射频热疗对膝骨关节炎实验兔血液中白细胞介素-1β及肿瘤坏死因子-α表达的影响

目的 探讨射频热疗对兔膝骨关节炎形成过程中关节软骨组织形态学及血清中白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）的影响。 方法 选取雄性家兔54只,采用改良Hulth造模法将其右后肢制成实验性膝关节骨关节炎模型。待造模成功后,将上述实验兔随机分为模型组、鹿瓜多肽组及射频热疗组。鹿瓜多肽组于制模后给予鹿瓜多肽肌肉注射,射频热疗组于制模后给予射频热疗干预,模型组制模后未给予特殊处理。于治疗7d、13d及19d时每组分别取6只实验兔处死,取右侧股骨内侧髁软骨,采用改良Mankins标准对其进行形态学评分,同时采用ELISA法检测各组实验兔血清中IL-1β及TNF-α含量。 结果 经相同时间治疗后,发现模型组、鹿瓜多肽组及射频热疗组右侧股骨内侧髁软骨Mankins评分及血清中IL-1β、TNF-α含量均依次降低,组间差异均具有统计学意义（P<0.05）。射频热疗组随着治疗时间延长,其右侧股骨内侧髁软骨Mankins评分及血清中IL-1β、TNF-α含量均逐渐降低,各观察时间点间差异均具有统计学意义（P<0.05）。 结论 射频热疗治疗兔膝骨关节炎的疗效明显优于鹿瓜多肽,其治疗机制可能与调控血清中IL-1β、TNF-α含量有关。     

射频热疗对膝骨关节炎实验兔滑膜中白细胞介素-1β及肿瘤坏死因子-α表达的影响

目的 观察射频热疗对兔膝骨关节炎（OA）形成过程中关节软骨形态及滑膜中白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）表达的影响。 方法 选取雄性家兔54只,采用改良Hulth造模法将其右后肢制成实验性膝OA模型。待造模成功后,将上述实验兔随机分为模型组、鹿瓜多肽组及射频热疗组。鹿瓜多肽组给予鹿瓜多肽肌肉注射,每日注射1次;射频热疗组给予射频热疗干预,选择谐振模式,温度设定为36.5~38.5 ℃,每日治疗1次;模型组未给予特殊处理。于治疗6 d、12 d及18 d时每组分别取6只实验兔处死,取右侧股骨内侧髁软骨,采用改良Mankins标准对其进行形态学评分,同时采用ELISA法检测各组实验兔软骨滑膜中IL-1β及TNF-α含量。 结果 经相同时间治疗后,发现模型组、鹿瓜多肽组及射频热疗组右侧股骨内侧髁软骨Mankins评分及滑膜中IL-1β、TNF-α含量均依次降低,组间差异均具有统计学意义（P<0.05）。射频热疗组随治疗时间延长,其右侧股骨内侧髁软骨Mankins评分及滑膜中IL-1β、TNF-α含量均逐渐降低,各观察时间点间差异均具有统计学意义（P<0.05）。 结论 与鹿瓜多肽肌肉注射比较,射频热疗能进一步改善膝OA实验兔股骨内侧髁软骨损伤,其治疗机制可能与调控软骨滑膜中IL-1β、TNF-α含量有关。     

电针对实验性兔膝骨关节炎模型白细胞介素-1β和基质金属蛋白酶-1表达的影响

目的:观察电针治疗前后兔膝骨关节炎(KOA)模型关节冲洗液中细胞因子白介素-1 β(IL-1 β)和软骨中基质金属蛋白酶-1(MMP-1)表达的变化,探讨电针治疗KOA的作用机制.方法:将30只新西兰大耳兔随机分为正常组、模型组及电针组.正常组为对照组,模型组和电针治疗组采用左膝关节伸直位管型石膏固定6周制作KOA模型,电针治疗组电针治疗14d.分别观察各组兔造模结束和治疗后左膝关节冲洗液中IL-1 β含量变化,治疗后各组兔左股骨内侧髁软骨MMP-1表达的变化.结果:采用放免法行关节冲洗液IL-1 β含量测定,造模结束后正常组与模型组、电针治疗组组间比较,其后两者明显高于前者(P＜0.05),治疗结束后模型组、电针治疗组组间比较,前者显著高于后者(P＜0.05).治疗结束后软骨免疫组化法MMP-1测定,模型组和电针治疗组的MMP-1阳性率明显高于正常组(P＜0.05),且模型组MMP-1阳性率高于电针治疗组(P＜0.05).结论:电针能有效治疗KOA,其作用机制可能是电针使KOA关节中细胞因子IL-1 β和软骨中MMP-1的含量减少,从而降低Ⅱ型胶原和蛋白聚糖的降解,促进新的Ⅱ型胶原和蛋白聚糖合成,改善血液循环,促进经气运行,从而有利于关节渗出液吸收,促进软骨的修复.     

牛膝联合超声波治疗对膝骨关节炎实验兔软骨组织中胰岛素样生长因子-1及Ⅱ型胶原蛋白的影响

目的 观察牛膝联合超声波治疗对膝骨关节炎（OA）模型兔膝关节软骨组织中胰岛素样生长因子-1（IGF-1）及Ⅱ型胶原蛋白的影响,初步探讨其防治OA的作用机制。 方法 采用随机数字表法将新西兰大白兔分为正常组、模型组、牛膝组、超声波组及观察组。参照Hulth造模法将模型组、牛膝组、超声波组及观察组实验兔制成膝关节OA动物模型。于造模1周后牛膝组、超声波组分别给予牛膝、超声波治疗,观察组则给予牛膝及超声波联合治疗。于治疗4周后取材,采用免疫组织化学法分别检测各组实验兔软骨组织中IGF-1和Ⅱ型胶原含量,并通过图像分析系统比较各组间差异。 结果 牛膝组、超声波组及观察组软骨组织中IGF-1表达均较模型组明显增强（P<0.05）;超声波组IGF-1表达与牛膝组间差异无统计学意义（P>0.05）,观察组IGF-1表达较牛膝组、超声波组均明显增强（P<0.05）。牛膝组、超声波组及观察组软骨组织中Ⅱ型胶原表达均较模型组明显增强（P<0.05）;超声波组Ⅱ型胶原表达与牛膝组间差异无统计学意义（P>0.05）,观察组Ⅱ型胶原表达较牛膝组、超声波组均明显增强（P<0.05）。 结论 中药牛膝联合超声波治疗能显著提高OA实验兔软骨组织中IGF-1及Ⅱ型胶原蛋白表达,该联合疗法值得进一步深入探讨。     

电针对兔膝骨关节炎软骨细胞基质金属蛋白酶-13表达的影响

目的:探讨电针对兔膝骨关节炎(KOA)模型软骨细胞基质金属蛋白酶-13(MMP-13)表达的影响。方法:30只新西兰大耳兔随机分为正常组、模型组及电针治疗组。正常组不造模,模型组和电针治疗组均采用左膝关节伸直位管型石膏固定法,建立KOA模型。喂养6周后,电针组电针治疗10d。各组均取股骨内侧髁软骨,观察软骨细胞及MMP-13的变化。结果:按Mankin评分比较软骨结构,各组间差异有显著性(P<0.05)。正常组MMP-13未检出,模型组MMP-13检出率较高,电针治疗组MMP-13检出率下降。MMP-13在KOA软骨细胞中的表达与正常组差异有显著性意义,电针治疗组与模型组差异有显著性意义(P<0.01)。结论:电针治疗促使兔骨关节炎模型软骨细胞重新排列,减少软骨细胞中MMP-13表达,对OA治疗有一定作用。     

透骨消痛胶囊对早期骨关节炎软骨细胞超微结构与软骨基质的影响

目的:观察透骨消痛胶囊对大鼠早期骨关节炎模型软骨细胞超微结构及软骨基质的影响。方法:24只雄性大鼠按照体质量随机分成正常组、模型组、中药组,每组8只。采用膝关节腔注射木瓜蛋白酶建立骨关节炎大鼠模型,给予透骨消痛胶囊水溶液干预4周后处死大鼠,取股骨髁关节软骨进行电镜和光镜制样,观察软骨细胞显微、超微结构;组织化学法定量软骨基质蛋白多糖、Ⅱ型胶原含量。结果:软骨细胞超微结构观察,与正常组比较,模型组软骨细胞增生、簇聚,细胞器大量减少或肿胀;与模型组比较,中药组软骨细胞聚集减少,粗面内质网、高尔基复合体、线粒体等细胞器数量增多。软骨基质含量检测发现,与正常组比较,模型组蛋白多糖和Ⅱ型胶原含量均显著降低(P0.01);与模型组比较,中药组蛋白多糖和Ⅱ型胶原含量均显著升高(P0.01)。结论:透骨消痛胶囊可减轻早期骨关节炎软骨细胞变性、内质网和线粒体等损伤,增加软骨基质合成,从而延缓骨关节炎软骨退变。     

Ⅱ型胶原注射骨关节炎时C-反应蛋白及类风湿因子的表达

背景：Ⅱ型胶原和硫酸软骨素是关节软骨的重要组成成分,不仅具有保护软骨的作用,还能抑制关节炎的病变。目的：通过检测类风湿因子和C-反应蛋白的表达评价Ⅱ型胶原及Ⅱ型胶原复合硫酸软骨素注射对骨性关节炎的疗效。方法：采用改良Hulth法制作大鼠膝关节骨性关节炎模型,造模后模型组关节腔注射生理盐水、透明质酸钠组给予透明质酸钠凝胶注射、Ⅱ型胶原组给予单纯Ⅱ型胶原注射、Ⅱ型胶原复合硫酸软骨素组给予Ⅱ型胶原复合硫酸软骨素注射治疗。各组动物于术后进行日常观察、称质量、血清抗体及组织病理检查。结果与结论：造模后模型组大鼠血类风湿因子和C-反应蛋白水平均有所升高,炎症加剧;而与模型组相比,各给药组大鼠类风湿因子和C-反应蛋白水平均有所下降,炎症有所减轻,其中Ⅱ型胶原复合硫酸软骨素组大鼠血清中类风湿因子水平显著下降（P〈0．01）。结果显示Ⅱ型胶原与透明质酸钠均具有预防和治疗骨关节炎的作用,能缓解骨关节炎病变,Ⅱ型胶原联合硫酸软骨素的疗效更明显。     

体外冲击波治疗兔膝骨关节炎：白细胞介素1β及基质金属蛋白酶13的表达

背景：白细胞介素1β和基质金属蛋白13能促进软骨细胞的分解代谢,抑制软骨细胞的合成修复能力,引起细胞外基质的降解,在骨关节炎的发生中有十分重要的作用。 目的：观察体外冲击波对兔膝骨关节炎软骨细胞中白细胞介素1β和基质金属蛋白酶13表达的影响。 方法：将30只新西兰兔随机分为治疗组、模型组、对照组,每组10只。治疗组和模型组均采用改良伸直位固定6周,制备兔膝骨关节炎模型。治疗组造模后给予体外冲击波治疗1次,能流密度0.1 mJ/mm2,冲击次数1000次。对照组不作任何处理。各组兔于治疗后4周处死,取膝关节液和关节软骨。苏木精-伊红染色和甲苯胺蓝染色法检测各组膝关节病理学形态改变,采用酶联免疫吸附法测定关节液白细胞介素1β水平,免疫组化法检测白细胞介素1β和基质金属蛋白酶13的表达。 结果与结论：治疗组和模型组关节液白细胞介素1β水平较对照组明显增高（P 〈0.01）,治疗结束后治疗组关节液白细胞介素1β水平较模型组下降（P 〈0.05）。治疗组和模型组软骨组织Mankin评分较对照组明显增高（P〈0.01）,治疗结束后治疗组软骨组织Mankin评分较模型组下降（P〈0.05）。治疗组和模型组软骨细胞白细胞介素1β和基质金属蛋白酶13阳性表达率较对照组明显增高（P〈0.01）,治疗结束后治疗组软骨细胞白细胞介素1β和基质金属蛋白酶13阳性表达率较模型组下降（P〈0.05）。结果可见体外冲击波能下调膝骨关节炎软骨细胞白细胞介素1β和基质金属蛋白酶13的表达,促进Ⅱ型胶原和蛋白聚糖的合成,从而对膝骨关节炎起防治作用。     

3.0T MR T1ρ及T2 mapping评估兔股骨内侧髁关节软骨退变

目的 观察3.0T MR T1ρ及T2 mapping评估兔股骨内侧髁关节软骨退变的价值。方法 将40只兔随机分为2周组、4周组、6周组及对照组各10只。对2周组、4周组及6周组兔建立右后肢膝骨关节炎模型并分别制动2、4及6周，对照组不予处理；行T1ρ及T2 mapping成像。处死动物后取股骨内侧髁关节软骨病变最严重区域行病理切片及染色；根据国际骨关节炎研究学会（OARSI）分级标准分为正常组、退变早期组及退变中晚期组，测定Ⅱ型胶原、蛋白多糖、β-Catenin及基质金属蛋白酶（MMP）-13，观察T1ρ及T2 mapping评估其关节软骨退变的价值。结果 最终对37只兔造模成功，正常组8只、早期退变组20只、中晚期退变组9只；3组股骨内侧髁关节软骨T1ρ值及T2值差异均有统计学意义（P均<0.05），两两比较差异亦有统计学意义（P均<0.05）。T1ρ值及T2值与OARSI分级（r=0.72、0.73，P均<0.01）、MMP-13表达（r=0.84、0.59，P均<0.01）及β-Catenin表达（r=0.76、0.66，P均<0.01）均呈正相关，与Ⅱ型胶原含量（r=－0.70、－0.61，P均<0.01）及蛋白多糖含量（r=－0.82、－0.57，P均<0.01）均呈负相关。对正常组及退变早期组共28只兔行logistic回归分析，T1ρ值联合T2值鉴别兔正常与早期右后肢股骨内侧髁关节软骨退变的曲线下面积为0.84，敏感度及特异度分别为90.40%及75.26%。结论 3.0T MR T1ρ及T2 mapping可定量评估兔股骨内侧髁关节软骨退变，用于判断其早期退变较具价值。     

健膝强骨丸对膝骨关节炎家兔模型关节软骨病理改变的影响

背景：膝骨关节炎的病理学改变不可逆转,属中医“痹证”范畴,治疗目的是缓解或解除症状,延缓关节退变。健膝强骨丸方是武汉大学基础医学院荆州市第三人民医院的经验方,可补益肝肾,祛风散寒,除湿通络,强骨健膝。目的：观察健膝强骨丸对膝骨关节炎兔模型膝骨关节软骨的保护作用,及其对软骨细胞骨形态发生蛋白7表达的影响。方法：36只新西兰兔随机分为3组,每组12只,分别运用改良Hulth术制备兔膝骨关节炎模型。造模后第6周,给药组予健膝强骨丸0.1 g/kg 灌胃,模型组和正常对照组予等量生理盐水灌胃。给药4周后通过软骨Mankin’s 评分方法行兔膝关节软骨评分,电镜下观察软骨形态,免疫组化法检测膝关节软骨细胞骨形态发生蛋白7表达情况。结果与结论：给药组兔膝关节软骨病理退变程度较其他2组轻,膝关节软骨细胞骨形态发生蛋白7的表达量较其他2组高,差异有显著性意义（P＜0.05）。提示健膝强骨丸可增强膝骨关节炎模型兔关节软骨细胞骨形态发生蛋白7的表达,从而促进膝关节软骨再生,减少软骨变形坏死,达到治疗关节炎的目的。     

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.