基质金属蛋白酶及其抑制剂与急性心肌梗死的关系

目的 检测急性心肌梗死(AMI)患者血清中基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶-9(MMP-9)以及基质金属蛋白酶抑制剂-1(TIMP-1)的水平变化,探讨MMP-3、MMP-9及TIMP-1与AMI的关系.方法 选择急性心肌梗死(AMI) 患者67例,其中男44例,女23例,发病3小时至5天.入院后肘正中静脉采血,选择同期住院非冠心病患者40例作为对照组,应用ELISA法测定血清MMP-3、MMP-9、TIMP-1含量.结果 AMI组和对照组血清中MMP-3含量为(34.1±36.1)ng/mL和(10.5±5.0)ng/mL(P＜0.01),MMP-9含量为(381.0±103.2 ng/mL)ng/mL和(205.6±80.2 ng/mL)ng/mL(P＜0.01),TIMP-1含量为(2 382.2±1 011.8 ng/mL)ng/mL和(1 952.8±1 126.9 ng/mL)ng/mL(P＜0.05),MMP-3/TIMP-1比值为(0.015 2±0.013 4)和(0.008 7±0.011 1)(P＜0.05),MMP-9/TIMP-1比值为(0.179 3±0.059 6)和(0.144 6±0.096 6)(P＜0.05).结论 MMP-3、MMP-9过度表达以及MMP-3/TIMP-1、MMP-9/TIMP-1比例失衡,导致了动脉粥样斑块的破裂和心肌梗死的发生.     

血清基质金属蛋白酶及其组织抑制物的变化及临床意义

目的探讨原发性高血压（EH）患者血清基质金属蛋白酶（MMPs）及其组织抑制物（TIMPs）检测的变化及临床意义。方法采用酶联免疫吸附试验法分别测定90例未经治疗的EH患者（EH组）和60例健康体检者（对照组）血清MMP-9和TIMP-1水平。经6个月降压治疗后，检测EH患者的血清MMP-9和TIMP-1水平，并与治疗前进行对比分析。结果治疗前EH组的血清MMP-9和TIMP-1水平明显低于对照组，差异有统计学意义（P〈0、01，t=8、484、8、483）。EH组患者MMP-9与TIMP-1呈显著正相关（r=0．585，P〈0、01），但其水平与收缩压和舒张压无相关性（P〉0．05）。与治疗前相比，EH组治疗后的血清MMP-9和TIMP-1水平明显增高，差异有统计学意义（P〈0．01，t=16．597、26．298）。结论EH患者MMP-9和TIMP-1降低可能反映了EH患者细胞外基质代谢异常，可将其作为EH相关血管活性异常的间接标志物。     

基质金属蛋白酶-1及其组织抑制因子-1、肿瘤坏死因子-α在溃疡性结肠炎患者外周血中的表达及其意义

目的探讨基质金属蛋白酶-1（MMP-1）及其组织抑制因子-1（TIMP-1）、肿瘤坏死因子-α（TNF-α）在溃疡性结肠炎患者外周血中的表达及其意义。方法46例溃疡性结肠炎患者与40例健康体检者,分别设为UC组与对照组。清晨空腹采取静脉血,离心分离血浆,ELISA法检测血浆中MMP-1、TIMP-1、TNF-α水平。结果UC组患者（活动期,缓解期）血浆MMP-1、TIMP-1、TNF-α水平明显高于对照组（P〈0．05）;UC组活动期MMP-1、TIMP-1、TNF-α水平明显高于缓解期（P〈0．05）。不同病情UC患者血浆MMP-1、TIMP-1、TNF-α水平有显著差异（P〈0．05）,病情越重,血浆MMP-1、TIMP-1、TNF-α水平越高。结论外周血MMP-1、TIMP-1、TNF-α水平可反映UC病情变化。     

系统性红斑狼疮患者外周血中基质金属蛋白酶-3及其金属蛋白酶组织抑制剂-1的表达及其临床意义

目的研究系统性红斑狼疮(SLE)患者血清中基质金属蛋白酶-3(MMP-3)及金属蛋白酶组织抑制剂-1(TIMP-1)的表达,分析MMP-3、TIMP-1与各临床指标及不同肾脏病理类型之间的关系。方法采用酶联免疫吸附法(ELISA)对60例SLE患者及30例健康人血清中MMP-3及TIMP-1的水平同时检测后进行分析。结果 SLE患者血清MMP-3、TIMP-1水平均较正常人降低,MMP-3/TIMP-1比值较正常人升高(P<0.001);狼疮肾炎(LN)患者血清MMP-3、TIMP-1水平均较非LN患者降低(P<0.001);活动期患者血清MMP-3、TIMP-1水平均较缓解期患者降低(P<0.001);各病理类型LN组间血清MMP-3、TIMP-1水平差异无统计学意义(P>0.05);血清MMP-3、TIMP-1水平与尿蛋白、SLE疾病活动指数(SLEDAI)、抗ds-DNA呈负相关(rs-MMP-3分别为-0.507、-0.817、-0.457,P<0.001;rs-TIMP-1分别为-0.416、-0.720、-0.506,P<0.001),与补体C3、C4呈正相关(rs-MMP-3分别为0.346、0.377,P<0.01;rs-TIMP-1分别为0.418、0.361,P<0.01),与ESR、CRP、BUN、Scr无明显相关性(P>0.05)。结论血清MMP-3、TIMP-1水平在SLE患者中降低,降低的程度可以反映SLE病情活动情况;MMP-3与TIMP-1比例失衡可能在SLE的发病机制中起重要作用。     

MMP-9、TIMP-1、IGF-1在子宫内膜异位症不孕患者中的动态监测意义

目的探讨基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶组织抑制物-1(TIMP-1)、胰岛素样生长因子-I(IGF-1)水平在子宫内膜异位症不孕中的动态监测意义。方法选取2017年10月-2019年10月本院子宫内膜异位症不孕患者278例作为观察组,同期健康体检女性86例作为对照组。观察组根据患者疾病特征选取治疗方案,对比两组、观察组不同美国生育协会(R-AFS)分期患者、是否受孕患者血清MMP-9、TIMP-1、IGF-1水平,分析血清MMP-9、TIMP-1、IGF-1水平与R-AFS分期关系、血清MMP-9、TIMP-1、IGF-1单独及联合预测受孕的价值。结果观察组血清MMP-9、IGF-1水平高于对照组,TIMP-1水平低于对照组(P0.05);观察组随R-AFS分期升高,血清MMP-9、IGF-1水平呈升高趋势,TIMP-1水平呈降低趋势(P0.05);血清MMP-9、IGF-1水平与R-AFS分期呈正相关,TIMP-1水平与R-AFS分期呈负相关(P0.05);血清MMP-9、TIMP-1、IGF-1水平联合预测受孕的AUC值大于任一指标单独预测(P0.05)。结论 MMP-9、TIMP-1、IGF-1水平变化与子宫内膜异位症不孕患者R-AFS分期关系密切,且是术后受孕的影响因素,动态监测可为临床完善治疗方案提供参考。     

肺炎患儿血清MMP-9、TIMP-1、sICAM-1、IL-6的变化及其意义

目的探讨重症肺炎患儿血清基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-1(TIMP-1)、可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素-6(IL-6)的水平变化及其意义。方法选取我院2016年1月-2017年1月儿科收治的120例肺炎患儿,根据病情分为重症肺炎组52例、轻症肺炎组68例,选取同期健康婴幼儿60例(对照组),检测并对比两组的血清MMP-9、TIMP-1、sICAM-1、IL-6水平,并根据病原学检测结果、治疗前后进行对照分析。结果重症组患儿的血清MMP-9、TIMP-1、sICAM-1、IL-6水平显著的高于轻症组、对照组(P0.05);轻症组的血清MMP-9、TIMP-1、sICAM-1、IL-6水平显著高于对照组(P0.05);病毒感染组患儿的血清MMP-9、TIMP-1、sICAM-1、IL-6水平显著的高于非病毒感染组患儿(P0.05);治疗后,恢复期的肺炎患儿的血清MMP-9、TIMP-1、sICAM-1、IL-6水平较急性期均显著的降低(P0.05)。结论肺炎患儿血清MMP-9、TIMP-1、sICAM-1、IL-6水平在不同病情、病原体及治疗阶段皆有变化,可以作为临床诊断及治疗的参考指标。     

劳力性热射病患者APACHEⅡ评分与TIMP-1及MMP-9、PCT的相关性研究

[目的]探讨劳力性热射病（EHS）患者血清中基质金属蛋白酶抑制剂-1（TIMP-1）水平与基质金属蛋白酶-9（MMP-9）、降钙素原（PCT）等相关因子水平及与急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）的相关性.[方法]回顾性分析本院住院部2010年5月至2013年10月收治的49例EHS患者,根据患者的APACHEⅡ评分为低分组、高分组.比较两组患者的TIMP-1、PCT、MMP-9水平（采用ELISA方法检测）及与APACHEⅡ评分的相关性.[结果]在不同APACHEⅡ评分患者中,低分组患者的TIMP-1水平明显高于高分组患者,MMP-9、PCT水平则明显低于高分组患者,且两组相比较差异均有显著性（均P＜0.01）.相关分析显示TIMP-1与A-PACHEⅡ评分存在明显负相关（P＜0.01）,MMP 9、PCT等与APACHEⅡ存在正相关（P＜0.01）.[结论]EHS患者血清炎症因子与APACHEⅡ评分关系密切,可作为病情进展评价及疗效判定的指标,其可为临床诊疗该疾病提供新的思路.     

基质金属蛋白酶3联合C反应蛋白检测评估女性类风湿关节炎病情活动性

目的 探讨血清基质金属蛋白酶3 （MMP-3）联合C反应蛋白（CRP）检测在女性类风湿关节炎（RA）病情活动性评估中的价值.方法 酶联免疫吸附法分别检测100例女性RA患者及31例正常女性血清MMP-3水平并收集临床资料,应用受试者工作特征曲线（ROC）进行诊断价值分析.结果 （1）女性RA患者血清MMP-3水平显著高于正常对照组（P＜0.001）,活动期（DAS28≥2.6,n=75）显著高于缓解期（DAS28 ＜2.6,n=25,P ＜0.001）,并与CRP（r =0.544,P＜0.001）、ESR（r=0.449,P ＜0.001）、DAS28（r=0.414,P＜0.001）等呈显著正相关;（2）根据试剂盒提供的女性正常参考值范围上限60 ng/ml,血清MMP-3诊断女性RA病情活动的敏感度为92％,特异度为48％;（3）血清MMP-3诊断女性RA病情活动的ROC曲线下面积为0.81（P ＜0.001）,最佳诊断界限值为216 ng/ml,相应的敏感度为56％,特异度为92％;（4）血清MMP-3与CRP联合检测诊断女性RA病情活动的敏感度（97％）较单独检测CRP（84％）显著升高（x2=7.878,P=0.005）,特异度（96％）较单独检测血清MMP-3显著升高（x2=14.86,P＜0.001）.结论 血清MMP-3可用于评估女性RA患者病情活动性,MMP-3联合CRP检测可提高诊断的敏感度和特异度,是最佳的联合检测方案.     

多发性硬化患者血清及脑脊液中抗CNPase抗体和基质金属蛋白酶-9水平的临床意义

目的通过观察多发性硬化(MS)患者血清和脑脊液(CSF)中抗2',3'-环核苷酸磷酸二酯酶(CNPase)抗体的阳性率,以及基质金属蛋白酶-9(MMP-9)水平的动态变化规律,探讨其对疾病诊断的价值。方法选取MS患者69例为观察组,同时期健康者64例为对照组。采用酶联免疫吸附法(ELASE)测定并比较两组患者血清及脑脊液中的抗CNPase抗体阳性率和MMP-9水平。结果观察组患者血清及CSF中抗CNPase抗体阳性率均明显高于对照组(P<0.05);观察组急性期患者血清和CFS中的MMP-9水平均明显高于对照组和缓解期(P<0.05),且缓解期与对照组比较,差异无统计学意义(P>0.05)。结论血清及脑脊液中抗CNPase抗体检测可为MS的诊断提供重要依据,MMP-9水平在MS患者的血清及脑脊液中的动态变化规律可以反映疾病活动性。     

超声造影评估基质金属蛋白酶-9活化调控对颈动脉斑块内新生血管的影响

目的 应用颈动脉超声造影（CEUS）技术半定量评估斑块内新生血管（IPN），探讨基质金属蛋白酶-9(MMP-9)启动子基因-1562C/T变异、MMP-9与基质金属蛋白酶组织抑制剂-1比值（MMP-9/TIMP-1）对IPN的影响。方法 纳入180例颈动脉粥样硬化斑块患者，应用CEUS评估IPN分级并分组。ELISA法检测血清MMP-9、TIMP-1水平，Sanger法对基因测序；应用相关性分析及logistic回归分析各参数对IPN的影响并绘制ROC曲线。结果 血清MMP-9、MMP-91562C/T变异、MMP-9/TIMP-1比值与IPN超声造影分级呈正相关（r=0.332,r=0.238,r=0.683,P <0.001）,logistic回归显示MMP-9/TIMP-1比例失衡是IPN独立危险因素（OR=6.110,95%CI:1.097～34.033,P=0.039）,MMP-9/TIMP-1比值≥2.12,IPN超声造影分级≥Ⅲ级的AUC为0.89，敏感度为84.90%，特异度为85.10%。结论 MMP-9酶抑制剂调控MMP-9/TIMP-1比例失衡是IPN独立危...     

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.