复方泛影葡胺对肠切除肠吻合术后患者早期肠功能复苏的影响

目的 探讨复方泛影葡胺在肠道手术后早期肠功能复苏中的作用。方法 腹部外伤后行肠切除肠吻合术后患者80例为研究对象。随机分为研究组及对照组各40例。均放置鼻空肠管至Treitz韧带以下,对照组术后第1天直接开始肠内营养,研究组先以复方泛影葡胺60~80 ml鼻饲,其后序贯肠内营养支持。观察两组一般临床指标(血常规、血清转氨酶、白蛋白、血尿素氮、肌肝、胆固醇、甘油三酯)、术后肛门排气时间、肠黏膜通透性改变,术后第1、3、7天经胃管注入亚甲蓝,观察尿液出现蓝色的时间以观察肠道吸收功能。结果 两组均无严重不良反应,对照组2例、研究组1例出现机械性肠梗阻,均退出研究。营养支持前后两组患者的一般临床观察指标均无明显变化。研究组平均肛门排气时间明显短于对照组[(1.8±0.3)d vs(3.2±1.3)d],差异有统计学意义(P<0.05)。术后第3天对照组肠黏膜通透性明显升高(P<0.05)。研究组与对照组术后血浆D-乳酸水平第3天[(36.8±15.7)mg/L vs(56.6±12.5)mg/L],第7天[(21.9±16.8)mg/L、(42.5±17.4)mg/L],差异均有统计学意义(P均<0.01)。研究组肠内营养第1天、第3天管饲亚甲蓝后尿液出现蓝色时间为(6.3±0.6)h、(5.3±0.5)h,与对照组[(7.2±0.3)h、(6.9±0.4)h]比较差异均无统计学意义(P均>0.05),术后第7天研究组明显优于对照组[(4.0±0.3)h vs(6.2±0.5)h,P<0.05]。结论 复方泛影葡胺能促进肠切除肠吻合术后患者早期肠功能复苏,促进肠黏膜屏障恢复,可作胃肠道术后早期肠功能复苏的措施。     

丙氨酰谷氨酰胺对急性肺损伤患者的保护作用及其机制初探

目的 观察丙氨酰谷氨酰胺(Ala-Gln)对急性肺损伤(ALI)患者的保护作用及其机制.方法 110例ALI患者随机分为对照组(50例)和Ala-Gln组(60例).对照组给予常规治疗,Ala-Gln组在常规治疗的基础上,加用Ala-Gln,疗程7天,分别观察两组间治疗前后血清谷氨酰胺(Gln)、热休克蛋白70(HSP70)水平、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及机械通气时间的差异.结果 Ala-Gln组治疗后血清HSP70、Gln水平明显增高,与治疗前比较差异有统计学意义,HSP70 (1.99±0.66) μg/L vs (1.34±0.68) μg/L( P＜0.01);Gln (386.15±68.60)μg/L vs (304.72±73.70) μg/L(P＜0.01).与对照组治疗后比较差异亦有统计学意义,Gln (386.15±68.60) μg/L vs (303.74±78.08) μg/L( P＜0.01);HSP70 (1.99±0.66) μg/L vs(1.35±0.48)μg/L(P＜0.01).Ala-Gln组治疗前后Gln浓度比与HSP70浓度比呈明显正相关(r=0.809,P＜0.01),对照组治疗前后血清Gln、HSP70水平差异无统计学意义,对照组治疗前后Gln浓度比与HSP70浓度比无明显相关性(r=0.147,P＞0.05).Ala-Gln组机械通气时间明显低于对照组,(162.20±96.33)小时vs (235.00±107.90)小时(P＜0.05).治疗后APACHEⅡ评分的改善明显优于对照组,(8.40±2.17)分vs (11.10±2.42)分(P＜0.05).结论 Ala-Gln治疗可显著提高ALI患者血清Gln、HSP70水平、缩短机械通气时间,改善APACHEⅡ评分,提示Ala-Gln对ALI患者具有保护作用,其机制可能与提高患者体内Gln、HSP70水平有关.     

强化阿托伐他汀对冠状动脉介入术后对比剂肾病的影响

目的 研究术前应用大剂量阿托伐他汀对冠状动脉介入术后肾功能的影响,探讨预防或减轻对比剂肾病(CIN)的新方法.方法 选择我院2008年10月至2009年3月住院应用优维显370对比剂行冠状动脉介入的病例200例.记录患者性别、年龄等临床资料,肌酐、β2-微球蛋白等实验室检查,发生CIN情况等临床指标.随机分为强化治疗组120例,常规治疗组80例.比较两组间上述临床指标的差别.强化治疗组又分为标准水化治疗组(65例)及强化阿托伐他汀组(55例).分析各组对冠状动脉介入术后肾功能的影响.结果 (1)3组患者血浆肌酐浓度造影后第3天比较:标准水化治疗组[ (74.6±14.5)μmol/L]、强化阿托伐他汀组[(83.4±16.2) μmol/L]低于常规治疗组[(95.2±17.4)μmol/L](P均＜0.05);造影后第7天比较,标准水化治疗[(73.3±14.1)μmol/L]、强化阿托伐他汀组[ (79.5 ±14.3)μmol/L]低于常规治疗组[(87.4±14.5)μmol/L](P均＜0.05),标准水化治疗组低于强化阿托伐他汀组(P＜0.05).(2)造影后第3天血浆p2-微球蛋白比较,标准水化治疗组[(0.55±0.11)μmol/L]、强化阿托伐他汀组[(0.59 ±0.10) μmol/L]低于常规治疗组[(0.77±0.12) μmol/L](P均＜0.05);造影后第7天比较,标准水化治疗组[(0.54±0.09)μmol/L]、强化阿托伐他汀组[(0.59±0.12)μmol/L]低于常规治疗组[(0.65±0.10)μmol/L](P均＜0.05),标准水化治疗组低于强化阿托伐他汀组(P＜0.05).(3)常规治疗组的CIN发病率(12.5％)高于标准水化治疗组(3.1％)、强化阿托伐他汀组(3.6％),差异均有统计学意义(P均＜0.05);强化阿托伐他汀组的CIN发病率高于标准水化治疗组,但两组比较差异无统计学意义(P＞0.05).结论 (1)标准水化治疗、强化阿托伐他汀治疗方案均能预防PCI术后CIN的发生,而标准水化治疗似能更好地改善患者PCI术后的肾脏功能.(2)强化阿托伐他汀在保护PCI术后肾脏损伤的疗效与标准水化治疗相似,冠心病患者PCI围手术期给予大剂量阿托伐他汀是临床预防CIN的一种安全有效的方法.     

胆碱酯酶抑制剂中毒大鼠肠屏障功能和形态结构变化及宾赛克嗪治疗作用的研究

目的 观察胆碱酯酶抑制剂类神经性毒剂中毒后大鼠肠屏障功能和组织形态结构的变化以及宾赛克嚷的治疗作用.方法 40只雄性Wistar大鼠按随机数字表法均分为对照组、维埃克斯染毒模型组及宾赛克嗪1、3、9 mg/kg治疗组.皮下注射维埃克斯13μg/kg染毒;宾赛克嗪组在染毒后5 min腹腔注射相应剂量药物.各组于染毒后3 h取血,检测血浆D-乳酸浓度及二胺氧化酶(DAO)活性;同时取小肠组织,观察肠黏膜形态和超微结构变化.结果 与对照组比较.模型组血浆D-乳酸浓度和DAO活性均明显升高[D-乳酸:(87.752±22.906)mg/L比(29.072±6.546)mg/L,DAO:(6.72±0.93)U/L比(2.99±0.43)U/L,均P<0.01];宾赛克嗪1、3、9 mg/kg组呈现剂量依赖性降低血浆D-乳酸浓度和DAO活性,其中宾赛克嗪9 mg/kg组可逆转染毒后血浆D-乳酸浓度[(45.290±11.141)mg/L]和DAO活性C(3.17±0.68)U/L]增高(均P<0.01).光镜下观察模型组大鼠空肠和回肠肠壁变薄,皱壁变短,结构紊乱,固有层毛细血管扩张充血,黏膜间质水肿等病理变化;电镜下观察模型组大鼠回肠上皮细胞发生坏死,细胞器损伤,紧密连接破坏等变化.宾赛克嗪1、3、9 mg/kg组呈现剂量依赖性抑制小肠的病理变化.结论 胆碱酯酶抑制剂中毒时出现肠黏膜上皮细胞损伤,肠黏膜屏障功能破坏,通透性增加;宾赛克嗪能抑制中毒肠黏膜屏障结构和功能的损伤.     

连续性高容量血液滤过对多器官功能障碍综合征患者血清炎性介质水平及血管内皮功能的影响研究

目的 探讨连续性高容量血液滤过(CHVHF)对多器官功能障碍综合征(MODS)患者血清炎性介质水平及血管内皮功能的影响.方法 选择2013年5月至2014年6月湖北省恩施自治州民族医院收治的80例MODS患者作为研究对象.采用随机数字表法将80例MODS患者分为研究组(n=40)与对照组(n=40).所有患者均有明确的原发疾病,且出现MODS,均符合《MODS诊断标准、病情严重度评分及预后评估系统和中西医结合证型诊断》中关于MODS的诊断标准.本研究纳入标准:年龄为35～68岁,符合MODS诊断标准,且首次行CHVHF治疗.排除标准:妊娠期妇女、接受免疫抑制治疗者及慢性肾功能衰竭者.对照组患者采用间歇性血液透析(IHD)及常规治疗方案,研究组患者在对照组治疗方案基础上进行CHVHF治疗.检测两组患者靶器官功能、血清炎性介质水平、血管内皮功能指标及治疗效果,并进行统计学分析.本研究遵循的程序符合湖北省恩施自治州民族医院医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象的知情同意,并与之签署临床研究知情同意书.两组受试对象性别构成比、年龄、原发病类型、急性生理和慢性健康状况评分系统(APACHE)Ⅱ评分、MODS评分、治疗时间等临床资料比较,差异均无统计学意义(P＞0.05).结果 ①治疗前,研究组与对照组MODS患者血清淀粉酶、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、肌酐及尿素氮水平比较,差异均无统计学意义(P＞0.05).治疗后,研究组患者血清淀粉酶、ALT、AST、肌酐及尿素氮水平与治疗前相比,均显著减低,并且差异均有统计学意义[血清淀粉酶水平:(156.7±17.4) U/L与(316.3±45.3) U/L,t=20.671,P=0.000;血清ALT水平:(62.1±7.8) U/L与(88.3±9.3) U/L,t=13.598,P=0.000;血清AST水平:(58.7±6.9) U/L与(108.4±12.4) U/L,t=22.209,P=0.000;血清肌酐水平:(125.2±15.5) μmol/L与(321.4±54.2) μmol/L,t=21.997,P=0.000;血清尿素氮水平:(12.1±1.5)mmol/L与(25.3±3.2) mmol/L,t=23.488,P=0.000].治疗后,对照组患者血清中上述5种靶器官功能指标与治疗前相比,亦均显著减低,并且差异亦均有统计学意义[血清淀粉酶水平:(241.1±30.4)U/L与(312.2±43.3) U/L,t=8.501,P=0.008;血清ALT水平:(87.7±9.3) U/L与(98.3±10.3) U/L,t=4.853,P=0.036;血清AST水平:(87.7±9.1)U/L与(107.6±13.1) U/L,t=7.878,P=0.010;血清肌酐水平:(189.7±23.4)μmol/L与(318.6±55.2) μmol/L,t=13.597,P=0.000;血清尿素氮水平:(18.6±2.3) mmol/L与(25.3±3.3) mmol/L,t=10.559,P=0.000].治疗后,研究组患者血清淀粉酶、ALT、AST、肌酐及尿素氮水平均显著低于对照组,并且差异均有统计学意义(t=15.218、17.645、16.029、14.506、14.796,P=0.000).②治疗前,研究组与对照组MODS患者血清降钙素原(CRP)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6与-8水平比较,差异均无统计学意义(P＞0.05).治疗后,研究组患者血清CRP、TNF-a、IL-6与-8水平治疗前均显著降低,并且差异均有统计学意义[血清CRP水平:(11.3±1.6) mg/L与(25.1±3.2)mg/L,t=24.035,P=0.000;血清TNF-α水平:(326.3±41.2) ng/L与(468.0±52.0) ng/L,t=13.502,P=0.000;血清IL-6水平:(64.1±6.8) ng/L与(123.2±22.1) ng/L,t=16.186,P=0.000;血清IL-8水平:(121.3±10.1) ng/L与(196.3±23.1) ng/L,t=18.781,P=0.000].治疗后,对照组患者血清中上述4种炎性介质水平与治疗前相比,亦均显著减低,并且差异亦均有统计学意义[血清CRP水平:(18.8±2.4)mg/L与(25.1±3.3)mg/L,t=9.731,P=0.000;血清TNF-α水平:(368.2±42,4)ng/L与(461.6±52.1) ng/L,t=12.865,P=0.000;血清IL-6水平:(78.1±7.3) ng/L与(123.1±21.1) ng/L,t=12.712,P=0.000;血清IL-8水平:(135.4±9.3) ng/L与(195.3±22.4) ng/L,t=15.572,P=0.000].治疗后,研究组患者血清中CRP、TNF-α、IL-6与-8水平均显著低于对照组,并且差异有统计学意义(t=11.619、4.486、8.850、6.489,P=0.000、0.035、0.005、0.022).③治疗前,研究组与对照组MODS患者血清可溶性细胞间黏附分子(sICAM)-1、可溶性血管细胞黏附分子(sVCAM)-1、血管性假血友病因子(vWF)及基质金属蛋白酶(MMP)-9水平比较,差异均无统计学意义(P＞0.05).治疗后,研究组患者血清sICAM-1、sVCAM-1、vWF及MMP-9水平与治疗前相比,均显著减低,并且差异均有统计学意义[血清sICAM-1水平:(203.4±32.3) μg/L与(445.3±56.2) μg/L,t=22.579,P=0.000;血清sVCAM-1水平:(325.5±35.2) μg/L与(436.4±48.2)μg/L,t=11.734,P=0.000;血清vWF水平:(263.4±34.5) μg/L与(512.4±60.2)μg/L,t=22.682,P=0.000;血清MMP-9水平:(104.5±16.6) μg/L与(148.3±26.5) μg/L,t=8.859,P=0.008].治疗后,对照组患者血清中上述4种内皮损伤因子水平与治疗前相比,亦均显著减低,并且差异均有统计学意义[血清sICAM-1水平:(313.5±45.7)μg/L与(442.2±55.3)μg/L,t=11.344,P=0.000;血清sVCAM-1水平:(389.6±35.6) μg/L与(435.9±47.6) μg/L,t=8.804,P=0.007;血清vWF水平:(341.3±41.3) μg/L与(508.6±59.3) μg/L,t=14.628,P=0.000;血清MMP-9水平:(126.1±21.6) μg/L与(147.6±25.6) μg/L,t=4.063,P=0.035].治疗后,研究组患者血清sICAM-1、sVCAM-1、vWF及MMP-9水平均显著低于对照组,并且差异有统计学意义(t=12.433、8.084、9.141、5.014,P=0.000、0.008、0.000、0.032).④研究组患者病情好转或痊愈率为80.0％(32/40),显著高于对照组的60.0％(24/40),并且差异有统计学意义(x2=4.713,P＜0.05).结论 CHVHF治疗有助于改善MODS患者靶器官功能,减低患者血清中炎性介质水平与内皮损伤因子水平,进而保护血管内皮功能,提高治疗效果.但因本研究纳入样本量较小,CHVHF治疗MODS的作用机制及确切疗效,尚有待更多的基础、临床研究予以证实.     

慢性肝病患者妇科腹腔镜手术耐受性分析

目的 探讨肝脏疾病基础的患者妇科腹腔镜手术的耐受性.方法 选择肝炎无症状携带者26例、轻型慢性肝炎28例、肝硬化代偿期患者21例进行妇科腹腔镜手术.均分别于术前及术后第1、3、7天抽血复查肝功能:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBil).结果 无症状携带者、轻型慢性肝炎患者妇科腹腔镜手术后第1天肝功能ALT、AST浓度较术前有上升,差异均有统计学意义[无症状携带者:ALT:术前(20.4±4.5) U/L,术后第1天(67.2±7.9)U/L,t=2.32;AST:术前(18.3±2.3)U/L,术后第1天(71.8±18.2) U/L,t=2.15.轻型慢性肝炎患者:ALT:术前(110.2±8.3)U/L,术后第1天(210.2±5.6)U/L,t=2.31;AST:术前(146.8±23.6)U/L,术后第1天(256.5±19.3)U/L,t =2.45.P均＜0.05];但术后第3、7天,2组以上两个指标的水平均接近术前,差异均无统计学意义(P均＞0.05);无症状携带者、轻型慢性肝炎者组术后各时期ALB、TBiL与术前比较,差异均无统计学意义(P均＞0.05).肝硬化代偿期组术后第1天表现为ALT、AST、TBiL浓度上升,差异均有统计学意义[ALT:术前(122.9±6.2) U/L,术后第1天(301.6±9.6) U/L,t =2.95;AST:术前( 156.6±12.7)U/L,术后第1天(327.8±21.8) U/L,t=3.11;TBiL:术前(28.2±2.1)μ mol/L,术后第1天(57.2±3.2)μmol/L,t =2.98.P均＜0.01];术后第3天略恢复,与术前相比差异有统计学意义[术后第3天:ALT( 235.4±7.9) U/L,t =2.41;AST( 241.5±20.7)U/L,t=2.33;TBiL(43.9±4.2)μmol/L,=2.67.P均＜0.05],但所有患者仍处于代偿期.术后第7天各项指标与术前相比差异均无统计学意义(P均＞0.05).结论 肝炎无症状携带者、轻型慢性肝炎、肝硬化代偿期患者妇科腹腔镜手术后可以出现肝功能的异常,但有可逆性.肝硬化代偿期患者手术后肝功能恢复较肝炎无症状携带者、轻型慢性肝炎患者迟,但患者仍处于代偿期.     

成人法洛四联症一期根治术后ICU延迟恢复的危险因素

目的探讨成人法洛四联症(tetralogy of Fallot,TOF)一期根治术后ICU延迟恢复的危险因素。方法行一期根治术成人TOF患者165例,依据ICU恢复时间分为延迟恢复组(ICU恢复时间超过总体75%分位)40例和对照组125例,比较2组一般资料、生化检查结果、病理特征及手术相关指标;多因素logistic回归分析TOF患者一期根治术后ICU延迟恢复的危险因素。结果延迟恢复组术前血肌酐水平[(80.14±22.31)μmol/L]高于对照组[(70.10±13.25)μmol/L],血小板计数[(159.28±65.01)×10~6/L]、左室射血分数(left ventricular ejection fraction,LVEF)[(61.55±7.77)%]低于对照组[(183.21±64.50)×10~6/L、(64.46±6.91)%](P0.05),体外循环时间[(189.21±95.82)min]、主动脉阻断时间[(134.93±52.69)min]、呼吸机辅助时间[(58.94±76.41)min]、ICU时间[(4.88±3.53)d]较对照组[(146.08±47.12)min、(107.62±35.62)min、(21.93±7.53)min、(1.50±0.76)d]长(P0.05),术后并发症发生率(25.00%)较对照组(2.40%)高(P0.05);多因素logistic回归分析结果显示,呼吸机辅助时间≥36h(OR=8.529,95%CI:2.650~27.458,P0.001),术前LVEF60%(OR=2.817,95%CI:1.020~7.776,P=0.046),术前血肌酐80 μmol/L(OR=2.635,95%CI:1.047~6.631,P=0.040),发生术后并发症(OR=5.869,95%CI:1.068~32.248,P=0.042)为成人TOF一期根治术后ICU延迟恢复的危险因素。结论术前心脏收缩功能不良(LVEF60%)、肾功能不良(血肌酐80μmol/L)、呼吸机辅助时间长(≥36h)、发生术后并发症是TOF患者一期根治术后ICU延迟恢复的危险因素。     

谷氨酰胺对脓毒症大鼠血清免疫刺激性的影响

目的 观察脓毒症大鼠血清对RAW264.7细胞的免疫刺激作用及谷氨酰胺(Gln)的影响,并探讨其保护作用的机制.方法 SD大鼠18只,随机分为假手术组(sham组)、脓毒症组、Gln处理组(GLN组).采用盲肠结扎穿孔术(CLP)制备大鼠脓毒症模型,术后即刻从尾静脉注射Gln 0.75 g/kg(GLN组)或等量生理盐水(sham和脓毒症组).3组均于术后6 h采血并取肺组织,并将血清与RAW264.7细胞孵育4 h后收集上清液.鲎试剂法定量测定血浆内毒素浓度;比色法检测血浆D-乳酸和血清Gln水平;酶联免疫吸附法(ELISA)测定肺组织及血清作用于RAW264.7细胞后上清液中肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平.结果 3组血清Gln浓度无明显差异.GLN组血浆D-乳酸和内毒素水平明显低于脓毒症组(D-乳酸:(2.04±0.13)mg/L比(5.08±0.47)mg/L;内毒素:(0.011±0.003)mg/L比(5.085±1.647)mg/L,P均<0.01].脓毒症组血清刺激内毒素激活的RAW264.7细胞释放炎症因子明显高于sham组,GLN组明显低于脓毒症组(P<0.05或P<0.01),而GLN组与sham组比较差异无统计学意义.GLN组肺组织匀浆中TNF-α浓度明显低于脓毒症组((31.01±14.23)μg/L比(80.18±26.27)μg/L,P<0.01].结论 脓毒症大鼠血清对巨噬细胞释放炎症因子有明显的促进作用,而Gln可抑制脓毒症血清的该作用,这可能与Gln改变肠道通透性有关.     

丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性和血浆二胺氧化酶的研究

目的探讨丙氨酰谷氨酰胺对重型颅脑损伤患者肠黏膜通透性及血浆二胺氧化酶的影响。方法选择2014年9月至2016年3月该院重症监护室收治的78例重型颅脑损伤患者,根据患者接诊时间进行编号后将单双号分成2组,均采取综合治疗,39例单号患者为对照组,接受普通营养支持,39例双号患者为观察组,同时给予丙氨酰谷氨酰胺增强营养支持,比较2组患者的治疗效果。结果治疗后观察组患者营养代谢指标血清清蛋白(ALB)为(37.78±4.20)g/L、转铁蛋白(TRF)为(2.38±0.36)g/L、前清蛋白(PA)为(0.48±0.04)g/L与治疗前比较,差异有统计学意义(t=7.70、7.48、6.80,P0.05);且与对照组比较,差异有统计学意义(t=7.03、6.87、6.30,P0.05)。治疗后观察组患者免疫球蛋白A(IgA)(2.79±0.36)g/L、免疫球蛋白G(IgG)(13.76±1.64)g/L、免疫球蛋白M(IgM)(2.28±0.42)g/L与治疗前比较,差异有统计学意义(t=7.43、7.30、7.04,P0.05);且与对照组比较,差异有统计学意义(t=6.60、6.81、6.30,P0.05)。与对照组比较,观察组患者治疗后第3、7天时乳果糖排泄率[(0.25±0.05)%、(0.18±0.06)%]明显降低(t=6.56、6.81,P0.05);治疗后第3、7天时血浆二胺氧化酶(DAO)[(2.92±0.25)、(1.57±0.18)U/mL]明显降低(t=7.20、6.92,P0.05);治疗后第1、3、7天时D-乳酸[(0.19±0.04)、(0.15±0.05)、(0.09±0.06)μg/L]均明显降低(t=7.52、8.02、8.29,P0.05);治疗后第3、7天时内毒素(LPS)[(0.27±0.06)、(0.16±0.03)U/L]明显降低(t=6.88、7.20,P0.05)。结论丙氨酰谷氨酰胺用于重症颅脑损伤患者能纠正营养代谢障碍,改善患者营养状况,保护肠道黏膜屏障功能,提高机体免疫力。     

血清基质金属蛋白酶-1、2、3、9在胸部主动脉疾病和急性心肌缺血中的检测及意义

目的 探讨血清基质金属蛋白酶(MMPs)-1、2、3、9在急、慢性胸部主动脉疾病和急性心肌缺血的变化及意义.方法 共80例急性主动脉夹层、慢性主动脉夹层、胸部主动脉瘤、急性心肌缺血患者及正常对照16例,采用ELISA方法检测血清MMP-1、2、3、9.结果与急性主动脉夹层组相比,急性心肌缺血组MMP-3升高,2组比较差异有统计学意义[(19.10±3.11) μg/L与(11.89±1.31) μg/L,P=0.02].与其他组相比,正常对照组MMP-1[(1.30±0.56) μg/L]明显低于急性夹层动脉瘤组[(2.99 ±0.78) μg/L,P=0.03]、慢性夹层动脉瘤组[(3.12 ±0.78) μg/L,P=0.02]、胸主动脉瘤组[(3.01±1.01) μg/L,P=0.03]、急性心肌缺血组[(5.01±0.98)μg/L,P=0.01].MMP-1与年龄增加呈正相关(r =0.38,P＜0.05).在急性主动脉夹层手术的患者,MMP-1、MMP-3和MMP-9含量手术后即刻较手术前升高,而MMP-2减少,差异均有统计学意义(P均＜0.05);术后24h,MMP-1、MMP-2及MMP-9回到术前水平.结论 对于胸主动脉疾病和急性心肌缺血,测定血清MMP含量为简单、快速、有效的临床指标,可在基层卫生中心开展.     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."