复合振动对去势骨质疏松大鼠骨强度的作用

目的：观察复合振动骨质疏松大鼠骨强度的影响。方法：4.5月龄SD雌性未育大鼠24只,随机分为对照组和两个实验组。卵巢摘除法骨质疏松造模成功后,实验组各自接受不同的复合振动,分别测大鼠腰椎、股骨骨密度,胫骨骨微结构,腰椎、股骨力学性能。结果：两振动组大鼠腰椎、股骨骨密度均有明显增加,腰椎：0.0055±0.0126g/cm2,0.0132±0.0078g/cm2,股骨：0.0078±0.0081g/cm2,0.0145±0.0053g/cm2,但仅振动2组骨结构（小梁骨数量、间距、连接密度、骨体积分数）和骨极限强度有显著性改善。结论：特定复合振动可以增强去势骨质疏松大鼠骨强度,与同类研究比较可降低振动强度,在治疗骨质疏松方面有应用前景。     

复合振动对卵巢切除大鼠骨质量的作用

背景:目前所使用的全身振动防治骨质疏松所需振动强度较大,人体不适感较强.作者设计了复合振动,前期实验发现复合振动可在更低强度下有效预防卵巢切除大鼠的骨密度下降. 目的:课题创新性提出低强度复合振动可维持生长期卵巢切除SD大鼠骨质量的理论假设,并期望实验结果加以验证.方法:SPF级4月龄雌性未育SD大鼠32只,随机分为正常对照组、卵巢切除组以及振动1、振动2组,每组大鼠均为8只.振动1组接振45～55Hz,0.05～0.1 g;振动2组接振45～55Hz,0.12～0.21 g.振动20min/次,1次/d,5次/周,休息间隔不大于2d.实验时间13周.观察振动干预前后大鼠活体骨密度,体外标本骨微结构以及生物力学性能. 结果与结论:卵巢切除组腰椎骨密度下降(P<0.05),而正常对照组与两振动组有显著性增加,股骨骨密度均增加,组间差异无显著性意义;卵巢切除各组骨微结构参数均明显下降,但振动2组骨小梁数量、骨小梁厚度、骨小梁间距、骨体积分数相对于卵巢切除组有显著改善:腰椎骨强度值两振动组较卵巢切除组显著增加(P=0.025、0.006),与正常对照组比较差异无显著性意义.实验结果证明,特定的复合振动舒适感较好的低强度下可以有效预防卵巢切除SD大鼠骨密度下降,减轻骨微结构破坏程度,维持骨强度,具有改善卵巢切除大鼠骨质量的作用和潜在的预防骨质疏松作用.     

钙加维生素D预防骨质疏松的实验研究

目的 观察钙加维生素D对卵巢切除大鼠骨密度，骨强度和骨代谢的影响。方法 将40只SD雌性大鼠随机分为4组：假手术组（A），去卵巢组（B），去卵巢并给钙加维生素D组（C）和去卵巢单纯给钙组（D）。实验12周后处死各组大鼠。结果 与B组相比，C组大鼠股骨骨密度最大载荷，骨皮质厚度等明显增加；血清抗酒石酸酸性磷酸酶（TRAP）和骨钙素（OC）明显降低。D组和C组股骨最大应力，弹性载荷，弹性模量等均明显增高。结论 钙加维生素D组在改善骨密度和骨生物力学参数，抑制骨吸收和骨转换方面明显优于单纯补钙组。     

去势大鼠血清血管内皮生长因子水平和骨密度的相关性*

背景：血管内皮生长因子在促进骨质疏松性骨折愈合中发挥重要作用,而它是否影响骨密度变化还没明确。目的：观察去势大鼠血清血管内皮生长因子水平和骨密度及成骨细胞变化的相关性。方法：SD 雌性大鼠40只随机数字表法均分为去势组和对照组,3个月后测大鼠全身、腰椎及股骨骨密度。大鼠 ELISA 试剂盒测血清中血管内皮生长因子的水平,同时两组大鼠股骨干骺端固定,脱钙,脱水、石蜡包埋、切片,苏木精-伊红染色,每切张片随意取5个视野(10×40)行股骨远侧干骺端成骨细胞计数在光学显微镜。结果与结论：去势3个月后大鼠体质量明显增加(P <0.05),去势组全身、腰椎及股骨骨密度较对照组全身、腰椎及股骨骨密度降低(P <0.05),表明骨质疏松的模型建立。而去势大鼠和对照大鼠血管内皮生长因子水平比较差异无显著性意义(P >0.05),去势组及对照组的成骨细胞数量无明显差异(P >0.05),去势组及对照组骨密度与成骨细胞数及血清血管内皮生子水平无相关性。提示去势大鼠的骨密度下降,体质量升高,而去势大鼠骨密度的降低与血清血管内皮生长因子变化可能无关。     

不同强度脉冲电磁场对去势大鼠股骨骨钙含量的影响

目的：通过不同强度低频脉冲电磁场干预去势大鼠骨质疏松模型，测定各组大鼠的股骨骨钙含量，探索治疗骨质疏松最适合的磁场强度。方法：按随机分组原则用密闭信封法将雌性3月龄SD大鼠50只分为5组：Sham对照组10只、OVX对照组10只、OVXⅠ组10只、OVXⅡ组10只、OVXⅢ组10只。除Sham对照组以外，对所有动物按文献方法切除双侧卵巢去势造模。OVXⅠ组、OVXⅡ组和OVXⅢ组三组大鼠每天在频率为8Hz，强度分别为0．77mT、3．82mT和9．87mT的磁场环境中治疗40min，共30d。Sham对照组和OVX对照组不进行干预。各组动物均在满30d后股动脉放血处死，取左侧股骨作骨钙含量测定。结果：OVX对照组大鼠的股骨骨钙含量显著低于其他4组大鼠（尸〈0．05或P〈0．01）。结论：在磁场频率一致和干预时间相同的前提下．本文所用三种不同磁场强度的PEMFs治疗具有增加去势大鼠股骨骨钙含量的作用（P〈0．01或P〈0．05），3．82mT的PEMFs较0．77mT的PEMFs更能增加股骨骨钙含量。     

大豆异黄酮干预去势大鼠骨密度及成骨细胞雌激素受体α的表达

背景：大豆异黄酮是一类植物雌激素,对绝经后骨质疏松症治疗具有重要意义。目的：进一步验证大豆异黄酮对去势大鼠骨密度和成骨细胞雌激素受体α表达的影响。方法：将12月龄去势雌性SD大鼠随机分为3组,大豆异黄酮组和对照组大鼠摘除双侧卵巢,假手术组只进行手术入路,不切除卵巢。大豆异黄酮组切除卵巢后,每日灌胃大豆异黄酮,连续40d。对照组喂等量生理盐水。结果与结论：喂饲40d后对照组大鼠左侧股骨骨密度值显著低于假手术组（P〈0.05）,提示骨质疏松模型成功。大豆异黄酮组大鼠左侧股骨骨密度高于对照组（P〈0.05）;大豆异黄酮组雌激素受体α的表达量高于对照组（P〈0.05）。提示大豆异黄酮可增加去势大鼠骨密度,提高去势大鼠成骨细胞雌激素受体α的表达,促进成骨细胞增殖。     

大豆异黄酮对去卵巢大鼠骨矿物质含量及骨密度的影响

目的：探讨大豆异黄酮对去卵巢大鼠股骨的骨矿物质含量及骨密度的影响。方法：实验选用4月龄雌性wistar大鼠70只，按体质量随机分为7组，除对照组外，其他大鼠腹腔手术去除双侧卵巢，建立骨质疏松模型，分别给予不同剂量(高、中、低剂量)的大豆异黄酮，同时设立假手术组、去卵巢对照组和雌激素对照组。实验结束后，取大鼠股骨进行骨重量、骨矿物质含量及骨密度的测定，并作X线片。结果：各组大鼠的股骨长度和重量无显著性差异；去卵巢对照组大鼠股骨中钙和磷的含量[(143．60&;#177;8．80)，(87．94&;#177;7．46)mg／g]与正常对照组[(174．88&;#177;20．01)，(107．97&;#177;9．46)mg／g]相比显著降低(t=14．69，21．07，P&;lt;0．05)；大豆异黄酮剂量组和雌激素组骨钙、骨磷含量与对照组接近。X线片和骨密度测定发现大鼠去除卵巢后，股骨的骨量尤其是股骨干骺端的骨量明显丢失，骨密度显著下降，给予大豆异黄酮和雌激素后骨量丢失得到抑制，骨密度变化不大。结论：大豆异黄酮具有抑制骨量丢失、预防骨质疏松的作用。     

去卵巢骨质疏松大鼠骨组织和骨髓细胞FoxO1蛋白在全身垂直振动条件下的变化

背景：FoxO1蛋白参与多种多样的细胞和生理过程,包括细胞增殖与凋亡、活性氧的反应、长寿、癌症、细胞周期和代谢的调节等。研究认为振动负荷能促进新陈代谢,延缓肌肉疲劳,加速骨适应性重建。
　　目的：进一步验证全身垂直振动对去卵巢骨质疏松大鼠骨组织和骨髓细胞叉头框转录因子 O 亚族1(FoxO1)蛋白表达的影响。
　　方法：将36只健康3月龄雌性SD大鼠,按体质量分层后随机分为假手术组、去卵巢静止组和去卵巢振动组。在手术后第11周,对去卵巢振动组大鼠实施7周每天不间断的全身垂直振动治疗,2次/d,每次振动训练15 min,间隔10 min,振动频率为90 Hz,振动幅度为0.5 mm。于末次处理结束24-48 h内,游离各组大鼠第5腰椎、右侧股骨和胫骨,用双能X射线骨密度仪检测右股骨和第5腰椎的离体骨密度,用Western blot检测右胫骨近端和骨髓细胞FoxO1蛋白的表达。
　　结果与结论：骨密度检测结果显示,与去卵巢静止组比较,去卵巢振动组大鼠股骨远端和近端以及第5腰椎骨密度显著增加,而股骨中段无显著变化。Western blot检测结果显示：FoxO1蛋白在胫骨组织中不表达,但在骨髓细胞中表达。与假手术组比较,去卵巢静止组大鼠骨髓细胞FoxO1蛋白表达水平无显著变化;与去卵巢静止组比较,去卵巢振动组大鼠骨髓细胞FoxO1蛋白表达水平显著下降。结果表明,全身垂直振动能抑制FoxO1蛋白在去卵巢大鼠骨髓细胞中的表达。     

他莫西芬对去势大鼠骨生物力学性能的影响

目的 评价他莫西芬对雌激素缺乏引起的骨生物力学性能下降的预防作用。方法 采用4月龄Sprague-Dawley(SD)雌性大鼠切除卵巢作动物模型，术后给予他莫西芬治疗连续12周。结果 与假手术组相比去势组骨密度、股骨生物力学性质、腰椎骨形态计量指标均有显差异；他莫西芬处理组与去势组比较，股骨骨密度、股骨最大载荷、桡度、最大应力、弹性模量显升高、骨形态计量参数的改变均有显性。结论 他莫西芬能抑制去势引起的SD大鼠骨生物力学性能下降。     

钙加维生素D预防骨质疏松的实验研究

目的观察钙加维生素D对卵巢切除大鼠骨密度、骨强度和骨代谢的影响。方法将40只SD雌性大鼠随机分为4组:假手术组(A),去卵巢组(B),去卵巢并给钙加维生素D组(C)和去卵巢单纯给钙组(D)。实验12周后处死各组大鼠。结果与B组相比,C组大鼠股骨骨密度最大载荷、骨皮质厚度等明显增加;血清抗酒石酸酸性磷酸酶(TRAP)和骨钙素(OC)明显降低。D组和C组股骨最大应力、弹性载荷、弹性模量等均明显增高。结论钙加维生素D组在改善骨密度和骨生物力学参数、抑制骨吸收和骨转换方面明显优于单纯补钙组。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.