磷酸化p38丝裂原活化蛋白激酶与转化生长因子β1在正常和腰椎间盘退变组织中的表达

背景：研究表明p38丝裂原活化蛋白激酶信号转导通路与椎间盘退变过程中炎症反应密切相关。目的：检测腰退变椎间盘组织和正常腰椎间盘组织中磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1的表达。方法：选取经手术切除的36例退变椎间盘组织和10例正常椎间盘组织为对象,应用免疫组织化学法检测两组中磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1的表达,并应用真彩色病理图像分析系统进行分析。结果与结论：腰退变椎间盘组织中磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1的阳性表达率均高于正常椎间盘组织（P〈0.05）,证实磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1在退变椎间盘组织中呈高表达。     

磷酸化p38丝裂原活化蛋白激酶与转化生长因子β1在正常和腰椎间盘退变组织中的表达

背景:研究表明p38丝裂原活化蛋白激酶信号转导通路与椎间盘退变过程中炎症反应密切相关。目的:检测腰退变椎间盘组织和正常腰椎间盘组织中磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1的表达。方法:选取经手术切除的36例退变椎间盘组织和10例正常椎间盘组织为对象,应用免疫组织化学法检测两组中磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1的表达,并应用真彩色病理图像分析系统进行分析。结果与结论:腰退变椎间盘组织中磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1的阳性表达率均高于正常椎间盘组织(P<0.05),证实磷酸化p38丝裂原活化蛋白激酶和转化生长因子β1在退变椎间盘组织中呈高表达。     

p38 MAPK信号转导通路与椎间盘退变

p38 MAPK信号通路是丝裂原活化蛋白激酶(MAPK)介导的信号转导通路的重要分支,它在炎症、细胞应激、凋亡、细胞周期和生长等多种生理和病理过程中起重要作用.既往在骨关节炎的研究中发现,p38参与炎性因子的激活、软骨细胞的凋亡等,与骨关节炎的病理过程密切相关.椎间盘退变也存在炎性反应、细胞凋亡等病理变化,这其中p38 MAPK信号转导通路发挥的作用尚不明确.现将既往此类文献加以综述.     

低氧诱导因子在调节椎间盘髓核细胞功能中的研究进展

椎间盘退变性疾病引起的颈、肩、腰、腿痛已经严重影响人类日常生活,给社会造成了严重的经济负担,但目前治疗效果不佳。既往研究结果表明,髓核细胞代谢活动、低氧诱导因子含量的变化均能影响椎间盘退变。现在人们已经开始从组织工程学上来探讨椎间盘退变性疾病的治疗,希望找到有效方法来阻止椎间盘退变甚至能够逆转椎间盘退变的方法。椎间盘的一个显著特点就是氧含量低,而低氧诱导因子能够使机体很好地适应低氧环境。目前研究表明,低氧诱导因子能够调节髓核细胞的生物学功能,并且可能成为阻止椎间盘退变进展甚至逆转椎间盘退变的关键因素。本文就低氧诱导因子对髓核细胞代谢、细胞外基质表达、细胞凋亡、细胞自噬的调控作一综述。     

白细胞介素-1对椎间盘退变影响的研究进展

椎间盘退变机制复杂,研究提示白细胞介素-1(IL-1)对椎间盘退变有重要的影响.IL-1降解细胞外基质,影响蛋白质的表达,引起细胞营养障碍,造成椎间盘细胞对负荷应力敏感,诱导椎间盘细胞老化退变,引起细胞凋亡.进年来研究显示干预IL-1诱导的椎间盘炎性反应,可预防和逆转椎间盘退变,治疗椎间盘疾病.     

椎间盘退变的生物学治疗技术进展

在椎间盘发生退变的早期,主要出现生物化学改变,即椎间盘细胞数量减少,蛋白多糖与Ⅱ型胶原等细胞外基质降减增加.因此,治疗椎间盘退变的理想方法应是在分子生物学基础上阻止与逆转椎间盘退变.生物学治疗方法主要包括直接注射活性蛋白因子、基因治疗及干细胞为基础的组织工程学.直接注射活性蛋白因子可增强椎间盘细胞的活性,从而阻止椎间盘退变,但生长因子等活性蛋白半衰期较短,限制其应用.因此,比较理想的方法是将活性蛋白因子基因利用载体导入细胞内,并能够长期表达,从而调节细胞活性,即基因治疗.干细胞为基础的组织工程学是应用生物相容性良好的载体将干细胞植入椎间盘内,通过增加椎间盘细胞的数量增强椎间盘的生物活性,从而修复退交的椎间盘.目前,组织工程与基因治疗仍处于实验阶段.随着分子生物学技术的飞速发展以及基因工程治疗逐渐应用于临床,基因治疗椎间盘退变将具有较大前景.     

体外培养人正常椎间盘髓核细胞与退变髓核细胞的生物学性状比较:可以为干预退变髓核细胞提供最佳时机吗?

背景:人体椎间盘是一个承受载荷却又缺乏血管的结构,因而容易发生退行性变,但椎间盘退变的机制尚不明确.目的:通过体外培养人正常椎间盘髓核细胞与退变髓核细胞生物学性状比较,认识退变髓核细胞的细胞学退变时机.方法:分离、培养人正常及退变椎间盘髓核细胞,对两种细胞采用光镜、电镜等形态学方法进行大体形态和超微结构观察,采用生长曲线和XTT实验研究两种细胞的生长动力学差异,测定髓核细胞的活力和细胞Ⅱ型胶原及糖胺多糖的mRNA表达.结果与结论:退变椎间盘细胞至少要比正常椎间盘细胞提前2代出现形态学老化表现.退变髓核细胞表现为G1期阻滞,使细胞不能进入S期,细胞有丝分裂受到抑制.退变髓核细胞总体来说,生长要比正常髓核细胞快,但老化也较快.退变髓核细胞自第1代开始,Ⅱ型胶原和糖胺多糖的mRNA表达比同期正常髓核细胞低得多.说明在体外培养条件下,退变髓核细胞持续增殖能力低,更容易衰老、凋亡.提示退变髓核细胞体外培养衰老较快,进行干预试验逆转椎间盘退变的最佳时机为传2代之前的细胞.     

成骨蛋白1在椎间盘退变和修复中的作用

背景:椎间盘的再生修复是当前骨科疾病治疗所面临的一个难题,而成骨蛋白1具有强大的骨诱导活性,能够在体内诱导骨和软骨形成.目的:总结并讨论成骨蛋白1在椎间盘退变和修复中的作用.方法:由第一作者用计算机检索中国期刊全文数据库(CNKI:1990/2010)和Pubmed数据库(1990/2010),检索词分别为"椎间盘,退变,成骨蛋白1/骨形态发生蛋白7"和"intervertebral disc,degeneration,osteogenic protein-1/bone morphogenic protein-7"语言分别设定为中文和英文.从体外和体内两方面对成骨蛋白1对椎间盘细胞及其退变的影响进行介绍.结果与结论:共检索到56篇文章,按纳入和排除标准对文献进行筛选,共纳入27篇文章.结果表明成骨蛋白1具有促进细胞合成蛋白多糖和胶原的作用,可调节和恢复椎间盘退变中细胞外的基质代谢,可有效延缓椎间盘退变.     

组织蛋白酶K在人椎间盘中的表达及意义(英文)

背景:研究证实,椎间盘内酶类的激活与基质成分的降解密切相关.已知基质金属蛋白酶和金属蛋白酶组织抑制剂两个酶系统在椎间盘细胞外基质改变过程中发挥着重要作用,除两者外,其他对细胞外基质有降解作用的蛋白酶是否也参与了椎间盘的退变过程?目的:检测正常和退变人椎间盘细胞中组织蛋白酶K的表达,探讨组织蛋白酶K与椎间盘退变的相关性.方法:应用免疫组化S-P法和ELISA法对30例腰椎间盘突出症患者椎间盘组织中组织蛋白酶K进行检测,并取15例健康成人(尸体)和脊柱骨折手术患者正常椎间盘组织作对照,观察组织蛋白酶K在正常和退变人椎间盘细胞中的蛋白表达.结果与结论:正常椎间盘和退变椎间盘中均有组织蛋白酶K表达,退变椎间盘中组织蛋白酶K表达水平明显高于正常组,差异有显著性意义(P＜0.05).提示组织蛋白酶K可能参与了椎间盘退变的病理改变.     

体外培养人退变髓核细胞的生物学性状

背景:椎间盘退行性变后很难自行修复,研究退变髓核细胞的生物学特性可为研究椎间盘退变机制、组织工程椎间盘构建、基因治疗等提供理论基础.目的:观察体外培养的人退变髓核细胞的生物学特性.方法:分离培养人退变椎间盘髓核细胞,采用光镜、电镜观察细胞的形态和超微结构,荧光定量PCR技术检测髓核细胞Ⅱ型胶原和糖胺多糖mRNA的表达.ELISA法检测细胞培养上清中人Ⅱ型胶原水平,DMMB比色法检测细胞培养上清中糖胺多糖水平.结果与结论:体外培养的传2代内的退变椎间盘髓核细胞结构与原代细胞相似,传3代后的细胞出现退变及凋亡改变.对体外培养第1代的退变髓核细胞和正常髓核细胞的Ⅱ型胶原和糖胺多糖进行检测发现,退变髓核细胞Ⅱ型胶原、糖胺多糖mRNA水平及细胞外基质中Ⅱ型胶原和糖胺多糖的表达均明显低于正常髓核细胞,呈现去分化趋势.     

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.     

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.     

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.     

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.