脑梗死与基因多态性

目的：脑梗死是多因素共同作用的复杂的多基因遗传病，探讨脑梗死与基因多态性问的相关性。资料来源：应用计算机检索PubMed1 980—01／2005-03与脑梗死基因多态性相关文章，检索词“cerebral infarction，gene polymophysm”并限定文章语种为English。检索维普中文科技期刊全文数据库1989—01／2005-03期间的相关文章，并限定文章语种为中文，检索词“脑梗死，基因多态性”。资料选择：对资料进行初审，选取试验包含上述关键词的文献，然后开始查找全文。纳入标准：①临床试验，无论是否为单盲，双盲或非盲法。②试验包含正常对照组和脑梗死组。排除综述文献和Meta分析。资料提炼：共收集到符合主题的英文研究性文献65篇，其中55篇文献符合纳入标准；收集到中文文献113篇，28篇文献符合纳入标准。选择有代表性的19篇中、英文文献列入参考文献。资料综合：研究发现血管紧张索Ⅱ受体、血管紧张素转换酶、载脂蛋白E、纤维蛋白原、雌激素受体、纤溶酶原激活物抑制剂1的基因多态性与脑梗死相关。结论：脑梗死的发病和预后与多种因素有关，尽管基因多态性与脑梗死的相关性研究成果不尽一致，但对各种相关基因多态性的研究为脑梗死的防治提供了新的思路。     

心理动力学的新修正与发展：内在小孩疗法原理及其应用

目的：介绍了内在小孩疗法是一种源于心理动力学的心理治疗技术，以提升来访者自尊与自我价值感、减少白怨白恨、增强自爱与自我抚慰的能力为工作目标。资料来源：应用计算机检索计算机在线检索PubMed与ScienceDirect及EBBSCO数据库1980—01／2005—12期间的国内外关于内在小孩疗法方面的文献，检索词为“Inner Child Therapy”，限定语言种类为English。另检索海峡两岸1990／2005期间的中文出版书目，限定文章语言种类为中文，检索词为“心理分析，内在小孩”。资料选择：对资料进行初审，选择涉及内在小孩疗法与心理动力学方法的文章。资料提炼：共收集到相关文献54篇，按上述标准纳入12篇，其余文献均被排除。资料综合：12篇文献中有2篇为系统介绍心理治疗方法与理论的中文简体专著，5篇系中国台湾出版的中文繁体字版内在小孩理论与疗法译著，1篇文献系中国台湾专家的文献；其他则为英文文献。结论：内在小孩疗法强调自我关爱是心理成长与康复的重要机制，很适合在中国应用。     

原发性骨质疏松症相关基因的多态现象

目的：综合分析原发性骨质疏松症相关基因的多态性。 资料来源：应用计算机检索Pubmed 1995—01／2005—12有关原发性骨质疏松症相关基因多态性的文献，检索词“osteoporosis，genetic polymorphism”，并限定文章语言种类为English。同时应用计算机检索CNKI数据库1997—01／2005—12有关原发性骨质疏松症基因多态性的文献，检索词“骨质疏松，基因，多态现象”，并限定文章语言种类为中文。 资料选择：对检索到的有关原发性骨质疏松症相关基因多态性的信息进行整理，选取针对性强的文章。同一领域的文献则选择权威杂志或不同人种的文章。 资料提炼：共检索到371篇相关文献，其中24篇文章符合要求。 资料综合：研究证明，维生素D受体基因、Ⅰ型胶原基因、雌激素受体基因、转化生长因子β基因、降钙素受体基因、瘦素受体基因等基因多态性与原发性骨质疏松症的关系存在许多相互矛盾的结论，可能是有些研究样本含量比较少或种族及环境的差异所致。 结论：尽管有关基因多态性与骨质疏松的关系存在许多相互矛盾的结论，但骨质疏松的遗传受多基因控制是比较肯定的，应在更多的种族之间对基因多态性进行研究。另外，目前有关男性骨质疏松和基因与基因之间协同作用的研究较少，有必要加强。     

脑性瘫痪患儿踝足矫形器的应用

目的踝足矫形器是小儿脑性瘫痪治疗中最常见的一种矫形器，探讨不同种类踝足矫形器的特点及有效性。方法应用计算机检索PubMed 1992—07／2004—05期间相关文章．检索词为“orlhoses，cerebral palsy”，并限定文章语言种类为English，同时计算机检索《中国临床康复》1990-01／2004-05期间相关文章，并限定语言种类为中文，检索词“矫形器，脑性瘫痪”。结果英文文献共检得19篇，除6篇为重复研究，选取13篇纳入；中文文献共检出2篇，全部纳入。结论不同设计的踝足矫形器对脑性瘫痪患儿的治疗作用各有侧重，最好据实际情况为患儿佩戴最适合的矫形器。踝足矫形器是脑性瘫痪治疗中一项重要的有效的治疗手段。     

解偶联蛋白特征

学术背景：机体产热部位主要在线粒体，产热量主要取决于线粒体t解偶联蛋白，即位于线粒体内膜介导H＋内流的跨膜蛋白质形成的“质子漏”的程度。大概有25％ATP中的代谢能是由于质子遗漏现象而被转化成热量的形式散失的。通常测定机体产热量可知晓机体能量代谢的概况，进而可研究对肥胖产生的影响。 目的：总结解偶联蛋白的作用机制、解偶联蛋白多态性与肥胖的关系及其表达的调节因素等，为肥胖发生机制及其防治工作的研究开辟新途径。 检索策略：应用计算机检索Medline1997—01／2007—07与解偶联蛋白相关的文章。检索词“Uncoupling proteins”，限定文章语言种类为English：同时计算机检索1997—01／2007—07中国期刊全文数据库与解偶联蛋白相关的文章，检索词“解偶联蛋白”，限定文章语言种类为中文。另外手工检索到相关文献20篇。对资料进行初审，纳入标准：①解偶联蛋白家族中各成员相关研究。②解偶联蛋白与肥胖方面的研究。③解偶联蛋白研究的临床、实验研究报道。排除标准：研究目的与本综述目的无关、重复研究的文献。阅读标题和摘要进行初筛。排除因研究目的与本研究无关者98篇，内容重复性的研究112篇。保留220篇中英文文献进一步分析。 文献评价：220篇文献中动物实验和在体、离体、细胞学实验98篇。综述、述评、讲座类文献32篇。系统评价／Meta分析15篇。临床研究75篇。共34个研究满足全部纳入标准。予以纳入。 资料综合：至今为止。在哺乳动物体内已识别出5种解偶联蛋白质。解偶联蛋白1在人体能量平衡中的作用不大。解偶联蛋白2和解偶联蛋白3与肥胖和2型糖尿病的发生可能有一定的相关性。解偶联蛋白4基因表达于大鼠脂肪组织中，并可能参与肥胖的发生发展。解偶联蛋白5则在脑与睾丸中含量?     

人类白细胞抗原新等位基因B*07:110的序列分析及确认

背景：近几年来,随着中华骨髓库的建立和人类白细胞抗原分型技术的不断发展和提高,中国人类白细胞抗原新等位基因不断被发现。目的：采用序列分析确认1例中国人的人类白细胞抗原新等位基因。方法：应用聚合酶链式反应-序列特异性寡核苷酸探针基因分型技术进行样本的人类白细胞抗原基因分型,并应用基于测序的方法分析该基因序列及与最相近等位基因序列的差异。结果与结论：聚合酶链式反应-序列特异性寡核苷酸探针结果显示,该样本人类白细胞抗原B基因座反应格局出现异常;基因测序结果表明,其B基因座第2外显子序列与所有已知人类白细胞抗原B等位基因序列均不一致,在所检测的第2、3外显子中,与序列同源性最高的等位基因B*07：01：02的差异是在第2外显子发生了nt 226和nt 228两个A->G核苷酸取代,导致第76位密码子由ATA->GTG,相应的导致氨基酸由异亮氨酸(I)改变为缬氨酸(V)。将其序列提交国际基因数据库(GenBank)及IMGT/HLA数据库,证实该新人类白细胞抗原等位基因为国际上首次发现,被世界卫生组织织人类白细胞抗原因子命名委员会正式命名为人类白细胞抗原B*07：110(HM989017)。     

运动和营养补充对白细胞介素的影响

目的：采用文献法总结白细胞介素1、白细胞介素2、白细胞介素6的作用，运动与白细胞介素的关系以及营养补充对运动后白细胞介素水平的影响，为了解运动、营养和免疫的关系提供一定的理论依据和参考。 资料来源：通过计算机检索Springer数据库1990—01／2005—09关于白细胞介素和运动相关的文章，检索词主要为“Interleukin，exercise”，并限定文章语言为English；同时检索中文期刊全文数据库1995—01／2005—05关于白细胞介素、细胞因子和运动相关的文章，检索词为“白细胞介素，细胞因子，运动，免疫”，限定语言种类为中文。 资料选择：对资料进行初审。选择与白细胞介素1、白细胞介素2、白细胞介素6与运动有关的文章以及营养补剂与白细胞介素有关的文章。纳入标准：白细胞介素1、白细胞介素2、白细胞介素6与运动及营养补剂与白细胞介素有关的文章。排除标准：重复性研究和综述。 资料提炼：共搜集到与标准相符的文章65篇，排除重复性研究25篇。纳入40篇。其中运动和白细胞介素1有关的文章13篇，运动和白细胞介素2有关的文章10篇，运动和白细胞介素6有关的文章12篇，营养补剂对白细胞介素水平的影响5篇。 资料综合：白细胞介素是一类介导机体体液免疫和细胞免疫功能的重要细胞因子。不同运动方式、运动强度和运动时间对白细胞介素1、白细胞介素2和白细胞介素6的产生均有不同的影响。 结论：食用合适的营养补剂能有效减轻运动性免疫抑制，调节白细胞介素的分泌和释放，从而起到调节机体免疫功能的作用。     

基因组学及其相关技术在运动人体科学中的应用

目的：简要回顾运动人体科学的发展历程，对基因组学与基因芯片技术在运动人体科学中的应用现状进行了综述，展望基因组学及相关技术在运动人体科学中的发展方向。资料来源：应用计算机检索PUBMED 2003-01／2005-11期间的相关文章，检索词为“Genomics，Gene Chip，Exercise Sciences”，并限定文章语言种类为English。同时计算机检索万方数据库2003-01／2005-11期间的相关文章，检索词为“基因组学，基因芯片，运动人体科学”，并限定文章语言种类为中文。资料选择：对资料进行初审，并查看每篇文献后的引文。纳入标准：文章所述内容应与基因组学及基因芯片技术的研究相关。排除标准：重复研究或Meta分析类文章。资料提炼：共收集到53篇相关文献，11篇文献符合纳入标准，排除的．42篇文献为内容陈旧或重复。资料综合：在运动人体科学每一个发展阶段，先进的科学技术对该学科的发展产生了深刻的影响。目前基因组学及其相关技术在运动人体科学中的应用体现在以下几个方面：在全民健身与健康研究中，利用基因组学探讨运动对相关疾病基因的影响，已成为运动人体科学研究的热点；在竞技体育的科学研究中，利用基因组学相关技术能对运动能力相关基因进行深入了解和挖掘。随着基因组学的发展以及基因芯片技术的逐步完善，运动人体科学的研究将向分子水平上深入，并将对运动与健康、运动与竞技水平的提高产生更为深刻的影响。结论：基因组学及相关技术的发展和完善，对运动人体科学的研究起到了很好的促进作用。从基因水平上进一步对运动与人体适应进行实质性研究，将产生“运动基因组学”、“运动营养基因组”等全新的概念和学科，这些学科的研究热点将集中在运动营养基因组学、运动员基因选材和基因诊断、运动损伤的基因治疗等方面。     

骨关节炎与白细胞介素17的关系

目的：综合分析骨关节炎与细胞因子白细胞介素17的关系。资料来源：应用计算机检索Pubmed 1995—01／2005—12有关细胞因子白细胞介素17与骨关节炎关系的文章，检索词“osteoarthritis，IL-17”，并限定文章语言种类为English；同时应用计算机检索中国期刊全文数据库1995—01／2005—02有关细胞因子白细胞介素17与骨关节炎关系的文章，检索词“骨关节炎，白细胞介素17”，并限定文章语言种类为中文。资料选择：对检索到的白细胞介素17、骨关节炎方面的相关信息进行整理，选取针对性强的文章。同一领域的文献则选择近期发表或权威杂志的文章。资料提炼：共检索到44篇相关文献，其中16篇文章符合要求。排除28篇，其中16篇系重复同一研究，12篇为临床报道。资料综合：白细胞介素17通过与其受体结合发挥生物学作用，其可能通过增加关节软骨细胞诱导性一氧化氮合酶表达和一氧化氮产量，增强软骨细胞基质金属蛋白酶（MMP-1／3／13）的表达，增强蛋白聚糖酶和胶原酶活性，促进软骨蛋白多糖及胶原降解，并增强单核细胞对软骨基质的破坏，从而诱导和加速骨关节炎的发生和发展。结论：白细胞介素17在骨关节炎疾病发生和发展中所起的作用已基本肯定，但其作用途径以及其与症状的关系等尚未完全明确。从分子水平阐明骨关节炎的发病途径以及针对该途径的免疫治疗都有待于进一步探索。     

动脉粥样硬化与平滑肌细胞凋亡的调控

目的：探讨动脉粥样硬化过程中影响平滑肌细胞凋亡的各种影响因素及其传导通路。资料来源：应用计算机检索Medline1995-01／2003-12有关平滑肌细胞凋亡与动脉粥样硬化关系的文献，检索词为“atherosclerosis，apoptosis，SMC”，并限定文章语言种类为English。同时计算机检索中文期刊全文数据库及万方数据库1994—01／2003-12有关平滑肌细胞凋亡与动脉粥样硬化关系的文献，限定文章语言种类为中文，检索词为“动脉粥样硬化、凋亡、平滑肌细胞”。资料选择：选取所有检索到的相关文献，包括动物实验、细胞培养和临床研究，进行初审，排除不符合要求的文献。评价指标主要是内容是否所需，资料是否真实，设计是否严密，实施过程是否严格，统计学处理是否合理。资料提炼：共检索48篇有关平滑肌细胞凋亡与动脉粥样硬化关系的文献，其中16篇符合要求。排除的32篇中，26篇与平滑肌细胞凋亡的调控无关，6篇内容重复。资料综合：选取16篇文献，对动脉粥样硬化中平滑肌细胞凋亡的调控因素进行深入分析。①动脉粥样硬化中影响细胞凋亡的外部信号：氧化低密度脂蛋白、机械扩张、炎性细胞因子、活性氧、血管紧张素Ⅱ和内皮素1等。（2）动脉粥样硬化中影响细胞凋亡的内部基因及传导信号：c-myc、Bcl-2、P53、Id3基因及白细胞介素1β转换酶家族。结论：动脉粥样硬化中平滑肌细胞凋亡的调控需要外部影响因素和内部相关基因通过不同的传导通路共同完成。     

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.     

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.     

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.     

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.     

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.     

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.