THE RELATION OF PARATHYROID FUNCTION TO PREGNANCY-INDUCED HYPERTENTION

Parathyrin (PTH) and calcitonin were measured with radioimmunoassay in 39 cases of pregnancy-induced hypertension (PIH) in late pregnancy, 76 cases in normal early pregnancy and 278 cases in late pregnancy without PIH. Markedly increased PTH was noted in the women in late pregnancy, indicating the state of secondary hyperparathyroidism. PTH values in the women in late pregnancy with PIH were higher than those in the normal early pregnancy group, but lower than those in the women in late pregnancy without PIH. The difference between PTH values in the PIH group and late pregnancy without PIH group was of statistical significance (P<0.05), while no significant difference was seen between calcitonin values of the two groups (P > 0.05). The results suggest that the pathogenesis of PIH may be related to the function of parathyroid.

Comparative study of indocyanine green-R15,Child-Pugh score,and model for end-stage liver disease score for prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in TIPS.AIM To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with PHT.METHODS This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June 2019.All patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before TIPS.According to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE group.The prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS HE.The ICG-R15 was identified as an independent predictor of post-TIPS HE.The AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),respectively.The non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND： Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE： To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN： A randomized controlled trial. SETTING： Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS： Twenty healthy little pigs, either male or female, weighing 4.5-5.5 kg, were used. Neurotrend-typed multiparameter monitoring system （Diametrics Company, British）; CMA/100 micro-injection pump （Carnegie Company, Sweden）. METHODS： The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups： the normothermia group （control group, n =10） and moderate hypothermia group （n =10）. ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure （MEP）, and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide （PaCO2）, arterial partial pressure of carbon dioxide （PaCO2）, HCO3-]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure （CPP, CPP=MAP（ICP）, brain tissue partial oxygen pressure （PO2）, partial pressure of carbon dioxide （PCO2）, HCO3- and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33-35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES： ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS： All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation： In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [（3.31±1.19）, （5.33±0.95） kPa, P 〈 0.05], CCP was higher, brain tissue PCO2 [（12.03±1.73）, （10.59±2.01） kPa, P 〈 0.05], and brain tissue pH value was higher [（7.03± 1.63）, （9.40±1.30） kPa, P 〈 0.05], whereas the brain temperature was decreased as compared with that before cooling [（34.9±0.3）, （37.2±0.2） ℃, P 〈 0.05]. ② Results of blood gases analysis in the moderate hypothermia group： There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group （P 〉 0.05） CONCLUSION： Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.

The relation between prognosis and nocturnal blood pressure variation in hypertensive patients with lacunar infarct

Objective We conducted a study using MRI and ambulatory blood pressure monitoring(ABPM) to determine whether an in-apporpriately low nocturnal blood pressure, or an excess fall in nocturnal blood pressure, might be responsible for lacunar infarct. Method ABPM and Casul blood pressure(CBP) were examined in 35 hypertentives with lacunar infarct(LI)and 33 hypertentives without lacunar infarct as control group. Results There is no significant difference of CBP between two groups. But the mean nighttime systolic blood pressure (nSBP) and diastolic blood pressure (nDBP) in patients with lacunar infarct were significantly smaller than in patients without lacunar infarct. The ratio of nSBP/dSBP and nDBP/dDBP in SI were smaller than in control group respectively. Conclusions The results indicate that an inap-propriately low nocturnal blood pressure, or an excessive fall in nocturnal blood pressure, is associated with lacunar infarct. It is necessary not only to control high blood pressure but also to pay attention to circadian changes of blood pressure during the course of anti-hypertensive treatment.

PATHOLOGIC CHANGES OF MUSCLE IN VENOUS INSUFFICIENCY

The pathologic changes in the muscle biopsy specimens of 26 patients with venous insufficiency were studied A total of 19 biopsied specimens of the gastrocnemius exhibited pathologic change, 9 patients had selective atrophy of type 2 fibre, 4 patients had denervative change,and 6 patients had evidence of myopathic change, but specimens removed from adductor longus muscle of patients as the control group revealed no significant change. The results suggest that chronic venous insufficiency results in muscle pathologic changes. The combined effect of elevated venous capacitance secondary to venous insufficiency and poor muscle contraction contributes to venous hypertention.