心肌缺血-再灌注损伤中血清一氧化氮水平变化的意义

目的：探讨一氧化氮（ＮＯ）在心肌缺血－再灌注损伤和心肌缺血预适应中的作用。方法：制备家兔心肌缺血－再灌注损伤和心肌缺血预适应的模型，检测血清ＮＯ、血浆过氧化物歧化酶（ＳＯＤ）活性、丙二醛（ＭＤＡ）等氧自由基浓度和血清心肌酶水平。结果：再灌注损伤（ＩＲＩ）组血清心肌酶明显升高，脂质过氧化物降解产物ＭＤＡ异常升高，ＳＯＤ活性则显著降低，伴随ＮＯ代谢产物ＮＯ＾－２升高，与缺血预适应和对照组比较，Ｐ〈０．     

SD大鼠不同肠缺血时间观察长期存活率模型的筛选

目的:探讨SD大鼠肠缺血合适缺血时间,筛选适合于观察肠缺血再灌注长期存活率的SD大鼠肠缺血再灌注模型。方法:采用肠系膜上动脉夹闭法建立小肠缺血再灌注模型,将60只SD大鼠随机分为5组,A组为假手术组,B～E组分别为肠缺血60、75、90、120min组,每组12只。术后正常饲养,观察大鼠1～7d的存活率和存活状态。结果:缺血60min组存活率及动物状态与假手术组相比无明显差异(P>0.05)。缺血75min组第1天存活50%,第3、7天均存活42%,动物毛发尚有光泽,反应灵敏,与假手术组 (100%)相比,存活率差异有统计学意义(P<0.05)。缺血90min组和缺血120min组第1、3、7天存活率明显低于假手术组 (P<0.01),动物毛发无光泽,低头、躬背,反应迟钝,活动减少。缺血75min组第3天存活率及缺血90min、缺血120min两组的存活率明显低于缺血60min组(P<0.05)。结论:随小肠缺血时间延长,再灌注大鼠术后存活率下降。肠缺血75min SD大鼠是肠缺血再灌注观察长期存活率的模型相对理想的选择。     

川芎嗪注射液对脑缺血-再灌注损伤家兔血清白细胞介素-8的影响

目的：观察川芎嗪注射液（ＴＭＲＩ）对脑缺血－再灌注损伤（ＣＩＲＩ）家兔血清白细胞介素－８（ＩＬ－８）的合成和释放的影响,并探讨其脑保护机制。方法：制备家兔ＣＩＲＩ模型,随机分为假手术对照组、缺血－再灌注组和ＴＭＲＩ组,分别在缺血前、缺血３０分钟、再灌注３０、６０、１２０分钟取静脉血,测定血清ＩＬ－８浓度,实验结束取脑皮质ＨＥ染色,光镜观察脑组织病理学改变。结果：缺血－再灌注组在脑缺血－再灌注时间不同时间点血清ＩＬ－８水平随脑缺血－再灌注时间延长呈进行性升高,分别为缺血前的１．３８、１．６２、１．９３和２．２９倍,明显高于假手术组,光镜下白细胞大量浸润、神经元明显损伤;ＴＭＲＩ组不同时间点血清ＩＬ－８浓度显著低于缺血－再灌注组,光镜下白细胞浸润、神经元损伤程度较缺血－再灌注组明显减轻,而与假手术组比较均无显著性差     

高压氧对家兔急性脊髓缺血再灌注损伤的保护作用

目的　通过建立兔脊髓缺血再灌注损伤模型观察其组织病理学、生化指标及影像学变化,探讨脊髓缺血再灌注损伤机制。在此基础上研究高压氧对脊髓缺血损伤的保护作用。方法　采用夹闭法制备家兔急性脊髓缺血再灌注损伤模型,测定脊髓缺血４０ 分钟及再灌注后脂质过氧化物（ＬＰＯ）含量以及超氧化物歧化酶（ＳＯＤ） 活性,并观察神经功能缺失程度及组织病理学变化,同时观察腰（Ｌ４）为中心脊髓磁共振扫描（ＭＲＩ）的变化。结果　脊髓缺血４０ 分钟后所有动物均出现双后肢瘫痪,肌力为２ 级,再灌注后动物神经功能有不同程度的恢复;缺血后脊髓组织ＬＰＯ 含量明显升高,ＳＯＤ活性下降,与正常对照及假手术组相比差异有显著性（ Ｐ＜０ ．０５）,再灌注后ＬＰＯ 含量有所下降,直至２４ 小时恢复正常,ＳＯＤ 则在再灌注２～６ 小时活性进一步降低,至２４ 小时恢复正常水平。组织病理学显示缺血后即有明确的病理改变,再灌注后这种改变更为严重;ＭＲＩ显示脊髓缺血后Ｔ２ 加权像有明确的异常高信号;ＨＢＯ 治疗组与缺血再灌注６ 小时对照组相比较,ＬＰＯ含量下降,ＳＯＤ活性增强,差异有显著性（ Ｐ＜０ ．０５）。结论　脂质过氧化是脊髓缺血再灌注损伤的主要机制,高压氧治疗可增强自由基清除     

大黄对大鼠肠缺血再灌注所致肺损伤过程肿瘤坏死因子、一氧化氮和磷脂酶A2的影响

目的：观察肿瘤坏死因子（ＴＮＦ）、内源性一氧化氮（ＮＯ）和磷脂酶Ａ２（ＰＬＡ２）在大鼠小肠缺血再灌注（ＩＲ）所致肺损伤发病过程中的作用,及大黄对ＴＮＦ、ＮＯ和ＰＬＡ２的影响,探讨大黄防治肠源性肺损伤的机制。方法：ＳＤ大鼠随机分为肠缺血再灌注组、假手术组、大黄治疗组和安慰剂组。以１２５Ｉ标记小牛血清白蛋白（ＢＳＡ）肺摄取指数作为评价肺损伤的指标,以髓过氧化物酶（ＭＰＯ）作为评价多形核白细胞（ＰＭＮ）在组织中聚集的指标,分别测定各组动物不同时间血浆、肺组织ＴＮＦ含量,血浆（血清）、肺及小肠组织内源性ＮＯ含量及ＰＬＡ２活性。结果：大黄可显著改善ＩＲ导致的低血压状态并明显抑制再灌注导致的肺ＭＰＯ活性升高（Ｐ＜０．０１）;抑制肠缺血和再灌注早期出现的血浆及肺组织ＴＮＦ水平升高（Ｐ＜０．０１）;抑制肠缺血期和再灌注期血清、肺及小肠组织ＰＬＡ２活性升高（Ｐ＜０．０５或Ｐ＜０．０１）及再灌注期的内源性ＮＯ释放（Ｐ＜０．０５或Ｐ＜０．０１）;降低肺毛细血管通透性（Ｐ＜０．０１）。结论：缺血再灌注早期应用大黄能明显防治大鼠ＩＲ所致的肺损伤,这种作用可能是通过抑制ＴＮＦ、内源性ＮＯ及ＰＬＡ２等介质的释放实现的。     

兔脑缺血再灌注后NSE和S-100的表达及其血清水平的变化

目的：探讨兔大脑中动脉缺血再灌注（MCAO／R）后脑组织神经元特异性烯醇化酶（NSE）和S-100蛋白的表达及其血清含量的变化。方法：将制作成功的兔MCAO／R模型58只，随机分为永久性缺血组30只和缺血再灌注组28只；另取10只动物行假手术分别作为缺血组（5只）及再灌注组（5只）的对照组。免疫组化法检测脑缺血再灌注不同时间脑组织NSE和S-100蛋白的表达，ELISA法检测血清NSE和S-100的含量。结果：假手术组脑组织NSE和S-100表达微弱，血清含量较低。永久性脑缺血3h和缺血再灌注2h后，脑组织NSE和S-100表达同步升高和降低．变化趋势基本一致，但NSE和S-100表达在缺血再灌注47h组较永久性缺血48h组再次明显升高。血清NSE和S-100水平直到缺血5h和再灌注5h开始同步升高，较脑组织NES和S-100表达时间延迟3h。结论：神经细胞和胶质细胞对缺血再灌注损伤非常敏感，再灌注可加重脑组织的损伤，破坏血-脑屏障，NSE和S-100从脑脊液循环进入了血液循环．血清NSE和S-100的水平可作为评价脑损伤程度和转归的早期指标。     

肢体缺血中处理与缺血后处理改善严重失血性休克大鼠急性肾损伤作用的比较

目的:比较肢体缺血中处理与缺血后处理在严重失血性休克急性肾损伤中的作用。方法:38只清洁级大鼠随机分为4组:假手术组8只,缺血再灌注组、缺血中处理组、缺血后处理组各10只。假手术组不失血不输血,其余3组于60 min匀速抽出大鼠总血容量45%的血液,维持休克40 min后于40 min内匀速回输全部血液,复苏后4 h回笼,继续观察72 h。失血20 min时,缺血中处理组对大鼠肢体进行4个周期的阻断动脉血流5 min、松开再灌注5 min。缺血后处理组周期性阻断血流和恢复灌注同缺血中处理组,但于停止失血时进行。缺血再灌注组仅回输血液。于动物准备结束及复苏后4 h分别抽血检测肌酐(Cr)、尿素氮(BUN),72 h后取大鼠肾脏行病理检查,记录大鼠存活时间。结果:与假手术组相比,缺血再灌注组复苏后Cr、BUN明显升高,肾脏病理损伤较重,存活时间明显缩短;与缺血再灌注组相比,缺血中处理组、后处理组复苏后大鼠Cr、BUN均下降,肾脏病理损伤减轻,大鼠存活时间明显延长,尤以缺血中处理组明显(P0.05)。结论:与缺血后处理相比,缺血中处理能使肾脏更早的对缺血再灌注进行适应,从而更好地减轻失血性休克缺血再灌注所致的急性肾损伤。     

大鼠肠缺血—再灌注模型中多个器官细胞凋亡的观察

目的：探讨多脏器功能失常综合征发病中细胞凋亡的作用。方法：建立大鼠肠系膜上动脉夹闭模型，常规组织切片，ＨＥ染色，普通光学显微镜检查及吖啶橙溴化乙锭双重染色的荧光显微镜观察肠、肝、肺、肾４个器官组织的细胞死亡现象，并在石蜡切片上计数凋亡细胞的百分比；荧光显微镜下计数缺血再灌注不同时间分离的肝细胞中活细胞、凋亡细胞和坏死细胞数。结果：①肠缺血再灌注后各时间点均可观察到细胞凋亡及细胞坏死现象；②局灶性的肾小球和肾小管坏死主要分布在肾皮质与髓质交界处；③肝细胞凋亡和细胞坏死的百分比均随肠缺血再灌注时间延长而升高，且与假手术组比较均有显著性差异（Ｐ均＜０．０５）；缺血１２０分钟、再灌注６０分钟组与缺血１８０分钟组比较，细胞凋亡与细胞坏死的百分比均较高（Ｐ均＜０．０５）。结论：肠缺血再灌注后多个器官组织在短时间内即可发生大量细胞凋亡，这在多器官功能障碍发病中可能具有重要意义     

P选择素单克隆抗体对大鼠肝缺血—再灌注损伤的治疗作用研究

目的：探讨Ｐ选择素单克隆抗体（单抗）对大鼠肝缺血再灌注损伤的保护作用。方法：在肝缺血再灌注大鼠模型上观察了细胞间粘附分子１和Ｐ选择素的变化，并用Ｐ选择素单抗对其进行阻断治疗。结果：缺血再灌注大鼠肝细胞发生水肿及空泡变性，血清天冬氨酸转氨酶和丙氨酸转氨酶水平升高；但再灌注前５分钟经静脉注射Ｐ选择素单抗，则肝组织与正常组相近，肝细胞未见空泡变性，血清酶水平明显减低；酶联免疫吸附试验发现，再灌注后血清ＩＣＡＭ１和血浆Ｐ选择素水平显著升高，经Ｐ选择素单抗处理的大鼠血ＩＣＡＭ１和Ｐ选择素明显下降。结论：ＩＣＡＭ１和Ｐ选择素与缺血再灌注损伤密切相关，Ｐ选择素单抗对肝缺血再灌注损伤具有保护作用。     

缺血后处理神经保护作用的实验研究

目的：探讨缺血后处理对大鼠全脑缺血再灌注损伤的影响。方法30只雄性SD大鼠随机分为三组（n=10）,建立四血管阻断全脑缺血模型。假手术组：单纯麻醉和手术操作,无缺血过程;缺血再灌注组：缺血10 min后再灌注;缺血后处理组：缺血10 min后以10 s再灌注/10 s阻断,共6个循环实现缺血后处理。再灌注后于第1天和第3天进行行为学观察;在72 h后进行病理学检测。结果 Morris水迷宫提示：再灌注后第1天,缺血再灌注组的平均上台时间（84.76±10.22）s较假手术组（27.08±7.52）s明显延长,差异有统计学意义（t=14.84, P＜0.05）,缺血后处理组的平均上台时间（50.24±9.72）s明显少于缺血再灌注组,差异有统计学意义（t=7.74, P＜0.05）。再灌注后第3天,缺血再灌注组的上台时间（55.90±11.26）s仍明显长于缺血后处理组（29.22±5.82）s,差异有统计学意义（t=6.65, P＜0.05）。72 h后病理学染色提示：缺血再灌注组和缺血后处理组海马CA1区存活神经元分别为假手术组的25.90％和64.60％。结论缺血后处理可以明显减少大鼠全脑缺血再灌注后神经元死亡,减轻行为学缺损,对大鼠全脑缺血再灌注有神经保护作用。     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."