转化生长因子β1/Smads通路在急性心肌梗死后心肌重塑中的作用及祛瘀生新法的干预研究

目的通过研究祛瘀生新中药对转化生长因子(TGF)-β1/Smads通路的影响,探讨祛瘀生新法对急性心肌梗死后心肌重塑的效应机制。方法清洁级雄性Wistar大鼠50只随机分为正常组、假手术组、模型组、中药组、西药组,每组10只。中药组大鼠术前3 d给药,1次/d。7 d后,检测外周血骨髓间充质干细胞(BMSCs)含量,实时荧光定量RT-PCR检测心肌组织TGF-β1mRNA、Smad3 mRNA、Smad7 mRNA表达,并观察心肌组织HE染色结果及免疫组化检测心肌c-kit细胞数。结果模型组较假手术组心肌组织TGF-β1mRNA、Smad3 mRNA表达均增加(P<0.05),Smad7 mRNA表达降低(P<0.05)。中药组心肌组织TGF-β1mRNA、Smad3 mRNA表达降低,Smad7 mRNA表达增加,中药组及西药组较模型组c-kit细胞数明显增多,并能减轻心肌组织的病理损伤。中药组与西药组比较,TGF-β1mRNA、Smad3 mRNA和Smad7 mRNA表达无显著性差异(P>0.05)。结论祛瘀生新法能有效抑制急性心肌梗死后心肌重塑。     

细胞外信号调节激酶1/2在慢性肺疾病新生大鼠肺成纤维细胞中的研究

目的 探讨持续吸入高氧致慢性肺疾病新生大鼠肺成纤维细胞中细胞外信号调节激酶(ERK) 1/2蛋白信号表达的动态变化.方法 足月新生鼠生后12 h内分别持续吸人体积分数90％的高氧和空气,于3、7、14 d随机处死动物后,进行肺成纤维细胞的原代培养,应用免疫组化、Western-blot及real-time PCR方法检测ERK1/2蛋白及mRNA表达.结果 免疫组化及Western blot结果显示,高氧7、14 d时高氧组肺成纤维细胞p-ERK1/2蛋白的表达均明显高于同时间点对照组(P＜0.01).Western blot结果同时显示各组间ERK1/2总蛋白的表达差异无统计学意义.real-time PCR结果表明各组间ERK1、ERK2 mRNA水平差异无统计学意义(P＞0.05).结论 ERK1/2蛋白水平磷酸化活化参与了高氧致新生大鼠慢性肺疾病中肺纤维化的发生.     

赖氨大黄酸促进大鼠心肌Smad7表达的研究

目的初步探讨赖氨大黄酸(RHL)对肾性压力负荷性心肌纤维化模型大鼠Smad7表达的影响。方法将32只大鼠随机分为对照组、模型组、赖氨酸组及RHL组,每组8只,用"两肾一夹"法建立肾性压力负荷性心肌纤维化模型,通过测量鼠尾动脉收缩压及左心室质量指数评价造模效果,通过Masson染色观察大鼠心肌纤维化病变程度,采用免疫组织化学法及实时荧光定量聚合酶链反应在蛋白及mRNA水平检测Smad7表达情况。结果与模型组相比,经RHL治疗后肾性压力负荷性心肌纤维化大鼠心肌组织中Smad7蛋白及mRNA表达均明显升高,差异有统计学意义(P0.05)。结论 RHL可有效抑制肾性压力负荷性大鼠心肌纤维化进程,其机制与上调Smad7表达,靶向拮抗TGF-β/Smads信号传导通路有关。     

缺氧诱导因子1α在大鼠急性缺血心肌组织中的变化

目的:了解缺氧诱导因子1αmRNA和蛋白质在大鼠急性缺血心肌组织中表达的变化规律。方法:实验在南通大学生物技术系,江苏省神经生物学重点实验室完成。①实验分组:雄性SD大鼠78只,其中42只大鼠随机分为7组,每组6只,分别设为空白对照组(0h)和缺血0.5h,1h,1.5h,2h,3h,4h组,检测缺氧诱导因子1αmRNA表达变化。另外36只大鼠随机分为6组,每组6只,分别设为空白对照组(0h)和缺血1h,2h,4h,5h,6h组,检测缺氧诱导因子1α蛋白表达变化。②实验方法:通过结扎大鼠左冠状动脉前降支,构建左室心肌缺血模型。术中心电图等证明结扎成功后,分别在上述不同时间点取缺血心肌组织,分别运用反转录聚合酶链式反应法和免疫组织化学方法检测缺血心肌组织中缺氧诱导因子1αmRNA和蛋白质的表达变化。结果:缺氧诱导因子1αmRNA和蛋白质在正常大鼠心肌中微量表达,心肌缺血后表达明显增高,并随缺血时间变化而变化。0.5h缺氧诱导因子1αmRNA表达显著增加(P<0.05),1.0～2.0h达到高峰(P<0.01),以后逐渐下降并趋向基线。心肌缺血后1h缺氧诱导因子1α蛋白质表达明显上升(P<0.05),4h达到高峰(P<0.01),随缺血时间延长表达回降。结论:缺氧诱导因子1α在缺血心肌组织中高表达。缺氧诱导因子1α在大鼠缺血心肌组织中表达的上调,可能参加了心肌缺血的代偿机制,有助于改善心肌供血。     

缺氧预处理诱导的乳鼠心肌细胞miRNA表达谱的变化

目的 分析大鼠乳鼠心肌细胞经历缺氧预处理后miRNA的表达谱变化,探索其缺氧预处理机制和治疗靶点。方法 大鼠乳鼠心肌细胞原代培养,经过缺氧预处理和缺氧复氧损伤后检验心肌细胞存活率和乳酸脱氢酶浓度,miRNA芯片技术检测正常心肌和缺氧预处理心肌细胞miRNA表达谱差异,实时定量PCR验证结果的可信性,分析明显差异表达的miRNA的生物学功能。结果 心肌细胞存活率和乳酸脱氢酶浓度结果证实缺氧预处理模型制备成功。miRNA芯片技术结果表明,与正常对照组心肌细胞相比,缺氧预处理心肌细胞中有6个miRNA表达上调,有5个表达下调,其中一部分miRNA的生物学功能与心血管功能相关。结论 缺氧预处理可导致大鼠乳鼠心肌细胞microRNA表达谱发生变化,其可能是缺氧复氧损伤潜在的治疗靶点。     

赖氨大黄酸对胆汁淤积性肝纤维化大鼠Smad2、Smad3表达的影响

目的探讨赖氨大黄酸(RHL)对胆汁淤积性肝纤维化模型大鼠Smad2、Smad3表达的影响。方法采用胆总管结扎(BDL)的手术方法建立大鼠胆汁淤积性肝纤维化模型,将大鼠随机分为5组:对照组、模型组、赖氨酸组、低剂量RHL组[35mg/(kg·d)]、高剂量RHL组[70mg/(kg·d)]。应用实时荧光定量PCR的方法检测大鼠肝脏组织中Smad2、Smad3mRNA的相对表达量。Western blot的方法检测Smad2、Smad3蛋白时相对表达量的变化。结果与模型组大鼠比较,经RHL治疗后胆汁淤积性肝纤维化大鼠肝脏组织中Smad2、Smad3mRNA相对表达量降低,差异有统计学意义(P0.05);与模型组大鼠相比,经RHL治疗后胆汁淤积性肝纤维化大鼠肝脏组织中Smad2、Smad3蛋白的相对表达量降低,差异有统计学意义(P0.05)。结论 RHL能够抑制肝纤维化的发展,可能是通过抑制Smad2、Smad3mRNA和蛋白的表达,阻断TGF-β1/Smads信号传导通路实现的。     

姜黄素对缺氧再给氧大鼠心脏微血管内皮细胞ICAM-1表达的影响

目的：研究姜黄素对缺氧再给氧大鼠心脏微血管内皮细胞粘附分子ICAM－1表达的影响。方法：培养大鼠心脏微血管内皮细胞，建立细胞缺氧再给氧模型，采用酶联免疫吸附试验（ELISA）测定内皮细胞粘附分子ICAM－1的蛋白表达，Northern blot分析测定ICAM－1mRNA的表达。结果：缺氧后内皮细胞ICAM－1的蛋白和mRNA表达明显升高，缺氧再给氧后增高更明显，姜黄素组ICAM－1的蛋白和mRNA的表达较缺氧再给氧组明显下降，呈剂量依赖效应。结论：姜黄素能明显下调缺氧再给氧大鼠心脏微血管内皮细胞ICAM－1的表达，抑制内皮细胞的激活。     

二氮嗪预处理缺氧复氧大鼠心肌微血管内皮细胞PI3K、Akt、FKN mRNA的表达

背景:在缺氧复氧早期,促使心肌微血管内皮细胞增殖的措施,涉及一系列相关基因的改变和受多种基因调控。目的:观察二氮嗪预处理对缺氧复氧大鼠心肌微血管内皮细胞增殖和PI3K、Akt和FKNmRNA表达的影响。方法:培养SD大鼠心肌微血管内皮细胞,按照不同的干预方式将细胞随机均分为正常对照组、缺氧/复氧组、二氮嗪组、二氮嗪+阻断剂组。观察凋亡细胞形态、活力及PI3K、Akt和FKNmRNA转录水平。结果与结论:与正常对照组比较,缺氧/复氧组细胞增殖率显著降低、Akt和FKN显著升高(P<0.01)。与缺氧/复氧组比较,二氮嗪组细胞增殖率显著升高(P<0.05);PI3K和Akt显著升高、FKN显著降低(P<0.01)。二氮嗪+阻断剂组取消了二氮嗪的作用,与缺氧/复氧组比较差异无显著性意义。说明二氮嗪预处理通过促使细胞增殖,上调PI3K、AktmRNA表达、下调FKNmRNA表达而实现对缺氧复氧心肌微血管内皮细胞损伤的保护。     

缺氧与复氧对脑动脉内皮细胞一氧化氮合酶Ⅲ表达的影响

目的：用原代培养的脑动脉内皮细胞(CAEC)进行缺氧、复氧，观察一氧化氮合酶Ⅲ(NOSⅢ)基因表达的变化，探讨缺氧、复氧影响NO生成的分子机制。方法：将原代培养的CAEC进行缺氧1h，复氧2、6、12和24h，用逆转录-聚合酶链式反应(RT-PCR)和免疫细胞化学方法检测NOSⅢ mRNA和蛋白质表达的变化。结果：①CAEC缺氧1h，NOSⅢ mRNA和蛋白质表达明显高于正常对照组；②缺氧1h后复氧2、6和12h，NOSⅢ mRNA和蛋白质表达下调，其中复氧6h，其表达降至最低，24h后表达恢复至正常。结论：缺氧引起脑动脉内皮细胞NOSⅢ基因表达上调，而复氧使其表达明显下调。     

下调Smad7表达对PC12细胞OGD损伤的影响

目的探讨抑制Smad7基因表达对PC12细胞氧糖剥夺(OGD)损伤的影响及其机制。方法利用PC12细胞OGD模型体外模拟神经细胞缺血性损伤,通过RNA干扰技术,沉默Smad7基因表达,实时定量PCR、Western blot检测Smad7基因的表达情况,MTT检测下调Smad7基因表达对细胞OGD损伤存活率的影响,Western blot检测Activin A(ActA)蛋白的表达情况。结果体外合成的siRNA转染可下调Smad7基因转录及蛋白水平的表达;经OGD16h,阳性转染组细胞存活率较阴性组显著增加,阳性转染组细胞ActA蛋白表达较阴性组显著升高。结论Smad7可负向调控缺血损伤诱导的ActA/Smads通路激活过程,抑制其表达能够发挥神经保护作用。     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.