益气活血法对脑出血大鼠脑组织促血管生成素-1及其受体表达的影响

目的：通过观察益气活血法中药对脑出血大鼠脑损伤区组织促血管生成素-1（Ang-1）及其受体〔为含免疫球蛋白样环和上皮生长因子样域酪氨酸激酶-2（Tie-2）〕表达的影响,探讨益气活血法治疗脑出血的作用机制。方法：288只SD大鼠被随机分为正常组8只,假手术组、模型组、益气活血组、益气组和活血组各56只。采用型胶原酶诱导脑出血大鼠模型。相应灌服益气活血法代表方补阳还五汤全方及其益气组分、活血组分药物（剂量均为临床70 kg成人用量的3倍）。各组于术后1、2、4、7、14、21和28 d各取8只大鼠,采用苏木素-伊红（HE）染色观察大鼠脑组织形态学改变,用免疫组化法检测Ang-1及其受体Tie-2的表达,计数阳性血管作为观察指标。结果：HE染色显示正常组及假手术组各时间点未见血肿及局部明显病理学改变,而益气活血组微血管段多于活血组、益气组和模型组。免疫组化研究显示正常组及假手术组不同时间点Ang-1和Tie-2表达均未见明显变化;模型组、益气组、活血组及益气活血组脑出血后1 d即有Ang-1和Tie-2表达,模型组与益气组至21 d达到高峰,随后开始下降,活血组及益气活血组表达高峰时间提前至14 d,至21 d仍维持一定的表达水平。结论：在脑出血微血管系统重建过程中,益气活血法可能通过强化血肿周围Ang-1和受体Tie-2的表达,进而促进脑出血损伤区血管新生的作用,促进脑出血大鼠神经功能的恢复。     

莫诺苷对局灶性脑缺血再灌注大鼠血管生成素1及其受体Tie-2的影响

目的观察莫诺苷对局灶性脑缺血再灌注大鼠血管生成素1(Ang-1)及其受体Tie-2的影响。方法 20只健康成年雄性Sprague-Dawley大鼠随机分为假手术组,模型组,莫诺苷小、中、大剂量组,每组4只。线栓法制备大鼠大脑中动脉阻塞模型,术后予莫诺苷30 mg/kg、90 mg/kg、270 mg/kg每天1次灌胃。术后7 d采用Western blotting法分析皮层Ang-1及其受体Tie-2的表达。结果模型组患侧皮层Ang-1、Tie-2的表达均比假手术组明显增加(P0.01)。莫诺苷大剂量组Ang-1、Tie-2的表达较模型组明显提高(P0.01),莫诺苷中、大剂量组Tie-2的表达较模型组显著提高(P0.001)。结论莫诺苷能上调局灶性脑缺血大鼠缺血再灌注皮层Ang-1及受体Tie-2的表达,促进血管再生。     

高压氧对脑出血大鼠脑内血管新生的影响

目的:探讨高压氧对脑出血大鼠脑内血管新生的作用机制。方法:将120只SD大鼠随机分为假手术组、脑出血组和高压氧组。采用组织切片HE染色显微镜下观察各组大鼠血肿周围脑组织新生血管形成情况;采用免疫组织化学分析方法检测各组大鼠脑内缺氧诱导因子(HIF)1-α、血管内皮生长因子(VEGF)的蛋白表达含量;采用荧光定量RT-PCR方法测定各组大鼠脑组织HIF1-αm RNA、VEGF m RNA的表达水平。结果:血肿周围脑组织切片经HE染色后光镜下观察可见,随着出血后时间延长,高压氧组血肿已基本吸收,较脑出血组可见大量分布的血管样结构和微血管,新生血管数目明显增多,假手术组未见明显血肿及新生血管的病理改变。脑出血组和高压氧组HIF1-α和VEGF蛋白表达在第14、21、28天比较差异均有显著性意义(P<0.01)。三组(假手术组、脑出血组、高压氧组)比较,高压氧组HIF1-αm RNA、VEGF m RNA表达值分别高于脑出血组和假手术组,HIF1-αm RNA在第14、21、28天时三组比较差异均有显著性意义(P<0.05);VEGF m RNA在第21、28天时三组比较差异均有显著性意义(P<0.05)。结论:高压氧能增加脑出血大鼠脑内HIF1-α、VEGF蛋白和m RNA表达水平,促进新生血管形成,加快血肿吸收,改善脑出血大鼠损伤神经功能,促进其康复。     

康复训练对脑缺血损伤大鼠血管生成素的影响

目的：研究运动训练能否促进大鼠局部脑缺血再灌注后的功能恢复并从血管生成素及其受体的角度探讨其机制。方法：成年雄性SD大鼠18只，随机分成运动组、静止组、假手术组。每组6只。大脑中动脉闭塞（MCAO）法造模24h后，运动组给予2周的电动跑台训练，每天30min。采用神经行为学评分、脑梗死体积评价神经功能恢复情况；免疫组化法从蛋白水平观察Ang-1、2，Tie-2的表达情况。结果：2周后，运动组的神经行为学评分高于静止组，脑梗死体积减小具有显著性意义，Ang-1、Tie-2的蛋白表达显著高于静止组与假手术组。结论：运动训练能够促进脑缺血大鼠神经功能恢复．这种改变可能与Antg／Tie-2通路的上调有关。     

电针对脑缺血大鼠血管生成素及其受体表达的影响

目的：观察电针能否促进大鼠局部脑缺血再灌注后的功能恢复,并观察电针对血管生成素及其受体表达的影响,从而探讨其促进功能恢复的内在机制。方法：成年雄性SD大鼠18只,随机分成电针组、对照组和假手术组,每组6只。大脑中动脉闭塞（MCAO）法造模24h后,电针组给予针刺百会、曲池、足三里,每天30min,连续治疗2周,对照组及假手术组以相同的方法予以抓取和固定。采用神经行为学评分评价神经功能恢复情况;免疫组化法从蛋白水平观察Ang-1、2,Tie-2的表达情况。结果：2周后,电针治疗组的神经行为学评分明显高于对照组（P〈0.05）,并低于假手术组（P〈0.05）;Ang-1、Ang-2及Tie-2的表达显著高于对照组（P〈0.05）。结论：电针能够促进脑缺血大鼠神经功能恢复,这种改变可能与Ang/Tie-2通路上调有关。     

血管生成素在糖尿病大鼠肾组织中的表达及氯沙坦的作用

目的探讨血管生成素(angiopoietins,Ang)及其受体Tie-2和血管内皮生长因子(VEGF)在糖尿病大鼠肾组织中的表达以及氯沙坦对其表达的影响。方法将SD大鼠随机分为正常对照组(A组),糖尿病组(B组)和糖尿病氯沙坦治疗组(C组),用链脲佐菌素(STZ)诱导大鼠生成糖尿病模型。治疗8周后处死大鼠,采用实时定量RT-PCR和免疫组化方法分别检测三组大鼠肾组织中Ang-1、Ang-2、Tie-2和VEGF的表达;测定大鼠平均肾小球体积和肾小球细胞外基质相对含量;同时检测大鼠尿蛋白/肌酐值等指标。结果与A组大鼠相比,B组大鼠肾组织VEGF和Ang-2表达水平显著升高(P0.05)。经氯沙坦治疗后,上述血管生长因子表达水平显著下降(P0.05)。Ang-2表达水平与平均肾小球体积、尿蛋白/肌酐值成正相关(P0.05)。结论Ang/Tie-2参与早期糖尿病肾损害的发生。氯沙坦可能通过下调这些血管生长因子的表达发挥肾保护作用。     

运动对缺血性脑卒中大鼠血管生成素基因表达的影响

目的研究运动能否促进大鼠局部脑缺血再灌注后的功能恢复，并观察运动对血管生成素及其受体基因表达的影响，从而探讨功能恢复的内在机制。方法成年雄性SD大鼠18只，随机分成运动组、静止组、假手术组，每组6只。大脑中动脉梗塞（MCAO）法造模24h后，运动组予以2周的电动跑台训练，每天30min。采用神经行为学评分、脑梗死体积评价神经功能恢复情况，实时定量聚合酶链反应（real-timePcn）法从分子水平观察血管生成素-1（Ang-1）、血管生成素-2（Ang-2）及内皮特异性酪氨酸激酶受体-2（Tie-2）的基因表达情况。结果2周后运动组的神经行为学评分高于静止组，脑梗死体积显著小于静止组，Ang-1、Tie-2的mRNA表达均显著大于静止组与假手术组。结论运动能够促进缺血性脑卒中大鼠神经功能的恢复，这种改变可能与Ang／Tie-2通路的上调有关。     

高糖状态下大鼠肾小球系膜细胞Ang-2、Tie-2、VEGF的变化及氯沙坦对其的影响

目的:研究高糖状态下大鼠肾小球系膜细胞血管生成素-2(Ang-2)和其受体Tie-2及血管内皮生长因子(VEGF)的变化以及血管紧张素受体拮抗剂氯沙坦对其的影响.方法:细胞同步化后分为对照组(含糖5.5 mmol/L)、甘露醇组(含糖5.5 mmol/L +19.5 mmol/L甘露醇)、高糖组(含糖30 mmol/L)、氯沙坦组(含糖30 mmol/L + 10-5 mol/L 氯沙坦),培养48 h.real-time PCR法检测Ang-2、Tie-2、VEGF mRNA表达,western blot法检测Ang-2、Tie-2、VEGF蛋白表达. 结果:Ang-2、Tie-2、VEGF mRNA和蛋白在对照组及甘露醇组仅有少量表达,而在高糖组明显升高(P ＜ 0.05),氯沙坦组Ang-2、Tie-2、VEGF mRNA和蛋白的水平较高糖组出现下调(P ＜ 0.05). 结论:Ang-2及VEGF参与糖尿病肾损害的发生,氯沙坦可能通过下调这些血管生长因子的表达发挥肾保护作用.     

Ang-1在多发性骨髓瘤患者中的表达及临床意义

目的 研究血管生成素-1(angiopoietin-1,Ang-1)及其受体Tie-2在多发性骨髓瘤(MM)患者和骨髓瘤细胞株RPMI8226的表达情况,探讨其意义.方法 采用RT-PCR和Western blot方法检测112例MM患者、24例非肿瘤患者(对照组)以及RPMI8226细胞株中Ang-1及其受体Tie-2的表达水平,分析阳性率及表达水平在MM患者与对照组、MM不同分期间的差异,探讨Ang-1表达与MM患者骨髓微血管密度、临床分期及预后的关系.结果 MM组Ang-1表达阳性率、表达水平均显著高于对照组(P＜0.05);Ang-1表达阳性率在初治组和复发/难治MM组的差异无统计学意义(P＞0.05),但复发/难治MM组的Ang-1表达水平高于初治组(P＜0.05);Tie-2 mRNA仅在12例MM患者中检出,对照组未检出.MM患者骨髓微血管密度(25.21±0.80)明显高于对照组(5.23±0.20)(P＜0.01);Ang-1阳性患者的骨髓微血管密度(32.98±1.70)高于Ang-1阴性患者(16.55±1.30)(P＜0.05);Ang-1表达阳性率在Ⅱ期和Ⅲ期MM患者中差异无统计学意义(52.1%对60.9%,P＞0.05),但Ⅲ期MM患者Ang-1蛋白的表达水平(0.40±0.07)明显高于Ⅱ期患者(0.22±0.04)(P＜0.05);初治患者中,治疗无效组Ang-1表达阳性率(70.0%)明显高于有效组(19.1%)(P＜0.01).结论 Ang-1在MM患者中高表达;Ang-1表达与MM临床分期、预后判断及靶向治疗有关.     

髓系白血病患者中血管生成素及受体酪氨酸激酶的表达及其意义

目的:探讨血管生成素及受体酪氨酸激酶(Angs及Tie-2)与髓系白血痛的关系.以及与血管内皮生长因子(VEGF)的相互关系.方法:应用半定量RT-PCR检测80例急性髓系白血病(AML)、10例慢性髓系白血病(CML)和10例正常人骨髓单个核细胞(BMNCs)中Ang-1、Ang-2、Tie-2和VEGF mRNA的表达.用流式细胞术检测白血病细胞增殖指数(PI).结果:与正常对照相比,除Ang-1外,Ang-2、Tie-2和VEGF mRNA在初治的髓系白血病中表达均增高,缓解后降低.在Ang-2与VEGF双阳性白血病组,髓外浸润率明显增高(P<0.05);Ang-2/Tie-2双阳性组缓解率低(P<0.05)、PI增高(P<0.05)并与CML的发展阶段有关.结论:髓系白血病患者高表达Angs/Tie-2,同时其与VEGF之间相互作用,与白血病的发展阶段相关.     

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.     

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.