脑源性神经营养因子的研究现状

神经营养因子（neurotrophic factors,NTFs）是-类小分子多肽物质,在神经系统发生、发育过程中能够促进细胞的增殖、生长、分化、存活及功能表达,影响突触可塑性,在成熟的神经系统中具有维持神经细胞生存的作用,在神经系统损伤的情况下具有神经保护与修复的作用。     

麻醉治疗中神经调节效应的机制

麻醉效应的解剖学基础就是机体的神经系统，任何麻醉都是通过对神经系统包括中枢神经系统和周围神经系统的作用而发挥效应的，因此神经系统的功能又是麻醉效应的生理学基础。机体的系统、器官、组织和细胞的功能受到来自不同方面的因素进行综合的调控，才能达到一种功能上的平衡。而神经一体液因素是机体发挥正常功能最重要的调节机制。虽然人     

神经类固醇对神经的营养保护作用

传统理论认为人体类固醇激素在肾上腺皮质、性腺和胎盘组织合成,这些类固醇分别调节人体各种生理功能及代谢过程。近年来的研究表明神经系统自身也可以合成并分泌类固醇激素,不需外周内分泌腺的帮助。并发现神经类固醇对神经系统的结构和功能有极其重要的作用。1神经类固醇的提出与命名神经类固醇的概念是在1981年由Baulien等[1]首先提出的。当初Baulien等发现成年雄性大鼠前部和后部脑组织中孕烯醇酮(PREG)、硫酸孕烯醇酮(PREGS)、别孕烯醇酮(THP)、脱氢表雄酮(DHEA)及其硫酸脱氢表雄酮(DHE-AS)含量显著高于血浆含量,即使将分泌…     

神经干细胞移植治疗神经疾病机制的基础研究

神经干细胞(neural stem cells,NSCs)移植对神经系统疾病有一定的治疗作用,其可能的机制有:补充缺失的神经元、机体缺少的酶、载体蛋白、受体,自身分泌或携带的神经因子,携带目的基因,去除致病基因,减少神经细胞凋亡,促进血管再生,促进血管内皮细胞再生,重建血脑屏障,与宿主的细胞网络整合等。本文对NSCs移植治疗神经系统疾病的机制研究进展做一综述。     

P2受体与神经损伤

神经系统中，很多生理和病理生理现象和嘌呤信号相关，包括：神经元与神经胶质之间的相互作用．神经干细胞的分化，神经系统疾病以及神经系统对损伤的反应，神经免疫和神经血管之间的相互作用，交感神经的传递和可塑性，胶质细胞的分化，胶质间的细胞信号通信，髓鞘形成等。以下将主要就嘌呤2受体（P2受体）在神经损伤中的作用进行介绍。     

水疗法在神经系统疾病中的应用研究进展

尽管神经系统疾病的病因及发病机制不尽相同,但其身体及心理表现有许多共性,均可严重影响患者的正常生活。水疗法是应用水治疗疾病及功能康复的方法统称,具有无创、安全、有效等特点。因此,应用水疗法对神经系统疾病进行康复治疗逐渐成为研究热点。本文主要从生理学及神经生理学角度阐述了水疗法的可能作用机制,并对水疗法在神经系统疾病的临床应用及其相关功能障碍的康复作用两方面进行综述,旨在探讨水疗法临床应用的更佳干预方案。     

凝血酶在中枢神经系统中的作用

凝血酶不仅是凝血级联反应中的关键酶，且能与多种类型细胞反应而引起广泛的细胞生物学效应。凝血酶对神经系统，尤其是中枢神经系统的作用正日益受到广泛的重视。凝血酶的神经作用机制较为复杂，低浓度时有细胞保护作用，高浓度时则有细胞毒性作用，但具体机制尚未完全阐明，现对近年来凝血酶相关研究进展进行综述。     

孕酮对脊髓损伤的保护作用及机制

越来越多的动物和临床实验结果显示,孕酮除在生殖过程中的作用外,在神经系统损伤后也有一定的神经保护和促进神经再生作用,被认为是一个潜在的有治疗作用的神经甾体。本文就孕酮对脊髓损伤（spinal cord injury,SCI）治疗作用的相关研究及进展做一综述。     

酒精所致精神、神经障碍66例临床分析

近年来由于社会经济的发展，人民生活水平的提高及其他各种因素，饮酒人数日渐增多。酒精所致的精神、神经系统障碍明显增加。为了探讨酒精的毒性作用以便提高认识，早诊断、早治疗、减少酒精所造成的精神、神经损害程度，现将我院1998年～2003年5月间门诊、住院酒精所致精神、神经系统障碍66例病人的临床资料分析如下。     

神经胶质-免疫机制在疼痛中的作用

疼痛产生和维持的机制研究一直局限于神经元及由此形成的网络,对组成神经系统的另一类细胞——神经胶质细胞关注甚少。神经胶质细胞在疼痛机制中的作用,是今后疼痛研究的新方向。作者通过探讨神经胶质-免疫机制在神经病理痛发生和维持中的作用,希望为今后镇痛药物研究提供新的靶点。     

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.     

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.     

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.     

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.