久强脑立清对急性高血压大鼠重要器官的保护作用

目的探讨久强脑立清（JNQ）对急性高血压大鼠重要器官脑、肾、心的影响。方法采用左旋硝基精氨酸（L-NNA）制做急性高血压大鼠模型，然后给高、中、低剂量JNQ和阳性对照药硝苯地平，观察心功能指标及重要器官HE染色的变化。结果急性高血压大鼠血压两周后比对照升高36％，脑、肾、心均可见病理性改变，但各组大鼠的心率、心电图和血压未见明显差异。经JNQ治疗的大鼠心肌收缩力和心肌耗氧量明显下降，左室内压上升速度明显减慢；脑、心、肾病理改变有不同程度改善。结论尽管JNQ对急性高血压大鼠的心率、血压无明显影响，但可降低心肌耗氧，改善心功能指标，对重要器官脑、肾、心的病变有较明显的保护作用。     

久强脑立清对自发性高血压大鼠血浆血栓素A2和前列环素水平的影响

目的探讨久强脑立清 (JNQ )对自发性高血压大鼠 (SHR)血浆血栓素A2 (TXA2 )和前列环素 (PGI2 )水平的影响。方法设立JNQ低、中、高剂量 3个组 ,剂量分别为 0 13 3 g/kg、0 2 65 g/kg和 0 5 3 0g/kg ,SHR和正常Wistar大鼠对照组给予 1%羧甲基纤维素溶媒对照 ,分别灌胃给药 5周后 ,分离血浆 ,用放免法测定血浆中TXA2 和PGI2 的稳定代谢产物TXB2 和 6 keto PGF1α的水平。结果SHR血浆TXB2 及TXB2 /6 keto PGF1α(T/P)值明显上升 (P <0 0 1) ,PGI2 无明显变化 (P >0 0 5 )。经JNQ3种剂量治疗 5周后 ,SHR的血浆TXB2 均显著下降 ,并呈明显的剂量依赖关系 ,高剂量组SHR血浆 6 keto PGF1α水平也有明显提高 ,各治疗组T/P比值均下降。结论JNQ对SHR血浆TXA2 /PGI2 的平衡失调有明显的改善作用     

久强脑立清促进自发性高血压大鼠脑内降钙素基因相关肽和突触素Ⅰ的表达

目的 研究久强脑立清(JNQ)对自发性高血压大鼠(SHR)脑内降钙素基因相关肽(CGRP)和突触素Ⅰ表达的影响。方法 大鼠随机分为4组：Wistar组、SHR组、JNQ低剂量SHR组、JNQ高剂量SHR组。给药3周后，用免疫组织化学的方法检测CGRP和突触素Ⅰ在海马齿状回、CA1区和大脑皮层的表达变化。结果 与Wistar组比较，SHR组CGRP和突触素Ⅰ在海马齿状回、CA1区和大脑皮层的表达均降低，给予低剂量JNQ后能够增加CGRP在大脑皮层的表达，高剂量JNQ既能够增加CGRP在海马齿状回、CA1区和皮层的表达，还能增加突触素Ⅰ在海马CA1区的表达。结论 JNQ可能通过上调CGRP的表达来改善SHR脑内的微循环，通过上调突触素Ⅰ的表达来增强SHR中枢神经系统的调控功能。     

黄芪对自发性高血压大鼠血压的急性效应

目的　观察黄芪对自发性高血压大鼠 (SpontaneouslyHypertensiveRats,SHR)血压的急性影响。方法　腹腔给予不同剂量的黄芪后 ,用间接测压法测定SHR血压。再分别连续给予不同剂量的黄芪 ,8周后 ,用直接法测定静脉给予黄芪对SHR血压的影响。结果　 1、SHR腹腔注射不同剂量黄芪在观察的各时间点 (5分、15分、30分、6 0分、12 0分 )并不引起血压的急性变化 (P >0 .0 5 )。 2、黄芪长期腹腔注射可以控制SHR血压的升高 (P <0 .0 1)。 3、急性静脉给药可以引起SHR血压短时间内明显下降 ,并且呈剂量相关效应 (P <0 .0 5或P <0 .0 1)。结论　黄芪急性腹腔给药不影响SHR血压 ,但长期腹腔给药可以控制SHR血压的升高。急性静脉给药可以引起短时间内明显的血压下降。     

盐酸戊乙奎醚对内毒素休克兔器官的保护作用

目的观察不同剂量盐酸戊乙奎醚(长托宁)对内毒素休克兔血压及重要器官形态学的影响。方法35只健康新西兰大白兔随机分成正常对照组、休克组、长托宁低剂量组(0．05 mg/kg)、长托宁中剂量组(0．15 mg/kg)和长托宁高剂量组(0．45 mg/kg)。采用静脉注射大肠杆菌脂多糖制作内毒素休克模型。长托宁各组分别于静注脂多糖后立即静注不同剂量长托宁。连续监测给药后动物平均动脉压;光学显微镜下观察各组动物心、肺、肝、肾的形态学变化。结果给药后90 min,中剂量组动物血压较休克组明显改善,低、高剂量组改善不明显。长托宁低、中、高剂量组动物各组织病变不同程度较休克组减轻,中剂量组病变减轻更明显。结论长托宁能改善内毒素休克兔的血压,减轻内毒素休克引起的重要器官的组织损伤;相对于低、高剂量长托宁,中剂量在改善血压及减轻组织损伤方面效果更为显著。     

黄芪对自发性高血压大鼠的抗高血压效应及其机制的初步研究

目的明确黄芪对自发性高血压大鼠血压的调节作用并探讨其可能机制。方法SHR19只，采用不同剂量的黄芪注射液1．8g、2．4g和3．6g腹腔注射给药，1天1次，共8周。并连续定时观察血压变化，8周后处死SHR。并比较用药各组与不用药组的血压、左心室肥厚指数和淋巴细胞钙离子水平、血浆内皮素-1含量的差异。结果黄芪腹腔注射给药8周后，黄芪组SHR血压在总体上随时间呈下降趋势，空白组血压自实验开始后第4周继续升高（P〈0．01）。SHR空白组的左心室肥厚指数明显高于低剂量黄芪组、中剂量黄芪组、高剂量黄芪组SHR和各组WKY（P〈0．01）。中剂量黄芪组和高剂量黄芪组SHR比较空白组SHR的淋巴细胞内钙离子水平明显下降（P〈0．05或P〈0．01）。中剂量黄芪组和高剂量黄芪组SHR比较空白组SHR的血浆内皮素-1水平明显下降（P〈0．01）。结论慢性腹腔注射给药可以控制SHR血压进一步升高和改善高血压过程中的LVH，黄芪的这种作用可能与降低淋巴细胞内钙离子超载和血浆内皮素-1水平有关。     

厄贝沙坦对自发性高血压大鼠肾脏的影响

目的 :探讨厄贝沙坦对肾脏的保护作用 ,以及与核转录因子κB(NF -KappaB) p6 5和NF -κB依赖的基质金属蛋白酶 -9(MMP - 9)在自发性高血压大鼠 (SHR)肾组织中表达的关系。方法 :将 14只SHR随机分为对照组和治疗组 ,以WKR为正常对照。治疗组以厄贝沙坦 5 0mg·kg-1·d-1灌胃 12周 ,观察大鼠的血压、尿蛋白及肾组织病理改变 ;并用免疫组化的方法测定肾皮质核转录因子κB及MMP - 9的表达 ;MMP - 9mRNA由原位杂交检测。结果 :治疗组血压显著下降、尿蛋白显著减少(P <0 .0 1) ;NF -κBp6 5蛋白表达水平下调 (P <0 .0 1) ;MMP - 9的表达同时下降 ,以肾小管 -间质最为显著 (P <0 .0 1)。对照组大鼠肾小动脉壁显著增生肥厚 ,甚至可见纤维素性坏死 ,肾小球血管腔狭小 ,个别肾小球硬化 ,肾小管 -间质有淋巴细胞浸润 ;治疗组的肾小动脉结构基本正常 ,未见肾小球硬化。结论 :厄贝沙坦能显著减少尿蛋白 ,缓解SHR肾小动脉硬化改变 ,保护肾功能 ;NF -κB参与SHR疾病的进展 ,其过程可能与MMP - 9有关。     

八厘麻毒素的降压与肾脏保护作用

目的探讨八厘麻毒素长期灌胃给药的降压和肾脏保护作用以及该作用与血管紧张素Ⅱ(AngⅡ)及内皮型一氧化氮合成酶(eNOS)之间的关系。方法 35只14周龄自发性高血压大鼠(SHR),随机分为5组(n=7):八厘麻毒素大剂量组、八厘麻毒素中剂量、八厘麻毒素小剂量组、卡托普利组和SHR模型组。7只W istar大鼠作为空白对照组。灌胃给药6周后,测量各组大鼠尾动脉压和心率;检测血浆和肾脏AngⅡ含量和eNOS含量;观察肾脏病理改变,图像分析软件分析肾小管损伤指数。结果与空白对照组比较,SHR模型组血压显著升高(P<0.01),心率增快(P<0.01);AngⅡ含量明显升高(P<0.01),而eNOS含量明显降低(P<0.01)。八厘麻毒素各剂量均能明显降低血压和减慢心率(P<0.01),并不同程度降低AngⅡ含量(P<0.05或P<0.01),升高eNOS含量(P<0.05或P<0.01)。HE染色见空白对照组大鼠肾脏结构基本正常,SHR模型组大鼠肾小球萎缩、硬化,肾小动脉管壁增厚,肾小管间质损伤系数较空白对照组明显升高(P<0.01),各药物治疗组均不同程度改善肾脏的病理变化,减轻肾小管间质损伤(P<0.01)。结论八厘麻毒素对SHR具有良好的降压、减慢心率与肾脏保护作用,其机制可能与降低AngⅡ含量,升高eNOS含量以及减慢心率有关。     

维生素C对自发性高血压大鼠血压的影响

目的:观察维生素C对自发性高血压大鼠(SHR)血压的影响及血清一氧化氮、血浆内皮素1、血浆血管紧张素Ⅱ(AngⅡ)含量的影响。方法:选购10周龄SHR随机分为SHR-0组、SHR-1组、SHR-2组,每组各30只;WKY大鼠8只。1周后SHR-0组及WKY组分别10mL蒸馏水灌胃,SHR-1组10mL 2.5%维生素C溶液灌胃,SHR-2组2ml 5%维生素C溶液灌胃,10ml均在10~15min内完成重复灌胃,分别比较实验干预前、持续给药1、2、4、8、12周后4组不同时间的血压变化;干预前和干预12周后随机选取8只SHR大鼠及4只WKY大鼠,比较各组血清一氧化氮、血浆内皮素1、血浆AngⅡ变化。结果:在实验干预前,SHR收缩压高于同龄WKY组(P0.05),舒张压差异无统计学意义(P0.05)。与SHR-0比较,SHR-1持续给药第2周末收缩压降低(P0.05);SHR-2持续给药第1至12周末舒张压、第2至12周末收缩压降低(P0.05)。与SHR-1组比较,SHR-2在持续给药第2至12周末收缩压降低(P0.05),第1、第4至12周末舒张压降低(均P0.05)。WKY组在干预前及干预12周后血清一氧化氮、血浆内皮素1、血浆AngⅡ差异无统计学意义(P0.05)。与WKY组相比,SHR干预前血清一氧化氮降低,血浆内皮素1、血浆AngⅡ增多(均P0.05)。与WKY相比,干预12周后SHR-0、SHR-1血清一氧化氮降低,血浆内皮素1升高;SHR-0血浆AngⅡ升高。干预12周后与SHR-0组相比,SHR-1、SHR-2血清一氧化氮上升,血浆内皮素1、血浆AngⅡ下降(均P0.05)。干预12周后与SHR-1组相比,SHR-2血清一氧化氮上升,血浆内皮素1下降(P0.05)。结论:维生素C延缓了自发性高血压大鼠的血压升高,抑制了血清一氧化氮的减少及血浆内皮素1、血浆AngⅡ的增多。     

肾去神经术抗自发性高血压大鼠心肌胶原纤维增生的研究

目的通过研究肾去神经术(RDN)对自发性高血压大鼠(SHR)心肌组织血管紧张素Ⅱ(AngⅡ)表达的影响,验证RDN对SHR大鼠血压调节作用,探讨其抗心肌胶原纤维增生的作用及其可能机制。方法 30只约12周龄雄性SHR大鼠随机分成3组,分别为:手术组、假手术组、无手术对照组(阳性对照组),另取10只相同体重雄性WKY大鼠作为正常血压大鼠(阴性对照组)。术后10周处死实验动物,取心肌、肾脏组织,测定左心室质量分数(LVMI),酶联免疫吸附法(ELISA)测定肾脏匀浆组织去甲肾上腺素(NE)浓度及心肌匀浆组织AngⅡ浓度,病理切片HE染色观察心肌细胞形态,苦味酸天狼星红染色计算心肌胶原纤维含量。结果术后第2、4、6、8周收缩压及舒张压手术组均明显低于假手术组、无手术对照组(P<0.05),LVMI手术组[(2.48±0.12)mg/g]明显低于假手术组[(2.91±0.26)mg/g]、无手术对照组[(2.82±0.32)mg/g](P<0.05),肾脏NE含量及心肌匀浆液中AngⅡ含量手术组[NE:(80.26±7.42)ng/g;AngⅡ:(375.50±23.05)pg/g]明显低于假手术组[NE:(170.02±11.75)ng/g;AngⅡ:(421.52±36.84)pg/g]、无手术对照组[NE:(183.30±18.23)ng/g;AngⅡ:(419.07±43.87)pg/g](P<0.05),心肌胶原纤维手术组[1 631(888~3 121)]含量明显低于假手术组[5 961(3 539~13 456)]、无手术对照组[6 024(3 417~12 022)](P<0.05)。结论 RDN能明显降低SHR大鼠血压,抑制其心肌胶原纤维增生和左心室质量增加,此机制可能与抑制肾交感神经及降低心肌AngⅡ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.     

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.     

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.