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主动脉夹层动脉瘤支架置入术中血钾浓度异常增高二例

The Protective Effects of Ischemic Postconditioning on Ischemiareperfusion Myocardium and the Relationship with Mitochondrial Adenosine Triphosphate Sensitive K+ Channels

Objective To investigate the protective effects of ischemic postconditioning (IPo) on ischemiareperfusion (I/R) myocardium and the relationship with mitochondrial adenosine triphosphate (ATP) sensitive K+ channels (mitoKATP) and provide evidences to the development of druginduced postconditioning. Methods Langendorff models were established in 40 Wistar rats which were divided into 5 groups by random number table with 8 rats in each group. Normal control group(NC group): the rat hearts were continuously reperfused by KrebsHenseleit bicarbonate buffer (K-HB) for 100 min without any other treatment; I/R group: the rat hearts underwent a 40-min global ischemia followed by a 60-min reperfusion; IPo group: after a 40-min global ischemia, the process of 10-second reperfusion followed by a 10-second ischemia was repeated 6 times, then there was a continuous 58min reperfusion; 5-hydroxydecanoic acid(5-HD) group: after a 40min global ischemia, hearts with 5HD(100 μmol/L) K-HB were reperfused for 15min and then perfused without 5HD for 45min；IPo+5-HD group: after a 40-min global ischemia, the process that the isolated hearts with 5-HD(100 μmol/L) KHB were reperfused for 10second followed by a 10second ischemia was repeated 6 times, then the hearts with 5-HD(100 μmol/L) KHB were continuously [CM(159mm]perfused for 13-min followed by reperfusion without 5-HD(100 μmol/L) K-HB for 45-min. The cardiac function,coronary flow(CF), cardiac troponin I(cTnI) content in coronary effluent, the area of acute myocardial infarction (AMI) and myocardial ultrastructure were observed. Results Left ventricular developed pressure(74.3±3.3 mm Hg vs. 57.1±3.3 mm Hg,t=1300, P=0.000),+dp/dtmax(1 706.6±135.6 mm Hg/s vs. 1 313.3±96.2 mm Hg/s,t=6.28,P=0.000),－dp/dtmax(1 132.8±112.1 mm Hg/s vs. 575.7±67.7 mm Hg/s,t=13.48, P=0.000) and CF(6.49±0.30 ml/min vs. 3.70±0.24 ml/min,t=28.6,P=0.000) in IPo group were higher than those in I/R group. Left ventricular enddiastolic pressure(10.9±1.7mm Hg vs. 26.2±1.5 mm Hg,t=－19.21, P=0000)and cTnI content in coronary effluent (0.62±0.01 ng/ml vs. 0.71±0.01 ng/ml, t=-12.00,P=0.000) were lower than those in I/R group; the area of AMI decreased 20.8％ compared with that in I/R group (Plt;0.05). The myocardial protective effect in IPo+5HD group was similar with that in IPo group, but lower than that in IPo group. The electron microscope showed that IPo and IPo+5HD could reduce myocardial fiber damage and mitochondrial damage caused by I/R. Conclusion IPo can protect I/R myocardium, which is achieved mainly by activating mitoK-ATP channels. 

Efficacy of Potassium Magnesium Aspartate in Prevention of Arrhythmia after Cardiac Heart Surgery

ObjectiveTo systematically review the clinical efficacy of potassium magnesium aspartate in prevention of arrhythmia after cardiac heart surgery. MethodsSearching PubMed, MEDLINE, EMbase, The Cochrane Library (Issue 5, 2014), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about the clinical efficacy of potassium magnesium aspartate in prevention of arrhythmia after cardiac heart surgery from the date of establishment of the databases to May 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two reviewers independently. Meta-analysis was then conducted by RevMan 5.2 software. ResultsA total of nine RCTs involving 825 patients were enrolled. The results of meta-analysis indicated that: compared with the control group, timely giving supplement of potassium magnesium aspartate before and after surgery significantly reduced the incidences of arrhythmia (OR=0.25, 95%CI 0.09 to 0.69, P=0.008), premature beats (OR=0.08, 95%CI 0.03 to 0.23, P < 0.000 01), tachycardia (OR=0.29, 95%CI 0.17 to 0.49, P < 0.000 01) and 24 h low cardiac output (OR=0.27, 95%CI 0.10 to 0.72, P=0.009); and increased auto-resuscitation rates (OR=12.16, 95%CI 4.82 to 30.68, P < 0.000 01), with significant differences. However, the two groups were alike in the incidences of atrial fibrillation (OR=0.05, 95%CI-0.16 to 0.05, P=0.34) and ventricular fibrillation (OR=1.24, 95%CI 0.73 to 2.13, P=0.43). ConclusionPotassium magnesium aspartate is effective in prevention of arrhythmias after cardiac surgery, and protective to the myocardium. However, compared with conventional treatment it cannot significantly decrease the incidences of atrial fibrillation and ventricular fibrillation. Due to the limited quantity and quality of the included studies, more multi-centre high quality RCTs with large sample size are needed to verify the above conclusion.

The diagnosis and treatment of Gitelman syndrome in adults

Gitelman syndrome (GS) is an autosomal recessive kidney disorder characterized by low blood levels of potassium and magnesium, decreased excretion of calcium in the urine, and elevated blood pH. The disorder is named for Gitelman, an American nephrologist. He first described it in 1966, after observing a pair of sisters with the disorder. The disorder is caused by inactivating mutations in the SLC12A3 gene, resulting in improper function of the thiazide-sensitive sodium-chloride co-transporter located in the distal convoluted tubule of the kidney. GS was formerly considered a subset of Bartter syndrome until the distinct genetic and molecular bases of these disorders were identified. GS is usually managed by a liberal salt intake together with oral magnesium and potassium supplements. This review aims to establish an initial framework to enable clinical auditing and thus improve quality control of care.

Visualization analysis of research hotspots and development trends of hyperkalemia in hemodialysis patients

Objective To analyze the research hotspots and trends in the field of hyperkalemia in hemodialysis patients at home and abroad, and to provide reference for the research and prevention and control of hyperkalemia in hemodialysis patients. Methods China National Knowledge Infrastructure (CNKI) and Web of Science databases were searched by computer for literature about the hyperkalemia in hemodialysis patients published between January 1995 and January 2023. The included literature was analyzed using visualization analysis tools for visualization, including high-frequency keywords, keyword co-occurrence map, keyword emergence intensity and keyword time series prediction. Results A total of 10 275 articles were included. Among them, there were 10 036 articles from web of science and 239 articles from CNKI. The number of articles in this research field showed a trend of steady increase year by year. The United States was in a leading position in the research and development in this field, followed by China. At the same time, the research in this field presents the characteristics of multidisciplinary integration. The development trends of research hotspots in the next 5 years were risk and health education research. Conclusions The number of research articles related to hyperkalemia in hemodialysis patients is gradually increasing. Multidisciplinary approach and integration is a research hotspot and frontier in the development of hyperkalemia in hemodialysis patients both domestically and internationally.

氯化钾加入甘露醇治疗低钾型周期性麻痹42例疗效观察

目的：探讨更为安全、有效的静脉补钾治疗低钾型周期性麻痹的方法。方法：收集本院住院低钾型周期性麻痹患者，应用半随机法分为治疗组和对照组进行临床对照研究。治疗组将氯化钾加入5%甘露醇静脉补钾，对照组常规补钾，监测血钾及肌力的恢复情况。结果：治疗组疗效明显，优于对照组(Plt;0.05)。结论：将氯化钾加入5%甘露醇治疗低钾型周期性麻痹疗效好，安全可行。

A Multicenter Randomized Controlled Clinical Trial on Potassium and Magnesium Supplementary Effects of Potassium Aspartate and Magnesium Aspartate Injection in Gastrointestinal Surgery Patients During Absolute Fasting

Objective　To evaluate the safety and efficacy of potassium and magnesium supplement with potassium aspartate and magnesium aspartate injection in gastrointestinal surgery patients during absolute fasting．Methods　A multicenter randomized controlled clinical trial was conducted in 111 patients after gastrointestinal surgery. For trial group，56 patients were given potassium aspartate and magnesium aspartate injection （Panangin®） in half of the total potassium replenished dose and the rest half of the potassium replenished dose was given in 10% potassium chloride injection．For control group，55 patients were given 10% potassium chloride injection for the total dose of potassium replenished．Such treatments maintained five consecutive days after surgical operation．Clinical observations were performed until patients were discharged from the hospitals．Results　Before the intervention，there were no significant differences for the baseline between two groups （P＞0.05）．There was no significant difference for the serum potassium level between two groups （P＞0.05） after intervention．The amount of urinary potassium （mmol/24 h） for patients in the trial group was significantly lower than that in the control group during treatment after operation．The serum magnesium level of control group was much lower than that of control group （P＜0.05）. In the clinical observation process，no drug-related adverse event was observed．Conclusions　The supplementary effect of potassium and magnesium for potassium aspartate and magnesium aspartate injection in patients with gastrointestinal surgery during absolute fasting is significant，and superior to potassium chloride injection for potassium supplement．Potassium aspartate and magnesium aspartate injection is a safe and appropriate choice for patients with potassium depletion．

钾通道与癫痫

离子通道是体内兴奋性调节的物质基础。其结构和/或功能异常，是癫痫的重要发病机制之一。钾通道是其中分布最广、类型最多的一类离子通道，目前已有多项研究证实钾通道与癫痫之间关系密切。现主要对钾通道结构与分类、钾通道异常及其相关的癫痫作一综述，从而为阐明癫痫的发病机制提供依据，为研制新型抗癫痫药物提供理论基础。

The Role of Mitochondrial Adenosine Triphosphatesensitive Potassium Channel in Immature Myocardial Ischemic Preconditioning

Objective To investigate the role of mitochondrial adenosine triphosphatesensitive potassium channel(mitoKATP) in immature myocardial ischemic preconditioning, and to provide evidence for immature myocardial protection. Methods Langendorff isolated heart infused model was used in the experiment. Twentyfour rabbits (aged from 14 to 21 days) were randomly divided into 4 groups：ischemiareperfusion group（I/R group）, myocardial ischemic preconditioning group(E1 group), 5hydroxydecanoate(5-HD) group (E2 group) and Diazoxide (Diaz) group(E3 group). Hemodynamics recovery rate, myocardial water content(MWC), the leakage rates of serum creatine kinase and lactate dehydrogenase, adenosine triphosphate content, superoxide dismutase activity, malondialdehyde content, myocardial cell Ca2+ content and myocardial mitochondrial Ca2+ content, myocardial mitochondrial Ca2+-ATPase activity, the adenosine triphosphate(ATP) synthesizing ability of myocardial mitochondria were tested, and myocardial ultrastructure was observed via electron microscopy. Results The hemodynamics recovery rate, myocardial water content(P＜0.05), adenosine triphosphate content, superoxide dismutase activity, myocardial mitochondrial Ca2+-adenosine triphosphyatase(ATPase) activity and the ATP synthesizing ability of myocardial mitochondria of the rabbits in E1 and E3 group were significantly better than that in I/R group and E2 group(P＜0.05). Malondialdehyde content, the leakage rates of serum creatine kinase and lactate dehydrogenase, myocardial cell Ca2+ content and myocardial mitochondrial Ca2+ content of the rabbits in E1 group and E3 group were significantly lower than that in I/R group and E2 group (P＜0.05). The myocardial ultrastructure injury in E1 and E3 group were significantly reduced compared with that in I/R and E2 group. Conclusion Myocardial ischemic preconditioning has significant protective effects on immature myocardium. Its mechanism may be related to the activation of mitoKATP.

Genetic study of patients with Gitelman syndrome

ObjectiveTo screen pathogenic gene mutations of Gitelman syndrome (GS).MethodsPatients with GS diagnosed and treated in the Department of Endocrinology and Metabolism, West China Hospital of Sichuan University from January 2015 to December 2020 and their family members were included. The pathogenic genes were screened by second-generation sequencing combined with first-generation validation.ResultsA total of 15 GS patients were included. Gene analysis of patients indicated SLC12A3 gene mutation, including 9 cases of compound heterozygous mutation and 6 cases of heterozygous mutation. A total of 12 reported pathogenic sites and 8 new pathogenic mutations were found. Among the newly discovered pathogenic mutations, four were missense mutations (c.539C>A, p.T180K; c.1077C>G, p.N359K; c.1967C>T, p.P656L; and c.2963T>C, p.I988T), one was frame shift mutation caused by single base deletion (c.2543delA, p.D848fs), one was nonsense mutation (c.2129C>A, p.S710X), one was large fragment deletion (exon 7-8 partial coding sequence deletion), and one was coding sequence deletion and abnormal base sequence insertion (IVS7-1 to c.976 deletion GCGGACATTTTTG insertion into ACCGAAAATTTT).ConclusionIn this study, 8 new gene mutations leading to GS were found, and the exact pathogenesis of GS remains to be further confirmed.