不同转移潜能人肝癌细胞系的差异表达蛋白质组分析及意义

目的比较研究转移性肝癌细胞系中蛋白质表达谱的改变,筛查在转移中起重要作用的关键蛋白质分子.方法用双向电泳(2-DE)及液相色谱-电喷雾-串联质谱(LC-ESI-MS/MS)对3种不同转移潜能人肝癌细胞系Hep3B、MHCC97L、MHCC97H的差异蛋白质组进行分析. 结果 Hep3B、MHCC9TL和MHCC9TH分别平均检测到976±112个蛋白点(n=3)、1092±40个蛋白点(n=3),和888±15个蛋白点(n=3),以其中MHCC97L图谱为参考胶,Hep3B、MHCC9TL和MHCC9TH分别与其匹配的平均匹配点数为637±37个(n=3)、771±16个(n=2)和589±51个(n=3),平均匹配率分别为65.7 %,72.1%,66.2%.不同胶间蛋白质斑点的位置偏差[等电聚焦(IEF)]方向为(2.95± 0.95)mm,聚丙烯酰胺凝胶电泳方向为(2.87±0.88)mm.Hep3B、MHCC97L、MHCC97H中有359个蛋白质点匹配.与Hep3B比,MHCC97L有103个点未匹配,相差10倍以上的上调点和下调点分别为57个和49个;MHCC97H有113个点未匹配,相差10倍以上的上调点有47个,相差10倍以上的下调点有52个.质谱可鉴定出S100A4,S100A6,S100A11,Annexin1等26种胶内差异蛋白质.结论与不转移肝癌细胞相比,转移性肝癌细胞有明显的差异性蛋白表达谱.推测肝癌侵袭转移性与细胞内多种差异蛋白相关.     

呼吸肌训练改善老年慢性阻塞性肺疾病患者肺功能和生活质量

目的:观察呼吸肌训练对老年慢性阻塞性肺疾病(chronicobstructivepulmonarydisease,COPD)患者肺功能和生活质量的影响。方法:采用单纯随机配对分组,将89例符合COPD诊断标准的Ⅱ～Ⅲ级缓解期患者分为呼吸肌训练组(A组,n=45)和非呼吸肌训练组(B组,n=44)。A组患者由专科医师教会呼吸肌训练方法(缩唇-腹式呼吸法和呼吸肌运动体操),并定期随访督导。监测两组治疗前、6个月后第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FVC)比值(FEV1/FVC)、血气分析指标卧位动脉血氧分压(PaO2)和二氧化碳分压(PaCO2)的变化;同时进行生活质量评分对比。结果:经6个月的督导治疗,两组肺功能FEV1,FEV1/FVC(%)和Pa-CO2犤A组:(1.8±0.7)L,(69.5±12.1)%,(5.4±0.4)kPa;B组:(1.5±0.6)L,(56.4±11.5)%,(7.0±0.7)kPa犦的差别有显著性意义(t=2.47、2.38、2.56,P均<0.05),PaO2犤A组:(11.5±0.8)kPa;B组:(8.5±0.9)kPa犦的差别有非常显著性意义(t=3.54,P<0.01);两组生活质量总均分、F1、F2、F3、F4犤A组:2.10±0.26,2.18±0.28,2.11±0.23,2.09±0.25,2.26±0.29;B组:2.37±0.34,2.31±0.30,2.32±0.32,2.41±0.35,2.46±0.38犦的差别有显著性意义(t=2.41,2.52,2.39,2.62,2.35,P均<0.05)。结论:呼吸肌训练不仅能明显改善老年COPD患者生     

腺苷A1受体系统对兔脑缺血的保护效应

目的探讨腺苷A1受体系统对兔脑缺血的保护作用.方法家兔24只随机分为3组,分别为对照组(Ⅰ组,n=8)、缺血组(Ⅱ组,n=8)、腺苷A1受体激动剂+缺血组(Ⅲ组,n=8),股动脉抽血至平均动脉压35～40 mmHg时,阻断双侧颈总动脉诱导脑缺血.观察术后第3天海马CA1区神经元密度.结果Ⅱ组神经元密度为(76.50±5.26)个/mm,显著低于Ⅰ组神经元密度(208.13±11.08)个/mm(P＜0.05);而Ⅲ组神经元密度(130.78±18.07)个/mm明显高于Ⅱ组(P＜0.05).结论激活腺苷A1受体系统能减轻脑缺血性损害.     

亚力克对小鼠脑损伤后脂质过氧化及能量代谢能力的影响

目的:ALEC(亚力克)是由α-亚麻酸(A)、L-赖氨酸(L)、维生素E(E)及维生素C(C)组成的复方,通过正交试验设计,以脑组织中乳酸含量为指标,确定4者比例(A:L:E:C为432:187:18:8),并研究ALEC对小鼠脑损伤后丙二醛(MDA)、一氧化氮(NO)及三磷酸腺苷酶(ATPase)和唾液酸(SA)的影响。方法:70只昆明种小鼠,单纯随机分为6组:对照组(n=11),生理盐水(NS)组(n=11),氟苯桂嗪(Nimodipine)组(n=12),ALEC高、中、低(HALEC,MALEC,LALEC)组(每组12只)。除对照组外,其余各组给予腹腔注射NS,Nimodipine和不同剂量ALEC后进行持续缺氧处理,造成急性持续性缺氧脑损伤模型,检测各组小鼠脑组织中MDA,SA及NO含量和ATPpase活性。结果:小鼠经持续低氧处理后,脑组织中MDA犤(4.06±0.37)nmol/L犦和NO犤(0.69±0.09)μmol/L犦含量与对照组比犤(2.27±0.27)nmol/g,(1.39±0.23)μmol/L犦明显升高(t=1.20,0.95,P<0.05～0.01),而Ca2+-ATPase(42±64)nmol/s,Na+/K+-ATPase(256±69)nmol/s,Mg2+-ATPase(192±103)nmol/s,SA(0.094±0.010)nmol/mg含量与对照组犤(539±136),(619±111),(511±117)nmol/s,(0.156±0.017)nmol/mg犦比明显降低(t=8.9,9.7,4.1,5.4,P<0.01)。HALEC组可使MDA(2.65±0.48)nmol/g和NO(1.36±0.19)μmol/L含量降低,使Na+/K+-A     

树鼩肝癌形成过程中凋亡抑制基因的表达及与细胞凋亡的关系

背景：目前对肝细胞癌(HCC)的研究大多数只局限于对人的肝癌及癌旁组织进行研究，这种研究方法的最大缺陷是不能动态观察肝癌形成过程中的不同时期的各种变化。目的：利用实验诱发树鼩向肝癌的动物模型，动态研究在树鼩肝癌形成过程中凋亡抑制基因(survivin)的表达及其抑制凋亡的机制。设计：完全随机对照实验。干预：实验组给予AFB1(黄曲霉毒素B1)105周，然后继续喂正常饲料至150周。对照组动物不喂AFB1，仅按正常饲养方法同样喂至150周。实验期间每隔15周对实验组和对照组动物打开腹腔进行肝组织活检。活检组织用40g／L中性甲醛固定，石蜡包埋。然后将对照组30，60，90周和实验组30，60周及HCC组织的切片，采用免疫组织化学S-P法和脱氧核糖核酸末端转移酶介导的缺口末端标记(TUNEL)技术，进行survivin基因蛋白和凋亡细胞的检测。主要观察指标：树鼩肝细胞癌形成过程中每一阶段的survivin基因蛋白的表达情况和细胞凋亡的情况。结果：survivin基因与HCC的发生有关，在树鼩HCC形成过程中，其表达呈递增趋势。survivin在对照组30，60，90周，实验组30，60周平均得分分别为0．62，0．77，0．92，1．02，1．6，在树鼩HCC组织切片中平均得分为5．34，与各组肝组织中的表达差异有显著性意义(t=3．0580，3．2564，3．0316，4．7715，3．8036，P&;lt;0．01)。结论：survivin表达与凋亡指数呈负相关，survivin表达抑制细胞凋亡。     

异丙酚对缺血再灌注肝脏血管内皮细胞功能的调控

目的:以透明质酸评估血管内皮细胞功能,并观察其在肝缺血再灌注损伤中的作用及异丙酚的调控效果。方法:实验于2002-06/2005-01在温州医学院病理生理学教研室及第一附属医院手术室进行。①分组:实验兔20只和肝癌手术患者18例均随机分为肝缺血再灌注组(n=10,n=9)和异丙酚治疗组(n=10,n=9)。②给药:兔异丙酚治疗组肝门阻断前即刻用微量注射器泵经颈内静脉持续给予异丙酚20mg/(kg·h),直至术毕前10min。肝癌患者异丙酚治疗组肝门阻断前即刻用微量注射器泵经外周静脉持续给予异丙酚4mg/(kg·h),直至术毕前10min。③检测指标:分别于缺血前(阻断前)、缺血45min(兔)或阻断25min(患者)和再灌注45min(兔)或再开放25min(患者)共3个时相点,用放射免疫法测定血浆透明质酸浓度,赖氏法检测谷丙转氨酶活性。结果:20只实验兔和18例肝癌手术患者均进入结果分析。①肝缺血再灌注期间,实验兔和肝癌手术患者血浆透明质酸浓度、谷丙转氨酶活性明显升高,尤以再灌注45min或再开放25min为著犤兔透明质酸(2.03±0.65)μg/L,谷丙转氨酶(1.03±0.14)μkat/L;患者透明质酸(0.59±0.14)μg/L,谷丙转氨酶(2.11±0.25)μkat/L,(P<0.05或P<0.01)犦。②异丙酚可逆转上述指标的异常变化犤再灌注45min兔透明质酸(1.21±0.28)μg/L;谷丙转氨酶(0.76±0.16)μkat/L;阻断25min患者透明质酸(0.44±0.10)μg/L;谷丙转氨酶(0.78±0.29)μkat/L,(P<0.05或P<0.01)犦。②实验兔及肝癌手术患者于缺血再灌注期间,透明质酸与谷丙转氨酶之间均存在着明显的正相关犤r=0.883(实验兔)和0.754(患者),P均<0.01犦。结论:血管内皮细胞功能紊乱在肝缺血再灌注损伤发生、发展中起重要的作用,异丙酚可通过保护血管内皮细胞而减轻肝缺血再灌注损伤。     

利凡诺—低温乙醇结合法分离的人血免疫球蛋白质量研究

本文对分别采用利凡诺—低温乙醇结合法(R—E 法)、低温乙醇法(E 法)和利凡诺—硫酸铵结合法(R—AS 法)分离的人血免疫球蛋白质量进行了对比观察。结果用 R—E 法分离的免疫球蛋白纯度为96.67±0.93%,其中 IgG、IgA 和 IgM 组分占89.26±0.81%、6.29±0.38%和1.16±0.28%(n=10),IgG 单体和双体为95.96±1.38%,多聚体为3.04±0.73%,裂解物为1.02±1.04(n=7)。用 E 法和 R—AS 法分离的同类制品纯度分别为89.20±5.45%和96.22±0.67%,IgG、IgA 和 IgM 组分分别占88.59±4.87%、0.34±0.21%、0.15±0.09%(n=8)和88.90±1.46%、7.08±1.28%、0.24±0.29%(n=6)。E 法制品中 IgG 单体和双体为98.43±0.57%,多聚体为0.96±0.25%,裂解物为0.62±0.33%(n=3)。3种方法分离的免疫球蛋白制品经57℃加热4小时外观无明显变化。     

电刺激诱发表面肌电信号的初步实验研究

目的为探索一种无创的肌电检测方法,进行有关诱发表面肌电信号的实验。方法设计了电刺激诱发表面肌电信号检测实验系统,采用恒流电刺激器刺激腓总神经,记录小腿外侧肌肉的诱发表面肌电信号。结果分别对6例正常受试者和5例重症肌无力患者进行了测试,发现电刺激引起肌肉疲劳过程中,正常受试者和重症肌无力患者诱发肌电信号的变化显著不同,首次刺激记录到的诱发肌电P1波的中角度(A1)对照组(6.45±2.57),重症肌无力组(1.79±0.72),持续刺激30s记录到的诱发肌电P1波的中幅度(A2)对照组(3.41±1.77),重症肌无力组(0.29±0.12),与对照组相比差异有显著性意义(t=4.078,4.446,P<0.05)。结论诱发肌电信号的检测分析对于研究肌肉的疲劳耐受性具有意义,该研究方法有一定的临床应用价值。     

毫米波、高压氧对红细胞、淋巴细胞免疫粘附功能的作用

目的:探讨毫米波、高压氧对机体免疫功能的影响及其可能机制。方法:将昆明种小鼠(n=60)双盲随机抽样分为2组,毫米波组(n=30)用频率36GHz,功率密度7.3～14.6W/m2的毫米波辐射荷瘤小鼠背部30min,1次/d,连续8d;对照组(n=30)在同等条件下进行假辐射。同种属小鼠(n=60)采用同种分组方法分为7组(每组n=10),其中6组经0.25MPa(绝对压)992mL/LO2的高压氧不同次数暴露,对照组在常压下以压缩空气持续通风,以上各组小鼠分别采用花环法测定红细胞C3b受体花环率(redbloodcell-C3breceptorrosettesrate,RCR,%),肿瘤细胞-红细胞花环率(tumour-redbloodcellrosetterate,TRR,%)及脾脏、胸腺淋巴细胞-肿瘤细胞花环率(tumourcell-lymphocyterosetterate,TLR,%)。结果:①在毫米波辐射后0d和6d时,辐射组RCR犤2.0±1.6和4.0±1.5犦,TRR犤3.3±1.0和3.8±1.5犦,TLR(胸腺:5.2±1.8和5.8±1.4;脾脏:2.7±1.0和6.2±1.8)与对照组相比,均无明显差异(t=0.928～2.431,P均>0.05);在3d时,辐射组RCR(7.0±1.6),TRR(6.5±1.6),TLR(胸腺:12.4±3.0;脾脏:11.7±2.3)显著高于对照组(t=6.328～7.195,P均<0.05)。②与对照组比较,高压氧暴露1,3,5d时RCR,TRR,TLR(脾脏、胸腺)显著降低(t=1.923～8.531,P<0.01～0.05),而暴露15,20d时逐渐回升,与对照     

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.     

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.     

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.