人参皂苷Rb1通过减轻线粒体损伤对大鼠脊髓缺血再灌注损伤的保护作用

目的观察人参皂甙Rb1预处理对大鼠脊髓缺血再灌注损伤后的干预效果,探讨人参皂甙Rb1对抗脊髓缺血再灌注损伤可能的线粒体干预机制。方法构建大鼠脊髓缺血再灌注损伤模型,随机分为假手术组(n=12)、缺血再灌注损伤组(SCII组,n=12)和人参皂甙Rb1药物组(药物组,n=48),药物组(n=48)又分为10 mg/kg、20 mg/kg、40 mg/kg、80 mg/kg四个亚组,每组12只,术前30 min及术后每天,腹腔注射相应剂量人参皂甙Rb1。各组于损伤后48 h行大鼠后肢神经功能评分;分别检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)含量;取脊髓组织检测SOD、MDA含量以及细胞色素C氧化酶(COX)活性。结果与SCII组比较,药物组BBB评分升高(P0.05),血清及脊髓组织SOD含量升高,MDA含量减少,脊髓组织COX活性升高(P0.05);且呈剂量依赖性,但40 mg/kg与80 mg/kg之间无明显变化。结论人参皂甙Rb1可以通过抑制线粒体损伤,减轻大鼠脊髓缺血再灌注损伤后的氧化应激,且在10~40 mg/kg范围呈剂量依赖性。     

人参皂苷Rg1对大鼠脊髓缺血再灌注损伤后细胞凋亡的影响

目的探索人参皂苷Rg1对于大鼠脊髓缺血再灌注损伤(SCII)后细胞凋亡的影响。方法成年健康Sprague-Dawley大鼠48只,随机分为假手术组(n=8)、缺血组(n=8)、再灌注组(n=16只)和药物组(n=16)。假手术组仅安放球囊不阻断血流;缺血组脊髓缺血30 min;药物组大鼠分别于脊髓缺血前30 min及术后腹腔注射人参皂苷Rg1 30 mg/kg;再灌注组与药物组相同时间点注射相同体积生理盐水。假手术组、缺血组于缺血后30 min,药物组和再灌注组于再灌注后6 h及24 h应用HE染色检测细胞形态改变,应用免疫组织化学染色检测Bcl-2及survivin表达。结果缺血组、再灌注组及药物组HE染色均有神经元损伤,药物组损伤较其他两组明显减轻。缺血组、再灌注组和药物组survivin、Bcl-2阳性细胞明显高于假手术组(t3.896,P0.01)。药物组6 h、24 h survivin及Bcl-2蛋白阳性细胞均较再灌注组显著增加(t6.693,P0.001)。结论人参皂苷Rg1可减少早期大鼠SCII后神经元损害,增加抗凋亡蛋白survivin、Bcl-2的表达,抑制凋亡。     

神经生长因子对大鼠脑缺血再灌注损伤的神经保护

目的探讨神经生长因子（NGF）对大鼠局灶性脑缺血再灌注损伤的保护作用。方法线栓法建立大鼠右侧大脑中动脉缺血-再灌注损伤模型,同时给予NGF治疗。检测肿瘤坏死因子-α（TNF-α）、自介素-1（IL-1）、白介素-6（IL-6）,丙二醛（MDA）及超氧化物歧化酶（SOD）含量及神经细胞的凋亡数。结果NGF组TNF-α、IL-1较缺血再灌注损伤（IR）组明显下降,差异有统计学意义。与IR组相比,NGF组SOD活性明显升高、MDA及IL-6含量明显下降,差异有统计学意义。神经细胞的凋亡检测发现,与IR组比较,NGF组凋亡细胞数明显降低,差异有统计学意义。结论NGF可以减轻炎症反应和改善氧自由基代谢,减少脑组织细胞的凋亡,对局灶性脑缺血再灌注损伤大鼠具有保护作用。     

HMGB1移位和释放与肝脏缺血再灌注损伤的机制

目的探讨HMGB1移位和释放与肝脏缺血再灌注损伤的关联。方法选取45只1月龄的雄性SD大鼠,采用随机数字法,将其分为假手术组、缺血再灌注组、HMGB1干预组,每组15只。比较三组大鼠肝功能指标、肝组织中细胞凋亡指数、炎症因子表达和氧化应激水平。结果缺血再灌注组肝组织ALT、AST、MDA、细胞凋亡指数、MPO、组肝组织HMGB1mRNA及其蛋白表达、肝组织TNF-α、IL-6表达高于假手术组,HMGB1干预组较缺血再灌注组低,但仍高于假手术组(P0.05)。缺血再灌注组SOD明显低于假手术组,HMGB1干预组明显高于缺血再灌注组、低于假手术组(P0.05)。结论输注HMGBI抗体可有效改善大鼠肝脏缺血再灌注损伤,机制与下调炎性因子表达、降低炎症引起的细胞凋亡相关。     

丁香酚对大鼠肾缺血再灌注性损伤保护作用的研究

目的探讨丁香酚(EUG)对大鼠肾缺血再灌注(RI/R)损伤的保护作用及相关分子机制。方法肾动脉夹闭法制作肾缺血30 min再灌注12 h模型,90只SD大鼠随机分为3组:对照组,模型组和实验组,每组30只。其中实验组制作动物模型前采用丁香酚200 mg/kg预处理2周,对照组,模型组给予等体积生理盐水。化学定量法检测大鼠血清肌酐(Scr)、尿素氮(BUN),酶联免疫吸附(ELISA)法检测血清和肾组织丙二醛(MDA)、超氧化物歧化酶(SOD),并利用Western blot和免疫组织化学染色染色检测肾脏组织NF-κB蛋白表达。结果化学定量结果显示,模型组大鼠血清Scr、BUN较对照组显著提高(P0.05),而实验组丁香酚可显著降低大鼠血清Scr、BUN,与模型组比较差异有统计学意义(P0.05);Elisa结果显示,与对照组相比,模型组大鼠血清和肾组织MDA含量显著增高,SOD水平显著降低(P0.05),而丁香酚可显著降低大鼠血清和肾组织MDA含量,提高SOD水平(P0.05);Western blot及免疫组织化学染色结果显示,丁香酚可明显抑制蛋白NF-κB蛋白表达(P0.05)。结论丁香酚可通过降低氧化应激水平和抗NF-κB抑制大鼠肾缺血再灌注性损伤。     

肝X受体激动剂GW3965预处理对大鼠肝移植再灌注期肝脏保护作用的实验研究

目的探讨经过GW3965预处理激动肝X受体(LXR)后对SD大鼠肝移植缺血再灌注损伤(IRI)的保护作用及其机制。方法 70只雄性、健康的SD大鼠,分为假手术组(SO组,14只)GW3965预处理组(GW3965组,14对)和原位肝移植组(OLT组,14对);术后分别检测各时相点的血清转氨酶、肝组织病理改变、血浆炎症因子(TNF-α、IL-1)水平,肝病理组织中NF-κB表达水平。结果再灌注6、24h后原位肝移植组与GW3965组血浆炎症因子表达水平、血清转氨酶、肝脏组织病理损伤程度、核因子κB(NF-κB)表达水平均高于SO组;而再灌注6、24h后,GW3965组血清转氨酶、血浆炎症因子表达水平、肝脏组织病理损伤、NF-κB表达水平低于OLT组,差异有统计学意义(P0.05)。结论预先经过GW3965激动供肝的LXR后可以有效降低肝移植再灌注期肝脏内毒素信号通路中的核因子κB NF-κB表达和其下游炎症肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)因子的产生,从而有效保护移植供肝缺血再灌注的损伤。     

促红细胞生成素对兔脊髓缺血再灌注损伤后核因子-κB表达的影响

目的 探讨促红细胞生成素(EPO)对兔脊髓缺血再灌注损伤后神经功能及核因子-κB(NF-κB)表达的影响.方法 建立兔脊髓缺血再灌注损伤模型,应用Tarlov评分法、免疫组化方法对各组动物后肢神经功能及脊髓组织NF-kB表达变化进行观察.结果 促红细胞生成素治疗组神经功能恢复较缺血再灌注组明显提高(P<0.01),NF-κB表达明显低于缺血再灌注组(P<0.01).结论 EPO对缺血再灌注损伤的脊髓具有保护作用,其作用机制与抑制NF-kB表达有关.     

瑞芬太尼后处理对兔缺血再灌注损伤脊髓的影响

目的：探讨瑞芬太尼后处理对兔脊髓缺血再灌注损伤的作用。方法选取36只雄性日本大耳白兔随机分为3组,每组12只,分别为假手术对照组（S组）、缺血/再灌注损伤组（C组）、瑞芬太尼后处理组（R组）。再灌注24 h后处死动物,取L3～5组织标本,原位细胞凋亡法测定细胞凋亡的情况,电镜下观察病理学结果,羟胺法测定脊髓组织超氧化物歧化酶（SOD）含量,硫代巴比妥酸法测定丙二醛（MDA）含量。结果缺血再灌注后24 h,与S组比较,C组凋亡细胞明显增多（P＜0.05）,脊髓组织病理学损伤程度明显加重,脊髓MDA含量明显增加,SOD含量明显降低（P＜0.05）;与C组比较,R组脊髓组织病理学损伤程度明显减轻,凋亡细胞明显减少（P＜0.05）,脊髓MDA含量明显降低,SOD含量明显增加（P＜0.05）。结论瑞芬太尼能减轻兔脊髓缺血再灌注损伤,抑制神经细胞凋亡坏死,具有脊髓保护作用。     

三七总皂苷对大鼠肾缺血再灌注损伤的保护作用及其线粒体机制

目的:观察三七总皂苷(血栓通注射液的药物成分)对大鼠肾缺血再灌注损伤的保护作用,分析其可能的线粒体机制。方法:实验于2006-01/09在广州医学院病理生理学实验室完成。实验分组:取108只SD雄性大鼠,随机分为假手术组、缺血再灌注模型组、三七总皂苷组,每组36只。实验干预:①假手术组:实验前1h腹腔注射生理盐水,全麻下行右肾摘除,左肾暴露40min后取下。②缺血再灌注模型组:实验前1h腹腔注射生理盐水,全麻下行右肾摘除,左肾动脉夹闭缺血45min后再灌注1h。③三七总皂苷组:实验前1h腹腔注射血栓通注射液70mg/kg,其余方法同缺血再灌注模型组。实验评估:①再灌注后1h取肾组织匀浆检测肾组织超氧化物歧化酶活性、丙二醛含量。②测血浆肌酐、尿素氮、血清降钙素基因相关肽含量。③电镜观察肾组织线粒体超微结构的改变。④检测线粒体细胞色素氧化酶、琥珀酸脱氢酶活性,Ca2 含量。结果:108只大鼠均进入结果分析。①三七总皂苷组肾组织超氧化物歧化酶活性高于缺血再灌注模型组;丙二醛含量低于缺血再灌注模型组。②三七总皂苷组血浆肌酐、尿素氮含量低于缺血再灌注模型组;降钙素基因相关肽水平高于缺血再灌注模型组。③电镜观察三七总皂苷组线粒体结构有明显的改善,嵴数目减少不多,且排列较整齐,没有线粒体崩解的情况。④三七总皂苷组肾组织线粒体中细胞色素氧化酶、琥珀酸脱氢酶活性高于缺血再灌注模型组;Ca2 含量低于缺血再灌注模型组。结论:三七总皂苷对肾缺血再灌注损伤有明显保护作用,其保护作用机制与直接清除自由基,提高琥珀酸脱氢酶、细胞色素氧化酶活性、升高血清降钙素基因相关肽水平,降低钙超载,从而减轻线粒体损伤有关。     

舒血宁对肠缺血再灌注大鼠肝脏保护作用的研究

目的:观察舒血宁注射液对肠缺血再灌注大鼠导致的肝脏损害是否具有保护作用。方法:采用肠缺血再灌注模型,将30只SD大鼠随机分为假手术组(Sham组)、肠缺血再灌注组(IIR组)与舒血宁注射液组(SXN组),观察舒血宁治疗对IIR大鼠术后6h肝组织中丙二醛(MDA)、超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平以及病理改变的影响。结果:舒血宁治疗组可降低肠缺血再灌注大鼠术后肝组织中MDA、TNF-α和IL-1β的含量,提高SOD抗氧化活性。结论:舒血宁注射液可部分纠正肠缺血再灌注肝脏的脂质过氧化损害,减少再灌注后大鼠肝脏的炎性损伤。     

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.     

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.