电针对局灶性脑缺血再灌注大鼠缺血周围皮质与纹状体区波形蛋白表达的影响

目的:观察电针对局灶性脑缺血再灌注损伤后大鼠缺血周围皮质纹状体区波形蛋白(vimentin)的影响。方法:雄性SD大鼠36只,随机分为假手术组、模型组、电针组。采用改良线栓法制备大脑中动脉闭塞(MCAO)法建立大鼠局灶性脑缺血再灌注模型。术后第1天开始电针大鼠患侧肢体"曲池"、"足三里"穴30min,1次/天,至动物处死。对各组大鼠在电针干预前后进行神经行为学评分,同时在电针干预第3天、第7天后,分别对3组大鼠进行CatWalk步态分析系统的运动行为学检测,免疫组化检测大鼠缺血周围皮质与纹状体区vimentin表达。结果:电针干预第3天、第7天后,与相同时间点模型组比较,电针组的神经功能缺损症状明显改善(P0.05或P0.01);Cat Walk步态分析系统结果显示,电针组运动速度增加,持续时间减少,差异均有显著性意义(P0.05);在大鼠缺血周围皮质和纹状体区,电针组vimentin表达均显著增加(P0.05)。结论:电针能明显促进局灶性脑缺血再灌注大鼠缺血周围皮质纹状体区vimentin的增殖,改善脑缺血大鼠的神经功能缺损及运动功能。     

弥散张量成像观察电针对缺血性脑卒中大鼠运动皮层-纹状体神经传导束的影响

目的运用小动物磁共振弥散张量成像(DTI),探讨电针曲池、足三里穴对大脑中动脉闭塞致缺血性脑卒中模型大鼠缺血侧运动皮层-纹状体神经传导束完整性的影响。方法 36只成年雄性Sprague-Dawley大鼠随机分为假手术组、模型组和电针组,每组12只,后两组线栓法制备缺血2 h再灌注模型。术后24 h,电针组电针患侧曲池、足三里穴,每天1次,连续14 d。改良神经功能缺损评分(m NSS)评价大鼠神经功能缺损情况;转棒测试观察大鼠运动功能;小动物磁共振成像系统行T2加权成像(T2WI)、DTI扫描,测量脑梗死体积,运动皮层、纹状体区神经传导束相对各向异性分数(r FA)和相对神经纤维数。结果模型组和电针组大鼠较假手术组m NSS评分显著增加;干预7 d、14 d后,电针组评分较模型组降低(P0.05);转棒测试电针组较模型组转棒上停留时间延长(P0.05)。T2WI成像显示,电针组较模型组脑梗死体积减少(P0.05);DTI成像发现,电针组较模型组大鼠缺血侧运动皮层、纹状体r FA增加,运动皮层相对纤维束数增多(P0.05)。结论电针曲池、足三里穴可改善缺血性脑卒中大鼠运动功能,与促进缺血侧运动皮层-纹状体神经传导束损伤的修复相关。     

脑缺血再灌注损伤大鼠CREB信号通路调控及电针足三里作用机制

目的探讨脑缺血再灌注损伤大鼠环磷腺苷效应元件结合蛋白(c AMP-response element binding protein,CREB)信号通路调控及电针足三里作用机制。方法选择100只健康雄性SPF级Wistar大鼠,随机分为假手术组、模型组、电针组、电针+阻断剂组,每组各25只。电针+阻断剂组造模前注射H-89阻断剂,模型组、电针组、电针+阻断剂组均行脑缺血再灌注损伤模型,假手术组和模型组不予电针干预,电针组、电针+阻断剂组电针足三里干预7 d。评估大鼠神经行为学评分,观察脑梗死体积,检测血管内皮生长因子(vascular endothelial growth factor,VEGF)、CREB和磷酸化CREB(p-CREB)的表达水平,记录CREB和VEGF的基因表达水平。结果与假手术组比较,造模2 h、干预7 d模型组、电针组和电针+阻断剂组大鼠神经行为学评分均明显升高,脑梗死体积均明显增大,差异有统计学意义(P 0. 05);与本组造模2 h比较,干预7 d模型组、电针组和电针+阻断剂组神经行为学评分均明显降低,电针组干预7 d脑梗死体积减小,差异有统计学意义(P 0. 05);与电针组比较,模型组、电针+阻断剂组干预7 d神经行为学评分升高,脑梗死体积增大,差异有统计学意义(P 0. 05)。与电针组比较,假手术组、模型组、电针+阻断剂组VEGF表达量均减少,差异有统计学意义(P 0. 05)。与假手术组比较,模型组、电针组、电针+阻断剂组p-CREB和p-CREB/CREB蛋白表达水平与VEGF基因表达水平升高,差异有统计学意义(P 0. 05);与电针组比较,模型组、电针+阻断剂组p-CREB和p-CREB/CREB蛋白表达水平与VEGF基因表达水平降低,差异有统计学意义(P 0. 05)。结论电针足三里可改善脑缺血神经行为学功能,其机制可能与激活CREB通路,刺激下游VEGF表达,进而促进神经血管再生有关。     

电针联合运动训练对脑梗死大鼠运动能力的影响及相关机制分析

目的:观察电针联合运动训练对脑梗死大鼠运动能力的影响,并探讨其对Wnt/β-catenin信号通路的影响。方法:将大鼠随机分为假手术组(SC)、模型组(IC)、跑台组(T)、跑台+电针组(T+EA)、跑台+电针非穴位组(T+ENA),各18只,SC组及IC组抓取后不予任何治疗。T组术后24h予匀速跑台训练,运动强度为10m/min,每天运动30min,每天1次,T+EA组在电针曲池、足三里穴后再予跑台训练,方法同跑台组,T+ENA组在电针非经穴点后再予跑台训练,方法同跑台组,各组均干预7天。观察各组大鼠神经行为学评分、步态、行为活动、脑梗死体积、病理学结构变化、脑细胞凋亡率,Western Blot及RT-PCR法检测脑组织Wnt-1/β-catenin信号通路关键分子蛋白及mRNA表达变化。结果:神经行为学检测显示T+EA组脑梗死大鼠的神经缺损评分下调,大鼠的步态及行为活动改善。TTC染色、HE染色、透射电镜显示与其他组相比,T+EA组大鼠的脑梗死体积明显缩小,病理学形态及超微结构明显改善,Western Blot及RT-PCR显示T+EA可明显上调大鼠脑组织中Wnt-1、β-catenin、Bcl-2的蛋白及mRNA水平,下调GSK-3β、Bax的蛋白及mRNA水平(P0.05)。结论:电针联合运动训练可明显改善脑梗死大鼠运动能力,其作用机制可能与激活Wnt/β-catenin信号通路有关。     

电针对蛛网膜下腔出血大鼠脑血流灌注影响与神经功能障碍的关联研究

目的:研究电针对蛛网膜下腔出血大鼠不同时期针刺对SAH大鼠脑血流灌注的影响。方法:将90只SD大鼠随机分为假手术组、模型组、电针组、尼莫地平组、尼莫地平+电针组,每组各18只。采用Bederson法建立SAH模型,于造模后第1、3、5、7天分别对各亚组大鼠进行Loeffler神经行为学评分及Morris水迷宫逃避潜伏期测定,并检测相应时间点大鼠皮质脑血流。结果:电针组与模型组比较,第3、5、7天rCBF有显著差异(P0.05),第5、7天Loeffler评分及逃避潜伏期有显著差异(P0.05)。尼莫地平+电针组与电针组及尼莫地平组比较,第1、3、5、7天rCBF有显著差异(P0.05),第3、5、7天Loeffler评分有显著差异(P0.05),第5、7天逃避潜伏期有显著差异(P0.05)。结论:针刺大鼠百会、神庭穴可明显改善SAH大鼠脑血管痉挛增加脑血流灌注,从而改善认知功能障碍及行为学功能障碍。     

穴位不同针刺方式促进缺血性脑卒中手功能恢复的研究

目的:研究穴位不同针刺方式促进缺血性脑卒中手功能障碍的恢复。方法:将120例缺血性脑卒中手功能障碍的患者随机分为手针(AC)组、电针(EA)组、神经肌肉电刺激(NMES)组和假穴位刺激(Sham)组4组,每组各30例,所有的病例均接受常规的康复训练,手针组在此基础上增加手法针刺治疗,电针组则增加电刺激治疗,神经肌肉电刺激组则增加肌电刺激,治疗假穴位刺激组则接受假刺激治疗,穴位统一选择"曲池"和"外关"两穴,1次/d,30min/次,5d/周,共4周。所有的患者均于治疗前后采用简式Fugl-Meyer上肢运动功能评价表(FMU)、改良Barthel指数评定(MBI)对患者患侧上肢运动功能及日常生活活动能力进行评价。结果:治疗前4组患者的FMU评分和MBI评分差异无显著性意义(P0.05),治疗后4组患者FMU和MBI评分均有提高(P0.05)。组间比较,治疗后,手针组、电针组、神经肌肉电刺激组和假穴位刺激组相比,三组疗效指标FMU和MBI的前后变化值明显优于假穴位刺激组(P0.05)。神经肌肉电刺激组比电针组、手针组在改善上肢运动功能疗效指标FMU值更明显(P0.01),而电针组和手针组相比较,电针组比手针组改善上肢运动功能疗效指标FMU值更显著(P0.05)。神经肌肉电刺激、手针和电针三组在改善患者ADL能力疗效指标MBI评分上差异不显著(P0.05)。结论:三种穴位不同针刺方式均可改善缺血性脑卒中手功能障碍的运动功能和促进ADL能力的恢复,神经肌肉电刺激结合了电刺激和患者主动运动模式,比针刺刺激更有利于脑卒中后手功能的恢复。     

电针曲池、足三里对缺血再灌注大鼠缺血侧运动皮层小胶质细胞与外泌体蛋白的影响及机制

目的：探究缺血再灌注损伤大鼠缺血侧运动皮层中 M2型小胶质细胞衍生的外泌体表达,观察电针曲池、足三里穴对缺血再灌注损伤大鼠运动功能的影响及其可能机制。方法：36只雄性SD（Sprague Dawley）大鼠随机分为假手术组、模型组和电针组各12只,采用Zea Longa神经行为学评分进行神经功能缺损评定;Catwalk跑台实验评估运动功能;免疫组化法标记缺血侧运动皮层M2型小胶质细胞阳性细胞数量,免疫荧光双标法标记其外泌体蛋白CD81的表达。结果：干预7 d后,电针组与模型组大鼠相比,Zea Longa 评分显著降低（P＜0.05）;步行速度增快（P＜0.01）,持续时间减少（P＜0.05）,大鼠爪印面积显著性增加(P<0.01);缺血侧运动皮层M2型小胶质细胞及其分泌的外泌体蛋白 CD81增多,差异均有统计学意义（P＜0.01）。结论：电针曲池、足三里穴可促进缺血侧运动皮层M2型小胶质细胞外泌体的分泌,发挥神经保护作用,有效改善缺血再灌注损伤大鼠的运动功能。     

电针对慢性期脊髓损伤大鼠功能恢复及神经营养因子表达的影响

摘要 目的:研究督脉电针对慢性期脊髓损伤大鼠功能康复及神经营养因子的表达的影响,探讨督脉经上不同穴位电针的作用是否存在差异。 方法:将32只雄性SD大鼠随机分为4组：假模组、模型对照组、头部督脉电针组（“百会、风府”）、背部督脉电针组(“大椎、命门”),每组8只。建立大鼠脊髓损伤模型,各治疗组于术后1周开始6周的电针治疗。采用BBB运动功能评分法评定大鼠后肢运动功能的恢复情况。术后7周处死大鼠,采用实时荧光定量PCR及Western-blot方法检测受损脊髓脑源性神经营养因子（BDNF）、神经营养素-3（NT-3）mRNA和蛋白的表达。 结果:电针干预组BBB评分高于模型组（P<0.05),且背部督脉电针组评分明显高于头部督脉电针组(P<0.05)。电针治疗后大鼠脊髓BDNF及NT-3 mRNA和蛋白的表达与模型对照组比较均明显上调（均P<0.05）,且背部督脉电针组高于头部督脉电针组（P<0.05）。 结论:电针治疗能增强受损伤脊髓神经营养因子的表达和促进大鼠后肢运动功能的恢复,背部督脉电针组作用强于头部督脉电针组。     

夹脊电针对自体髓核移植大鼠神经功能及痛阈的影响

目的：探讨在大鼠自体髓核移植致腰神经根性疼痛模型中,夹脊电针对大鼠运动功能评分（BBB）及机械刺激缩爪反射潜伏期值（PWT）、热辐射缩爪反射潜伏期值（PWL）的影响。方法：将32只SD大鼠随机分成电针组、腰痛宁组、假手术组、空白对照组,建立大鼠自体髓核移植致腰神经根性疼痛模型,电针组给予夹脊电针治疗,腰痛宁组给予腰痛宁灌胃,假手术组及空白对照组不予治疗,分别于造模前、造模后7d（治疗前）、造模后21d（治疗后）观察大鼠BBB、PwT及PwL评分的变化。结果：治疗前空白组BBB、PWT及PWL评分均显著高于电针组、腰痛宁组及假手术组（P〈0．05）,电针组、腰痛宁组及假手术组组间比较差异无统计学意义。治疗后电针组、腰痛宁组、假手术组大鼠BBB、PWT及PWL评分均明显高于治疗前（P〈0．05）;电针组与假手术组治疗后组间差异无统计学意义,且均明显高于腰痛宁组（P〈0．05）。结论：髓核是腰椎间盘突出症引起腰腿疼痛及神经功能障碍的重要原因,夹脊电针可改善腰椎间盘突出症神经功能障碍,减轻疼痛。     

督脉电针结合游泳训练对大鼠全横断脊髓损伤后GAP-43和Nogo-A表达的影响

目的:通过检测大鼠脊髓损伤后运动功能恢复情况和神经生长相关蛋白-43(GAP-43)、神经轴突生长抑制剂-A(Nogo-A)的表达来探讨督脉电针结合游泳训练干预脊髓损伤的作用机制。方法:选用雌性SD大鼠180只,随机分为正常组、假手术组、模型组、游泳训练组、督脉电针组(督电组)、督脉电针结合游泳训练组(联合组)。用外科手术尖形刀片横切断暴露脊髓的方法致大鼠T9-T10段脊髓全横断模型。术后各时间点对各组大鼠进行BBB评分;免疫组化检测各时间点损伤段脊髓GAP-43和Nogo-A的表达;Western blot检测各时间点损伤段脊髓Nogo-A的表达。结果:与模型组相比,联合组和督电组BBB评分显著增加,联合组在术后第14、21、28、35天较督电组BBB评分显著增加,具有显著性差异(P0.05)。与模型组相比,督电组和联合组GAP-43的表达显著增加,Nogo-A的表达显著减少,具有显著性差异(P0.05),联合组在术后第14、21、28、35天较电针组GAP-43的表达显著增加,Nogo-A的表达显著减少,具有显著性差异(P0.05)。结论:(1)督脉电针和游泳训练都能通过促进脊髓损伤大鼠GAP-43的表达和抑制Nogo-A的表达来促进神经的修复。(2)联合治疗对大鼠运动功能的恢复更为有效。     

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.     

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.     

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.     

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.