Dose-response comparisons of five lung surfactant factor (LSF) preparations in an animal model of adult respiratory distress syndrome (ARDS).

1. We have examined the effects of five different lung surfactant factor (LSF) preparations in the rat lung lavage model. In this model repetitive lung lavage leads to lung injury with some similarities to adult respiratory distress syndrome with poor gas exchange and protein leakage into the alveolar spaces. These pathological sequelae can be reversed by LSF instillation soon after lavage. 2. The tested LSF preparations were: two bovine: Survanta and Alveofact: two synthetic: Exosurf and a protein-free phospholipid based LSF (PL-LSF) and one Recombinant LSF at doses of 25, 50 and 100 mg kg-1 body weight and an untreated control group. 3. Tracheotomized rats (10-12 per dose) were pressure-controlled ventilated (Siemens Servo Ventilator 900C) with 100% oxygen at a respiratory rate of 30 breaths min-1, inspiration expiration ratio of 1:2, peak inspiratory pressure (PIP) of 28 cmH2O at positive end-expiratory pressure (PEEP) of 8 cmH2O. Two hours after LSF administration, PEEP and in parallel PIP was reduced from 8 to 6 (1st reduction), from 6 to 3 (2nd reduction) and from 3 to 0 cmH2O (3rd reduction). 4. Partial arterial oxygen pressure (PaO2, mmHg) at 5 min and 120 min after LSF administration and during the 2nd PEEP reduction (PaO2(PEEP23/3)) were used for statistical comparison. All LSF preparations caused a dose-dependent increase for the PaO2(120'), whereas during the 2nd PEEP reduction only bovine and recombinant LSF exhibited dose-dependency. Exosurf did not increase PaO2 after administration of the highest dose. At the highest dose Exosurf exerted no further improvement but rather a tendency to relapse.(ABSTRACT TRUNCATED AT 250 WORDS)     

PEEP值设定对麻醉中呼气末肺容量和氧合程度的影响

目的探讨PEEP值设定对麻醉中呼气末肺容量和氧合程度的影响,为临床合理设定PEEP值,提高治疗效果提供依据。方法 26例因体外循环心内直视术麻醉时急性呼吸窘迫综合征（ARDS）行插管通气治疗,根据氧合情况,缓慢、连续递增PEEP（人工控制）以及估计由最大限度氧运输决定的最佳PEEP,以满足最好的全身动脉或恢复肺部顺应性。结果随着PEEP压力水平的不断增高,PO2水平呈上升趋势,而PCO2在压力为0.9时最高,各组间的差异具有统计学意义。患者体内CI水平随着压力的增加而降低,在PEEP为0.9kPa时各组间DO2水平变化不明显,PEEP为1.6kPa时较压力为0组出现明显下将,差异具有显著性（P〈0.05）。结论 PEEP治疗体外循环心内直视术后ARDS患者PaO2有一定提高,但高压力水平的PEEP反而会使DO2下降。所以应使用依次递增的方法 ,根据患者的具体状况确定最佳的PEEP值。     

Effect of hyperoxia on 5-hydroxytryptamine uptake by the neonatal rabbit lung

Neonatal rabbits were exposed to either normoxia (21% oxygen) or hyperoxia (^• 95% oxygen) for 2–4 days, and isolated ventilated perfused lung preparations from the various animals were studied.5-Hydroxytryptamine (5HT) uptake, perfusion pressure, alveolar lavage protein and lung tissue vitamin E concentrations were measured. There was no difference in mortality between the two groups at any time point. There was no difference in perfusion pressures at any time point. There were no differences between normoxic and hyperoxic animals in alveolar lavage protein or 5 HT uptake at 2 and 3 days. At 4 days, 5HT uptake (fractional) was lower in the hyperoxia group than in controls (0.65 ± 0.033 v. 0.75 ± 0.013 (mean ± SE); p ≤ 0.05) and alveolar lavage protein was higher compared to normoxia (1111 ± 415 μg/ml v. 481 ± 78 μg/ml; p ≤ 0.05). Lung vitamin E concentrations were higher at 3 days in rabbits exposed to hyperoxia compared to normoxia (16.5 ± 1.8 μg/gm v. 12.3 ± 0.6 μg/gm; p ≤ 0.05). In air exposed animals there was a decrease in lung vitamin E concentration after 2 days, whereas hyperoxia exposed animals had no significant decrease in lung vitamin E concentrations from 2–4 days exposure. These studies establish that the decrease in 5HT uptake, albeit delayed compared to that described previously in adult animals, is a reasonable measure of pulmonary oxygen toxicity in newborn rabbits.     

A rat model of acute respiratory distress syndrome (ARDS): Part 1. Time dependency of histological and pathological changes

The time course of histopathological changes in a rat lung lavage model of the acute respiratory distress syndrome (ARDS) was analyzed by sacrificing animals 10, 30, 60, 180, and 210 min after the last lung parenchyma lavage which was performed with physiological saline solution. This lavage depleted the lung from its natural surfactant resources leading into a pathophysiological cascade similar to that of the acute respiratory distress syndrome. Tracheotomized rats (12 animals per time point) were pressure-controlled ventilated (Siemens Servo Ventilator 900C) with 100% oxygen at a respiratory rate of 30 breaths/min, inspiration-expiration ratio of 1:2, peak inspiratory pressure of 28 cm H2O at positive end-expiratory pressure (PEEP) of 8 cm H2O. During the whole experimental period, the ventilation was not changed. Blood gases (partial arterial oxygen pressures [PaO2, mmHg] and partial arterial carbon dioxide pressures [PaCO2, mmHg]) were estimated before, directly after, and 10, 30, 60, 90, 120, 150, 180, and 210 min after the last lavage. For grading lung lavage-induced histopathological changes associated with the time-dependent development of ARDS, slides were coded and evaluated without any knowledge of the sacrifice time. A semiquantitative grading was performed with respect to the severity of the following parameters: hyaline membrane formation (HM), interstitial and intraalveolar edema edema (E), and margination and infiltration of polymorphonuclear neutrophil leukocytes (PMNL) into the lung alveoli. The severity of these parameters showed a time-dependent increase after the last lavage. This was accompanied by a time-dependent decrease in partial arterial oxygen pressure (PaO2) values during the early postlavage period (up to 30 min). Thereafter, PaO2 levels remained fairly stable. The severity of intraalveolar and/or perivascular hemorrhages within the lung was not time dependent. The rat lavage model shows similarities to the pathophysiological sequelae occuring during the acute phase of the acute respiratory distress syndrome in humans. Most of the characteristic pathognomic histological changes seen in humans can be observed in this lung lavage model. This ARDS model is brief and easy in its experimental design, showed a good and homogeneous reproducibility of pathophysiological and histopathological parameters, and is therefore a useful model to estimate the influence of therapeutic pharmacological treatments of ARDS.     

缬沙坦联合阿托伐他汀对老年单纯收缩期高血压治疗效果分析

目的 探讨缬沙坦联合阿托伐他汀应用在老年单纯收缩期高血压患者中的临床疗效及应用价值.方法 将本院治疗的单纯收缩期高血压老年患者150例采用随机数字法分为观察组和对照组,每组75例,对照组给予缬沙坦治疗,观察组联合阿托伐他汀治疗,记录两组临床疗效.结果 观察组干预后收缩压为(125.28±4.16) mmHg(1mmHg=0.133 kPa),舒张压为(72.32±3.28) mmHg,脉压为(57.36±2.33)mmHg,显著优于对照组[分别为(135.38±8.21)mmHg、(79.66±5.43) mmHg、(67.76±3.88)mmHg],均P＜0.05.观察组干预后颈总动脉内中膜厚度(0.80±0.11)nmm,颈动脉膨大处内中膜厚度为(0.91±0.09)mm,颈内动脉内中膜厚度为(0.66±0.05) mm,显著优于对照组[分别为(0.86±0.19)mm、(1.01±0.17) mm、(0.74±0.14) mm],均P＜0.05.结论 缬沙坦联合阿托伐他汀应用在老年单纯收缩期高血压患者中可以有效降低脉压差,改善患者颈动脉内膜厚度,延缓动脉硬化进展.     

采用呼气末正压通气治疗神经源性肺水肿64例临床观察

目的探讨采用呼气末正压（PEEP）通气治疗神经源性肺水肿的疗效。方法对64例神经源性肺水肿患者经过及时采用PEEP通气治疗,观察临床治疗效果。结果采用PEEP通气治疗后所有患者的缺氧症状、肺水肿体征均得迅速改善,与治疗前比较心率。呼吸频率、血氧饱和度、氧分压、二氧化碳分压的改善均具有统计学意义（P〈0．01）。结论采用PEEP通气治疗神经源性肺水肿有较好的临床效果。     

眼球按摩护理对青光眼患者术后眼压及疼痛的影响

目的 探究眼球按摩护理对青光眼患者术后眼压及疼痛的影响.方法 将2014年6月至2015年12月本院收治的114例拟行手术治疗的青光眼患者纳入研究,根据随机数表法分为两组,每组各57例.对照组予以常规护理,观察组予以常规护理+眼球按摩护理.护理后,两组的术后眼压控制情况及疼痛感比较.结果 术后3、6个月,观察组的眼压水平分别为(14.63±2.31) mmHg(1 mmHg=0.133kPa)、(14.87±2.05) mmHg;对照组为(16.69±2.12) mmHg、(18.74±3.24) mmHg,观察组的眼压水平优于对照组,差异有统计学意义(P＜0.05);术后第3天及出院前,观察组患者的疼痛评分为(4.23±1.32)分、(3.79±0.82)分;对照组为(5.14±1.29)分、(4.67±1.32)分,观察组的疼痛评分低于对照组,差异有统计学意义(P＜0.05).结论 对青光眼患者术后行眼球按摩护理可以有效控制患者眼压水平,缓解手术带来的疼痛感.     

Effects of Lung Surfactant Factor (LSF) Treatment on Gas Exchange and Histopathological Changes in an Animal Model of Adult Respiratory Distress Syndrome (ARDS): Comparison of Recombinant LSF with Bovine LSF

Summary: Repetitive lung lavage of adult rats leads to lung injury similar to ARDS resulting in poor gas exchange, protein leakage and infiltration of polymorphonuclear neutrophils (PMN) into the alveolar spaces (J Appl Physiol 1983; 55: 131-138). In a previous dose response comparison we have demonstrated that poor gas exchange could be improved by lung surfactant factor (LSF) instillation soon after lavage. Since Surfacten® (Tokyo Tanabe Co. Ltd., Tokyo, Japan) was described in vitro to inhibit PMN activity, we compared this preparation with a Recombinant LSF preparation (Byk Gulden, Konstanz, Germany; phospholipids plus human identical surfactant protein C) at doses of 25, 50 and 100 mg/kg body weight. Their efficacy was compared with an untreated control group with respect to improving gas exchange, inhibition of hyaline membrane formation and inhibition of the inflammatory response after multiple lavage. Tracheotomized rats were pressure-controlled ventilated (Siemens Servo Ventilator 900C, Sweden) with 100% oxygen at a respiratory rate of 30 breaths/min, inspiration:expiration ratio of 1:2, peak inspiratory pressure (PIP) of 28 cmH₂O at positive end-expiratory pressure (PEEP) of 8 cmH₂O. Two hours after LSF administration PEEP was reduced from 8 to 6 cmH₂O (first PEEP-reduction), from 6 to 3 (second reduction) and from 3 to 0 cmH₂O (third reduction) and finally raised to 8 cmH₂O. Results for the averaged partial arterial oxygen pressure [PaO₂ (mmHg)] of the 2 h period [PaO₂(5′-120′)] and for the PaO₂ during the second PEEP reduction [PaO₂(PEEP23/3)] were calculated. Both LSF preparations caused a dose-dependent increase of the PaO₂(5′-120′) and the PaO₂(PEEP23/3). Similarly, the formation of hyaline membranes was inhibited by both LSF preparations in a dose-dependent manner. Inhibition of the inflammatory response (infiltration of PMN) was not effected by either of the LSF preparations at any dose level. The described variations in ventilator settings are useful to evaluate the deflation stability and re-expansion potential of different LSF preparations. The reported results give evidence that prevention of atelectasis by LSF treatment improves gas exchange and inhibits formation of hyaline membranes, leading to the conclusion that LSF treatment may be a promising therapy in ARDS patients.     

Evaluation of the effects on choroidal thickness of bimatoprost 0.03% versus a brinzolamide 1.0%/timolol maleate 0.5% fixed combination

Objective: To investigate the effects of two different medical treatment options on choroidal thickness (CT) in cases of open-angle glaucoma (OAG).

Methods: Sixty-seven eyes newly diagnosed with OAG and 52 healthy eyes constituting the control group were included in the study. Glaucomatous eyes were randomly divided into two subgroups; Group I was started on bimatoprost 0.03% and Group II on a brinzolamide 1.0%/timolol maleate 0.5% fixed combination (BTFC). Intraocular pressure (IOP), ocular pulse amplitude (OPA) and subfoveal CT measurements were performed in all eyes in the study before treatment and on weeks 2, 4 and 8 after treatment.

Results: Mean initial IOP values in groups I and II and the control group were 25.5?±?4.7, 25.1?±?5.2 and 16.1?±?2.9?mmHg, mean OPA values were 3.7?±?1, 3.6?±?1.4 and 2.4?±?0.6?mmHg and mean CT values were 269.4?±?83, 264.5?±?84.4 and 320.1?±?56.6?μm, respectively. Eight weeks after treatment, mean IOP values in Groups I and II and the control group were 18.3?±?2.6, 18.1?±?3.4 and 15.7?±?2.9?mmHg, mean OPA values were 2.9?±?1.2, 2.8?±?1.5 and 2.3?±?0.8?mmHg and mean CT values were 290.2?±?87.3, 271.8?±?82.5 and 319.3?±?56.8?μm, respectively. No significant difference was determined in terms of the decrease in IOP and OPA obtained after treatment in Group I and Group II. However, a significant difference was observed between the two groups in terms of choroidal thickening after treatment.

Conclusion: The use of topical ocular hypotensive medication in eyes with OAG results in an increase in CT. This increase is relatively greater with bimatoprost 0.03% therapy compared to BTFC.     

EFFECTS OF CORTISOL ON BLOOD PRESSURE AND SALT PREFERENCE IN NORMAL HUMANS

1. Adrenocorticotrophic hormone (ACTH) and corticosteroids stimulate salt appetite in laboratory animals. The hypothesis tested was that cortisol administration increases salt preference in humans. 2. Sodium taste studies (detection and recognition thresholds, taste intensity and preference tests) were conducted before, during and after cortisol administration (200 mg/day for 5 days) in normal men on a free diet. 3. Cortisol significantly increased systolic blood pressure (SBP), 113 ± 3–130±4 mmHg, P < 0.05; diastolic blood pressure (DBP), 65±3–81±2 mmHg, P < 0.05; mean arterial pressure (MAP), 81± 2–97± 3 mmHg, P < 0.05; and bodyweight, 72.9±3.0–75.4±3.3 kg, P < 0.05. 4. Salt detection and recognition thresholds, taste intensity and preference for sodium chloride were unchanged following cortisol.     

压力控制容量保证通气模式在腹腔镜袖状胃切除术中的应用

目的探究在腹腔镜袖状胃切除术中,应用压力控制容量保证通气(PCV-VG)模式对病态肥胖病人呼吸力学及气体交换功能的影响。方法选取 2020年 5―12月徐州医科大学附属医院腹腔镜袖状胃切除术病人 80例,分为压力控制容量保证组( P组)和容量控制组( V组)。记录插管后 5 min(T1)、建立气腹后 30 min(T2)、 60 min(T3)、撤气腹后 5 min(T4)的气道峰压(Ppeak)、气道平均压( Pmean)、肺动态顺应性( Cdyn)、潮气量( TV)、动脉氧分压( PaO₂)、动脉二氧化碳分压( PaCO₂),动脉氧饱和度(SaO₂)并计算氧合指数( OI)、动脉 -呼气末二氧化碳分压差( Pa-ETCO₂)、肺泡 -动脉血氧分压差( Pa-AO₂)、死腔率( VD/ VT),术后 3d肺部并发症发生率。结果排除剔除病例后, 72例病人纳入最终分析,每组 36例。在 T1T2T3、T4时点, P组的 Ppeak［( 20.69±     

COMPARISON OF HAEMODYNAMIC RESPONSES TO POSITIVE-END-EXPIRATORY VENTILATION AND PERICARDIAL EFFUSION IN DOGS

1. The haemodynamic responses to progressive increments in positive end-expiratory pressure ventilation (PEEP) were assessed in dogs in the presence and absence of pericardial effusion (2-2 ml saline/kg). 2. Increasing levels of PEEP (0, 4, 8, 16 cm H₂O) were associated with increases in right atrial, left atrial, pericardial and pulmonary artery diastolic pressure; increases in pulmonary vascular resistance; decreases in aortic blood pressure; and decreases in cardiac index or stroke index. 3. Pericardial effusion that was associated with an increase in pericardial pressure of 3 mmHg was not associated with significant changes in aortic blood pressure or stroke index. In contrast 8 cm PEEP was associated with significant decreases in both these haemodynamic variables yet pericardial pressure increased only 2-2 mmHg. 4. For these levels of PEEP and pericardial effusion, the same haemodynamic response to PEEP was observed regardless of the presence or the absence of pericardial effusion. 5. Similar changes in aortic blood pressure and stroke index despite different pericardial pressures is reflected by significantly different intercepts in the linear model relating these haemodynamic variables to pericardial pressure in the presence and absence of pericardial effusion. 6. The results suggest that these haemodynamic consequences of PEEP are primarily a function of pulmonary hyperinflation and are less dependent on increases in extracardiac pressure per se.     

L-精氨酸治疗缺氧性肺动脉高压

目的 :探讨L -精氨酸 (L -Arg)干预缺氧性肺血管结构重建的机制。方法 :将18只Wistar大鼠采用随机设计分为对照组、缺氧组和缺氧 +L -Arg组 (共6个配伍组 )。以右心导管法测定肺动脉压力 ,并对大鼠肺组织标本进行显微结构观察和超微结构观察 ,同时以免疫组化方法分析肺动脉I型胶原表达。结果 :缺氧组大鼠肺动脉平均压 (mPAP)为 (2 7±0 3)kPa ,对照组为 (2 1±0 1)kPa ,两者比较 ,P<0 05。缺氧组大鼠肺血管显微及超微结构发生明显改变 ,有肺血管结构重建形成。然而 ,缺氧 +L -Arg组大鼠mPAP为 (2 2±0 2)kPa ,缺氧组为 (2 7±0 3)kPa ,两者比较 ,P<0 05。L -Arg缓解了缺氧性肺血管结构重建的形成。结论 :L -Arg 对缺氧性肺血管结构重建以及缺氧性肺动脉高压的形成有重要的调节作用     

尼群的平对麻醉犬冠脉流量、心肌耗氧量、二氧化碳产生率的影响

尼群的平20μg/kg iv显著降低麻醉犬血压的过程,冠状窦流量明显增加。持续3h,冠状窦氧含量增加,氧摄取率、心肌耗氧量、二氧化碳产生率降低,持续了3h以上,说明该剂适用于高血压伴心肌缺血。     

杨桃根醇提物对正常大鼠血压的影响

目的 研究杨桃根Averrhoa carambola root醇提物对正常大鼠血压的影响.方法 40只正常大鼠随机均分为5组:阳性对照组、正常对照组及杨桃根醇提物高、中、低剂量组.大鼠麻醉后以颈总动脉插管法连接心功能分析系统,待颈动脉血压稳定10 min后,测定给药前和十二指肠给药后30、60、90、120、150、180、210、240 min时大鼠的心率、收缩压、舒张压和平均动脉压.结果 杨桃根醇提物高剂量组大鼠的收缩压、舒张压、平均压分别于给药后60 min(由119.06±11.45 mmHg降至112.58±12.27 mmHg)、60 min(由110.91 ±9.83 mmHg降至95.44±14.82 mmHg)、90 min(由115.94±12.92 mmHg降至94.58±12.23 mmHg)开始降低;中剂量组大鼠的收缩压、舒张压、平均压分别于给药后150 min(由122.01±13.52 mmHg降至100.87 ± 15.04 mmHg)、90 min(由110.88 ± 13.75 mmHg降至89.52±17.91 mmHg)、90 min(由115.39±11.61 mmHg降至99.72±12.67 mmHg)开始降低.杨桃根醇提物对正常大鼠的心率无明显影响.结论 杨桃根醇提物能降低正常大鼠的血压.     

不同剂量布比卡因腰硬联合麻醉对剖宫产患者循环的影响

目的探讨不同剂量的布比卡因腰硬联合麻醉对剖宫产孕妇循环的影响。方法90例择期行剖宫产术的孕产妇,按数字表法随机分为3组,行腰麻-硬膜外联合麻醉(CSEA),分别在蛛网膜下腔注入0.5%布比卡因(0.75%布比卡因2 mL+0.9%生理盐水1 mL)1.3 mL(A组)、<160 cm为1.2 mL,160～165 cm为1.3 mL,165～170 cm为1.4 mL,>170为1.5 mL(B组)和1.0 mL+硬膜外2%利多卡因3 mL(C组)。记录各组麻醉至手术开始的时间和手术时间;观察各组麻醉阻滞效果、麻黄碱用量;记录各组产妇在麻醉前、麻醉后仰卧、麻醉后5 min、麻醉后10 min、娩婴、各时间点心率、血压的变化情况;记录产妇恶心、呕吐、低血压等情况。结果三组间的手术时间及麻醉至手术开始的时间差异无统计学意义(P>0.05);麻醉后5 min收缩压C组(112.9±1.8)mmHg,高于A组(101.9±2.4)mmHg,P<0.05;麻醉后10 min收缩压C组(111.6±2.2)mmHg,低于A组(102.3±2.7)mmHg,P<0.05;娩婴时收缩压C组(121.4±2.5)mmHg与A组(109.8±2.3)mmHg、B组(113.8±2.0)mmHg比较,差异有统计学意义(P<0.05);麻醉后10 min舒张压C组(68.7±1.5)mmHg与A组(59.5±2.0)mmHg比较,差异有统计学意义(P<0.05);其他各时间点三组收缩压与舒张压间差异无统计学意义(P>0.05)。三组间各时间点心率变化无统计学意义。A、B、C三组的阻滞效果分别为(1.00±0.00)、(1.00±0.00)和(1.20±0.07)分,A、B组阻滞完善度优于C组(P<0.05);麻黄碱用量C组(0.0±0.0)低于A组(5.3±1.2)和B组(6.0±1.6),P<0.05;低血压发生率A组43.3%,B组40%,高于C组3.3%,P<0.05;三组间的恶心、呕吐及胸闷发生率差异没有统计学意义(P>0.05)。结论小剂量腰麻(1.0 mL)复合硬膜外追加利多卡因3 mL对剖宫产患者循环影响最小,恶心、呕吐及低血压发生率低,麻黄素用量少,麻醉效果相对差;固定剂量组1.3 mL与根据身高调整腰麻用量组相比,差异均无统计学意义。     

黄芪注射液对脂多糖致大鼠急性肺损伤后细胞凋亡的保护作用

目的:研究黄芪注射液对脂多糖所致大鼠急性肺损伤(ALI)后细胞凋亡的保护作用,探讨其可能的机制。方法:雄性Wistar大鼠200～250 g 45只,随机分成3组,NS对照组、ALI组和黄芪注射液组。后2组以颈外静脉注射脂多糖5 mg·kg~(-1)致急性肺损伤。分别观察各组呼吸频率、动脉血氧分压(PaO_2),处死后检测肺组织湿/干(W/D)比值,免疫组化法检测肺泡上皮细胞Bcl-2、Bax蛋白表达。结果:NS对照组呼吸频率为(73±s 6)次·min~(-1),PaO_2为(90．0±2．0)mmHg,W/D比值为3．287±0．024, Bax/Bcl-2为0．5±1．0;ALI组与NS对照组相比,呼吸频率增快为(112±6)次·min~(-1)(P＜0．01),PaO_2降低为(46±3)mmHg(P＜0．01),W/D比值升高为5．151±0．023(P＜0．01),Bax/Bcl-2上升为7．8±0．7(P＜0．01);黄芪注射液组与ALI组相比,呼吸频率减慢为(94±4)次·min~(-1)(P＜0．01),PaO_2上升为(84±6)mmHg(P＜0．01),W/D比值降低为4．809±0．014(P＜0．01),Bax/Bcl-2下降为0．1±0．7 (P＜0．01)。结论:黄芪注射液可能通过降低Bax/Bcl-2细胞比例抑制细胞凋亡,减轻脂多糖所致ALI。     

SIMILARITY OF BLOOD PRESSURE FOR EACH GENOTYPE OF THE INSERTION/DELETION POLYMORPHISM OF THE DIPEPTIDYL CARBOXYPEPTIDASE-1 GENE IN DIFFERENT AGE GROUPS OF PATIENTS WITH SEVERE, FAMILIAL ESSENTIAL HYPERTENSION

1. The association of alleles of an insertion/deletion polymorphism (I/D) of the dipeptidyl carboxypeptidase-1 gene with hypertension is controversial. If a particular allele makes a major contribution to blood pressure, then hypertensives homozygous for this allele could be expected to have higher high blood pressure than those homozygous for the alternate allele. 2. The present study examined this hypothesis by comparing pretreatment blood pressures of hypertensives who had been genotyped for the I/D polymorphism. Blood pressures for different age groups (< 50, 50–59 and ≥60 years) were also examined for each genotype. In addition, several other parameters were examined. 3. Systolic blood pressures were found to be 167 ± 3, 167 ± 3 and 170 ± 6 mmHg (mean ± s.e.) for the genotypes II, ID and DD, respectively. Diastolic blood pressures were 113 ± 4, 111 ± 2 and 111 ± 4, for the respective genotypes. One-way anova showed that the respective blood pressure values did not differ significantly across genotypes. Blood pressures for different age groups of hypertensives were also similar. 4. In addition, body mass index, mean age and sex did not differ between genotypes, either for the group as a whole or for the different age groups. 5. In conclusion, the present study could find no evidence to support a genetic association between the I/D polymorphism of DCP1 and blood pressure in a group with severe, familial hypertension living in Sydney.     

依普罗沙坦与氯沙坦在轻中度原发性高血压病人中的降压疗效比较

目的:以氯沙坦为对照,观察依普罗沙坦治疗轻、中度原发性高血压(EH)病人的疗效与安全性。方法:采用前瞻性、随机、双盲、阳性药对照研究。符合方案的50例轻、中度EH病人经筛选期(2 wk)、安慰剂导入期(2 wk)后,随机分为依普罗沙坦组(n=24)与氯沙坦组(n=26)。在治疗期,2组病人分别每日1次口服依普罗沙坦600 mg或氯沙坦50 mg。若4 wk血压不达标,即坐位舒张压(DBP)≥90 mmHg (1 mmHg=0．133 3 kPa),加氢氯噻嗪12．5 mg,每日1次口服至8 wk。观察治疗前、治疗后4 wk与8 wk血压、心率以及治疗前后血、尿常规,血生化及心电图改变。结果:在治疗后8 wk,依普罗沙坦组的收缩压(SBP)与DBP分别下降了(12±s 10)mmHg与(12±5)mmHg,氯沙坦组的降压幅度分别为(14±9)mmHg与(10±6)mmHg,治疗前后比较有非常显著差异(P<0．01);但2组间血压下降的幅度无显著差异(P>0．05)。依普罗沙坦组与氯沙坦组的降压总有效率分别为100％和8l％,2组疗效无显著差异(P>0．05)。依普罗沙坦组加用氢氯噻嗪病例为9例(38％),而氯沙坦组为6例(23％),p> 0．05。2组心率及血液生化检查结果,治疗前后变化均无显著意义(P>0．05),均无严重不良反应发生。结论:依普罗沙坦与氯沙坦均能有效降低轻、中度EH病人的血压,疗效相似,都具有良好的安全性。     

Survival of Verapamil-Poisoned Rats Treated with Triiodothyronine

Life-threatening toxicity due to calcium channel blocker ingestion is commonly encountered by emergency medicine physicians and toxicologists. Despite a vast array of research on its treatment, results have proven inconsistent. The goal of this study is to evaluate potential vasopressor effects of triiodothyronine (T3) in rats poisoned with verapamil. Following anesthesia and intubation, ten Sprague–Dawley rats were given intravenous verapamil infusion of 10 mg/kg/h. This dose was titrated until a mean arterial pressure (MAP) of 50–55 mmHg was achieved and maintained for a period of at least 5 min. The verapamil infusion was then maintained at that rate. Five rats were randomized to receive a T3 bolus of 0.4 mcg/kg preceding an infusion of 1.5 mcg/kg/day which was doubled every 2 min until any of the following endpoints: systolic blood pressure of 100 mmHg, an elapsed time of 60 min, or death. The other five received an equal volume of normal saline solution. The primary outcome measure was survival with secondary outcomes of MAP and heart rate. The T3 group did have a slightly longer, yet not statistically significant, average time to cessation of electrical activity—30.0?±?14.4 min versus 23.8?±?9.5 min in the placebo group. Average MAP decreased nearly identically in the two groups. Heart rates were not reliable indicators of toxicity in this rat model as there was little decrease until immediately prior to death in most animals. Despite significant variability in toxicity among individual animals, no statistically significant difference in survival time, heart rate, or MAP was found between groups treated with T3 and those receiving saline.