Objective To investigate the changes and clinical relationship of plasma adrenomedullin( ADM) , atrial natriuretic polypeptide( ANP) , and heart rate variability( HRV) in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Seventy-five inpatients with OSAHS were enrolled in this study. According to the apnea hypopnea index ( AHI) by polysomnography, the subjects were divided into a mild group, a moderate group, and a severe group. Meanwhile, HRV was screened bydynamic electrocardiogram in sleep laboratory. HRV parameters were obtained including LF ( low frequency power) , HF( high frequency power) , pNN50( percentage of NN50 in the total number of N-N intervals) ,SDNN( standard deviation of the N-N intervals) , rMSSD( square root of the mean squared differences of successive N-N intervals ) . Plasma levels of ADM/ANP were measured by radioimmunoassay. Results The levels of SDNN ( P lt;0. 05) , rMSSD, pNN50, LF ( P lt; 0. 05) and HF were gradually reduced, and the levels of ADM ( P lt;0. 05) and ANP ( P lt; 0. 05) were increased with increasing severity of OSAHS. Linear correlation analysis demonstrated that SDNN was negatively correlated with ADM( r = - 0. 423, P lt;0. 05)and ANP( r = - 0. 452, P lt; 0. 05) , and LF was also negatively correlated with ADM( r = - 0. 348, P lt;0. 05) . Conclusion Lower HRV is associated with more sever OSAHS, and it may be modulated neurohumorally by ADM and ANP.
Abstract： Objective To investigate the influence of vasoactive intestinal peptide （VIP) on the sling fibers and the clasp fibers of the lower esophageal sphincter （LES） and the difference， and explore whether VIP belongs to a nonadrenergic and noncholinergic （NANC） neurotransmitter. Methods Thirty LES specimens were obtained from 30 patients with high-position carcinoma of the middle thoracic esophagus who underwent esophagectomy from March to August 2010 in Fourth Affiliated Hospital of Hebei Medical University. There were 14 male patients and 16 female patients with their average age of 58.0±6.1 years. The clasp fibers and sling fibers were isolated and suspended in perfusion. Exogenous VIP was added to the two kinds of strips to draw a concentration-effect curve. Electric field stimulation （EFS） or exogenous VIP was applied to clasp fibers and sling fibers， and the influence of VIP （10-28） on LES was compared. Results ExogenousVIP in different concentration caused concentration-dependent relaxation of the sling fibers and clasp fibers of LES in vitro. There was statistical difference in relaxation between the sling fibers and clasp fibers under same VIP concentration （P＜0.05）， and the relaxation of sling fibers was more significant than that of clasp fibers. VIP （10-28） transiently inhibited the relaxationof the sling fibers and clasp fibers caused by exogenous VIP. VIP （10-28） also transiently inhibited the relaxation of the sling fibers and clasp fibers after the activation of EFS. Conclusion The relaxation of sling fibers and clasp fibers induced by EFS is related to VIP. VIP is a kind of NANC neurotransmitter in human LES.
目的:探讨肾上腺嗜铬细胞瘤的诊治方法。方法:回顾性分析我院1995年10月～2008年10月收治37例肾上腺嗜铬细胞瘤的临床资料,总结其主要临床表现、手术方法及围手术期血压的控制方法。结果:37例患者均行手术治疗,其中35例术后血压恢复正常,2例术后血压未降至正常水平。结论:肾上腺嗜铬细胞瘤的诊断主要依靠多种内分泌激素的测定及B超、CT的定位检查,确诊依赖于病理检查,手术切除是有效的治疗方法。术前的降压、扩容和术后的补液升压等围手术期的处理是手术治疗成功的关键。
Objective To evaluate the treatment of surgery and high-dose corticosteroid relevant factors to prognosis in traumatic optic neuropathy. Methods Forty patients(40 eyes) with traumatic optic neuropathy were enrolled.Optic nerve decompression using transcranial approaches,sinus endoscopy and orbital-ethmoidal sinus rout were performed in 14 patients.Eleven patients were treated with high-dose corticosteroids (5 cases with 1 mg/kg dexamethasone,6 cases with 30 mg/kg methylprednisolone) and 15 patients received nonspecific management chose by themselves.The outcomes of visual acuity in short term and final stage were compared between surgery,high-dose corticosteroid and nonspecific treatment.Multiple variable analysis was done to determine the factors affecting the outcome of visual acuity. Results No light perception were found in 19 cases (19 out of 44 cases,47.5%),whereas visual acuity was light perception to 0.02 in 12 cases (30.0%) and 0.05 or better in 9 cases (22.5%).The odds ratio of high-dose corticosteroid to nonspecific therapy was 2.96 (P=0.0125).The final visual acuity in patients treated with high-dose corticosteroid were better than other two groups (P=0.005,P=0.023,respectively).The short term (within 3 days) effective rate was higher in corticosteroid therapy group than operated group (P=0.024).No light perception following optic nerve trauma appeared to be more danger as 2.14 folds (P=0.0349) than those with light perception or better in term of final visual acuity outcome. Conclusions High-dose corticosteroid may be benefit to traumatic optic neuropathy.The treatment in traumatic optic neuropathy using optic nerve decompression needs to be determined.No light perception at initial is an important risk factor in the outcome. (Chin J Ocul Fundus Dis,2000,16:75-77)
目的 观察不同浓度肾上腺素与利多卡因混合液头皮浸润注射对开颅术患者血流动力学的影响。方法 选取2010年5月－10月80例颅内肿瘤患者，随机分成4组，行1%利多卡因溶液混合不同浓度的肾上腺素16 mL头皮浸润注射。肾上腺素浓度：A组2.5 μg/mL、B组5.0 μg/mL、C组7.5 μg/mL、D组10.0 μg/mL。记录注射前（T0）、注射后5 min内（T1-10）心率（HR）、平均动脉压（MAP）、收缩压（SBP）、舒张压（DBP），根据各时段的MAP最低值和最高值，计算MAP的降低率和升高率，计数各组MAP下降10%以内、10%～20%和20%以上的例数。 结果 C组的MAP下降例数最多且MAP下降率最高，与其他组间比较差异有统计学意义（P＜0.05）。组内比较，C组MAP、SBP在1.5、2.0、2.5 min时、DBP在2 min时和D组MAP和DBP在1.5、2.0 min时下降差异有统计学意义（P＜0.05）。4组血压下降的同时伴HR增快，但HR组间差异无统计学意义（P＞0.05）。 结论 低浓度的肾上腺素与10%利多卡因混合液用于开颅术患者头皮浸润注射时可导致血压下降。
Objective To discuss the effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes. Methods A total of 50 patients scheduled for selective cesarean section under combined spinal and epidural anesthesia were selected as the study subjects between July 2015 and June 2016. They were randomly allocated into two groups with 25 in each. Group CII underwent continuous phenylephrine infusion [0.5 μg/(kg·min)] immediately after anesthesia to adjust the blood pressure, while group CON accepted single-dose phenylephrine injection (50 μg) after anesthesia when systolic pressure was lower than 90 mm Hg (1 mm Hg=0.133 kPa) or when the decrease of mean arterial pressure (MAP) was higher than 20% of the base value. The infusion of phenylephrine was stopped after the fetus was taken out. MAP, cardiac output, cardiac index (CI) at the time when the patient went into the delivery room (T1), before anesthesia (T2), 1 minute after anesthesia (T3), 3 minutes after anesthesia (T4), 10 minutes after anesthesia (T5), and delivery (T6) were recorded. Blood gas analysis of fetal umbilical arterial blood was carried out and neonatal Apgar score was recorded. Results Hemodynamics was more stable in group CII compared with group CON. Heart rate at T4 and T5, and cardiac output at T5 and T6 in group CON were significantly lower than those in group CII (P<0.05). The neonatal umbilical arterial blood pH value, base excess and HCO3－ were all significantly lower, while partial pressure of carbon dioxide was significantly higher in group CON than group CII (P<0.05). Conclusion Compared with single-dose phenylephrine injection, continuous phenylephrine infusion has more stable hemodynamics, and exert less effect on maternal and infant outcomes for patients undergoing cesarean section under combined spinal and epidural anesthesia.
Objective To assess the efficacy of medical expulsive therapy for ureteral calculi with tamsulosin. Methods We searched PubMed, MEDLINE, EMBASE, BIOSIS, International Pharmaceutical Abstracts (IPA) Database, The Cochrane Library and Chinese Journal Full-text Database from 1995 to September 2006, as well as the proceedings of urological scientific conferences from 2000 to 2006. Randomized controlled trials(RCTs) comparing tamsulosin and other therapies for ureteral calculi among adults were included. Data were extracted by two reviewers independently and synthesized by STATA 9.0 software. Results A total of 16 studies involving 1521 patients with distal or juxtavesical ureteral calculi were included. Compared with conservative therapy, tamsulosin showed higher expulsion rate [RR 1.50, 95%CI (1.20 to 1.87), Plt;0.0001], shorter expulsion time [SMD –1.29, 95%CI (–2.27, –0.31)] and fewer patients requiring ESWL or ureteroscopy [RR 0.40, 95%CI (0.27, 0.59), Plt;0.05]. Compared with conservative therapy, the combination of tamsulosin plus deflazacort also showed higher expulsion rate [RR 1.59, 95%CI (1.31, 1.93)], shorter expulsion time [SMD –0.8, 95%CI (–1.18, –0.42)] and fewer patients requiring ESWL or ureteroscopy [RR 0.13, 95%CI (0.06, 0.31), Plt;0.05]. Compared with deflazacort alone, the combination of tamsulosin plus deflazacort demonstrated similar expulsion rate [RR 1.31, 95%CI (0.78, 2.23), P=0.31], but significantly reduced the dosage of analgesics [SMD 15.20, 95%CI (14.98, 15.52)] and decreased the proportion of patients requiring ESWL or ureteroscopy [RR 0.09,, 95%CI (0.02, 0.47), Plt;0.05]. Compared with deflazacort plus nifedipine, the combination of tamsulosin plus deflazacort showed higher expulsion rate [RR 1.20, 95%CI (1.07, 1.35), P=0.002], but similar expulsion time [SMD –1.34, 95%CI (–3.47, 0.79)] and proportion of patients requiring ESWL or ureteroscopy [RR 0.34, 95%CI (0.05, 2.22), Pgt;0.05]. As for side effects, tamsulosin-based treatment and conservative therapy were comparable (Pgt;0.05). Conclusions Tamsulosin has a beneficial effect on the expulsion of ureteral calculi, especially for distal and juxtavesical ureteral calculi. Tamsulosin-based medical expulsive therapy at the dosage of 0.4mg daily is effective and safe for patients with distal ureteral calculi. More large-scale studies are required to define the efficacy of combination therapy of tamsulosin plus deflazacort.
ObjectiveTo systematically evaluate the correlation between type-2 diabetes mellitus (T2DM) and T/C polymorphism in 190 locus ofβ3-adrenergic receptor (β3-AR) gene in Chinese population. MethodsThe following databases such as CNKI, VIP, CBM, PubMed, EMbase, the Cochrane Library (Issue 8, 2012) and WanFang Data were searched to collect case-control studies on the correlation between T2DM and T/C polymorphism in 190 locus of β3-AR gene. The retrieval time was from October 1980 to October 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality. Then the meta-analysis was conducted by using RevMan 5.0 and Stata 12.0 software, and the publication bias was analyzed by means of Egger's linear regression. ResultsA total of 11 studies involving 1 602 T2DM patients and 1 773 healthy volunteers were included. The results of meta-analyses showed that, for Chinese population, TC genotype in case group was more than that in control group[OR=1.19, 95%CI (1.01, 1.40), P=0.04]. CC+TC genotype in case group was more than that in control group[OR=1.23, 95%CI (1.05, 1.45), P=0.01]. Allele C in case group was more than that in control group[OR=1.24, 95%CI (1.08, 1.43), P=0.003]. ConclusionsThe allele C in 190 locus of β3-AR gene in Chinese population is significantly associated with T2DM. For the quantity and quality limitation of the included studies, this conclusion has to be further proved by more studies.