任务导向性训练对局灶性脑梗死大鼠前肢运动功能及缺血区突触素和生长相关蛋白-43 表达的影响

目的观察任务导向性训练对局灶性脑缺血大鼠前肢运动功能和缺血区周围皮质突触素和生长相关蛋白(GAP)-43 表达的影响。方法采用内皮素-1(ET-1)诱导局灶性脑缺血大鼠前肢损伤模型。将大鼠随机分为假手术组、模型组、任务导向组和跑台组,每组又分为3 d、7 d、14 d、21 d 4 个亚组,每个亚组各6 只。造模后24 h 对任务导向组进行前肢抓取训练,跑台组给予跑台训练,模型组不给予任何干预。用网屏实验分析大鼠的运动功能,应用免疫组化方法观察各组不同时间点缺血灶周围皮质突触素和GAP-43 表达。结果造模后14 d 和21 d 任务导向组大鼠前肢运动功能优于模型组(P<0.01)和跑台组(P<0.05)。任务导向组缺血区周围皮质突触素平均光密度值在造模后14 d 和21 d 优于模型组和跑台组(P<0.05);任务导向组缺血区周围皮质GAP-43 阳性细胞数量在造模后7 d 和14 d 优于模型组和跑台组(P<0.05)。结论任务导向性训练法可促进局灶性脑缺血大鼠前肢运动功能的恢复,疗效优于动物跑台训练,其机制可能是与增强脑缺血区周围皮质突触素和GAP-43 的表达有关。     

跑台训练对慢性脑缺血大鼠海马区Notch1和突触素表达的影响

目的:研究跑台训练对慢性脑缺血大鼠海马区Notch1和突触素(SYN)表达的影响,从而探讨跑台训练对慢性脑缺血的康复作用及其可能的分子机制。方法:选取雄性的SD大鼠90只,随机分为9组,3个假手术对照组(7d、14d、28d)、3个模型组(7d、14d、28d)和3个跑台训练组(7d、14d、28d),每组10只。采用双侧颈总动脉永久性结扎法制备慢性脑缺血模型,假手术组仅分离双侧颈总动脉不结扎。跑台训练组于术后第3天开始跑台训练,1周训练6d。在各个时间点,应用Western-blot和免疫组化分析各组大鼠海马区Notch1和突触素表达的变化情况。结果:与同时段的假手术组相比较,模型组和跑台训练组海马组织Notch1蛋白含量和表达在28d时都发生明显降低(P0.05);其中,模型组对比跑台组降低更为明显(P0.05)。模型组和跑台训练组较假手术组突触素(synaptophysin,SYN)蛋白含量和表达也发生降低。其中,跑台训练组Notch1和SYN蛋白含量和表达在28d时要明显高于模型组(P0.05)。结论:跑台训练可以增加慢性脑缺血大鼠海马区Notch1和突触素的表达。     

神经生长因子对大鼠缺血性脑损伤急性期的疗效研究

目的:观察神经生长因子(NGF)对脑缺血急性期大鼠脑组织超微结构及突触素(Syp)表达的影响。方法:健康雄性SD大鼠36只,随机分为假手术组、缺血组和NGF组各12只,后2组线栓法制备MCAO模型,NGF组给予NGF腹腔注射治疗14d,其余2组腹腔注射等量生理盐水治疗14d。术后14d,WesternBlot测定各组脑组织中Syp的表达;术后28d,透射电镜观察各组脑组织超微结构。结果:术后14d,缺血组和NGF组脑组织Syp蛋白含量均显著高于假手术组(P<0.01),NGF组脑组织Syp蛋白含量高于缺血组(P<0.05);术后28d,电镜显示NGF组脑组织超微结构损伤较轻,突触数目较多,突触形态基本正常。结论:急性期腹腔注射NGF可减轻大鼠脑缺血性损伤程度,可能通过增加脑组织Syp的表达来促进脑缺血性损伤后突触的形成。     

跑台训练对大鼠脑缺血再灌注损伤后胶质纤维酸性蛋白和脑源性神经营养因子表达的影响

目的观察跑台训练对大鼠脑缺血再灌注损伤后胶质纤维酸性蛋白(GFAP)和脑源性神经营养因子(BDNF)表达的影响。方法成年雄性Wistar大鼠30只随机分为假手术组、模型组和跑台训练组,每组10只。采用线栓法制备大脑中动脉阻塞2 h再灌注模型。假手术组插线10 mm后即刻退出。跑台训练组在造模成功后第3天进行跑台训练12 d,在造模后第4、8、15天采用改良神经功能缺损评分(m NSS)对各组大鼠评分,造模后第15天HE染色观察脑组织病理学变化,Western blotting检测BDNF和GFAP表达。结果造模后15 d,与模型组比较,跑台训练组m NSS评分明显降低(F=9.931,P0.01),缺血侧皮质脑组织病理损伤减轻,GFAP(t=6.73)和BDNF(t=3.78)表达明显升高(P0.01)。结论跑台训练可促进大鼠脑缺血再灌注损伤后GFAP和BDNF的表达,促进神经功能的恢复。     

中风康对局灶性脑缺血大鼠脑组织超微结构的影响

目的:探讨中药中风康对局灶性脑缺血大鼠脑组织超微结构的影响.方法:采用线栓法复制局灶性脑缺血大鼠模型.以步长脑心通为对照,于脑缺血48 h观察中风康(主要成分:枸杞子、怀牛膝、川芎、水蛭、地龙、橘络、胆南星、石菖蒲、冰片等)对局灶性脑缺血大鼠脑组织含水量和超微结构的影响.结果:与假手术组比较,模型组出现明显的血-脑屏障和神经元超微结构损害,脑组织含水量增加(P<0.01);与模型组比较,各治疗组脑组织超微结构损害均有不同程度减轻,脑组织含水量均下降(P均<0.01).结论:中风康可减轻缺血时脑组织超微结构的损害,维护血-脑屏障的完整性,有效减轻脑水肿和神经元的缺血坏死.     

康复训练对脑缺血大鼠突触体素表达的影响

目的研究康复训练对脑缺血大鼠突触体素表达的影响。 方法将80只SD大鼠随机分为脑缺血组、制动组、康复训练组及假手术组。脑缺血组、制动组及康复训练组大鼠均制成脑缺血动物模型,假手术组制模方法同上,但不阻断大脑中动脉血流。假手术组及脑缺血组大鼠于制模结束后均置于普通笼内饲养,制动组大鼠术后则置于网状笼内固定,康复训练组大鼠术后每天给予康复训练,包括滚笼、平衡木、转棒及网屏训练。于实验进行1,7,14及21 d时各组分别取5只大鼠检测神经、运动功能以及大脑皮质突触体素表达水平。 结果从术后第7天开始,康复训练组大鼠神经及运动功能均明显优于脑缺血组及制动组。假手术组大鼠脑皮质内可见突触体素免疫产物呈点状分布,密度较高;脑缺血组大鼠随缺血时间延长,其脑皮质内突触体素免疫产物逐渐减少,密度降低;制动组大鼠随缺血时间延长,其脑皮质内突触体素免疫产物减少程度更显著;康复训练组随缺血时间延长,其脑皮质内突触体素免疫产物减少幅度逐渐趋缓,明显高于制动组水平。 结论脑缺血能显著降低实验大鼠脑皮质突触体素水平,康复训练能明显增强大鼠脑皮质突触体素表达,促进神经突触再生及神经、运动功能恢复。     

跑台训练对大鼠脑缺血再灌注后脑组织基质金属蛋白酶-2和血管内皮生长因子表达的影响

摘要 目的：探讨跑台训练对大鼠脑缺血再灌注神经功能恢复和缺血脑组织中MMP-2和VEGF表达的影响。 方法：用线栓法制作Wistar大鼠大脑中动脉梗死再灌注模型,35只大鼠随机分为假手术组、跑台训练组和手术对照组。跑台训练和手术对照组又分为跑3天、跑7天、跑14天3个亚组,各亚组及假手术组每组5只大鼠。跑台组于术后第3天开始给予跑台训练,假手术组及手术对照组不予跑台训练。于跑3天、跑7天、跑14天3个时间点进行神经功能评估后处死大鼠。采用RT-PCR技术测定缺血区脑组织中MMP-2及VEGF的水平。 结果：跑台训练组在跑7天、跑14天神经功能评分明显低于对照组(P＜0.05)。跑台训练组缺血区脑组织在跑7天、跑14天MMP-2水平高于对照组（P＜0.05）,各时间点VEGF水平均高于对照组(P＜0.05)。 结论：跑台训练能通过上调MMP-2及VEGF的表达,促进血管形成和神经再生等,有利于脑损伤后神经功能的恢复。     

缺氧缺血脑损伤大鼠脑神经结构与突触素表达的变化

目的 研究大鼠缺氧缺血性脑损伤（HIBD）后脑神经结构与突触素表达的变化.方法 将7日龄SD大鼠分为HIBD组和假手术对照组.采用单侧颈总动脉结扎术建立缺氧缺血性脑损伤大鼠模型,于脑缺氧缺血后1,4,7,14,28 d采集脑组织标本,进行HE染色和透射电镜观察其组织病理学及神经超微结构变化,并用免疫组化技术检测大鼠脑皮质及海马CA1区突触素的表达.结果 HIBD组脑损伤后神经元突起呈灶性坏死,突触数量减少、结构破坏;同时突触素的表达逐渐增高,至7 d达到高峰;而后开始下降,至28 d明显低于相应对照组（P〈0.001）.假手术对照组突触素表达水平则随日龄增加逐渐增高（P〈0.001）.结论 缺氧缺血性脑损伤可影响发育期脑组织神经结构与突触素的表达,损伤后两周内脑神经具有较强的突触可塑性.     

针康法对局灶性脑缺血大鼠前肢运动功能及缺血区突触素和生长相关蛋白-43表达的影响

目的观察针康法对局灶性脑缺血大鼠前肢运动功能及缺血区周围皮质突触素和相关蛋白-43(GAP-43)表达的影响。方法采用内皮素-1(ET-1)诱导局灶性脑缺血大鼠前肢损伤模型。将大鼠随机分为5组:假手术组、模型组、康复组、针刺组、针康组,每组又分为3d、7d、14d、21d4个亚组。造模后24h对针康组进行头穴丛刺结合前肢抓取训练,康复组给予前肢抓取训练,针刺组仅头穴丛刺法,模型组不给予任何干预。分析前肢抓取成功率及应用免疫组化方法观察各组不同时间点缺血灶周围皮质突触素和GAP-43表达。结果造模后各时间点,针康组大鼠前肢抓取成功率优于模型组、康复组和针刺组(P<0.05)。针康组缺血区周围皮质突触素平均光密度在造模后14d和21d优于模型组、康复组和针刺组(P<0.05);针康组缺血区周围皮质GAP-43阳性细胞数量在造模后7d和14d优于模型组、康复组和针刺组(P<0.05)。结论针康法可促进局灶性脑缺血大鼠前肢运动功能的恢复,其机制可能与增强脑缺血区周围皮质突触素和GAP-43的表达有关。     

P-选择素在大鼠脑缺血-再灌注损伤中表达的实验研究

目的研究P-选择素在大鼠局灶性脑缺血再灌注后的表达规律,探讨P-选择素在脑缺血再灌注损伤中的作用.方法 36只雄性SD大鼠随机分为假手术组和脑缺血2h再灌注组(3h,6h,12h,24h,48h),采用尼龙线栓法建立大鼠局灶性脑缺血再灌注模型,用免疫组化方法检测脑组织缺血再灌注不同时间点P-选择素的表达.结果假手术组未见P-选择素的表达,P-选择素在脑缺血再灌注后3h出现少量表达,12h达高峰,48h仍有表达.结论大鼠局灶性脑缺血再灌注损伤中,P-选择素的表达明显上调,根据炎症反应的机理,说明其介导了白细胞、脑微血管内皮细胞的粘附,参与了脑缺血再灌注损伤的病理过程.     

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.     

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.     

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.     

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.