善术后转归.     

Ruptured sinus Valsalva aneurysm, a rare cause of heart failure

A 35-year-old male presented with symptoms of shortness of breath and ankle oedema which had developed within a few days. The symptoms had started suddenly following a mountain bike trip. Physical examination revealed a blood pressure of 90/40 mmHg, no fever and a continuous murmur on auscultation of the heart, as well as signs of left and right heart failure. Echocardiography showed moderate pericardial effusion and a hyperdynamic left and right ventricle with signs of right ventricular volume overload. Turbulent flow was seen in the aortic root and a shunt was demonstrated from the aortic root to the right atrium (figure 1) through a ruptured sinus Valsalva aneurysm of the non-coronary cusp (figure 2).