慢性冠状动脉狭窄及侧枝循环动物模型的建立

目的：建立慢性冠状动脉狭窄及侧枝循环动物模型,方法：健康小型猪10只,开胸游离冠状动脉左回旋支（LCX）主干,采用改良Ameroid缩窄器,制作左回旋支慢性狭窄及缺血后侧枝循环生成模型,术前与术后3周分别进行冠脉造影及超声心功能检查,结果：4只LCX完全闭塞,5只狭窄大于75％,心肌收缩及舒张功能明显下降,左前降支血管增粗,迂回,多支分支伸向缺血区形成血管网,无心肌梗塞表现,结论：采用Ameroid缩窄器可以成功地制作慢性冠状动脉狭窄及侧权循环形成的动物模型。     

直接心肌内注射血管内皮生长因子基因对慢性缺血心肌侧枝循环生成的影响

目的观察血管内皮生长因子基因(rAAV2-hVEGF165)直接心肌内注射促进慢性缺血心肌侧枝循环生成的作用。方法小型猪左冠状动脉回旋支放置血管缩窄环,建立慢性心肌缺血模型。5周后应用心电图、冠脉造影和心脏核磁共振成像确认左回旋支闭塞或相应心肌的缺血。动物随机分为实验组和对照组,分别在缺血心肌内直接注射rAAV2-VEGF165(1×1012virus genomeml)或同等量的磷酸盐缓冲液或rAAV2-LACZ(1×1012virus genomeml)。治疗后6个月,冠状动脉造影了解有无侧枝循环生成。结果放置血管缩窄环后5周,所有动物均出现左回旋支完全、次全闭塞和旋支供血区域的心肌缺血。治疗后3个月,缺血心肌内可检测到LACZ和VEGF蛋白的阳性表达;治疗后6个月,VEGF组缺血心肌内毛细血管和小动脉密度均高于对照组(P<0.05);结论直接在小型猪慢性缺血心肌内注射rAAV2-VEGF165,VEGF165基因可转染入心肌组织内,并可在缺血部位显著促进侧枝循环形成。     

有氧训练对慢性冠状动脉狭窄猪心肌血管内皮生长因子表达的影响

目的 :研究有氧训练对慢性冠状动脉狭窄动物血管内皮生长因子 (vascularendothelialgrowthfactor,VEGF)及心肌侧枝血管生成的影响。方法 :应用Ameroid缩窄器制备小型猪慢性冠状动脉狭窄模型 ,术后 4w随机分为 4组 :对照组 (不运动 ) ,运动 4w组 ,运动 6w组 ,运动 8w组。运动组进行平板训练 :速度 2 .90km/h ,坡度 5 % ,时间30min/d ,5d/w。病理学分析心肌侧枝血管生成 ,Westernblot分析VEGF蛋白表达。结果 :运动组缺血心肌部位的毛细血管数目显著高于非运动组 (6 .9± 1 .3vs 4 .6± 0 .9条 /HPR ,P <0 .0 1 )。VEGF蛋白条带的密度分析显示 :运动 4w组 (652 7± 1 0 89)、运动 6w组 (6739± 1 72 0 )和运动 8w组 (9556± 2 32 9)均显著高于对照组 (2 936± 1 61 0 ,P <0 .0 1 )。运动组合计平均VEGF表达量显著高于非运动组 (782 8± 81 8vs 2 936± 1 61 0 ,P <0 .0 1 )。结论 :有氧训练可以促进慢性冠状动脉狭窄后心肌VEGF表达 ,与冠状动脉侧枝循环生成增加有关     

有氧训练对猪慢性冠状动脉狭窄后内皮细胞介导的侧支循环依赖血管扩张的影响

目的探讨有氧训练后侧支循环依赖血管的扩张与内皮介导的一氧化氮合酶(ecNOS)的基因表达之间的关系. 方法健康雄性3月龄猪22只,采用Ameroid缩窄器建立慢性冠状动脉左回旋支(LCX)狭窄模型后,随机分为对照组(n=7)和运动组(n=8).对照组保持安静饲养7周;运动组进行中等强度有氧运动训练7周.以逆转录-聚合酶链反应(RT-PCR)法测定未狭窄冠状动脉左前降支(LAD)和侧支循环依赖的LCX小动脉ecNOS的mRNA表达情况. 结果运动组LCX和LAD小动脉的ecNOS mRNA的表达无差异,P>0.05;对照组LCX小动脉ecNOS的mRNA表达较LAD显著下降,P<0.01. 结论运动训练可以上调狭窄的冠状动脉ecNOS的基因表达,增加一氧化氮(NO)的产生,改善侧支循环依赖的血管的扩张,改善心肌供血.     

应用改良Ameroid法建立冠状动脉慢性狭窄模型的实验研究

目的:通过改良手术操作寻求一种建立高效、稳定、经济的冠状动脉慢性脉狭窄模型的方法,为康复相关基础研究提供有力模型保障。方法:实验选用普通级雄性苏中猪17头,通过改良的Ameroid法把缩窄器(AmeroidConstrictor)放置在猪的冠状动脉左回旋支主干上,制作冠状动脉左回旋支慢性狭窄模型。结果:17头猪中术后存活4周以上的12头猪大体标本显示冠状动脉左回旋支主干完全闭塞,且均无明显肉眼可见的心肌梗死。结论:通过改良的Ameroid法可以稳定地建立冠状动脉狭窄及闭塞的大动物模型。     

背向散射技术与彩色室壁运动技术评价慢性冠状动脉狭窄存活心肌的实验研究

目的　研究超声背向散射及彩色室壁运动技术对猪慢性冠状动脉狭窄、侧支循环形成后存活心肌的检出价值。方法　健康小型猪 10只 ,开胸放置Ameroid缩窄器 ,分别于手术前、术后 1d、3d、1周、2周、3周、4周利用超声背向散射、彩色室壁运动技术采集胸骨旁长轴、乳头肌短轴、心尖四腔、两腔观的标准切面图像 ,术前、术后 1周、2周、3周、4周进行冠状动脉造影 ,4周处死动物行病理检查。结果　除1只猪由于技术原因被剔除外 ,其余 9只均成功地建立了慢性冠状动脉狭窄侧支循环模型 ;术后 3d时背向散射积分值 (IBS % )升高 ,背向散射积分周期变化 (CVIB % )降低 ,1周时变化最明显 ,4周时未恢复至正常 ;而术后 3d左室后壁增厚率 (ΔT % )降低 ,室壁运动积分指数 (WMSI)升高 ,1周变化最明显 ,至 4周时与术前相比仍有明显差异 (P <0 .0 5 )。结论　背向散射与彩色室壁运动技术可以检出猪慢性冠状动脉狭窄、侧支循环形成后的存活心肌。     

应用改良Ameroid法建立冠状动脉慢性狭窄模型的实验研究

目的：通过改良手术操作寻求一种建立高效、稳定、经济的冠状动脉慢性脉狭窄模型的方法，为康复相关基础研究提供有力模型保障。方法：实验选用普通级雄性苏中猪17头，通过改良的Ameroid法把缩窄器(Ameroid Constrictor)放置在猪的冠状动脉左回旋支主干上，制作冠状动脉左回旋支慢性狭窄模型。结果：17头猪中术后存活4周以上的12头猪大体标本显示冠状动脉左回旋支主干完全闭塞，且均无明显肉眼可见的心肌梗死。结论：通过改良的Ameroid法可以稳定地建立冠状动脉狭窄及闭塞的大动物模型。     

心肌桥压缩程度与冠状动脉粥样硬化狭窄程度的关系

目的:基于冠状动脉造影结果,探讨心肌桥压缩程度与冠状动脉粥样硬化狭窄程度之间的相关性。方法:对行冠状动脉造影检查的病例,回顾性分析心肌桥压缩程度与冠状动脉各节段狭窄程度的关系。采用单因素分析比较组间基线资料差异,采用相关分析探讨心肌桥压缩程度与冠状动脉粥样硬化狭窄程度之间的相关性。采用Logistic回归分析探讨是否存在心肌桥、心肌桥压缩程度对冠状动脉粥样硬化的影响。结果:共纳入455例病例,其中140例发现有心肌桥。MannWhitney检验结果显示:有心肌桥者左前降支近段、中段、远段,以及左回旋支近段、中段粥样硬化狭窄程度显著低于无心肌桥者,差异有统计学意义(均P0.05)。Spearman相关分析结果显示:心肌桥压缩程度与冠状动脉粥样硬化狭窄程度(左前降支近段、中段、远段,左回旋支近段、中段)呈负相关(相关系数均1,均P0.05)。二元单因素Logistic回归分析结果显示:心肌桥是冠状动脉粥样硬化狭窄(左前降支近段、中段、远段,左回旋支近段)的保护因素(OR值分别为0.415,0.643,0.423,0.417,均P0.05);心肌桥压缩程度与冠状动脉粥样硬化狭窄(左前降支近段、中段、远段,左回旋支近段、中段)的保护因素(OR值分别为0.982,0.992,0.978,0.983,0.990,均P0.05)。二元多因素Logistic回归分析结果显示:心肌桥是左前降支近段粥样硬化(OR=0.443,P0.001)、左前降支中段粥样硬化(OR=0.656,P=0.045)、左回旋支近段粥样硬化(OR=0.431,P=0.001)的独立保护因素。结论:心肌桥是冠状动脉粥样硬化的保护性因素,对预防冠状动脉粥样硬化有积极意义。     

冠状动脉心肌桥的诊断及临床意义

目的探讨冠状动脉心肌桥的诊断以及临床意义.方法对486例行冠状动脉造影(CAG)检查资料进行了回顾性分析.结果共检出13例心肌桥,检出率为2.67%;其中位于左前降支(LAD)12例,左回旋支(LCX)1例;合并冠状动脉粥样硬化症2例;临床表现急性心肌梗死1例,心绞痛4例.结论冠脉造影是冠状动脉心肌桥的特异性诊断方式;局部冠状动脉收缩期狭窄是心肌桥的主要征象;心肌桥患者多数无临床症状,严重者可致心绞痛甚至心肌梗死.     

MSCT冠状动脉成像与冠状动脉造影的对比研究

目的 :研究MSCT在冠状动脉成像中的临床应用价值。方法 :4 0例疑冠状动脉狭窄者行MSCT扫描 ,利用最大密度投影 (MIP)重建 ,2D重建 ,仿真内窥镜技术 ,了解冠状动脉病变情况 ,并与冠状动脉造影对比。结果 :4 0例 16 0支血管经MSCT成像 ,134支 (84 % )可用于影像学评价 ,2 6支 (16 % )不能评价。冠状动脉造影发现狭窄 4 6支 ,其中左前降支 (LAD)病变 18支 ,回旋支 (LCA)病变 12支 ,左主干 (LMA) 3支 ,右冠 (RCA)病变 13支。MSCT发现狭窄 4 1支 ,其中左前降支病变 14支 ,回旋支病变 12支 ,左主干病变 3支 ,右冠病变 12支。敏感性为 82 .6 % (38/ 4 6 ) ,特异性 97.3% (111/ 114 )。结论 :在控制心率的情况下 ,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.