运动康复锻炼对冠心病经皮冠状动脉介入术后患者心肺功能及生活质量的影响

目的:探讨运动康复锻炼对冠心病经皮冠状动脉介入术(PCI)后患者心肺功能及生活质量的影响。方法:选取2016年10月-2018年4月期间我院收治的冠心病稳定性心绞痛患者80例,根据随机数字表法将患者分为对照组(n=40)和运动康复组(n=40),其中对照组给予常规康复运动,运动康复组在此基础上联合运动康复训练。比较两组患者术后12周的心肺功能指标,比较两组患者术前、术后2周、术后12周的6 min步行距离,比较两组患者术前、术后12周生活质量评分。结果:运动康复组患者术后12周峰值摄氧量、峰值通气量、峰值功率、每搏输出量、代谢当量以及摄氧效率斜率均高于对照组患者(P0.05)。两组患者术后2周、术后12周6 min步行距离均较术前增加,且运动康复组高于对照组(P0.05)。两组患者术后12周生理机能、生理职能、躯体疼痛、精神健康评分均较术前升高,且运动康复组高于对照组(P0.05);而两组患者术后12周社会功能、总体健康、精力、情感职能评分比较差异无统计学意义(P0.05)。结论:PCI术后患者给予运动康复锻炼,可显著提升患者生活质量,对患者心肺功能恢复具有较好的促进作用。     

A multiscale 0-D/3-D approach to patient-specific adaptation of a cerebral autoregulation model for computational fluid dynamics studies of cardiopulmonary bypass

Neurological complication often occurs during cardiopulmonary bypass (CPB). One of the main causes is hypoperfusion of the cerebral tissue affected by the position of the cannula tip and diminished cerebral autoregulation (CA). Recently, a lumped parameter approach could describe the baroreflex, one of the main mechanisms of cerebral autoregulation, in a computational fluid dynamics (CFD) study of CPB. However, the cerebral blood flow (CBF) was overestimated and the physiological meaning of the variables and their impact on the model was unknown. In this study, we use a 0-D control circuit representation of the Baroreflex mechanism, to assess the parameters with respect to their physiological meaning and their influence on CBF. Afterwards the parameters are transferred to 3D-CFD and the static and dynamic behavior of cerebral autoregulation is investigated.     

Cre recombinase induces DNA damage and tetraploidy in the absence of LoxP sites

The spatiotemporal manipulations of gene expression by the Cre recombinase (Cre) of bacteriophage P1 has become an essential asset to understanding mammalian genetics. Accumulating evidence suggests that Cre activity can, in addition to excising targeted loxP sites, induce cytotoxic effects, including abnormal cell cycle progression, genomic instability, and apoptosis, which can accelerate cancer progression. It is speculated that these defects are caused by Cre-induced DNA damage at off-target sites. Here we report the formation of tetraploid keratinocytes in the epidermis of keratin 5 and/or keratin 14 promoter-driven Cre (KRT5- and KRT14-Cre) expressing mouse skin. Biochemical analyses and flow cytometry demonstrated that Cre expression also induces DNA damage, genomic instability, and tetraploidy in HCT116 cells, and live-cell imaging revealed an extension of the G₂ cell cycle phase followed by defective or skipping of mitosis as cause for the tetraploidy. Since tetraploidy eventually leads to aneuploidy, a hallmark of cancer, our findings highlight the importance of distinguishing non-specific cytopathic effects from specific Cre/loxP-driven genetic manipulations when using Cre-mediated gene deletions.     

家兔心跳骤停复苏模型的研究进展

心跳骤停是临床医学中最为危急的事件之一,其发生发展过程涉及了一系列的病理生理学改变。近几年来,有关于心跳骤停复苏的研究有很多,也取得了一定的进展,但关于其各种不同类型心跳骤停的病理生理学改变的理解仍不是十分的全面,其有效地治疗药物和治疗手段也仍需要进一步的研究。因此,成功地制备与人类心跳骤停相似的动物模型就显得非常必要来,这不仅是深入研究心跳骤停复苏病理生理学改变的重要基础和研究途径,也是研制其治疗药物及方法的有效手段。本文重点讨论家兔各种类型心跳骤停复苏模型不同的研究方法。     

单唾液酸神经节苷脂对体外循环大鼠海马神经元的影响

目的:探讨单唾液酸神经节苷脂(GM1)对体外循环大鼠海马神经元凋亡的影响及机制。方法:18只健康成年雄性SD大鼠,随机分为3组:正常对照组、CPB组和GM1组。经右颈静脉插管引流,右颈动脉插管灌注建立CPB,转流时间60 min,建立CPB动物模型。CPB后3 h时处死大鼠,4%多聚甲醛灌注固定后取左侧大脑组织,利用TUNEL法观察海马神经元凋亡,免疫组化法检测海马神经元Caspase-3蛋白表达,并用电子显微镜观察神经元超微结构变化。结果:与正常组比较,GM1组和CPB组海马神经元凋亡细胞平均积分光密度(IA)、Caspase-3蛋白表达均增强(P<0.01)。GM1组海马神经元凋亡细胞平均积分光密度(IA)为8.94±0.42,与CPB组(14.87±0.70)相比明显降低(P<0.01);GM1组海马Caspase-3阳性神经细胞平均积分光密度比CPB组降低了38.84%(P<0.01)。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;GM1组神经元细胞核圆形,线粒体嵴少量减少,细胞器仍可见。结论:单唾液酸神经节苷脂对体外循环大鼠海马神经元凋亡具有明显的抑制作用,其机制与抑制Caspase-3的表达有关。     

Obstructive Sleep Apnea in Extremely Overweight Adolescents undergoing Bariatric Surgery

Objectives: To determine the prevalence of obstructive sleep apnea (OSA) in extremely overweight adolescents and to examine the effect of significant weight loss on OSA severity. Research Methods and Procedures: We reviewed the anthropometric and polysomnographic data on all extremely overweight adolescents who underwent laparoscopic Roux en Y gastric bypass surgery at Cincinnati Children's Hospital Medical Center from July 2001 to September 2004. Repeat polysomnograms were performed after significant weight loss. Comparisons were made between pre‐ and postoperative polysomnographic data. Results: Nineteen of 34 patients (55%) who underwent bariatric surgery were diagnosed with OSA. Subsequent to surgery, 10 of these patients returned for follow‐up polysomnographic testing. After significant weight loss (mean, 58 kg), OSA severity markedly decreased in all patients (median apnea‐hypopnea index at baseline vs. after weight loss, 9.1 vs. 0.65). Discussion: Our study indicated that OSA was highly prevalent in extremely overweight adolescents meeting eligibility criteria for bariatric surgery. The significant weight loss after gastric bypass was associated with a marked reduction in OSA severity.     

Fish passage experience at small-scale hydro-electric power plants in France

There are more than 1,700 small-scale hydro-electric power stations in France today, which can be found on the majority of rivers with migratory species in them. This article gives an overview of the different types of fish facilities in use at these small-scale hydro plants. The relative advantages and drawbacks of each type of fish pass are discussed, with reference to the requirements of migratory species and the site-specific constraints. Emphasis is placed on the problems of attraction and maintenance. The article also mentions the various techniques used to evaluate existing or recently constructed fish passes. Experience in using bypass facilities combined with trashracks for downstream juvenile salmonids and eels are related. The author points out the severe cumulative impact which may occur due to the existence of several small-scale hydro projects on the same river. He presents his view on the priorities for research on fish passage facilities, especially on “fish friendly” small-scale hydropower intakes. Guest editors: R. L. Welcomme & G. Marmulla Hydropower, Flood Control and Water Abstraction: Implications for Fish and Fisheries     

1600例重症心脏瓣膜置换术中的体外循环管理

目的报告1600例重症心脏瓣膜置换术中的体外循环管理技术。方法CPB中采用低液面预充、中度血液稀释、浅低温、HCT22～25％,心肌保护为高钾含血停跳液灌注。对心胸比例超过85％,合并肝大、腹水、肺长期淤血的患者,CPB中采用超滤法。结果体外循环时间90～357min,主动脉阻断时间50～170min,心脏停跳时间54～175min,术中灌注压55～70mmHg,中心静脉压0～5cm H2O,尿量平均200～800ml,自动复跳1047例,占65％。结论为了提高重症心脏瓣膜手术的体外循环质量,增加手术成功率,强调：(1)中度血液稀释,提高胶体渗透压;(2)CPB中用高钾含血停搏液作为心肌保护,必须做到按时、足量灌注;(3)及时补充碱性药物和电解质;(4)补充充足的镁离子可增加细胞内的钾离子浓度。     

瓣膜病变合并肾功能不良患者的体外循环管理

目的：探讨瓣膜病变合并肾功能不良患者的体外循环管理方法。方法：2003年1月～6月在我院接受瓣膜置换术且术前肾功能检查指标异常的15名患者作为研究组,2002年1月～6月符合上述条件的18名患者作为对照组。两组患者体外循环管理的不同之处在于：研究组患者在体外循环中应用平衡超滤,严格选用抗生素,少用或不用人工胶体,不用甘露醇,体外循环中避免肾缺血。结果：研究组患者术后肾功能明显好于对照组。结论：在研究组患者中应用的上述措施对术前就用肾功能损伤的患者是有帮助的。