电针改善局灶性脑缺血大鼠学习记忆障碍的脑影像结构和超微结构研究

目的:观察电针神庭、百会对局灶性脑缺血再灌注大鼠学习记忆能力的影响,探讨其可能的作用机制。方法:将SPF级雄性大鼠45只随机分为假手术组、模型组和电针组,每组各15只;模型组和电针组均用改良的线栓法建立大鼠左侧大脑中动脉局灶性缺血(MCAO)再灌注模型;电针组大鼠予以电针神庭、百会,共7d。用Morris水迷宫检测大鼠的学习记忆能力,小动物MRI、TTC染色检测脑梗体积,透射电镜观察大鼠脑超微结构的变化。结果:与模型组比较,电针组可以明显改善MCAO大鼠找到平台的时间和减少错误率,并能减小大鼠脑梗死体积,差异具有显著性(P0.05);电针组大鼠脑线粒体、核膜等超微结构改善明显。结论:电针神庭、百会能够减小脑梗死体积,改善脑的超微结构,改善MCAO大鼠的学习记忆能力。     

电针对脑缺血再灌注大鼠学习记忆能力及MMP-2、MMP-9蛋白表达的影响

目的:探讨电针神庭、百会穴对局灶性脑缺血大鼠学习记忆的影响,及其可能的机制。方法:雄性SD大鼠45只,随机分为假手术组、模型组、电针组,每组15只大鼠。模型组、电针组均采用线栓法制备局灶性脑缺血损伤大鼠模型。电针组电针神庭、百会穴7d。各组在造模后第3天开始采用Morris水迷宫检测学习记忆能力;2,3,5-氯化三苯基四氮唑染色法检测大鼠脑梗死的体积;Western blotting法检测大鼠左侧海马基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)蛋白的表达。结果:同模型组相比,电针组大鼠学习记忆能力改善(P0.05),脑梗死体积明显减少(P0.01),海马组织中MMP-2、MMP-9蛋白表达降低(P0.05)。结论:电针能改善局灶性脑缺血再灌注大鼠学习记忆能力,其机制可能与抑制MMP-2、MMP-9蛋白表达相关。     

电针对局灶性脑缺血再灌注损伤大鼠学习记忆功能的影响

目的探讨电针神庭、百会对局灶性脑缺血再灌注损伤大鼠学习记忆功能的影响及其机制。方法雄性Sprague-Dawley大鼠45 只,随机分为假手术组(n=15)、模型组(n=15)和电针组(n=15)。模型组、电针组用线栓法制备局灶性脑缺血2 h 再灌注损伤模型。电针组行电针干预7 d。各组在造模后3 d 开始行Morris 水迷宫测试。7 d 后尼氏染色观察海马神经细胞变化,逆转录PCR检测Bcl-2、Bax mRNA表达。结果电针组逃避潜伏期显著低于模型组(P<0.001),穿过平台次数显著低于模型组(P=0.001)。电针组海马区细胞损伤及Bax mRNA水平降低、Bcl-2 mRNA水平提高(P<0.05)。结论电针能改善局灶性脑缺血再灌注损伤大鼠学习记忆能力,保护神经细胞,其机制可能与调节凋亡相关基因Bax、Bcl-2 的表达有关。     

电针百会、神庭穴对脑缺血再灌注大鼠学习记忆影响的小动物磁共振波谱研究

目的:观察脑缺血再灌注损伤大鼠海马区神经细胞代谢,探讨电针改善脑缺血再灌注损伤大鼠学习记忆能力的机制。方法:将SD大鼠按照随机数字表分为假手术组、模型组、电针组;利用Koizumi线栓法制备左侧大脑中动脉缺血再灌注大鼠模型,电针百会、神庭穴,每天1次,每次30 min,持续7 d;采用Morris水迷宫评估大鼠学习记忆能力,小动物核磁共振T2WI成像观察大鼠脑梗死,小动物磁共振波谱(MRS)观察大鼠海马区神经细胞代谢。结果:电针干预7 d后,大鼠在Morris水迷宫中穿越平台的次数显著增加(P0.01);大鼠脑梗死体积减少(P0.01),大鼠海马区N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)左侧/右侧含量的比值均升高(P0.05)。结论:电针刺激百会、神庭穴可改善脑缺血再灌注损伤大鼠海马区NAA和Cho的代谢,起到神经保护作用,从而改善学习记忆能力。     

电针神庭、百会对大脑中动脉闭塞大鼠学习记忆的影响及机制研究

目的:研究磷酸化的环磷腺苷效应元件结合蛋白(p-c AMP-response element binding protein,p-CREB)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)在大鼠脑缺血再灌注中的表达,探讨电针神庭、百会对脑缺血再灌注大鼠学习记忆功能的影响及其可能机制。方法:36只雄性SD大鼠,随机分为假手术组、模型组和电针组,每组分配12只。采用大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)法建立局灶性脑缺血再灌注大鼠模型。电针组电针神庭、百会穴干预7d。各组采用Morris水迷宫实验评估大鼠的学习记忆功能;TTC染色观察缺血梗死体积;免疫组化染色检测海马CA1区pCREB,BDNF的表达。结果:与假手术组比较,模型组鼠到达水下平台的潜伏期长些(P0.01),通过平板的次数少些(P0.01)。电针组与模型组比较潜伏期显著短些(P0.05),通过平台的次数显著多些(P0.01)。与假手术组比较,模型组的p-CREB阳性细胞明显减少而BDNF光密度明显增加。与模型组比较,电针组的p-CREB阳性细胞明显增加(P0.01)而BDNF光密度也增加(P0.05),梗死的体积则小些。结论:电针神庭、百会可改善脑缺血再灌注大鼠的学习记忆功能,其作用机制可能与上调缺血侧海马CA1区pCREB,BDNF的表达有关。     

电针对脑缺血再灌注大鼠学习记忆能力及RhoA蛋白表达的影响

目的探讨电针神庭、百会穴对脑缺血再灌注模型大鼠学习记忆能力的影响及其可能机制。方法 45只雄性Sprague-Dawley大鼠随机分为假手术组(n=15)、模型组(n=15)和电针组(n=15)。模型组和电针组均采用左侧大脑中动脉缺血(MCAO)再灌注模型。电针组电针神庭、百会穴共7 d。采用Morris水迷宫测试观察大鼠学习记忆能力;尼氏染色观察大鼠海马神经元形态结构变化;Western blotting法检测大鼠左侧海马Rho A蛋白的表达。结果与模型组相比,电针组学习记忆能力改善(P0.05),海马神经元损伤减少(P0.05),海马组织中Rho A蛋白表达降低(P0.05)。结论电针能够改善脑缺血再灌注大鼠学习记忆能力,其机制可能与抑制Rho A蛋白表达有关。     

电针神庭、百会对脑缺血再灌注大鼠学习记忆能力和LIM激酶1磷酸化的影响

目的探讨电针神庭、百会穴对脑缺血再灌注大鼠海马突触可塑性和学习记忆能力的影响,及其可能的机制。方法雄性Sprague-Dawley大鼠32只,随机分为假手术组、模型组、电针组、非穴组,每组8只。模型组、电针组、非穴组采用线栓法制备大鼠脑缺血120 min再灌注模型。电针组电针神庭、百会14 d,非穴组电针大鼠双侧胁下非经非穴14 d。采用Morris水迷宫检测学习记忆能力;电镜观察海马区突触形态;Western blotting检测海马LIM激酶1及其磷酸化水平。结果与假手术组比较,模型组大鼠逃避潜伏期明显增加(t6.789,P0.01),穿越平台次数显著减少(t=8.695,P0.001),突触数减少,LIM激酶1总蛋白(t=7.568,P0.01)及磷酸化水平下降(t=8.874,P0.001);与模型组比较,电针组大鼠平均逃避潜伏期明显减少(t4.938,P0.01),穿越平台次数显著增多(t=-7.891,P0.001),突触数量增多,LIM激酶1总蛋白(t=-6.473,P0.01)及磷酸化水平上升(t=-6.579,P0.01)。非穴组各项指标与模型组比较无显著性差异(P0.05)。结论电针神庭、百会穴可以改善脑缺血再灌注大鼠学习记忆能力,可能与LIM激酶1磷酸化水平升高进而改善突触可塑性有关。     

电针百会、神庭穴对脑缺血再灌注大鼠学习记忆能力及海马CA1区突触超微结构的影响

目的观察电针百会、神庭穴对脑缺血再灌注大鼠学习记忆能力及损伤大鼠海马CA1区突触超微结构的影响。方法雄性Sprague-Dawley大鼠25只随机分为假手术组(n=6)和手术组(n=19)。手术组线栓法建立左侧大脑中动脉栓塞90 min后再灌注模型,筛选符合纳入标准的12只大鼠随机分为模型组和电针组各6只。电针组电针百会、神庭穴7 d。采用Longa评分检测大鼠神经功能;小动物磁共振成像分析系统T2加权成像观察脑梗死体积;Barnes迷宫测试检测大鼠学习记忆能力;透射电镜观察海马CA1区突触超微结构。结果与模型组相比,电针组Longa评分降低(P0.05),脑梗死体积明显减少(P0.01);Barnes迷宫测试逃避潜伏期明显缩短(P0.01),平均进入错误洞口次数显著减少(P0.001)。透射电镜显示,模型组突触结构溶解,数量减少,囊泡稀疏、破坏;与模型组相比,电针组突触结构较清晰,突触数量较多,突触囊泡较多。结论电针百会、神庭能有效改善脑缺血再灌注大鼠的学习记忆能力,其机制可能与改善海马CA1区突触的超微结构,提高突触可塑性有关。     

高压氧对大鼠局灶性脑缺血再灌注神经细胞caspase-3表达的影响

目的探讨高压氧对大鼠局灶性脑缺血再灌注神经细胞caspase-3表达的影响。方法选取健康雄性Wistar大鼠60只，随机分为假手术组、模型组及HBO组，采用栓线法阻断大脑中动脉3h建立大鼠局灶性脑缺血一再灌注损伤模型。应用免疫组织化学方法检测再灌注6h、24h、48h、72h和120h各时间点大鼠脑组织神经细胞caspase-3的表达。结果假手术组无caspase-3表达。模型组和HBO组再灌注各时间点caspase-3的表达均增高，HBO组大鼠再灌注6h、24h和48h各时间点easpase-3的表达均明显低于模型组（P〈0．05）。结论脑缺血再灌注后caspase-3表达增强，高压氧治疗可抑制大鼠脑神经细胞easpase-3的活性，减少脑神经细胞凋亡，具有脑神经保护作用。     

电针对脑缺血再灌注大鼠学习记忆功能及海马组织Nogo-A/NgR表达的影响

目的:观察电针对脑缺血再灌注大鼠学习记忆功能及海马组织Nogo-A/Ng R表达的影响,探讨电针治疗脑卒中后认知功能障碍的作用机制。方法:将45只雄性SD大鼠随机分为假手术组、模型组和电针组,每组均15只。模型组和电针组参照Longa线栓法建立大鼠局灶性脑缺血再灌注模型。电针组针刺"百会穴"和"神庭穴",共干预7天;假手术组和模型组在同等条件下饲养和抓取。利用Morris水迷宫实验评估大鼠的学习记忆功能;TTC染色法观察脑梗死体积;免疫印迹法检测脑梗死侧海马组织Nogo-A及其受体Ng R的表达。结果:与模型组相比,电针组大鼠逃避潜伏期和找到平台所经过的路程缩短,跨越平台次数增加(P<0.05);电针组大鼠脑梗死体积减小(P<0.05);电针组大鼠海马区Nogo-A及其受体Ng R的表达量降低(P<0.05)。结论:电针可改善脑缺血再灌注大鼠的学习记忆功能,其作用机制可能与抑制脑梗死侧海马组织中Nogo-A及其受体Ng R的表达有关。     

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.     

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.