醋酸曲安西龙对瘢痕增生的抑制

目的 观察激素对瘢痕组织胶原合成的改变。探讨其对瘢痕增生的抑制作用。方法 将临床12例患者的增生性瘢痕分别移植到12只裸鼠的皮下，其中6只接受激素治疗，其他6只用生理盐水对照，移植物内注射^3H-脯氨酸并于l0，15，20d后取标本。结果 治疗组的胶原合成部分的脉冲数在第l0,15，20天为(10306&;#177;l013)，(8106&;#177;2010)。(7716&;#177;l836)c／(min&;#183;g)，均明显低于对照组。而且治疗组胶原合成的脉冲数在第l0,15，20天为(4073&;#177;398),(3174&;#177;319),(2681&;#177;306)c／(min&;#183;g)。结论 激素能够减少瘢痕组织的胶原合成，从而可以有效地抑制瘢痕增生。     

β-七叶皂甙钠对大鼠脊髓损伤后肢体运动功能的影响

目的:观察β-七叶皂甙钠治疗大鼠急性脊髓损伤后肢体运动功能的变化,探讨β-七叶皂甙钠对大鼠急性脊髓损伤的保护和促进修复作用。方法:实验于2003-12/2004-03在解放军第二军医大学长海医院骨科实验室完成。45只SD大鼠随机分为正常对照组11只,模型对照组12只,10mg/(kg·d)β-七叶皂甙钠治疗组11只,20mg/(kg·d)β-七叶皂甙钠治疗组11只。按Allen改良法制备脊髓损伤动物模型,10mg/(kg·d)和20mg/(kg·d)β-七叶皂甙钠治疗组分别在术后腹腔注射β-七叶皂甙钠注射液10mg/(kg·d)和20mg/(kg·d)。模型对照组和正常对照组在术后注射等量生理盐水,共持续10d。用斜板试验法和BBB评分法观察大鼠脊髓损伤后运动功能的变化。结果:1只10mg/kgβ-七叶皂甙钠治疗组大鼠在术后第2天和1只正常对照组大鼠在术后第1天由于饲养不当死亡,其余43只大鼠均进入结果分析。①各组大鼠斜板试验临界角度:在术后第7,14,21天时10mg/(kg·d)和20mg/(kg·d)β-七叶皂甙钠治疗组明显高于模型对照组[第7天:(37.88±1.76)°,(38.94±2.15)°,(35.48±1.23)°;第14天:(44.39±1.87)°,(45.96±1.81)°,(39.48±1.23)°;第21天:(44.75±2.11)°,(46.66±1.46)°,(41.42±0.98)°,t=2.27～4.67,P<0.05～0.01]。20mg/(kg·d)β-七叶皂甙钠治疗组与10mg/(kg·d)β-七叶皂甙钠治疗组基本一致。②各组大鼠BBB评分结果:在术后第7,14,21天时10mg/(kg·d)和20mg/(kg·d)β-七叶皂甙钠治疗组明显高于模型对照组[第7天:(7.20±0.98),(7.51±0.85),(4.46±0.90)分;第14天:(10.43±0.90),(10.98±0.59),(6.54±0.73)分;第21天:(10.78±0.96),(11.67±0.49),(7.90±0.54)分,t=2.54～8.6,P<0.05～0.01]。20mg/(kg·d)β-七叶皂甙钠治疗组与10mg/(kg·d)β-七叶皂甙钠治疗组基本一致。结论:β-七叶皂甙钠可以增加大鼠实验性急性脊髓损伤后运动功能的恢复速度及最终恢复程度。     

Ⅰ型及Ⅲ型前胶原核酶对裸鼠增生性瘢痕的干预

目的:观察Ⅰ,Ⅲ型前胶原核酶对裸鼠增生性瘢痕的作用效果。方法:实验于2004-02/06在中山大学医学院实验动物中心、电子显微镜室及第一附属医院外科实验室进行。①建立裸鼠增生性瘢痕动物模型(80只)。②将裸鼠随机分为实验组Ⅰ型组20只,注射Ⅰ型前胶原核酶;Ⅲ型组20只,注射Ⅲ型前胶原核酶;Ⅰ型+Ⅲ型组20只,注射Ⅰ型及Ⅲ型前胶原核酶;各组又分为2.5μg/100μL及5.0μg/100μL两个剂量组,每个剂量组各10只裸鼠。对照组:生理盐水组10只,注射生理盐水;空白对照组10只。于建立模型的第4周开始,实验组与生理盐水组每天用微量注射器行瘢痕内多位点注射1次,共7d;第6周取材。③应用苦味酸-天狼猩红染色偏振光法,结合图像分析技术,观察分析各组胶原含量及分布的改变。④电子显微镜观察各组实验前后超微结构的改变。结果:①各实验组瘢痕体积均缩小;Ⅰ型组、Ⅰ型+Ⅲ型组实验后与实验前比较体积明显缩小[Ⅰ型组2.5μg/100μL:(25.6±1.2),(28.3±2.1)mm3,5.0μg/100μL:(27.9±3.0),(30.4±1.7)mm3;Ⅰ型+Ⅲ型组2.5μg/100μL:(24.8±1.6),(29.5±3.3)mm3,5.0μg/100μL:(24.6±1.7),(27.8±1.8)mm3,t=1.981～2.025,P<0.05]。②Ⅰ型组、Ⅰ型+Ⅲ型组与对照组相比Ⅰ型胶原纤维分布明显减少。③生理盐水、空白对照组具有典型的增生性瘢痕的特点,各实验组瘢痕形态改变不明显。④实验组及对照组的超微结构改变无明显差异。结论:Ⅰ和Ⅲ型前胶原核酶均可有效地减少裸鼠增生性瘢痕中胶原的含量。     

蛋白激酶A在干扰素-γ抑制创面愈合和瘢痕形成中的作用

目的:观察干扰素γ(IFN-γ)用于兔耳伤口肉芽组织和瘢痕组织后蛋白激酶A(ProtinaseA,PKA)活性变化及对伤口愈合和瘢痕形成影响,探讨PKA的信号转导作用。方法:用32P掺入法测定使用IFN-γ前后兔耳伤后3,6,11～16d(上皮化时),以及上皮后14,30,45和60d组织的PKA活性,观察伤口愈合时间和瘢痕变化。结果:上皮化时肉芽组织和伤口周边组织的PKA活性高于正常皮肤犤(1.5±0.6)pmol/min·mg,t=3.76,P<0.001和(1.4±0.5)pmol/min·mg,t=2.96,P<0.01犦。IFN-γ延迟创面愈合约1.5d(t=2.64,P=0.01),同时进一步活化PKA:肉芽组织在伤后6d和上皮化时犤(1.6±0.6)pmol/min·mg,t=2.59,P<0.05和(1.8±0.7)pmol/min·mg,t=2.92,P<0.01犦和周边组织上皮化时犤(1.7±0.6)pmol/min·mg,t=2.42,P<0.05犦高于对照。增生性瘢痕组织的PKA活性仅在上皮化时升高犤(1.5±0.5)pmol/min·mg,t=2.26,P<0.05犦,非增生性瘢痕组织的PKA活性在上皮化时犤(1.4±0.5)pmol/min·mg,t=2.08,P<0.05犦和上皮化后14d犤(1.4±0.5)pmol/min·mg,t=2.08,P<0.05犦时较高;IFN-γ进一步升高上皮化时IFN-γ1组:犤(1.8±0.7)pmol/min·mg,t=2.92,P<0.01犦和伤后14d时非增生性瘢痕组织的PKA活性犤IFN-γ1组:(1.79±0.6)pmol/min·mg,t=2.59,P<0.05和IFN-γ2组:(     

人瘢痕组织中组胺含量与瘙痒症状的正相关性组胺在增生与非增生性瘢痕组织中没有差异

目的测定不同瘙痒程度的增生与非增生性瘢痕组织和正常皮肤中组胺水平的差异,评价组胺在人瘢痕瘙痒发生中的意义.方法瘢痕和正常皮肤标本取自于中山大学附属第一医院烧伤科2002-09/2004-12收治的住院或门诊需手术切除瘢痕的89例患者.瘢痕瘙痒的程度可分为0级无瘙痒感;1级瘙痒很轻,轻抓可缓解;2级瘙痒令人烦恼,需较强烈的搔抓方可缓解,可以耐受;3级瘙痒影响工作或不能耐受,需长时间不断搔抓,无语言表达能力的儿童表现为吵闹不安.用荧光法测定不同程度瘙痒的瘢痕组织和正常皮肤中组胺水平并分析其与瘢痕瘙痒的关系.结果①增生性瘢痕和非增生性瘢痕组织中组胺的含量明显高于正常皮肤[(236.32±26.79),(225.68±25.53),(162.31±18.97)ng/g,P＜0.01],但在增生性瘢痕和非增生性瘢痕组织中却无明显差异(P＞0.05).②2和3级瘙痒瘢痕组织中组胺含量高于0级[0级(173.57±19.85)ng/g,2级(235.32±22.67)ng/g,3级(246.73±27.98)ng/g,P＜0.01],1级瘙痒瘢痕组织中组胺含量与0级无显著性差异[1级(182.38±20.23)ng/g,P＞0.05],3级瘙痒瘢痕组织中组胺含量与2级无显著性差异(P＞0.05).③瘢痕的瘙痒程度与组胺的含量呈正相关(r=0.912,P＜0.01).结论①增生和非增生性瘢痕组织中组胺水平无明显差异.②瘢痕局部组织中组胺含量的升高与瘙痒有关,组胺含量升高瘙痒程度加重.     

人增生性瘢痕瘙痒症状与局部5-羟色胺的含量

目的:测定不同程度瘙痒的瘢痕组织和正常皮肤中5-羟色胺水平,评价5-羟色胺在增生性瘢痕瘙痒症状中的作用。方法:实验于2002-09/2004-12在中山大学附属第一医院烧伤科和外科实验室完成。取瘢痕和正常皮肤标本89例(每例患者均有1处瘢痕)。男48例,女41例。其中增生性瘢痕68例,非增生性瘢痕21例。两组病例中各取8例正常皮肤组织作为对照。应用荧光法测定不同程度瘙痒的瘢痕组织和正常皮肤中5-羟色胺水平,并分析其与瘢痕瘙痒程度(分级:0级:无瘙痒感;1级:瘙痒很轻,轻抓可缓解;2级:瘙痒令人烦恼,需较强烈的搔抓方可缓解,可以耐受;3级:瘙痒影响工作或不能耐受,需长时间不断搔抓,无语言表达能力的儿童表现为吵闹不安)的关系。结果:①5-羟色胺含量:增生性瘢痕明显高于非增生性瘢痕和正常皮肤犤(467.82±38.92),(382.79±34.36),(378.65±29.98)ng/g,P<0.01犦。②不同瘙痒级别的瘢痕组织中5-羟色胺含量:3级和2级显著高于10级和0级犤(479.32±40.16),(470.33±39.12),(393.37±37.56),(381.25±32.09)ng/g,P<0.01犦。③瘢痕部位瘙痒程度与局部5-羟色胺含量的关系呈正相关(r=0.918,P<0.01)。结论:瘢痕中、重度瘙痒组织中5-羟色胺含量显著高于轻度瘙痒和无瘙痒组织;增生性瘢痕组织中的5-羟色胺含量显著高于非增生性瘢痕和正常皮肤。提示5-羟色胺在瘢痕的中、重度瘙痒症状中起重要作用。     

中药复方驱铅制剂对铅染毒大鼠脑海马齿状回及CA1区和CA3区一氧化氮合酶的影响

目的:观察中药复方驱铅制剂对铅染毒大鼠记忆改善的影响,并以依地酸钙钠做标准对照。方法:实验于2001-11/12在湖南师范大学生命科学院动物实验室完成。①选用健康SD大鼠60只,随机分成6个组,每组10只。阴性对照组、阳性对照组、驱铅灵(由党参15g、鸡血藤15g等组成)3.3g/(kg·d)组、驱铅灵6.6g/(kg·d)组、驱铅灵13.2g/(kg·d)组、依地酸钙钠组。②阳性对照组、依地酸钙钠组、驱铅灵各组均用20g/L的醋酸铅溶液以10μL/g体质量的剂量灌胃,1次/d,第11天停染1d,共3周。③停止染毒后第2天,驱铅灵各组分别用相应剂型的中药复方驱铅灵10μL/g体质量灌胃,1次/d,第11天停1d,共3周。④依地酸钙钠组用5g/L依地酸钙钠溶液以10μL/g体质量的剂量(50mg/kg)腹腔注射,1周注射4d,停3d,共3周。⑤阴性对照组、阳性对照组用蒸馏水灌胃,1次/d,第11天停染1d,共3周。⑥观察驱铅灵制剂对铅染毒大鼠脑海马组织结构的改善以一氧化氮合酶阳性细胞数目的多少及阳性细胞产物平均吸光度的大小作为评价指标,对大鼠海马结构形态学损伤以一氧化氮合酶阳性产物吸光度表示。结果:纳入60只,均进入结果分析,无缺失值。①铅染毒大鼠脑齿状回阳性产物吸光度情况:驱铅灵3.3g,6.6g,13.2g/(kg·d)组与依地酸钙钠组显著大于阳性对照组犤(0.0692±0.0043),(0.0707±0.0022),(0.0645±0.0027),(0.0720±0.0037),(0.0538±0.0068)A,(F=12.383,P<0.01)犦。②铅染毒大鼠脑CA1区阳性产物吸光度变化:驱铅灵3.3g,6.6g,13.2g/(kg·d)组与依地酸钙钠组的阳性产物吸光度显著大于阳性对照组犤(0.0638±0.0033),(0.0648±0.0027),(0.0613±0.0029),(0.0655±0.0037),(0.0605±0.0026),(F=10.585,P<0.01)犦。③铅染毒大鼠脑CA3区阳性产物吸光度变化:驱铅灵3.3g,6.6g,13.2g/(kg·d)组与依地酸钙钠组在脑CA3区显著大于阳性对照组犤(0.0682±0.0044),(0.0702±0.0047),(0.0630±0.0044),(0.0733±0.0051),(0.0545±0.0027),(F=18.867,P<0.01)犦。结论:中药复方驱铅制剂低、中、高各剂量组均能改善铅染毒大鼠脑海马结构的形态学损害,改善铅致学习记忆的损害,其效果与依地酸钙钠相似,不同剂量的驱铅制剂作用效果比较无显著差别。     

参仙汤对多发性脑梗死性痴呆大鼠学习记忆能力的干预效应

背景解放军总医院自行研制的参仙汤方,经临床初步观察28例脑血管性痴呆患者,其智能量表分值有明显提高.目的观察中药复方参仙汤对多发性脑梗死性痴呆大鼠学习记忆的影响,并对其抗自由基损伤能力进行分析.设计双盲随机对照实验.单位解放军总医院中医科.材料实验于1997-05/12在解放军总医院中医科完成.选取3个月龄SD大白鼠72只,随机分为6组正常对照组,痴呆模型组,阿尼西坦组,参仙汤30,15,7.5/g(kg·d)剂量组,12只/组.参仙汤由人参、仙灵脾、何首乌、地龙等组成.按传统煎药法煎取药液,以恒温水浴锅分别浓缩成含生药2.0,1.0,0.5g/mL.方法参仙汤30,15,7.5g/(kg·d)剂量组分别按成人每公斤体质量剂量的20,10,5倍给予参仙汤灌胃,剂量分别为生药30,15,7.5g/(kg·d);阿尼西坦组给予100 mg/(kg·d)阿尼西坦灌胃;痴呆模型组和正常对照组分别灌以等量生理盐水.连续给药7 d,第7天给药后1h开始造模.除正常对照组外,其余各组均造模.左心室注射液体石蜡栓子0.25 mL/kg,建立多发性脑梗死模型.造模后继续给药至42 d.然后采用水迷宫实验对大鼠学习记忆能力进行评估.实验结束后1h将各组大鼠脱臼处死,进行组织、脏器各项生化指标的测定.主要观察指标参仙汤对多发性脑梗死性痴呆大鼠水迷宫作业时间、作业正确次数、脏器生化指标的影响.结果实验纳入72只大鼠,操作过程中脱落9只,最后共63只大鼠进入结果分析.①参仙汤对多发性脑梗死性痴呆大鼠水迷宫作业时间的影响与痴呆模型组比较,参仙汤15,30g/(kg·d)剂量组于迷宫实验第5天均明显缩短[(24.1±13.3),(14.7±6.9),(13.7±7.5)s,P均＜0.05].②参仙汤对多发性脑梗死性痴呆大鼠水迷宫作业正确次数的影响与痴呆模型组比较,参仙汤15,30g/(kg·d)剂量组于迷宫实验第5天均显著增加[(1.70±2.07),(3.82±1.89),(4.36±1.75)次,P＜0.01].③参仙汤对多发性脑梗死性痴呆大鼠超氧化物歧化酶的影响与痴呆模型组比较,参仙汤15,30g/(kg·d)剂量组脑、肝组织超氧化物歧化酶活力均显著增加[(127.2±7.2),(171.3±11.5),(181.7±10.9)μkat/kg,P＜0.001;(168.0±23.7),(185.8±14.9),(200.7±15.4)μkat/kg,P＜0.05,P＜0.01].④参仙汤对多发性脑梗死性痴呆大鼠丙二醛含量的影响与痴呆模型组比较,参仙汤15,30g/(kg·d)剂量组脑、肝组织丙二醛含量均明显降低[(296.0±37.8),(204.6±43.5),(197.3±43.5)nmol/g,P＜0.001;(238.9±60.8),(160.3±29.4),(152.1±34.4)nmol/g,P＜0.01].⑤参仙汤对多发性脑梗死性痴呆大鼠丙二醛含量的影响与痴呆模型组比较,参仙汤15,30g/(kg·d)剂量组脑、肝组织脂褐素含量均明显降低[(10.88±1.95),(6.35±1.55),(5.85±1.23)μg/g,P＜0.001;(7.17±1.75),(4.38±1.54),(3.69±1.24)μg/g,P＜0.01].结论中药参仙汤具有提高多发性脑梗死性痴呆大鼠脏器组织超氧化物歧化酶活力、减轻脂质过氧化反应、降低组织丙二醛和脂褐素含量的作用,通过减轻脑缺血再灌注的自由基损伤,从而改善多发性脑梗死性痴呆大鼠的学习记忆能力.     

依那普利对自发性高血压大鼠心脏局部Ang Ⅱ、ACE和Chymase活性的影响

目的研究自发性高血压大鼠(SHR)心脏局部AngⅡ、ACE和Chymase活性及ACEI依那普利对其影响,探讨ACE和Chymase对SHR心脏局部AngⅡ形成的作用.方法12周龄SHR 40只,随机分为两组,一组依那普利治疗30 mg/(kg·d),另一组作为对照,同时设一同周龄的WKY作为正常对照,测量各组的AngⅡ浓度、ACE和Chymase活性.结果(1)SHR组AngⅡ浓度为(5.780±3.734)ng/(mg组织),显著高于WKY组(2.723±0.84)ng/(mg组织)(P＜0.05);而依那普利治疗SHR-d组AngⅡ浓度为(2.757±2.717)ng/(mg组织),与WKY组相比无统计学意义(P＞0.05).(2)SHR、SHR-d、WKY 3组ACE活性分别为(0.60±0.13)U/(mL·mg组织),(0.47±0.12)U/(mL·mg组织),(0.45±0.19)U/(mL·mg组织),SHR组与SHR-d、WKY两组比较均差异有显著性(P＜0.05),SHR-d组与WKY组比较差异无显著性(P＞0.05).(3)Chymase活性测定,SHR组为(28.65±7.51)nmol/(min·mg组织),SHR-d组为(27.69±8.61)nmol/(min·mg组织),WKY组(27.68±8.16)nmol/(min·mg组织),3组两两比较均差异无显著性(P＞0.05).结论应用ACEI能有效抑制SHR心脏局部AngⅡ生成,提示ACE在SHR心脏局部AngⅡ形成中其重要作用.     

美金胺重复用药对新生大鼠的毒性反应

目的N-甲基-D-天冬氨酸受体离子通道拮抗剂美金胺对缺氧缺血具有明显的脑保护效果,观察重复应用大剂量美金胺对SD新生大鼠可能造成的不良影响。方法实验于2003-10/2004-03在新华医院中心实验室进行。选用7日龄SD新生大鼠80只,随机分为美金胺54,35,23m g/(kg·d)组及对照组4组,每组20只。连续14d分别经腹腔注射美金胺54,35,23mg/(kg·d)或注射用水(10μL/g)。14d后每组取13只大鼠给予断头处死,余7只大鼠停药恢复1周后断头处死,分别观察大鼠用药后的毒性反应及体质量增长情况。结果78只大鼠进入结果分析。①各剂量美金胺组动物在用药后均有不同程度的不良反应,主要发生在用药后第1～5天,但均能在用药后三四个小时内恢复正常。②美金胺54,35,23m g/(kg·d)组分别在用药后第6,5,4天出现耐受。其中美金胺54m g/(kg·d)组2只大鼠分别在连续用药第10天和第12天死亡,其他动物均存活。③各剂量组动物在用药后均有不同程度的体质量增长减缓,连续用药14d后美金胺54,35,23mg/(kg·d)组大鼠体质量明显低于对照组[(29.26±3.61),(30.46±4.10),(30.57±2.82),(37.72±3.04)g,P<0.01]。④停药7d后,美金胺35,23mg/(kg·d)组大鼠体质量与对照组比较差异已不明显,但美金胺54mg/(kg·d)组大鼠体质量仍显著低于对照组[(56.52±10.68),(74.05±5.13)g,P<0.01]。结论①不同剂量的美金胺连续应用14d,可能会对大鼠的生长有抑制作用,但停药后可获代偿性恢复。②新生大鼠对美金胺有较好的耐受性。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.