超声引导下组织块接种制作兔肾VX2瘤模型及传代保存

目的　探讨术中组织块包埋和超声引导下穿刺组织块接种制作兔肾VX2 瘤模型的方法 ,并对这两种方法进行比较。方法　采用剪切法制备兔VX2 瘤组织块悬液 ,应用超声引导下经皮组织块推注法建立 5 8只兔肾VX2 肿瘤模型 ,应用术中组织块包埋法建立 8只兔肾VX2 肿瘤模型 ,应用自然组织谐波技术观察肿瘤生长 ,并观察浅表淋巴结转移及动物的一般情况 ;3周内自然死亡者立即行尸体解剖 ,未死者种植后 3周处死行尸体解剖 ,获得兔肾VX2 肿瘤标本 ,进行HE切片染色。结果　两种方法建立的兔肾VX2 瘤模型组织学表现与传代种兔相同 ;术中包埋组种植成功率 5 0 % ,超声引导下穿刺组种植成功率 96.5 5 % ;术中包埋组腹壁种植率 2 5 % ,超声引导下穿刺组腹壁种植率 5 .17%。结论　超声引导下穿刺法建立兔肾VX2 肿瘤模型方法简便 ,成功率高 ,更适用于各种研究的需要     

超声造影评价肝肿瘤血管形成的实验研究

目的应用二维超声观测兔VX2肝肿瘤生长及能量多普勒超声造影评价肿瘤血管形成.方法将VX2瘤组织块悬液0.3ml (约含107～108个瘤细胞/ml) 超声引导下注入15只新西兰白兔肝左叶,拔针前针道注入0.2 ml加热的琼脂糖,超声监测肿瘤生长.肿瘤生长至3周时,静脉团注超声造影剂,能量多普勒检测肿瘤血流信号,并通过图像分析技术定量测定肿瘤内彩色血管平均密度(MCVD).同时二维超声测定肿瘤大小与大体病理的测定结果进行相关性分析.采用免疫组化技术检测肿瘤内微血管密度(MVD).结果①二维超声肿瘤表现为等回声、低回声及略高回声,以等回声居多,周围可见声晕;②彩色多普勒和能量多普勒均可检出血流信号;③肿瘤与肝实质无明显边界,可见多个核分裂相;④超声与大体病理下测定肿瘤的最大切面直径有相关关系;⑤能量多普勒超声造影测定肿瘤内MCVD与免疫组化测定的肿瘤内MVD之间有线性相关.结论超声能有效监测肿瘤生长.能量多普勒超声造影测定肿瘤内MCVD,可用于肿瘤内血管形成的评价.     

兔VX2肝癌模型的建立及超声监测

目的探讨兔VX2肝癌模型建立的方法及超声技术对肿瘤的监测。 方法采用瘤块肝内种植法建立起兔VX2肝癌模型,病理解剖验证VX2瘤株在兔肝脏的成瘤情况;用2D、CDFI及超声造影观察肿瘤的大小、回声、血流灌注及生长特点,从而评估超声在兔VX2肝癌模型监测中的应用价值。 结果采用瘤块移植法成功建立起稳定的兔VX2肝癌模型,成瘤率为93.33%;超声能准确测量肿瘤的大小,能实时、准确地监测肝内肿瘤的回声变化及肿瘤血管的分布情况;超声造影肿瘤为典型的“快进快出”表现。 结论瘤块移植法是一种操作简单、成瘤率高的建立兔VX2肝癌模型的方法;超声技术能准确、方便、无创地监测肝脏肿瘤及肿瘤血管;采用超声影像技术对兔VX2肝癌生长特征的监测结果为临床利用该模型来评价诊治肝癌的新技术、新疗法的疗效提供了监测方法。     

超声介入植入法在兔肝VX2肿瘤模型制作中的应用

目的 探讨兔肝VX2肿瘤模型的超声介入制作方法.方法 取60只新西兰大白兔,随机分为A、B、C 3组,每组20只,分别采用开腹手术瘤块埋入法、超声引导下瘤块悬液注射法和超声介入瘤块植入法制作兔肝VX2肿瘤模型,术后超声观察28 d.结果 兔肝VX2肿瘤模型制作方法中,A组兔肝VX2肿瘤模型肝内单发VX2肿瘤10只,腹壁浸润5只,死亡5只;B组兔肝VX2肿瘤模型肝内单发VX2肿瘤11只,腹壁浸润4只,腹腔种植4只,死亡1只;C组兔肝VX2肿瘤模型肝内单发VX2肿瘤20只,未见腹壁浸润及腹腔种植.与A、B组相比,C组模型制作时间短(3 min vs 55 min、46 min,P<0.01),肝内单发VX2肿瘤种植成功率高(100%vs 50.0%、55.0%,P<0.01),并且C组兔肝VX2肿瘤模型制作损伤小,术后恢复快.结论 超声介入瘤块植入法制作兔肝VX2肿瘤模型具有成功率高、损伤小、省时省力等优点.该方法在兔肝VX2肿瘤模型制作中具有很高的应用价值.     

兔VX2肌肿瘤模型制作方法的改良及超声评价

目的 改良VX2肌肿瘤模型的制作方法,并采用超声对肿瘤进行评价。方法 健康新西兰兔20只,随机分为超声引导组和切口包埋组,每组10只,于实验兔双侧后肢肌肉行VX2肿瘤种植,超声引导组采用超声引导下组织块接种法,切口包埋组采用切口组织块包埋法,每侧种植约1 mm³的VX2瘤块。观察比较两组肿瘤接种所需时间、成瘤率,且分别于种植后第7、14、21、26天进行超声检查,观察肿瘤生长情况。结果 超声引导组及切口包埋组肿瘤接种所需时间分别为(93.78±7.42)s与(251.81±17.87)s,成瘤率分别为100%(20/20)、80.00%(16/20),两组间差异有统计学意义(P<0.05);超声引导组与切口包埋组接种成功的肿瘤均为单发,且大小均一。结论 超声引导下接种1 mm³大小瘤块建立兔VX2肌肿瘤模型操作简单、快速、成功率高、肿瘤生长均一,是实验研究肿瘤介入治疗的理想动物模型。     

兔VX2骨肿瘤模型的生长特性及其超声动态观察

目的 探讨实验兔胫骨 VX2 移植瘤的生长特性及不同时间段二维超声、彩色多普勒血流成像(CDFI)及超声造影声像图表现与病理特征.方法采用手术直视下瘤块移植法建立12只新西兰大白兔VX2 胫骨肿瘤模型,应用二维超声、CDFI和超声造影观察21、28、35 d后实验兔胫骨移植瘤部位肿瘤大小、形态、内部回声及血流灌注情况以...     

兔VX2肾癌模型的制作方法改进及超声观察

目的探讨兔肾癌模型的制作方法及超声在肾癌生长中的监测作用。方法新西兰大白兔30只平均分为两组,A组采用超声引导下组织块注射法,B组采用手术直视下组织块接种法建立VX2肾癌模型,比较两种方法的成瘤率,种植后隔天一次监测VX2肾癌的超声声像变化。结果超声引导组和手术组的种植成功率分别为53.3%(8/15)和86.7%(13/15),超声引导组的肾包膜下血肿和肾外种植率均高于术中组;VX2小肾癌的超声声像特征与临床小肾癌接近。结论手术直视下组织块注射法是建立VX2肾癌模型的可靠方法,成功率高。超声是监测兔VX2肾癌生长的简便可靠的影像学方法之一。     

超声引导下组织块接种制作兔肝VX2瘤模型

目的探讨超声引导下穿刺组织块接种制作兔肝VX2瘤模型的方法及评价超声检查在监测VX2肝癌中的应用价值。方法24只新西兰白兔超声引导下将VX2肿瘤组织块接种于兔肝脏内,接种后随机分为3组,每组8只,分别于接种后10、14、21d行超声检查,并于检查后处死动物,行病理检查。结果兔VX2肝肿瘤接种成功率为95.83%(23/24),超声表现为圆形或类圆形低回声结节,其周边血供丰富,中央血供稀少;各组超声所测肿瘤直径与病理所测直径之间差异均无统计学意义。结论超声引导下穿刺组织块接种制作兔肝VX2瘤模型方法简单,创伤小,成功率高。     

兔VX2肝癌改良模型的建立及螺旋CT评价

目的探讨超声引导下经皮穿刺组织块注射法制作兔VX2肝癌模型,并与开腹组织块种植法进行比较.方法新西兰白兔24只,随机分成2组,12只/组,分别采用超声引导下经皮穿刺注射瘤组织块及开腹瘤组织块接种的方式种植于肝脏.肿瘤种植后14天,CT平扫及增强扫描与病理组织学结合评价肿瘤接种成功率及生长情况.结果肿瘤接种成功率两组均为91.7%.肿瘤最大直径穿刺组和开腹组分别为(1.04±0.12)cm和(1.09士0.14)cm,两种方法无统计学差异.肿瘤种植后发生感染率及肿瘤坏死率,开腹种植组(感染率:45.5%;坏死率:72.7%)明显高于经皮穿刺组(感染率:0;坏死率:27.3%),并有统计学意义(P＜0.05).结论超声引导下经皮穿刺注射瘤组织块建立兔VX2肝癌模型具有方法简单、成功率高、动物损伤小、肿瘤坏死率低等特点,为肝癌临床治疗和相关基础研究提供成熟的大型实验动物模型.     

两种建立兔肝VX2肿瘤模型方法的比较

目的应用彩超观察VX2肿瘤声像图特征,了解其生长特点,比较超声引导下经皮兔肝穿刺VX2肿瘤接种及开腹直视下接种两种方法。方法新西兰大白兔18只,随机分成2组。分别在超声引导下及开腹直视下将同大小瘤块接种在兔肝左右叶。比较两种建模方法下肿瘤生长情况,观察接种后并发症。结果超声引导下及开腹直视下原位接种成功率分别为44.44%(818)、66.67%(1218),异位种植率分别为11.11%(19)、25.00%(416),无统计学差异;与开腹接种方法相比,超声引导下接种方法肿瘤生长速度慢,并发症少,无淋巴结转移。结论研究者可根据研究目的选择适宜的模型建立方法。     

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.     

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.     

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.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.