按摩对大鼠骨骼肌急性钝挫伤后膜修复蛋白dysferlin和annexin A1表达的影响

目的:研究大鼠骨骼肌急性钝挫伤后,按摩对细胞膜特异性修复蛋白dysferlin和annexin A1表达的影响,探讨按摩促进骨骼肌急性损伤修复的可能机制。方法:42只成年SD雄性大鼠随机抽取6只作为正常对照组,其余36只为模型组。模型组在建立右下肢急性腓肠肌钝挫伤模型后,随机分为自然恢复组和按摩治疗组,根据治疗时间分为损伤后7d、14d、21d三个时间点,每个时间点6只。正常对照组和自然恢复组不做治疗;按摩治疗组在建模后48h开始每天于损伤局部行按摩治疗。免疫荧光双标法标记dysferlin和annexin A1,运用激光共聚焦显微镜摄片,观察其在细胞内分布及表达;运用蛋白质印迹法检测其表达量。结果:激光共聚焦显微镜结果显示:正常肌细胞中两种荧光信号主要分布于近细胞膜周围,强度较弱,无共表达现象;模型组各时间点,两种荧光信号强度均明显增加,胞浆内也有弥散性分布,随时间的延长,信号强度逐渐减弱,细胞膜共表达现象增加;其中按摩治疗组荧光信号强度较同时期自然恢复组减弱明显,细胞膜上共表达现象增多。蛋白质印记结果显示:模型组各时间点较正常对照组,dysferlin和annexin A1蛋白表达升高,差异显著;随着时间的延长,模型组蛋白表达量均下降,自然恢复组和按摩治疗组在损伤后14d和21d比较,差异均有显著性意义(P0.05);损伤后21d,自然恢复组较按摩治疗组dysferlin表达量比较,差异有显著性意义(P0.05);损伤后14d和21d,自然恢复组较按摩治疗组annexin A1表达量比较,差异有显著性意义(P0.05)。结论:这可能是其促进肌细胞膜修复相关机制之一。     

电针对骨骼肌钝挫伤模型大鼠细胞周期素依赖性蛋白激酶5表达的影响

目的观察电针对骨骼肌钝挫伤大鼠细胞周期素依赖性蛋白激酶5（CDK5）表达的影响,探讨电针治疗骨骼肌损伤、促进肌肉功能恢复的作用机制。 方法将32只SD大鼠按照随机数字表法分为正常组（n=4）、模型组（n=4）、自然恢复组（n=12）、电针组（n=12）,正常组不做特殊处理,其余各组使用自制重物打击器建立骨骼肌钝挫伤模型。自然恢复组不做电针干预、自然恢复;电针组于造模48h后开始电针干预,每日1次,每次15min。模型组于建模24h后处死,目的在于验证造模成功,自然恢复组、电针组分别于造模后第7、14、21天处死取材,使用苏木精-伊红（HE）染色观察组织形态变化,采用免疫印迹和实时定量荧光PCR分别检测CDK5蛋白及其mRNA的表达情况。 结果HE染色显示,与正常组比较,各组可见大量肌纤维断裂溶解及炎性细胞浸润。电针组与自然恢复组比较,肌卫星细胞增殖更快,新生肌纤维明显增多,修复更为迅速。自然恢复组、电针组两组CDK5蛋白表达量较正常组均升高（P<0.05）,且电针组明显低于自然恢复组(P<0.05),PCR检测结果也进一步表明,自然恢复组mRNA表达水平显著高于电针组（P<0.05）,且均高于正常组（P<0.05）。 结论骨骼肌钝挫伤可使大鼠骨骼肌中CDK5蛋白表达升高,电针促进骨骼肌肌肉功能恢复的机制可能与抑制CDK5蛋白及mRNA的表达水平有关。     

电针阿是穴对骨骼肌损伤大鼠肌肉再生及碱性成纤维细胞生长因子表达的影响

目的观察电针阿是穴对骨骼肌损伤大鼠腓肠肌增殖细胞核抗原(PCNA)、结蛋白(Desmin)及碱性成纤维细胞生长因子(bFGF)表达的影响,探讨电针阿是穴对骨骼肌损伤后肌卫星细胞增殖分化的可能机制。方法将78只雄性Sprague-Dawley大鼠随机分为模型组6只,空白组、电针组、自然修复组各24只,每组再分为1 d、4 d、7 d、14 d 4个亚组,各6只。模型组、自然修复组与电针组采用腓肠肌钝挫伤结合离心运动的方法造模,模型建立后,模型组取腓肠肌行HE染色,其余各组按时间点相应处理并取腓肠肌行PCNA、Desmin和bFGF免疫组化染色。结果自然修复组各时间点PCNA表达均明显高于空白组(P<0.01);Desmin在损伤后1 d、14 d低于空白组(P<0.05),损伤后7 d高于空白组(P>0.05);bFGF在损伤后7 d高于空白组(P<0.01)。电针组PCNA、bFGF与Desmin的表达在损伤后1 d、4 d均高于自然修复组(P<0.05)。结论电针阿是穴能促进肌卫星细胞增殖,加快其成肌分化,缩短损伤修复进程,其机制可能与上调及提前bFGF的表达有关。     

推拿对骨骼肌急性钝挫伤模型大鼠炎症、氧化应激及细胞自噬相关因子的影响

目的 观察推拿对大鼠骨骼肌急性钝挫伤修复过程中炎症、氧化应激、细胞自噬相关因子的影响,探讨推拿治疗骨骼肌损伤可能的作用机制。 方法 采用随机数字表法将42只成年雄性Sprague-Dawley（SD）大鼠分为正常组（n=6）、模型组（n=18）、治疗组（n=18）,模型组和治疗组再根据取材的时间点随机分为1d、7d、14d三个亚组（n=6）。模型组和治疗组用自备打击器建立腓肠肌急性钝挫伤模型,治疗组于造模48h后开始推拿治疗,每日1次,每次15min。各组分别于各自的取材时间点心脏采血后取损伤侧腓肠肌,苏木精-伊红染色(HE）观察损伤部位腓肠肌形态学变化;酶联免疫法（ELISA）检测各组大鼠血清肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）、C反应蛋白（CRP）、前列腺素E2（PGE2）表达水平;紫外-可见分光光度法检测各组大鼠血清超氧化物歧化酶（SOD）,丙二醛（MDA）含量;Western blotting检测各组大鼠腓肠肌自噬微管相关蛋白1轻链3（LC3）、Bcl-2同源结构域蛋白Beclin1、泛素结合蛋白P62表达水平。 结果 骨骼肌损伤修复过程中,HE染色显示,各时间点模型组较正常组细胞形态崩塌,肿胀明显,7d和14d亚组有成肌细胞核出现。各时间点治疗组较模型组恢复更好,新生肌细胞较多,形态更趋正常。ELISA结果显示,模型组各取材时间点较正常组同取材时间点血清促炎因子明显升高,但治疗组1d和7d组较模型组同取材时间点显著降低,差异有统计学意义（P<0.05）。紫外-可见分光光度法结果显示,模型组血清SOD和MDA含量较正常组明显升高,治疗组SOD较模型组同取材时间点显著升高,差异有统计学意义（P<0.05）,MDA较模型组同取材时间点显著降低,差异有统计学意义（P<0.05）。Western blotting结果显示,模型组各取材时间点较正常组腓肠肌LC3（II/I）、Beclin1明显降低,P62明显升高,而治疗组较模型组同取材时间点LC3（II/I）、Beclin1显著升高,P62显著降低,差异均有统计学意义（P<0.05）。 结论 骨骼肌损伤后,其炎症及氧化应激水平明显升高,细胞自噬活性明显降低,通过推拿治疗能有效减轻机体炎症反应,降低其氧化应激损害,提高组织细胞自噬活性,从而加速受损组织的修复,这可能是推拿促进骨骼肌损伤修复的机制之一。     

推拿对失神经骨骼肌萎缩大鼠自噬相关因子Beclin-1、液泡分选蛋白34和微管相关蛋白轻链3的mRNA表达的影响

目的探讨推拿延缓失神经骨骼肌萎缩的相关机制。方法 77只Sprague-Dawley雄性大鼠随机分为假手术组(n=7)、模型组(n=35)和推拿组(n=35)。后两组通过暴露并切断胫神经的方法制备失神经骨骼肌萎缩大鼠模型。造模后第2天,推拿组术侧下肢进行推拿干预。分别在造模后0 d、7 d、14 d、21 d和28 d取材,测定术侧腓肠肌湿重比,HE染色测定腓肠肌肌纤维截面积和直径,逆转录实时定量聚合酶链反应检测术侧腓肠肌组织中自噬相关因子Beclin-1、液泡分选蛋白34 (Vps34)和微管相关蛋白轻链3 (LC3)的mRNA表达。结果三组0 d时,腓肠肌湿重比、肌纤维截面积和直径,以及Beclin-1、Vps34和LC3的mRNA表达均无显著性差异(F 1.321, P 0.05)。与假手术组比较,模型组和推拿组腓肠肌湿重比、肌纤维截面积和直径在不同时间下降(P 0.05),推拿组肌湿重比(除21 d)均高于模型组(P 0.05),推拿组肌纤维截面积和直径(除21 d)均大于模型组(P 0.05)。与假手术组相比,模型组和推拿组术侧腓肠肌Beclin-1、 Vps34、 LC3mRNA表达在不同时间升高(P 0.05),推拿组各项mRNA表达(除14 d)均高于模型组(P 0.05)。组内比较,模型组和推拿组腓肠肌湿重比、肌纤维截面积和直径随时间呈进行性下降趋势(P 0.05);模型组Beclin-1、Vps34 mRNA表达在21 d后呈上升趋势(P 0.05),LC3 mRNA表达在21 d升高(P 0.05);推拿组Beclin-1 mRNA表达呈先上升后下降的趋势(P 0.05),Vps34和LC3 mRNA表达(除14 d)呈先上升后下降趋势(P 0.05)。结论推拿可能通过上调自噬相关因子Beclin-1、Vps34和LC3的mRNA表达,促进细胞自噬的激活,清除损伤细胞器和蛋白质,为肌纤维再生提供一定的合成底物和能量,从而减轻失神经骨骼肌萎缩的程度。     

电针对大鼠急性骨骼肌损伤修复中生长相关蛋白和聚集蛋白表达的影响

目的:通过观察电针治疗对急性骨骼肌损伤中生长相关蛋白(GAP-43)及聚集蛋白(agrin)表达的影响,探讨电针促进受损骨骼肌功能恢复的作用机制。方法:将32只SD大鼠随机分为正常组(A组,n=4)、模型组(B组,n=4)、自然恢复组(C组,n=12)、电针组(D组,n=12),A组为空白对照不做任何处理,其余各组使用自制重物打击器建立骨骼肌急性钝挫伤模型,C组不做电针处理自然恢复,D组于造模后48h开始电针干预,每日1次,每次15min。于造模后24h处死B组取材观察造模是否成功,C组及D组于建模后第7、14、21天三个时间点同时取材使用HE染色观察组织形态变化,Western-bolt检测GAP-43及agrin表达情况。结果:HE染色显示:与A组比较,各组肌细胞大量溶解、肌纤维排列紊乱及炎性细胞浸润。D组与C组比较,肌卫星细胞增殖较快,新生肌纤维明显增多,修复更为迅速。在正常组织中GAP-43表达量极少,骨骼肌损伤后各组中GAP-43表达量显著增高(P0.05);在第14天,GAP-43表达量达到高峰,D组继续表达呈上升趋势(P0.01),C组开始下降,但仍高于A组(P0.05)。与A组相比,骨骼肌受损后各时间点C、D两组agrin的表达明显增多(P0.05),其中D组差异最为显著(P0.01)。结论:电针有促进受损骨骼肌恢复的作用,可能与提高GAP-43和agrin的表达水平有关。     

推拿联合跑台训练对急性骨骼肌损伤大鼠肌蛋白代谢相关因子的影响

目的 观察推拿、跑台训练及联合干预对急性骨骼肌损伤大鼠腓肠肌蛋白代谢信号通路相关分子雷帕霉素靶蛋白(mTOR)、磷酸化(p-)mTOR、p70核糖体蛋白S6激酶(p70S6K)、p-p70S6K、Smad2/3、肌生成抑制素(MSTN)表达的影响,探讨骨骼肌修复的可能机制。 方法 采用随机数字表法将30只雄性SD大鼠分为正常组、自然恢复组、推拿组、跑台组及联合组。通过打击器制备大鼠右后肢急性骨骼肌损伤动物模型。于造模24 h后推拿组予以患侧拇指揉法干预,跑台组予以跑台训练,联合组则予以推拿及跑台训练联合干预;各组大鼠每周干预5次,连续干预3周。于干预结束后进行行为学检测,分析各组大鼠步态并统计落入电网次数,采用HE染色测定腓肠肌纤维横截面积,采用免疫印迹法检测mTOR、p-mTOR、p70S6K、p-p70S6K、Smad2/3蛋白相对表达量,采用实时荧光定量PCR法检测腓肠肌中MSTN mRNA相对表达量。 结果 电网打击实验结果显示,推拿组、跑台组及联合组被打击次数均较自然恢复组明显减少(P<0.05)。推拿组、跑台组及联合组肌纤维横截面积、患侧腓肠肌湿重均较自然恢复组明显增加(P<0.05);且跑台组、联合组肌纤维横截面积亦较推拿组明显增大（P<0.05）。与正常组比较,自然恢复组、推拿组、跑台组及联合组mTOR、p-mTOR、p70S6K、p-p70S6K蛋白相对表达量均明显升高(P<0.05),Smad2/3蛋白相对表达量和MSTN mRNA相对表达量均明显降低(P<0.05);与自然恢复组比较,推拿组、跑台组及联合组mTOR、p-mTOR、p70S6K、p-p70S6K蛋白相对表达量均明显升高(P<0.05),Smad2/3蛋白相对表达量及MSTN mRNA相对表达量均明显减少(P<0.05);与推拿组比较,跑台组及联合组mTOR、p-mTOR、p70S6K、p-p70S6K蛋白相对表达量均明显增加(P<0.05),Smad2/3蛋白相对表达量及MSTN mRNA相对表达量均明显降低(P<0.05)。 结论 早期推拿、跑台训练及联合干预均可能通过抑制Myostatin-Smad2/3信号通路,促进mTOR-p70S6K信号通路来增加急性骨骼肌损伤大鼠肌蛋白合成,促进肌肉肥大,改善损伤后腓肠肌结构及功能,且以跑台训练及跑台训练联合推拿干预的疗效较显著。     

小鼠骨骼肌损伤修复过程中肌再生调节因子和血管再生因子的表达规律研究

目的:观察骨骼肌损伤修复过程中肌再生调节因子和血管再生因子表达规律,探讨肌再生调节因子和血管再生因子在骨骼肌损伤修复过程中可能发挥的作用。方法:40只雄性C57小鼠随机分为对照组(C组,n=8)和损伤组(S组,n=32)。骨骼肌钝挫伤后0d,1d,3d,7d,14d取右侧腓肠肌用于HE染色,左侧腓肠肌进行荧光定量PCR检测肌再生调节因子(Myo D,myogenin,IGF-1,MGF,HGF,u PA,Myostain,GDF11,LIF)和血管再生因子(HIF-1α,Angpt-1,VEGF)mRNA表达变化。结果:(1)骨骼肌钝挫伤后第3天有少量再生肌纤维,第7天显著增加,第14天基本恢复正常。(2)与对照组相比,生肌调节因子(Myo D,myogenin,IGF-1,MGF,HGF,u PA,GDF11,LIF)mRNA在损伤后表达显著增加(P0.05或P0.01),Myostain mRNA在损伤后表达显著降低(P0.01)。(3)血管再生因子(HIF-1α,Angpt1)m RNA在损伤后表达显著增加(P0.05或P0.01)而VEGF mRNA在损伤后表达显著降低(P0.05)。结论:骨骼肌钝挫伤后多种肌再生调节因子表达上调,可能促进骨骼肌再生。血管再生因子(HIF-1α和Angpt1)表达上调,可能参与了骨骼肌损伤后血管再生以及骨骼肌再生。     

电针对失神经骨骼肌萎缩大鼠胰岛素样生长因子1、肌肉生长抑制素及肌卫星细胞增殖的影响

目的探讨电针延缓失神经骨骼肌萎缩的可能机制。方法 49只雄性Sprague-Dawley大鼠随机分为正常组(A组,n=7)、自然恢复组(B组,n=21)和电针治疗组(C组,n=21)。A组不做处理,其余两组切断坐骨神经制备失神经性骨骼肌萎缩模型。术后1 d,C组术侧腓肠肌给予电针足三里、承山治疗每天1次。术后7 d、14 d、21 d分别测定术侧腓肠肌湿重比,HE染色测定肌纤维直径及截面积,Western blotting检测胰岛素样生长因子1(IGF-1)、肌肉生长抑制素(Myostatin)以及增殖细胞核抗原(PCNA)蛋白,RT-PCR检测IGF-1、Myostatin和PCNA基因表达。结果与A组比较,B组和C组腓肠肌湿重比、肌纤维截面积及直径均显著下降(P0.001),但C组显著高于B组(P0.001)。C组IGF-1、PCNA蛋白和基因表达高于B组(P0.05),Myostatin蛋白和基因表达低于C组(P0.05)。结论电针能有效促进IGF-1的表达,抑制Myostatin的表达,从而促进肌卫星细胞增殖。这可能是电针延缓失神经性骨骼肌肌萎缩的机制之一。     

SD大鼠骨骼肌钝挫伤早期的组织病理变化

背景:骨骼肌钝挫伤后继续运动对骨骼肌组织愈合的影响目前还没有确切的定论。目的:观察急性骨骼肌钝挫伤SD大鼠跑台运动后的组织病理变化。方法:将64只SD大鼠随机分为正常对照组、模型组、自然愈合组、运动干预组,后3组建立左后肢腓肠肌中段骨骼肌钝挫伤模型,模型组造模后6h处死取材,运动干预组进行跑台运动干预,自然愈合组继续饲养,但不进行运动干预。结果与结论:自然愈合组、运动干预组大鼠急性腓肠肌钝挫伤后24h～3d内损伤肌肉组织中均出现大量炎细胞浸润,5d时显著下降,同期内各时间点运动干预组炎细胞数显著多于自然愈合组(P<0.05);7d时两组炎细胞基本消失,伤后5d两组均开始出现少量瘢痕组织,随时间延长而逐渐增加,7～14d时运动干预组瘢痕组织面积显著高于自然愈合组(P<0.01);伤后14d两组瘢痕组织均仍有增多趋势。表明急性骨骼肌钝挫伤后早期运动训练可加重损伤局部炎性反应,并导致瘢痕组织过度形成,对损伤骨骼肌的修复存在负面影响。     

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.     

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.     

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.     

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.