内毒素性播散性轿管内凝血家兔血浆肿瘤坏死因子水平的变化

采用间隔２４ｈ静脉注射内毒素（ＬＰＳ）的方法，给家兔诱导全身性施瓦茨曼反应（ＧＳＲ），以此作为家兔内毒素性 播散性血管内凝血（ＤＩＣ）模型。在造模前后不同时间采用ＥＬＩＳＡ方法测定血浆肿瘤坏因子（ＴＮＦ）水平。结果：在第１次注射ＬＰＳ后２ｈ血浆ＴＮＦ水平最高，其次为第２次注射ＬＰＳ后６ｈ和１２ｈ，均较 实验前明显升高。作者初步讨论了不同时相出现ＴＮＦ高峰的可能机制。     

内毒素性播散性血管内凝血家兔血浆白细胞介素8的动态变化及其发生机制

探讨播散性血管内凝血（ＤＩＣ）时循环血中血浆白细胞介素８（ＩＬ８）的动态变化规律及其可能的发生机制。采用间隔２４小时两次静脉注射内毒素（ＬＰＳ）方法制作家兔内毒素性ＤＩＣ模型。在模型复制前后不同时间采用夹心酶联免疫吸附法（ＥＬＩＳＡ）测定ＩＬ８水平；同时观察了外周血白细胞（ＷＢＣ）和中性粒细胞（ＰＭＮ）及脏器组织的病理变化。实验发现：在第１次注射ＬＰＳ后２小时血浆ＩＬ８出现峰值（８３９．８１±５６．６１ｎｇ／Ｌ），其次为第２次注射ＬＰＳ后２小时ＩＬ８为６５４．３７±６８．３８ｎｇ／Ｌ，且呈平坦的单峰曲线，持续时间较长（６小时），均较实验前（４２．９４±１３．８５ｎｇ／Ｌ）明显增高（Ｐ＜０．０１）。ＩＬ８与ＷＢＣ和ＰＭＮ计数变化密切相关（ｒ＝０．８０９，Ｐ＜０．０１；ｒ＝０．７９５，Ｐ＜０．０１）。作者认为：ＩＬ８参与内毒素性ＤＩＣ的发生，确定机体受内毒素攻击后释放ＩＬ８的时机，适时应用拮抗剂，将具有重要的临床意义     

急性肺损伤的炎症反应机制与药物治疗探讨

目的：探讨急性肺损伤的炎症反应机制以及雷公藤单体Ｔ４（Ｔ４）对炎症反应的影响。方法：小鼠腹腔注射内毒素（ＬＰＳ）复制急性肺损伤模型。动物分为生理盐水对照组、ＬＰＳ组、Ｔ４组（腹腔注射Ｔ４ ８５ μｇ／ｋｇ）和地塞米松组（地塞米松７０ ｍ ｇ／ｋｇ）。酶联免疫吸附法测定肿瘤坏死因子 α（ＴＮＦ α）、白细胞介素 １β（ＩＬ １β）、ＩＬ ６ 和ＩＬ １０ 浓度。一氧化氮（ＮＯ）的产物ＮＯ－２ 浓度以Ｇｒｉｅｓｓ法测定。以肺湿重与干重比值反映肺含水量。结果：Ｔ４组小鼠肺湿重与干重比值（３．９０±０．６２）与ＬＰＳ组（５．９５±０．９９）比较显著降低（Ｐ＜ ０．０５）。ＬＰＳ组血浆ＴＮＦ α、ＩＬ １β和ＩＬ ６浓度分别为（１３２．５±５．０）ｎｇ／Ｌ、（１８３．７±５８．６）ｎｇ／Ｌ和（３ ２９０．１±９２４．２）ｎｇ／Ｌ，Ｔ４组血浆ＴＮＦ α（０ ｎｇ／Ｌ）与ＬＰＳ组比较显著降低，Ｔ４ 组血浆ＩＬ １β和ＩＬ ６〔（３９．１±３１．８）ｎｇ／Ｌ和（８５９．６±８２９．９）ｎｇ／Ｌ〕与ＬＰＳ组比较亦显著降低。与ＬＰＳ组比较，Ｔ４ 组小鼠肺泡灌洗液中ＴＮＦ α浓度从（２２９．３±２０．３）ｎｇ／Ｌ显著降低到（２８．５±３３．４）ｎｇ／Ｌ。     

免疫吸附特异性清除循环肿瘤坏死因子-α对内毒素休克时心脏损伤的保护作用

目的：探讨免疫吸附特异性清除循环肿瘤坏死因子α（ＴＮＦα）对内毒素休克时心脏损伤的影响及其可能机制。方法：给新西兰白兔一次性静注大肠杆菌内毒素（ＬＰＳ）８．０×１０９ＣＦＵ／ｋｇ,１小时后经抗ＴＮＦα单克隆抗体亲和免疫吸附柱进行血液灌流２小时,观察平均动脉压（ＭＡＰ）,血浆ＴＮＦα活性和丙二醛（ＭＤＡ）含量,血清天冬氨酸转氨酶（ＡＳＴ）、乳酸脱氢酶（ＬＤＨ）和α羟丁酸脱氢酶（ＨＢＤＨ）以及全血谷胱甘肽过氧化物酶（ＧＳＨＰｘ）活力变化。注射ＬＰＳ后２４小时取心脏行组织病理检查。结果：免疫吸附治疗后,动物低血压状态明显改善;血浆ＴＮＦα水平迅速下降,ＭＤＡ含量明显降低;全血ＧＳＨＰｘ活力显著提高;血清ＡＳＴ、ＬＤＨ和ＨＢＤＨ明显下降;心肌充血、多形核粒细胞浸润及心肌细胞变性坏死均明显减轻。结论：免疫吸附特异性清除循环ＴＮＦα能显著减轻内毒素休克时心脏损伤的程度     

热毒清对内毒素性播散性血管内凝血家兔血液肿瘤坏死因子白细胞介素－1和血小板活化因子的影响

采用间隔２４ｈ两次静脉注射内毒素方法制作家兔内毒素性播散性血管内凝血（ＤＩＣ）模型，同时给予生理盐水、地塞米松和热毒清等不同处理。结果：地塞米松组和热毒清组造模后测得的血浆肿瘤坏死因子（ＴＮＦ）、全血血小板活化因子（ＰＡＦ）、外周血单个核细胞（ＰＢＬＭＮＣ）诱生ＴＮＦ和诱生白细胞介务－１（ＩＬ－１）的水平均较模型组有明显降低（Ｐ＜０．００１～０．０５）；病理学检查亦发现地塞米松组和热毒清组家兔的肝、肺组织出血、坏死和肝、肺、肾组织中微血栓形成的程度均较模型组轻。说明热毒清和地塞米松均能阻抑内毒素性ＤＩＣ的发生和发展，其作用机制可能是降低血液中ＴＮＦ、ＩＬ－１和ＰＡＦ等炎症介质的水平，从而减轻血管内皮细胞和组织器官损伤，防止凝血系统激活。     

肿瘤坏死因子对大鼠器官功能损伤的实验研究

将２１只大鼠随机分成肿瘤坏死因子作用２４ｈ组、７２ｈ组和生理盐水对照组。实验组用重组人的肿瘤坏死因子α型（ｒｈ－ＴＮＦ－α）×１０￣５Ｕ·ｋｇ￣（－１）／ｄ持续静脉泵入，分别于２４ｈ．７２ｈ活杀，观察血液及心、肝、肺、肾、肠组织ＴＮＦ水平；过氧化物歧化酶（ＳＯＤ）活性；丙二醛及血浆内毒素含量；组织超弱发光和白细胞吞噬发光、血气、肝肾功能及血培养情况。结果：实验２４ｈ组血浆ＴＮＦ显著升高，各脏器功能无明显受损，血培养及内毒素测定阴性、白细胞吞噬功能无变化；但ＴＮＦ可使血浆及组织氧自由基和脂质过氧化产物增加，全血ＳＯＤ活性下降。     

多器官衰竭患者血中肿瘤坏死因子与纤维连结蛋白的动态观测及临床意义

对１７例已发生多器官衰竭（ＭＯＦ）的患者，于发病后第１～２０天分别进行血浆肿瘤坏死因子（ＴＮＦ）与纤维连结蛋白（ｆｎ）的动态观测。结果：①全部患者病程各时间点的血浆Ｆｎ均值均低于正常值（２５２．１２±２４．７２ｍｇ／Ｌ），ＴＮＰ均值则明显高于正常值（５．５０±０．２７ｕｇ／Ｌ）。②ＭＯＦ发生５天内Ｆｎ均值波动下降，第６天有明显回升达正常界限，第７天降低后再度明显回升，但于第１０天又见下降而后波动在１８０．００～２３０．００ｍｇ／Ｌ。③ＴＮＦ均值在ＭＯＦ发生５天内逐日上升，达到４５．００１ｕｇ／Ｌ，而后虽有一定波动，但基本持续在３２．００ｕｇ／Ｌ以上。作者认为：与正常人比较，ＴＮＦ的增高变化比Ｆｎ降低变化更为明显，且较稳定，故作为诊断参考指标１ＮＦ比Ｆｎ更有价值。     

低分子量肝素对大鼠内毒素休克的保护作用

用大鼠内毒素（ＬＰＳ）休克模型，观测其平均动脉压（ＭＡＰ）、血浆肿瘤坏死因子（ＴＮＦ）、组织因子（ＴＦ）、组织因子途径抑制物（ＴＦＰＩ）含量、抗凝血酶Ⅲ（ＡＴⅢ）活性的变化、血白细胞及血小板计数，探讨低分子量肝素（ＬＭＷＨ）对大鼠内毒素休克的作用。结果：ＬＰＳ组大鼠ＭＡＰ呈进行性下降，血浆ＴＮＦ和ＴＦ含量显著升高，ＡＴⅢ活性明显降低，ＴＦＰＩ／ＴＦ比值降低，血白细胞和血小板计数下降，与对照组比较差异显著；而ＬＭＷＨ＋ＬＰＳ组的以上指标变化与对照组比较均无显著性差异。证明ＬＭＷＨ对ＬＰＳ所致的大鼠休克有保护作用     

急性肺损伤肺组织和血浆NO、ET-1变化的研究

目的 探讨急性肺损伤（ＡＬＩ）时肺组织和血浆一氧化氮（ＮＯ）、皮内素－１（ＥＴ－１）和白细胞介素８（ＩＬ－８）水平的变化和作用。方法 采用间隔２４ｈ两次注射大肠杆菌内毒素（ＬＰＳ）的方法,复制家兔内毒素急性肺损伤模型。结果 ＡＬＩ组浆、肺组织均浆及支气管肺泡灌洗液（ＢＡＬＦ）中ＮＯ、ＥＴ－１和ＩＬ－８水平显著升高（Ｐ〈０．０１）,ＢＡＬＦ内中性料细胞（ＰＭＮ）明显增多,肺系数（ＬＰＬ）、肺水含量     

内毒素休克兔循环血一氧化氮和内皮素—1的动态观察

目的：观察内毒素休克兔循环血一氧化氮（ＮＯ）和内皮素１（ＥＴ１）的动态变化，进一步探讨内毒素休克的发病机制。方法：新西兰白兔２５只，经颈外静脉一次性注射大肠杆菌内毒素（ＬＰＳ，Ｅ．ｃｏｌｉＯ１１１Ｂ４８．０×１０９ｃｆｕ／ｋｇ），观察平均动脉压（ＭＡＰ）、血浆肿瘤坏死因子α（ＴＮＦα）、ＮＯ－２和ＥＴ１的动态变化，以及组织一氧化氮合酶（ＮＯＳ）活性与器官功能变化。结果：一次性注射ＬＰＳ后，ＭＡＰ呈双相下降；血浆ＴＮＦα活性变化呈陡直的单峰曲线；ＮＯ－２含量于实验后３０分钟迅速增高，实验后６小时达峰值，实验后２４小时仍高于实验前；实验后２４小时心脏组织中ＮＯＳ活性明显高于肝、肺和肾组织；血浆ＥＴ１含量呈双相增高（０．５小时、８小时），实验后２４小时仍高于注射前；血浆ＮＯ－２与ＥＴ１含量呈显著正相关；肝、肾功能损害进行性加重。结论：一次性静注ＬＰＳ后，ＮＯ的生成迅速而持久地增加，ＥＴ１的合成与释放则呈双相增加。ＮＯ与ＥＴ呈显著正相关     

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.     

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.     

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.     

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.     

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.     

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.