产气脂质纳米粒的制备及其光声成像研究

目的研制一种可生物降解,其产物可完全排除机体的光声成像材料。方法采用薄膜水化法加脂质体挤出法制备产气脂质纳米粒;应用肉眼、光镜、电镜、激光粒径仪检测纳米粒物理特性;光声成像仪、红外光谱仪探讨纳米粒光声成像机制;应用光声成像仪检测纳米粒体外、体内成像效果及安全性。结果肉眼观察碳酸氢铵脂质纳米粒呈透明乳状,粒径(230.9±54.58)nm,电位(-22.8±5.75)m V,稳定性较好。纳米粒光声信号随浓度、温度、时间增加而增强;体外激光辐照对细胞无损伤作用。经鼠尾静脉注入纳米粒,各组正常裸鼠血氨浓度均较对照组升高(均P0.05),但精神体征与对照组无明显改变。荷瘤裸鼠肿瘤局部出现光声信号,于4 h达到高峰,随后逐渐消失;激光能量对皮肤及皮下组织均无损伤作用。结论碳酸氢铵脂质纳米粒可用于光声成像,且安全、有效、价廉、无副作用。     

一种产气超声/光声双模态纳米粒的制备及性质检测

目的 研制一种包碳酸氢铵溶液的脂质纳米粒,并观察其超声/光声成像效果。方法 采用薄膜水化法加挤出法制备脂质包裹碳酸氢铵溶液的纳米粒,光镜、电镜、激光粒径仪和电位检测仪检测纳米粒一般物理特性,并通过光声成像仪观察其超声/光声成像效果。结果 制备的纳米粒呈圆球形,形态规则,大小分布均匀,无明显聚集,平均粒径为(230.90±54.58)nm,电位为(-22.81±5.75)mV。碳酸氢铵纳米粒有超声/光声信号,双蒸水纳米粒无超声/光声信号。结论 成功制备包碳酸氢铵溶液脂质纳米粒,可用于超声及光声成像,为进一步体外、体内成像实验奠定了基础。     

载印度墨水相变型光声/超声双模态造影剂的制备及体外显影

目的 制备一种新型的光声/超声双模态造影剂,观察其体外光致相变作用以及光声/超声显影效果。方法 采用多步乳化法 合成载印度墨水及全氟己烷(PFH)的高分子微球(i-PFH-PLGA),检测其基本理化性质、光致相变作用及体外增强光声及超声成像的显像效果。结果 制备的i-PFH-PLGA呈球型,平均粒径为(542.1±68.91)nm。经激光辐照后,显微镜下可观察到较多的i-PFH-PLGA纳米粒发生液气相转变产生微泡;体外光声成像实验显示,i-PFH-PLGA纳米粒可检测到明显的光声信号,且光声信号的强度随纳米粒浓度的增加而增强;体外超声成像实验显示,经激光照射后,i-PFH-PLGA纳米粒组回声强度较辐照前明显增强(P<0.05),而单纯的液态氟碳和印度墨水辐照前后回声强度未见明显改变。结论 成功制备出的载印度墨水和液态氟碳的双模态造影剂可用于体外光声/超声成像研究。     

载吲哚菁绿和液态氟碳的光致相变型纳米粒的制备及增强体内成像的实验研究

目的制备一种光致相变型液态氟碳纳米粒,研究其体外相变及体内增强光声、超声成像能力。方法采用三步乳化技术制备出以聚乳酸-羟基乙酸共聚物(PLGA)为载体,液态氟碳(PFH)和吲哚菁绿(ICG)为内核的纳米粒,检测该纳米粒的粒径和电位,然后体外激光辐照激发纳米粒相变,体内观察该纳米粒增强超声及光声成像的能力。结果成功制备出包裹PFH和ICG的光致相变型纳米粒,该纳米粒平均粒径(599.2±134.3)nm,平均电位(-24.10±4.09)m V。激光辐照后,纳米粒可发生相变转变成微米级的微泡,体内增强了裸鼠移植瘤的光声及超声信号。结论制备的光致相变型纳米粒在激光作用下发生相变,并可增强体内超声、光声成像,为临床疾病的诊断提供了新的思路。     

一种产气纳米粒光声成像机制及体外成像的实验研究

目的通过体外实验观察脂质包裹的碳酸氢铵纳米粒用于光声成像的效果,并探讨其光声成像机制。方法应用红外光谱仪及光声成像仪分别检测各相关物质获得光谱图及光声信号图,阐明纳米粒成像机制;然后用光声成像仪检测纳米粒在不同时间、浓度、温度的变化情况。结果 (1)碳酸氢铵溶液近红外吸收峰约在1 300nm,包水纳米粒、氨水和葡萄糖约在1 100nm,双蒸水约在720nm,CO2约在700nm。(2)纳米粒随辐照时间,光声信号强度逐渐增大,然后再逐步降低;纳米粒浓度降低,产生光声信号强度及面积减小;纳米粒随温度升高,光声信号强度及面积增加。结论产气光声成像造影剂在体外具有光声成像的能力,并随时间、浓度、温度的增加可增强成像效果;CO_2可能是该造影剂光声成像的原因。     

载ICG和PFH的光致相变型纳米粒—一种双模态分子探针宫玉萍 陈澄 孙阳 王志刚

目的 制备一种光致相变型液态氟碳纳米粒,研究其体外相变及体内增强光声、超声成像能力。方法 采用三步乳化技术制备出以PLGA为载体,液态氟碳(PFH)及吲哚菁绿(ICG)为内核的纳米粒,检测该纳米粒的的粒径、电位,然后体外激光辐照激发纳米粒相变,体内观察该纳米粒增强超声及光声成像的能力。结果 成功制备出包裹PFH和ICG的光致相变纳米粒,为球形,其平均粒径为599.2nm,平均电位为-24.1mv。激光辐照纳米粒时,纳米粒可发生相变转变成微米级的微泡,体内增强了裸鼠移植瘤的光声及超声信号。结论 制备的光致相变型纳米粒在激光作用下发生相变并增强体内超声、光声成像,为临床疾病的诊断提供新思路。     

携IR780碘化物液态氟碳纳米粒造影剂的制备及体外双模态成像

目的 制备携带IR780碘化物的液态氟碳纳米粒（IFNPs）,观察其体外超声/光声双模态成像效果。方法 以羟基端乳酸/羟基乙酸共聚物（PLGA-COOH）、IR780碘化物和全氟戊烷（PFP）为原料,采用双乳化法制备PLGA包裹的纳米粒IFNPs。以光学显微镜、共聚焦显微镜、透射电子显微镜及扫描电子显微镜检测其一般物理特性;以马尔文粒径分析仪分析其粒径大小、分布及表面电位;以紫外分光光度计测定IFNPs中IR780的包封率;观察IFNPs体外光声成像和超声成像的能力。结果 成功制备出IFNPs,其形态规则,大小均一,透射电子显微镜下表现为外壳黑色、内部灰白色的球形结构,扫描电子显微镜显示纳米粒表面光滑。IFNPs粒径为（241.87±3.47）nm,电位为（-0.766±0.096）mV,IR780包封率为（90.38±0.48）%。随IFNPs浓度增加,体外光声成像及超声成像效果均显著增强。结论 携带IR780碘化物的液态氟碳纳米粒造影剂制备成功,可用于体外超声/光声双模态成像。     

单宁酸铁包裹的载全氟己烷纳米粒三模态成像的实验研究

目的制备一种三模成像纳米粒,评价其光声/超声/磁共振成像效果。方法制备载单宁酸铁(Fe~ⅢTA)并包裹全氟己烷(PFH)的PLGA纳米粒。检测其相关表征。体外评估Fe~ⅢTA/PLGA/PFH纳米粒在激光辐照后的温度变化和超声信号变化。激光激发后进行光声信号采集。并对不同Fe浓度纳米粒MRI成像。结果成功制备Fe~ⅢTA/PLGA/PFH纳米粒,其粒径为(229.4±37.94)nm,电位为(-17.6±7.64)mV。激光辐照后,纳米粒温度升高,超声成像提示回声强度明显增强;激光辐照后,光声成像检测到明显的光声信号;磁共振成像显示Fe~ⅢTA/PLGA/PFH纳米粒在T1W1呈高信号。结论成功制备Fe~ⅢTA/PLGA/PFH纳米粒,具有良好的光热效应,具有良好的体外光声/超声/磁共振成像效果。     

产气光声成像造影剂在荷瘤裸鼠的研究

目的体内实验观察产气光声成像造影剂成像效果及其安全性。方法应用光声成像仪检测荷瘤裸鼠皮下肿瘤光声成像效果,血氨测定和裸鼠精神体征观察,并行肉眼观及病理检测。结果 (1)纳米粒注入荷瘤鼠后皮下肿瘤处30min见少量光声信号,1h逐渐增多,光声信号强度逐渐增大,4h达高峰,然后逐渐减少,24h完全消失;对照组与空白对照组注射前后均未见光声信号。(2)经鼠尾静脉注入纳米粒各组正常裸鼠血氨浓度均较对照组升高(P0.05),但精神体征观察1个月,精神好、行动灵敏、大便成形、觅食及活动与对照组无明显改变。(3)肉眼观察肿瘤局部皮肤完整、无损伤。(4)病理检查皮肤及皮下肿瘤细胞未见明显坏死,结构完整。结论脂质包裹碳酸氢铵光声成像造影剂可用于体内光声成像,是一种安全、有效、价廉和无副作用的光声成像增效剂。     

载血卟啉单甲醚高分子纳米粒用于光声显像引导下声动力治疗:实验研究

目的 制备一种载血卟啉单甲醚（HMME）的多功能分子探针,评估其体外光声成像及声动力治疗（SDT）效果。方法 采用双乳化法制备载HMME的聚乳酸-乙醇酸（PLGA）纳米粒（HMME@PLGA）,观察纳米粒的基本表征和体外增强光声显像情况,通过流式细胞仪检测人乳腺癌MDA-MB-231细胞与HMME@PLGA共孵育后在超声辐照下产生活性氧的能力,并在细胞水平验证其SDT效果。结果 所制备的HMME@PLGA纳米粒大小均一,形态规则,平均粒径为（333.67±17.50）nm,表面电位为（-10.57±1.98）mV,包封率为75.62%,载药量为2.90%,浓度为1 mg/ml的纳米粒与人乳腺癌MDA-MB-231细胞共孵育24 h的细胞存活率为87.21%。随浓度增加,纳米粒光声信号逐渐增强。经超声辐照,HMME@PLGA纳米粒能使人乳腺癌MDA-MB-231细胞产生大量活性氧,并产生明显细胞毒性作用,使细胞大量死亡,Calcein-AM/PI染色呈红色荧光;通过吖啶橙染色观测到细胞溶酶体结构消失。结论 本研究成功制备了包裹HMME的高分子纳米粒,可实现体外光声成像引导下的SDT。     

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.     

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.     

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.     

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.