脑缺血后立即高压氧治疗对脑缺血再灌注损伤大鼠脑梗死体积的影响

目的观察脑缺血后立即给予单次高压氧（HBO）治疗对脑缺血再灌注大鼠梗死体积的影响。 方法选取45只SD雌性大鼠采用Longa线栓法制备局灶性脑缺血再灌注损伤模型，将制模成功的42只大鼠按随机数字表法分为HBO治疗组、高压空气组和缺血对照组，每组14只大鼠。HBO治疗组立即单次给予HBO治疗（2.0ATA，110min）干预；高压空气组则给予与HBO治疗组同样处理，但不供氧；缺血对照组不做任何特殊处理，大鼠在脑缺血后常温常压下呼吸空气。3组大鼠分别于脑梗死后8h断头取脑组织，冷冻、切片、染色、固定后，测量各切片梗死灶面积和全脑面积，根据脑梗死体积/全脑体积计算梗死灶体积所占百分比的方法检测梗死灶体积的变化。 结果HBO治疗组、高压空气组及缺血对照组大鼠的脑梗死体积百分比分别为（5.90±2.92）%、（16.27±4.83）%和（15.00±7.71）%，HBO治疗组较缺血对照组及高压空气组大鼠脑梗死体积百分比明显减小（P<0.05），高压空气组与缺血对照组大鼠梗死体积百分比相比，差异无统计学意义（P&rt;0.05）。 结论脑缺血后立即给予单次110min HBO治疗能明显减小局灶性脑缺血再灌注大鼠的梗死灶体积。     

超早期高压氧对大鼠局灶性脑缺血后梗死体积及脑组织水含量的影响

目的:探讨超早期高压氧(HBO)对大鼠局灶性脑缺血的梗死体积及脑组织含水量的影响。方法:将60只健康的SD大鼠随机分成假手术组、对照组和HBO组各20只,应用线栓法制作大鼠局灶性脑缺血模型,HBO组大鼠给予HBO治疗。各组大鼠均于缺血后12h断头取脑,比较各组脑梗死体积、脑组织水含量。结果:与对照组比较,HBO组梗死体积及脑组织含水量明显减少(P<0.05)。结论:超早期HBO治疗能够减低脑水肿,减小脑梗死体积,进而促进神经功能的恢复、产生治疗作用。     

高压氧对大鼠局灶性脑缺血再灌注损伤小胶质细胞和基质金属蛋白酶的影响

目的：探讨高压氧(HBO)对大鼠局灶性脑缺血再灌注损伤脑梗死体积的影响及其可能作用机制。方法：应用血管内细丝栓堵大脑中动脉(MCA)制作局灶脑缺血再灌注大鼠模型，用HBO(2.0ATA)治疗后，观察MCA缺血2h再灌注损伤6h、24h、48h、72h、120h和10d各组大鼠脑梗死灶体积百分比、小胶质细胞和基质金属蛋白酶-9(MMP-9)蛋白的变化。结果：HBO组与缺血组相比72h～120h梗死灶体积百分比减小，缺血24-48h小胶质细胞减少，缺血48h和120h MMP-9蛋白表达减少。结论：HBO能减小脑缺血梗死灶体积，其作用可能与HBO抑制小胶质细胞活化及下调MMP-9蛋白表达有关。     

超短波对大鼠局灶性脑缺血再灌注后大脑的保护作用

目的 观察超短波对大鼠局灶性脑缺血再灌注损伤的保护作用，并探讨其作用机制。方法 用线栓法制备右侧大脑中动脉栓塞-再灌注(MCA-0R)大鼠模型，将造模后动物分为3组：空白对照组(n＝16)、对照组(n＝24)和治疗组(n＝24)，治疗组在再灌注6h时给予无热量超短波治疗10min，所有大鼠于24h后断头取脑，分别观察形态学变化，测量梗死灶体积、脑含水量、丙二醛(MDA)和超氧化物歧化酶(SOD)含量。结果 再灌注6h时给予超短波治疗能减轻大鼠缺血侧脑含水量，提高抗氧化酶SOD含量，降低自由基产物MDA的含量，病理损伤减轻，而对大鼠梗死灶体积的影响不明显。结论 超短波对大鼠局灶性脑缺血再灌注损伤具有神经保护作用。     

钙拮抗剂对大鼠脑缺血后血-脑脊液屏障通透性的影响

目的观察钙拮抗剂对大鼠脑缺血后血-脑脊液屏障(BBB)通透性的影响。方法制备脑缺血再灌注(CIR)大鼠模型150只,在大鼠缺血2 h后进行再灌注。将大鼠平均分为观察组(造模后腹腔注射尼莫地平)与对照组(造模后腹腔注射生理盐水),在6 h、12 h、24 h、48 h、72 h时间点分别进行再灌注,观察每个时间点BBB通透性损伤情况与梗死灶体积百分比。结果随着时间的延长,CIR后BBB通透性与梗死灶体积百分比出现逐步上升,且在12 h、48h达到双高峰。观察组的BBB通透性及脑梗死灶体积百分比的上升较对照组较为明显(P0.05)。结论大鼠实验结果提示,CIR能够提升BBB的通透性,增加梗死灶体积百分比,而早期使用钙拮抗剂能够加重上述情况。     

高压氧对成年大鼠脑梗死灶体积和基质金属蛋白酶的影响

目的探讨高压氧 (HBO)对成年大鼠持续性局灶脑缺血梗死灶体积的影响及其可能的作用机制。方法应用血管内细丝线栓堵大脑中动脉 (MCA)制作持续性脑缺血大鼠模型 ,用HBO (2 .0ATA)治疗后 ,观察MCA缺血后 6h、2 4h、48h、72h、12 0h和 10d各组大鼠脑梗死灶体积、基质金属蛋白酶 (matrixmetalloproteinase ,MMP)MMP 2和MMP 9的变化。 结果与缺血组相比 ,HBO组大鼠 12 0h和 10d梗死灶体积减小 ,缺血 48— 12 0hMMP 9蛋白表达减少 ,MMP 2蛋白表达无明显变化。结论HBO能减小脑缺血梗死灶体积 ,其作用可能与HBO下调MMP 9蛋白表达有关。     

阿司匹林、盐酸氟桂利嗪联合预处理对SD大鼠局部脑缺血再灌注损伤的保护作用

目的采用Sprague-Dawley（SD）大鼠局灶性脑缺血再灌注模型,观察神经功能缺损评分、脑梗死体积及脑组织病理形态改变,探讨阿司匹林联合盐酸氟桂利嗪预处理对SD大鼠局灶性脑缺血再灌注损伤是否有保护作用。方法36只雄性健康sD大鼠,随机分为2组：对照组（n=18）、阿司匹林＋盐酸氟桂利嗪组（治疗组,n=18）,各组按脑缺血90min再灌注3h（n=6）、6h（n=6）、24h（n=6）分为3个亚组。比较两组在相同再灌注各时间点神经功能缺损评分、脑梗死体积和脑组织病理形态的改变。结果治疗组相同再灌注各时间点神经功能缺损评分优于对照组（P〈0．05）;脑梗死体积明显小于对照组（P〈0．05）;与对照组相比,治疗组变性、坏死的神经元减少,空泡化改变减轻,组织间水肿减轻。结论阿司匹林联合盐酸氟桂利嗪预处理能减轻SD大鼠局灶性脑缺血再灌注损伤,减轻神经功能缺损症状,缩小梗死体积,减轻神经细胞变性、坏死及组织水肿。     

即时高压氧治疗对大鼠脑缺血后脑水肿及水通道蛋白4 表达的影响

目的观察即时高压氧治疗对缺血早期脑水肿形成的影响,并探讨其可能的机制。方法健康成年雄性清洁级Sprague-Dawley 大鼠18 只,随机分为假手术组(n=6)、对照组(n=6)和高压氧组(n=6)。对照组及高压氧组采用线栓法制备大鼠大脑中动脉阻塞(MCAO)模型,其中高压氧组在舱内升压时进行模型制备并予高压氧治疗60 min。各组均于术后6 h 行Longa 评分法评分,采用干湿比重法检测脑组织含水量,免疫组化SP 法观察水通道蛋白4 (AQP4)表达,应用图像分析系统进行半定量分析。结果与对照组比较,高压氧组大鼠神经功能评分改善(P<0.05),缺血半球脑含水量减少(P<0.05),AQP4 表达量减少(P<0.05)。结论即时高压氧治疗可有效缓解脑缺血后症状,对脑水肿的发生有抑制作用;AQP4 表达减少可能是其机制之一。     

拜阿司匹灵预处理对高血糖SD大鼠局部脑缺血再灌注损伤中ICAM-1的影响

目的采用高血糖条件下SD大鼠局灶性脑缺血再灌注损伤模型,通过观察大鼠脑梗死体积、细胞问粘附分子的表达情况,探讨预防性应用拜阿司匹灵对高血糖条件下SD大鼠局灶性脑缺血再灌注损伤的脑保护作用。方法随机分为对照组与拜阿司匹灵组,两组按缺血90min再灌注3h、6h、12h再分为3个亚组。各组均建立高血糖模型及SD大鼠右侧大脑中动脉缺血再灌注模型。分别测量梗死体积,免疫组化方法测定ICAM-1的表达情况。结果拜阿司匹灵组与对照组相同再灌注时间点相比较：梗死体积减小（P均〈0．01）;缺血区ICAM-1表达减少（P均〈0．01）。结论预防性应用拜阿司匹灵能减轻高血糖条件下的局灶性脑缺血再灌注损伤,缩小梗死体积,使损伤脑区ICAM-1表达减少。     

阿司匹林、盐酸氟桂利嗪联合预处理对高血糖SD大鼠局部脑缺血再灌注损伤的保护作用

目的采用高血糖条件下Sprague-Dawley（SD）大鼠局灶性脑缺血再灌注模型,观察神经功能缺损评分、脑梗死体积及脑组织病理形态改变,探讨阿司匹林联合盐酸氟桂利嗪预处理对高血糖SD大鼠局灶性脑缺血再灌注损伤是否有保护作用。方法36只雄性健康SD大鼠,建立高血糖模型后随机分为2组：对照组（n=18）、阿司匹林＋盐酸氟桂利嗪组（治疗组,n=18）,各组按脑缺血90min再灌注3h（n=6）、6h（n=6）、24h（n=6）分为3个亚组。比较两组在相同再灌注各时间点神经功能缺损评分、脑梗死体积和脑组织病理形态的改变。结果治疗组相同再灌注各时间点神经功能缺损评分好于对照组（P〈0．05）;治疗组脑梗死体积明显小于对照组（P〈0．01）;治疗组与对照组相比,变性、坏死的神经元减少,空泡化改变减轻,组织间水肿减轻。结论阿司匹林联合盐酸氟桂利嗪预处理能减轻高血糖条件下的局灶陛脑缺血再灌注损伤,减轻神经功能缺损症状,缩小梗死体积,减轻神经细胞变性、坏死及组织水肿。     

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.