羟乙基淀粉对内毒素感染大鼠血浆细胞因子表达和单个核细胞NF—κB活性的影响

目的　研究羟乙基淀粉溶液 (HES 2 0 0 /0 5 )对内毒素腹腔感染大鼠炎症反应的影响 ,并探讨分子机制。方法　雄性Wistar大鼠随机分为对照组、内毒素组 (LPS 6mg/kg)、LPS HES组 (HES 3 75、7 5、15、30mL/kg)及HES对照组 (30mL/kg)。分别于LPS注入后 4h检测血浆肿瘤坏死因子 (TNF -α)和细胞因子诱导的中性粒细胞趋化因子 (CINC)浓度 ,2h检测循环血单个核细胞核转录因子kappaB(NF -κB)水平。结果　大鼠内毒素感染时血浆TNF -α和CINC浓度及单个核细胞NF -κB活性明显上升 (P <0 0 5 )。 3 75和 7 5mL/kgHES能明显降低TNF -α和NF -κB水平 (P <0 0 5 ) ;3 75、7 5和 15mL/kgHES能明显降低CINC水平 (P <0 0 5 )。结论　较低剂量HES具有抑制内毒素腹腔感染大鼠炎症反应的作用 ,这种作用的产生与其对NF -κB的抑制有关。HES对感染状态有保护作用。     

脓毒症患者单个核细胞Toll样受体4表达与内毒素耐受的关系

目的观察革兰阴性菌感染所致脓毒症患者外周血单个核细胞Toll样受体4(TLR4)的表达与内毒素耐受之间的关系。方法以重症监护病房治疗的32例革兰阴性菌感染所致脓毒症患者为研究对象,另选20例为健康对照组。两组入选人员均晨起空腹采血,分离外周血单个核细胞,采用流式细胞仪技术检测单个核细胞表面TLR4的表达;另一部分外周血分离单个核细胞,并加入1μg/ml脂多糖(LPS)培养24h,同样进行流式细胞仪检测单个核细胞表面TLR4的表达。并应用放射免疫法测定血清及外周血单个核细胞培养液中TNF-α、IL-6的浓度。结果 (1)脓毒症组外周血单个核细胞表面TLR4表达、血清细胞因子TNF-α、IL-6浓度均明显高于健康对照组(均P<0.001)。(2)脓毒症组患者外周血单个核细胞经LPS刺激后培养上清液中TNF-α、IL-6的浓度显著低于健康对照组(均P<0.05),脓毒症组患者外周血单个核细胞经LPS刺激后TLR4表达较刺激前轻度下调,但刺激前后组间无统计学差异(P>0.05)。结论脓毒症患者外周血单个核细胞体外给予大剂量LPS刺激后可以产生内毒素耐受,但这种现象不能单纯用TLR4的表达下调解释,其可能存在更复杂的机制。内毒素耐受状况下,单个核细胞表现为促炎因子表达的明显下调。     

儿童结核病周围血单个核细胞分泌的TNF-α与PPD皮试的关系

目的探讨儿童结核病周围血单个核细胞(PBMC)分泌的肿瘤坏死因子-α(TNF-α)与PPD皮试反应之间的关系.方法按常规方法PPD皮试,根据其硬结大小分为A组(直径≥20 mm)、B组(15～19 mm)和C组(≤9 mm).分离PBMC,用卡介苗提取素作刺激物、体外孵育附壁的PBMC,收取上清,用ELISA方法测定TNF-α含量.结果A组,B组和C组之间,PBMC分泌的TNF-α有显著性差异(P<0.01).结论结核病患儿PBMC分泌的TNF-α检测与PPD皮试反应强度密切相关.     

儿童结核病周围血单个核细胞分泌的TNF-α与PPD皮试的关系

目的探讨儿童结核病周围血单个核细胞(PBMC)分泌的肿瘤坏死因子 α(TNF α)与PPD皮试反应之间的关系。方法按常规方法PPD皮试 ,根据其硬结大小分为A组 (直径≥ 2 0mm)、B组 (15～ 19mm )和C组 (≤ 9mm )。分离PBMC ,用卡介苗提取素作刺激物、体外孵育附壁的PBMC ,收取上清 ,用ELISA方法测定TNF α含量。结果A组 ,B组和C组之间 ,PBMC分泌的TNF α有显著性差异 (P <0 .0 1)。结论结核病患儿PBMC分泌的TNF α检测与PPD皮试反应强度密切相关     

儿童结核病周围血单个核细胞分泌的TNF-α与PPD皮试的关系

〖目的〗探讨儿童结核病周围血单个核细胞(PBMC)分泌的肿瘤坏死因子-α(TNF-α)与PPD皮试反应之间的关系.〖方法〗按常规方法PPD皮试,根据其硬结大小分为A组(直径≥20 mm)、B组(15～19 mm)和C组(≤9 mm).分离PBMC,用卡介苗提取素作刺激物、体外孵育附壁的PBMC,收取上清,用ELISA方法测定TNF-α含量.〖结果〗A组,B组和C组之间,PBMC分泌的TNF-α有显著性差异(P＜0.01).〖结论〗结核病患儿PBMC分泌的TNF-α检测与PPD皮试反应强度密切相关.     

罗格列酮对内毒素血症大鼠肺内炎症反应的影响

目的探讨PPARγ激动剂罗格列酮(ROSI)对内毒素感染大鼠肺脏炎症反应的影响。方法24只雄性Wistar大鼠,随机分为对照组、ROSI组、内毒素(LPS)组和ROSI处理组(ROSI LPS),每组6只。注射LPS或生理盐水,4h后测定肺组织髓过氧化物酶(MPO)活性、肿瘤坏死因子α(TNFα)和中性粒细胞趋化因子1(CINC1)浓度以及核因子κB(NFκB)的活性。结果与LPS组比较,ROSI LPS组MPO活性、TNFα和CINC1浓度、NFκB活性均降低(P<0.01)。结论ROSI能减轻内毒素血症所致的肺脏炎症反应,其机制与抑制NFκB激活有关。     

益肾健脾胶囊对人工髋关节松动影响的细胞因子学研究

目的探讨益肾健脾胶囊对人工髋关节松动的影响。方法随机选择准备行人工髋关节置换术患者20例。采集外周血，分离单个核细胞，每例标本分成5份。A组：仅单个核细胞，为对照组；B组：单个核细胞＋骨水泥微粒；C组：单个核细胞＋骨水泥微粒＋益肾健脾胶囊（3mg／ml）。D组：单个核细胞＋骨水泥微粒＋益肾健脾胶囊（6mg／ml）。E组：单个核细胞＋骨水泥微粒＋益肾健脾胶囊（12mg／ml）。培养48h后，用ELISA测定细胞上清液中肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6含量。结果B组的TNF—α和1L-6含量均明显高于A组（P〈0．01）；C组的TNF—α和IL-6含量明显低于B组（P〈0．05）。结论骨水泥微粒可刺激单个核细胞分泌TNF—α和IL-6，而益肾健脾胶囊能有效地抑制单个核细胞分泌TNF—α和IL-6。益肾健脾胶囊能防治人工关节置换术后由TNF—α和IL-6等溶骨性细胞因子引起的假体周围的骨溶解，因此该制剂有望成为防治人工关节松动的有效药物。     

异甘草酸镁对慢性乙型肝炎患者外周血单个核细胞 TLR3信号途径的影响

目的：研究异甘草酸镁对慢性乙型肝炎患者外周血单个核淋巴细胞TLR3信号途径的影响。方法分离外周血单个核细胞（ PBMC ）,检测异甘草酸镁对细胞生长的影响。 PolyI：C和异甘草酸镁加入PBMC培养液,半定量PCR检测TLR3信号途径中的TLR3、TRIF（ Toll样受体接头分子）、肿瘤坏死因子α（TNFα）、干扰素β1（IFNβ1）的表达。结果异甘草酸镁对单个核细胞的生长抑制作用呈剂量依赖型,800、400、200、100、50、25、12.5和6.25μg/ml八组的抑制率分别为58％,52％,40％,30％,23％,17％,8％,6％,除12.5和6.25μg/ml两组间比较无统计学差异（ P＞0.05）外,其余各组间比较均有统计学差异（ P＜0.01）。RT-PCR结果显示IFNβ1在200μg/ml异甘草酸镁组和空白对照组表达分别为14.6±2.43,9.79±3.02,P＝0.0003;TNFα在200μg/ml组、100μg/ml组、空白对照组分别为10.59±1.67,13.3±2.07,15.7±1.59,各组间比较差异均有统计学意义（ P＜0.05）。 TLR3和TRIF在各组间的表达无显著差异。结论异甘草酸镁可能促进单个核细胞产生干扰素,同时又能抑制炎症因子TNFα的转录,这可能是该药的抗炎、免疫调节机制之一。     

参附注射液对内毒素所致大鼠全身炎症反应综合征的作用

目的:探讨参附注射液对内毒素所致大鼠全身炎症反应综合征(SIRS)的治疗作用及其机制.方法:静脉注射脂多糖(LPS)建立大鼠SIRS模型.健康雄性Wistar大鼠45只,按随机数字表法分为假手术对照组(C组)、LPS致伤组(L组)和参附注射液治疗组(T组).L、T组动物制模后分为1、2、4和6 h 4个亚组.在4个时间点分别取血,采用酶联免疫吸附法(ELISA)检测单个核细胞中核转录因子-κB(NF-κB)活性、血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平,观察肺脏和肝脏的病理学变化,并与C组比较.结果:L组单个核细胞中NF-κB活性明显增高,2 h最明显(0.604±0.020),显著高于对照组(0.112±0.017);血清TNF-α浓度明显升高,2 h最明显[(1 644.8±25.9)ng/L],显著高于对照组[(55.9±19.2)ng/L];血清IL-6浓度随时间推移不断升高,显著高于对照组.病理结果显示,L组肺泡出血、水肿、大量炎症细胞浸润;肝脏毛细血管扩张、充血、水肿和炎症细胞浸润.参附注射液可以显著降低NF-κB活性、TNF-α及IL-6水平,减轻肺脏和肝脏病理损伤.结论:参附注射液可通过抑制NF-κB活性对大鼠SIRS起保护作用.     

核因子κB活性在心肺脑复苏后的变化

目的观察心搏骤停患者经心肺脑复苏(CPCR)后核因子κB(NFκB)活性和肿瘤坏死因子α(TNFα)水平的变化及意义。方法以电泳迁移率变动分析法(EMSA)检测外周血单个核细胞的NFκB活性,放射免疫法测定血清TNFα水平。结果NFκB活性、TNFα水平和APACHEⅡ评分在复苏后多脏器功能障碍综合征(PRMODS)组和死亡组分别明显高于非PRMODS组和存活组(P<0.05);NFκB活性、TNFα水平和APACHEⅡ评分均呈正相关(P<0.05)。结论心搏骤停和CPCR过程可以使NFκB激活、TNFα表达增加,这对PRMODS的发生、病情轻重具有重要决定作用。     

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.     

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.